Physical activity among older adults with multimorbidity: Evidence from a population-based health survey.

INTRODUCTION: The promotion of physical activity has been recognized as an important component in the management and prevention of multimorbidity, a condition that is increasing prevalent worldwide, including in Brazil. However, there is a scarcity of studies exploring the disparity in physical activity levels between individuals with and without multimorbidity. Therefore, the study aimed to estimate the prevalence of multimorbidity and physical activity among older adults, as well as analyze the relationship of a sufficient level of physical activity and multimorbidity, while considering sociodemographic characteristics of residents in São Paulo, Brazil. MATERIALS AND METHODS: Data from 1.019 participants aged 60 years or older (59.7% female; mean age 69.7±7.7) were collected from the Health Survey (ISA-Capital, 2015) conducted in the city of São Paulo, Brazil. We defined multimorbidity as the presence of two or more chronic conditions, and for physical activity, classified a sufficient level (≥150 min/week). Prevalence Ratios (PR) with 95% Confidence Intervals (95%CI) were estimated using univariate and multivariate Poisson regression to examine the relationship between multimorbidity and sufficient level of physical activity. RESULTS: 67.7% of the participants lived with multimorbidity, while 30.1% had achieved a sufficient level of physical activity. There was a higher prevalence of sufficient level of physical activity among older adults with two (PR = 1.38; 95%CI 1.02-1.88) and four (PR = 1.37; 95%CI 1.00-1.87) chronic conditions. Older adults with multimorbidity who were 70 years or older (PR = 1.77; 95%IC 1.13-2.77), female (PR = 1.65; 95%CI 1.16-2.36), without a partner (PR = 1.43; 95%IC 1.03-1.99), and had a per capita income of 1 to 2.5 (PR = 1.83; 95%IC 1.00-3.33) were more likely to achieve a sufficient level of physical activity compared to their peers without multimorbidity. CONCLUSIONS: The study highlights sociodemographic disparities in the sufficient level of physical activity among multimorbidity, suggesting the importance of considering these factors when planning public policies aimed at promoting physical activity.

Infant mortality in the municipality of São Paulo: trend and social inequality (2006-2019).

OBJECTIVE: Considering the published evidence on the impact of recent economic crises and the implementation of fiscal austerity policies in Brazil on various health indicators, this study aims to analyze how the trend and socio-spatial inequality of infant mortality behaved in the municipality of São Paulo from 2006 to 2019. METHODS: This is an ecological study with a temporal trend analysis that was developed in municipality of São Paulo, using three residence area strata differentiated according to their social vulnerability following the 2010 São Paulo Social Vulnerability Index. Infant mortality rate, as well as neonatal, and post-neonatal mortality rates, were calculated for each social vulnerability stratum, each year in the period, and for the first and last three triennia. Temporal trends were analyzed by the Prais-Winsten regression model and inequality magnitude, by rate ratios. RESULTS: We found a decline in infant mortality rate and its components from 2006 to 2015, greater in the stratum with low social vulnerability and in the post-neonatal period when compared to the neonatal one. This decline ended in 2015, stagnating in the next period (2016-2019). Our analysis of infant mortality inequality across social vulnerability stratum showed a significant increase from the initial to the final triennia in the analyzed period; rate ratios increased from 1.36 to 1.48 in the high stratum (compared to the low social vulnerability stratum), and from 1.19 to 1.32 between the medium and low social vulnerability strata. CONCLUSIONS: The observed stagnation of infant mortality rate decline in 2015 and the increase in socio-spatial inequality point to the urgent need to reformulate current public policies to reverse this situation and reduce inequalities in the risk of infant death.

Analysis of education level in access and use of health care services, ISA-Capital, São Paulo, Brazil, 2003 and 2015.

The great socioeconomic inequality that prevails in Brazil and the existence of a national health system with universal coverage places the need to monitor the evolution and social inequities regarding access to these services. This study aims to analyze the changes in the prevalence of health care use and the extent of social inequality in the demand, use and, access, resolution of health problems, satisfaction, and health care use of Brazilian Unified National Health System (SUS) according to education levels in the population living in the urban area of the Municipality of São Paulo, in 2003 and 2015. We analyzed data from two population-based household health surveys (Health Survey in São Paulo City - ISA-Capital) from 2003 and 2015. Dependent variables related to health care use in the two weeks preceding the survey and due to diseases included demand, access, satisfaction, problem resolution, and the public or private nature of the service. Prevalence was estimated using level of education and prevalence ratios (PR) by the Poisson regression. In the period, the demand for health care, access, resolution, and use of public health care increased from 2003 to 2015. Inequities in public health care use changed from 2003 to 2015 according to level of education. We found no social inequities in health care use in the municipality of São Paulo regarding demand, access, satisfaction, and resolution according to levels of education. Results show progress in the use and resolution of health care services, as well as the strong concentration of the use of SUS by the population with lower education. Results indicate the progress that SUS has made, but also show persistent challenges in the use and access to services.

Epidemiologic Characteristics, Time Trend, and Seasonality of Orofacial Clefts in São Paulo State, Brazil. 2008-2019.

OBJECTIVE: To characterize the epidemiology, identify trends in prevalence, seasonality, and risk factors for orofacial clefts (OFC), selecting the São Paulo state (SPS) population database. DESIGN: A population-based study to estimate the OFC prevalence trends in recent years, stratified by maternal age and SPS geographical clusters. SETTING: All live births (LB) with OFC in SPS from 2008-2019. PATIENTS: 5342 cases of OFC among 7 301 636 LB. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: OFC prevalence trends, annual percent change (APC) with a 95% confidence interval, and seasonality. RESULTS: We found an OFC prevalence of 7.3/10 000LB in SPS, Brazil. Among all the cases, the majority were male (57.1%), Caucasian (65.4%), 77.8% born at term, 75.8% weight >2500 g, 97.1% singleton, and 63.9% of births were by cesarean section. From 2008-2019, SPS presented a stationary OFC prevalence trend; in São Paulo city, the highest APC was observed (0.05%); the maternal age group with the highest OFC prevalence rate was ≥35 years (9.2/10 000LB). We identified the existence of seasonal variation based on the conception date in the final months of the year, corresponding to the spring season (P < .001). CONCLUSION: OFC had a stationary prevalence trend in recent years, with the highest prevalence in the Central North Cluster and ≥35 years maternal age group. Seasonality was observed in the spring season, and congenital malformation of lips was the most common associated pathology. This population-based study is the first to summarize the current epidemiology of OFC in SPS.

Social inequalities in access to cancer screening and early detection: A population-based study in the city of São Paulo, Brazil.

OBJECTIVE: This study monitors trends in access to cancer screening, focusing on mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA), assessing the magnitude of inequality in the city of São Paulo from 2003 to 2015 according to education level. METHOD: This is a cross-sectional population-based study conducted with data from the 2003, 2008, and 2015 editions of the Health Survey of the City of São Paulo (ISA-Capital). Outcome variables were the proportion of mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA) tests according to the protocols. Inequality was measured by education level according to years of study. For static analysis, Poisson regression was used to estimate proportion ratios. RESULTS: The proportion of Pap smears remained stationary at a high level (>89%) throughout the study period, while access to mammography and PSA tests significantly increased in the 2003‒2015 period. The present results indicate inequalities in access to cancer screening due to education, and being more expressive for mammography and PSA tests. However, this inequality significantly decreased over the period analyzed comparing the most educated individuals with those with the lowest educational level. In addition, an increase in the proportion of tests performed in the Brazilian Unified Health System was identified, especially for mammography and PSA tests, in the period 2003‒2015. CONCLUSIONS: The inequalities observed in the access to preventive exams were influenced by the level of education. The offer of exams was expanded, more significantly for mammography and PSA, especially among the less educated group.

Analysis of education level in access and use of health care services, ISA-Capital, São Paulo, Brazil, 2003 and 2015 / Análise da escolaridade no acesso e utilização de serviços de saúde, ISA-Capital, São Paulo, Brasil, 2003 e 2015 / Análisis de la educación en el acceso y el uso de los servicios de salud, ISA-Capital, São Paulo, Brasil, 2003 y 2015

The great socioeconomic inequality that prevails in Brazil and the existence of a national health system with universal coverage places the need to monitor the evolution and social inequities regarding access to these services. This study aims to analyze the changes in the prevalence of health care use and the extent of social inequality in the demand, use and, access, resolution of health problems, satisfaction, and health care use of Brazilian Unified National Health System (SUS) according to education levels in the population living in the urban area of the Municipality of São Paulo, in 2003 and 2015. We analyzed data from two population-based household health surveys (Health Survey in São Paulo City - ISA-Capital) from 2003 and 2015. Dependent variables related to health care use in the two weeks preceding the survey and due to diseases included demand, access, satisfaction, problem resolution, and the public or private nature of the service. Prevalence was estimated using level of education and prevalence ratios (PR) by the Poisson regression. In the period, the demand for health care, access, resolution, and use of public health care increased from 2003 to 2015. Inequities in public health care use changed from 2003 to 2015 according to level of education. We found no social inequities in health care use in the municipality of São Paulo regarding demand, access, satisfaction, and resolution according to levels of education. Results show progress in the use and resolution of health care services, as well as the strong concentration of the use of SUS by the population with lower education. Results indicate the progress that SUS has made, but also show persistent challenges in the use and access to services.

A grande iniquidade socioeconômica que prevalece no Brasil e a existência de um sistema nacional de saúde com cobertura universal torna necessário o acompanhamento da evolução e das iniquidades sociais no acesso aos serviços. Analisar as mudanças na prevalência do uso de serviços de saúde e o grau de iniquidade social considerando a demanda, o uso e acesso, resolução de problemas de saúde, satisfação e utilização dos serviços de saúde do Sistema Único de Saúde (SUS), segundo o nível de escolaridade, na população residente na zona urbana do Município de São Paulo, em 2003 e 2015. Foram analisados dados de dois inquéritos domiciliares de saúde de base populacional (Inquérito de Saúde do Município de São Paulo - ISA-Capital) de 2003 e 2015. As variáveis dependentes relacionadas à utilização de serviços de saúde nas duas semanas anteriores à pesquisa e devido à presença de alguma doença incluem: demanda, acesso, satisfação, resolução do problema e a natureza pública ou privada do serviço. A prevalência foi estimada por meio da escolaridade e das razões de prevalência (RP) por regressão de Poisson. Entre 2003 e 2015, a demanda por cuidados de saúde, acesso, resolutividade e utilização de serviços públicos de saúde aumentou. As iniquidades no uso da saúde pública mudaram de 2003 para 2015 quando se trata do nível de escolaridade. Não foram encontradas iniquidades sociais na utilização dos serviços de saúde no Município de São Paulo em termos de demanda, acesso, satisfação e resolutividade, segundo o nível de escolaridade. Os resultados mostram avanços na utilização e resolutividade dos serviços de saúde, bem como uma forte concentração do uso do SUS pela população com menor nível de escolaridade. Os resultados indicam os avanços do SUS, mas também mostram que ainda há desafios no uso e acesso aos serviços.

La gran desigualdad socioeconómica que prevalece en Brasil y la existencia de un sistema nacional de salud con cobertura universal hace necesario el seguimiento de la evolución y de las desigualdades sociales en el acceso a los servicios. Analizar los cambios en la prevalencia del uso de servicios de salud y el grado de desigualdad social considerando la demanda, el uso y acceso, resolución de problemas de salud, satisfacción y utilización de los servicios de salud del Sistema Único de Salud brasileño (SUS), según el nivel de educación, en la población residente en la zona urbana del Municipio de São Paulo, en 2003 y 2015. Se analizaron los datos de dos encuestas de salud domiciliaria de base poblacional (Encuesta de Salud en el Municipio de São Paulo - ISA-Capital) de 2003 y 2015. Las variables dependientes relacionadas con el uso de los servicios de salud en las dos semanas anteriores a la investigación y debido a la presencia de alguna enfermedad incluyen: la demanda, el acceso, la satisfacción, la resolución del problema y la naturaleza pública o privada del servicio. La prevalencia se estimó mediante la educación y las razones de prevalencia (RP) mediante regresión de Poisson. Entre 2003 y 2015, aumentó la demanda de atención médica, el acceso, la resolución y el uso de los servicios de salud pública. Las desigualdades en el uso de la salud pública cambiaron de 2003 a 2015 en lo que respecta al nivel de educación. No fueron encontradas desigualdades sociales en la utilización de los servicios de salud en el municipio de São Paulo en términos de demanda, acceso, satisfacción y resolutividad, según el nivel de educación. Los resultados muestran avances en la utilización y la resolutividad de los servicios de salud, así como una fuerte concentración del uso del SUS por parte de la población con menor nivel de educación. Los resultados indican los avances del SUS, pero también muestran que todavía hay desafíos en el uso y acceso a los servicios.

Infant mortality in the municipality of São Paulo: trend and social inequality (2006-2019) / Mortalidade infantil no município de São Paulo: tendência e desigualdade social (2006-2019)

ABSTRACT OBJECTIVE Considering the published evidence on the impact of recent economic crises and the implementation of fiscal austerity policies in Brazil on various health indicators, this study aims to analyze how the trend and socio-spatial inequality of infant mortality behaved in the municipality of São Paulo from 2006 to 2019. METHODS This is an ecological study with a temporal trend analysis that was developed in municipality of São Paulo, using three residence area strata differentiated according to their social vulnerability following the 2010 São Paulo Social Vulnerability Index. Infant mortality rate, as well as neonatal, and post-neonatal mortality rates, were calculated for each social vulnerability stratum, each year in the period, and for the first and last three triennia. Temporal trends were analyzed by the Prais-Winsten regression model and inequality magnitude, by rate ratios. RESULTS We found a decline in infant mortality rate and its components from 2006 to 2015, greater in the stratum with low social vulnerability and in the post-neonatal period when compared to the neonatal one. This decline ended in 2015, stagnating in the next period (2016-2019). Our analysis of infant mortality inequality across social vulnerability stratum showed a significant increase from the initial to the final triennia in the analyzed period; rate ratios increased from 1.36 to 1.48 in the high stratum (compared to the low social vulnerability stratum), and from 1.19 to 1.32 between the medium and low social vulnerability strata. CONCLUSIONS The observed stagnation of infant mortality rate decline in 2015 and the increase in socio-spatial inequality point to the urgent need to reformulate current public policies to reverse this situation and reduce inequalities in the risk of infant death.

RESUMO OBJETIVO Considerando as evidências publicadas sobre o impacto de crises econômicas e da implementação de políticas de austeridade fiscal em vários indicadores de saúde, e a ocorrência recente desses eventos no Brasil, o objetivo deste estudo foi analisar o comportamento da tendência e da desigualdade socioespacial da mortalidade infantil no município de São Paulo, entre 2006 e 2019. MÉTODOS Trata-se de estudo ecológico de análise de tendência temporal, desenvolvido no município de São Paulo e em três estratos de áreas de residência, diferenciadas segundo nível de vulnerabilidade social, a partir do Índice Paulista de Vulnerabilidade Social de 2010. Calcularam-se as taxas de mortalidade infantil, neonatal e pós-neonatal para cada um dos estratos de vulnerabilidade social, para cada ano do período e para o primeiro e o último triênios. A tendência temporal foi analisada com o modelo de regressão de Prais-Winsten e a magnitude da desigualdade avaliada pelas razões de taxas. RESULTADOS O declínio das taxas de mortalidade infantil e de seus componentes, observado entre 2006 e 2015, que foi mais elevado no estrato de baixa vulnerabilidade social e no período pós-neonatal em comparação ao neonatal, foi interrompido em 2015, com estagnação das taxas no período subsequente (2016-2019). A análise da desigualdade da mortalidade infantil entre os estratos de vulnerabilidade social revelou aumento significativo entre os triênios inicial e final do período analisado; as razões de taxas cresceram de 1,36 para 1,48 entre o estrato de alta em relação ao de baixa vulnerabilidade social e de 1,19 para 1,32 entre o de média e de baixa vulnerabilidade social. CONCLUSÕES O estancamento do declínio da taxas de mortalidade infantil em 2015 e o aumento da desigualdade socioespacial observados apontam para a necessidade premente de reformulação das políticas públicas vigentes para reversão desse quadro, visando reduzir a iniquidade presente no risco de morte infantil.

Desigualdades socioespaciais da mortalidade prematura por doenças crônicas não transmissíveis no município de São Paulo, Brasil, 2006-2019 / Spatial inequalities of premature mortality for chronic non-transmissible diseases in the municipality of São Paulo, Brazil, 2006 to 2019

Resumo Introdução Este estudo utiliza dados de mortalidade para monitorar as desigualdades sociais em saúde. Objetivo Analisar a tendência das taxas da mortalidade prematura (30-69 anos) por grupos selecionados de DCNT em áreas de inclusão e exclusão social no Município de São Paulo (MSP), entre 2006 e 2019, e avaliar a magnitude das desigualdades nos triênios de 2006-2008 e 2017-2019. Método Utilizou-se o Índice de Exclusão/Inclusão para delimitação das áreas, regressão de Prais-Winsten para análise das tendências e Razão entre Taxas (RT) para mensurar as desigualdades. Resultados As tendências apresentaram declínios, sendo maiores na área de inclusão social, no sexo masculino, para Doenças Isquêmicas do Coração (DIC), Doenças Crônicas das Vias Respiratórias Inferiores (DCR) e Diabetes Mellitus (DM). Ocorreram aumentos significativos das RT no sexo masculino para DIC (1,62 e 2,17), DCR (1,60 e 3,00) e DM (1,81 e 2,26), enquanto no feminino não se observou ampliação. Conclusão O declínio das taxas nas áreas de exclusão social, a não ampliação da desigualdade nas mulheres, e por doenças cerebrovasculares e hipertensivas nos homens, provavelmente se devem à existência de um sistema universal de saúde. A ampliação da desigualdade entre homens requer adequação dos serviços de saúde para assegurar a integralidade desse grupo.

Abstract Background This study uses mortality data to monitor social inequalities in health. Objective To analyze the trend in premature mortality rates (30 to 69 years) by selected groups of NCDs in areas of social inclusion and exclusion in the city of São Paulo, between 2006 and 2019, and to assess the magnitude of inequalities in the years 2006-2008 and 2017-2019. Method The Exclusion/Inclusion Index was used to delimit areas, Prais-Winsten regression to analyze trends, and rate ratio (RT) to measure inequalities. Results The trends showed declines, with greater social inclusion in males for ischemic heart diseases (IHD), chronic diseases of the lower respiratory tract (DLRT) and diabetes mellitus (DM). There were significant increases in RT in males for IHD (1.62 and 2.17), DCR (1.60 and 3.00) and DM (1.81 and 2.26), while in females there was no increase. Conclusion The decline in rates in areas of social exclusion, the non-expansion of inequality in women and, due to cerebrovascular and hypertensive diseases in men, is probably due to the existence of a universal health system. The expansion of inequality between men requires adequate health services to ensure the integrality of this group.

Social inequalities in access to cancer screening and early detection: A population-based study in the city of São Paulo, Brazil

Abstract Objective: This study monitors trends in access to cancer screening, focusing on mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA), assessing the magnitude of inequality in the city of São Paulo from 2003 to 2015 according to education level. Method: This is a cross-sectional population-based study conducted with data from the 2003, 2008, and 2015 editions of the Health Survey of the City of São Paulo (ISA-Capital). Outcome variables were the proportion of mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA) tests according to the protocols. Inequality was measured by education level according to years of study. For static analysis, Poisson regression was used to estimate proportion ratios. Results: The proportion of Pap smears remained stationary at a high level (>89%) throughout the study period, while access to mammography and PSA tests significantly increased in the 2003-2015 period. The present results indicate inequalities in access to cancer screening due to education, and being more expressive for mammography and PSA tests. However, this inequality significantly decreased over the period analyzed comparing the most educated individuals with those with the lowest educational level. In addition, an increase in the proportion of tests performed in the Brazilian Unified Health System was identified, especially for mammography and PSA tests, in the period 2003-2015. Conclusions: The inequalities observed in the access to preventive exams were influenced by the level of education. The offer of exams was expanded, more significantly for mammography and PSA, especially among the less educated group.

Mortality attributable to cardiovascular diseases in young adults residents in Brazil / Mortalidade atribuível às doenças cardiovasculares em adultos jovens residentes no Brasil

Introdução: doenças Cardiovasculares são as principais causas de morte no mundo. Apesar da redução da incidência e mortalidade por DCV no século XX, os valores permanecem elevados no século XXI. No Brasil, há lacuna de estudos populacionais que estimaram as taxas padronizadas de mortalidade por doenças cardiovasculares em adultos jovens.Objetivo: avaliar a tendência da mortalidade por doenças cardiovasculares em adultos jovens, segundo sexo, faixa etária e regiões do Brasil.Método: estudo de séries temporais com uso de dados secundários oficiais dos Sistemas de Informações sobre Mortalidade (SIM). Foram consideradas todas as mortes por doenças cardiovasculares (I00-I-99) em adultos jovens faixa etária 20-49 anos, residentes no Brasil, no período de 01 de janeiro de 2008 a 31 de dezembro de 2017. Os dados foram extraídos do Departamento de Informática do SUS (DATASUS). Foi utilizado o modelo de regressão Prais-Winsten e calculada a Variação Percentual Anual (VPA). Todas as análises foram realizadas no software STATA 14.0.Resultados: durante período 2008-2017, foram identificadas 294.232 mortes (8,7%) por doença cardiovascular em adultos jovens com idade entre 20-49 anos. Identificou-se a redução da mortalidade por DCV em todas as regiões do Brasil, exceto nos indivíduos de 20-24 anos, residentes na região Nordeste, a qual apresentou aumento (VPA: 2,45%) (p<0,05) 2013-2017. A maior variação da tendência de mortalidade ocorreu na região Sul (VPA: -25,2%). Enquanto a menor variação de tendência da mortalidade ocorreu na região Nordeste (VPA: -8,8%). O declínio anual foi menor no segundo quinquênio (2013-2017) em comparação ao primeiro (2008-2012). Além disso, o declínio foi mais acentuado entre as mulheres (VPA: -2,51%) (p<0,05) 2008-2012 e em adultos jovens com idade entre 40-44 anos (VPA: -2,91%) (p<0,05) 2008-2012. Ademais, a tendência de mortalidade por DCV se estabilizou a partir de 2013 no sexo masculino (p>0,05).Conclusão: os resultados demonstram tendência decrescente da mortalidade por Doença Cardiovascular em adultos jovens no Brasil, entre 2008-2017. Conclui-se que existe desigualdade na tendência de mortalidade por DCV segundo sexo, faixa etária e regiões do Brasil.

Introduction: cardiovascular diseases are the leading causes of death in the world. Despite the reduction in CVD incidence and mortality in the 20th century, the values remain high in the 21st century. In Brazil, there is a gap in population studies that estimated standardized mortality rates from cardiovascular diseases in young adults.Objective: to assess the trend in mortality from cardiovascular diseases in young adults, according to sex, age group and regions of Brazil.Methods: ecological time series study using official secondary data from Mortality Information Systems (SIM). All deaths from cardiovascular diseases (I00-I-99) in young adults aged 20-49 years, residing in Brazil, in the period from January 1, 2008 to December 31, 2017, were considered. Data were extracted from the Department of Informatics of the SUS (DATASUS). The Prais-Winsten regression model was used and the Annual Percentage Variation (APV) was calculated. All analyzes were performed in STATA 14.0 software.Results: during the period 2008-2017, 294,232 deaths (8.7%) from cardiovascular disease were identified in young adults aged 20-49 years. A reduction in CVD mortality was identified in all regions of Brazil, except for individuals aged 20-24 years, residing in the Northeast region, which showed an increase (APC: 2.45%) (p<0.05) 2013 -2017. The greatest variation in the mortality trend occurred in the South region (APC: -25.2%). While the smallest change in mortality trend occurred in the Northeast region (APC: -8.8%). The annual decline was smaller in the second quinquennium (2013-2017) compared to the first (2008-2012). Furthermore, the decline was more pronounced among women (APC: -2.51%) (p<0.05) 2008-2012 and in young adults aged 40-44 years (APC: -2.91%) (p<0.05) 2008-2012. Furthermore, the trend in CVD mortality stabilized from 2013 onwards in males (p>0.05).Conclusion: the results demonstrate a decreasing trend in mortality from Cardiovascular Disease in young adults in Brazil, between 2008-2017. It is concluded that there is inequality in the trend of mortality from CVD according to sex, age group and regions of Brazil.

Early neonatal mortality trend in adolescent pregnant women in the State of São Paulo, Brazil, from 1996 to 2017.

BACKGROUND: The Infant mortality rate indicates the quality of life of a population. Infant mortality has two important components: neonatal mortality, divided into early and late and post-neonatal mortality. The more developed a country is and the greater its population's well-being, the greater the weight of the neonatal component on infant mortality. In addition several factors may determine or be associated with the occurrence of infant deaths including maternal age. The teenage pregnancy rates in Latin America and the Caribbean remain the second highest in the world, In Brazil, between 2010 and 2015, for every thousand adolescents between 15 and 19 years old, about 69 became pregnant and gave birth to their babies. Thus, the objective of this study is to evaluate the trend of Early Neonatal Mortality Rates in children of pregnant adolescents, which occurred in the period 1996-2017, in the state of São Paulo, Brazil, according to the maternal age group. METHODS: This is an ecological study of time series using official mortality data obtained from the Mortality Information System and live birth data obtained from the Live Birth Information System. Deaths of newborns aged between zero and six complete days were collected by place of residence. The trends in rates per 1,000 live births were calculated by Prais-Winsten regression, obtaining their annual percentage change (VPA) and the respective 95% confidence intervals, analyzed by age group. All analyzes were processed using the STATA 15.1 software. RESULTS: In the state of São Paulo, between 1996 and 2017, 16,161 deaths were reported in children from zero to six days old and 2,320,584 live births in mothers aged 10-19 years, living in the state of São Paulo, Brazil. Of this total, it was observed that the early neonatal mortality rate decreased until the year 2005-2006, remained stationary after, and was higher in newborns of mothers aged 10-14 years (13.18 per 1,000) compared to mothers between 15-19 years (6.75 per 1,000). CONCLUSIONS: In conclusion, although the early neonatal mortality rate showed a significant decreasing trend until approximately 2005, it remained stables after that.

Trends in case-fatality rates of COVID-19 in the World, between 2019 - 2020 / Tendência das taxas de letalidade de covid-19 no mundo, entre 2019-2020

INTRODUCTION: CoV infections can potentially cause from a simple cold to a severe respiratory syndrome, such as the Severe Acute Respiratory Syndrome and the Middle East Respiratory Syndrome (MERS-CoV). The COVID-19 created a new reality for global healthcare modelsOBJETIVE: To evaluate trends in case-fatality rates of COVID-19 in the WorldMETHODS: We conducted a population-based time-series study using public and official data of cases and deaths from COVID-19 in Argentina, Australia, Brazil, Chile, China, Colombia, France, Germany, India, Iran, Italy, Japan, Mexico, Morocco, New Zealand, Nigeria, Peru, Saudi Arabia, South Africa, South Korea, Spain, Switzerland, United Kingdom, United States and Russian, between December, 2019 and August, 2020. Data were based on reports from European Centre for Disease Prevention and Control. COVID-19 was defined by the International Classification of Diseases, 10th revision (U07.1). A Prais-Winsten regression model was performed and the Daily Percentage Change (DPC) calculated determine rates as increasing, decreasing or flatRESULTS: During the study period, trends in case-fatality rates in the world were flat (DPC = 0.3; CI 95% [-0.2: 0.7]; p = 0.225). In Africa, Morocco had decreasing trends (DPC = -1.1; CI 95% [-1.5: -0.7]; p < 0.001), whereas it were increasing in South Africa (p < 0.05) and flat in Nigeria (p > 0.05). In the Americas, Argentina showed a decreasing trend in case-fatality rates (DPC = -0.6; CI 95% [-1.1: -0.2]; p = 0.005), the U.S. had flat trends (p > 0.05) and all other American countries had increasing trends (p < 0.05). In Asia, Iran had decreasing trends (DPC = -1.5; CI 95% [-2.6 : -0.2]; p = 0.019); China and Saudi Arabia showed increasing trends (p < 0.05), while in India, Japan and South Korea they were flat (p > 0.05). European countries had mostly increasing trends (p < 0.05): Germany, Italy, Spain, the UK and Russia; France and Switzerland had flat trends (p > 0.05). Finally, in Oceania, trends in case-fatality rates were flat in Australia (p > 0.05) and increasing in New Zealand (p < 0.05CONCLUSION: Trends in case-fatality rates of COVID-19 in the World were flat between December, 31 and August, 31. Argentina, Iran and Morocco were the only countries with decreasing trends. On the other hand, South Africa, Brazil, Canada, Chile, Colombia, Mexico, Peru, China, Saudi Arabia, Germany, Spain, United Kingdom, Russian and New Zealand had increasing trends in case-fatality rate. All the other countries analyzed had flat trends. Based on case-fatality rate data, our study supports that COVID-19 pandemic is still in progress worldwide

INTRODUÇÃO: As infecções por CoV podem causar desde um simples resfriado até uma síndrome respiratória grave, como a Síndrome Respiratória Aguda Grave e a Síndrome Respiratória do Oriente Médio (MERS-CoV). O COVID-19 impôs uma nova realidade em termos de modelos globais de saúdeOBJETIVO: Avaliar as tendências das taxas de letalidade do COVID-19 no mundoMÉTODO: Estudo de séries temporais de base populacional usando dados públicos e oficiais de casos e mortes por COVID-19 na Argentina, Austrália, Brasil, Chile, China, Colômbia, França, Alemanha, Índia, Irã, Itália, Japão, México, Marrocos, Nova Zelândia, Nigéria, Peru, Arábia Saudita, África do Sul, Coreia do Sul, Espanha, Suíça, Reino Unido, Estados Unidos (EUA) e Rússia, entre 31 dezembro de 2019 e 31 agosto de 2020. Os dados foram baseados nos relatórios do Centro Europeu de Prevenção e Controle de Doenças. COVID-19 foi definido pela Classificação Internacional de Doenças, 10ª revisão (U07.1). Para análise estatística, foi realizado o modelo de regressão de Prais-Winsten, a partir do qual foi possível calcular a variação percentual de mudança diária (DPC) das taxas, classificadas como crescentes, decrescentes ou estacionáriasRESULTADOS: Durante o período do estudo, as taxas de letalidade no mundo permaneceram estacionárias (DPC = 0,3; IC 95% [-0,2: 0,7]; p = 0,225). Na África, Marrocos teve tendência decrescente (DPC = -1,1; IC 95% [-1,5: -0,7]; p <0,001), enquanto na África do Sul houve tendência crescente (p < 0,05) e estacionária na Nigéria (p > 0,05). Em relação às Américas, a Argentina revelou tendência decrescente nas taxas de letalidade (DPC = -0,6; IC 95% [-1,1: -0,2]; p = 0,005), os EUA demonstraram tendência estacionária (p > 0,05) e todos os outros países americanos demonstraram tendências crescentes (p < 0,05). Na Ásia, o Irã apresentou tendência decrescente (DPC = -1,5; IC 95% [-2,6: -0,2]; p = 0,019); China e Arábia Saudita apresentaram tendências crescentes (p <0,05), enquanto Índia, Japão e Coreia do Sul mantiveram tendência estacionária (p > 0,05). A maioria dos países europeus apresentaram tendências crescentes (p <0,05): Alemanha, Itália, Espanha, Reino Unido e Rússia; França e Suíça demonstraram tendências estacionárias (p > 0,05). Por fim, na Oceania, a tendência nas taxas de letalidade na Austrália foi estacionária (p > 0,05) e aumentou na Nova Zelândia (p < 0,05CONCLUSÃO: A tendência nas taxas de letalidade por COVID-19 no mundo permaneceu estacionária entre 31 de dezembro de 2019 e 31 de agosto de 2020. Argentina, Irã e Marrocos foram os únicos países com tendências decrescentes. Por outro lado, África do Sul, Brasil, Canadá, Chile, Colômbia, México, Peru, China, Arábia Saudita, Alemanha, Espanha, Reino Unido, Rússia e Nova Zelândia apresentaram tendências crescentes de letalidade. Todos os outros países analisados demonstraram tendências estacionárias. De acordo com dados de letalidade, nosso estudo confirma que a pandemia de COVID-19 ainda está em fase de progressão em todo o mundo

Human Papillomavirus (HPV) and the quadrivalent HPV Vaccine among Brazilian adolescents and parents: Factors associated with and divergences in knowledge and acceptance.

BACKGROUND: Low national immunization coverage (44.64%) requires strengthening the vaccination campaign to improve knowledge about HPV and its vaccine among adolescents and parents/guardians. Our aim is to evaluate factors related to knowledge about HPV, its vaccine, acceptability and divergences among Brazilian adolescents and parents/guardians. METHODS: A cross-sectional study was performed at a health unit of Sao Paulo University, Brazil, from 2015 to 2016. The convenience sample comprised 1047 individuals, including 74% (n = 776) adolescents and 26% (n = 271) parents/guardians, who answered a survey (knowledge about HPV, its vaccine, barriers and acceptability). RESULTS: The main source of information for adolescents was school (39%, n = 298); for parents/guardians, it was health professionals (55%, n = 153). Parents/guardians were 2.48 times more likely than adolescents to know that HPV caused changes in the Pap smear test [RR 2.48, 95% CI 2.03-3.01 (p < 0.001)], 1.43 times likely to be aware that HPV was a sexually transmitted infection [RR 1.43, 95% CI 1.22-1.68 (p < 0.001)], and 2.77 times likely to be informed that the HPV vaccine decreased the chance of having genital warts [RR 2.77, 95% CI 2.22-2.47 (p < 0.001)]. Girls knew more about the topic than boys (RR 1.67; 95% CI 1.10-2.60); education increased parents' knowledge [(RR 3.38; 95% CI 1.71-6.69)]. CONCLUSION: Female adolescents and parents/guardians with a higher level of education are factors related to suitable knowledge about HPV and its vaccine among Brazilian respondents. There were differences between parents/guardians and adolescents in HPV awareness, clinical implications, vaccine knowledge and vaccine acceptance.

Anemia and iron deficiency in primigent parturients in a municipality of Brazilian west Amazon.

To analyze the prevalence of anemia and associated factors in primiparous parturient.Cross-sectional study conducted in a municipality of the Brazilian Western Amazon from July 2014 to December 2015. A convenience sample of 461 first-time pregnant women were interviewed. Data on their sociodemographic, clinical, obstetric, personal habits and nutritional status were collected. Anemia and iron depletion were measured by peripheral blood collection with hemoglobin, hematocrit, serum ferritin and transferrin saturation index. To test the association between the variables, the χ tests were applied and Poisson regression analysis with a 95% confidence interval was performed, and P < .05 values were considered significant. The Forward stepwise strategy was used to construct the adjusted model. These analyzes were performed using the STATA 14.0 program (College Station, TX, 2013).A higher risk of anemia was identified among adolescent; white; who had a partner; with unpaid occupation, with less than eight years of formal education. Residents in the countryside; smokers; who had more than six prenatal consultations and were overweight.Anemia was reported in 28.20% and iron depletion in 60.52% of parturient women. The variables studied did not have association with the anemia outcome, except alcohol consumption.

[Factors associated with lack of hospital care in deaths from cerebrovascular disease, São Paulo, Brazil: a comparative analysis of 1996-1998 and 2013-2015]. / Fatores associados à falta de assistência hospitalar nos óbitos por doença cerebrovascular, São Paulo, Brasil: análise comparativa entre 1996-1998 e 2013-2015.

The objective was to assess sociodemographic and clinical factors related to the lack of hospital care in deaths from ischemic and hemorrhagic cerebrovascular disease (CVD) in the state of São Paulo, Brazil, in 1996-1998 and 2013-2015. The study used data on deaths from the Mortality Information System. Poisson regression was used to analyze the association between lack of hospital care and the study variables. Of the 127,319 individuals that died of CVD in the two three-years periods, 19,362 (15.2%) had failed to receive hospital care. Lack of hospital care in deaths from CVD remained practically unchanged in relation to sociodemographic and clinical characteristics, except for distributions by sex. The more recent three-year period showed higher risk of death from CVD without hospital care among Asian-descendant individuals (RR = 1.48), while lower risk of death from CVD without hospital care in the more recent period was associated with black color (RR = 0.85), brown color (RR = 0.86), married individuals (RR = 0.70), those living in the capital city of São Paulo (RR = 0.92), those who received medical care (RR = 0.17), and those with hemorrhagic CVD (RR = 0.47). In addition, lack of hospital care in deaths from hemorrhagic CVD was lower among married individuals (RR = 0.67), those living in the capital city of São Paulo (RR = 0.74), and those who received medical care (RR = 0.08). Sociodemographic and clinical characteristics were associated with the lack of hospital care in deaths from ischemic and hemorrhagic CVD, suggesting that there are differences in care for CVD patients.

O objetivo foi avaliar os fatores sociodemográficos e clínicos relacionados à falta de assistência hospitalar em óbitos por doença cerebrovascular (DCV) e DCV hemorrágica, no Estado de São Paulo, Brasil, nos triênios 1996-1998 e 2013-2015. Foram utilizados dados dos óbitos provenientes do Sistema de Informações sobre Mortalidade. Para analisar a associação entre a falta de atendimento hospitalar e as variáveis consideradas no estudo utilizou-se a regressão de Poisson. Dos 127.319 indivíduos que morreram por DCV nos dois triênios, 19.362 (15,2%) não tiveram assistência hospitalar. A falta de atendimento hospitalar em óbitos por DCV manteve-se praticamente inalterada para as características sociodemográficas e clínicas, exceto a distribuição por sexo. No período mais recente, identificou-se maior risco de óbito por DCV sem assistência hospitalar entre indivíduos de cor da pele amarela (RR = 1,48), já em pessoas de cor preta (RR = 0,85), parda (RR = 0,86), nos casados (RR = 0,70), naqueles que residiam no Município de São Paulo (RR = 0,92), nos que tiveram assistência médica (RR = 0,17) e naqueles acometidos pela DCV hemorrágica (RR = 0,47) o risco de óbito sem assistência hospitalar foi menor. Além disso, a falta de atendimento hospitalar em óbitos por DCV hemorrágica foi menor entre os casados (RR = 0,67), naqueles que residiam no Município de São Paulo (RR = 0,74) e nos que tiveram assistência médica (RR = 0,08). As características sociodemográficas e clínicas estiveram associadas com a falta de assistência hospitalar em óbitos por DCV e DCV hemorrágica, sugerindo que há diferenças no atendimento ao paciente com DCV.

El objetivo fue evaluar factores sociodemográficos y clínicos, relacionados con la falta de asistencia hospitalaria en óbitos por enfermedad cerebrovascular (ECV) y ECV hemorrágica, en el Estado de São Paulo, Brasil, durante los trienios 1996-1998 y 2013-2015. Se utilizaron datos de los óbitos procedentes del Sistema de Informaciones sobre Mortalidad. Para analizar la asociación entre la falta de atención hospitalaria y las variables consideradas en el estudio se utilizó la regresión de Poisson. De los 127.319 individuos que murieron por ECV en los dos trienios, 19.362 (15,2%) no tuvieron asistencia hospitalaria. La falta de atención hospitalaria en óbitos por ECV se mantuvo prácticamente inalterada, respecto a las características sociodemográficas y clínicas, excepto en la distribución por sexo. En el período más reciente se identificó un mayor riesgo de óbito por ECV sin asistencia hospitalaria entre individuos de ascendencia asiática (RR = 1,48), mientras que en personas afrodescendientes (RR = 0,85), mestizos (RR = 0,86), casados (RR = 0,70), en aquellos que residían en el municipio de São Paulo (RR = 0,92), en quienes contaron con asistencia médica (RR = 0,17) y en aquellos afectados por la ECV hemorrágica (RR = 0,47), el riesgo de muerte sin asistencia hospitalaria fue menor. Además, la falta de atención hospitalaria en fallecimientos por ECV hemorrágica fue menor entre los casados (RR = 0,67), en aquellos que residían en el municipio de São Paulo (RR = 0,74) y en los que contaron asistencia médica (RR = 0,08). Las características sociodemográficas y clínicas se asociaron con la falta de asistencia hospitalaria en óbitos por ECV y ECV hemorrágica, sugiriendo que existen diferencias en la atención al paciente con una ECV.

Knowledge gaps and acquisition about HPV and its vaccine among Brazilian medical students.

OBJECTIVE: To analyze factors associated with knowledge gaps and acquisition about HPV and its vaccine among medical students. METHOD: Cross-sectional and analytical study conducted at the University of São Paulo Medicine School, in 2016. A convenience sample of students completed a data collection instrument containing questions on knowledge about HPV and its vaccine, and vaccine acceptability. The level of knowledge and acceptability established as a "good level" was 80% of correct answers on the questionnaire. Internal validity was calculated with Cronbach's alpha value (α) = 0.74. Bivariate and multiple analyzes were performed using the Stata® program (Stata Corp, College Station, USA) 14.0. RESULTS: To evaluate the internal consistency of the instrument applied, the Cronbach's alpha equation was used, obtaining the alpha value (α) = 0.74 for this population. This value attests that the consistency of the answers obtained with this questionnaire is considered substantial and acceptable. Among the 518 medical students who completed the survey, the majority were men 312 (60.4%) with a mean age of 23 (± 2.8) years old; 199 (38.3%) of the students were in the final years of graduation (5th and 6th years). Students in the first, second and third year of study had a 51% higher risk of a knowledge gap when compared to students in the final years of graduation [PR 1.51 (1.3:1.8); p <0.001]. Men were at 22% higher risk of unsatisfactory knowledge than women are [PR 1.22 (1.07: 1.39). There was no knowledge acquisition during medical school in the following questions (p <0.05), indication of vaccine for individuals with HIV and contraindication in pregnant patients. CONCLUSION: Male medical students, in the first year of medical school, and those who were not vaccinated had significant knowledge gaps about HPV. The novelty of the study includes the finding of non- acquisition of knowledge during the medical school graduation on safety and vaccination schedule and vaccine administration in specific populations.

Fatores associados à falta de assistência hospitalar nos óbitos por doença cerebrovascular, São Paulo, Brasil: análise comparativa entre 1996-1998 e 2013-2015 / Factors associated with lack of hospital care in deaths from cerebrovascular disease, São Paulo, Brazil: a comparative analysis of 1996-1998 and 2013-2015 / Factores asociados a la falta de asistencia hospitalaria en fallecimientos por enfermedad cerebrovascular, São Paulo, Brasil: análisis comparativo entre 1996-1998 y 2013-2015

O objetivo foi avaliar os fatores sociodemográficos e clínicos relacionados à falta de assistência hospitalar em óbitos por doença cerebrovascular (DCV) e DCV hemorrágica, no Estado de São Paulo, Brasil, nos triênios 1996-1998 e 2013-2015. Foram utilizados dados dos óbitos provenientes do Sistema de Informações sobre Mortalidade. Para analisar a associação entre a falta de atendimento hospitalar e as variáveis consideradas no estudo utilizou-se a regressão de Poisson. Dos 127.319 indivíduos que morreram por DCV nos dois triênios, 19.362 (15,2%) não tiveram assistência hospitalar. A falta de atendimento hospitalar em óbitos por DCV manteve-se praticamente inalterada para as características sociodemográficas e clínicas, exceto a distribuição por sexo. No período mais recente, identificou-se maior risco de óbito por DCV sem assistência hospitalar entre indivíduos de cor da pele amarela (RR = 1,48), já em pessoas de cor preta (RR = 0,85), parda (RR = 0,86), nos casados (RR = 0,70), naqueles que residiam no Município de São Paulo (RR = 0,92), nos que tiveram assistência médica (RR = 0,17) e naqueles acometidos pela DCV hemorrágica (RR = 0,47) o risco de óbito sem assistência hospitalar foi menor. Além disso, a falta de atendimento hospitalar em óbitos por DCV hemorrágica foi menor entre os casados (RR = 0,67), naqueles que residiam no Município de São Paulo (RR = 0,74) e nos que tiveram assistência médica (RR = 0,08). As características sociodemográficas e clínicas estiveram associadas com a falta de assistência hospitalar em óbitos por DCV e DCV hemorrágica, sugerindo que há diferenças no atendimento ao paciente com DCV.

The objective was to assess sociodemographic and clinical factors related to the lack of hospital care in deaths from ischemic and hemorrhagic cerebrovascular disease (CVD) in the state of São Paulo, Brazil, in 1996-1998 and 2013-2015. The study used data on deaths from the Mortality Information System. Poisson regression was used to analyze the association between lack of hospital care and the study variables. Of the 127,319 individuals that died of CVD in the two three-years periods, 19,362 (15.2%) had failed to receive hospital care. Lack of hospital care in deaths from CVD remained practically unchanged in relation to sociodemographic and clinical characteristics, except for distributions by sex. The more recent three-year period showed higher risk of death from CVD without hospital care among Asian-descendant individuals (RR = 1.48), while lower risk of death from CVD without hospital care in the more recent period was associated with black color (RR = 0.85), brown color (RR = 0.86), married individuals (RR = 0.70), those living in the capital city of São Paulo (RR = 0.92), those who received medical care (RR = 0.17), and those with hemorrhagic CVD (RR = 0.47). In addition, lack of hospital care in deaths from hemorrhagic CVD was lower among married individuals (RR = 0.67), those living in the capital city of São Paulo (RR = 0.74), and those who received medical care (RR = 0.08). Sociodemographic and clinical characteristics were associated with the lack of hospital care in deaths from ischemic and hemorrhagic CVD, suggesting that there are differences in care for CVD patients.

El objetivo fue evaluar factores sociodemográficos y clínicos, relacionados con la falta de asistencia hospitalaria en óbitos por enfermedad cerebrovascular (ECV) y ECV hemorrágica, en el Estado de São Paulo, Brasil, durante los trienios 1996-1998 y 2013-2015. Se utilizaron datos de los óbitos procedentes del Sistema de Informaciones sobre Mortalidad. Para analizar la asociación entre la falta de atención hospitalaria y las variables consideradas en el estudio se utilizó la regresión de Poisson. De los 127.319 individuos que murieron por ECV en los dos trienios, 19.362 (15,2%) no tuvieron asistencia hospitalaria. La falta de atención hospitalaria en óbitos por ECV se mantuvo prácticamente inalterada, respecto a las características sociodemográficas y clínicas, excepto en la distribución por sexo. En el período más reciente se identificó un mayor riesgo de óbito por ECV sin asistencia hospitalaria entre individuos de ascendencia asiática (RR = 1,48), mientras que en personas afrodescendientes (RR = 0,85), mestizos (RR = 0,86), casados (RR = 0,70), en aquellos que residían en el municipio de São Paulo (RR = 0,92), en quienes contaron con asistencia médica (RR = 0,17) y en aquellos afectados por la ECV hemorrágica (RR = 0,47), el riesgo de muerte sin asistencia hospitalaria fue menor. Además, la falta de atención hospitalaria en fallecimientos por ECV hemorrágica fue menor entre los casados (RR = 0,67), en aquellos que residían en el municipio de São Paulo (RR = 0,74) y en los que contaron asistencia médica (RR = 0,08). Las características sociodemográficas y clínicas se asociaron con la falta de asistencia hospitalaria en óbitos por ECV y ECV hemorrágica, sugiriendo que existen diferencias en la atención al paciente con una ECV.

Increasing prevalence, time trend and seasonality of gastroschisis in São Paulo state, Brazil, 2005-2016.

To estimate the gastroschisis seasonality and trend of prevalence in recent years, stratified by maternal age and geographical clusters of São Paulo state, a population-based study was designed. We used data from the Live Births Information System (SINASC) in São Paulo state, Brazil, from 2005 to 2016. Trends of prevalence were evaluated for the specific subgroups using the Prais-Winsten regression model, and the Durbin-Watson test was used, to estimate the regression coefficient, the annual percent change (APC), and 95% confidence interval (CI). We observed 1576 cases of gastroschisis among 7,317,657 live births (LB), a prevalence of 2.154 (95% CI: 2.047-2.260) per 10,000 LB which included, 50.6% males, 67.4% Caucasians, 53.4% preterm births, and 80.9% caesarean births. The prevalence of gastroschisis significantly increased by 2.6% (95% CI: 0.0-5.2) per year, and this trend was higher in mothers aged 30-34 years (APC: 10.2, 95% CI: 1.4-19.4) than in mothers of other age groups. Between 2011 and 2016, we identified the existence of seasonality based on the date of conception in the middle months of the year (p = 0.002). This is the first and largest population-based study summarizing current epidemiology and identifying trend of prevalence of gastroschisis in São Paulo state.

Knowledge and acceptability of the human papillomavirus vaccine among health professionals in Acre state, western Amazon.

OBJECTIVE: To evaluate the knowledge and acceptability of the human papillomavirus (HPV) vaccine among health professionals from western Amazonia. METHODS: A cross-sectional study was conducted in the Sistema Assistencial è Saúde da Mulher e da Criança (Health Care System for Women and Children; SASMC) in Acre, Brazil, in 2017. The participants comprised 196 health professionals. The data collection instrument contained 31 questions about HPV, its clinical repercussions for women, and the HPV vaccine. Quantitative variables were presented as medians and 95% confidence intervals (CIs), and p<0.05 was considered statistically significant. For the analyses, chi-square tests and Mann-Whitney tests were used. The collected data were analyzed using Stata®11.0. RESULTS: Of the 196 health professionals, 39.8% (n=76) were physicians and 61.2% (n=120) were other health professionals. The interviewees were mostly female (n=143, 73%, 95% CI 66.1 to 78.9%) who worked in the medical field (n=81, 41.3%, 95% CI 34.4 to 48.6%), and the median age was 38 years (95% CI 36.0 to 39.7). Physicians had increased knowledge regarding only the statement "cervical cancer is one of the main causes of cancer in women", with a proportion ratio of 0.88 (0.80; 0.97) and p<0.001. Regarding clinical knowledge of the HPV vaccine, a low proportion of correct answers was obtained for all the questions, and no significant differences were found between the groups. CONCLUSION: Acceptability and knowledge of HPV and its vaccine were similar among health professionals, with knowledge gaps in questions about the relation between smoking and cervical cancer and specific clinical knowledge.

Mortality due to traffic accidents, before and after the reduction of the average speed of motor vehicles in the city of São Paulo, Brazil, from 2010 to 2016 / Mortalidade por acidentes de trânsito, antes e após redução da velocidade média de veículos automotores na cidade de São Paulo, Brasil, no período de 2010 a 2016

INTRODUCTION: Traffic accidents represent a relevant global public health problem and are associated with behavioral factors, vehicle maintenance, urban space precariousness and traffic surveillance. They are important causes of morbidity and mortality due to the increasing number of vehicles and changes in lifestyle and risk behaviors in the general population OBJECTIVE: To analyze mortality numbers due to land transport accidents reported in the city of São Paulo, Brazil, before and after the decline of average speed of motor vehicles METHODS: A study of temporal series was carried out using official database provided by the Sistema de Informação sobre Mortalidade. Data was collected according to the type of occurrence and place of residence in São Paulo, SP, Brazil. Other sources of data were Death Certificates. Population data was collected by the foundation SEADE for the other years used, and data from 2010 was collected by the Instituto Brasileiro de Geografia e Estatística do Brasil (IBGE), the Brazilian institute of geography and statistics. More death data has been collected using the tenth review of the WHO International Classification of Diseases (V00- V89) for overall population and were stratified in age groups (<10 years, 10-19 years, 20-49 years, 50 years and more), city (São Paulo) and the year timetable (2010, 2011, 2012, 2013, 2014, 2015 and 2016). The data was calculated based on plain death rate and standardized, for gender and age group. The measures of mortality were used for the construction of temporal series by the regression model of Prais-Winsten. All the analysis were made through the statistics program Stata 14.0 RESULTS: Reportedly, 7288 deaths occurred due to land accidents in São Paulo, the state's capital, between 2010 and 2016. The higher proportion of deaths happened between men with age between 20-49 years, brownish skin color, marital status single, between 4 e 7 years of study. 72.55% of deaths happened within of hospitals and/or other health establishments. The deaths ranged 1.200 in 2010 and went down to 779 in 2016. The standard mortality for transport accidents between 2010 and 2016 fluctuated from 10.04 to 6.29 for every 100 thousand inhabitants CONCLUSION: There was a decrease in deaths related to traffic accidents in individuals over 20 years of age. After the reduction of the average speed of motor vehicles in the city of São Paulo, the decline in mortality due to traffic accidents was more pronounced among individuals aged 50 years or older, with significant differences for men and women

INTRODUÇÃO: Os acidentes de trânsito representam um relevante problema global de saúde pública e estão associados a fatores comportamentais, segurança dos veículos e precariedade do espaço urbano. Configuram-se como importantes causas de morbidade e mortalidade devido ao número crescente de veículos, mudanças no estilo de vida e comportamentos de risco na população geral OBJETIVO: Analisar a mortalidade por acidentes de Trânsito, notificados no município de São Paulo, Brasil, antes e após redução da velocidade média de veículos automotores MÉTODO: Trata-se de estudo de séries temporais com microdados oficiais do Sistema de Informação sobre Mortalidade. Os dados foram coletados por local de ocorrência e de residência para o município de São Paulo, SP, Brasil. A fonte de dados foi a Declaração de Óbito. Dados da população foram obtidos por intermédio de estimativas realizadas pela fundação SEADE para os anos intercensitários e para 2010, coletados pelo Instituto Brasileiro de Geografia e Estatística do Brasil (IBGE). Dados dos óbitos por acidentes de Trânsito foram coletados usando a décima revisão da Classificação Internacional de Doenças (V00- V89) pelo total da população e foram estratificadas em grupos de idades (<10 anos, 10-19 anos, 20-49 anos, 50 anos e mais), município (São Paulo) e anos do calendário (2010, 2011, 2012, 2013, 2014, 2015 e 2016). Foram calculadas as taxas de mortalidade brutas e padronizadas, por sexo e faixa etária. Foram utilizadas as medidas de mortalidade para construção de séries temporais através do modelo de regressão de Prais-Winsten. Todas as análises foram efetuadas no programa estatístico Stata 14.0 RESULTADOS: Foram notificados 7,288 óbitos por acidentes de Trânsito ocorridos na cidade de São Paulo de residentes da capital do estado, durante o período 2010 a 2016. A maior proporção de óbitos ocorreu entre indivíduos do sexo masculino, com idade entre 20-49 anos, cor da pele branca, estado civil solteiro, entre 4 e 7 anos de estudo. 72.55% dos óbitos ocorreram dentro de hospitais e/ou outros estabelecimentos de saúde. Os óbitos variaram de 1,200 em 2010 para 779 em 2016. A mortalidade padronizada por acidentes de Trânsito entre 2010 e 2016 variou de 10.04 para 6.29 por 100 mil habitantes CONCLUSÃO: Observou-se diminuição dos óbitos relacionados aos acidentes de trânsito em indivíduos acima de 20 anos. Após redução da velocidade média de veículos automotores na cidade de São Paulo, o declínio da mortalidade por acidentes de trânsito foi mais acentuado entre indivíduos com 50 anos ou mais, com diferenças para homens e mulheres