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1.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(4): 472-478, Oct.-Dec. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1041354

RESUMEN

ABSTRACT Objective: To create an electronic instrument in order to analyze the adequacy of the preterm infants' nutritional therapy, checking the difference between the prescribed and the administered diet. Methods: A prospective and observational study on newborns with birthweight ≤1,500g and/or gestational age ≤32 weeks, without congenital malformations. The electronic instrument was developed based on Microsoft Excel 2010 spreadsheets and aimed at automatically calculating body weight gain, calories and macronutrients received daily by each patient from parenteral nutrition, intravenous hydration and enteral feedings. The weekly means of each nutrient were used to compare the prescribed and administered diets. Results: To evaluate the instrument, 60 newborns with a birth weight of 1,289±305 g and a gestational age of 30±2 weeks were included. Of them, 9.6% had restricted growth at birth and 55% at discharge. The median length of stay was 45±17 days. There were significant differences between prescribed and administered diet for all of the macronutrients and for total calories in the first three weeks. The lipid was the macronutrient with the greatest percentage error in the first week of life. Conclusions: The use of a computational routine was important to verify differences between the prescribed and the administered diet. This analysis is necessary to minimize calculation errors and to speed up health providers' decisions about the nutritional approach, which can contribute to patients' safety and to good nutritional practice. Very low birth weight infants are extremely vulnerable to nutritional deficiencies and any reduction in macronutrients they receive may be harmful to achieve satisfactory growth.


RESUMO Objetivo: Elaborar um instrumento eletrônico para análise da adequação da terapia nutricional dos recém-nascidos pré-termo, verificando a diferença entre a dieta prescrita e a administrada. Métodos: Estudo observacional prospectivo em recém-nascidos com peso de nascimento ≤1.500 g e/ou idade gestacional ≤32 semanas, sem malformações congênitas. O instrumento eletrônico foi desenvolvido com base em planilhas do Microsoft Excel 2010 para calcular automaticamente ganho de peso corporal, calorias e macronutrientes diariamente recebidos pelos pacientes por meio de dietas parenteral e enteral. Para comparar a dieta prescrita e a administrada, foram utilizados os resultados das médias semanais. Resultados: Para avaliar o instrumento, foram incluídos 60 recém-nascidos com peso de nascimento de 1.289±305 g e idade gestacional de 30±2 semanas. Destes, 9,6% apresentavam restrição de crescimento no nascimento e 55% no momento da alta. A média de internação foi de 45±17 dias. Foram verificadas diferenças significativas entre a dieta prescrita e a administrada para todos os macronutrientes e calorias totais nas três primeiras semanas. O lipídeo foi o macronutriente com o maior erro percentual na primeira semana. Conclusões: O emprego de uma rotina computacional foi importante para verificar discrepâncias entre a dieta prescrita e a administrada. Essa análise é necessária para minimizar erros de cálculo e agilizar as decisões da equipe de saúde acerca da abordagem nutricional, podendo contribuir para a segurança do paciente e para a boa prática nutricional. Os recém-nascidos de muito baixo peso são extremamente vulneráveis às deficiências nutricionais e qualquer redução nos macronutrientes recebidos pode ser deletéria para o crescimento satisfatório.


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Apoyo Nutricional/normas , Errores Médicos/estadística & datos numéricos , Registros Electrónicos de Salud , Cuidado del Lactante/normas , Pautas de la Práctica en Medicina , Brasil , Recien Nacido Prematuro/fisiología , Estudios Prospectivos , Apoyo Nutricional/estadística & datos numéricos , Errores Médicos/prevención & control , Seguridad del Paciente , Cuidado del Lactante/estadística & datos numéricos , Fenómenos Fisiológicos de la Nutrición
3.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190015.SUPL.2, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31596386

RESUMEN

INTRODUCTION: Despite the improvement in oral health conditions observed in the Brazilian population, there are still high social inequalities that must be monitored. OBJECTIVE: To evaluate income inequality in oral hygiene practices, oral health status and the use of dental services in the adult and senior Brazilian population. METHODS: Data from the National Health Survey conducted in 2013 (Pesquisa Nacional de Saúde - PNS 2013) were used for the population aged 18 years old or older. RESULTS: Inequalities were found among the income strata in most of the oral health indicators evaluated. The greatest inequalities were observed in the use of dental floss, in hygiene practices (PR = 2.85 in adults and PR = 2.45 in seniors), and in total tooth loss (PR = 6.74 in adults and PR = 2.24 in seniors) and difficulty in chewing (PR = 4.49 in adults and PR = 2.67 in seniors) among oral condition indicators. The magnitude of inequalities was high in both groups in most oral condition indicators. Income was a factor that persisted in limiting access to dental services, and even the lower income segments had high percentages that paid for dental consultations. CONCLUSION: Based on data from the first PNS, the findings of this study enabled the identification of oral health and dental care aspects more compromised by income differentials, thus, contributing to the planning of dental care in Brazil and to stimulate the monitoring of these disparities with data from future surveys.


Asunto(s)
Servicios de Salud Dental/estadística & datos numéricos , Encuestas de Salud Bucal/métodos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Renta/estadística & datos numéricos , Salud Bucal/estadística & datos numéricos , Clase Social , Adolescente , Adulto , Brasil/epidemiología , Encuestas de Salud Bucal/estadística & datos numéricos , Femenino , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Higiene Bucal , Prevalencia , Análisis de Regresión , Factores Socioeconómicos , Adulto Joven
4.
BMC Health Serv Res ; 19(1): 668, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533716

RESUMEN

BACKGROUND: In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities. METHODS: We purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May-September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups. RESULTS: BC women's sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women's attendances (adjusted odds ratio, AOR 3.54, 95% CI 1.45-8.64, p = 0.009; no gender difference among BC attendees), while BC men were more likely than WBI men (and BC women) to report attending because of a partner's symptoms or diagnosis (AOR 1.82, 95% CI 1.14-2.90; AOR BC men compared with BC women: 4.36, 95% CI 1.42-13.34, p = 0.014). Among symptomatic attendees, BC women were less likely than WBI women to report care-seeking elsewhere before attending the sexual health clinic (AOR 0.60, 95% CI 0.38-0.97, p = 0.039). No ethnic differences, or gender differences among BC attendees, were observed in symptom duration, or reporting sex whilst symptomatic. Among those reporting previous diagnoses with or treatment for bacterial STI, no differences were observed in partner notification. CONCLUSIONS: Differences in STI diagnosis rates observed between BC and WBI ethnic groups were not explained by the few ethnic differences which we identified in sexual healthcare-seeking and use. As changes take place in service delivery, prompt clinic access must be maintained - and indeed facilitated - for those at greatest risk of STI, regardless of ethnicity.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Salud Sexual , Adolescente , Adulto , Grupo de Ascendencia Continental Africana/etnología , Anciano , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Región del Caribe/etnología , Estudios Transversales , Inglaterra/epidemiología , Grupos Étnicos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Utilización de Instalaciones y Servicios , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/etnología , Asunción de Riesgos , Factores Sexuales , Conducta Sexual/etnología , Parejas Sexuales , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/etnología , Encuestas y Cuestionarios , Adulto Joven
5.
Qual Life Res ; 28(9): 2491-2500, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31203563

RESUMEN

PURPOSE: Socioeconomic inequalities are recognized as a major problem with people in low socioeconomic groups having worse subjective oral health outcomes, including oral health-related quality of life (OHRQoL). However, only a few longitudinal studies assessed the impact of contextual and individual socioeconomic determinants in adolescents' OHRQoL. We estimate the impact of socioeconomic inequalities on adolescents' OHRQoL over a 2-year period. METHODS: This study followed up a random sample of 1134 12-year-old schoolchildren for 2 years in Brazil. OHRQoL was assessed by the Brazilian version of the Child Perceptions Questionnaire for 11- to 14-year-old Children (CPQ11-14) at baseline and follow-up. Participants were clinically examined for dental caries, gingival bleeding, and malocclusion. The schoolchildren's parents answered a questionnaire regarding socioeconomic status, social capital, and adolescents' use of dental service. Socioeconomic contextual variables were collected from official city publications. Multilevel linear regression models fitted the associations between socioeconomic factors and overall CPQ11-14 scores over time. RESULTS: A total of 747, 14-year-old adolescents were reassessed for OHRQoL (follow-up rate of 66%). Adolescents with lower mean income school's neighborhood (P < 0.05), household income (P < 0.05), and maternal schooling (P < 0.05) had higher overall CPQ11-14 scores. Female sex, attending a dentist by toothache, dental caries, and malocclusion were also associated with higher overall CPQ11-14 scores. CONCLUSIONS: Adolescents from low socioeconomic background reported worse OHRQoL at 2-year follow-up compared to those from high socioeconomic background. Actions toward health inequalities need to address socioeconomic factors in adolescence.


Asunto(s)
Atención Odontológica/estadística & datos numéricos , Caries Dental/diagnóstico , Disparidades en el Estado de Salud , Salud Bucal/estadística & datos numéricos , Calidad de Vida/psicología , Clase Social , Adolescente , Brasil , Niño , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Masculino , Maloclusión/diagnóstico , Análisis Multinivel , Padres , Índice Periodontal , Características de la Residencia , Instituciones Académicas , Factores Socioeconómicos , Encuestas y Cuestionarios
6.
PLoS One ; 14(5): e0217557, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31150461

RESUMEN

BACKGROUND: Monitoring and reducing inequalities in health care has become more relevant since the adoption of the Sustainable Development Goals (SDGs). The SDGs bring an opportunity to put the assessment of inequalities by ethnicity on the agenda of decision-makers. The objective of this qualitative study is to know how current monitoring is carried out and to identify what factors influence the process in order to incorporate indicators that allow the evaluation of inequalities by ethnicity. METHODS: We conducted 17 semi-structured interviews with key informants from the health ministry, monitoring observatories, research centers, and international organizations, involved in maternal health care monitoring in Mexico. Our analysis was interpretative-phenomenological and focused on examining experiences about monitoring maternal health care in order to achieve a full picture of the current context in which it takes place and the factors that influence it. RESULTS: The obstacles and opportunities pointed out from the participants emerge from the limitations or advantages associated with the accuracy of evaluation, availability of information and resources, and effective management and decision-making. Technicians, coordinators, researchers or decision-makers are not only aware of the inequalities but also of its importance. However, this does not lead to political decisions permitting an indicator to be developed for monitoring it. As for opportunities, the role of international organizations and their links with the countries is crucial to carry out monitoring, due to political and technical support. CONCLUSIONS: The success of a monitoring system to help decision-makers reduce inequalities in health care depends not only on accurate evaluations but also on the context in which it is implemented. Understanding the operation, obstacles and opportunities for monitoring could be a key issue if the countries want to advance towards assessing inequalities and reducing health inequities with the aid of concrete policies and initiatives.


Asunto(s)
Disparidades en Atención de Salud , Servicios de Salud Materna/organización & administración , Salud Materna , Factores Socioeconómicos , Toma de Decisiones en la Organización , Femenino , Necesidades y Demandas de Servicios de Salud/organización & administración , Humanos , México , Embarazo , Investigación Cualitativa , Mejoramiento de la Calidad , Desarrollo Sostenible
7.
Rev Saude Publica ; 53: 40, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31066818

RESUMEN

OBJECTIVE: To estimate coverage, examine trend and assess the disparity reduction regarding household income during prenatal care between mothers living in Rio Grande, state of Rio Grande do Sul, in 2007, 2010, 2013 and 2016. METHODS: This study included all recent mothers living in this municipality, between 1/1 and 12/31 of those years, who had a child weighing more than 500 grams or 20 weeks of gestational age in one of the only two local maternity hospitals. Trained interviewers applied, still in the hospital and up to 48 hours after delivery, a unique and standardized questionnaire, seeking to investigate maternal demographic and reproductive characteristics, the socioeconomic conditions of the family and the assistance received during pregnancy and childbirth. To assess the adequacy of prenatal care, the criteria proposed by Takeda were used, which considers only the number of prenatal appointments and gestational age at initiation, and by Silveira et al., who in addition to these two variables, considers the achievement of some laboratory tests. Chi-square tests were used to compare proportions and assess the linear trend. RESULTS: The total of 10,669 recent mothers were included in this survey (96.8% of the total). Prenatal coverage substantially increased between 2007 and 2016. According to Takeda, it rose from 69% to 80%, while for Silveira et al., it increased from 21% to 55%. This improvement occurred for all income groups (p < 0.01). The disparity between the extreme categories of income reduced, according to Takeda, and increased according to Silveira et al. CONCLUSIONS: The provision of prenatal care, considering only the number of appointments and the early start, occurred in greater proportion among the poorest. However, only the richest recent mothers were contemplated with more elaborate care, such as laboratory tests, which increased the disparities in the provision of prenatal care.


Asunto(s)
Disparidades en Atención de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/tendencias , Atención Prenatal/estadística & datos numéricos , Atención Prenatal/tendencias , Adolescente , Adulto , Brasil , Niño , Composición Familiar , Femenino , Humanos , Edad Materna , Embarazo , Valores de Referencia , Factores Socioeconómicos , Encuestas y Cuestionarios , Factores de Tiempo , Adulto Joven
8.
Med. intensiva (Madr., Ed. impr.) ; 43(4): 217-224, mayo 2019. graf, tab
Artículo en Español | IBECS | ID: ibc-183126

RESUMEN

Objetivo: Analizar la diferencia entre el grado de importancia y satisfacción de las necesidades de los familiares de pacientes en una unidad de cuidados intensivos (UCI). Diseño: Estudio descriptivo de corte transversal, analítico. Ámbito: UCI médico-quirúrgica de un hospital universitario en Chile. Participantes: Familiares de pacientes críticos con estancia igual o superior a 48 horas, mayores de 18 años y con al menos una visita al paciente. Variables de interés: Se utilizó el cuestionario Critical Care Family Needs Inventory para determinar la diferencia entre el grado de importancia y satisfacción de las necesidades de los familiares. Además, se clasificaron las necesidades según las categorías propuestas por el análisis de importancia-rendimiento (AIR). Resultados: Un total de 253 familiares fueron reclutados, observándose una diferencia negativa (satisfacción

Objective: To analyze the difference between the degree of importance and satisfaction of the needs of family members of patients in an Intensive Care Unit (ICU). Design: A descriptive, cross-sectional analytical study was carried out. Setting: Medical - surgical ICU of a university hospital in Chile. Participants: Family members of critical patients with a length of stay of ≥ 48hours, over 18 years of age, and with at least one visit to the patient. Variables of interest: The Critical Care Family Needs Inventory questionnaire was used to determine the difference between the degree of importance and satisfaction of the needs of the family members. In addition, the needs were classified according to the categories proposed by importance - performance analysis (IPA). Results: A total of 253 family members were recruited, observing a negative gap (satisfaction

Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Necesidades y Demandas de Servicios de Salud , Cuidados Críticos , Familia/psicología , Satisfacción Personal , Evaluación de Necesidades , Unidades de Cuidados Intensivos , Estudios Transversales , Chile , Prestación de Atención de Salud
9.
Trends Psychiatry Psychother ; 41(1): 27-35, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30994784

RESUMEN

INTRODUCTION: User satisfaction assessment in mental health services is an important indicator of treatment quality. The objective of this study was to evaluate treatment satisfaction in a sample of inpatients with mental disorders and the associations between levels of satisfaction and clinical/sociodemographic variables. METHODS: This exploratory study investigated 227 psychiatric inpatients who answered the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and the Perception of Change Scale (EMP). SATIS scores were analyzed according to associations with clinical and sociodemographic data. Pearson correlations were used to correlate SATIS scores with other variables. RESULTS: We found a high degree of satisfaction with care at the psychiatric inpatient unit assessed. In general, patients rated maximum satisfaction for most items. The highest satisfaction scores were associated with patients receiving treatment through the Brazilian Unified Health System (SUS) and with less education. SATIS showed a moderate positive correlation with EMP. The worst evaluated dimension was physical facilities and comfort of the ward. CONCLUSION: Patients treated via SUS may be more satisfied than patients with private health insurance when treated in the same facility. The evaluation of treatment satisfaction can be used to reorganize services at psychiatric inpatient units.


Asunto(s)
Pacientes Internos/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Trastornos Mentales/terapia , Servicios de Salud Mental/estadística & datos numéricos , Satisfacción del Paciente , Servicio de Psiquiatría en Hospital/estadística & datos numéricos , Adulto , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
10.
Lima; Perú. Ministerio de Salud; 20190400. 27 p. ilus, tab.
Monografía en Español | LILACS, LIPECS | ID: biblio-988199

RESUMEN

El documento contiene: la finalidad, objetivos, ámbito de aplicación, base legal, metodología del estudio de caso: La experiencia del Perú en el desarrollo, la implementación y el monitoreo de estándares de calidad de los servicios de salud diferenciados para adolescentes.


Asunto(s)
Adolescente , Estándar de Identidad y Calidad de Productos y Servicios , Instituciones de Salud , Atención a la Salud
11.
Community Dent Oral Epidemiol ; 47(3): 274-280, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30908697

RESUMEN

OBJECTIVES: This study aimed to test associations between a municipal social development indicator and indicators of public dental services; examine differences in the achievement of public dental services goals between fluoridated and nonfluoridated municipalities; and, quantify contribution of a municipal social development indicator in estimated mean differences in the public dental services indicators between fluoridated and nonfluoridated municipalities. METHODS: A secondary analysis of data from 293 municipal dental health services records from Southern Brazil between 2010 and 2015 was conducted. Multivariable log-binomial regression models were fitted to test the associations between municipal Human Development Index (HDI) and multiple public dental services indicators (proportion of public dental health service coverage, the proportion of tooth extraction among all clinical procedures, and monthly participation in supervised tooth brushing). Cut-off points for outcomes were based on state goals for public dental services. Blinder-Oaxaca decomposition analyses were performed to quantify the relative contribution of HDI in the differences in outcomes according to the municipal water fluoridation status. RESULTS: Municipalities within the lowest tertile of HDI had 66% lower prevalence of having insufficient public dental health service coverage (less than state goals)than those in the highest tertile of HDI (PR: 0.44; 95% CI: 0.24, 0.50). Municipalities with lowest HDI had nearly 30% higher prevalence of failing the state goals regarding the proportion of extraction and supervised tooth brushing (PR: 1.30; 95% CI: 1.20, 1.40 and PR: 1.34; 95% CI: 1.23, 1.45, respectively). Mean public dental health service coverage was higher in nonfluoridated municipalities than fluoridated municipalities, and municipal HDI explained 36% of the total estimated mean difference. CONCLUSIONS: This study found associations between municipal social development and public dental services indicators in Southern Brazil. However, higher HDI was associated with lower public dental health service coverage, lower proportion of extraction and higher coverage of supervised tooth brushing [Correction added on 2 April 2019, after first online publication: In the preceding sentence, the text "but with a higher proportion of extraction and supervised tooth brushing" was changed to "lower proportion of extraction and higher coverage of supervised tooth brushing"]. Municipal HDI contributed significantly towards the gap in public dental coverage between fluoridated and nonfluoridated municipalities, favoring nonfluoridated municipalities. These findings have important policy implications for reducing oral health inequalities as it highlights the interplay between key oral health policies and their distribution according to municipal social development.


Asunto(s)
Atención Odontológica , Cambio Social , Brasil , Fluoruración , Disparidades en el Estado de Salud , Humanos , Salud Bucal , Factores Socioeconómicos
12.
Int J Epidemiol ; 48(Suppl 1): i37-i45, 2019 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-30883657

RESUMEN

BACKGROUND: Antenatal care and correctly indicated caesarean section can positively impact on health outcomes of the mother and newborn. Our objective was to describe how coverage and inequalities for these interventions changed from 1982 to 2015 in Pelotas, Brazil. METHODS: Using perinatal data from the 1982, 1993, 2004 and 2015 Pelotas birth cohorts, we assessed antenatal care coverage and caesarean section rates over time. Antenatal care indicators included the median number of visits, the prevalence of mothers attending at least six visits and the proportion who started antenatal care in the first trimester of pregnancy and attended at least six visits. We described these outcomes according to income quintiles and maternal skin colour, to identify inequalities. We described overall, private sector and public sector caesarean section rates. Differences in prevalence were tested using chi-square testing and median differences using Kruskal-Wallis testing. RESULTS: From 1982 to 2015, the median number of antenatal care visits and the prevalence of mothers attending at least six visits increased in all income quintiles and skin colour groups. Inequalities were reduced, but not eliminated. The overall proportion of caesarean births increased from 27.6% in 1982 to 65.1% in 2015, when 93.9% of the births in the private sector were by caesarean section. Absolute income-related inequalities in caesarean sections increased over time. CONCLUSIONS: Special attention should be given to the antenatal care of poor and Black women in order to reduce inequalities. The explosive increase in caesarean sections requires radical changes in delivery care policies, in order to reverse the current trend.


Asunto(s)
Cesárea/estadística & datos numéricos , Renta/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Adolescente , Adulto , Brasil/epidemiología , Cesárea/tendencias , Niño , Femenino , Humanos , Renta/tendencias , Modelos Logísticos , Estudios Longitudinales , Embarazo , Atención Prenatal/tendencias , Adulto Joven
13.
Int J Epidemiol ; 48(Suppl 1): i72-i79, 2019 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-30883659

RESUMEN

BACKGROUND: Brazil has made substantial improvements in the duration of breastfeeding. We use data from four population-based cohorts to examine how trends and inequalities in breastfeeding indicators changed over time in a Brazilian city. METHODS: Data from four birth cohorts, each including all births in a calendar year (1982, 1993, 2004 and 2015) in the city of Pelotas were used. Information on breastfeeding was collected when children were aged between 3 and 20 months. The prevalences of continued breastfeeding at 1 year of age and of exclusive breastfeeding at 3 months were calculated according to family income, maternal skin colour and sex. RESULTS: Prevalence of breastfeeding at 12 months increased from 16% to 41% in the 33-year period. The prevalence of exclusive breastfeeding at 3 months increased from 7% in 1993 to 45% in 2015. Increases in exclusive breastfeeding at 3 months were seen in all socioeconomic groups, but the 2015 rates remain highest (57.2%) among the women in the richest quintile, and lowest among those in the poorest quintile (34.6%). Black mothers were more likely to breastfeed at 12 months than Whites in the four cohorts. In the earlier cohorts, breastfeeding at 12 months was more common among the poor, but by 2015 these differences had disappeared. CONCLUSIONS: There were important positive changes in breastfeeding practices during this period, but less than half of the children in 2015 were receiving the full benefits of breast milk. Improved breastfeeding practices are being adopted by high-income women to a greater extent than by poor women.


Asunto(s)
Lactancia Materna/estadística & datos numéricos , Cuidado del Lactante , Brasil/epidemiología , Femenino , Humanos , Renta , Lactante , Recién Nacido , Masculino , Pobreza , Factores de Tiempo
14.
Int J Epidemiol ; 48(Suppl 1): i63-i71, 2019 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-30883660

RESUMEN

BACKGROUND: Hospital admissions in infancy are declining in several countries. We describe admissions to neonatal intensive care units (NICU) and other hospitalizations over a 33-year period in the Brazilian city of Pelotas. METHODS: We analysed data from four population-based birth cohorts launched in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. NICU and other hospital admissions during infancy were reported by the mothers in the perinatal interview and at the 12-month visit, respectively. We describe these outcomes by sex of the child, family income and maternal skin colour. RESULTS: In 1982, NICUs did not exist in the city; admissions into NICUs increased from 2.7% of all newborns in 1993 to 6.7% in 2015, and admission rates were similar in all income groups. Hospitalizations during the first year of life fell by 29%, from 23.7% in 1982 to 16.8% in 2015, and diarrhoea admissions fell by 95.2%. Pneumonia admissions fell by 46.3% from 1993 to 2015 (no data available for 1982). Admissions due to perinatal causes increased during the period. In the poorest income quintile, total admissions fell by 33% (from 35.7% to 23.9%), but in the richest quintile these remained stable at around 10%, leading to a reduction in inequalities. Over the whole period, children born to women with black or brown skin were 30% more likely to be admitted than those of white-skinned mothers. CONCLUSIONS: Whereas NICU admissions increased, total admissions in the first year of life declined by nearly one-third. Socioeconomic disparities were reduced, but important gaps remain.


Asunto(s)
Diarrea Infantil/epidemiología , Hospitalización/tendencias , Neumonía/epidemiología , Brasil/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Modelos Logísticos , Masculino , Factores Socioeconómicos
15.
BMC Oral Health ; 19(1): 39, 2019 03 07.
Artículo en Inglés | MEDLINE | ID: mdl-30845948

RESUMEN

BACKGROUND: Oral health inequalities are profound worldwide. Despite major improvements in oral health, inequalities exist for many racial and ethnic groups, by socioeconomic status, gender, age, and geographic location. Therefore, the purpose of this study was to investigate trends of socio-economic inequalities in access to oral health services in Peru before and after the implementation of Universal Health Assurance (AUS). METHODS: Analytical cross-sectional study based on the National Household Survey on Living Conditions and Poverty (ENAHO) 2004, 2008, 2010 and 2017. Two periods were defined before and after the AUS Law (2009). Use of oral health services was the dependent variable, for the general population and according to ages, the area of residence, and natural region. Measurements of inequality in the use of health services were made based on the concentration curves (CC), dominance test and concentration index (CI). RESULTS: We included a number of 85,436 (2004), 88,673 (2008), 87,074 (2010) and 124,142 (2017) participants. The proportion of people who used oral health services was 8.4% (2014), 10.1% (2008), 10.6% (2010) and 10.4% (2017). Use of oral health services showed an increase in different age groups, urban and rural areas, and natural regions of residence during the study period. The CC were distributed below the line of equality, indicating an inequality of use of oral health services, in favor of the richest groups and dominance of the CC in 2017 over the previous years. Changes in the CI were statistically significant for < 5 years and in the rural area, and for the period 2010-2017 they were also significant in the general population, children aged 5-17 years, urban area, and Andean and Jungle regions, which indicates a reduction in the concentration of use of these services in these groups. CONCLUSIONS: The use of oral health services in Peru increased and inequality decreased in the period 2004-2017, coinciding with the implementation of the AUS. However, the use of these services continue having a distribution in favor of the richest populations. It requires the introduction of new strategies and oral health programs in the Peruvian population, with the aim of closing the gap currently mediated by the economic possibilities.


Asunto(s)
Salud Bucal , Pobreza , Adolescente , Niño , Preescolar , Estudios Transversales , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Humanos , Perú , Factores Socioeconómicos
16.
BMC Public Health ; 19(1): 247, 2019 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-30819146

RESUMEN

BACKGROUND: Mortality is a robust indicator of health and offers valuable insight into the health of immigrants. However, mortality estimates can vary significantly depending on the manner in which immigrant status is defined. Here, we assess the impact of nationality, country of origin, and length of stay in the host country on mortality estimates in an immigrant population in Aragón, Spain. METHODS: Cross-sectional retrospective study of all adult subjects from the EpiChron Cohort in 2011 (n = 1,102,544), of whom 146,100 were foreign-born (i.e., according to place of birth) and 127,213 were non-nationals (i.e., according to nationality). Directly standardized death proportions between years 2012-2015 were calculated, taking into account the age distribution of the European population in 2013. Binary logistic regression was used to compare the four-year probability of death. RESULTS: The age- and sex-standardized number of deaths per 1000 subjects were 45.1 (95%CI 44.7-45.2) for the Spanish-born population, 29.3 (95%CI 26.7-32.1) for the foreign-born population, and 18.4 (95%CI 15.6-21.6) for non-Spanish nationals. Compared with the Spanish-born population, the age- and sex-adjusted likelihood of dying was equally reduced in the foreign-born and non-national populations (OR 0.6; 95%CI 0.5-0.7) when the length of stay was less than 10 years. No significant differences in mortality estimates were detected when the length of stay was over 10 years. CONCLUSIONS: Mortality estimates in immigrant populations were lower than those of the native Spanish population, regardless of the criteria applied. However, the proportion of deaths was lower when immigrant status was defined using nationality instead of country of birth. Age- and sex-standardized death proportions tended to increase with increased length of stay in the host country.


Asunto(s)
Emigrantes e Inmigrantes/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Equidad en Salud/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Mortalidad , Adolescente , Adulto , África , Anciano , Anciano de 80 o más Años , Asia , Estudios de Cohortes , Estudios Transversales , Europa Oriental , Femenino , Humanos , América Latina , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España , Adulto Joven
17.
Trends psychiatry psychother. (Impr.) ; 41(1): 27-35, Jan.-Mar. 2019. tab
Artículo en Inglés | LILACS | ID: biblio-1004836

RESUMEN

Abstract Introduction User satisfaction assessment in mental health services is an important indicator of treatment quality. The objective of this study was to evaluate treatment satisfaction in a sample of inpatients with mental disorders and the associations between levels of satisfaction and clinical/sociodemographic variables. Methods This exploratory study investigated 227 psychiatric inpatients who answered the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and the Perception of Change Scale (EMP). SATIS scores were analyzed according to associations with clinical and sociodemographic data. Pearson correlations were used to correlate SATIS scores with other variables. Results We found a high degree of satisfaction with care at the psychiatric inpatient unit assessed. In general, patients rated maximum satisfaction for most items. The highest satisfaction scores were associated with patients receiving treatment through the Brazilian Unified Health System (SUS) and with less education. SATIS showed a moderate positive correlation with EMP. The worst evaluated dimension was physical facilities and comfort of the ward. Conclusion Patients treated via SUS may be more satisfied than patients with private health insurance when treated in the same facility. The evaluation of treatment satisfaction can be used to reorganize services at psychiatric inpatient units.


Resumo Introdução A avaliação da satisfação do usuário nos serviços de saúde mental é um importante indicador da qualidade do tratamento. O objetivo deste estudo foi avaliar a satisfação com o tratamento em uma amostra de pacientes internados com transtornos mentais e as associações entre os níveis de satisfação e variáveis clínicas/sociodemográficas. Métodos Este estudo exploratório investigou 227 pacientes psiquiátricos internados que responderam a Escala de Satisfação do Paciente com os Serviços de Saúde Mental (SATIS-BR) e a Escala de Percepção da Mudança (EMP). Os escores SATIS-BR foram analisados segundo associações com dados clínicos e sociodemográficos. Correlações de Pearson foram usadas para correlacionar escores SATIS com outras variáveis. Resultados Encontramos alto grau de satisfação com o atendimento na unidade de internação psiquiátrica avaliada. Em geral, os pacientes atribuíram satisfação máxima para a maioria dos itens. Os maiores escores de satisfação foram associados a pacientes em tratamento pelo Sistema Único de Saúde (SUS) e com menor escolaridade. A SATIS mostrou uma correlação positiva moderada com EMP. A pior dimensão avaliada foi associada às instalações físicas e conforto da enfermaria. Conclusão Pacientes com cobertura pelo SUS podem estar mais satisfeitos do que pacientes com planos privados de saúde quando tratados na mesma unidade. A avaliação da satisfação com o tratamento pode ser usada para reorganizar serviços em unidades de internação psiquiátrica.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adulto Joven , Servicio de Psiquiatría en Hospital/estadística & datos numéricos , Satisfacción del Paciente , Pacientes Internos/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Trastornos Mentales/terapia , Servicios de Salud Mental/estadística & datos numéricos , Brasil , Estudios Transversales , Persona de Mediana Edad
18.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(1): 43-52, Jan.-Mar. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1013123

RESUMEN

Abstract Objectives: to analyze the prenatal care of pregnant teenagers interviewed in the post-partum period in Brazilian maternity hospitals, according to economic status and skin color. Methods: data were obtained from the Birth in Brazil study, a national hospital-based survey in 2011 and 2012. Information was obtained from interviews with the postpartum women and from data collected from their prenatal cards. Multivariate logistic regression was used to verify whether maternal and prenatal care characteristics were associated with ina-dequate prenatal care. Results: a total of 3,317 teenage mothers were interviewed in the postpartum period, 84.4% of whom had received inadequate prenatal care, with worse results for lower-income, lower-schooling, and multiparous teens. In the same way, it became evident the higher proportion of black teenagers and those from economic classes D/E among those who failed to receive routine laboratory tests, who received little orientation on the pregnancy, labor, and childbirth, and who were forced to go from one maternity hospital to another before being admitted to give birth. Conclusions: strategies targeted to the most vulnerable pregnant teenagers should be implemented in order to achieve greater equality in teenagers' prenatal care, seeking to assure easier access, earlier initiation of care, and greater case-resolution capacity


Resumo Objetivos: analisar a assistência pré-natal de puérperas adolescentes brasileiras, segundo as características econômicas e de cor da pele. Métodos: foram utilizados dados da pesquisa Nascer no Brasil, um inquérito nacional de base hospitalar, realizado entre 2011 e 2012. As informações foram obtidas por meio de entrevistas com as puérperas e coleta de dados dos cartões de pré-natal. Realizou-se regressão logística multivariada para verificar quais características maternas e dos cuidados recebidos estavam associadas à inadequação da assistência pré-natal. Resultados: um total de 3.317 puérperas adolescentes foram entrevistadas, tendo 84,4% recebido cuidado inadequado durante o pré-natal, com pior resultado para as adolescentes de classe econômica mais baixa, menor escolaridade e multíparas. Do mesmo modo, ficou evidente a maior proporção de adolescentes da classe econômica D/E e de cor da pele preta que não conseguiram realizar exames preconizados como rotina durante a gravidez, que receberam poucas orientações sobre a gestação e parto, e que mais peregrinaram em busca de maternidade para realização do parto. Conclusões: estratégias direcionadas ao grupo de adolescentes mais vulneráveis devem ser implementadas visando maior equidade na assistência pré-natal de adolescentes, buscando garantir acesso facilitado, início precoce da assistência e maior resolutividade.


Asunto(s)
Humanos , Femenino , Embarazo , Adolescente , Embarazo en Adolescencia , Atención Prenatal , Disparidades en el Estado de Salud , Racismo , Factores Socioeconómicos , Brasil , Salud Materno-Infantil , Encuestas Epidemiológicas , Servicios de Salud Materno-Infantil , Inequidad Social
19.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(1): 63-70, Jan.-Mar. 2019. tab
Artículo en Inglés | LILACS | ID: biblio-1013124

RESUMEN

Abstract Objectives: to identify the frequency and factors associated with the non-realization of puerperal consultations in women resident of a medium-sized municipality in Brazil. Methods: a prospective cohort study based on data collected in two time points, the first 48h and after the 42nd day post-childbirth. In order to analyze data, proportions were compared using the chi-square test, and the adjusted analysis was performed using Poisson regression, according to a predetermined hierarchical model. Significance level was set at 5%. Results: of the 572 women included in the study, 24.8% did not perform puerperal consul-tations. The factors associated with the non-realization of puerperal consultations were: lower income (1 st tercile PR= 2.01; CI95%= 1.21-3.33 - 2 nd tercile PR= 1.94; CI95%=1.17-3.20) and schooling (≤ 8 years PR= 2.00; CI95%= 1.24-3.24), comorbidities during preg-nancy (PR= 1.45; CI95%= 1.01-2.09), realization of antenatal care in the public service (PR= 1.74; CI95%= 1.18-2.58) and non-use of contraceptive methods (PR= 3.10; CI95%=1.86-5.16). Conclusions: puerperal revision does not seem to be valued in the antenatal care, mainly in the public health system. An important inequality was identified in the provision of this service, since women more prone to recurring pregnancy and with lower income and schooling were the ones that least returned to the puerperal consultation.


Resumo Objetivos: identificar a frequência da não realização das consultas de puerpério e fatores associados em mulheres residentes de um município de médio porte no Brasil. Métodos: estudo de coorte prospectiva através da coleta de dados em dois momentos, nas primeiras 48h e após o 42º dia pós-parto. Para a análise dos dados, utilizou-se o teste qui-quadrado para comparar proporções e, para a análise ajustada, Regressão de Poisson obedecendo ao modelo hierárquico pré-determinado. O nível de significância adotado foi de 5%. Resultados: das 572 mulheres incluídas no estudo, 24,8% não realizaram consulta de puerpério. Os fatores associados a não realização da consulta de puerpério foram: menor renda (1º tercil RP= 2,01 IC95%= 1,21-3,33 - 2º tercil RP= 1,94 IC95%= 1,17-3,20), escolaridade (≤ 8 anos RP= 2,00 IC95%= 1,24-3,24); mulheres que apresentaram alguma comorbidade durante a gestação (RP 1,45; IC95%= 1,01-2,09), realizaram o pré-natal em serviço público (RP= 1,74; IC95%= 1,18-2,58) e que não usaram método anticoncepcional (RP= 3,10; IC95%= 1,86-5,16). Conclusões: a revisão puerperal não parece estar sendo valorizada no pré-natal, principalmente no sistema público de saúde. Foi identificada uma importante iniquidade na prestação desse serviço, pois as mulheres de menor renda, escolaridade e mais expostas a uma gravidez recorrente foram as que menos retornaram à consulta puerperal.


Asunto(s)
Humanos , Femenino , Embarazo , Derivación y Consulta/estadística & datos numéricos , Estudios de Cohortes , Periodo Posparto , Disparidades en el Estado de Salud , Servicios de Salud Materno-Infantil , Atención Primaria de Salud , Sistema Único de Salud , Brasil
20.
Rev Bras Epidemiol ; 21Suppl 02(Suppl 02): e180004, 2019 Feb 04.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-30726349

RESUMEN

INTRODUCTION: Understanding racial disparities in Brazil has been very complex and poorly investigated in some population segments, such as the elderly individuals. OBJECTIVE: This study aimed to present descriptively a comparative analysis in a racial perspective of sociodemographic profile, health conditions, and health service use by older people in the city of São Paulo. METHODS: This is a cross-sectional analysis of the Health, Welfare and Aging Study (SABE). For this study, 1,345 elderly individuals were considered in the cohort of 2010. Data about the black, brown, and white elders were selected. The data were addressed in three major axes: sociodemographic, health conditions, and health service use. The chosen epidemiological measure of association was the prevalence ratio (PR), as well as the percentage values for expressing differences among the groups. RESULTS AND CONCLUSION: The results showed a more favorable scenario for the aging of the white elderly compared to those of brown or black color, considering sociodemographic indicators, health conditions or use and access to health services.


Asunto(s)
Envejecimiento/etnología , Servicios de Salud para Ancianos/estadística & datos numéricos , Disparidades en el Estado de Salud , Grupo de Ascendencia Continental Africana , Distribución por Edad , Anciano , Anciano de 80 o más Años , Brasil/etnología , Estudios Transversales , Femenino , Evaluación Geriátrica , Conductas Relacionadas con la Salud/etnología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Religión , Distribución por Sexo , Factores Socioeconómicos
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