Hospitalization, mortality and public healthcare expenditure in Brazil during the COVID-19 crisis: vulnerabilities in the spotlight

ABSTRACT BACKGROUND: Multiple opinion-based communications have highlighted the actions of the Brazilian government during the pandemic. Nevertheless, none have appraised public data to identify factors associated with worsening of the healthcare system. OBJECTIVE: To analyze and collate data from public health and treasury information systems in order to understand the escalating process of weakening of Brazilian healthcare and welfare since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. DESIGN AND SETTING: Secondary data study conducted using multiple public databases administered by the Brazilian federal government. METHODS: We processed information from multiple national databases and appraised health and economic-related data. RESULTS: Based on our analyses, there were substantial reductions in inpatient hospital admissions and in the numbers of patients seeking primary care services, along with a decrease in immunization coverage. Moreover, we observed a considerable decline in government transfers to hospital services (reduction of 82.0%) and a diminution of public outlays in several healthcare-related subfunctions ("hospital and outpatient care", "primary care", "prophylactic and therapeutic support" and "epidemiological surveillance"). We observed an increase in the overall mortality rate over the period analyzed, especially regarding all group-based diseases. Notably, there were remarkable differences among geographic, racial, gender and other parameters, thus revealing the impact of vulnerabilities on COVID-19 outcomes. CONCLUSION: This assessment of documentation of public expenditure and the shrinkage of investment in sensitive areas of the healthcare system in Brazil emphasized areas that still require collective attention in order to guarantee national welfare.

Hipertensão arterial e diabetes mellitus em uma região metropolitana de desigualdade social: inquérito populacional / Arterial hypertension and diabetes mellitus in a metropolitan region facing social inequality: a population-based survey / Hipertensión arterial y diabetes mellitus en una región metropolitana desigualdad en social: encuesta poblacional

Objetivo: Estimar a prevalência de hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) autorreferidas e verificar os fatores associados. Métodos: Estudo transversal realizado em 2015 que utilizou dados do inquérito populacional Saúde em Vespasiano. A amostra compôs-se por 1.206 adultos para os quais se calcularam e compararam-se as razões de prevalências de hipertensão arterial sistêmica (HAS), diabetes mellitus (DM) e HAS+DM e seus respectivos intervalos de confiança de 95%, segundo sexo, faixa etária, escolaridade e renda, utilizando regressão de Poisson com variância robusta. Resultados: Encontraram-se as seguintes prevalências de HAS, DM e HAS+DM, respectivamente, de 21,8%; 7,8% e 5,3%. Para os três grupos de doenças, a prevalência mostrou-se maior em mulheres, com idade superior a 65 anos, ensino fundamental incompleto e renda inferior a dois salários mínimos (valor-p<0,05). Conclusão: A maior prevalência e distribuição de HAS e DM observou-se entre mulheres idosas, com menor tempo de escolaridade e dependentes do Sistema Único de Saúde (SUS).

Objective: To estimate the prevalence of self-reported systemic arterial hypertension (SAH) and diabetes mellitus (DM) and check for associated factors. Methods: A cross-sectional study was carried out in 2015 using data from the Health in Vespasiano population-based survey. The sample consisted of 1,206 adults for whom the prevalence ratios of systemic arterial hypertension (SAH), diabetes mellitus (DM) and SAH+DM and their respective 95% confidence intervals were calculated and compared according to sex, age range, education and income using Poisson regression with robust variance. Results: The prevalence rates of SAH, DM and SAH+DM were, respectively, 21.8%; 7.8% and 5.3%. For the three groups of diseases, the prevalence was higher in women, those aged over 65 years, those with incomplete primary education and those with income below two minimum wages (p-value <0.05). Conclusion: The highest prevalence and distribution of SAH and DM was observed in older women, those with less study time and dependent on the Unified Health System (Sistema Único de Saúde ­ SUS).

Objetivo: Estimar la prevalencia de hipertensión arterial sistémica (HAS) y diabetes mellitus (DM) autorreferidas y verificar los factores asociados. Métodos: Estudio transversal realizado en 2015 que utilizó datos de la encuesta poblacional Salud en Vespasiano. La muestra fue compuesta por 1.206 adultos para los cuales se calcularon y se compararon las razones de prevalencias de hipertensión arterial sistémica (HAS), diabetes mellitus (DM) y HAS+DM y sus respectivos intervalos de confianza de 95%, según sexo, franja etaria, escolaridad y renta, utilizando regresión de Poisson con varianza robusta. Resultados: Fueron encontradas las siguientes prevalencias de HAS, DM y HAS+DM, respectivamente, de 21,8%; 7,8% y 5,3%. Para los tres grupos de enfermedades, la prevalencia se mostró mayor en mujeres, con edad superior a 65 años, enseñanza primaria incompleta y renta inferior a dos salarios mínimos (valor-p<0,05). Conclusión: La mayor prevalencia y distribución de HAS y DM fue observada entre mujeres mayores, con menor tiempo de escolaridad y dependientes del Sistema Único de Salud (SUS).

Hospitalization, mortality and public healthcare expenditure in Brazil during the COVID-19 crisis: vulnerabilities in the spotlight.

BACKGROUND: Multiple opinion-based communications have highlighted the actions of the Brazilian government during the pandemic. Nevertheless, none have appraised public data to identify factors associated with worsening of the healthcare system. OBJECTIVE: To analyze and collate data from public health and treasury information systems in order to understand the escalating process of weakening of Brazilian healthcare and welfare since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. DESIGN AND SETTING: Secondary data study conducted using multiple public databases administered by the Brazilian federal government. METHODS: We processed information from multiple national databases and appraised health and economic-related data. RESULTS: Based on our analyses, there were substantial reductions in inpatient hospital admissions and in the numbers of patients seeking primary care services, along with a decrease in immunization coverage. Moreover, we observed a considerable decline in government transfers to hospital services (reduction of 82.0%) and a diminution of public outlays in several healthcare-related subfunctions ("hospital and outpatient care", "primary care", "prophylactic and therapeutic support" and "epidemiological surveillance"). We observed an increase in the overall mortality rate over the period analyzed, especially regarding all group-based diseases. Notably, there were remarkable differences among geographic, racial, gender and other parameters, thus revealing the impact of vulnerabilities on COVID-19 outcomes. CONCLUSION: This assessment of documentation of public expenditure and the shrinkage of investment in sensitive areas of the healthcare system in Brazil emphasized areas that still require collective attention in order to guarantee national welfare.

Perceived quality of life among Brazilian medical students: initial findings from a follow-up study.

This study evaluates Brazilians medical students' Quality of Life and verified associated factors, according to graduation medical cycles: basic (two first years), theoretical-practical (third and fourth years) and clinical (fifth and sixth years). Data were obtained from QualiMed study, conducted at Medical School of Federal University of Minas Gerais, Brazil, using WHOQOL-Bref. Analyses were performed using ANOVA and multiple logistic regressions. A total of 1470 medical students participated and were more satisfied than dissatisfied with their quality of life. Psychological Domain obtained the worst assessment (60.64) and Environment Domain the best one (68.14). The perception of quality of life improved over the course, being worse in the basic cycle and better in the clinical cycle, statistically different for all domains (p-value<0.05). Most variables were negatively associated with quality of life, indicating that their absence reduces the chances of a better perception. Absence of regular physical activity and having depression symptoms were negatively associated with all WHOQOL-Bref Domains. Individual, behavioral and psychological aspects negatively impact the quality of life of evaluated students. Psychological support strategies, encouraging resilience and carrying out physical activities are recommended to improve quality of life, mainly in first years of medical school.

THE EDUCATIONAL ENVIRONMENT THROUGH THE LENSES OF A PEER MENTORING GROUP FOR MEDICAL STUDENTS / EL ENTORNO EDUCATIVO A TRAVÉS DE LOS LENTES DE UN GRUPO DE TUTORÍA DE PARES PARA ESTUDIANTES DE MÉDICA / O AMBIENTE EDUCACIONAL PELAS LENTES DE UM GRUPO DE MENTORIA ENTRE PARES PARA ESTUDANTES DE MEDICINA

The perception of the learning process is shaped by individual experiences and related to the academic environment. This article aimed to evaluate the perception of the educational environment of medical students linked to the peer-mentoring group GEDAAM (Study Group on Didactics Applied to Medical Learning) at the Federal University of Minas Gerais. The data come from a cross-sectional study with 129 members of GEDAAM. The Dundee Ready Education Environment Measure (DREEM) scale was used to assess the perception of the educational environment. Descriptive and comparative analysis were performed (Chi-square test). For almost all assessed domains, the students' perception was more positive than negative (Global score = 108.41). The longer the length of stay at GEDAAM, the worse the Global perception of the educational environment. It is suggested that participating in GEDAAM contributes to a more critical view of the medical teaching environment. 

La percepción del proceso de aprendizaje está conformada por experiencias individuales y relacionada con el entorno académico. Este artículo tuvo como objetivo evaluar la percepción del entorno educativo de los estudiantes de medicina vinculados al grupo de mentoría entre pares GEDAAM (Grupo de Estudio de Didáctica Aplicada al Aprendizaje de la Medicina) de la Universidad Federal de Minas Gerais. Los datos provienen de un estudio transversal con 129 miembros de GEDAAM. Se utilizó la escala Dundee Ready Education Environment Measure (DREEM) para evaluar la percepción del entorno educativo. Se realizaron análisis descriptivos y comparativos (prueba de Chi-cuadrado). Para casi todos los dominios evaluados, la percepción de los estudiantes fue más positiva que negativa (puntuación global = 108,41). Cuanto más tiempo se pasa en GEDAAM, peor es la percepción global del entorno educativo. Se sugiere que la participación en el GEDAAM contribuya a una visión más crítica del entorno de la enseñanza médica.

A percepção do processo de aprendizagem é moldada por experiências individuais e relacionadas ao meio acadêmico. Este artigo objetivou avaliar a percepção do ambiente educacional de estudantes de medicina ligados ao grupo de mentoria entre pares GEDAAM (Grupo de Estudos em Didática Aplicada ao Aprendizado da Medicina) da Universidade Federal de Minas Gerais. Os dados são provenientes de estudo transversal com 129 membros do GEDAAM. A escala Dundee Ready Education Environment Measure (DREEM) foi utilizada para avaliar a percepção do ambiente educacional. Foram realizadas análises descritivas e comparativas (Teste Qui-quadrado). Para quase todos os Domínios avaliados a percepção dos estudantes foi mais positiva do que negativa (escore Global=108,41). Quanto maior o tempo de permanência no GEDAAM, pior a percepção Global do ambiente educacional. Sugere-se que participar do GEDAAM contribua para uma visão mais crítica do ambiente de ensino de medicina.

Mentoria entre pares: percepções de suporte social e ambiente educacional de estudantes de medicina / Peer mentoring: medical students' perceptions of social support and the educational environment

Resumo: Introdução: Programas de mentoria entre pares são apontados como suporte efetivo na transição dos estudantes para o ensino superior, colaborando com sua saúde mental e seu desempenho acadêmico. Objetivos: Este estudo teve como objetivos mensurar e comparar a percepção de suporte social e avaliação do ambiente educacional entre estudantes membros e não membros do Grupo de Estudos em Didática Aplicada ao Aprendizado da Medicina (Gedaam), no curso de graduação em Medicina da Universidade Federal de Minas Gerais (UFMG). Método: Trata-se de estudo transversal que utilizou dados do cruzamento entre os bancos da pesquisa QualiMed e dos registros do Gedaam. Dos 1.470 estudantes que participaram do inquérito QualiMed, 347 eram vinculados ao Gedaam. A percepção do suporte social foi mensurada pela Escala de Satisfação com o Suporte Social (ESSS); e a avaliação do ambiente educacional, pelo Dundee Ready Education Environment Measure (DREEM). Realizaram-se análises descritivas e comparativas univariadas por meio do qui-quadrado de Pearson e do teste t de Student, considerando um valor-p < 0,05 para verificação da significância estatística. Os dados foram analisados no software Statistical Package for Social Sciences (SPSS), versão 19.0. Resultado: Verificou-se diferença estatisticamente significativa entre membros e não membros nas variáveis ciclo do curso, sexo, orientação sexual, recebimento de bolsas de auxílio e prática de atividade física regular. Os participantes do Gedaam apresentaram pior percepção quando comparados a não membros em todos os domínios da ESSS, exceto para a satisfação com atividades sociais (valor-p < 0,05). O ambiente educacional foi avaliado pelos dois grupos como tendo "muitos problemas" (escore = 95,51 para membros Gedaam e 100,05 para não membros), com diferença estatisticamente significativa. Conclusão: Observou-se um perfil mais crítico em relação à percepção de suporte social e ao ambiente acadêmico entre os estudantes. Sugere-se que a mentoria entre pares auxilie positivamente o percurso acadêmico e pessoal dos estudantes de Medicina.

Abstract: Introduction: Peer mentoring programs are seen as effective support for student transition to higher education, contributing to their mental health and academic performance. Objective: To measure and compare the perception of social support and evaluation of the educational environment among student members and non-members of the Grupo de Estudos em Didática Aplicada ao Aprendizado da Medicina (Study Group in Didactics Applied to Learning in Medicine - GEDAAM), on the undergraduate medicine course at the Federal University of Minas Gerais (UFMG). Method: Cross-sectional study using data from the crossover between QualiMed research data and GEDAAM records. Of the 1,470 students who participated in the QualiMed survey, 347 were associated to GEDAAM. The perception of social support was measured by the Social Support Satisfaction Scale (ESSS) and the educational environment assessment by the Dundee Ready Education Environment Measure (DREEM). Univariate descriptive and comparative analysis were performed using Pearson's Chi-square and Student's t-test, considering a p-value <0.05 to verify statistical significance. Data were analyzed using Statistical Package for Social Sciences (SPSS) software, version 19.0. Results: A statistically significant difference was found between members and non-members in course stage, sex, sexual orientation, receipt of aid grants and practice of regular physical activity. GEDAAM participants had a worse perception when compared to non-members in all ESSS Domains, except for satisfaction with social activities (p-value <0.05). The educational environment was assessed by both groups as having "many problems" (score = 95.51 for GEDAAM members and 100.05 for non-members), with a statistically significant difference. Conclusion: A more critical profile was observed in relation to the perception of social support and the academic environment among students. It is suggested that peer mentoring positively helps the academic and personal path of medical students.

Estimates of the impact of COVID-19 on mortality of institutionalized elderly in Brazil. / Estimativas de impacto da COVID-19 na mortalidade de idosos institucionalizados no Brasil.

The COVID-19 pandemic poses difficulties for long-term care institutions for the elderly, with increased mortality rates for the residents. This study aims to estimate the impact of COVID-19 on mortality of institutionalized elderly in Brazil. Estimates of the percentage of elderly deaths occurring in care homes were calculated for Brazil, States and Regions using estimates for the total number of deaths. The estimation was based upon information available for other countries. The weighted percentage was 44.7% and 107,538 COVID-19 deaths were estimated for the elderly in these institutions in Brazil in 2020. Higher numbers of deaths were expected in the Southeast Region (48,779 deaths), followed by the Northeast Region (28,451 deaths); São Paulo was the most affected State (24,500 deaths). The strong impact of COVID-19 on the elderly population living in long-term care facilities is clear. Estimates for the country exceeded 100,000 elderly people, potentially the most fragile and vulnerable, and are based upon a conservative number of total deaths, in view of other estimates and the alarming situation of death growth in Brazil from COVID-19.

Estimativas de impacto da COVID-19 na mortalidade de idosos institucionalizados no Brasil / Estimates of the impact of COVID-19 on mortality of institutionalized elderly in Brazil

Resumo O presente estudo tem como objetivo estimar o impacto da COVID-19 na mortalidade de idosos institucionalizados no Brasil. Foram estimados números de óbitos pela doença para o País, Unidades da Federação e Regiões, com base nas estimativas calculadas e efetuadas neste trabalho do percentual de óbitos de idosos que ocorreriam em instituições de longa permanência de acordo com os totais. Essa estimativa foi baseada em informações disponíveis para uma série de países. O percentual ponderado foi de 44,7%. Estimaram-se 107.538 óbitos de idosos nestas instituições no Brasil em 2020, por COVID-19. São previstos maiores números de óbitos na Região Sudeste (48.779 óbitos), seguida da Região Nordeste (28.451 óbitos); São Paulo é a Unidade da Federação que na estimativa será mais afetada (24.500 óbitos). Fica claro o forte impacto da COVID-19 na população idosa residente em instituições de longa permanência para idosos. As estimativas ultrapassam para o país 100 mil idosos, potencialmente os mais frágeis e vulneráveis, e são baseadas em número de óbitos totais conservador, tendo em vista outras estimativas e a situação alarmante de crescimento dos números de óbitos no Brasil.

Abstract The COVID-19 pandemic poses difficulties for long-term care institutions for the elderly, with increased mortality rates for the residents. This study aims to estimate the impact of COVID-19 on mortality of institutionalized elderly in Brazil. Estimates of the percentage of elderly deaths occurring in care homes were calculated for Brazil, States and Regions using estimates for the total number of deaths. The estimation was based upon information available for other countries. The weighted percentage was 44.7% and 107,538 COVID-19 deaths were estimated for the elderly in these institutions in Brazil in 2020. Higher numbers of deaths were expected in the Southeast Region (48,779 deaths), followed by the Northeast Region (28,451 deaths); São Paulo was the most affected State (24,500 deaths). The strong impact of COVID-19 on the elderly population living in long-term care facilities is clear. Estimates for the country exceeded 100,000 elderly people, potentially the most fragile and vulnerable, and are based upon a conservative number of total deaths, in view of other estimates and the alarming situation of death growth in Brazil from COVID-19.

Dirigir moto ou carro entre adolescentes: inquérito "saúde em Vespasiano", 2015 / Adolescents driving motorcycles or cars: inquiry "health in Vespasiano", 2015

INTRODUÇÃO: Inquérito de base populacional realizado em Vespasiano, Minas Gerais, em 2015/2016. Adolescentes e não habilitados para uso de veículos motorizados, representam maior risco para acidentes no trânsito. OBJETIVOS: Analisar o relato de frequência de dirigir moto e carro alguma vez na vida por adolescentes, bem como fatores associados a esse evento. MÉTODOS: Participaram 424 adolescentes com idades entre 11 e 17 anos, selecionados em amostra aleatória. Foram calculadas as frequências do relato de dirigir moto e carro alguma vez na vida associadas às variáveis explicativas bem como odds ratio, e seu intervalo de confiança a 95% Para análise, foi utilizado o software SPSS, versão 19.0. RESULTADOS: 26,4% dos adolescentes relataram ter dirigido moto e 23,6% ter dirigido carro alguma vez na vida. Na faixa etária de 14 a 17 anos observou-se frequência maior de relato de ter dirigido moto (78,6%) e carro (81,0%) comparados à faixa de 11 a 13 anos (21,4% e 19,0% respectivamente. Adolescentes que ingeriram bebida alcoólica alguma vez na vida apresentaram 2,9 vezes mais chance de relatar ter dirigido moto (IC 95% 1,8 - 4,6) e 2,7 vezes mais chance de relatar ter dirigido carro alguma vez na vida (IC 95% 1,7 - 4,3). 13,9% dos adolescentes relataram ter sofrido acidente de trânsito durante a vida, como motorista, passageiro ou pedestre. CONCLUSÕES: Em Vespasiano, 26,4% dos adolescentes estudados relataram ter dirigido moto e 23,6% carro, o que reforça a necessidade de maior reflexão quanto a estratégias preventivas à ocorrência da transgressão da lei de trânsito pelos adolescentes.(AU)

Introduction: Population based survey conducted in Vespasiano City, Minas Gerais State, Brasil, em 2015/2016. Young unlicensed drivers are more likely to adopt several inappropriate behaviors while driving. Objectives: determine and quantify the association between driving motorcycle and car sometime in life and selected explanatory variables. Methods: 424 teenagers aged 11-17 years were selected in a household random sample of census tracts. The frequency driving a motorcycle and/or car was calculated. Associations were quantified through the odds ratio and its 95% confidence interval. For the analysis we used the software SPSS, 19.0 version. Results: 26.4% of adolescents reported driving motorcycle and 23.6% have driven car sometime in life. The age group 14-17 years reported the a higher frequency of driving motorcycle (78.6%) and car (81%) compared to the age group 11 to 13 years (21.4% and 19%, respectively). Teens who used alcohol in their lifetime were 2.9 (CI 95% 1.8 ­ 4.6) times more likely to ride motorcycle and 2.7 (CI 95% 1.7 ­ 4.3) times more likely to drive a car; 13.9% of adolescents reported having suffered a traffic accident during life as a driver, passanger or pedestrian. Conclusions: In Vespasiano, 26.4% of adolescents reported having driven motorcycle and 23.6% have driven car. This result may contribute to discussion and preventive strategies for health and safety actions related to the occurrence of the violation of the traffic law by adolescents.(AU)

Psychometric properties of the Vulnerability to Abuse Screening Scale for screening abuse of older adults.

OBJECTIVE: Adapt and evaluate the psychometric properties of the Vulnerability to Abuse Screening Scale to identify risk of domestic violence against older adults in Brazil. METHODS: The instrument was adapted and validated in a sample of 151 older adults from a geriatric reference center in the municipality of Belo Horizonte, State of Minas Gerais, in 2014. We collected sociodemographic, clinical, and abuse-related information, and verified reliability by reproducibility in a sample of 55 older people, who underwent re-testing of the instrument seven days after the first application. Descriptive and comparative analyses were performed for all variables, with a significance level of 5%. The construct validity was analyzed by the principal components method with a tetrachoric correlation matrix, the reliability of the scale by the weighted Kappa (Kp) statistic, and the internal consistency by the Kuder-Richardson estimator formula 20 (KR-20). RESULTS: The average age of the participants was 72.1 years (DP = 6.96; 95%CI 70.94-73.17), with a maximum of 92 years, and they were predominantly female (76.2%; 95%CI 69.82-83.03). When analyzing the relationship between the scores of the Vulnerability to Abuse Screening Scale, categorized by presence (score > 3) or absence (score < 3) of vulnerability to abuse, with clinical and health conditions, we found statistically significant differences for self-perception of health (p = 0.002), depressive symptoms (p = 0.000), and presence of rheumatism (p = 0.003). There were no statistically significant differences between sexes. The Vulnerability to Abuse Screening Scale acceptably evaluated validity in the transcultural adaptation process, demonstrating dimensionality coherent with the original proposal (four factors). In the internal consistency analysis, the instrument presented good results (KR-20 = 0.69) and the reliability via reproducibility was considered excellent for the global scale (Kp = 0.92). CONCLUSIONS: The Vulnerability to Abuse Screening Scale proved to be a valid instrument with good psychometric capacity for screening domestic abuse against older adults in Brazil. OBJETIVO: Adaptar e avaliar as propriedades psicométricas da Escala Triagem de Vulnerabilidade ao Abuso (Vulnerability to Abuse Screening Scale - VASS) para identificar risco de violência doméstica contra idosos no Brasil. MÉTODOS: O instrumento foi adaptado e validado em uma amostra de 151 idosos de um centro de referência do idoso, do município de Belo Horizonte, MG, em 2014. Foram coletadas informações sociodemográficas, clínicas e relacionadas a abusos. A confiabilidade via reprodutibilidade foi verificada em uma amostra de 55 idosos, submetidos ao reteste do instrumento sete dias após a primeira aplicação. Foram realizadas análises descritivas e comparativas para todas as variáveis, com nível de significância de 5%. A validade de construto foi analisada pelo método de componentes principais com matriz de correlação tetracórica, a confiabilidade da escala pela estatística Kappa ponderado (Kp) e a consistência interna pelo estimador Kuder-Richardson fórmula 20 (KR-20). RESULTADOS: A idade média dos participantes foi 72,1 anos (DP = 6,96; IC95% 70,94-73,17), com máxima de 92 anos, e o sexo foi predominantemente feminino (76,2%; IC95% 69,82-83,03). Ao analisar a relação entre os escores da Escala Triagem de Vulnerabilidade ao Abuso, categorizados em presença (índice > 3) ou ausência (índice < 3) de vulnerabilidade para abuso, com condições clínicas e de saúde, encontramos diferenças estatisticamente significantes para autopercepção de saúde (p = 0,002), sintomas depressivos (p = 0,000) e presença de reumatismo (p = 0,003). Em relação ao sexo, não houve diferença estatisticamente significante. A Escala Triagem de Vulnerabilidade ao Abuso comportou-se de forma aceitável na avaliação da validade no processo de adaptação transcultural, demonstrando dimensionalidade coerente com a proposta original (quatro fatores). Na análise da consistência interna, o instrumento apresentou bons resultados (KR-20 = 0,69) e a confiabilidade via reprodutibilidade foi considerara excelente para a escala global (Kp = 0,92). CONCLUSÕES: A Escala Triagem de Vulnerabilidade ao Abuso mostra-se como instrumento válido e com boas capacidades psicométricas para o rastreio de abuso doméstico contra idosos no contexto brasileiro.

Psychometric properties of the Vulnerability to Abuse Screening Scale for screening abuse of older adults / Propriedades psicométricas da Vulnerability to Abuse Screening Scale para rastreio de abuso contra idosos

ABSTRACT OBJECTIVE Adapt and evaluate the psychometric properties of the Vulnerability to Abuse Screening Scale to identify risk of domestic violence against older adults in Brazil. METHODS The instrument was adapted and validated in a sample of 151 older adults from a geriatric reference center in the municipality of Belo Horizonte, State of Minas Gerais, in 2014. We collected sociodemographic, clinical, and abuse-related information, and verified reliability by reproducibility in a sample of 55 older people, who underwent re-testing of the instrument seven days after the first application. Descriptive and comparative analyses were performed for all variables, with a significance level of 5%. The construct validity was analyzed by the principal components method with a tetrachoric correlation matrix, the reliability of the scale by the weighted Kappa (Kp) statistic, and the internal consistency by the Kuder-Richardson estimator formula 20 (KR-20). RESULTS The average age of the participants was 72.1 years (DP = 6.96; 95%CI 70.94–73.17), with a maximum of 92 years, and they were predominantly female (76.2%; 95%CI 69.82–83.03). When analyzing the relationship between the scores of the Vulnerability to Abuse Screening Scale, categorized by presence (score > 3) or absence (score < 3) of vulnerability to abuse, with clinical and health conditions, we found statistically significant differences for self-perception of health (p = 0.002), depressive symptoms (p = 0.000), and presence of rheumatism (p = 0.003). There were no statistically significant differences between sexes. The Vulnerability to Abuse Screening Scale acceptably evaluated validity in the transcultural adaptation process, demonstrating dimensionality coherent with the original proposal (four factors). In the internal consistency analysis, the instrument presented good results (KR-20 = 0.69) and the reliability via reproducibility was considered excellent for the global scale (Kp = 0.92). CONCLUSIONS The Vulnerability to Abuse Screening Scale proved to be a valid instrument with good psychometric capacity for screening domestic abuse against older adults in Brazil.

RESUMO OBJETIVO Adaptar e avaliar as propriedades psicométricas da Escala Triagem de Vulnerabilidade ao Abuso (Vulnerability to Abuse Screening Scale – VASS) para identificar risco de violência doméstica contra idosos no Brasil. MÉTODOS O instrumento foi adaptado e validado em uma amostra de 151 idosos de um centro de referência do idoso, do município de Belo Horizonte, MG, em 2014. Foram coletadas informações sociodemográficas, clínicas e relacionadas a abusos. A confiabilidade via reprodutibilidade foi verificada em uma amostra de 55 idosos, submetidos ao reteste do instrumento sete dias após a primeira aplicação. Foram realizadas análises descritivas e comparativas para todas as variáveis, com nível de significância de 5%. A validade de construto foi analisada pelo método de componentes principais com matriz de correlação tetracórica, a confiabilidade da escala pela estatística Kappa ponderado (Kp) e a consistência interna pelo estimador Kuder-Richardson fórmula 20 (KR-20). RESULTADOS A idade média dos participantes foi 72,1 anos (DP = 6,96; IC95% 70,94–73,17), com máxima de 92 anos, e o sexo foi predominantemente feminino (76,2%; IC95% 69,82–83,03). Ao analisar a relação entre os escores da Escala Triagem de Vulnerabilidade ao Abuso, categorizados em presença (índice > 3) ou ausência (índice < 3) de vulnerabilidade para abuso, com condições clínicas e de saúde, encontramos diferenças estatisticamente significantes para autopercepção de saúde (p = 0,002), sintomas depressivos (p = 0,000) e presença de reumatismo (p = 0,003). Em relação ao sexo, não houve diferença estatisticamente significante. A Escala Triagem de Vulnerabilidade ao Abuso comportou-se de forma aceitável na avaliação da validade no processo de adaptação transcultural, demonstrando dimensionalidade coerente com a proposta original (quatro fatores). Na análise da consistência interna, o instrumento apresentou bons resultados (KR-20 = 0,69) e a confiabilidade via reprodutibilidade foi considerara excelente para a escala global (Kp = 0,92). CONCLUSÕES A Escala Triagem de Vulnerabilidade ao Abuso mostra-se como instrumento válido e com boas capacidades psicométricas para o rastreio de abuso doméstico contra idosos no contexto brasileiro.

Integralidade, condições de oferta de serviços e processo de trabalho de Equipes de Saúde da Família em Belo Horizonte / Integrality, conditions of service delivery and work process of Family Health Teams in Belo Horizonte

RESUMO Busca-se analisar a relação entre ações de integralidade e as condições de oferta dos serviços, além do processo de trabalho das Equipes de Saúde da Família, em centros de saúde de um distrito de Belo Horizonte (MG). É um estudo transversal com questionário autoaplicável. Ao todo, 538 profissionais participaram do estudo. Foram realizadas análises descritivas e comparativas, por meio do qui-quadrado de Pearson, e de um valor -p=0,05 para verificação da significância estatística. Tanto as condições de oferta dos serviços quanto o processo de trabalho se mostraram associados à realização de ações de integralidade, sendo que o planejamento se mostrou a ferramenta mais importante para a realização de tais atividades.

ABSTRACT The aim was to analyze the relation between integrality interventions and conditions of service delivery, in addition to the work process of Family Health Teams, in health centers in a district of the city of Belo Horizonte (MG). It is a cross-sectional study with self-administered questionnaire. Descriptive and comparative analyses were carried out through Pearson's chi-square, using p=0.05 value to verify the statistical significance. Both service delivery conditions and the work process showed association with the accomplishment of integrality interventions, and planning proved to be the most important tool for the accomplishment of such activities.

Comparação do perfil de idosos ativos e não ativos do programa bolsa família / Comparison of profile of beneficiary and non-beneficiary elderly of the bolsa família program

OBJETIVOS: Descrever o perfil dos idosos do Cadastro Único da Assistência Social (CADÚNICO), da Secretaria Municipal de Assistência Social de Betim-MG e verificar se há diferença nas condições de vida entre ativos e não ativos inseridos no Programa Bolsa Família (PBF). METODOLOGIA: Estudo transversal com base nos dados secundários obtidos no CADÚNICO no período de janeiro de 2004 a janeiro de 2011. Os idosos foram divididos em dois grupos: ativos (aqueles que recebiam o benefício) e não ativos (aqueles que, apesar de cadastrados, não o recebiam). As variáveis sociodemográficas e de saúde analisadas para comparação entre os grupos foram: sexo, faixa etária, renda, raça/cor, escolaridade, estado civil, situação no mercado de trabalho, moradia e deficiência. RESULTADOS: Dos 8.555 idosos cadastrados, 14,1% eram ativos no PBF. A média de idade foi de 68 anos (mediana de 67 anos), com maior proporção de mulheres (58,0%). A mediana de distribuição da "renda" entre ativos foi de R$60,00 (Q1= R$40,00 e Q3= R$100,00) e de R$100,00 entre não ativos (Q1= R$60,00 e Q3= R$170,00). À medida que a escolaridade aumenta, menor a chance de o idoso estar ativo no PBF. Já para os idosos solteiros e divorciados, a chance de estar ativo no PBF era maior [OR 1,79 (IC 1,54-2,09); OR 1,46 (IC 1,20-1,78), respectivamente]. Sobre a presença ou ausência de deficiências, não houve diferença significativa entre os dois grupos. De modo geral, os idosos viviam em casa própria, construída com tijolo/alvenaria, com rede pública de água e esgoto, com iluminação própria e lixo coletado. CONCLUSÃO: O Programa Bolsa Família representa garantia necessária de renda mínima para o idoso em situação de vulnerabilidade social. Por outro lado, a comparação do perfil de idosos ativos e não ativos põe em relevo a limitação do programa, a saber, ser direcionado apenas aos mais necessitados, sendo incapaz de se estender, como direito, a todos cuja situação assim exige.

OBJECTIVES: To describe the elderly's profile in the Unified Register of Social Service (CADUNICO), of the Municipal Social Service in the city of Betim, Minas Gerais state, Brazil, and assess the differences in living conditions between beneficiaries and non-beneficiaries of the Bolsa Familia Program (BFP). METHODS: Cross-sectional study based on secondary data obtained in the CADUNICO from January 2004 to January 2011. The elderly were divided into two groups: beneficiaries (those who received the benefit), and non-beneficiaries (those who, although registered, did not receive it). Sociodemographic and health variables analyzed to compare the groups were: gender, age, income, race / color, educational level, marital status, situation in the labor market, housing and disability. RESULTS: Of the 8,555 registered elderly, 14.1% were active in the BFP. The average age was 68 years (median 67 years), with higher proportion of women (58.0%). The median distribution of "income" among beneficiaries was R$60.00 (Q1 = R$40.00 and Q3 = R$100.00) and R$100.00 for non-beneficiaries (Q1 = R$60.00 and Q3 = R$170.00). As education increases, the less chance of the elderly to be active in the BFP. As for the single and divorced elderly, the chance to be active in the BFP was greater [OR 1.79 (CI 1.54-2.09); OR 1.46 (CI 1.20-1.78), respectively]. On the presence or absence of failures, there was no significant difference between the two groups. In general, older people living in their own houses, built with brick / masonry, with public water and sewage, with its own lighting and garbage collected. CONCLUSION: The BFP is a necessary warranty of minimum income for socially vulnerable elderly. On the other hand, the comparison of profiles of beneficiary and non-beneficiary seniors highlights the program's limitations, namely, to be directed only to the neediest, being unable to extend, as a right, to all whose situation so requires.

Avaliação da completitude das notificações compulsórias relacionadas ao trabalho registradas por município polo industrial no Brasil, 2007 - 2011 / Evaluation of the completeness of compulsory work-related notifications recorded by county industrial center in Brazil, 2007 - 2011

OBJETIVO: Analisar a completitude dos campos de notificações dos agravos à saúde do trabalhador registrados em um município polo industrial brasileiro no período de 01/01/2007 a 31/12/2011. MÉTODOS: Pesquisa descritiva baseada em dados secundários e composta pela totalidade de registros relacionados ao trabalho (n = 2.345) no Sistema Nacional de Agravos de Notificação, utilizando critérios preconizados pelo Guidelines for Evaluating Public Health Surveillance Systems do Center for Disease Control and Prevention. Verificou-se a completitude dos campos presentes nas fichas de notificação e investigação por meio do percentual de campos preenchidos, do coeficiente de correlação de Spearman e de análise gráfica. RESULTADOS: Foi identificado um decréscimo no percentual de preenchimento para a maioria dos campos essenciais (n = 18; 64%). O grau de completitude dos campos obrigatórios foi elevado (> 85%), constatando-se que a maior parte dos campos não discriminados teve um preenchimento entre 0 e 25% e índices variados para os campos essenciais (0 - 98%). Foi verificada importante variabilidade na completitude dos campos essenciais, observando-se três variáveis com correlação negativa e significativa (r s= -0,9; p = 0,0347) e apenas uma com correlação positiva e também significativa. CONCLUSÃO: A qualidade da maioria dos dados armazenados foi classificada como regular a excelente para variáveis importantes quanto ao delineamento das condições de saúde do trabalhador e à deflagração de ações de vigilância. Todavia, recomenda-se o uso rotineiro de avaliações da qualidade dos dados dos sistemas de informação em saúde do trabalhador no Sistema Único de Saúde. .

OBJECTIVE: To analyze the completeness of workers health problems notification fields registered in a Brazilian municipal industrial hub in the period from January 1st, 2007 to December 31st, 2011. METHODS: Descriptive study based on secondary data and composed of all records related to work (n = 2,345 ) in the National Disease Notification System, using criteria recommended by the Guidelines for Evaluating Public Health Surveillance Systems created by the Center for Disease Control and Prevention. The completeness of the fields present in the research and report forms was assessed by the percentage of filled fields, the Spearman correlation coefficient and graphical analysis. RESULTS: In most of the essential fields it was identified a decrease in the percentage of filling (n = 18; 64%). The degree of completeness of compulsory fields was high (> 85%); most of the non-discriminated fields were 0 - 25% filled; there were variable indexes for key fields (0 - 98%). Considerable variability was observed in the completeness of the key fields, having three variables with significant negative correlation (rs = -0.9; p = 0.0347). Only one variable showed significant positive correlation. CONCLUSION: The quality of most of the stored data was classified as regular to excellent for important variables on the design of worker health and surveillance actions. However, we recommend routine quality data assessments in workers health information systems in the Unified Health System. .

Evaluation of the completeness of compulsory work-related notifications recorded by county industrial center in Brazil, 2007 - 2011.

OBJECTIVE: To analyze the completeness of workers health problems notification fields registered in a Brazilian municipal industrial hub in the period from January 1st, 2007 to December 31st, 2011. METHODS: Descriptive study based on secondary data and composed of all records related to work (n = 2,345 ) in the National Disease Notification System, using criteria recommended by the Guidelines for Evaluating Public Health Surveillance Systems created by the Center for Disease Control and Prevention. The completeness of the fields present in the research and report forms was assessed by the percentage of filled fields, the Spearman correlation coefficient and graphical analysis. RESULTS: In most of the essential fields it was identified a decrease in the percentage of filling (n = 18; 64%). The degree of completeness of compulsory fields was high (> 85%); most of the non-discriminated fields were 0 - 25% filled; there were variable indexes for key fields (0 - 98%). Considerable variability was observed in the completeness of the key fields, having three variables with significant negative correlation (rs = -0.9; p = 0.0347). Only one variable showed significant positive correlation. CONCLUSION: The quality of most of the stored data was classified as regular to excellent for important variables on the design of worker health and surveillance actions. However, we recommend routine quality data assessments in workers health information systems in the Unified Health System.

Risco nutricional e sua associação com o tempo e desfecho da internação de pacientes com aids em um hospital de referência em infectologia de Belo Horizonte / Nutritional Risk and their Association with Time and Hospitalization Outcomes for Patients with AIDS in a Referral Hospital for Infectious Diseases in Belo Horizonte

O objetivo do presente estudo foi analisar a possível associação entre o risco nutricional de indivíduos infectados pelo HIV/AIDS com o tempo e desfecho da internação. Foram estudadas as variáveis sexo, idade, diagnóstico nutricional, período e desfecho da internação por meio dos protocolos de triagem nutricional e prontuários de 238 pacientes internados com AIDS em um hospital de Belo Horizonte no ano de 2010. A análise estatística foi realizada utilizando o estado nutricional como variável dependente para a realização de análises descritivas e comparativas por meio do qui-quadrado de Pearson. A presença de risco nutricional foi observada na maioria dos pacientes (74,8 %). O tempo médio de internação foi de aproximadamente 22 dias (DP= 21,3 dias), sendo que a maior parte dospacientes (50,4%) permaneceu internada por mais de 18 dias. Quanto ao desfecho da internação, 12,6 % evoluíram para óbito. Foi observada uma associação estatisticamente significativa (valor-p = 0,035) entre o diagnóstico nutricional e o tempo de internação, o que indica que pacientes com risco nutricional têm maiores chances de permanecer internados por mais tempo. Não foi encontradaassociação entre as demais variáveis em função do risco nutricional. Contudo, verifica-se que pacientes com risco nutricional e com maior tempo de permanência hospitalar apresentam maior desfecho de óbitos. Conclui-se que o risco nutricional aumenta o período de internação em pacientes com AIDS o que pode levar a um aumento da mortalidade desses pacientes.

The aim of this study was to examine the possible association between nutritional risk of individuals infected with HIV / AIDS over time and hospitalization outcomes. Variables studied were sex, age, nutrition diagnosis, timing and outcome of admission through the protocols of nutritional screening and medical records of 238 patients hospitalized with AIDS in a hospital in Belo Horizonte in 2010. Statistical analysis was performed using nutritional status as a dependent variable for the descriptiveand comparative analysis using the chi-square test. The presence of nutritional risk was observed in most patients (74.8%). The average length of hospitalization was approximately 22 days (SD = 21.3 days), and most patients (50,4%) remained hospitalized for more than 18 days. Outcome admission 12.6% died. We observed statistically significant association (p-value = 0.035) between the nutritional diagnosis and length of stay, indicating that patients at nutritional risk are more likely to remainhospitalized longer. No association was found between the other variables according to nutritional risk.However, it appears that patients at nutritional risk and with a longer hospital stay outcomes are moredeaths. We conclude that nutritional risk increases the length of hospitalization in AIDS patient whichmay lead to increased mortality of these patients.

[Fatal work-related injuries and interpersonal violence in Brazil, 2000-2010]. / Accidentes de trabajo fatales y violencia interpersonal en Brasil, 2000-2010.

In this study, we present estimates of the proportionate mortality of work injuries involving interpersonal violence in Brazil from 2000 to 2010. Data come from the Mortality Information System based on death certificates from the Health Ministry, which in Brazil include a field for recording work-related injuries that must be completed in all deaths due to external causes. There were 1,368,732 deaths due to external causes, 31,576 (2.3%) due to work injuries, and only 226 (0.02%) due to work injuries involving interpersonal violence. Nearly 80% of the death certificates did not include data in the work injury field. Most cases occurred among males (94.3%) 25-34 years of age with less than high school education in the Southeast and Northeast country regions, primarily in the manufacturing and agricultural industries. The majority of cases were caused by firearms, followed by sharp instruments, with a relative increase in this last category during the study period. Findings suggest underrecording of diagnoses that recognize the work-related nature of the death. Better training on death certificate completion and studies to quantify the underrecording of work injuries and work injuries involving interpersonal violence are needed.