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Houvèssou GM, Farías-Antúnez S, Bertoldi AD, da Silveira MF. Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort. Rev Saude Publica 2024; 58:02. [PMID: 38381892 PMCID: PMC10878683 DOI: 10.11606/s1518-8787.2024058005585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/04/2023] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To describe the prevalence of contraindicated use of combined hormonal contraceptives, progesterone-only contraceptives, and intrauterine devices in mothers participating in the 2015 Pelotas Birth Cohort according to the WHO medical eligibility criteria. METHODS The biological mothers of children belonging to the 2015 Pelotas birth cohort who attended the 48-month follow-up were studied. The 48-month follow-up data were collected from January 1, 2019, to December 31, 2019. Contraindicated use of modern contraceptives was considered to occur when these women presented at least one of the contraindications for the use of modern contraceptives and were using these methods. The prevalence of contraindicated use was calculated according to each independent variable and their respective 95% confidence intervals (95%CI). RESULTS The analyzed sample consisted of 3,053 women who used any modern contraceptive method. The prevalence of contraindicated use of modern contraceptives totaled 25.9% (95%CI: 24.4-27.5). Combined hormonal contraceptives showed the highest prevalence of contraindicated use (52.1%; 95%CI: 49.3-54.8). The prevalence of contraindicated use of modern contraceptives methods was greater in women with family income between one and three minimum wages, a 25-30 kg/m2 body mass index, indication by a gynecologist for the used method, and purchasing the contraceptive method at a pharmacy. The higher the women's education, the lower the prevalence of inappropriate use of modern contraceptives. CONCLUSION In total, one in four women used modern contraceptives despite showing at least one contraindication. Policies regarding women's reproductive health should be strengthened.
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Affiliation(s)
- Gbènankpon Mathias Houvèssou
- Universidade Federal de PelotasFaculdade de MedicinaPrograma de Pós-graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Simone Farías-Antúnez
- Universidade Federal de Santa CatarinaFaculdade de MedicinaDepartamento de Ciências da SaúdeFlorianópolisSCBrasilUniversidade Federal de Santa Catarina. Faculdade de Medicina. Departamento de Ciências da Saúde. Florianópolis, SC, Brasil
| | - Andréa D. Bertoldi
- Universidade Federal de PelotasFaculdade de MedicinaPrograma de Pós-graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Mariângela Freitas da Silveira
- Universidade Federal de PelotasFaculdade de MedicinaPrograma de Pós-graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-graduação em Epidemiologia. Pelotas, RS, Brasil
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2
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Wendt A, Bielemann RM, Wehrmeister FC, Ricardo LIC, Müller WDA, Machado AKF, da Cruz MF, Bertoldi AD, Brage S, Ekelund U, Tovo-Rodrigues L, Crochemore-Silva I. Is rest-activity rhythm prospectively associated with all-cause mortality in older people regardless of sleep and physical activity level? The 'Como Vai?' Cohort study. PLoS One 2024; 19:e0298031. [PMID: 38363743 PMCID: PMC10871497 DOI: 10.1371/journal.pone.0298031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/16/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE This study aims to test the association of rest-activity rhythm (intradaily variability and interdaily stability) with all-cause mortality in an older adult cohort in Brazil. It also assesses whether the amount of time spent at each intensity level (i.e., physical activity and nocturnal sleep) interferes with this association. METHODS This cohort study started in 2014 with older adults (≥60 years). We investigated deaths from all causes that occurred until April 2017. Rest-activity rhythm variables were obtained using accelerometry at baseline. Intradaily variability indicates higher rhythm fragmentation, while interdaily stability indicates higher rhythm stability. Cox proportional-hazard models were used to test the associations controlling for confounders. RESULTS Among the 1451 older adults interviewed in 2014, 965 presented valid accelerometry data. During the follow-up period, 80 individuals died. After adjusting the analysis for sociodemographic, smoking, morbidity score, and number of medicines, an increase of one standard deviation in interdaily stability decreased 26% the risk of death. The adjustment for total sleep time and inactivity did not change this association. On the other hand, the association was no longer significant after adjusting for overall physical activity and moderate to vigorous physical activity. CONCLUSION Rest-activity rhythm pattern was not associated with mortality when physical activity was considered, possibly because this pattern could be driven by regular exercise. Promoting physical activity remains a relevant strategy to improve population health.
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Affiliation(s)
- Andrea Wendt
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Renata Moraes Bielemann
- Post-Graduation Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- School of Nutrition, Federal University of Pelotas, Pelotas, Brazil
| | | | - Luiza I. C. Ricardo
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | | | | | | | - Andréa D. Bertoldi
- Post-Graduation Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Soren Brage
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Chronic diseases, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Inácio Crochemore-Silva
- Post-Graduation Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduation Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
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3
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Karam SA, Costa FDS, Correa MB, Bertoldi AD, Barros FC, Demarco FF. Socioeconomic inequalities related to maternal perception of children's oral health at age 4: Results of a birth cohort. Community Dent Oral Epidemiol 2023; 51:872-878. [PMID: 35906753 DOI: 10.1111/cdoe.12779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To estimate socioeconomic inequalities in the maternal perception of children's oral health from a birth cohort study in Brazil. METHODS The data from this study were collected through perinatal interviews and at the 48-month follow-up from the 2015 Pelotas Birth Cohort Study. The main outcome was the maternal perception of children's oral health, dichotomized into positive (good/very good) and negative (fair/bad/very bad). The secondary outcome was untreated dental caries (absence and presence, according to the ICDAS index - International Caries Detection and Assessment System). For the statistical analysis, the absolute inequality index (Slope Index of Inequality - SII) and the relative concentration index (Concentration Index - CIX) were used. Analyses were stratified by maternal educational level, family income and wealth index. RESULTS The prevalence of outcomes was 19.4% (95% CI 18.2; 20.7) for the negative maternal perception of children's oral health and 15.6% (95% CI 14.4; 16.8) for untreated dental caries. Socioeconomics inequalities were observed in negative maternal perception of children's oral health in both absolute and relative terms. A SII of -16.6 (95% CI -20.8; -12.5) was observed for family income, with higher prevalence in poor families. A higher prevalence of the negative maternal perception of children's oral health was observed in mothers without any educational level or a few years of study (CIX -21.1 [95% CI -24.5; -17.7]). CONCLUSIONS This study demonstrates socioeconomics disparities in the maternal perception of children's oral health and in the prevalence of untreated caries in children. A higher concentration of negative maternal perception of children's oral health was identified among the most socioeconomically vulnerable individuals. The findings reinforce the presence of socioeconomic inequalities in subjective measures about children's oral health.
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Affiliation(s)
- Sarah Arangurem Karam
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Graduate Program in Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | | | - Andréa D Bertoldi
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Graduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Flávio Fernando Demarco
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Graduate Program in Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
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4
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Houvèssou GM, Farías-Antúnez S, Bertoldi AD, da Silveira MF. Demand and unmet need for modern contraception among mothers from a Pelotas Birth Cohort. Rev Saude Publica 2023; 57:40. [PMID: 37556662 PMCID: PMC10355318 DOI: 10.11606/s1518-8787.2023057004863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/02/2022] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To determine the total demand and unmet need for contraception with modern methods and their determinants among mothers participating in the 2015 Pelotas Birth Cohort. METHODS Data from the 48-month follow-up of mothers participating in the 2015 Pelotas Birth Cohort were analyzed. Only biological mothers (aged up to 49 years) of children belonging to the 2015 Birth Cohort and who answered the 48-month questionnaire were included in the study sample. Logistic regression and respective 95% confidence intervals were used to determine associated factors. RESULTS The study sample consisted of 3577 biological mothers. The prevalence of use of any contraceptive and of modern contraceptives was 86.0% (95%CI: 84.8-87.1) and 84.9% (95%CI: 83.7-86.1), respectively. The prevalence of unmet need for modern contraceptives was 10.7% (95%CI: 9.7-11.7), and the total demand for contraceptives was 95.6%. The factors associated with an unmet need for modern contraception were being over 34 years of age (OR = 0.6, 95%CI: 0.5-0.8), not having a husband or partner (OR = 1.9, 95%CI: 1.4-2.6), not being the head of the household (OR = 0.6, 95%CI: 0.4-0.9), having had three or more pregnancies (OR = 1.9, 95%CI: 1.3-2.6), and having had an abortion at least once after the birth of the child participating in the cohort (OR = 1.9, 95%CI: 1.0-3.6). CONCLUSIONS Despite the high prevalence of modern contraceptive use, one in ten women had an unmet need for modern contraception and was at risk of unplanned pregnancy.
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Affiliation(s)
- Gbènankpon Mathias Houvèssou
- Universidade Federal de PelotasPostgraduate Program in EpidemiologyPelotasRSBrazilUniversidade Federal de Pelotas. Postgraduate Program in Epidemiology. Pelotas, RS, Brazil.
| | - Simone Farías-Antúnez
- Universidade Federal de PelotasPostgraduate Program in EpidemiologyPelotasRSBrazilUniversidade Federal de Pelotas. Postgraduate Program in Epidemiology. Pelotas, RS, Brazil.
| | - Andréa D. Bertoldi
- Universidade Federal de PelotasPostgraduate Program in EpidemiologyPelotasRSBrazilUniversidade Federal de Pelotas. Postgraduate Program in Epidemiology. Pelotas, RS, Brazil.
| | - Mariângela Freitas da Silveira
- Universidade Federal de PelotasPostgraduate Program in EpidemiologyPelotasRSBrazilUniversidade Federal de Pelotas. Postgraduate Program in Epidemiology. Pelotas, RS, Brazil.
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5
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Murray J, Bauer A, Loret de Mola C, Martins RC, Blumenberg C, Esposti MD, Stein A, Barros FC, Hallal PC, Silveira MF, Bertoldi AD, Domingues MR. Child and Maternal Mental Health Before and During the COVID-19 Pandemic: Longitudinal Social Inequalities in a Brazilian Birth Cohort. J Am Acad Child Adolesc Psychiatry 2023; 62:344-357. [PMID: 36075481 PMCID: PMC9441217 DOI: 10.1016/j.jaac.2022.07.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/18/2022] [Accepted: 08/29/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has caused major stress for families and children, particularly in the context of prolonged school closures. Few longitudinal studies are available on young children's mental health, including data both before and during the pandemic. This study examined experiences that might increase risk for mental health problems among caregivers and young children during the COVID-19 pandemic and inequalities driven by pre-pandemic disadvantage. METHOD This prospective, population-based birth cohort study in Pelotas, Brazil, analyzed 2,083 children and caregivers with data from before the pandemic in 2019, when children were 4 years old, and again in 2020, when schools were closed for a long period during the pandemic. Child conduct problems, emotional problems, and hyperactivity-inattention problems were assessed using the Strengths and Difficulties Questionnaire. Family financial hardship, relationship difficulties, caregiver mental health, parenting practices, and child fears and isolation were considered as potential risk factors. RESULTS Across the whole population, the only significant increase in mental health problems from before to during the pandemic was found for maternal depression. However, poorer families were at far greater risk of experiencing serious financial problems, food shortages, increased conflict in adult relationships, parenting problems, and child worries about food availability during the pandemic. In turn, these difficulties were associated with increases in multiple mental health problems for both caregivers and children. Increased child mental health problems were most strongly associated with concurrent maternal anxiety (β > 0.20, p < .001, for each of child conduct, emotional, and hyperactivity problems), maternal depression (β = 0.26, p < .001, for child emotional problems), partner criticism (β = 0.21, p < .001, for child conduct problems), and harsh parenting (β > 0.20, p < .001, for both child conduct and hyperactivity problems). Child worry about COVID-19 was associated with increased emotional problems (β = 0.14, p < .001), but children's isolation was not associated with their mental health. CONCLUSION Overall, the impact of the COVID-19 pandemic on mental health is a mixed picture, but for families in poverty, marked material and interpersonal difficulties were associated with increases in mental health problems among children and caregivers.
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Affiliation(s)
- Joseph Murray
- Federal University of Pelotas, Brazil; Human Development and Violence Research Centre, Brazil.
| | - Andreas Bauer
- Federal University of Pelotas, Brazil; Human Development and Violence Research Centre, Brazil
| | - Christian Loret de Mola
- Federal University of Pelotas, Brazil; Human Development and Violence Research Centre, Brazil; University of Rio Grande, Brazil, and Universidad Científica del Sur Lima-Peru, Peru
| | - Rafaela Costa Martins
- Federal University of Pelotas, Brazil; Human Development and Violence Research Centre, Brazil
| | | | - Michelle Degli Esposti
- Federal University of Pelotas, Brazil; Human Development and Violence Research Centre, Brazil
| | - Alan Stein
- University of Oxford, United Kingdom, the University of the Witwatersrand, South Africa, and the African Health Research Institute, South Africa
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6
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Vargas PM, Schneider BC, Costa CS, César JA, Bertoldi AD, Tomasi E, Demarco FF, Gonzalez MC, Bielemann RM. Age is the most important factor for change in body mass index and waist circumference in older people in southern Brazil. Nutrition 2022; 109:111956. [PMID: 36863112 DOI: 10.1016/j.nut.2022.111956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 12/05/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of this study is to assess the changes in body mass index and waist circumference (WC) and their associations with sociodemographic, behavioral, and health characteristics in non-institutionalized older people in southern Brazil over a period of ≤6 y. METHODS This is a prospective study, with interviews conducted in 2014 and in 2019 to 2020. Of the 1451 individuals from Pelotas, Brazil, aged >60 y and interviewed in 2014, 537 were reevaluated in 2019 to 2020. An increase or decrease was defined as a variation of ≥5% in body mass index and WC in the second visit compared with the first. The association with changes in outcomes was assessed according to sociodemographic, behavioral, and health characteristics using multinomial logistic regression. RESULTS Approximately 29% of the older participants lost body mass. Regarding WC, there was an increase in 25.6% in the older participants. The older participants ages ≥80 y had greater odds of losing body mass (odds ratio [OR] = 4.73; 95% confidence interval [CI], 2.29-9.76) and of reducing WC (OR = 2.84; 95% CI, 1.59-6.94). Former smokers had, on average, 41% and 64% lower odds of losing and gaining body mass (95% CI, 0.37-0.95 and 95% CI, 0.19-0.68, respectively), and those who were on ≥5 medications had greater odds of gaining body mass (OR = 1.92; 95% CI, 1.12-3.28) and WC (OR = 1.79; 95% CI, 1.18-2.74). CONCLUSIONS Despite the high proportion of older people who kept their body mass index and WC stable during this period, many of them lost body mass and gained WC. The findings also highlighted the importance of age in the nutritional changes observed in the population.
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Affiliation(s)
- Priscila M Vargas
- Nutrititon and Food Graduate Program, Federal University of Pelotas, Pelotas, Brazil.
| | - Bruna C Schneider
- Epidemiology Graduate Program, Federal University of Pelotas, Pelotas, Brazil
| | - Caroline S Costa
- Epidemiology Graduate Program, Federal University of Pelotas, Pelotas, Brazil
| | - Juraci Almeida César
- Public Health Graduate Program, Federal University of Rio Grande, Pelotas, Brazil
| | - Andréa D Bertoldi
- Epidemiology Graduate Program, Federal University of Pelotas, Pelotas, Brazil
| | - Elaine Tomasi
- Epidemiology Graduate Program, Federal University of Pelotas, Pelotas, Brazil
| | - Flávio F Demarco
- Epidemiology Graduate Program, Federal University of Pelotas, Pelotas, Brazil; Dentistry Graduate Program, Federal University of Pelotas, Pelotas, Brazil
| | - Maria Cristina Gonzalez
- Epidemiology Graduate Program, Federal University of Pelotas, Pelotas, Brazil; Health and Behavior Graduate Program, Catholic University of Pelotas, Pelotas, Brazil
| | - Renata M Bielemann
- Nutrititon and Food Graduate Program, Federal University of Pelotas, Pelotas, Brazil
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7
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Echeverria MS, Schuch HS, Cenci MS, Motta JVS, Bertoldi AD, Hallal PC, Demarco FF. Trajectories of Sugar Consumption and Dental Caries in Early Childhood. J Dent Res 2022; 101:724-730. [PMID: 35114848 DOI: 10.1177/00220345211068743] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study verifies the association between the trajectory of sugar consumption and dental caries in the 2015 Pelotas Birth Cohort in Pelotas, Brazil. It was conducted with data from the follow-ups at 3, 12, 24, and 48 mo from the 2015 Birth Cohort, which included 4,275 children born alive in hospitals in Pelotas. Data collection included standardized questionnaires for first caregivers applied by trained interviewers at all follow-ups. Exposure was the trajectory of sugar consumption from 3 to 48 mo (always low, always intermediate, increasing, and always high), obtained by group-based trajectory modeling. The outcome of this study was dental caries, obtained through clinical examination performed by calibrated dentists at 48 mo of age. Socioeconomic conditions and oral health instruction from a health professional during the first 4 y of life were included in the analysis as potential confounders. Prevalence ratios and their 95% confidence intervals were provided from generalized estimating equations with a log-Poisson with robust variance specification. In total, 3,654 (91.1%) children participated in the survey at 48 mo, and 2,806 children had complete data for the analyzes performed. Of these, 1,012 (36.1%; 95% confidence interval [CI], 34.3-37.8) experienced caries, and 723 (25.8%; 95% CI, 24.2-27.4) had cavitated caries. Regarding cavitated caries, the prevalence was 1.48 times higher in the group with increasing sugar consumption than children with always low consumption. There is an association between the trajectory of sugar consumption and dental caries at 48 mo. Children with increasing and always high sugar consumption have the highest prevalence of caries.
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Affiliation(s)
- M S Echeverria
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - H S Schuch
- Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - M S Cenci
- Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - J V S Motta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - A D Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - P C Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - F F Demarco
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil.,Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
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8
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Bielemann RM, Demarco FF, Gonzalez MC, Bertoldi AD. Reply to: Objectively Measured Physical Activity Reduces the Risk of Mortality Among Brazilian Older Adults. J Am Geriatr Soc 2020; 68:1349-1350. [PMID: 32413157 DOI: 10.1111/jgs.16461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Renata M Bielemann
- Post-Graduate Program in Nutrition and Foods, Federal University of Pelotas, Pelotas, Brazil.,Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Flávio F Demarco
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.,Post-Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Maria Cristina Gonzalez
- Post-Graduate Program in Nutrition and Foods, Federal University of Pelotas, Pelotas, Brazil.,Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Andréa D Bertoldi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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9
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Tovo-Rodrigues L, Carpena MX, Martins-Silva T, Santos IS, Anselmi L, Barros AJD, Barros FC, Bertoldi AD, Matijasevich A. Low neurodevelopmental performance and behavioural/emotional problems at 24 and 48 months in Brazilian children exposed to acetaminophen during foetal development. Paediatr Perinat Epidemiol 2020; 34:278-286. [PMID: 32196712 DOI: 10.1111/ppe.12649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 11/26/2019] [Accepted: 12/22/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several studies have reported that there is an association between developmental and emotional/behavioural problems in children exposed to acetaminophen during foetal development. However, few studies have focused on development and behavioural outcomes in early life. OBJECTIVES To test the association between prenatal exposure to acetaminophen and low neurodevelopmental performance at 24 months and behavioural/emotional problems at 48 months of life. METHODS We used data from the 2004 Pelotas Birth Cohort, a population-based longitudinal prospective study. Neurodevelopment was evaluated at 24 months using Battelle's Developmental Inventory (BDI) (n = 3737). We assessed global function as well as each domain (personal-social, adaptative, motor, cognitive, and communication). Behavioural/emotional problems were assessed at 48 months using the Child Behaviour Checklist (CBCL) (n = 3624). We used the CBCL total, externalising, and internalising symptomatology and individual subscales (withdrawn, somatic complaints, anxious/depressed, social problems, cognitive problems, attention problems, aggressive behaviour, and rule-breaking behaviour). Acetaminophen use during pregnancy was retrospectively assessed at the perinatal follow-up. Poisson regression and multiple linear regression analyses were used to test the association, adjusting for several family and maternal sociodemographic and health factors, medication use during pregnancy, and the sex of the child. RESULTS Acetaminophen exposure during prenatal development was not associated with low neurodevelopmental performance at 24 months assessed using the BDI or to emotional and behavioural problems assessed at 48 months using the CBCL in the adjusted models. CONCLUSIONS We cannot confirm the existence of an association between acetaminophen used during pregnancy and low neurodevelopmental performance at 24 months and emotional/behavioural problems at 48 months of life based on the present results.
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Affiliation(s)
| | - Marina Xavier Carpena
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Thais Martins-Silva
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil.,Postgraduate Program Pediatrics Child Health, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciana Anselmi
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Andréa D Bertoldi
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, SP, Brazil
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10
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Halal CS, Bassani DG, Santos IS, Tovo-Rodrigues L, Del-Ponte B, Silveira MF, Bertoldi AD, Barros FC, Nunes ML. Maternal perinatal depression and infant sleep problems at 1 year of age: Subjective and actigraphy data from a population-based birth cohort study. J Sleep Res 2020; 30:e13047. [PMID: 32285520 DOI: 10.1111/jsr.13047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 12/16/2022]
Abstract
This study used data from 2,222 mothers and infants participating in a population-based birth cohort to verify whether maternal depression in the perinatal period was associated with poor infant sleep. Mothers who scored ≥13 points on the Edinburgh Postnatal Depression Scale at 16-24 weeks of gestation and/or 3 months after delivery were considered perinatally depressed. The main outcome variable was poor infant sleep at 12 months of age, defined as >3 night wakings, nocturnal wakefulness >1 hr or total sleep duration <9 hr. Infant sleep data were obtained with the Brief Infant Sleep Questionnaire (BISQ) and 24-hr actigraphy monitoring. Prevalence of perinatal depression in the sample was 22.3% (95% confidence interval [CI], 20.5-24.0). After Poisson regression, infants of depressed mothers showed an adjusted relative risk (RR) of 1.44 (95% CI, 1.00-2.08; p = .04) for >3 night wakings with questionnaire-derived data. When actigraphy data were analysed, no association was found between perinatal depression and poor infant sleep (adjusted RR, 1.20; 95% CI, 0.82-1.74; p = .35). In conclusion, although mothers in the depressed group were more likely to report more night wakings, objective data from actigraphy did not replicate this finding. Dysfunctional cognition, maternal behavioural factors and sleep impairment associated with perinatal depression may affect the mother's impression of her infant's sleep.
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Affiliation(s)
- Camila S Halal
- PhD Program of Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Conceição Hospital Group, Hospital Criança Conceição, Porto Alegre, Brazil
| | - Diego G Bassani
- Centre for Global Child Health, The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Bianca Del-Ponte
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Mariangela F Silveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Andréa D Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.,Graduate Studies Program in Health and Behaviour, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Magda L Nunes
- Division of Neurology, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Brain Institute (BRAIns), Porto Alegre, Brazil
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11
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Neves PAR, Gatica-Domínguez G, Santos IS, Bertoldi AD, Domingues M, Murray J, Silveira MF. Poor maternal nutritional status before and during pregnancy is associated with suspected child developmental delay in 2-year old Brazilian children. Sci Rep 2020; 10:1851. [PMID: 32024929 PMCID: PMC7002477 DOI: 10.1038/s41598-020-59034-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/23/2020] [Indexed: 01/17/2023] Open
Abstract
Inadequate pre-pregnancy BMI and gestational weight gain (GWG) have been associated with sub-optimal child development. We used data from the 2015 Pelotas (Brazil) Birth Cohort Study. Maternal anthropometry was extracted from antenatal/hospital records. BMI (kg/m2) and GWG (kg) adequacy were classified according to WHO and IOM, respectively. Development was evaluated using the INTER-NDA assessment tool for 3,776 children aged 24 months. Suspected developmental delay (SDD) was defined as <10th percentile. Associations between maternal exposures and child development were tested using linear and logistic regressions. Mediation for the association between BMI and child development through GWG was tested using G-formula. Sex differences were observed for all child development domains, except motor. Maternal pre-pregnancy underweight increased the odds of SDD in language (OR: 2.75; 95%CI: 1.30-5.80), motor (OR: 2.28; 95%CI: 1.20-4.33), and global (OR: 2.14; 95% CI: 1.05-4.33) domains for girls; among boys, excessive GWG was associated with SDD in language (OR: 1.59; 95%CI: 1.13-2.24) and cognition (OR: 1.59; 95%CI: 1.15-2.22). Total GWG suppressed the association of pre-pregnancy BMI with percentiles of global development in the entire sample. Maternal underweight and excessive GWG were negatively associated with development of girls and boys, respectively. The association of pre-pregnancy BMI with global child development was not mediated by GWG, irrespective of child's sex.
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Affiliation(s)
- Paulo A R Neves
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas. Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, Brazil.
| | - Giovanna Gatica-Domínguez
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas. Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas. Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, Brazil
| | - Andréa D Bertoldi
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas. Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, Brazil
| | - Marlos Domingues
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas. Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, Brazil
- Postgraduate Program in Physical Education, School of Physical Education, Universidade Federal de Pelotas. Rua Luís de Camões, 625, Três Vendas, 96055-630, Pelotas, Brazil
| | - Joseph Murray
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas. Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, Brazil
| | - Mariângela F Silveira
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas. Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, Brazil
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12
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Bielemann RM, LaCroix AZ, Bertoldi AD, Tomasi E, Demarco FF, Gonzalez MC, Crespo da Silva PA, Wendt A, Mohnsam da Silva IC, Brage S, Ekelund U, Pratt M. Objectively Measured Physical Activity Reduces the Risk of Mortality among Brazilian Older Adults. J Am Geriatr Soc 2020; 68:137-146. [PMID: 31592540 DOI: 10.1111/jgs.16180] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/14/2019] [Accepted: 08/17/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Use of objectively measured physical activity (PA) in older adults to assess relationship between PA and risk of all-causes mortality is scarce. This study evaluated the associations of PA based on accelerometry and a questionnaire with the risk of mortality among older adults from a city in Southern Brazil. DESIGN A cohort study. SETTING Urban area of Pelotas, Southern Brazil. PARTICIPANTS A representative sample of older adults (≥60 y) from Pelotas, enrolled in 2014. MEASUREMENTS Overall physical activity (mg), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were estimated by raw accelerometer data. The International Physical Activity Questionnaire estimated leisure time and commuting PA. Hazard ratios (excluding deaths in the first 6 mo) stratified by sex were estimated by Cox regression analysis considering adjustment for confounders. RESULTS From the 1451 older adults interviewed in 2014, 145 died (10%) after a follow-up of an average 2.6 years. Men and women in the highest tertile of overall PA had on average a 77% and 92% lower risk of mortality than their less active counterparts (95% confidence interval [CI] = .06-.84 and 95% CI = .01-.65, respectively). The highest tertile of LPA was also related to a lower risk of mortality in individuals of both sexes (74% and 91% lower risk among men and women, respectively). MVPA statistically reduced the risk of mortality only among women (hazard ratio [HR] = .30 and HR = .07 in the second and third tertiles). Self-reported leisure-time PA was statistically associated with a lower risk of mortality only among men. Women in the highest tertiles of commuting PA showed a lower risk of mortality than those in the reference group. CONCLUSION Accelerometry-based PA was associated with a lower risk of mortality among Brazilian older adults. Older individuals should practice any type of PA. J Am Geriatr Soc 68:137-146, 2019.
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Affiliation(s)
- Renata M Bielemann
- Post-Graduate Program in Nutrition and Foods, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Andrea Z LaCroix
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California
| | - Andréa D Bertoldi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Elaine Tomasi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Flávio F Demarco
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Maria Cristina Gonzalez
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | | | - Andrea Wendt
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Inácio Crochemore Mohnsam da Silva
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Michael Pratt
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California
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13
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Murray J, Santos IS, Bertoldi AD, Murray L, Arteche A, Tovo-Rodrigues L, Cruz S, Anselmi L, Martins R, Altafim E, Soares TB, Andriotti MG, Gonzalez A, Oliveira I, da Silveira MF, Cooper P. The effects of two early parenting interventions on child aggression and risk for violence in Brazil (The PIÁ Trial): protocol for a randomised controlled trial. Trials 2019; 20:253. [PMID: 31046826 PMCID: PMC6498476 DOI: 10.1186/s13063-019-3356-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 04/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children in many low- and middle-income countries (LMICs) are at high risk for exposure to violence and later violent behaviour. The World Health Organization has declared an urgent need for the evaluation and implementation of low-cost parenting interventions in LMICs to prevent violence. Two areas of significant early risk are harsh parenting and poor child cognitive and socio-emotional development. Parenting interventions suitable for LMIC contexts have been developed targeting these risk factors and have been shown to have promising effects. However, their impact on child aggression, a key precursor of violence, has yet to be determined. The Pelotas Trial of Parenting Interventions for Aggression (PIÁ) has been designed to address this issue. METHODS We are conducting a randomised controlled trial to evaluate two early parenting interventions for mothers of children aged between 30 and 42 months in a Brazilian city. The first of these, dialogic book-sharing (DBS), aims to promote child cognitive and socio-emotional development; and the second, the ACT Raising Safe Kids Program (ACT), is designed to reduce harsh parenting. These interventions are being compared with a control group receiving neither intervention. Three hundred and sixty-nine families in a birth cohort are being randomly allocated to one of the three groups (DBS, ACT, Control). Facilitators deliver the interventions to groups of five to 10 mothers at weekly sessions for 8 weeks in DBS and 9 weeks in ACT. Independent assessments of parenting and child development are being made before the interventions, shortly afterwards, and at follow-up 6 months later. The primary outcome is child aggression, and the two main secondary outcomes are: (1) child cognitive and socio-emotional development and (2) harsh parenting. Longer-term outcomes will be investigated as the birth cohort is followed into late childhood, adolescence, and adulthood. DISCUSSION The Pelotas Trial of Parenting Interventions for Aggression (PIÁ) aims to evaluate the impact of two early parenting interventions on child aggression and several other key risk factors for the development of violence, including aspects of parenting and child cognition and socio-emotional functioning. The study is being carried out in a LMIC context where violence constitutes a major social and health burden. Since the two interventions are brief and, with modest levels of training, readily deliverable in LMIC settings, a demonstration that they benefit parenting and reduce risk factors for violence would be of major significance. TRIAL REGISTRATION Brazilian Ministry of Health Register of Clinical Trials, ID: RBR-2kwfsk . Registered on 6 June 2018.
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Affiliation(s)
- Joseph Murray
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil
| | - Iná S. Santos
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil
| | - Andréa D. Bertoldi
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil
| | - Lynne Murray
- University of Reading, Reading, UK
- University of Cape Town, Cape Town, South Africa
| | - Adriane Arteche
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegro, Brazil
| | - Luciana Tovo-Rodrigues
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil
| | - Suélen Cruz
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil
| | - Luciana Anselmi
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil
| | - Rafaela Martins
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil
| | - Elisa Altafim
- Postgraduate Programme in Mental Health, University of São Paulo, Ribeirão Preto, SP Brazil
| | | | | | - Andrea Gonzalez
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
| | - Isabel Oliveira
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil
| | | | - Peter Cooper
- University of Reading, Reading, UK
- University of Cape Town, Cape Town, South Africa
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14
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Aristides Dos Santos AM, Perelman J, Jacinto PDA, Tejada CAO, Barros AJD, Bertoldi AD, Matijasevich A, Santos IS. Income-related inequality and inequity in children's health care: A longitudinal analysis using data from Brazil. Soc Sci Med 2019; 224:127-137. [PMID: 30772611 PMCID: PMC6411923 DOI: 10.1016/j.socscimed.2019.01.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/09/2019] [Accepted: 01/17/2019] [Indexed: 11/29/2022]
Abstract
The Brazilian Unified Health System was created in the late 1980s to ensure free universal access to health care and was funded by taxes and social contributions. The persistent inequity in access to health services in favour of richer individuals in Brazil has been observed in the literature. However, to the best of our knowledge, no measurement of inequality in medicine use or private health insurance (PHI) among children has been performed with longitudinal data. This paper uses inequality indices and their decompositions to analyse the income-related inequalities/inequities in children's health care in the city of Pelotas, Brazil, using longitudinal data following children from 12 to 72 months of age. Our sample with data in all waves has between 1877 and 2638 children (varying according to outcome). We seek to answer three questions: i) How does the inequality/inequity in health care evolve as children grow up? ii) What are the main factors associated with inequality in children's health care? iii) How much of the change in inequality/inequity is explained by mobility in children's health care and income mobility? We found that inequities in health care have their beginnings in early childhood but that there was a reduction in inequity at 72 months of age. Ownership of children's PHI was associated with greater pro-rich inequity in health care. The reduction in inequality/inequity was linked to mobility in the sense that initially poorer children had greater gains in health care (a greater increase in PHI ownership and a lower reduction in medicine use). Despite this improvement among the poorest, apparently, the Brazilian public health service seems to fail to ensure equity in health care use among children, with possible long-term consequences on inequalities in health. The inequities in health care have their beginnings even in early childhood. Income and mother's education have a strong contribution in the inequalities. Private health insurance has strong contribution in inequalities of medicine use. There was reduction in inequity for children's health care in Pelotas/Brazil. This improvement for poorest children occurred when they reached 72 months.
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Affiliation(s)
| | - Julian Perelman
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Portugal
| | | | | | - Aluísio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil
| | - Andréa D Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil
| | - Alicia Matijasevich
- Department of Preventive Medicine, Faculty of Medicine, FMUSP, University of São Paulo, Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil
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15
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Hallal PC, Bertoldi AD, Domingues MR, da Silveira MF, Demarco FF, da Silva ICM, Barros FC, Victora CG, Bassani DG. Cohort Profile: The 2015 Pelotas (Brazil) Birth Cohort Study. Int J Epidemiol 2018; 47:1048-1048h. [PMID: 29126133 PMCID: PMC6124621 DOI: 10.1093/ije/dyx219] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Pedro C Hallal
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Andréa D Bertoldi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Marlos R Domingues
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | | | - Flávio F Demarco
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | | | - Fernando C Barros
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Diego G Bassani
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Centre for Global Child Health, Hospital for Sick Children & Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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16
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Vieira LS, Gomes AP, Bierhals IO, Farías-Antúnez S, Ribeiro CG, Miranda VIA, Lutz BH, Barbosa-Silva TG, Lima NP, Bertoldi AD, Tomasi E. Falls among older adults in the South of Brazil: prevalence and determinants. Rev Saude Publica 2018; 52:22. [PMID: 29489998 PMCID: PMC5825131 DOI: 10.11606/s1518-8787.2018052000103] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/20/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Evaluate the prevalence and the factors associated with the occurrence of falls among older adults. METHODS A cross-sectional study with a representative sample of 1,451 elderly residents in the urban area of Pelotas, RS, in 2014. A descriptive analysis of the data was performed and the prevalence of falls in the last year was presented. The analysis of demographic, socioeconomic, behavioral and health factors associated with the outcome was performed using Poisson regression with adjustment for robust variance according to the hierarchical model. The variables were adjusted to each other within each level and for the higher level. Those with p ≤ 0.20 were maintained in the model for confounding control and those with p < 0.05 were considered to be associated with the outcome. RESULTS The prevalence of falls among older adults in the last year was 28.1% (95%CI 25.9–30.5), and most occurred in the person’s own residence. Among the older adults who fell, 51.5% (95%CI 46.6–56.4) had a single fall and 12.1% (95%CI 8.9–15.3) had a fracture as a consequence, usually in the lower limbs. The prevalence of falls was higher in women, adults of advanced age, with lower income and schooling level, with functional incapacity for instrumental activities, and patients with diseases such as diabetes, heart disease, and arthritis. CONCLUSIONS The occurrence of falls reached almost a third of the older adults, and the prevalence was higher in specific segments of the population in question. About 12% of the older adults who fell fractured some bone. The factors associated with the occurrence of falls identified in this study may guide measures aimed at prevention in the older adult population.
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Affiliation(s)
- Luna S Vieira
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil
| | - Ana Paula Gomes
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil
| | - Isabel O Bierhals
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil
| | - Simone Farías-Antúnez
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil
| | - Camila G Ribeiro
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil
| | - Vanessa I A Miranda
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil
| | - Bárbara H Lutz
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil
| | - Thiago G Barbosa-Silva
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil
| | - Natália P Lima
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil
| | - Andréa D Bertoldi
- Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brasil
| | - Elaine Tomasi
- Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brasil
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17
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Coll CVN, Domingues MR, Gonçalves H, Bertoldi AD. Perceived barriers to leisure-time physical activity during pregnancy: A literature review of quantitative and qualitative evidence. J Sci Med Sport 2016; 20:17-25. [PMID: 27372276 DOI: 10.1016/j.jsams.2016.06.007] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/24/2016] [Accepted: 06/16/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Identify perceived barriers to leisure-time physical activity during pregnancy to inform future interventions aimed at improving physical activity levels in pregnancy. DESIGN PubMed/Medline and Web of Science databases were systematically searched using a reference period between 1986 and January/2016. METHODS A comprehensive search strategy was developed combining the following keywords: (barriers OR constraints OR perceptions OR attitudes) AND (physical activity OR exercise OR motor activity) AND (pregnancy OR pregnant women OR antenatal OR prenatal). Thematic synthesis was conducted to analyze the data. A socioecological model was used to categorize the reported barriers. RESULTS Twelve quantitative studies and 14 qualitative studies were included. Barriers belonging to the intrapersonal level of the socioecological model were the most reported in the studies and were categorized in five themes as follows: (1) Pregnancy-related symptoms and limitations; (2) Time constraints; (3) Perceptions of already being active, (4) Lack of motivation and (5) Mother-child safety concerns. At the interpersonal level, barriers were coded into two descriptive themes: (1) Lack of advice and information and (2) Lack of social support. Two other themes were used to summarize Environmental, Organizational and Policy barriers: (1) Adverse weather and (2) Lack of resources. CONCLUSIONS A range of relevant barriers to leisure-time physical-activity engagement during pregnancy were identified in this literature review. Pregnancy-related symptoms and limitations barriers were the most reported in studies, regardless of study design. Mother-child safety concerns, lack of advice/information and lack of social support were also important emphasized pregnancy-related barriers to be targeted in future interventions.
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Affiliation(s)
- Carolina V N Coll
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil.
| | - Marlos R Domingues
- Postgraduate Program in Physical Education, Federal University of Pelotas, Brazil
| | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil
| | - Andréa D Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil
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18
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Katrein F, Tejada CAO, Restrepo-Méndez MC, Bertoldi AD. [Inequality in Brazilian women's access to medicines for chronic diseases]. CAD SAUDE PUBLICA 2016; 31:1416-26. [PMID: 26248097 DOI: 10.1590/0102-311x00083614] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 02/05/2015] [Indexed: 05/28/2023] Open
Abstract
This study aimed to assess the prevalence of access to continuous prescription drugs for a group of chronic diseases and to investigate the existence of socioeconomic inequalities in access. The data are from the Brazilian National Demographic and Health Survey on Women and Children (2006), with a sample of 15,575 women 15 to 49 years of age. Among these women, 7,717 were diagnosed with a chronic disease that required acquiring medicine and were considered eligible for the study. The dependent variable was defined as the diagnosis of a chronic disease and the need to obtain medication for treatment. Multivariate analysis used Poisson regression. Higher access was associated with residence in a rural area, having one or two chronic diseases, and higher socioeconomic status. Prevalence of access to medication was high, but the analysis revealed socioeconomic inequality in access to medicines in favor of the wealthy, while identifying the most vulnerable groups as the poorest and those with more chronic diseases.
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19
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Tejada CAO, Bertoldi AD, Carraro A, Ribeiro FG, Motta JVDS, Barros FC, Horta BL, Barros AJD. [Poor dad, poor child? An investigation of intergenerational income mobility in the 1982 Birth Cohort in Pelotas, Rio Grande do Sul State, Brazil]. CAD SAUDE PUBLICA 2015. [PMID: 26200370 DOI: 10.1590/0102-311x00067714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Brazil is one of the countries with the lowest intergenerational income mobility. This article aimed to analyze intergenerational income mobility in the 1982 Birth Cohort in Pelotas, Rio Grande do Sul State. Two methods were used, intergenerational income elasticity and quantile regressions, in order to measure heterogeneity in income mobility as a function of different levels of parents' past income. The results show relatively high income mobility for Brazilian standards. The main explanation is that the data cover the children's income at a younger age (about 23 years). Quantile regressions show higher social mobility in the intermediary social stratum. The results reinforce the notion of two opposite "traps", poverty and wealth.
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da Silva MT, Barros AJD, Bertoldi AD, de Andrade Jacinto P, Matijasevich A, Santos IS, Tejada CAO. Determinants of out-of-pocket health expenditure on children: an analysis of the 2004 Pelotas Birth Cohort. Int J Equity Health 2015; 14:53. [PMID: 26051372 PMCID: PMC4467315 DOI: 10.1186/s12939-015-0180-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 05/18/2015] [Indexed: 08/30/2023] Open
Abstract
Background The present study aimed to examine the impact of socioeconomic, demographic, and health status-related factors on out-of-pocket expenditure on health care for children. Methods Data were obtained from a birth cohort study conducted in the city of Pelotas, state of Rio Grande do Sul (RS), southern Brazil, in 2004. The final sample is a result of adjusts made in order to keep in the analysis only those that attended to 3 follow-ups (at 12, 24 and 48 months of age). Estimates were carried out using the Panel Data Tobit Model with random effects. Results The study showed that expenditure on medicines was 20 % less likely in those considered healthy children by their mothers and, if there was any expenditure with healthy children, the expected expenditure was reduced by 58 %. A 1 % increase in household income increased the expected expenditure on medicines by 16 %, and by 23 % in children with private health insurance coverage. Conclusions All types of health care expenditures examined were higher for children covered by private health insurance. Although total health care expenditure was higher for children of better-off families, it represented a lower share of these families’ income evidencing income inequality in health care expenditures. Electronic supplementary material The online version of this article (doi:10.1186/s12939-015-0180-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marcelo Torres da Silva
- Programa de Pós-Graduação em Organizações e Mercados, Universidade Federal de Pelotas, Rua Gomes Carneiro 1, Pelotas, RS, 96010-610, Brazil.
| | - Aluísio J D Barros
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil.
| | - Andréa D Bertoldi
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil.
| | - Paulo de Andrade Jacinto
- Programa de Pós-Graduação em Economia do Desenvolvimento, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Iná S Santos
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil.
| | - Cesar Augusto Oviedo Tejada
- Programa de Pós-Graduação em Organizações e Mercados, Universidade Federal de Pelotas, Rua Gomes Carneiro 1, Pelotas, RS, 96010-610, Brazil.
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Sun J, Boing AC, Silveira MPT, Bertoldi AD, Ziganshina LE, Khaziakhmetova VN, Khamidulina RM, Chokshi MR, McGee S, Suleman F. Efforts to secure universal access to HIV/AIDS treatment: a comparison of BRICS countries. J Evid Based Med 2014; 7:2-21. [PMID: 25155561 DOI: 10.1111/jebm.12081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/12/2013] [Indexed: 01/11/2023]
Abstract
This article illustrates how the BRICS countries have been building their focused leadership, making important high level commitment and national policy changes, and improving their health systems, in addressing the HIV/AIDS epidemics in respective settings. Specific aspects are focused on efforts of creating public provisions to secure universal access to ARVs from the aspects of active responsive system and national program, health system strengthening, fostering local production of ARVs, supply chain management, and information system strengthening. Challenges in each BRICS country are analyzed respectively. The most important contributors to the success of response to HIV/AIDS include: creating legal basis for healthcare as a fundamental human right; political commitment to necessary funding for universal access and concrete actions to secure equal quality care; comprehensive system to secure demands that all people in need are capable of accessing prevention, treatment and care; active community involvement; decentralization of the management system considering the local settings; integration of treatment and prevention; taking horizontal approach to strengthen health systems; fully use of the TRIPS flexibility; and regular monitoring and evaluation to serve evidence based decision making.
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Affiliation(s)
- Jing Sun
- National Institute of Hospital Administration, National Health and Family Planning Commission (NHFPC), BRICS Medicines Alliance, Pharmaceutical Policy Research Theme Group Leader of International Network for Rational Use of Drugs (INRUD) China Core Group, China
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Bertoldi AD, Kanavos P, França GVA, Carraro A, Tejada CAO, Hallal PC, Ferrario A, Schmidt MI. Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: a comprehensive literature review. Global Health 2013; 9:62. [PMID: 24299125 PMCID: PMC4220809 DOI: 10.1186/1744-8603-9-62] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 11/11/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND With an estimated 74% of all deaths attributable to non-communicable diseases (NCDs) in 2010, NCDs have become a major health priority in Brazil. The objective of the study was to conduct a comprehensive literature review on diabetes in Brazil; specifically: the epidemiology of type 2 diabetes, the availability of national and regional sources of data (particularly in terms of direct and indirect costs) and health policies for the management of diabetes and its complications. METHODS A literature search was conducted using PubMed to identify articles containing information on diabetes in Brazil. Official documents from the Brazilian government and the World Health Organization, as well as other grey literature and official government websites were also reviewed. RESULTS From 2006 to 2010, an approximate 20% increase in the prevalence of self-reported diabetes was observed. In 2010, it was estimated that 6.3% of Brazilians aged 18 years or over had diabetes. Diabetes was estimated to be responsible for 278,778 years of potential life lost for every 100,000 people. In 2013, it is estimated that about 7% of patients with diabetes has had one or more of the following complications: diabetic foot ulcers, amputation, kidney disease, and fundus changes. The estimated annual direct cost of diabetes was USD $3.952 billion in 2000; the estimated annual indirect cost was USD $18.6 billion. The two main sources of data on diabetes are the information systems of the Ministry of Health and surveys. In the last few years, the Brazilian Ministry of Health has invested considerably in improving surveillance systems for NCDs as well as implementing specific programmes to improve diagnosis and access to treatment. CONCLUSIONS Brazil has the capacity to address and respond to NCDs due to the leadership of the Ministry of Health in NCD prevention activities, including an integrated programme currently in place for diabetes. Strengthening the surveillance of NCDs is a national priority along with recognising the urgent need to invest in improving the coverage and quality of mortality data. It is also essential to conduct regular surveys of risk factors on a national scale in order to design effective preventive strategies.
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Affiliation(s)
- Andréa D Bertoldi
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 3° piso, Pelotas, RS, Brazil, 96.020-220
| | - Panos Kanavos
- LSE Health, London School of Economics and Political Science, London, UK
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Giovanny V A França
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 3° piso, Pelotas, RS, Brazil, 96.020-220
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
| | - André Carraro
- Programa de Pós-Graduação em Organizações e Mercados, Universidade Federal de Pelotas, RS, Brazil
| | | | - Pedro C Hallal
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 3° piso, Pelotas, RS, Brazil, 96.020-220
| | - Alessandra Ferrario
- LSE Health, London School of Economics and Political Science, London, UK
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Maria Inês Schmidt
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Costa VPP, Bertoldi AD, Baldissera EZ, Goettems ML, Correa MB, Torriani DD. Traumatic dental injuries in primary teeth: severity and related factors observed at a specialist treatment centre in Brazil. Eur Arch Paediatr Dent 2013; 15:83-8. [PMID: 23856808 DOI: 10.1007/s40368-013-0068-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/27/2013] [Indexed: 11/28/2022]
Affiliation(s)
- V P P Costa
- Post-Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
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Barros AJD, Ronsmans C, Axelson H, Loaiza E, Bertoldi AD, França GVA, Bryce J, Boerma JT, Victora CG. Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries. Lancet 2012; 379:1225-33. [PMID: 22464386 DOI: 10.1016/s0140-6736(12)60113-5] [Citation(s) in RCA: 390] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Countdown to 2015 tracks progress towards achievement of Millennium Development Goals (MDGs) 4 and 5, with particular emphasis on within-country inequalities. We assessed how inequalities in maternal, newborn, and child health interventions vary by intervention and country. METHODS We reanalysed data for 12 maternal, newborn, and child health interventions from national surveys done in 54 Countdown countries between Jan 1, 2000, and Dec 31, 2008. We calculated coverage indicators for interventions according to standard definitions, and stratified them by wealth quintiles on the basis of asset indices. We assessed inequalities with two summary indices for absolute inequality and two for relative inequality. FINDINGS Skilled birth attendant coverage was the least equitable intervention, according to all four summary indices, followed by four or more antenatal care visits. The most equitable intervention was early initation of breastfeeding. Chad, Nigeria, Somalia, Ethiopia, Laos, and Niger were the most inequitable countries for the interventions examined, followed by Madagascar, Pakistan, and India. The most equitable countries were Uzbekistan and Kyrgyzstan. Community-based interventions were more equally distributed than those delivered in health facilities. For all interventions, variability in coverage between countries was larger for the poorest than for the richest individuals. INTERPRETATION We noted substantial variations in coverage levels between interventions and countries. The most inequitable interventions should receive attention to ensure that all social groups are reached. Interventions delivered in health facilities need specific strategies to enable the countries' poorest individuals to be reached. The most inequitable countries need additional efforts to reduce the gap between the poorest individuals and those who are more affluent. FUNDING Bill & Melinda Gates Foundation, Norad, The World Bank.
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Affiliation(s)
- Aluísio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
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Bertoldi AD, Tavares NUL, Hallal PC, Araújo CL, Menezes AMB. Medicine use among adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study. CAD SAUDE PUBLICA 2011; 26:1945-53. [PMID: 20963292 DOI: 10.1590/s0102-311x2010001000011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Accepted: 09/22/2009] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to investigate medicine use and associated factors among adolescents. This was a prospective cohort study including 4,452 adolescents born in Pelotas, Rio Grande do Sul State, Brazil, in 1993. Information on medicine use in the 15 days prior to the interviews was collected from the mothers. Overall prevalence of medicine use was 30.9%, and 64.7% of the medicines had been prescribed by a physician. The most frequently used pharmacological groups were medicines for the nervous (35.9%) and respiratory systems (25.7%). Medicine use was directly associated with socioeconomic status, maternal schooling, complications during pregnancy or delivery, and neonatal problems resulting in the need for intensive care. Underweight and obese adolescents were more likely to use medicines as compared to those with normal body mass index. A direct association was observed between maternal use of hypnotic drugs and sedatives and adolescent medicine use. It is essential to implement educational policies aimed at promoting rational use of medicines by adolescents.
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Affiliation(s)
- Andréa D Bertoldi
- Centro de Ciências da Saúde, Universidade do Vale do Rio dos Sinos, Av. Unisinos 950, São Leopoldo, RS, Brazil.
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Hallal PC, Dumith SC, Bertoldi AD, Scalco DL, Menezes AMB, Araújo CL. Well-being in adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study. CAD SAUDE PUBLICA 2010; 26:1887-94. [DOI: 10.1590/s0102-311x2010001000004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 08/11/2009] [Indexed: 11/22/2022] Open
Abstract
Studies on well-being and its possible determinants are rare in the international literature, and almost non-existent in Brazil, particularly among youth. The present study focused on the epidemiology of well-being among adolescents belonging to a birth cohort. Well-being was measured using face-to-face interviews, with a question whose answer was based on a graphic scale of faces. 4,452 adolescents were interviewed. Approximately half (49.4%) classified themselves as very happy (face 1); this proportion was higher among girls than boys. Poorer adolescents were more likely than their wealthier peers to identify with the happiest face (number 1), but were also more likely to report moderate to low levels of well-being (faces 3-7). Body mass index was inversely associated with well-being. Among girls, physical activity was directly associated with well-being.
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Affiliation(s)
- Pedro C. Hallal
- Universidade Federal de Pelotas, Brasil; Universidade Federal de Pelotas, Brasil
| | | | | | | | | | - Cora Luiza Araújo
- Universidade Federal de Pelotas, Brasil; Universidade Federal de Pelotas, Pelotas
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Hallal PC, Menezes AMB, Bertoldi AD, Dumith SC, Araújo CL. Resting pulse rate among adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study. CAD SAUDE PUBLICA 2010; 26:1963-71. [DOI: 10.1590/s0102-311x2010001000013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 09/14/2009] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to describe resting pulse rate and associated factors among adolescents. This was a cross-sectional analysis nested in a prospective cohort study, including 4,452 adolescents born in Pelotas, Rio Grande do Sul State, Brazil in 1993, representing 87.5% of the original cohort. Pulse rate was measured with an electronic device at the beginning and end of the interview, and the mean value was used in the analyses. Mean pulse rate was 78.4bpm (SD = 11.0) in the total sample, 76.5bpm (SD = 10.7) in boys, and 80.2bpm (SD = 10.9; p < 0.001) in girls. Black adolescents showed lower mean pulse rates. There was a direct association between pulse rate and blood pressure. Physical activity was inversely associated with pulse rate in the crude analysis only. Elevated pulse rate is strongly associated with high blood pressure, and both variables are predictors of risk of chronic disease in adulthood.
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Affiliation(s)
- Pedro C. Hallal
- Universidade Federal de Pelotas, Brasil; Universidade Federal de Pelotas, Brasil
| | | | | | | | - Cora Luiza Araújo
- Universidade Federal de Pelotas, Brasil; Universidade Federal de Pelotas, Brasil
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Bertoldi AD, Barros AJD, Camargo AL, Hallal PC, Vandoros S, Wagner A, Ross-Degnan D. Household expenditures for medicines and the role of free medicines in the Brazilian public health system. Am J Public Health 2010; 101:916-21. [PMID: 20724692 DOI: 10.2105/ajph.2009.175844] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to investigate, across different socioeconomic groups, the proportion of household medicine expenses that were paid by households and the proportion paid by the Brazilian national health system. METHODS We carried out a survey in Porto Alegre, Brazil, that included 2988 individuals of all ages. We defined 2 expenditure variables: "out-of-pocket medicines value" (the sum of retail prices of all medicines used by family members within the previous 15 days and paid for out of pocket) and "free medicines value" (a similar definition for medicines obtained without charge). RESULTS In 2003, the Brazilian national health system provided, free of charge, 78% of the monetary value of medicines reported (79% in the bottom wealth quintile and 32% in the top 2 quintiles). The mean out-of-pocket expense for medicines was 6 times greater among the top wealth quintiles compared with those in lower quintiles, but free medicines constituted a 3-times-greater proportion of potential expenditures for medicines among the bottom quintile than among the top 2 quintiles. CONCLUSIONS Free provision of medicines seems to be saving substantial amounts of medicine expenditures for poor people in Brazil.
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Affiliation(s)
- Andréa D Bertoldi
- Programa de Pós-graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil.
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Paniz VMV, Fassa AG, Maia MDFS, Domingues MR, Bertoldi AD. Measuring access to medicines: a review of quantitative methods used in household surveys. BMC Health Serv Res 2010; 10:146. [PMID: 20509960 PMCID: PMC2890644 DOI: 10.1186/1472-6963-10-146] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Accepted: 05/30/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medicine access is an important goal of medicine policy; however the evaluation of medicine access is a subject under conceptual and methodological development. The aim of this study was to describe quantitative methodologies to measure medicine access on household level, access expressed as paid or unpaid medicine acquisition. METHODS Searches were carried out in electronic databases and health institutional sites; within references from retrieved papers and by contacting authors. RESULTS Nine papers were located. The methodologies of the studies presented differences in the recall period, recruitment of subjects and medicine access characterization. CONCLUSIONS The standardization of medicine access indicators and the definition of appropriate recall periods are required to evaluate different medicines and access dimensions, improving studies comparison. Besides, specific keywords must be established to allow future literature reviews about this topic.
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Affiliation(s)
- Vera Maria V Paniz
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil.
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Fernandes LCL, Bertoldi AD, Barros AJD. Utilização dos serviços de saúde pela população coberta pela Estratégia de Saúde da Família. Rev Saude Publica 2009; 43:595-603. [DOI: 10.1590/s0034-89102009005000040] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Accepted: 12/16/2008] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar os padrões de utilização dos serviços de saúde em comunidades cobertas pela Estratégia de Saúde da Família. MÉTODOS: Estudo transversal de base populacional com amostra de 2.988 indivíduos, de todas as idades, residentes em áreas de abrangência da Estratégia de Saúde da Família, em Porto Alegre (RS), entre julho e setembro de 2003. Foram aplicados questionários pré-codificados a todos os moradores dos domicílios sorteados sobre informações demográficas, socioeconômicas e de saúde. Nas análises foram calculadas razões de prevalências, intervalos com 95% de confiança e aplicados testes do qui-quadrado. Realizou-se regressão de Poisson na análise multivariável para possíveis fatores de confusão. RESULTADOS: Pessoas do sexo feminino, com 60 anos ou mais, com cor da pele branca, com menor nível socioeconômico, sem cobertura por plano de saúde e com autopercepção de saúde ruim tiveram maior probabilidade de utilizar a unidade de saúde da família local. Em relação aos usuários de outros serviços de saúde, o padrão foi semelhante para as variáveis sexo, idade e autopercepção de saúde, mas foi encontrada uma maior utilização por pessoas com maior nível socioeconômico e com cobertura por plano de saúde. CONCLUSÕES: A utilização da unidade de saúde da família local foi maior entre as pessoas com menor nível socioeconômico e sem cobertura por plano de saúde, indicando indivíduos mais pobres como prioritários das ações governamentais. A mudança do modelo assistencial e a implantação da Estratégia de Saúde da Família tendem a melhorar progressivamente as condições de saúde da população mais pobre, minimizando as desigualdades em saúde.
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Tavares NUL, Bertoldi AD, Muccillo-Baisch AL. [Antimicrobial prescription in family health units in Southern Brazil]. CAD SAUDE PUBLICA 2009; 24:1791-800. [PMID: 18709220 DOI: 10.1590/s0102-311x2008000800008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 12/26/2007] [Indexed: 11/22/2022] Open
Abstract
This paper describes antimicrobial prescription, clinical indications, and seasonal characteristics in primary health care. We performed a cross-sectional study in family health units in Bagé, Rio Grande do Sul State, Brazil, in July 2005 and January 2006. All medical prescriptions (n = 2,877) were analyzed, and the prevalence rates for antimicrobial prescription in winter and summer were 30.4% (95%CI: 28.5-32.4) and 21% (95%CI: 19.1-22.9), respectively. The most frequently prescribed antimicrobials were amoxicillin and sulfamethoxazole-trimethoprim. The main clinical indications for antimicrobial prescription were non-specific upper respiratory tract infections (22.5%), throat infections (20.8%), urinary tract infections (13.3%), otitis (8.5%), and sinusitis (7.5%). We observed differences between summer and winter in prescriptions for the same diseases. Seasonal differences between treatment profiles for the same diseases show the absence of a consistent antimicrobial prescription pattern in primary health care, contrary to World Health Organization guidelines, which advocate the establishment of protocols for antimicrobial use at all levels of care, as a strategy to prevent inadequate usage and the occurrence of strains that are resistant to available antimicrobials.
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Affiliation(s)
- Noemia U L Tavares
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Rio Grande, Rio Grande, Brasil.
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Bertoldi AD, Barros AJD, Wagner A, Ross-Degnan D, Hallal PC. A descriptive review of the methodologies used in household surveys on medicine utilization. BMC Health Serv Res 2008; 8:222. [PMID: 18976465 PMCID: PMC2584639 DOI: 10.1186/1472-6963-8-222] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 10/31/2008] [Indexed: 12/04/2022] Open
Abstract
Background Studies carried out in the community enable researchers to understand access to medicines, affordability, and barriers to use from the consumer's point of view, and may stimulate the development of adequate medicines policies. The aim of the present article was to describe methodological and analytical aspects of quantitative studies on medicine utilization carried out at the household level. Methods Systematic review of original papers with data collected in studies in which the household was a sampling unit, published between 1995 and 2008. The electronic review was carried out in Medline/Pubmed, Scielo and Lilacs. The reference lists of the papers identified were examined, as well as other publications by their authors. Studies on the utilization of specific pharmacological groups, or those including only respondents with a given disease were excluded. Results Out of 4852 papers initially identified in the literature search, 61 fulfilled our inclusion criteria. Most studies were carried out in Europe and North America and used a cross-sectional approach. More than 80% used face-to-face interviews for data collection, and the most frequently used recall period for assessing medicine utilization was 14–15 days. In 59% of the studies, interviewers were trained to request the packaging of the medicines reported by the subjects; medical prescriptions were requested less frequently (15% of the studies). Conclusion These data will be useful for updating researchers on what methods their peers are currently using. Such information may help overcome challenges in the planning and analyses of future studies. Moreover, this publication may contribute to the improvement of the quality of medicine use data obtained in household surveys.
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Affiliation(s)
- Andréa D Bertoldi
- Programa de pós-graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, Brazil.
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Abstract
BACKGROUND The Brazilian public health system, free and universal, should limit out-of-pocket health expenses. However, Brazil was reported as one of the countries with the highest proportion of families experiencing catastrophic expenditure. This study was designed to assess occurrence of high health spending in a low-income population, as well as the pattern of out-of-pocket health payments. METHODS A cross-sectional study was done in Porto Alegre, Brazil, in 2003, with a sample representative of families covered by the Family Health Program. Health expenses were recorded with reference to 30 days prior to the interview and income data were collected with reference to the previous calendar month. Health expenditure was explored in terms of total household health expenditure >5, 10 and 20% of household income and >40% households capacity to pay. RESULTS The final study sample included 869 households. Medicines were responsible for 47% of household expenditure with health; second came private health plans which accounted for 22%. The richest spent, on average, 70 times more them the poorest with health plans, 26 times more with dental treatment and six times more with medicines. About 16% households committed 20% or more of their income with health, independent of economic position. Similarly, 12% of the households had health expenditure in excess of 40% of their capacity to pay. CONCLUSION The proportion of income spent on health was similar across economic groups, but this 'equality' is achieved at an unacceptably high level. Specific strategies to reduce such vulnerability are needed.
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Affiliation(s)
- Aluísio J D Barros
- Centro de Pesquisas Epidemiológicas, Universidade Federal de Pelotas, Pelotas, RS, Brasil.
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Barros AJD, Santos IS, Bertoldi AD. Can mothers rely on the Brazilian health system for their deliveries? An assessment of use of the public system and out-of-pocket expenditure in the 2004 Pelotas Birth Cohort Study, Brazil. BMC Health Serv Res 2008; 8:57. [PMID: 18366672 PMCID: PMC2276487 DOI: 10.1186/1472-6963-8-57] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 03/18/2008] [Indexed: 11/21/2022] Open
Abstract
Background In a country where comprehensive free health care is provided via a public health system (SUS), an unexpected high frequency of catastrophic out-of-pocket expenditure has been described. We studied how deliveries were financed among mothers of a birth cohort and whether they were an important source of household out-of-pocket expenditure. Methods All deliveries occurring in the city of Pelotas, Brazil, during 2004, were recruited for a birth cohort study. All mothers were interviewed just after birth and three months later. Comprehensive data on the pregnancy, delivery, birth conditions and newborn health were collected, along with detailed information on expenses related to the delivery. Results The majority of the deliveries (81%) were financed by the public health system, a proportion that increased to more than 95% among the 40% poorest mothers. Less than 1% of these mothers reported some out-of-pocket expenditure. Even among those mothers covered by a private health plan, nearly 50% of births were financed by the SUS. Among the 20% richest, a third of the deliveries were paid by the SUS, 50% by private health plans and 17% by direct payment. Conclusion The public health system offered services in quantity and quality enough to attract even beneficiaries of private health plans and spared mothers from the poorest strata of the population of practically any expense.
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Affiliation(s)
- Aluísio J D Barros
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, RS, Brasil.
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Santos IS, Barros AJD, Matijasevich A, Tomasi E, Medeiros RS, Domingues MR, Bertoldi AD, Barros FC, Victora CG. Mothers and their pregnancies: a comparison of three population-based cohorts in Southern Brazil. CAD SAUDE PUBLICA 2008; 24 Suppl 3:S381-9. [DOI: 10.1590/s0102-311x2008001500003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 01/09/2008] [Indexed: 11/22/2022] Open
Abstract
Mothers from the 1982, 1993 and 2004 Pelotas birth cohorts were compared across biological, socioeconomic, demographic and reproductive characteristics. Women in the 2004 cohort had higher levels of education, gained more weight during pregnancy, and were heavier at the beginning and end of their pregnancy than mothers who gave birth in 1993 and 1982. There was an important increase in obesity rates (body mass index > 30kg/m²) over the 22 years of the study. Mean parity decreased from 1.3 in 1982 to 1.1 in 2004, with a growing proportion of primiparas and a decline in the proportion of women with > 4 children. The mean birth interval increased from 33.5 months in 1982 to 65.7 in 2004. Smoking during pregnancy decreased from 35.6% in 1982 to 25.1% in 2004. As with other characteristics, the change in smoking status differed according to income, with higher reductions among the wealthiest (from 24.9% to 8.7%) than among the poorest mothers (from 43.7% to 33.6%). In general terms, between 1993 and 2004 there was a decrease in the prevalence of maternal risk factors for unfavorable perinatal outcomes.
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Barros AJD, da Silva dos Santos I, Victora CG, Albernaz EP, Domingues MR, Timm IK, Matijasevich A, Bertoldi AD, Barros FC. Coorte de nascimentos de Pelotas, 2004: metodologia e descrição. Rev Saude Publica 2006; 40:402-13. [PMID: 16810363 DOI: 10.1590/s0034-89102006000300007] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Descrever uma coorte de nascimentos que teve início em 2004, para avaliar condições pré e perinatais dos recém-nascidos, morbi-mortalidade infantil, características e desfechos do início da vida e acesso, utilização e financiamento da atenção à saúde. MÉTODOS: Todas as crianças nascidas na zona urbana dos municípios de Pelotas e Capão do Leão (bairro Jardim América), no ano de 2004, foram identificadas e suas mães convidadas a fazer parte do estudo. No seu primeiro ano foram realizadas visitas às mães por ocasião do nascimento das crianças, aos três e aos 12 meses de idade. Nessas visitas um questionário foi aplicado às mães, com perguntas sobre saúde; hábitos de vida; utilização de serviços de saúde; situação socioeconômica; estimativa de idade gestacional; medidas antropométricas do recém-nascido (peso, comprimento, perímetros cefálico, torácico e abdominal); medidas antropométricas da mãe (peso e altura) e avaliação de desenvolvimento infantil. RESULTADOS: Do total de crianças elegíveis (4.558), mais de 99% foram recrutadas para o estudo logo após o nascimento. A taxa de seguimento foi de 96% aos três meses e de 94% aos 12 meses. Dentre os resultados iniciais destacaram-se: a taxa de mortalidade infantil de 19,7 por mil, sendo 66% dos óbitos infantis no período neonatal; freqüência de 15% de prematuros e 10% de baixo peso ao nascer; as cesarianas representaram 45% dos partos. CONCLUSÕES: A terceira coorte de nascimentos em Pelotas mostrou uma situação de estabilidade da mortalidade infantil nos últimos 11 anos, com predomínio da mortalidade neonatal, além de aumento da prematuridade e partos cesarianos.
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Affiliation(s)
- Aluísio J D Barros
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil.
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Abstract
The prevalence of overweight and its association with demographic, socioeconomic, behavioral, and biological variables were evaluated. The sample included 810 adolescents (10-19 years of age) living in the urban area of Pelotas, a southern Brazilian city. Overweight was defined as a body mass index > or = the 85th percentile, according to sex and age, and compared to the First National Health and Nutrition Examination Survey, following the WHO recommendation for adolescents. A clustering sampling strategy was used, and both the crude and adjusted analyses (Poisson Regression) took this strategy into account. The prevalence of overweight was 19.3% (95%CI: 16.6-22.0) and there was no difference between the sexes. The following groups presented a greater probability of being overweight: those classified in the wealthiest socioeconomic groups, those who had dieted to lose weight within the previous 3 months, those who watch 4 or more hours of television per day, and those who have less than 3 regular meals per day. After stratification by gender, high socioeconomic level was associated with greatest risk of overweight among boys. Dieting to lose weight during the previous 3 months, 4 or more hours of television viewing per day, and less than 3 formal meals per day were risk factors for overweight among girls.
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Affiliation(s)
- Carmem L Dutra
- Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Brazil.
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Abstract
This study evaluated knowledge and use of generic drugs in a population-based sample of adults from a southern Brazilian city. The outcomes were: the proportion of generics in total medicines used; theoretical and practical knowledge about generics; and strategies used to buy medicines on medical prescriptions. The recall period for drug utilization was 15 days. The proportion of generics in total medicines was 3.9%. While 86.0% knew that generics cost less and 70.0% that the quality is similar to brand name medicines, only 57.0% knew any packaging characteristics that distinguish generics from other medicines. The highest proportion of generic drug utilization was in the antimicrobial pharmacological group. A brand name medicine (with a brand similar to the generic name) was mistakenly classified as a generic through photos by 48.0% of the interviewees. Among subjects who bought medicines in the 15-day period, 18.9% reported buying a generic, but this result should be interpreted with caution, because the population frequently fails to differentiate between generics and other medicines.
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Affiliation(s)
- Andréa D Bertoldi
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil.
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Hallal PC, Wells JCK, Bertoldi AD, Gazalle FK, Silva MC, Domingues MR, Carret MLV, Araújo CLP, Gigante DP. A shift in the epidemiology of low body mass index in Brazilian adults. Eur J Clin Nutr 2005; 59:1002-6. [PMID: 15970943 DOI: 10.1038/sj.ejcn.1602204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To study the prevalence and current predictors of low body mass index (BMI) in a population undergoing a rapid nutritional transition. DESIGN Population-based cross-sectional study. SETTINGS Individuals living in the urban area of Pelotas, a medium-sized southern Brazilian city, were interviewed at home. SUBJECTS A multiple-stage sampling strategy was used. Out of 3372 eligible subjects, 3047 were interviewed. The study was restricted to adults (> or = 20 y). MAIN OUTCOME MEASURE Low BMI was defined as <18.5 kg/m2. RESULTS The prevalence of low BMI was 2.7% (95% confidence interval: 2.1; 3.3), higher in women than men (3.8 vs 1.3%; P < 0.001). In the whole sample (men and women combined), living without a partner and current smoking were positively associated with low BMI. Among women, low BMI presented a U-shaped relationship with age and was positively associated with educational level. The prevalence of low BMI in young women was 6.3%, and in highly educated young women was 8.9%. CONCLUSIONS Consistently with previous Brazilian studies, a decline in the overall prevalence of low BMI is clear. However, differently from these studies, the predictors of low BMI in women are similar to those observed within developed countries (including low age and high education), possibly indicating an increase in eating disorders.
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Affiliation(s)
- P C Hallal
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
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Hallal PC, Matsudo SM, Matsudo VKR, Araújo TL, Andrade DR, Bertoldi AD. Physical activity in adults from two Brazilian areas: similarities and differences. CAD SAUDE PUBLICA 2005; 21:573-80. [PMID: 15905920 DOI: 10.1590/s0102-311x2005000200024] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Lack of comparability has been a major limitation in studies on physical activity, due to the utilization of different methodological instruments and inconsistent cut-off points. This study aims to compare the levels of physical activity in adults from two Brazilian areas: (a) São Paulo, the richest State in the country; (b) Pelotas, a medium-sized southern Brazilian city. Both sites used cross-sectional population-based designs, with multiple-stage sampling strategies. Level of physical activity was assessed with the short version of the International Physical Activity Questionnaire. Prevalence of sedentary lifestyle was three times higher in Pelotas than in São Paulo. On the other hand, the proportion of very active subjects was significantly higher in Pelotas. The proportion of insufficiently active individuals (sedentary + irregularly active) was almost identical between the sites. Socioeconomic status was inversely related to level of physical activity in both sites. Among the insufficiently active subjects, those living in São Paulo are at least engaged in a limited amount of activity. On the other hand, among sufficiently active people, those living in Pelotas are more active.
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Abstract
OBJETIVO: Descrever o perfil dos tratamentos medicamentosos usados nas infecções respiratórias, com o intuito de auxiliar o estabelecimento de ações que otimizem o manejo dessas importantes entidades nosológicas. MÉTODOS: Foi realizado um estudo transversal de base populacional que incluiu uma amostra de 6.145 indivíduos residentes na zona urbana do município de Pelotas, RS, localizado na Região Sul do Brasil, no período de 1999/2000. Para coleta de dados foram utilizadas entrevistas com questionário estruturado contendo perguntas sobre o uso de medicamentos para o tratamento de infecções respiratórias nos 30 dias que antecederam a entrevista. Para análise estatística dos dados utilizou-se o teste de qui-quadrado de Pearson. RESULTADOS: A prevalência global de infecções respiratórias tratadas foi de 6,3%. Ela foi maior nas crianças de até quatro anos de idade (18%) e menor nos idosos (60 anos ou mais) (3%; p<0,001). As faringoamigdalites foram as infecções mais freqüentemente tratadas (41%). Cinqüenta e nove por cento dos entrevistados usaram antimicrobianos no tratamento de infecções respiratórias. O antimicrobiano mais utilizado foi a amoxicilina (38%). Entre as drogas sintomáticas utilizadas, os antiinflamatórios não esteróides foram os mais citados (27%). CONCLUSÕES: A maioria das infecções respiratórias para as quais se utilizou algum medicamento são tratadas com antimicrobianos, apesar de a etiologia viral ser a mais prevalente nessas doenças. O uso excessivo dessas drogas, além de aumentar os custos dos tratamentos, pode levar à emergência de resistência bacteriana aos antimicrobianos mais freqüentemente utilizados.
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Affiliation(s)
- Laura S Berquó
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brazil
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Abstract
OBJETIVO: Estudar os padrões de utilização de medicamentos, classificando-os por grupos farmacológicos e verificando os determinantes individuais desse uso. MÉTODOS: Delineamento transversal de base populacional. Amostra composta por 3.182 indivíduos com 20 anos de idade ou mais, residentes na região urbana do município de Pelotas, RS. O processo de amostragem foi conduzido em múltiplos estágios. O instrumento foi um questionário estruturado, utilizando um período recordatório de 15 dias e aplicado através de entrevistas individuais. Na análise bruta, foram utilizados os seguintes testes: qui-quadrado para comparação de proporções, teste t para comparação de médias e o teste de tendência linear. A análise ajustada foi conduzida através de uma regressão de Poisson. RESULTADOS: A prevalência de uso global de medicamentos foi de 65,9%. Os seguintes grupos apresentaram maiores prevalências de utilização de medicamentos após análise ajustada: mulheres, idosos, indivíduos de nível econômico mais elevado e com pior autopercepção de saúde. Os grupos farmacológicos mais utilizados foram os analgésicos, antiinflamatórios e anti-hipertensivos. CONCLUSÕES: A prevalência de uso de medicamentos foi superior às encontradas em outros estudos nacionais e internacionais. O estudo dos determinantes individuais de utilização de medicamentos indica os grupos mais sujeitos ao uso excessivo, o que pode embasar estratégias específicas para diminuir a utilização nesses grupos, tais como políticas mais restritivas para prescrição e venda de medicamentos.
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Affiliation(s)
- Andréa D Bertoldi
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brasil.
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Abstract
OBJETIVO: A emergência de cepas microbianas com crescentes níveis de resistência aos antimicrobianos tem sido objeto de preocupação em todo o mundo. Entre as causas apontadas para o fenômeno, está o uso abusivo e indiscriminado de drogas antimicrobianas. O presente estudo visa fornecer informações sobre o padrão de utilização dessas drogas em uma população urbana. MÉTODOS: Em um estudo transversal, de base populacional, 6.145 indivíduos de todas as idades residentes na zona urbana de Pelotas, Rio Grande do Sul, foram entrevistados sobre o uso de antimicrobianos nos 30 dias que antecederam a entrevista. RESULTADOS: A prevalência global de utilização de antimicrobianos encontrada foi de 8%. Essa foi maior entre as crianças até quatro anos de idade (14%; p<0,001), entre as mulheres (9%; p=0,004) e entre os separados/divorciados (10%; p=0,02). As indicações clínicas principais foram infecções do trato respiratório (50%), infecções do trato urinário (16%) e infecções dentárias (9%). As drogas antimicrobianas mais utilizadas foram as penicilinas (41%), as sulfas (17%) e as tetraciclinas (8%). CONCLUSÕES: O uso intensivo de drogas de última geração, temido por muitos estudiosos do tema, não foi confirmado. A possibilidade de redução da utilização de antimicrobianos existe, uma vez que as afecções do trato respiratório (a principal indicação para o seu uso) são, em sua maioria, de etiologia viral, e seu tratamento não se beneficia com drogas antimicrobianas.
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Affiliation(s)
- Laura S Berquó
- Programa de Pós-graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brasil
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Abstract
OBJECTIVE To evaluate the prevalence of sexually transmitted disease (STD) symptoms and associated risk factors in an adult population. METHODS A population-based cross-sectional study was conducted among residents of the metropolitan area of Pelotas, Brazil. Subjects were 20 years old or more. A self-administered questionnaire was used to gather information about sexual behavior and STD symptoms. Multivariate analysis was undertaken using logistic regression. RESULTS The prevalence of STDs was 13.5%. A higher risk of STDs was found in non-white younger women with more sexual partners and who did not use condoms in their last sexual relationship. Among men, early initiation of sexual activity and anal sex were positively associated with the outcome. Higher risks were found among women with lower schooling. CONCLUSIONS The present study identified a significant prevalence of STD symptoms in this population and showed differences in risk factors according to gender. Since many STDs are asymptomatic and symptomatic cases are often either not perceived as disease by patients or not diagnosed in health services, the actual prevalence may be even greater. The study results suggest that cohabitation with a sexual partner does not reduce the risk of STDs in this population and showed sex differences for risk factors, both of which should be taken into account while approaching this issue.
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Affiliation(s)
- Maria Laura Vidal Carret
- Programa de Pós-graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brasil.
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Abstract
Para avaliar a situação de utilização e acesso aos serviços de odontologia no Brasil e estudar diferenciais entre os estratos socioeconômicos, utilizaram-se dados da Pesquisa Nacional por Amostragem de Domicílios (PNAD) de 1998, realizada pelo IBGE. A análise, que levou em conta o desenho amostral, indicou um nível baixo de utilização de serviços odontológicos. Setenta e sete por cento das crianças de 0-6 anos e 4% dos adultos de 20-49 anos nunca haviam consultado um dentista. Entre estes adultos, comparando-se os 20% mais pobres com os 20% mais ricos, observou-se que o número de desassistidos era 16 vezes maior entre os primeiros. No grupo de 0-6 anos, as crianças ricas consultaram o dentista cinco vezes mais do que as pobres no ano anterior à entrevista. Cerca de 4% dos que procuraram atendimento odontológico não o obtiveram, 8% dos quais entre os mais pobres e 1% entre os mais ricos. A maioria (68%) dos atendimentos do grupo mais pobre foi financiada pelo SUS, enquanto 63% deles foram pagos pelos mais ricos. As maiores desigualdades no acesso e na utilização de serviços odontológicos foram encontradas, exatamente, nos grupos de menor acesso ou utilização. A participação do SUS nos atendimentos odontológicos é muito mais baixa do que na atenção médica.
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