Temporal and spatial distribution trends of polio vaccine coverage in less than one-year old children in Brazil, 2011-2021.

BACKGROUND: Low polio vaccine coverage can result in the spread of Poliovirus to areas free from viral circulation. This study analyzed the temporal trends and spatial distribution of polio vaccine coverage in one year-old children in Brazil, between 2011 and 2021. METHODS: This was an ecological, time-series study (2011 to 2021) with annual vaccine coverages against poliomyelitis, extracted from the Information System of the National Immunization Program from the 26 States and the Distrito Federal (DF). The percentage reductions in vaccination coverage in Brazil and in the Regions were calculated. Prais-Winsten regression models were used to analyze time series for the Regions and States, and spatial analysis identified the distribution of clusters (high-high; low-low; high-low and low-high) of vaccination coverages across Brazilian municipalities, using a 5% significance level. RESULTS: From 2011 to 2021, the coverage of polio vaccines decreased by 29,9%. There was a progressive increase observed in clusters resulting in low vaccination coverages (140 low-low Brazilian municipalities in 2011 vs. 403 in 2021), mostly reported in the North and Northeast regions of the country. There was a downward trend in vaccination coverages in 24 of the 26 States and DF (p ≤ 0.05). CONCLUSIONS: The reduction in polio vaccine coverage, as observed in the North and Northeast regions of Brazil, may favor the spread of Poliovirus. Therefore, vaccination strategies should be prioritized for children residing in areas with sharp and recurrent declines in vaccination coverages, including travelers, migrants, and refugees.

Number of doses of Measles-Mumps-Rubella vaccine applied in Brazil before and during the COVID-19 pandemic.

BACKGROUND: Due to the social isolation measures adopted in an attempt to mitigate the risk of transmission of SARS-CoV-2, there has been a reduction in vaccination coverage of children and adolescents in several countries and regions of the world. OBJECTIVE: Analyze the number of doses of vaccine against Measles-Mumps-Rubella (MMR) applied before and after the beginning of mitigation measures due to COVID-19 pandemic in Brazil. METHODS: The data collected refer to the number of doses of the MMR vaccine applied monthly to the target population residing in Brazil: cahildren, aged 12 months (first dose) and children, aged 9 years (second dose), from April 2019 to December 2020. Differences in MMR vaccine doses from April 2019 to March 2020 (before the start of mitigation measures) and April 2020 to September 2020 (after the start of the mitigation measures) were evaluated. Spatial analysis identified clusters with a high percentage of reduction in the median of applied doses no Brazil. RESULTS: There was a reduction in the median of doses applied in the Regions North (- 33.03%), Northeast (- 43.49%) and South (- 39.01%) e nos Estados Acre (- 48.46%), Amazonas (- 28.96%), Roraima (- 61.91%), Paraíba (- 41.58%), Sergipe (- 47.52%), Rio de Janeiro (-59.31%) and Santa Catarina (- 49.32) (p < 0.05). High-high type spatial clusters (reduction between 34.00 and 90.00%) were formed in the five regions of Brazil (Moran's I = 0.055; p = 0.01). CONCLUSION: A reduction in the number of MMR vaccine doses was evidenced as a possible effect by the restrictive actions of COVID-19 in Brazil.

Prevalence and factors associated with possible cases of familial hypercholesterolemia in Brazilian adults: a cross-sectional study.

This study aimed to estimate the prevalence of possible cases of FH and analyze associated factors in the adult Brazilian population. Cross-sectional study with laboratory data from the Brazilian National Health Survey, with 8521 participants. Possible cases of FH were defined according to the Dutch Lipid Clinic Network criteria. The prevalence and 95% confidence intervals (95% CI) of possible cases of FH were estimated according to sociodemographic variables, lifestyle, diabetes, hypertension, altered tests, treatment and self-rated health. Logistic regression was used to analyze the associations. The prevalence of possible cases of FH was 0.96%, higher in women, between 45 and 59 years, white race/skin color and others, less education, people with diabetes, hypertension and total cholesterol ≥ 310 mg/dL. The presence of FH was positively associated with regular self-rated health (OR 1.96; 95% CI 0.99-3.84), poor/very poor (OR 3.02; 95% CI 1.30-7.03) and negatively with black race/skin color (OR 0.10; 95% CI 0.02-0.46) and complete elementary school, incomplete high school (OR 0.47; 95% CI 0.23-0.98) and complete high school and more (OR 0.45; 95% CI 0.21-0.95). FH affects 1:104 Brazilian adults, these findings contribute to understanding the burden of disease in Brazil. Due to the scarcity of studies on FH in low- and middle-income countries, further studies are desirable.

Inequalities in health care and access to health services among adults with self-reported arterial hypertension: Brazilian National Health Survey.

This study compared indicators of care and access to health services by adults who self-reported hypertension in 2013 and 2019, analyzing those indicators according to gender, age group, schooling level, and race/color. This is an analytic study with data from the Brazilian National Health Survey (PNS), conducted in 2013 and 2019 in Brazil. The indicators to care and access to health services by individuals with arterial hypertension in both surveys were compared. For 2019, those indicators were analyzed according to sociodemographic characteristics. This study estimated the proportions, prevalence ratio (PR), and their respective 95% confidence intervals (95%CI). In total, 60,202 individuals were evaluated in 2013 and 88,531 in 2019, of these 24.4% reported arterial hypertension in 2013 and 23.9% in 2019. Women received more medical care for hypertension within the last year (PR = 1.07; 95%CI: 1.04; 1.11), had the last physician appointment at an basic health unit (PR = 1.11; 95%CI: 1.05; 1.17) than men. About race/color, black people had more hospitalization for hypertension or some complication (PR = 1.2; 95%CI: 1.05; 1.38) and intense or very intense degree of limitation in performing daily activities (PR = 1.37; 95%CI: 1.06; 1.76). In 2019, inequalities were evidenced and worse indicators were observed for males, black, with low education and young age. Therefore, investments in the Brazilian Unified National Health System, as well as public policies and strategic actions are essential to reduce inequalities, promote health care.

Yellow fever vaccination before and during the covid-19 pandemic in Brazil.

OBJECTIVE: To analyze the number of yellow fever vaccine doses administered before and during the covid-19 pandemic in Brazil. METHODS: This is an ecological, time series study based on data from the National Immunization Program. Differences between the median number of yellow fever vaccine doses administered in Brazil and in its regions before (from April/2019 to March/2020) and after (from April/2020 to March/2021) the implementation of social distancing measures in the country were assessed via the Mann-Whitney test. Prais-Winsten regression models were used for time series analyses. RESULTS: We found a reduction in the median number of yellow fever vaccine doses administered in Brazil and in its regions: North (-34.71%), Midwest (-21.72%), South (-63.50%), and Southeast (-34.42%) (p < 0.05). Series showed stationary behavior in Brazil and in its five regions during the covid-19 pandemic (p > 0.05). Brazilian states also showed stationary trends, except for two states which recorded an increasing trend in the number of administered yellow fever vaccine doses, namely: Alagoas State (before: ß = 64, p = 0.081; after: ß = 897, p = 0.039), which became a yellow fever vaccine recommendation zone, and Roraima State (before: ß = 68, p = 0.724; after: ß = 150, p = 0.000), which intensified yellow fever vaccinations due to a yellow fever case confirmation in a Venezuelan State in 2020. CONCLUSION: The reduced number of yellow fever vaccine doses administered during the covid-19 pandemic in Brazil may favor the reemergence of urban yellow fever cases in the country.

Bullying among Brazilian adolescents: evidence from the National Survey of School Health, Brazil, 2015 and 2019. / Bullying entre adolescentes brasileiros: evidências das Pesquisas Nacionais de Saúde do Escolar, Brasil, 2015 e 2019.

OBJECTIVE: to estimate the prevalence rate of indicators related to bullying among Brazilian students aged 13 to 17 years and compare its occurrence between 2015 and 2019. METHOD: this is a descriptive cross-sectional study, with data from the National Survey of School Health, carried out in all Brazilian states. The prevalence rate and confidence intervals (95%CI) of the indicators were estimated in 2019. Student's t test was used (p ≤ 0.01) to test the differences between editions. RESULTS: the prevalence rate of bullying decreased from 20.4% (95%CI: 19.2 - 21.5) in 2015 to 12.0% (95%CI: 11.6 - 12.5) in 2019. The reasons cited for being bullied were similar in both editions: bodily appearance, facial appearance, and color/race. Prevalence rates were similar between states. The state of Tocantins presented the highest number of bully-victims; states of Mato Grosso and Amapá had the highest number of adolescents being involved in cyberbullying situations, and the state of Rio de Janeiro presented the highest number of bullies. CONCLUSION: there was a reduction by half in bullying and in the report on not being treated well among Brazilian adolescents; however, the prevalence rate of being bullied and cyberbullying are high in the country. Therefore, attention should be paid to policies to reduce and confront this issue on the national scene.(1) Bullying is still significantly present among Brazilian students. (2) The occurrence among boys from private schools stands out. (3) Similar motivation in both editions: bodily and facial appearance, and color/race. (4) Evidence for the implementation of actions and policies in the national territory. (5) Contribution to the United Nations (UN) 2030 Agenda in the country.

Self-reported arterial hypertension, use of health services and guidelines for care in Brazilian population: National Health Survey, 2019. / Hipertensão arterial autorreferida, uso de serviços de saúde e orientações para o cuidado na população brasileira: Pesquisa Nacional de Saúde, 2019.

OBJECTIVE: To describe the prevalence of arterial hypertension according to sociodemographic characteristics in Brazil and to analyze the indicators related to access to health services and guidelines for controlling the disease in the country. METHODS: Cross-sectional descriptive study using the National Health Survey (PNS) conducted in 2019. The prevalence of hypertension was estimated with a 95% confidence interval, in addition to the proportions of hypertension indicators. RESULTS: There were 88,531 respondents, of which 23.9% self-reported hypertension, more prevalent among females (26.4%) and the elderly (55.0%). Among those who self-reported hypertension, 57.8% reported medical attention in the last six months; most received guidance on self-care; 66.1% were seen in public health services; and 45.8%, in primary health care units. CONCLUSION: The prevalence of hypertension in the Brazilian population was high, with most people who self-reported the condition being seen in services of the Brazilian National Health System (SUS), where they received guidance on health promotion.

Vaccination against human papillomavirus in Brazilian schoolchildren: National Survey of School Health, 2019.

OBJECTIVE: to analyze the prevalence of schoolchildren vaccinated against human papillomavirus (HPV) and the reasons related to non-vaccination. METHOD: cross-sectional study, with data from the 2019 National Survey of School Health. The sample consisted of 160,721 students aged 13 to 17 years. The prevalence and confidence intervals (95%CI) of vaccinated adolescents were estimated according to location, sex, and administrative dependence of the school. The differences between the strata were evaluated with the Chi-square test. Adjusted prevalence ratios (aPR) and 95%CI were estimated with the Poisson regression model. RESULTS: most of the students were vaccinated (62.9%), and the prevalence of girls (76.1%) was higher than that of boys (49.1%). The most prevalent reason for not vaccinating was "did not know they had to take" (46.8%), with the highest aPR in public schoolchildren in Brazil (1.6; 95%CI 1.5;1.7), from the Northeast region (1.2; 95%CI 1.1;1.2), and in students from private schools in the Northeast regions (1.1; 95%CI 1.1;1.2) and North (1.3; 95%CI 1.2;1.4). CONCLUSION: one out of every two Brazilian schoolchildren was vaccinated against HPV. Misinformation was a recurring reason for non-vaccination. The North and Northeast regions had the highest prevalence of non-vaccinated people, observed mainly in adolescents from public schools. HIGHLIGHTS: (1) 63% of Brazilian schoolchildren reported having been vaccinated against human papillomavirus (HPV).(2) In Brazil, in 2019, the prevalence of immunized girls was higher than that of boys.(3) Misinformation and fear are reasons for hesitating vaccination.(4) Social and health inequalities may reflect upon HPV vaccination.(5) Achieving the goal of 80% in HPV vaccination coverage is a challenge in Brazil.

Evaluation of community physical activity programs in Brazil: a scoping review. / Avaliação de programas comunitários de atividade física no Brasil: uma revisão de escopo.

Community physical activity programs were created to encourage and increase the practice of physical activity in the Brazilian population and promote healthy life habits. The Brazilian Ministry of Health invested in the evaluation of these programs and consolidated partnerships that favor the development of relevant evidence on the topic. The current study aimed to identify and summarize the scientific highlights on the approaches and results of evaluations performed in the Health Academy Program and City Academy Program. This is a scoping review based on the methodology of the Joanna Briggs Institute. We used the MEDLINE via PubMed, LILACS, Scopus, and Cochrane databases, the website of the Health Academy Program, the Catalogue of Theses and Dissertations of the Brazilian Graduate Studies Coordinating Board, and the Brazilian Digital Library of Theses and Dissertations. The sample included quantitative or qualitative primary studies with no limit on year of publication. Twenty-four studies published from 2009 to 2020 were selected and subdivided according to the approaches to evaluation: evaluability, sustainability, process (supply and structure), outcome (impact and satisfaction), and degree of inference (adequacy, plausibility, and probability). The results of the evaluations showed that the programs offer various activities, positively impact users' health indicators, and contribute to the increase in leisure-time physical activity. The evaluation of these programs is essential for the administration, health services, and healthcare workers, since it allows verifying the implementation of the proposed activities, coverage, access, impact, and interference by the political context in their continuity.

Os programas comunitários de atividade física foram criados para incentivar e aumentar esta atividade na população brasileira e promover hábitos de vida saudável. O Ministério da Saúde investiu na avaliação desses programas e consolidou parcerias que favoreceram a construção de importantes marcos sobre o tema. Este estudo objetivou identificar e sintetizar as evidências científicas sobre as abordagens e resultados das avaliações realizadas no Programa Academia da Saúde e Programa Academia da Cidade. Trata-se de uma revisão de escopo baseada na metodologia do Instituto Joanna Briggs. Utilizaram-se as bases MEDLINE via PubMed, LILACS, Scopus e Cochrane, o site do Programa Academia da Saúde, o Catálogo de Teses e Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e a Biblioteca Digital Brasileira de Teses e Dissertações. Incluíram-se estudos primários quantitativos ou qualitativos, sem limite temporal. Selecionaram-se 24 publicações entre 2009 e 2020, que foram subdivididas de acordo com as abordagens da avaliação: avaliabilidade, sustentabilidade, processo (oferta e estrutura), resultado (impacto e satisfação) e grau de inferência (adequação, plausibilidade e probabilidade). Os resultados das avaliações mostraram que os programas oferecem diversas atividades, impactam positivamente nos indicadores de saúde dos usuários e contribuem para o aumento de atividade física no lazer. A avaliação desses programas é fundamental para a gestão, serviços de saúde e profissionais, pois permite verificar a implementação das ações propostas, a cobertura, o acesso e o impacto, bem como a interferência do contexto político na sua continuidade.

Los programas comunitarios de actividad física fueron creados para incentivar y aumentar la práctica de actividad física en la población brasileña y promover hábitos de vida saludable. El Ministerio de Salud de Brasil invirtió en la evaluación de estos programas y consolidó colaboraciones que favorecieron la construcción de importantes evidencias sobre este asunto. Este estudio tuvo el objetivo de identificar y sintetizar las evidencias científicas sobre los abordajes y resultados de las evaluaciones realizadas en el Programa Academia de la Salud y Programa Academia de la Ciudad. Se trata de una revisión de alcance, basada en la metodología del Instituto Joanna Briggs. Se utilizaron las bases MEDLINE a través de PubMed, LILACS, Scopus y Cochrane, el sitio web del Programa Academia de la Salud, el Catálogo de Tesis y Disertaciones de la Coordinación de Perfeccionamiento de Personal de Nivel Superior y en la Biblioteca Digital Brasileña de Tesis y Disertaciones. Se incluyeron estudios primarios cuantitativos o cualitativos, sin límite temporal. Se seleccionaron 24 publicaciones entre 2009 y 2020. Se subdividieron de acuerdo con los abordajes de evaluación: disponibilidad, sostenibilidad, proceso (oferta y estructura), resultado (impacto y satisfacción) y grado de inferencia (adecuación, plausibilidad y probabilidad). Los resultados de las evaluaciones mostraron que los programas ofrecen diversas actividades, impactan positivamente en los indicadores de salud de los usuarios y contribuyen al aumento de actividad física en el ocio. La evaluación de estos programas es fundamental para la gestión, servicios de salud y profesionales, puesto que permite verificar la implementación de las acciones propuestas, la cobertura, el acceso y el impacto, así como la interferencia del contexto político en su continuidad.

Monitoring and projection of targets for risk and protection factors for coping with noncommunicable diseases in Brazilian capitals. / Monitoramento e projeções das metas de fatores de risco e proteção para o enfrentamento das doenças crônicas não transmissíveis nas capitais brasileiras.

This study aimed to monitor the trends and projections of targets of risk and protection factors for coping with noncommunicable diseases in Brazilian capitals and verify whether the economic crisis and austerity policies have interfered with these targets' behavior. This is a time-series study with data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey. We analyzed the trends in the prevalence of tobacco use, obesity, physical activity, consumption of fruits and vegetables, and alcohol abuse, and their projections until 2025. The Prais-Winsten regression was employed. We adopted the Interrupted Time-Series, considering the 2006-2014 and 2015-2019 periods. A reduction in tobacco use, increase in obesity, consumption of fruits and vegetables, physical activity, and alcohol use was observed between 2006 and 2014. Most indicators have shown worse performance since 2015. Projections foresee that targets for curbing obesity and alcohol abuse will not be achieved. Some changes were identified in the indicators profiles, reinforcing the importance of the continuous monitoring and sustainability of actions, policies, and programs to promote health and control these diseases and their risk factors.

Monitorar as tendências e as projeções das metas de fatores de risco e proteção para o enfrentamento das doenças crônicas não transmissíveis nas capitais brasileiras e verificar se a crise econômica e as políticas de austeridade interferiram no comportamento dessas metas. Estudo de série temporal com dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico. Foram analisadas as tendências das prevalências de fumantes, obesidade, prática de atividade física, consumo de frutas e hortaliças e de bebidas alcoólicas, e suas projeções até 2025. Empregou-se a regressão de Prais-Winsten. Utilizou-se a Série Temporal Interrompida de 2006 a 2014 e 2015 a 2019. Entre 2006 e 2014, houve redução de fumantes e aumento da obesidade, do consumo de frutas e hortaliças, de atividade física e do uso de álcool. A maioria dos indicadores demonstrou pior desempenho a partir de 2015. Pelas projeções, as metas de deter a obesidade e reduzir o uso de álcool não seriam atingidas. Houve mudanças no comportamento dos indicadores, o que reforça a importância do monitoramento contínuo, e da sustentabilidade das ações, políticas e programas de promoção a saúde e de controle dessas doenças e seus fatores de risco.

Convergence in alcohol abuse in Brazilian capitals between genders, 2006 to 2019: what population surveys show.

OBJECTIVE: To analyze the temporal trend of the prevalence of alcohol abuse among adults in Brazilian capitals, between 2006 and 2019. METHODS: Time series study, based on data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel), between 2006 and 2019. The population consisted of adults (≥ 18 years old) with landline telephone residing in Brazilian capitals. The trend analysis was performed by linear regression. RESULTS: Between 2006 and 2019 there was a significant increase (p = 0.03) in the abusive consumption of alcoholic beverages in the total adult population, from 15.6 to 18.8%. Among men, there was a stability trend (p = 0.96), and among women, there was an increase from 7.7 to 13.3% (p < 0.001; ß = 0.295). In the male gender stratified by capitals, from 2006 to 2019 there was a reduction in Belém, Fortaleza, João Pessoa, Macapá, Manaus, Natal, Recife, São Luis, and Teresina. On the other hand, there was growth in the Federal District. Among women, the trend was upward in: Aracaju, Belo Horizonte, Cuiabá, Curitiba, Florianópolis, Goiânia, Palmas, Porto Alegre, Rio de Janeiro, Salvador, São Paulo, Vitória, and the Federal District. CONCLUSION: The results indicate that more adult women are currently drinking in excess compared to previous years, suggesting an increased risk of alcohol-related harm in this portion of the population in Brazilian capitals, bringing about a convergence effect with the prevalence among men and women.

Analysis of demand and access to services in the last two weeks previous to the National Health Survey 2013 and 2019.

OBJECTIVE: Compare the demand and use of health services between 2013 and 2019, and analyze the associated sociodemographic and health variables in 2019. METHODS: Cross-sectional study with data from the National Health Survey (PNS) 2013 and 2019. The prevalence and 95% confidence intervals (95% CI) for the demand and use of health services were estimated. In 2019, the differences in the indicators were analyzed according to sociodemographic variables and the crude and adjusted by sex and age prevalence ratios (RP) were estimated. RESULTS: There was an increase of 22% in the demand for health care in the last two weeks, going from 15.3% (95%CI 15.0-15.7) in 2013 to 18.6% (95%CI 18.3-19.0) in 2019. There was a reduction in use in the last two weeks, from 97% (95%CI 96.6-97.4) in 2013 to 86.1% (95%CI 85.4-86.8) in 2019, which was observed for most Federation Units. In 2019, the demand for care was greater among women, the elderly, those with high schooling, individuals with health insurance and poor self-rated health. They obtained greater access to health services in the fifteen days prior to the survey: men, children or adolescents up to 17 years of age, people with health insurance and poor health self-assessment. CONCLUSION: The demand for health services has grown and reduced access in the last 15 days between 2013 and 2019. These differences may have been exacerbated by the austerity measures implemented in the country.

Tobacco use, cessation, secondhand smoke and exposure to media about tobacco in Brazil: results of the National Health Survey 2013 and 2019.

OBJECTIVE: To compare indicators of tobacco use, secondhand smoke, cessation and exposure to pro- and anti-tobacco media in 2013 and 2019, and to describe these indicators according to sociodemographic variables in 2019. METHODS: Cross-sectional study with data from the National Health Survey. The indicators of use, secondhand smoke, cessation and exposure to tobacco-related media were evaluated. Prevalence and confidence intervals (95%CI) were estimated for the total population in 2013 and 2019 and according to sociodemographic variables for 2019. Poisson regression with robust variance was used to assess differences in prevalence. RESULTS: There was an improvement in most of the indicators studied: an increase in ex-smokers, a reduction in secondhand smoke and attempts to quit smoking. All pro- and anti-tobacco media exposure indicators declined. When considering the prevalence according to sociodemographic characteristics in 2019, 43.8% (95%CI 41.6-46.0) of men tried to quit smoking, and 50.8% (95%CI 48.5-53.2) of women. Secondhand smoke at home was higher among women (10.2%; 95%CI 9.7-10.8). Among those who thought about quitting smoking because of warnings, the proportion was higher among women (48.0%; 95%CI 45.3-50.6). Tobacco use was higher among men (43.8%; 95%CI 41.6-46.0), in the population aged 40 to 59 years (14.9%; 95%CI 14.2-15.6), with a lower level of education (17.6%; 95%CI 16.8-18.4). CONCLUSION: The study showed improvement in tobacco-related indicators between the years studied. It is noteworthy that this advance was smaller in relation to the other periods previously analyzed, and therefore, greater investments in public policies to combat and control smoking in Brazil are necessary.

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.

Noncommunicable diseases and changes in lifestyles during the COVID-19 pandemic in Brazil. / Doenças crônicas não transmissíveis e mudanças nos estilos de vida durante a pandemia de COVID-19 no Brasil.

OBJECTIVE: To compare lifestyle changes during the COVID-19 pandemic according to the presence or absence of noncommunicable diseases (NCDs) in Brazilian adults. METHODS: Cross-sectional study, using data from the ConVid survey, between April and May 2020. The following variables were evaluated: lifestyle and presence of one or more NCDs (diabetes, hypertension, respiratory disease, heart disease, and cancer). Sociodemographic characteristics were used as adjustment. Relative frequencies and confidence intervals (CI) of 95% of the explanatory variables were calculated before and during the pandemic. For the comparison of groups, with or without NCDs, crude and adjusted (PRadj) prevalence ratios were estimated by Poisson regression. RESULTS: There was a reduction in physical activity (60% in those without NCDs and 58% in those with NCDs) and in vegetable consumption (10.8% in those without NCDs and 12.7% in those with NCDs). On the other hand, there was an increase in the time spent watching television and on screens of computer/tablet (302% and 43.5% in those without NCDs and 196.5% and 30.6% with NCDs, respectively); consumption of frozen meals (43.6% in those without NCDs and 53.7% with NCDs), snacks (42.3% without NCDs and 31.2% with NCDs), and chocolate (14.8% without NCDs). During the pandemic, patients with NCDs were less active (PRadj = 0.77; 95%CI 0.65 - 0.92), had greater habit of watching TV (PRadj = 1.16; 95%CI 1.08 - 1.26), and consumed less vegetables (PRadj = 0.88; 95%CI 0.81 - 0.96). CONCLUSION: It was evident that adults with NCDs had their lifestyles more altered during the COVID-19 pandemic.

OBJETIVO: Comparar as mudanças de estilos de vida durante a pandemia COVID-19, segundo a presença ou não de doenças crônicas não transmissíveis (DCNT) em adultos brasileiros. MÉTODOS: Estudo transversal, com dados da pesquisa ConVid - Pesquisa de Comportamentos, realizada entre abril e maio de 2020. Avaliaram-se as variáveis estilo de vida e presença de uma ou mais DCNT (diabetes, hipertensão, doença respiratória, doença do coração e câncer). As características sociodemográficas foram usadas como ajuste. Calcularam-se as frequências relativas e os intervalos de confiança (IC) de 95% das variáveis antes da e durante a pandemia. Para a comparação de grupos, sem ou com DCNT, estimaram-se as prevalências e razões de prevalência bruta e ajustada (RPa) utilizando a regressão de Poisson. RESULTADOS: Houve redução da prática de atividade física (60% nos sem DCNT e 58% nos com DCNT) e do consumo de hortaliças (10,8% nos sem DCNT e 12,7% nos com DCNT). Verificou-se aumento no tempo de uso de televisão e computador/tablet (302 e 43,5% nos sem DCNT e 196,5 e 30,6% nos com DCNT, respectivamente); consumo de congelados (43,6% nos sem DCNT e 53,7% com DCNT), salgadinhos (42,3% sem DCNT e 31,2% com DCNT) e chocolate (14,8% sem DCNT). Durante a pandemia, portadores de DCNT apresentaram menor prática de atividade física suficiente (RPa = 0,77; IC95% 0,65 - 0,92), maior hábito de assistir à televisão (RPa = 1,16; IC95% 1,08 - 1,26) e menor consumo de hortaliças (RPa = 0,88; IC95% 0,81 - 0,96). CONCLUSÃO: Evidenciou-se que adultos com DCNT tiveram seus estilos de vida mais alterados durante a pandemia de COVID-19.

Inequalities in mammography and Papanicolaou test coverage: a time-series study.

BACKGROUND: Cancer is a serious public issue problem worldwide. In Brazil, breast cancer is the most common type and cervical cancer is the third most frequent among women. OBJECTIVE: To analyze the temporal trend of coverage of mammography and cervical oncotic cytological testing, between 2007 and 2018. DESIGN AND SETTING: Time-series study conducted in the 26 Brazilian state capitals and in the Federal District. METHODS: A linear regression model was used to estimate trends in coverage of mammography and cervical oncotic cytological testing over the period. The data collection system for Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel) was used. RESULTS: A significant increase in mammography coverage was observed, from 71.1% in 2007 to 78.0% in 2018. There was a trend towards an increase among women with 0 to 8 years of schooling, in all regions of Brazil. Regarding cervical oncotic cytological testing coverage, there was a trend towards stability during the period analyzed, reaching 81.7% in 2018. On the other hand, there was a significant increase in the northern region. CONCLUSIONS: There was an improvement in the coverage of these screening examinations, especially regarding mammography. However, it is still necessary to expand their provision, quality and surveillance, aimed towards women's health.

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.

Trends in smoking prevalence in all Brazilian capitals between 2006 and 2017.

OBJECTIVE: To evaluate the trends in smoking prevalence in all Brazilian capitals between 2006 and 2017. METHODS: This was a study of temporal trends in smoking, based on information from the Telephone-based System for the Surveillance of Risk and Protective Factors for Chronic Diseases. The trends in smoking prevalence were stratified by gender, age, level of education, and capital of residence. We used linear regression analysis with a significance level of 5%. RESULTS: From 2006 to 2017, the overall prevalence of smoking in the Brazilian capitals declined from 19.3% to 13.2% among men and from 12.4% to 7.5% among women (p < 0.05 for both). Despite the overall decline in the prevalence of smoking in all of the capitals, the rate of decline was lower in the more recent years. There was also a reduction in the prevalence of former smoking (22.2% in 2006 to 20.3% in 2017). In contrast, there was an upward trend in the prevalence of former smoking among individuals with a lower level of education (from 27.9% in 2006 to 30.0% in 2017). In 2017, the prevalence of smoking among men was highest in the cities of Curitiba, São Paulo, and Porto Alegre, whereas it was highest among women in the cities of Curitiba, São Paulo, and Florianópolis. CONCLUSIONS: There have been improvements in smoking prevalence in Brazil. Annual monitoring of smoking prevalence can assist in the battle against chronic noncommunicable diseases.

Mudanças nas doenças crônicas e os fatores de risco e proteção antes e após a terceira onda da COVID-19 no Brasil / Changes in chronic diseases and risk and protective factors before and after the third wave of COVID-19 in Brazil

Resumo Objetivou-se comparar as mudanças ocorridas nos comportamentos de risco e proteção para doenças crônicas não transmissíveis (DCNT), morbidade referida e realização de exames preventivos de câncer antes e ao final da terceira onda da pandemia de COVID-19 no Brasil. Trata-se de uma série histórica do sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) entre 2006 e 2021. Foram analisadas as tendências dos indicadores utilizando a regressão linear, e para calcular as diferenças entre os anos, empregou-se teste T de Student. Observou-se redução da prevalência da prática de atividade física (AF) no tempo livre e AF no deslocamento; e aumento da prevalência de adultos com prática insuficiente de AF, do comportamento sedentário e inatividade física nos anos de pandemia. Também houve piora nos indicadores de excesso de peso, obesidade e diabetes durante a pandemia. A hipertensão, estável no período de 2009 a 2019, aumentou nos anos da pandemia. Ocorreu redução das coberturas de exames preventivos de mamografia e citologia do colo de útero, diferindo da tendência anterior. Em conclusão, os achados apontam piora dos indicadores de DCNT. Por isso, ações de promoção à saúde tornam-se prioritárias nesse contexto.

Abstract The present study aimed to compare changes in risk and protective behaviors for non-communicable diseases (NCDs), self-reported morbidity, and preventive cancer tests prior to and at the end of the third wave of the COVID-19 pandemic in Brazil. This study analyzes a historical series from the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL) for the years 2006 and 2021. Trends were analyzed using linear regression, and the Student's t test was used to calculate differences between years. A decline in the prevalence of leisure-time physical activity (PA) and PA while commuting; and increased prevalence of adults with insufficient PA practice, sedentary behavior, and physical inactivity were observed. A worsening of the indicators of overweight, obesity, and diabetes was also observed during the pandemic. Hypertension was stable during the period from 2009 to 2019 and increased during the years of the pandemic. There was a reduction in the coverage of preventive mammograms and cervical cytology exams, differing from the previous trend. In conclusion, the findings point to the worsening of NCD indicators. Therefore, health promotion actions are a priority in this context.

Tabagismo no Brasil: percepções dos resultados de pesquisas domiciliares / Smoking in Brazil: insights from the results of the household surveys / Tabaquismo en Brasil: percepciones de los resultados de encuestas en hogares

Introdução: o uso do tabaco em suas diferentes formas continua a ser uma das principais causas de morte evitáveis no Brasil. Com uma história de sucesso notável, o Brasil alcançou uma das maiores reduções significativas na prevalência do tabagismo desde 1990. No entanto, é preocupante que a taxa de declínio do consumo de tabaco tenha diminuído nos últimos anos, conforme sugerem as pesquisas. Objetivos: o presente estudo teve como objetivo comparar os resultados de três pesquisas domiciliares realizadas pelo Instituto Brasileiro de Geografia e Estatística (IBGE). Métodos: foi realizada a comparação da prevalência do uso de tabaco entre entrevistados com 18 anos ou mais, assim como foi avaliada a porcentagem de mudanças na prevalência entre 2008, 2013 e 2019, usando dados de três pesquisas: The Global Tobacco Adult Survey, do ano de 2008, e a Pesquisa Nacional de Saúde do Brasil, dos anos de 2013 e 2019. Além disso, analisamos a prevalência no Brasil e seus estados de acordo com idade, gênero, nível educacional e raça. Resultados: a prevalência do tabagismo ativo diminuiu 19% entre 2008 e 2013, passando de 18,2% (IC 95%: 17,7;18,7%), em 2008, para 14,7% (IC 95%: 14,2;15,2%), em 2013. No entanto, em 2019, a prevalência foi de 12,6% (IC 95%: 12,2;13,0%), revelando uma redução de 14,3%. O tabagismo foi maior entre a população com baixo nível de escolaridade, status de renda mais baixo e raça/cor da pele preta e parda. Conclusão: a prevalência do tabagismo diminuiu no Brasil nas últimas três décadas. No entanto, recentemente, houve uma redução na intensidade da queda, exigindo atenção e análise cuidadosa das estratégias de prevenção e abandono do tabagismo.(AU)