Time trend analysis and impacts of the COVID-19 pandemic on mammography and Papanicolaou test coverage in Brazilian state capitals.

BACKGROUND: Breast and cervical cancer are major public health issues globally. The reduction in incidence and mortality rates of these cancers is linked to effective prevention, early detection, and appropriate treatment measures. This study aims to analyze the temporal trends in the prevalence of mammography and Papanicolaou test coverage among women living in Brazilian state capitals between 2007 and 2023, and to compare the coverage of these tests before and during the Covid-19 pandemic. METHODS: A time series study was conducted using data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey from 2007 to 2023. The variables analyzed included mammography and Papanicolaou test coverage according to education level, age group, race/skin color, regions, and Brazilian capitals. The Prais-Winsten regression model was used to analyze the time series, and Student's t-test was employed to compare the prevalence rates between 2019 and 2023. RESULTS: Between 2007 and 2023, mammography coverage showed a stationary trend (71.1% in 2007 and 73.1% in 2023; p-value = 0.75) with a declining trend observed among women with 12 years or more of education (APC= -0.52% 95%CI -1.01%; -0.02%). Papanicolaou test coverage for all women aged between 25 and 64 exhibited a downward trend from 82% in 2007 to 76.8% in 2023 (APC= -0.45% 95%CI -0.76%; -0.13%). This decline was also noticed among those with 9 years or more of education; in the 25 to 44 age group; among women with white and mixed race; and in the Northeast, Central-West, Southeast, and South regions. When comparing coverage before and during Covid-19 pandemic, a reduction was noted for both tests. CONCLUSIONS: Over the years, there has been stability in mammography coverage and a decline in Papanicolaou test. The COVID-19 pandemic negatively impacted the number of these tests carried out among women, highlighting the importance of actions aimed at increasing coverage, especially among the most vulnerable groups.

Eating behavior and dietary practices are associated with age, sex, body mass index, and body fat in individuals with type 2 diabetes and/or hypertension in Brazil.

Type 2 diabetes (T2DM), hypertension, and obesity are major contributors to global mortality. This study aimed to evaluate eating behavior and dietary practices among individuals with T2DM and/or hypertension, examining their associations with sociodemographic and anthropometric characteristics. We hypothesized that these factors may contribute to body mass index (BMI) and body fat (BF) levels in these individuals. In a cross-sectional study, adults/older individuals diagnosed with T2DM and/or hypertension were included. Eating behavior was evaluated via Three-factor Eating Questionnaire-R21. Dietary practices were assessed using the Dietary Guidelines for the Brazilian Population (DGBP) questionnaire. Poisson regression examined associations between eating behaviors, dietary practices, and sociodemographic factors. Linear regressions were employed to analyze relationships between eating behavior, dietary practices, BMI, and BF. The study included 275 primarily female (70.5%) participants under 60 years old (54.2%). Male and older participants had a lower prevalence of high scores in the 'emotional eating' (EE; PR: 0.40 [0.25;0.63]) and 'uncontrolled eating' (UE; PR: 0.68 [0.50;0.92]) domains. In contrast, older patients had a higher prevalence of adherence to the DGBP recommendations (PR:1.53 [1.20;1.94]). A positive association was observed between high EE (ß:3.71 [1.98;5.44]) and UE (ß:2.85 [1.15;4.55]) scores and BMI, whereas higher dietary practice scores (ß:-2.19 [-3.88;-0.50]) were negatively associated with BMI. High EE (ß:2.20 [0.38;4.02]) and UE (ß:1.92 [0.17;3.67]) scores were positively associated with BF regardless of the confounding factors included. Higher scores on the dietary practices were inversely associated with BF (ß:-1.94 [-3.67;-0.21]). Understanding dietary behaviors and practices can facilitate a more comprehensive and effective treatment approach.

Racial inequalities in the development of multimorbidity of chronic conditions: results from a Brazilian prospective cohort.

BACKGROUND: The occurrence of multimorbidity and its impacts have differentially affected population subgroups. Evidence on its incidence has mainly come from high-income regions, with limited exploration of racial disparities. This study investigated the association between racial groups and the development of multimorbidity and chronic conditions in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS: Data from self-reported white, brown (pardos or mixed-race), and black participants at baseline of ELSA-Brasil (2008-2010) who were at risk for multimorbidity were analysed. The development of chronic conditions was assessed through in-person visits and self-reported diagnosis via telephone until the third follow-up visit (2017-2019). Multimorbidity was defined when, at the follow-up visit, the participant had two or more morbidities. Cumulative incidences, incidence rates, and adjusted incidence rate ratios (IRRs) were estimated using Poisson models. RESULTS: Over an 8.3-year follow-up, compared to white participants: browns had a 27% greater incidence of hypertension and obesity; and blacks had a 62% and 45% greater incidence, respectively. Blacks also had 58% more diabetes. The cancer incidence was greater among whites. Multimorbidity affected 41% of the participants, with a crude incidence rate of 57.5 cases per 1000 person-years (ranging from 56.3 for whites to 63.9 for blacks). Adjusted estimates showed a 20% higher incidence of multimorbidity in black participants compared to white participants (IRR: 1.20; 95% CI: 1.05-1.38). CONCLUSIONS: Significant racial disparities in the risk of chronic conditions and multimorbidity were observed. Many associations revealed a gradient increase in illness risk according to darker skin tones. Addressing fundamental causes such as racism and racial discrimination, alongside considering social determinants of health, is vital for comprehensive multimorbidity care. Intersectoral, equitable policies are essential for ensuring health rights for historically marginalized groups.

Chronic oral disease burden at the first 1000 days: Intergenerational risk factors, BRISA cohort.

OBJECTIVE: To analyze multiple-causal models, including socioeconomic, obesity, sugar consumption, alcohol smoking, caries, and periodontitis variables in pregnant women with early sugar exposure, obesity, and the Chronic Oral Disease Burden in their offspring around the first 1000 days of life. METHODS: The BRISA cohort study, Brazil, had two assessments: at the 22nd-25th gestational weeks and during the child's second year (n = 1141). We proposed a theoretical model exploring the association between socioeconomic and pregnancy factors (age, smoking, alcohol, sugars, obesity, periodontitis, and caries) and child's variables (sugars and overweight) with the outcome, Chronic Oral Disease Burden (latent variable deduced from visible plaque, gingivitis, and tooth decay), using structural equation modeling. RESULTS: Caries and periodontitis were correlated in pregnant women. Addictive behaviors in the gestational period were correlated. Obesity (Standardized coefficient - SC = 0.081; p = 0.047) and added sugar consumption (SC = 0.142; p = 0.041) were observed intergenerationally in the pregnant woman-child dyads. Sugar consumption by the children (SC = 0.210; p = 0.041) increased the Chronic Oral Disease Burden. CONCLUSIONS: Poor caries and periodontal indicators were correlated in pregnant women and their offspring. Obesity and sugar consumption act intergenerationally. Oral health in early life may change life trajectory since the worst oral conditions predict main NCDs.

Burden of disease and direct costs to the health system attributable to high body mass index in Brazil.

OBJECTIVES: Excess weight, measured by a high body mass index (BMI), is associated with the onset of many diseases, which can, in turn, lead to disability and premature death, subsequently placing a significant burden on healthcare services. This study analysed the burden of disease and the direct costs to the Brazilian Unified Health System (Sistema Único de Saúde [SUS]) attributable to high BMI in the Brazilian population. STUDY DESIGN: Ecological study. METHODS: This ecological study had two components: (1) a time-series assessment to analyse the burden of diseases attributable to high BMI from 1990 to 2019 in Brazil; and (2) a cross-sectional design to estimate the direct costs of SUS hospitalisations and outpatient procedures attributable to high BMI in 2019. Estimates from the Global Burden of Disease study and the costs of hospital admissions and outpatient procedures from the Department of Informatics of the Brazilian Unified Health System were used. Deaths, years of life lost to premature death (YLLs), years lived with disability (YLDs), and years of life lost adjusted for disability (DALYs) were analysed. The direct health cost was obtained in Brazilian Real (R$) and converted in international Dollars (INT$). RESULTS: The current study found a reduction in the number of DALYs, YLLs, and deaths per 100,000 population of cardiovascular disease (CVD) attributable to high BMI and an increase in YLD due to diabetes and cardiovascular disease attributable to high BMI from 1990 to 2019. In 2019, high BMI resulted in 2404 DALYs, 658 YLDs, 1746 YLLs, and 76 deaths per 100,000 inhabitants. In the same year, INT$377.30 million was spent on hospitalisations and high- and medium-complexity procedures to control non-communicable diseases attributable to high BMI. The states in the South and Southeast regions of Brazil presented the highest total cost per 10,000 inhabitants. CVDs and chronic kidney disease showed the highest costs per hospital admission, whereas neoplasms and CVDs presented the highest costs for outpatient procedures. CONCLUSIONS: High BMI causes significant disease burden and financial costs. The highest expenses observed were not in locations with the highest burden of disease attributable to high BMI. These findings highlight the need to improve current public policies and apply cost-effective intervention packages, focussing on equity and the promotion of healthier lifestyles to reduce overweight/obesity, especially in localities with low socioeconomic status.

Presence of metabolic syndrome markers in very low birth weight ex-premature infants during early adolescence.

OBJECTIVES: To investigate the association of growth patterns with overweight/obesity and markers of metabolic syndrome in ex-premature adolescents; to assess the relationship between the increase (1 SD) in Z-score weight at term and at 2 years with outcomes in adolescents with or without intrauterine growth restriction; and to evaluate the association between the Cook criteria and overweight/obesity according to body mass index. METHODS: Cohort, retrospective, analytical study. Population: adolescents born weighting<1,500 g. RESULTS: One hundred twenty-seven adolescents (11.3 years) were included. There is an association between the 1 SD increase in the percentile (Pc) of weight at 40 weeks and at 2 years in the population with adequate birth weight (PCA) with insulin levels, resistance, and sensitivity at 11 years. Catch-up at 2 years was associated with significantly higher proportion of HDL value<41 (18.75 vs. 5.36 %) OR 4.08 95% CI (1.04-16.05) p=0.031. Overweight/obesity was associated with waist circumference index>0.5, HDL<41, and with blood pressure greater than Pc 90 for sex and height. CONCLUSIONS: In preterm infants, a 1 SD increase in weight Z score at 40 weeks and 2 years was predictive of metabolic and cardiovascular disorders in adolescence.

Disability and costs of IHD attributable to the consumption of trans-fatty acids in Brazil.

OBJECTIVE: To estimate the disability and costs of the Brazilian Unified Health System for IHD attributable to trans-fatty acid (TFA) consumption in 2019. DESIGN: This ecological study used secondary data from the Global Burden of Disease (GBD) Study 2019 to estimate the years lived with disability from IHD attributable to TFA in Brazil in 2019. Data on direct costs (purchasing power parity: 1 Int$ = R$ 2·280) were obtained from the Hospital and Ambulatory Information Systems of the Brazilian Unified Health System. Moreover, the total costs in each state were divided by the resident population in 2019 and multiplied by 10 000 inhabitants. The relationship between the socio-demographic index, disease and economic burden was investigated. SETTING: Brazil and its twenty-seven states. PARTICIPANTS: Adults aged ≥ 25 years of both sexes. RESULTS: IHD attributable to TFA consumption resulted in 11 165 years lived with disability (95 % uncertainty interval 932­18 462) in 2019 in Brazil. A total of Int$ 54 546 227 (95 % uncertainty interval 4 505 792­85 561 810) was spent in the Brazilian Unified Health System in 2019 due to IHD attributable to TFA, with the highest costs of hospitalisations, for males and individuals aged ≥ 50 years or over. The highest costs were observed in Sergipe (Int$ 6508/10 000; 95 % uncertainty interval 576­10 265), followed by the two states from the South. Overall, as the socio-demographic index increases, expenditures increase. CONCLUSIONS: TFA consumption results in a high disease and economic IHD burden in Brazil, reinforcing the need for more effective health policies, such as industrial TFA elimination, following the international agenda.

Retrospective review of medicine utilization for noncommunicable diseases in three public sector pharmacies in Jamaica.

Objective: The rational use of medicines offers a cost-saving strategy to maximize therapeutic outcomes for developing and developed countries. The aim of this study was to evaluate the rational use of medicines for selected noncommunicable diseases (NCDs) at three pharmacies at public hospitals in Jamaica using the World Health Organization's (WHO's) prescribing indicators. Methods: In this retrospective cross-sectional study, prescriptions for adult outpatients containing at least one medicine for cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease or asthma that were filled between January and July 2019 were reviewed using WHO's prescribing indicators for the rational use of medicines. Data were analyzed and expressed as descriptive and inferential statistics. For all analyses conducted, significance was determined at P < 0.05. Results: A total of 1 500 prescriptions covering 5 979 medicines were reviewed; prescriptions were mostly written for female patients aged 42-60 years. Polypharmacy was observed in 35.6% (534) of prescriptions, and there was an average of 4 medicines per prescription, with a maximum of 17. Most of the prescriptions at each site were filled, with the main reason for not dispensing a medicine being that it was out of stock. Generic prescribing was high for all sites, accounting for more than 95% (5 722) of prescribed medicines. There was full compliance with prescribing according to the WHO Model List of Essential Medicines at two of the sites, but it was just off the target at Site 1, by 1.4%. Conclusions: The WHO guidelines for the rational use of medicines were followed with respect to the proportion of medicines prescribed from the WHO Model List and the proportion of antibiotics prescribed. The number of medicines per prescription and the proportion of medicines prescribed by generic name did not meet the WHO criteria. However, prescribing was aligned with treatment guidelines for the selected NCDs.

Body mass index and healthy lifestyle practices among Peruvian university students: a comparative study among academic discipline.

Background: Excess body weight and an unhealthy lifestyle are a risk factor for noncommunicable diseases. University students are susceptible to unhealthy habits and obesity. This study compared body mass index (BMI) and healthy lifestyle practices among university students from four academic disciplines: Health Sciences, Business Sciences, Human Sciences and Education, and Engineering/Architecture. Methods: A cross-sectional study was carried out using a sample of 6,642 university students selected by non-probability convenience sampling. The Diet and Healthy Lifestyle Scale (DEVS), the Peruvian validation of the Vegetarian Lifestyle Index (VLI), was used to assess healthy lifestyle practices. Results: Students in the areas of Business Sciences and Engineering/Architecture had a higher BMI than their peers in Health Sciences (B = 0.35, 95% CI: 0.15-0.56 and 0.32, 95% CI: 0.13-0.52; p = 0.001). Additionally, these students tended to adopt less healthy lifestyle (B = -0.11, 95% CI: -0.20 to -0.01 and -0.09, 95% CI: -0.18 to -0.00; p < 0.05) compared to those in Health Sciences. Conclusion: Although students of Health Sciences and Human Sciences and Education exhibited healthy lifestyle patterns, there is a clear need to improve eating and living habits in general among the university population to mitigate the risk factors associated with non-communicable diseases.

Bioactive Compounds from Pigmented Corn (Zea mays L.) and Their Effect on Health.

Pigmented corn is a gramineae food of great biological, cultural and nutritional importance for many Latin American countries, with more than 250 breeds on the American continent. It confers a large number of health benefits due to its diverse and abundant bioactive compounds. In this narrative review we decided to organize the information on the nutrients, bioactive compounds and phytochemicals present in pigmented corn, as well as their effects on human health. Phenolic compounds and anthocyanins are some of the most studied and representative compounds in these grasses, with a wide range of health properties, mainly the reduction of pro-oxidant molecules. Carotenoids are a group of molecules belonging to the terpenic compounds, present in a large number of pigmented corn breeds, mainly the yellow ones, whose biological activity incorporates a wide spectrum. Bioactive peptides can be found in abundance in corn, having very diverse biological effects that include analgesic, opioid and antihypertensive activities. Other compounds with biological activity found in pigmented corn are resistant starches, some fatty acids, phytosterols, policosanols, phospholipids, ferulic acid and phlobaphenes, as well as a great variety of vitamins, elements and fibers. This review aims to disseminate and integrate the existing knowledge on compounds with biological activity in pigmented corn in order to promote their research, interest and use by scientists, nutrition professionals, physicians, industries and the general population.

Co-creation process of an intervention to implement a multiparameter point-of-care testing device in a primary healthcare setting for non-communicable diseases in Peru.

BACKGROUND: Point-of-care testing (POCT) devices are diagnostic tools that can provide quick and accurate results within minutes, making them suitable for diagnosing non-communicable diseases (NCDs). However, these devices are not widely implemented in healthcare systems and for this reason is relevant to understand the implementation process. AIM: To describe the process and define a strategy to implement a multiparameter POCT device for diagnosing and managing NCDs in one region of Peru. METHODS: A descriptive and non-experimental study, using the participatory methodologies of co-creation process. It was conducted in one region of Peru (Tumbes) to design an intervention for implementing a multiparameter POCT device. Two co-creation sessions were conducted involving five groups: community members, primary healthcare workers, these groups in both rural and urban settings, and regional decision-makers. These sessions included activities to understand patient journeys in receiving care for NCDs, identify facilitators and barriers to POCT devices usage, and define an implementation strategy for POCT devices in both rural and urban settings of Tumbes. The research team analysed the data and summarized key topics for discussion after each session. RESULTS: A total of 78 participants were enrolled across the five groups. Among community members: 22.2% had only diabetes, 24.1% had only hypertension, and 18.5% had both diagnoses. In the patient journey, community members mentioned that it took at least three days to receive a diagnosis and treatment for an NCD. Most of the participants agreed that the POCT devices would be beneficial for their communities, but they also identified some concerns. The strategy for POCT devices implementation included healthcare workers training, POCT devices must be placed in the laboratory area and must be able to perform tests for glucose, glycated haemoglobin, cholesterol, and creatinine. Advertising about POCT devices should be displayed at the healthcare centres and the municipality using billboards and flyers. CONCLUSIONS: The co-creation process was useful to develop strategies for the implementation of multiparameter POCT devices for NCDs, involving the participation of different groups of stakeholders guided by moderators in both, rural and urban, settings in Peru.

Recruiting hard-to-reach populations via respondent driven sampling for mobile phone surveys in Colombia: a qualitative study.

BACKGROUND: Uptake of mobile phone surveys (MPS) is increasing in many low- and middle-income countries, particularly within the context of data collection on non-communicable diseases (NCDs) behavioural risk factors. One barrier to collecting representative data through MPS is capturing data from older participants.Respondent driven sampling (RDS) consists of chain-referral strategies where existing study subjects recruit follow-up participants purposively based on predefined eligibility criteria. Adapting RDS strategies to MPS efforts could, theoretically, yield higher rates of participation for that age group. OBJECTIVE: To investigate factors that influence the perceived acceptability of a RDS recruitment method for MPS involving people over 45 years of age living in Colombia. METHODS: An MPS recruitment strategy deploying RDS techniques was piloted to increase participation of older populations. We conducted a qualitative study that drew from surveys with open and closed-ended items, semi-structured interviews for feedback, and focus group discussions to explore perceptions of the strategy and barriers to its application amongst MPS participants. RESULTS: The strategy's success is affected by factors such as cultural adaptation, institutional credibility and public trust, data protection, and challenges with mobile phone technology. These factors are relevant to individuals' willingness to facilitate RDS efforts targeting hard-to-reach people. Recruitment strategies are valuable in part because hard-to-reach populations are often most accessible through their contacts within their social network who can serve as trust liaisons and drive engagement. CONCLUSIONS: These findings may inform future studies where similar interventions are being considered to improve access to mobile phone-based data collection amongst hard-to-reach groups.

Incidence of traffic light labelling on noncommunicable diseases: a roadmap for achieving sustainable development.

The production and diversity of the supply of food products has grown exponentially in recent decades, along with the increase in cardiovascular diseases associated with poor diet. Among the factors, one of the most important is the lack of information for the consumer when purchasing. The present work evaluates the impact of implementing the traffic light labelling of foods in reducing deaths due to Noncommunicable Diseases (NCD). Econometric techniques of two-way effects panel data from 21 Ecuadorian provinces taken from official sources for the analysis period 2010-2019. For Ecuador, a favourable impact was found in the reduction of the NCD mortality rate, especially in the last three years; in 2017, it was reduced by 0.129%, in 2018 by 0.305%, and in 2019 by 0.289%. An implication of economic policy is the advertising regulation of products that may affect health, strengthening surveillance and sanctioning companies that fail to comply with the regulation.

Effects of Supplementation of Murici (Byrsonima crassifolia) and Taperebá (Spondias mombin) Pulp Extracts on Food Intake, Body Parameters, and Oxidative Stress Markers in Healthy Rats.

This study evaluates the effects of supplementation of murici (Byrsonima crassifolia) and taperebá (Spondias mombin) pulp extracts on dietary intake, body composition, biochemical parameters, and markers of oxidative stress. Two experiments were conducted with a total of 80 healthy male Wistar rats and a 30-day supplementation. In the first experiment, animals were divided into control (C) group, murici group 50 mg/(kg⸱day) (50Mu), murici group 100 mg/(kg⸱day) (100Mu), and murici group 200 mg/(kg⸱day) (200Mu). In the second experiment, animals were divided into C group, taperebá group 50 mg/(kg⸱day) (50Tap), taperebá group 100 mg/(kg⸱day) (100Tap), and taperebá group 200 mg/(kg⸱day) (200Tap). Results showed lower feed intake in 50Mu, 100Mu, and 100Tap groups (13%, 12%, and 10%, respectively, P < .05) and lower body fat in 200Mu, 100Tap, and 200Tap groups (16.0%, 29.1%, and 27.1%, respectively, P < .05). Only the 100Tap group showed reduced adipose tissue content (30.4%; P < .05). Increased plasma antioxidant capacity was observed at all doses for both fruits. Taperebá supplementation reduced ferrous oxidation-xylenol orange levels (50Tap: 8.4%, 100Tap: 16.1%, 200Tap: 24.3%; P < .05) and increased thiol levels (50Tap: 39%, 100Tap: 31%; P < .05). Serum thiobarbituric acid reactive substances levels were reduced in all groups receiving taperebá (50Tap: 77.7%, 100Tap: 73.1%, 200Tap: 73.8%; P < .05) and murici (50Mu: 44.5%, 100Mu: 34%, 200Mu: 43%; P < .05). Therefore, it is suggested that the inclusion of these fruits in the diet can contribute to health maintenance and disease prevention, through their effects on controlling food intake, improving body composition, and in combating oxidative stress.

Genetic polymorphisms in the angiotensin converting enzyme, actinin 3 and paraoxonase 1 genes in women with diabetes and hypertension

ABSTRACT Objective: To study associations between polymorphisms in the angiotensin converting enzyme (ACE I/D), actinin 3 (ACTN3 R577X) and paraoxonase 1 (PON1 T(-107)C) genes and chronic diseases (diabetes and hypertension) in women. Materials and methods: Genomic DNA was extracted from saliva samples of 78 women between 18 and 59 years old used for genetic polymorphism screening. Biochemical data were collected from the medical records in Basic Health Units from Southern Brazil. Questionnaires about food consumption, physical activity level and socioeconomic status were applied. Results: The XX genotype of ACTN3 was associated with low HDL levels and high triglycerides, total cholesterol and glucose levels. Additionally, high triglycerides and LDL levels were observed in carriers of the TT genotype of PON1, and lower total cholesterol levels were associated to the CC genotype. As expected, women with diabetes/hypertense had increased body weight, BMI (p = 0.02), waist circumference (p = 0.01), body fat percentage, blood pressure (p = 0.02), cholesterol, triglycerides (p = 0.02), and blood glucose (p = 0.01), when compared to the control group. Conclusion: Both ACTN3 R577X and PON1 T(-107)C polymorphisms are associated with nutritional status and blood glucose and lipid levels in women with diabetes/hypertense. These results contribute to genetic knowledge about predisposition to obesity-related diseases.

Retrospective review of medicine utilization for noncommunicable diseases in three public sector pharmacies in Jamaica / Revisión retrospectiva del uso de medicamentos para enfermedades no transmisibles en tres farmacias del sector público de Jamaica / Revisão retrospectiva do uso de medicamentos para doenças não transmissíveis em três farmácias da rede pública na Jamaica

ABSTRACT Objective. The rational use of medicines offers a cost-saving strategy to maximize therapeutic outcomes for developing and developed countries. The aim of this study was to evaluate the rational use of medicines for selected noncommunicable diseases (NCDs) at three pharmacies at public hospitals in Jamaica using the World Health Organization's (WHO's) prescribing indicators. Methods. In this retrospective cross-sectional study, prescriptions for adult outpatients containing at least one medicine for cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease or asthma that were filled between January and July 2019 were reviewed using WHO's prescribing indicators for the rational use of medicines. Data were analyzed and expressed as descriptive and inferential statistics. For all analyses conducted, significance was determined at P < 0.05. Results. A total of 1 500 prescriptions covering 5 979 medicines were reviewed; prescriptions were mostly written for female patients aged 42-60 years. Polypharmacy was observed in 35.6% (534) of prescriptions, and there was an average of 4 medicines per prescription, with a maximum of 17. Most of the prescriptions at each site were filled, with the main reason for not dispensing a medicine being that it was out of stock. Generic prescribing was high for all sites, accounting for more than 95% (5 722) of prescribed medicines. There was full compliance with prescribing according to the WHO Model List of Essential Medicines at two of the sites, but it was just off the target at Site 1, by 1.4%. Conclusions. The WHO guidelines for the rational use of medicines were followed with respect to the proportion of medicines prescribed from the WHO Model List and the proportion of antibiotics prescribed. The number of medicines per prescription and the proportion of medicines prescribed by generic name did not meet the WHO criteria. However, prescribing was aligned with treatment guidelines for the selected NCDs.

RESUMEN Objetivo. El uso racional de los medicamentos proporciona una estrategia de ahorro de costos para maximizar los resultados terapéuticos tanto en los países en desarrollo como en los países desarrollados. El objetivo de este estudio fue evaluar el uso racional de medicamentos para algunas enfermedades no transmisibles (ENT) seleccionadas en tres farmacias de hospitales públicos de Jamaica, usando los indicadores de prescripción de la Organización Mundial de la Salud (OMS). Métodos. En este estudio transversal retrospectivo se examinaron las prescripciones realizadas a pacientes ambulatorios adultos que incluían al menos un medicamento para enfermedades cardiovasculares, diabetes, cáncer, enfermedad pulmonar obstructiva crónica o asma, dispensadas entre enero y julio del 2019, utilizando los indicadores de prescripción para el uso racional de medicamentos de la OMS. Los datos se analizaron y expresaron mediante estadística descriptiva e inferencial. Para todos los análisis realizados se estableció un nivel de significación de p <0,05. Resultados. Se examinó un total de 1 500 prescripciones que incluían 5 979 medicamentos; la mayor parte de ellas correspondían a pacientes de sexo femenino de 42 a 60 años. Se observó que había polimedicación en el 35,6% (534) de las prescripciones, con un promedio de 4 y un máximo de 17 medicamentos por receta. En todos los centros se dispensó la mayor parte de los medicamentos prescritos, y el motivo principal para no hacerlo fue la falta de existencias del medicamento en cuestión. La prescripción de genéricos fue elevada en todos los centros y supuso más del 95% (5 722) de los medicamentos prescritos. En dos centros la prescripción se realizó en su totalidad de acuerdo con la Lista Modelo de Medicamentos Esenciales de la OMS, pero en el centro 1 no se alcanzó el objetivo por un 1,4%. Conclusiones. Se siguieron las directrices de la OMS para el uso racional de medicamentos en cuanto a la proporción de medicamentos prescritos de la Lista Modelo de la OMS y la proporción de antibióticos prescritos. El número de medicamentos por receta y la proporción de medicamentos prescritos mediante su nombre genérico no cumplieron con los criterios de la OMS. Sin embargo, las prescripciones estaban en consonancia con las directrices de tratamiento de las enfermedades no transmisibles seleccionadas.

RESUMO Objetivo. O uso racional de medicamentos é uma estratégia de contenção de custos para maximizar os resultados terapêuticos em países desenvolvidos e em desenvolvimento. O objetivo deste estudo foi avaliar o uso racional de medicamentos para algumas doenças não transmissíveis selecionadas em três farmácias de hospitais públicos na Jamaica a partir dos indicadores de prescrição preconizados pela Organização Mundial da Saúde (OMS). Métodos. Estudo transversal retrospectivo que avaliou receitas médicas de pacientes ambulatoriais adultos contendo pelo menos um medicamento prescrito para doença cardiovascular, diabetes, câncer, doença pulmonar obstrutiva crônica ou asma e dispensadas entre janeiro e julho de 2019. A avaliação foi realizada a partir dos indicadores de prescrição preconizados pela OMS para o uso racional de medicamentos. Os dados obtidos foram analisados por meio de estatísticas descritivas e inferenciais. O nível de significância de p <0,05 foi adotado em todas as análises. Resultados. Ao todo, foram analisadas 1 500 receitas médicas compreendendo 5 979 medicamentos. Em sua maioria, as receitas foram prescritas para pacientes do sexo feminino com idades entre 42 e 60 anos. A polifarmácia foi observada em 35,6% (534) das receitas; em média, foram prescritos 4 medicamentos, até um máximo de 17. As farmácias estudadas dispensaram a maior parte dos medicamentos receitados. O principal motivo para não fornecer algum medicamento foi o desabastecimento. O percentual de medicamentos genéricos foi alto em todos os locais, representando mais de 95% (5 722) do volume receitado. Houve plena observância da Lista Modelo de Medicamentos Essenciais da OMS nas receitas analisadas em dois dos locais estudos, e observância quase completa (diferença de 1,4%) no local 1. Conclusões. As diretrizes da OMS de uso racional de medicamentos foram cumpridas no que se refere ao percentual de medicamentos receitados de acordo com a Lista Modelo da OMS e o percentual de antibióticos receitados. Os critérios da OMS não foram cumpridos quanto ao número de medicamentos por receita e ao percentual receitado usando o nome genérico. Porém, os medicamentos foram receitados de acordo com as diretrizes terapêuticas para as doenças não transmissíveis selecionadas.

Interpretabilidade dos escores da medida genérica DISABKIDS-37 para doenças crônicas não transmissíveis (MGDC-37) / Interpretability of the DISABKIDS-37 generic measure scores for chronic noncommunicable diseases (MGDC-37)

Introdução: As Doenças Crônicas Não Transmissíveis são as principais causas de morbimortalidade no mundo, responsáveis por 70% das mortes globais e 74% das causas de mortes no Brasil e, pelo fato de estarem associadas ao elevado número de mortes prematuras, perda de qualidade de vida e impactos econômicos negativos para indivíduos, famílias e a sociedade em geral, desde 2003, a Organização Mundial de Saúde têm destacado a necessidade de atenção para mudanças no cenário epidemiológico, com a relevância da atenção às crianças e aos adolescentes. O instrumento DISABKIDS Chronic Generic Measure long form 37 utilizado para mensuração da Qualidade de Vida de crianças e adolescentes com Doenças Crônicas Não Transmissíveis, tem sido traduzido e adaptado para várias culturas e idiomas de forma a ser aplicado por pesquisadores e por profissionais da saúde. Pesquisadores do Grupo de Pesquisa sobre Medidas em Saúde cadastrado no diretório dos Grupos de Pesquisa do Conselho Nacional de Desenvolvimento Científico e Tecnológico, disponibilizaram a versão brasileira denominada Medida Genérica DISABKIDS-37 para Doenças Crônicas Não Transmissíveis, objeto deste estudo. Objetivos: Disponibilizar os escores para Interpretabilidade da Medida Genérica DISABKIDS-37 para crianças e adolescentes brasileiros com Doenças Crônicas Não Transmissíveis, versões Patient Reported Outcomes e Observer Reported Outcomes. Método: Estudo transversal com população constituída de crianças e adolescentes brasileiros com Doenças Crônicas Não Transmissíveis e seus respectivos pais ou cuidadores. A amostra foi composta por 306 participantes. Os dados foram coletados em instituições de saúde do estado de São Paulo e Maranhão. Para os resultados, são apresentados os escores brutos, escores padronizados, percentis e t-escores dos escores de Qualidade de Vida nas dimensões Independência, Emocional, Inclusão Social, Exclusão Social, Limitação, Tratamento e Total, respectivamente, das versões do Instrumento, segundo adaptação e validação para o Brasil e Grupo DISABKIDS Europa. Resultados: De forma global, a Medida Genérica DISABKIDS - 37 para Doenças Crônicas Não Transmissíveis discriminou o impacto negativo das Doenças Crônicas Não Transmissíveis, nos atributos Qualidade de Vida, de crianças e de adolescentes, na sua percepção ou na percepção de seus pais ou cuidadores, sendo maior no Brasil do que na Europa. Este resultado foi observado na maioria das dimensões, para crianças e adolescentes e em 50% das dimensões para seus pais ou cuidadores. Considerações Finais: Este trabalho é um avanço no conhecimento científico e finaliza o longo e produtivo caminho da adaptação do DISABKIDS Chronic Generic Measure long form 37 para o Brasil. Os resultados apresentados mostram escores de fácil interpretação que podem ser agora utilizados na produção de resultados válidos e fidedignos pelos envolvidos no cuidado à saúde da população de crianças e adolescentes no Brasil.

Introduction: Chronic Non-Communicable Diseases are the main causes of morbidity and mortality in the world, responsible for 70% of global deaths and 74% of the causes of deaths in Brazil and, because they are associated with a high number of premature deaths, loss of quality of life and negative economic impacts for individuals, families and society in general, since 2003 the World Health Organization has highlighted the need to pay attention to changes in the epidemiological scenario, with the relevance of attention to children and adolescents. The DISABKIDS Chronic Generic Measure long form 37 used to measure the Quality of Life of children and adolescents with Chronic Non-Communicable Diseases, has been translated and adapted to various cultures and languages to be applied by researchers and health professionals. Researchers from the Research Group on Health Measures, registered in the directory of Research Groups of the Brazilian National Council for Scientific and Technological Development, have made available the Brazilian version called the DISABKIDS-37 Generic Measure Scores for Chronic Noncommunicable Diseases, which is the subject of this study. Objectives: To make available the DISABKIDS-37 Generic Measure Scores for Brazilian children and adolescents with Chronic Noncommunicable Diseases, Patient Reported Outcomes and Observer Reported Outcomes versions. Method: Cross-sectional study with a population consisting of Brazilian children and adolescents with Chronic Non-Communicable Diseases and their respective parents or caregivers. The sample consisted of 306 participants. Data were collected in health institutions in the states of São Paulo and Maranhão. For the results, it was showed the raw scores, standardized scores, percentiles and t-scores of the Quality of Life scores in the Independence, Emotional, Social Inclusion, Social Exclusion, Limitation, Treatment and Total dimensions, respectively, of the versions of the Instrument, according to adaptation and validation for Brazil and DISABKIDS Group Europe. Results: In general, the DISABKIDS-37 Generic Measure Scores for Chronic Noncommunicable Diseases discriminated the negative impact of Chronic Non-Communicable Diseases on the attributes of Quality of Life of children and adolescents, in their perception or their parents or caregivers' perception, being higher in Brazil than in Europe. This result was observed in most dimensions for children and adolescents and in 50% of the dimensions for their parents or caregivers. Final considerations: This study is an advance in scientific knowledge and completes the long and productive journey of adapting the DISABKIDS Chronic Generic Measure long form 37 to Brazil. The results showed easy-to-interpret scores that can now be used to produce valid and reliable results for those involved in the health care of children and adolescents in Brazil.

Metabolic syndrome: experiences in relation to healthcare / Síndrome metabólico: experiencias en relación con el cuidado de la salud / Síndrome metabólica: vivências em relação ao cuidado com a saúde

ABSTRACT Objective: to interpret the experiences of people with metabolic syndrome in relation to healthcare. Method: this is qualitative research using Grounded Theory as a method and Symbolic Interactionism as a framework for analysis. It was carried out at a Basic Health Unit in the city of Marília/SP, Brazil, with 24 interviews in three sample groups (patients, family members and healthcare professionals), from February 9, 2022 to January 16, 2023. Results: a total of 734 codes were identified and grouped into categories and subcategories, with the central phenomenon being "(Not) Taking Care of Health", which is characterized as a dualistic process that encompasses both neglect and care. Aspects relating to neglecting health include the categories: "Considering not having health problems"; "Having difficulties understanding and resisting following care"; and "Lack of adherence to treatment". In the aspect of taking care of the health, there are the categories: "Understanding that they have metabolic syndrome"; "Receiving guidance"; and "Counting on support". Conclusion: the experience of people with metabolic syndrome permeates the biological, psychological, social and spiritual spheres, as they deal with their health problems according to the social interaction maintained with themselves and other people. Therefore, meaningful communication and bonding with healthcare team are the main tools for adherence to treatment.

RESUMEN Objetivo: interpretar las experiencias de las personas con síndrome metabólico en relación con la atención sanitaria. Método: investigación cualitativa utilizando la Teoría Fundamentada como método y el Interaccionismo Simbólico como referencia de análisis. Se realizó en una Unidad Básica de Salud de la ciudad de Marília/SP, Brasil, con 24 entrevistas en tres grupos muestra (pacientes, familiares y profesionales de la salud), del 9 de febrero de 2022 al 16 de enero de 2023. Resultados: se identificaron 734 códigos que se agruparon en categorías y subcategorías, siendo el fenómeno central el "(Des) Cuidado con la Salud", que se caracteriza por ser un proceso dualista que abarca tanto el abandono como el cuidado. Los aspectos relacionados con el abandono de la salud incluyen las categorías: "Considerar no tener problemas de salud"; "Tener dificultades para comprender y resistirse a seguir los cuidados"; y "Falta de adherencia al tratamiento". En el aspecto de cuidar su salud, existen las categorías: "Entendiendo que tienen síndrome metabólico"; "Recibir orientación"; y "Confiar en el apoyo". Conclusión: la experiencia de las personas con síndrome metabólico permea los ámbitos biológico, psicológico, social y espiritual, ya que abordan sus problemas de salud de acuerdo con la interacción social que mantienen consigo mismos y con otras personas. Por lo tanto, la comunicación significativa y el vínculo con el equipo de salud son las principales herramientas para la adherencia al tratamiento.

RESUMO Objetivo: interpretar as vivências de pessoas com síndrome metabólica no que se refere ao cuidado com a saúde. Método: pesquisa qualitativa utilizando como método a Teoria Fundamentada nos Dados e como referencial para análise o Interacionismo Simbólico. Foi realizada em uma Unidade Básica de Saúde do município de Marília/SP, Brasil, com 24 entrevistas em três grupos amostrais (pacientes, familiares e profissionais da saúde), no período de nove de fevereiro de 2022 a 16 de janeiro de 2023. Resultados: identificaram-se 734 códigos que foram agrupados, chegando-se às categorias e subcategorias, tendo como fenômeno central "(Des) Cuidando da saúde", que se caracteriza como processo dualista que perpassa tanto pelo descuidando quanto pelo cuidando. Os aspectos referentes ao descuidando da saúde incluem as categorias: "Considerando não ter problemas de saúde"; "Tendo dificuldades de compreensão e resistência para seguir os cuidados"; e "Faltando adesão ao tratamento". No aspecto cuidando da saúde, encontram-se as categorias: "Compreendendo que possuem síndrome metabólica"; "Recebendo orientações"; e "Contando com apoio". Conclusão: a vivência das pessoas com síndrome metabólica perpassa pelas esferas biológica, psicológica, social e espiritual, pois eles lidam com seus problemas de saúde de acordo com a interação social mantida consigo próprio e com as demais pessoas. Portanto, a comunicação significativa e o vínculo com a equipe de saúde são as principais ferramentas de adesão ao tratamento.

Um breve panorama sobre a Agenda 2030, as doenças crônicas não transmissíveis e os desafios de não deixar ninguém para trás / A brief overview of the 2030 Agenda, noncommunicable diseases and the challenges of leaving no one behind / Un breve panorama de la Agenda 2030, las enfermedades crónicas no transmisibles y los desafíos de no dejar a nadie atrás

Resumo: Este ensaio traz uma reflexão teórica sobre os desafios para alcançar as metas dos Objetivos do Desenvolvimento Sustentável da Agenda 2030, considerando seu lema de "não deixar ninguém para trás". Para exemplificar esses desafios, apresenta-se como pano de fundo as doenças crônicas não transmissíveis (DCNT), um dos principais temas da agenda da saúde global antes da pandemia de COVID-19, discutindo as dimensões políticas e econômicas que determinam sua presença e avanço global. Após um breve panorama sobre as DCNT, busca-se responder a três perguntas: em "Sem deixar ninguém para trás?", elencamos alguns temas para refletir sobre como e quem tem ficado historicamente para trás, aprofundando um pouco mais os exemplos ao adentrar em "Quem tem ficado para trás no mundo?" e "Quem tem ficado para trás no Brasil?". A partir de dados da literatura mais relevante e recente sobre o tema, apresentamos os desafios e alguns caminhos para não deixar ninguém para trás em um mundo em que o modo de produção tem historicamente vulnerabilizado alguns grupos sociais, com destaque para a população negra e a população indígena. Trazemos nas considerações finais a inspiração do ideograma Sankofa para lembrar que as respostas para o desenvolvimento sustentável que buscamos podem estar em algum lugar de nosso passado mais originário e tradicional, e que é preciso apostar na construção de novos caminhos a partir de outras epistemologias e cosmovisões presentes do outro lado da linha abissal.

Abstract: This essay provides a theoretical reflection on the challenges of meeting the Sustainable Development Goals of the 2030 Agenda, considering its motto of "leave no one behind". To exemplify these challenges, we discuss noncommunicable diseases (NCDs), one of the main issues on the global health agenda before the COVID-19 pandemic, and the political and economic dimensions that determine their presence and global spread. After a brief overview of NCDs, the text seeks to answer three questions: In "Leaving no one behind?" we list some themes to reflect on how and who has historically been left behind, delving a little deeper into the examples in "Who has been left behind in the world?" and "Who has been left behind in Brazil?". Using data from the most relevant and recent literature on the subject, we discuss the challenges and some ways to leave no one behind in a world where the mean of production has historically made some social groups vulnerable, especially black and Indigenous populations. In our final remarks, we draw inspiration from the Sankofa ideogram to remember that the answers to the sustainable development we seek may lie somewhere in our most primordial and traditional past. And that it is necessary to invest on building new paths from different worldviews and approaches to epistemology on the other side of the abyssal line.

Resumen: Este ensayo aporta una reflexión teórica acerca de los desafíos para lograr las metas de los Objetivos de Desarrollo Sostenible de la Agenda 2030, teniendo en cuenta su lema "no dejar a nadie atrás". Para ejemplificar estos desafíos, tomamos como telón de fondo las enfermedades crónicas no transmisibles (ECNT), uno de los principales temas de la agenda de salud global antes de la pandemia de COVID-19, discutiendo las dimensiones políticas y económicas que determinan su presencia y avance global. Después de un breve panorama de las ECNT, el texto busca responder tres preguntas: En "¿Sin dejar a nadie atrás?" enumeramos algunos temas para reflexionar sobre cómo y quién ha quedado históricamente atrás, profundizando un poco más los ejemplos al centrarse en "¿Quién ha quedado atrás en el mundo?" y "¿Quién ha quedado atrás en Brasil?". Con base en datos de la literatura más relevante y reciente sobre el tema, presentamos los desafíos y algunas maneras de no dejar a nadie atrás en un mundo en el que el modo de producción ha vulnerabilizado históricamente a algunos grupos sociales, con énfasis en la población negra y en la población indígena. En nuestras consideraciones finales, nos inspiramos en el ideograma de Sankofa para recordar que las respuestas al desarrollo sostenible que buscamos pueden estar en algún lugar de nuestro pasado más original y tradicional. Y es necesario apostar por la construcción de nuevos caminos basados en otras epistemologías y cosmovisiones presentes al otro lado de la línea abisal.