Integrating surveillance data on water-related diseases and drinking-water quality; action-research in a Brazilian municipality.

The Brazilian Ministry of Health proposed a research study involving municipal professional staff conducting both epidemiological and water quality surveillance to facilitate the integration of the data which they collected. It aimed to improve the intersectoral collaboration and health promotion activities in the municipalities, especially regarding drinking-water quality. We then conducted a study using the action-research approach. At its evaluation phase, a technique which we called 'the tree analogy' was applied in order to identify both possibilities and challenges related to the proposed interlinkage. Results showed that integrating the two data collection systems cannot be attained without prior institutional adjustments. It suggests therefore the necessity to unravel issues that go beyond the selection and the interrelation of indicators and compatibility of software, to include political, administrative and personal matters. The evaluation process led those involved to re-think their practice by sharing experiences encountered in everyday practice, and formulating constructive criticisms. All this inevitably unleashes a process of empowerment. From this perspective, we have certainly gathered some fruit from the Tree, but not necessarily the most visible.

Mortality patterns in municipalities of a mining region before the Brumadinho dam failure, state of Minas Gerais, Brazil.

OBJECTIVE: To describe the patterns of overall mortality and mortality from external causes and the temporal evolution in the municipalities of the Paraopeba River Basin, before the socio-environmental disaster of the Brumadinho dam and, additionally, to investigate the correlation between mortality and socioeconomic deprivation in these municipalities. METHODS: Global Burden of Disease Study mortality estimates for 26 municipalities in the state of Minas Gerais, Brazil, were analyzed. Rates of overall mortality and mortality from external causes were estimated in the triennia (T) T1 (2000 to 2002), T2 (2009 to 2011), and T3 (2016 to 2018). Pearson's correlation coefficient measured the association between mortality rates and socioeconomic deprivation, according to the Brazilian Deprivation Index (IBP). RESULTS: There was a decrease in overall mortality in the Paraopeba River Basin from 717.7/100 thousand to 572.6/100 thousand inhabitants, and in most municipalities between T1-T3. Mortality from external causes increased from 73.3/100 thousand to 82.1/100 thousand, and it was higher in these municipalities compared with the mean for Brazil and Minas Gerais. Deaths from suicide and interpersonal violence increased from 29.6/100 thousand to 43.2/100 thousand in most of the 26 municipalities. Death rates due to unintentional injuries decreased during the period, and those due to transport injuries, increased. There was a positive correlation between socioeconomic deprivation and the percent change in mortality rates. CONCLUSION: Despite the strong presence of mining activity in the region, such did not reflect in the improvement of the sanitary situation. Death rates due to external causes increased in the period, associated with inequalities, which must be considered in the planning for the recovery of the disaster areas.

Premature mortality due to noncommunicable diseases in Brazilian capitals: redistribution of garbage causes and evolution by social deprivation strata.

OBJECTIVE: To analyze premature mortality due to noncommunicable chronic diseases (NCDs) in Brazilian capitals and the Federal District (DF) after redistribution of garbage causes and the temporal evolution according to social deprivation strata in the 2010 to 2012 and 2017 to 2019 triennia. METHODS: Corrections were applied to the Mortality Information System (Sistema de Informação sobre Mortalidade - SIM) data such as the redistribution of garbage codes (GC). Premature mortality rates due to NCDs were calculated and standardized by age. The differences among NCDs mortality rates were analyzed according to the Brazilian Deprivation Index (Índice Brasileiro de Privação - IBP) categories and between the three-year periods. RESULTS: In the capitals as a whole, rates increased between 8 and 12% after GC redistribution and the greatest increases occurred in areas of high deprivation: 11.9 and 11.4%, triennia 1 and 2, respectively. There was variability between the capitals. There was a reduction in rates in all strata of deprivation between the three-year periods, with the greatest decrease in the stratum of low deprivation (-18.2%) and the lowest in the stratum of high deprivation (-7.5%). CONCLUSION: The redistribution of GC represented an increase in mortality rates, being higher in the strata of greater social deprivation. As a rule, a positive gradient of mortality was observed with increasing social deprivation. The analysis of the temporal evolution showed a decrease in mortality from NCDs between the triennia, especially in areas of lower social deprivation.

Road traffic injuries and deaths and the achievement of UN Sustainable Development Goals in Brazil: results from the Global Burden of Disease Study, 1990 to 2019.

INTRODUCTION: Brazil ranks 5th in the number of deaths due to road injuries. This study aimed to analyze mortality and disabilities resulting from road injuries in Brazil, and to assess the Sustainable Development Goals (SDG) target of reducing deaths due to road injuries by 50% by 2030. METHODS: This descriptive and exploratory study used the estimates from the Global Burden of Disease 2019: indicators of mortality, premature deaths, and disabilities according to sex, age group, and type of transport for 1990, 2015, and 2019. Time trends in mortality rates from 1990 to 2019 were assessed, and a projection for 2030 was calculated, applying a linear regression model. RESULTS: Deaths due to road injuries were 44,236 in 1990, and 44,529 in 2019, representing a 43% reduction in mortality rates. The highest rates were in the North, Northeast, and Midwest regions of Brazil, in males and young adults. A 77% reduction was observed in mortality rates for pedestrians and an increase of 53% for motorcyclists and of 54% for cyclists during the period. In terms of motorcycle road injuries, the mortality rate for men increased from 7.3/100,000 (1990) to 11.7/100,000 inhabitants (2019). The rates of premature deaths and disabilities were also higher for men when compared to women. Amputations, fractures, spinal cord injuries, and head trauma were the main types of road injuries. The projections for 2030 show that Brazil might not reach the SDG target. CONCLUSIONS: Despite the decline in mortality rates, the 2030 Agenda's target might not be achieved.

Premature mortality due to non-communicable diseases in Brazilian municipalities estimated for the three-year periods of 2010 to 2012 and 2015 to 2017.

OBJECTIVE: To estimate premature mortality due to noncommunicable diseases (NCDs) in Brazilian municipalities. METHODS: This ecological study estimated premature mortality rates due to cardiovascular diseases, chronic respiratory diseases, cancer and diabetes in Brazilian municipalities, for the three-year periods of 2010 to 2012 and 2015 to 2017, and it analyzed the spatial and temporal distribution of these rates. Data treatment combined proportional redistribution of the missing data and ill-defined causes, and the application of coefficients for under-registration correction. The local empirical Bayesian estimator was used to calculate municipal mortality rates. RESULTS: Rates for the set of chronic diseases decreased in Brazil between the three-year periods. The mean rates for total NCDs declined in the South, Southeast and Central-West regions, remained stable in the North and increased in the Northeast. Mortality rates due to cardiovascular diseases were the highest in all regions but showed the greatest declines between the periods. Cancers were the second leading cause of death. The North and Northeast regions stood out as having increased mean rates of cancer between the periods analyzed and showing the highest mean premature mortality rates due to diabetes in the 2015 to 2017 period. CONCLUSION: Spatial and temporal distribution of premature mortality rates due to NCDs differed between Brazilian municipalities and regions in the three-year periods evaluated. The South and Southeast had decreased rates of deaths due to cardiovascular and chronic respiratory diseases, as well as diabetes. The North and Northeast had increased rates of deaths due to cancer. There was an increase in the rate of deaths due to diabetes in the Central-West.

Fruit and vegetable consumption, leisure-time physical activity and binge drinking in Belo Horizonte, Brazil, according to the Health Vulnerability Index.

OBJECTIVE: To estimate the prevalence of fruit and vegetable consumption, practice of leisure time physical activity (LTPA) and binge drinking for small areas of Belo Horizonte, Minas Gerais. METHODS: Ecological study conducted with data from the Surveillance System for Risk and Protection Factors for Noncommunicable Diseases by Telephone Survey (Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico - Vigitel). The prevalence of risk and protection factors from 2006 to 2013 were estimated and the 95% confidence intervals calculated. "Small areas" corresponded to the municipality division into four strata of health risk classification given by the Health Vulnerability Index 2012 (Índice de Vulnerabilidade à Saúde - IVS). RESULTS: The mean prevalences for the period were: about 42% of regular intake of fruit and vegetable, 34.7% of leisure time activity and 20.4% of binge drinking. The prevalence of fruit and vegetable consumption was higher in low-risk areas (58.5%; 95%CI 56.8 - 60.2) and lower in very high-risk areas (32.3%; 95%CI 27.7 - 36.9). The practice of LTPA was higher in low-risk areas (40.8%; 95%CI 38.9 - 42.8) and lower in very high risk (25.2%; 95%CI 20.6 - 29.9). Binge drinking was higher in low-risk areas (22.9%; 95%CI 21.7 - 24.2) compared to very high-risk areas (14.3%; 95%CI 11.4 - 17.3). CONCLUSION: It was identified a gradient in the distribution of risk and protection factors for noncommunicable diseases in Belo Horizonte according to the risk classification. This information can support programs aimed at reducing health inequalities, especially in the most vulnerable areas.

Use of health services and adherence to social distancing by adults with Noncommunicable Diseases during the COVID-19 pandemic, Brazil, 2020. / Uso dos serviços de saúde e adesão ao distanciamento social por adultos com doenças crônicas na pandemia de COVID-19, Brasil, 2020.

The present study investigates the association between the self-reported diagnosis of noncommunicable disease (NCD) and the adherence to social distancing and the use of health services during the COVID-19 pandemic. This was a cross-sectional study with Brazilian adults who participated in the ConVid- Behavior Survey, conducted online between April 24 and May 24, 2020(n = 45.161). This studyconsidered the following NCDs: diabetes, hypertension, respiratory disease, heart disease, and cancer, and evaluated the use of health services and the adherence to social distancing, as well as estimated the prevalences and adjusted prevalence ratio (aPR); 33,9% (95% CI: 32,5-35,3) referred to one or more NCD. Individuals with NCDsshowed a greater adherence to intense social distancing (aPR: 1,07;95% CI: 1,03-1,11), sought out health services more often (aPR:1,24; 95% CI:1,11-1,38), and found greater difficultyin scheduling doctor's appointments (aPR:1.52; 95% CI 1,35-1,71), receiving healthcare treatment (APR:1,50;95% CI:1,22-1,84) and medication (APR:2,17;95% CI:1,77-2,67), and performing examinations (APR:1,78;95% CI:1,50-2,10) and scheduled interventions (APR:1,65;95% CI:1,16-2,34). The presence of NCDs was associated with social distancing, seeking out health care, and difficulty in using health services.

Este estudo investiga a associação entre diagnóstico autorreferido de Doença Crônica Não Transmissível (DCNT) e adesão ao distanciamento social e utilização dos serviços de saúde durante a pandemia de COVID-19. Estudo transversal com adultos brasileiros que participaram da ConVid Pesquisa de Comportamentos, realizada de 24 de abril a 24 de maio de 2020, via web (n = 45.161). Considerou as DCNT: diabetes, hipertensão, doença respiratória, doença do coração e câncer. Avaliou a utilização de serviços de saúde e a adesão ao distanciamento social. Estimou as prevalências e razões de prevalências ajustadas (RPa). 33,9% (IC95%: 32,5-35,3) referiu uma ou mais DCNT. Indivíduos com DCNT tiveram maior adesão ao distanciamento social intenso (RPa:1,07; IC95%:1,03-1,11), procuraram mais o serviço de saúde (RPa:1,24; IC95%:1,11-1,38) e tiveram mais dificuldades para marcar consulta (RPa:1,52; IC95%:1,35-1,71), conseguir atendimento de saúde (RPa:1,50; IC95%:1,22-1,84) e medicamentos (RPa:2,17; IC95%:1,77-2,67), realizar exames (RPa:1,78; IC95%:1,50-2,10) e intervenções programadas (RPa:1,65; IC95%:1,16-2,34). A presença de DCNT associou-se à maior adesão ao distanciamento social, procura por atendimento de saúde e dificuldade na utilização dos serviços de saúde.

Estimates of hypertension and diabetes mellitus prevalence according to Health Vulnerability Index in Belo Horizonte, MG, Brazil.

OBJECTIVE: To estimate the prevalences of hypertension and diabetes for small areas in Belo Horizonte, according to the Health Vulnerability Index (HVI). METHODS: Ecological study with data from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel) conducted in Belo Horizonte, from 2006 to 2013. The self-reported diagnosis of diabetes and hypertension were evaluated. The estimates of prevalence and the 95% confidence interval (95%CI) were calculated using the direct and indirect method by HVI grouped into four categories: low, medium, high and very high health risk. RESULTS: During the period evaluated, 26% (95%CI 25.2 - 26.8) and 6.1% (95%CI 6.7 - 6.5) of the adult population from Belo Horizonte reported being hypertensive and diabetic, respectively. According to the indirect method to obtain estimates of hypertension and diabetes prevalences per HVI, it was found that areas of very high risk had a higher prevalence of adults with hypertension (38.6%; 95%CI 34.8 - 42.4) and diabetes (16.2%; 95%CI 13.1 - 19.3) when compared to the low risk (28.2%; 95%CI 27.0 - 29.4 and 6%; 95%CI 5.4 - 6.7, respectively). CONCLUSION: The adult population living in areas at high risk for health had a higher prevalence of hypertension and diabetes compared to those with a lower risk.

Inequalities in the use of health services by adults and elderly people with and without noncommunicable diseases in Brazil, 2019 National Health Survey.

OBJECTIVE: The objective of this study was to investigate the use of health services and limitations in performing usual activities by adults and elderly people with and without noncommunicable chronic diseases (NCDs), according to sociodemographic strata. METHODS: This is a cross-sectional study in which data from the 2019 National Health Survey were analyzed. The final sample corresponded to 88,531 households with interviews carried out, referring to individuals aged 18 years and above. The prevalence of use of services by the population with NCDs was compared with that of the population without NCDs and stratified by socioeconomic and demographic variables. Prevalence ratios (PRs) and 95% confidence intervals (95%CI) were calculated. RESULTS: In 2019, 47.6% (95%CI 47.0-48.3) of the population reported having one or more NCDs. Population with NCDs had more medical consultations in the last 12 months (adjusted PR [APR]=1.21; 95%CI 1.20-1.23), used more health services in the last 2 weeks (APR=2.01; 95%CI 1.91-2.11), were referred to more hospitalization (APR=2.11; 95%CI 1.89-2.36), and had more limitations in performing usual activities (APR=2.52; 95%CI 2.30-2.76), compared with the population without NCDs. A positive dose-response gradient was observed between the number of comorbidities and the use of services. In all socioeconomic and demographic strata, the prevalence of indicators was higher in people with NCDs. CONCLUSION: The presence of NCDs was associated with a higher frequency of use of health services (i.e., consultation, use of services, and hospitalization) and the restriction of usual activities in all socioeconomic and demographic strata.

Mortality among Brazilian adolescents and young adults between 1990 to 2019: an analysis of the Global Burden of Disease study. / Mortalidade de adolescentes e adultos jovens brasileiros entre 1990 e 2019: uma análise do estudo Carga Global de Doença.

Mortality indicators for Brazilians aged between 10 and 24 years old were analyzed. Data were obtained from the Global Burden of Disease (GBD) 2019 Study, and absolute numbers, proportion of deaths and specific mortality rates from 1990 to 2019 were analyzed, according to age group (10 to 14, 15 to 19 and 20 to 24 years), sex and causes of death for Brazil, regions and Brazilian states. There was a reduction of 11.8% in the mortality rates of individuals aged between 10 and 24 years in the investigated period. In 2019, there were 13,459 deaths among women, corresponding to a reduction of 30.8% in the period. Among men there were 39,362 deaths, a reduction of only 6.2%. There was an increase in mortality rates in the North and Northeast and a reduction in the Southeast and South states. In 2019, the leading cause of death among women was traffic injuries, followed by interpersonal violence, maternal deaths and suicide. For men, interpersonal violence was the leading cause of death, especially in the Northeast, followed by traffic injuries, suicide and drowning. Police executions moved from 77th to 6th place. This study revealed inequalities in the mortality of adolescents and young adults according to sex, causes of death, regions and Brazilian states.

Trata-se de análise de indicadores de mortalidade de brasileiros com idades entre 10 e 24 anos. Foram analisados os dados do Global Burden of Disease (GBD) 2019, utilizando números absolutos, proporção de óbitos e taxas de mortalidade específicas entre 1990 e 2019, segundo faixa etária (10 a 14, 15 a 19 e 20 a 24 anos), sexo e causas de morte para Brasil, regiões e estados brasileiros. Houve redução de 11,8% nas taxas de mortalidade de indivíduos com idades entre 10 e 24 anos no período investigado. Em 2019, ocorreram 13.459 mortes entre mulheres, correspondendo à redução de 30,8% no período. Entre homens ocorreram 39.362 óbitos, redução de apenas 6,2%. Houve aumento das taxas de mortalidade no Norte e Nordeste e redução em estados do Sudeste e Sul. Em 2019, entre mulheres a primeira causa de morte foram lesões por transporte, seguidas por violência interpessoal, mortes maternas e suicídio. Para os homens, a violência interpessoal foi a primeira causa de morte, em especial no Nordeste, seguida das lesões por transporte, do suicídio e dos afogamentos. Execuções policiais passaram do 77º para o 6º lugar. Este estudo revelou desigualdades na mortalidade de adolescentes e adultos jovens segundo sexo, causas de óbito, regiões e estados brasileiros.

Factors associated with salt intake in the Brazilian adult population: National Health Survey. / Fatores associados ao consumo de sal na população adulta brasileira: Pesquisa Nacional de Saúde.

This paper aims to identify the factors associated with high salt intake in the Brazilian adult population. This is a cross-sectional study with 8,083 adults participating in the National Health Survey (PNS, 2014/15). Salt intake was based on the estimation of 24-hour urinary sodium calculated from the sodium/creatinine ratio in spot urine samples. The highest quartile of the distribution was considered high salt intake. The relationship between high salt consumption and sociodemographic factors, lifestyles, morbidity, and self-rated health status was analyzed by calculating the crude prevalence ratios and the prevalence ratios adjusted for age and gender. Approximately 28.1% had an estimated salt intake higher than 10.56 g/day. Overweight (Adjusted Prevalence Ratio; 95%CI - PRadj 1.23; 1.09-1.39), obesity (PRadj 1.61; 1.43-1.83), and diabetes (PRadj 1.36; 1.17-1.58) were positively associated with high salt intake. Female gender (PRadj 0.73; 0.66-0.80), high schooling level (PRadj 0.88; 0.79-0.99), living in the North and chronic kidney disease (PRadj 0.71; 0.56-0.90) were protective factors. Salt consumption is elevated nationwide and in all population subgroups, requiring coordinated actions.

O objetivo deste artigo é identificar os fatores associados ao consumo elevado de sal na população brasileira adulta. Estudo transversal com dados de 8.083 adultos da Pesquisa Nacional de Saúde (PNS, 2014/15). O consumo de sal foi baseado na estimativa de excreção urinária de sódio de 24 horas, calculada pela relação sódio/creatinina em amostra de urina casual. Considerou-se consumo elevado o quartil mais alto da distribuição. A relação entre consumo elevado de sal e fatores sociodemográficos, estilos de vida, morbidade e autoavaliação do estado de saúde foi analisada pelo cálculo das razões de prevalência brutas e ajustadas por idade e sexo. 28,1% apresentavam consumo estimado de sal maior que 10,56 g/dia. Estiveram positivamente associados ao consumo elevado de sal a presença de sobrepeso (Razão de Prevalência ajustada; IC95% - RPaj 1,23; 1,09-1,39), obesidade (RPaj 1,61; 1,43-1,83) e diabetes (RPaj 1,36; 1,17-1,58). Foram fatores de proteção o sexo feminino (RPaj 0,73; 0,66-0,80), escolaridade elevada (RPaj 0,88; 0,79-0,99), morar na região Norte e presença de doença renal crônica (RPaj 0,71; 0,56-0,90). O consumo de sal é elevado em todo o país e em todos os subgrupos da população, demandando ações coordenadas para seu enfrentamento.

Factors associated with increased cigarette consumption in the Brazilian population during the COVID-19 pandemic. / Fatores associados ao aumento do consumo de cigarros durante a pandemia da COVID-19 na população brasileira.

Social distancing measures adopted in various countries to mitigate the impact of the COVID-19 pandemic can lead to unwanted effects on their populations' health and behaviors. This study aimed to investigate smoking behavior in the Brazilian adult population during the COVID-19 pandemic and analyze factors associated with the increase in cigarette consumption. An online survey was performed, and the final sample included 45,160 individuals. The study used post-stratification weights and calculated crude prevalence ratios (PR) and adjusted by sex, age, and schooling, and respective 95% confidence intervals (95%CI). Poisson regression models with robust variance were applied to analyze associations between increased cigarette consumption and sociodemographic variables and adherence to social distancing, quality of sleep, state of mind, and changes in work and earnings. Prevalence of smokers was 12% (95%CI: 11.1-12.9), 34% of whom reported an increase in cigarette consumption. The increase was greater among women (PR = 1.27; 95%CI: 1.01-1.59) and individuals with incomplete secondary schooling (PR = 1.35; 95%CI: 1.02-1.79). The increase in cigarette consumption was associated with worse quality of sleep, feeling isolated from family members or sad, depressed, or anxious, loss of earnings, and worse self-rated health. Health promotion strategies, smoking prevention, and encouragement for smoking cessation, as well as mental health interventions, should be continued and reinforced in the context of social distancing during the COVID-19 pandemic.

Medidas de distanciamento social adotadas em diversos países para mitigar o impacto da pandemia de COVID-19 podem acarretar efeitos indesejáveis sobre a saúde e o comportamento das populações. Este estudo objetivou investigar o comportamento de fumar na população adulta brasileira durante a pandemia de COVID-19 e analisar os fatores associados ao aumento do consumo de cigarro. Foi realizado um inquérito virtual e a amostra final correspondeu a 45.160 indivíduos. Foram utilizados pesos de pós-estratificação e calculadas as razões de prevalência (RP) brutas e ajustadas por sexo, idade e escolaridade, e os respectivos intervalos de 95% de confiança (IC95%). Modelos de regressão de Poisson com variância robusta foram aplicados para a análise de associação entre o aumento do consumo de cigarros e as variáveis sociodemográficas e as relativas à adesão ao distanciamento social, qualidade do sono, estado de ânimo, alteração no trabalho e nos rendimentos. A prevalência de fumantes foi de 12% (IC95%: 11,1-12,9), dos quais 34% relataram aumento no consumo de cigarros. Esse aumento foi maior entre as mulheres (RP = 1,27; IC95%: 1,01-1,59) e entre indivíduos com o Ensino Médio incompleto (RP = 1,35; IC95%: 1,02-1,79). O aumento do consumo de cigarros esteve associado à piora da qualidade do sono, sentir-se isolado dos familiares, triste ou deprimido, ansioso, ficar sem rendimentos e pior avaliação do estado de saúde. Estratégias de promoção da saúde, de prevenção do uso e de incentivo à cessação do consumo de cigarros, bem como intervenções em saúde mental, devem ser continuadas e reforçadas no contexto de distanciamento social durante a pandemia de COVID-19.

Las medidas de distanciamiento social adoptadas en diversos países para mitigar el impacto de la pandemia de COVID-19 pueden acarrear efectos indeseables sobre la salud y el comportamiento de las poblaciones. Este estudio tuvo como objetivo investigar el comportamiento de fumar en la población adulta brasileña, durante la pandemia de COVID-19, y analizar los factores asociados al aumento del consumo de tabaco. Se realizó una encuesta virtual y la muestra final correspondió a 45.160 individuos. Se utilizaron pesos de pos-estratificación y se calcularon las razones de prevalencia (RP) brutas y ajustadas por sexo, edad y escolaridad, así como los respectivos intervalos de 95% de confianza (IC95%). Se aplicaron modelos de regresión de Poisson con variancia robusta para el análisis de asociación entre el aumento del consumo de tabaco y las variables sociodemográficas, así como las relativas a la adhesión al distanciamiento social, calidad del sueño, estado de ánimo, cambios en el trabajo e ingresos. La prevalencia de fumadores fue de un 12% (IC95%: 11,1-12,9), de los cuales un 34% relataron un aumento en el consumo de cigarrillos. Este aumento fue mayor entre las mujeres (RP = 1,27; IC95%: 1,01-1,59) y entre individuos con la enseñanza media incompleta (RP = 1,35; IC95%: 1,02-1,79). El aumento del consumo de tabaco estuvo asociado con un empeoramiento de la calidad del sueño, sentirse aislado de los familiares, triste o deprimido, ansioso, quedarse sin ingresos, al igual que con una peor evaluación del estado de salud. Las estrategias de promoción de salud, prevención del consumo y de alicientes para dejar el hábito de fumar, así como intervenciones en salud mental, deben ser continuas y estar reforzadas en el contexto de distanciamiento social durante la pandemia de COVID-19.

The COVID-19 pandemic and changes in the lifestyles of Brazilian adolescents.

OBJECTIVE: To analyze changes in the lifestyles of Brazilian adolescents during the COVID-19 pandemic. METHODS: Cross-sectional study carried out with adolescents who participated in the survey "ConVid Adolescentes - Pesquisa de Comportamentos". The indicators related to lifestyles before and during the COVID-19 pandemic were evaluated: consumption of healthy and unhealthy foods, physical activity and sedentary behavior, smoking and consumption of alcohol. Prevalence and 95% confidence intervals were calculated for the total population and according to sex and age group. RESULTS: A total of 9,470 adolescents participated in the study. During the period of social distancing, there was an increase in the prevalence of vegetables consumption (from 27.34 to 30.5%), frozen foods (from 13.26 to 17.3%), chocolates and sweets (from 48.58 to 52.51%), and time in front of screens (from 44.57 to 70.15%). On the other hand, there was a decrease in the practice of physical activity (from 28.70 to 15.74%) and in the consumption of alcohol (from 17.72 to 12.77%). Differences were observed according to sex and age group. CONCLUSION: The results show changes in the lifestyle of adolescents and an increase in health risk behaviors.

Profile of cases due to burn attended in emergency care units in Brazilian capitals in 2017. / Perfil dos casos de queimadura atendidos em serviços hospitalares de urgência e emergência nas capitais brasileiras em 2017.

OBJECTIVES: To describe the profile of burn victims attended in emergency services and to identify associations between the variables investigated. METHODS: Cross-sectional study based on data from the 2017 survey "Surveillance of violence and accidents in emergency units". We used descriptive analysis, according to demographic characteristics and aspects related to the burn injury, as well as the correspondence analysis technique, which allowed to verify possible associations between the variables investigated. RESULTS: Burns were more frequent: in adults aged between 20 and 39 years (40.7%); in men (57.0%); in the household (67.7%); due to hot substances (52.0%). Household accidents were more frequent in the age group 0-15 years (92.0%) and elderly (84.4%), and in women (81.6%). Accidents in commerce, services and industry affected individuals aged 16 to 59 years (73.6%). Referral to other hospitals was associated with cases in the elderly and hospitalization with the cases in individuals aged between 0 and 15 years old. Events in the working age population were associated with alcohol use and the workplace. Among women, it is suggested to associate burn accidents with household and hot substances. CONCLUSIONS: The results point to the need for oriented actions in the field of health education, as well as labor regulation and supervision.

Noncommunicable diseases in the Journal Ciência & Saúde Coletiva: a bibliometric study. / Doenças Crônicas Não Transmissíveis na Revista Ciência & Saúde Coletiva: um estudo bibliométrico.

Noncommunicable Diseases are an important public health issue in Brazil and worldwide. This study aimed to analyze the scientific production published by the "Journal Ciência & Saúde Coletiva" in order to shed light on its contributions for the dissemination of scientific knowledge and the debate regarding noncommunicable diseases. A bibliometric study on the publications from 1996 to 2019 related to noncommunicable diseases was carried out. A total of 458 documents that met the eligibility criteria were selected. An increasing trend in the number of publications per year was found; at some points, it coincided with political and institutional milestones in Brazil. Quantitative research papers stood out, as did studies on risk and protective factors. Public educational and research institutions led the publishing and the financing of the studies. Most authors were female. The journal has been reflecting the magnitude of the theme and its prioritization on the public agenda by promoting the debate and providing a scientific dissemination of content related to noncommunicable diseases.

As Doenças Crônicas Não Transmissíveis configuram importante problema de saúde pública no Brasil e no mundo. Visando conferir visibilidade às contribuições da revista Ciência & Saúde Coletiva para a divulgação do conhecimento científico e o debate das questões relacionadas às Doenças Crônicas Não Transmissíveis, o presente estudo teve por objetivo analisar a produção científica publicada pela revista. Realizou-se um estudo bibliométrico das publicações veiculadas no período de 1996 a 2019, referentes a essas doenças. Com base em critérios de elegibilidade, selecionou-se um total de 458 publicações. Observou-se tendência temporal de aumento das publicações, coincidente com o estabelecimento de marcos político-institucionais no país. Destacaram-se os artigos quantitativos e os estudos sobre fatores de risco e proteção. Evidenciou-se a liderança das instituições públicas de ensino e pesquisa na produção científica sobre o tema e, também, no financiamento público dos estudos. Os autores que mais publicaram são majoritariamente do sexo feminino. A revista vem refletindo a magnitude e a prioridade da temática na agenda pública ao promover o debate e oportunizar a divulgação científica sobre as doenças crônicas.

Women and evaluation of inequalities in the distribution of risk factors for Chronic non-communicable diseases (NCD), Vigitel 2016-2017. / Mulheres e avaliação das desigualdades na distribuição de fatores de risco de doenças crônicas, Vigitel 2016-2017.

OBJECTIVE: To compare the distribution of chronic non-communicable diseases (CNCD) indicators among adult female beneficiaries and non-beneficiaries of the Bolsa Família Program (BFP) in Brazilian capitals. METHODS: Analysis of Vigitel telephone survey data in 2016 and 2017. Gross and adjusted prevalence ratios (PR) and their respective confidence intervals were estimated using Poisson Regression model. RESULTS: Women with BF have lower schooling, are young people, live more frequently in the Northeast and North of the country. Higher prevalence of risk factors were found in woman receiving BF. The adjusted PR of the BF women were: smokers (PR = 1.98), overweight (PR = 1.21), obesity (PR = 1.63), fruits and vegetables (PR = 0.63), consumption of soft drinks (PR = 1.68), bean consumption (PR = 1.25), physical activity at leisure (PR = 0.65), physical activity at home (PR = 1.35), time watching TV (PR = 1.37), self-assessment of poor health status (PR =2.04), mammography (PR = 0.86), Pap smears (PR = 0.91), hypertension (PR = 1.46) and diabetes (PR = 1,66). When women were compared among strata of the same schooling, these differences were reduced. CONCLUSION: Worst indicators among women receiving BF reflect social inequalities inherent in this most vulnerable group. The study also shows that BF is being targeted at the most vulnerable women.

OBJETIVO: Comparar a distribuição de indicadores de doenças crônicas não transmissíveis (DCNT) entre mulheres adultas beneficiárias e não beneficiárias do Programa Bolsa Família (PBF) nas capitais brasileiras. MÉTODOS: Análise de dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) em 2016 e 2017. Foram estimados as razões de prevalência (RP) brutas e ajustadas e seus respectivos intervalos de confiança usando o modelo de regressão de Poisson. RESULTADOS: Mulheres do PBF tem menor escolaridade, são mais jovens e vivem com maior frequência nas regiões Nordeste e Norte do país. Prevalências mais elevadas de fatores de risco foram encontradas nas mulheres beneficiárias do PBF. A RP ajustada por idade das mulheres com BF foram: fumantes (RP = 1,98), excesso de peso (RP = 1,21), obesidade (RP = 1,63), frutas e hortaliças (RP = 0,63), consumo de refrigerantes (RP = 1,68), consumo de feijão (RP = 1,25), prática de atividade física no lazer (RP = 0,65), atividade física no domicílio (RP = 1,35), tempo assistindo à TV (RP = 1,37), autoavaliação do estado de saúde ruim (RP = 2,04), mamografia (RP = 0,86), Papanicolau (RP = 0,91), hipertensão (RP = 1,46) e diabetes (RP = 1,66). Quando comparadas as mulheres entre estratos de mesma escolaridade, as diferenças entre os fatores de risco foram reduzidas. CONCLUSÃO: Piores indicadores entre mulheres que recebem BF refletem desigualdades sociais inerentes a esse grupo mais vulnerável. O estudo evidencia também que o PBF está sendo destinado às mulheres mais vulneráveis.

Mortality patterns in municipalities of a mining region before the Brumadinho dam failure, state of Minas Gerais, Brazil / Padrões de mortalidade em municípios de uma região mineradora antes do rompimento da barragem de Brumadinho, Minas Gerais, Brasil

ABSTRACT Objective: To describe the patterns of overall mortality and mortality from external causes and the temporal evolution in the municipalities of the Paraopeba River Basin, before the socio-environmental disaster of the Brumadinho dam and, additionally, to investigate the correlation between mortality and socioeconomic deprivation in these municipalities. Methods: Global Burden of Disease Study mortality estimates for 26 municipalities in the state of Minas Gerais, Brazil, were analyzed. Rates of overall mortality and mortality from external causes were estimated in the triennia (T) T1 (2000 to 2002), T2 (2009 to 2011), and T3 (2016 to 2018). Pearson's correlation coefficient measured the association between mortality rates and socioeconomic deprivation, according to the Brazilian Deprivation Index (IBP). Results: There was a decrease in overall mortality in the Paraopeba River Basin from 717.7/100 thousand to 572.6/100 thousand inhabitants, and in most municipalities between T1-T3. Mortality from external causes increased from 73.3/100 thousand to 82.1/100 thousand, and it was higher in these municipalities compared with the mean for Brazil and Minas Gerais. Deaths from suicide and interpersonal violence increased from 29.6/100 thousand to 43.2/100 thousand in most of the 26 municipalities. Death rates due to unintentional injuries decreased during the period, and those due to transport injuries, increased. There was a positive correlation between socioeconomic deprivation and the percent change in mortality rates. Conclusion: Despite the strong presence of mining activity in the region, such did not reflect in the improvement of the sanitary situation. Death rates due to external causes increased in the period, associated with inequalities, which must be considered in the planning for the recovery of the disaster areas.

RESUMO: Objetivo: Descrever os padrões de mortalidade geral e por causas externas e a evolução temporal nos municípios da Bacia Hidrográfica do Rio Paraopeba previamente ao desastre socioambiental de Brumadinho e, adicionalmente, investigar a correlação entre a mortalidade e a privação socioeconômica nesses municípios. Métodos: Foram analisadas estimativas de mortalidade do Estudo Carga Global de Doenças referentes a 26 municípios de Minas Gerais. Calcularam-se taxas de mortalidade geral e por causas externas nos triênios (T) T1 (2000 a 2002), T2 (2009 a 2011) e T3 (2016 a 2018). O coeficiente de correlação de Pearson mediu associação entre as taxas de mortalidade e a privação socioeconômica, segundo Índice Brasileiro de Privação. Resultados: Houve declínio da mortalidade geral na Bacia Hidrográfica do Rio Paraopeba de 717,7/100.000 para 572,6/100.000 hab. e na maioria dos municípios entre T1-T3. A mortalidade por causas externas aumentou de 73,3/100.000 para 82,1/100.000 e foi mais elevada nesses municípios comparando-se com a média do Brasil e de Minas Gerais. As mortes por suicídio e violência interpessoal aumentaram de 29,6/100.000 para 43,2/100.000 na maioria dos 26 municípios. Os acidentes não intencionais reduziram-se no período, e as taxas por acidente de transporte aumentaram. Houve correlação positiva entre a privação socioeconômica e a variação percentual das taxas de mortalidade. Conclusão: Apesar da forte presença da atividade mineradora na região, isso não refletiu na melhoria do quadro sanitário, as causas externas aumentaram no período, associadas às desigualdades, o que deve ser considerado no planejamento para a recuperação das áreas do desastre.

Premature mortality due to noncommunicable diseases in Brazilian capitals: redistribution of garbage causes and evolution by social deprivation strata / Mortalidade prematura por doenças crônicas não transmissíveis em capitais brasileiras: redistribuição de causas garbage e evolução por estratos de privação social

ABSTRACT Objective: To analyze premature mortality due to noncommunicable chronic diseases (NCDs) in Brazilian capitals and the Federal District (DF) after redistribution of garbage causes and the temporal evolution according to social deprivation strata in the 2010 to 2012 and 2017 to 2019 triennia. Methods: Corrections were applied to the Mortality Information System (Sistema de Informação sobre Mortalidade - SIM) data such as the redistribution of garbage codes (GC). Premature mortality rates due to NCDs were calculated and standardized by age. The differences among NCDs mortality rates were analyzed according to the Brazilian Deprivation Index (Índice Brasileiro de Privação - IBP) categories and between the three-year periods. Results: In the capitals as a whole, rates increased between 8 and 12% after GC redistribution and the greatest increases occurred in areas of high deprivation: 11.9 and 11.4%, triennia 1 and 2, respectively. There was variability between the capitals. There was a reduction in rates in all strata of deprivation between the three-year periods, with the greatest decrease in the stratum of low deprivation (-18.2%) and the lowest in the stratum of high deprivation (-7.5%). Conclusion: The redistribution of GC represented an increase in mortality rates, being higher in the strata of greater social deprivation. As a rule, a positive gradient of mortality was observed with increasing social deprivation. The analysis of the temporal evolution showed a decrease in mortality from NCDs between the triennia, especially in areas of lower social deprivation.

RESUMO Objetivo: Analisar a mortalidade prematura por doenças crônicas não transmissíveis (DCNT) nas capitais brasileiras e Distrito Federal (DF) após redistribuição das causas garbage, e a evolução temporal segundo estratos de privação social nos triênios 2010 a 2012 e 2017 a 2019. Métodos: Foram aplicadas correções ao Sistema de Informação sobre Mortalidade (SIM), sendo empregada metodologia para redistribuição das causas garbage (CG). As taxas de mortalidade prematura por DCNT padronizadas por idade foram estimadas. Foram analisadas as diferenças entre as taxas de mortalidade por DCNT segundo categorias do Índice Brasileiro de Privação (IBP) e entre os triênios. Resultados: No conjunto das capitais, as taxas aumentaram entre 8 e 12% após a redistribuição de CG, e os maiores acréscimos ocorreram em áreas de alta privação: 11,9 e 11,4%, triênios 1 e 2, respectivamente. Houve variabilidade entre as capitais. Observou-se redução das taxas em todos os estratos de privação entre os triênios, sendo maior decréscimo no estrato de baixa privação (-18,2%), e menor no estrato de alta privação (-7,5%). Conclusão: A redistribuição de CG representou aumento das taxas de mortalidade, sendo maior nos estratos de maior privação social. Via de regra, observou-se gradiente positivo de mortalidade com o aumento da privação social. A análise da evolução temporal evidenciou decréscimo da mortalidade por DCNT entre os triênios, sobretudo em áreas de menor privação social.

Road traffic injuries and deaths and the achievement of UN Sustainable Development Goals in Brazil: results from the Global Burden of Disease Study, 1990 to 2019

Abstract INTRODUCTION: Brazil ranks 5th in the number of deaths due to road injuries. This study aimed to analyze mortality and disabilities resulting from road injuries in Brazil, and to assess the Sustainable Development Goals (SDG) target of reducing deaths due to road injuries by 50% by 2030. METHODS: This descriptive and exploratory study used the estimates from the Global Burden of Disease 2019: indicators of mortality, premature deaths, and disabilities according to sex, age group, and type of transport for 1990, 2015, and 2019. Time trends in mortality rates from 1990 to 2019 were assessed, and a projection for 2030 was calculated, applying a linear regression model. RESULTS: Deaths due to road injuries were 44,236 in 1990, and 44,529 in 2019, representing a 43% reduction in mortality rates. The highest rates were in the North, Northeast, and Midwest regions of Brazil, in males and young adults. A 77% reduction was observed in mortality rates for pedestrians and an increase of 53% for motorcyclists and of 54% for cyclists during the period. In terms of motorcycle road injuries, the mortality rate for men increased from 7.3/100,000 (1990) to 11.7/100,000 inhabitants (2019). The rates of premature deaths and disabilities were also higher for men when compared to women. Amputations, fractures, spinal cord injuries, and head trauma were the main types of road injuries. The projections for 2030 show that Brazil might not reach the SDG target. CONCLUSIONS: Despite the decline in mortality rates, the 2030 Agenda's target might not be achieved.

Calidad del sueño y experiencias afectivas durante la pandemia de COVID-19 en adultos residentes en el estado de Minas Gerais / Qualidade do sono e vivências afetivas de adultos residentes no estado de minas gerais durante a pandemia de covid-19 / Sleep quality and affective experiences of adults living in the state of minas gerais during the covid-19 pandemic

RESUMO Objetivos: verificar se a adesão à medida de distanciamento social e características sociodemográficas se associam com as alterações percebidas, durante a pandemia de COVID-19, na qualidade do sono e nas vivências afetivas de brasileiros residentes em Minas Gerais. Método: estudo transversal que analisou dados de questionário on-line aplicado a adultos e idosos residentes no estado de Minas Gerais. Foram estimadas prevalências e razões de prevalências, brutas e ajustadas, para as variáveis investigadas. Resultados: entre 35% e 55% dos respondentes referiram alterações nas vivências afetivas, como solidão, tristeza e ansiedade, e alterações do sono durante o período de isolamento social. Em geral, essas alterações foram mais frequentes entre aqueles que realizaram o isolamento de forma intensa ou total, indivíduos do sexo feminino e pessoas mais jovens. Conclusão: no presente estudo, foram observadas alterações importantes na qualidade de sono e nas vivências afetivas da população mineira, atingindo mais as pessoas do sexo feminino, pessoas mais jovens e que fizeram isolamento social intenso. É importante ofertar cuidados em saúde mental a fim de evitar os impactos negativos do distanciamento social em situações de pandemia.

RESUMEN Objetivos: verificar si la adherencia a la medida de distanciamiento social y las características sociodemográficas están asociadas a los cambios percibidos en la calidad del sueño y las experiencias afectivas de los brasileños residentes en Minas Gerais durante la pandemia de COVID-19. Método: estudio transversal que analizó datos de un cuestionario online aplicado a adultos y ancianos residentes en el estado de Minas Gerais. Se estimaron las prevalencias y las razones de prevalencia, brutas y ajustadas, de las variables investigadas. Resultados: entre el 35% y el 55% de los encuestados refieren alteraciones en las vivencias afectivas como soledad, tristeza, ansiedad, y alteraciones del sueño durante el período de aislamiento social. En general, estos cambios fueron más frecuentes entre los que estaban intensa o totalmente aislados, las mujeres y los individuos más jóvenes. Conclusión: en el presente estudio observamos alteraciones importantes en la calidad del sueño y en las vivencias afectivas de la población de Minas Gerais, afectando más al sexo femenino, a las personas más jóvenes y a las que habían estado en intenso aislamiento social. Es importante prestar atención a la salud mental para evitar los efectos negativos del distanciamiento social en situaciones de pandemia.

ABSTRACT Objectives: to verify whether adherence to the social distancing measure and sociodemographic characteristics are associated with perceived changes, during the COVID-19 pandemic, in sleep quality and affective experiences of Brazilians living in Minas Gerais. Method: a cross-sectional study that analyzed data from an online questionnaire applied to adults and older adults living in the state of Minas Gerais. Prevalence values and prevalence ratios, both adjusted and adjusted, were estimated for the variables investigated. Results: between 35% and 55% of the respondents reported changes in affective experiences, such as loneliness, sadness and anxiety, as well as changes in sleep during the social isolation period. In general, those alterations were more frequent among those who adhered to intense or total isolation, female individuals and younger people. Conclusion: in this study, important changes were observed in sleep quality and in the affective experiences of the population of Minas Gerais, affecting more females, younger people and individuals who adhered to intense social isolation. It is important to offer mental health care in order to avoid the negative impacts of social distancing in pandemic situations.