Acceptability of teleconsultation in a public service specialized in the prevention and care of HIV infection and other sexually transmitted infections / Aceitabilidade da teleconsulta em um serviço público especializado na prevenção e cuidado da infecção pelo HIV e outras infecções sexualmente transmissíveis

Introduction: Telemedicine was leveraged for its contribution to mitigate the impact of COVID-19 in Brazil and worldwide. Objective: We aim to evaluate the acceptability of incorporating teleconsultation through synchronized videoconference by users and professionals in a service specialized in the prevention and treatment of the human immunodeficiency virus and other sexually transmitted infections, and to identify associated factors. Methods: This is a cross-sectional study with 410 users and 57 professionals who answered a category-standardized questionnaire. Predictors of acceptability were assessed using logistic regression model. Results: A total of 364 (88.8%) users said they would accept the modality. The factors positively associated with the odds of acceptance were the self-assessment of having favorable conditions to participate in a teleconsultation (aOR 54.8; 95%CI 12.4­242.1; p<0.001), the perception of saving money (aOR 5.2; 95%CI 1.9­14.0; p=0.001), and perceived convenience of the modality (aOR 6.7; 95%CI 2.9­15.9; p<0.001). Factors associated with reduced odds of acceptance were the fear of not being evaluated well (aOR 0.2; 95%CI 0.1­0.4; p<0.001), or remaining long without seeing the professional (aOR 0.2; 95%CI 0.1­0.5; p<0.001). The acceptance of the modality among professionals was 75.4% and the perception of its convenience (aOR 16.8; 95%CI 2.6­108.4; p=0.003) and that the institution has appropriated conditions (aOR 7.7; 95%CI 1.5­40.6; p=0.016) were associated with increased odds of accepting its incorporation in their routine. Conclusion: Governance should invest in infrastructure and support, secure protocols, digital literacy, and training of its users and employees for video teleconsultation. (AU)

Introdução: A telemedicina foi alavancada por sua contribuição para mitigar o impacto da COVID-19 no Brasil e no mundo. Objetivo: Pretendemos avaliar a aceitabilidade da incorporação da teleconsulta por videoconferência síncrona por usuários e profissionais de um serviço especializado na prevenção e tratamento da infecção pelo vírus da imunodeficiência humana (HIV) e outras infecções sexualmente transmissíveis, bem como identificar fatores associados. Métodos: Estudo transversal com 410 usuários e 57 profissionais, que responderam a um questionário padronizado por categoria. Os preditores de aceitabilidade foram avaliados utilizando-se um modelo de regressão logística. Resultados: O total de 364 (88,8%) usuários disseram que aceitariam a modalidade. Os fatores positivamente associados à probabilidade de aceitação foram a autoavaliação quanto a ter condições favoráveis para participar de uma teleconsulta (razão de chances ajustada ­ aOR 54,8; intervalo de confiança de 95% ­ IC95% 12,4­242,1; p<0,001), a percepção de poupar dinheiro (aOR 5,2; IC95% 1,9­14,0; p=0,001) e a percepção de conveniência da modalidade (aOR 6,7; IC95% 2,9­15,9; p<0,001). As menores probabilidades de aceitação foram o medo de não ser bem avaliado (aOR 0,2; IC95% 0,1­0,4; p<0,001) e de permanecer muito tempo sem ver o profissional (aOR 0,2; IC95% 0,1­0,5; p<0,001). A aceitação da modalidade pelos profissionais foi de 75,4% e a percepção de sua conveniência (aOR 16,8; IC95% 2,6­108,4; p=0,003) e a de que a instituição possui condições favoráveis (aOR 7,7; IC95% 1,5­40,6; p=0,016) foram associadas com a maior probabilidade de aceitar a incorporação da modalidade em sua rotina. Conclusão: A governança deve investir em infraestrutura e apoio, protocolos seguros, literacia digital e treinamento de seus usuários e funcionários para a videoconsulta. (AU)

Frecuencia y factores relacionados al no cumplimiento del control prenatal en gestantes de 35 años o más en el Cauca, Colombia, 2016-2018 / Frequency and associated factors of non-adherence to prenatal care in pregnant women 35 years of age or older in Cauca, Colombia, 2016-2018

RESUMEN Objetivos: describir la frecuencia del no cumplimiento del control prenatal en gestantes de 35 años o más del departamento del Cauca, Colombia, y hacer un análisis exploratorio de los factores asociados. Materiales y métodos: estudio descriptivo de corte transversal. Se incluyeron gestantes entre 35 y 41 años afiliadas a la Entidad Administradora de Planes de Beneficios Asociación Indígena del Cauca Entidad Promotora de Salud-I (EAPB AIC-I) e inscritas al programa de control prenatal, entre 2016 y 2018. Se excluyeron pacientes con registros sin información completa. Se analizaron variables sociodemográficas, clínicas y la frecuencia de no asistencia adecuado al control prenatal a través de estadística descriptiva, y se calcularon Odd Ratios con sus intervalos de confianza para los factores asociados. Resultados: en 1016 pacientes entre 35 y 41 años evaluadas se encontró una frecuencia de no cumplimiento de mínimo seis controles prenatales de 61,3 %. El antecedente de aborto (OR ajustado: 0,46; IC 95 % 0,33-0,64,) y gravidez de cinco o más (OR ajustado: 3,22; IC 95 % 1,50-6,91) fueron los factores asociados. Conclusiones: el no cumplimiento de controles prenatales por gestantes de 35 o más años inscritos en la EAPB AIC-I del Cauca es alto. Se requieren nuevos estudios cualitativos que evalúen factores culturales y sociales presentes en estas comunidades que afectan la adherencia al control prenatal, así como estudios prospectivos que confirmen el análisis exploratorio de los factores asociados a la no adherencia. Es importante que las empresas aseguradoras del régimen subsidiado realicen actividades de promoción en estas comunidades para incrementar su cumplimento.

ABSTRACT Objectives: To describe the frequency and factors associated with non-adherence to prenatal follow-up in pregnant women 35 years of age or older in the department of Cauca, Colombia, between 2016 and 2018. Material and methods: Cross-sectional, descriptive observational study of records of pregnant women between 35 and 41 years of age affiliated to the Cauca Indigenous Association Health Benefit Plan Management Organization-I (EAPB AIC-I) and registered in the prenatal care program, between 2016 and 2018. Duplicate records and records with incomplete information were excluded. Sociodemographic and clinical variables, as well as program outcomes, were analyzed using descriptive statistics. Odds ratios and their confidence intervals were calculated. Results: In 1016 patients between 35 and 41 years of age, a frequency of 61.3 % of non-adherence to at least six prenatal visits was found. History of abortion (adjusted OR: 0.46; 95 % CI 0.33-0.64) and pregnancy of five or more (adjusted OR: 3,22; IC 95 % 1,50-6,91) were the associated factors. Conclusions: Non-adherence to prenatal care by pregnant women of 35 years or more affiliated to the Cauca EAPB AIC-I is high. Further qualitative studies are needed to examine the cultural and social factors present in these communities that may affect adherence to prenatal monitoring, together with prospective studies to confirm the exploratory analysis of factors associated with non-adherence. Insurance organizations in the subsidized regime should be called upon to conduct promotion activities in these communities in order to improve adherence.

Prevalence and Determinants of Adequate Compliance with Antenatal Care in Peru / Prevalência e determinantes da conformidade adequada à atenção pré-natal no Peru

Abstract Objective To determine the adequacy of compliance with antenatal care (ANC) by pregnant women in Peru and to identify the associated factors. Methods An analytical cross-sectional study of data from the 2019 Peruvian Demographic and Family Health Survey (Encuesta Demográfica y de Salud Familiar, ENDES, in Spanish) was conducted. The dependent variable was adequate compliance with ANC (provided by skilled health care professionals; first ANC visit during the first trimester of pregnancy; six or more ANC visits during pregnancy; ANC visits with appropriate content) by women aged 15 to 49 years in their last delivery within the five years prior to the survey. Crude and adjusted prevalence ratios and their 95% confidence intervals were calculated using a log-binomial regression model. Results A total of 18,386 women were analyzed, 35.0% of whom adequately complied with ANC. The lowest proportion of compliance was found with the content of ANC (42.6%). Sociodemographic factors and those related to pregnancy, such as being in the age groups of 20 to 34 years and 35 to 49 years, havingsecondaryor higher education, belonging to a wealth quintile of the population other than the poorest, being from the Amazon region, not being of native ethnicity, having a second or third pregnancy, and having a desired pregnancy, increased the probability of presenting adequate compliance with ANC. Conclusion Only 3 out of 10women in Peru showed adequate compliancewith ANC. Compliance with the content of ANC must be improved, and strategies must be developed to increase the proportion of adequate compliance with ANC.

Resumo Objetivo Determinar a adequação do cumprimento dos cuidados pré-natais (CPN) por mulheres grávidas no Peru e identificar os fatores associados. Métodos Foi realizado um estudo analítico transversal dos dados da Pesquisa Demográfica e de Saúde da Família Peruana de 2019 (Encuesta Demográfica y de Salud Familiar, ENDES, em espanhol). A variável dependente foi conformidade adequada coma CPN (fornecida por profissionais de saúde qualificados; primeira visita CPN durante o primeiro trimestre de gravidez; seis ou mais visitas CPN durante a gravidez; visitas CPN com conteúdo apropriado) por mulheres de 15 a 49 anos em seu último parto nos cinco anos anteriores à pesquisa. Os índices de prevalência bruta e ajustada e seus intervalos de confiança de 95% foram calculados usando um modelo de regressão log-binomial. Resultados Foi analisado um total de 18.386 mulheres, das quais 35,0% cumpriram adequadamente o CPN. A menor proporção de conformidade foi encontrada com o conteúdo de ANC (42,6%). Fatores sociodemográficos e aqueles relacionados à gravidez, como estar na faixa etária de 20 a 34 anos e 35 a 49 anos, ter educação secundária ou superior, pertencer a um quintil de riqueza da população que não a mais pobre, ser da região da selva, não ser de etnia nativa, ter um segundo ou terceiro gravidez, e tendo uma gravidez desejada, aumentou a probabilidade de apresentar conformidade adequada com CPN. Conclusão Apenas 3 em cada 10 mulheres no Peru mostraram conformidade adequada com o CPN. O cumprimento do conteúdo do CPN deve ser melhorado, e estratégias devem ser desenvolvidas para aumentar a proporção de cumprimento adequado com o CPN.

Impacto de la pandemia por SARS-CoV-2 en la administración de vacunas del Calendario Nacional de Inmunizaciones en menores de 2 años / Impact of the SARS-CoV-2 pandemic on the administration of vaccines as per the national immunization schedule in children younger than 2 years

Introducción. El menor número de consultas a los centros de atención desde el comienzo de la pandemia por SARS-CoV-2podría afectar la vacunación obligatoria.Objetivo. Evaluar el impacto de la pandemia por SARS-CoV-2en la administración de vacunas pentavalente y triple viral a niños menores de 2 años en el vacunatorio de un hospital pediátrico de la Ciudad de Buenos Aires.Método. Estudio transversal, que utilizó registros informatizados del vacunatorio, de enero a mayo de 2019 y 2020.Resultados. Desde la segunda quincena de marzo de 2020, se observó un 64,2 % de disminución en la aplicación de vacunas. Al examinar la primera dosis de pentavalente y triple viral, la reducción fue del 74,9 % y del 55,1 %, respectivamente.Conclusión. A partir de la segunda quincena de marzo de 2020, se observó una disminución del 64,2 % en las vacunas aplicadas respecto del mismo período en el año anterio

Introduction. The reduction in the number of visits to health care centers since the onset of the SARS-CoV-2 pandemic may affect mandatory vaccination.Objective. To assess the impact of the SARS-CoV-2 pandemic on the administration of the pentavalent and the measles, mumps, and rubella (MMR) vaccines to children younger than 2 years at the vaccination center of a children's hospital in the Autonomous City of Buenos Aires.Method. Cross-sectional study using the vaccination center's digital records from January to May 2019 and 2020.Results. In the second fortnight of March 2020, vaccinations dropped by 64.2 %. When examining the first dose of the pentavalent and MMR vaccines, such reduction was 74.9 % and 55.1 %, respectively.Conclusion. As of the second fortnight of March 2020, vaccinations dropped by 64.2 % compared to the same period of the previous year.

Willingness to vaccinate against influenza A (H1N1)pdm09 among Brazilian civil servants: Pró-Saúde cohort study / Disposição para vacinar contra influenza A (H1N1)pdm09 entre funcionários técnico-administrativos universitários: estudo de coorte Pró-Saúde

ABSTRACT: Objective: To investigate sociodemographic factors associated with the willingness to take the pandemic influenza vaccine. Methods: This is a cross-sectional study of Brazilian civil servants participating in the fourth wave (2012-2013) of the longitudinal Pró-Saúde Study. Associations were expressed as odds ratios (OR) and 95% confidence intervals (95%CI), estimated by multivariate logistic regression models. Results: Among 2,828 participants, 15.9% would not be willing to vaccinate in the future if the Brazilian Ministry of Health promoted a new vaccination campaign against pandemic influenza. Not willing to vaccinate in the future was strongly associated with not taking the pandemic influenza vaccine in 2010 (OR = 9.0, 95%CI 6.9 - 11.6). Among the unvaccinated, females, those aged > 60 years, and non-health care workers were less willing to vaccinate in the future. Again, in the vaccinated group, females were less willing to vaccinate. Conclusion: Multidisciplinary efforts should be encouraged in order to identify reasons for refusing vaccination, focusing on the individual and group perceptions of susceptibility, severity, benefits, and barriers to vaccination. Such information is needed to identify target groups for the delivery of customized interventions towards preventing emerging pandemics, such as avian influenza and COVID-19.

RESUMO: Objetivo: Investigar fatores sociodemográficos associados à disposição em adotar a vacina contra influenza pandêmica. Métodos: Estudo transversal entre servidores técnico-administrativos participantes da quarta onda (2012-2013) do estudo longitudinal Pró-Saúde. Associações foram expressas como razões de chances (RC) e intervalos de confiança de 95% (IC 95%), estimados mediante modelos de regressão logística multivariada. Resultados: Entre os 2.828 participantes, 15,9% não estariam dispostos a serem vacinados no futuro se o Ministério da Saúde do Brasil promovesse uma nova campanha de vacinação contra influenza pandêmica. Não estar disposto a ser vacinado no futuro foi fortemente associado a não receber a vacina contra influenza pandêmica em 2010 (RC = 9,0, IC95% 6,9 - 11,6). Entre os não vacinados, mulheres, maiores de 60 anos e profissionais de outras áreas que não a saúde estavam menos dispostos a serem vacinados no futuro. Novamente, para aqueles vacinados, as mulheres estavam menos dispostas a serem vacinadas. Conclusão: Abordagens multidisciplinares devem ser estimuladas para identificar as razões para recusa vacinal, com foco nas percepções individual e coletivas sobre suscetibilidade, gravidade, benefícios e barreiras à vacinação. Essas informações são necessárias para identificar grupos-alvo para a oferta de intervenções particularizadas para a prevenção de pandemias emergentes, como a de influenza aviária e de covid-19.

Analysis of Health Service Utilization and its Influencing Factors among Patients with Pneumoconiosis in China / 生物医学与环境科学（英文）

Pneumoconiosis, an interstitial lung disease that occurs from breathing in certain kinds of damaging dust particles, is a major occupational disease in China. Patients diagnosed with occupational pneumoconiosis can avail of free medical treatment, whereas patients without a diagnosis of occupational diseases cannot not claim free medical treatment in most provinces from the government before 2019. This study aimed to analyze the priority of medical facility selection and its influencing factors among patients with pneumoconiosis. A total of 1,037 patients with pneumoconiosis from nine provinces in China were investigated. The health service institutions most frequently selected by the patients were county-level hospitals (37.5%). The main reason for the choice was these hospitals' close distance to the patients' homes (47.3%). The factors for the choice of health care institutions were living in the eastern region (

Paediatric emergency department attendances during COVID-19 and SARS in Singapore

INTRODUCTION@#We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore.@*METHODS@#Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004).@*RESULTS@#Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January-July 2019, to 274 per day in January-July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January-July 2019 (19,629) to January-July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January-July 2019 and 21% in January-July 2020.@*CONCLUSION@#Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally.

Fatores associados à busca por serviços preventivos de saúde entre adultos brasileiros: Pesquisa Nacional de Saúde, 2013 / Factors associated with preventive health services search among Brazilian adults: National Health Survey, 2013

Resumo O objetivo deste artigo é verificar os fatores associados à busca por serviços preventivos de saúde pela população adulta brasileira. A amostra foi composta por participantes da Pesquisa Nacional de Saúde (2013), que relataram procura por algum serviço de saúde nos últimos 15 dias, classificado em "tratamento/diagnóstico" ou "preventivo". As variáveis exploratórias incluíram sexo, faixa etária, cor de pele, estado conjugal, escolaridade, localização do domicílio, posse de plano privado de saúde e tempo de cadastro na ESF. As associações foram verificadas pelas razões de prevalência (RP), obtidas pelo modelo de Poisson, considerando a complexidade do desenho amostral. A amostra foi composta por 32.377 indivíduos que buscaram o serviço de saúde, sendo 12,94% para ações "preventivas". A procura por estes cuidados foi mais frequente entre mulheres e menos frequente entre os mais velhos, que não viviam com companheiro, com menor escolaridade. Não possuir plano privado de saúde foi associado a menor busca por prevenção. Ser adscrito à ESF não foi associada a busca por ações preventivas. Mesmo com os esforços e com o reconhecimento da importância da prevenção, a maioria dos indivíduos ainda busca os serviços de saúde para tratamento.

Abstract The objective of this article is to examine factors associated with preventive health services search among Brazilian adults. Sample included adults participants from the National Health Survey (2013), that had reported any health service search in prior 15 days, categorized into "treatment/diagnosis" or "preventive" service. Exploratory variables included sex, age, race, marital status, education, household situation, private health plan enrolment and time of FHS enrolment. Associations were verified by prevalence ratios (PR), estimated using robust Poisson regression, considering complexity of sampling parameters. Final sample included 32,377 individuals, 12,94% have searched "preventive" services. Preventive search was more often among women and less often among the older adults, those not living with partner, with less education. Having private health plan was associated with less preventive services search. FHS enrolment were not associated with preventive search. By conclusion, although some efforts and the importance of preventive actions, most of individuals search for treatment services.

Utilização de serviço de saúde bucal no pré-natal na atenção primária à saúde: dados do PMAQ-AB / Oral healthcare utilization during prenatal care in primary healthcare: data from PMAQ-AB

Resumo O objetivo foi avaliar a prevalência de utilização de serviço de saúde bucal no pré-natal e seus fatores associados, a partir dos dados dos ciclos I (2011-12) e II (2013-14) do PMAQ-AB. Estudo transversal, com população de 4.340 mulheres (ciclo I) e de 6.209 mulheres (ciclo II), com o desfecho de utilização de serviço de saúde bucal no pré-natal. Regressão de Poisson Multinível foi utilizada para obtenção das razões de prevalência (RP). No ciclo I, a prevalência de utilização de serviço de saúde bucal no pré-natal foi de 45,9% e de 51,9%, no ciclo II. No ciclo I, municípios de grande porte (RP = 1,35; IC95% 1,05-1,81), renda entre 1 e 2 salários mínimos (RP = 1,13; IC95% 1,03-1,25), de 31 a 40 anos (RP = 1,33; IC95% 1,15-1,54) e possuir registro de consulta odontológica (RP=1,17; IC95%:1,06-1,29), estiveram associadas ao desfecho. No ciclo II, região Sudeste (RP = 1,18; IC95% 1,03-1,36), alta cobertura de saúde bucal (RP = 1,11; IC95% 1,01-1,22), ter de 31 a 40 anos (RP = 1,22; IC95% 1,09-1,36), equipe em ações de educação permanente (RP = 1,14; IC95% 1,01-1,30) e horário de funcionamento que atenda às necessidades (RP = 1,40; IC95% 1,25-1,57), estiveram associadas ao desfecho. Fatores individuais e fatores relacionados à organização do serviço estão associados à utilização de serviços de saúde bucal durante o pré-natal.

Abstract The aim was to evaluate the prevalence of utilization of prenatal oral health services and its associated factors, through data from Cycle I (2011-12) and II (2013-14) of PMAQ-AB. This was cross-sectional study with 4,340 women (Cycle I) and 6,209 women (Cycle II), with outcome of utilization oral health service in prenatal care. Multilevel Poisson regression was used for obtain prevalence ratios (PR). In Cycle I, the prevalence of prenatal oral health service utilization was 45.9% and 51.9% in cycle II. In cycle I, large municipalities (PR = 1.35; 95%CI 1.05-1.81), income ranging from 1 to 2 minimum wages (PR = 1.13; 95%CI 1.03-1.25), age ranging from 31 to 40 years old (PR = 1.33, 95%CI 1.15-1.54) and registry of dental appointments (PR = 1.17; 95%CI 1.06-1.29) they were associated with the outcome. In cycle II, southeast region (PR = 1.18; 95%CI 1.03-1.36), high oral healthcare coverage (PR = 1.11; 95%CI 1.01-1.22), age ranging from 31 to 40 years old (PR = 1.22; 95%CI 1.09-1.36), the health workers enrollment in permanent education actions (PR = 1.14; 95%CI 1.01-1.30) and opening times that match the user's needs (PR = 1.40; 95%CI 1.25-1.57) they were associated with the outcome. The individual factors and factors related to the organization of the healthcare service are associated with oral healthcare utilization during prenatal care.

PNAD COVID-19: um novo e poderoso instrumento para Vigilância em Saúde no Brasil / PNAD COVID-19: A powerful new tool for Public Health Surveillance in Brazil

Resumo O Ministério da Saúde declarou em 03 de fevereiro de 2020 estado de emergência em saúde pública de importância nacional em decorrência da pandemia pelo novo coronavírus SARS-CoV-2. Com isso, o IBGE adiou a realização do Censo Demográfico de 2020 e passou a formular uma PNAD COVID-19. O inquérito contou com uma amostra total de 349 mil pessoas em cerca de 200 mil domicílios. Do total da população-residente brasileira, o IBGE estimou em maio/2020 que 24,0 milhões (11,4%) tiveram pelo menos um dos sintomas de síndrome gripal (SG). Desse contingente, 20,2 milhões (84,3% do total dos sintomáticos) não procuraram unidade de saúde. As inovações trazidas para a vigilância em saúde e o pioneirismo do IBGE demonstram ser possível, em um país continental e que vem experimentando diversas epidemias locais em momentos diferentes em seu território, que outros países também desenvolvam inquéritos domiciliares semelhantes, com coleta de dados semanal (referida às semanas epidemiológicas) por telefone de forma inovadora e tempestiva. A PNAD COVID-19 trouxe ainda uma nova tecnologia para o Instituto, resgatando o papel de avaliador externo do Sistema Único de Saúde (SUS).

Abstract On February 3, 2020, the Brazilian Ministry of Health declared a state of emergency in public health of national relevance due to the pandemic caused by the new coronavirus SARS-CoV-2. As a result, IBGE postponed the 2020 Demographic Census and started to formulate a COVID-19 PNAD. The survey included a total sample of 349 thousand people in about 200 thousand households. Of the total Brazilian resident population, the IBGE estimated in May/2020 that 24.0 million (11.4%) had at least one of the flu-like syndrome symptoms. Of this contingent, 20.2 million (84.3% of all symptomatic patients) did not seek health care. The innovations brought to health surveillance and the IBGE's pioneering spirit show that it is possible, in a continental country that has been experiencing several local epidemics at different times in its territory, that other countries also develop similar household surveys, with weekly data collection (referred to epidemiological weeks) by telephone in an innovative and timely manner. The COVID-19 PNAD also brought new technology to the Institute, reviving its role as an external evaluator of the Unified Health System (SUS).

Understanding of Human Papilloma Virus Vaccine Receipt among Adolescents in Trinidad and Tobago / Comprensión del Recibo de la Vacuna Contra el VPH entre los Adolescentes en Trinidad y Tobago

ABSTRACT Objective: To understand the barriers or factors that may hinder receipt of the human papilloma virus (HPV) among adolescent girls, 14-18 years old, and evaluate the awareness level about HPV and the HPV vaccine acceptance. Methods: A questionnaire consisting of two parts, demographic and family history of cervical cancer, and a cluster of questions about HPV, was distributed to 651 female adolescents in 17 secondary schools in Trinidad and Tobago to determine knowledge, attitude, and awareness levels pertaining to HPV and acceptance of the HPV vaccine. Chi-square tests and logistic regressions were used. Results: Of the 651 students completing questionnaires, the majority (61%) were in the 15-16 age group; and 76% were either of African descent or multi-racial. There were significant associations between a family member having a diagnosis of cervical cancer and knowledge that cervical cancer is caused by the HPV virus, that the virus is spread sexually, and the likelihood of getting cervical cancer in the future (p = < 0.05). However, the majority (63%) did not know that cervical cancer is caused by the HPV virus or that the virus was spread sexually. Conclusion: Lack of knowledge of the HPV vaccine was seen among adolescents from each school. There is need for education on cervical cancer and its causes, and the HPV virus.

RESUMEN Objetivo: Entender las barreras o factores que pueden obstaculizar la recepción del virus del papiloma humano (VPH) entre las adolescentes, de 14-18 años, y evaluar el nivel de concientización sobre el VPH y la aceptación de la vacuna contra el VPH. Métodos: Un cuestionario de dos partes -antecedentes demográficos e historia familiar de cáncer cervicouterino--, y un grupo de preguntas sobre el VPH, fueron distribuidos entre 651 adolescentes femeninas en 17 escuelas secundarias de Trinidad y Tobago para determinar los niveles de conocimiento, actitud y concientización relacionados con el VPH y la aceptación de la vacuna contra el VPH. Se utilizaron pruebas de Chi-cuadrada y regresiones logísticas. Resultados: De las 651 estudiantes que respondieron los cuestionarios, la mayoría (61%) estaban en el grupo de edad de 15-16 años; y el 76% eran de ascendencia africana o multirracial. Hubo asociaciones significativas entre un miembro de la familia con diagnóstico de cáncer cervical y el conocimiento de que el cáncer cervical es causado por el virus del VPH, que el virus se propaga sexualmente, y que existe la probabilidad de contraer cáncer cervical en el futuro (p = < 0.05). Sin embargo, la mayoría (63%) no sabía que ese tipo de cáncer es causado por el virus VPH, ni que el virus se propaga sexualmente. Conclusión: Se observó falta de conocimiento de la vacuna contra el VPH entre las adolescentes de cada escuela. Hay necesidad de educación sobre el cáncer cervical y sus causas, y el virus del VPH.

Twelve-month utilization rates and adequacy of treatment for mental health and substance use disorders in Argentina

Objective: To estimate the 12-month prevalence of mental health services utilization (overall and by type of service sector), the adequacy of treatment provided, and sociodemographic correlates in the Argentinean Study of Mental Health Epidemiology (ASMHE). Methods: The ASMHE is a multistage probability household sample representative of adults in urban areas of Argentina. The World Health Organization World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to evaluate psychiatric diagnosis and service utilization. Results: Among those with a disorder, 27.6% received any treatment in the prior 12 months. Of these, 78.3% received minimally adequate treatment using a broad definition and only 43.6% using a stringent definition. For individuals with a disorder, more services were provided by mental health professionals (17.7%) than by general medical professionals (11.5%) or non-healthcare sectors (2.6%). Younger individuals with low education and income were less likely to receive treatment; those never married and those with an anxiety or mood disorder were more likely to receive treatment. Among those in treatment, treatment was least adequate among younger individuals with low education and low income. Conclusions: Policies to increase access to services for mental health disorders in Argentina are needed, as is training for primary care practitioners in the early detection and treatment of psychiatric disorders.

Preventive healthcare-seeking behavior among poor older adults in Mexico: the impact of Seguro Popular, 2000-2012 / Comportamiento en cuidado preventivo de salud entre adultos pobres mayores en México: impacto del Seguro Popular, 2000-2012

Abstract: Objective: Determine the effect of Seguro Popular (SP) on preventive care utilization among low-income SP beneficiaries and uninsured elders in Mexico. Materials and methods: Fixed-effects instrumental-variable (FE-IV) pseudo-panel estimation from three rounds of the Mexican National Health and Nutrition Survey (2000, 2006 and 2012). Results: Our findings suggest that SP has no significant effect on the use of preventive services, including screening for diabetes, hypertension, breast cancer and cervical cancer, by adults aged 50 to 75 years. Conclusions: Despite the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in healthcare access and utilization still exist in Mexico. The Mexican government must keep working on extending health insurance coverage to vulnerable adults. Additional efforts to increase health care coverage and to support preventive care are needed to reduce persistent disparities in healthcare utilization.

Resumen: Objetivo: Determinar el efecto del Seguro Popular (SP) en la utilización de la atención preventiva entre beneficiarios de SP de bajos ingresos y ancianos sin seguro en México. Material y métodos: Estimación de pseudopanel de variables instrumentales de efectos fijos (FE-IV) en tres rondas de la Encuesta Nacional de Salud y Nutrición de México (2000, 2006 y 2012). Resultados: El SP no tiene un efecto significativo en el uso de los servicios preventivos, incluida la detección de diabetes, hipertensión, cáncer de mama y cáncer de cuello uterino en adultos de 50 años o más. Conclusiones: Aún existen desigualdades en el acceso a la asistencia médica en México. El gobierno mexicano debe seguir trabajando para extender la cobertura del seguro de salud a la población más vulnerable. Se necesitan esfuerzos adicionales para aumentar la cobertura de atención médica y apoyar la atención preventiva para reducir las disparidades persistentes.

HPV vaccine acceptance is high among adults in Mexico, particularly in people living with HIV / Aceptación de la vacuna contra VPH es alta entre adultos en México, especialmente en personas con VIH

Abstract: Objective. To measure HPV vaccine acceptance in diverse Mexican adult popula­tions, taking into account HIV status. Materials and methods: A total of 1 329 men and women, with and without HIV, participated in one of three intervention studies, offering HPV vaccination, carried out in the states of Morelos, Tlaxcala and Mexico City; either the bivalent (Morelos n=103, Tlaxcala n=127) or quadrivalent HPV-vaccine (Mexico City n=1 099) was offered. Results: HPV vaccine was accepted by 80.3% of participants; acceptance was higher in people living with HIV than those without (84.4 vs. 78%, p=0.004). Women had greater HPV infection knowledge (p<0.0001) than men and slightly higher (p=0.4) vaccine acceptance. The main reason for vaccine non-acceptance among HIV-positive participants was their doctor recommended they not get vaccinated. Conclusion: Acceptance of HPV-vaccine was high in men and women regardless of HIV status. Even higher rates of acceptability may be achieved by educating healthcare providers to recommend HPV vaccine to their patients.

Resumen: Objetivo. Medir la aceptación de la vacuna de VPH en una muestra diversa de población adulta mexicana, teniendo en cuenta su estado de VIH. Material y métodos: 1 329 hombres y mujeres con y sin VIH participaron en tres estudios de intervención, realizados en los estados de Morelos, Tlaxcala y Ciudad de México. Se ofreció la vacuna bivalente (Morelos n=103, Tlaxcala n=127) o la cuadrivalente (Ciudad de México n=1 099) contra VPH. Resultados: La vacuna fue aceptada por 80.3% de los participantes; la aceptación fue mayor en personas que viven con VIH que en aquéllas que no (84.4 vs. 78%, p=0.004). Las mujeres (p<0.0001) tenían mayor conocimientos sobre VPH que los hombres y una aceptación de la vacuna ligeramente mayor (p=0.4). El motivo principal de la no aceptación de la vacuna entre personas con VIH fue que su médico recomendó que no se vacunaran. Conclusión: La aceptación de la vacuna contra el VPH fue alta en hombres y mujeres, independientemente del estado de VIH. Se pueden lograr mayores tasas de aceptabilidad educando a los proveedores de atención médica para que recomienden la vacuna contra el VPH a sus pacientes.

Does knowing someone with breast cancer influence the prevalence of adherence to breast and cervical cancer screening? / Conhecer alguém com câncer de mama influencia a prevalência da adesão ao rastreamento dos cânceres de mama e colo uterino?

Abstract Objective To evaluate the prevalence of adherence to screening methods for breast and cervical cancer in patients attended at a university hospital and to investigate whether knowing someone with breast cancer, moreover belonging to the patient's family, affects the adherence to the screening recommendations. Methods This was a cross-sectional and quantitative study. A structured interview was applied to a sample of 820 women, between 20 and 69 years old, who attended a university hospital in the city of Juiz de for a, MG, Brazil. For the analysis, the chi-square test was used to assess possible associations between the variables, and the significance level was set at p-value ≤ 0.05 for a confidence interval (CI) of 95%. Results More than 95.0% of the sample performed mammography and cervical cytology exam; 62.9% reported knowing someone who has or had breast cancer, and this group was more likely to perform breast self-examination (64.9%; odds ratio [OR] 1.5; 95% CI 1.12-2.00), clinical breast examination (91.5%; OR 2.11; 95% CI 1.37-3.36), breast ultrasound (32.9%; OR 1.81, 95% CI 1.30-2.51), and to have had an appointment with a breast specialist (28.5%; OR 1.98, 95% CI 1.38-2.82).Women with family history of breast cancer showed higher propensity to perform breast self-examination (71.0%; OR 1.53 95% CI 1.04-2.26). Conclusion There was high adherence to the recommended screening practices; knowing someone with breast cancer might make women more sensitive to this issue as they were more likely to undergo methods which are not recommended for the screening of the general population, such as breast ultrasound and specialist consultation; family history is possibly an additional cause of concern.

Resumo Objetivos Avaliar a prevalência da adesão aosmétodos de rastreamento dos cânceres de mama e de colo uterino em pacientes atendidas em um hospital universitário e investigar se conhecer alguém com câncer de mama e, o fato de este pertencer à família, modifica a adesão às recomendações de rastreamento. Métodos Estudo transversal e quantitativo. Uma entrevista estruturada foi aplicada a uma amostra de 820 pacientes do sexo feminino, entre 20 e 69 anos, usuárias de um hospital universitário na cidade de Juiz de Fora, MG. Para a análise, o Teste Quiquadrado foi usado para avaliar a possibilidade de associação entre as varáveis, e o valor de significância foi determinado em valor-p ≤ 0,05 para um intervalo de confiança (IC) de 95%. Resultados Mais de 95,0% da amostra realizava os exames de mamografia e colpocitologia; 62,9% relataram conhecer alguém que teve ou tem câncer de mama, sendo que este grupo realizou, com maior frequência, autoexame (64,9%; razão de prevalência [RP] 1,5; IC 95% 1,12-2,00), exame clínico (91,5%; RP 2,11; IC 95% 1,37- 3,36) e ultrassonografia das mamas (32,9%; RP 1,81, IC 95% 1,30-2,51) e consulta ao mastologista (28,5%; RP 1,98, IC 95% 1,38-2,82). Mulheres com história familiar de câncer de mama realizaramcommaior prevalência o autoexame das mamas (71,0%; RP 1,53 IC 95% 1,04-2,26). Conclusão A amostra apresentou elevada adesão aos métodos de rastreamento preconizados; conhecer alguém com câncer de mama pode tornar as mulheres mais sensíveis a essa questão, aumentando a realização de medidas não recomendadas para o rastreamento da população geral, como ultrassonografia das mamas e consulta com médico especialista; a história familiar possivelmente implica em um fator de preocupação adicional.

Aporte del uso de herramientas básicas de Telemedicina en la atención de niños y adolescentes con Artritis idiopática juvenil, en el Hospital de Puerto Montt. Chile / Contribution of the use of basic telemedicine tools to the care of children and adolescents with juvenile idiopathic arthritis at the Puerto Montt Hospital, Chile

Resumen: Niños y adolescentes con enfermedades reumatológicas, requieren atención especializada e integral, sin embargo, reumatólogos e inmunólogos pediátricos se concentran en hospitales con tecnología específica, costosa y moderna. Como algunos pacientes con Artritis idiopática juvenil (AIJ) vive en áreas rurales, lejanas y de accesibilidad limitada, el uso de Telemedicina (TM) puede optimizar el diagnóstico, seguimiento y pronóstico. Objetivo: Mostrar 10 años de experiencia de un modelo de atención mixta: presencial y a distancia, usando TM básica; el impacto institucional, ventajas, des ventajas y aceptación reportados por padres y pacientes. Pacientes y Método: Estudio exploratorio, descriptivo, retrospectivo con componente cualitativo. Previa autorización de comité ético-científico del Servicio de salud del Reloncaví y la aplicación de consentimiento/asentimiento informado, se efectuó revisión de historias clínicas y se aplicó encuesta cualitativa a padres y niños mayores de 14 años con AIJ, atendidos entre 2005-2015 en el policlínico de reumatología infantil Hospital Puerto Montt. Resultados: Participaron 27/35 pacientes con AIJ atendidos por pediatra capacitado, aseso rado a distancia (1.000 km) por inmunólogo. 8/35 pacientes no contestaron por opción o cambio de domicilio. 70 % de padres y pacientes aceptaron el modelo de atención y 4% preferirían atención esporádica solo por especialista para diagnóstico y seguimiento. El número de pacientes trasladados anualmente disminuyó de 10 a 1. Las ventajas del modelo de atención superaron las desventajas per cibidas por padres y pacientes con AIJ. Conclusión: El uso de herramientas de TM en AIJ disminuyó los traslados, mejoró el seguimiento y fue considerado ventajoso por los padres y pacientes.

Abstract: Children and adolescents with rheumatologic diseases require specialized and comprehensive care, but pediatric rheumatologists and immunologists are concentrated in hospitals with specific, high-cost and modern technology. Considering that some patients with juvenile idiopathic arthritis (JIA) live in rural, remote and limited accessibility areas, the use of Telemedicine (TM) can optimize diag nosis, follow-up and prognosis. Objective: Reporting 10 years of experience of a mixed care model: face-to-face and distance, using basic TM; the institutional impact, advantages, disadvantages and acceptance informed by parents and patients. Patients and Method: Exploratory, descriptive, and re trospective study with qualitative component. After the authorization of a scientific-ethics committee of the Reloncaví Health Service and the application of informed consent, a review of medical records was carried out and a qualitative survey was applied to parents and children over 14 years of age with JIA, seen between 2005-2015 in the pediatric ambulatory rheumatology polyclinic of Puerto Montt Hospital. Results: The were 27/35 participating patients with JIA attended by a trained pediatrician and assisted by distance (1,000 km) by an immunologist. The 8/35 patients did not answer by choice or change of address. The 70% of parents and patients accepted the model of care and 4% would pre fer sporadic care only by specialists for diagnosis and follow-up. The number of patients transferred annually decreased from 10 to 1. The advantages of the care model outweighed the disadvantages perceived by parents and JIA patients. Conclusion: The use of TM tools in JIA decreased transfers, improved follow-up and were considered advantageous by patients and their parents.

Vaccine confidence and hesitancy in Brazil / Confiança nas vacinas e hesitação em vacinar no Brasil / Confianza y renuencia a las vacunas en Brasil

Despite the overall benefits of immunization, vaccine hesitancy has been a growing trend and has been associated with the resurgence of vaccine-preventable diseases. The aim of this study was to assess vaccine confidence and hesitancy in Brazil, as part of a wider project to map vaccine confidence globally. One thousand subjects were interviewed, either online or face-to-face, based on a general questionnaire regarding perceptions on vaccines and vaccination. Further exploratory questions were used with the subset of respondents who were parents of children aged under 5. Such questions extracted information regarding vaccination behavior, opinions on vaccination and government health services, and vaccine hesitancy. Reasons for hesitancy were classified as relating to confidence, convenience and/or complacency, and the population was also analyzed socio-demographically. The results showed that overall confidence in immunization was higher than confidence in family planning services, community health workers and emergency services. Seventy-six people reported hesitancy to vaccinate. The commonest reasons for hesitancy were issues with confidence (41.4%), efficacy/safety of the vaccine (25.5%) and concerns about adverse events (23.6%). The sociodemographic analysis revealed that vaccine hesitancy was associated with marital status, level of education and income. Despite overall vaccine confidence being high, a clear trend toward lower levels of confidence was associated with higher levels of hesitancy, which warrants on-going monitoring, due to the dynamic and changing nature of vaccine hesitancy.

Apesar dos benefícios globais da imunização, a hesitação em vacinar é uma tendência crescente que tem sido associada ao ressurgimento das doenças imunopreveníveis. O estudo teve como objetivo avaliar a confiança nas vacinas e a hesitação em vacinar no Brasil, como parte de um projeto mais amplo para mapear a confiança em vacinas em nível global. Foram entrevistadas mil pessoas, direta ou virtualmente, usando um questionário geral sobre percepção em relação às vacinas e à vacinação. Foram utilizadas perguntas exploratórias adicionais no subconjunto de entrevistados que eram pais de crianças abaixo de cinco anos de idade. Essas perguntas produziram informações sobre o comportamento em relação à vacinação, opiniões sobre vacinação e serviços públicos de saúde e hesitação em vacinar. Os motivos da hesitação foram classificados em relação à confiança, conveniência e/ou acomodação, e a população também foi analisada conforme as características sociodemográficas. Os resultados mostraram que a confiança geral na imunização foi maior do que nos serviços de planejamento familiar, agentes comunitários de saúde e serviços de emergência. Setenta e seis pessoas relataram hesitação em vacinar. Os motivos mais frequentes da hesitação diziam respeito a confiança (41,4%), eficácia/segurança da vacina (25,5%) e preocupações com eventos adversos (23,6%). A análise sociodemográfica mostrou que a hesitação em vacinar estava associada ao estado civil, escolaridade e renda. Apesar da alta confiança geral na vacinação, uma clara tendência para níveis de confiança mais baixos esteve associada a níveis mais altos de hesitação, o que justifica o monitoramento permanente dessa tendência, em função da natureza dinâmica da hesitação em vacinar.

A pesar de lo beneficios generales de la inmunización, la renuencia a la vacunación ha sido una tendencia en crecimiento que ha sido asociada con el resurgimiento de las enfermedades prevenibles por vacunación. El objetivo de este estudio fue evaluar la confianza y renuencia a las vacunas en Brasil, como parte de un proyecto más amplio para mapear la confianza en las vacunas globalmente. Mil sujetos fueron entrevistados, bien en línea o cara-a-cara, mediante un cuestionario general respecto a sus percepciones sobre las vacunas y la vacunación. Se utilizaron otras preguntas exploratorias con el subconjunto de encuestados, que eran padres de niños con una edad inferior a los cinco años. Tales preguntas recabaron información respecto al comportamiento sobre la vacunación, opiniones sobre vacunación y servicios de salud gubernamentales, así como su renuencia a las vacunas. Las razones para esta última se clasificaron como aquellas relacionadas con la confianza, conveniencia y/o complacencia, y la población fue también analizada sociodemográficamente. Los resultados mostraron que la confianza general en inmunización fue más alta que la confianza en servicios de planificación familiar, trabajadores de salud comunitarios y servicios de emergencia. Setenta y seis personas informaron de renuencia a la vacunación. Las razones más comunes para la renuencia fueron temas relacionados con la confianza (41,4%), eficacia/seguridad de la vacuna (25,5%) y preocupaciones sobre efectos adversos (23,6%). El análisis sociodemográfico reveló que la renuencia a la vacunación estaba asociada con el estado civil, nivel de educación e ingresos. A pesar de que la confianza general en las vacunas es alta, existe una clara tendencia hacia niveles más bajos de confianza, que estaba asociada con altos niveles de renuencia, lo que garantiza una supervisión permanente, debido a la dinámica y naturaleza cambiante del rechazo a las vacunas.

Primary care and healthcare utilization among older Brazilians (ELSI-Brazil)

ABSTRACT OBJECTIVE To characterize healthcare access and utilization among older Brazilians. METHODS Data are from the baseline wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative, population-based cohort study of persons aged 50 years and older conducted in 2015/2016 (n = 9,412). The prevalence of barriers to primary care and number and type of doctor visits in the past 12 months are compared by three main sources of healthcare (private, Family Health Strategy, traditional public clinics). Two-part multivariable hurdle analyses assess the relation between healthcare utilization, primary care problems, and source of healthcare, while controlling for healthcare determinants. RESULTS Females comprised 54% of the sample, with a mean age of 63 years. There were no demographic differences by source of healthcare. Nearly 83% had at least one doctor visit in the past 12 months, with higher use among private health plan holders. Private health plan holders most frequently visited specialists, while those using the public system were more likely to visit a general practitioner. Primary care barriers averaged 3.5 out of 12 and were the highest among those using traditional health posts. A greater number of primary care problems was negatively associated with all types of healthcare utilization. CONCLUSIONS By international standards, access to basic healthcare among older Brazilians is relatively high. Nevertheless, different levels of primary care problems between the public and private sectors and resulting utilization patterns suggest the need to continue working to close remaining gaps.

Characteristics of women who do not consult a doctor: a population-based study / Características das mulheres que não consultam com médico: estudo de base populacional

ABSTRACT OBJECTIVE To analyze the prevalence of not consulting a doctor within a year. METHODS Cross-sectional population-based study, including women aged 20-60 years, living in the urban area of São Leopoldo, state of Rio Grande do Sul, in 2015. The association between variables and outcome was assessed using prevalence ratios and 95% confidence intervals (95%CI). The adjusted analysis was performed using Poisson regression with robust variance. RESULTS Among the 1,127 women participating in the study, 954 (84.6%, 95%CI 82.5-86.7) reported having consulted a physician in the year prior to the interview, 173 (15.4%, 95%CI 13.2-17.5) did not. Women belonging to lower income classes D and E, younger, and smokers had higher prevalences of no medical visits. The participants with hypertension had a higher prevalence of consultations. CONCLUSIONS There was no expected evolution in the local health system, despite the emergence of the policies implemented in this period. It is necessary to provide care for those in less favored socioeconomic conditions and for younger women.

RESUMO OBJETIVO Analisar a prevalência de não consultar com médico no período de um ano. MÉTODOS Estudo transversal de base populacional, incluindo mulheres de 20 a 60 anos, residentes na zona urbana de São Leopoldo, RS, em 2015. A associação entre as variáveis e o desfecho foi avaliada por meio das razões de prevalência e dos intervalos de 95% de confiança (IC95%). A análise ajustada foi realizada por meio da regressão de Poisson com variância robusta. RESULTADOS Entre as 1.127 mulheres participantes do estudo, 954 (84,6%; IC95% 82,5-86,7) referiram consultar com médico no ano anterior à entrevista, 173 (15,4%; IC95% 13,2-17,5) não consultaram. As mulheres inseridas nas classes econômicas D e E, com menor idade, e fumantes apresentaram maiores prevalências de não consulta médica. As participantes com hipertensão arterial tiveram maior prevalência de consultas. CONCLUSÕES Não houve a esperada evolução no sistema local de saúde, apesar do surgimento das políticas implantadas nesse período. É necessário provimento da atenção para os indivíduos em condições socioeconômicas menos favorecidas e para as mulheres mais jovens.