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1.
J Clin Epidemiol ; 152: 110-115, 2022 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-36241035

RESUMO

OBJECTIVE: Here, we examined the accuracy measures of a set of automated deduplication tools to identify duplicate in the eligibility process of systematic reviews. STUDY DESIGN AND SETTING: A planned search strategy was carried out on seven electronic databases until May 31, 2021. Using manual search as the reference standard, we assessed sensibility, specificity, negative predictive value, and positive predictive value (PPV). RESULTS: Specificity ranged from 0.96 to 1.00. Rayyan, Mendeley, and Systematic Review Accelerator (SRA) presented high sensibility (0.98 [95% CI = 0.94-1.00]; 0.93 [95% CI = 0.88-0.97] and 0.90 [95% CI = 0.84-0.95], respectively), whereas EndNote X9 and Zotero had only fair sensitivity (0.73 [95% CI = 0.65-0.80] and 0.74 [95% CI = 0.66-0.81], respectively). Negative predictive value ranged from 0.99 to 1.00. Mendeley and SRA had good PPV (0.93 [95% CI = 0.88-0.97] and 0.99 [95% CI = 0.96-1.00], respectively). PPV was fair for EndNote X9 (0.61 [95% CI = 0.54-0.69]) and Zotero (0.62 [95% CI = 0.54-0.69]) and poor for Rayyan (0.41 [95% CI = 0.36-0.47]). CONCLUSION: Choosing the most suitable tool depends on its interface's characteristics, the algorithm to identify and exclude duplicates, and the transparency of the process. Therefore, Rayyan, Mendeley, and SRA proved to be accurate enough for the systematic reviews' deduplication step.

2.
Front Pharmacol ; 13: 927179, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36034836

RESUMO

Background: The treatment of rheumatoid arthritis (RA), a chronic systemic inflammatory autoimmune disease, is based on disease-modifying anti-rheumatic drugs (DMARDs). Typically, it starts with conventional synthetic DMARDs (csDMARDs), and depending on the patient's response to the treatment and the adverse events experienced, biological DMARDs (bDMARDs) are initiated. bDMARDs are more specific to inflammatory factors than csDMARDs and more efficient in inducing remission and low disease activity. Thus, this study aimed to assess the effectiveness of biological therapy in patients with rheumatoid arthritis in administrative health databases. Methods: PubMed, Embase, Lilacs, Ovid, Scopus, and Web of Science databases were searched from inception to 21 October 2021, to identify observational studies that evaluated the effectiveness of biological therapy in patients with rheumatoid arthritis using administrative databases and real-world data. The methodological quality was assessed by the methodological index for non-randomized studies (MINORS). A fixed or random-effects model estimated risk ratios with 95% confidence intervals. The analysis was divided into four groups: tumor necrosis factor inhibitors (TNFi) versus non-TNFi; TNFi versus TNFi (adalimumab, etanercept, and golimumab versus infliximab); bDMARDs versus Janus kinase inhibitors (JAKi); and bDMARDs monotherapy versus combination therapy (bDMARDs and MTX). Results: Twenty-one records were eligible for inclusion in this systematic review and meta-analysis; seven population-based cohorts, eight prospective, and six retrospective cohort studies. Overall, 182,098 rheumatoid arthritis patients were evaluated. In the meta-analysis, lower effectiveness was observed among TNFi users than in non-TNFi (RR: 0.88; 95% CI: 0.81-0.95; p < 0.01; I2 = 94.0%) and bDMARDs than in JAKi (RR: 0.86; 95% CI: 0.79-0.94; p < 0.01; I2 = 93.0%). Higher effectiveness among adalimumab, etanercept, and golimumab than in infliximab (RR: 1.19; 95% CI: 1.05-1.36; p < 0.01; I2 = 96.0%) was found. No significant differences in the effectiveness of bDMARD monotherapy compared to combination therapy (RR: 0.83; 95% CI: 0.68-1.00; p < 0.01; I2 = 81.0%) was observed. E-value analysis indicated that the estimates were not robust against unmeasured confounding. Conclusion: According to the available real-world data, our results suggest that biological therapy effectively treats patients with rheumatoid arthritis, indicating higher effectiveness with non-TNFi and JAKi than with TNFi. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID#CRD42020190838, identifier CRD42020190838.

3.
Front Pharmacol ; 13: 928471, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36034855

RESUMO

Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease that affects the synovial fluid of joints, tendons, and some extra-articular sites. Biologic agents have been highly effective and are comparable in reducing RA symptoms, slowing disease progression, and improving physical function; however, concerns have been raised about the risks of several potential adverse effects. Thus, this study aimed to assess the safety of biological therapy in patients with rheumatoid arthritis in observational studies using administrative health databases. Methods: PubMed, Embase, Lilacs, Ovid, Scopus, and Web of Science were searched from inception to 21 October 2021. The analysis was divided into five groups: tumor necrosis factor inhibitors (TNFi) versus non-TNFi; TNFi versus csDMARDs; bDMARDs versus csDMARDs; abatacept versus bDMARDs; and TNFi versus Janus kinase inhibitors (JAKi). The adverse events were cancer, cardiovascular events, infection, herpes zoster, tuberculosis, and death. The methodological quality of the studies was assessed by the Newcastle-Ottawa Scale. A random-effects model estimated risk ratios with 95% confidence intervals. Results: Thirty-one studies were eligible for inclusion in the present systematic review, published from 2014 to 2021. A total of 1,039,398 RA patients were assessed. The 31 studies evaluated eleven different biological drugs. No significant differences were found regarding safety between TNFi versus non-TNFi (RR 1.08; 95% CI 0.92-1.28; p < 0.01; I2 = 93.0%), TNFi versus csDMARDs (RR 0.91; 95% CI 0.75-1.10; p < 0.01; I2 = 87.0%), bDMARDs versus csDMARDs (RR 0.99; 95% CI 0.82-1.20; p < 0.01; I2 = 93.0%), abatacept versus bDMARDs (RR 0.80; 95% CI 0.54-1.18; p < 0.01; I2 = 90.0%), and TNFi versus JAKi (RR 3.54; 95% CI 0.30-42.09; p = 0.01; I2 = 81.0%). In the subgroup analysis, among studies comparing abatacept to TNFi, a lower risk of cardiovascular events was associated with abatacept (RR 0.37; 95% CI 0.24-0.55). Conclusion: Our results do not suggest an increased risk of adverse events associated with biological therapy in treating RA patients, indicating a lower risk of cardiovascular events with abatacept than TNFi. However, these findings must be interpreted with caution given the limitations of this study and the low/very low certainty of the evidence. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?, identifier [CRD42020190838].

4.
Preprint em Português | SciELO Preprints | ID: pps-4524

RESUMO

Introdução: As políticas públicas são essenciais para reduzir a morbimortalidade infantil. Este estudo descreve a evolução das políticas relacionadas à atenção à criança no âmbito da Atenção Primária à Saúde (APS) no Brasil, implementadas desde a criação do Sistema Único de Saúde (SUS). Metodologia: Revisão narrativa da literatura com base nos principais marcos regulatórios com influência direta ou indireta na Atenção à Saúde da Criança (ACS) na APS, publicados entre 1990 e 2017. Resultados: Foram analisados ​​31 documentos oficiais, organizados em uma linha do tempo e classificados em três categorias: I) Normas do SUS e da APS; II) diretrizes para os serviços de saúde materno-infantil no âmbito da APS; e, III) políticas intersetoriais. Conclusão:A evolução das políticas de CSC no Brasil é marcada por uma série de conquistas em prol da ampliação dos direitos sociais e da garantia do direito à saúde que ampliou o acesso aos serviços de saúde e contribuiu para a melhoria das condições de vida e de vida das crianças. No entanto, as desigualdades sociais e os desafios no acesso e qualidade da atenção na APS são persistentes, com retrocessos causados ​​pela implementação de medidas de austeridade desde 2016.


Introdução: Políticas públicas são fundamentais para a redução da morbimortalidade na infância. O presente estudo descreve uma evolução política relacionada à Atenção Primária à Saúde da Criança no âmbito da Atenção Primária Saúde (APS) no Brasil, desde a criação do Sistema Único de Saúde (SUS). Metodologia: Revisão narrativa da literatura com base nos principais marcos normativos com influência na Atenção à Saúde da Criança no âmbito da APS, publicados entre 1990 e 2017. Resultados: Foram analisados 31 documentos oficiais, distribuídos numa linha do tempo, classificados em: I) normatização do SUS e da APS; II) orientação aos serviços de saúde materno-infantil no âmbito da APS e III) políticas intersetoriais. Conclusão: A evolução das políticas pensadas no Brasil está marcada para serviços e como soluções da série de direitos sociais e como possibilidades de vistas da vida. Porém, além das desigualdades sociais, desafios no acesso e na qualidade do cuidado na APS se fazem persistentes, com retrocessos são persistentes agravados com a capacidade de trabalhar1 em medidas de austeridade curso desde 206.

5.
J Affect Disord ; 314: 86-93, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35810830

RESUMO

Multimorbidity is a global health issue impacting the quality of life of all ages. Multimorbidity with a mental disorder is little studied and is likely to have been affected by the COVID-19 pandemic. We used a survey of 14,007 respondents living in Brazil to investigate whether people who already had at least one chronic medical condition had more depression and anxiety symptoms during social distancing in 2020. Generalized linear models and structural equation modelling were used to estimate the effects. A 19 % and 15 % increase in depressive symptoms were found in females and males, respectively, for each unit of increase in the observed value of reported chronic disease. Older subjects presented fewer symptoms of depression and anxiety. There was a 16 % increase in anxiety symptoms in females for each unit increase in the reported chronic disease variable and a 14 % increase in males. Younger subjects were more affected by anxiety symptoms in a dose-response fashion. High income was significantly related to fewer depressive and anxiety symptoms in both males and females. Physical activity was significantly associated with fewer anxiety and depression symptoms. Structural equation modelling confirmed these results and provided further insight into the hypothesised paths.


Assuntos
COVID-19 , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Brasil/epidemiologia , COVID-19/epidemiologia , Doença Crônica , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Humanos , Masculino , Multimorbidade , Pandemias , Qualidade de Vida
6.
Rev Saude Publica ; 56: 53, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35703607

RESUMO

OBJECTIVE: To evaluate the performance of tuberculosis control in Brazilian municipalities. METHODS: This is an ecological study on Brazilian municipalities that notified at least four new cases of tuberculosis, with a minimum of one new case of pulmonary tuberculosis between 2015 and 2018. The municipalities were stratified according to the population in < 50 thousand, 50-100 thousand, 100-300 thousand, and > 300 thousand inhabitants, and the k-means method was used to group them within each population range according to the performance of six indicators of the disease. RESULTS: A total of 2,845 Brazilian municipalities were included, comprising 98.5% (208,007/211,174) of new tuberculosis cases in the period. For each population range, three groups (A, B, and C) of municipalities were identified according to the performance of the indicators: A, the most satisfactory; B, the intermediates; and C, the least satisfactory. Municipalities in group A with < 100 thousand inhabitants presented results above the targets for laboratory confirmation (≥ 72%), abandonment (≤ 5%), and cure (≥ 90%), and comprised 2% of new cases of the disease. Conversely, municipalities of groups B and C presented at least five indicators with results below the targets - HIV testing (< 100%), contact investigation (< 90%), directly observed therapy (< 90%), abandonment (> 5%), and cure (< 90%) -, and corresponded to 66.7% of new cases of tuberculosis. In group C of municipalities with > 300 thousand inhabitants, which included 19 of the 27 capitals and 43.1% of new cases of tuberculosis, the lowest percentages of contact investigation (mean = 56.4%) and directly observed therapy (mean = 15.4%) were verified, in addition to high abandonment (mean = 13.9%) and low coverage of primary health care (mean = 66.0%). CONCLUSIONS: Most new cases of tuberculosis occurred in municipalities with unsatisfactory performance for disease control. Expanding the coverage of primary health care in these places can reduce abandonment and increase the contact investigation and directly observed therapy.


Assuntos
Tuberculose Pulmonar , Tuberculose , Brasil/epidemiologia , Cidades , Busca de Comunicante , Humanos , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/prevenção & controle
7.
Gene ; 838: 146706, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-35772656

RESUMO

BACKGROUND: Polymorphisms in genes related to the activation and development of regulatory T cells (Tregs), such as FOXP3, may be associated with asthma and atopy development. Additionally, environmental factors such as exposure to infections can modify the effect of these associations. This study evaluated the impact of polymorphisms in the FOXP3 on the risk of asthma and atopy as also gene-environment interactions in these outcomes. METHODS: This study included 1,246 children from the SCAALA program, between 4 and 11 years of age. DNA was extracted from peripheral blood and eight SNPs (rs2280883, rs11465476, rs11465472, rs2232368, rs3761549, rs3761548, rs2232365 and rs2294021) were genotyped using the 2.5 HumanOmni Beadchip from Illumina (San Diego, California, USA) or TaqMan qRT-PCR. RESULTS: The rs2232368 (Allele T) was positively associated with asthma symptoms (OR = 1.95, CI = 1.04 to 3.66, p = 0.040) and skin prick test (SPT) reactivity to aeroallergens (OR = 2.31, CI = 1.16 to 4.59, p = 0.017). The rs3761549 (Allele T) was positively associated with SPT reactivity (OR = 1.44, CI = 1.03 to 2.02, p = 0.034). The rs2280883 (Allele C) was negatively associated with specific IgE to aeroallergens (OR = 0.83, CI = 0.70 to 0.99, p = 0.040). Furthermore, the rs2280883 played a protective role in the development of atopy only in individuals seropositive to Epstein-Barr virus (EBV) infection (OR = 0.74, CI = 0.60 to 0.92, p = 0.003 and OR = 0.74; 95% CI = 0.61-0.91, p = 0.007 for SPT and slgE respectively), but not in individuals without EBV infection. CONCLUSION: Polymorphisms in the FOXP3 gene were associated with the risk of atopy and asthma development in our population. In addition, EBV infection had an effect modifier of the observed association for rs2280883 variant.


Assuntos
Asma , Infecções por Vírus Epstein-Barr , Hipersensibilidade Imediata , Asma/genética , Brasil , Criança , Fatores de Transcrição Forkhead/genética , Interação Gene-Ambiente , Predisposição Genética para Doença , Herpesvirus Humano 4 , Humanos , Hipersensibilidade Imediata/genética , Polimorfismo de Nucleotídeo Único
8.
Artigo em Inglês | MEDLINE | ID: mdl-35564740

RESUMO

This study aimed to assess the impact of the Bolsa Familia Program on perinatal outcomes of pregnant women. A cohort study was conducted with pregnant women supported by prenatal services at 17 Family Health Units in Bahia, Brazil. A previously tested structured questionnaire, which has sociodemographic, economic, prenatal care, lifestyle, and nutritional variables, has been used to collect data. The outcomes included premature birth and low birth weight. A hierarchical conceptual model was constructed, and logistic regression analysis was performed. From a total of 1173 pregnant women, the identified average age was 25.44 years and 34.10% had pre-gestational overweight. The non-beneficiary pregnant women presented a 1.54 (95% CI = 0.46-5.09) times higher chance of giving birth to children with low weight and a 1.03 (95% CI = 95% CI = 0.53-2.00) times chance of premature birth when compared to the beneficiary group. In the multilevel model, some variables were statistically significant, such as age between 18 and 24 years (p = 0.003), age greater than or equal to 35 years (p = 0.025), family income (p = 0.008), employment status (p = 0.010), and maternal height (p = 0.009). The Bolsa Familia Program, as an integrated strategy of social inclusion and economic development, is suggested to exert a protective effect on the health of mother-concept binomial.


Assuntos
Nascimento Prematuro , Adolescente , Adulto , Brasil/epidemiologia , Criança , Estudos de Coortes , Feminino , Humanos , Renda , Gravidez , Gestantes , Nascimento Prematuro/epidemiologia , Adulto Jovem
9.
BMJ Glob Health ; 7(4)2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35428678

RESUMO

INTRODUCTION: Arthropod-borne viruses (arboviruses) are of notable public health importance worldwide, owing to their potential to cause explosive outbreaks and induce debilitating and potentially life-threatening disease manifestations. This systematic review and meta-analysis aims to assess the relationship between markers of socioeconomic position (SEP) and infection due to arboviruses with mosquito vectors. METHODS: We conducted a systematic search on PubMed, Embase, and LILACS databases to identify studies published between 1980 and 2020 that measured the association of SEP markers with arbovirus infection. We included observational studies without geographic location or age restrictions. We excluded studies from grey literature, reviews and ecological studies. Study findings were extracted and summarised, and pooled estimates were obtained using random-effects meta-analyses. RESULTS: We identified 36 observational studies using data pertaining to 106 524 study participants in 23 geographic locations that empirically examined the relationship between socioeconomic factors and infections caused by seven arboviruses (dengue, chikungunya, Japanese encephalitis, Rift Valley fever, Sindbis, West Nile and Zika viruses). While results were varied, descriptive synthesis pointed to a higher risk of arbovirus infection associated with markers of lower SEP, including lower education, income poverty, low healthcare coverage, poor housing materials, interrupted water supply, marital status (married, divorced or widowed), non-white ethnicities and migration status. Pooled crude estimates indicated an increased risk of arboviral infection associated with lower education (risk ratio, RR 1.5 95% CI 1.3 to 1.9); I2=83.1%), interruption of water supply (RR 1.2; 95% CI 1.1 to 1.3; I2=0.0%) and having been married (RR 1.5 95% CI 1.1 to 2.1; I2=85.2%). CONCLUSION: Evidence from this systematic review suggests that lower SEP increases the risk of acquiring arboviral infection; however, there was large heterogeneity across studies. Further studies are required to delineate the relationship between specific individual, household and community-level SEP indicators and arbovirus infection risks to help inform targeted public health interventions. PROSPERO REGISTRATION NUMBER: CRD42019158572.


Assuntos
Infecções por Arbovirus , Arbovírus , Infecção por Zika virus , Zika virus , Animais , Infecções por Arbovirus/epidemiologia , Humanos , Mosquitos Vetores , Fatores Socioeconômicos
10.
Psychiatry Res ; 309: 114427, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35124546

RESUMO

The COVID-19 pandemic hit individuals with chronic conditions the hardest. It is known that anxiety symptoms are frequent in post-COVID conditions. We want to examine whether multimorbidity is associated with anxiety in post-COVID patients. We reported descriptive statistics from 389 post-COVID patients and perform a linear regression with anxiety symptoms measured using the Hospital Anxiety and Depression (HAD) scale. For each extra chronic condition, there was a mean increase of 0.11 in the HAD-anxiety score. However, there was a reduction for age and being male. These findings can potentially help policy-makers better organize post-COVID health services and improve patients care.


Assuntos
COVID-19 , Pandemias , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Depressão/diagnóstico , Humanos , Masculino , Multimorbidade , SARS-CoV-2
11.
Trans R Soc Trop Med Hyg ; 116(2): 100-107, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34015825

RESUMO

BACKGROUND: Mycobacterium leprae was the first microorganism directly associated with a disease, however, there are still important gaps in our understanding of transmission. Although household contacts are prioritized, there is evidence of the importance of extrahousehold contacts. The goal of this article is to contribute to our understanding of the transmission of leprosy ex-household. METHODS: We compare co-location data of 397 leprosy cases and 211 controls drawn from the Centro de Dermatologia Sanitária D. Libânia in Fortaleza, Brazil. We collected lifetime geolocation data related to residence, school attendance and workplace and developed novel methods to establish a critical distance (Rc) for exposure and evaluated the potential for transmission for residence, school and workplace. RESULTS: Our methods provide different threshold values of distance for residence, school and workplace. Residence networks demonstrate an Rc of about 500 m. Cases cluster in workplaces as well. Schools do not cluster cases. CONCLUSIONS: Our novel network approach offers a promising opportunity to explore leprosy transmission. Our networks confirm the importance of coresidence, provide a boundary and suggest a role for transmission in workplaces. Schools, on the other hand, do not demonstrate a clustering of cases. Our findings may have programmatic relevance.


Assuntos
Hanseníase , Análise por Conglomerados , Características da Família , Humanos , Hanseníase/epidemiologia , Mycobacterium leprae , Rede Social
12.
J Racial Ethn Health Disparities ; 9(3): 938-945, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-33821449

RESUMO

Emerging evidence suggests that vicarious racial experiences of discrimination may negatively influence child health. Few studies have focus on childhood asthma symptoms and potential moderators of such relationship. METHODS: We used two population-based cross-sectional studies from the Social Change Allergy and Asthma in Latin America project in Salvador, Brazil. A total of 1003 children and mothers interviewed in 2006 were included, of whom 873 were reached again in 2013. Vicarious racial discrimination was assessed in mothers by applying the Experiences of Discrimination scale. Data on wheeze and environmental exposures were collected with standardized questionnaires. Levels of allergen-specific IgE were measured to identify atopy. Generalized estimating equations were used to estimate the association between maternal discrimination and wheezing and asthma phenotypes. Interaction terms were evaluated to identify whether mothers' mental health and family social support modified such associations. RESULTS: Children whose mothers reported racial discrimination had greater odds of have asthma symptoms (OR 1.75; 95% CI 1.15-2.67) and non-atopic asthma (OR 1.92; 95% CI 1.09-3.40). When we considered effect modification by social support, we found a higher ORs when the level of social support was lower (OR 2.43; 95% IC 1.19-4.97) than when the level of social support was higher (OR 1.12; CI 0.64-1.96). CONCLUSION: Maternal discrimination was associated with asthma symptoms and with non-atopic phenotype among their children. Enjoying wider social support network appears to buffer the effect on asthmatic symptoms. Intervention on childhood asthma needs to incorporate strategies that target the family.


Assuntos
Asma , Hipersensibilidade Imediata , Racismo , Adolescente , Criança , Estudos Transversais , Humanos , Hipersensibilidade Imediata/diagnóstico , Racismo/psicologia , Sons Respiratórios
13.
J Periodontol ; 93(7): 954-965, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-34792204

RESUMO

BACKGROUND: Maternal hyperglycemia, periodontitis, and adverse gestational outcomes are important health problems. The present study investigated the hypothesis that periodontitis and the glycemic level of mothers may have opposing influences on birth weight (BW). This study evaluated the effect of high glycemic levels, albeit within the normal range, on the association between periodontitis and low birth weight (LBW). METHODS: A total of 732 women took part in this case-control study; 172 were mothers of children with LBW <2,500 g, and 560 were mothers of children with BW ≥2,500 g. The BW of newborns was obtained from medical records, and information on socioeconomic-demographic, lifestyle behavior were obtained through interviews. Glycated hemoglobin (HbA1c) levels were evaluated, and full-mouth periodontal examination was carried out within 7 days postpartum. Hierarchical and logistic regression analysis evaluated the effect of glycemic levels on the association between periodontitis and LBW by subgroups, estimating odds ratios (OR) with 95% confidence intervals (95% CI). RESULTS: In the group with HbA1c levels <5.6%, a statistically significant relationship existed between periodontitis and LBW. Using the Centre for Disease Control/American Academy of Periodontics criteria, the ORadjusted was 1.55; 95% CI: 1.04 to 2.31; using the Gomes-Filho et al. criteria the ORadjusted was 1.91; 95% CI, 1.06 to 3.45. In the group with higher HbA1c levels but still within the normal range (≥5.6% and <6.5%), the findings showed no association between periodontitis and LBW. CONCLUSION: Higher maternal glycemic levels within the normal range, inferior to those indicative of gestational diabetes, diabetes mellitus, or hyperglycemia, and periodontitis have opposing effects on BW, altering the association magnitude.


Assuntos
Hiperglicemia , Periodontite , Peso ao Nascer , Estudos de Casos e Controles , Criança , Feminino , Humanos , Hiperglicemia/complicações , Recém-Nascido de Baixo Peso , Recém-Nascido , Mães , Periodontite/complicações , Fatores de Risco
14.
Rev. saúde pública (Online) ; 56: 53, 2022. tab, graf
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1390025

RESUMO

ABSTRACT OBJECTIVE To evaluate the performance of tuberculosis control in Brazilian municipalities. METHODS This is an ecological study on Brazilian municipalities that notified at least four new cases of tuberculosis, with a minimum of one new case of pulmonary tuberculosis between 2015 and 2018. The municipalities were stratified according to the population in < 50 thousand, 50-100 thousand, 100-300 thousand, and > 300 thousand inhabitants, and the k-means method was used to group them within each population range according to the performance of six indicators of the disease. RESULTS A total of 2,845 Brazilian municipalities were included, comprising 98.5% (208,007/211,174) of new tuberculosis cases in the period. For each population range, three groups (A, B, and C) of municipalities were identified according to the performance of the indicators: A, the most satisfactory; B, the intermediates; and C, the least satisfactory. Municipalities in group A with < 100 thousand inhabitants presented results above the targets for laboratory confirmation (≥ 72%), abandonment (≤ 5%), and cure (≥ 90%), and comprised 2% of new cases of the disease. Conversely, municipalities of groups B and C presented at least five indicators with results below the targets - HIV testing (< 100%), contact investigation (< 90%), directly observed therapy (< 90%), abandonment (> 5%), and cure (< 90%) -, and corresponded to 66.7% of new cases of tuberculosis. In group C of municipalities with > 300 thousand inhabitants, which included 19 of the 27 capitals and 43.1% of new cases of tuberculosis, the lowest percentages of contact investigation (mean = 56.4%) and directly observed therapy (mean = 15.4%) were verified, in addition to high abandonment (mean = 13.9%) and low coverage of primary health care (mean = 66.0%). CONCLUSIONS Most new cases of tuberculosis occurred in municipalities with unsatisfactory performance for disease control. Expanding the coverage of primary health care in these places can reduce abandonment and increase the contact investigation and directly observed therapy.


RESUMO OBJETIVO Avaliar o desempenho no controle da tuberculose dos municípios brasileiros. MÉTODOS Estudo ecológico com municípios brasileiros que notificaram pelo menos quatro casos novos de tuberculose, com no mínimo um caso novo de tuberculose pulmonar entre 2015 e 2018. Os municípios foram estratificados de acordo com a população em < 50 mil, 50-100 mil, 100-300 mil e > 300 mil habitantes e foi utilizado o método k-médias para agrupá-los dentro de cada faixa populacional segundo desempenho de seis indicadores da doença. RESULTADOS Foram incluídos 2.845 municípios brasileiros abrangendo 98,5% (208.007/211.174) dos casos novos de tuberculose do período. Para cada faixa populacional identificou-se três grupos (A, B e C) de municípios segundo desempenho dos indicadores: A os mais satisfatórios, B os intermediários e C os menos satisfatórios. Municípios do grupo A com < 100 mil habitantes apresentaram resultados acima das metas para confirmação laboratorial (≥ 72%), abandono (≤ 5%) e cura (≥ 90%), e abrangeram 2% dos casos novos da doença. Por outro lado, os municípios dos grupos B e C apresentaram pelo menos cinco indicadores com resultados abaixo das metas - testagem HIV (< 100%), exame de contatos (< 90%), tratamento diretamente observado (< 90%), abandono (> 5%) e cura (< 90%) -, e corresponderam a 66,7% dos casos novos de tuberculose. Já no grupo C dos municípios com > 300 mil habitantes, que incluiu 19 das 27 capitais e 43,1% dos casos novos de tuberculose, encontrou-se os menores percentuais de exames de contatos (média = 56,4%) e tratamento diretamente observado (média = 15,4%), elevado abandono (média = 13,9%) e baixa cobertura da atenção básica (média = 66,0%). CONCLUSÕES Grande parte dos casos novos de tuberculose ocorreu em municípios com desempenho insatisfatório para o controle da doença, onde expandir a cobertura da atenção básica pode reduzir o abandono e elevar o exame de contatos e tratamento diretamente observado.


Assuntos
Avaliação de Processos e Resultados em Cuidados de Saúde , Tuberculose/prevenção & controle , Brasil , Avaliação de Programas e Projetos de Saúde , Cidades , Estudos Ecológicos
15.
Public Health Nutr ; : 1-11, 2021 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-34915949

RESUMO

OBJECTIVE: In Brazil, national estimates of childhood malnutrition have not been updated since 2006. The use of health information systems is an important complementary data source for analysing time trends on health and nutrition. This study aimed to examine temporal trends and socio-demographic inequalities in the prevalence of malnutrition in children attending primary health care services between 2009 and 2017. DESIGN: Time trends study based on data from Brazil's Food and Nutrition Surveillance System. Malnutrition prevalence (stunting, wasting, overweight and double burden) was annually estimated by socio-demographic variables. Prais-Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95 % CI were calculated. SETTING: Primary health care services, Brazil. PARTICIPANTS: Children under 5 years old. RESULTS: In total, 15,239,753 children were included. An increase in the prevalence of overweight (APC = 3·4 %; P = 0·015) and a decline in the prevalence of wasting (-6·2 %; P = 0·002) were observed. The prevalence of stunting (-3·2 %, P = 0·359) and double burden (-1·4 %, P = 0·630) had discrete and non-significant reductions. Despite the significant reduction in the prevalence of undernutrition among children in the most vulnerable subgroups (black, conditional cash transfer's recipients and residents of poorest and less developed areas), high prevalence of stunting and wasting persist alongside a disproportionate increase in the prevalence of overweight in these groups. CONCLUSIONS: The observed pattern in stunting (high and persistent prevalence) and increase in overweight elucidate setbacks in advances already observed in previous periods and stresses the need for social and political strategies to address multiple forms of malnutrition.

16.
Cad Saude Publica ; 37(9): e00168918, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34669771

RESUMO

The objective of the present study was to evaluate the association between social position and anthropometric status in women and men Brazilian adult. This was a cross-sectional study that used baseline data collected from 2008 to 2010 for the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil, in Portuguese), in the six major Brazilian state capital cities. A total of 15,105 active and retired civil servants aged from 35 to 74 years. Two latent variables were defined by latent class analysis, social position and anthropometric status. Both constructs and the analyses were separately evaluated by sex. Associations were assessed using multivariate logistic regression analysis with adjustment for age, self-reported skin color/race, and marital status. Around 44% of the women and 26% of the men were classified as overweight or obese. Social position tended to be lower in women (43.2%) and higher among men (40.4%). Heavier women were more likely to be black and brown-skinned, whereas slimmer women were more likely to be white. After adjustment, women's weight increased as social position decreased (OR = 1.52; 95%CI: 1.36-1.70), whereas in men weight decreased as social position decreased (OR = 0.87; 95%CI: 0.76-0.99). Social position affected the anthropometric status of women and men differently, with body patterns also being affected by ethnicity/skin color, showing the potentiality of taking the intersectional perspective when investigating the possible social determinants of the phenomenon.


Assuntos
Classe Social , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Análise de Classes Latentes , Estudos Longitudinais , Masculino , Fatores Socioeconômicos
17.
Cad Saude Publica ; 37(7): e00130020, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34346981

RESUMO

Our study aims to describe trends in new case detection rate (NCDR) of leprosy in Brazil from 2006 to 2017 overall and in subgroups, and to analyze the evolution of clinical and treatment characteristics of patients, with emphasis on cases diagnosed with grade 2 physical disabilities. We conducted a descriptive study to analyze new cases of leprosy registered in the Brazilian Information System for Notificable Diseases (SINAN), from 2006-2017. We calculated the leprosy NCDR per 100,000 inhabitants (overall and for individuals aged < 15 and ≥ 15 years) by sex, age, race/ethnicity, urban/rural areas, and Brazilian regions, and estimated the trends using the Mann-Kendall non-parametric test. We analyzed the distributions of cases according to relevant clinical characteristics over time. In Brazil, there was a sharp decrease in the overall NCDR from 23.4/100,000 in 2006 to 10.3/100,000 in 2017; among children < 15 years, from 6.94 to 3.20/100,000. The decline was consistent in all Brazilian regions and race/ethnicity categories. By 2017, 70.2% of the cases were multibacillary, 30.5% had grade 1 (G1D) or 2 (G2D) physical disabilities at diagnosis and 42.8% were not evaluated at treatment completion/discharge; cases with G2D at diagnosis were mostly detected in urban areas (80%) and 5% of cases died during the treatment (leprosy or other causes). Although the frequency of leprosy NCDR decreased in Brazil from 2006 to 2017 across all evaluated population groups, the large number of cases with multibacillary leprosy, physical disabilities or without adequate evaluation, and among children suggest the need to reinforce timely diagnosis and treatment to control leprosy in Brazil.


Assuntos
Pessoas com Deficiência , Hanseníase Multibacilar , Hanseníase , Brasil/epidemiologia , Criança , Humanos , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Grupos Populacionais
18.
Rev Saude Publica ; 55: 35, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34105604

RESUMO

OBJECTIVE: To analyze the epidemic of COVID-19 in northeastern Brazil, one of the regions most affected by the virus. METHODS: The official data for COVID-19, from March 2020 to March 2021 in the states of the Northeast Region (NE), were used. The analysis of capital cities and states for accumulated weekly cases and confirmed deaths was made using the JoinPoint Trend Analysis application. RESULTS: In one year, the Northeast region reported 22.9% of the cases and 21.5% of the deaths in the country due to COVID-19. At the beginning of the pandemic, all states showed a growing number of cases, first in the capitals and then in the interior. Following this wave, decreases are observed in all states and their capitals, but with many still reporting a large number of cases. In the middle of the 2nd semester of 2020 the number of cases begins to increase again simultaneously in states and their capitals-some at explosive speed-especially in late 2020 and early 2021. A similar pattern is observed in deaths, which exceed or approach the peak seen in the first wave. In the first wave, all capitals and northeastern states adopted intense isolation measures. Fortaleza, Recife and Teresina reached the highest isolation index of all capitals, close to 0.60. This index decreases, with a slight growth trend until the end of December. With the exception of Fortaleza and Salvador, the other capitals fell to less than 0.40. CONCLUSION: The Brazilian NE and the country are in increasingly complicated health, social and economic situations. It is necessary to speed up vaccinations and maintain non-pharmacological measures: face masks, social distancing measures and hygiene care, in addition to policies to protect workers who have lost their incomes and to subsidize small business owners.


Assuntos
COVID-19 , Pandemias , Brasil/epidemiologia , Cidades , Humanos , SARS-CoV-2
19.
Front Psychiatry ; 12: 665257, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34135785

RESUMO

Background: Genetics influence the vulnerability to alcohol use disorders, and among the implicated genes, three previous studies have provided evidences for the involvement of LRRK2 in alcohol dependence (AD). LRRK2 expression is broadly dysregulated in postmortem brain from AD humans, as well as in the brain of mice with alcohol dependent-like behaviors and in a zebrafish model of alcohol preference. The aim of the present study was to evaluate the association of variants in the LRRK2 gene with AD in multiethnic populations from South and North America. Methods: Alcohol-screening questionnaires [such as CAGE and Alcohol Use Disorders Identification Test (AUDIT)] were used to determine individual risk of AD. Multivariate logistic regression analyses were done in three independent populations (898 individuals from Bambuí, Brazil; 3,015 individuals from Pelotas, Brazil; and 1,316 from the United States). Linkage disequilibrium and conditional analyses, as well as in silico functional analyses, were also conducted. Results: Four LRRK2 variants were significantly associated with AD in our discovery cohort (Bambuí): rs4768231, rs4767971, rs7307310, and rs1465527. Two of these variants (rs4768231 and rs4767971) were replicated in both Pelotas and US cohorts. The consistent association signal (at the LRRK2 locus) found in populations with different genetic backgrounds reinforces the relevance of our findings. Conclusion: Taken together, these results support the notion that genetic variants in the LRRK2 locus are risk factors for AD in humans.

20.
BMC Public Health ; 21(1): 1253, 2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187454

RESUMO

BACKGROUND: Malaria causes 400 thousand deaths worldwide annually. In 2018, 25% (187,693) of the total malaria cases in the Americas were in Brazil, with nearly all (99%) Brazilian cases in the Amazon region. The Bolsa Família Programme (BFP) is a conditional cash transfer (CCT) programme launched in 2003 to reduce poverty and has led to improvements in health outcomes. CCT programmes may reduce the burden of malaria by alleviating poverty and by promoting access to healthcare, however this relationship is underexplored. This study investigated the association between BFP coverage and malaria incidence in Brazil. METHODS: A longitudinal panel study was conducted of 807 municipalities in the Brazilian Amazon between 2004 and 2015. Negative binomial regression models adjusted for demographic and socioeconomic covariates and time trends were employed with fixed effects specifications. RESULTS: A one percentage point increase in municipal BFP coverage was associated with a 0.3% decrease in the incidence of malaria (RR = 0.997; 95% CI = 0.994-0.998). The average municipal BFP coverage increased 24 percentage points over the period 2004-2015 corresponding to be a reduction of 7.2% in the malaria incidence. CONCLUSIONS: Higher coverage of the BFP was associated with a reduction in the incidence of malaria. CCT programmes should be encouraged in endemic regions for malaria in order to mitigate the impact of disease and poverty itself in these settings.


Assuntos
Malária , Pobreza , Brasil/epidemiologia , Cidades , Humanos , Malária/epidemiologia , Malária/prevenção & controle , Modelos Estatísticos
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