Prevalência e fatores associados à doença renal crônica em pacientes hipertensos cadastrados na estratégia de saúde da família de Rio Branco, Acre / Prevalence and factors associated with chronic kidney disease in hypertensive patients registered in the family health strategy of Rio Branco, Acre / Prevalencia y factores asociados a la enfermedad renal crónica en pacientes hipertensos registrados en la estrategia de salud familiar de Rio Branco, Acre

Introdução: analisar a prevalência e os fatores associados à doença renal crônica em pessoas com hipertensão arterial (HAS) cadastrados na Estratégia de Saúde da Família em Rio Branco, Acre. Método: Trata-se de um estudo transversal realizado com hipertensos cadastrados nas Estratégias de Saúde da Família (ESF), na zona urbana de Rio Branco, Acre, em 2019. A DRC foi definida por TFG < 60 ml/1,72m², estimada a partir da fórmula Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), ou presença de albuminúria > 29 mg/g. Medidas de associação foram estimadas por regressão logística, com grau de confiança de 95%. Resultados: A prevalência de DRC foi de 27,3% em pessoas com HAS. Observou-se associação estatisticamente significativa nos pacientes hipertensos entre DRC e escolaridade (ensino fundamental ­ OR: 1,56; IC95%:1,09; 2,23; sem escolaridade ­ OR:1,87; IC95%: 1,14; 3,07), não controle da pressão arterial (OR: 2,39; IC95%: 1,45; 3,94), sedentarismo (OR: 1,63; IC95%: 1,02; 2,60). Conclusão: A DRC apresenta alta prevalência nos hipertensos, evidenciando a necessidade de medidas em saúde pública para prevenção de complicações mediante melhor controle da doença e mudanças no estilo de vida.

Introduction: To analyze the prevalence and factors associated with chronic kidney disease in people with hypertension (SAH) registered in the Family Health Strategy in Rio Branco, Acre. Method: This is a cross-sectional study carried out with hypertensive patients registered in the Family Health Strategies (ESF), in the urban area of Rio Branco, Acre, in 2019. CKD was defined by GFR < 60 ml/1.72m², estimated from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, or presence of albuminuria > 29 mg/g. Association measures were estimated using logistic regression, with a 95% confidence level. Results: The prevalence of CKD was 27.3% in people with hypertension. A statistically significant association was observed in hypertensive patients between CKD and education (primary education ­ OR: 1.56; 95% CI: 1.09; 2.23; no education ­ OR: 1.87; 95% CI: 1.14; 3.07), lack of blood pressure control (OR: 2.39; 95% CI: 1.45; 3.94), sedentary lifestyle (OR: 1.63; 95% CI: 1.02; 2.60). Conclusion: CKD has a high prevalence in hypertensive patients, highlighting the need for public health measures to prevent complications through better control of the disease and changes in lifestyle.

Introducción: Se analizó la prevalencia y los factores asociados a la enfermedad renal crónica (ERC) en personas con hipertensión arterial (HTA) inscritas en la Estrategia de Salud Familiar en Rio Branco, Acre. Método: Estudio transversal con hipertensos inscritos en las Estrategias de Salud Familiar (ESF) en la zona urbana de Rio Branco, Acre, en 2019. La ERC se definió por un FG <60 ml/1,72m², estimado a partir de la fórmula de Colaboración de Epidemiología de Enfermedades Renales Crónicas (CKD-EPI), o la presencia de albuminuria >29 mg/g. Se estimaron medidas de asociación mediante regresión logística, con un nivel de confianza del 95%. Resultados: La prevalencia de ERC fue del 27,3% en personas con HTA. Se observó una asociación estadísticamente significativa entre la ERC y la escolaridad (educación primaria ­ OR: 1,56; IC95%: 1,09; 2,23; sin escolaridad ­ OR: 1,87; IC95%: 1,14; 3,07), falta de control de la presión arterial (OR: 2,39; IC95%: 1,45; 3,94), y sedentarismo (OR: 1,63; IC95%: 1,02; 2,60) en pacientes hipertensos. Conclusión: La ERC presenta una alta prevalencia en pacientes hipertensos, lo que destaca la necesidad de medidas de salud pública para prevenir complicaciones mediante un mejor control de la enfermedad y cambios en el estilo de vida.

Estudo das doenças crônicas sob a ótica da qualidade em saúde: aspectos metodológicos / Study of chronic diseases from the perspective of quality in health: methodological aspects

Descrever os aspectos metodológicos e desenho amostral do Estudo das Doenças Crônicas sob a ótica da qualidade em saúde (Edoc-Quali). O estudo é composto por pesquisas de quatro populações distintas: coordenadores das unidades da Atenção Primária em Saúde; profissionais das equipes da Estratégia de Saúde da Família (ESF); usuários cadastrados nas ESFs com hipertensão arterial; e usuários cadastrados nas ESFs com diabetes mellitus do tipo 2. Participaram 30 gestores e 338 profissionais, que responderam percepções sobre estrutura física e processo de trabalho da equipe, com aplicação do PCATool-Brasil, e dados relativos ao processo de cuidado a esses pacientes. Também foram entrevistadas 672 pessoas com HAS, e 324 com DM2, além de avaliação física, coleta de material biológico e realização do eletrocardiograma. A avaliação da qualidade do cuidado segundo os gestores e profissionais e dos resultados obtidos junto aos usuários do serviço favoreceu o controle de complicações.

To describe the methodological aspects and sample design of the Study of Chronic Diseases from the perspective of quality in health (Edoc-Quali). Consisting of surveys of four distinct populations: coordinators of Primary Health Care units, professionals from the Family Health Strategy (FHS) teams, users registered in the FHS with arterial hypertension; and users registered in the FHS with type 2 diabetes mellitus. 30 managers and 338 participated professionals who answered perceptions about the physical structure and work process of the team with the application of PCATool-Brasil and data related to the care process for these patients. As for the study with users, 672 people with SAH and 324 with DM2 were interviewed, in addition to physical assessment, collection of biological material and electrocardiogram. The assessment of the quality of care according to managers and professionals, and the results obtained from service users, contributes to the control of complications.

Prevalência de diabetes mellitus e fatores associados em adultos: inquérito de base populacional / Prevalence of diabetes mellitus and associated factors in adults: population-based survey

Estimar a prevalência de diabetes mellitus e os fatores associados em adultos. Trata-se de um inquérito realizado com 1.637 indivíduos nas zonas urbana e rural do município de Rio Branco, Acre. Diabetes foi definido pela presença de glicemia no plasma em jejum ≥ 126 mg/dl ou utilização de hipoglicemiante oral ou insulina. Medidas de associação foram estimadas por regressão logística hierarquizada. A prevalência de diabetes foi de 6,5% (n = 202). Após análise, a chance de ser diabético esteve independente e positivamente associada a idade ≥ 60 anos (OR: 6,67; IC95%: 1,83-24,30); história familiar de diabetes mellitus (OR: 2,88; IC95%: 1,43-5,81); circunferência da cintura aumentada (OR: 1,83; IC95%:1,01-3,33); dislipidemia (OR: 2,95; IC95%: 1,34-6,49); anemia (OR: 3,15; IC95%: 1,30-7,60); e doença renal crônica (DRC) (OR: 4,00; IC95%: 1,70-9,33). Foi detectada uma prevalência de 6,5%, estando o diabetes associado com idade, história familiar, anemia e DRC. Indica-se a necessidade do adequado rastreio de comorbidades nesses pacientes.

To estimate the prevalence of diabetes mellitus and associated factors in adults.Survey carried out with 1,637 individuals in urban and rural areas of the municipality of Rio Branco, state of Acre. Diabetes was defined by the presence of fasting plasma glucose ≥ 126 mg/dl or the use of oral hypoglycemic agents or insulin. Association measures were estimated by hierarchical logistic regression.The prevalence of diabetes was 6.5% (n = 202). After analysis, the chance of being diabetic was independently and positively associated with age ≥ 60 years (OR: 6.67; 95%CI: 1.83-24.30); family history of diabetes mellitus (OR: 2.88; 95%CI: 1.43-5.81); increased waist circumference (OR: 1.83; 95%CI: 1.01-3.33); dyslipidemia (OR: 2.95; 95%CI: 1.34-6.49); anemia (OR: 3.15; 95%CI: 1.30-7.60); and chronic kidney disease (CKD) (OR: 4.00; 95%CI: 1.70-9.33). A prevalence of 6.5% was detected, with diabetes associated with age, family history, anemia, and CKD. The need for adequate screening of comorbidities in these patients is indicated.

National Vaccine Coverage Survey 2020: methods and operational aspects.

OBJECTIVE: The national vaccination coverage survey on full vaccination at 12 and 24 months of age was carried out to investigate drops in coverage as of 2016. METHODS: A sample of 37,836 live births from the 2017 or 2018 cohorts living in capital cities, the Federal District, and 12 inner cities with 100 thousand inhabitants were followed for the first 24 months through vaccine record cards. Census tracts stratified according to socioeconomic levels had the same number of children included in each stratum. Coverage for each vaccine, full vaccination at 12 and 24 months and number of doses administered, valid and timely, were calculated. Family, maternal and child factors associated with coverage were surveyed. The reasons for not vaccinating analyzed were: medical contraindications, access difficulties, problems with the program, and vaccine hesitancy. RESULTS: Preliminary results showed that less than 1% of children were not vaccinated, full coverage was less than 75% at all capitals and the Federal District, vaccines requiring more than one dose progressively lost coverage, and there were inequalities among socioeconomic strata, favorable to the highest level in some cities and to the lowest in others. CONCLUSION: There was an actual reduction in full vaccination in all capitals and the Federal District for children born in 2017 and 2018, showing a deteriorating implementation of the National Immunization Program from 2017 to 2019. The survey did not measure the impacts of the COVID-19 pandemic, which may have further reduced vaccination coverage.

National Vaccine Coverage Survey 2020: methods and operational aspects / Inquérito Nacional de Cobertura Vacinal 2020: métodos e aspectos operacionais

ABSTRACT Objective: The national vaccination coverage survey on full vaccination at 12 and 24 months of age was carried out to investigate drops in coverage as of 2016. Methods: A sample of 37,836 live births from the 2017 or 2018 cohorts living in capital cities, the Federal District, and 12 inner cities with 100 thousand inhabitants were followed for the first 24 months through vaccine record cards. Census tracts stratified according to socioeconomic levels had the same number of children included in each stratum. Coverage for each vaccine, full vaccination at 12 and 24 months and number of doses administered, valid and timely, were calculated. Family, maternal and child factors associated with coverage were surveyed. The reasons for not vaccinating analyzed were: medical contraindications, access difficulties, problems with the program, and vaccine hesitancy. Results: Preliminary results showed that less than 1% of children were not vaccinated, full coverage was less than 75% at all capitals and the Federal District, vaccines requiring more than one dose progressively lost coverage, and there were inequalities among socioeconomic strata, favorable to the highest level in some cities and to the lowest in others. Conclusion: There was an actual reduction in full vaccination in all capitals and the Federal District for children born in 2017 and 2018, showing a deteriorating implementation of the National Immunization Program from 2017 to 2019. The survey did not measure the impacts of the COVID-19 pandemic, which may have further reduced vaccination coverage.

RESUMO Objetivo: Inquérito nacional de cobertura vacinal aos 12 e 24 meses de idade foi realizado para investigar as quedas nas coberturas a partir de 2016. Métodos: Amostra de 37.836 nascidos vivos das coortes de 2017 e 2018 residentes nas capitais, Distrito Federal (DF) e 12 cidades com mais de 100 mil habitantes, acompanhados nos primeiros 24 meses por registros nas cadernetas de vacinação. Setores censitários foram estratificados segundo condições socioeconômicas, e o mesmo número de crianças foi incluído para cada estrato. Calcularem-se coberturas vacinais de cada vacina e coberturas completas aos 12 e 24 meses, doses aplicadas, válidas e oportunas. Fatores familiares, maternos e da criança associados à cobertura foram pesquisados. Os motivos para não vacinar analisados foram: contraindicações médicas, dificuldades de acesso, problemas no funcionamento do programa e hesitação vacinal. Resultados: Os resultados preliminares mostram que menos de 1% das crianças não foram vacinadas, as coberturas pelo esquema completo são menores que 75% em todas as capitais e no DF, as vacinas com mais de uma dose perdem cobertura progressivamente, há diferenças entre os estratos socioeconômicos, favoráveis aos estratos mais altos em algumas cidades e aos estratos mais baixos em outras. Conclusão: Houve realmente redução da cobertura vacinal em todas as capitais e no DF para as crianças nascidas em 2017 e 2018, denotando piora na execução do Programa Nacional de Imunizações durante os anos de 2017 a 2019. O inquérito realizado não mensurou os impactos da pandemia de COVID-19 que podem ter reduzido ainda mais as coberturas vacinais.

Polysubstance use in a Brazilian national sample: Correlates of co-use of alcohol and prescription drugs.

Background: Responses to problem substance use have largely focused on illicit drugs, but reports on rising prescription drug misuse worldwide raise questions about their combined use with alcohol and potential consequences. The current study assessed prevalence of alcohol in conjunction with nonmedical opioid and benzodiazepine use across a nationally representative sample of adults in Brazil. Methods: Cross-sectional data on prevalence were estimated from the 2015 Brazilian Household Survey on Substance Use. We estimated past month nonmedical use of benzodiazepines and alcohol and past month nonmedical use of opioids and alcohol among adults who reported any past-year alcohol use. Zero-inflated Poisson models assessed independent correlates of alcohol and nonmedical opioid use, and alcohol and nonmedical benzodiazepine use. Results: Among adults who reported past year alcohol use, 0.4% (N = 257,051) reported past month alcohol and non-medical benzodiazepine use, and 0.5% (N = 337,333) reported past month alcohol and non-medical opioid use. Factors independently associated with co-use of alcohol and benzodiazepines included having depression (adjusted prevalence ratio (aPR):4.61 (95%CI 1.76-12.08)), anxiety (aPR:4.21 (95%CI 1.59-11.16)) and tobacco use (aPR: 5.48 (95%CI 2.26-13.27)). Factors associated with past-month alcohol and opioid use included having experienced physical or a threat of violence (aPR: 4.59 (95%CI 1.89-11.14)), and tobacco use (aPR:2.81(95%CI:1.29-6.12)). Conclusions: Co-use of prescription drugs with alcohol remains relatively rare among Brazilians, but findings point to a unique profile of persons at risk. Results of this study are important in light of changing dynamics and international markets of prescription drugs and the need for more research on use of these substances on a global scale.

Ocorrência de dislipidemias e fatores associados em adultos: um estudo de prevalência / Incidencia de dislipidemias y factores asociados en adultos: un estudio de prevalencia / Occurrence of dyslipidemia and associated factors in adults: a prevalence study

RESUMO Objetivo: estimar a prevalência de dislipidemias e os fatores associados em adultos de Rio Branco, Acre. Métodos: estudo de delineamento seccional, populacional, que avaliou adultos (18 a 59 anos) residentes nas zonas urbana e rural de Rio Branco em 2014. As dislipidemias foram definidas conforme os critérios da Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Ateroscle rose. Empregou-se regressão logística para estimar as odds ratio (OR) e intervalos de confiança de 95% (IC95%). Resultados: a prevalência de dislipidemia, HDL-c baixo, hipertrigliceridemia isolada, hipercolesterolemia isolada e hiperlipidemia mista foi de 56,1%, 37,4%, 23,6%, 9,8% e 3,5%, respectivamente. No modelo final multivariado, apenas a obesidade (OR = 1,86; IC95%: 1,12;3,10) manteve associação estatisticamente significativa com a dislipidemia. Entre os subtipos de dislipidemias, associaram-se à hipertrigliceridemia isolada as variáveis: faixa etária de 40 a 49 anos (OR = 2,17; IC95%: 1,53;4,80); hipercolesterolemia isolada (OR = 2,52; IC95%: 1,23;5,15); HDL-c baixo (OR = 2,53; IC95%: 1,65;3,86); obesidade (OR = 2,10; IC95%: 1,25;3,53); e diabetes mellitus (OR = 5,41; IC95%: 1,46;20,4). Conclusão: a prevalência de alterações lipídicas foi elevada entre adultos. Estratégias de intervenções para diagnóstico, tratamento e intensificação de medidas preventivas e orientações de estilo de vida saudáveis são importantes nessa população.

RESUMEN Objetivo: estimar la prevalencia de dislipidemias y los factores asociados en adultos de Rio Branco, Acre-Brasil. Métodos: estudio de investigación seccional, poblacional, que evaluó adultos (18 a 59 años) residentes en las zonas urbana y rural de Rio Branco en 2014. Las dislipidemias fueron definidas conforme a los criterios de la Actualización de la Directriz Brasileña de Dislipidemias y Prevención de la Aterosclerosis. Se empleó regresión logística para estimar las odds ratio (OR) e intervalos de confianza del 95% (IC95%). Resultados: la prevalencia de dislipidemia, HDL-c bajo, hipertrigliceridemia aislada, hipercolesterolemia aislada e hiperlipidemia mixta fue de 56,1%, 37,4%, 23,6%, 9,8% y 3,5%, respectivamente. En el modelo final multivariado, solo la obesidad (OR = 1,86; IC95%: 1,12;3,10) mantuvo una asociación estadísticamente significativa con la dislipidemia. Entre los subtipos de dislipidemias, se asociaron a la hipertrigliceridemia aislada las variables: franja etaria de 40 a 49 años (OR = 2,17; IC95%: 1,53;4,80); hipercolesterolemia aislada (OR = 2,52; IC95%: 1,23;5,15); HDL-c bajo (OR = 2,53; IC95%: 1,65;3,86); obesidad (OR = 2,10; IC95%: 1,25;3,53); y diabetes mellitus (OR = 5,41; IC95%: 1,46;20,4). Conclusión: la prevalencia de cambios lipídicos fue elevada entre adultos. Estrategias de intervenciones para el diagnóstico, tratamiento e intensificación de medidas preventivas y orientaciones de estilo de vida saludables son importantes en esa población.

ABSTRACT Objective: to estimate the prevalence of dyslipidemia and associated factors in adults in Rio Branco, Acre. Methods: a cross-sectional, population-based study that assessed adults (age 18 to 59 years) living in urban and rural areas of Rio Branco in 2014. Dyslipidemias were defined according to the criteria of the Brazilian Guidelines Update on Dyslipidemias and Prevention of Atherosclerosis. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI95%). Results: the prevalence of dyslipidemia, low HDL-c, isolated hypertriglyceridemia, isolated hypercholesterolemia and mixed hyperlipidemia was 56.1%, 37.4%, 23.6%, 9.8% and 3.5%, respectively. In the final multivariate model, only obesity (OR = 1.86; CI95%: 1.12; 3.10) maintained a statistically significant association with dyslipidemia. Among the dyslipidemia subtypes, the following variables were associated with isolated hypertriglyceridemia: age group 40 to 49 years (OR = 2.17; CI95%: 1.53; 4.80); isolated hypercholesterolemia (OR = 2.52; CI95%: 1.23; 5.15); low HDL-c (OR = 2.53; CI95%: 1.65; 3.86); obesity (OR = 2.10; CI95%: 1.25;3.53); and diabetes mellitus (OR = 5.41; CI95%: 1.46; 20.4). Conclusion: the prevalence of lipid alterations was high among adults. Intervention strategies for diagnosis, treatment and intensification of preventive measures and healthy lifestyle guidelines are important in this population.

Use of medication and associated factors in adults living in Rio Branco, Acre. Use of medication in adults

Abstract We analyzed use of medication and associated factors in adults aged 18-59 years living in Rio Branco, Acre. This is a cross-sectional and population-based study that used a probabilistic sample of the population from rural and urban areas of the city of Rio Branco, Acre. The Prevalence Ratio (PR) was calculated with 95% confidence intervals and associations were estimated by Poisson regression. This study found a 29.4% prevalence ratio of use of medication among individuals aged from 18 to 59 years (685 adults: 473 women and 212 men; producing estimates for 211,902 adults: 110,769 women and 101,133 men). After adjusted analysis, their use was associated with: age (50-59 years, PR: 2.36; 95%CI: 2.29-2.43); women (PR: 1.25; 95%CI: 1.23-1.27); up to elementary school (PR: 1.13; 95%CI: 1.11-1.15); and poor or very poor self-rated health (PR: 1.47; 95%CI: 1.43-1.51). The health conditions associated with use of medication were: number of comorbidities, hypertension, diabetes, insomnia, depression, number of health complaints and use of health services. The most frequently used drugs were those belonging to the following ATC categories: alimentary tract and metabolism, cardiovascular system, nervous system, and the musculoskeletal system.

Sampling plan of the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey.

The article describes methodological aspects in defining the study population, sampling plan, and sample weigthing and calibration of effective sample of the Brazilian National Survey on Child Nutrition (ENANI-2019). This population-based household survey assessed breastfeeding and dietary intake, anthropometric assessment of nutritional status, and micronutrient deficiencies by blood biomarkers in children under five years of age. The data were obtained with a probability sample, with stratification by the five geographic regions in the country and clustering by census enumeration areas (CEAs). The sample was calculated at 15,000 households distributed in 1,500 CEAs, with 300 allocated in each of Brazil's five major geographic regions and 10 eligible households per CEA, sampled using inverse sampling. The required population parameters were thus estimated to reach the study's objectives. The basic sampling design weights were calculated as the inverse probabilities of the households' inclusion in the study. Imputation was used to compensate for non-response to items in the target variables, except for data on the blood biomarkers. Finally, calibration used population totals of children in 60 post-strata, defined by cross-classification of the following variables: major geographic region, sex, and age. The final sample included 14,558 children residing in 12,524 households, distributed in 1,382 CEAs in the 26 states of Brazil and the Federal District. The data from the ENANI-2019 survey will support strategies for the promotion and implementation of public policies for children under five years of age.

General methodological aspects in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey.

This article aims to present general methodological aspects of the Brazilian National Survey on Child Nutrition (ENANI-2019), from the conception of the study design to details of the data collection. This is a household-based population survey with a sample calculated at 15,000 households to identify children under five years of age, conducted in 123 municipalities in Brazil's 26 states and the Federal District. ENANI-2019 includes data on breastfeeding and dietary intake; anthropometric nutritional status of all children and their biological mothers; and nutritional status concerning the following micronutrients: iron (hemoglobin and ferritin), zinc, selenium, and vitamins A, B1, B6, B12, D, E, and folic acid of children from 6 to 59 months of age. A total of 193,212 households were visited, of which 19,951 were eligible, and 12,524 were included in the study. A total of 14,558 children were studied, of whom 13,990 (96.1%) and 13,921 (95.6%) had their body mass and length/stature measured, respectively, and 14,541 (99.9%) underwent 24-hour dietary recalls (24HR). Of the 12,598 children eligible for blood sample collection, 8,739 (69.3%) had at least one laboratory parameter measured. Data were collected from February 2019 to March 2020, when the survey was interrupted due to the COVID-19 pandemic. The evidence produced by the ENANI-2019 survey can back the formulation, follow-up, and/or reorientation of food and nutrition policies such as the promotion of breastfeeding and healthy eating and the prevention and control of different forms of malnutrition.

Autoavaliação negativa associada ao estado objetivo da saúde e à qualidade de vida em adultos / Negative self-assessment associated with objective health status and quality of life in adults

O objetivo do presente estudo foi estimar a prevalência de autoavaliação negativa da saúde e os fatores a ela associados em adultos. Para tanto, realizou-se um inquérito com adultos de 18 a 59 anos, das zonas urbana e rural do município de Rio Branco, Acre, no ano de 2014. Os possíveis fatores relacionados a tal autoavaliação foram verificados por regressão logística múltipla. A prevalência de autoavaliação negativa da saúde foi de 12,1%, estando associada a idade, estresse (OR: 1,87; IC 95%: 1,04-3,38), uso de medicamentos (OR: 2,23; IC 95%: 1,19-4,20) e autorrelato de insônia (OR: 2,33; IC 95%: 1,20-4,53) ou depressão (OR: 2,03; IC 95%: 1,02-4,04). A lipoproteína de baixa densidade também esteve associada, bem como o tercil inferior dos domínios físico e psicológico da qualidade de vida. Conclui-se que a autoavaliação de saúde refletiu as condições físicas e psicológicas e constitui uma medida do estado global de saúde do indivíduo.

The prevalence of negative self-rated health and associated factors in adults are estimated. A survey was conducted with adults aged 18 to 59 years, from urban and rural areas in the municipality of Rio Branco AC Brazil, in 2014. The possible factors associated with self-evaluation were verified by multiple logistic regression. The prevalence of negative self-rated health was 12.1%, associated with age, stress (OR: 1.87; 95% CI: 1.04-3.38), use of medicine (OR: 2, 23; 95% CI: 1.19-4.20) and self-reported insomnia (OR: 2.33; 95% CI: 1.20-4.53) or depression (OR: 2.03; 95% CI: 1.02-4.04). Low-density lipoprotein and the lower tercile of the physical and psychological domains of life quality were also associated. Results show that self-rated health reflected physical and psychological conditions and actually assessed the individual's overall health status.

Prevalence of polypharmacy and associated factors in older adults living in Rio Branco, Acre, Brazil: a cross-sectional population-based study, 2014. / Prevalência e fatores associados à polifarmácia em idosos residentes em Rio Branco, Acre, Brasil: estudo transversal de base populacional, 2014.

OBJECTIVE: To analyze polypharmacy prevalence and associated factors in older adults living in Rio Branco, Acre, Brazil, in 2014. METHODS: This was a cross-sectional population-based study using complex sampling with older adults. Polypharmacy was defined as concomitant use of five or more medications. RESULTS: Polypharmacy prevalence was 14.9% (95%CI 11.8;18.6), positively associated with females (OR=2.29 - 95%CI 1.41;3.74), white race/skin color (OR=1.61 - 95%CI 1.10;2.38), dependence (OR=1.65 - 95%CI 1.05;2.60), change in eating habits/dieting (OR=1.66 - 95%CI 1.16;2.36), hospitalization in the last 12 months (OR=1.61 - 95%CI 1.02;2.53) and presence of the following self-reported morbidities: systemic arterial hypertension (OR=2.40 - 95%CI 1.33;4.34), diabetes mellitus (OR=2.17 - 95%CI 1.23;3.84), osteoporosis (OR=2.92 - 95%CI 1.84;4.64) and heart problems (OR=2.94 - 95%CI 1.90;4.56). CONCLUSION: This study found that polypharmacy in the older adults was associated with demographic and health conditions.

[Chronic kidney disease among adults in Rio Branco, State of Acre: a population-based survey]. / Doença renal crônica em adultos de Rio Branco, Acre: inquérito de base populacional.

The scope of this study was to establish the prevalence of CKD and associated factors among young adults (18-59 years of age) from Rio Branco in the State of Acre. It involved a population-based survey conducted in 2014, in the urban and rural areas of the municipality and CKD was defined as the glomerular filtration rate (GFR) < 60ml/min/1.73m², estimated by the CKD-EPI, and the presence of albuminuria > 29 mg/g. Association measures were estimated by logistic regression, with a confidence level of 95%. The overall prevalence of CKD was 6.2%. The presence of CKD was higher among women, aged 40 to 59 years, with non-white skin color, with lower schooling, and of sedentary disposition. There were statistically significant differences in the distribution according to the presence of CKD in the hypertension, diabetes and hospitalization variables over the past 12 months. CKD among adults was associated with the female sex (OR: 2.41, 95%CI: 1.14-5.12), diabetes (OR: 4.67, 95%CI: 1.28-17.03) and arterial hypertension (OR: 1.98; 95%CI: 1.16-3.37). CKD reveals a high prevalence and is associated with chronic diseases, calling for the need for public health measures for early detection and prevention of its progression.

O objetivo do presente estudo foi verificar a prevalência de DRC e os fatores a ela associados em adultos jovens (18-59 anos) de Rio Branco, Acre. Trata-se de um inquérito de base populacional realizado em 2014, nas zonas urbana e rural do município de Rio Branco, Acre. A DRC foi definida pela taxa de filtração glomerular (TFG) < 60 ml/min/1,73 m², estimada pela CKD-EPI, e presença de albuminúria > 29 mg/g. Medidas de associação foram estimadas por regressão logística, com grau de confiança de 95%. A prevalência geral de DRC foi de 6,2%. A presença de DRC foi maior entre as mulheres, naqueles com 40 a 59 anos, de cor da pele não-branca, com menor escolaridade e entre os sedentários. Houve diferenças estatisticamente significativas na distribuição segundo a presença de DRC nas variáveis hipertensão arterial, diabetes e internação nos últimos 12 meses. A DRC entre os adultos esteve associada ao sexo feminino (OR: 2,41; IC95%: 1,14-5,12), diabetes (OR: 4,67; IC95%: 1,28-17,03) e hipertensão arterial (OR: 1,98; IC95%: 1,16-3,37). A DRC apresenta alta prevalência e está associada às doenças crônicas, evidenciando a necessidade de medidas em saúde pública para detecção precoce e prevenção da sua progressão.

Prevalence of polypharmacy and associated factors in elderly living in Rio Branco, Acre, Brazil: cross-sectional population-based study, 2014 / Prevalencia y factores asociados con la polifarmacia en residentes de edad avanzada en Rio Branco, Acre, Brasil: estudio transversal de base poblacional, 2014 / Prevalência e fatores associados à polifarmácia em idosos residentes em Rio Branco, Acre, Brasil: estudo transversal de base populacional, 2014

Objective: To analyze the prevalence and factors associated with polypharmacy inelderly people living in Rio Branco, Acre, Brazil, in 2014. Methods: Cross-sectionalpopulation-based study, verification by complex sampling, with elderly people.Polypharmacy was defined as the concomitant use of five or more drugs. Results: Theprevalence of polypharmacy was 14.9% (95%IC 11,8;18,6), positively associated withfemales (OR=2.29 ­ 95%CI 1.41;3.74), white skin color (OR=1.61 ­ 95%CI 1.10;2.38),dependence (OR=1.65 ­ 95%CI 1.05;2.60), change in eating habits/diet use (OR=1.66 ­95%CI 1,16;2.36), hospitalization in the last 12 months (OR=1.61 ­ 95%CI 1.02;2.53)and presence of the following self-reported morbidities: systemic arterial hypertension(OR=2.40 ­ 95%CI 1.33;4.34), diabetes mellitus (OR=2.17 ­ 95%CI 1.23;3.84),osteoporosis (OR=2.92 ­ 95%CI 1.84;4.64) and problems (OR=2.94 ­ 95%CI1.90;4.56). Conclusion: The polypharmacy in the elderly found in this study wasassociated with demographic and health conditions.

Objetivo: Analisar a prevalência e os fatores associados à polifarmácia em idososresidentes em Rio Branco, Acre, Brasil, em 2014. Métodos: Estudo transversal de basepopulacional, obtido por amostragem complexa, com idosos. A polifarmácia foidefinida como o uso concomitante de cinco ou mais fármacos. Resultados: Aprevalência de polifarmácia foi de 14,9% (IC95% 11,8;18,6), associada positivamente aosexo feminino (OR=2,29 ­ IC95% 1,41;3,74), raça/cor da pele branca (OR=1,61 ­ IC95%1,10;2,38), dependência (OR=1,65 ­ IC95% 1,05;2,60), mudança de hábitos 3alimentares/uso de dieta (OR=1,66 ­ IC95% 1,16;2,36), internação nos últimos 12 meses(OR=1,61 ­ IC95% 1,02;2,53) e presença das seguintes morbidades autorreferidas:hipertensão arterial sistêmica (OR=2,40 ­ IC95% 1,33;4,34), diabetes mellitus (OR=2,17­ IC95% 1,23;3,84), osteoporose (OR=2,92 ­ IC95% 1,84;4,64) e problemas cardíacos(OR=2,94 ­ IC95% 1,90;4,56). Conclusão: A polifarmácia em idosos encontrada nesteestudo esteve associada às condições demográficas e de saúde.

Doença renal crônica em adultos de Rio Branco, Acre: inquérito de base populacional / Chronic kidney disease among adults in Rio Branco, State of Acre: a population-based survey

Resumo O objetivo do presente estudo foi verificar a prevalência de DRC e os fatores a ela associados em adultos jovens (18-59 anos) de Rio Branco, Acre. Trata-se de um inquérito de base populacional realizado em 2014, nas zonas urbana e rural do município de Rio Branco, Acre. A DRC foi definida pela taxa de filtração glomerular (TFG) < 60 ml/min/1,73 m², estimada pela CKD-EPI, e presença de albuminúria > 29 mg/g. Medidas de associação foram estimadas por regressão logística, com grau de confiança de 95%. A prevalência geral de DRC foi de 6,2%. A presença de DRC foi maior entre as mulheres, naqueles com 40 a 59 anos, de cor da pele não-branca, com menor escolaridade e entre os sedentários. Houve diferenças estatisticamente significativas na distribuição segundo a presença de DRC nas variáveis hipertensão arterial, diabetes e internação nos últimos 12 meses. A DRC entre os adultos esteve associada ao sexo feminino (OR: 2,41; IC95%: 1,14-5,12), diabetes (OR: 4,67; IC95%: 1,28-17,03) e hipertensão arterial (OR: 1,98; IC95%: 1,16-3,37). A DRC apresenta alta prevalência e está associada às doenças crônicas, evidenciando a necessidade de medidas em saúde pública para detecção precoce e prevenção da sua progressão.

Abstract The scope of this study was to establish the prevalence of CKD and associated factors among young adults (18-59 years of age) from Rio Branco in the State of Acre. It involved a population-based survey conducted in 2014, in the urban and rural areas of the municipality and CKD was defined as the glomerular filtration rate (GFR) < 60ml/min/1.73m², estimated by the CKD-EPI, and the presence of albuminuria > 29 mg/g. Association measures were estimated by logistic regression, with a confidence level of 95%. The overall prevalence of CKD was 6.2%. The presence of CKD was higher among women, aged 40 to 59 years, with non-white skin color, with lower schooling, and of sedentary disposition. There were statistically significant differences in the distribution according to the presence of CKD in the hypertension, diabetes and hospitalization variables over the past 12 months. CKD among adults was associated with the female sex (OR: 2.41, 95%CI: 1.14-5.12), diabetes (OR: 4.67, 95%CI: 1.28-17.03) and arterial hypertension (OR: 1.98; 95%CI: 1.16-3.37). CKD reveals a high prevalence and is associated with chronic diseases, calling for the need for public health measures for early detection and prevention of its progression.

Substance use, self-rated health and HIV status in Brazil.

ABSTRACTWe compared the prevalence of of non-injecting drug use (NIDU) and Self-Rated Health (SRH) among individuals self-reporting as HIV-positive (PLWHA), HIV-negative and unknown at the III Brazilian Household Survey on Substance Use. Overall, 16,273 individuals, 12-65 years old, were interviewed in 2015. Prevalence and Standard Error (SE) were estimated considering the complex sample design and weight calibration. Chi-square tests with Rao-Scott adjustment were used to test independence between NIDU, SRH and HIV status. PLWHA presented higher frequencies of 12-month use for most substances than those reporting to be HIV-negative: alcohol use prevalence was 49.5% (SE 12.8) vs. 43.1% (SE 0.7), p = 0.34; tobacco 45.3% (SE 12.7) vs. 15.3% (SE 0.4), p < 0.01; amphetamines 1.7% (SE 1.7) vs. 0.3% (SE 0.1), p = 0.51; cannabis 10.5%(SE 6.7) vs. 2.5%(0.2), p = 0.06; powder cocaine 3.6% (SE 3.0) vs. 0.9% (SE 0.1), p = 0.45; crack-cocaine 5.3% (SE 3.2) vs. 0.3% (SE 0.1), p < 0.01; inhalants 3.6% (SE 3.0) vs. 0.2% (SE 0), p = 0.03; ketamine 1.7%(SE 1.7) vs. 0.1% (SE 0), p = 0.23; and opioids 1.7% (SE 1.7) vs. 1.4% (SE 0.2), p = 0.93. PLWHA also reported worse SRH. Our results and the scarcity of integrated substance use and HIV treatments call for innovative, cost-effective approaches to tackle these public health challenges.

Prevalência e fatores associados à utilização de medicamentos potencialmente inapropriados para pessoas idosas em Rio Branco, Acre, Brasil: um estudo de base populacional / Prevalence and factors associated the use of potentially inappropriate medications by older adults in Rio Branco, Acre, Brazil: a population-based study

Resumo Objetivo Verificar a prevalência e analisar os fatores associados ao uso de medicamentos potencialmente inapropriados (MPI) em pessoas idosas de Rio Branco, Acre, Brasil. Método Trata-se de um estudo transversal de base populacional. A variável dependente foi uso de pelo menos um MPI, de acordo com os critérios do Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos (CBMPII), independentemente da condição clínica. Na avaliação da associação entre o uso de medicamentos inapropriados e as variáveis independentes, realizou-se análise bruta e ajustada por meio de regressão logística, utilizando-se o modelo hierarquizado por razão de chances (OR). Resultados A prevalência de uso de pelo menos um MPI entre os 1.016 participantes foi de 25,9% (IC95% 22,3; 29,8), associada positivamente a sexo feminino (OR=1,38; IC95% 1,01; 1,90), dependência quanto às atividades instrumentais da vida diária (OR=1,37; IC95% 1,02; 1,83), autoavaliação de saúde negativa (OR=1,54; IC95% 1,12; 2,11), internação nos últimos 12 meses (OR=1,79; IC95% 1,19; 2,69) e presença de mais de três comorbidades (OR= 2,56; IC95% 1,97; 3,33). A subcategoria mais utilizada foi dos inibidores de bombas de prótons, por 11,3% (9,2; 13,8). Conclusão A prevalência de uso de MPI por idosos da amostra foi de um quarto, estando associada ao sexo feminino e a condições de saúde. Ações de conscientização fazem-se necessárias para garantia dos benefícios no uso dos medicamentos.

Abstract Objective To verify the prevalence and analyze the factors associated with the use of potentially inappropriate medications (PIM) in the older adults in Rio Branco, Acre, Brazil. Method This is a cross-sectional population-based study. The dependent variable was the use of at least one PIM, according to the criteria of the Brazilian Consensus on Potentially Inappropriate Medicines for the older adults, regardless of clinical condition. In evaluating the association between the use of inappropriate medications and the independent variables, a crude and adjusted analysis was performed using logistic regression, using the hierarchical model by odds ratio (OR). Results The prevalence of using at least one PIM among the 1,016 participants was 25.9% (95%CI 22.3; 29.8), positively associated with female sex (OR=1.38; 95%CI 1.01; 1.90), dependence on instrumental activities of daily living (OR=1.37; 95%CI 1.02; 1.83), negative self-rated health (OR=1.54; 95%CI 1.12; 2.11), hospitalization in the last 12 months (OR=1.79; 95%CI 1.19; 2.69) and presence of more than three comorbidities (OR=2.56; 95%CI 1.97; 3.33). The most used subcategory was proton pump inhibitors by 11.3% (9.2; 13.8). Conclusion The prevalence of PIM use by elderly in this population was a quarter, being associated with female gender and health conditions. Awareness actions are necessary to guarantee the benefits of using medications.

Prevalência e fatores associados à polifarmácia em idosos residentes em Rio Branco, Acre, Brasil: estudo transversal de base populacional, 2014 / Prevalencia y factores asociados con la polifarmacia en residentes de adultos mayores en Rio Branco, Acre, Brasil: estudio transversal de base poblacional, 2014 / Prevalence of polypharmacy and associated factors in older adults living in Rio Branco, Acre, Brazil: a cross-sectional population-based study, 2014

Objetivo: Analisar a prevalência e os fatores associados à polifarmácia em idosos residentes em Rio Branco, Acre, Brasil, em 2014. Métodos: Estudo transversal de base populacional, obtido por amostragem complexa, com idosos. A polifarmácia foi definida como o uso concomitante de cinco ou mais fármacos. Resultados: A prevalência de polifarmácia foi de 14,9% (IC95% 11,8;18,6), associada positivamente ao sexo feminino (OR=2,29 - IC95% 1,41;3,74), raça/cor da pele branca (OR=1,61 - IC95% 1,10;2,38), dependência (OR=1,65 - IC95% 1,05;2,60), mudança de hábitos alimentares/uso de dieta (OR=1,66 - IC95% 1,16;2,36), internação nos últimos 12 meses (OR=1,61 - IC95% 1,02;2,53) e presença das seguintes morbidades autorreferidas: hipertensão arterial sistêmica (OR=2,40 - IC95% 1,33;4,34), diabetes mellitus (OR=2,17 - IC95% 1,23;3,84), osteoporose (OR=2,92 - IC95% 1,84;4,64) e problemas cardíacos (OR=2,94 - IC95% 1,90;4,56). Conclusão: A polifarmácia em idosos encontrada neste estudo esteve associada às condições demográficas e de saúde.

Objetivo: Analizar la prevalencia y los factores asociados a la polifarmacia en adultos mayores residentes en Rio Branco, Acre, Brasil, en 2014. Métodos: Estudio poblacional transversal, verificación por muestreo complejo, con adultos mayores. La polifarmacia se definió como el uso concomitante de cinco o más fármacos. Resultados: La prevalencia de la polifarmacia fue de 14,9% (IC95% 11,8;18,6), asociada positivamente al sexo femenino (OR=2,29 - IC95% 1,41;3,74), raza/color de piel blanca (OR=1,61 - IC95% 1,10;2,38), dependencia (OR=1,65 - IC95% 1,05;2,60), cambio en los hábitos alimentarios/dieta (OR=1,66 - IC95% 1,16;2,36), hospitalización en los últimos 12 meses (OR=1,61 - IC95% 1,02;2,53) y presencia de las siguientes morbilidades autoinformadas: hipertensión arterial sistémica (OR=2,40 - IC95% 1,33;4,34), diabetes mellitus (OR=2,17 - IC95% 1,23;3,84), osteoporosis (OR=2,92 - IC95% 1,84;4,64) y problemas cardíacos (OR=2,94 - IC95% 1,90;4,56). Conclusión: La polifarmacia en adultos mayores encontrada en este estudio se asoció a condiciones demográficas y de salud.

Objective: To analyze polypharmacy prevalence and associated factors in older adults living in Rio Branco, Acre, Brazil, in 2014. Methods: This was a cross-sectional population-based study using complex sampling with older adults. Polypharmacy was defined as concomitant use of five or more medications. Results: Polypharmacy prevalence was 14.9% (95%CI 11.8;18.6), positively associated with females (OR=2.29 - 95%CI 1.41;3.74), white race/skin color (OR=1.61 - 95%CI 1.10;2.38), dependence (OR=1.65 - 95%CI 1.05;2.60), change in eating habits/dieting (OR=1.66 - 95%CI 1.16;2.36), hospitalization in the last 12 months (OR=1.61 - 95%CI 1.02;2.53) and presence of the following self-reported morbidities: systemic arterial hypertension (OR=2.40 - 95%CI 1.33;4.34), diabetes mellitus (OR=2.17 - 95%CI 1.23;3.84), osteoporosis (OR=2.92 - 95%CI 1.84;4.64) and heart problems (OR=2.94 - 95%CI 1.90;4.56). Conclusion: This study found that polypharmacy in the older adults was associated with demographic and health conditions.

Sampling plan of the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey / Plano amostral do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019): inquérito domiciliar de base populacional / Plan de muestreo del Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019): encuesta domiciliaria de base poblacional

The article describes methodological aspects in defining the study population, sampling plan, and sample weigthing and calibration of effective sample of the Brazilian National Survey on Child Nutrition (ENANI-2019). This population-based household survey assessed breastfeeding and dietary intake, anthropometric assessment of nutritional status, and micronutrient deficiencies by blood biomarkers in children under five years of age. The data were obtained with a probability sample, with stratification by the five geographic regions in the country and clustering by census enumeration areas (CEAs). The sample was calculated at 15,000 households distributed in 1,500 CEAs, with 300 allocated in each of Brazil's five major geographic regions and 10 eligible households per CEA, sampled using inverse sampling. The required population parameters were thus estimated to reach the study's objectives. The basic sampling design weights were calculated as the inverse probabilities of the households' inclusion in the study. Imputation was used to compensate for non-response to items in the target variables, except for data on the blood biomarkers. Finally, calibration used population totals of children in 60 post-strata, defined by cross-classification of the following variables: major geographic region, sex, and age. The final sample included 14,558 children residing in 12,524 households, distributed in 1,382 CEAs in the 26 states of Brazil and the Federal District. The data from the ENANI-2019 survey will support strategies for the promotion and implementation of public policies for children under five years of age.

O objetivo deste artigo é descrever aspectos metodológicos referentes à definição da população da pesquisa, plano amostral, ponderação e calibração da amostra efetiva do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019). Trata-se de um inquérito populacional de base domiciliar que realizou avaliação do aleitamento materno e de consumo alimentar, avaliação antropométrica do estado nutricional, e avaliação das deficiências de micronutrientes mediante análise de biomarcadores sanguíneos em crianças menores de 5 anos de idade. Seus dados foram obtidos por meio de uma amostra probabilística domiciliar, com estratificação geográfica por macrorregião e conglomeração por setores censitários. A amostra foi dimensionada em 15.000 domicílios, distribuídos em 1.500 setores censitários, sendo 300 em cada macrorregião e 10 domicílios elegíveis por setor, através de amostragem inversa. Assim, estimaram-se os parâmetros populacionais requeridos para atingir os objetivos do estudo. Os pesos amostrais básicos do desenho foram calculados como inversos das probabilidades de inclusão dos domicílios na pesquisa. Para compensar a não resposta de itens das variáveis pesquisadas foi usada imputação, com exceção para os dados de biomarcadores sanguíneos. A calibração empregou totais populacionais de crianças para 60 pós-estratos definidos por cruzamento das variáveis macrorregião, sexo e idade. A amostra final compreendeu 14.558 crianças, residentes em 12.524 domicílios, distribuídos em 1.382 setores censitários nas 27 Unidades da Federação. Os dados do ENANI-2019 poderão subsidiar estratégias de promoção e implementação de políticas públicas para crianças menores de 5 anos.

El objetivo de este artículo es describir aspectos metodológicos referentes a definición de la población de la investigación, plan de muestreo, ponderación de la muestra y muestra efectiva del Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019). Se trata de una encuesta poblacional de base domiciliaria, que realizó una evaluación de la lactancia materna y de consumo alimentario, así como una evaluación antropométrica del estado nutricional y de las deficiencias de micronutrientes, mediante análisis de biomarcadores sanguíneos en niños menores de cinco años de edad. Sus datos se obtuvieron mediante una muestra probabilística domiciliaria, con estratificación geográfica por macrorregión y conglomerados por sectores censitarios. La muestra se circunscribió a 15.000 domicilios, distribuidos en 1.500 sectores censitarios, encontrándose 300 en cada macrorregión, junto 10 domicilios elegibles por sector, a través de un muestreo inverso. De esta forma, se estimaron los parámetros poblacionales requeridos para alcanzar los objetivos del estudio. Los pesos básicos de las muestras del diseño se calcularon como inversos a las probabilidades de inclusión de los domicilios en la investigación. Para compensar la no respuesta de ítems de las variables investigadas se usó la imputación, con excepción de los datos con biomarcadores sanguíneos. La calibración empleó totales poblacionales de niños para los 60 post estratos, definidos mediante el cruce de las variables macrorregión, sexo y edad. La muestra final comprendió 14.558 niños, residentes en 12.524 domicilios, distribuidos en 1.382 sectores censitarios dentro de las 27 Unidades de la Federación. Los datos del ENANI-2019 podrán apoyar estrategias de promoción e implementación de políticas públicas para niños menores de cinco años.