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Bottura B, Haddad RF, Alvarenga-Bezerra V, Campos V, Perez L, Resende C, Asencio FDA, Liao AW, Gomes MTV, Zlotnik E, Moretti-Marques R. Developing a Nomogram for Prioritizing Hysteroscopy in Endometrial Cancer Diagnosis: A Case-Control Study. J Clin Med 2024; 13:1145. [PMID: 38398458 PMCID: PMC10889308 DOI: 10.3390/jcm13041145] [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: 01/02/2024] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: The pandemic led to significant healthcare disruptions, resulting in postponed surgeries and extended waiting times for non-urgent treatments, including hysteroscopies essential for diagnosing endometrial cancer. This study aims to formulate a risk stratification model to enhance the prioritization of hysteroscopy procedures in Brazil; (2) Methods: A case-control study was conducted at Vila Santa Catarina Hospital in São Paulo, analyzing the medical records of 2103 women who underwent hysteroscopy between March 2019 and March 2022. We used bivariate analysis and multivariate linear regression to identify risk factors associated with endometrial cancer and formulate a nomogram; (3) Results: The findings revealed a 5.5% incidence of pre-invasive and invasive endometrial disease in the study population, with an average waiting time of 120 days for hysteroscopy procedures. The main risk factors identified were hypertension, diabetes, postmenopausal bleeding, and obesity; (4) Conclusions: This research highlights the urgent need for efficient prioritization of hysteroscopy procedures in the wake of the pandemic. The developed nomogram is an innovative tool for identifying patients at higher risk of endometrial cancer, thus facilitating timely diagnosis and treatment and improving overall patient outcomes in a strained healthcare system.
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Affiliation(s)
- Bruna Bottura
- Ginecologia Oncológica, Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho, São Paulo 04378-500, SP, Brazil; (B.B.); (V.A.-B.); (R.M.-M.)
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Raphael Federicci Haddad
- Ginecologia Oncológica, Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho, São Paulo 04378-500, SP, Brazil; (B.B.); (V.A.-B.); (R.M.-M.)
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Vanessa Alvarenga-Bezerra
- Ginecologia Oncológica, Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho, São Paulo 04378-500, SP, Brazil; (B.B.); (V.A.-B.); (R.M.-M.)
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Vinicius Campos
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Luiza Perez
- Weill Cornell Medicine, New York, NY 10075, USA;
| | - Carolina Resende
- Ginecologia Oncológica, Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho, São Paulo 04378-500, SP, Brazil; (B.B.); (V.A.-B.); (R.M.-M.)
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Fernanda de Almeida Asencio
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Adolfo Wenjaw Liao
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Mariano Tamura Vieira Gomes
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Eduardo Zlotnik
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Renato Moretti-Marques
- Ginecologia Oncológica, Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho, São Paulo 04378-500, SP, Brazil; (B.B.); (V.A.-B.); (R.M.-M.)
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
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Miranda AE, Santos PC, Coelho RA, Pascom ARP, de Lannoy LH, Ferreira ACG, Gaspar PC, Maciel EL, Barreira D, Pereira GFM. Perspectives and challenges for mother-to-child transmission of HIV, hepatitis B, and syphilis in Brazil. Front Public Health 2023; 11:1182386. [PMID: 37663837 PMCID: PMC10470844 DOI: 10.3389/fpubh.2023.1182386] [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: 03/08/2023] [Accepted: 07/21/2023] [Indexed: 09/05/2023] Open
Abstract
Background Eliminating mother-to-child transmission (MTCT) of HIV, hepatitis B, and syphilis is a challenge in Brazil. Many policies have been implemented since 1986, but important gaps remain. This study aimed to describe the trends of MTCT in Brazil and evaluate the gaps and perspectives in this scenario. Methods This is a descriptive study conducted with secondary data publicly available in the information systems of the Brazilian Ministry of Health regarding data on HIV, syphilis, and hepatitis B in pregnant women and children from 2011 to 2021. Results HIV and hepatitis B have had constant rates over the years in pregnant women, with the detection rates around 2.5/1,000 live birth (LB) and 0.5/1.000LB, respectively. The same did not happen with syphilis, which has shown an increasing line in the last decade. In 2011, the detection rate of syphilis in pregnancy was 4.7/1,000LB, and in 2021 it reached 27.1/1,000LB. Regarding the trends in children, an important decrease was observed in HIV/AIDS (incidence rate from 0.18/1,000 in 2011 to 0.04/1,000 in 2021) and Hepatitis B (incidence rate from 0.9/1,000LB in 2011 to 0.5/1,000LB in 2021). For congenital syphilis, there is a continuous increase, being 3.3/1,000LB in 2011 and 9.9/1,000LB in 2021. Data from the HIV clinical monitoring showed that antiretroviral treatment coverage among pregnant women identified increased slightly between 2011 and 2021, in Brazil, from 92.3% to 94.3%. For syphilis, 82.5% of pregnant women were treated with benzathine penicillin, and 88.7% in 2011. The historical series of hepatitis B vaccination coverage in children has decreased over the years; it was 96% in 2013 and 76% in 2021. Conclusion These data show many gaps and some perspectives in the MTCT program in Brazil. The country is close to reaching MTCT HIV elimination, but there are many challenges regarding HBV and syphilis. These data can be used to organize the strategies to improve the Brazilian response to MTCT elimination of HIV, hepatitis B, and syphilis.
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Affiliation(s)
- Angelica E. Miranda
- Post-graduation Program in Infectious Diseases, Federal University of Espirito Santo, Vitória, Brazil
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Patricia C. Santos
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Ronaldo A. Coelho
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Ana Roberta P. Pascom
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Leonor Henriette de Lannoy
- Post-graduation Program in Infectious Diseases, Federal University of Espirito Santo, Vitória, Brazil
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Ana Cristina Garcia Ferreira
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Pamela Cristina Gaspar
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
- Post-graduation Program in Public Health, University of Brasilia, Brasília, Brazil
| | - Ethel Leonor Maciel
- Post-graduation Program in Infectious Diseases, Federal University of Espirito Santo, Vitória, Brazil
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Draurio Barreira
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Gerson Fernando Mendes Pereira
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
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Pradhan P, Lavallee M, Akinola S, Escobar Gimenes FR, Berard A, Methot J, Piche ME, Gonella JM, Cloutier L, Leclerc J. Causality assessment of adverse drug reaction: A narrative review to find the most exhaustive and easy-to-use tool in post-authorization settings. J Appl Biomed 2023; 21:59-66. [PMID: 37376882 DOI: 10.32725/jab.2023.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The core motive of pharmacovigilance is the detection and prevention of adverse drug reactions (ADRs), to improve the risk-benefit balance of the drug. However, the causality assessment of ADRs remains a major challenge among clinicians, and none of the available tools of causality assessment used for assessing ADRs have been universally accepted. OBJECTIVE To provide an up-to-date overview of the different causality assessment tools. METHODS We conducted electronic searches in MEDLINE, EMBASE, and the Cochrane database. The eligibility of each tool was screened by three reviewers. Each eligible tool was then scrutinized for its domains (the reported specific set of questions/areas used for calculating the likelihood of cause-and-effect relation of an ADR) to discover the most comprehensive tool. Finally, we subjectively assessed the tool's ease-of-use in a Canadian, Indian, Hungarian, and Brazilian clinical context. RESULTS Twenty-one eligible causality assessment tools were retrieved. Naranjo's tool and De Boer's tool appeared the most comprehensive among all the tools, covering 10 domains each. Regarding "ease-of-use" in a clinical setting, we judged that many tools were hard to implement in a clinical context because of their complexity and/or lengthiness. Naranjo's tool, Jones's tool, Danan and Benichou's tool, and Hsu and Stoll's tool appeared to be the easiest to implement into various clinical contexts. CONCLUSION Among the many tools identified, 1981 Naranjo's scale remains the most comprehensive and easy to use for performing causality assessment of ADRs. Upcoming analysis should compare the performance of each ADR tool in clinical settings.
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Affiliation(s)
- Pallavi Pradhan
- University of Quebec at Trois-Rivieres, Department of Anatomy, Trois-Rivieres, Canada
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
| | - Maude Lavallee
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
- Laval University, Faculty of Pharmacy, Laval, Canada
| | - Samuel Akinola
- University of Pecs, Faculty of Health Sciences, Department of Nursing, Pecs, Hungary
| | | | - Anick Berard
- University Hospital Center, Research Center of Sainte-Justine, Montreal, Canada
- University of Montreal, Faculty of Pharmacy, Montreal, Canada
| | - Julie Methot
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
- Laval University, Faculty of Pharmacy, Laval, Canada
| | - Marie-Eve Piche
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
- Laval University, Faculty of Medicine, Laval, Canada
| | | | - Lyne Cloutier
- University of Quebec at Trois-Rivieres, Department of Nursing, Trois-Rivieres, Canada
| | - Jacinthe Leclerc
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
- Laval University, Faculty of Pharmacy, Laval, Canada
- University of Quebec at Trois-Rivieres, Department of Nursing, Trois-Rivieres, Canada
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Luizaga CTDM, Jardim BC, Wünsch V, Eluf J, Silva GAE. Recent changes in trends of mortality from cervical cancer in Southeastern Brazil. Rev Saude Publica 2023; 57:25. [PMID: 37075421 PMCID: PMC10118416 DOI: 10.11606/s1518-8787.2023057004709] [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: 03/18/2022] [Accepted: 07/08/2022] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE To analyze the trends of cervical cancer mortality in Brazilian Southeastern states, and to compare them to Brazil and other regions between 1980 and 2020. METHODS Time series study based on data from the Sistema de Informações de Mortalidade (Brazilian Mortality Information System). Death data were corrected by proportional redistribution of deaths from ill-defined causes and cervical cancer of unspecified portion. Age-standardized and age-specific rates were calculated by screening target (25-39 years; 40-64 years) and non-target (65 years or older) age groups. Annual percentage changes (APC) were estimated by linear regression model with breakpoints. The coverage of Pap Smear exam in the Unified Health System (SUS) was evaluated between 2009 and 2020 according to age group and locality. RESULTS There were increases in corrected mortality rates both in 1980 and in 2020 in all regions, with most evident increments at the beginning of the series. There was a decrease in mortality nationwide between 1980-2020; however, the state of São Paulo showed a discrete upward trend in 2014-2020 (APC=1.237; 95%CI 0.046-2.443). Noteworthy is the trend increment in the 25-39 year-old group in all study localities, being sharper in the Southeast region in 2013-2020 (APC=5.072; 95%CI 3.971-6.185). Screening coverage rates were highest in São Paulo and lowest in Rio de Janeiro, with a consistent decline from 2012 onwards at all ages. CONCLUSIONS São Paulo is the first Brazilian state to show a reversal trend in mortality from cervical cancer. The changes in mortality patterns identified in this study point to the need for reorganization of the current screening program, which should be improved to ensure high coverage, quality, and adequate follow-up of all women with altered test results.
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Affiliation(s)
| | - Beatriz Cordeiro Jardim
- Universidade do Estado do Rio de JaneiroInstituto de Medicina Social Hesio CordeiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro. Instituto de Medicina Social Hesio Cordeiro. Rio de Janeiro, RJ, Brasil
- nstituto Nacional de CâncerRio de JaneiroRJBrasilInstituto Nacional de Câncer. Rio de Janeiro, RJ, Brasil
| | - Victor Wünsch
- Fundação Oncocentro de São PauloSão PauloSPBrasilFundação Oncocentro de São Paulo. São Paulo, SP, Brasil
- Universidade de São PauloFaculdade de Saúde PúblicaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. São Paulo, SP, Brasil
| | - José Eluf
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil
| | - Gulnar Azevedo e Silva
- Universidade do Estado do Rio de JaneiroInstituto de Medicina Social Hesio CordeiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro. Instituto de Medicina Social Hesio Cordeiro. Rio de Janeiro, RJ, Brasil
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Freitas-Junior R, Ferreira Bandeira de Melo Rocha A, Ribeiro Soares L. Mammography Coverage in Brazil and the Presidential Elections: Is There Anything to Celebrate? JCO Glob Oncol 2023; 9:e2200358. [PMID: 36595736 PMCID: PMC10166385 DOI: 10.1200/go.22.00358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Ruffo Freitas-Junior
- Mastology Program, Teaching Hospital, Federal University of Goiás (HC/UFG), Goiânia, Brazil.,Araújo Jorge Hospital, Goiás Anticancer Association (ACCG), Goiânia, Brazil
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Venkateswaran S, Slaria S, Mukherjee S. Political motivation as a key driver for universal health coverage. Front Public Health 2022; 10:922578. [PMID: 36457324 PMCID: PMC9705759 DOI: 10.3389/fpubh.2022.922578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Variation in public investments to health, health outcomes, and progress toward universal health coverage across countries is vast and neither economic status nor the knowledge on solutions have borne out to be binding constraints to health improvements. The drivers for universal health coverage go beyond the macro-economic context of a nation, and as pointed out by scholars, are deeply linked with the extent of political prioritization of healthcare. Low public investments to health in India and slow movement toward universal health coverage underline the need for more attention to the political priority accorded to health in the country. While the role of politics in policy reforms has been established by several scholars, this paper seeks to identify the intrinsic motivations or incentives that drive political priority. Drawing on the experience of nine countries, the paper attempts to inform the analysis for countries such as India (where progress toward universal health coverage remains slow), on the political incentives for prioritization of healthcare, and how these may be shaped or strengthened. The analysis finds that health care reforms happen in (at least) two stages: the existence and recognition of a national context and a problem, followed by political opportunities and motivations which lead political leaders to address the identified problem. The paper separates motivation as a distinct factor for analysis because, in the absence of strong incentives, not every political opportunity may lead to attention to an issue, and finds that reforms were motivated by a need to gain political legitimacy by an incoming regime, or by its political ideology, or a combination of both. Importantly, political motivation does not always take root in itself, but often driven by external factors and stakeholders who contribute to creating or strengthening incentives for political attention. A greater role from citizens and other actors such as elected representatives, questioning status quo and highlighting the schisms in the social contract between a political regime and citizens may contribute to shifting the source of legitimacy for leaders.
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Affiliation(s)
- Sandhya Venkateswaran
- Centre for Social and Economic Progress, New Delhi, India,Lancet Citizen's Commission on Reimagining India's Health System, New Delhi, India,*Correspondence: Sandhya Venkateswaran
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Aires RFDF, Salgado CCR. A Multi-Criteria Approach to Assess the Performance of the Brazilian Unified Health System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11478. [PMID: 36141751 PMCID: PMC9517662 DOI: 10.3390/ijerph191811478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Brazil's Unified Health System (SUS) provides universal free access to health services and is considered a model for the rest of the world. One of the tools used by the Brazilian government to assess this system is the Index of Unified Health System Performance (IDSUS). However, this method has a number of limitations, such as disregarding the opinion of healthcare decision makers. Thus, the aim of the present study was to propose a model based on the R-TOPSIS in order to assess the performance of the SUS. Methodologically, the main steps for proposing multi-criteria models were followed, and to validate the model, a real case study with a set of six cities (alternatives) of the state of São Paulo was used. The results provide a clearer picture of the differences in terms of potential and obtained access, as well as the effectiveness of health services in the cities analyzed. Likewise, the proposal of integrating multiple criteria as well as considering healthcare decision makers proved to be decisive for the results obtained, even in comparison with the other approaches. It was concluded that the proposed method provides a robust and adequate analysis of health systems performance.
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Rajan D, Ayazi MH, Moradi-Lakeh M, Rostamigooran N, Rahbari M, Damari B, Farshad AA, Majdzedeh R, Koch K. People's Voice and Civil Society Participation as a Core Element of Universal Health Coverage Reforms: Review of Experiences in Iran. Int J Health Policy Manag 2022; 11:1650-1657. [PMID: 34634887 PMCID: PMC9808236 DOI: 10.34172/ijhpm.2021.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/04/2021] [Indexed: 01/12/2023] Open
Abstract
Health governance challenges can make or break universal health coverage (UHC) reforms. One of the biggest health governance challenges is ensuring meaningful participation and adequately reflecting people's voice in health policies and implementation. Recognizing this, Iran's Health Transformation Plan (HTP) lays out the country's blueprint for UHC with an explicit emphasis on the 'socialization of health.' 'Socialization' is seen as a key means to contribute to HTP objectives, meaning the systematic and targeted engagement of the population, communities, and civil society in health sector activities. Given its specific cultural and historical context, we sought to discern what notions such as 'civil society,' 'non-governmental organization,' etc mean in practice in Iran, with the aim of offering policy options for strengthening and institutionalizing public participation in health within the context of the HTP. For this, we reviewed the literature and analysed primary qualitative data. We found that it may be more useful to understand Iranian civil society through its actions, ie, defined by its motivation and activities rather than the prevailing international development understanding of civil society as a structure which is completely independent of the state. We highlight the blurry boundaries between the different types of civil society organizations (CSOs) and government institutions and initiatives, as well as high levels of overlaps and fragmentation. Reducing fragmentation as a policy goal could help channel resources more efficiently towards common HTP objectives. The National Health Assembly (NHA) model which was first launched in 2017 offers a unique platform for this coordination role, and could be leveraged accordingly.
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Affiliation(s)
- Dheepa Rajan
- Health System Governance and Financing Department, World Health Organization (WHO), Geneva, Switzerland
| | | | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Narges Rostamigooran
- Secretariat of Supreme Council of Health and Food Security, Ministry of Health and Health Education; Tehran, Iran
| | - Maryam Rahbari
- Community Based Participatory Research Center, Iranian Institute for Reduction of High – Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Behzad Damari
- Department of Governance and Health, Institute of Neuroscience, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Asghar Farshad
- Occupational Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzedeh
- Community Based Participatory Research Center, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kira Koch
- Health System Governance and Financing Department, World Health Organization (WHO), Geneva, Switzerland
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Time-to-treatment initiation for cutaneous melanoma reflects disparities in healthcare access in Brazil: a retrospective study. Public Health 2022; 210:1-7. [PMID: 35863157 DOI: 10.1016/j.puhe.2022.06.006] [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: 12/15/2021] [Revised: 05/24/2022] [Accepted: 06/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aimed at identifying the sociodemographic and first treatment characteristics affecting time-to-treatment initiation (TTI) of patients with cutaneous melanoma assisted by the Brazilian Unified Health System (SUS). STUDY DESIGN Retrospective observational study using cutaneous melanoma cases recorded in the Brazilian Hospital-Based Cancer Registries (HBCR). METHODS A total of 12,783 cutaneous melanoma cases were included in the analysis. Based on the legislation, TTI in Brazil is 60 days; therefore, the cohort was dichotomized into TTI within 60 days and over. The association among variables was evaluated through the Chi-squared test. Kaplan-Meier method and log-rank hypothesis test were used to determine the probability of initiating treatment within 60 days. Cox proportional hazards regression model was used for multivariate analysis. RESULTS Median TTI was 28 days (95% CI, 25-29). First treatment in SUS provided more than 60 days after diagnosis (34.8%) was associated with females; low level of formal education; living or getting treatment in northern Brazil; being diagnosed in SUS and treated at different healthcare facilities, in addition to starting treatment with radiotherapy or systemic therapy. There were no significant differences in access to health care before and after the enactment of the 60-day law. CONCLUSION Increased TTI for cutaneous melanoma is associated with sociodemographic and first treatment characteristics in Brazil; approximately one-third of cases did not have access to first treatment within the period established by law. Receiving the diagnosis and treatment at different healthcare facilities (transitions in care) is the main independent factor associated with TTI longer than 60 days.
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Silva GAE. Comments on education-related health inequities in noncommunicable diseases. CAD SAUDE PUBLICA 2022; 38Suppl 1:e00160621. [PMID: 35544922 DOI: 10.1590/0102-311x00160621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/23/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Gulnar Azevedo E Silva
- Instituto de Medicina Social Hesio Cordeiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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Tiguman GMB, Silva MT, Galvão TF. Health services utilization in the Brazilian Amazon: panel of two cross-sectional studies. Rev Saude Publica 2022; 56:2. [PMID: 35239925 PMCID: PMC8849293 DOI: 10.11606/s1518-8787.2022056003663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/19/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the use of health services among adults living in Manaus, Amazonas. METHODS This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI). RESULTS The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals – sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06–1.12), health insurance (PR = 1.13; 95%CI 1.09–1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84–0.90) and informal workers (PR = 0.89; 95%CI 0.84–0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05–1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33–2.12) but lower in men (PR = 0.55; 95%CI 0.44–0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51–0.89), and unemployed (PR = 0.72; 95%CI 0.53–0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01–1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65–0.86). CONCLUSIONS From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services.
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Affiliation(s)
| | - Marcus Tolentino Silva
- Universidade de Sorocaba. Programa de Pós-Graduação em Ciências Farmacêuticas. Sorocaba, São Paulo, Brasil
| | - Taís Freire Galvão
- Universidade Estadual de Campinas. Faculdade de Ciências Farmacêuticas. Campinas, São Paulo, Brasil
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Tiguman GMB, Silva MT, Galvão TF. Prevalence of depressive and anxiety symptoms and their relationship with life-threatening events, tobacco dependence and hazardous alcohol drinking: a population-based study in the Brazilian Amazon. J Affect Disord 2022; 298:224-231. [PMID: 34715191 DOI: 10.1016/j.jad.2021.10.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/26/2021] [Accepted: 10/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The burden of mental health disorders is high and may be particularly alarming in developing countries. We assessed the prevalence of depressive and anxiety symptoms and their relationship with life-threatening events, tobacco dependence, and hazardous alcohol drinking in the Brazilian Amazon. METHODS Cross-sectional population-based study conducted in Manaus in 2019 with adults selected by probabilistic sampling. Depressive symptoms were measured by the PHQ-9 instrument (cut-off ≥9) and anxiety symptoms by the GAD-7 scale (cut-off ≥10). Prevalence ratios (PRs) of depressive and anxiety symptoms were calculated by Poisson regression with robust variance with 95% confidence intervals (CI) following a hierarchical model. Partial least squares structural equation modeling was used to investigate the relationship between the outcomes and risk behaviors. RESULTS Out of the 2,321 participants, 24.3% (95%CI 22.2-26.5%) had depressive and 21.6% (95%CI 19.6-23.7%) had anxiety symptoms. Depressive symptoms were more frequent in women (PR=1.32; 95%CI 1.08-1.61), lower social class (PR=1.59; 95%CI 1.11-2.27), life-threatening events (PR=2.66; 95%CI 2.00-3.54), tobacco dependence (PR=1.84; 95%CI 1.37-2.47), worse health statuses (p<0.001), and chronic diseases (PR=1.63; 95%CI 1.33-2.00), but were lower in older adults (p=0.014). Anxiety symptoms were higher in women (PR=1.74; 95%CI 1.42-2.14), lower educational levels (PR=2.19; 95%CI 1.38-3.47), evangelical individuals (PR=1.28; 95%CI 1.05-1.57), having no religion (PR=1.72; 95%CI 1.24-2.38), life-threatening events (PR=3.26; 95%CI 2.41-4.41), tobacco dependence (PR=1.53; 95%CI 1.09-2.16), worse health statuses (p<0.001), and chronic diseases (PR=1.77; 95%CI 1.40-2.25). Depressive symptoms, anxiety symptoms, and life-threatening events were directly correlated with one another, while tobacco dependence and hazardous alcohol drinking were significantly intercorrelated (p<0.05). LIMITATIONS Cross-sectional design limits the assessment of causality. Recall bias was possible as responses were self-reported. GAD-7 scale was not validated in the Brazilian population. CONCLUSION Nearly a quarter of the population had depressive symptoms and one-fifth presented anxiety symptoms, which were associated with socioeconomic, behavioral, and health-related factors. Implementation of social well-being policies is required to minimize the burden of mental health disorders in the Amazonian population.
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Affiliation(s)
| | - Marcus Tolentino Silva
- Post-Graduate Program of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Taís Freire Galvão
- Faculty of Pharmaceutical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
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13
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Women's (limited) agency over their sexual bodies: Contesting contraceptive recommendations in Brazil. Soc Sci Med 2021; 290:114276. [PMID: 34565613 DOI: 10.1016/j.socscimed.2021.114276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 07/10/2021] [Accepted: 07/27/2021] [Indexed: 12/27/2022]
Abstract
Unintended pregnancies constitute a serious public health concern in Brazil, representing up to 55% of all pregnancies, and are prevalent among women with low income and low educational backgrounds. Lack of assistance to women in their decision-making has hindered the adoption of more effective contraceptive models. Although clinical consultations constitute an important locus to assist women in decision-making and to facilitate access to subsidized methods, our current knowledge of how contraception is discussed and decisions are reached in actual consultations is limited. Just as scarce is our knowledge of how patients respond and resist contraception recommendations and how physicians counter or accommodate patients. Using a corpus of 103 audio-recorded medical visits and conversation analytic (CA) methods, this paper examines recommendation sequences in the under-investigated gynecological consultations in the Brazilian public healthcare system (SUS). The quantitative analysis reveals a strong orientation to physicians as having primary rights to govern the oversight of women's bodies: 94% of the recommendations are delivered as pronouncements (e.g., "You'll take X″), the most authoritative action type. Patients largely assume an agreeable and passive role (66%), leading to scarce negotiation and minimal involvement in decision-making. However, in a few cases (12%), all involving contraception, patients become overtly agentive, responding with active resistance. A qualitative analysis of that subset shows that despite women's gaining some agency over their sexual bodies, that agency is still limited. Whereas physicians accommodate patient resistance on grounds of biomedically-related side-effects and incorrect assumptions about the women's lives, they overlook patient resistance based on gendered struggles over contraceptive methods in the domestic sphere. By failing to consider women's lack of agency in choosing whether to have sex or to use condoms, doctors show unawareness of significant consequences of the recommended method, which might include domestic dispute and violence and, paradoxically, ultimately misfire, leading to unwanted pregnancy.
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Snakebites in Rural Areas of Brazil by Race: Indigenous the Most Exposed Group. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179365. [PMID: 34501955 PMCID: PMC8431164 DOI: 10.3390/ijerph18179365] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/28/2021] [Accepted: 09/03/2021] [Indexed: 01/02/2023]
Abstract
Animal stings are environmental hazards that threaten millions annually and cause a significant socioeconomic impact. Snakebite envenoming affects 2.7 million people globally every year, mostly the poorest and rural communities, with approximately 27,000 annual cases in Brazil. This study’s objective is to identify the most exposed racial group for snakebites in rural areas of Brazil and analyze possible differences in the outcome of an accident. A retrospective epidemiological study was conducted using a database of rural snakebite cases from Brazil’s Ministry of Health (2017). Descriptive analysis and a regression model were performed to examine the association of bad outcomes after a snakebite with several covariables. While mixed-race individuals presented the highest number of cases (61.79%), indigenous and white populations were the racial groups with the highest and lowest exposure rates (194.3 and 34.1 per 100,000 population, respectively). The fatality rate was 3.5 times higher in the indigenous population compared to the white population. In the multivariable model, the number of hours between the accident and health care received and the case classification suggested an association with a bad outcome. Snakebite is prominent in Brazil, particularly among indigenous groups. Antivenom is available in the Brazilian Health System; however, efforts need to be made for decentralization.
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15
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Adewole DA, Reid S, Oni T, Adebowale AS. Geospatial distribution and bypassing health facilities among National Health Insurance Scheme enrollees: implications for universal health coverage in Nigeria. Int Health 2021; 14:260-270. [PMID: 34185841 PMCID: PMC9070472 DOI: 10.1093/inthealth/ihab039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/15/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022] Open
Abstract
Background This study was carried out to enable an assessment of geospatial distribution and access to healthcare facilities under the National Health Insurance Scheme (NHIS) of Nigeria. The findings will be useful for efficient planning and equitable distribution of healthcare resources. Methods Data, including the distribution of selected health facilities, were collected in Ibadan, Nigeria. The location of all facilities was recorded using Global Positioning System and was subsequently mapped using ArcGIS software to produce spider-web diagrams displaying the spatial distribution of all health facilities. Results The result of clustering analysis of health facilities shows that there is a statistically significant hotspot of health facility at 99% confidence located around the urban areas of Ibadan. The significant hotspot result is dominated by a feature with a high value and is surrounded by other features also with high values. Away from the urban built-up area of Ibadan, health facility clustering is not statistically significant. There was also a high level (94%) of bypassing of NHIS-accredited facilities among the enrollees. Conclusions Lopsided distribution of health facilities in the study area should be corrected as this may result in inequity of access to available health services.
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Affiliation(s)
- David A Adewole
- Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Public Health & Family Medicine, Division of Public Health Medicine, University of Cape Town, Cape Town, South Africa
| | - Steve Reid
- Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, E47 OMB Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa
| | - Tolu Oni
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK.,Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ayo S Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
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16
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Bitencourt MR, Alarcão ACJ, Silva LL, Dutra ADC, Caruzzo NM, Roszkowski I, Bitencourt MR, Marques VD, Pelloso SM, Carvalho MDDB. Predictors of violence against health professionals during the COVID-19 pandemic in Brazil: A cross-sectional study. PLoS One 2021; 16:e0253398. [PMID: 34138953 PMCID: PMC8211185 DOI: 10.1371/journal.pone.0253398] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/03/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The increase in violence against health professionals in the COVID-19 pandemic makes it necessary to identify the predictors of violence, in order to prevent these events from happening. OBJECTIVE Evaluating the prevalence and analyzing the variables involved in the occurrence of violence against health professionals during the COVID-19 pandemic in Brazil. METHOD This is a cross-sectional study conducted online involving Brazilian health professionals during the COVID-19 pandemic. The data were collected through a structured questionnaire (Google Online Form) sent to health professionals on social networks and analyzed through logistic regression by using sociodemographic variables. The set of grouped variables was assigned to the final model when p <0.05. A network was built using the Mixed Graph Models (MGM) approach. A centrality measurement chart was constructed to determine which nodes have the greatest influence, strength and connectivity between the nodes around them. RESULTS The predictors of violence in the adjusted regression model were the following: being a nursing technician / assistant; having been working for less than 20 years; working for over 37 hours a week; having suffered violence before the pandemic; having been contaminated with COVID-19; working in direct contact with patients infected by the virus; and having family members who have suffered violence. The network created with professionals who suffered violence demonstrated that the aggressions occurred mainly in the workplace, with an indication of psycho-verbal violence. In cases in which the aggressors were close people, aggressions were non-verbal and happened both in public and private places. The assaults practiced by strangers occurred in public places. CONCLUSIONS Violence against health professionals occurs implicitly and explicitly, with consequences that can affect both their psychosocial well-being and the assistance given to their patients and families.
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Affiliation(s)
| | | | - Lincoln Luís Silva
- Department of Health Sciences, State University of Maringá (UEM), Maringa, Parana, Brazil
| | | | | | - Igor Roszkowski
- Department of Health Sciences, State University of Maringá (UEM), Maringa, Parana, Brazil
| | | | - Vlaudimir Dias Marques
- Department of Health Sciences, State University of Maringá (UEM), Maringa, Parana, Brazil
| | - Sandra Marisa Pelloso
- Department of Health Sciences, State University of Maringá (UEM), Maringa, Parana, Brazil
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17
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Bispo JP, Serapioni M. Community participation: Lessons and challenges of the 30 years of health councils in Brazil. J Glob Health 2021; 11:03061. [PMID: 33828840 PMCID: PMC8005309 DOI: 10.7189/jogh.11.03061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- José Patrício Bispo
- Multidisciplinary Health Institute, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - Mauro Serapioni
- Center for Social Studies, University of Coimbra (UC) and visiting professor Federal University of Santa Catarina (UFSC). Coimbra, Portugal
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18
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Moreira DC, Bispo Júnior JP, Nery AA, Cardoso JP. [Users' assessment of the work by the Expanded Family Health and Basic Healthcare Centers (NASF-AB) according to attributes of primary care]. CAD SAUDE PUBLICA 2021; 36:e00031420. [PMID: 33440417 DOI: 10.1590/0102-311x00031420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/09/2020] [Indexed: 11/21/2022] Open
Abstract
The study aimed to evaluate the work by the Expanded Family Health and Basic Healthcare Centers (NASF-AB), from the users' perspective, based on the attributes of comprehensive primary healthcare (PHC). This was a qualitative multiple case study conducted in six municipalities (counties) in the state of Bahia, Brazil. The theoretical and methodological frame of reference was an evaluative matrix based on the following attributes: access, longitudinality, and comprehensiveness. The matrix also considered the assumption of Inter-Consultation Support and the guidelines of the Family Health Strategy. Data and information were obtained from 44 interviews with users of the NASF-AB and observation of the centers' activities and routine work in the health units. The study showed that users have limited access to the NASF-ABs' activities. The availability of clinical care was insufficient, access was facilitated by home visits, and the acceptability was jeopardized by frustrations from unmet expectations. Longitudinal care has not been prioritized in the centers' work, with limited involvement by supporters in developing continuing care. Group activities showed the potential for forming bonds. In the attribute of comprehensiveness, the presence of NASF-ABs helped increase activities and case-resolution capacity, but the linkage with the healthcare network was negligible. In conclusion, the work by the NASF-AB displayed limitations for the development of comprehensive PHC. The results also suggest potentialities with the capacity to strengthen primary care that have not been fully explored.
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Affiliation(s)
- Diane Costa Moreira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
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19
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Silva GAE, Jardim BC, Ferreira VDM, Junger WL, Girianelli VR. Cancer mortality in the Capitals and in the interior of Brazil: a four-decade analysis. Rev Saude Publica 2020; 54:126. [PMID: 33295593 PMCID: PMC7688260 DOI: 10.11606/s1518-8787.2020054002255] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/17/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE: to describe the trend of mortality from general cancer and more frequent types among men and women living in the Capitals and other municipalities of the five macro-regions of Brazil between 1978 and 2017. METHODS: Time series study with mortality data corrected by redistribution of ill-defined causes. Proportional cancer mortality was calculated for Brazil and regions. The annual percentage change in rates for total cancer and specific types in each segment and in the selected unit of analysis was calculated by generalized linear regression with Gaussian binding. RESULTS: the proportion of cancer increased progressively for both sexes from 1978 to 2017. Important differences between the Capitals and the interior of the macro-regions were seen with disaggregated data. The greatest declines occurred for stomach cancer, except in the northern and interior regions of the Northeast, and for the cervix cancer, with a generalized fall, with the exception of the interior of the northern region. Lung cancer decreased among men in the Southeast and South regions and had a generalized increase among women. Breast and prostate cancers tended to decrease in the Southeast and South regions and among residents of the Capitals but showing an increase in the interior of the North and Northeast regions. Colorectal cancer had a general tendency to increase; with stability among men in the Capitals of the South region and among women of the Southeast and Midwest regions and, since 2007, a decrease among women in the South region. CONCLUSIONS: Cancer mortality showed great variation among residents of capitals and the interior of the country's major regions. Clear decrease in mortality was seen for the main types in the Southeast and South regions. The North and Northeast regions have patterns compatible with cancers associated with poverty, while the large increase of the cancers related to sedentary lifestyle stand out.
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Affiliation(s)
- Gulnar Azevedo E Silva
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
| | - Beatriz Cordeiro Jardim
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil.,Instituto Nacional de Câncer José Alencar Gomes da Silva. Rio de Janeiro, RJ, Brasil
| | - Vanessa de Melo Ferreira
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
| | - Washington Leite Junger
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
| | - Vania Reis Girianelli
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Rio de Janeiro, RJ, Brasil
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20
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Gomes FMDS, Santo MCCDE, Gryschek RCB, Bertolozzi MR, França FODS. Access to drinking water and sewage treatment in Brazil: a challenge for the control of waterborne infectious diseases. Rev Inst Med Trop Sao Paulo 2020; 62:e71. [PMID: 33027395 PMCID: PMC7534402 DOI: 10.1590/s1678-9946202062071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Maria Cristina Carvalho do Espírito Santo
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Pesquisa Médica de Imunopatologia da Esquistossomose e Outras Parasitoses (LIM06), São Paulo, São Paulo, Brazil
| | - Ronaldo César Borges Gryschek
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Pesquisa Médica de Imunopatologia da Esquistossomose e Outras Parasitoses (LIM06), São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, Núcleo de Medicina Tropical, São Paulo, São Paulo, Brazil
| | - Maria Rita Bertolozzi
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem em Saúde Coletiva, São Paulo, São Paulo, Brazil
| | - Francisco Oscar de Siqueira França
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, Núcleo de Medicina Tropical, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, Laboratório de Pesquisa Médica em Imunologia (LIM48), São Paulo, São Paulo, Brazil
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21
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Azevedo E Silva G, Giovanella L, de Camargo KR. Brazil's National Health Care System at Risk for Losing Its Universal Character. Am J Public Health 2020; 110:811-812. [PMID: 32374681 DOI: 10.2105/ajph.2020.305649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Gulnar Azevedo E Silva
- Gulnar Azevedo e Silva is with the Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Brazil and the Brazilian Association of Collective Health (ABRASCO), Rio de Janeiro, Brazil. Ligia Giovanella is with the Escola Nacional de Saúde Pública Sérgio Arouca-Fundação Oswaldo Cruz, Brazil and the Primary Health Care Network-ABRASCO. Kenneth Rochel de Camargo Jr is with the Instituto de Medicina Social, UERJ and is an AJPH associate editor
| | - Ligia Giovanella
- Gulnar Azevedo e Silva is with the Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Brazil and the Brazilian Association of Collective Health (ABRASCO), Rio de Janeiro, Brazil. Ligia Giovanella is with the Escola Nacional de Saúde Pública Sérgio Arouca-Fundação Oswaldo Cruz, Brazil and the Primary Health Care Network-ABRASCO. Kenneth Rochel de Camargo Jr is with the Instituto de Medicina Social, UERJ and is an AJPH associate editor
| | - Kenneth Rochel de Camargo
- Gulnar Azevedo e Silva is with the Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Brazil and the Brazilian Association of Collective Health (ABRASCO), Rio de Janeiro, Brazil. Ligia Giovanella is with the Escola Nacional de Saúde Pública Sérgio Arouca-Fundação Oswaldo Cruz, Brazil and the Primary Health Care Network-ABRASCO. Kenneth Rochel de Camargo Jr is with the Instituto de Medicina Social, UERJ and is an AJPH associate editor
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22
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Andrade FBD, Antunes JLF, Andrade FCD, Lima-Costa MFF, Macinko J. Education-Related Inequalities in Dental Services Use among Older Adults in 23 Countries. J Dent Res 2020; 99:1341-1347. [PMID: 32623932 DOI: 10.1177/0022034520935854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to measure the magnitude of education-related inequalities in the use of dental services among older adults (aged 50 y or older) from a sizable multicountry sample of 23 upper-middle- and high-income countries. This study used cross-sectional data from nationally representative surveys of people aged 50 y and over. Countries included in the Health and Retirement Study surveys were the following: Brazil, China, South Korea, Mexico, United States, Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Greece, Italy, Israel, Luxembourg, Poland, Portugal, Slovenia, Spain, Sweden, and Switzerland. The dependent variable was the use of dental services, based on the self-report of having had a dental visit within the previous year, except for the United States and South Korea, which used 2-y recall periods. Educational level was used as the measure of socioeconomic position and was standardized across countries. Multivariate logistic regression modeling was used to evaluate the factors associated with the use of dental services, and the magnitude of education inequalities in the use of dental services was assessed using the slope index of inequality (SII) to measure absolute inequalities and the relative index of inequality for relative inequalities. The pooled prevalence of the use of dental services was 31.7% and ranged from 18.7% in China to 81.2% in Sweden. In the overall sample, the absolute difference in the prevalence of use between the lowest and highest educational groups was 20 percentage points. SII was significant for all countries except Portugal. Relative educational inequalities were significant for all countries and ranged from 3.2 in Poland to 1.2 in Sweden. There were significant education-related inequalities in the use of dental care by older adults in all countries. Monitoring these inequalities is critical to the planning and delivery of dental services.
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Affiliation(s)
- F Bof de Andrade
- Oswaldo Cruz Foundation, Rene Rachou Institute, Belo Horizonte, Brazil
| | - J L F Antunes
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - F C D Andrade
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - M F F Lima-Costa
- Oswaldo Cruz Foundation, Rene Rachou Institute, Belo Horizonte, Brazil
| | - J Macinko
- Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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