The newborn screening tests in Brazil: regional and socioeconomic prevalence and inequalities in 2013 and 2019

Abstract Objective: To analyze the prevalence evolution of Guthrie, hearing, and eye screening testing among newborns in Brazil, between 2013 and 2019, according to demographic and socioeconomic characteristics. Methods: This is a cross-sectional study with data from 5231 infants from the Pesquisa Nacional de Saude (PNS), in 2013, and 6637 infants, in 2019, for the Guthrie test, hearing, and red reflex tests. The authors analyzed the outcomes according to the region of residence, self-reported color/race, having health insurance, and per capita household income. By using bivariate and multivariate Poisson regression models, the prevalence ratios and their respective 95 % Confidence Intervals (CI95%) were calculated for each year. Results: In 2013, Guthrie test, hearing, and red reflex tests were performed in 96.5 % (95%CI 95,8;97,0), 65.8 % (95%CI 63,9;67,7), and 60.4 % (95%CI 58,5;62,3) of infants, respectively. In 2019, the prevalence was 97.8 % (95%CI 97,3;98,2) in the Guthrie test, 81.6 % (95%CI 80,3;82,9) in the hearing test, and 78.6 % (95%CI 77,1;79,9) in the red reflex test. The testing frequency was higher among residents of the Southeast and South regions of Brazil, among infants whose mother or guardian was white, had health insurance, and was in the higher income strata; and the most evident differences were in the eye and hearing testing. Conclusions: The coverage inequalities according to the region of residence, income, and having health insurance highlight the need to use strategies that enable exams to be carried out, with more information about their importance, encompassing actions from primary care, prenatal care to the puerperium, aiming at universal access and equity.

The newborn screening tests in Brazil: regional and socioeconomic prevalence and inequalities in 2013 and 2019.

OBJECTIVE: To analyze the prevalence evolution of Guthrie, hearing, and eye screening testing among newborns in Brazil, between 2013 and 2019, according to demographic and socioeconomic characteristics. METHODS: This is a cross-sectional study with data from 5231 infants from the Pesquisa Nacional de Saúde (PNS), in 2013, and 6637 infants, in 2019, for the Guthrie test, hearing, and red reflex tests. The authors analyzed the outcomes according to the region of residence, self-reported color/race, having health insurance, and per capita household income. By using bivariate and multivariate Poisson regression models, the prevalence ratios and their respective 95 % Confidence Intervals (CI95%) were calculated for each year. RESULTS: In 2013, Guthrie test, hearing, and red reflex tests were performed in 96.5 % (95%CI 95,8;97,0), 65.8 % (95%CI 63,9;67,7), and 60.4 % (95%CI 58,5;62,3) of infants, respectively. In 2019, the prevalence was 97.8 % (95%CI 97,3;98,2) in the Guthrie test, 81.6 % (95%CI 80,3;82,9) in the hearing test, and 78.6 % (95%CI 77,1;79,9) in the red reflex test. The testing frequency was higher among residents of the Southeast and South regions of Brazil, among infants whose mother or guardian was white, had health insurance, and was in the higher income strata; and the most evident differences were in the eye and hearing testing. CONCLUSIONS: The coverage inequalities according to the region of residence, income, and having health insurance highlight the need to use strategies that enable exams to be carried out, with more information about their importance, encompassing actions from primary care, prenatal care to the puerperium, aiming at universal access and equity.

The independent and joint contribution of objective and subjective socioeconomic status on oral health indicators.

OBJECTIVES: The understanding of how subjective socioeconomic status (SSS) relates to objective socioeconomic status (OSS), and how both conditions act together in oral health outcomes is still unclear. This study aims to test the independent and joint association between OSS and SSS with oral health, to assess the role of socioeconomic status discrepancies, and to evaluate the role of SSS in the association between OSS and oral health. METHODS: Data from 1140 adults from a population-based study in Southern Brazil were used. We applied diagonal reference models DRM to disentangle the effects of OSS (education) and SSS (MacArthur Scale) to oral health outcomes. The outcomes were functional dentition clinically evaluated (FD ≥20 teeth) and self-reported oral health SROH. We also examined the discrepancy between OSS and SSS to oral health indicators and the effect measure modification (EMM) of SSS on the association between OSS and oral health. RESULTS: Subjective socioeconomic status and OSS contributed equally to SROH, while OSS explained a substantially higher amount of FD than SSS (0.85 vs 0.15). An EMM of SSS was found on the association between OSS and fair/poor SROH, with a relative excess risk due to interaction (RERI) of 1.08. Less evidence of EMM was found for FD (RERI = 0.14). Individuals with lower SSS and OSS had four times the risk of the outcomes than the reference group. CONCLUSIONS: Adults with concordant lower SSS and OSS have a worse oral health than those with concordant higher status. There was evidence that the association between OSS and SROH is modified by SSS.

Clustering of risk behaviors for chronic noncommunicable diseases: a population-based study in southern Brazil.

OBJECTIVE: The purpose of this study was to investigate the prevalence and identify factors associated with simultaneous risk behaviors for chronic noncommunicable diseases in adults in a southern capital in Brazil. METHOD: A cross-sectional, population-based study was carried out with 1720 adults in Florianópolis, Brazil. The simultaneous occurrence of tobacco smoking, abusive drinking, inadequate or unhealthy diet, and physical inactivity during leisure was assessed. The independent variables were demographic and socioeconomic characteristics. RESULTS: Only 8.3% of the respondents did not have any of these factors, whereas the simultaneous occurrence of two or more risk behaviors was 59.4%. The simultaneous presence of four risk behaviors (3.4%) was 220% higher of what would be expected by combining the individual prevalence of these factors (1.5%). The likelihood of individuals having two or more risk behaviors simultaneously was greater in young men, with black skin color, living without a partner, with lower household per capita income, and lower education. CONCLUSION: It is necessary to implement programs that reduce the risk behaviors for chronic noncommunicable diseases among adults in Brazil, especially between young men with low education and income.

O Ensino da bioética nos cursos de graduação em odontologia do estado de São Paulo / Bioethics teaching in dentistry undergraduate courses at São Paulo state, Brazil

O ensino da disciplina de Bioética nos cursos de graduação é um tema emergente cuja discussão é imperativa,especialmente na área de ciências da saúde. Em se tratando dos cursos de Odontologia, a maioria das faculdades reconhece a necessidade da formação de um profissional sensível às reflexões éticas na relação com o paciente. Assim, foi realizada uma verificação quantitativa do oferecimento da disciplina de Bioética nos cursos de graduação em Odontologia do Estado de São Paulo, por meio da observação de suas respectivas estruturas curriculares. Os resultados evidenciaram graves lacunas quanto ao ensino da Bioética nas Faculdades de Odontologia paulistas, uma vez que dos 47 cursos pesquisados, apenas quatro a possuem em sua grade curricular. Nestas, a disciplina é ministrada por docentes com inserção na área de Bioética. Em três delas o oferecimento da disciplina se dá a partir da metade do curso e em uma no primeiro ano. Assim, há a necessidade de se incrementar a carga horária ou, na maioria dos casos, de se criar a disciplina de Bioética nos cursos de graduação em Odontologia investigados, de modo que o aluno possa autonomamente refletir e tomar decisões pautado em princípios éticos.

The teaching of Bioethics in undergraduate courses is an issue that needs to be discussed, especially inHealth Sciences. Particularly, in relation to Dentistry, it was verified that the majority of the college programsrecognizes the need to prepare a professional sensible to the ethical reflections about his/her patient. Theaim of this research was to verify the disciplines offered in the Dentistry undergraduate courses at São PauloState, Brazil, through the analysis of their respective curricular structures. The results have highlightedsignificant gaps about Bioethics teaching in Dentistry courses. From the 47 educational courses searchedonly four had this subject in their curricular grade. In these courses these disciplines were ministered byteachers with degree in Bioethics. In three of them, the discipline offered was ministered from the secondgrade onward, and only in one, it was ministered in the first grade. So it is necessary to increase the educationload or, in the majority of the cases, to create the discipline of Bioethics in the Dentistry undergraduatecourses investigated, so that the academics would have autonomy to reflect upon and take decisions basedon ethical principles.