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1.
Int J Health Plann Manage ; 34(4): e1846-e1853, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31515900

RESUMO

BACKGROUND: Although Brazil has a public and universal healthcare system, utilization of health services is marked by social and regional discrepancies. OBJECTIVE: To assess the prevalence and factors associated with underutilization of healthcare services in the Brazilian Amazon. METHOD: Cross-sectional, population-based study. Adults aged over 18 years old were selected through probabilistic sampling. Underutilization of healthcare services was defined as never seeing a physician or a dentist. Poisson regression with robust variance was performed to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs). A complex sample design was considered. RESULTS: A total of 4001 individuals were included, of which 419 (10.4%; 95% CI, 9.5-11.4%) never visited a physician or a dentist. In the adjusted analysis, underutilization was higher among poorer people (PR = 3.32; 95% CI, 2.16-5.11), men (PR = 1.34; 95% CI, 1.10-1.65), people with brown skin color (Brazilian mixed race; PR = 1.34; 95% CI, 1.02-1.76), and people who are separated (PR = 1.40; 95% CI, 1.01-1.94) and widowed (PR = 1.55; 95% CI, 1.02-2.37), when compared with the reference categories. Individuals with informal jobs, those who are retired, students/housewives, and unemployed people were more vulnerable to underutilization than formal workers (P < .04). CONCLUSION: Underutilization of healthcare services occurs in one-tenth of adults in Manaus Metropolitan Region and is associated with social and economic inequities.

2.
Cad Saude Publica ; 35(6): e00110718, 2019 Jul 04.
Artigo em Português | MEDLINE | ID: mdl-31291425

RESUMO

Femicide is the intentional killing of a woman or girl on account of her gender. The term allows differentiating crimes of gender violence from murders of women in other circumstances. The aim of this study is to characterize femicides, sometimes called feminicides, that occurred in 2015 in Campinas, São Paulo State, Brazil. The information was obtained from death certificates of city residents whose underlying cause of death had been classified as external cause. Semi-structured interviews were held by applying the verbal autopsy method, and femicides were classified as: intimate partner, non-intimate partner, and by connection. In the year 2015 there were 582 deaths from external causes, 185 of which were homicides, and 26 (14.1%) of the latter were females. Of these, 19 were classified as femicides. Victims' mean age was 31.5 years (standard deviation 7.18). The majority of the women were white (47.4%), had complete primary schooling (52.6%), single (63.2%), and with children (84.2%). The deaths generally occurred by highly violent mechanisms in the form of physical and sexual aggression. The murders were perpetrated in the victim's domicile with cold steel weapons or firearms, with extreme violence, motivated mainly by the victim's desire for separation, jealousy, and misunderstanding with the aggressor. The mortality coefficient for femicide was 3.2 per 100,000 women in 2015, corresponding to one death for every 31,250 women that year. The study's results show that femicide in Campinas is the main category of murders of women. The consequences of this type of violence are enormous in terms of human rights violations.

3.
Cad. Saúde Pública (Online) ; 35(6): e00110718, 2019. tab
Artigo em Português | LILACS-Express | ID: biblio-1011700

RESUMO

O femicídio é a morte intencional de uma mulher pelo fato de ser mulher. O termo permite diferenciar os crimes por violência de gênero dos homicídios de mulheres em outras circunstâncias. O objetivo deste trabalho é caracterizar os femicídios, também chamados feminicídios, que ocorreram em 2015 em Campinas, São Paulo, Brasil. Foram tomadas como fonte de informação as declarações de óbitos de residentes da cidade cuja causa básica do óbito foi classificada como causa externa. Entrevistas semiestruturadas foram realizadas aplicando-se o método de autópsia verbal, e, classificados os casos de femicídio como: íntimo, não íntimo e por conexão. No ano de 2015, foram recebidas 582 declarações de óbitos por causas externas, 185 corresponderam a homicídios, sendo 26 (14,1%) femininos. Dentre esses, 19 foram classificados como femicídio. A média de idade das vítimas foi de 31,5 anos (desvio padrão 7,18 anos). A maioria correspondeu a mulheres brancas (47,4%), com Ensino Fundamental (52,6%), solteiras (63,2%), com filhos (84,2%). As mortes, em geral, ocorreram por mecanismos altamente violentos, na forma de agressão física e sexual. Os assassinatos foram perpetrados no domicílio da vítima, com arma branca ou de fogo, com expressiva violência, motivados, principalmente, pelo desejo de separação da vítima, ciúmes e desentendimento com o agressor. Em Campinas, o coeficiente de mortalidade por femicídio foi de 3,2 por 100 mil mulheres em 2015, o que correspondeu à morte de uma em cada 31.250 mulheres no ano. Os resultados da pesquisa permitem ver que o femicídio na cidade é a principal categoria entre os homicídios femininos. As consequências desse tipo de violência são consideráveis em termos de violação de direitos humanos. Este estudo auxilia a compreensão das motivações e consequências da violência contra a mulher e contribui para uma melhor visibilidade sobre o tema.


Femicide is the intentional killing of a woman or girl on account of her gender. The term allows differentiating crimes of gender violence from murders of women in other circumstances. The aim of this study is to characterize femicides, sometimes called feminicides, that occurred in 2015 in Campinas, São Paulo State, Brazil. The information was obtained from death certificates of city residents whose underlying cause of death had been classified as external cause. Semi-structured interviews were held by applying the verbal autopsy method, and femicides were classified as: intimate partner, non-intimate partner, and by connection. In the year 2015 there were 582 deaths from external causes, 185 of which were homicides, and 26 (14.1%) of the latter were females. Of these, 19 were classified as femicides. Victims' mean age was 31.5 years (standard deviation 7.18). The majority of the women were white (47.4%), had complete primary schooling (52.6%), single (63.2%), and with children (84.2%). The deaths generally occurred by highly violent mechanisms in the form of physical and sexual aggression. The murders were perpetrated in the victim's domicile with cold steel weapons or firearms, with extreme violence, motivated mainly by the victim's desire for separation, jealousy, and misunderstanding with the aggressor. The mortality coefficient for femicide was 3.2 per 100,000 women in 2015, corresponding to one death for every 31,250 women that year. The study's results show that femicide in Campinas is the main category of murders of women. The consequences of this type of violence are enormous in terms of human rights violations.


El feminicidio es la muerte intencional de una mujer por el hecho de ser mujer. El término permite diferenciar los crímenes por violencia de género de los homicidios de mujeres en otras circunstancias. El objetivo de este trabajo es caracterizar los feminicidios que se produjeron en 2015 en Campinas, São Paulo, Brasil. Se tomó como fuente de información las declaraciones de óbitos de residentes de la ciudad, cuya causa básica del fallecimiento fue clasificada como causa externa. Se realizaron entrevistas semiestructuradas aplicando el método de autopsia verbal y clasificando los casos de feminicidio como: íntimo, no íntimo y por conexión. Durante el año 2015 se recibieron 582 declaraciones de óbito por causas externas, 185 correspondieron a homicidios, siendo 26 (14,1%) femeninos. Entre ellos, 19 se clasificaron como feminicidio. La media de edad de las víctimas fue 31,5 años (desviación estándar 7,18 años). La mayoría correspondió a mujeres blancas (47,4%), con enseñanza fundamental (52,6%), solteras (63,2%), con hijos (84,2%). Las muertes, en general, se produjeron por mecanismos altamente violentos, en forma de agresión física y sexual. Los asesinatos los perpetraron en el domicilio de la víctima con arma blanca o de fuego, con manifiesta violencia, motivados principalmente por el deseo de separación de la víctima, celos o disputas con el agresor. En Campinas, el coeficiente de mortalidad por feminicidio fue de 3,2 por cada 100.000 mujeres en 2015, lo que correspondió a la muerte de una de cada 31.250 mujeres al año. Los resultados de la investigación permiten observar que el feminicidio en la ciudad es la principal categoría entre los homicidios femeninos. Las consecuencias de este tipo de violencia son considerables en términos de violación de derechos humanos.

4.
J Affect Disord ; 236: 180-186, 2018 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-29747135

RESUMO

BACKGROUND: The purpose of this study was to assess the prevalence and associated factors of generalized anxiety disorder (GAD) in adults using the seven-item GAD scale (GAD-7) and to evaluate the properties of the two-item (GAD-2) as a population screening tool. METHODS: We carried out a cross-sectional population-based study in the Manaus Metropolitan Region in 2015, Brazil. Adults aged 18 years or more were eligible to participate. We performed probabilistic three-phase sampling and collected sociodemographic and clinical variables. Descriptive statistics and a Poisson regression with robust variance with corrections for complex sampling were used. The accuracy of GAD-2 was assessed using GAD-7 as the gold standard. RESULTS: We included 4001 participants. The prevalence of GAD was 8.4% (95% confidence interval 7.6-9.4%) and was significantly associated with self-reported poor health status and presenting depressive symptoms (p < 0.01). GAD-2 sensitivity was 63.9%, and its specificity was 97.4%. LIMITATIONS: Because of the cross-sectional design of the study, the results are prone to reverse causality and recall bias. The surveyed people were not questioned about their medical diagnosis of anxiety, access to mental health services, or alcohol, tobacco or other drug use. The screening tools were not validated in the Brazilian or Amazon population. CONCLUSION: About eight in 100 adults living in Manaus presented GAD, and it is more prevalent among people with a poorer health status and depression. Because of its low sensitivity, GAD-2 is not useful as a screening tool.


Assuntos
Transtornos de Ansiedade/epidemiologia , Programas de Rastreamento/normas , Escalas de Graduação Psiquiátrica/normas , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Brasil/epidemiologia , Estudos Transversais , Depressão/psicologia , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Distribuição de Poisson , Prevalência , Análise de Regressão , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Inquéritos e Questionários/normas
5.
Health Qual Life Outcomes ; 15(1): 159, 2017 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-28807027

RESUMO

BACKGROUND: To analyze perceptions of health-related quality of life and associated factors in populations from the Manaus Metropolitan Region. METHODS: We conducted a population-based cross-sectional study from May to August 2015. Adults aged 18 years and older were selected using probabilistic three-phase cluster sampling and stratified by sex and age, based on official estimates. Quality of life data were collected using the European Quality of Life 5-Dimensions 3-Levels (EQ-5D-3L) along with socioeconomic, demographic, and health perception data. Utility scores were calculated using the Brazilian version of the EQ-5D-3L. Descriptive statistics were derived, and a multivariate Tobit regression model with correction for complex sampling was performed to identify the variables that influence utility levels. RESULTS: A total of 4001 participants were included. The average utility score was 0.886 (95% confidence interval [CI]: 0.881-0.890) with significant differences according to living area (the capital (0.882 ± 0.144) or inner cities (0.908 ± 0.122; p < 0.001)). The dimension for which the highest proportion of people reported moderate to severe problems was pain/discomfort (39%), followed by anxiety/depression (18%). Men had a higher quality of life than women (ß = 0.041, p < 0.001). Not working was a factor that increased quality of life compared with being formally employed (ß = 0.031, p = 0.037). The poorest people had a lower quality of life than the richest people (ß = -0.118, p < 0.001). Better health perceptions increased utility scores (p < 0.001), while being separated decreased the scores (ß = -0.052, p = 0.001). CONCLUSION: Health-related quality of life in the Manaus Metropolitan Region was high, as expected for the general population, and was higher among individuals who lived in the inner cities, men and those in higher social classes. Gender discrepancies and differences in quality of life between the capital and inner cities should be further investigated.


Assuntos
Qualidade de Vida , População Urbana/estatística & dados numéricos , Adulto , Ansiedade/psicologia , Brasil , Estudos Transversais , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/psicologia , Vigilância da População , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
6.
J Affect Disord ; 222: 162-168, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28709023

RESUMO

BACKGROUND: Depression is an affective disorder and one of the main contributors to the burden of disease worldwide. Our purpose is to estimate the prevalence of depressive symptoms and associated factors in the population of the Manaus Metropolitan Region. METHODS: We conducted a population-based, cross-sectional study with a probabilistic three-phase sampling in 2015, based on a previously calculated sample size. Adults living in Manaus and seven inner cities of the metropolitan region were surveyed for depressive symptoms using the Patient Health Questionnaire (PHQ-9) and a cutoff score of ≥ 9. We performed a Poisson regression with robust variance using a hierarchical approach to calculate the prevalence ratio (PR) of depression and 95% confidence intervals (CIs). RESULTS: Among 4001 participants (response rate 76%), the prevalence of current depressive symptoms was 7% (95% CI: 6-8%). Depressive symptoms were more frequent in inhabitants of Manaus than in those from the countryside (PR = 6.13, 95% CI: 2.91-12.91); in women than in men (PR = 2.55, 95% CI: 1.96-3.33); in indigenous than in white people (PR = 2.56, 95% CI: 1.24-5.30); and in those with hypertension (PR = 1.47, 95% CI: 1.13-1.92), cardiac disease (PR = 1.62, 95% CI: 1.12-2.33), and poor health status (fair: PR = 5.10, 95% CI: 2.50-10.37; bad: PR = 10.27, 95% CI: 4.92-21.44 very bad: PR = 21.14, CI 95%: 10.16-43.99). High school education (PR = 0.55, 95% CI: 0.32-0.95) and middle class economic status (PR = 0.33, 95% CI: 0.12-0.89) were protective factors. LIMITATIONS: Limitations include the lack of measurement of physical activity, religious beliefs, leisure time, and use of alcohol and other drugs since these factors can affect depression and health status. CONCLUSION: Seven out of every 100 adults from the Manaus Metropolitan Region have depressive symptoms. This rate is higher in women, individuals living in Manaus, indigenous people, people with hypertension or chronic cardiac disease, and those with a poor health status.


Assuntos
Depressão/epidemiologia , Adulto , Brasil/epidemiologia , Estudos Transversais , Depressão/etiologia , Feminino , Nível de Saúde , Humanos , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Proteção , Projetos de Pesquisa , Fatores Socioeconômicos , Inquéritos e Questionários
7.
Rev. Fac. Med. (Bogotá) ; 62(1): 9-15, ene.-mar. 2014. ilus, tab
Artigo em Espanhol | LILACS-Express | ID: lil-712536

RESUMO

Antecedentes. La formación en investigación se clasifica en investigación formativa y en investigación científica. Por medio de su aplicación se definen los problemas relevantes de investigación y se genera nuevo conocimiento. Las instituciones académicas superiores vinculan a los estudiantes de pregrado de medicina con el fin de integrarlos a los procesos académicos investigativos, fomentando sus habilidades para convertirse luego en investigadores formales. Sin embargo, no existe información en Colombia sobre la participación de estudiantes de medicina en las publicaciones de revistas indexadas. Objetivo. Evaluar el nivel de participación de estudiantes de pregrado en publicaciones de revistas médicas y académicas colombianas indexadas en las categorías A1 y A2 del sistema Publindex de Colciencias. Materiales y métodos. Revisión sistemática cualitativa de la literatura. Se incluyeron las revistas médicas que hacen parte del índice Publindex de Colciencias, clasificadas en la categoría A1, las dos revistas A2 con mayor índice de impacto, las 2 revistas con mayor número de visitas en la base de datos SciELO y dos revistas académicas que incluyeran estudiantes de pregrado de la carrera de medicina. Se evaluó la participación de estudiantes de pregrado en manuscritos publicados por revista evaluada, el tipo de diseños epidemiológicos mayormente empleados, las áreas de conocimiento donde han participado estudiantes de pregrado y la afiliación académica de los estudiantes. Resultados. Las revistas evaluadas fueron: Biomédica, Colombia médica, Revista de Salud Pública y Revista colombiana de psiquiatría, en la categoría A1; Revista colombiana de anestesiología, Revista gerencia y políticas en Salud, Revista colombiana de obstetricia y ginecología, Revista colombiana de gastroenterología, Iatreia y Revista de la Facultad de Medicina, en la categoría A2. Se evaluaron 1738 artículos con participación de 7212 autores, 122 de los cuales (7,02%) cuentan con participación de estudiantes de pregrado. El diseño epidemiológico más utilizado por los estudiantes de pregrado fue el de corte transversal (33,6%). Las universidades con mayor porcentaje de participación de estudiantes fueron: la Universidad de Antioquia (22,95%), la Universidad Nacional de Colombia (10,66%) y la Universidad del Valle (10,66%). Conclusiones. Se evidencia que la participación de estudiantes de pregrado en las revistas médicas y académicas, en general, es baja (7,02%) en los procesos de investigación científica. Se espera que las revistas y las instituciones superiores fortalezcan sus procesos para motivar los estudiantes a vincularse a procesos investigativos desde etapas tempranas de la formación, dada la importancia de la investigación en salud para los profesionales desde el rol de consumidores y generadores de conocimiento.


Background. Training in research divides in formative research and scientific research. Its application defines relevant research problems and generate new knowledge. Superior academic institutions link undergraduate medicine students to integrate them into the academic research processes; these processes encourage skills to become developers. However, there is no information in Colombia about the participation of medicine students in indexed journal publications. Objective. To evaluate the level of participation of undergraduate students in medical journals and academic Colombian publications indexed in A1 and A2 categories of Colciencias's Publindex system. Materials and methods. Qualitative systematic review of literature. The research involved medical journals indexed at Colciencias's Publindex system, qualified in category A1, two A2 journals with the highest impact index, two journals with the highest number of visits in the SciELO database and two academic journals including undergraduate medicine students. The evaluation included the participation of undergraduate students in published manuscripts of the journals evaluated, the type of epidemiological designs mostly employees, knowledge areas where undergraduate students have participated and the students' academic affiliation. Results. The journals evaluated were: Biomédica, Colombia médica, Revista de Salud Pública and Revista colombiana de psiquiatría, in A1 category; Revista colombiana de anestesiología, Revista gerencia y políticas en Salud, Revista colombiana de obstetricia y ginecología, Revista colombiana de gastroenterología, Iatreia and Revista de la Facultad de Medicina de la Universidad Nacional, in A2 category. The evaluation took 1738 items, involving 7212 authors, 122 (7.02%) with undergraduate participation. The most commonly used epidemiological design for undergraduates was the cross section (33.6%). Universities with the highest percentage of student's participation were the Universidad de Antioquia (22.95%), Universidad Nacional de Colombia (10.66%) and the Universidad del Valle (10.66%). Conclusions. The participation of undergraduate students in academic medical and academic journals is generally low (7.02%) in the processes of scientific research. It is expected that journals and higher education institutions strengthen their processes to motivate students to link to research processes from early stages of training, because health research is very important for professionals in the role of consumers and producers of knowledge.

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