Vulnerability synthetic indices: a literature integrative review

Prevalence of hearing loss and health vulnerability in children aged 25 to 36 months: an analysis of spatial distribution

PURPOSE

To analyze the association between hearing loss and health vulnerability in children aged 25 to 36 months.

METHODS

Analytical observational cross-sectional study conducted through child hearing screening in nine day-care centers. The screening consisted of anamnesis, otoscopy, tympanometry, transient otoacoustic emissions, and pure tone audiometry. For each exam performed, the 'pass' and 'fail' criteria were established. The children's residential addresses were georeferenced and a choropleth map of the spatial distribution was built, considering the Health Vulnerability Index (HVI). The analysis of the association between the HVI and the variables sex, auditory assessment, and region area of the household was performed using Pearson's Chi-square and Fisher's Exact tests.

RESULTS

Ninety-five children of both sexes were evaluated, of which 44.7% presented alterations in at least one of the exams performed, being referred for otorhinolaryngological evaluation and subsequent auditory assessment. Of the observed changes, 36.9% occurred in the tympanometry and 7.8% in the transient otoacoustic emissions. Among children referred for reassessment, 9.7% were diagnosed with conductive hearing loss, 13.6% results within normal limits and 21.4% did not attend for assessment. Of the children who presented the final diagnosis of conductive hearing loss (9.7%), 1.9% were classified as low-risk HVI and 6.8% as medium-risk HVI. There was statistical significance between HVI and the child's place of residence.

CONCLUSION

The association between hearing loss and HIV was not statistically significant; however, it was possible to observe that 77.7% of the children with hearing loss resided in sectors with medium- risk HIV.

Influence of social and environmental factors for Culex quinquefasciatus distribution in Northeastern Brazil: a risk index

Culex quinquefasciatus is a vector of lymphatic filariasis. One important component in planning filariasis control activities is the mapping of vector distribution. A tool that involves socio-environmental factors and Cx. quinquefasciatus density can contribute to the identification of areas that should be prioritized in surveillance actions. This is an ecological study based on the construction and validation of a risk score of urban areas according to social and environmental variables extracted from a national database. Based on this stratification, female Cx. quinquefasciatus were captured. In total, 30,635 Cx. quinquefasciatus were captured, of which 17,161 (56%) were females. The highest vector density index of mosquitoes were captured in households located in the high-risk stratum and the indicator proved to be a tool that identified an association between social and environmental conditions and areas with the highest vector density index of females Cx. quinquefasciatus.

Health inequalities in Brazil: proposed prioritization to achieve the Sustainable Development Goals

This study aimed to develop a prioritization index to speed up the achievement of national health targets proposed in the 2030 Agenda. This is an ecological study that addressed the Health Regions in Brazil. The index incorporated 25 indicators with analytical proximity to the official indicators of the 2030 Agenda whose data are available from public municipal sources for the period of 2015-2019. According to our study, the index was a powerful method to support health management decisions. The results showed the most vulnerable territories are located in the North Region of the country, and therefore, these are priority areas for resource allocation. The analysis of subindices highlighted local health bottlenecks, reinforcing the need for municipalities in each region to set their own priorities while making decisions for health resource allocation. By indicating Health Regions and priority themes for more investments, this investigation shows paths to support the implementation of the 2030 Agenda, from the local to the national level, in addition to providing elements that can be used by policy makers to minimize the effects of social inequalities on health, prioritizing territories with worse indices.

Double screening for syphilis and HIV in pregnant women in a priority municipality for the elimination of vertical transmission in Brazil: incidence, risk factors and spatial analysis

BACKGROUND

The Brazilian Ministry of Health (MoH) recommends double screening (DS) for syphilis and HIV during the first and third trimesters of antenatal care (ANC) to mitigate vertical transmission. We surveyed DS outcomes and their associated factors in a priority Brazilian municipality with >100 000 inhabitants who face challenges for both health problems.

METHODS

A total of 399 women were followed up throughout pregnancy using medical records. Spatial and multinomial logistic analyses were performed.

RESULTS

There was an incidence rate of 24.8%, 59.4% and 15.8% for 'full DS', 'partial DS' and 'without DS', respectively. Younger women and those with a history of both prematurity and multiparity were less likely to be in the 'full DS' category. There was an overlap of high-density clusters of 'full DS' and 'ANC in better quality basic health units', adherent to both the Family Health Strategy and the National Program for Access and Quality Improvement in Primary Care.

CONCLUSIONS

The poor DS outcomes presented in 75% of the cases were mostly linked to delays in starting ANC appointments or their discontinuity. Thus, the MoH recommendations, accompanied by ongoing training, technical assistance and the periodic evaluation of their implementation, need to effectively reach providers and promote counseling and awareness about the importance of DS for pregnant women.

Relationship between income inequality, socioeconomic development, vulnerability index, and maternal mortality in Brazil, 2017

BACKGROUND

Public health recognizes that health conditions depend on factors related to the development patterns income distribution, degree of poverty, working conditions, among other social determinants. The objective of this study was to analyze the association of maternal mortality with the Human Development Index (HDI), Gini Index, Income per capita, and the Social Vulnerability.

METHOD

The study analyzed the relationship between MMR and socioeconomic indicators in the 26 federative units and the Federal District of Brazil, in 2017. The socioeconomic indicators used in the study were: HDI, Gini Index, Income per capita, and SVI. Crude and adjusted linear regression were performed between maternal mortality and socioeconomic indicators.

RESULTS

When analyzing which socioeconomic determinants that are related to maternal mortality ratio rates, a higher per capita income positive effect was observed for lower MMR (β = - 150.8; CI 95% -289.9 to - 11.7; r2 = 0.17; p = 0.035), as well as a trend of higher MMR in relation to the SVI (β = 97.7; CI 95% -12.2 to 207.6; r2 = 0.12; p = 0.079). In model found by the stepwise forward selections, only the per capita income was um index related to less RMM (β = - 0.02; CI 95% -0.05 to - 0.002; r2 = 0.15; p = 0.028).

CONCLUSION

The findings showed that the per capita income has a negative association MMR in the different states of Brazil, but seems canceled because of the other socioeconomic determinants related to the poor live conditions.

Prevalence of virological and serological markers of SARS-CoV-2 infection in the population of Ribeirão Preto, Southeast Brazil: an epidemiological survey

INTRODUCTION:

This epidemiological household survey aimed to estimate the prevalence of the current and past SARS-CoV-2 infections in Ribeirão Preto, a municipality of southeast Brazil.

METHODS:

The survey was conducted in two phases using a clustered sampling scheme. The first phase spanned May 1-3 and involved 709 participants. The second phase spanned June 11-14, 2020, and involved 646 participants.

RESULTS:

During the first phase, RT-PCR performed on nasopharyngeal swabs was positive at 0.14%. The serological tests were positive in 1.27% of the patients during the first phase and 2.79% during the second phase. People living in households with more than five members had a prevalence of 10.83% (95%CI: 1.58-74.27) higher than those living alone or with someone other. Considering the proportion of the positive serological test results with sex and age adjustments, approximately 2.37% (95%CI: 1.32-3.42) of the population had been cumulatively infected by mid-June 2020, which is equivalent to 16,670 people (95%CI: 9,267-24,074). Considering that 68 deaths from the disease in the residents of the city had been confirmed as at the date of the second phase of the survey, the infection fatality rate was estimated to be 0.41% (95%CI: 0.28-0.73). Our results suggest that approximately 88% of the cases of SARS-CoV-2 infection at the time of the survey were not reported to the local epidemiological surveillance service.

CONCLUSIONS:

The findings of this study provide in-depth knowledge of the COVID-19 pandemic in Brazil and are helpful for the preventive and decision-making policies of public managers.

A Vulnerability Analysis for the Management of and Response to the COVID-19 Epidemic in the Second Most Populous State in Brazil

The COVID-19 pandemic has the potential to affect all individuals, however in a heterogeneous way. In this sense, identifying specificities of each location is essential to minimize the damage caused by the disease. Therefore, the aim of this research was to assess the vulnerability of 853 municipalities in the second most populous state in Brazil, Minas Gerais (MG), in order to direct public policies. An epidemiological study was carried out based on Multi-Criteria Decision Analysis (MCDA) using indicators with some relation to the process of illness and death caused by COVID-19. The indicators were selected by a literature search and categorized into: demographic, social, economic, health infrastructure, population at risk and epidemiological. The variables were collected in Brazilian government databases at the municipal level and evaluated according to MCDA, through the Program to Support Decision Making based on Indicators (PRADIN). Based on this approach, the study performed simulations by category of indicators and a general simulation that allowed to divide the municipalities into groups of 1-5, with 1 being the least vulnerable and 5 being the most vulnerable. The groupings of municipalities were exposed in their respective mesoregions of MG in a thematic map, using the software Tabwin 32. The results revealed that the mesoregion of Norte de Minas stands out with more than 40% of its municipalities belonging to group 5, according to economic, social and health infrastructure indicators. Similarly, the Jequitinhonha mesoregion exhibited almost 60% of the municipalities in this group for economic and health infrastructure indicators. For demographic and epidemiological criteria, the Metropolitana de Belo Horizonte was the most vulnerable mesoregion, with 42.9 and 26.7% of the municipalities in group 5, respectively. Considering the presence of a population at risk, Zona da Mata reported 42.3% of the municipalities in the most vulnerable group. In the joint analysis of data, the Jequitinhonha, Vale do Mucuri and Vale do Rio Doce mesoregions were the most vulnerable in the state of MG. Thus, through the outlined profile, the present study proved how socioeconomic diversity affects the vulnerability of the municipalities to face COVID-19 outbreak, highlighting the need for interventions directed to each reality.

Interfaces of vulnerability dimensions in violence against children

OBJECTIVE

present and discuss the potential use of the concept of vulnerability for the development of practices to address violence against children.

METHOD

this is a theoretical study that presents the characteristics of the phenomenon of violence against children, to which the concept of vulnerability is applied.

RESULTS

proposal of a framework for the analysis of violence against children in the perspective of vulnerability, creating individual and collective dimensions. Violence against children, when analyzed in the perspective of this concept, broadens the understanding of this phenomenon, as it exposes aspects and conditions from outside the family that are co-responsible for the occurrence of this phenomenon.

CONCLUSION

developing studies to identify the vulnerability of children to violence is essential for the development of practices to address this issue.

Religiosity and patterns of alcohol consumption among users of primary healthcare facilities in Brazil

Abstract Background A number of studies have been reported on the role of religiosity in health beliefs and behaviors. Objective The objective of this cross-sectional study is to examine the association between religious involvement and patterns of alcohol consumption in a large representative sample of users of primary healthcare facilities in Ribeirão Preto, Southeast Brazil. Method Data were collected through personal interviews. Religiosity was measured using the Duke University Religion Index (DUREL) and the alcohol consumption was measured using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire. Multinomial logistic regression models were used to evaluate the associations between the participant characteristics, the AUDIT risk levels, and the drinking groups. Results The sample was composed of 841 women with a mean age of 39.5 years old and 214 men with a mean age of 45.1 years old. A significant relationship between patterns of alcohol consumption and the multiple dimensions of religiosity was detected, such as religious affiliation, religious practices, self-perception of the level of religiosity and the ORA, NORA and IR components of DUREL. Lower levels of drinking risk were detected among religious individuals and among those who practice their religions compared to individuals who have no religion and/or non-practicing individuals, respectively. Conclusion A lifestyle motivated by religious concerns is associated with alcohol use habits among the Brazilian users of the public healthcare facilities.

Malocclusion and social vulnerability: a representative study with adolescents from Belo Horizonte, Brazil

Malocclusion is public health problem because of its high prevalence, treatment possibility, and impact on the individual's quality of life. This article aims to determining the prevalence of malocclusion in adolescents and to test its association with social vulnerability. A representative transversal study was performed with 1612 adolescents aged between 11 and 14 years old who came from public and private schools in Belo Horizonte, Brazil. The adolescents were examined by three calibrated examiners for diagnosis of malocclusion, using the Dental Aesthetic Index. The Social Vulnerability Index from Belo Horizonte was used to determine the degree of social vulnerability from adolescents. The data were analyzed using Poisson regression with robust variance (p<0,05). Most adolescents presented absence/minor malocclusion (68.7%). Dental crowding was diagnosed in 51.9% from the sample, diastema in 23.7%, anterior open bite in 7.6 %. Malocclusion was associated with social vulnerability (PR=1.25;95% CI=1.01-1.55). Dental crowding was the most prevalent type of malocclusion. The more socially vulnerable adolescents had worse indicators of malocclusion.

Night beds in psychosocial attention care centers for alcohol and drugs: analysis and characterization

OBJECTIVE

To analyze and characterize the use of night beds in a Psychosocial Attention Care Center for Alcohol and Drugs (Centro de Atenção Psicossocial Álcool e Drogas - CAPS ad).

METHOD

It is a quantitative, documental, descriptive and retrospective study. Data were gathered from 565 medical records. An analysis of continuous variables was performed.

RESULTS

When admitted to the beds, most users (87.6%) consumed multiple substances daily and were vulnerable, specially in street situation (68.3%). These users were admitted on an average of two times, undergoing a previous evaluation by the nurse (85.8%), usually for detoxication or due to the vulnerable condition. They stayed in the center for an average of seven days and 31.1% did not finish what was proposed. For a few cases, hospital support was needed. Overall, discharges were planned, but the return happened without booking.

CONCLUSION

Social issues cut through the use of night beds, however, it is a therapeutic resource that meets significant demands and is present in the daily lives of vulnerable users as a comprehensive care.

Attachment styles of People Living with HIV/AIDS

Factors that involve the dynamics in interpersonal relationships and may have consequences in health are still little explored in people living with HIV/AIDS. The aim was to identify the evidences of literature regarding adult attachment style and HIV. It is an Integrative literature review. Seven databases were explored, using the combination of key words and Boolean connectors: "Attachment Style OR Object Attachment AND HIV". A reasonable number of articles addressed attachment among people with HIV as a mediator to post-traumatic stress disorder, depression and stress. The prevalence of insecure attachment in this group was high. Evidence was also found in relation to the attachment as an important factor to adaptation to the diagnosis of HIV, attachment and behavior in interpersonal relationships, and emphasize the possibility of changing the attachment style.

Vulnerabilidade social em famílias que convivem com comportamento aditivo por tempo prolongado

Resumo Objetivo Analisar a vulnerabilidade social de famílias que convivem por tempo prolongado com o comportamento aditivo de um de seus membros. Métodos Estudo transversal, com familiares de 29 usuários de drogas, internados com trauma físico associado à intoxicação por drogas de abuso entre abril a setembro de 2014. Utilizou-se o Índice de Vulnerabilidade das Famílias Paranaenses, composto pelas dimensões: adequação do domicílio; perfil e composição familiar; acesso ao trabalho e renda e escolaridade. Os dados foram analisados por medidas de tendência. Resultados Os usuários tinham média de idade de 40,1 anos e comportamento aditivo médio de 20,8 anos. Apenas três famílias não estavam em vulnerabilidade social, e a maior vulnerabilidade foi em relação ao acesso ao trabalho e renda (79,3%) e escolaridade (82,6%), com relação proporcional entre essas dimensões. Conclusão Encontrou-se agravamento da vulnerabilidade em indicadores de longo prazo, proporcional aos anos de enfrentamento às drogas.