Prevalence of trachoma in indigenous and non-indigenous areas, Northeastern Brazil, 2019-2021.

Objective: To estimate the prevalence of trachoma in indigenous and non-indigenous populations in selected areas of the state of Maranhão, in northeastern Brazil. Methods: This was a population-based survey with probabilistic sampling. For the diagnosis of trachoma, external ocular examination was performed using head magnifying loupes, at 2.5X magnification. The prevalence of trachomatous inflammation - follicular (TF) in children aged 1-9 years and the prevalence of trachomatous trichiasis (TT) in the population aged ≥15 years were estimated. Relative frequencies of sociodemographic and environmental characteristics were obtained. Results: The study included 7 971 individuals, 3 429 from non-indigenous populations and 4 542 from indigenous populations. The prevalence of TF in non-indigenous and indigenous populations was 0.1% and 2.9%, respectively, and the prevalence of TT among indigenous populations was 0.1%. Conclusions: The prevalence of TF and TT in the two evaluation units in the state of Maranhão were within the limits recommended for the elimination of trachoma as a public health problem. However, the prevalence of TF was higher in the indigenous evaluation unit, indicating a greater vulnerability of this population to the disease. The prevalence of TF of below 5.0% implies a reduction in transmission, which may have resulted from improved socioeconomic conditions and/or the implementation of the World Health Organization SAFE strategy.

Sexual behavior and self-declaration of sexual orientation among people 18-64 years in Brazil: results from the Knowledge, Attitudes, and Practices survey, 2013 and the National Health Survey, 2019.

BACKGROUND: Population surveys involving the monitoring of high-risk sexual behavior have been recognized as important public health tools to control the HIV epidemic and other sexually transmitted infections (STIs). METHODS: Using data from the Knowledge, Attitudes, and Practices survey (PCAP-2013) and from the National Health Survey (PNS-2019), indicators of sexual behavior were compared according to sociodemographic characteristics among individuals aged 18-64 years, including size (%) estimates of men who have sex with men (MSM) and women who have sex with women (WSW). Specifically, the PNS-2019 prevalence estimates of homosexual, bisexual, heterosexual males and females were compared with those from the PCAP-2013. To compare PCAP and PNS proportional distributions, the Pearson's chi-square test, adjusted by the Rao-Scott's correction, was applied. RESULTS: Size (%) estimates of MSM and WSW obtained by direct questions from the PCAP-2013, showed higher homosexuality prevalence estimates than those resulting from the PNS-2019 self-declared sexual orientation. Significant differences were found between the MSM proportions according to the PCAP-2013 (3.7%; 95% CI 3.1-4.4%) and to the PNS-2019 (2.2%; 95% CI 1.9-2.5), and between the WSW proportions (4.6%; 95% CI 4.0-5.4%) and (2.1%; 95% CI 1.8-2.4), respectively. Results from both surveys showed MSM and WSW prevalence estimates increase with educational level, decrease with age, and is larger among people who do not live with partner, live in urban areas and in state capitals. Regarding condom use at last sexual intercourse, no differences between the PCAP-2013 and the PNS-2019 estimates were found at the national level, but significant improvements were found for MSM, people aged 18-24 and 25-34 years, and individuals not living with a partner. CONCLUSIONS: The underestimation of MSM and WSW prevalence by self-declared sexual orientation suggests that sexual minorities face many difficulties related to disclosing their sexuality and reinforces the importance of developing public health interventions for changing population attitudes and promoting sexual orientation disclosure. Moreover, the low use of condoms in both surveys (PCAP-2013 and PNS-2019) carried out 6 years apart highlights the need of public policies to expand prevention strategies for HIV infection and other STIs.

Health vulnerabilities in female sex workers in Brazil, 2016.

Female sex workers (FSW) suffer stigma and discrimination that negatively impact their physical and mental health and affect access to health care services. This paper aims to describe selected health indicators among FSW in 12 Brazilian cities in 2016. Brazilian cross-sectional Biological Behavioral Surveillance Survey was conducted in 2016 among 4328 FSW recruited by respondent-driven sampling. The sample weighing was inversely proportional to participant's network sizes and the seeds were excluded from the analysis. Health indicators were estimated with 95% confidence interval and included indicators of health status, symptoms of depression, antenatal care, pap smear coverage, signs and symptoms of sexually transmitted infection, contraception and regular condom use, number of births and children alive per women, human immunodeficiency virus and syphilis testing, usual source of care, and perception of discrimination. Most participants self-rated their health as very good/good (65.8%) and 27.7% were positively screened for major depressive disorder episode on Patient Health Questionnaire-2. Antenatal coverage was 85.8% and 62.3% of FSW had access to pap smear exam in the past 3 years. A total of 67.0% of FSW were using some contraceptive method at the time of the study. Male condom was the most common method (37.1%), followed by oral pill (28.9%). A total of 22.5% FSW had never been tested for HIV and the main reasons were "not feeling at risk" (40.4%) and "being afraid or ashamed" (34.0%). The vast majority of FSW used Brazilian National Health System as their usual source of health care (90.2%). Approximately one-fifth of the participants felt discriminated against or were treated worse for being FSW (21.4%) and only 24.3% disclose their sex work status in health services. The vulnerability of FSW is expressed in all health indicators. Indicators of health status, antenatal care, pap smear coverage, and contraception were worse than in the Brazilian population, and point out to the importance of increase FSW's access to health care services. Also, stigma and discrimination emerged as an important barrier to FSW's health care in all dimensions and need to be struggled.

Cross-validation of four different survey methods used to estimate illicit cigarette consumption in Brazil.

OBJECTIVE: To cross-validate estimates of the size of the illicit cigarette trade based on the results of four different survey methods. METHODS: In 2018/2019, four non-industry-funded, large-scale studies were conducted in selected Brazilian cities: packs discarded in household garbage/PDG (1 city), packs littered in the streets/PLS (5 cities), a phone survey of tobacco users' purchase behaviors/VIGITEL (5 cities), and a face-to-face household survey of tobacco users' purchase behaviors/FTF-household (2 cities). The proportions of illicit cigarettes consumed were based on the price paid by smokers in their last purchase (VIGITEL or FTF-household) and/or direct observation of brand names and health warnings (PDG, PLS or FTF-household). RESULTS: Based on PLS, the share of packs that avoided taxation ranged from 30.4% (95% CI 25.6% to 35.7%) in Rio de Janeiro to 70.1% (95% CI 64.6% to 75.0%) in Campo Grande; and PDG conducted in Rio de Janeiro found an even lower proportion point estimate of illicit cigarette use (26.8%, 95% CI 25.1% to 28.6%). In FTF-household, the share of illicit cigarette consumption based on the self-reported price ranged from 29.1% (95% CI 22.4% to 35.7%) in Rio de Janeiro to 37.5% (95% CI 31.2% to 43.7%) in São Paulo, while estimates based on pack observation ranged from 29.9% (95% CI 23.3% to 36.5%) in Rio de Janeiro to 40.7% (95% CI 34.3% to 47.0%) in São Paulo. For all cities, VIGITEL presented the lowest levels of illicit consumption, and most illicit brands were produced in Paraguay. CONCLUSIONS: Small differences in the estimated levels of illicit trade across methods were found, except for the phone survey. The cross-validation of estimates from independent studies is important to help effectively implement tobacco excise tax policy in Brazil and other low-income and middle-income countries.

Associations of Sociodemographic Factors and Health Behaviors with the Emotional Well-Being of Adolescents during the COVID-19 Pandemic in Brazil.

This cross-sectional study utilizes data from a nationwide web-based survey aimed to identify the factors affecting the emotional well-being of Brazilian adolescents aged 12-17 during the period of school closures and confinement. Data collection took place from 27 June to 17 September 2020. We used the "virtual snowball" sampling method, and students from private and public schools were included. A total of 9470 adolescents were analyzed. A hierarchical logistic regression model was used to find the factors associated with reporting at least two of three self-reported problems-sadness, irritability, and sleep problems. The main proximal factor was loneliness (AdjOR = 8.12 p < 0.001). Problems related to school closures also played an important role. Regular intake of fruits and vegetables, as well as physical activity, demonstrated a positive influence on emotional well-being, while excessive screen time (AdjOR = 2.05, p < 0.001) and alcohol consumption negatively affected outcomes (AdjOR = 1.73, p < 0.001). As for distal variables, less affluent adolescents were the most affected, and males reported fewer emotional problems than females. Uncertainty regarding the disease in a context of socioeconomic vulnerability, together with rises in unhealthy behaviors and isolation from their immediate social circles, have negatively affected adolescents' emotional status throughout the COVID-19 pandemic.

Web Data Mining: Validity of Data from Google Earth for Food Retail Evaluation.

To overcome the challenge of obtaining accurate data on community food retail, we developed an innovative tool to automatically capture food retail data from Google Earth (GE). The proposed method is relevant to non-commercial use or scholarly purposes. We aimed to test the validity of web sources data for the assessment of community food retail environment by comparison to ground-truth observations (gold standard). A secondary aim was to test whether validity differs by type of food outlet and socioeconomic status (SES). The study area included a sample of 300 census tracts stratified by SES in two of the largest cities in Brazil, Rio de Janeiro and Belo Horizonte. The GE web service was used to develop a tool for automatic acquisition of food retail data through the generation of a regular grid of points. To test its validity, this data was compared with the ground-truth data. Compared to the 856 outlets identified in 285 census tracts by the ground-truth method, the GE interface identified 731 outlets. In both cities, the GE interface scored moderate to excellent compared to the ground-truth data across all of the validity measures: sensitivity, specificity, positive predictive value, negative predictive value and accuracy (ranging from 66.3 to 100%). The validity did not differ by SES strata. Supermarkets, convenience stores and restaurants yielded better results than other store types. To our knowledge, this research is the first to investigate using GE as a tool to capture community food retail data. Our results suggest that the GE interface could be used to measure the community food environment. Validity was satisfactory for different SES areas and types of outlets.

Prevalence of arterial hypertension in Brazilian adults and its associated factors and activity limitations: a cross-sectional study.

BACKGROUND: Hypertension is a serious global public health problem that affects a large part of the Brazilian adult population and can cause limitations and losses of quality of life. OBJECTIVE: The objective of this study was to analyze the association of hypertension and its correlated limitations, with sociodemographic and epidemiological factors. DESIGN AND SETTING: Cross-sectional study analyzing information on 44,271 adults (30 years or older) from the Brazilian National Health Survey of 2013. METHODS: The prevalence of hypertension and the degree of limitation of the patients' activities associated with hypertension, according to sociodemographic characteristics, anthropometric measurements and lifestyles, were calculated for both sexes. To analyze the strength of association, bivariate and multivariate Poisson regression were used. RESULTS: Hypertension was the most prevalent risk factor among Brazilian adults aged 30 years or older (40.7%). It was strongly associated with the aging process (prevalence ratio, PR 3.51), obesity (PR 1.73), heart disease (PR 1.67) and stroke (PR 1.86). Furthermore, limitations associated with hypertension were more prevalent among those with comorbidities from noncommunicable diseases relating to hypertension complications (stroke PR 1.47; heart disease PR 1.69) and with incomplete elementary education (PR 1.19). CONCLUSIONS: This study showed sociodemographic inequality in the prevalence of hypertension, especially in the population with some degree of limitation associated with hypertension. It showed that improvements in access to primary care services for controlling hypertension at its initial stages are essential in order to avoid comorbidities of greater severity and limitations and losses of quality of life, especially among socially disadvantaged people.

Sex work stigma and non-disclosure to health care providers: data from a large RDS study among FSW in Brazil.

BACKGROUND: Stigma in health services may be detrimental to health seeking attitudes and practices. This study investigates non-disclosure of sex work to health care providers among female sex workers (FSW) in Brazil and its association with the utilization of health care services. METHODS: This study used cross-sectional respondent-driven sampling, carried out in 12 Brazilian cities to identify HIV risk behaviors among FSW. We first assessed statistical associations of sociodemographic, human right violations, health service access and utilization, and discrimination variables with non-disclosure of FSW status to health care providers as outcome. Secondly, we investigated the association of non-disclosure of FSW status with selected preventive health care outcomes: HIV testing, PAP smear exam, and post-exposure prophylaxis (PEP). Adjusted odds ratio with 95% confidence intervals were calculated by multivariable logistic regressions. RESULTS: Among 4245 recruited FSW, a high percentage received free condoms (82%) but only 24.4% were counseled on STI. Most FSW used non-specialized public healthcare routinely (62.6%), but only 51.5% had a Pap smear exam in the last two years and less than 40% were tested for HIV in the last 12 months. Among FSW who engaged in risky behavior (49.6%), only 8.3% used PEP. Regarding human rights violations, approximately 15% were required to give part of their earnings to owners of workplace establishments, 38% started sex work under 18 years old and 6% were required to periodically present their HIV test results. 21.3% reported having faced discrimination in health services, and 24.3% always disclosed their FSW status. Multivariable logistic models indicated significant associations of non-disclosure on the four healthcare outcomes, with lower odds of using preventive health services among women who did not disclose their sex work status, even after controlling for age, educational level, NGO affiliation, and type of health care routinely used. CONCLUSIONS: Our results indicate that sex work stigmatization within health services may be one of the main barriers to STI control and HIV response among FSW. It is essential to combat stigmatization and discrimination against FSW in health services to guarantee the appropriate uptake of preventive services available in the public health system in Brazil.

Changes in attitudes, risky practices, and HIV and syphilis prevalence among female sex workers in Brazil from 2009 to 2016.

BACKGROUND: The present study aims at investigating the progress made toward controlling the human immunodeficiency virus (HIV)/AIDS epidemic among female sex workers (FSW) from 2009 to 2016. METHODS: The baseline of respondent-driven sampling (RDS) study among FSW was carried out in 2009, in 10 Brazilian municipalities. In 2016, information on FSW were collected in 12 municipalities. The analyses took into account the dependence among observations, resulting from the recruitment chains, and the unequal probabilities of selection, resulting from the different network sizes. We analyzed changes in attitudes and risky behavior practices as well as variations in HIV and syphilis prevalence based on the comparison of 95% confidence intervals for each estimate. RESULTS: Information on 2523 (2009) and 4245 (2016) FSW were analyzed. Commercial sex debut shifted to younger ages: while in 2009 the proportion of women who started sex work under 18 years old was 28.3%, in 2016 this percentage rose to 38.3%. The proportion of FSW affiliated to a nongovernmental organization (NGO) in defense of their rights (14.0%), in 2009, decreased to 7.8%, in 2016, as well as the proportion of FSW who received counseling on sexually transmitted infections (STI) in the past 6 months, from 47.5% to 24.4%. Relevant improvements were found for HIV testing in the last 12 months (from 20.3% to 39.3%). The proportions of those who were never tested for syphilis dropped from 57.9% to 48.5%. However, an opposite decreasing trend was found for the Pap smear examination in the last 12 months, decreasing from 43.6% to 31.5%. Regular condom use with clients significantly increased in the period. Regarding HIV prevalence, the 5% level was sustained and no significant differences were found, but syphilis prevalence was found to be more than 3 times higher in 2016 (8.5%) than in 2009 (2.4%). DISCUSSION: Many are the challenges to be faced in attempting to reverse the upward trend of syphilis among FSW in Brazil. Despite the progress in condom distribution free of charge, it is necessary to increase awareness campaigns, emphasize the use, reaffirm STI counseling, and reiterate the need of regular syphilis screening in this key population group.

Factors associated with HIV infection among female sex workers in Brazil.

BACKGROUND: Female sex workers (FSWs) are one of the most-at-risk population groups for human immunodeficiency virus (HIV) infection. This paper aims at identifying the main predictors of HIV infection among FSW recruited in the 2nd Biological and Behavioral Surveillance Survey in 12 Brazilian cities in 2016. METHOD: Data were collected on 4245 FSW recruited by respondent driven sampling (RDS). Weights were inversely proportional to participants' network sizes. To establish the correlates of HIV infection, we used logistic regression models taking into account the dependence of observations resultant from the recruitment chains. The analysis included socio-demographic sex work characteristics, sexual behavior, history of violence, alcohol and drug use, utilization of health services, and occurrence of other sexually transmitted infections (STIs). RESULTS: HIV prevalence was estimated as 5.3% (4.4%-6.2%). The odds ratio (OR) of an HIV-positive recruiter choosing an HIV-positive participant was 3.9 times higher than that of an HIV-negative recruiter (P < .001). Regarding socio-demographic and sex work characteristics, low educational level, street as the main work venue, low price per sexual encounter, and longer exposure time as a sex worker were found to be associated with HIV infection, even after controlling for the homophily effect. The OR of being HIV infected among FSW who had been exposed to sexual violence at least once in a lifetime (OR = 1.5, P = .028) and the use of illicit drugs at least once a week were highly significant as well, particularly for frequent crack use (OR = 3.6, P < .001). Among the sexual behavior indicators, not using condoms in some circumstances were significantly associated with HIV infection (OR = 1.8, P = .016). Regarding the occurrence of other STI, the odds of being HIV infected was significantly higher among FSW with a reactive treponemal test for syphilis (OR = 4.6, P < .001). CONCLUSIONS: The main factors associated with HIV infection identified in our study characterize a specific type of street-based sex work in Brazil and provided valuable information for developing interventions. However, there is a further need of addressing social and contextual factors, including illicit drug use, violence, exploitation, as well as stigma and discrimination, which can influence sexual behavior.

Prevalence estimates of HIV, syphilis, hepatitis B and C among female sex workers (FSW) in Brazil, 2016.

BACKGROUND: Female sex workers (FSW) bear a high burden of sexually transmitted infections (STI). In this paper, we estimate the prevalence of human immunodeficiency virus (HIV), HBV = hepatitis B virus (HBV), HCV = hepatitis C virus (HCV), syphilis and co-infections in the second Biological and Behavioral Surveillance Survey among FSW in Brazil. METHOD: The survey was conducted in 12 Brazilian cities from July to November 2016. We used respondent-driven sampling (RDS) to recruit 350 FSW in each city. Rapid tests were used for screening HIV, syphilis, HCV, and HBV. Confirmatory tests were performed on all samples with reactive rapid test result. All testing algorithms and interpretations were done according to the recommendations of the Department of STI/AIDS and viral hepatitis, Ministry of Health. The STI diagnoses were given by: confirmed HIV infection by a positive result on Western blot; active syphilis infection, defined by a RPR titer equal or greater than 1/8; viremia period of HBV and HCV infections, characterized by a detectable (or quantifiable) viral load. Prevalence estimates and standard errors were calculated using statistical procedures suitable for data collected by RDS. RESULTS: Excluding the seeds, 4245 FSW were enrolled. Prevalence estimates were: HIV 5.3% (95% CI: 4.4%-6.2%); active syphilis 8.5% (95% CI: 7.3%-9.7%); HBV 0.4% (95% CI: 0.2%-0.7%); and, HCV 0.9% (95% CI: 0.6%-1.3%). Among the 4154 FSW tested for the 4 infections, 13.3%; (95% CI 12.0%-14.8%) were diagnosed with at least one of the infections, of which 87.6% (95% CI: 83.3%-90.9%) had single infections. The prevalence of HIV/syphilis co-infection was 1.09% (95% CI: 0.7%- 1.6%) and of HIV/HCV or HBV infections was 0.4% (95% CI: 0.2%-0.7%). CONCLUSIONS: Our results reveal the need to conduct more studies to estimate the prevalence of STI and co-infections among FSW in Brazil. Longitudinal trends in the prevalence estimates of HIV and other STI provide information to monitor changes in this high-risk population. Additionally, the study highlights the importance of measuring the hepatitis burden among FSW living with HIV, and the need of including FSW in all aspects of STI prevention, care, and treatment programs.

Inequities in Healthcare utilization: results of the Brazilian National Health Survey, 2013.

BACKGROUND: The Brazilian Unified Health System is a public healthcare system that has universal and equitable access among its main principles, but the continental size of the country and the complexity of the public health system complicate the task of providing equal access to all. We aim to investigate the factors associated with inequities in healthcare utilization in Brazil. METHODS: We employed data from a nationally representative cross-sectional study (2013 National Health Survey; n = 60,202). The outcome was underutilization of healthcare by adults, defined as lack of utilization of one or more of these services: physician or dentist consultation, and blood glucose or blood pressure screening. A logistic regression model, considering the complex sample, was employed (alpha = 5 %). RESULTS: 0.7 % of the sample never visited a physician, 3.3 % never visited a dentist, 3 % never underwent blood pressure screening, 11.5 % never underwent blood glucose screening, and 15 % never utilized at least one of these services. Multivariate models showed a higher likelihood of underutilization of healthcare among individuals of the lowest social class "E" (AOR = 6.31, 95 % CI = 3.76-10.61), younger adults (Adjusted Odds Ratio, or AOR = 4.40, 95 % CI = 3.78-5.12), those with no formal education or incomplete primary education (AOR = 2.93, 95 % CI = 2.30-3.74), males (AOR = 2.16, 95 % CI = 1.99-2.35), and those without private health insurance (AOR = 2.11, 95 % CI = 1.83-2.44). Individuals self-classified as "white" were less likely to report underutilization (AOR = 0.82, 95 % CI = 0.75-0.90). CONCLUSIONS: Despite recent expansion of primary healthcare and oral health programs in Brazil, we observed gaps in healthcare utilization among the most vulnerable segments of the population.

Perception of the Brazilian population on medical health care. Brazil, 2013.

The objective was to analyze the perception of the Brazilian population on the medical health care, using data from the National Health Survey, 2013. Among those who have consulted with doctor in the 12 months prior to the survey, we analyzed 12 aspects related to health services and medical consultation, according to type of care (public/ private). By multivariate logistic regression, factors associated with dissatisfaction with the care received were investigated. For the dimensionality reduction of the assessed aspects, we used principal component analysis. The survey revealed that 74.2% of the adult Brazilian population consulted a doctor. Among the differences by type of care, stood out the way of getting an appointment, the type of doctor, the waiting time for service, and the reason for consultation. Median scores were concentrated in 80 (good), except for the waiting time between SUS users. Proportions of very good evaluation were, however, higher among users of the private sector. Despite the positive evaluation in both sectors, public and private, the configuration of the Federative Units in the plane formed by the two principal component axes followed a pattern of striking regional differences.

Lifestyle among former cancer patients in Brazil in 2013.

People who have been diagnosed with cancer tend to adopt healthier lifestyles. This study analyzes the prevalence of smoking, eating fruits and vegetables, exercise and the use of alcoholic beverages among individuals who reported to have been diagnosed with cancer in the PNS (Pesquisa Nacional de Saúde or National Health Survey). The prevalence and corresponding 95% confidence intervals were calculated for consuming fruits and vegetables, sedentary lifestyle (no exercise), use of alcoholic beverages, being overweight and tobacco use. The associa-tion between having received a diagnosis of cancer and the risk and protection factors was analyzed using a Poisson regression, adjusted by sociodemographic variables and other chronic comorbidities. The analyses were stratified by time since the diagnosis and the type of cancer related to the factors analyzed. The types of cancer most often reported were breast and cervix in women, and prostate and stomach in men. Among those who had cancer diagnoses, there was a higher consumption of fruits and vegetables, higher proportion of ex-smokers, however, increased use of alcohol. There was no difference in the frequency of exercise or incidence of being overweight between the two groups. Measures to promote health and prevent chronic diseases should be implemented in the follow-up of people who have had cancer, in an effort to ensure integrated healthcare.

Determinants of self-rated health and the influence of healthy behaviors: results from the National Health Survey, 2013.

OBJECTIVE: To investigate the determinants of self-rated health in Brazil and the influence of healthy lifestyles. METHODS: We used data from the National Health Survey (PNS), 2013. The self-rated health was categorized as very good/good, fair, and poor/very poor. Differences in the distribution of self-rated health according to the age group and sex were tested. Logistic regression models were used to test the effects of educational level, race/skin color, and the presence of at least one noncommunicable chronic disease on poor/very poor health perception. In addition, the influence of healthy behaviors was tested controlling for the effects of sociodemographic factors and the presence of at least one chronic disease. RESULTS: We analyzed 60,202 individuals; about 66.1% rated their health as very good/good and 5.9% as poor/very poor; about 47.1% reported the diagnosis of at least one noncommunicable chronic disease; and only 9.3% reported a "healthy lifestyle" (do not use tobacco products, consume fruits and vegetables properly, and do physical activity during leisure time). Among the sociodemographic factors, age, sex, educational level, and race were significantly associated with self-rated health and the presence of at least one chronic disease. The effects of all healthy behaviors were statistically significant even after controlling for the other determinants. CONCLUSION: Although the adoption of healthy lifestyles in Brazil is still insufficient, the association of healthy practices with self-perception of health found in this study is an indication that the Brazilian population is beginning to relate healthy behaviors to their well-being and better health evaluation.

Prevalence of chronic non-communicable diseases and association with self-rated health: National Health Survey, 2013.

OBJECTIVE: To analyze the profile of 10 chronic noncommunicable diseases investigated in the National Health Survey carried out in Brazil in 2013 and their association with the self-rated health. METHODS: A cross-sectional, population-based nationwide study with 60,202 individuals aged 18 years old or more. Sampling process by conglomerate was carried out in three stages of selection: census tract, household, and individual. The prevalence of chronic diseases by age, gender and educational status and the confidence intervals of 95% , the mean age at the first diagnosis and the proportion of limitation of the usual activities were calculated. To test the association with self-rated health, the logistic regression procedure adjusted for gender and age was used. RESULTS: The more prevalent diseases were hypertension (21.4%), depression (7.6%), arthritis (6.4%), and diabetes mellitus (6.2%). Individuals diagnosed with stroke reported greater limitations in the daily activities (38.6%). There was a gradient in the prevalence by age and educational level, and all the diseases were more frequent among women. A worse self-rated health was observed among those with a diagnosis of stroke (OR = 3.60; p < 0.001) and those who referred two diseases (OR = 5.53; p < 0.001) or three or more diseases (OR = 10.86; p < 0.001). CONCLUSIONS: Because these diseases are associated with modifiable risk factors, the prevention with population focus is the best strategy to reduce the burden of these diseases.

Recommendations and practice of healthy behaviors among patients with diagnosis and diabetes in Brazil: National Health Survey (PNS), 2013.

OBJECTIVE: To analyze healthy life style recommendations given in health care and the adoption of healthy behaviors among hypertension and diabetes patients. METHODS: We analyzed the recommendations according to the place of the last health care visit (primary health care, other public facilities, and private health care facilities). The effects of having a diagnosis of hypertension or diabetes on the adoption of healthy practices were analyzed by multivariate logistic regression models, using sex, age, and educational level as control variables, and the following outcomes: current use of tobacco products; regular physical activity during leisure time; recommended intake of fruits and vegetables; perception of low salt intake; frequent consumption of sweets; and excessive alcohol consumption. RESULTS: Approximately 88% of hypertension patients received recommendations to have a healthy diet, 91% to eat less salt, 83% to practice regular physical activity, and 76% to not to smoke. Among diabetic patients, all recommendations related to nutrition were very frequent, reaching 95% for the habit of having fruits and vegetables regularly. The effect of having a diagnosis of hypertension was significant for non-use of tobacco products and perception of low salt intake. The diagnosis of diabetes mainly influenced the habit of not consuming sweets often. CONCLUSION: Results evidenced that people with diagnosis of hypertension and diabetes give priority to not use (stop) harmful health behaviors than to adopt practices that will bring benefits to their health. It is necessary to promote not only the adverse effects of harmful habits, but also the benefits of healthy behaviors to aging well.

Prevalence and factors associated with nutritional deviations in women in the pre-pregnancy phase in two municipalities of the State of Rio de Janeiro, Brazil.

OBJECTIVE: To assess the prevalence and potential factors associated with pre-pregnancy nutritional status of women. METHODS: This is a cross-sectional study carried out between December 2007 and November 2008 with 1,535 women in the first trimester of pregnancy and randomly selected in health units of the Brazilian public health system (SUS) in the municipalities of Queimados and Petrópolis in the State of Rio de Janeiro. The diagnosis of nutritional deviations was based on the Body Mass Index, according to the classification of the Institute of Medicine, and the following categories were obtained: underweight, normal weight, overweight and obesity. In the statistical analysis, the multinomial logistic regression model was used and an odds ratio and confidence interval of 95% were estimated. RESULTS: The sample included women between 13 and 45 years. The prevalence of underweight, overweight and obesity were 10, 18 and 11%, respectively. Women living in Queimados, adolescents, women who did not live with a partner and smokers had a higher proportion of low pre-pregnancy weight. There was an association between hypertension, overweight and obesity. Adolescents presented lower chance to overweight and obesity. Living in Queimados reduced the odds of overweight. CONCLUSION: The proportion of pre-pregnancy nutritional deviations was high, and recognizing factors that lead to them is very important for an early identification of women at nutritional risk, with view to interventions to reduce the adverse effects of malnutrition on maternal and child health.

Analysis of data collected by RDS among sex workers in 10 Brazilian cities, 2009: estimation of the prevalence of HIV, variance, and design effect.

BACKGROUND: Respondent-driven sampling (RDS) is a chain-referral method that is being widely used to recruit most at-risk populations. Because the method is respondent driven, observations are dependent. However, few publications have focused on methodological challenges in the analysis of data collected by RDS. METHODS: In this article, we propose a method for estimating the variance of the HIV prevalence rate, based on the Markov transition probabilities and within recruitment cluster variation. The method was applied to a female commercial sex workers study carried out in 10 Brazilian cities in 2008. Both the inverse of network size and the size of the city were considered in the estimation of overall sampling weights. The study included a behavior questionnaire and rapid tests for HIV and syphilis. RESULTS: About 2523 interviews were conducted successfully, excluding the seeds. Results show a positive homophily between recruits for those HIV+; HIV- recruiters selected HIV+ recruits 4% of the time; HIV+ recruiters selected other HIV+ recruits 19.6% of the time, about 5 times higher. The prevalence rate was estimated at 4.8% (95% confidence interval: 3.4 to 6.1), and a design effect of 2.63. CONCLUSIONS: Using statistical methods for complex sample designs, it was possible to estimate HIV prevalence, standard error, and the design effect analytically. Additionally, the proposed analysis lends itself to logistic regression, permitting multivariate models. The stratification in cities has proved suitable for reducing the effect of design and can be adopted in other RDS studies, provided the weights of the strata are known.

Risk factors associated with HIV prevalence among female sex workers in 10 Brazilian cities.

BACKGROUND: HIV prevalence is 15 times higher among female sex workers (FSWs) than in the overall Brazilian female population. In this article, we investigated factors associated to HIV infection among FSW, recruited by Respondent-driven sampling (RDS), in 10 Brazilian cities in 2008-2009. METHOD: The total sampling was 2523 FSWs. The variables considered in the study included sociodemographic characteristics and those related to profession, knowledge, and source of information on sexually transmitted infection/AIDS, access to condoms, sexual behavior, health care and sexually transmitted infection signs, discrimination and violence, and the use of alcohol and drugs. Sampling weights were proportional to the inverse of network size and for the generation of global results for the 10 cities, data were calibrated by the population size. Multivariate logistic regression models were used, taking into account the dependency structure of observations. RESULTS: The longest period of prostitution (odds ratio [OR], 1.040; 95% confidence interval [CI], 1.013-1.067), the lowest price charged for sex (OR, 0.713; 95% CI, 0.522-0.970), the association with other sexually transmitted infections such as syphilis (OR, 2.186; 95% CI, 1.064-4.488), and the fact of would waive the use of condom on client's request (OR, 3.735; 95% CI, 1.449-9.661) were the most important associated risk factors to HIV infection among FSWs. Purchase of condoms (OR, 0.503; 95% CI, 0.304-0.833) was a relevant preventive factor. CONCLUSIONS: The use of RDS proved to be appropriate for the recruitment of FSWs as long as the statistical analysis takes into account the dependency structure of observations. The HIV infection predictors here depicted can support public health policies focused on this population group in Brazil.