Estudio de prevalencia, conocimiento y control de la hipertensión arterial en barrios vulnerables de Argentina / Prevalence, knowledge and control of arterial hypertension in vulnerable neighborhoods of Argentina: A Cross-sectional Study

Introducción: La hipertensión arterial (HTA) representa el principal factor de riesgo individual, con mayor carga a nivel mundial de enfermedades cardiovasculares (ECV). En nuestro país, algunos trabajos epidemiológicos han mostrado marcadas diferencias en las prevalencias de estos factores de riesgo de acuerdo con la población evaluada. Sin embargo, no hay estudios epidemiológicos de evaluación de factores de riesgo cardiovascular exclusivos referentes a barrios vulnerables con muy bajos recursos económicos, socioculturales y poca accesibilidad a los sistemas de salud. Materiales y métodos: Estudio observacional de corte transversal multicéntrico en habitantes de comunas vulnerables de muy bajos recursos, como asentamientos populares y barrios carenciados con muestreo aleatorizado simple de casas. Se realizaron tomas de presión arterial (PA), medidas antropométricas, así como cuestionarios epidemiológicos, económicos y socioculturales. Se describen los hallazgos: prevalencia, conocimiento y control de la PA en las distintas regiones. Se efectuó una regresión logística para determinar las variables independientes a los resultados principales. Resultados: Se analizaron 989 participantes. La prevalencia de HTA global fue de 48,2%. Un total de 82% tenía un índice de masa corporal (IMC) >25 kg/m2. De estos pacientes, 45,3% tenían menos de seis años de educación. Este último aspecto se asoció a mayor prevalencia de HTA de forma independiente. De los hipertensos, 44% desconocían su padecimiento y solo en 17,2% estaba controlado, asociándose esto a tener obra social (OS) y mayor nivel educativo. Únicamente 24% estaban bajo tratamiento combinado. Conclusión: La prevalencia de HTA en barrios vulnerables es elevada, superando a la de otros estratos sociales con niveles de conocimiento, tratamiento y control de la HTA bajos, similar a otras poblaciones. Se detectó un uso insuficiente de la terapia combinada.

Introduction: Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access. Methods: A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes. Results: A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy. Conclusion: The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations... (AU)

[Homelessness as a determinant of health and its impact on quality of life]. / Sinhogarismo como determinante de la salud y su impacto en la calidad de vida.

OBJECTIVE: To determine the health status of the homeless population who spend the night on the streets and in shelters (extreme residential exclusion), with reference to their quality of life, self-perceived health, comorbidity and access to health resources. METHOD: A cross-sectional descriptive study was carried out on a sample of 263 homeless people in the city of Valencia by means of a nocturnal count and using the EQ-5D-3L Health Related Quality of Life questionnaire and questions from the European Quality of Life Survey for Spain. RESULTS: Of the people who participated in the study, 129 of them slept outdoors, 49% (62.79% men, 19.37% women and 17.84% unidentified), while 134 slept in hostels, i.e. 51% (67.16% men and 32.84% women) with an estimated average age of 41.53 years and 55% had been living on the street for less than 12 months. People staying overnight on the streets presented worse quality of life and more than a quarter of the sample lacked a health card. CONCLUSIONS: There is a relationship between homelessness and poor health conditions in terms of quality of life, perceived health, comorbidity and accessibility to health to resources. The inverse care law is evidenced.

Unpacking gender-specific risk and protective factors for mental health status among Congolese refugees in Uganda.

Background: Research indicates refugees from the Democratic Republic of Congo (DRC), particularly females, have a higher incidence of mental health problems compared to the global norm for conflict-affected populations.Objective: This study aimed to unpack gender differences in the mental health of Congolese refugees by examining specific risk (trauma exposure, adaptation challenges, and discrimination) and protective factors (marital status, literacy, and social resources) in relation to posttraumatic stress symptoms (PTSS) and depression. Method: Utilizing systematic random sampling, we surveyed 667 adult refugees (370 females, 297 males) in the Kyaka II refugee settlement in Western Uganda. A multi-group path analysis was conducted, initially allowing for variance between genders and subsequently comparing a constrained model, where paths were set equal across groups.Results: The unconstrained model presented an excellent fit to the data. When paths were set to be equal across groups, the decline in model fit, confirmed by a chi-square difference test, indicated differences in the model for males and females. A series of Z-tests were used to compare individual paths. Experiencing discrimination was a stronger risk factor for depression among men, whereas a history of rape was more strongly associated with depression for females. Being literate and a member of a social group in the settlement were stronger protective factors for depression among men, whereas living with a partner and a felt sense of connection to their community was more important for women. Associations between risk and protective factors and PTSS were more similar across groups, only membership in a group was significantly moderated by gender; with group membership being more impactful for males.Conclusion: The results highlight similarities and differences in predictors of distress for male and female Congolese refugees and point to potential avenues for tailoring programming to be gender sensitive.

This research identified key differences in how specific traumatic experiences and social factors correlate with psychological distress for male and female Congolese refugees, underscoring the need for tailored support strategies.The study reveals that while discrimination is a stronger predictor of depression in men, experiences of rape are more closely linked to depression in women. Conversely, social factors like literacy and group membership offer more protection to men, whereas relationship status and community connection are more protective for women.The findings shed light on the importance of gender-sensitive mental health and psychosocial support interventions.

Diferencias en la evolución del sobrepeso y la obesidad infantil en España en el periodo 2011-2019 por sexo, edad y nivel socioeconómico: resultados del estudio ALADINO / Differences in the temporal trends of childhood overweight and obesity in Spain in the 2011-2019 period by sex, age and socioeconomic level: Results of the ALADINO study

Introducción: El exceso de peso infantil es un problema de salud pública creciente. El objetivo del trabajo es estudiar la evolución de la prevalencia de sobrepeso, de obesidad y de obesidad central en escolares de 6 a 9años en España entre 2011 y 2019 según características demográficas y socioeconómicas.MetodologíaSe incluyeron las rondas 2011, 2015 y 2019 del estudio observacional, descriptivo y transversal ALADINO en escolares de ambos sexos de 6 a 9años. Se realizó un análisis descriptivo de la evolución de la prevalencia de sobrepeso y de obesidad según los criterios de la Organización Mundial de la Salud (OMS) y la International Obesity Task Force (IOTF), así como obesidad central, y las variables demográficas y socioeconómicas asociadas.ResultadosEntre 2011 y 2019 se redujo la prevalencia de sobrepeso (criterios OMS) en niños de 6, 7 y 8años (−5,4, −5,7 y −5,3 puntos porcentuales, respectivamente) y niños cuyos progenitores tenían estudios superiores (−5,3 puntos porcentuales). Por renta, el sobrepeso en niños se redujo en todos los niveles de ingresos. Sin embargo, entre 2011 y 2019 se mantuvieron estables tanto la prevalencia de sobrepeso en niñas como la prevalencia de obesidad según las referencias OMS e IOTF y la de obesidad central en ambos sexos.ConclusionesLas prevalencias de sobrepeso y de obesidad en escolares de 6 a 9años en España siguen siendo altas. Entre 2011 y 2019 disminuyó la prevalencia de sobrepeso en niños de 6 a 8años y aquellos cuyos progenitores tienen estudios universitarios, mientras que la obesidad en niños, el sobrepeso y la obesidad en niñas, y la obesidad central en ambos sexos han permanecido estables. (AU)

Introduction: Childhood excess weight is a growing public health problem. The aim of this study was to assess temporal trends in the prevalence of overweight, obesity and central obesity in schoolchildren aged 6 to 9years in Spain between 2011 and 2019 based on demographic and socioeconomic characteristics.MethodologyThe analysis included data from the 2011, 2015 and 2019 rounds of the cross-sectional observational and descriptive ALADINO study in schoolchildren of both sexes aged 6 to 9years. We conducted a descriptive analysis of the trends in the prevalence of overweight and obesity (defined according to the criteria of the World Health Organization [WHO] and the International Obesity Task Force [IOTF]) and of central obesity, in addition to associated demographic and socioeconomic variables.ResultsBetween 2011 and 2019, the prevalence of overweight (WHO criteria) decreased in boys aged 6, 7 and 8years (by −5.4%, −5.7% and −5.3%, respectively) and boys whose parents had a higher educational attainment (by −5.3%). In relation to the socioeconomic level, overweight in boys declined at all income levels. However, between 2011 and 2019, both the prevalence of overweight in girls and the prevalence of obesity (applying the WHO and IOTF criteria) and the prevalence of central obesity in both sexes remained stable.ConclusionsThe prevalence of overweight and the prevalence of obesity in schoolchildren aged 6 to 9years in Spain remain high. Between 2011 and 2019, the prevalence of overweight in children aged 6 to 8years and in children whose parents had university degrees decreased, whereas obesity in boys, overweight and obesity in girls and central obesity in both sexes remained stable. (AU)

RISKY BEHAVIORS AMONG SCHOOL-AGED ADOLESCENTS AND SOCIAL DETERMINANTS OF HEALTH / CONDUCTAS DE RIESGO ENTRE ADOLESCENTES EN EDAD ESCOLAR Y DETERMINANTES SOCIALES DE LA SALUD / COMPORTAMENTOS DE RISCO ENTRE ADOLESCENTES ESCOLARES E DETERMINANTES SOCIAIS DA SAÚDE

This study aimed to identify the association between the occurrence of risk behaviors among school adolescents and the Social Determinants of Health of both the students and their families. This is a descriptive, correlational, cross-sectional study, with a quantitative approach, carried out with adolescents enrolled in elementary school (final years) and high school, in public schools in the metropolitan region and the agrestic region of Pernambuco, between June and August 2023. Two instruments were used: a sociodemographic questionnaire prepared by the researchers and the Risk Behavior Index. The data was analyzed using Epi info and SPSS software. The results revealed that aspects such as age, gender, religion, marital status, physical activity and family structure were related to the behaviors assessed and could act as risk or protective factors. When considering ways of conducting actions to protect, prevent and mitigate risk behaviors among school adolescents, it is imperative to include the involvement of health and education professionals in the development of strategies that facilitate the development of dialogical spaces. It is also important to encourage responsible protagonism and active participation by adolescents in making decisions about their lives and health.

Este estudio tuvo como objetivo identificar la asociación entre la ocurrencia de comportamientos de riesgo entre adolescentes escolares y los Determinantes Sociales de la Salud tanto de los alumnos como de sus familias. Se trata de un estudio descriptivo, correlacional, transversal, con abordaje cuantitativo, realizado entre adolescentes matriculados en la enseñanza fundamental (años finales) y secundaria en escuelas públicas de las regiones metropolitana y agreste de Pernambuco, entre junio y agosto de 2023. Se utilizaron dos instrumentos: un cuestionario sociodemográfico elaborado por los investigadores y el Índice de Comportamiento de Riesgo. Los datos fueron analizados utilizando los softwares Epi info y SPSS. Los resultados mostraron que aspectos como la edad, el sexo, la religión, el estado civil, la actividad física y la estructura familiar estaban relacionados con los comportamientos evaluados y podían actuar como factores de riesgo o de protección. Al pensar en formas de conducir acciones para proteger, prevenir y mitigar las conductas de riesgo entre los adolescentes escolarizados, es fundamental considerar la participación de los profesionales de la salud y de la educación en el desarrollo de estrategias que faciliten la construcción de espacios dialógicos. También es importante fomentar el protagonismo responsable y la participación activa de los adolescentes en la toma de decisiones sobre sus vidas y su salud.

Este estudo objetivou identificar a associação entre a ocorrência de comportamentos de risco entre adolescentes escolares e os Determinantes Sociais de Saúde tanto dos estudantes quanto de suas famílias. Trata-se de um uma pesquisa descritiva, correlacional, de delineamento transversal, com abordagem quantitativa, realizada ao público de adolescentes matriculados no Ensino Fundamental II e Médio, em escolas públicas da região metropolitana e do agreste de Pernambuco, durante o período de junho a agosto de 2023. Foram aplicados 2 instrumentos: um questionário sociodemográfico elaborado pelos pesquisadores e o Índice de Comportamentos de Risco. Os dados foram analisados com suporte dos softwares Epi info e SPSS. Os resultados evidenciaram que aspectos como idade, gênero, religião, estado civil dos adolescentes, prática de atividades físicas e estrutura familiar obtiveram relações com os comportamentos avaliados, podendo agir como fatores de risco ou protetivos. Ao pensar formas de conduzir ações de proteção, prevenção e mitigação de comportamentos de risco entre adolescentes escolares, é crucial considerar o envolvimento de profissionais da saúde e da educação no desenvolvimento de estratégias que facilitem a criação de espaços dialógicos. Ademais, o estímulo ao protagonismo responsável e participação ativa dos adolescentes na tomada de decisões relacionadas às suas vidas e saúde.

Association between socioeconomic status and hospitalisation requirement in older patients attended at the emergency department: A retrospective cohort study.

INTRODUCTION AND OBJECTIVE: A low socioeconomic status (SES) has been associated with poor health results. The present study aimed to investigate if SES of older patients attending the emergency department is associated with the use of healthcare resources and outcomes. PATIENTS AND METHODS: Observational, retrospective study including consecutive patients 65 years or older admitted to the emergency department. Variables at baseline, index episode, and follow-up were recorded. SES was measured using an indirect theoretical index and patients were categorised into two groups according to whether they lived in a neighbourhood with a low or high SES. Primary outcomes included hospitalisation after the emergency department visit and prolonged hospitalisation (>7 days) at index episode. Secondary outcomes included emergency department re-consultant and hospital admission in the following 3 months after the index episode, and all-cause mortality after long-term follow-up. Logistic regression and cumulative hazards regression models were used to investigate associations between SES and outcomes. RESULTS: The cohort included 553 patients (80 years [73-85], 50.5% female, 55.9% with low SES). After the emergency department visit, 234 patients (42.3%) required hospital admission. A low SES was inversely associated with hospitalisation with an adjusted odds ratio=0.654 (95% CI 0.441-0.970). Among hospitalised patients, a low SES was associated with prolonged hospitalisation (adjusted odds ratio=2.739; 95% CI 1.470-5.104). Follow-up outcomes, including all-cause mortality, were not associated with SES. CONCLUSIONS: Older patients living in more deprived urban areas were hospitalised less often after emergency department care, but hospital stays were longer. Understanding the effect of social determinants in healthcare use is mandatory to tailor resources to patient needs.

Differences in the temporal trends of childhood overweight and obesity in Spain in the 2011-2019 period by sex, age and socioeconomic level: results of the ALADINO study.

INTRODUCTION: Childhood excess weight is a growing public health problem. The aim of this study was to assess temporal trends in the prevalence of overweight, obesity and central obesity in schoolchildren aged 6-9 years in Spain between 2011 and 2019 based on demographic and socioeconomic characteristics. METHODOLOGY: The analysis included data from the 2011, 2015 and 2019 rounds of the cross-sectional observational and descriptive ALADINO study in schoolchildren of both sexes aged 6-9 years. We conducted a descriptive analysis of the trends in the prevalence of overweight and obesity (defined according to the criteria of the World Health Organization and the International Obesity Task Force) and of central obesity, in addition to associated demographic and socioeconomic variables. RESULTS: Between 2011 and 2019, the prevalence of overweight (WHO criteria) decreased in boys aged 6, 7 and 8 years (by -5.4%, -5.7% and -5.3%, respectively) and boys whose parents had a higher educational attainment (by -5.3%). In relation to the socioeconomic level, overweight in boys declined at all income levels. However, between 2011 and 2019, both the prevalence of overweight in girls and the prevalence of obesity (applying the WHO and IOTF criteria) and the prevalence of central obesity in both sexes remained stable. CONCLUSIONS: The prevalence of overweight and the prevalence of obesity in schoolchildren aged 6-9 years in Spain remain high. Between 2011 and 2019, the prevalence of overweight in children aged 6-8 years and in children whose parents had university degrees decreased, whereas obesity in boys, overweight and obesity in girls and central obesity in both sexes remained stable.

Vulnerabilidade social no contexto da pandemia de COVID-19: uma discussão bioética / Social vulnerability in the context of the COVID-19 pandemic: a bioethical discussion / Vulnerabilidad social en el contexto de la pandemia del COVID-19: una discusión bioética

Objetivo: analisar, sob um olhar bioético, a vulnerabilidade social referente à saúde durante o contexto da pandemia de COVID-19. Metodologia: foram incluídas publicações de 1º de janeiro a 31 de dezembro de 2020, revisadas por pares, identificadas nas bases de dados Pubmed, SciELO e LILACS. Foram utilizados para realizar a busca na base Pubmed o termo MESH "COVID-19" conjugado com os termos: "vulnerable population", "population groups", "social determinants of health", "health equity". Os descritores DECS equivalentes em português e em espanhol dos termos MESH foram utilizados na busca nas outras duas bases. Resultados: de um total de 132 artigos, após a aplicação dos critérios de inclusão e exclusão, foram identificados 21 artigos elegíveis. Os temas mais abordados na amostra foram: vulnerabilidades referentes a pessoas idosas, raça, minorias étnicas, condições socioeconômicas precárias, gênero feminino, pessoas com deficiência e condições crônicas de saúde. Observou-se artigos abordando mais de uma temática, integrando aspectos diversos de populações vulneráveis. Com base nos dados encontrados foram feitas análise e discussão com foco em vulnerabilidade como conceito bioético, além de conexões com discriminação e determinação social da saúde. Conclusão: os resultados apontam para a violação de direitos explicitados na Declaração Universal de Bioética e Direitos Humanos. Ao aumentar a disparidade da morbimortalidade por COVID-19 de grupos populacionais já impactados pela determinação social da saúde, constata-se uma violação do direito à saúde, indicando que governos e sociedades falham em respeitar a vulnerabilidade de grupos sociais no contexto pandêmico.

Objective: to analyze, from a bioethical perspective, social vulnerability in relation to health during the context of the COVID-19 pandemic. Methods: The study included peer-reviewed publications from January 1st until December 31st 2020, identified in Pubmed, SciELO and LILACS data basis. Mesh terms were utilized for research in Pubmed as follows: "COVID-19" conjugated with the terms: "vulnerable population", "population groups", "social determinants of health", "health equity". Portuguese and Spanish equivalents DECS terms were used for searching in the other two databases. Results: a total of 132 articles were found. After applied inclusion and exclusion criteria, were 21 eligible articles. The most recurrent themes were: racial, ethnic and social-economics, gender, age, disability and chronic health conditions. Articles addressing more than one theme were observed, integrating different aspects of vulnerable populations. A bioethical discussion with focus in vulnerability based in the data retrieved took place and connections with discrimination and social determinants of health were made. Conclusion: results point to the violation of rights explained in the Universal Declaration of Bioethics and Human Rights. By increasing the disparity in morbidity and mortality from COVID-19 of population groups already impacted by the social determination of health, there is a violation of the right to health, indicating that governments and societies fail to respect the vulnerability of social groups in the pandemic context.

Objetivo: analizar desde un punto de vista bioético, la vulnerabilidad social relacionada con la salud durante el contexto de la pandemia de la COVID-19. Metodología: se incluyeron publicaciones revisadas por pares del 1 de enero al 31 de diciembre de 2020, identificadas en las bases de datos Pubmed, SciELO y LILACS. Se utilizó el término MESH "COVID-19" para buscar en la base de datos Pubmed junto con los términos: "población vulnerable", "grupos de población", "determinantes sociales de la salud", "equidad en salud". Los descriptores DECS equivalentes en portugués y español de los términos MESH fueron utilizados en la búsqueda en las otras bases.Resultados: de un total de 132 artículos, tras aplicar los criterios de inclusión y exclusión, se identificaron 21 artículos. Los temas más discutidos fueron: vulnerabilidades relacionadas con los adultos mayores, raza (énfasis en personas negras), minorías étnicas, condiciones socioeconómicas precarias, género femenino, personas con discapacidad y condiciones crónicas de salud. Se observaron artículos que abordaban más de un tema, integrando diferentes aspectos de las poblaciones vulnerables. A partir de los datos encontrados, se realizó análisis y discusión con foco en la vulnerabilidad como concepto bioético, así como las conexiones con la discriminación y la determinación social de la salud. Conclusión: los resultados apuntan a la violación de los derechos explícitos en la Declaración Universal de Bioética y Derechos Humanos. Al aumentar la disparidad en la morbimortalidad por COVID-19 de grupos poblacionales ya impactados por la determinación social de la salud, se vulnera el derecho a la salud, indicando que los gobiernos y las sociedades no respetan la vulnerabilidad de los grupos sociales ante la pandemia.

[Evaluation of a coding guide on social determinants of health in primary care consultations: A mixed study]. / Evaluación de una guía de codificación de determinantes sociales de la salud en las consultas de atención primaria: Estudio mixto.

OBJECTIVE: To evaluate a coding guide for social determinants of health in primary care consultations as an effective tool in the professional's daily workflow. DESIGN: Mixed sequential explanatory study. Formed by a quantitative part (experimental) and a qualitative part (descriptive-evaluative). LOCATION: All the primary care teams of the Central Catalonia Management (32 teams). PARTICIPANTS AND SETTING: All nursing, social work and medical professionals working in the 32 primary care teams of the Catalan Institute of Health in Central Catalonia from February 2023 to July 2023. METHODS: A social determinants of health coding guide was developed. This guide was created in a multidisciplinary and multicenter manner. Purposive sampling. Quantitatively, the number of diagnoses recorded by the experimental group versus the control group was counted. Qualitatively, a thematic analysis was carried out from a socio-constructivist perspective. RESULTS: The results were significant and satisfactory. Using a quantitative methodology, the effectiveness of the use of the guide was assessed. A significant increase in the use of the social determinants was observed in the intervention group vs. the control group, with a percentage of post-intervention use of 19.53% in the control group and 32.26% in the intervention group (P < .001). The number of diagnoses recorded increased from 312 to 1322 in the intervention group, while it remained the same in the control group. The main factors identified through qualitative methodology that may explain the effectiveness of the guideline were: 1) the effectiveness of the guideline among primary care professionals, 2) the appropriateness of the guideline by assessing its usefulness and practicality, 3) feasibility and 4) specific contributions to the improvement of the guideline. CONCLUSIONS: The social determinants of health coding guide is effective, appropriate and can be implemented in the workflow of primary health care professionals for good recording of the social determinants of health.

[Prevalence, knowledge and control of arterial hypertension in vulnerable neighborhoods of Argentina: A Cross-sectional Study]. / Estudio de prevalencia, conocimiento y control de la hipertensión arterial en barrios vulnerables de Argentina.

INTRODUCTION: Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access. METHODS: A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes. RESULTS: A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence. Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy. CONCLUSION: The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations. Inadequate use of combination therapy was observed. This study underscores the urgent need for targeted interventions addressing cardiovascular risk factors in poor areas to mitigate the burden of CVD.

Los determinantes sociales de la salud y su influencia en la prevalencia y pronóstico de la EPOC: una revisión exploratoria / Social determinants of health that impact COPD prevalence and prognosis: a scoping review

Objetivo: el objetivo de esta revisión es estudiar el efecto que los determinantes sociales de la salud tienen sobre la prevalencia y pronóstico de la enfermedad pulmonar obstructiva crónica (EPOC). Métodos: se ha hecho una revisión exploratoria (scoping review) de los artículos publicados entre 2013 y 2023, y una búsqueda bibliográfica en Pubmed. Se encontraron 31 artículos que cumplieran los criterios de inclusión. Resultados: niveles educativos precarios, así como bajos ingresos económicos se relacionan con un aumento en el riesgo de EPOC, con incrementos del 44,9% y el 22,9% de los casos respectivamente. La dedicación a ciertos oficios, como la agricultura o los servicios de restauración, también aumenta la prevalencia de esta enfermedad y su impacto sobre la mortalidad. La soltería o viudez, el desempleo y vivir en áreas rurales con alta contaminación atmosférica son factores que se asocian a más hospitalizaciones, síntomas graves, menor productividad y mayor mortalidad. Las desigualdades sociales afectan el acceso a la atención médica y la adherencia al tratamiento. La EPOC es más común en hombres y en personas mayores, aunque algunos estudios muestran mayor riesgo en mujeres debido a su dedicación a las tareas domésticas y su exposición a sustancias contaminantes. Conclusiones: determinantes sociales de la salud como el bajo nivel socioeconómico, la ocupación laboral, la contaminación doméstica o ambiental, el estado civil, lugar de residencia o dificultad de acceso al sistema sanitario actúan como factores de riesgo de la EPOC e influyen desfavorablemente sobre ella.(AU)

Aim: the objective of this review is to study the impact of social determinants of health on the prevalence and prognosis of COPD.Methods: an exploratory scoping review of papers published between 2013 and 2023 was performed. A bibliographic search was conducted on pubmed, yielding 31 papers that met the inclusion criteria.Results: low educational levels and low incomes are linked to an increased risk of COPD with increments of 44.9% and 22.9% of cases respectively. Involvement in certain occupations such as agriculture or food services also increases the prevalence of the disease and its impact on mortality. Being single or widowhood, unemployment, and living in rural areas with high air pollution are associated with more hospitalizations, severe symptoms, reduced productivity and higher mortality. Social inequalities impact access to medical care and treatment adherence. COPD is more common in men and the elderly, although some studies reveal a higher risk in women due to household chores and exposure to pollutants.Conclusions: social determinants of health such as low socio-economic status, occupational status, household or environmental pollution, marital status, place of residence or difficulty accessing the healthcare system act as risk factors for COPD and have an unfavourable impact on this.(AU)

[Digital literacy as a key element in the digital transformation of health organizations]. / La alfabetización digital como elemento clave en la transformación digital de las organizaciones en salud.

In the last years, the digital transformation, has become a reality influencing organizational processes and advancing services for users. This transformation must align with WHO guidelines, addressing the needs of individuals globally and acknowledging Social Determinants of Health and emerging Digital Determinants of Health and the digital divide thas has been created. To accomplish this, the appropriate legislation and infrastructures are required. Correspondingly technology enables enhanced self-care and increased participation in decision-making across various levels, consequently, addressing the digital divide must not be an exception, and needs to include citizens, communities, entities, and professionals to work on how to diminish it and solve it. As a result of this national and supranational campaigns should formulate unified plans and strategies, that include training requirements and establishing programs for both professionals and users, highlighting the significance of incorporating digital knowledge on both groups.

Posttraumatic stress and depression symptom classes in parents of trauma-exposed children: a transdiagnostic perspective using pooled individual participant data.

Background: In the aftermath of child trauma, post-traumatic stress (PTS) and depression symptoms often co-occur among trauma exposed children and their parents. Studies have used latent class analysis (LCA) to examine PTS and depression symptoms and identify homogeneous subgroups among trauma exposed children. However, little is known about subgroups or classes of PTS and depression reactions of parents of traumatised children.Objectives: (1) Determine PTS and depression symptom classes at 2-9 months post-trauma, and (2) to examine sociodemographic covariates among parents of trauma exposed children.Methods: Using harmonised individual participant data (n = 702) from eight studies (Australia, UK, US) included in the Prospective studies of Acute Child Trauma and Recovery Data Archive (PACT/R), we modelled these phenomena at the symptom level using LCA.Results: Our LCA yielded three solutions: 'high internalizing symptom' class (11%); 'low PTS-high depression' class (17%); and 'low internalizing symptom' class (72%). Parents of children in the 'low PTS-high depression' class were more likely to have children of older age and be part of an ethnic minority, compared to the 'low internalizing symptoms' class. Mothers were more likely to be in the 'high internalizing symptom' class compared to the 'low internalizing symptoms' class.Conclusions: These findings reveal a qualitative structure and relationship between depression and PTS symptoms that highlights the importance of assessing and targeting a broad range of internalising symptoms in post-trauma psychological treatment.

Using harmonised individual participant data from eight studies included in the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive we identified three distinct classes of parental internalising reactions using Latent Class Analysis.Mothers, family ethnic minority status, and children of older age were associated with distinct classes of problematic symptoms.The findings from the present study highlight the need for assessing and targeting a broad range of internalising symptoms after trauma, and that mothers, parents of older children and families with ethnic minority status might be at risk for elevated symptoms.

Sinhogarismo como determinante de la salud y su impacto en la calidad de vida / Homelessness as a determinant of health and its impact on quality of life

Objetivo Conocer el estado de salud de la población sin hogar en situación residencial extrema (pernocta en la calle o en un albergue), en referencia a su calidad de vida, salud autopercibida, comorbilidad y acceso a recursos sanitarios. Método Sobre la muestra de 263 personas en situación de sinhogarismo se realizó un estudio descriptivo transversal en la ciudad de Valencia por medio de recuento nocturno y haciendo uso del Cuestionario de Calidad de Vida Relacionada con la Salud EQ-5D-3L y de preguntas de la Encuesta de Calidad de Vida Europea para España. Resultados De las personas que participaron en el estudio, 129 dormían a la intemperie, un 49% (62,79% hombres, 19,37% mujeres y 17,84% sin identificar), mientras que 134 pernoctaron en albergues, lo que supone el 51% (67,16% hombres y 32,84% mujeres). La media de edad estimada era de 41,53 años y el 55% de ellas residían en la calle desde hacía menos de 12 meses. Las personas que pernoctaban en la calle presentaron peor calidad de vida, y más de una cuarta parte de la muestra carece de tarjeta sanitaria. Conclusiones Existe una relación entre la falta de vivienda y las condiciones de salud deficientes referidas a la calidad de vida, la salud percibida, la comorbilidad y la accesibilidad a los recursos sanitarios. Se evidencia la ley de cuidados inversos. (AU)

Objective To determine the health status of the homeless population who spend the night on the streets and in shelters (extreme residential exclusion), with reference to their quality of life, self-perceived health, comorbidity and access to health resources. Method A cross-sectional descriptive study was carried out on a sample of 263 homeless people in the city of Valencia by means of a nocturnal count and using the EQ-5D-3L Health Related Quality of Life questionnaire and questions from the European Quality of Life Survey for Spain. Results Of the people who participated in the study, 129 of them slept outdoors, 49% (62.79% men, 19.37% women and 17.84% unidentified), while 134 slept in hostels, i.e. 51% (67.16% men and 32.84% women) with an estimated average age of 41.53 years and 55% had been living on the street for less than 12 months. People staying overnight on the streets presented worse quality of life and more than a quarter of the sample lacked a health card. Conclusions There is a relationship between homelessness and poor health conditions in terms of quality of life, perceived health, comorbidity and accessibility to health to resources. The inverse care law is evidenced. (AU)

Pobreza energética y salud en población gitana y en población general de España / Energy poverty and self-rated health among Roma population and general population in Spain

Objetivo: Cuantificar la pobreza energética en población gitana y población general de España, en 2016, y observar la asociación de este fenómeno con la salud autopercibida, ajustando por los principales determinantes socioeconómicos. Método: La pobreza energética fue definida como la incapacidad económica para mantener el calor dentro del hogar, la presencia de humedad en la vivienda y tener retrasos en el pago de facturas de suministros, con datos de dos encuestas europeas para España en 2016: la Encuesta sobre Ingresos y Condiciones de Vida (EU-SILC) y la Segunda Encuesta sobre Minorías y Discriminación (EU-MIDIS II). Se calcularon modelos de regresión logística jerárquica con la salud autopercibida como variable resultado, ajustando progresivamente por variables demográficas (género y edad), ambientales (temperatura del hogar, humedad y retrasos en las facturas) y socioeconómicas (nivel educativo, estado civil y situación ocupacional). Resultados: El 45% de la población gitana mostró niveles moderados o altos de pobreza energética. La odds ratio (OR) de mala salud autopercibida era mayor en la población gitana (OR: 3,11; intervalo de confianza del 95% [IC95%]: 2,59-3,74). No poder mantener una temperatura adecuada en el interior del hogar incrementó considerablemente el riesgo de mala salud (OR: 2,10; IC95%: 1,90-2,32). Tras ajustar por variables demográficas, ambientales y socioeconómicas, no observamos asociación entre población de adscripción y salud autopercibida. Conclusiones: Considerando los principales determinantes sociales, indicadores de pobreza energética incluidos, ser una persona gitana no se asocia con declarar mala salud. Este resultado señala la relevancia de abordar los factores socioeconómicos, la pobreza energética entre ellos, para reducir las desigualdades en salud.(AU)

Objective: To quantify energy poverty in Roma population and in general population in Spain, in 2016, as well as to observe the association of this phenomenon with self-rated health, adjusted according to the main socio-economic determinants. Method: Energy poverty has been defined as the financial inability to keep a home warm, the presence of dampness in the dwelling and falling into arrears in utility bills, using data from two European surveys from Spain in 2016: the Survey on Income and Living Conditions (EU-SILC) and the Second Survey on Minorities and Discrimination (EU-MIDIS II). Hierarchical logistic regression models were estimated with self-rated health as the outcome variable, progressively adjusted according to demographic (gender and age), environmental (household temperature, humidity and arrears in utility bills) and socio-economic (level of education, marital status and employment status) variables. Results: Our results show that 45% of the Roma population had moderate or high levels of energy poverty. The odds ratio (OR) of poor self-rated health was higher in the Roma population (OR: 3.11; 95% confidence interval [95% CI]: 2.59–3.74). The inability to maintain an adequate indoor temperature significantly increased the risk of poor health (OR: 2.10; 95% CI: 1.90–2.32). After adjusting according to demographic, environmental and socio-economic variables, no association was observed between the population of ascription and self-rated health. Conclusions: Taking into account the main social determinants, including energy poverty indicators, being Roma is not associated with reporting poor health. This result points to the importance of tackling socio-economic factors, including energy poverty, to reduce health inequalities.(AU)

Self-perception of mental health, COVID-19 and associated sociodemographic-contextual factors in Latin America / Autopercepción de la salud mental, COVID-19 y factores sociodemográficos y contextuales asociados en Latinoamérica / Autopercepção da saúde mental, COVID-19 e fatores sociodemográficos e contextuais associados na América Latina

Abstract This study aimed to estimate the prevalence of alterations in self-perceived mental health during the COVID-19 pandemic and their associated factors in four Latin American countries. This is a cross-sectional study based on data collected from adults in 2021 through the Collaborative Response COVID-19 Survey by the MacDonnell Academy at Washington University in St. Louis (United States). The sample was composed of 8,125 individuals from Brazil, Colombia, Mexico, and Chile. A generalized linear model for a binary outcome variable with a logistic link and fixed country effects was used. There were 2,336 (28.75%) individuals who considered having suffered alterations in self-perceived mental health. Unemployed individuals (OR = 1.40; 95%CI: 1.24-1.58), those with bad/regular quality of life (OR = 5.03; 95%CI: 4.01-6.31), and those with high socioeconomic status (OR = 1.66; 95%CI: 1.41-1.96) had a higher risk of self-perceived mental health alterations than those with full-time employment, excellent quality, and low socioeconomic status. According to the fixed-effects model, Brazilians living in the country during the pandemic, who disagreed with their government's decisions (OR = 2.05; 95%CI: 1.74-2.42) and lacked trust in their government (OR = 2.10; 95%CI: 1.74-2.42) had a higher risk of having self-perceived mental health alterations. Nearly 30% of respondents indicated that the COVID-19 pandemic altered their self-perceived mental health. This outcome was associated with political, sociodemographic, and health risk factors. These findings should help policymakers develop post-pandemic community interventions.

Resumen Este estudio tuvo como objetivo estimar la prevalencia de alteraciones en la autopercepción de la salud mental durante la pandemia de COVID-19 y sus factores asociados en cuatro países de América Latina. Este es un estudio transversal de datos recopilados de adultos en el 2021 por medio de la investigación Respuesta Colaborativa a COVID-19 de la Academia McDonnell en la Universidad Washington en St. Louis (Estados Unidos). La muestra estuvo compuesta por 8.125 personas de Brasil, Colombia, México y Chile. El estudio utilizó un modelo lineal generalizado para una variable de desenlace binario con un enlace logístico y efectos fijos por país. En total, 2.336 (28,75%) personas consideraron que habían sufrido alteraciones en la autopercepción de la salud mental. Los desempleados (OR = 1,40; IC95%: 1,24-1,58), aquellos con calidad de vida mala/regular (OR = 5,03; IC95%: 4,01-6,31) y aquellos con alto nivel socioeconómico (OR = 1,66; IC95%: 1,41-1,96) presentaron mayor riesgo de alteraciones en la autopercepción de la salud mental que aquellos con empleo a tiempo completo, excelente calidad y bajo nivel socioeconómico. Según el modelo de efectos fijos, los brasileños que vivían en el país durante la pandemia y que no estuvieron de acuerdo con las decisiones del gobierno (OR = 2,05; IC95%: 1,74-2,42) y no confiaban en su gobierno (OR = 2,10; IC95%: 1,74-2,42) presentaron mayor riesgo de alteraciones en la autopercepción de la salud mental. Casi el 30% de los encuestados indicaron que la pandemia de COVID-19 alteró su autopercepción de la salud mental. Este desenlace se asoció con factores políticos, sociodemográficos y de riesgo a la salud. Estos hallazgos deben ayudar a los formuladores de políticas a desarrollar intervenciones comunitarias pospandémicas.

Resumo Este estudo teve como objetivo estimar a prevalência de alterações na autopercepção de saúde mental durante a pandemia de COVID-19 e seus fatores associados em quatro países da América Latina. Este é um estudo transversal de dados coletados de adultos em 2021 por meio da pesquisa Resposta Colaborativa à COVID-19 da Academia McDonnell na Universidade Washington em St. Louis (Estados Unidos). A amostra foi composta por 8.125 pessoas do Brasil, Colômbia, México e Chile. O estudo utilizou um modelo linear generalizado para uma variável de desfecho binário com uma conexão logística e efeitos fixos do país. No total, 2.336 (28,75%) pessoas consideraram ter sofrido alterações na autopercepção de saúde mental. Os desempregados (OR = 1,40; IC95%: 1,24-1,58), aqueles com qualidade de vida ruim/regular (OR = 5,03; IC95%: 4,01-6,31) e aqueles com alto nível socioeconômico (OR = 1,66; IC95%: 1,41-1,96) apresentaram maior risco de alterações na autopercepção de saúde mental do que aqueles com emprego em tempo integral, excelente qualidade e baixo nível socioeconômico. De acordo com o modelo de efeitos fixos, os brasileiros que viviam no país durante a pandemia, que discordavam das decisões do governo (OR = 2,05; IC95%: 1,74-2,42) e não confiavam em seu governo (OR = 2,10; IC95%: 1,74-2,42) apresentaram maior risco de alterações na autopercepção de saúde mental. Quase 30% dos entrevistados indicaram que a pandemia da COVID-19 alterou sua autopercepção de saúde mental. Esse desfecho estava associado a fatores políticos, sociodemográficos e de risco à saúde. Estes achados devem ajudar os formuladores de políticas a desenvolver intervenções comunitárias pós-pandemia.

Determinantes del estado de vacunación infantil: abordando la brecha de equidad en República Dominicana-2019 / Determinants of childhood immunization status: addressing the equity gap in the Dominican Republic­2019

Introducción: Las desigualdades amenazan el progreso del país hacia la equidad y la cobertura de vacunación infantil. Siendo la cobertura inferior a la meta del 90% de la Organización Mundial de la Salud. Objetivo: Identificar los determinantes sociales y las desigualdades en el estado de vacunación infantil en República Dominicana, 2019. Métodos: Se realiza un análisis basado en la Encuesta de Indicadores Múltiples por Conglomerados. Incluyendo una muestra ponderada de 1674 niños de 12-23 meses. Se calcula la regresión logística multinomial para identificar factores asociados a la vacunación. Adoptando p<0,05 para significación estadística. Utilizando una razón de probabilidades ajustada con intervalo de confianza del 95%. Empleando HEAT 4.0 para medir desigualdades y SPSS.23 para gestión y análisis de datos. Resultados: La edad media de los niños fue 17,4±3,5 meses. El 33% de ellos estaban completamente vacunados. La cobertura fue significativamente menor entre hijos de madre sin educación [AOR= 7,27; IC95%= 2,98­17,74]. La mayor cobertura se concentra en niños con altos niveles de educación y riqueza. Conclusión: Para lograr una cobertura de vacunación completa y equitativa, las intervenciones de salud pública deben diseñarse para satisfacer las necesidades de grupos de alto riesgo.

Introduction: In the Dominican Republic, inequalities threaten progress towards childhood vaccination equity and coverage, the latter being inferior to the World Health Organization's 90% goal. Objective: Identify the social determinants and inequalities in the state of childhood vaccination in the Dominican Republic, 2019. Methods: An analysis based on the Multiple Indicator Cluster Surveys is conducted. Including a weighted sample of 1674 children aged 12-23 months. The multinomial logistic regression is calculated to identify factors associated with vaccination. Using p<0,05 for statistical significance and an adjusted probability ratio with a 95% confidence interval. Employing HEAT 4.0 to measure inequalities and SPSS.23 for data management and analysis. Results: The children's mean age was 17,4±3,5 months. 33% of them were completely vaccinated. Coverage was significantly lower in children of mothers without education [AOR= 7,27; CI95%= 2,98­17,74]. Coverage was the highest in kids with high levels of education and wealth. Conclusion: To achieve complete and equitable vaccine coverage, public health interventions should be designed to satisfy the needs of high-risk groups.

Factors related to health literacy among Brazilian adolescents: cross-sectional study / Factores relacionados con la alfabetización en salud de adolescentes brasileños: estudio transversal / Fatores relacionados ao letramento em saúde de adolescentes brasileiros: estudo transversal

ABSTRACT Objective: To analyze the relationship between sociodemographic and clinical factors with health literacy in Brazilian adolescents. Method: This is a cross-sectional study with 526 adolescents aged 14 to 19. Data were collected virtually between July and September 2021 using a sociodemographic characterization questionnaire, clinical profile and the Health Literacy Assessment Tool - Portuguese version. The variables were evaluated by multiple linear regression with normal response, with significance p < 0.05. Results: The average age was 16.9 years (±1.6), the average health literacy score was 25.3 (±5.4). Female gender (p = 0.014), university educational level (p = 0.002) and use of medication (p = 0.020) were related to higher levels of health literacy. Adolescents with chronic illnesses had a higher total literacy score, on average 1.51 points, compared to those without chronic illnesses. Conclusion: Male adolescents and those with less education performed worse in health literacy and, therefore, deserve special attention in health promotion actions.

RESUMEN Objetivo: Analizar la relación entre factores sociodemográficos y clínicos con la alfabetización en salud de adolescentes brasileños. Método: Se trata de un estudio transversal llevado con 526 adolescentes entre 14 y 19 años. Los datos se recogieron virtualmente entre julio y septiembre de 2021 mediante un cuestionario de caracterización sociodemográfica, de perfil clínico y de la Health Literacy Assessment Tool - versión en portugués. Las variables se sopesaron por regresión linear múltiple con respuesta normal y significación p < 0,05. Resultados: La edad promedio era de 16,9 años (±1,6) y la puntuación media en alfabetización en salud de 25,3 (±5,4). El sexo femenino (p = 0,014), la mayor escolaridad (p = 0,002) y el uso de medicación (p = 0,020) estaban relacionados con niveles más altos de alfabetización en salud. Los adolescentes con enfermedades crónicas obtuvieron una puntuación total de alfabetización más alta, en media, 1,51 puntos, en comparación con los que no padecían dichas enfermedades. Conclusión: Adolescentes del sexo masculino y aquellos con menos escolaridad presentaron un desempeño pobre en la alfabetización en salud y, por esa razón, necesitan atención especial durante las acciones de promoción de la salud.

RESUMO Objetivo: Analisar a relação entre fatores sociodemográficos e clínicos com o letramento em saúde de adolescentes brasileiros. Método: Trata-se de um estudo transversal com 526 adolescentes de 14 a 19 anos. Os dados foram coletados virtualmente entre julho e setembro de 2021 por meio de questionário de caracterização sociodemográfica, do perfil clínico e do Health Literacy Assessment Tool - versão em português. As variáveis foram avaliadas por regressão linear múltipla com resposta normal, com significância p < 0,05. Resultados: A média de idade foi de 16,9 anos (±1,6), a pontuação média do letramento em saúde foi de 25,3 (±5,4). Sexo feminino (p = 0,014), maior escolaridade (p = 0,002) e uso de medicamentos (p = 0,020) foram relacionados a maiores níveis de letramento em saúde. Adolescentes com doenças crônicas apresentaram pontuação total do letramento superior, em média 1,51 pontos, comparados aos sem doença crônica. Conclusão: Adolescentes do sexo masculino e os com menor escolaridade apresentaram pior desempenho no letramento em saúde e, por isso, merecem especial atenção nas ações de promoção da saúde.

Social determinants and access to health services in patients with COVID-19: a cross-sectional study / Determinantes sociales y acceso a los servicios sanitarios en pacientes con COVID-19: un estudio transversal / Determinantes sociais e acesso aos serviços de saúde em pacientes com COVID-19: estudo seccional

ABSTRACT Objective: To verify the association between social determinants of health and access to health services for COVID-19 patients. Method: Analytical, cross-sectional study, carried out in three states in the Northeast of Brazil (Ceará, Maranhão and Pernambuco), with 968 patients, using questionnaires with sociodemographic data, determinants and the Primary Care Assessment Tool, adapted to the reality of COVID-19, with 58 items, classified as high (score ≥ 6.6) and low (score < 6.6), whose high value reveals better standards of access to health services. The Chi-square test was used for comparative analysis. Results: There was a significant difference (p < 0.05) between the domains of the instrument and the following determinants: age, skin color, body mass index, origin, schooling, employment, services close to home, first service, income and means of transport. Conclusion: Access to health services for people with COVID-19 was associated with various determinants, including individual, behavioural and social ones, correlated with the structural and organizational aspects of the health services offered by the three states of Northeastern Brazil.

RESUMEN Objetivo: Verificar la asociación de los determinantes sociales de la salud con el acceso de los pacientes con COVID-19 a los servicios de salud. Método: Estudio analítico, transversal, realizado en tres estados del Nordeste de Brasil (Ceará, Maranhão y Pernambuco), con 968 pacientes, utilizando cuestionarios con datos sociodemográficos, determinantes y la Herramienta de Evaluación de la Atención Primaria (PCATool), adaptada a la realidad de la COVID-19, con 58 ítems, clasificados en alto (puntuación ≥ 6,6) y bajo (puntuación < 6,6), cuyo valor alto revela mejores estándares de acceso a los servicios de salud. Se utilizó la prueba de chi-cuadrado para analizar las comparaciones. Resultados: Hubo diferencia significativa (p < 0,05) entre los dominios del instrumento y los siguientes determinantes: edad, color de piel, índice de masa corporal, origen, escolaridad, empleo, servicios cercanos al domicilio, primer servicio, ingreso y medio de transporte. Conclusión: El acceso a los servicios de salud de las personas con COVID-19 se asoció a diversos determinantes, entre ellos individuales, comportamentales y sociales, correlacionados con los aspectos estructurales y organizativos de los servicios de salud ofrecidos por los tres estados del nordeste de Brasil.

RESUMO Objetivo: Verificar a associação dos determinantes sociais da saúde com o acesso de pacientes com COVID-19 aos serviços de saúde. Método: Estudo analítico, transversal, desenvolvido em três estados do Nordeste brasileiro (Ceará, Maranhão e Pernambuco), com 968 pacientes, utilizando-se de questionários de dados sociodemográficos, determinantes e do Primary Care Assessment Tool, adaptado para realidade da COVID-19, com 58 itens, classificado em alto (escore ≥ 6,6) e baixo (escore < 6,6), cujo valor alto revela melhores padrões de acesso aos serviços de saúde. Para análise comparativa, empregou-se o teste do Qui-quadrado. Resultados: Verificou-se diferença significativa (p < 0,05) entre os domínios do instrumento e os seguintes determinantes: idade, cor da pele, índice de massa corporal, procedência, escolaridade, vínculo empregatício, serviços próximos à residência, primeiro serviço de atendimento, renda e meios de transporte. Conclusão: O acesso aos serviços de saúde de pessoas com COVID-19 esteve associado aos diversos determinantes, sendo estes individuais, comportamentais, sociais, correlacionados aos aspectos estruturais e organizacionais dos serviços de saúde ofertados pelos três estados do Nordeste brasileiro.

Neonatal mortality in countries of the Americas, 2000-2020: trends, inequalities, and target-setting / Mortalidad neonatal en los países de la Región de las Américas, 2000-2020: tendencias, desigualdades y establecimiento de metas / Mortalidade neonatal nos países das Américas, 2000-2020: tendências, desigualdades e definição de metas

ABSTRACT Objective. To analyze temporal trends and inequalities in neonatal mortality between 2000 and 2020, and to set neonatal mortality targets for 2025 and 2030 in the Americas. Methods. A descriptive ecological study was conducted using 33 countries of the Americas as units of analysis. Both the percentage change and average annual percentage change in neonatal mortality rates were estimated. Measurements of absolute and relative inequality based on adjusted regression models were used to assess cross-country social inequalities in neonatal mortality. Targets to reduce neonatal mortality and cross-country inequalities were set for 2025 and 2030. Results. The estimated regional neonatal mortality rate was 12.0 per 1 000 live births in 2000-2004 and 7.4 per 1 000 live births in 2020, representing a percentage change of -38.3% and an average annual percentage change of -2.7%. National average annual percentage changes in neonatal mortality rates between 2000-2004 and 2020 ranged from -5.5 to 1.9 and were mostly negative. The estimated excess neonatal mortality in the 20% most socially disadvantaged countries, compared with the 20% least socially disadvantaged countries, was 17.1 and 9.8 deaths per 1 000 live births in 2000-2004 and 2020, respectively. Based on an extrapolation of recent trends, the regional neonatal mortality rate is projected to reach 7.0 and 6.6 neonatal deaths per 1 000 live births by 2025 and 2030, respectively. Conclusions. National and regional health authorities need to strengthen their efforts to reduce persistent social inequalities in neonatal mortality both within and between countries.

RESUMEN Objetivo. Analizar las desigualdades en la mortalidad neonatal y las tendencias en el transcurso del tiempo entre el 2000 y el 2020, y establecer metas en materia de mortalidad neonatal para el 2025 y el 2030 en la Región de las Américas. Métodos. Se realizó un estudio ecológico descriptivo con información de 33 países de la Región de las Américas que se usaron como unidades de análisis. Se calculó tanto la variación porcentual como la variación porcentual anual media de las tasas de mortalidad neonatal. Se utilizaron mediciones de la desigualdad absoluta y relativa basadas en modelos de regresión ajustados, para evaluar las desigualdades sociales en los diversos países en cuanto a la mortalidad neonatal. Se establecieron metas de reducción de la mortalidad neonatal y de las desigualdades en los diversos países para el 2025 y el 2030. Resultados. La tasa de mortalidad neonatal en la Región fue de 12,0 por 1 000 nacidos vivos en el período 2000-2004 y de 7,4 por 1 000 nacidos vivos en el 2020, lo que representa una variación porcentual del -38,3% y una variación porcentual anual media del -2,7%. Las variaciones porcentuales anuales medias de las tasas de mortalidad neonatal a nivel nacional entre el período 2000-2004 y el 2020 oscilaron entre -5,5 y 1,9, y fueron en su mayor parte negativas. El exceso de mortalidad neonatal estimado en el 20% de los países más desfavorecidos socialmente, en comparación con el 20% de los países menos desfavorecidos socialmente, fue de 17,1 muertes por 1 000 nacidos vivos en el período 2000-2004 y de 9,8 muertes por 1 000 nacidos vivos en el 2020. Al extrapolar las tendencias más recientes, se prevé que la tasa de mortalidad neonatal de la Región alcance valores de 7,0 y 6,6 muertes neonatales por 1 000 nacidos vivos en el 2025 y el 2030, respectivamente. Conclusiones. Las autoridades de salud nacionales y regionales deben fortalecer las medidas para reducir las desigualdades sociales que aún persisten en materia de mortalidad neonatal, tanto entre los distintos países como dentro de cada país.

RESUMO Objetivo. Analisar as tendências temporais e desigualdades em mortalidade neonatal entre 2000 e 2020 e estabelecer metas de mortalidade neonatal para 2025 e 2030 na Região das Américas. Métodos. Estudo ecológico descritivo examinando 33 países das Américas como unidades de análise. Foram estimadas a variação percentual e a variação percentual anual média das taxas de mortalidade neonatal. Foram usadas medidas de desigualdade absoluta e relativa baseadas em modelos de regressão ajustados para avaliar desigualdades sociais entre países em termos de mortalidade neonatal. Foram definidas metas de redução da mortalidade neonatal e das desigualdades entre países para 2025 e 2030. Resultados. A taxa regional estimada de mortalidade neonatal foi de 12,0 por mil nascidos vivos em 2000-2004, e de 7,4 por mil nascidos vivos em 2020, representando uma variação percentual de -38,3%, e uma variação percentual anual média de -2,7%. As variações percentuais anuais médias nacionais das taxas de mortalidade neonatal entre 2000-2004 e 2020 variaram entre -5,5 e 1,9 e, em sua maioria, foram negativas. O excesso estimado de mortalidade neonatal nos países que estavam entre os 20% mais desfavorecidos socialmente, em comparação com os países entre os 20% menos desfavorecidos, foi de 17,1 e 9,8 mortes por mil nascidos vivos em 2000-2004 e 2020, respectivamente. Com base em extrapolação das tendências recentes, estima-se que a taxa de mortalidade neonatal regional deve atingir 7,0 e 6,6 mortes neonatais por mil nascidos vivos em 2025 e 2030, respectivamente. Conclusões. As autoridades de saúde nacionais e regionais precisam intensificar seus esforços para reduzir desigualdades sociais persistentes na mortalidade neonatal, tanto dentro dos países quanto entre eles.