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Guimarães JMN, Jackson JW, Barber S, Griep RH, da Fonseca MDJM, Camelo LV, Barreto SM, Schmidt MI, Duncan BB, Cardoso LDO, Pereira AC, Chor D. Racial Inequities in the Control of Hypertension and the Explanatory Role of Residential Segregation: a Decomposition Analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Racial Ethn Health Disparities 2024; 11:1024-1032. [PMID: 37052798 DOI: 10.1007/s40615-023-01582-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/04/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023]
Abstract
The mechanisms underlying racial inequities in uncontrolled hypertension have been limited to individual factors. We investigated racial inequities in uncontrolled hypertension and the explanatory role of economic segregation in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). All 3897 baseline participants with hypertension (2008-2010) were included. Uncontrolled hypertension (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg), self-reported race (White/Brown/Black people), and neighborhood economic segregation (low/medium/high) were analyzed cross-sectionally. We used decomposition analysis, which describes how much a disparity would change (disparity reduction; explained portion) and remain (disparity residual; unexplained portion) upon removing racial differences in economic segregation (i.e., if Black people had the distribution of segregation of White people, how much we would expect uncontrolled hypertension to decrease among Black people). Age- and gender-adjusted prevalence of uncontrolled hypertension (39.0%, 52.6%, and 54.2% for White, Brown, and Black participants, respectively) remained higher for Black and Brown vs White participants, regardless of economic segregation. Uncontrolled hypertension showed a dose-response pattern with increasing segregation levels for White but not for Black and Brown participants. After adjusting for age, gender, education, and study center, unexplained portion (disparity residual) of race on uncontrolled hypertension was 18.2% (95% CI 13.4%; 22.9%) for Black vs White participants and 12.6% (8.2%; 17.1%) for Brown vs White participants. However, explained portion (disparity reduction) through economic segregation was - 2.1% (- 5.1%; 1.3%) for Black vs White and 0.5% (- 1.7%; 2.8%) for Brown vs White participants. Although uncontrolled hypertension was greater for Black and Brown vs White people, racial inequities in uncontrolled hypertension were not explained by economic segregation.
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Affiliation(s)
- Joanna M N Guimarães
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil.
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sharrelle Barber
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Maria de J M da Fonseca
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil
| | - Lidyane V Camelo
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Sandhi M Barreto
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, Hospital das Clínicas de Porto Alegre, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, Hospital das Clínicas de Porto Alegre, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Leticia de O Cardoso
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo, São Paulo, SP, Brazil
| | - Dora Chor
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil
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Amorim LC, Cherchiglia ML, Reis IA. [Beneficiaries of private health plans that used the public outpatient hemodialysis network in Brazil between 2012 and 2019]. CAD SAUDE PUBLICA 2023; 39:e00188422. [PMID: 37820235 PMCID: PMC10566561 DOI: 10.1590/0102-311xpt188422] [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: 10/10/2022] [Revised: 05/12/2023] [Accepted: 05/30/2023] [Indexed: 10/13/2023] Open
Abstract
Reimbursement to Brazilian Unified National Health System (SUS) is the most visible interface of the public-private relationship and its analysis can expand our understanding of the use of SUS by the supplementary sector. The study aims to characterize the beneficiaries of private health plans who underwent hemodialysis in the SUS, from 2012 to 2019, in relation to: gender, age group, region of residence, characteristics of the private health plans and the operators and of the care provided to them. The characteristics of the private health plans and the modality of the operators of the beneficiaries where then compared with data of the other beneficiaries in Brazil. An individual-centered database was constructed based on data from the Brazilian National Supplementary Health Agency (ANS); information on beneficiaries in Brazil was consulted in Brazilian Health Informatics Department (DATASUS). Frequency distributions were used to summarize the data, standardization by age and sex for characteristics of the private health plans and modality of the operators and ratio to compare frequencies. A total of 31,941 beneficiaries underwent hemodialysis in the SUS, 11,147 (34.9%) outside their municipality of residence, and 6,423 (20.11%) used the SUS for 25 months or more. When compared with other beneficiaries in Brazil, those who underwent hemodialysis in the SUS were more frequently linked to old private health plans (ratio, r = 2.41), collective by adherence (r = 1.76), individual/family (r = 1.36), outpatient (r = 4.66), municipal (r = 3.88), and/or philanthropic (r = 7.32). Private health plans with restrictive characteristics may have hindered the access of beneficiaries who performed hemodialysis in SUS to the networks of their operators and have represented one more among the factors that may have influenced the use of SUS by those beneficiaries, even with coverage provided for in their contracts.
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Affiliation(s)
| | | | - Ilka Afonso Reis
- Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Chronic hemodialysis patients with COVID-19 cared for by the public health system have higher mortality than those treated in private facilities: analysis of the Brazilian dialysis registry. Int Urol Nephrol 2023; 55:449-458. [PMID: 35994131 PMCID: PMC9395793 DOI: 10.1007/s11255-022-03289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/26/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Brazil is the third country globally in dialysis patients. Little is known about the impact of the type of health insurance on the outcome of these patients after COVID-19. METHODS We analyzed comorbidities, sociodemographic factors, and dialysis-related parameters from a retrospective cohort study of 1866 Brazilian chronic hemodialysis patients with COVID-19 from Feb 2020-July 2021. We evaluated the influence of health insurance (private vs. public) on the intensive care unit admission and 90 day fatality risk. RESULTS From 1866 hemodialysis patients, 455 (24%) were admitted to the intensive care unit, and 350 (19%) died. The mean age was 57.5 years, 88% had public health insurance. Crude case-fatality rate was not different between groups (private vs. public risk ratio 1.11; 95% CI 0.82-1.52, p = 0.498). In fully adjusted multivariate models, patients with private health insurance did not have a higher chance to be admitted to an intensive care unit (odds ratio 0.97; 95% CI 0.63-1.50, p = 0.888), but they presented a lower death risk (hazard ratio 0.56; 95% CI 0.37-0.85, p = 0.006). CONCLUSION The type of health insurance did not influence the access of hemodialysis patients with COVID-19 to an intensive care unit, but patients with private health insurance had a lower mortality risk.
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Gomes MMF, de Souza Cruz RC, Vasconcelos AMN, Izuka A, Bom CG, Parra da Luz LD, Uchimura KY, Terabe S, Cortez-Escalante JJ, Almirón M. [Reregistration of the population residing in Foz do Iguaçu, Brazil, in compliance with the Primary Health Care PolicyReinscripción de la población residente en Foz do Iguaçu, Brasil, en cumplimiento de la Política de atención primaria de salud]. Rev Panam Salud Publica 2022; 46:e158. [PMID: 36582618 PMCID: PMC9791460 DOI: 10.26633/rpsp.2022.158] [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: 01/24/2022] [Accepted: 04/27/2022] [Indexed: 12/28/2022] Open
Abstract
Objective To present the experience and results of the reregistration of residents in Foz do Iguaçu, a border town located in the state of Paraná, Brazil, to meet the guidelines of the national Primary Health Care (PHC) Policy and its new financing model (Programa Previne Brasil). Method A scanning strategy (convenience sample) was used for data collection, with 52 263 households visited and 22 710 interviews conducted from September to November 2019. The interviews were conducted face-to-face by 54 community health workers. Data were collected on the household (ownership status, urban or rural location, type of household, construction material, availability of electrical and sewage networks, water supply and waste disposal). Demographic and health information on the residents was also collected. Results The reregistration process revealed that most residents were home owners and lived in well-constructed homes, located mostly in urban areas, served by electricity, with access to water supply and garbage collection. Of the reregistered population, 52.8% were women, 62.5% were aged between 15 and 59 years and 60.0% declared themselves white. Among respondents aged 15 or over, 90.0% had completed elementary school. The main occupation was "formal salaried job". Additionally, 18.6% of the interviewees declared themselves to be hypertensive and 7.0%, diabetic. Conclusions The reregistration process uncovered relevant information to support both PHC planning as well as social assistance, work and housing initiatives; it was also fundamental to define health care strategies in this border town during the COVID-19 pandemic.
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Affiliation(s)
- Marília Miranda Forte Gomes
- Universidade de Brasília (UnB)Brasília (DF)BrasilUniversidade de Brasília (UnB), Brasília (DF), Brasil.,Marília Miranda Forte Gomes,
| | | | | | - Adriana Izuka
- Secretaria Municipal de Saúde de Foz do IguaçuFoz do Iguaçu (PR)BrasilSecretaria Municipal de Saúde de Foz do Iguaçu, Foz do Iguaçu (PR), Brasil.
| | - Carmensita Gaievski Bom
- Secretaria Municipal de Saúde de Foz do IguaçuFoz do Iguaçu (PR)BrasilSecretaria Municipal de Saúde de Foz do Iguaçu, Foz do Iguaçu (PR), Brasil.
| | - Larissa Djanilda Parra da Luz
- Secretaria Municipal de Saúde de Foz do IguaçuFoz do Iguaçu (PR)BrasilSecretaria Municipal de Saúde de Foz do Iguaçu, Foz do Iguaçu (PR), Brasil.
| | - Kátia Yumi Uchimura
- Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS). Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS).
| | - Sandro Terabe
- Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS). Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS).
| | - Juan José Cortez-Escalante
- Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS). Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS).
| | - Maria Almirón
- Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS). Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS).
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Pérez RA, Tejada CAO, Triaca LM, Bertoldi AD, dos Santos AMA. Socioeconomic inequality in health in older adults in Brazil. DIALOGUES IN HEALTH 2022; 1:100009. [PMID: 38515904 PMCID: PMC10953994 DOI: 10.1016/j.dialog.2022.100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 03/23/2024]
Abstract
Objective This study analyzed socioeconomic inequality in self-rated health for older adults (aged fifty or over) in Brazil. Methods Data from the 2015-2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). Socioeconomic inequality in self-rated health was measured using the concentration index, which was decomposed to analyze the contribution of different factors. Results This study revealed that 11.5% of the older adults interviewed reported their health as poor and very poor. For the complete sample, the estimated concentration index, -0.2434, indicated that there is a concentration of poor and very poor self-rated health among older and poorer adults. Income, education and having a private health insurance plan are the factors that contributed most to the observed inequality. Discussion The decomposition showed that there are avoidable inequalities in relation to socioeconomic status for older adults in Brazil. These factors can guide the formulation of social and health policies aimed at reducing health inequalities.
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Affiliation(s)
- Raquel Alves Pérez
- Posgraduate Program in Economics, Federal University of Pelotas (Universidade Federal de Pelotas - UFPel), Rio Grande do Sul, Brazil
| | - Cesar Augusto Oviedo Tejada
- Posgraduate Program in Economics, Federal University of Pelotas (Universidade Federal de Pelotas - UFPel), Rio Grande do Sul, Brazil
| | - Lívia Madeira Triaca
- Posgraduate Program in Economics, Federal University of Pelotas (Universidade Federal de Pelotas - UFPel), Rio Grande do Sul, Brazil
- Department of Economics, Federal University of Rio Grande Foundation (Fundação Universidade Federal do Rio Grande – FURG), Rio Grande, Brazil
| | - Andréa Dâmaso Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas (Universidade Federal de Pelotas - UFPel), Rio Grande do Sul, Brazil
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de Carvalho Costa IMNB, da Silva DG, Oliveira JLM, Silva JRS, Pereira LMC, Vieira Sousa Alves L, de Andrade FA, de Góes Jorge J, de Oliveira LMSM, de Almeida RR, Oliveira VB, Martins LS, Costa JO, de Souza MFC, Voci SM, Almeida-Santos MA, Aidar FJ, Baumworcele L, Sousa ACS. Adherence to Secondary Prevention Measures after Acute Coronary Syndrome in Patients Associated Exclusively with the Public and Private Healthcare Systems in Brazil. Prev Med Rep 2022; 29:101973. [PMID: 36161134 PMCID: PMC9502285 DOI: 10.1016/j.pmedr.2022.101973] [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: 04/22/2022] [Revised: 07/28/2022] [Accepted: 08/27/2022] [Indexed: 11/24/2022] Open
Abstract
Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity.
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Francisco PMSB, Assumpção DD, Bacurau AGDM, Neri AL, Malta DC, Borim FSA. Prevalence of chronic diseases in octogenarians: data from the National Health Survey 2019. CIENCIA & SAUDE COLETIVA 2022; 27:2655-2665. [PMID: 35730836 DOI: 10.1590/1413-81232022277.22482021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/21/2021] [Indexed: 11/21/2022] Open
Abstract
This article aims to estimate the prevalence of chronic diseases/conditions in octogenarians according to sex, age groups and private health insurance, and its relationship with difficulty in performing usual activities. Cross-sectional population-based study with elderly data (n = 6,098) from the National Health Survey (PNS) 2019. Prevalences and 95% confidence intervals were estimated. The prevalences were: hypertension 61.7%, chronic back problem 30.0%, hypercholesterolemia 22.0%, diabetes 20.3%; arthritis/rheumatism 19.4%, heart disease 19.3%, depression 9.4%, cancer 8.9%, cerebrovascular accident (CA) 7.5%, asthma 4.9%, lung disease (LD) 4.2% and kidney failure (KF) 3.0%. Hypertension, chronic back problem, hypercholesterolemia, major arthritis/rheumatism and depression in women, and cancer in men. Major heart disease, hypercholesterolemia, arthritis/rheumatism, KF, cancer and depression in those with private health insurance. Restriction of usual activities 14.8%, more frequent in cardiac patients, with chronic back problem, arthritis/rheumatism, KF, depression, CA, cancer and LD. There were higher prevalences in women and in those who have health insurance. Difficulties in usual activities related to diseases demand the expansion of care for the older adults.
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Affiliation(s)
| | - Daniela de Assumpção
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária. 13083-887 Campinas SP Brasil.
| | - Aldiane Gomes de Macedo Bacurau
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária. 13083-887 Campinas SP Brasil.
| | - Anita Liberalesso Neri
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária. 13083-887 Campinas SP Brasil.
| | | | - Flávia Silva Arbex Borim
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária. 13083-887 Campinas SP Brasil. .,Faculdade de Ciências da Saúde, Universidade de Brasília. Brasília DF Brasil
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Recurrence of an Episode of Low Back Pain: An Inception Cohort Study in Emergency Departments. J Orthop Sports Phys Ther 2022; 52:484-492. [PMID: 35584012 DOI: 10.2519/jospt.2022.10775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To (1) determine the 1-year estimate of recurrence of low back pain (LBP) in a cohort of people presenting to emergency departments who have recently recovered from an episode of acute LBP in a middle-income country, (2) estimate a recurrence of LBP stratified by the STarT Back Screening Tool (SBST), and (3) determine prognostic factors for the recurrence of LBP. DESIGN Prospective inception cohort study. METHODS We included 238 patients who presented to emergency departments with recent-onset nonspecific LBP in São Paulo, Brazil. The outcome was the recurrence of an episode of LBP, assessed using 2 definitions: (1) 12-month recall alone and (2) pain measurements at follow-up. Prognostic factors were determined by logistic regression. RESULTS Within 1 year, the estimated recurrence of an episode of LBP ranged from 35% (79/225 events) (first definition) to 44% (100/226 events) (second definition). When patients were stratified by the SBST, the estimate of recurrence ranged from 29% to 37% (21-27/73 events) for low-risk patients, from 33% to 39% (24-28/72 events) for medium-risk patients, and from 43% to 56% (34-45/80 events) for high-risk patients. Age, perceived risk of persistent LBP, and disability were independent prognostic factors associated with LBP recurrence within 1 year. CONCLUSION After recovering from a previous episode of acute LBP, 4 in every 10 patients experienced a recurrence within 1 year. This estimate varied depending on the classification used in the SBST. Within 1 year, age, perceived risk of persistent LBP, and baseline disability were predictors of recurrence. J Orthop Sports Phys Ther 2022;52(7):484-492. Epub: 18 May 2022. doi:10.2519/jospt.2022.10775.
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Bacurau AGDM, Francisco PMSB. Doenças crônicas em idosos e vacinação contra a influenza. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)2819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: As informações sobre a presença de doenças crônicas nos idosos não são registradas durante as campanhas de vacinação contra influenza, o que dificulta sua identificação (proporção) nos idosos vacinados. Objetivo: Descrever a prevalência de doenças crônicas autorreferidas em idosos vacinados contra a influenza; verificar a influência da mídia na decisão de tomar a vacina; e se recebeu orientações sobre a importância dela, segundo o tipo de profissional de saúde. Métodos: Estudo transversal descritivo, com dados coletados por meio de entrevistas com idosos vacinados contra influenza (n=798) em um Centro de Saúde de Campinas (SP) em 2019. Resultados: Na amostra estudada, a maioria eram mulheres (58,0%), indivíduos com ensino médio completo ou ensino superior (53,0%) e com plano de saúde (72,3%). As doenças mais prevalentes foram hipertensão arterial (56,9%; intervalo de confiança — IC95% 53,4–60,3), diabetes (24,7%; IC95% 21,8–27,8), doenças cardíacas (13,6%; IC95% 11,4–16,2) e respiratórias (5,6%; IC95% 4,2–7,5). A maioria (58,0%) considerou que a mídia influenciou sua decisão de tomar a vacina. Receberam orientações sobre a importância da vacinação 21,1% dos idosos, fornecidas principalmente por médicos/as (67,4%), enfermeiros/as (18,2%) e agentes de saúde (7,0%). Conclusões: A investigação mostrou que as principais doenças referidas pelos idosos vacinados foram hipertensão arterial, diabetes, cardiopatias e doenças respiratórias. A orientação de profissionais da saúde foi pouco relatada pelos idosos e a maioria referiu influência da mídia na decisão de vacinar-se. Ressaltam-se a necessidade e a relevância de investir em estratégias de comunicação em saúde, a fim de esclarecer a população sobre a importância da vacinação contra a influenza para as pessoas idosas e com doenças crônicas.
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Baumann A, Vázquez A, Macchione A, Lima A, Coelho A, Juras M, Ribeiro M, Kohlsdorf M, Carothers B. Translation and validation of the evidence-based practice attitude scale (EBPAS-15) to Brazilian Portuguese: Examining providers' perspective about evidence-based parent intervention. CHILDREN AND YOUTH SERVICES REVIEW 2022; 136:106421. [PMID: 35431379 PMCID: PMC9012479 DOI: 10.1016/j.childyouth.2022.106421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Few existing evidence-based parent interventions (EBPIs) for prevention and treatment of child and youth mental health disorders are implemented in low-middle-income countries. This study aimed to translate and confirm the factor structure of the Evidence-Based Practice Attitude Scale (EBPAS-15) survey in Brazilian Portuguese with the goal of examining providers' perspective about EBPIs. METHODS We translated and back translated the EBPAS-15 from English to Brazilian Portuguese. Participants were recruited via snowball sampling and data were collected using an online survey from July of 2018 through January of 2020. A confirmatory factor analysis was conducted to determine if the scale retained its original structure. Open-ended questions about providers' perspectives of their own clinical practice were coded using the Theoretical Domains Framework (TDF). Analyses included data from 362 clinicians (318 women, 41 men) from 20 of the 27 states of Brazil. Participants on average were 26.7 years old, held specialist degrees in the field of psychology, actively worked as therapists, and practiced in private clinics. RESULTS The translation of the EBPAS to Brazilian Portuguese retained the same four-factor structure as the English version except for dropping one item from the Divergence domain. When asked about the challenges in their practices, providers generally referred to parents as clients with little skills to discipline their children and lacking knowledge about child development. DISCUSSION The Brazilian version of the EBPAS-15 is promising, but future research should consider using quantitative data alongside qualitative information to better understand providers' attitudes about evidence-based interventions to inform implementation efforts. TRIAL REGISTRATION N/A.
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Affiliation(s)
- A.A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, MO, USA
| | | | - A.C. Macchione
- Centro Paradigma de Ciências do Comportamento, São Paulo, Brazil
| | - A. Lima
- Sam Houston State University, TX, USA
| | - A.F. Coelho
- Universidade de Brasilia, Brasília-DF, Brazil
| | - M. Juras
- Florida Gulf Coast University, USA
| | - M. Ribeiro
- Aiutare Instituto de Psicologia, Brasília-DF, Brazil
| | - M. Kohlsdorf
- Centro Universitario UniCEUB, Brasília-DF, Brazil
| | - B.J. Carothers
- Brown School, Washington University in St. Louis, Missouri, United States
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Shaw RJ, Harron KL, Pescarini JM, Pinto Junior EP, Allik M, Siroky AN, Campbell D, Dundas R, Ichihara MY, Leyland AH, Barreto ML, Katikireddi SV. Biases arising from linked administrative data for epidemiological research: a conceptual framework from registration to analyses. Eur J Epidemiol 2022; 37:1215-1224. [PMID: 36333542 PMCID: PMC9792414 DOI: 10.1007/s10654-022-00934-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 10/16/2022] [Indexed: 11/08/2022]
Abstract
Linked administrative data offer a rich source of information that can be harnessed to describe patterns of disease, understand their causes and evaluate interventions. However, administrative data are primarily collected for operational reasons such as recording vital events for legal purposes, and planning, provision and monitoring of services. The processes involved in generating and linking administrative datasets may generate sources of bias that are often not adequately considered by researchers. We provide a framework describing these biases, drawing on our experiences of using the 100 Million Brazilian Cohort (100MCohort) which contains records of more than 131 million people whose families applied for social assistance between 2001 and 2018. Datasets for epidemiological research were derived by linking the 100MCohort to health-related databases such as the Mortality Information System and the Hospital Information System. Using the framework, we demonstrate how selection and misclassification biases may be introduced in three different stages: registering and recording of people's life events and use of services, linkage across administrative databases, and cleaning and coding of variables from derived datasets. Finally, we suggest eight recommendations which may reduce biases when analysing data from administrative sources.
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Affiliation(s)
- Richard J Shaw
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK.
| | - Katie L Harron
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Julia M Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elzo Pereira Pinto Junior
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Mirjam Allik
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| | - Andressa N Siroky
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Departamento de Estatística, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Desmond Campbell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, 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
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
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12
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Francisco PMSB, Assumpção DD, Bacurau AGDM, Neri AL, Malta DC, Borim FSA. Prevalence of chronic diseases in octogenarians: data from the National Health Survey 2019. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022277.22482021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract This article aims to estimate the prevalence of chronic diseases/conditions in octogenarians according to sex, age groups and private health insurance, and its relationship with difficulty in performing usual activities. Cross-sectional population-based study with elderly data (n = 6,098) from the National Health Survey (PNS) 2019. Prevalences and 95% confidence intervals were estimated. The prevalences were: hypertension 61.7%, chronic back problem 30.0%, hypercholesterolemia 22.0%, diabetes 20.3%; arthritis/rheumatism 19.4%, heart disease 19.3%, depression 9.4%, cancer 8.9%, cerebrovascular accident (CA) 7.5%, asthma 4.9%, lung disease (LD) 4.2% and kidney failure (KF) 3.0%. Hypertension, chronic back problem, hypercholesterolemia, major arthritis/rheumatism and depression in women, and cancer in men. Major heart disease, hypercholesterolemia, arthritis/rheumatism, KF, cancer and depression in those with private health insurance. Restriction of usual activities 14.8%, more frequent in cardiac patients, with chronic back problem, arthritis/rheumatism, KF, depression, CA, cancer and LD. There were higher prevalences in women and in those who have health insurance. Difficulties in usual activities related to diseases demand the expansion of care for the older adults.
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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: 8] [Impact Index Per Article: 2.7] [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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14
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Francisco PMSB, Assumpção DD, Bacurau AGDM, Silva DSMD, Malta DC, Borim FSA. Multimorbidity and use of health services in the oldest old in Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210014. [PMID: 34910068 DOI: 10.1590/1980-549720210014.supl.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/22/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of multimorbidity in long-lived Brazilian individuals (age ≥80 years) and to associated it with the use of health services. METHODS Cross-sectional population-based study with data from the 2019 National Survey of Health (n=6,098). Frequencies of use of services were estimated for older people with multimorbidity and according to sex, health insurance ownership, and self-rated health. The prevalence rates, crude and adjusted prevalence ratios, and the respective 95% confidence intervals were calculated. RESULTS The average age of the older adults was 85 years and about 62% were women; the prevalence of multimorbidity was 57.1%, higher in women, in those who have health insurance, and who reside in the southern region of the country (p<0.05). In the oldest old with multimorbidity, the use of services in the last 15 days reached 64.6%, and more than 70% were hospitalized in the last year or did not carry out activities in the previous two weeks for health reasons. Differences were observed for the indicators of service use in relation to sex, health insurance ownership, and self-rated health, according to multimorbidity. CONCLUSION Indicators for the use of health services were higher in older individuals who have two or more chronic diseases, regardless of sociodemographic conditions and self-rated health, showing the impact of multimorbidity per se in determining the use of services among the oldest old.
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Affiliation(s)
| | - Daniela de Assumpção
- School of Medical Sciences, Universidade Estadual de Campinas, - Campinas (SP), Brazil
| | | | | | | | - Flávia Silva Arbex Borim
- School of Medical Sciences, Universidade Estadual de Campinas, - Campinas (SP), Brazil.,School of Health Sciences, Universidade de Brasília- Brasília (DF), Brazil
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15
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Gomes de Macedo Bacurau A, Sato APS, Francisco PMSB. Reasons for nonadherence to vaccination for influenza among older people in Brazil. PLoS One 2021; 16:e0259640. [PMID: 34748598 PMCID: PMC8575254 DOI: 10.1371/journal.pone.0259640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022] Open
Abstract
This study aimed to estimate the prevalence of non-vaccination and the reasons for nonadherence to the influenza vaccine among older Brazilians according to sociodemographic characteristics. A cross-sectional study was conducted with data from older people (≥ 60 years of age; n = 23,815) who participated in the 2013 National Health Survey. Frequencies of non-vaccination and the main reasons for nonadherence were calculated with respective 95% confidence intervals. The prevalence of non-vaccination was 26.9% (approximately 7,106,730 older people). The reason rarely gets the flu was the most cited among the men (28.2%), the 60-to-69-year-old age group (29.6%), individuals with higher education (41.9%), and those with health insurance (32.3%). Fear of a reaction was the most cited reason in the northeastern region (25.4%), among women (29.3%), longer-lived individuals (≥70 years; 28.7%), and those who did not know how to read/write (26.7%). A total of 12.1% reported not believing in the vaccine's protection, and 5.5% did not know that it was necessary to take vaccine. The proportions of the main reasons for non-vaccination varied by sociodemographic characteristics. This study's findings highlight the need to increase older people's knowledge regarding influenza and influenza vaccines. Healthcare providers should be encouraged to counsel older people-especially those in subgroups with lower adherence, such as residents in the Northeast region, those aged 60-69 years, those who do not know how to read/write, those without a spouse/companion, and those without health insurance-regarding the different aspects of the vaccine and formally indicate it for groups at risk.
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Affiliation(s)
| | - Ana Paula Sayuri Sato
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
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16
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Paes SC, Paiva NS, Kawa H, Fonseca SC. [Unsafe abortions in the State of Rio de Janeiro, Brazil: magnitude and time trend from 2008 to 2017]. CAD SAUDE PUBLICA 2021; 37:e00299720. [PMID: 34730695 DOI: 10.1590/0102-311x00299720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/01/2021] [Indexed: 11/21/2022] Open
Abstract
Data on unsafe abortions are scarce, and estimates based on hospitalizations have pointed to a decline in recent years. The study aimed to analyze the time trend in unsafe abortions in the State of Rio de Janeiro, Brazil, from 2008 to 2017. We used secondary data on hospitalizations in the Brazilian Unified National Health System (SUS) due to complications of abortion in childbearing-age women (CAW) 15 to 44 years of age. We applied indirect estimation with a correction factor based on national and state data. We calculated the unsafe abortion rate per CAW (UAR-CAW), ratio of unsafe abortions per live births (RUA-LB), according to age bracket. We also calculated new indicators: spontaneous abortion rate (SAR) and unspecified abortion rate (USAR) per CAW; ratio of spontaneous abortions (RSA) and ratio of unspecified abortions (RUSA) per live births, independently of age. Time trend was calculated by Joinpoint regression, calculating the annual percent change (APC) and 95% confidence intervals (95%CI). The women that most induced abortions were 20 to 24 years of age, with UAR of 8 per 1,000. Pregnancies that ended in unsafe abortion were most frequent in the 40-44-year bracket: UAR of 16 to 20 per 100 live births. Adolescents showed a reduction in UAR from 2015 to 2017 (APC = -10; 95%CI: -18.2; -1.1), while there was an increase in women 40-44 years of age from 2008 to 2017 (APC = 2.2; 95%CI 0.5 to 4.0). The other age brackets and the indicator UAR-LB showed stability. SAR (APC = -3.5; 95%CI: -5.9; -1.0), and RSA (APC = -3.8; 95%CI: -6.3; -1.2) decreased, while USAR (APC = 6.6; 95%CI: 1.7; 11.8) and RUSA (APC = 6.4; 95%CI: 1.6; 11.3) increased during the period. The magnitude and time trend of unsafe abortions in the State of Rio de Janeiro differed according to age bracket and ICD-10 code.
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Affiliation(s)
- Stéphanie Chaves Paes
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal Fluminense, Niterói, Brasil
| | - Natália Santana Paiva
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Hélia Kawa
- Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Brasil
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de Pádua Paz I, Konstantyner T, de Castro Cintra Sesso R, de Xavier Pinto CC, de Camargo MFC, Nogueira PCK. Access to treatment for chronic kidney disease by children and adolescents in Brazil. Pediatr Nephrol 2021; 36:2827-2835. [PMID: 33675411 DOI: 10.1007/s00467-021-05009-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study aimed to identify main factors associated with child and adolescent access to chronic kidney disease (CKD) treatment in Brazil. METHODS Multi-center cross-sectional study conducted in eight pediatric nephrology centers across all Brazilian geographic regions. Information was collected on characteristics associated with referral and treatment of patients with CKD. The following outcomes were analyzed as follows: (1) age at first consultation, and (2) time elapsed between referral and treatment at the specialized service. RESULTS Three hundred thirty-five children were assessed. Variables associated with age at first consultation were as follows: CAKUT (HR=1.7; 95%CI 1.3-2.2, p<0.01); private health plan (HR=1.54; 95%CI 1.06-2.23, p=0.02); modified Medical Outcomes Study Social Support Survey mMOS-SS score (HR=1.02; 95%CI 1.00-1.03, p=0.024); maternal age (HR=0.96; 95%CI 0.95-0.97, p<0.01); and number of siblings in the household (HR=0.86; 95%CI 0.79-0.83, p<0.01). Significant variables associated with time elapsed between referral and treatment at the specialized service were as follows: each additional occupant sharing the household (HR=0.94; 95%CI:0.89-0.99, p=0.02), residing in the Northeast (HR=0.81; 95%CI:0.67-0.98, p=0.03) and having someone to take them to the physician (HR=1.36; 95%CI 1.07-1.74, p=0.01). The median time interval between patient referral and treatment by the service was 11 days (IQR 10-31). CONCLUSION There are potentially modifiable factors hampering access of children with CKD to specialized treatment. The importance of the role of social support for the two outcomes should serve as an alert for health managers and professionals to consider this aspect throughout all steps of the care process of children with CKD.
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Affiliation(s)
- Isabel de Pádua Paz
- Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Tulio Konstantyner
- Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Paulo Cesar Koch Nogueira
- Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil.,Hospital Samaritano de São Paulo, Sao Paulo, Brazil
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18
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Tesser CD, Serapioni M. Obstacles to SUS universalization: tax expenditures, labor union demands and health insurance state subsidy. CIENCIA & SAUDE COLETIVA 2021; 26:2323-2333. [PMID: 34231742 DOI: 10.1590/1413-81232021266.22602019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 08/24/2019] [Indexed: 11/21/2022] Open
Abstract
In the light of the comparative analysis of health systems, we discuss three strategic phenomena for the SUS universalization, as follows: a) health tax expenditures; b) State funding of private plans for public servants; and c) trade union's demand for private health plans. Among the ideal types of health systems, SUS is universal in law, but hybrid in practice: Beveridgian in primary health care (PHC) and mixed in specialized/hospital care; without really being universal (public spending is only 43% of total health expenditure). There is a massive state subsidy to the private sector, through health tax expenditures (30% of the federal health budget) and financing of private plans for public servants, which generates incoherence, segmentation of the health system and inequities. Despite the general support to the SUS, the union movements have been using private health plans in collective recruitment (76% of them), reinforcing the private sector. Reducing health tax expenditures - including state funding of servants' private plans - would significantly increase the SUS budget and facilitate articulation between health workers and trade unionists, bringing the high strength of unions closer to the long struggle for the universality of the SUS and PHC.
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Affiliation(s)
- Charles Dalcanale Tesser
- Departamento de Saúde Pública, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. Campus Universitário. Trindade. 88040-900 Florianópolis SC Brasil.
| | - Mauro Serapioni
- Centro de Estudos Sociais, Universidade de Coimbra. Sé Nova Coimbra Portugal
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19
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Souza Júnior PRBD, Szwarcwald CL, Damacena GN, Stopa SR, Vieira MLFP, Almeida WDSD, Oliveira MMD, Sardinha LMV, Macário EM. Health insurance coverage in Brazil: analyzing data from the National Health Survey, 2013 and 2019. CIENCIA & SAUDE COLETIVA 2021; 26:2529-2541. [PMID: 34133632 DOI: 10.1590/1413-81232021266.1.43532020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/02/2020] [Indexed: 11/22/2022] Open
Abstract
This paper aimed to describe health insurance coverage in Brazil. Data from the 2013 and 2019 editions of the National Health Survey (PNS) were analyzed. The medical or dental health insurance coverage was analyzed according to demographic and socioeconomic characteristics, work status, urban/rural area, and Federation Unit. Coverage of medical or dental health insurance was 27.9% (95% CI: 27.1-28.8) for 2013 and 28.5% (95% CI: 27.8-29.2) for 2019. The results show coverage is still concentrated in large urban centers, in the Southeast and South, among those with better socioeconomic status and some formal employment. In 2019, only 30.7% of formal workers reported the monthly payment is made directly to the providers, while 72.7% of informal workers reported this information. About 92% of medical health insurance covers hospitalization, and almost 20% of women with health insurance are not covered for labor. Only 11.7% of women aged between 15 and 44 are covered for childbirth by health insurance. The results show the health insurance coverage is still quite unequal, reinforcing the Unified Health System (SUS) importance for the Brazilian population.
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Affiliation(s)
- Paulo Roberto Borges de Souza Júnior
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4635, Manguinhos, Pavilhão Haity Moussatché. 21045-360 Rio de Janeiro RJ Brasil.
| | - Célia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4635, Manguinhos, Pavilhão Haity Moussatché. 21045-360 Rio de Janeiro RJ Brasil.
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4635, Manguinhos, Pavilhão Haity Moussatché. 21045-360 Rio de Janeiro RJ Brasil.
| | - Sheila Rizzato Stopa
- Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Brasília DF Brasil
| | | | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4635, Manguinhos, Pavilhão Haity Moussatché. 21045-360 Rio de Janeiro RJ Brasil.
| | - Max Moura de Oliveira
- Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Brasília DF Brasil
| | - Luciana Monteiro Vasconcelos Sardinha
- Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Brasília DF Brasil
| | - Eduardo Marques Macário
- Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Brasília DF Brasil
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20
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Bezerra HDS, Alves RM, de Souza TA, Medeiros ADA, Barbosa IR. Factors Associated With Mental Suffering in the Brazilian Population: A Multilevel Analysis. Front Psychol 2021; 12:625191. [PMID: 33841256 PMCID: PMC8026874 DOI: 10.3389/fpsyg.2021.625191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/26/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To analyze how individual characteristics and the social context are associated with mental distress symptoms in the Brazilian population. Method: A multilevel cross-sectional study with data from the 2013 National Health Survey. There were two dependent variables: (a) decreased vital energy and somatic symptoms, (b) the presence of depressive thoughts. The independent variables were biological characteristics, education and income, habits and lifestyle, and context variables. Bivariate analysis was performed, and Prevalence Ratios calculated in a Poisson Regression (95% CI). A multilevel Poisson Regression was performed to verify the effect of individual and contextual variables. Results: Regarding depressive thoughts, young and middle-aged individuals, low education, women, absence of partner, smokers or former smokers, and absence of health insurance were the categories at highest risk; belonging to classes D-E and living in states with lower expected years of schooling proved to be protective factors. Similar results were found for the second outcome. Conclusions: Symptoms of mental distress were associated with the individual characteristics and contextual aspects of the federation unit. These findings indicate the importance of strengthening psychosocial care aimed at vulnerable groups.
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Affiliation(s)
| | - Roberta Machado Alves
- Graduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Talita Araujo de Souza
- Graduate Program of Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Arthur de Almeida Medeiros
- Graduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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21
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Pilotto LM, Celeste RK. Contextual determinants for use of dental services according to different healthcare financing systems: Andersen's model. Community Dent Oral Epidemiol 2021; 50:99-105. [PMID: 33719085 DOI: 10.1111/cdoe.12636] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/06/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore contextual factors associated with overall dental service use, and investigate whether these factors influenced choice of the type of service according to the healthcare financing alternatives (public services; out-of-pocket services; and private health insurance), by adults and older individuals, based on the most recent Andersen's behavioural model. METHODS Cross-sectional study with individual data on 17,305 adults from 177 Brazilian municipalities in the National Oral Health Survey (SBBrasil 2010). Municipal-level information was obtained from health information systems and census data. Multilevel multinomial logistic regression was carried out for multivariable analysis. RESULTS In the previous year, 38.2% of the individuals visited the dentist; of which 21.4% used out-of-pocket spending, 11.6% used public services and 5.2% private dental insurance. Municipalities with population coverage of public primary dental care >80% had higher chances of using public services (OR = 1.28, 95%CI:1.00-1.64) than those with ≤60%, but lower chances of using private insurance (OR = 0.56, 95%CI:0.38-0.83). Municipalities with population coverage of private dental insurance > 5% had lower chances of using public services (OR = 0.62, 95%CI:0.47-0.81) than those with <1% coverage, and greater chances of using private insurance (OR = 4.33, CI:95% 2.02-9.29). These factors were not associated with out-of-pocket dental services. CONCLUSIONS Municipal coverage of dental services is associated with dental care use, and this is different according to the type of financing system (public or private), as they may change the individual's choice of service. A large public healthcare system may increase public service use for those with reduced access and decrease private service use.
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Affiliation(s)
- Luciane Maria Pilotto
- Department of Social and Preventive Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Roger Keller Celeste
- Department of Social and Preventive Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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22
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Dos Santos Andrade LS, De Melo Santos TT, Case de Oliveira ME, Lima Gomes KA, Araújo Pereira Soares AR, Almeida de Oliveira T, Weller M. Shorter delay to treatment by integrated diagnostic services and NGO-provided support among breast cancer patients in two Brazilian referral centres. J Public Health Res 2021; 10:1880. [PMID: 33709643 PMCID: PMC8314677 DOI: 10.4081/jphr.2021.1880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/06/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The diagnosis of breast cancer requires a complicated series of diagnostic exams. The present study addressed the delay of patients who used publicly and privately financed diagnostic services. Non-governmental organizations (NGOs) donated diagnostic mammograms and biopsies. DESIGN AND METHODS Data from 304 patients were obtained from two Brazilian referral centres. In one referral centre (FAP), diagnostic mammography, clinic-histopathological exam and immunohistochemistry were outsourced, whereas in the other centre (HNL), these services were integrated. Cox regression, Kaplan-Meier analysis and non-parametric tests were used to compare variables and time intervals. RESULTS If diagnostic mammography was financed privately and covered by private health insurance, the likelihood of a delay of >90 days between the first medical visit and the initiation of treatment decreased 2.15-fold (95%CI: 1.06- 4.36; p=0.033) and 4.44-fold (95%CI: 1.58-12.46; p=0.004), respectively. If the clinic-histopathological exam was outsourced (FAP) and publicly or privately financed, the median time between diagnostic mammography and the diagnostic result was 53 and 65 days in the integrated (HNL) and outsourced public system, compared to 29 days in the outsourced private system (p<0.050). The median time between the first medical visit and the diagnostic results of patients who were supported by NGOs, who financed their diagnostic services privately, and who used exclusively public diagnostic services was, respectively, 28.0, 48.5 and 77.5 days (p<0.050). CONCLUSION Patients who used privately financed health services had shorter delays. Compared to outsourcing, the integration of the publicly financed clinic- histopathological exam diminished the delay. The support of patients by NGOs accelerated patient flow.
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Affiliation(s)
| | | | | | - Kedma Anne Lima Gomes
- Post Graduate Program in Public Health, State University of Paraíba (UEPB), Campina Grande-Paraíba.
| | | | | | - Mathias Weller
- Post Graduate Program in Public Health, State University of Paraíba (UEPB), Campina Grande-Paraíba.
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Constante HM, Bastos JL. Mapping the Margins in Health Services Research: How Does Race Intersect With Gender and Socioeconomic Status to Shape Difficulty Accessing HealthCare Among Unequal Brazilian States? INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 51:155-166. [PMID: 33323017 DOI: 10.1177/0020731420979808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research on healthcare inequities has centralized whether marginalized racial, gender, or socioeconomic (SES) groups are afforded equitable access to care, yet scant investigations have focused on how race intersects with other social statuses to shape difficulty accessing health services. Contextual specificity has also been under-researched in this field of knowledge. Data from 59,249 respondents 18 years of age and over from the 2013 Brazilian National Health Survey were analyzed using multilevel regressions models. We test 3 hypotheses: racial, gender, and socioeconomically oppressed groups are each more likely to report difficulty accessing health services (H1); compared to high-SES white men, low-SES Black women report expressively higher frequencies of the outcome (H2); and intersectional healthcare inequities are larger among low-SES Brazilian states (H3). Partially supporting H1 and H2, results suggest that race and SES, but not gender, are each strong predictors of difficulty accessing healthcare, with low-SES Black respondents facing the highest odds of reporting this outcome. Although H3 was not supported, intersectional groups residing in low-SES Brazilian states were more likely to report difficulty accessing healthcare. This study demonstrated that, together with contextual specificity, the intersections of race with other axes of marginalization should be at the forefront of research and policy addressing healthcare inequities.
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Affiliation(s)
- Helena Mendes Constante
- Federal University of Santa Catarina, Campus Universitário, Trindade, Florianópolis, Santa Catarina, Brazil
| | - João Luiz Bastos
- Federal University of Santa Catarina, Campus Universitário, Trindade, Florianópolis, Santa Catarina, Brazil
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Caleffi M, Crivelatti I, Burchardt NA, Ribeiro RA, Acevedo Y, Job LG, Nonnemacher N, Rosa DD. Breast cancer survival in Brazil: How much health care access impact on cancer outcomes? Breast 2020; 54:155-159. [PMID: 33120081 PMCID: PMC7586236 DOI: 10.1016/j.breast.2020.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/13/2020] [Accepted: 10/08/2020] [Indexed: 01/20/2023] Open
Abstract
Background Breast cancer has a high incidence and increasing mortality in Southern Brazil. The present study evaluated clinical and sociodemographic characteristics, and their association with overall survival in a private cancer center. Methods 1113 breast cancer patients were included in this study. The association between survival and clinicopathological and sociodemographic characteristics was analyzed using Cox regression and Kaplan-Meyer curves. Results Median age at diagnosis was 52 years (SD 13.5). Most patients were diagnosed in stages 0 and I (62.7%), while only 1.3% had stage IV disease. Five- and 10-year overall survival were 93.5% and 83.8%, respectively. According to multivariate analysis, age at diagnosis (HR 1.05; CI95 1.03–1.06), staging (stage III: HR 4.04; CI95 1.34–12.19; stage IV: HR 9.61; CI95 2.17–42.50), high KI67 (HR 5.46; CI95 1.27–23.32) and distant recurrence (HR 7.28; CI95 4.79–11.06) were significantly associated with survival. Smoking status, years of education, BMI, and tumor biological status were not significantly associated with mortality. Conclusions This cohort of Brazilian patients, who received timely and appropriate treatment, achieved outcomes that are comparable to those from high income countries. Breast cancer mortality seems dependent on the quality of health care available to patients. High breast cancer mortality in Brazil might be associated with the type of health care that is available to women. Staging, intermediate/high KI67, distant recurrence and increasing age at diagnosis were associated with higher risk of death. Brazilian patients who receive adequate and timely treatment may achieve outcomes similar to those of high-income countries. The high breast cancer mortality in Brazil seems dependent on the health care system available to cancer patients.
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Affiliation(s)
- Maira Caleffi
- Breast Cancer Center, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil.
| | - Isabel Crivelatti
- Breast Cancer Center, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Norah A Burchardt
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rodrigo A Ribeiro
- Post-Graduation Program in Epidemiology, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Yulieth Acevedo
- Breast Cancer Center, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Laura Gianotti Job
- Breast Cancer Center, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Nouara Nonnemacher
- Breast Cancer Center, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Daniela Dornelles Rosa
- Breast Cancer Center, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil; Post-Graduation Program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Oncology Center, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil. PLoS One 2020; 15:e0240631. [PMID: 33057414 PMCID: PMC7561084 DOI: 10.1371/journal.pone.0240631] [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: 05/12/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background Improving access and quality in health care is a pressing issue worldwide and pay for performance (P4P) strategies have emerged as an alternative to enhance structure, process and outcomes in health. In 2011, Brazil adopted its first P4P scheme at national level, the National Programme for Improving Primary Care Access and Quality (PMAQ). The contribution of PMAQ in achieving the Sustainable Development Goals related to maternal and childcare remains under investigated in Brazil. Objective To estimate the association of PMAQ with the provision of maternal and childcare in Brazil, controlling for socioeconomic, geographic and family health team characteristics. Method We used cross-sectional quantile regression (QR) models for two periods, corresponding to 33,368 Family Health Teams (FHTs) in the first cycle and 39,211 FHTs in the second cycle of PMAQ. FHTs were analysed using data from the Brazilian Ministry of Health (SIAB and CNES) and the Brazilian Institute for Geography and Statistics (IBGE). Results The average number of antenatal consultations per month were positively associated with PMAQ participating teams, with larger effect in the lower tail (10th and 25th quantiles) of the conditional distribution of the response variable. There was a positive association between PMAQ and the average number of consultations under 2 years old per month in the 10th and 25th quantiles, but a negative association in the upper tail (75th and 90th quantiles). For the average number of physician consultations for children under 1 year old per month, PMAQ participating teams were positively associated with the response variable in the lower tail, but different from the previous models, there is no clear evidence that the second cycle gives larger coefficients compared with first cycle. Conclusion PMAQ has contributed to increase the provision of care to pregnant women and children under 2 years at primary healthcare level. Teams with lower average number of antenatal or child consultations benefited the most by participating in PMAQ, which suggests that PMAQ might motivate worse performing health providers to catch up.
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26
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Barone MTU, Harnik SB, de Luca PV, Lima BLDS, Wieselberg RJP, Ngongo B, Pedrosa HC, Pimazoni-Netto A, Franco DR, Marinho de Souza MDF, Malta DC, Giampaoli V. The impact of COVID-19 on people with diabetes in Brazil. Diabetes Res Clin Pract 2020; 166:108304. [PMID: 32623040 PMCID: PMC7332443 DOI: 10.1016/j.diabres.2020.108304] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023]
Abstract
UNLABELLED The present study aims at identifying main barriers faced by people living with diabetes in Brazil during the COVID-19 pandemic. METHODS In a convenience sampling study, data were collected from 1701 individuals, aged 18 or above; 75.54% female participants; 60.73% T1D and 30.75% T2D, between April 22nd and May 4th, using an anonymous and untraceable survey containing 20 multiple choice questions (socio-demographic; health status and habits of life during COVID-19 pandemic). Relationship between variables was established using the multiple correspondence analysis technique. RESULTS 95.1% of respondents reduced their frequency of going outside of their homes; among those who monitored blood glucose at home during the pandemic (91.5%), the majority (59.4%) experienced an increase, a decrease or a higher variability in glucose levels; 38.4% postponed their medical appointments and/or routine examinations; and 59.5% reduced their physical activity. T1D, the youngest group, was more susceptible to presenting COVID-19 symptoms despite not being testing; whilst the T2D group had higher frequency of comorbidities that are additional risk factors for COVID-19 severity. CONCLUSIONS This study provides a first hand revelation of the severity of COVID-19 on individuals with diabetes in Brazil. Their habits were altered, which impacted their glycemia, potentially increasing the risk of poor outcomes and mortality if infected by SARS-CoV-2, and of acute and chronic diabetes complications.
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Affiliation(s)
- Mark Thomaz Ugliara Barone
- International Diabetes Federation (IDF), 166 Chaussee de La Hulpe B-1170, Brussels, Belgium; ADJ Diabetes Brasil (ADJ), Rua Padre Antônio Tomás, 213, Zip Code 05003-010, Água Branca, São Paulo, SP, Brazil; Fórum Intersetorial para Combate às DCNTs no Brasil (ForumDCNTs), Rua Padre Antônio Tomás, 213, Zip Code 05003-010, Água Branca, São Paulo, SP, Brazil; Sociedade Brasileira de Diabetes (SBD), Rua Afonso Braz 579, Salas 72/74, Vila Nova Conceição, Zip Code 04511-011, São Paulo, SP, Brazil.
| | - Simone Bega Harnik
- Universidade de São Paulo (USP), Instituto de Matemática e Estatística, Departamento de Estatística, Rua do Matão 1010, Cidade Universitária, Zip Code 05508-090, São Paulo, SP, Brazil
| | - Patrícia Vieira de Luca
- Fórum Intersetorial para Combate às DCNTs no Brasil (ForumDCNTs), Rua Padre Antônio Tomás, 213, Zip Code 05003-010, Água Branca, São Paulo, SP, Brazil; Associação Brasileira de Hipercolesterolemia Familiar (AHF), Rua Machado Bittencourt 190, Vila Clementino, Zip Code 04044-000, São Paulo, Brazil
| | - Bruna Letícia de Souza Lima
- ADJ Diabetes Brasil (ADJ), Rua Padre Antônio Tomás, 213, Zip Code 05003-010, Água Branca, São Paulo, SP, Brazil; Fórum Intersetorial para Combate às DCNTs no Brasil (ForumDCNTs), Rua Padre Antônio Tomás, 213, Zip Code 05003-010, Água Branca, São Paulo, SP, Brazil
| | - Ronaldo José Pineda Wieselberg
- International Diabetes Federation (IDF), 166 Chaussee de La Hulpe B-1170, Brussels, Belgium; ADJ Diabetes Brasil (ADJ), Rua Padre Antônio Tomás, 213, Zip Code 05003-010, Água Branca, São Paulo, SP, Brazil; Fórum Intersetorial para Combate às DCNTs no Brasil (ForumDCNTs), Rua Padre Antônio Tomás, 213, Zip Code 05003-010, Água Branca, São Paulo, SP, Brazil; Sociedade Brasileira de Diabetes (SBD), Rua Afonso Braz 579, Salas 72/74, Vila Nova Conceição, Zip Code 04511-011, São Paulo, SP, Brazil
| | - Belinda Ngongo
- Pan African Women in Health (PAWH), P.O.Box 95535, Grant Park, Johannesburg, South Africa
| | - Hermelinda Cordeiro Pedrosa
- Sociedade Brasileira de Diabetes (SBD), Rua Afonso Braz 579, Salas 72/74, Vila Nova Conceição, Zip Code 04511-011, São Paulo, SP, Brazil; Research Centre, Endocrinology Unit - Regional Taguatinga Hospital - Secretary of Health, Brasilia, Federal District and Brazilian Society of Diabetes (SBD), Rua Afonso Braz 579, Salas 72/74, Vila Nova Conceição, Zip Code 04511-011, São Paulo, SP, Brazil
| | - Augusto Pimazoni-Netto
- Sociedade Brasileira de Diabetes (SBD), Rua Afonso Braz 579, Salas 72/74, Vila Nova Conceição, Zip Code 04511-011, São Paulo, SP, Brazil; Hospital do Rim e Hipertensão - Centro de Hipertensão e Metabologia Cardiovascular, Grupo de Educação e Controle do Diabetes, Rua Leandro Dupret, 365, Vila Clementino, Zip Code 04025-011, São Paulo, SP, Brazil
| | - Denise Reis Franco
- ADJ Diabetes Brasil (ADJ), Rua Padre Antônio Tomás, 213, Zip Code 05003-010, Água Branca, São Paulo, SP, Brazil; Sociedade Brasileira de Diabetes (SBD), Rua Afonso Braz 579, Salas 72/74, Vila Nova Conceição, Zip Code 04511-011, São Paulo, SP, Brazil
| | - Maria de Fatima Marinho de Souza
- Fórum Intersetorial para Combate às DCNTs no Brasil (ForumDCNTs), Rua Padre Antônio Tomás, 213, Zip Code 05003-010, Água Branca, São Paulo, SP, Brazil; Vital Strategies, Public Health Programs, Rua São Bento, 470, cj. 104, Centro, Zip Code 01010-010, São Paulo, SP, Brazil
| | - Deborah Carvalho Malta
- Universidade Federal de Minas Gerais (UFMG), Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Avenida Alfredo Balena 190, Santa Efigênia, Zip Code 30130-100, Belo Horizonte, MG, Brazil
| | - Viviana Giampaoli
- Universidade de São Paulo (USP), Instituto de Matemática e Estatística, Departamento de Estatística, Rua do Matão 1010, Cidade Universitária, Zip Code 05508-090, São Paulo, SP, 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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Guttier MC, Tejada CAO, Wehrmeister FC, Silveira MF, Domingues MR, Barros AJD, Santos IS, Matijasevich A, Bassani DG, Bertoldi AD. [Expenditures on childbirth care: a comparison of the 2004 and 2015 birth cohorts in Pelotas, Rio Grande do Sul State, Brazil]. CAD SAUDE PUBLICA 2020; 36:e00120019. [PMID: 32638880 DOI: 10.1590/0102-311x00120019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/02/2019] [Indexed: 11/22/2022] Open
Abstract
Although most childbirth care in Brazil is financed by the Brazilian Unified National Health System (SUS), there are out-of-pocket expenditures (private personal costs) involved in births. This study aims to compare maternal out-of-pocket expenditures in births of children from the Pelotas Birth Cohorts of 2004 and 2015. The study drew on information collected right after birth and at three months of age. The target variables include sociodemographic and economic data, private health plan coverage, and expenditures related to the birth. Values from 2004 were adjusted to 2015 by the general price index. There was an increase in private health plan coverage from 33.4% (95%CI: 31.9-34.9) to 45.1% (95%IC: 43.6-46.7) in the target period, directly associated with the families' socioeconomic status (p < 0.001). There was an increase in mean expenditures on hospitalization for the birth, from BRL 60.38 (SD = 288.66) to BRL 171.15 (SD = 957.07), and in additional medical expenditures, from BRL 191.60 (SD = 612.86) to BRL 1,424.80 (SD = 4,459.16) among mothers admitted to hospital under their private health plans (and there was no significant difference in these expenditures for mothers that opted for direct payment). There was an important increase in expenditures for childbirth care, especially among mothers admitted to hospital under private health plans.
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Affiliation(s)
- Marília Cruz Guttier
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Fernando C Wehrmeister
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Marlos R Domingues
- Programa de Pós-graduação em Educação Física, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Iná S Santos
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Diego G Bassani
- Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Andréa Dâmaso Bertoldi
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
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Rocha AG, de Souza PRA, Wachholz GE, Fraga LR, Sanseverino MTV, Terra AP, da Silva AA, Vianna FSL, Abeche AM, Larrandaburu M, Del Campo M, Schuler-Faccini L. Fetal Alcohol Spectrum Disorders: Health Needs Assessment in Brazil. Alcohol Clin Exp Res 2020; 44:660-668. [PMID: 31984499 DOI: 10.1111/acer.14294] [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: 06/21/2019] [Accepted: 01/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fetal alcohol syndrome (FAS) is a disorder caused by alterations in embryo-fetal development due to prenatal alcohol exposure. It is estimated that between 0.5 and 2 per 1,000 individuals are born with FAS every year. In Brazil, there are few studies addressing the extent of the problem of FAS/fetal alcohol spectrum disorders (FASD); these studies are confined to limited geographic areas. Therefore, we decided to perform a health needs assessment for FAS/FASD in Brazil. METHODS To estimate the prevalence of FAS and FASD in Brazil, we used information from the literature, which estimates between 0.5 and 2/1,000 births per year for FAS and 10 to 50/1,000 for FASD. RESULTS We estimated that approximately 1,500 to 6,000 children are born with FAS every year. Considering the whole population, the prevalence would be 95,377 to 380,000 affected people. However, when we consider FASD as a whole, we estimate that between 1,900,000 and 9,500,000 Brazilians might suffer the more severe consequences of alcohol exposure during pregnancy and be living with FASD. CONCLUSION The results of the current study indicate that FAS and FASD are prevalent disorders in Brazil, and more policies targeting alcohol intake during pregnancy must be developed.
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Affiliation(s)
- Anastácia Guimarães Rocha
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo Ricardo Assis de Souza
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela Elis Wachholz
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Rosa Fraga
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Morphological Sciences, Institute of Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Teresa V Sanseverino
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Anna Pires Terra
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - André Anjos da Silva
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Univates University, Lajeado, Brazil
| | - Fernanda Sales Luiz Vianna
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alberto Mantovani Abeche
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Miguel Del Campo
- Department of Pediatrics, University of California San Diego, San Diego, California
| | - Lavínia Schuler-Faccini
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Santos TTDM, Andrade LSDS, de Oliveira MEC, Gomes KAL, de Oliveira TA, Weller M. Availability of Diagnostic Services and their Impact on Patient Flow in Two Brazilian Referral Centres of Breast Cancer Treatment. Asian Pac J Cancer Prev 2020; 21:317-324. [PMID: 32102505 PMCID: PMC7332143 DOI: 10.31557/apjcp.2020.21.2.317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/09/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND System delay (SD) is a leading cause of advanced stage of disease and poor prognosis among Brazilian breast cancer patients. METHODS Cox regression and Kaplan-Meier analysis were used to identify variables that contributed to SD among 128 breast cancer patients. Time intervals between first medical consultation and treatment initiation were compared among patients of two referral centres: Patients of a referral centre with outsourced (FAP), respectively, integrated (HNL) diagnostic services. RESULTS Women who used a specialized private clinic at the beginning of patient flow had an 2.32 fold increased chance (95% CI: 1.17 - 4.60; p = 0.016) of hospital admission within 90 days after first medical consultation, compared to women who used a public health care provider (HCP). Of 73 and 34 patients of the FAP hospital and the HNL, respectively, 10 (13.7%) and 11 (32.5%) used one HCP prior to hospital admission (p = 0.000). The median time between first medical consultation and treatment initiation was 150 days. The median time between first medical consultation and hospital admission was 136.0 and 52.0 days for patients of the FAP hospital, respectively the HNL (p < 0.050). The median time between first medical consultation and diagnostic mammography was 36.5 and 23.0 days for patients from the FAP hospital and the HNL (p < 0.050). CONCLUSIONS Usage of public diagnostic services was associated with increased SD, whereas the usage of private diagnostic services diminished it. The usage of a lower number of HCPs accelerated patient flow.
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Chioro A, Calife K, Barros CRDS, Martins LC, Calvo M, Stanislau E, Pereira LA, Caseiro M. Covid-19 em uma Região Metropolitana: vulnerabilidade social e políticas públicas em contextos de desigualdades. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-11042020e414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A Covid-19 chegou rapidamente à periferia das grandes cidades brasileiras, a qual é socialmente mais vulnerável. A baixa capacidade de testagem resulta na adoção de medidas sem informações consistentes sobre o comportamento da doença e interfere na adoção de ações de controle. Objetivou-se estimar a prevalência de infecção por SARS-CoV-2 na população da Região Metropolitana da Baixada Santista (RMBS) e analisar impactos da vulnerabilidade social e de políticas públicas implementadas em contextos de desigualdades. Estudo de caráter quantitativo, transversal, mediante inquérito sorológico seriado e aplicação de questionário em amostragem populacional estratificada e coleta domiciliar, nos nove municípios da RMBS. Conclui-se que a soroprevalência medida foi de 1,4% na primeira fase, e de 2,2% na segunda; permitindo estimar 15 pessoas infectadas para cada caso notificado na primeira fase, e 10 na seguinte. A letalidade foi recalculada para 0,40% e 0,48% em cada fase, aproximando-se da casuística internacional. Pessoas mais vulneráveis são as mais atingidas pela pandemia, devendo ser consideradas: informalidade no trabalho, baixa renda, cor da pele autorreferida como preta ou parda e informações ambivalentes quanto à prevenção. Os resultados reforçam a importância do isolamento social e da adoção de medidas econômicas e sociais protetivas destinadas às populações vulneráveis.
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Affiliation(s)
| | - Karina Calife
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), Brasil
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Cruz PKR, Vieira MA, Carneiro JA, Costa FMD, Caldeira AP. Difficulties of access to health services among non-institutionalized older adults: prevalence and associated factors. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2020. [DOI: 10.1590/1981-22562020023.190113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To estimate the prevalence and factors associated with the difficulties of access to health services among non-institutionalized older adults in the town of Montes Claros, Minas Gerais, Brazil. Method: A cross-sectional study nested in a population-based cohort of community-dwelling older adults was carried out in Montes Claros, Minas Gerais, Brazil. Data collection was performed in the homes of the older adults between November 2016 and February 2017. Demographic, socioeconomic, and health-related variables and access to and use of health services were evaluated. Bivariate analyzes (Pearson’s chi-squared test) were conducted, adopting a level of significance lower than 0.20 for inclusion of the independent variables in the multiple model. The final model was generated by Poisson regression analysis, with robust variance, and the variables maintained were associated with difficulty in using the health services up to a level of significance of 0.05 (p<0.05). Results: 394 older adults participated in this study, 33% of whom reported difficulties with access. In multiple analysis, greater difficulty of access was registered among older adults without a partner; who could not read; were frail and had a negative self-perception of health. Older adults face greater difficulties with access when seeking public services. Conclusion: A high perception of difficulty with access was identified, determined by social and physical aspects inherent to aging, and which may be worsened by the characteristics of public services. There is a need for investments in the health care of older adults, in order to guarantee care that promotes healthy aging.
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Affiliation(s)
| | | | - Jair Almeida Carneiro
- Universidade Estadual de Montes Claros, Brazil; Centro Universitário FIPMoc de Montes Claros, Brasil
| | - Fernanda Marques da Costa
- Universidade Estadual de Montes Claros, Brazil; Universidade Estadual de Montes Claros, Brazil; Centro Universitário FIPMoc de Montes Claros, Brasil
| | - Antônio Prates Caldeira
- Centro Universitário FIPMoc de Montes Claros, Brasil; Universidade Estadual de Montes Claros, Brazil
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Factors Associated With Early Virological Response in HIV-Infected Individuals Starting Antiretroviral Therapy in Brazil (2014-2015): Results From a Large HIV Surveillance Cohort. J Acquir Immune Defic Syndr 2019; 78:e19-e27. [PMID: 29557856 PMCID: PMC6023593 DOI: 10.1097/qai.0000000000001684] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To identify clinical, sociodemographic, and treatment-related factors associated with early virological response in HIV-infected adults starting antiretroviral treatment (ART) in Brazil in 2014–2015. Methods: Data from 4 information systems from the Brazilian AIDS Program were combined to create a historical cohort. Unconditional logistic regression models were used to assess the likelihood of not achieving viral load suppression (VLS), defined as having either a viral load (VL) count >200 copies per milliliter or an aids-related death recorded within 180 ± 90 days after treatment initiation. Results: Among 76,950 individuals, 64.8% were men; median age, CD4+, and VL counts were 34 years, 378 cells per micro liter, and 38,131 copies per milliliter, respectively, and 85.2% achieved VLS. In the multivariate analysis, some factors which increased the odds of non-VLS were as follows: lower CD4+ and higher VL counts, younger age, heterosexual or injection drug use groups (relative to men who have sex with men), lower educational level, black/brown race, higher pill burden, and higher dosing frequency. Regimens containing boosted protease inhibitors were similar to those containing nonnucleoside reverse transcriptase inhibitors and superior to those containing unboosted protease inhibitors (all P values <0.001). No difference was observed between patients with CD4+ counts 350–499 and 500+ cells per micro liter. Conclusions: Our findings support the decision made in Brazil in 2013 to recommend immediate initiation of ART regardless of clinical stage or CD4+. Several factors were found to be associated with poorer virologic outcomes and should be addressed to maximize ART adherence and success rates.
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Oliveira IM, Duarte YADO, Zanetta DMT. Prevalence of Systemic Arterial Hypertension Diagnosed, Undiagnosed, and Uncontrolled in Elderly Population: SABE Study. J Aging Res 2019; 2019:3671869. [PMID: 31565434 PMCID: PMC6745120 DOI: 10.1155/2019/3671869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 08/16/2019] [Indexed: 02/05/2023] Open
Abstract
Systemic arterial hypertension is the most prevalent chronic noncommunicable disease among older people. This study aimed to estimate the prevalence of hypertension in the elderly and to analyze factors associated with diagnosed, undiagnosed, and uncontrolled hypertension. This is a cross-sectional study of data from the SABE study-Health, Well-Being, and Aging Survey-a multiple-cohort study, obtained in 2010, composed of a probabilistic sample representative of the population of the São Paulo city aged ≥60 years. Hypertension was self-reported or defined by increased blood pressure. Multinomial regression assessed factors associated with diagnosis and lack of diagnosis of hypertension (reference: no hypertension), and logistic regression assessed factors associated with uncontrolled hypertension (reference: controlled). The prevalence of hypertension was 79.5%, and in 51% of individuals with the condition, hypertension was uncontrolled. Undiagnosed hypertension was associated with nonwhite skin color (OR: 1.89, CI: 1.11-3.19), being uninsured (OR: 1.77, CI: 1.04-3.03), overweight (OR: 2.38, CI: 1.09-5.19), higher education (OR: 0.46, CI: 0.22-1.94), and ≥1 chronic disease (OR: 0.28; CI: 0.13-0.58). Diagnosed hypertension was associated with age between 70 and 79 years (OR: 2.02, CI: 1.34-3.05), age ≥80 (OR: 2.73, CI: 1.72-4.31), nonwhite skin color (OR: 1.48, CI: 1.01-2.18), being uninsured (OR: 1.70, CI: 1.18-2.47), at least one medical consultation in the last year (OR: 1.86, CI: 1.06-3.25), obesity (OR: 2.50, CI: 1.61-3.88), and ≥1 chronic disease (OR: 2.81, CI: 1.94-4.08). Among those with hypertension, being uncontrolled was associated with widowhood (OR: 1.73, CI: 1.23-2.43), being uninsured (OR: 1.38, CI: 1.02-1.87), and female gender (OR: 0.61, CI: 0.43-0.87). The prevalence of hypertension was high in this population, and its diagnosis and control were associated with socioeconomic, demographic, and healthcare access factors.
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Bertoldi AD, Wagner AK, Emmerick ICM, Chaves LA, Stephens P, Ross-Degnan D. The Brazilian private pharmaceutical market after the first ten years of the generics law. J Pharm Policy Pract 2019; 12:18. [PMID: 31417682 PMCID: PMC6692923 DOI: 10.1186/s40545-019-0179-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/28/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives To describe changes in the private market for selected originators, branded generics (‘similares’), and generic products during the 10 years following passage of the Brazilian Generics Law. Methods We analyzed longitudinal data collected by IQVIA® on quarterly sales by wholesalers to retail pharmacies in Brazil from 1998 through 2010, grouped by originators, branded generics, and generic products in three therapeutic classes (antibiotics, antidiabetics, and antihypertensives). Outcomes included market share (proportion of the total private market volume), sales volume per capita, prices and number of manufacturers by group. Results In the private market share, generics became dominant in each therapeutic class but the speed of uptake varied. Originators consistently lost most market share while branded generics varied over time. By the end of the study period, generics were the most sold product type in all classes, followed by branded generics. The number of generic manufacturers increased in all classes, while branded generics increased just after the policy but then decreased slowly through the end of 2010. For approximately 50% of the antibiotics analyzed, branded generics and generics had lower prices than originators. For antidiabetics, branded generic and generic prices were quite similar during the period analyzed. Price trends for the various subclasses of antihypertensive exhibited very different patterns over time. Conclusion Sales of branded generics and originators decreased substantially in the three therapeutic classes analysed following the introduction of the generics policy in Brazil, but the time to market dominance of generics varied by class.
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Affiliation(s)
- Andréa Dâmaso Bertoldi
- 1Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 3º piso, Pelotas, RS CEP 96.020-220 Brazil
| | - Anita K Wagner
- 2Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215 USA
| | - Isabel Cristina Martins Emmerick
- 3Department of Surgery, Division of Thoracic Surgery, University of Massachusetts Medical School, 67 Belmont street, #201, Worcester, MA 01605 USA
| | - Luisa Arueira Chaves
- 4Pharmacy School, Federal University of Rio de Janeiro, Campus Macaé, Av. Aluizio da Silva Gomes, 50, Novo Cavaleiros, Macaé, RJ 27930-560 Brazil
| | | | - Dennis Ross-Degnan
- 2Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215 USA
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Comparative effectiveness of first-line antiretroviral therapy: results from a large real-world cohort after the implementation of dolutegravir. AIDS 2019; 33:1663-1668. [PMID: 31082860 DOI: 10.1097/qad.0000000000002254] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We aimed to assess the effectiveness of first-line antiretroviral therapy (ART) regimens in achieving viral suppression at 12 months, from 2014 to 2017 in Brazil. DESIGN A retrospective cohort study utilizing programmatic data from the Brazilian HIV Program. METHODS Adults (aged 15-80 years) who started ART from January 2014 to July 2017 and had a viral load 365 (±90) days after treatment initiation were included. Associations with achieving viral suppression (<50 copies/ml) at 365 (±90) days were assessed using logistic regression. Our main study variable was ART regimen, and covariates included year of ART initiation, sex/exposure group, age, education, race, region, baseline CD4 and viral load counts, and adherence measured by pharmacy refill data. We performed both intent-to-treat and per-protocol analogous analyses. RESULTS Out of 107 647 ART-naive patients, 71.5% initiated with tenofovir/lamivudine/efavirenz (TLE) and 10.5% with tenofovir/lamivudine/dolutegravir (TLD). Median age and CD4 cell counts were 34 [interquartile range (IQR) 26-46] and 379 cells/μl (IQR 190-568), respectively; 68.0% were men. Viral suppression by 12 months was 84.0% [95% confidence interval (95% CI) 83.7-84.2] with TLE and 90.5% (95% CI 90.0-91.0) with TLD, and below 80% for protease-inhibitor-based regimens. In the multivariable intent-to-treat-analogous analysis, controlling for cofactors related to viral suppression including adherence, the adjusted odds ratio (aOR) for TLD's viral suppression relative to TLE was 1.56 (95% CI 1.40-1.75). Findings were robust to secondary per-protocol analogous and sensitivity analysis. CONCLUSION Our results showed the superiority of dolutegravir- over efavirenz- and protease-inhibitor-based regimens in suppressing viral replication in a real-word cohort of HIV-positive adults. This superiority was not driven by higher levels of adherence with dolutegravir-based regimens.
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de Oliveira LMSM, Costa IMNBDC, da Silva DG, Silva JRSS, Barreto-Filho JAS, Almeida-Santos MA, Oliveira JLM, Buarque MDBM, Vieira DADS, Sousa ACS. Readmission of Patients with Acute Coronary Syndrome and Determinants. Arq Bras Cardiol 2019; 113:42-49. [PMID: 31271598 PMCID: PMC6684196 DOI: 10.5935/abc.20190104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/23/2018] [Accepted: 11/01/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) is responsible for high rates of hospital admission and readmission, which are associated with increased costs for the patient and the health system, and increased in-hospital mortality rates. OBJECTIVE To evaluate readmission in patients with ACS and its determinants. METHODS This was a retrospective cohort study of adult and elderly patients with ACS, readmitted to public and private referral cardiology hospitals within one year after the first hospitalization for ACS. The occurrence of readmissions, the time elapsed from the first to the second admission, and the use of medications at admission were collected from the medical records. Associations between categorical variables were evaluated by the chi-square test or the Fisher's exact test. Multiple logistic regression was used to evaluate predictors for readmissions. A p < 0.05 was set as statistically significant. RESULTS Readmission rate was 21.5% (n = 115) and mean time between admissions was 122.7 ± 112.1 days. The patients were mostly men (64.0%), mean age of 63.15 ± 12.3 years. Among readmitted patients, 7% had a prognosis of "death", and 68.7% were readmitted more than once within a one-year period. The main reasons of readmission were cardiovascular diseases including ACS. Private health care and the diagnosis of congestive heart failure were associated with multiple logistic regression. CONCLUSION ACS was the main cause of readmission, with higher prevalence among users of supplemental health care. Readmissions were associated with previous diagnosis of congestive heart failure and the type of health care provided.
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Affiliation(s)
| | - Ingrid Maria Novais Barros de Carvalho Costa
- Universidade Federal de Sergipe - Departamento de
Pós-Graduação em Ciências da Saúde, São
Cristovão, SE - Brazil
- Instituto Federal de Educação Ciência e
Tecnologia de Sergipe, São Cristovão, SE - Brazil
| | | | | | - José Augusto Soares Barreto-Filho
- Universidade Federal de Sergipe - Departamento de
Pós-Graduação em Ciências da Saúde, São
Cristovão, SE - Brazil
- Universidade Federal de Sergipe - Departamento de Medicina,
São Cristovão, SE - Brazil
- Fundação São Lucas - Centro de Ensino e
Pesquisa, Aracaju, SE - Brazil
| | | | - Joselina Luzia Meneses Oliveira
- Universidade Federal de Sergipe - Departamento de
Pós-Graduação em Ciências da Saúde, São
Cristovão, SE - Brazil
- Universidade Federal de Sergipe - Departamento de Medicina,
São Cristovão, SE - Brazil
| | | | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe - Departamento de
Pós-Graduação em Ciências da Saúde, São
Cristovão, SE - Brazil
- Universidade Federal de Sergipe - Departamento de Medicina,
São Cristovão, SE - Brazil
- Fundação São Lucas - Centro de Ensino e
Pesquisa, Aracaju, SE - Brazil
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Nunes J. The everyday political economy of health: community health workers and the response to the 2015 Zika outbreak in Brazil. REVIEW OF INTERNATIONAL POLITICAL ECONOMY 2019; 27:146-166. [PMID: 32256198 PMCID: PMC7077346 DOI: 10.1080/09692290.2019.1625800] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
How is neoliberalism implicated in concrete health vulnerabilities? How do macro-level political economy, policy and institutions translate into everyday experiences? Drawing on Marxist, feminist and International Political Economy critiques of everyday life, the article advances an everyday political economy of health focused on four key components: power, agency, intersectionality and the mutual implication of the global and the local. These components enable a nuanced investigation of concrete experiences of health and disease, and of the local implementation of health policies in the context of neoliberalism. The framework is applied to the case of the 2015 public health response to Zika in Brazil, and specifically to the role of community health workers, close-to-community healthcare providers tasked with bridging the health system and vulnerable groups. The everyday practice of these workers, and their working conditions overwhelmingly characterized by precarity and low pay, reveal the presence of global neoliberal dynamics pertaining to the reconfiguration of the Brazilian state as healthcare provider in a context of encroaching austerity, privatization and narrowly-defined cost-efficiency. These dynamics impacted detrimentally upon the effectiveness of the Zika response.
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Affiliation(s)
- João Nunes
- Department of Politics, University of York, Heslington, York, United Kingdom of Great Britain and Northern Ireland
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Stopa SR, Cesar CLG, Alves MCGP, Barros MBDA, Goldbaum M. Uso de serviços de saúde para controle da hipertensão arterial e do diabetes mellitus no município de São Paulo. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22:e190057. [DOI: 10.1590/1980-549720190057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 10/05/2018] [Indexed: 11/21/2022] Open
Abstract
RESUMO: Objetivo: Descrever as prevalências do uso de serviços de saúde para controle da hipertensão arterial (HA) e do diabetes mellitus (DM) no município de São Paulo nos anos de 2003, 2008 e 2015 e analisar os fatores associados a esse uso no ano de 2015. Métodos: Foram analisados dados de população adulta provenientes dos inquéritos de saúde no município de São Paulo em 2003, 2008 e 2015. Foram estimadas as prevalências e seus intervalos de confiança de 95% nos 3 anos para descrever as prevalências do uso de serviços de saúde para controle da HA e do DM. Para 2015, foram estimadas as prevalências para as mesmas variáveis segundo características sociodemográficas, geográficas e de saúde. Utilizou-se regressão logística multinomial para estimar modelos de análise para HA e DM. Resultados: Observou-se aumento significativo no percentual de pessoas que referiram ir ao serviço de saúde de rotina por causa da HA e do DM no período 2003 a 2015. Em 2015, maior uso de serviços de saúde de rotina para controle da HA foi observado entre os idosos e as pessoas que referiram possuir plano de saúde. No caso do DM, houve associação entre o uso de serviços e baixa escolaridade. Ser idoso diminui o risco de não ir ao serviço de saúde para o controle da HA, enquanto ser do sexo masculino e não possuir plano de saúde aumentam esse risco significativamente. Conclusões: Identificar como os indivíduos com HA e DM utilizam os serviços de saúde para controle das doenças é de extrema relevância para reduzir barreiras no acesso e, ainda, orientar políticas de saúde no intuito de reduzir desigualdades.
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Malta DC, Bernal RTI, Vieira Neto E, Curci KA, Pasinato MTDM, Lisbôa RM, Cachapuz RF, Coelho KSC. Trends in risk and protective factors for non-communicable diseases in the population with health insurance in Brazil from 2008 to 2015. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 21:e180020. [PMID: 30517471 DOI: 10.1590/1980-549720180020.supl.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 11/16/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To analyze trends in risk and protective factors for non-communicable diseases (NCD) and access to preventive tests in the population with health insurance in Brazilian state capitals between 2008 and 2015. METHODS This is a cross-sectional study that analyzed data collected from the Surveillance of Risk and Protective Factors for non-communicable diseases (NCD) Telephone Survey (Sistema Nacional de Vigilância de Doenças Crônicas por Inquérito Telefônico - Vigitel) on adults aged 18 years and older. We analyzed trends in NCD indicators among health insurance users in approximately 30 thousand interviews done between 2008 and 2015. We used the simple linear regression model to calculate the trends. RESULTS Health insurance users showed an increase in the prevalence of protective factors such as fruit and vegetable consumption, and physical activity in leisure time. Also, there was a decrease in risk factors such as smoking and soft drink consumption, increase in mammography coverage, and a drop in smoking prevalence. However, overweight, obesity, and diabetes increased. CONCLUSION There are differences according to gender, and, in general, women accumulate more protective factors and men, more risk factors.
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Affiliation(s)
- Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Regina Tomie Ivata Bernal
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Eduardo Vieira Neto
- Diretoria de Normas e Habilitação dos Produtos, Agência Nacional de Saúde Suplementar - Rio de Janeiro (RJ), Brasil
| | - Katia Audi Curci
- Diretoria de Normas e Habilitação dos Produtos, Agência Nacional de Saúde Suplementar - Rio de Janeiro (RJ), Brasil
| | | | - Raquel Medeiros Lisbôa
- Diretoria de Normas e Habilitação dos Produtos, Agência Nacional de Saúde Suplementar - Rio de Janeiro (RJ), Brasil
| | - Renata Fernandes Cachapuz
- Diretoria de Normas e Habilitação dos Produtos, Agência Nacional de Saúde Suplementar - Rio de Janeiro (RJ), Brasil
| | - Karla Santa Cruz Coelho
- Diretoria de Normas e Habilitação dos Produtos, Agência Nacional de Saúde Suplementar - Rio de Janeiro (RJ), Brasil
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Ramos ACV, Alves LS, Berra TZ, Popolin MP, Arcoverde MAM, Campoy LT, Martoreli JF, Lapão LV, Palha PF, Arcêncio RA. [Family Health Strategy, private health care, and inequalities in access to mammography in BrazilEstrategia de Salud Familiar, salud suplementaria y desigualdad en el acceso a la mamografía en Brasil]. Rev Panam Salud Publica 2018; 42:e166. [PMID: 31093194 PMCID: PMC6398316 DOI: 10.26633/rpsp.2018.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 08/15/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the association between access to mammography and coverage by private health insurance or by the public healthcare system through the Family Health Strategy (FHS). METHOD An ecological study was performed with data obtained from the Unified Health System Data Processing Department (DATASUS). Time trends were analyzed using the Prais-Winsten method, having the Brazilian federal units as units of analysis. Multiple linear regression was used to investigate the relationship between the dependent variable - women aged 50 to 69 years who never had a mammogram - and the independent variables (coverage by the FHS or private health care and socioeconomic aspects). RESULTS Acre was the only Brazilian state for which an increasing growth trend in private health care was not observed. Roraima, Tocantins, Maranhão, Piauí, Rio Grande do Norte, and Paraíba showed a stable trend for FHS coverage, whereas all other federal units had increasing coverage. A significant association was observed between never having had a mammogram at 50 to 69 years of age and the variables mean per capita income and FHS and private health care coverage (R2 = 0.77; P < 0.001). CONCLUSION Unequal access to mammography is a reality in Brazil. Both private health care and the FHS have contributed to improve health care accessibility for Brazilian women.
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Affiliation(s)
- Antônio Carlos Vieira Ramos
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto (SP), Brasil,Correspondência: Antônio Carlos Vieira Ramos,
| | - Luana Seles Alves
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto (SP), Brasil
| | - Thaís Zamboni Berra
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto (SP), Brasil
| | - Marcela Paschoal Popolin
- Universidade Federal de Mato Grosso (UFMT), Instituto de Ciências da Saúde, Campus de Sinop, Sinop, (MT), Brasil
| | - Marcos Augusto Moraes Arcoverde
- Universidade Estadual do Oeste do Paraná (UNIOESTE), Campus de Foz do Iguaçu, Centro de Educação, Letras e Saúde, Foz do Iguaçu (PR), Brasil
| | - Laura Terenciani Campoy
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto (SP), Brasil
| | - José Francisco Martoreli
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto (SP), Brasil
| | - Luís Velez Lapão
- Universidade Nova de Lisboa, Instituto de Higiene e Medicina Tropical, Lisboa, Portugal
| | - Pedro Fredemir Palha
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto (SP), Brasil
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Tackling low back pain in Brazil: a wake-up call. Braz J Phys Ther 2018; 23:189-195. [PMID: 30337255 DOI: 10.1016/j.bjpt.2018.10.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/28/2018] [Accepted: 10/03/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Low back pain is the leading cause of years lived with disability in Brazil based upon Global Burden of Disease estimates. Since 1990, the number of years lived with disability has increased by 79.7%, and this number is expected to continue to rise due to population growth and ageing. Yet, similarly to other countries, little attention has been given to it in both the public and private health systems, arguably making it an overlooked epidemic in Brazil. There is evidence that Brazil has adopted unwarranted practices in the management of low back pain in a similar manner to what has been observed in high-income countries. To tackle the burden of low back pain in Brazil, we need highly coordinated efforts from government, the private sector, universities, health workers and civil society. OBJECTIVE This masterclass intends to provide an overview of the challenges faced by Brazil in relation to low back pain management and propose potential solutions that could potentially be implemented based on experiences reported in the literature.
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Miotto BA, Guilloux AGA, Cassenote AJF, Mainardi GM, Russo G, Scheffer MC. Physician's sociodemographic profile and distribution across public and private health care: an insight into physicians' dual practice in Brazil. BMC Health Serv Res 2018; 18:299. [PMID: 29688856 PMCID: PMC5914025 DOI: 10.1186/s12913-018-3076-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 03/28/2018] [Indexed: 11/16/2022] Open
Abstract
Background The intertwined relation between public and private care in Brazil is reshaping the medical profession, possibly affecting the distribution and profile of the country’s medical workforce. Physicians’ simultaneous engagement in public and private services is a common and unregulated practice in Brazil, but the influence played by contextual factors and personal characteristics over dual practice engagement are still poorly understood. This study aimed at exploring the sociodemographic profile of Brazilian physicians to shed light on the links between their personal characteristics and their distribution across public and private services. Methods A nation-wide cross-sectional study using primary data was conducted in 2014. A representative sample size of 2400 physicians was calculated based on the National Council of Medicine database registries; telephone interviews were conducted to explore physicians’ sociodemographic characteristics and their engagement with public and private services. Results From the 2400 physicians included, 51.45% were currently working in both the public and private services, while 26.95% and 21.58% were working exclusively in the private and public sectors, respectively. Public sector physicians were found to be younger (PR 0.84 [0.68–0.89]; PR 0.47 [0.38–0.56]), less experienced (PR 0.78 [0.73–0.94]; PR 0.44 [0.36–0.53]) and predominantly female (PR 0.79 [0.71–0.88]; PR 0.68 [0.6–0.78]) when compared to dual and private practitioners; their income was substantially lower than those working exclusively for the private (PR 0.58 [0.48–0.69]) and mixed sectors (PR 0.31 [0.25–0.37]). Conversely, physicians from the private sector were found to be typically senior (PR 1.96 [1.58–2.43]), specialized (PR 1.29 [1.17–1.42]) and male (PR 1.35 [1.21–1.51]), often working less than 20 h per week (PR 2.04 [1.4–2.96]). Dual practitioners were mostly middle-aged (PR 1.3 [1.16–1.45]), male specialists with 10 to 30 years of medical practice (PR 1.23 [1.11–1.37]). Conclusion The study shows that more than half of Brazilian physicians currently engage with dual practice, while only one fifth dedicate exclusively to public services, highlighting also substantial differences in socio-demographic and work-related characteristics between public, private and dual-practitioners. These results are consistent with the international literature suggesting that physicians’ sociodemographic characteristics can help predict dual practice forms and prevalence in a country. Electronic supplementary material The online version of this article (10.1186/s12913-018-3076-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bruno Alonso Miotto
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo, Doutor Arnaldo Avenue, nº 455, São Paulo, SP, 01246-903, Brazil.
| | - Aline Gil Alves Guilloux
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo, Doutor Arnaldo Avenue, nº 455, São Paulo, SP, 01246-903, Brazil
| | - Alex Jones Flores Cassenote
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo, Doutor Arnaldo Avenue, nº 455, São Paulo, SP, 01246-903, Brazil
| | - Giulia Marcelino Mainardi
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo, Doutor Arnaldo Avenue, nº 455, São Paulo, SP, 01246-903, Brazil
| | - Giuliano Russo
- Centre for Primary Care and Public Health, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - Mário César Scheffer
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo, Doutor Arnaldo Avenue, nº 455, São Paulo, SP, 01246-903, Brazil
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Dietrichkeit Pereira JG, Frontanilla Recalde TS, Barreto Costa P, Jacometti V, Vigorito Magalhães L, Alves Da Silva RH. Forensic odontology education:from undergraduate to PhD - a Brazilian experience. THE JOURNAL OF FORENSIC ODONTO-STOMATOLOGY 2017; 35:149-156. [PMID: 29384745 PMCID: PMC6100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Forensic Odontology is a topic present in the majority of Dental Schools in Brazil, and due to this reality, some universities develop activities related to undergraduate and graduate students, from the Dentistry course until the Ph.D. degree. AIM To present the education experience related to Forensic Odontology at School of Dentistry of Ribeirão Preto (USP - University of São Paulo), showing the strategies and activities in the different degrees (Dental course, Forensic Odontology Specialization Program, Specific Professional Training, Master, and Ph.D.). RESULTS To the undergraduate students, many activities are developed in order to demonstrate all the possibilities that Forensic Dentistry allow, including theoretical and practical activities; in the Forensic Odontology Specialization Program, the dentists are trained to act as Forensic Odontologists in all its amplitude; in the Specific Professional Training, some courses are available, related to specific topics as DVI, Forensic Facial Reconstruction, Auditor in Dental Care Insurance and others; and in the Master and Ph.D. Programs, the professionals receive training in skills like teaching, research, student's guidance and others. CONCLUSION In Brazil, Forensic Odontology is a well-known field in Dentistry and universities develop an important role in training a qualified workforce.
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Affiliation(s)
- J G Dietrichkeit Pereira
- Pathology Graduate Program (Forensic Odontology), Ribeirão Preto Medical School, Universidade de São Paulo, Brasil
| | - T S Frontanilla Recalde
- Pathology Graduate Program (Forensic Odontology), Ribeirão Preto Medical School, Universidade de São Paulo, Brasil
| | - P Barreto Costa
- Pathology Graduate Program (Forensic Odontology), Ribeirão Preto Medical School, Universidade de São Paulo, Brasil
| | - V Jacometti
- Pathology Graduate Program (Forensic Odontology), Ribeirão Preto Medical School, Universidade de São Paulo, Brasil
| | - L Vigorito Magalhães
- Pathology Graduate Program (Forensic Odontology), Ribeirão Preto Medical School, Universidade de São Paulo, Brasil
| | - R H Alves Da Silva
- Forensic Odontology, School of Dentistry of Ribeirão Preto, Universidade de São Paulo, Brasil
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McGregor AJ, Siqueira CE, Zaslavsky AM, Blendon RJ. Do elections matter for private-sector healthcare management in Brazil? An analysis of municipal health policy. BMC Health Serv Res 2017; 17:483. [PMID: 28701193 PMCID: PMC5508633 DOI: 10.1186/s12913-017-2427-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/03/2017] [Indexed: 12/02/2022] Open
Abstract
Background This study analyzed several political determinants of increased private-sector management in Brazilian health care. In Brazil, the poor depend almost exclusively on the public Unified Health System (the SUS), which remains severely underfunded. Given the overhead costs associated with privately contracted health services, increased private management is one driver of higher expenditures in the system. Although left parties campaign most vocally in support of greater public control of the SUS, the extent to which their stated positions translate into health care policy remains untested. Methods Drawing on multiple publicly available data sources, we used linear regression to analyze how political party-in-power and existing private sector health care contracting affect the share of privately managed health care services and outsourcing in municipalities. Data from two election periods—2004 to 2008 and 2008 to 2012—were analyzed. Results Our findings showed that although private sector contracting varies greatly across municipalities, this variation is not systematically associated with political party in power. This suggests that electoral politics plays a relatively minor role in municipal-level health care administration. Existing levels of private sector management appear to have a greater effect on the public-private makeup of the Brazilian healthcare system, suggesting a strong role of path dependence in the evolution of Brazilian health care delivery. Conclusion Despite campaign rhetoric asserting distinct positions on privatization in the SUS, factors other than political party in power have a greater effect on private-sector health system management at the municipal-level in Brazil. Given the limited effect of elections on this issue, strengthening participatory bodies such as municipal health councils may better enfranchise citizens in the fundamental debate over public and private roles in the health care sector.
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Affiliation(s)
- Alecia J McGregor
- Department of Community Health, Tufts University, 574 Boston Ave, Suite 208, Medford, MA, 02155, USA.
| | - Carlos Eduardo Siqueira
- Community Development and Planning, University of Massachusetts, Wheatley Hall, 4th Floor, 144-16, Boston, MA, 02125, USA
| | - Alan M Zaslavsky
- Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, USA
| | - Robert J Blendon
- Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
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