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Heidemann ITSB, Durand MK, Adão I, Romanoski PJ, Moreira AR, Belaunde AMA, da Silva VA, Maciel KS. Culture circle in primary care: dialogues with managers on health promotion. Rev Esc Enferm USP 2024; 58:e20230420. [PMID: 38985822 PMCID: PMC11236274 DOI: 10.1590/1980-220x-reeusp-2023-0420en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/06/2024] [Indexed: 07/12/2024] Open
Abstract
OBJECTIVE To identify health promotion strategies used by managers in primary health care. METHOD Qualitative research, of a participant action nature, which adopted the Culture Circle proposed by Paulo Freire as its methodological reference. Eleven primary health care managers from a medium-sized municipality in southern Brazil took part. RESULTS Nine generative themes emerged, categorized into four themes that highlight the interconnection between health promotion, social determinants and primary health care. These themes highlight preventive approaches, healthy habits and underline the need for a multidisciplinary approach to health care, recognizing the complexity of the dimensions involved, the influence of social determinants, environmental and health issues. These aspects call for intersectoral policies and actions, demonstrating the viability of health promotion in line with the principles of the Unified Health System. FINAL CONSIDERATIONS The autonomy of professionals working in primary health care services is highlighted, especially that of nurses, who play a central role in connecting and organizing health promotion actions.
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Affiliation(s)
| | - Michelle Kuntz Durand
- Universidade Federal de Santa Catarina, Departamento de Enfermagem. Florianópolis, SC, Brazil
| | - Izaltina Adão
- Universidade Federal de Santa Catarina, Departamento de Saúde Pública, Programa de Pós-Graduação em Saúde Coletiva. Florianópolis, SC, Brazil
| | | | - Adriana Rufino Moreira
- Universidade Federal de Santa Catarina, Departamento de Enfermagem. Florianópolis, SC, Brazil
| | | | - Vladimir Araujo da Silva
- Universidade Federal de Santa Catarina, Centro de Ciências Rurais, Departamento de Biociências e Saúde Única. Santa Catarina, SC, Brazil
| | - Kamila Soares Maciel
- Universidade Federal de Santa Catarina, Departamento de Enfermagem. Florianópolis, SC, Brazil
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Silva Júnior AE, de Oliveira ADS, Praxedes DRS, da Costa Paula DT, de Lima Macena M, de Menezes Toledo Florêncio TM, Clemente APG, Bueno NB. Social and Racial Disparities in Food Consumption Among Brazilian College Students: a Nationwide Study. J Racial Ethn Health Disparities 2023; 10:2630-2640. [PMID: 36344748 DOI: 10.1007/s40615-022-01441-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
This study aims to assess the association between economic class, race/skin color, and food consumption among Brazilian college students. A cross-sectional web-based survey was conducted with college students from all over Brazil. Demographic data, economic class, self-reported race/skin color, anthropometry, and food consumption markers from the Brazilian Food and Nutrition Surveillance System were collected. The final sample comprised 5843 participants with a mean age of 24.1 (SD: 6.3) years, 4292 (73.5%) were female, and 810 (13.9%) in the highest economic stratum. We observed a progressive decrease in the frequency of fresh fruits and vegetables consumption from higher to lower economic classes (p < 0.01 for both). Contrarily, there was a progressive increase in the frequency of consumption of beans from higher to lower economic classes (p < 0.01). The frequency consumption of vegetables was also associated with race/skin color (p < 0.01), being lower in brown (PR: 0.94; CI 95%: 0.90; 0.98), and black (PR: 0.91; 95% CI: 0.85; 0.98) individuals, compared to white individuals. Brown individuals showed higher frequency consumption of beans (PR: 1.10; 95% CI: 1.05; 1.15) than whites. When compared to individuals of white race/skin color, brown (PR: 1.07; 95% CI: 1.01; 1.13) and black (PR: 1.15; 95% CI: 1.07; 1.23) individuals showed higher frequency consumption of sweetened beverages. Economic class and race/skin color were independent factors associated with the food consumption of Brazilian college students.
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Affiliation(s)
- André Eduardo Silva Júnior
- Programa de Pós-Graduação em Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ana Debora Santos de Oliveira
- Faculdade de Nutrição, Universidade Federal de Alagoas, Avenida Lourival de Melo Mota S/N, Maceió-AL, 57072-970, Brazil
| | - Dafiny Rodrigues Silva Praxedes
- Programa de Pós-Graduação em Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Mateus de Lima Macena
- Programa de Pós-Graduação em Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Ana Paula Grotti Clemente
- Faculdade de Nutrição, Universidade Federal de Alagoas, Avenida Lourival de Melo Mota S/N, Maceió-AL, 57072-970, Brazil
| | - Nassib Bezerra Bueno
- Faculdade de Nutrição, Universidade Federal de Alagoas, Avenida Lourival de Melo Mota S/N, Maceió-AL, 57072-970, Brazil.
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Ferreira MS, da Silva ZP, de Almeida MF, Alencar GP. Is parenthood associated with self-rated health among women in Brazil? PLoS One 2023; 18:e0293262. [PMID: 37903132 PMCID: PMC10615280 DOI: 10.1371/journal.pone.0293262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/09/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Previous studies conducted in Europe and North America addressing the relationship between self-rated health and parenthood offer inconsistent results, with effects ranging from nonsignificant to significant and in opposite directions. The aim of the present study was to explore the relationship between parenthood and self-rated health (SRH) among women in Brazil (a country with strong inequalities) considering the time interval from the last delivery in the analyses, as proposed in previous studies set in Sweden. METHODS The study used data from cross-sectional National Health Surveys in Brazil conducted from 2013 to 2014 and 2019 to 2020 with selected groups of 20,046 and 25,100 women for whom complete data were available on the variables of interest. The primary outcome was self-rated health measured on a five-point scale. Partial proportional odds models were employed. RESULTS Compared to women that were not a parent, primiparous women whose delivery was within less than one year had a lower likelihood of worse SRH (OR (95% CI): 0.58-0.84 in 2013, and 0.64-0.94 in 2019), whereas multiparous women whose last delivery was more than one year earlier had greater likelihood of worse SRH (OR (95% CI): 1.08-1.27 in 2013, and 1.21-1.39 in 2019). CONCLUSIONS An association was found between parenthood and SRH among Brazilian women. Considering the epidemiological relevance of SRH, different aspects of parenthood concerning parity and time since the last delivery should be considered in further analyses.
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Affiliation(s)
- Matheus Souza Ferreira
- Department of Epidemiology, University of São Paulo, School of Public Health, São Paulo, Brazil
| | - Zilda Pereira da Silva
- Department of Epidemiology, University of São Paulo, School of Public Health, São Paulo, Brazil
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Nogueira FDAM, Damacena GN, Souza Júnior PRBD, Szcwarcwald CL. [Self-reported morbidities and lifestyles of agricultural and non-agricultural workers in Brazil: a comparative analysis between 2013 and 2019]. CIENCIA & SAUDE COLETIVA 2023; 28:1971. [PMID: 37436311 DOI: 10.1590/1413-81232023287.15922022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/15/2022] [Indexed: 07/13/2023] Open
Abstract
Differences in the profiles of illness and lifestyles among agricultural and non-agricultural workers were investigated using data from the National Health Survey (Brazilian acronym PNS) of 2013 and 2019. The prevalence and 95% CIs were calculated for the following variables: self-reported morbidities, poor self-rated health, limitations of usual activities, number of NCD, major or minor depression and lifestyles. The Poisson model was used to calculate crude and adjusted prevalence ratios, by gender and age. The sample weights and the conglomerate effect in 2013 and 2019 were considered in the analyses. A total of 33,215 non-agricultural workers and 3,797 agricultural workers were evaluated in 2013, whereas 47,849 non-agricultural workers and 4,751 agricultural workers were assessed in 2019. Agricultural workers are more susceptible to poor self-rated health, chronic back problems, excessive physical activity at work, smoking and lower consumption of vegetables and fruit. On the other hand, non-agricultural workers revealed a higher prevalence of asthma/bronchitis, depression and diabetes mellitus and greater consumption of candies and soft drinks. Differentiated NCD prevention and treatment actions for both groups of workers need to be prioritized.
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Affiliation(s)
- Fernanda de Albuquerque Melo Nogueira
- Programa de Pós-Graduação em Informação e Comunicação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica, Fundação Oswaldo Cruz. Av. Brasil 4.036, sala 210, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | | | - Celia Landmann Szcwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
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Darmawan ES, Kusuma D, Permanasari VY, Amir V, Tjandrarini DH, Dharmayanti I. Beyond the Plate: Uncovering Inequalities in Fruit and Vegetable Intake across Indonesian Districts. Nutrients 2023; 15:2160. [PMID: 37432281 DOI: 10.3390/nu15092160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are responsible for the deaths of 41 million individuals every year, with 77% of them occurring in low- and middle-income countries. Among the main NCD risk factors, inadequate intake of fruits and vegetables (FV) was one of the leading causes of death in 2019. Our study aims to identify disparities in inadequate FV intake among adults in 514 districts. We utilized the latest Indonesian Basic Health Survey 2018 to conduct geospatial and quantitative analyses. We used the World Health Organization's definition of inadequate FV intake, which refers to consuming less than five servings of fruit and vegetables daily. We analyzed inadequate FV intake among adults over the age of 18 years, as well as by gender and age group (including young adults 18-24 years, adults 25-59 years, and older adults 60+ years). Our study showed an alarmingly high prevalence of inadequate FV intake among adults, with 96.3% in 2018. The prevalence of inadequate FV intake drastically varied across 514 districts, ranging from 70.1% to 100%. Notable geographic and socioeconomic disparities were observed across the districts studied. Rural districts exhibited a higher prevalence of inadequate FV intake, translating to poorer diets, particularly among females and older adults, when compared to their urban counterparts. Interestingly, districts within more developed regions had poorer FV diets than those in less developed regions. Although districts with lower incomes generally had poorer FV diets, the association was not significant in multivariate analysis. However, districts with lower levels of education demonstrated poorer FV diets, especially among females, adults, and older adults. Despite its limitations, our study provides crucial insights for health policies in Indonesia and other LMICs.
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Affiliation(s)
- Ede Surya Darmawan
- Department of Health Administration and Policy, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia
| | - Dian Kusuma
- Department of Health Services Research and Management, School of Health & Psychological Sciences, City University of London, London EC1V 0HB, UK
| | - Vetty Yulianty Permanasari
- Department of Health Administration and Policy, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia
| | - Vilda Amir
- Center for Health Administration and Policy Studies, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia
| | - Dwi Hapsari Tjandrarini
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor 16915, Indonesia
| | - Ika Dharmayanti
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor 16915, Indonesia
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Aristides Dos Santos AM, Triaca LM, Leivas PHS. How is smoking distributed in relation to socioeconomic status? Evidence from Brazil in the years 2013 and 2019. ECONOMICS AND HUMAN BIOLOGY 2023; 49:101240. [PMID: 37044042 DOI: 10.1016/j.ehb.2023.101240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/19/2023] [Accepted: 03/18/2023] [Indexed: 05/08/2023]
Abstract
The present study aimed to analyze income-related inequality in tobacco consumption in Brazil using data from the National Health Survey at two points in time (2013 and 2019). This study contributes to the growing literature analyzing socioeconomic inequalities in tobacco use by investigating income-related inequalities in the consumption of different tobacco products in Brazil. The inequality measure is the concentration index with an Erreygers correction (EI), and the analysis of its decomposition allows the identification of the factors that determine such inequality. There is inequality in smoking concentrated in the poorest persons, and this pattern also occurs for manufactured cigarettes and roll-your-own cigarettes (RYO), while inequality in smoking cessation is concentrated among the wealthiest. Smoking inequalities were greater in men, older age groups, and RYO. In terms of evolution, the overall results indicated a small decline in smoking inequality. For the decomposition analysis, the results show that the main factors that affect tobacco inequality in terms of concentration in the poorest are education, income, and having private health insurance. The region variable, by contrast, has a positive contribution, since the wealthiest regions have individuals who are more likely to smoke. These results have important implications that serve as a basis for formulating public health policies. For example, greater inequalities for men and older individuals can be targeted by public policies with a special focus on these cases.
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Affiliation(s)
| | - Lívia Madeira Triaca
- Departament of Economics, Federal University of Rio Grande Foundation (Fundação Universidade Federal do Rio Grande - FURG), Rio Grande, Brazil; Posgraduate Program in Economics, Federal University of Pelotas (Universidade Federal de Pelotas - UFPel), Rio Grande Do Sul, Brazil
| | - Pedro Henrique Soares Leivas
- Departament of Economics, Federal University of Rio Grande Foundation (Fundação Universidade Federal do Rio Grande - FURG), Brazil
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Costa JC, de Jesus ACDS, de Jesus JGL, Madruga MF, Souza TN, Louzada MLDC. Differences in food consumption of the Brazilian population by race/skin color in 2017-2018. Rev Saude Publica 2023; 57:4. [PMID: 36820683 PMCID: PMC9933641 DOI: 10.11606/s1518-8787.2023057004000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/11/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To evaluate food consumption in Brazil by race/skin color of the population. METHODS Food consumption data from the Pesquisa de Orçamentos Familiares (POF - Household Budget Survey) 2017-2018 were analyzed. Food and culinary preparations were grouped into 31 items, composing three main groups, defined by industrial processing characteristics: 1 - in natura/minimally processed, 2 - processed, and 3 - ultra-processed. The percentage of calories from each group was estimated by categories of race/skin color - White, Black, Mixed-race, Indigenous, and Yellow- using crude and adjusted linear regression for gender, age, schooling, income, macro-region, and area. RESULTS In the crude analyses, the consumption of in natura/minimally processed foods was lower for Yellow [66.0% (95% Confidence Interval 62.4-69.6)] and White [66.6% (95%CI 66.1-67.1)] groups than for Blacks [69.8% (95%CI 68.9-70.8)] and Mixed-race people [70.2% (95%CI 69.7-70.7)]. Yellow individuals consumed fewer processed foods, with 9.2% of energy (95%CI 7.2-11.1) whereas the other groups consumed approximately 13%. Ultra-processed foods were less consumed by Blacks [16.6% (95%CI 15.6-17.6)] and Mixed-race [16.6% (95%CI 16.2-17.1)], with the highest consumption among White [20.1% (95%CI 19.6-20.6)] and Yellow [24.5% (95%CI 20.0-29.1)] groups. The adjustment of the models reduced the magnitude of the differences between the categories of race/skin color. The difference between Black and Mixed-race individuals from the White ones decreased from 3 percentage points (pp) to 1.2 pp in the consumption of in natura/minimally processed foods and the largest differences remained in the consumption of rice and beans, with a higher percentage in the diet of Black and Mixed-race people. The contribution of processed foods remained approximately 4 pp lower for Yellow individuals. The consumption of ultra-processed products decreased by approximately 2 pp for White and Yellow groups; on the other hand, it increased by 1 pp in the consumption of Black, Mixed-race, and Indigenous peoples. CONCLUSION Differences in food consumption according to race/skin color were found and are influenced by socioeconomic and demographic conditions.
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Affiliation(s)
- Janaína Calu Costa
- Universidade Federal de PelotasCentro Internacional para Equidade em SaúdePrograma de Pós-Graduação em EpidemiologiaPelotasRSBrasil Universidade Federal de Pelotas. Centro Internacional para Equidade em Saúde. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Amanda Cristina da Silva de Jesus
- Universidade de São PauloFaculdade de Saúde PúblicaPrograma de Pós-Graduação em Nutrição em Saúde PúblicaSão PauloSPBrasil Universidade de São Paulo. Faculdade de Saúde Pública. Programa de Pós-Graduação em Nutrição em Saúde Pública. São Paulo, SP, Brasil
| | - Juliana Giaj Levra de Jesus
- Universidade de São PauloFaculdade de Saúde PúblicaPrograma de Pós-Graduação em Nutrição em Saúde PúblicaSão PauloSPBrasil Universidade de São Paulo. Faculdade de Saúde Pública. Programa de Pós-Graduação em Nutrição em Saúde Pública. São Paulo, SP, Brasil
| | - Mariana Ferreira Madruga
- Universidade de São PauloFaculdade de MedicinaPrograma de Pós-Graduação em Saúde ColetivaSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Coletiva. São Paulo, SP, Brasil.
- Universidade de São PauloNúcleo de Pesquisas Epidemiológicas em Nutrição e SaúdeSão PauloSPBrasil Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
| | - Thays Nascimento Souza
- Universidade de São PauloFaculdade de Saúde PúblicaPrograma de Pós-Graduação em Nutrição em Saúde PúblicaSão PauloSPBrasil Universidade de São Paulo. Faculdade de Saúde Pública. Programa de Pós-Graduação em Nutrição em Saúde Pública. São Paulo, SP, Brasil
- Universidade de São PauloNúcleo de Pesquisas Epidemiológicas em Nutrição e SaúdeSão PauloSPBrasil Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
| | - Maria Laura da Costa Louzada
- Universidade de São PauloFaculdade de Saúde PúblicaPrograma de Pós-Graduação em Nutrição em Saúde PúblicaSão PauloSPBrasil Universidade de São Paulo. Faculdade de Saúde Pública. Programa de Pós-Graduação em Nutrição em Saúde Pública. São Paulo, SP, Brasil
- Universidade de São PauloNúcleo de Pesquisas Epidemiológicas em Nutrição e SaúdeSão PauloSPBrasil Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
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Reis de Souza V, Kelly S, Cerdeira Sabino E, Mendes de Oliveira F, Silva T, Miranda Teixeira C, Máximo C, Loureiro P, Barbara de Freitas Carneiro-Proietti A, Gomes I, Custer B, de Almeida-Neto C. Factors Associated with Leg Ulcers in Adults with Sickle Cell Disease in Brazil. Adv Skin Wound Care 2023; 36:98-105. [PMID: 36662043 DOI: 10.1097/01.asw.0000911152.41719.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To define the prevalence of leg ulcers and identify the clinical and laboratory factors associated with leg ulcers in adult participants. METHODS The authors conducted a cross-sectional study of 1,109 patients who were 18 years or older with SS or Sβ0-thalassemia genotypes from a Brazilian cohort. Investigators assessed the prevalence of factors associated with leg ulcers from 2013 to 2017. RESULTS The prevalence of leg ulcers was 21%. Increasing age (odds ratio [OR], 1.07; range, 1.06-1.09), male sex (OR, 2.03; range, 1.44-2.87), treatment with chronic transfusion therapy (OR, 1.88; range, 1.15-3.03), higher indirect bilirubin levels (OR, 1.48; range, 1.02-2.16), and low hemoglobin levels (OR, 2.17; range, 1.52-3.11) were associated with leg ulcers. Participants who self-reported as Black (OR, 6.75; range, 2.63-21.32), mixed (OR, 3.91; range, 1.55-12.20), and other/unknown (OR, 3.84; range, 1.04-15.24) were more likely to have leg ulcers compared with those who self-reported as White. CONCLUSIONS The prevalence of leg ulcers in this Brazilian cohort was higher than the prevalence reported in developed countries. Known factors such as age and male sex were corroborated. The increased bilirubin level and decreased hemoglobin levels among participants with leg ulcers support the hypothesis that hemolysis is correlated with leg ulcer pathogenesis. Self-reported black skin color was an independent predictor of leg ulcers and warrants further study to understand the etiology and implications of this finding.
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Affiliation(s)
- Valquíria Reis de Souza
- Valquíria Reis de Souza, MSc, is Biologist, Instituto de Medicina Tropical, University of São Paulo, Brazil. Shannon Kelly, MD, is Associate Professor, Pediatrics, Vitalant Research Institute, San Francisco, California. Also at Instituto de Medicina Tropical, University of São Paulo, Ester Cerdeira Sabino, MD, PhD, is Associate Professor and Franciane Mendes de Oliveira, BSc, is Master's Degree Student. Tassila Silva, PhD, is Assistant Professor, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte. Carolina Miranda Teixeira, MSc, is Biologist and Master, Faculdade de Medicina, Universidade Federal de Minas Gerais. Claudia Máximo, MD, is Hematologist at Hemorio, Hemocentro do Rio de Janeiro. Paula Loureiro, MD, PhD, is Adjunct Professor and Researcher at Hemope and Universidade de Pernambuco, Recife. Also at Fundação Hemominas, Hemocentro de Minas Gerais, Anna Barbara de Freitas Carneiro-Proietti, MD, PhD, is Senior Researcher. Isabel Gomes, PhD, is Researcher at Universidade Federal de Minas Gerais. Brian Custer, PhD, MPH, is Director, Vitalant Research Institute, San Francisco, California and Professor of Laboratory Medicine, University of California, San Francisco. Cesar de Almeida-Neto, MD, PhD, is Associate Professor at Faculdade de Medicina da Universidade de São Paulo and Chief of Apheresis Department at Fundação Pró-Sangue Hemocentro de São Paulo. Acknowledgment: This work was supported by the National Institutes of Health National Heart, Lung, and Blood Institute by grant HHSN268201100007I. Recipient Epidemiology and Donor Evaluation Study-III: International Component (Brazil), with the participation of the following centers and investigators. Brazilian participants: Instituto de Medicina Tropical de São Paulo (USP): Ester C. Sabino, Cecilia Alencar; Fundação Pró-Sangue (São Paulo): Alfredo Mendrone, Jr, Cesar de Almeida Neto, Ligia Capuani; Instituto de Tratamento do Câncer Infantil (São Paulo): Miriam Park; Faculdade de Medicina da Universidade de São Paulo (São Paulo): Paula Blatyta; Hemominas-Belo Horizonte (Minas Gerais): Anna Bárbara de Freitas Carneiro-Proietti, Andre Belisario, Carolina Miranda Teixeira, Tassila Salomon, Franciane Mendes de Oliveira, Valquíria Reis. Hemominas; Montes Claros (Minas Gerais): Rosemere Afonso Mota, José Wilson Sales; Hemominas-Juiz de Fora (Minas Gerais): Daniela de Oliveira Werneck; Fundação Hemope-Recife (Pernambuco): Paula Loureiro, Aderson Araújo, Dahra Teles Hemorio (Rio de Janeiro): Clarisse Lobo, Claudia Máximo, Luiz Amorin; Instituto de Matemática e Estatística da Universidade de São Paulo-USP (São Paulo): João Eduardo Ferreira, Márcio Katsumi Oikawa, Pedro Losco Takecian, Mina Cintho Ozahata, Rodrigo Muller de Carvalho. US Investigators: Vitalant Research Institute and University of California San Francisco: Brian Scott Custer, Michael P. Busch, and Thelma Therezinha Gonçalez; Research Triangle Institute: Donald Brambilla, Liliana R. Preiss, Christopher McClure; UCSF Benioff Children's Hospital Oakland: Shannon Kelly; National Heart, Lung, and Blood Institute-Simone A. Glynn. The authors have disclosed no other financial relationships related to this article. Submitted February 16, 2022; accepted in revised form August 12, 2022
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de Sousa LCM, Silva NR, Azeredo CM, Rinaldi AEM, da Silva LS. Health-related patterns and chronic kidney disease in the Brazilian population: National Health Survey, 2019. Front Public Health 2023; 11:1090196. [PMID: 37089474 PMCID: PMC10117670 DOI: 10.3389/fpubh.2023.1090196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 03/10/2023] [Indexed: 04/25/2023] Open
Abstract
Objective The aim of this study was to identify patterns related to health and their association with chronic kidney disease (CKD) in the Brazilian population. Methods We used data from the National Health Survey (PNS), 2019. Participants were interviewed and answered questions related to socioeconomic and demographic information (gender, age, education, race/color), health conditions (presence of hypertension, diabetes mellitus, hyperlipidemia, cardiovascular disease, overweight and CKD) and lifestyle (smoking, alcohol consumption, physical activity and food consumption). To identify patterns, we used exploratory factor analysis. We performed logistic regression models to describe the association of CKD with each pattern in crude models and adjusted for gender, age group, education level and race/color. Results A total of 90,846 individuals were evaluated. The prevalence of CKD was 1.49% (95% CI: 1.3-1.6). Three health-related patterns - metabolic factors, behavioral risk factors and behavioral protective factors - were identified by factor analysis. Metabolic factors were determined by the presence of hypertension, diabetes mellitus, hyperlipidemia and cardiovascular diseases. Behavioral risk factors were determined by smoking, alcohol consumption, regular consumption of soft drinks, sweets and artificial juices, and high salt consumption. The protective behavioral factors were established by the practice of physical activity and regular consumption of vegetables and fruits. Participants of the highest tertile for metabolic factors were more likely to have CKD in the adjusted model (OR = 3.61, 95% CI: 2.69-4.85), when compared to those of the lower tertile. Conclusion The pattern referring to metabolic factors was associated with a higher chance of presenting CKD.
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Sexual and addictive risk behaviors and sexually transmitted infections in illegal gold miners in French Guiana: A multicenter observational study. PLoS One 2022; 17:e0272932. [PMID: 36174015 PMCID: PMC9522014 DOI: 10.1371/journal.pone.0272932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/28/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Common representations of the world of gold mining–especially illegal–are usually negative: the activity conjures up images of drug trafficking, human exploitation, the sex trade, environmental destruction, and infectious diseases, in particular sexually transmitted infections (STIs). The aim of the present article is to describe the levels of risk behaviors such as transactional sex, multiple sexual partners, and the frequency of condom use, addictive substance consumption, and the prevalence of STIs among the population of illegal gold miners in French Guiana (FG), a French overseas entity in Amazonia, in order to guide potential interventions. Methods An observational multicenter cross-sectional study was carried out from October to December 2019 along the two borders of FG with Suriname and Brazil at rest sites used by the miners. Results Among the 499 participants, transactional sex was very prevalent, declared by 33.5% of men and 8.4% of women. Condoms were more frequently used for transactional sex than with a non-commercial partner (93.4% versus 42.1%). More women were tested for HIV than men (91.1% versus 55.2%). Excessive alcohol consumption (57.3%%) and tobacco use (41.2%) were very frequent, but cocaine or crack consumption was low (1.2%), which refuted our initial assumption. Consumers of alcohol had more sexual partners and reported condom use more frequently. Prevalence of HIV, HCV, HBV, and syphilis was respectively 0.5% (95% CI: 0.1–2.1), 2.1% (95% CI: 0.7–3.6), 1.6% (95% CI: 0.3–2.8), and 12.4% (95% CI: 9.0–15.7), which was higher than in the local population, especially for syphilis. Conclusion This study documents for the first time the risk behaviors of gold miners in FG. Although the level of condom use was high, the prevalence of STIs combined with the high rate of transactional sex should encourage an increase in prevention and screening, in particular through rapid tests, given the mobility of the population concerned.
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Hone T, Macinko J, Trajman A, Palladino R, Coeli CM, Saraceni V, Rasella D, Durovni B, Millett C. Expansion of primary healthcare and emergency hospital admissions among the urban poor in Rio de Janeiro Brazil: A cohort analysis. LANCET REGIONAL HEALTH. AMERICAS 2022; 15:100363. [PMID: 36778075 PMCID: PMC9904151 DOI: 10.1016/j.lana.2022.100363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Robust evidence on the relationship between primary care and emergency admissions is lacking in low- and middle-income countries. This study evaluates how the phased roll out of the family health strategy (FHS) to the urban poor in Rio de Janeiro Brazil affected emergency hospital admissions and readmissions from ambulatory-care sensitives conditions (ACSCs). Methods A cohort of 1.2 million adults in Rio de Janeiro city were followed for five years (Jan 2012 to Dec 2016). The association between FHS use and the likelihood of emergency hospital admissions and 30-day readmissions were evaluated using multi-level Poisson regression models with inverse probability treatment weighting and regression adjustment (IPTW-RA) for socioeconomic and household characteristics. Inequalities in associations were examined across groups of causes and by key socioeconomic groups. Results Records from 2,551,934 primary care consultations and 15,627 admissions were analysed. In IPTW-RA analyses, each additional FHS consultation was associated with a 3% lower rate of ACSC admission (RR: 0.97; 95%CI: 0.95, 0.98), a 63% lower rate of 30-day readmissions from any non-birth cause (RR: 0.37; 95%CI: 0.30, 0.46), and an 57% lower rate of 30-day readmissions from ACSCs (RR: 0.43; 95%CI: 0.33, 0.55). Individuals who were older, had the lowest educational attainment, were unemployed, and had higher incomes had larger reductions in ACSC admissions associated with FHS use. Interpretation Investment in primary care is important for reducing emergency hospital admissions and their associated costs in LMICs. Funding DFID/MRC/Wellcome Trust/ESRC.
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Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, Imperial College London, London, United Kingdom,Corresponding author at: Public Health Policy Evaluation Unit, Imperial College London, Third Floor, Reynold's Building, Charing Cross Hospital, St Dunstan's Road, London W6 8RP, United Kingdom.
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, United States
| | | | - Raffaele Palladino
- Public Health Policy Evaluation Unit, Imperial College London, London, United Kingdom,Department of Public Health, University “Federico II” of Naples, Italy
| | - Claudia Medina Coeli
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valeria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Davide Rasella
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain,Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Betina Durovni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, London, United Kingdom,Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz, Salvador, Brazil,Comprehensive Health Research Center and Public Health Research Centre, NOVA National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
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12
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Cruz DKA, da Silva KS, Lopes MVV, Parreira FR, Pasquim HM. Socioeconomics inequities associated with different domains of physical activity: results of the National Health Survey 2019, Brazil. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2021398. [PMID: 35920462 PMCID: PMC9897818 DOI: 10.1590/ss2237-9622202200015.especial] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 01/04/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To examine the socioeconomic indicators associated with engagement in physical activity (PA) in the leisure-time, transportation, domestic and occupational domains, in Brazilian adults. METHODS Cross-sectional study with secondary data from the National Health Survey (PNS), conducted in 2019. The factors associated with engagement in PA were analyzed using logistic regression. RESULTS The study involved 88,500 Brazilian adults with mean age of 45 ± 17.5 years old. Longer working hours [odds ratio (OR) = 0.74; 95%CI 0.66;0.82; > 40h vs. ≥ 20h] and female sex (OR = 0.67; 95%CI 0.63;0.71) were associated with lower chances of engaging in leisure-time PA. Higher income (OR = 3.20; 95%CI 2.79;3.67; > 5 vs. ≥ minimum wage) and education level (OR = 3.01; 95%CI 2.74;3.32 - complete higher education vs. incomplete elementary school) were positively associated with leisure-time PA. CONCLUSION Socioeconomic correlates were strongly related to engagement in PA in Brazilian adults, suggesting a pattern of inequity marked by the need for survival, which is socially reproduced.
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Affiliation(s)
| | - Kelly Samara da Silva
- Universidade Federal de Santa Catarina, Programa de Pós-graduação em
Educação Física, Florianópolis, SC, Brazil
| | - Marcus Vinicius Veber Lopes
- Universidade Federal de Santa Catarina, Programa de Pós-graduação em
Educação Física, Florianópolis, SC, Brazil
| | | | - Heitor Martins Pasquim
- Universidade Federal de São Paulo, Departamento de Ciências do
Movimento Humano, Santos, SP, Brazil
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Ferreira-Batista NN, Postali FAS, Diaz MDM, Teixeira AD, Moreno-Serra R. The Brazilian Family Health Strategy and adult health: Evidence from individual and local data for metropolitan areas. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101143. [PMID: 35550232 DOI: 10.1016/j.ehb.2022.101143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 11/29/2021] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
Previous studies have found that the expansion of primary health care in Brazil following the country-wide family health strategy (ESF), one of the largest primary care programs in the world, has improved health outcomes. However, these studies have relied either on aggregate data or on limited individual data, with no fine-grained information available concerning household participation in the ESF or local supply of ESF services, which represent crucial aspects for analytical and policy purposes. This study analyzes the relationship between the ESF and health outcomes for the adult population in metropolitan areas in Brazil. We investigate this relationship through two linked dimensions of the ESF: the program's local supply of health teams and ESF household registration. In contrast with previous studies focusing on comparisons between certain definitions of "treated" versus "nontreated" populations, our results indicate that the local density of health teams is important to the observed effects of the ESF on adult health. We also find evidence consistent with the presence of positive primary health care spillovers to people not registered with the ESF. However, current ESF coverage levels in metropolitan areas have limited ability to address prevailing health inequalities. Our analysis suggests that the local intensity of ESF coverage should be a key consideration for evaluations and policy efforts related to future ESF expansion.
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Barros MBDA, Medina LDPB, Lima MG, Sousa NFDS, Malta DC. Changes in prevalence and in educational inequalities in Brazilian health behaviors between 2013 and 2019. CAD SAUDE PUBLICA 2022; 38Suppl 1:e00122221. [PMID: 35857955 DOI: 10.1590/0102-311x00122221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 04/28/2022] [Indexed: 11/22/2022] Open
Abstract
Considering the relevance of health behaviors for chronic diseases prevalence and mortality and the increase in income concentration observed in the world and in Brazil, this study aimed to evaluate the changes in the prevalence and in the educational inequalities of Brazilian adult health behaviors between 2013 and 2019. We analyzed data of 49,025 and 65,803 adults (18-59 years of age) from the Brazilian National Health Survey (PNS), 2013 and 2019. Prevalence of health behaviors (smoking, alcohol intake, diet, physical activity and sedentarism) were estimated for three educational strata, for both surveys. Prevalence ratios (PR) between year of survey and between educational strata were estimated by Poisson regression models. Significant reductions were found in the prevalence of smoking, physical inactivity, sedentarism, insufficient consumption of fruits, and the excessive consumption of sweetened beverages. However, an increase was observed in alcohol consumption and binge drinking; vegetable consumption remained stable. Contrasting the favorable change in some behaviors, inequalities among schooling strata remained very high in 2019, specially for smoking (PR = 2.82; 95%CI: 2.49-3.20), passive smoking (PR = 2.88; 95%CI: 2.56-3.23) and physical inactivity (PR = 2.02; 95%CI: 1.92-2.13). There was a significant increase in the educational inequality regarding physical inactivity (21%), insufficient intake of fruit (8%) and in the frequent consumption of sweetened beverages (32%). The persistence and enlargement of inequalities highlight the behaviors and social segments that should be special targets for policies and programs focused in promoting healthy lifestyles.
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Fernandes APG, Cardoso VR, dos Santos KC, Migliaccio MM, Pinto JM. Factors related to the accumulation of healthy behavior among older adults attending primary Health Care. JOURNAL OF POPULATION AGEING 2022; 15:677-690. [PMID: 35855847 PMCID: PMC9281228 DOI: 10.1007/s12062-022-09376-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/22/2022] [Indexed: 10/31/2022]
Abstract
The adoption and maintenance of healthy behaviors contribute for its accumulation throughout life, which require more than information disclosure and recommendations. Biopsychosocial factors may work as barriers to adherence to healthier behaviors, and yet have been underexplored. The objective was to investigate the factors related to the accumulation of healthy behavior among older adults attending Primary Health Care. Cross-sectional analysis with 201 older adults from baseline of Longitudinal Investigation of Functioning Epidemiology (LIFE) was performed in a Southeastern Brazilian city. The Healthy Behavior Score (HBS), ranging from 0 to 8, was calculated by the sum of the following habits: Physical activity practice, healthy eating, water consumption, night sleep time, not smoking, not drinking alcohol, frequent social relations, and spirituality. A linear multivariate regression was performed to test the influence of biopsychosocial aspects on HBS, with 95% confidence interval. Higher number of healthy behaviors was related to high social support, better cognitive status, less depressive symptoms and lower functional performance. Additionally, age and resilience score were correlated to healthy behaviors, which were higher among women and those with sufficient income. Multivariate analysis revealed depressive symptoms, functional performance and education as independent predictors of HBS. Depressive symptoms, functional performance and education are predictors of accumulation of health behaviors, independently of health status, contextual and sociodemographic aspects. Higher social support partially contributed to the higher number of healthy behaviors, and should be considered in public health policies for healthy longevity.
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Malta DC, da Silva AG, Gomes CS, Stopa SR, de Oliveira MM, Sardinha LMV, Caixeta RB, Pereira CA, Rios-Neto ELG. Monitoring the goals of the plans for coping with Chronic Non-Communicable Diseases: results of the National Health Survey, Brazil, 2013 and 2019. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2021364. [PMID: 35830015 PMCID: PMC9897829 DOI: 10.1590/ss2237-9622202200008.especial] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/05/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To monitor the achievement of the action plans for the prevention and control of Non-Communicable Diseases agreed-upon targets. METHODS Cross-sectional study, with data from the 2013 and 2019 National Health Survey. The following targets, up to 2025, were evaluated: physical inactivity, alcohol consumption, salt/sodium, tobacco use, high blood pressure, diabetes, overweight, obesity, cervical cytology testing, and drug therapy and counseling. To check whether the targets were achieved, the prevalence ratio was calculated (PR). RESULTS 60,202 individuals were assessed in 2013, and 88,531 in 2019. The targets for physical inactivity (PR = 0.88; 95%CI 0.86;0.90) and cervical cytology coverage (79.4%; 95%CI 78.3;80.3) were achieved. Tobacco use was reduced, albeit below the target. The prevalence of hypertension, diabetes, overweight, obesity and alcohol consumption increased, and the targets will not be attained. CONCLUSION Two indicators reached the agreed targets, however it is necessary to advance in actions and policies to meet the others.
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Affiliation(s)
| | - Alanna Gomes da Silva
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em
Enfermagem, Belo Horizonte, MG, Brazil
| | - Crizian Saar Gomes
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em
Saúde Pública, Belo Horizonte, MG, Brazil
| | - Sheila Rizzato Stopa
- Ministério da Saúde, Departamento de Análise de Situação de Saúde,
Brasília, DF, Brazil
| | - Max Moura de Oliveira
- Universidade Federal de Goiás, Instituto de Patologia Tropical e
Saúde Pública, Goiânia, GO, Brazil
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Nascimento BR, Brant LCC, Naback ADN, Veloso GA, Polanczyk CA, Ribeiro ALP, Malta DC, Ferreira AVL, Oliveira GMMD. Carga de Doenças Cardiovasculares Atribuível aos Fatores de Risco nos Países de Língua Portuguesa: Dados do Estudo “Global Burden of Disease 2019”. Arq Bras Cardiol 2022; 118:1028-1048. [PMID: 35703642 PMCID: PMC9345142 DOI: 10.36660/abc.20210680] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/08/2021] [Indexed: 12/26/2022] Open
Abstract
Fundamento: O impacto dos fatores de risco (FR) sobre a morbimortalidade por doença cardiovascular (DCV) na maioria dos países de língua portuguesa (PLP) é pouco conhecido. Objetivo: Analisar a morbimortalidade por DCV atribuível aos FR e sua variação nos PLP de 1990 a 2019, a partir de estimativas do estudo Global Burden of Disease (GBD) 2019. Métodos: Avaliamos as mudanças nos FR ocorridas no período, as taxas de mortalidade e os anos de vida perdidos por incapacidade (DALYs), padronizados por idade, entre 1990 e 2019. Realizou-se a correlação entre a variação percentual das taxas de mortalidade e o índice sociodemográfico (SDI) de cada PLP pelo método de Spearman. O valor p<0,05 foi considerado estatisticamente significativo. Resultados: A pressão arterial sistólica (PAS) elevada foi o principal fator de risco para mortalidade e DALY por DCV para todos os PLP. A mortalidade por DCV mostrou uma tendência de redução em 2019, maior em Portugal (-66,6%, IC95% -71,0 - -61,2) e no Brasil (-49,8%, IC95% -52,5 - -47,1). Observou-se tendência à correlação inversa entre SDI e a variação percentual da mortalidade, que foi significativa para os riscos dietéticos (r=-0,70, p=0,036), colesterol LDL elevado (r=-0,77, p=0,015) e PAS elevada (r=-0,74, p=0,023). Conclusões: Além da PAS, os FR dietéticos e metabólicos justificaram uma maior variação da carga de DCV, correlacionada com o SDI nos PLP, sugerindo a necessidade de adoção de políticas de saúde adaptadas à realidade de cada país, visando a redução de seu impacto sobre a população.
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Bertuol C, Oliveira SND, Tozetto AVB, Duca GFD. Leisure-time physical activities and their association with active behavior in other domains and sociodemographic aspects: a population-based study with adults residing in the Brazilian state capitals and the Federal District. CIENCIA & SAUDE COLETIVA 2022; 27:2187-2196. [PMID: 35649008 DOI: 10.1590/1413-81232022276.16802021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to identify the types of leisure-time physical activity (LTPA) most practiced and their association with active behavior in other domains and the sociodemographic aspects in Brazilian adults (≥ 18 years old). It was a cross-sectional study, using data from a population-based system (Vigitel, 2017). Binary logistic regression was used. In the 29,323 LTPA practitioners (51.3% men), the five types of activities most performed were: walking (36.6%), weight training (17.7%), soccer (11.7%), jogging (8.3%), and aerobics (6.7%). The LTPA that had the greatest associations with sociodemographic variables were soccer, walking, and aerobics, all with p-value ≤ 0.01. When considering the other domains of physical activity, participants who reported doing household physical activity were more likely to walk and less likely to practice weight training, soccer and aerobics. Those who did active commuting had more of a chance to walking and less of a chance to weight train, while individuals who practiced occupational physical activity were less likely to walk and more likely to play soccer. Important differences in sociodemographic aspects and active behavior in the other domains were found according to the LTPA type.
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Affiliation(s)
- Cecília Bertuol
- Departamento de Educação Física, Universidade Federal de Santa Catarina. Campus Universitário Reitor João David Ferreira Lima, Centro de Desportos. 88040-900 Florianópolis SC Brasil.
| | - Silas Nery de Oliveira
- Departamento de Educação Física, Universidade Federal de Santa Catarina. Campus Universitário Reitor João David Ferreira Lima, Centro de Desportos. 88040-900 Florianópolis SC Brasil.
| | - Alexandre Vinicius Bobato Tozetto
- Departamento de Educação Física, Universidade Federal de Santa Catarina. Campus Universitário Reitor João David Ferreira Lima, Centro de Desportos. 88040-900 Florianópolis SC Brasil.
| | - Giovani Firpo Del Duca
- Departamento de Educação Física, Universidade Federal de Santa Catarina. Campus Universitário Reitor João David Ferreira Lima, Centro de Desportos. 88040-900 Florianópolis SC Brasil.
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Werneck AO, Vancampfort D, Stubbs B, Silva DR, Cucato GG, Christofaro DGD, Santos RD, Ritti-Dias RM, Bittencourt MS. Prospective associations between multiple lifestyle behaviors and depressive symptoms. J Affect Disord 2022; 301:233-239. [PMID: 34986379 DOI: 10.1016/j.jad.2021.12.131] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/13/2021] [Accepted: 12/31/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Our aim was to analyze the associations between multiple lifestyle behaviors and depressive symptoms. METHODS We included 4,725 adults (18-59y), that provided data in routine health evaluations of a hospital in Brazil, followed for a mean period of 3.1 ± 1.6 years. Physical activity, alcohol consumption (measured using Alcohol Use Disorders Identification Test) and tobacco smoking were categorized as: (1) absence of the behavior (inactivity i.e. not complying with 150 min of moderate-to-vigorous PA/week, not smoking, no risky drinking, i.e. AUDIT<5) during baseline and follow-up; (2) Absence during baseline and presence during follow-up; (3) Presence during baseline and absence during follow-up; (4) Presence during both time points. Depressive symptoms were measured with the Beck Inventory was adopted to analyze patterns of depressive symptoms over time (as exposure). C-reactive protein [HS-CRP]) was assessed and its role in the association was tested. Incidence indicators of behaviors and depressive symptoms were created and used as outcomes. We used crude and adjusted Poisson regression analysis. RESULTS Fully adjusted models revealed that persistently physical inactive participants (RR:1.71;95%CI:1.33-2.21), those who became physically inactive (1.68;1.19-2.26), with consistently risky drinking (1.62;1.15-2.30), and who became risky drinkers (1.62;1.15-2.30) had higher risk for incidence of elevated depressive symptoms. Vice versa participants with incidence of depressive symptoms over time presented higher risk for physical inactivity (1.44;1.11-1.87) and risky drinking (1.65;1.16-2.34) incidence. HS-CRP did not influence the associations. LIMITATIONS Self-reported physical activity, binary tobacco smoking, and non-probabilistic sampling. CONCLUSIONS There is a prospective relationship between elevated depressive symptoms and adverse lifestyle behaviors.
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Affiliation(s)
- André O Werneck
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo (USP), Av. Dr. Arnaldo 715 Cerqueira César, São Paulo 01246-904, Brazil.
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Brendon Stubbs
- Department of Psychological Medicine, Psychology and Neuroscience, Institute of Psychiatry, King's College London, United Kingdom and South London and Maudsley NHS Foundation Trust, De Crespigny Park, Box SE5 8AF, London, United Kingdom
| | - Danilo R Silva
- Department of Physical Education, Federal University of Sergipe, UFS, São Cristóvão, Brazil
| | - Gabriel G Cucato
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Diego G D Christofaro
- Department of physical education, Universidade Estadual Paulista "Júlio de Mesquita Filho", Presidente Prudente, Brazil
| | - Raul D Santos
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Heart Institute (InCor), University of São Paulo Medical School Hospital, Sao Paulo, Brazil
| | - Raphael M Ritti-Dias
- Post-graduate Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, Brazil
| | - Márcio S Bittencourt
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil; Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, Brazil
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Houvèssou GM, Leventhal DGP, Silva EVD. Obesity and COVID-19 in-hospital fatality in southern Brazil: impact by age and skin color. Rev Saude Publica 2022; 56:4. [PMID: 35239926 PMCID: PMC8849284 DOI: 10.11606/s1518-8787.2022056004329] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To estimate the relative risk (RR) of death associated with obesity, the attributable fraction in the exposed/with obesity (AFo), and the hospitalized population attributable risk (hospitalized PAR) associated with obesity of death among all adults and among Black and non-Black adults hospitalized for severe COVID-19 in the state of Rio Grande do Sul, Brazil. METHODS This retrospective cohort study of prognostic factors analyzed all cases of adults hospitalized for severe COVID-19 in the state of Rio Grande do Sul, Brazil. The occurrence of obesity was measured using secondary data from hospital teams’ surveillance records. The outcome assessed was hospital deaths caused by severe COVID-19. Poisson regression was used to estimate RRs and 95% confidence intervals (95%CI). RESULTS The study sample consisted of 100,099 patients hospitalized for severe COVID-19, most of whom were White (84.7%) and male (54.7%). The effect of obesity was strongly modified by age, being higher in younger age groups. For the 18–39-year-old age group, RR = 2.54 (95%CI: 2.33–2.77), and in individuals 70 years and above, RR = 1.09 (95%CI: 1.05–1.13). For the 18–39-year-old age range, AFo = 60.6% and AFo = 42.5% in individuals 40–59 years old. For all hospitalizations, Hospitalized PAR measuring obesity for individuals 18–39 years old was 25.3%, while in the 40–59-year-old range, the hospitalized PAR = 11.2%. The hospitalized PAR was 31.7% in the Black population aged 18–39 years and 24.8% in non-Blacks. The hospitalized PAR was also larger in Blacks aged 40-59 years. CONCLUSIONS Obesity largely impacted in-hospital case-fatality rates among young adults and Black people contaminated by COVID-19. These data highlight the extent of the risk concerning obesity, a highly prevalent chronic condition.
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Affiliation(s)
- Gbènankpon Mathias Houvèssou
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Daniel G P Leventhal
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Eduardo Viegas da Silva
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil.,Centro de Vigilância em Saúde do Estado do Rio Grande do Sul. Porto Alegre, RS, Brasil
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Rebouças P, Falcão IR, Barreto ML. Social inequalities and their impact on children's health: a current and global perspective. J Pediatr (Rio J) 2022; 98 Suppl 1:S55-S65. [PMID: 34951980 PMCID: PMC9510930 DOI: 10.1016/j.jped.2021.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To describe the consequences of social inequalities on children's health as a global and persistent problem, demonstrating its historical and structural roots in different societies. DATA SOURCES Relevant articles in the PubMed/MEDLINE database, in addition to those found in a manual search and in the bibliographic references of selected studies and consultation to the websites of international organizations to obtain relevant data and documents. DATA SYNTHESIS To understand how inequities affect health, it is necessary to know the unequal distribution of their social determinants among population groups. In the case of children, the parental pathway of determinants is central. The non-equitable way in which many families or social groups live, determined by social and economic inequalities, produces unequal health outcomes, particularly for children. This is observed between and within countries. Children from the most vulnerable population groups consistently have worse health conditions. Interventions aimed at children's health must go beyond care and act in an integrated manner on poverty and on social and economic inequalities, aiming to end systematic and unfair differences. CONCLUSIONS Despite the considerable advances observed in children's health in recent decades at a global level, the inequalities measured by different indicators show that they persist. This scenario deserves attention from researchers and decision-makers, especially in the context of the global health crisis caused by the COVID-19 pandemic, which has further intensified the situation of vulnerability and social inequalities in health around the world.
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Affiliation(s)
- Poliana Rebouças
- Fundação Oswaldo Cruz Center, Centro de Integração de Dados e Conhecimento para Saúde (CIDACS), Salvador, BA, Brazil.
| | - Ila R Falcão
- Fundação Oswaldo Cruz Center, Centro de Integração de Dados e Conhecimento para Saúde (CIDACS), Salvador, BA, Brazil
| | - Mauricio L Barreto
- Fundação Oswaldo Cruz Center, Centro de Integração de Dados e Conhecimento para Saúde (CIDACS), Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Instituto de Saúde Coletiva, Salvador, BA, Brazil
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22
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Brant LCC, Nascimento BR, Veloso GA, Gomes CS, Polanczyk C, de Oliveira GMM, Flor LS, Gakidou E, Ribeiro ALP, Malta DC. Burden of Cardiovascular diseases attributable to risk factors in Brazil: data from the "Global Burden of Disease 2019" study. Rev Soc Bras Med Trop 2022; 55:e0263. [PMID: 35107526 PMCID: PMC9009428 DOI: 10.1590/0037-8682-0263-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/05/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION To better understand trends in the main cause of death in Brazil, we sought to analyze the burden of cardiovascular risk factors (RF) and cardiovascular diseases (CVD) attributable to specific RFs in Brazil from 1990 to 2019, using the estimates from the GBD 2019 study. METHODS To estimate RF exposure, the Summary Exposure Value (SEV) was used, whereas for disease burden attributed to RF, mortality and disability-adjusted life-years (DALY) due to CVD were used. For comparisons over time and between states, we compared age-standardized rates. The sociodemographic index (SDI) was used as a marker of socioeconomic conditions. RESULTS In 2019, 83% of CVD mortality in Brazil was attributable to RF. For SEV, there was a reduction in smoking and environmental RF, but an increase in metabolic RF. High systolic blood pressure and dietary risks continue to be the main RF for CVD mortality and DALY. While there was a decline in age-standardized mortality rates attributable to the evaluated RF, there was also a stability or increase in crude mortality rates, with the exception of smoking. It is important to highlight the increase in the risk of death attributable to a high body mass index. Regarding the analysis per state, SEVs and mortality attributable to RF were higher in those states with lower SDIs. CONCLUSIONS Despite the reduction in CVD mortality and DALY rates attributable to RF, the stability or increase in crude rates attributable to metabolic RFs is worrisome, requiring investments and a renewal of health policies.
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Affiliation(s)
- Luisa Campos Caldeira Brant
- Universidade Federal de Minas Gerais, Faculdade de Medicina e Hospital das Clínicas, Belo Horizonte, MG, Brasil
| | - Bruno Ramos Nascimento
- Universidade Federal de Minas Gerais, Faculdade de Medicina e Hospital das Clínicas, Belo Horizonte, MG, Brasil
| | - Guilherme Augusto Veloso
- Universidade Federal de Minas Gerais, Departamento de Estatística, Programa de Pós-Graduação em Estatística, Belo Horizonte, MG, Brasil
| | - Crizian Saar Gomes
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Medicina Preventiva e Social, Programa de Pós-Graduação em Saúde Pública, Belo Horizonte, MG, Brasil
| | - Carisi Polanczyk
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS, Brasil
| | | | - Luisa Sorio Flor
- University of Washington, Institute of Health Metrics and Evaluation, Seattle, USA
| | - Emmanuela Gakidou
- University of Washington, Institute of Health Metrics and Evaluation, Seattle, USA
| | - Antonio Luiz Pinho Ribeiro
- Universidade Federal de Minas Gerais, Faculdade de Medicina e Hospital das Clínicas, Belo Horizonte, MG, Brasil
| | - Deborah Carvalho Malta
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Belo Horizonte, MG, Brasil
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23
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Chan JJL, Tran-Nhu L, Pitcairn CFM, Laverty AA, Mrejen M, Pescarini JM, Hone TV. Inequalities in the prevalence of cardiovascular disease risk factors in Brazilian slum populations: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000990. [PMID: 36962864 PMCID: PMC10022010 DOI: 10.1371/journal.pgph.0000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Social and environmental risk factors in informal settlements and slums may contribute to increased risk of cardiovascular disease (CVD). This study assesses the socioeconomic inequalities in CVD risk factors in Brazil comparing slum and non-slum populations. METHODS Responses from 94,114 individuals from the 2019 Brazilian National Health Survey were analysed. The United Nations Human Settlements Programme definition of a slum was used to identify slum inhabitants. Six behavioural risk factors, four metabolic risk factors and doctor-diagnosed CVD were analysed using Poisson regression models adjusting for socioeconomic characteristics. RESULTS Compared to urban non-slum inhabitants, slum inhabitants were more likely to: have low (less than five days per week) consumption of fruits (APR: 1.04, 95%CI 1.01-1.07) or vegetables (APR: 1.08, 95%CI 1.05-1.12); drink four or more alcoholic drinks per day (APR: 1.05, 95%CI 1.03-1.06); and be physically active less than 150 minutes per week (APR: 1.03, 95%CI 1.01-1.04). There were no differences in the likelihoods of doctor-diagnosed metabolic risk factors or CVD between the two groups in adjusted models. There was a higher likelihood of behavioural and metabolic risk factors among those with lower education, with lower incomes, and the non-White population. CONCLUSIONS Brazilians living in slums are at higher risk of behavioural risk factors for CVD, suggesting local environments might impact access to and uptake of healthy behaviours.
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Affiliation(s)
- Jasper J L Chan
- Imperial College School of Public Health, Imperial College London, London, United Kingdom
| | - Linh Tran-Nhu
- Division of Biosciences, University College London, London, United Kingdom
| | - Charlie F M Pitcairn
- Imperial College School of Public Health, Imperial College London, London, United Kingdom
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Matías Mrejen
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, SP, Brazil
| | - Julia M Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Thomas V Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
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Camelo LV, Coelho CG, Chor D, Griep RH, Almeida MDCCD, Giatti L, Barreto SM. Racismo e iniquidade racial na autoavaliação de saúde ruim: o papel da mobilidade social intergeracional no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). CAD SAUDE PUBLICA 2022; 38:e00341920. [DOI: 10.1590/0102-311x000341920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/11/2021] [Indexed: 11/22/2022] Open
Abstract
Resumo: Pretos e pardos apresentam grandes desvantagens de saúde, possuem menores chances de ascensão na hierarquia social no curso de vida e menores níveis socioeconômicos do que brancos como resultado do racismo estrutural. Entretanto, pouco se sabe sobre o papel mediador da mobilidade intergeracional na associação entre racismo e saúde. O objetivo do presente estudo foi investigar a associação entre racismo e a autoavaliação de saúde, e verificar em que medida a mobilidade social intergeracional media essa associação. Estudo transversal realizado com dados de 14.386 participantes da linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Escolaridade materna, escolaridade do participante, classe sócio-ocupacional do chefe de família e classe sócio-ocupacional do participante compuseram os indicadores de mobilidade social intergeracional (educacional e sócio-ocupacional). Modelos de regressão logística foram utilizados. A prevalência de autoavaliação de saúde ruim foi de 15%, 24% e 28% entre brancos, pardos e pretos, respectivamente. Após ajustes por idade, sexo e centro de investigação foram encontradas maiores chances de autoavaliação de saúde ruim entre pretos (OR = 2,15; IC95%: 1,92-2,41) e pardos (OR = 1,82; IC95%: 1,64-2,01) quando comparados aos brancos. A mobilidade educacional e sócio-ocupacional intergeracional mediaram, respectivamente, 66% e 53% da associação entre a raça/cor e autoavaliação de saúde ruim em pretos, e 61% e 51% em pardos, respectivamente. Resultados confirmam a iniquidade racial na autoavaliação de saúde e apontam que a mobilidade social intergeracional desfavorável é um importante mecanismo para explicar essa iniquidade.
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Malta DC, Bernal RTI, Lima MG, Silva AGD, Szwarcwald CL, Barros MBDA. Socioeconomic inequalities related to noncommunicable diseases and their limitations: National Health Survey, 2019. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210011. [PMID: 34910065 DOI: 10.1590/1980-549720210011.supl.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/26/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE to analyze socioeconomic inequalities in the self-reported prevalence of NonCommunicable Diseases (NCDs) and their disabilities in the Brazilian adult population. METHODS Cross-sectional study with data from the National Health Survey carried out in 2019. The self-reported prevalences of individuals with some noncommunicable diseases were calculated, according to sociodemographic characteristics; and the prevalence and prevalence ratio of these diseases and degrees of disability, according to education and possession of a private health plan. RESULTS 47.6% of the population reported having at least one noncommunicable diseases. Noncommunicable diseases increased progressively with age and were more prevalent in women (PR 1.13; 95%CI 1.1-1.15), in black (PR 1.04; 95%CI 1.01-1, 06) or brown individuals (PR 1.05; 95%CI 1.01-1.09), illiterate or with incomplete elementary education (PR 1.12; 95%CI 1.08-1.16), in the Southeast (PR 1.10; 95%CI 1.05-1.14) and the South (PR 1.07; 95%CI 1.03-1.12) and among individuals who do not have private health insurance (PR 1.02; 95%CI 1.0-1.05). For the majority of noncommunicable diseases investigated, the highest reports of disabilities were among those with low education and without health insurance. CONCLUSION adults with less education and without private health plans have a higher prevalence of noncommunicable diseases and a higher degree of disability. Thus, it is important to analyze health indicators in the face of different populations and disparities, in order to understand and monitor health inequalities.
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Affiliation(s)
- Deborah Carvalho Malta
- Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Regina Tomie Ivata Bernal
- Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | | | - Alanna Gomes da Silva
- Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Célia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
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Sehn AP, Tornquist D, Tornquist L, Brazo-Sayavera J, Reuter CP. Biological and socioeconomic factors as moderator in relationship between leisure-time physical activity and cardiometabolic risk in adolescents from southern Brazil. Environ Health Prev Med 2021; 26:90. [PMID: 34521350 PMCID: PMC8442526 DOI: 10.1186/s12199-021-01012-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given the important repercussions that sociodemographic factors can have on physical activity, especially in the field of leisure, and cardiometabolic risk, it seems relevant to analyze the implications of these variables on the relationship between physical activity in leisure time (LTPA) and cardiometabolic risk. In this sense, the present study aims to verify the moderating role of biologic and socioeconomic factors in the relationship between LTPA and cardiometabolic risk in adolescents in southern Brazil. METHODS Cross-sectional study that included 1596 adolescents selected at random (58.2% girls), aged between 10 and 17 years. LTPA, biological and socioeconomic factors were assessed using a self-reported questionnaire and the cardiometabolic risk score (total cholesterol/HDL-c ratio, triglycerides, fasting glucose, systolic blood pressure, and waist circumference, considering the participant's age and sex) was included as an outcome. Associations and moderations were tested by multiple linear regression models. RESULTS It was observed a positive interaction of LTPA and sex (p = 0.048) and LTPA and school system (p = 0.037), and negative interaction of LTPA and skin color (p = 0.040), indicating that these factors were moderators in the relationship between LTPA and clustered cardiometabolic risk score (cMetS) in adolescents. A reduction in cardiometabolic risk was observed according to the increase in weekly minutes of LTPA among boys, non-white adolescents, and students from municipal schools. CONCLUSIONS The association between LTPA and cardiometabolic risk was moderated by sex, skin color, and school system in adolescents from southern Brazil.
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Affiliation(s)
- Ana Paula Sehn
- Graduate Program in Health Promotion, University of Santa Cruz do Sul (UNISC), Av. Independência, 2293, Universitário, Santa Cruz do Sul, Rio Grande do Sul 96815-900 Brazil
| | - Debora Tornquist
- Graduate Program in Physical Education, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul Brazil
| | - Luciana Tornquist
- Graduate Program in Physical Education, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul Brazil
| | - Javier Brazo-Sayavera
- Department of Sports and Computer Sciences, Universidad Pablo de Olavide, Seville, Spain
| | - Cézane Priscila Reuter
- Graduate Program in Health Promotion, Department of Health Sciences, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Rio Grande do Sul Brazil
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Duarte da Silva K, Vargas-Ferreira F, Dâmaso Bertoldi A, Celso Lopes Fernandes de Barros F, Fernando Demarco F, Britto Correa M, Beatriz Chaves Tarquinio S. Oral mucosal lesions in pregnant women: A population-based study. Oral Dis 2021; 28:1891-1900. [PMID: 34333827 DOI: 10.1111/odi.13981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/29/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the prevalence of oral mucosal lesions (OML) and oral self-examination and their associated factors among pregnant women from the 2015 Pelotas Birth Cohort Study, Brazil. METHODS Pregnant women who would deliver babies in 2015 were included in the antenatal study. Data related to demographic, socio-economic and behavioural conditions were collected using questionnaires. Participants were also clinically assessed for oral health outcomes. The outcomes were the presence of OMLs and oral self-examination. Size, location, time of onset and symptomatology of the lesions were collected. Descriptive and bivariate analysis, and Poisson regression were performed. p-Value <0.05 was set to indicate statistical significance. RESULTS Data from 2481 pregnant women were analysed. Four hundred and nine (16.5%) had at least one OML. The most prevalent lesions were exostosis (80/16.6%), coated tongue (70/14.5%) and benign oral brownish pigmentation (68/14.1%). Non-white skin colour was associated with a higher prevalence of OMLs (PR 1.3; 95% CI 1.1-1.6), while daily use of dental floss was positively associated with the prevalence of oral self-examination (PR 1.4; 95% CI 1.2; 1.5). CONCLUSIONS Almost 20% of pregnant women presented OML, which were more prevalent in non-white individuals. Women with better oral care were more likely to perform oral self-examination.
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Affiliation(s)
| | - Fabiana Vargas-Ferreira
- Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Flávio Fernando Demarco
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil.,Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Dulgheroff PT, da Silva LS, Rinaldi AEM, Rezende LFM, Marques ES, Azeredo CM. Educational disparities in hypertension, diabetes, obesity and smoking in Brazil: a trend analysis of 578 977 adults from a national survey, 2007-2018. BMJ Open 2021; 11:e046154. [PMID: 34281920 PMCID: PMC8291309 DOI: 10.1136/bmjopen-2020-046154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Our study aimed to assess social inequality trends for hypertension, diabetes mellitus, smoking and obesity from 2007 to 2018 in adults from Brazilian capitals. SETTING Data from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey study, a cross-sectional telephone survey, conducted annually from 2007 to 2018. PARTICIPANTS We used data from 578 977 Brazilian adults (≥18 years). DESIGN Cross-sectional surveys conducted annually from 2007 to 2018. PRIMARY OUTCOME MEASURES Participants responded to a questionnaire about medical diagnosis of hypertension and diabetes, smoking status, weight and height. Educational inequalities (0-3, 4-8, 9-11 and 12 or more years of study) by sex and skin colour were assessed trough absolute, Slope Index of Inequality (SII) and relative measures of inequality, Concentration Index and trends were tested by Prais-Winsten. RESULTS All outcomes were more prevalent in the least educated. The largest absolute educational inequality was observed for hypertension (SIItotal=-37.8 in 2018). During 2007-2018, the total educational disparity remained constant for hypertension, increased for diabetes and smoking, and decreased for obesity. Overall, inequality was higher among women and non-whites, compared with men and whites. We found a reduction in absolute inequality for hypertension among non-whites, an increase for diabetes in all strata, and an increase for smoking in women and non-whites. The relative inequality decreased in women and whites and increased for smoking in all strata, except among men. CONCLUSION The educational inequality reduced for obesity, remained constant for hypertension and increased for diabetes and smoking from 2007 to 2018 in Brazilian adults.
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Affiliation(s)
| | | | | | - Leandro F M Rezende
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventiva, Sao Paulo, SP, Brazil
| | - Emanuele Souza Marques
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Liu Q, Huang S, Qu X, Yin A. The status of health promotion lifestyle and its related factors in Shandong Province, China. BMC Public Health 2021; 21:1146. [PMID: 34130669 PMCID: PMC8207564 DOI: 10.1186/s12889-021-11152-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aims to explore the status of Shandong Province, China residents' health promotion lifestyle and its influencing factors, especially to explore how health attitude affects health promotion lifestyle, thus can make targeted recommendations for health promotion in China and similar areas. METHODS 1800 adults were selected from urban and rural areas of Shandong Province, China, using multistage stratified, cluster random sampling method. A survey was conducted face-to-face from March to May, 2018, using Health Promotion Lifestyle Profile and Health Attitude Questionnaire. The between-group measured data were compared by One-way ANOVA or t-tests. The correlation between the health attitude and health promotion lifestyle was examined by Pearson correlation. Logistic regression model was used to examine the related factors influencing health promotion lifestyle. Health promotion lifestyle is the dependent variable, and gender, education level, annual family per capita income and health attitude are the independent variables. RESULTS The mean (SD) of HPLP-IICR total score of the participants was 82.12(16.63). 54.50% of the participants had poor or average health promotion lifestyle, while 45.50% had good or excellent health promotion lifestyle. Significant differences existed in health promotion lifestyle among different gender, education level, income level, marital status, and health attitude (Ps < 0.001). Multivariable Logistic regression model found that male (OR = 0.35, 95% CI: 0.12-0.34), high school education level (OR = 0.57, 95% CI:0.17-0.41), junior middle school & below (OR = 0.42; 95% CI:0.12-0.33), annual family per capita income with < 10,000 CNY (OR = 2.53, 95% CI:1.24-2.06; OR = 2.14, 95% CI:1.08-3.12), low health affection (OR = 0.39, 95% CI:2.15-4.22), and low health behavioral intention (OR = 0.21; 95% CI: 2.33-5.29) were statistically significant correlates of average or poor health promotion lifestyle. CONCLUSIONS The health lifestyle needs to be further promoted in Shandong Province, China. The government and social sectors are encouraged to make more efforts to improve the accessibility and quality of health services. Meanwhile, individual responsibility cannot be ignored as well. More affective factors and operable measures should be added to enhance health affection and health behavioral intention, so as to enhance health promotion lifestyle.
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Affiliation(s)
- Qianqian Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
- Student Counseling Center, Shandong University, Jinan, 250100, China
| | - Shusheng Huang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Xiaoyuan Qu
- School of Nursing and Health, Henan University, Kaifeng, 475000, China
| | - Aitian Yin
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China.
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Thumé E, Kessler M, Machado KP, Nunes BP, Volz PM, Wachs LS, Soares MU, Saes MO, Duro SM, Dilélio AS, Facchini LA. Cohort study of ageing from Bagé (SIGa-Bagé), Brazil: profile and methodology. BMC Public Health 2021; 21:1089. [PMID: 34098933 PMCID: PMC8182998 DOI: 10.1186/s12889-021-11078-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Bagé Cohort Study of Ageing is a population-based cohort study that has recently completed the first follow-up of a representative sample of older adults from Bagé, a city with more than 100,000 inhabitants located in the state of Rio Grande do Sul, Brazil. This is one of the first longitudinal studies to assess the impact of primary health care coverage on health conditions and inequalities. Our aim is to investigate the prevalence, incidence and trends of risk factors, health behaviours, social relationships, non-communicable diseases, geriatric diseases and disorders, hospitalisation, self-perceived health, and all-cause and specific-cause mortality. In addition, we aim to evaluate socioeconomic and health inequalities and the impact of primary health care on the outcomes under study. METHODS/DESIGN The study covers participants aged 60 or over, selected by probabilistic (representative) sampling of the urban area of the city of Bagé, which is covered by Primary Health Care Services. The baseline examination included 1593 older adults and was conducted from July 2008 to November 2008. After eight to nine years (2016/2017), the first follow-up was conducted from September 2016 to August 2017. All participants underwent an extensive core assessment programme including structured interviews, questionnaires, cognitive testing (baseline and follow-up), physical examinations and anthropometric measurements (follow-up). RESULTS Of the original participants, 1395 (87.6%) were located for follow-up: 757 elderly individuals (47.5%) were re-interviewed, but losses in data transfer occurred for 22. The remaining 638 (40.1%) had died. In addition, we had 81 (5.1%) refusals and 117 (7.3%) losses. Among the 1373 older adults who were followed down, there was a higher proportion of female interviewees (p=0.042) and a higher proportion of male deaths (p=0.001) in 2016/2017. There were no differences in losses and refusals according to gender (p=0.102). There was a difference in average age between the interviewees (68.8 years; SD ±6.5) and non-interviewees (73.2 years; SD ±9.0) (p<0.001). Data are available at the Department of Social Medicine in Federal University of Pelotas, Rio Grande do Sul, Brazil, for any collaboration.
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Affiliation(s)
- Elaine Thumé
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil.
| | - Marciane Kessler
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil
- Institute of Health Equity, University College London, London, UK
| | - Karla P Machado
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil
| | - Bruno P Nunes
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil
| | - Pamela M Volz
- Department of Social Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Louriele S Wachs
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil
| | - Mariangela U Soares
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil
| | - Mirelle O Saes
- Post-Graduate Programme in Health Science, Federal University of Rio Grande, Rio Grande, Brazil
| | - Suele M Duro
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil
| | | | - Luiz A Facchini
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Szwarcwald CL, Damacena GN, Barros MBDA, Malta DC, Souza Júnior PRBD, Azevedo LO, Machado ÍE, Lima MG, Romero D, Gomes CS, Werneck AO, Silva DRPD, Gracie R, Pina MDFD. Factors affecting Brazilians' self-rated health during the COVID-19 pandemic. CAD SAUDE PUBLICA 2021; 37:e00182720. [PMID: 33950075 DOI: 10.1590/0102-311x00182720] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/28/2020] [Indexed: 01/02/2023] Open
Abstract
This is a cross-sectional study investigating the factors affecting brazilians' self-rated health during the COVID-19 pandemic, based on data from the web-based behavior survey. Carried out from April 24 to May 24, 2020, the survey recruited participants by a chain sampling procedure. Its outcome was the worsening of self-rated health during the pandemic. Statistical analysis was based on a hierarchical model of determination. Logistic regression models were used to test the associations between sociodemographic characteristics, pre-existing health conditions, lifestyle indicators and intensity of social restraint measures, and biological and psychological issues during the pandemic. From the total sample of 45,161 participants, 29.4% reported worsening of health state during this period. After adjusting for hierarchical distal factors, the health problems mostly associated with worsening health state were: bad self-rated health (adjusted OR = 4.35, p < 0.001), health care seeking for mental health problem (adjusted OR = 3.95, p < 0.001), and for COVID-19 (adjusted OR = 3.60, p < 0.001). People who experienced sleep problems, worsening of back pain, depression and at least one flu symptom during the pandemic were twice as likely to report worsening of health status. Sedentary and eating behaviors and adherence to social distancing measures showed significant correlation with the outcome. There exists a relation between social, biological, and psychological factors, mediated by lifestyles and variables pertaining to confinement. Altogether, these factors have negatively affected self-rated health during the COVID-19 pandemic in Brazil.
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Affiliation(s)
- Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | | | - Luiz Otávio Azevedo
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ísis Eloah Machado
- Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, Brasil
| | | | - Dália Romero
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Crizian Saar Gomes
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | | - Renata Gracie
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Maria de Fátima de Pina
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Feter N, Leite JS, Cardoso RK, Rombaldi AJ. Economic burden of physical inactivity in hospitalizations due to dementia: a Brazilian nationwide study. CAD SAUDE PUBLICA 2021; 37:e00046520. [PMID: 33566988 DOI: 10.1590/0102-311x00046520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/24/2020] [Indexed: 11/21/2022] Open
Abstract
Our study aimed at determining the economic burden of leisure-time physical inactivity in hospitalizations due to dementia in Brazil. In this national-wide descriptive study, we used secondary data from the Brazilian Health Informatics Department and from the latest Brazilian National Health Survey (2013). Rate of hospitalization and economic cost were extracted from 2013. Leisure-time physical inactivity prevalence was used to estimate its population attributable fraction for dementia. Outcomes were stratified into sex (man/woman), age groups (< 50, 50-59, 60-69, 70-79, 80+), ethnicity (white, black, mixed race, other), and region (South, Southeast, North, Northeast, and Central). In 2013, 3,724 people were hospitalized due to dementia in Brazil resulting in a total cost of BRL 17,971,833.85 (USD 7,673,973.05). More than half of cost among men was spent with individuals younger than 59 years, white and mixed-race, and from Southeast region. Proportion of cost was higher in women older than 60 years and white. In 2013, 37% of all hospitalization from dementia in Brazil were attributable to physical inactivity, with values reaching 42.9% and 43.8% for men and women aged 80 or older, respectively. Physical inactivity cost BRL 6,994,254.75 (USD 2,986,546.78) in 2013 on hospitalizations due to dementia in Brazil. Higher attributable-cost was found for patients younger than 50 years and women older than 80. Strategies to preserve the quality of life of these patients are needed to reduce the burden for the patients, their family, and on the healthcare system.
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Affiliation(s)
- Natan Feter
- Universidade Federal de Pelotas, Pelotas, Brasil.,The University of Queensland, St. Lucia, Australia
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Pescarini JM, Craig P, Allik M, Amorim L, Ali S, Smeeth L, Barreto ML, Leyland AH, Aquino EML, Katikireddi SV. Evaluating the impact of the Bolsa Familia conditional cash transfer program on premature cardiovascular and all-cause mortality using the 100 million Brazilian cohort: a natural experiment study protocol. BMJ Open 2020; 10:e039658. [PMID: 33444195 PMCID: PMC7682454 DOI: 10.1136/bmjopen-2020-039658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/30/2020] [Accepted: 09/30/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Brazil's Bolsa Familia Program (BFP) is the world's largest conditional cash transfer scheme. We shall use a large cohort of applicants for different social programmes to evaluate the effect of BFP receipt on premature all-cause and cardiovascular mortality. METHODS AND ANALYSIS We will identify BFP recipients and non-recipients among new applicants from 2004 to 2015 in the 100 Million Brazilian Cohort, a database of 114 million individuals containing sociodemographic and mortality information of applicants to any Brazilian social programme. For individuals applying from 2011, when we have better recorded income data, we shall compare premature (age 30-69) cardiovascular and all-cause mortality among BFP recipients and non-recipients using regression discontinuity design (RDD) with household monthly per capita income as the forcing variable. Effects will be estimated using survival models accounting for individuals follow-up. To test the sensitivity of our findings, we will estimate models with different bandwidths, include potential confounders as covariates in the survival models, and restrict our data to locations with the most reliable data. In addition, we will estimate the effect of BFP on studied outcomes using propensity score risk-set matching, separately for individuals that applied ≤2010 and >2011, allowing comparability with RDD. Analyses will be stratified by geographical region, gender, race/ethnicity and socioeconomic position. We will investigate differential impacts of BFP and the presence of effect modification for a combination of characteristics, including gender and race/ethnicity. ETHICS AND DISSEMINATION The study was approved by the ethics committees of Oswaldo Cruz Foundation and the University of Glasgow College of Medicine and Veterinary Life Sciences. The deidentified dataset will be provided to researchers, and data analysis will be performed in a safe computational environment without internet access. Study findings will be published in high quality peer-reviewed research articles. The published results will be disseminated in the social media and to policy-makers.
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Affiliation(s)
- Julia M Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Craig
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Mirjam Allik
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Leila Amorim
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Brazil
| | - Sanni Ali
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Health Data Research (HDR), London, UK
| | - Mauricio L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Alastair H Leyland
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Estela M L Aquino
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Hone T, Saraceni V, Medina Coeli C, Trajman A, Rasella D, Millett C, Durovni B. Primary healthcare expansion and mortality in Brazil's urban poor: A cohort analysis of 1.2 million adults. PLoS Med 2020; 17:e1003357. [PMID: 33125387 PMCID: PMC7598481 DOI: 10.1371/journal.pmed.1003357] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/11/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Expanding delivery of primary healthcare to urban poor populations is a priority in many low- and middle-income countries. This remains a key challenge in Brazil despite expansion of the country's internationally recognized Family Health Strategy (FHS) over the past two decades. This study evaluates the impact of an ambitious program to rapidly expand FHS coverage in the city of Rio de Janeiro, Brazil, since 2008. METHODS AND FINDINGS A cohort of 1,241,351 low-income adults (observed January 2010-December 2016; total person-years 6,498,607) with linked FHS utilization and mortality records was analyzed using flexible parametric survival models. Time-to-death from all-causes and selected causes were estimated for FHS users and nonusers. Models employed inverse probability treatment weighting and regression adjustment (IPTW-RA). The cohort was 61% female (751,895) and had a mean age of 36 years (standard deviation 16.4). Only 18,721 individuals (1.5%) had higher education, whereas 102,899 (8%) had no formal education. Two thirds of individuals (827,250; 67%) were in receipt of conditional cash transfers (Bolsa Família). A total of 34,091 deaths were analyzed, of which 8,765 (26%) were due to cardiovascular disease; 5,777 (17%) were due to neoplasms; 5,683 (17%) were due to external causes; 3,152 (9%) were due to respiratory diseases; and 3,115 (9%) were due to infectious and parasitic diseases. One third of the cohort (467,155; 37.6%) used FHS services. In IPTW-RA survival analysis, an average FHS user had a 44% lower hazard of all-cause mortality (HR: 0.56, 95% CI 0.54-0.59, p < 0.001) and a 5-year risk reduction of 8.3 per 1,000 (95% CI 7.8-8.9, p < 0.001) compared with a non-FHS user. There were greater reductions in the risk of death for FHS users who were black (HR 0.50, 95% CI 0.46-0.54, p < 0.001) or pardo (HR 0.57, 95% CI 0.54-0.60, p < 0.001) compared with white (HR 0.59, 95% CI 0.56-0.63, p < 0.001); had lower educational attainment (HR 0.50, 95% CI 0.46-0.55, p < 0.001) for those with no education compared to no significant association for those with higher education (p = 0.758); or were in receipt of conditional cash transfers (Bolsa Família) (HR 0.51, 95% CI 0.49-0.54, p < 0.001) compared with nonrecipients (HR 0.63, 95% CI 0.60-0.67, p < 0.001). Key limitations in this study are potential unobserved confounding through selection into the program and linkage errors, although analytical approaches have minimized the potential for bias. CONCLUSIONS FHS utilization in urban poor populations in Brazil was associated with a lower risk of death, with greater reductions among more deprived race/ethnic and socioeconomic groups. Increased investment in primary healthcare is likely to improve health and reduce health inequalities in urban poor populations globally.
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Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Valeria Saraceni
- Health Surveillance Branch, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudia Medina Coeli
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anete Trajman
- Programa de Pós-graduação em Clínica Médica, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Mestrado Profissional em Atenção Primária à Saúde, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Davide Rasella
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Betina Durovni
- Centro de Estudos Estratégicos, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Malta DC, Duncan BB, Schmidt MI, Teixeira R, Ribeiro ALP, Felisbino-Mendes MS, Machado ÍE, Velasquez-Melendez G, Brant LCC, Silva DAS, Passos VMDA, Nascimento BR, Cousin E, Glenn S, Naghavi M. Trends in mortality due to non-communicable diseases in the Brazilian adult population: national and subnational estimates and projections for 2030. Popul Health Metr 2020; 18:16. [PMID: 32993685 PMCID: PMC7525955 DOI: 10.1186/s12963-020-00216-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/09/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Monitoring and reducing premature mortality due to non-communicable diseases (NCDs) is a global priority of Agenda 2030. This study aimed to describe the mortality trends and disability-adjusted life years (DALYs) lost due to NCDs between 1990 and 2017 for Brazil and to project those for 2030 as well as the risk factors (RFs) attributed deaths according to estimates of the Global Burden of Disease Study. METHODS We analyzed cardiovascular diseases, chronic respiratory diseases, neoplasms, and diabetes, and compared the mortality rates in 1990 and 2017 for all of Brazil and states. The study used the definition of premature mortality (30-69 years) that is used by the World Health Organization. The number of deaths, mortality rates, DALYs, and years of life lost (YLL) were used to compare 1990 and 2017. We analyzed the YLL for NCDs attributable to RFs. RESULTS There was a reduction of 35.3% from 509.1 deaths/100,000 inhabitants (1990) to 329.6 deaths/100,000 inhabitants due to NCDs in 2017. The DALY rate decreased by 33.6%, and the YLL rate decreased by 36.0%. There were reductions in NCDs rates in all 27 states. The main RFs related to premature deaths by NCDs in 2017 among women were high body mass index (BMI), dietary risks, high systolic blood pressure, and among men, dietary risks, high systolic blood pressure, tobacco, and high BMI. Trends in mortality rates due to NCDs declined during the study period; however, after 2015, the curve reversed, and rates fluctuated and tended to increase. CONCLUSION Our findings highlighted a decline in premature mortality rates from NCDs nationwide and in all states. There was a greater reduction in deaths from cardiovascular diseases, followed by respiratory diseases, and we observed a minor reduction for those from diabetes and neoplasms. The observed fluctuations in mortality rates over the last 3 years indicate that if no further action is taken, we may not achieve the NCD Sustainable Development Goals. These findings draw attention to the consequences of austerity measures in a socially unequal setting with great regional disparities in which the majority of the population is dependent on state social policies.
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Affiliation(s)
- Deborah Carvalho Malta
- Nursing School, Department of Maternal and Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Bruce Bartholow Duncan
- Postgraduate Program in Epidemiology and Hospital das Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology and Hospital das Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renato Teixeira
- School of Medicine, Graduate Program in Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antonio Luiz Pinho Ribeiro
- School of Medicine, Hospital das Clínicas,Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- School of Medicine, Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mariana Santos Felisbino-Mendes
- Nursing School, Department of Maternal and Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ísis Eloah Machado
- School of Medicine, Department of Family Medicine, Mental and Public Health, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Gustavo Velasquez-Melendez
- Nursing School, Department of Maternal and Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luisa Campos Caldeira Brant
- School of Medicine, Hospital das Clínicas,Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- School of Medicine, Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Bruno R Nascimento
- School of Medicine, Hospital das Clínicas,Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- School of Medicine, Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ewerton Cousin
- Postgraduate Program in Epidemiology and Hospital das Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Scott Glenn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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de Souza FC. Relationships between best-practice and greatest possible life expectancies. Eur J Ageing 2020; 17:331-339. [PMID: 32904848 DOI: 10.1007/s10433-019-00549-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This paper investigated the relationships between the best-practice and the greatest possible life expectancies by means of gaps, lags and decomposition analyses, from 1950-1955 up to 2095-2100. The data were gathered from the United Nations' World Population Prospects (2017), containing abridged period life tables, for both sexes combined, for 201 countries or areas, which allowed the identification of low-mortality regions that are sometimes omitted in previous studies. It was observed that both best-practice and greatest possible life expectancies rose and are expected to continue to rise linearly in a very similar way. Moreover, the average gap between the best-practice and the greatest possible life expectancies was of about 1.14 years and the average lag was 7.59 years. Finally, it was found that major contributions to the gap are typically due to age groups beyond 65 years.
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Affiliation(s)
- Filipe Costa de Souza
- Departamento de Ciências Contábeis e Atuariais, Centro de Ciências Sociais Aplicadas, Universidade Federal de Pernambuco, Cidade Universitária, Avenida dos Funcionários, S/N, Recife, PE CEP 50670-901 Brazil
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Costa LFL, de Mesquita Silva Montenegro M, Rabello Neto DDL, de Oliveira ATR, Trindade JEDO, Adair T, Marinho MDF. Estimating completeness of national and subnational death reporting in Brazil: application of record linkage methods. Popul Health Metr 2020; 18:22. [PMID: 32887639 PMCID: PMC7650525 DOI: 10.1186/s12963-020-00223-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 08/13/2020] [Indexed: 01/02/2023] Open
Abstract
Background In Brazil, both the Civil Registry (CR) and Ministry of Health (MoH) Mortality Information System (SIM) are sources of routine mortality data, but neither is 100% complete. Deaths from these two sources can be linked to facilitate estimation of completeness of mortality reporting and measurement of adjusted mortality indicators using generalized linear modeling (GLM). Methods The 2015 and 2016 CR and SIM data were linked using deterministic methods. GLM with covariates of the deceased’s sex, age, state of residence, cause of death and place of death, and municipality-level education decile and population density decile, was used to estimate total deaths and completeness nationally, subnationally and by population sub-group, and to identify the characteristics of unreported deaths. The empirical completeness method and Global Burden of Disease (GBD) 2017 estimates were comparators at the national and state level. Results Completeness was 98% for SIM and 95% for CR. The vast majority of deaths in Brazil were captured by either system and 94% were reported by both sources. For each source, completeness was lowest in the north. SIM completeness was consistently high across all sub-groups while CR completeness was lowest for deaths at younger ages, outside facilities, and in the lowest deciles of municipality education and population density. There was no clear municipality-level relationship in SIM and CR completeness, suggesting minimal dependence between sources. The empirical completeness method model 1 and GBD completeness estimates were each, on average, less than three percentage points different from GLM estimates at the state level. Life expectancy was lowest in the northeast and 7.5 years higher in females than males. Conclusions GLM using socio-economic and demographic covariates is a valuable tool to accurately estimate completeness from linked data sources. Close scrutiny of the quality of variables used to link deaths, targeted identification of unreported deaths in poorer, northern states, and closer coordination of the two systems will help Brazil achieve 100% death reporting completeness. The results also confirm the validity of the empirical completeness method.
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Affiliation(s)
- Luiz Fernando Lima Costa
- Brazilian Institute of Geography and Statistics (IBGE), Level 8, 500 Republic of Chile Avenue, Rio de Janeiro, RJ, 20031-170, Brazil
| | | | - Dacio de Lyra Rabello Neto
- Ministry of Health, SRTVN 701, Via W5 Norte, PO700 Building, 6th floor-DASNT, Brasilia, DF, 70723-040, Brazil
| | - Antonio Tadeu Ribeiro de Oliveira
- Brazilian Institute of Geography and Statistics (IBGE), Level 8, 500 Republic of Chile Avenue, Rio de Janeiro, RJ, 20031-170, Brazil
| | - Jose Eduardo de Oliveira Trindade
- Brazilian Institute of Geography and Statistics (IBGE), Level 8, 500 Republic of Chile Avenue, Rio de Janeiro, RJ, 20031-170, Brazil
| | - Tim Adair
- University of Melbourne, Melbourne School of Population and Global Health, The University of Melbourne, Level 5, Building 379, 207 Bouverie Street, Carlton, Victoria, 3010, Australia.
| | - Maria de Fatima Marinho
- Tele-Health/Federal University of Minas Gerais, Pres. Antônio Carlos, 6627-Pampulha, Belo Horizonte, MG, 31270-901, Brazil
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Malta DC, Bernal RTI, Vieira Neto E, Curci KA, Pasinato MTDM, Lisbôa RM, Cachapuz RF, Coelho KSC, Santos FPD, Freitas MIFD. Doenças Crônicas Não Transmissíveis e fatores de risco e proteção em adultos com ou sem plano de saúde. CIENCIA & SAUDE COLETIVA 2020; 25:2973-2983. [DOI: 10.1590/1413-81232020258.32762018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/03/2018] [Indexed: 11/21/2022] Open
Abstract
Resumo O estudo descreve as coberturas de planos de saúde e compara a ocorrência de fatores de risco (FR) e proteção de Doenças Crônicas Não Transmissíveis, na população com e sem planos de saúde nas capitais brasileiras. Foram analisados dados do inquérito telefônico Vigitel. Foi utilizado o modelo de regressão de Poisson para estimar a razão de prevalência (RP), comparando FR entre quem tem ou não plano de saúde. A cobertura de planos foi de 49,1%, mais elevada em Goiania, Vitória, Florianópolis e Belo Horizonte, entre adultos acima de 55 anos e com maior escolaridade. A população com planos de saúde apresenta prevalências mais elevadas de fatores de proteção como consumo de frutas e hortaliças (RP = 1,3 IC95% 1,2-1,3), prática de atividade física no tempo livre (RP = 1,2 IC95% 1,2-1,3), mamografia (RP = 1,2 IC95% 1,1-1,3) e Papanicolau (RP = 1,1 IC95% 1,2-1,3), e menor prevalência de FR como tabagismo (RP = 0,7 IC95% 0,6-0,8), avaliação de saúde ruim (RP = 0,8 IC95% 0,6-0,9), obesidade (RP = 0,8 IC95% 0,7-0,9), carne com gordura (RP = 0,9 IC95% 0,8-0,9) e leite com gordura (RP = 0,9 IC95% 0,8-0,9). Independentemente da escolaridade, a população que tem planos de saúde apresenta geralmente, melhores indicadores, como hábitos mais saudáveis e maior cobertura de exames preventivos.
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Malta DC, Bernal RTI, de Carvalho QH, Pell JP, Dundas R, Leyland A, de Vasconcelos LLC, de Magalhaes Cardoso LS, Stopa SR, Barreto ML. Women and evaluation of inequalities in the distribution of risk factors for Chronic non-communicable diseases (NCD), Vigitel 2016-2017. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200058. [PMID: 32520106 PMCID: PMC7613912 DOI: 10.1590/1980-549720200058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/09/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To compare the distribution of chronic non-communicable diseases (CNCD) indicators among adult female beneficiaries and non-beneficiaries of the Bolsa Família Program (BFP) in Brazilian capitals. METHODS Analysis of Vigitel telephone survey data in 2016 and 2017. Gross and adjusted prevalence ratios (PR) and their respective confidence intervals were estimated using Poisson Regression model. RESULTS Women with BF have lower schooling, are young people, live more frequently in the Northeast and North of the country. Higher prevalence of risk factors were found in woman receiving BF. The adjusted PR of the BF women were: smokers (PR = 1.98), overweight (PR = 1.21), obesity (PR = 1.63), fruits and vegetables (PR = 0.63), consumption of soft drinks (PR = 1.68), bean consumption (PR = 1.25), physical activity at leisure (PR = 0.65), physical activity at home (PR = 1.35), time watching TV (PR = 1.37), self-assessment of poor health status (PR =2.04), mammography (PR = 0.86), Pap smears (PR = 0.91), hypertension (PR = 1.46) and diabetes (PR = 1,66). When women were compared among strata of the same schooling, these differences were reduced. CONCLUSION Worst indicators among women receiving BF reflect social inequalities inherent in this most vulnerable group. The study also shows that BF is being targeted at the most vulnerable women.
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Affiliation(s)
| | | | | | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Lilybank Gardens – Glasgow, United Kingdom
| | - Ruth Dundas
- MRC/SCO Social and Public Health Sciences Unit, University of Glasgow – Glasgow, Reino Unido
| | - Alastair Leyland
- MRC/SCO Social and Public Health Sciences Unit, University of Glasgow – Glasgow, Reino Unido
| | | | | | | | - Mauricio Lima Barreto
- Centro of Health Data and Knowledge Integration, Fundação Oswaldo Cruz – Salvador (BA), Brazil
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Bedoya-Pacheco SJ, Emygdio RF, Nascimento JASD, Bravo JAM, Bozza FA. Intensive care inequity in Rio de Janeiro: the effect of spatial distribution of health services on severe acute respiratory infection. Rev Bras Ter Intensiva 2020; 32:72-80. [PMID: 32401976 PMCID: PMC7206958 DOI: 10.5935/0103-507x.20200012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/07/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To analyze the distribution of adult intensive care units according to geographic region and health sector in Rio de Janeiro and to investigate severe acute respiratory infection mortality in the public sector and its association with critical care capacity in the public sector. METHODS We evaluated the variation in intensive care availability and severe acute respiratory infection mortality in the public sector across different areas of the city in 2014. We utilized databases from the National Registry of Health Establishments, the Brazilian Institute of Geography and Statistics, the National Mortality Information System and the Hospital Admission Information System. RESULTS There is a wide range of intensive care unit beds per capita (from 4.0 intensive care unit beds per 100,000 people in public hospitals in the West Zone to 133.6 intensive care unit beds per 100,000 people in private hospitals in the Center Zone) in the city of Rio de Janeiro. The private sector accounts for almost 75% of the intensive care unit bed supply. The more developed areas of the city concentrate most of the intensive care unit services. Map-based spatial analysis shows a lack of intensive care unit beds in vast territorial extensions in the less developed regions of the city. There is an inverse correlation (r = -0.829; 95%CI -0.946 to -0.675) between public intensive care unit beds per capita in different health planning areas of the city and severe acute respiratory infection mortality in public hospitals. CONCLUSION Our results show a disproportionate intensive care unit bed provision across the city of Rio de Janeiro and the need for a rational distribution of intensive care.
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Affiliation(s)
- Sandro Javier Bedoya-Pacheco
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Romeu Ferreira Emygdio
- Coordenação de Recursos Naturais e Estudos Ambientais, Instituto Brasileiro de Geografia e Estatística, Rio de Janeiro, RJ, Brasil
| | | | | | - Fernando Augusto Bozza
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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Abstract
OBJECTIVES To analyze factors associated with age at natural menopause in elderly women who are part of the Health, Well-Being and Aging Study- which is a representative sample of elderly residents of the municipality of São Paulo, Brazil. METHODS Multivariate Cox proportional-hazards analysis using data from a total of 1,415 women with natural menopause. We included 163 women with hysterectomy, oophorectomy, and estrogen therapy as censored data. RESULTS The median age of natural menopause was 50 years. In the multivariate Cox proportional hazards, smoking was associated with earlier age at natural menopause for the three cohorts (2000, 2006, and 2010). Current smokers had a 35% higher risk of earlier natural menopause (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.12, 1.62) and former smokers had a 27% higher risk of earlier natural menopause (HR 1.27, 95% CI 1.09, 1.50), in comparison with never-smokers. Women with 8 years or more of formal education had a 33% lower risk of earlier natural menopause (HR 0.67, 95% CI 0.50, 0.89) than women with no education, and women who were separated, widowed, or divorced had a 15% higher risk of earlier natural menopause (HR 1.15, 95% CI 1.00, 1.31) in comparison with married women. Marital status and parity were associated with later age at natural menopause only in 2006. CONCLUSIONS We found significant associations of age at natural menopause with reproductive and lifestyle factors similar to some studies of women from developed countries.
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de Assis Araujo MS, Figueiredo ND, Camara VM, Froes Asmus CIR. Maternal-child exposure to metals during pregnancy in Rio de Janeiro city, Brazil: The Rio Birth Cohort Study of Environmental Exposure and Childhood Development (PIPA project). ENVIRONMENTAL RESEARCH 2020; 183:109155. [PMID: 32006767 DOI: 10.1016/j.envres.2020.109155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Environmental metal exposure during pregnancy can affect intrauterine growth and disrupt child development. Metal exposure in urban areas can occur through the air, water and food routes. The city of Rio de Janeiro is the second more populous of Brazil and the sixth most populous in the American continent and is characterized by a significant social-economic inequality and a large range of urban organization problems. OBJECTIVES To evaluate environmental heavy metal (arsenic, cadmium, lead and mercury) exposure in mother-newborns pairs in an urban area in Rio de Janeiro, Brazil. METHODS All pregnant women, over 16 years of age, who came to the University Maternity School for newborn delivery orientation, between October and November 2017, were invited to participate in the project. Socioeconomic, cultural, leisure, and living conditions data of from the parents were collected via questionnaire; whole maternal blood and umbilical cord blood samples were also collected. RESULTS Of the 209 eligible pregnant women 142 (68%) accepted the invitation to participate in the study. A total of 131 (92.3%) mothers delivered live born children, and maternal blood and umbilical cord blood were collected from 117 mother-newborn pairs. Metal concentrations above the detection limit were detected in all maternal and cord blood samples. Strong correlations of arsenic, cadmium, lead and mercury concentrations between maternal and umbilical cord blood were observed. Median lead and arsenic concentrations in maternal and umbilical cord blood were higher than values reported in other studies conducted in Brazil and worldwide. Lead concentrations in 25% of the umbilical cord blood samples were near of 5 μg/dL (P75 = 4.92 μg/dL). CONCLUSION The results reported herein indicate the need for the establishment of health surveillance programs in Brazil, in order to investigate and monitor the health effects of environmental heavy metal exposure in children since the gestation period.
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Affiliation(s)
| | | | - Volney M Camara
- Public Health Institute, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carmen I R Froes Asmus
- Public Health Institute, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Blatyta PF, Kelly S, Sabino E, Preiss L, Mendes F, Carneiro-Proietti AB, Werneck Rodrigues DDO, Mota R, Loureiro P, Maximo C, Park M, Mendrone-Jr A, Gonçalez TT, de Almeida Neto C, Custer B. Prevalence of serologic markers of transfusion and sexually transmitted infections and their correlation with clinical features in a large cohort of Brazilian patients with sickle cell disease. Transfusion 2020; 60:343-350. [PMID: 31804727 PMCID: PMC8010912 DOI: 10.1111/trf.15619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) often require red blood cell (RBC) transfusion for clinical complications, so may be exposed to transfusion-transmitted infections (TTIs). The prevalence of markers for human immunodeficiency virus (HIV), hepatitis C virus (HCV) and B (HBV), human T-cell lymphotropic virus (HTLV-1/2), Chagas disease, and syphilis in an SCD cohort in Brazil were studied. STUDY DESIGN AND METHODS Clinical history, interview data, blood samples, and medical chart review data were collected during cohort enrollment from November 2013 to May 2015. Serologic markers of infection were assessed. Standard measures of statistical association were calculated, and multivariable models were developed for the most prevalent infections to identify associated factors. RESULTS Infection markers were evident in 5.2% (144/2779) of the enrolled cohort. Anti-HCV was detected in 69 (2.5%), syphilis antibodies in 34 (1.2%), anti-HTLV-1/2 in 17 (0.6%), HBV surface antigen in 13 (0.5%), Chagas disease antibodies in 13 (0.5%), and anti-HIV in 8 (0.3%) of participants. Factors associated with increased odds of being anti-HCV reactive were older age, illegal drug use, increasing number of RBCs, more than three pain crises in the previous year, and geographic location. Syphilis was associated with older age, females, and smoking history. CONCLUSION HCV infection was more common in older patients who may have received RBCs before testing was performed on donations, suggesting possible historic transfusion transmission. The cohort showed decreasing rates of infections and a reduction in transfusion transmission markers in younger patients compared to historical literature except for syphilis, indicating contemporary reduced risk of TTI.
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Affiliation(s)
- Paula F Blatyta
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Shannon Kelly
- Vitalant Research Institute, San Francisco, California
| | - Ester Sabino
- Instituto de Medicina Tropical da FMUSP, Sao Paulo, Brazil
| | - Liliana Preiss
- Research Triangle Institute International, Rockville, Maryland
| | | | | | | | - Rosimere Mota
- Hemominas Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Paula Loureiro
- Hemope and Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Miriam Park
- Instituto da Criança-Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Cesar de Almeida Neto
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California
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Leisure-time physical activity and sports in the Brazilian population: A social disparity analysis. PLoS One 2019; 14:e0225940. [PMID: 31794582 PMCID: PMC6890238 DOI: 10.1371/journal.pone.0225940] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives To estimate the prevalence of leisure-time physical activity (LTPA) or sports in the Brazilian population according to demographic and income variables. Methods Data from 60,202 Brazilian individuals (18 years and over) were analyzed, belonging to the National Health Survey 2013 sample. The prevalence of different modalities of LTPA and sports was estimated according to age, sex, skin color and income. The adjusted prevalence ratios were estimated by Poisson regression. Results Of every thousand Brazilians, 695 do not practice LTPA or sports. Walking is the most practiced LTPA (98/1000), followed by soccer (68/1000) and weight training (45/1000). For poor and black men, the most frequent LTPA was soccer, and, for women, gymnastics and walking. The prevalence of weight training and gymnastics was higher for white people compared with black people. All LTPA practices were more prevalent in individuals with higher income, except for soccer. Running on a treadmill and weight training had, respectively, 24.7 and 6.4 times higher prevalence in the richer quartile. Conclusions The study allowed identifying the type of LTPA and sport reported as the most frequent by the Brazilian population according to age, sex, skin color, and income, detecting strong social disparities in these practices.
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Canuto R, Fanton M, Lira PICD. Iniquidades sociais no consumo alimentar no Brasil: uma revisão crítica dos inquéritos nacionais. CIENCIA & SAUDE COLETIVA 2019; 24:3193-3212. [DOI: 10.1590/1413-81232018249.26202017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 02/07/2018] [Indexed: 11/22/2022] Open
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Matijasevich A, Victora CG, Silveira MF, Wehrmeister FC, Horta BL, Barros FC. Maternal reproductive history: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982-2015. Int J Epidemiol 2019; 48:i16-i25. [PMID: 30883655 PMCID: PMC6422066 DOI: 10.1093/ije/dyy169] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2018] [Indexed: 12/29/2022] Open
Abstract
Background Brazil experienced important progress in maternal and child health in recent decades. We aimed at describing secular trends as well as socioeconomic and ethnic inequalities in reproductive history indicators (birth spacing, previous adverse perinatal outcome, parity and multiple births) over a 33-year span. Methods Four population-based birth cohort studies included all hospital births in 1982, 1993, 2004 and 2015 in Pelotas, Southern Brazil. Information on reproductive history was collected through interviews. Indicators were stratified by family income quintiles and skin colour. Absolute and relative measures of inequality were calculated. Results From 1982 to 2015, the proportion of primiparae increased from 39.2% to 49.6%, and median birth interval increased by 23.2 months. Poor women were more likely to report short intervals and higher parity, although reductions were observed in all income and ethnic groups. History of previous low birthweight was inversely related to income and increased by 7.7% points (pp) over time—more rapidly in the richest (12.1 pp) than in the poorest quintile (0.4 pp). Multiple births increased from 1.7% to 2.7%, with the highest increase observed among the richest quintile and for white women (220% and 70% increase, respectively). Absolute and relative income and ethnic-related inequalities for short birth intervals increased, whereas inequalities for previous low birthweight decreased over time. Conclusions In this 33-year period there were increases in birth intervals, multiple births and reports of previous low-birthweight infants. These trends may be explained by increased family planning coverage, assisted reproduction and a rise in preterm births, respectively. Our results show that socioeconomic and ethnic inequalities in health are dynamic and vary over time, within the same location.
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Affiliation(s)
- Alicia Matijasevich
- Department of Preventive Medicine, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Mariangela F Silveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.,Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
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Duarte APP, Rodrigues PRM, Ferreira MG, Cunha DB, Moreira NF, Sichieri R, Muraro AP. Socio-economic and demographic characteristics associated with risk behaviour patterns for chronic non-communicable diseases in Brazil: data from the National Health Survey, 2013. Public Health Nutr 2019; 22:2083-2091. [PMID: 30859926 PMCID: PMC10260586 DOI: 10.1017/s136898001900034x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/19/2018] [Accepted: 01/16/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To identify risk behaviour patterns for chronic non-communicable diseases (NCD) in the Brazilian population and to investigate associated socio-economic and demographic factors. DESIGN Factor analysis was used to identify patterns considering the following risk behaviours: consumption of soft drinks/artificial juice, sweet foods, red meat with apparent fat, chicken skin; inadequate consumption of fruits and vegetables; alcohol abuse; smoking; absence of physical activity during leisure time; and time spent watching television. The χ 2 test was used to compare ratios. All analyses accounted for weighting factors and the study's complex sampling design effect. The socio-economic and demographic variables evaluated were gender, age, schooling level and macro region of residence. SETTING National Health Survey, a household survey with national representation, conducted in 2013 in Brazil.ParticipantsIndividuals (n 60202) aged 18 years or over. RESULTS Four risk behaviour patterns were identified: 'Physical inactivity in leisure time and Inadequate consumption of fruits and vegetables', 'Saturated fat', 'Alcohol and Smoking' and 'Sedentary behaviour and Sugar', explaining 52·01 % of the total variance. Overall, greater adherence to 'Saturated fat' and 'Alcohol and Smoking' patterns was observed among men and those with lower education level. The 'Sedentary behaviour and Sugar' and 'Physical inactivity in leisure time and Inadequate consumption of fruits and vegetables' patterns had greater adherence among younger individuals, and the first was associated with higher education whereas the second with less education among individuals residing in the North and Northeast regions. CONCLUSIONS Risk behaviour patterns for NCD were heterogeneous, reflecting the socio-economic and demographic differences in Brazil.
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Affiliation(s)
- Ana Paula P Duarte
- Department of Food and Nutrition, Federal University of Mato Grosso, Cuiabá, MG, Brazil
| | | | | | - Diana Barbosa Cunha
- Department of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Naiara Ferraz Moreira
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, MS, Brazil
| | - Rosely Sichieri
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Ana Paula Muraro
- Institut of Public Health, Department of Public Health, Federal University of Mato Grosso, Av. Fernando Corrêa da Costa 2367, Bairro Boa Esperança, Bloco: CCBS III, Cuiabá, MT 78060-900, Brazil
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Rentería-Ramos R, Hurtado-Heredia R, Urdinola BP. Morbi-Mortality of the Victims of Internal Conflict and Poor Population in the Risaralda Province, Colombia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091644. [PMID: 31083523 PMCID: PMC6540234 DOI: 10.3390/ijerph16091644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 04/28/2019] [Accepted: 04/29/2019] [Indexed: 12/18/2022]
Abstract
This work studies the health status of two populations similar in most social and environmental interactions but one: the individuals from one population are victims of an internal armed conflict. Both populations are located in the Risaralda province, Colombia and the data for this study results from a combination of administrative records from the health system, between 2011 and 2016. We implemented a methodology based on graph theory that defines the system as a set of heterogeneous social actors, including individuals as well as organizations, embedded in a biological environment. The model of analysis uses the diagnoses in medical records to detect morbidity and mortality patterns for each individual (ego-networks), and assumes that these patterns contain relevant information about the effects of the actions of social actors, in a given environment, on the status of health. The analysis of the diagnoses and causes of specific mortality, following the Social Network Analysis framework, shows similar morbidity and mortality rates for both populations. However, the diagnoses' patterns show that victims portray broader interactions between diagnoses, including mental and behavioral disorders, due to the hardships of this population.
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Affiliation(s)
- Rafael Rentería-Ramos
- Departments of Physics and Statistics, Universidad Nacional de Colombia, Cra 45 Bogotá, Colombia.
- School of Basic Sciences, Technologies and Engineering, Universidad Nacional Abierta y a Distancia de Colombia, 111321 Bogotá, Colombia.
| | | | - B Piedad Urdinola
- Department of Statistics, Universidad Nacional de Colombia, Cra 45 Bogotá, Colombia.
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Bruno J, Machado J, Ferreira Y, Munsch L, Silès J, Steinmetz T, Rotonda C, Vismara L, Tarquinio C. Impact of attachment styles in the development of traumatic symptoms in French women victims of sexual violence. SEXOLOGIES 2019. [DOI: 10.1016/j.sexol.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Impact des styles d’attachement dans le développement des symptômes traumatiques chez des femmes françaises victimes de violences sexuelles. SEXOLOGIES 2019. [DOI: 10.1016/j.sexol.2018.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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