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1.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190002, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576978

RESUMO

INTRODUCTION: Respondent-Driven Sampling (RDS) has been used in surveys with key populations at risk of HIV infection, such as female sex workers (FSW). This article describes the application of the RDS method among FSW in 12 Brazilian cities, during a survey carried out in 2016. METHODOLOGY: A biological and behavioral surveillance study carried out in 12 Brazilian cities, with a minimum sample of 350 FSW in each city. Tests were performed for HIV, syphilis, and hepatitis B and C infections. A social-behavioral questionnaire was also applied. RESULTS: The sample was comprised of 4,328 FSW. For data analysis, the sample was weighted according to each participant's network size (due consideration to the implications of RDS complex design and to the effects of homophilia are recommended). DISCUSSION: Although RDS methods for obtaining a statistical sample are based on strong statistical assumptions, allowing for an estimation of statistical parameters, with each new application the method has been rethought. In the analysis of whole-sample data, estimators were robust and compatible with those found in 2009. However, there were significant variations according to each city. CONCLUSION: The achieved sample size was of great relevance for assessing progress and identifying problems regarding the prevention and treatment of Sexually Transmitted Infections. New RDS studies with more time and operational resources should be envisaged. This could further network development.


Assuntos
Infecções por HIV/epidemiologia , Inquéritos Epidemiológicos/métodos , Hepatite C/epidemiologia , Vigilância da População/métodos , Profissionais do Sexo/estatística & dados numéricos , Sífilis/epidemiologia , Brasil/epidemiologia , Cidades , Feminino , Humanos , Fatores de Risco , Tamanho da Amostra , Amostragem , Inquéritos e Questionários
2.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): e190002.supl.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596373

RESUMO

INTRODUCTION: This article aims to estimate reference values for laboratory tests of cholesterol, glycosylated hemoglobin and creatinine for the Brazilian adult population. METHODS: A descriptive study carried out with laboratory data from the National Health Survey (Pesquisa Nacional de Saúde - PNS). Samples of blood and urine were collected in a PNS subsample of 8,952 individuals aged 18 years old or older. To determine the reference values, exclusion criteria were applied: presence of previous diseases and outliers, defined by values outside the range estimated by the mean ± 1.96 × standard deviation. Subsequently, reference values were calculated according to gender, age group and race/skin color. RESULTS: Differences in reference values according to gender were observed. Women had higher values of total cholesterol, LDL-c and HDL-c. Glycosylated hemoglobin showed similar values in relation to gender, and creatinine was higher among men. The mean reference values were higher in the elderly population, aged 60 years old or older. The mean, lower and upper limits of total cholesterol and fractions of non-white people were slightly lower. There was no difference according to race/skin color for glycosylated hemoglobin and creatinine. CONCLUSION: The establishment of national reference parameters for laboratory tests, adapted to the sociodemographic and geographic characteristics, provides relevant information for evaluation of diagnosis and treatment of chronic diseases in Brazil.


Assuntos
Colesterol/sangue , Técnicas de Laboratório Clínico/normas , Creatinina/análise , Hemoglobina A Glicada/análise , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano , Brasil , Grupo com Ancestrais do Continente Europeu , Feminino , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Fatores Sexuais , Adulto Jovem
3.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190004.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596375

RESUMO

INTRODUCTION: This article aims at describing the National Health Survey (Pesquisa Nacional de Saúde- PNS) methodology of collecting laboratory exams data. METHODOLOGY: A subsample of 25% of the census tracts was selected, according to the stratification of the PNS sample, with a probability inversely proportional to the difficulty of collection. The collection of blood and urine was done in the households by a laboratory agent, among residents selected for individual interview. Due to the difficulties found in the field work, the sample did not reach the minimum expected number in some strata, and a post-stratification procedure was proposed for the data analysis. RESULTS: The collection of biospecimens was performed in 8,952 individuals. Laboratory tests were: glycated hemoglobin; total cholesterol; LDL cholesterol; HDL cholesterol; serology for dengue; red blood cell count (erythrogram) and white series count (leukogram); high performance liquid chromatography (HPLC) for diagnosis of hemoglobinopathies; creatinine. Theexcretion of potassium, salt and sodium and creatinine was estimated in the urine. The database of laboratory exams was weighed and made publicly available on the Oswaldo Cruz Foundation's PNS website and can be accessed without prior authorization. CONCLUSION: The total subsample of laboratory exams is of great value, since it allowed us to establish national reference parameters adequate to sociodemographic and geographic characteristics of the Brazilian population, providing relevant and complementary information for the analysis of the health situation of Brazil.


Assuntos
Técnicas de Laboratório Clínico/métodos , Coleta de Dados/métodos , Bases de Dados Factuais , Inquéritos Epidemiológicos/métodos , Adolescente , Adulto , Coleta de Amostras Sanguíneas/métodos , Brasil , Colesterol/sangue , Cromatografia Líquida de Alta Pressão , Dengue/sangue , Contagem de Eritrócitos , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Coleta de Urina/métodos , Adulto Jovem
4.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190005.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596376

RESUMO

OBJECTIVE: To analyze the prevalence of altered total cholesterol and fractions levels in the Brazilian population, according to biochemical data from the National Health Survey. METHODS: A descriptive study, using data from the National Health Survey, collected between 2014 and 2015. Total cholesterol and fractions were analyzed and population prevalences of altered values according to socio-demographic variables were calculated. The cutoff points considered were: total cholesterol ≥ 200mg/dl; low-density lipoprotein LDL ≥ 130mg/dL and high-density lipoprotein HDL < 40mg/dL. RESULTS: The prevalence of total cholesterol ≥200mg/dL in the population was 32.7%, and higher in women (35.1%). The prevalence of altered HDL was 31.8%, 22.0% in females and 42.8% in males. LDL ≥ 130mg/dL was found in 18.6% and was higher in women (19.9%). The population aged 45 years old and older and those with low levels of education presented a higher prevalence of altered cholesterol. CONCLUSION: Altered values of total cholesterol and fractions were frequent in the Brazilian population, especially among women, the elderly and people with low levels of education. These results may guide control and preventative actions such as healthy eating, physical activity and treatment, all of which aim to prevent coronary diseases.


Assuntos
HDL-Colesterol/sangue , LDL-Colesterol/sangue , Colesterol/sangue , Inquéritos Epidemiológicos/métodos , Hipercolesterolemia/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Brasil/epidemiologia , Estudos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Valores de Referência , Distribuição por Sexo , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
5.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190006.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596377

RESUMO

OBJECTIVE: To analyze the prevalence of diabetes mellitus (DM) according to different diagnostic criteria, in the Brazilian adult population, according to laboratory results from the Brazilian National Health Survey. METHODS: Analysis of laboratory data from the National Health Survey, collected between 2014 and 2015. The prevalence of diabetes was calculated according to different diagnostic criteria. The prevalence of diabetes was calculated according to the criterion of glycosylated hemoglobin ≥ 6.5% or using medication, using Poisson regression and calculating crude and adjusted PR and 95%CI. RESULTS: The prevalence of diabetes according to different criteria varies from 6.6 to 9.4%. Intermediate or pre-diabetes hyperglycemia ranged from 6.8 to 16.9%. Considering laboratory criteria or medication use, the prevalence of DM was 8.4 (95%CI 7.65-9.11). The adjusted PR for gender, age, educational level and region was lower for males (PR 0.75; 95%CI 0.63 - 0.89), increased with age: 30 to 34 years (PR 2.32; 95% CI 1.33 - 4.07), 40 to 59 years PR 8.1; 95%CI 4.86 - 13.46), 60 years old or older (PR 12.6; 95%CI 7.1 - 21.0), and higher educational levels was protective (PR 0.8; 95%CI 0.6 - 0.9). Therewas a higher PR in the Central West Region (PR 1.3; 95%CI 1.04 - 1.7), in overweight people (PR 1.8; 95%CI 1.4 - 2.1), and in obese people (PR 3.3; 95%CI 2.6 - 4.1). CONCLUSION: The prevalence of diabetes was higher in females, people over 30 years of age, in populations with low educational levels, and people who were overweight and obese. The study advances in determining the diabetes situation in the country through laboratory criteria.


Assuntos
Diabetes Mellitus/epidemiologia , Hemoglobina A Glicada/análise , Inquéritos Epidemiológicos/métodos , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/epidemiologia , Prevalência , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Adulto Jovem
6.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190007.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596378

RESUMO

OBJECTIVE: To describe the prevalence of hemoglobinopathies in the Brazilian adult population, according to laboratory tests from the National Health Survey. METHODS: A descriptive study was carried out with National Health Survey laboratory data collected between 2014 and 2015. The hemoglobinopathies test was performed using the High Performance Liquid Chromatography method. The results of the individual tests were interpreted as providing normal, homozygous or heterozygous results for S, C and D hemoglobin, in addition to other possible hemoglobinopathies. Prevalence of hemoglobinopathies according to gender, skin color, region, age and schooling was estimated. RESULTS: Hemoglobinopathies were present in 3.7% of the population. The main ones were the sickle cell trait (2.49%), thalassemia minor (0.30%) and suspected thalassemia major (0.80%). In relation to the sickle cell trait and suspected thalassemia major, there was a statistically significant difference for the skin color variable (p<0.05). The prevalences found for sickle cell trait according to skin color was: 4.1% among dark-skinned blacks, 3.6% among light-skinned blacks, 1.2% among whites, and 1.7% among others. CONCLUSION: The most prevalent hemoglobinopathies were the sickle cell trait and minor thalassemia, and were predominate among light- and dark-skinned black people. The study helps in identifying hemoglobinopathies and in genetic counseling in pre-conception.


Assuntos
Inquéritos Epidemiológicos/métodos , Traço Falciforme/epidemiologia , Talassemia beta/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Cromatografia Líquida de Alta Pressão , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Fatores Socioeconômicos , Adulto Jovem
7.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190008.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596379

RESUMO

OBJECTIVE: To verify the prevalence of anemia in Brazilian adults and elderly. METHODS: This is a cross-sectional study consisted of 8,060 subjects aged over 18 years old in all Brazilian states. We used data from laboratory tests of the Brazilian National Health Survey (Pesquisa Nacional de Saúde - PNS). The following indicators obtained by erythrogram were used: hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and red cell distribution width (RDW). Reference values of the World Health Organization (WHO) were used to determine anemia, which considers hemoglobin levels below 13.0 g/dL for men and less than 12.0 g/dL for women. Sociodemographic information was obtained by interview. RESULTS: The prevalence of anemia among Brazilian adults and elderly was 9.9%. Higher prevalence of anemia and more severe cases were found among women, elderly, people with low schooling, black skin color and residents of the North and Northeast regions. Normocytic normochromic anemia was the most common type of anemia (56.0%). CONCLUSION: The anemia prevalence found in the study was in agreement with the literature. It must be stressed that higher anemia prevalence was found in disadvantaged and older population. Considering the increase of the population over 60 years of age, interventions to prevent and treat anemia among adults and elderly is imperative in the health service network.


Assuntos
Anemia/epidemiologia , Inquéritos Epidemiológicos/métodos , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Brasil/epidemiologia , Estudos Transversais , Índices de Eritrócitos , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Valores de Referência , Índice de Gravidade de Doença , Distribuição por Sexo , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
8.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190009.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596380

RESUMO

OBJECTIVE: To estimate the salt intake in the Brazilian population according to their urinary sodium excretion. METHODS: The National Health Survey (2013) aimed to gather data on the health of adults (≥ 18 years) through a random selection of households. In each household, one adult was selected to have their biological data collected (anthropometry, blood pressure, and blood and urine tests). The urine sample was sent to a central laboratory to determine sodium (ion-selective electrode) and creatinine (Jaffé method) concentrations. Sodium excretion was estimated with the Tanaka equation. RESULTS: Urinary sodium and creatinine concentrations were measured in 8,083individuals (58% women). The mean salt intake was estimated at 9.34 g/day (95% confidence interval - 95%CI 9.27 - 9.41) and was higher in males (9.63 g/day; 95%CI 9.52 - 9.74) than in females (9.08 g/day; 95%CI 8.99 - 9.17). Wefound no significant differences regarding age group, ethnicity, or schooling. Salt intake was higher in the Southeast and South regions and lower in the Northeast and North. Only 2.4% (95%CI 2.0 - 2.8) of the sample consumed less than 5 g/day, and 58.2% (95%CI 56.7 - 59.6) of participants had an estimated intake of 8 to 12 g/day. CONCLUSION: The mean salt intake in the Brazilian population is approximately twice the recommended by the World Health Organization (5g/day).Given the association of high salt intake with hypertension and decreased renal function, these data indicate the need to adopt comprehensive public policies to reduce the consumption in the Brazilian population.


Assuntos
Dieta/estatística & dados numéricos , Inquéritos Epidemiológicos/métodos , Cloreto de Sódio na Dieta , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Valores de Referência , Distribuição por Sexo , Fatores Socioeconômicos , Cloreto de Sódio na Dieta/urina , Fatores de Tempo , Adulto Jovem
9.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190010.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596381

RESUMO

OBJECTIVE: To evaluate the renal function of the Brazilian adult population, according to laboratory criteria of the National Health Survey (Pesquisa Nacional de Saúde - PNS). METHODOLOGY: A descriptive study was carried out with laboratory data from the PNS, which was collected between the years 2014 and 2015. Population prevalence of the serum creatinine (CR) and estimated glomerular filtration rate (GFR) according to sociodemographic variables, were analyzed from the PNS laboratory data. RESULTS: The sample consisted of 8,535 individuals aged 18 years old or older for the study of CR and 7,457 for the study of GFR. The GFR prevalence < 60 mL/min/1.73 m2 was 6.7% (95%CI 6.0 - 7.4), higher in women (8.2% 95%CI 7.2 - 9.2) than in men (5.0% 95%CI 4.2 - 6.0) p < 0.001, and in elderly > 60 years old it was 21.4%. For the values of CR ≥ 1.3 mg/dL in men were 5.5% (95%CI 4.6 - 6.5), and in women values of CR ≥ 1.1 mg/dL were 4.6% (95%CI 4.0 - 5.4), with no diference between the genders, p = 0.140. CONCLUSION: Results from the PNS laboratory identified a higher prevalence of chronic kidney disease in the Brazilian population than that estimated in self-reported studies, with higher GFR < 60 mL/min/1.73 m2 in women, and reaching one fifth of the elderly. These tests may be useful for the purpose of identifying the disease early on and thus preventing the progression of renal damage and reduce the risk of cardiovascular events and mortality.


Assuntos
Inquéritos Epidemiológicos/métodos , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Creatinina/sangue , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Fatores Socioeconômicos , Adulto Jovem
10.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190011.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596382

RESUMO

INTRODUCTION: High income concentration prevails in Brazil and socioeconomic status influences living and health conditions, including dietary quality. OBJECTIVE: To measure the magnitude of social inequalities in the food quality profile of the Brazilian population. METHOD: We analyzed data from 60,202 adults who participated in the 2013 National Health Survey. The prevalence of indicators of food quality was estimated according to gender, ethnicity, income, schooling, and health insurance. We calculated prevalence ratios using multiple Poisson regression. RESULTS: Healthy food consumption was more prevalent among females, white people, and individuals with higher socioeconomic status. However, we also found a higher prevalence of some foods considered unhealthy, such as sweets, sandwiches, snacks, and pizzas, among the most favored social segments, in women, and white people, expressing the concomitance of healthy and unhealthy eating habits. The comparison between the consumption of skim and low-fat milk according to income (prevalence ratio - PR = 4.48) presented the most significant difference. CONCLUSION: In addition to the expressive social inequality identified in the Brazilian food profile, mixed patterns were detected, including healthy and unhealthy foods. These results point out the need for monitoring and promoting healthy eating habits, taking into account the social inequalities and contradictions concerning food intake.


Assuntos
Comportamento Alimentar , Qualidade dos Alimentos , Inquéritos Epidemiológicos/métodos , Inquéritos Nutricionais/métodos , Classe Social , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Inquéritos Nutricionais/estatística & dados numéricos , Prevalência , Fatores Socioeconômicos , Fatores de Tempo
11.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190012.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596383

RESUMO

OBJECTIVE: To evaluate the prevalence of noncommunicable disease (NCD) indicators, including laboratory tests, in the population of Brazilian women of reproductive age, according to whether or not they receive the Bolsa Família (BF) benefit. METHODS: A total of 3,131 women aged 18 to 49 years old who participated in the National Health Survey (Pesquisa Nacional de Saúde ) laboratory examination sub-sample were considered. We compared indicators among women of reproductive age (18 to 49 years old) who reported receiving BF or not, and calculated prevalence and confidence intervals, using Pearson's χ2. RESULTS: Women of reproductive age who were beneficiaries of BF had worse health outcomes, such as a greater occurrence of being overweight (33.5%) and obese (26.9%) (p < 0.001), having hypertension (13.4% versus 4.4%, p < 0.001), used more tobacco (11.2% versus 8.2%, p = 0.029), and perceived their health as worse (6.2% versus 2.4%, p < 0.001). CONCLUSION: Several NCD indicators were worse among women of childbearing age who were beneficiaries of BF. It should be emphasized that this is not a causal relationship, with BF being a marker of inequalities among women. The benefit has been directed to the population with greater health needs, and seeks to reduce inequities.


Assuntos
Doenças não Transmissíveis/epidemiologia , Assistência Pública/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Doença Crônica , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Prevalência , Valores de Referência , Reprodução/fisiologia , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
12.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190013.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596384

RESUMO

OBJECTIVE: To analyze social inequalities in the prevalence of indicators of active aging in the Brazilian older adult population. METHODS: This is a cross-sectional study with a sample of 11,177 older adults who participated in the Brazilian National Health Survey in 2013. We estimated the prevalence of five domains of active aging (social activities, civic engagement, leisure-time physical activity, paid work, and volunteer work) according to gender, ethnicity, schooling, income, and private health insurance. Prevalence ratios and confidence intervals were calculated using Poisson regression. RESULTS: The percentage of involvement in organized social activities, civic engagement, and physical activity was 25.1, 12.4, and 13.1%, respectively. Regarding work, 20.7% of the sample had a paid job, and 9.7% participated in volunteer work. Women had a higher prevalence of participation in organized social activities and volunteer work; while civic engagement and paid work were more frequent among men. White people were more likely to participate in social activities, volunteer work, and leisure-time physical activity, explained by their schooling. The strata with a higher level of schooling, income, and who had private health insurance showed a greater incidence of participation in all activities studied. CONCLUSION: The five activities analyzed are challenging for the proposed policy of active aging, as they are marked by considerable social inequality.


Assuntos
Envelhecimento/fisiologia , Exercício/fisiologia , Inquéritos Epidemiológicos/métodos , Classe Social , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Atividades de Lazer , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Trabalho/fisiologia , Trabalho/estatística & dados numéricos
13.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190014.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596385

RESUMO

OBJECTIVES: To analyze the socioeconomic and demographic differences in medication use to control hypertension and diabetes mellitus in Brazil. METHOD: Data from the National Health Survey (Pesquisa Nacional de Saúde - PNS) performed in Brazil in 2013 with a representative sample of the population aged 18years old or older were analyzed. The use of medications for hypertension and diabetes according to income, education, race, possession of a private health insurance plan and region of household were estimated. Theprevalence ratios adjusted for sex and age were also estimated using Poisson regression. RESULTS: 81.4% of the hypertensive population used medication to control the disease. The use was higher among females, white/Caucasian individuals and those with a private health plan. In the case of diabetes mellitus, 80.2% of the population used medication to control the disease and the use was higher in elderly patients, patients with a higher level of education, patients with a private health plan, and patients in the Southeast region. Inequalities according to income and health plan were small even in the strata of sex, age and geographic region analyzed. CONCLUSION: We found a high use of medication to control hypertension and diabetes. Socioeconomic inequalities in use were not expressive, probably due to medication policies that promote greater and equitable access to medicines in Brazil.


Assuntos
Anti-Hipertensivos/uso terapêutico , Diabetes Mellitus/tratamento farmacológico , Inquéritos Epidemiológicos/métodos , Hipertensão/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Disparidades em Assistência à Saúde , Humanos , Hipertensão/epidemiologia , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Classe Social , Fatores Socioeconômicos , Adulto Jovem
14.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190016.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596387

RESUMO

OBJECTIVE: To analyze the risk factors associated with the self-reported medical diagnosis of heart disease in Brazil. METHODS: This is a cross-sectional study, analyzing information from 60,202 adult participants of the Brazilian National Health Survey in 2013. Heart disease was defined by self-reported medical diagnosis of heart disease. We analyzed associations between the occurrence of disease and sociodemographic characteristics, health conditions and lifestyle. A hierarchical binary logistic regression model was used. RESULTS: The prevalence of self-reported diagnosis of heart disease in Brazil was 4.2% (confidence interval of 95% [95%CI] 4.0 ‒ 4.3) and was associated with females (odds ratio [OR] = 1.1; 95%CI 1.1 ‒ 1.1), people 65 years old or older (OR = 4.7; 95%CI 3.3 ‒ 5.6), poor or very poor health conditions (OR = 4.1; 95%CI 3.5 ‒ 4.6) and fair health conditions (OR = 2.4; 95%CI 2.2 ‒ 2.7), hypertensive individuals (OR = 2.4; 95%CI 2.2 ‒ 2.7), those with increased cholesterol (OR = 1.6; 95%CI 1.5 ‒ 1.8), overweight individuals (OR = 1.5; 95%CI 1.4 ‒ 1.8) and obese individuals (OR = 2.0; 95%CI 1.7 ‒ 2.2), sedentary behavior (OR = 1.5; 95%CI 1.02 ‒ 2.1), former smokers (OR = 1.4; 95%CI 1.3 ‒ 1.6) or current smokers (OR = 1.2; 95%CI 1.03 ‒ 1.3) and the consumption of fruits and vegetables 5 or more days each week (OR = 1.5; 95%CI 1.1 ‒ 1.5). CONCLUSION: The importance of knowledge on the prevalence of heart disease and associated risk factors in the present Brazilian epidemiological context must be emphasized because it guides actions to control and prevent cardiovascular diseases, the leading cause of death in Brazil and worldwide.


Assuntos
Autoavaliação Diagnóstica , Inquéritos Epidemiológicos/métodos , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Autorrelato/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Valores de Referência , Medição de Risco , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Adulto Jovem
15.
BMC Infect Dis ; 19(1): 594, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286891

RESUMO

BACKGROUND: People aging with HIV can experience a variety of health challenges associated with HIV and multimorbidity, referred to as 'disability'. Our aim was to characterize the disability experience and examine relationships between dimensions of disability among adults living with HIV. METHODS: We performed a structural equation modeling analysis with data from the Canadian web-based HIV, Health and Rehabilitation Survey. We measured disability using the HIV Disability Questionnaire (HDQ), a patient-reported outcome (69 items) that measures presence, severity and episodic features of disability across six domains: 1) physical symptoms, 2) cognitive symptoms, 3) mental-emotional health symptoms, 4) difficulties carrying out day-to-day activities, 5) uncertainty and worrying about the future, and 6) challenges to social inclusion. We used HDQ severity domain scores to represent disability dimensions and developed a structural model to assess relationships between disability dimensions using path analysis. We determined overall model fit with a Root Mean Square Error of Approximation (RMSEA) of < 0.05. We classified path coefficients of ≥ 0.2-0.5 as a medium (moderate) effect and > 0.5 a large (strong) effect. We used Mplus software for the analysis. RESULTS: Of the 941 respondents, most (79%) were men, taking combination antiretroviral medications (90%) and living with two or more simultaneous health conditions (72%). Highest HDQ presence and severity scores were in the uncertainty domain. The measurement model had good overall fit (RMSEA= 0.04). Results from the structural model identified physical symptoms as a strong direct predictor of having difficulties carrying out day-to-day activities (standardized path coefficient: 0.54; p < 0.001) and moderate predictor of having mental-emotional health symptoms (0.24; p < 0.001) and uncertainty (0.36; p < 0.001). Uncertainty was a strong direct predictor of having mental-emotional health symptoms (0.53; p < 0.001) and moderate direct predictor of having challenges to social inclusion (0.38; p < 0.001). The relationship from physical and cognitive symptoms to challenges to social inclusion was mediated by uncertainty, mental-emotional health symptoms, and difficulties carrying out day-to-day activities (total indirect effect from physical: 0.22; from cognitive: 0.18; p < 0.001). CONCLUSIONS: Uncertainty is a principal dimension of disability experienced by adults with HIV. Findings provide a foundation for clinicians and researchers to conceptualize disability and identifying areas to target interventions.


Assuntos
Infecções por HIV , Inquéritos Epidemiológicos , Canadá , Avaliação da Deficiência , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Infecções por HIV/reabilitação , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/normas , Humanos , Internet , Inquéritos e Questionários
16.
BMC Public Health ; 19(Suppl 2): 451, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159764

RESUMO

This Supplement aims to raise awareness and knowledge of how time use surveys may be applied to studying health behaviours such as physical activity, sedentary behaviour, and eating. This commentary provides an overview and discussion of the papers in this Supplement about time use and health research, and considers possible future directions for the field.


Assuntos
Actigrafia/métodos , Atividades Cotidianas , Inquéritos Epidemiológicos/métodos , Saúde Pública/métodos , Fatores de Tempo , Exercício , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Comportamento Sedentário
17.
BMC Public Health ; 19(Suppl 2): 453, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159771

RESUMO

BACKGROUND: Behaviour has diverse economic, social and health consequences. Linking time spent in different daily activities to energy expenditure (EE) is one way of investigating the health and physiological consequences of behaviour and identifying targets to improve population health and well-being. METHODS: We estimated behaviour-related EE for respondents to time use surveys (TUS) from three countries: UK 2001, Poland 2012 and US 2003-13. The Harmonised Multinational Time Use Survey (MTUS) activity categories were matched to MET estimates from the 2011 Compendium of Physical Activities. We attach METs values to each successive activity in the TUS, together with both the original UK, Polish and US activity classifications and the 68-category MTUS activity classification. We used TUS estimates of activity durations across 24-h to estimate the Physical Activity Level (PAL) for respondents from the three countries and the average time spent and MET values for different activity categories. RESULTS: PAL values ranged from 1.59 in the US to 1.74 in Poland. The main sources of daily EE from PA were paid and unpaid work activities. Discretionary PA accounted for only a very small part (~ 3%) of adult daily energy expenditures. Using the harmonised MTUS 68-activity classification reduced the variability of the aggregate PAEE measure by ~ 20%, but the patterns of association between key demographics (age, sex, educational attainment) were unaffected. TUS data were further used to (1) identify sources of daily PA, and (2) assess adherence to physical activity guidelines (PAG) on a single-day basis. Estimated adherence levels were similar to those reported from other TUS as well as frequency based estimates. CONCLUSIONS: Comparative studies of energy expenditure based on harmonised time use activity categories could provide insight into the relative importance of different activities for energy expenditure across different countries and demographic groups. However, new observational studies combining TUS data with accelerometer, direct observation and other measures of activity intensity are required for more accurate MET assignments to activity categories in TUS.


Assuntos
Metabolismo Energético , Exercício , Inquéritos Epidemiológicos/estatística & dados numéricos , Atividades Humanas/estatística & dados numéricos , Fatores de Tempo , Atividades Cotidianas , Adulto , Feminino , Inquéritos Epidemiológicos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Reino Unido , Estados Unidos
18.
BMC Public Health ; 19(Suppl 2): 454, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159781

RESUMO

BACKGROUND: Over the last 150 years, advanced economies have seen the burden of disease shift to non-communicable diseases. The risk factors for these diseases are often co-morbidities associated with unhealthy weight. The prevalence of overweight/obesity among adults in the advanced countries of the English-speaking world is currently more than two-thirds of the adult population. However, while much attention has concentrated on changes in diet that might have provoked this rapid increase in unhealthy weight, changes in patterns of eating have received little attention. METHODS: This article examines a sequence of large-scale, time use surveys in urban Australia stretching from 1974 to 2006. The earliest survey in 1974 (conducted by the Cities Commission) was limited to respondents aged between 18 and 69 years, while the later surveys (by the Australian Bureau of Statistics) included all adult (15 years of age or over) living private dwellings. Since time use surveys capture every activity in a day, they contain much information about mealtimes and the patterns of eating. This includes duration of eating, number of eating occasions and the timing of eating. Inferential statistics were used to test the statistical significance of these changes and the size of the effects. RESULTS: The eating patterns of urban Australian adults have changed significantly over a 32-year period and the magnitude of this change is non-trivial. Total average eating time as main activity has diminished by about a third, as have eating occasions, affecting particularly luncheon and evening meals. However, there is evidence that eating as secondary activity that accompanies another activity is now almost as frequent as eating at mealtimes. Moreover, participants seem not to report it. CONCLUSIONS: Contemporary urban Australians are spending less time in organized shared meals. These changes have occurred the over same period during which there has been a public health concern about the prevalence of unhealthy weight. Preliminary indications are that societies that emphasize eating as a commensal, shared activity through maintaining definite, generous lunch breaks and prioritizing eating at mealtimes, achieve better public health outcomes. This has implications for a strategy of health promotion, but to be sure of this we need to study countries with these more socially organized eating patterns.


Assuntos
Ingestão de Alimentos/psicologia , Comportamento Alimentar/psicologia , Obesidade/psicologia , Sobrepeso/psicologia , Adolescente , Adulto , Idoso , Anomia (Social) , Austrália/epidemiologia , Peso Corporal , Estudos Transversais , Dieta/psicologia , Dieta/estatística & dados numéricos , Epidemias , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Refeições , Pessoa de Meia-Idade , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Comportamento Social , Fatores de Tempo , População Urbana/estatística & dados numéricos , Adulto Jovem
19.
PLoS Med ; 16(3): e1002757, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30861006

RESUMO

BACKGROUND: Despite the sharp decline in global under-5 deaths since 1990, uneven progress has been achieved across and within countries. In sub-Saharan Africa (SSA), the Millennium Development Goals (MDGs) for child mortality were met only by a few countries. Valid concerns exist as to whether the region would meet new Sustainable Development Goals (SDGs) for under-5 mortality. We therefore examine further sources of variation by assessing age patterns, trends, and forecasts of mortality rates. METHODS AND FINDINGS: Data came from 106 nationally representative Demographic and Health Surveys (DHSs) with full birth histories from 31 SSA countries from 1990 to 2017 (a total of 524 country-years of data). We assessed the distribution of age at death through the following new demographic analyses. First, we used a direct method and full birth histories to estimate under-5 mortality rates (U5MRs) on a monthly basis. Second, we smoothed raw estimates of death rates by age and time by using a two-dimensional P-Spline approach. Third, a variant of the Lee-Carter (LC) model, designed for populations with limited data, was used to fit and forecast age profiles of mortality. We used mortality estimates from the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) to adjust, validate, and minimize the risk of bias in survival, truncation, and recall in mortality estimation. Our mortality model revealed substantive declines of death rates at every age in most countries but with notable differences in the age patterns over time. U5MRs declined from 3.3% (annual rate of reduction [ARR] 0.1%) in Lesotho to 76.4% (ARR 5.2%) in Malawi, and the pace of decline was faster on average (ARR 3.2%) than that observed for infant (IMRs) (ARR 2.7%) and neonatal (NMRs) (ARR 2.0%) mortality rates. We predict that 5 countries (Kenya, Rwanda, Senegal, Tanzania, and Uganda) are on track to achieve the under-5 sustainable development target by 2030 (25 deaths per 1,000 live births), but only Rwanda and Tanzania would meet both the neonatal (12 deaths per 1,000 live births) and under-5 targets simultaneously. Our predicted NMRs and U5MRs were in line with those estimated by the UN IGME by 2030 and 2050 (they overlapped in 27/31 countries for NMRs and 22 for U5MRs) and by the Institute for Health Metrics and Evaluation (IHME) by 2030 (26/31 and 23/31, respectively). This study has a number of limitations, including poor data quality issues that reflected bias in the report of births and deaths, preventing reliable estimates and predictions from a few countries. CONCLUSIONS: To our knowledge, this study is the first to combine full birth histories and mortality estimates from external reliable sources to model age patterns of under-5 mortality across time in SSA. We demonstrate that countries with a rapid pace of mortality reduction (ARR ≥ 3.2%) across ages would be more likely to achieve the SDG mortality targets. However, the lower pace of neonatal mortality reduction would prevent most countries from achieving those targets: 2 countries would reach them by 2030, 13 between 2030 and 2050, and 13 after 2050.


Assuntos
Mortalidade da Criança/tendências , Inquéritos Epidemiológicos/tendências , Mortalidade Infantil/tendências , Modelos Teóricos , África ao Sul do Saara/epidemiologia , Distribuição por Idade , Pré-Escolar , Feminino , Previsões/métodos , Inquéritos Epidemiológicos/métodos , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Lesoto/epidemiologia , Malaui/epidemiologia , Masculino , Ruanda/epidemiologia , Senegal/epidemiologia , Tanzânia/epidemiologia , Uganda/epidemiologia
20.
J Consult Clin Psychol ; 87(4): 321-331, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30883161

RESUMO

OBJECTIVE: Sexual minority individuals display elevated rates of psychiatric and substance use disorders compared with heterosexuals. Racial/ethnic minority individuals report lower prevalence of disorders compared with White individuals. Research on sexual minority mental health often neglects research on racial/ethnic minority mental health and vice versa. Therefore, at the intersection of sexual and racial/ethnic minority status, the prevalence of disorders remains unclear. METHOD: In a nationally representative sample (N = 36,309), we compared disorder prevalence between sexual minorities and same-race/ethnicity heterosexuals. We then examined the extent to which differences in disorder prevalence between sexual minorities and heterosexuals can be attributed to differences in discrimination experiences related to sexual minority status. We next compared prevalence of disorders for Black and Hispanic with White sexual minority individuals. We examined whether these patterns of associations were reflective of transdiagnostic factor differences among groups. RESULTS: Regardless of race/ethnicity, sexual minority individuals experience higher prevalence of disorders than heterosexuals. Controlling for discrimination experiences partially negates these disparities. At the intersection of racial/ethnic and sexual minority status, disorder prevalence is more nuanced: Although Black sexual minority individuals experience lower prevalence of disorders than Whites, Hispanic sexual minority individuals experience similar prevalence of disorders to Whites. Similar findings are observed using a transdiagnostic factors framework. CONCLUSIONS: These findings reveal important intersectional nuances in the prevalence of psychopathology often overlooked in the race/ethnicity and sexual orientation literatures. These results can inform future scholarship on risk and resilience among marginalized populations, including identifying protective factors associated with possessing certain multiple minority statuses. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Sexualidade/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupos de Populações Continentais/psicologia , Feminino , Inquéritos Epidemiológicos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Sexualidade/psicologia , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
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