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1.
Soc Sci Med ; 366: 117677, 2025 Feb.
Article in English | MEDLINE | ID: mdl-39827684

ABSTRACT

In 1888, Brazil became the last country in the Americas to abolish slavery. Historians have outlined the racialized health disparities of people of African descent in the post-abolition period. Epidemiologists have shown that twenty-first-century health disparities continue to mirror patterns from over a century ago. This cross-sectional analysis quantifies health disparities in a post-abolition maternity hospital using infant birth weight. It relies on hospital records on infants delivered between 1922 and 1926 (n = 2845) at the Maternidade Laranjeiras in the city of Rio de Janeiro, Brazil to run linear models assessing differences in infant birth weight by maternal skin color, age, number of pregnancies (parity), and nationality. African ancestry was correlated with lower birth weights. Infants born to Afro-descendant women had birth weights estimated to be 84 g lighter (p-value = 0.002 [95% CI -137, -32]) than infants born to Euro-descendant women. Among Afro-descendant women, infants born to Black (preta) women had birth weights estimated to be 100 g lighter (p-value = 0.001 [95% CI -160, -39]) and infants born to mixed-race (parda) women had birth weights estimated to be 70 g lighter (p-value = 0.022 [95% CI -130, -10]) than infants born to White women. The findings were likely the consequence of slavery's legacy, particularly race-based socioeconomic inequality - including more strenuous work schedules, poorer nutrition, and less sanitary living environments for people of African descent. The findings are consistent with current-day research on racialized health disparities in Brazil and demonstrate the importance of historical findings to public health research.


Subject(s)
Birth Weight , Humans , Brazil , Cross-Sectional Studies , Female , History, 20th Century , Infant, Newborn , Adult , Pregnancy , Health Status Disparities , Black People/statistics & numerical data , Enslavement/history , Enslavement/statistics & numerical data , White People/statistics & numerical data , History, 19th Century , White
2.
Cien Saude Colet ; 30(1): e02212024, 2025 Jan.
Article in Portuguese, English, Spanish | MEDLINE | ID: mdl-39879440

ABSTRACT

This article aims to identify the relationship between material deprivation and mortality from breast, cervical, and prostate neoplasms in the Brazilian adult population and the relationship between ethnicity/skin color and material deprivation. This cross-sectional ecological study calculated the mean mortality rate per 100,000 inhabitants, and deaths were standardized by age and gender and redistributed per to ill-defined causes, stratified by age group and ethnicity/skin color. We applied the Negative Binomial model, containing the interaction between ethnicity/skin color and the Brazilian Deprivation Index (IBP). We analyzed 85,903 deaths, and the most prevalent were those due to female breast neoplasms. The risk of death from cervical cancer was 8.5% higher for Black women than white women. In other places, mortality was higher among white people. For all causes, mortality increased with age. There was a significant interaction between ethnicity/skin color and IBP for all causes. Only deaths due to cervical neoplasms increased with higher IBP, while a decline was observed in other causes but was less significant among Black people. The IBP offers a multidimensional view of the socioeconomic conditions of the Brazilian population, allowing a better understanding of how social determinants operate on selected neoplasms.


O objetivo deste artigo é identificar a relação entre privação material e mortalidade por neoplasias de mama, colo do útero e próstata, na população adulta brasileira, e a relação existente entre raça/cor e privação material. Estudo ecológico transversal, calculou-se a taxa média de mortalidade/100.000 habitantes, com óbitos padronizados por idade e sexo e redistribuídos por causas mal definidas, estratificados por grupo etário e raça/cor. Aplicou-se o modelo Binomial Negativo, contendo a interação entre raça/cor e Índice Brasileiro de Privação (IBP). Foram analisados 85.903 óbitos, sendo mais prevalente os por neoplasias de mama. O risco de morte por neoplasia de colo do útero foi 8,5% maior para negras do que para brancas, nos demais sítios a mortalidade foi maior entre brancos. Para todas as causas com aumento da idade ocorreu aumento da mortalidade. Houve interação significativa entre raça/cor e IBP para todas as causas, apenas os óbitos por neoplasia de colo do útero aumentou com o aumento do IBP, nas demais houve redução. O IBP oferece uma visão multidimensional das condições socioeconômicas da população brasileira, permitindo melhor compreensão de como os determinantes sociais operam sobre as neoplasias selecionadas.


El objetivo es Identificar la relación entre privación material y mortalidad por neoplasias de mama, cuello uterino y próstata en la población adulta brasileña, y la relación entre raza/color y privación material. Este estudio ecológico transversal calculó la tasa media de mortalidad/100.000 habitantes, con defunciones estandarizadas por edad y sexo y redistribuidas según causas mal definidas, estratificadas por grupo de edad y raza/color. Se aplicó el modelo Binomial Negativo conteniendo la interacción entre raza/color y el Índice Brasileño de Privación (IBP). Se analizaron 85.903 defunciones, siendo las más prevalentes las debidas a neoplasias de mama. El riesgo de defunción por cáncer de cuello uterino fue 8,5% mayor para mujeres negras que para blancas. En otros lugares, la mortalidad fue mayor entre las personas blancas. Para todas las causas, hubo un aumento de la mortalidad con el aumento de la edad. Se observó una interacción significativa entre raza/color e IBP para todas las causas. Solo las defunciones por neoplasia cervical aumentaron con el aumento del IBP, en las demás hubo una reducción, pero menos significativa entre las personas negras. El IBP ofrece una visión multidimensional de las condiciones socioeconómicas de la población brasileña, permitiendo una mejor comprensión de cómo los determinantes sociales operan sobre neoplasias seleccionadas.


Subject(s)
Black People , Breast Neoplasms , Prostatic Neoplasms , Socioeconomic Factors , Uterine Cervical Neoplasms , White People , Humans , Brazil/epidemiology , Cross-Sectional Studies , Female , Adult , Middle Aged , Uterine Cervical Neoplasms/mortality , Uterine Cervical Neoplasms/ethnology , Male , Prostatic Neoplasms/mortality , Prostatic Neoplasms/ethnology , Breast Neoplasms/mortality , Breast Neoplasms/ethnology , Aged , Black People/statistics & numerical data , White People/statistics & numerical data , Young Adult , Health Status Disparities , Age Factors , Adolescent , Aged, 80 and over
3.
Cad Saude Publica ; 40(11): e00209523, 2025.
Article in Portuguese | MEDLINE | ID: mdl-39813564

ABSTRACT

This study aimed to investigate the presence of mental illness in victims of soil instability in neighborhoods affected by rock salt extraction from a mining company located in the city of Maceió, Alagoas, Brazil. It is a quantitative, descriptive-analytical, and cross-sectional study. The sample was intentional and non-probabilistic and consisted of 158 participants, with a 0.50 "power of effect" (moderate size effect) and a 99.9% confidence level. A link was made available on social media with an invitation to participate in the online survey. Most participants were adult, female, black/mixed-race, with a high level of education, and reported a perceived worsening in monthly income, physical and mental health, and in the self-perception of their lives after the relocation of their homes. Most participants had depressive symptoms (87.34%), moderate and severe anxiety (55.7%), and positive screening for common mental disorders (77.22%). By analyzing the current perception of the changes in the lives of former residents before and after being relocated due to the ground instability, it was identified that, after relocation, those with greater psychiatric demand and suicidal ideation had a higher prevalence of depressive symptoms, symptoms of severe anxiety, and positive screening for common mental disorders. This research highlights the importance of elaborating policies, strategies and actions to prevent impacts on mental health, recovery, and health rehabilitation in scenarios of socio-environmental disasters. Implementing preventive measures and offering adequate psychological and social support can reduce the detrimental effects of such disasters on the affected population.


Este estudo tem como objetivo investigar indícios de adoecimento mental em vítimas da instabilidade do solo nos bairros afetados pela extração de sal-gema de uma mineradora localizada na cidade de Maceió, Alagoas, Brasil. É um estudo quantitativo, descritivo-analítico e transversal. A amostra foi intencional e não probabilística e consistiu em 158 participantes, com "poder de efeito" de 0,50 (efeito de tamanho moderado) e nível de confiança de 99,9%. Foi disponibilizado um link em redes sociais com convite para participar da pesquisa online. A maioria dos participantes era adulta, do sexo feminino, preta/parda, elevado nível de escolaridade e relatou piora percebida na renda mensal, na saúde física e mental e na forma como veem sua vida após a realocação de suas residências. A maioria dos participantes apresentou sintomas depressivos (87,34%), ansiedade moderada e grave (55,7%) e rastreio positivo para transtornos mentais comuns (77,22%). Ao analisar a percepção atual das mudanças que aconteceram na vida dos ex-moradores antes e após serem realocados devido à instabilidade do solo, identificou-se que, após a realocação, aqueles com maior demanda psiquiátrica e ideação suicida apresentaram prevalência mais elevada para sintomas depressivos, sintomas de ansiedade grave e rastreio positivo para transtornos mentais comuns. Esta pesquisa destaca a importância de se pensar em políticas, estratégias e ações de prevenção dos impactos na saúde mental, na recuperação e na reabilitação da saúde em cenários de desastres socioambientais. Implementar medidas preventivas e oferecer suporte psicológico e social adequado pode reduzir os efeitos prejudiciais desses desastres sobre as pessoas afetadas.


El estudio tiene como objetivo investigar la presencia de enfermedades mentales en víctimas de la inestabilidad del suelo en barrios afectados por la extracción de sal de roca de una empresa minera ubicada en la ciudad de Maceió, Alagoas, Brasil. Se trata de un estudio cuantitativo, descriptivo-analítico y transversal. La muestra fue intencional y no probabilística y estuvo compuesta por 158 participantes, con un "poder del efecto" de 0,50 (efecto de tamaño moderado) y un nivel de confianza del 99,9%. Se facilitó un enlace en las redes sociales con una invitación a participar en la encuesta en línea. La mayoría de los participantes era adulto, mujer, negra/parda, con un alto nivel de educación y reportaron percibir un empeoramiento en sus ingresos mensuales, en su salud física y mental y en la forma en que ven sus vidas después de reubicar sus hogares. La mayoría de los participantes presentó síntomas depresivos (87,34%), ansiedad moderada y severa (55,7%) y detección positiva de trastornos mentales comunes (77,22%). Al analizar la percepción actual de los cambios que se produjeron en la vida de los exresidentes antes y después de ser reubicados debido a la inestabilidad del suelo, se identificó que tras la reubicación, aquellos con mayores demandas psiquiátricas e ideación suicida tuvieron mayor prevalencia de síntomas depresivos, síntomas de ansiedad severa y detección positiva de trastornos mentales comunes. Esta investigación resalta la importancia de pensar políticas, estrategias y acciones para prevenir impactos en la salud mental, recuperación y rehabilitación de la salud en escenarios de desastres socioambientales. Implementar medidas preventivas y ofrecer apoyo psicológico y social adecuado puede reducir los efectos nocivos de estos desastres en las personas afectadas.


Subject(s)
Mental Disorders , Mining , Socioeconomic Factors , Humans , Female , Brazil/epidemiology , Cross-Sectional Studies , Male , Adult , Middle Aged , Mental Disorders/epidemiology , Mental Disorders/psychology , Young Adult , Sociodemographic Factors , Depression/psychology , Depression/epidemiology , Prevalence , Surveys and Questionnaires
4.
Epidemiol Serv Saude ; 33(spe2): e20231310, 2024.
Article in English, Portuguese | MEDLINE | ID: mdl-39699472

ABSTRACT

OBJECTIVE: To analyze vaccination coverage up to 24 months of age according to race/ skin color in the 2017-2018 live birth cohort in Natal, Rio Grande do Norte, Brazil. METHODS: Population-based survey conducted in 2020 and 2021. Vaccination coverage up to 24 months of age was estimated according to administered, valid and timely doses. Crude association of race/skin color was estimated by calculating the crude Prevalence Ratio and respective 95% Confidence Intervals, using Poisson regression. RESULTS: Of the 688 children in the selected cohort, there was greater coverage among Black children for administered doses (White 30.5%; Black 47.8%; 95%CI) and valid doses (White 25.8%; Black 40.1%; 95%CI), although without statistical significance, and lower coverage for timely doses, in the full schedule excluding yellow fever (PR = 0.21; 95%CI 0.04;0.90). CONCLUSION: There was lower timely coverage among Black children compared to White children. MAIN RESULTS: It was found that racial inequalities and social disparities were reflected in vaccination coverage of Black children in the state of Rio Grande do Norte, showing lower prevalence of timely and full vaccination schedules among those children. IMPLICATIONS FOR SERVICES: The results demonstrate the need to strengthen equitable public policies and the implementation of practices that seek to improve vaccination coverage, thus reducing racial inequalities in child immunization. PERSPECTIVES: Health service managers will be able to plan actions and strategies in childhood immunization services, in order to increase vaccination coverage and reduce vaccination hesitancy among Black people and people from lower socioeconomic strata.


Subject(s)
Black People , Vaccination Coverage , Vaccination , White People , Humans , Brazil , Vaccination Coverage/statistics & numerical data , Infant , Male , Female , White People/statistics & numerical data , Black People/statistics & numerical data , Vaccination/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Child, Preschool , Skin Pigmentation , Infant, Newborn , Cohort Studies , Socioeconomic Factors , Birth Cohort
5.
Cad Saude Publica ; 40(10): e00088123, 2024.
Article in Portuguese | MEDLINE | ID: mdl-39504059

ABSTRACT

Hospitalization costs due to cardiovascular diseases are high. In 2019, for Bahia State, Brazil, alone, they exceeded BRL 153 million for the Brazilian Unified National Health System, surpassing the costs of cancer hospitalizations. This fact will show an upward trend with the increase in life expectancy in Brazil (7.3 years more by 2060). Introducing new technologies can mitigate the problem. This study analyzes the impact of telediagnostics in electrocardiogram on hospitalizations for cardiovascular diseases in 326 municipalities in Bahia from 2014 to 2020. Diff-in-diff estimator method was used for analysis of the periods before and after the implementation of telediagnostics in Bahia. Results show that the municipalities which introduced the new technology reduced cardiovascular diseases hospitalizations by 6 for each additional year. In the case of families benefiting from the Brazilian Income Transfer Program, the reduction was 3.26 hospitalizations, and 3.08 among municipalities with the specialized service. Hospitalization increase by 7.66 in the 30 to 59 age group and by 5.34 among men for each additional year. Results show a reduction of 1.15 hospitalizations for rheumatologic heart diseases and 1.39 among diabetic people. In terms of ethnicity/color, underreporting was identified in the conditions studied, resulting in more severe prognoses for blacks. Telediagnostics was effective in reducing this inequality by expanding access and reducing hospitalizations, playing a crucial role in public health and impacting mortality reduction. The theme, therefore, deserves further studies with different samples and sample periods.


Os gastos com internações por doenças do aparelho circulatório são elevados: em 2019, apenas para o Estado da Bahia, Brasil, excederam 153 milhões de reais para o Sistema Único de Saúde, superando os custos de internações por câncer. Esse fato tende a se acentuar com o aumento da expectativa de vida no Brasil (7,3 anos a mais até 2060). A introdução de novas tecnologias pode mitigar o problema. Este estudo analisa o impacto da utilização do telediagnóstico em eletrocardiograma nas internações por doenças cardiovasculares, em 326 municípios baianos durante o período de 2014 a 2020. O método de estimador diff-in-diff foi utilizado para a análise entre os períodos anterior e posterior à implantação do serviço no estado. Os resultados mostram que os municípios que introduziram a nova tecnologia reduziram em seis internações por doenças cardiovasculares a cada ano adicional. No caso das famílias beneficiadas pelo Bolsa Família, a redução foi de 3,26 internações, e de 3,08 entre os municípios com o serviço especializado. Verificou-se um aumento de 7,66 internações na faixa etária de 30 a 59 anos e um aumento de 5,34 entre homens, a cada ano adicional. Os resultados evidenciam uma redução de 1,15 internações por doenças cardíacas reumatológicas e de 1,39 entre as pessoas diabéticas. No quesito raça/cor, foi identificada subnotificação nas condições estudadas, resultando em prognósticos mais severos para a população preta. A tecnologia mostrou-se eficaz para reduzir essa desigualdade, ao expandir o acesso e reduzir as internações, tendo um papel crucial na saúde coletiva e impactando na redução da mortalidade. O tema, portanto, é merecedor de mais estudos, com amostras e períodos amostrais diferentes.


Los costos de las hospitalizaciones por enfermedades del sistema circulatorio son elevados: en el 2019, solo para el Estado de Bahía, Brasil, superaron los BRL 153 millones para el Sistema Único de Salud, superando los costos de las hospitalizaciones por cáncer. Este hecho tiende a acentuarse con el aumento de la esperanza de vida en Brasil (7,3 años más hasta el 2060). La introducción de nuevas tecnologías puede mitigar este problema. Este estudio analiza el impacto del uso del telediagnóstico por electrocardiograma en las hospitalizaciones por enfermedades cardiovasculares en 326 municipios de Bahía durante el período de 2014-2020. Para el análisis entre los períodos anterior y posterior a la implementación del servicio en el Estado, se utilizó el método de estimador diff-in-diff. Los resultados muestran que los municipios que introdujeron la nueva tecnología redujeron las hospitalizaciones por enfermedades cardiovasculares en 6 cada año adicional. En el caso de las familias beneficiarias del Bolsa Familia, la reducción fue de 3,26 hospitalizaciones y de 3,08 entre los municipios con servicio especializado. Se constató un aumento de 7,66 hospitalizaciones en el rango de edad de 30 a 59 años y un aumento de 5,34 entre hombres, por cada año adicional. Los resultados muestran una reducción de 1,15 hospitalizaciones por cardiopatías reumatológicas y de 1,39 entre personas diabéticas. En términos de raza/color, se identificó una infranotificación en las condiciones estudiadas, lo que resultó en pronósticos más severos para la población negra. La tecnología ha demostrado ser eficaz para reducir esta desigualdad, al ampliar el acceso y reducir las hospitalizaciones, desempeñando un papel crucial en la salud colectiva e impactando en la reducción de la mortalidad. El tema, por lo tanto, merece más estudios, con diferentes muestras y períodos muestrales.


Subject(s)
Cardiovascular Diseases , Hospitalization , Humans , Brazil/epidemiology , Cardiovascular Diseases/diagnosis , Hospitalization/statistics & numerical data , Male , Female , Middle Aged , Adult , Telemedicine/statistics & numerical data , Electrocardiography , Socioeconomic Factors , Aged , Young Adult , National Health Programs , Cities
6.
Ethn Dis ; 34(4): 221-229, 2024 Oct.
Article in English | MEDLINE | ID: mdl-39463812

ABSTRACT

Objective: To assess the absence of diabetic foot examination in Brazil and how ethnicity affected this outcome. Design: This is an analysis of a nationwide survey held in Brazil in 2019. Participants with diabetes and that were 15 years of age or older were eligible for inclusion in the analysis. Adjusted Poisson regression with robust variance was used to calculate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) of never having had the foot examined, with separate models according to ethnicity. Stata 14.2 was used for all calculations. Results: We included 6216 individuals with diabetes; 52.1% (95%CI: 50.0%-54.2%) reported never having had their feet examined by a health care professional and 61% self-declared as Black (Black and Brown [Brazilian mixed race]). A higher frequency of negligence was observed among Black individuals (55.3%; 52.5%-58.1%) than among White individuals (48.2%; 45.0%-51.5%). Negligence was higher between 15- to 39-year-old participants (PR = 1.34, 1.14-1.57), lower educational level (PR = 1.37, 1.13-1.65), higher alcohol consumption (PR = 1.18, 1.06-1.31), fair health status (PR = 1.11, 1.01-1.21), and diabetes diagnosis of up to 10 years (PR = 1.42, 1.28-1.57). Among Blacks, tobacco use and other factors increased the frequency of the outcome, whereas participation in the Brazilian Unified Health System primary care program was a protection factor (P<.05). Conclusion: Black Brazilians with diabetes had higher negligence of foot examination by health care professionals. Strengthening primary care would help mitigate systemic racism in Brazil.


Subject(s)
Diabetic Foot , Humans , Brazil/epidemiology , Female , Male , Adult , Middle Aged , Diabetic Foot/ethnology , Adolescent , Young Adult , Healthcare Disparities/ethnology , Aged , White People/statistics & numerical data , Physical Examination/statistics & numerical data , Surveys and Questionnaires , Diabetes Mellitus/ethnology , Diabetes Mellitus/epidemiology , Black People/statistics & numerical data , Prevalence
7.
Rev Bras Epidemiol ; 27: e240050, 2024.
Article in English, Portuguese | MEDLINE | ID: mdl-39417472

ABSTRACT

OBJECTIVE: To describe the sociodemographic, socio-occupational profile, and effects on the health of artisanal fishers from the state of Pernambuco, Brazil, affected by the oil disaster-crime in Brazil in 2019. METHODS: This is a cross-sectional epidemiological study, carried out in 16 municipalities on the coast of Pernambuco, with a sample made up of 1,259 artisanal fishers. A questionnaire containing 14 blocks was used, including socioeconomic issues, exposure to oil, among others. A descriptive analysis was carried out with calculation of simple frequencies and percentages. RESULTS: Of those interviewed, 95.1% considered fishing as their main occupation and 97% were carrying out this activity. Among fishers, the most common fishing spot was the mangrove, and wood fire was used in the work process by around 60% of the population. Regarding health issues, 34.4% reported a severe headache or migraine and 28.2% reported burning eyes, within one to three months after the oil spill. CONCLUSION: According to the results, working, health, and lifestyle conditions were impacted by the oil disaster-crime. Further research should be carried out to better understand the damage caused by exposure to oil and its effects on the health of fishers. Observing the profile of people who live in artisanal fishing territories in Pernambuco is paramount for public policies and government actions that promote safe and sustainable territories.


Subject(s)
Occupational Exposure , Petroleum Pollution , Socioeconomic Factors , Humans , Brazil/epidemiology , Cross-Sectional Studies , Male , Female , Adult , Middle Aged , Petroleum Pollution/adverse effects , Occupational Exposure/adverse effects , Occupational Exposure/statistics & numerical data , Fisheries , Surveys and Questionnaires , Young Adult , Occupational Diseases/epidemiology , Occupational Health , Disasters , Adolescent
8.
Cien Saude Colet ; 29(10): e11762023, 2024 Oct.
Article in Portuguese, English | MEDLINE | ID: mdl-39292046

ABSTRACT

This article aims to analyze the consumption of healthy food consumption markers, according to racial groups of Brazilian women interviewed in the 2019 National Health Survey (NHS). This work was a cross-sectional study with data from 45,148 white and black women, aged ≥ 20 years. The variables used were the consumption of fruits, vegetables and legumes, beans, and fish. The association between color/race and the dietary intake indicators was tested using crude Poisson regression and adjusted to estimate prevalence ratios and 95% confidence intervals (95%CI). The prevalence of the consumption of fruits and vegetables was statistically higher among white women, while fish and beans was higher among black women. After adjusting for socioeconomic and demographic variables, it was found that black women remained only less likely to consume fruit (PR = 0.91; 95% CI: 0.88-0.95) and only more likely to consume beans (PR = 1.07; 95% CI: 1.04-1.10) than whites. There were racial inequalities for the consumption of healthy foods among Brazilian women, indicating that color/race defined a dietary pattern for black women that put them in vulnerable conditions in terms of fruit consumption.


O objetivo do artigo é analisar o consumo de alimentos marcadores de uma alimentação saudável, segundo os grupos raciais de mulheres brasileiras entrevistadas na Pesquisa Nacional de Saúde 2019. Estudo transversal com dados de 45.148 mulheres brancas e negras de ≥ 20 anos de idade. Os marcadores utilizados foram o consumo de frutas, verduras e legumes e feijão e peixe. A associação de cor/raça com os indicadores de consumo alimentar foi testada por regressão de Poisson bruta e ajustada para estimar razões de prevalência e intervalo de confiança de 95%. A prevalência do consumo de frutas, verduras e legumes foi estatisticamente maior nas brancas, e o de peixes e feijão foi maior nas negras. Após o ajuste pelas variáveis socioeconômicas e demográficas, verificou-se que mulheres negras permaneceram apresentando menores chances apenas de consumir frutas (RP = 0,91; IC95%: 0,88-0,95) e maior somente de consumir feijão (RP = 1,07; IC95%: 1,04-1,10) do que as brancas. Verificaram-se desigualdades raciais para o consumo de alimentos saudáveis entre mulheres brasileiras, indicando que a cor/raça definiu um padrão alimentar para as mulheres negras que as colocam em condições vulneráveis em grande parte do consumo de frutas.


Subject(s)
Black People , Diet, Healthy , White People , Humans , Brazil , Female , Cross-Sectional Studies , Adult , Middle Aged , Young Adult , Diet, Healthy/statistics & numerical data , Black People/statistics & numerical data , White People/statistics & numerical data , Health Surveys , Socioeconomic Factors , Feeding Behavior , Fruit , Vegetables , Aged
9.
Cad Saude Publica ; 40(8): e00241022, 2024.
Article in Portuguese | MEDLINE | ID: mdl-39292136

ABSTRACT

This study aimed to measure access to medicines for the treatment of systemic arterial hypertension and type 2 diabetes mellitus in Brazil according to the mode of acquisition, as well as to analyze the factors associated with this access, based on data from the 2019 Brazilian National Survey of Health (PNS, acronym in Portuguese). Socioeconomic data and data related to the use of medicines by people aged 15 and over were analyzed in relation to access via the Brazilian Popular Pharmacy Program (PFPB, acronym in Portuguese) and via public services. The majority of Brazilians who took part in the PNS reported using medication to control hypertension in the previous 15 days (91.5%) and using oral medication for diabetes (95.2%) and/or insulin (70%). Most participants obtained oral medication for hypertension and type 2 diabetes mellitus via PFPB (45.2% and 53.6%, respectively), and the factors that most negatively influenced this access were older age, lower income, lower schooling, very poor self-rated health and not having private health insurance. Access to insulin, on the other hand, was most often via the public health service (69.7%), and the factors that most negatively influenced this access were black/mixed-race skin color, lower income, very poor self-rated health and not having private health insurance. Generally, the importance of the PFPB as a policy to increase access to essential medicines in Brazil was highlighted, considering the free supply of antihypertensive and antidiabetic drugs.


Este estudo objetivou mensurar o acesso aos medicamentos para o tratamento da hipertensão arterial sistêmica e diabetes mellitus tipo 2 no Brasil segundo a via de obtenção, bem como analisar os fatores associados a esse acesso, de acordo com os dados da Pesquisa Nacional de Saúde (PNS) de 2019. Foram analisados dados socioeconômicos e relacionados ao uso de medicamentos de pessoas de 15 anos ou mais, em relação ao acesso via Programa Farmácia Popular do Brasil (PFPB) e via serviço público. A maior parte dos brasileiros que participaram da PNS referiu fazer uso do medicamento para controle da hipertensão, nos últimos 15 dias (91,5%), assim como a maior parte referiu fazer uso de medicamento oral para diabetes (95,2%) e/ou uso da insulina (70%).Os medicamentos orais para hipertensão arterial sistêmica e diabetes mellitus tipo 2 foram obtidos majoritariamente via PFPB, sendo respectivamente (45,2% e 53,6%), e os fatores que mais influenciaram negativamente esse acesso foram maior faixa etária, menor renda, menor escolaridade, não ter plano de saúde e referir uma autoavaliação de saúde muito ruim. O acesso à insulina, por sua vez, se deu com maior frequência via serviço público de saúde (69,7%), e os fatores que mais influenciaram negativamente esse acesso foram raça preta/parda, menor renda, não ter plano de saúde e referir uma autoavaliação de saúde muito ruim. De forma geral, foi evidenciada a importância do PFPB como política de ampliação de acesso a medicamentos essenciais no Brasil, considerando a gratuidade dos anti-hipertensivos e antidiabéticos.


Este estudio tuvo como objetivo medir el acceso a los medicamentos para el tratamiento de la hipertensión arterial sistémica y de la diabetes mellitus tipo 2 en Brasil según la vía de obtención, además de analizar los factores asociados a este acceso, según datos de la Encuesta Nacional de Salud (PNS) de 2019. Se analizaron datos socioeconómicos y relacionados con el uso de medicamentos de personas de 15 años o más, con relación al acceso por medio del Programa Farmacia Popular de Brasil (PFPB) y por medio del servicio público. La mayor parte de los brasileños que participaron en la PNS refirió utilizar medicamentos para controlar la hipertensión, en los últimos 15 días (91,5%), así como la mayoría refirió el uso de medicamentos orales para la diabetes (95,2%) o uso de insulina (70%). Los medicamentos orales para hipertensión arterial sistémica y diabetes mellitus tipo 2 se obtuvieron en su mayoría por medio del PFPB, respectivamente (45,2% y 53,6%), y los factores que influyeron de forma más negativa en este acceso fueron mayor rango de edad, menores ingresos, menor escolaridad, no tener seguro de salud y reportar una autoevaluación de salud muy mala. El acceso a la insulina, a su vez, se produjo con mayor frecuencia por medio del servicio público de salud (69,7%), y los factores que influyeron de forma más negativa en este acceso fueron la raza negra/morena, menores ingresos, no tener plan de salud y reportar una autoevaluación de salud muy mala. En general, se destacó la importancia de la PFPB como política de ampliación del acceso a medicamentos esenciales en Brasil, considerando la gratuidad de los antihipertensivos y antidiabéticos.


Subject(s)
Diabetes Mellitus, Type 2 , Health Services Accessibility , Hypertension , Socioeconomic Factors , Humans , Brazil , Diabetes Mellitus, Type 2/drug therapy , Hypertension/drug therapy , Health Services Accessibility/statistics & numerical data , Male , Middle Aged , Adult , Female , Adolescent , Young Adult , Hypoglycemic Agents/therapeutic use , Health Surveys , Aged , Antihypertensive Agents/therapeutic use , Antihypertensive Agents/supply & distribution , Sociodemographic Factors
10.
Epidemiol Serv Saude ; 33(spe2): e20231216, 2024.
Article in English, Portuguese | MEDLINE | ID: mdl-39194084

ABSTRACT

OBJECTIVE: To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. METHODS: Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. RESULTS: 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. CONCLUSION: There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil. MAIN RESULTS: Marked racial inequalities were found in the obstacles to vaccination of children under 24 months in Brazil and to timely vaccination at 5 months and in the first year of life. IMPLICATIONS FOR SERVICES: Racial inequalities in the occurrence of vaccination shortcomings in health services, in the objective restrictions faced by families in taking their children to vaccination centers and in incomplete vaccination in a timely manner need to be addressed by the Brazilian National Health System. PERSPECTIVES: Equal public policies to address barriers to vaccination and qualification of health services need to be implemented. Studies need to deepen understanding of the structural determinants that lead to racial disparities.


Subject(s)
Healthcare Disparities , Mothers , Vaccination , Humans , Brazil , Infant , Vaccination/statistics & numerical data , Female , Retrospective Studies , Healthcare Disparities/statistics & numerical data , Mothers/statistics & numerical data , Child, Preschool , Male , Vaccination Coverage/statistics & numerical data , Infant, Newborn , Adult , Cohort Studies , Socioeconomic Factors , Black People/statistics & numerical data , Time Factors , Immunization Programs/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Young Adult , White People/statistics & numerical data
11.
Cien Saude Colet ; 29(9): e10582024, 2024 Sep.
Article in Portuguese, English | MEDLINE | ID: mdl-39194112

ABSTRACT

The objective was to analyze the spatial distribution of pregnancy in children under 14 years and six months by Brazilian region and municipality and sociodemographic and health characteristics of pregnant women and live births. Ecological study analyzing the Live Birth Information System (SINASC) from 2011 to 2021 in three age groups (< 14 years and six months, 15-19 years, and 20 years and above) by demographic and birth variables. We applied the Global and Local Moran. A total of 127,022 live births to girls aged 10-14 years were identified during the period, most of whom were Black, 21.1% in common-law or married relationships, with a lower proportion of seven prenatal care appointments and enrollment in the first trimester, a higher proportion of low birth weight and low Apgar score, residing in the North and Northeast. The mean live birth rate for 10-to-14-year-old girls was significantly autocorrelated with space, especially in municipalities of the Midwest and North. Pregnancy from 10 to 14 years of age reveals several vulnerabilities suffered by these girls due to pregnancy at an early age, which is more common among Black women, with implications for morbimortality for them and their children and the presumed violence in these cases, including denied access to legal abortion.


O objetivo foi analisar a distribuição espacial da gravidez em menores de 14 anos e seis meses segundo regiões e municípios brasileiros e características sociodemográficas e de saúde das parturientes e nascidos vivos. Estudo ecológico, analisando o Sistema de Informação sobre Nascidos Vivos (SINASC), 2011-2021, em três grupos etários (<14 anos e 6 meses, 15-19 e 20 anos e mais), segundo variáveis demográficas e do parto. Foram aplicados os Índices Global e Local de Moran. No período foram 127.022 nascidos vivos de meninas 10-14 anos, na maioria negras, 21,1% em união estável ou casadas, com menor proporção de 7 consultas de pré-natal e captação no primeiro trimestre, maior proporção de baixo peso ao nascer e baixo índice de Apgar, residentes nas regiões Norte e Nordeste. A taxa média de nascidos vivos de 10-14 anos mostrou autocorrelação significativa com o espaço, especialmente em municípios do Centro-Oeste e Norte. A gravidez de 10 a 14 revela uma sequência de vulnerabilidades sofridas por essas meninas, pela gravidez em idade precoce, maior frequência entre negras, com implicações na morbimortalidade para ela e seus filhos; e pela violência presumida nesses casos, incluindo o acesso negado ao aborto legal.


Subject(s)
Live Birth , Prenatal Care , Spatial Analysis , Humans , Brazil , Female , Pregnancy , Adolescent , Child , Young Adult , Prenatal Care/statistics & numerical data , Infant, Low Birth Weight , Pregnancy in Adolescence/statistics & numerical data , Infant , Infant, Newborn , Birth Rate/trends , Age Factors , Apgar Score , Black People/statistics & numerical data , Socioeconomic Factors
12.
Cien Saude Colet ; 29(9): e09952023, 2024 Sep.
Article in Portuguese, English | MEDLINE | ID: mdl-39194111

ABSTRACT

This article aims to know the perception of women on obstetric violence from a racial perspective. This was a qualitative study carried out in a public maternity hospital with 25 women in the city of Salvador, Bahia, Brazil. Data were collected through semi-structured interviews and participant observation from November 2021 to February 2022. Content analysis was used to organize the data obtained through the interviews. The results were analyzed through the theoretical contributions of intersectionality, focusing on the interaction between obstetric violence and obstetric racism. The narratives discuss issues of obstetric violence, institutional racism, and how these experiences are permeated by issues of race, gender, and class. Questions related to the feelings of these women regarding the experience of violence at the time of childbirth care were also highlighted. Obstetric racism denies reproductive rights and hinders access to respectful and equitable care for black women.


O objetivo deste artigo é conhecer a percepção de mulheres sobre a violência obstétrica em uma perspectiva racial. Trata-se de uma pesquisa qualitativa realizada em uma maternidade pública, com 25 mulheres, no município de Salvador, Bahia, Brasil. Os dados foram coletados por meio de entrevistas semiestruturadas e observação participante, no período de novembro de 2021 a fevereiro de 2022. Utilizou-se, para organização dos dados obtidos através das entrevistas, a análise de conteúdo. Os resultados foram analisados através das contribuições teóricas da interseccionalidade, tendo como foco a interação entre violência obstétrica e racismo obstétrico. As narrativas discorrem sobre questões da violência obstétrica, racismo institucional, e como essas vivências são permeadas pelas questões de raça, gênero e classe. Foram apontadas também questões relacionadas aos sentimentos dessas mulheres frente a vivência da violência no momento da assistência ao parto. O racismo obstétrico nega os direitos reprodutivos e dificulta o acesso a uma assistência respeitosa e equânime as mulheres negras.


Subject(s)
Qualitative Research , Racism , Violence , Adult , Female , Humans , Pregnancy , Young Adult , Brazil , Delivery, Obstetric/psychology , Health Services Accessibility , Hospitals, Maternity , Interviews as Topic , Racism/psychology , Reproductive Rights , Violence/ethnology , Black People/psychology , Obstetrics
13.
Cad Saude Publica ; 40(7): e00139323, 2024.
Article in Portuguese | MEDLINE | ID: mdl-39194138

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.


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.


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.


Subject(s)
COVID-19 , Global Health , Noncommunicable Diseases , Sustainable Development , Humans , Noncommunicable Diseases/prevention & control , Noncommunicable Diseases/epidemiology , Sustainable Development/trends , Brazil , COVID-19/epidemiology , COVID-19/prevention & control , Pandemics/prevention & control , SARS-CoV-2
14.
Viruses ; 16(8)2024 Aug 13.
Article in English | MEDLINE | ID: mdl-39205264

ABSTRACT

This study aimed to describe the prevalence of HTLV-1/2 in quilombola communities in the state of Pará and investigate the possible sociodemographic risk factors associated with the infection, as well as to trace the occurrence of the familial transmission of the virus. A total of 310 individuals living in eight quilombos located in the state of Pará (northern Brazil) were investigated for the presence of anti-HTLV-1/2 antibodies using an enzyme-linked immunosorbent assay (ELISA), and positive samples were confirmed using Western blot and/or real-time quantitative polymerase chain reaction (qPCR). Participants answered a questionnaire about sociodemographic aspects and risk factors for infection. Anti-HTLV-1/2 antibodies were detected in two individuals (one man and one woman), for an overall seroprevalence of 0.65%. Both individuals belonged to the community of São José de Icatú. The search for intrafamilial infection identified two other infected women, which increased the general prevalence of HTLV-1 among the Icatú to 6.25% (4/64). Western blot and qPCR confirmed their HTLV-1 infection, and phylogenetic analysis demonstrated that the isolates were of the cosmopolitan subtype and transcontinental subgroup. Epidemiological investigation of the cases revealed that the three women, at some point in their lives, had a relationship with the infected male individual. HTLV-1 is transmitted silently between individuals in the community of São José de Icatú with a present or past family relationship, stressing the need for screening and laboratory diagnosis to prevent further dissemination of the virus and surveillance of disease emergence.


Subject(s)
HTLV-I Infections , Human T-lymphotropic virus 1 , Phylogeny , Humans , Brazil/epidemiology , Female , Male , HTLV-I Infections/epidemiology , HTLV-I Infections/transmission , HTLV-I Infections/virology , Adult , Human T-lymphotropic virus 1/genetics , Human T-lymphotropic virus 1/isolation & purification , Human T-lymphotropic virus 1/classification , Human T-lymphotropic virus 1/immunology , Middle Aged , Seroepidemiologic Studies , Young Adult , Risk Factors , Prevalence , Adolescent , Black People , Aged , Human T-lymphotropic virus 2/genetics , Human T-lymphotropic virus 2/isolation & purification , Human T-lymphotropic virus 2/immunology
15.
Int J Artif Organs ; 47(6): 373-379, 2024 Jun.
Article in English | MEDLINE | ID: mdl-39086128

ABSTRACT

BACKGROUND/OBJECTIVE: A high prevalence of fatigue and a positive association between fatigue and post-hemodialysis recovery have been reported in predominantly white populations of maintenance hemodialysis (MHD) patients. The present study evaluates associations between self-reported fatigue by the 11-item Chalder Fatigue Questionnaire (CFQ-11) and the need for post-hemodialysis recovery in a predominantly African-descent MHD population. METHODS: A total of 233 patients (94% Black or Mixed-Race) participating in the "Prospective Study of the Prognosis of Patients on Maintenance Hemodialysis" (PROHEMO), Salvador, Brazil were recruited for this cross-sectional study. The CFQ-11 was used to measure fatigue: <4 for absent or mild, ⩾4 for moderate to severe. Patients were also asked if they needed some time to recover after the hemodialysis. Logistic regression was used to estimate odds ratio (OR) of the association with adjustments for age, sex, race, educational level, economic class level, diabetes, hearth failure, and hemoglobin. RESULTS: Mean age was 51.5 ± 12.5 years. Moderate to severe fatigue (⩾4 points) was observed in 70.8% (165/233), and absent or mild fatigue (<4 points) in 29.2% (68/233). Compared to patients with fatigue scores <4 (20.6%), the need for post-hemodialysis recovery was 2.5 times greater in patients with fatigue scores ⩾4 (52.7%). The covariate-adjusted logistic regression OR was 4.60, 95% CI: 2.27, 9.21. CONCLUSION: This study in MHD patients of predominantly African descent supports self-reported fatigue assessed by the CFQ-11 as a relevant predictor of the need for post-hemodialysis recovery. The results offer a rationale for investigating whether interventions to prevent fatigue reduce the need of post-hemodialysis recovery.


Subject(s)
Fatigue , Renal Dialysis , Humans , Male , Female , Middle Aged , Fatigue/physiopathology , Cross-Sectional Studies , Adult , Brazil/epidemiology , Surveys and Questionnaires , Black People/statistics & numerical data , Prospective Studies , Aged , Prevalence , Recovery of Function , Treatment Outcome
16.
Cien Saude Colet ; 29(7): e02992024, 2024 Jul.
Article in Portuguese, English | MEDLINE | ID: mdl-38958316

ABSTRACT

This article aims to understand the view of racial equity and the motivations for approaching the health of the black population in Collective Health, Nursing, and Medicine courses at a Brazilian public university, guided by the black perspective of decoloniality. Considering Institutional Racism, it is necessary to invest in the interfaces between the education and health sectors in the training of professionals for the Unified Health System. This is a qualitative study with an intervention-research approach, affirming a social and political commitment to transforming reality. Workshops were held with representatives of the Structuring Teaching Centers of the selected courses. The theme of the health of the black population has been elaborated in a prompt and decontextualized manner, with no reflection based on structural racism, power relations, and Brazilian socio-historical formation. This creates a distance from the guidelines proposed by the National Policy for Comprehensive Health of the Black Population. At the end of this article, perspectives are identified for the reorientation of health training, aimed at increasing democratic density and racial equity.


Este artigo objetiva compreender a visão de equidade racial e as motivações para a abordagem da saúde da população negra na formação dos cursos de Saúde Coletiva, Enfermagem e Medicina de uma universidade pública brasileira, orientado na perspectiva negra da decolonialidade. Considerando o Racismo Institucional, é preciso investir nas interfaces entre os setores educação e saúde na formação de profissionais para o Sistema Único de Saúde. Trata-se de estudo de natureza qualitativa com abordagem do tipo pesquisa-intervenção, afirmando um compromisso social e político de transformação da realidade. Para tanto, foram realizadas oficinas com representantes dos Núcleos Docentes Estruturantes dos cursos selecionados. A temática da saúde da população negra tem sido trabalhada de forma pontual e descontextualizada, sem uma reflexão do racismo estrutural, das relações de poder e da formação socio-histórica brasileira, o que se distancia das diretrizes propostas pela Política Nacional de Saúde Integral da População Negra. Ao final, são sinalizadas perspectivas para a reorientação da formação em saúde, visando ao aumento da densidade democrática e da equidade racial.


Subject(s)
Black People , Racism , Humans , Brazil , Health Policy , Health Equity , Delivery of Health Care/organization & administration , Universities , Qualitative Research
17.
Cien Saude Colet ; 29(7): e04352024, 2024 Jul.
Article in Portuguese, English | MEDLINE | ID: mdl-38958330

ABSTRACT

This essay elucidates the Healthcare and Intersectionality notions to prompt reflections on the interaction between healthcare professionals and individuals referred to as Nanás: elderly, poor, and Black women who represent a historically marginalized profile throughout Brazilian history. By delving into the arguments about the concept of Intersectionality and the multifaceted Care dimensions, it becomes apparent that there is a pressing need to broaden the perspective on women who access healthcare services, as they are inherently shaped by their life experiences. Moreover, it is imperative to acknowledge how the intersecting factors inherent in their profiles can influence the approach taken by those providing Care, which underscores the essentiality of an intersectional agency on the part of the agents involved in this encounter, namely the Nanás and healthcare workers, to effectively uphold the principles of comprehensiveness and equity within the Unified Health System (SUS).


O presente ensaio articula os conceitos de Cuidado em Saúde e Interseccionalidade para suscitar reflexões sobre o encontro entre o/a trabalhador/a de saúde e aquelas que aqui denominamos uma Naná: uma mulher, negra, idosa e periférica, perfil historicamente vulnerabilizado ao longo da história brasileira. Considerando as argumentações que envolvem o conceito de Interseccionalidade e as diferentes vertentes acerca do Cuidado, observamos a necessidade de se ampliar o olhar sobre estas que buscam os serviços de saúde já atravessadas por suas histórias de vida, e ponderar sobre os atravessamentos que seu perfil pode acionar em quem exerce o Cuidado. Aponta ser primordial uma agência interseccional por parte das/os agentes deste encontro, Nanás e profissionais de saúde, para que se concretizem os princípios de integralidade e equidade no Sistema Único de Saúde (SUS).


Subject(s)
Delivery of Health Care , Health Personnel , Humans , Brazil , Female , Delivery of Health Care/organization & administration , Health Personnel/psychology , Health Personnel/organization & administration , Aged , Black People/psychology , Poverty , Vulnerable Populations , National Health Programs/organization & administration , Health Services Accessibility , Healthcare Disparities
18.
Cad Saude Publica ; 40(7): e00103623, 2024.
Article in Portuguese | MEDLINE | ID: mdl-39082496

ABSTRACT

This study aimed to investigate the association between sociodemographic and behavioral factors and obesity from 2014 to 2021 in adults in São Paulo city, Brazil. A prospective study was carried out with 1,241 adults aged 18 years or above who lived in São Paulo and participated in the São Paulo Health Survey cohort (ISA) - Physical Activity and Environment. The outcome was obesity (yes/no), classified by body mass index and specific cut-off points for each age group. The exposure variables included sex, age, education, skin color, marital status, regional health coordination, physical activity in the four domains, and sedentary behaviors. Multilevel logistic regression models were used for longitudinal analysis. This study found a significant increase (27.7%) in the prevalence of obesity (from 22.6% to 28.9%). People who practiced at least 150 minutes of leisure-time physical activity per week (OR = 0.44; 95%CI: 0.26; 0.76), between 10 and 150 minutes per week of commuting physical activity (OR = 0.49; 95%CI: 0.30; 0.80), and had no partner (OR = 0.47; 95%CI: 0.28; 0.78) were less likely to be obese. People aged from 40 to 59 years (OR = 5.00; 95%CI: 2.02; 12.38) and who were black (OR = 4.70; 95%CI: 1.85; 11.95) were more likely to be obese. This study found an increase in the prevalence of obesity during the studied period, with increased odds for middle-aged and black people and decreased odds for those without a partner and those who practice physical activities in their leisure and as a form of commuting. These results can contribute to support programs and policies to control obesity.


O objetivo foi investigar a associação entre fatores sociodemográficos e comportamentais e a ocorrência da obesidade entre 2014 e 2021 em adultos da cidade de São Paulo, Brasil. Realizou-se estudo prospectivo com 1.241 adultos paulistanos, com 18 anos ou mais, participantes da coorte Inquérito de Saúde de São Paulo (ISA) - Atividade Física e Ambiente. O desfecho foi obesidade (sim/não), classificada por meio do índice de massa corporal e com pontos de corte específicos para cada faixa etária. As variáveis de exposição foram: sexo, idade, escolaridade, cor da pele, estado marital, coordenadoria regional de saúde, atividade física nos quatro domínios e comportamentos sedentários. Foram utilizados modelos de regressão logística multinível para a análise longitudinal. Houve aumento significativo de 27,7% na prevalência de obesidade (de 22,6% para 28,9%). Pessoas que praticavam ao menos 150 minutos semanais de atividade física no lazer (OR = 0,44; IC95%: 0,26; 0,76), entre 10 e 150 minutos semanais de atividade física de deslocamento (OR = 0,49; IC95: 0,30; 0,80) e sem companheiro(a) (OR = 0,47; IC95%: 0,28; 0,78) tiveram menos chances de ter obesidade. Pessoas entre 40 e 59 anos (OR = 5,00; IC95%: 2,02; 12,38) e de cor de pele preta (OR = 4,70; IC95%: 1,85; 11,95) apresentaram maiores chances de ter obesidade. O estudo identificou um aumento na prevalência de obesidade durante o período, com aumento nas chances para pessoas de meia idade e cor da pele preta, e diminuição nas chances para pessoas que vivem sem companheiro(a) e para praticantes de atividades físicas no lazer e como forma de deslocamento. Esses resultados podem contribuir para dar suporte a programas e políticas para o controle da obesidade.


El objetivo fue investigar la asociación entre factores sociodemográficos y conductuales y la presencia de la obesidad entre 2014 y 2021 en adultos de la ciudad de São Paulo, Brasil. Se realizó un estudio prospectivo con 1.241 adultos paulistanos, con 18 años o más, participantes de la cohorte Encuesta de Salud de São Paulo (ISA) - Actividad Física y Ambiente. El resultado fue obesidad (sí/no), clasificada a través del índice de masa corporal y con puntos de corte específicos para cada grupo de edad. Las variables de exposición fueron: sexo, edad, escolaridad, color de la piel, estado civil, coordinación regional de salud, actividad física en los cuatro dominios y comportamientos sedentarios. Para los análisis longitudinales se utilizaron modelos de regresión logística multinivel. Hubo un aumento significativo del 27,7% en la prevalencia de la obesidad (del 22,6% al 28,9%). Las personas que practicaron al menos 150 minutos semanales de actividad física por ocio (OR = 0,44; IC95%: 0,26; 0,76), entre 10 y 150 minutos semanales de actividad física de desplazamiento (OR = 0,49; IC95%: 0,30; 0,80) y sin compañero(a) (OR = 0,47; IC95%: 0,28; 0,78) tuvieron menos probabilidades de tener obesidad. Las personas entre 40 y 59 años (OR = 5,00; IC95%: 2,02; 12,38) y de color de piel negra (OR = 4,70; IC95%: 1,85; 11,95) presentaron mayores probabilidades de tener obesidad. El estudio identificó un aumento en la prevalencia de la obesidad durante ese período, con un aumento en las posibilidades para las personas de mediana edad y color de la piel negra, y una disminución en las posibilidades para las personas que viven sin pareja y para las que realizan actividades físicas por ocio y como forma de desplazamiento. Estos resultados pueden contribuir a apoyar los programas y políticas para el control de la obesidad.


Subject(s)
Exercise , Obesity , Sociodemographic Factors , Socioeconomic Factors , Humans , Obesity/epidemiology , Male , Adult , Female , Brazil/epidemiology , Middle Aged , Longitudinal Studies , Prevalence , Prospective Studies , Young Adult , Body Mass Index , Adolescent , Risk Factors , Sedentary Behavior , Aged , Health Surveys , Health Behavior
19.
Invest Educ Enferm ; 42(1)2024 Mar.
Article in English | MEDLINE | ID: mdl-39083822

ABSTRACT

Objective: To verify the association between reproductive autonomy and sociodemographic, sexual, and reproductive characteristics in Quilombola women (a term indicating the origin of politically organized concentrations of Afro-descendants who emancipated themselves from slavery). Methods: Cross-sectional and analytical study with 160 women from Quilombola communities in the southwest of Bahia, Brazil. Data were collected using the Reproductive Autonomy Scale and the questionnaire from the National Health Survey (adapted). Results: Out of the 160 participating women, 91.9% declared themselves as black, one out of every three were aged ≤ 23 years, 53.8% were married or had a partner, 38.8% had studied for ≤ 4 years, over half (58.1%) were unemployed, only 32.4% had a monthly income > R$ 430 (80 US dollars), 52.5% had their first menstruation at the age of 12, 70.7% had not accessed family planning services in the last 12 months, and over half used some method to avoid pregnancy (59.0%). The women had a high level of reproductive autonomy, especially in the "Decision-making" and "Freedom from coercion" subscales with a score of 2.53 and 3.40, respectively. A significant association (p<0.05) was found between the "Total reproductive autonomy" score and marital status, indicating that single or unpartnered women had higher autonomy compared to married or partnered women. Conclusion: The association of social determinants of health such as marital status, education, and age impacts women's reproductive choices, implying risks for sexual and reproductive health. The intergenerational reproductive autonomy of Quilombola women is associated with sociodemographic and reproductive factors.


Subject(s)
Personal Autonomy , Humans , Female , Brazil , Cross-Sectional Studies , Adult , Young Adult , Black People , Surveys and Questionnaires , Adolescent , Socioeconomic Factors , Middle Aged , Enslavement , Health Surveys , Sexual Behavior/statistics & numerical data , Family Planning Services , Sociodemographic Factors , Reproductive Behavior/statistics & numerical data , Reproductive Behavior/psychology
20.
Int J Equity Health ; 23(1): 143, 2024 Jul 18.
Article in English | MEDLINE | ID: mdl-39026324

ABSTRACT

BACKGROUND: Race and ethnicity are important drivers of health inequalities worldwide. However, the recording of race/ethnicity in data systems is frequently insufficient, particularly in low- and middle-income countries. The aim of this study is to descriptively analyse trends in data completeness in race/color records in hospital admissions and the rates of hospitalizations by various causes for Blacks and Whites individuals. METHODS: We conducted a longitudinal analysis, examining hospital admission data from Brazil's Hospital Information System (SIH) between 2010 and 2022, and analysed trends in reporting completeness and racial inequalities. These hospitalization records were examined based on year, quarter, cause of admission (using International Classification of Diseases (ICD-10) codes), and race/color (categorized as Black, White, or missing). We examined the patterns in hospitalization rates and the prevalence of missing data over a period of time. RESULTS: Over the study period, there was a notable improvement in data completeness regarding race/color in hospital admissions in Brazil. The proportion of missing values on race decreased from 34.7% in 2010 to 21.2% in 2020. As data completeness improved, racial inequalities in hospitalization rates became more evident - across several causes, including assaults, tuberculosis, hypertensive diseases, at-risk hospitalizations during pregnancy and motorcycle accidents. CONCLUSIONS: The study highlights the critical role of data quality in identifying and addressing racial health inequalities. Improved data completeness has revealed previously hidden inequalities in health records, emphasizing the need for comprehensive data collection to inform equitable health policies and interventions. Policymakers working in areas where socioeconomic data reporting (including on race and ethnicity) is suboptimal, should address data completeness to fully understand the scale of health inequalities.


Subject(s)
Health Information Systems , Health Status Disparities , Healthcare Disparities , Hospital Information Systems , Female , Humans , Male , Brazil , Health Information Systems/standards , Healthcare Disparities/statistics & numerical data , Hospital Information Systems/standards , Hospitalization/statistics & numerical data , Longitudinal Studies , Racial Groups/statistics & numerical data , Socioeconomic Factors , White People/statistics & numerical data , Black People/statistics & numerical data
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