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Novaes EMDFD, Aquino EML, Gabrielli L, Matos SMAD, Griep RH, Fonseca MDJMD, Almeida MDCCD, Patrão AL. [Body image perception, socioeconomic characteristics, and lifestyle in women participating in ELSA-Brasil in Bahia, Brazil]. CAD SAUDE PUBLICA 2024; 40:e00107823. [PMID: 38381869 PMCID: PMC10877697 DOI: 10.1590/0102-311xpt107823] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/30/2023] [Accepted: 10/09/2023] [Indexed: 02/23/2024] Open
Abstract
Body image distortion is an alteration in the perception of the body that can have repercussions on health. This study aims to estimate the prevalence of body image accuracy and distortion among women participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) living in Bahia State, Brazil, and to investigate associations with socioeconomic characteristics, lifestyle, and gynecological care seeking. A total of 609 women aged 50 to 69 years participated in the study, who answered face-to-face questionnaires from 2012 to 2014. The Stunkard silhouette scale was used to investigate accurate or distorted perception for more or less weight. The relative risk ratio (RR) was calculated by multinomial logistic regression using Stata 13. Most participants have an accurate perception of their own bodies (53.7%). Among those with distorted perception, there is a tendency to distort towards less weight (38.1%). In the multinomial regression analysis, the variables race/skin color and education remained associated with the distortion towards underweight. The race/skin color variable was positively associated with the distortion towards underweight among Mixed-race women (RR = 1.89; 95%CI: 1.13-3.16) and black (RR = 2.10; 95%CI: 1.25-3.55), while the education variable among those with up to high school education (RR = 1.65; 95%CI: 1.18-2.33). There were no associations with the other variables or with distortion for more weight. The results contribute to explaining the relationships between body image perception and socioeconomic factors, revealing that women of different races/skin colors and varying educational levels are influenced in different ways by social discourses, impacting the perception of their body image.
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Affiliation(s)
| | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | - Ligia Gabrielli
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | | | | | | | - Ana Luísa Patrão
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
- Faculdade de Psicologia e de Ciências da Educação, Universidade do Porto, Porto, Portugal
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Guimarães JMN, Pescarini JM, de Sousa Filho JF, Ferreira A, de Almeida MDCC, Gabrielli L, dos-Santos-Silva I, Santos G, Barreto ML, Aquino EML. Income Segregation, Conditional Cash Transfers, and Breast Cancer Mortality Among Women in Brazil. JAMA Netw Open 2024; 7:e2353100. [PMID: 38270952 PMCID: PMC10811554 DOI: 10.1001/jamanetworkopen.2023.53100] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Abstract
Importance Women living in income-segregated areas are less likely to receive adequate breast cancer care and access community resources, which may heighten breast cancer mortality risk. Objective To investigate the association between income segregation and breast cancer mortality and whether this association is attenuated by receipt of the Bolsa Família program (BFP), the world's largest conditional cash-transfer program. Design, Setting, and Participants This cohort study was conducted using data from the 100 Million Brazilian Cohort, which were linked with nationwide mortality registries (2004-2015). Data were analyzed from December 2021 to June 2023. Study participants were women aged 18 to 100 years. Exposure Women's income segregation (high, medium, or low) at the municipality level was obtained using income data from the 2010 Brazilian census and assessed using dissimilarity index values in tertiles (low [0.01-0.25], medium [0.26-0.32], and high [0.33-0.73]). Main Outcomes and Measures The main outcome was breast cancer mortality. Mortality rate ratios (MRRs) for the association of segregation with breast cancer deaths were estimated using Poisson regression adjusted for age, race, education, municipality area size, population density, area of residence (rural or urban), and year of enrollment. Multiplicative interactions of segregation and BFP receipt (yes or no) in the association with mortality (2004-2015) were assessed. Results Data on 21 680 930 women (mean [SD] age, 36.1 [15.3] years) were analyzed. Breast cancer mortality was greater among women living in municipalities with high (adjusted MRR [aMRR], 1.18; 95% CI, 1.13-1.24) and medium (aMRR, 1.08; 95% CI, 1.03-1.12) compared with low segregation. Women who did not receive BFP had higher breast cancer mortality than BFP recipients (aMRR, 1.17; 95% CI, 1.12-1.22). By BFP strata, women who did not receive BFP and lived in municipalities with high income segregation had a 24% greater risk of death from breast cancer compared with those living in municipalities with low income segregation (aMRR, 1.24: 95% CI, 1.14-1.34); women who received BFP and were living in areas with high income segregation had a 13% higher risk of death from breast cancer compared with those living in municipalities with low income segregation (aMRR, 1.13; 95% CI, 1.07-1.19; P for interaction = .008). Stratified by the amount of time receiving the benefit, segregation (high vs low) was associated with an increase in mortality risk for women receiving BFP for less time but not for those receiving it for more time (<4 years: aMRR, 1.16; 95% CI, 1.07-1.27; 4-11 years: aMRR, 1.09; 95% CI, 1.00-1.17; P for interaction <.001). Conclusions and Relevance These findings suggest that place-based inequities in breast cancer mortality associated with income segregation may be mitigated with BFP receipt, possibly via improved income and access to preventive cancer care services among women, which may be associated with early detection and treatment and ultimately reduced mortality.
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Affiliation(s)
| | - Julia M. Pescarini
- Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Andrea Ferreira
- Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, Brazil
- Ubuntu Center on Racism, Global Movements and Population Health Equity, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | | | - Ligia Gabrielli
- Secretaria de Saúde do Estado da Bahia, Centro de Diabetes e Endocrinologia da Bahia, Salvador, Brazil
| | - Isabel dos-Santos-Silva
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gervasio Santos
- Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, Brazil
| | - Mauricio L. Barreto
- Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Estela M. L. Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Góes EF, Guimarães JMN, Almeida MDCC, Gabrielli L, Katikireddi SV, Campos AC, Matos SMA, Patrão AL, Oliveira Costa ACD, Quaresma M, Leyland AH, Barreto ML, Dos-Santos-Silva I, Aquino EML. The intersection of race/ethnicity and socioeconomic status: inequalities in breast and cervical cancer mortality in 20,665,005 adult women from the 100 Million Brazilian Cohort. Ethn Health 2024; 29:46-61. [PMID: 37642313 DOI: 10.1080/13557858.2023.2245183] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES There is limited evidence regarding the impact of race/racism and its intersection with socioeconomic status (SES) on breast and cervical cancer, the two most common female cancers globally. We investigated racial inequalities in breast and cervical cancer mortality and whether SES (education and household conditions) interacted with race/ethnicity. DESIGN The 100 Million Brazilian Cohort data were linked to the Brazilian Mortality Database, 2004-2015 (n = 20,665,005 adult women). We analysed the association between self-reported race/ethnicity (White/'Parda'(Brown)/Black/Asian/Indigenous) and cancer mortality using Poisson regression, adjusting for age, calendar year, education, household conditions and area of residence. Additive and multiplicative interactions were assessed. RESULTS Cervical cancer mortality rates were higher among Indigenous (adjusted Mortality rate ratio = 1.80, 95%CI 1.39-2.33), Asian (1.63, 1.20-2.22), 'Parda'(Brown) (1.27, 1.21-1.33) and Black (1.18, 1.09-1.28) women vs White women. Breast cancer mortality rates were higher among Black (1.10, 1.04-1.17) vs White women. Racial inequalities in cervical cancer mortality were larger among women of poor household conditions, and low education (P for multiplicative interaction <0.001, and 0.02, respectively). Compared to White women living in completely adequate (3-4) household conditions, the risk of cervical cancer mortality in Black women with 3-4, 1-2, and none adequate conditions was 1.10 (1.01-1.21), 1.48 (1.28-1.71), and 2.03 (1.56-2.63), respectively (Relative excess risk due to interaction-RERI = 0.78, 0.18-1.38). Among 'Parda'(Brown) women the risk was 1.18 (1.11-1.25), 1.68 (1.56-1.81), and 1.84 (1.63-2.08), respectively (RERI = 0.52, 0.16-0.87). Compared to high-educated White women, the risk in high-, middle- and low-educated Black women was 1.14 (0.83-1.55), 1.93 (1.57-2.38) and 2.75 (2.33-3.25), respectively (RERI = 0.36, -0.05-0.77). Among 'Parda'(Brown) women the risk was 1.09 (0.91-1.31), 1.99 (1.70-2.33) and 3.03 (2.61-3.52), respectively (RERI = 0.68, 0.48-0.88). No interactions were found for breast cancer. CONCLUSION Low SES magnified racial inequalities in cervical cancer mortality. The intersection between race/ethnicity, SES and gender needs to be addressed to reduce racial health inequalities.
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Affiliation(s)
- Emanuelle F Góes
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Bahia, Brazil
| | - Joanna M N Guimarães
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Ligia Gabrielli
- Centro de Diabetes e Endocrinologia da Bahia, Secretaria de Saúde do Estado da Bahia, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Ana Clara Campos
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Ana Luísa Patrão
- Center for Psychology, Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | | | - Manuela Quaresma
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Alastair H Leyland
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Isabel Dos-Santos-Silva
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Galvão NMS, Matos SMAD, Almeida MDCCD, Gabrielli L, Barreto SM, Aquino EML, Schmidt MI, Amorim LDAF. Patterns of metabolic syndrome and associated factors in women from the ELSA-Brasil: a latent class analysis approach. CAD SAUDE PUBLICA 2023; 39:e00039923. [PMID: 38088734 PMCID: PMC10715568 DOI: 10.1590/0102-311xen039923] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/26/2023] [Accepted: 09/18/2023] [Indexed: 12/18/2023] Open
Abstract
This study aimed to identify patterns of metabolic syndrome among women and estimate their prevalence and relationship with sociodemographic and biological characteristics. In total, 5,836 women were evaluated using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Patterns of metabolic syndrome were defined via latent class analysis, using the following metabolic abnormalities as indicators: abdominal obesity, hyperglycemia, hypertension, hypertriglyceridemia, and reduced HDL cholesterol. The relationship between these patterns and individual characteristics was assessed using latent class analysis with covariates. Three patterns of metabolic syndrome were identified: high metabolic expression, moderate metabolic expression, and low metabolic expression. The first two patterns represented most women (53.8%) in the study. Women with complete primary or secondary education and belonging to lower social classes were more likely to have higher metabolic expression. Black and mixed-race women were more likely to have moderate metabolic expression. Menopausal women aged 50 years and older were more often classified into patterns of greater health risk. This study addressed the heterogeneous nature of metabolic syndrome, identifying three distinct profiles for the syndrome among women. The combination of abdominal obesity, hyperglycemia, and hypertension represents the main metabolic profile found among ELSA-Brasil participants. Sociodemographic and biological factors were important predictors of patterns of metabolic syndrome.
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Affiliation(s)
| | | | | | - Ligia Gabrielli
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | - Sandhi Maria Barreto
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | - Maria Inês Schmidt
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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Hamui RM, Aquino EML, Menezes GMS, Velho Barreto de Araújo T, Seabra Soares de Britto E Alves MT, Valongueiro Alves S, Almeida MDCC. Delays in obtaining hospital care and abortion-related complications within a context of illegality. PLoS One 2023; 18:e0286982. [PMID: 37315058 DOI: 10.1371/journal.pone.0286982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
Abortion, particularly when illegal, highlights inequities in different populations. Although abortion-related mortality is lower compared to other obstetric causes, abortion complications tend to be more lethal. Delays in seeking and obtaining care are determinants of negative outcomes. This study, nested within the GravSus-NE, analyzed healthcare delays and their association with abortion-related complications in three cities of northeastern Brazil (Salvador, Recife and São Luís). Nineteen public maternity hospitals were involved. All eligible women ≥18 years old hospitalized between August and December 2010 were evaluated. Descriptive, stratified and multivariate analyses were performed. Youden's index was used to determine delay. One model was created with all the women and another with those admitted in good clinical conditions, thus determining complications that occurred during hospitalization and their associated factors. Of 2,371 women, most (62.3%) were ≤30 years old (median 27 years) and 89.6% reported being black or brown-skinned. Most (90.5%) were admitted in good condition, 4.0% in fair condition and 5.5% in poor/very poor condition. Median time between admission and uterine evacuation was 7.9 hours. After a cut-off time of 10 hours, the development of complications increased considerably. Black women and those admitted during nightshifts were more likely to experience a wait time ≥10 hours. Delays were associated with severe complications (OR 1.97; 95%CI: 1.55-2.51), including in the women admitted in good condition (OR 2,56; 95%CI: 1.85-3.55), and even following adjustment for gestational age and reported abortion type (spontaneous/induced). These findings corroborate the literature, highlighting the social vulnerability of women hospitalized within Brazil's public healthcare system in a situation of abortion. The study strongpoints include having objectively measured the time between admission and uterine evacuation and having established a cut-off time defining delay based on conceptual and epidemiological criteria. Further studies should evaluate other settings and new measurement tools for effectively preventing life-threatening complications.
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Affiliation(s)
- Romina M Hamui
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Estela M L Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Greice M S Menezes
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
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Flores-Ortiz R, Fiaccone RL, Leyland A, Millett C, Hone T, Schmidt MI, Ferreira AJF, Ichihara MY, Teixeira C, Sanchez MN, Pescarini J, Aquino EML, Malta DC, Velasquez-Melendez G, de Oliveira JF, Craig P, Ribeiro-Silva RC, Barreto ML, Katikireddi SV. Subsidised housing and diabetes mortality: a retrospective cohort study of 10 million low-income adults in Brazil. BMJ Open Diabetes Res Care 2023; 11:e003224. [PMID: 37349106 PMCID: PMC10314413 DOI: 10.1136/bmjdrc-2022-003224] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/29/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Housing-related factors can be predictors of health, including of diabetes outcomes. We analysed the association between subsidised housing residency and diabetes mortality among a large cohort of low-income adults in Brazil. RESEARCH DESIGN AND METHODS A cohort of 9 961 271 low-income adults, observed from January 2010 to December 2015, was created from Brazilian administrative records of social programmes and death certificates. We analysed the association between subsidised housing residency and time to diabetes mortality using a Cox model with inverse probability of treatment weighting and regression adjustment. We assessed inequalities in this association by groups of municipality Human Development Index. Diabetes mortality included diabetes both as the underlying or a contributory cause of death. RESULTS At baseline, the mean age of the cohort was 40.3 years (SD 15.6 years), with a majority of women (58.4%). During 29 238 920 person-years of follow-up, there were 18 775 deaths with diabetes as the underlying or a contributory cause. 340 683 participants (3.4% of the cohort) received subsidised housing. Subsidised housing residents had a higher hazard of diabetes mortality compared with non-residents (HR 1.17; 95% CI 1.05 to 1.31). The magnitude of this association was more pronounced among participants living in municipalities with lower Human Development Index (HR 1.30; 95% CI 1.04 to 1.62). CONCLUSIONS Subsidised housing residents had a greater risk of diabetes mortality, particularly those living in low socioeconomic status municipalities. This finding suggests the need to intensify diabetes prevention and control actions and prompt treatment of the diabetes complications among subsidised housing residents, particularly among those living in low socioeconomic status municipalities.
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Affiliation(s)
- Renzo Flores-Ortiz
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Rosemeire L Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Institute of Mathematics, Federal University of Bahia, Salvador, Brazil
| | | | - Christopher Millett
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Thomas Hone
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Maria Inês Schmidt
- Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Andrêa J F Ferreira
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Maria Y Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Camila Teixeira
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Mauro N Sanchez
- Tropical Medicine Center, University of Brasilia, Brasília, Brazil
| | - Julia Pescarini
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Estela M L Aquino
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Deborah C Malta
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Juliane Fonseca de Oliveira
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Center of Mathematics of University of Porto (CMUP), University of Porto, Porto, Portugal
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rita C Ribeiro-Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | - Mauricio L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
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Alves FJO, Ramos D, Paixão ES, Falcão IR, de Cássia Ribeiro-Silva R, Fiaccone R, Rasella D, Teixeira C, Machado DB, Rocha A, de Almeida MF, Goes EF, Rodrigues LC, Ichihara MY, Aquino EML, Barreto ML. Association of Conditional Cash Transfers With Maternal Mortality Using the 100 Million Brazilian Cohort. JAMA Netw Open 2023; 6:e230070. [PMID: 36821115 PMCID: PMC9951038 DOI: 10.1001/jamanetworkopen.2023.0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
IMPORTANCE Conditional cash transfers (CCTs) have been consistently associated with improvements to the determinants of maternal health, but there have been insufficient investigations regarding their effects on maternal mortality. OBJECTIVE To evaluate the association between being a Bolsa Família program (BFP) beneficiary and maternal mortality and to examine how this association differs by duration of BFP receipt, maternal race, living in rural or urban areas, the Municipal Human Development Index (MHDI), and municipal primary health care coverage. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis was nested within the 100 Million Brazilian Cohort. Girls and women aged 10 to 49 years (hereinafter referred to as women) who had at least 1 live birth were included, using data from Brazilian national health databases linked to the 100 Million Brazilian Cohort (January 1, 2004, to December 31, 2015). Propensity score kernel weighting was applied to control for sociodemographic and economic confounders in the association between BFP receipt and maternal mortality, overall and stratified by different subgroups (race, urban or rural area, and MHDI), and duration of BFP receipt. Data were analyzed from July 12, 2019, to December 31, 2022. MAIN OUTCOME(S) AND MEASURES Maternal death. RESULTS A total of 6 677 273 women aged 10 to 49 years were included in the analysis, 4056 of whom had died from pregnancy-related causes. The risk of maternal death was 18% lower in women who received BFP (weighted odds ratio [OR], 0.82 [95% CI, 0.71-0.93]). A longer duration receiving BFP was associated with an increased reduction in maternal mortality (OR for 1-4 years, 0.85 [95% CI, 0.75-0.97]; OR for 5-8 years, 0.70 [95% CI, 0.60-0.82]; OR for ≥9 years, 0.69 [95% CI, 0.53-0.88]). Receiving BFP was also associated with substantial increases in the number of prenatal appointments and interbirth intervals. The reduction was more pronounced in the most vulnerable groups. CONCLUSIONS AND RELEVANCE This cross-sectional analysis nested within the 100 Million Brazilian Cohort found an association between BFP receipt and maternal mortality. This association was of greater magnitude in women with longer exposure to BFP and in the most vulnerable groups. These findings reinforce evidence that programs such as BFP, which have already proven effective in poverty reduction, have great potential to improve maternal survival.
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Affiliation(s)
- Flávia Jôse O. Alves
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Dandara Ramos
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Iyaleta Research Association, Salvador, Brazil
| | - Enny S. Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ila R. Falcão
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rita de Cássia Ribeiro-Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | - Rosemeire Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Camila Teixeira
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Daiane Borges Machado
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Aline Rocha
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | | | - Emanuelle F. Goes
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Iyaleta Research Association, Salvador, Brazil
| | - Laura C. Rodrigues
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Yury Ichihara
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Estela M. L. Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Maurício L. Barreto
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
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Patrão AL, da Conceição Almeida M, Henriques A, M Alvim Matos S, Barros H, Harter Griep R, Aquino EML. Body image distortion among Brazilian and Portuguese women with children: A comparative study between the ELSA-Brasil and Generation XXI cohorts. Prev Med 2022; 164:107316. [PMID: 36273617 DOI: 10.1016/j.ypmed.2022.107316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/17/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/28/2022]
Abstract
Solid evidence indicates that body image distortion is associated with various physical and mental health problems in women (e.g. Lee and Lee, 2016; Mölbert et al., 2017; Raj and Ploriya, 2020; Sagar, 2005; Shin et al., 2015). Furthermore, body image has been shown to vary according to life context and stage, particularly after a woman has had children. This scenario justifies the comparison between different countries and cultures. The objective of the present study was to evaluate the prevalence and associated factors of body image distortion/accuracy in Brazilian and Portuguese women with children. The study assessed women selected from two epidemiological cohorts: ELSA-Brasil in Brazil (n = 1468) and Generation XXI in Portugal (n = 3380). The data analyzed were based on multidimensional questionnaires from which sociodemographic and family characteristics as well as data associated with lifestyle and health were obtained. The results show that most women in both cohorts had an accurate perception of their own body size. In cases of distorted self-perception, the likelihood of the Brazilian women perceiving themselves as being heavier was greater if they had had cancer, whereas the Portuguese women were less likely to perceive themselves as heavier when they had less schooling. Perceiving themselves as thinner than they actually are, was associated with poorer self-perception of their own state of health in the Brazilian women and with poorer schooling in both the Brazilian and Portuguese women. The present findings contribute towards improving understanding of the influence of body image distortion on the health and wellbeing of Brazilian and Portuguese women, possibly leading to the implementation of health-promoting policies in both countries.
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Affiliation(s)
- Ana Luísa Patrão
- Center for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences, University of Porto, R. Alfredo Allen, 4200-135 Porto, Portugal; Collective Health Institute, Federal University of Bahia, R. Basílio da Gama, s/n, Canela, 40110-040 Salvador, Bahia, Brazil.
| | - Maria da Conceição Almeida
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Rua Waldemar Falcão, 121, Candeal, 40296-710 Salvador, Bahia, Brazil.
| | - Ana Henriques
- EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.
| | - Sheila M Alvim Matos
- Collective Health Institute, Federal University of Bahia, R. Basílio da Gama, s/n, Canela, 40110-040 Salvador, Bahia, Brazil.
| | - Henrique Barros
- EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal; Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Rosane Harter Griep
- Laboratory of Education in the Environment and Health, Oswaldo Cruz Institute, FIOCRUZ, Av. Brasil, 4365, Manguinhos, 21040-360 Rio de Janeiro, Brazil.
| | - Estela M L Aquino
- Collective Health Institute, Federal University of Bahia, R. Basílio da Gama, s/n, Canela, 40110-040 Salvador, Bahia, Brazil.
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Pescarini JM, Campbell D, Amorim LD, Falcão IR, Ferreira AJF, Allik M, Shaw RJ, Malta DC, Ali MS, Smeeth L, Barreto ML, Leyland A, Craig P, Aquino EML, Katikireddi SV. Impact of Brazil's Bolsa Família Programme on cardiovascular and all-cause mortality: a natural experiment study using the 100 Million Brazilian Cohort. Int J Epidemiol 2022; 51:1847-1861. [PMID: 36172959 PMCID: PMC9749722 DOI: 10.1093/ije/dyac188] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/13/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) has a disproportionate effect on mortality among the poorest people. We assessed the impact on CVD and all-cause mortality of the world's largest conditional cash transfer, Brazil's Bolsa Família Programme (BFP). METHODS We linked administrative data from the 100 Million Brazilian Cohort with BFP receipt and national mortality data. We followed individuals who applied for BFP between 1 January 2011 and 31 December 2015, until 31 December 2015. We used marginal structural models to estimate the effect of BFP on all-age and premature (30-69 years) CVD and all-cause mortality. We conducted stratified analyses by levels of material deprivation and access to healthcare. We checked the robustness of our findings by restricting the analysis to municipalities with better mortality data and by using alternative statistical methods. RESULTS We studied 17 981 582 individuals, of whom 4 855 324 were aged 30-69 years. Three-quarters (76.2%) received BFP, with a mean follow-up post-award of 2.6 years. We detected 106 807 deaths by all causes, of which 60 893 were premature; and 23 389 CVD deaths, of which 15 292 were premature. BFP was associated with reductions in premature all-cause mortality [hazard ratio (HR) = 0.96, 95% CI = 0.94-0.98], premature CVD (HR = 0.96, 95% CI = 0.92-1.00) and all-age CVD (HR = 0.96, 95% CI = 0.93-1.00) but not all-age all-cause mortality (HR = 1.00, 95% CI = 0.98-1.02). In stratified and robustness analyses, BFP was consistently associated with mortality reductions for individuals living in the two most deprived quintiles. CONCLUSIONS BFP appears to have a small to null effect on premature CVD and all-cause mortality in the short term; the long-term impact remains unknown.
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Affiliation(s)
- Julia M Pescarini
- Corresponding author. London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK. E-mail:
| | - Desmond Campbell
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Leila D Amorim
- Departamento de Estatística, Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Brazil
| | - Ila R Falcão
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Andrêa J F Ferreira
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Mirjam Allik
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Richard J Shaw
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Deborah C Malta
- Departamento materno infantil e saude pública, Universidade Federal de Minas gerais (UFMG), Belo Horizonte, Brazil
| | - M Sanni Ali
- Departments of Infectious Disease Epidemiology (JMP) and Epidemiology and Population Health (LS), Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Departments of Infectious Disease Epidemiology (JMP) and Epidemiology and Population Health (LS), Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK,Health Data Research (HDR), London, UK
| | - Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Alastair Leyland
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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10
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Matos SMA, Amorim LDAF, Pitanga FJG, Patrão AL, Barreto SM, Chor D, Cardoso LDO, Molina MDCB, Barreto ML, Aquino EML. Social position and anthropometric status among adults in the ELSA-Brasil study: a latent class analysis. CAD SAUDE PUBLICA 2021; 37:e00168918. [PMID: 34669771 DOI: 10.1590/0102-311x00168918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/27/2020] [Indexed: 11/22/2022] Open
Abstract
The objective of the present study was to evaluate the association between social position and anthropometric status in women and men Brazilian adult. This was a cross-sectional study that used baseline data collected from 2008 to 2010 for the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil, in Portuguese), in the six major Brazilian state capital cities. A total of 15,105 active and retired civil servants aged from 35 to 74 years. Two latent variables were defined by latent class analysis, social position and anthropometric status. Both constructs and the analyses were separately evaluated by sex. Associations were assessed using multivariate logistic regression analysis with adjustment for age, self-reported skin color/race, and marital status. Around 44% of the women and 26% of the men were classified as overweight or obese. Social position tended to be lower in women (43.2%) and higher among men (40.4%). Heavier women were more likely to be black and brown-skinned, whereas slimmer women were more likely to be white. After adjustment, women's weight increased as social position decreased (OR = 1.52; 95%CI: 1.36-1.70), whereas in men weight decreased as social position decreased (OR = 0.87; 95%CI: 0.76-0.99). Social position affected the anthropometric status of women and men differently, with body patterns also being affected by ethnicity/skin color, showing the potentiality of taking the intersectional perspective when investigating the possible social determinants of the phenomenon.
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Affiliation(s)
| | | | | | - Ana Luísa Patrão
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | - Dora Chor
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | | | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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11
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de Almeida RT, Matos SMA, Aquino EML. Individual and Combined Performance of Indicators of Overall and Central Obesity to Estimate Coronary Risk in ELSA-Brasil Participants. Arq Bras Cardiol 2021; 117:701-712. [PMID: 34346941 PMCID: PMC8528349 DOI: 10.36660/abc.20200360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/08/2020] [Accepted: 11/04/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Anthropometric indicators have been used in clinical practice and epidemiological studies for screening of health risk factors. OBJECTIVES To evaluate the individual discriminatory power of body adiposity index (BAI), body mass index (BMI), waist circumference (WC) and waist-hip-ratio (WHR) to identify individuals at risk for coronary heart disease and to evaluate whether combinations of anthropometric indicators of overall obesity with indicators of central obesity improve predictive ability in adults. METHODS A total of 15,092 participants (54.4% women) aged 35-74years were assessed at baseline of the ELSA-Brasil study. Individuals at risk for coronary heart disease were identified using the Framingham risk score and divided into very-high risk (VHR 20%) and high risk (HR10%). Measures of diagnostic accuracy and area under the ROC curves (AUC) were analyzed. Associations were tested using Poisson regression analysis with robust variance, according to age and sex. Statistical significance was set at 5%. RESULTS WHR showed the highest discriminatory power for VHR20% in all groups, with higher predictive ability in women (AUC: 0.802; 95%CI: 0.748-0.856 vs 0.657; 95%CI: 0.630-0.683 in the age range of 35-59 years, and AUC: 0.668; 95%CI: 0.621-0.715 vs 0.611; 95%CI: 0.587-0.635 in the age range of 60-74 years). BAI + WHR and BMI + WHR had the highest predictive power in men and women, respectively. Combinations of indicators of overall obesity with indicators of central obesity were more strongly associated with VHR20% and HR10% in all subgroups. CONCLUSION Combined indicators had greater predictive ability than indicators taken individually. BAI+ WHR and BMI + WHR were the best estimators of coronary risk in men and women, respectively, and WHR had the best individual performance.
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Affiliation(s)
- Rogério Tosta de Almeida
- Universidade Estadual de Feira de SantanaDepartamento de SaúdeFeira de SantanaBABrasilUniversidade Estadual de Feira de Santana - Departamento de Saúde, Feira de Santana, BA – Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia - Instituto de Saúde Coletiva, Salvador, BA – Brasil
| | - Sheila Maria Alvim Matos
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia - Instituto de Saúde Coletiva, Salvador, BA – Brasil
| | - Estela M. L. Aquino
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia - Instituto de Saúde Coletiva, Salvador, BA – Brasil
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12
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Albuquerque LDS, Griep RH, Aquino EML, Cardoso LDO, Chor D, Fonseca MDJMD. Factors associated with body image dissatisfaction in adults: a cross-sectional analysis of the ELSA-Brasil Study. Cien Saude Colet 2021; 26:1941-1954. [PMID: 34076134 DOI: 10.1590/1413-81232021265.07152019] [Citation(s) in RCA: 2] [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: 10/11/2018] [Accepted: 07/26/2019] [Indexed: 11/22/2022] Open
Abstract
The aim of this article is to assess the association between body image dissatisfaction and sociodemographic and health behaviors, according to sex. Data were analyzed for 6,289 women and 5,188 men (35-59 years), participants in the baseline of the Longitudinal Study of Adult Health (ELSA-Brasil), using multinomial regression. The odds of dissatisfaction due to feeling underweight were higher among in women with low schooling and those who only consumed fruit weekly. Moderate physical activity reduced this type of dissatisfaction by 50%. Higher odds of dissatisfaction due to overweight were seen in married women, those who practiced light physical activity, and former smokers. Men with secondary schooling and excessive alcohol consumption showed 50% higher odds of dissatisfaction due to underweight, while light or moderate physical activity increased the odds by 75% and 94%, respectively. Among men, light and moderate physical activity were also associated with increased odds of dissatisfaction due to overweight. These findings corroborate that unhealthy habits and behaviors can influence body image dissatisfaction with different patterns between women and men.
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Affiliation(s)
- Liliane da Silva Albuquerque
- Secretaria Municipal de Educação da cidade do Rio de Janeiro. Escola Municipal Lino Martins da Silva. R. Teixeira Ribeiro 1000 bloco 1, Campus Maré Bonsucesso. 21044-251 Rio de Janeiro RJ Brasil.
| | - Rosane Harter Griep
- Laboratório de Educação em Ambiente e Saúde, Instituto Oswaldo cruz, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | - Letícia de Oliveira Cardoso
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rio de Janeiro RJ Brasil
| | - Dóra Chor
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rio de Janeiro RJ Brasil
| | - Maria de Jesus Mendes da Fonseca
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rio de Janeiro RJ Brasil
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13
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Pilecco FB, Coelho CG, Fernandes QHRF, Silveira IH, Pescarini JM, Ortelan N, Gabrielli L, Aquino EML, Barreto ML. The effect of laboratory testing on COVID-19 monitoring indicators: an analysis of the 50 countries with the highest number of cases. ACTA ACUST UNITED AC 2021; 30:e2020722. [PMID: 34008747 DOI: 10.1590/s1679-49742021000200002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/25/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To analyse how testing the population influences the health indicators used to monitor the COVID-19 pandemic in the 50 countries with the highest number of diagnosed cases. METHODS This was an ecological study using secondary data retrieved on 8/19/2020. Cumulative incidence, mortality rate, case-fatality rate, and proportion of positive tests were calculated. The data were described and presented graphically, with their respective Spearman Correlation Coefficients. RESULTS The testing rate varied enormously between countries. Cumulative incidence and the proportion of positive tests were correlated with the number of tests, while the mortality rate and case-fatality rate showed low correlation with this indicator. CONCLUSION Most countries do not test enough to ensure adequate monitoring of the pandemic, and this is reflected in the quality of the indicators. Expanding the number of tests is essential, but it needs to be accompanied by other measures, such as isolation of diagnosed cases and contact tracing.
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Affiliation(s)
- Flávia Bulegon Pilecco
- Universidade Federal de Minas Gerais, Departamento de Medicina Preventiva e Social, Belo Horizonte, MG, Brasil
| | - Carolina Gomes Coelho
- Universidade Federal de Minas Gerais, Departamento de Medicina Preventiva e Social, Belo Horizonte, MG, Brasil
| | | | | | - Júlia Moreira Pescarini
- Fundação Instituto Oswaldo Cruz, Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
| | - Naiá Ortelan
- Fundação Instituto Oswaldo Cruz, Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
| | - Ligia Gabrielli
- Universidade Federal da Bahia, Instituto de Saúde Coletiva, Salvador, BA, Brasil
| | - Estela M L Aquino
- Universidade Federal da Bahia, Instituto de Saúde Coletiva, Salvador, BA, Brasil
| | - Maurício Lima Barreto
- Fundação Instituto Oswaldo Cruz, Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
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14
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Ferreira AJF, Pescarini J, Sanchez M, Flores-Ortiz RJ, Teixeira CS, Fiaccone R, Ichihara MY, Oliveira R, Aquino EML, Smeeth L, Craig P, Ali S, Leyland AH, Barreto ML, Ribeiro RDC, Katikireddi SV. Evaluating the health effect of a Social Housing programme, Minha Casa Minha Vida, using the 100 million Brazilian Cohort: a natural experiment study protocol. BMJ Open 2021; 11:e041722. [PMID: 33649053 PMCID: PMC8098948 DOI: 10.1136/bmjopen-2020-041722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/03/2020] [Accepted: 01/22/2021] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Social housing programmes have been shown to influence health, but their effects on cardiovascular mortality and incidence of infectious diseases, such as leprosy and tuberculosis, are unknown. We will use individual administrative data to evaluate the effect of the Brazilian housing programme Minha Casa Minha Vida (MCMV) on cardiovascular disease (CVD) mortality and incidence of leprosy and tuberculosis. METHODS AND ANALYSIS We will link the baseline of the 100 Million Brazilian Cohort (2001-2015), which includes information on socioeconomic and demographic variables, to the MCMV (2009-2015), CVD mortality (2007-2015), leprosy (2007-2015) and tuberculosis (2007-2015) registries. We will define our exposed population as individuals who signed the contract to receive a house from MCMV, and our non-exposed group will be comparable individuals within the cohort who have not signed a contract for a house at that time. We will estimate the effect of MCMV on health outcomes using different propensity score approaches to control for observed confounders. Follow-up time of individuals will begin at the date of exposure ascertainment and will end at the time a specific outcome occurs, date of death or end of follow-up (31 December 2015). In addition, we will conduct stratified analyses by the follow-up time, age group, race/ethnicity, gender and socioeconomic position. ETHICS AND DISSEMINATION The study was approved by the ethic committees from Instituto Gonçalo Muniz-Oswaldo Cruz Foundation and University of Glasgow Medical, Veterinary and Life Sciences College. Data analysis will be carried out using an anonymised dataset, accessed by researchers in a secure computational environment according to the Centre for Integration of Data and Health Knowledge procedures. Study findings will be published in high quality peer-reviewed research journals and will also be disseminated to policy makers through stakeholder events and policy briefs.
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Affiliation(s)
- Andrêa J F Ferreira
- Public Health Institute, Federal University of Bahia, Salvador, Brazil
- Centro de Integração de Dados e Conhecimentos Para Saúde (Cidacs), Fiocruz Bahia, Salvador, Brazil
| | - Julia Pescarini
- Centro de Integração de Dados e Conhecimentos Para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Mauro Sanchez
- Public Health, Universidade de Brasília, Brasilia, Brazil
| | - Renzo Joel Flores-Ortiz
- Center for Integration of Data and Health Knowledge (Cidacs), Fiocruz Bahia, Salvador, Brazil
| | | | - Rosemeire Fiaccone
- Mathematics and Statistics, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | - Estela M L Aquino
- Public Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Liam Smeeth
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Peter Craig
- Public Health Sciences Unit, University of Glasgow MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
| | - Sanni Ali
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Alastair H Leyland
- Public Health Sciences Unit, University of Glasgow MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
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15
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Ortelan N, Ferreira AJF, Leite L, Pescarini JM, Souto AC, Barreto ML, Aquino EML. Cloth masks in public places: an essential intervention to prevent COVID-19 in Brazil. Cien Saude Colet 2021; 26:669-692. [PMID: 33605343 DOI: 10.1590/1413-81232021262.36702020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/02/2020] [Indexed: 02/08/2023] Open
Abstract
There is increasing evidence that the use of masks is an indispensable protective measure against COVID-19, given the high transmissibility of the new coronavirus through the respiratory system, including by asymptomatic individuals. The use of cloth masks in public places has been established as a protective measure to be adopted alongside social distancing and hand hygiene. This narrative review aims to systematize the scientific evidence that informs the widespread use of cloth masks as a preventive measure against COVID-19 and to describe the evolution of positions contrary to or in favor of its use outside the home, in view of the advance of the new coronavirus pandemic globally. The scientific articles, technical notes, governmental decrees and other documents analyzed indicate that widespread use of masks has the potential to reduce the spread of the new coronavirus. We recommend that the Brazilian government adopt strategies to increase the supply of reusable cloth masks to the public, especially to vulnerable populations and to support studies on the impact of this measure to control the pandemic in the country. Finally, it is imperative to ensure that use of masks does not exacerbate stigmatization of racial groups that already face prejudice.
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Affiliation(s)
- Naiá Ortelan
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz Bahia. R. Mundo s/n, Trobogy. 41745-715 Salvador BA Brasil.
| | | | | | - Julia Moreira Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz Bahia. R. Mundo s/n, Trobogy. 41745-715 Salvador BA Brasil.
| | - Ana Cristina Souto
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA). Salvador BA Brasil
| | - Mauricio Lima Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz Bahia. R. Mundo s/n, Trobogy. 41745-715 Salvador BA Brasil.
| | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA). Salvador BA Brasil
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16
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Teixeira MG, Kerr LRFS, Ximenes RADA, Almeida RLFD, Ichihara MY, Albuquerque MDFMD, Aquino EML, Werneck GL, Carmo EH, Medronho RA, Oliveira WKD, Henriques CMP, Kendall C, Silva AAMD, Almeida Filho NM, Souza WVD, Veras MADSM, Penna GO, Silva GAE, Brandão Filho SP, Barreto ML. Fortalecer as atividades de informação e vigilância epidemiológica é essencial e urgente para reduzir a força de transmissão do SARS-CoV-2. Rev bras epidemiol 2021. [DOI: 10.1590/1980-549720210049] [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] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Estela M L Aquino
- Universidade Federal da Bahia, Brasil; Fundação Oswaldo Cruz, Brasil
| | | | | | | | | | | | - Carl Kendall
- Universidade Federal do Ceará, Brasil; Tulane School of Public Health and Tropical Medicine, Estados Unidos da América
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17
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Pescarini JM, Craig P, Allik M, Amorim L, Ali S, Smeeth L, Barreto ML, Leyland AH, Aquino EML, Katikireddi SV. Evaluating the impact of the Bolsa Familia conditional cash transfer program on premature cardiovascular and all-cause mortality using the 100 million Brazilian cohort: a natural experiment study protocol. BMJ Open 2020; 10:e039658. [PMID: 33444195 PMCID: PMC7682454 DOI: 10.1136/bmjopen-2020-039658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [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: 04/22/2020] [Revised: 07/30/2020] [Accepted: 09/30/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Brazil's Bolsa Familia Program (BFP) is the world's largest conditional cash transfer scheme. We shall use a large cohort of applicants for different social programmes to evaluate the effect of BFP receipt on premature all-cause and cardiovascular mortality. METHODS AND ANALYSIS We will identify BFP recipients and non-recipients among new applicants from 2004 to 2015 in the 100 Million Brazilian Cohort, a database of 114 million individuals containing sociodemographic and mortality information of applicants to any Brazilian social programme. For individuals applying from 2011, when we have better recorded income data, we shall compare premature (age 30-69) cardiovascular and all-cause mortality among BFP recipients and non-recipients using regression discontinuity design (RDD) with household monthly per capita income as the forcing variable. Effects will be estimated using survival models accounting for individuals follow-up. To test the sensitivity of our findings, we will estimate models with different bandwidths, include potential confounders as covariates in the survival models, and restrict our data to locations with the most reliable data. In addition, we will estimate the effect of BFP on studied outcomes using propensity score risk-set matching, separately for individuals that applied ≤2010 and >2011, allowing comparability with RDD. Analyses will be stratified by geographical region, gender, race/ethnicity and socioeconomic position. We will investigate differential impacts of BFP and the presence of effect modification for a combination of characteristics, including gender and race/ethnicity. ETHICS AND DISSEMINATION The study was approved by the ethics committees of Oswaldo Cruz Foundation and the University of Glasgow College of Medicine and Veterinary Life Sciences. The deidentified dataset will be provided to researchers, and data analysis will be performed in a safe computational environment without internet access. Study findings will be published in high quality peer-reviewed research articles. The published results will be disseminated in the social media and to policy-makers.
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Affiliation(s)
- Julia M Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Craig
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Mirjam Allik
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Leila Amorim
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Brazil
| | - Sanni Ali
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Health Data Research (HDR), London, UK
| | - Mauricio L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Alastair H Leyland
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Estela M L Aquino
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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18
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Pilecco FB, Leite L, Góes EF, Diele-Viegas LM, Aquino EML. Addressing racial inequalities in a pandemic: data limitations and a call for critical analyses. Lancet Glob Health 2020; 8:e1461-e1462. [PMID: 32946800 PMCID: PMC7492055 DOI: 10.1016/s2214-109x(20)30360-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Flávia B Pilecco
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil; CoVida Network, Bahia, Brazil.
| | - Luciana Leite
- Instituto de Biologia, Universidade Federal da Bahia, Bahia, Brazil; CoVida Network, Bahia, Brazil
| | - Emanuelle F Góes
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Bahia, Brazil; CoVida Network, Bahia, Brazil
| | | | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Bahia, Brazil; CoVida Network, Bahia, Brazil
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19
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da Fonseca MDJM, Pimenta IT, Albuquerque LDS, Aquino EML, Cardoso LDO, Chor D, Griep RH. Factors Associated with Body Size Perception and Body Image (Dis)Satisfaction in the Elderly: Results of the ELSA-Brasil Study. Int J Environ Res Public Health 2020; 17:ijerph17186632. [PMID: 32933014 PMCID: PMC7558384 DOI: 10.3390/ijerph17186632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 01/12/2023]
Abstract
The study aimed to assess the association between body image perception and (dis)satisfaction and sociodemographic and behavioral factors in the elderly, using multinomial logistic regression. Data were analyzed for 1686 women and 1499 men participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Men with less schooling and women with lower per capita income showed higher odds of underestimating their body size. Former smokers of both sexes showed higher odds of overestimating their body size; lower schooling and lower per capita income decreased these odds. Increasing age, lower per capita income, and smoking increased the odds of dissatisfaction due to thinness in men, and married marital status decreased these odds. In women, low per capita income, weekly consumption of vegetables, and smoking increased the odds of such dissatisfaction. Factors that increased the odds of dissatisfaction due to excess weight in both sexes were primary or secondary schooling and former smoking. In women, low per capita income, weak physical activity, weekly consumption of vegetables, and excessive alcohol intake also increased the odds of such dissatisfaction. The results suggest that improved living conditions and the adoption of healthy behaviors can help reduce misperceived negative body image among elderly.
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Affiliation(s)
- Maria de Jesus Mendes da Fonseca
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil; (I.T.P.); (L.d.O.C.); (D.C.)
- Correspondence:
| | - Isiyara Taverna Pimenta
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil; (I.T.P.); (L.d.O.C.); (D.C.)
| | | | - Estela M. L. Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador 40110-040, Brazil;
| | - Letícia de Oliveira Cardoso
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil; (I.T.P.); (L.d.O.C.); (D.C.)
| | - Dóra Chor
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil; (I.T.P.); (L.d.O.C.); (D.C.)
| | - Rosane Harter Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil;
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20
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Gabrielli L, Ghaderi S, Almeida MCC, Goes E, Gnoatto C, Almeida L, Menezes GMS, dos-Santos-Silva I, Aquino EML. Racial differences in mammographic density in Brazil: implications for mammographic screening. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mammographic density (MD)-the amount of radio-dense fibroglandular tissue seen on a mammogram - is a stronger biomarker of susceptibility to breast cancer and a major determinant of the sensitivity of mammographic screening. This study examined for the first time racial differences in MD in Brazil.
Methods
555 women (215 from the Longitudinal Study of Adult Health - ELSA-Brasil and 340 users of the Unified Health System - SUS) in Bahia were enrolled into the study. Participants completed an interview, had their heights and weights measured, and underwent a 2-view (cranio-caudal (CC) and medio-lateral-oblique (MLO)) digital mammography of each breast. MD was measured on the left MLO image using the semi-automated Cumulus software, and expressed as the percentage (PMD) of the breast area occupied by fibroglandular tissue. Linear regression models were fitted to assess ethnicity-PMD associations adjusting for age at mammography, body mass index (BMI) and reading batch (minimally-adjusted) and further for socio-economic and reproductive variables.
Results
The study population comprised 95 White (W), 270 Brown-mixed (Bm) and 169 Black (B) women, with a mean age at mammography of 58 (SD = 5.4) years. 63% W, 69% Bm and 49% B women had low educational level; 24% W, 47% Bm and 31% B women had ≥4 children. Minimally-adjusted analysis showed that relative to W women, PMD was 23% (1.23; 95% CI 1.04-1.45) higher in Bm and 4% (1.04; 0.89-1.21) higher in B; however, further adjustment for socio-economic and reproductive variables attenuated the racial differences (fully-adjusted model: 16% (1.16; 0.96-1.40) and 9% (1.09; 0.92-1.29) for Bm and B, respectively.
Conclusions
The racial differences in PMD were mainly accounted by ethnic differences in socio-economic and reproductive-related factors.
Implications Further studies should examine whether racial differences in PMD in Brazil lead to racial differences in false negative and interval cancer rates of mammographic screening.
Key messages
In Brazil, ethnic differences in socio-economic and reproductive-related factors are responsible for racial differences in mammographic density. More research is needed to address racial differences in breast cancer risk in Brazil.
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Affiliation(s)
- L Gabrielli
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - S Ghaderi
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - M C C Almeida
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz - Fiocruz, Salvador, Brazil
| | - E Goes
- Centro de Integração de Dados e Conhecimento para a Saúde, Fundação Oswaldo Cruz - Fiocruz, Salvador, Brazil
| | - C Gnoatto
- Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - L Almeida
- Cican - Centro Estadual de Oncologia, Secretaria de Saúde do Estado da Bahia, Salvador, Brazil
| | - G M S Menezes
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | - E M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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21
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Pescarini JM, Craig P, Allik M, Amorim L, Ali MS, Smeeth L, Barreto ML, Leyland A, Aquino EML, Katikireddi SV. The Brazilian conditional cash transfer program and cardiovascular mortality: a data linkage study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Conditional cash transfer programmes (CCTs) make monetary transfers to poor families conditional on health check-ups and/or education attendance. CCTs have been key in reducing poverty and improving child and maternal health in low- and middle-income countries (LMICs) but their impact on cardiovascular mortality have not been studied. We aimed to evaluate the effect of the CCT Bolsa Familia Program (BFP) on premature all-cause and cardiovascular mortality in Brazil.
Methods
The 100 Million Brazilian Cohort combined information about individuals applying for social programmes, the BFP and mortality data. We analysed ∼8 million individuals aged 30-69 who applied from 2011 to 2015. We calculated inverse probability weights (IPW) for the probability to receive BFP based on baseline observed characteristics (age, education, race, geographical location, household characteristics and year of application). Individuals were followed until they reached 70 years of age, died by any cause, or until 31st Dec 2015. We used Poisson regression (with person-years as the offset) and IPWs to compare BFP recipients to a comparable control population. Females and males were analysed separately.
Results
By following individuals for up to 4 years, 43,562 deaths by all-causes occurred among 4,197,658 females and 69,209 deaths among 3,672,393 males. Female BFP beneficiaries had approximately 60% lower all-cause mortality (IRR=0.40;95%CI=0.37-0.42) and CVD mortality (IRR=0.42;95%CI=0.37-0.47) than non-beneficiaries. Males who are BFP beneficiaries had ∼50% lower all-cause (IRR=0.53;95%CI=0.52-0.55) and 60% lower cardiovascular mortality (IRR=0.40;95%CI=0.38-0.42) than non-beneficiaries.
Conclusions
BFP, the world's largest CCT, may substantially decrease premature mortality. CCTs might have important implications for the growing burden of non-communicable diseases, with impacts potentially due to improved nutrition, socioeconomic conditions and improved primary care access.
Key messages
The Brazilian CCT, a widely recognized programme for poverty alleviation, have showed to be associated with lower overall and cardiovascular premature mortality in both women and men. Other countries, particularly LMICs, may learn from the health benefits of CCTs and should consider its potential large effect on mortality when planning austerity policies.
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Affiliation(s)
- J M Pescarini
- The Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - P Craig
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - M Allik
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - L Amorim
- Institute of Mathematics and Statistics, Federal University of Bahia, Salvador, Brazil
| | - M S Ali
- The Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Non-Communicable Disease Epidemiology, LSHTM, London, UK
| | - L Smeeth
- Department of Non-Communicable Disease Epidemiology, LSHTM, London, UK
- Health Data Research, London, UK
| | - M L Barreto
- The Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - A Leyland
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - E M L Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - S V Katikireddi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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22
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Patrão AL, Aquino EML, Almeida MC, Matos SMA. Psychosocial factors associated with a healthy lifestyle in Brazilian adult women. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
It has been estimated that over 50% of the premature deaths occurring in Western countries can be attributed to causes rooted in lifestyle. In turn, leading a healthy lifestyle has also been associated with a wide range of psychosocial factors. Today, it is known that these differ among men and women. The present article aimed to identify the psychosocial factors associated with healthy lifestyles in women from the ELSA-Brazil cohort, the largest study concerning adult health conducted in Brazil.
Methods
This cross-sectional study was conducted using ELSA-Brasil baseline data, collected between 2008-2010. All included individuals were aged between 35 and 74 years at the time of voluntary recruitment. The ELSA-Brasil cohort has 8,218 women, both currently working and retired, from six public higher education and research institutions. Data were collected using the ELSA-Brasil questionnaire, a multidimensional instrument encompassing a range of topics. The lifestyle indicator was constructed by summing the scores attributed to four different behaviors (smoking, excessive alcohol consumption, inadequate nutrition and insufficient physical activity).
Results
Among women of the ELSA-Brasil, the following factors are associated with a healthier lifestyle: an age of 50-59 years (OR = 1.41; IC95% 1.24-1.61); age 60 years or older (OR = 2.21; IC95% 1.79-2.72); race/skin color Asian (OR = 2.29; IC95% 1.57-3.36), white/Caucasian (OR = 1.57; IC95% 1.36-1.81) or mixed-race (OR = 1.24; IC95% 1.07-1.44); a high-school equivalent (secondary) level of education (OR = 1.31; IC95% 1.09-1.57) or university degree (tertiary) (OR = 1.89; IC95% 1.55-2.29); being retired (OR = 1.33; IC95% 1.12-1.59); the self-perception of health status as good/very good (OR = 1.27; IC95% 1.12-1.45).
Conclusions
These findings should contribute towards preventing chronic non-communicable in adult women in Brazil and in other similar settings.
Key messages
Socio-demografic factors, such as age, race, education and retirement, influence the lifestyle of Brazilian women. Psychological factors, such as self-perception of health status, influence the lifestyle of Brazilian women.
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Affiliation(s)
- A L Patrão
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - E M L Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - M C Almeida
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - S M A Matos
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
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23
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Almeida RT, Queiroz CO, Aquino EML. Declaring Physical Activity as ‘Essential’ During the COVID-19 Pandemic May not be a Good Measure. International Journal of Cardiovascular Sciences 2020. [DOI: 10.36660/ijcs.20200165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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24
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Dos-Santos-Silva I, De Stavola BL, Renna NL, Nogueira MC, Aquino EML, Bustamante-Teixeira MT, Azevedo E Silva G. Ethnoracial and social trends in breast cancer staging at diagnosis in Brazil, 2001-14: a case only analysis. Lancet Glob Health 2020; 7:e784-e797. [PMID: 31097280 PMCID: PMC6527520 DOI: 10.1016/s2214-109x(19)30151-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/15/2019] [Accepted: 02/28/2019] [Indexed: 12/25/2022]
Abstract
Background Policies for early detection of breast cancer, including clinical breast examinations and mammographic screening, were introduced in Brazil in 2004, but their effect on disease stage at diagnosis is unclear. We aimed to assess whether these policies have led to a decrease in the prevalence of late-stage breast cancer at diagnosis. Methods In this case only analysis, using an anonymised nationwide hospital based-cancer registry network, we identified women aged 18–89 years who had been diagnosed with an invasive breast cancer in Brazil during 2001–14. We extracted individual patient-level data on patient demographics, tumour variables, and health-care provider variables for the centre where the patient was diagnosed. Our objectives were to estimate the prevalence of late-stage breast cancer (TNM stage III or IV) at diagnosis overall, across age groups, and by ethnoracial and social strata (ie, self-reported ethnoracial group, as white, black, brown, Asian, or Indigenous, and educational level, marital status, and region of residence) across the study period, and compare these estimates with international data from high-income countries (Norway and the USA). We used logistic regression to estimate odds ratios (ORs) for late-stage versus early-stage (TNM stage I or II) breast cancer at diagnosis in relation to relevant exposures, either minimally adjusted (for age, year of diagnosis, and region of residence) or fully adjusted (for all patient, tumour, and health-care provider variables). Findings We identified 247 719 women who were diagnosed with invasive breast cancer between Jan 1, 2001, and Dec 31, 2014, with a mean age at diagnosis of 55·4 years (SD 13·3), of whom 36·2% (n=89 550) identified as white, 29·8% (n=73 826) as black or brown, and 0·7% (n=1639) as Asian or Indigenous. Prevalence of late-stage breast cancer at diagnosis remained high throughout 2001–14, at approximately 40%, was inversely associated with educational level (p value for linear trend <0·0001), and was higher for women who identified as black (minimally adjusted OR 1·61, 95% CI 1·53–1·70; fully adjusted OR 1·45, 95% CI 1·38–1·54) and brown (minimally adjusted OR 1·26, 95% CI 1·22–1·30; fully adjusted OR 1·18, 1·14–1·23) than those who identified as white. The predicted prevalence of late-stage cancer at diagnosis was highest for women who were black or brown with little or no formal education (48·8%, 95% CI 48·2–49·5) and lowest for women who were white with university education (29·4%, 28·2–30·6), but both these prevalences were higher than that of all women diagnosed with breast cancer in Norway before the introduction of mammography screening (ie, 16·3%, 95% CI 15·4%–17·2% in 1970–74). Similar ethnoracial and social patterns emerged in analyses restricted to the age group targeted by screening (50–69 years). Interpretation The persistently high prevalence of late-stage breast cancer at diagnosis across all ethnoracial and social strata in Brazil, although more substantially among the most disadvantaged populations, implies that early detection policies might have had little effect on breast cancer mortality so far, and highlights the need to focus primarily on timely diagnosis of symptomatic breast cancer rather than on screening for asymptomatic disease. Funding Newton Fund, Research Councils UK, and Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa.
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Affiliation(s)
- Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Bianca L De Stavola
- Population, Policy and Practice Programme, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Nelson L Renna
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mário C Nogueira
- Departamento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal de Juíz de Fora, Juíz de Fora, Brazil
| | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | | | - Gulnar Azevedo E Silva
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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25
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Aquino EML, Silveira IH, Pescarini JM, Aquino R, Souza-Filho JAD, Rocha ADS, Ferreira A, Victor A, Teixeira C, Machado DB, Paixão E, Alves FJO, Pilecco F, Menezes G, Gabrielli L, Leite L, Almeida MDCCD, Ortelan N, Fernandes QHRF, Ortiz RJF, Palmeira RN, Junior EPP, Aragão E, Souza LEPFD, Netto MB, Teixeira MG, Barreto ML, Ichihara MY, Lima RTDRS. Social distancing measures to control the COVID-19 pandemic: potential impacts and challenges in Brazil. Cien Saude Colet 2020; 25:2423-2446. [PMID: 32520287 DOI: 10.1590/1413-81232020256.1.10502020] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 pandemic has challenged researchers and policy makers to identify public safety measures forpreventing the collapse of healthcare systems and reducingdeaths. This narrative review summarizes the available evidence on the impact of social distancing measures on the epidemic and discusses the implementation of these measures in Brazil. Articles on the effect of social distancing on COVID-19 were selected from the PubMed, medRXiv and bioRvix databases. Federal and state legislation was analyzed to summarize the strategies implemented in Brazil. Social distancing measures adopted by the population appear effective, particularly when implemented in conjunction with the isolation of cases and quarantining of contacts. Therefore, social distancing measures, and social protection policies to guarantee the sustainability of these measures, should be implemented. To control COVID-19 in Brazil, it is also crucial that epidemiological monitoring is strengthened at all three levels of the Brazilian National Health System (SUS). This includes evaluating and usingsupplementary indicators to monitor the progression of the pandemic and the effect of the control measures, increasing testing capacity, and making disaggregated notificationsand testing resultstransparentand broadly available.
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Affiliation(s)
- Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA). R. Basílio da Gama s/no, Canela. 40110-040 Salvador BA Brasil.
| | - Ismael Henrique Silveira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA). R. Basílio da Gama s/no, Canela. 40110-040 Salvador BA Brasil.
| | | | - Rosana Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA). R. Basílio da Gama s/no, Canela. 40110-040 Salvador BA Brasil.
| | | | | | | | | | | | | | - Enny Paixão
- Grupo de síntese da Rede CoVida. Salvador BA Brasil
| | | | | | | | | | | | | | - Naiá Ortelan
- Grupo de síntese da Rede CoVida. Salvador BA Brasil
| | | | | | | | | | - Erika Aragão
- Grupo de síntese da Rede CoVida. Salvador BA Brasil
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26
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Aquino EML, Reichenheim M, Menezes GMS, Araújo TVBD, Alves MTSSBE, Alves SV, Almeida MDCC. Quality assessment of abortion care from the users' perspective: dimensional structure of the QualiAborto-Pt questionnaire. CAD SAUDE PUBLICA 2020; 36Suppl 1:e00197718. [PMID: 32049125 DOI: 10.1590/0102-311x00197718] [Citation(s) in RCA: 2] [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: 10/17/2018] [Accepted: 02/19/2019] [Indexed: 11/22/2022] Open
Abstract
Abortion complications are a major public health problem, and studies to assess the quality of abortion care require adequate measurement tools. This study is a continuation of such an instrument's refinement, the QualiAborto-Pt questionnaire. Using data from a survey of 2,336 women hospitalized for abortion complications in 19 hospitals in three state capitals in Northeast Brazil (Salvador - Bahia, Recife - Pernambuco, and São Luís - Maranhão), we implemented a series of exploratory and confirmatory factor analyses based on a 55-item prototype. The analyses indicate a structure with 17 items in five dimensions: reception, orientation, inputs/physical environment, technical quality, and continuity of care. All the items in the final model displayed acceptable reliability, absence of content redundancy, and factor specificity, as well as theoretical consistency with the respective dimensions. The solution also shows discriminant factor validity. Despite some persistent issues for further analysis and clarification, this version merits recommendation for use in Brazil.
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Affiliation(s)
- Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | - Michael Reichenheim
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Greice M S Menezes
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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Menezes GMS, Aquino EML, Fonseca SC, Domingues RMSM. Abortion and health in Brazil: challenges to research within a context of illegality. CAD SAUDE PUBLICA 2020; 36Suppl 1:e00197918. [PMID: 32049126 DOI: 10.1590/0102-311x00197918] [Citation(s) in RCA: 2] [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: 10/15/2018] [Accepted: 03/13/2019] [Indexed: 11/22/2022] Open
Abstract
Abortion research faces great challenges, even more so in contexts in which it is illegal. Women tend to omit the voluntary termination of pregnancy or to declare having miscarried, which results in an underestimation of abortions. Research on this subject is indispensable because it enables us to estimate the incidence of abortion and its complications, and to identify unmet demands and more vulnerable groups so as to subsidize health actions and policies. In this article, we seek to describe the main challenges faced by researchers through a review of original studies on abortion and our reflections based on empirical studies we have conducted. We discuss the difficulties in obtaining information, strategies and techniques used to increase accuracy and reliability and their limits and advantages, and strategies for estimating the occurrence of abortion and its complications, using direct (interviews and data from medical charts) and indirect (secondary data on mortality and morbidity) methods. When investigating abortion complications, we address studies on mortality and morbidity, emphasizing the specificities of abortion among obstetric causes. We discuss the main indicators used by researchers and methodological aspects of their construction. We make recommendations for overcoming methodological problems and conducting new studies. In the conclusion, we reiterate the relevance of research on abortion and the need for approaches that contemplate its complexity.
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Affiliation(s)
- Greice M S Menezes
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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Goes EF, Menezes GMS, Almeida MDCC, Araújo TVBD, Alves SV, Alves MTSSBE, Aquino EML. Racial vulnerability and individual barriers for Brazilian women seeking first care following abortion. CAD SAUDE PUBLICA 2020; 36Suppl 1:e00189618. [PMID: 32049120 DOI: 10.1590/0102-311x00189618] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 06/17/2019] [Indexed: 11/22/2022] Open
Abstract
Social inequalities in Brazil are reflected in women's search for abortion care, when they face individual, social, and structural barriers and are exposed to situations of vulnerability. Black women are the most heavily exposed to these barriers, from the search for the service to the care itself. The study aimed to analyze factors related to individual barriers in the search for first post-abortion care according to race/color. The study was conducted in Salvador (Bahia State), Recife, (Pernambuco State) and São Luís (Maranhão State), Brazil, with 2,640 patients admitted to public hospitals. Logistic regression was performed to analyze differences according to race/color (white, brown, and black), with "no individual barriers in the search for first care" as the reference category in the dependent variable. Of the women interviewed, 35.7% were black, 53.3% brown, and 11% white. Black women had less schooling, fewer children, and reported more induced abortions (31.1%) and more second-trimester abortions (15.4%). Black women reported more individual barriers in the search for first care (32% vs. 28% in brown women and 20.3% in whites), such as fear of being mistreated and lack of money for transportation. Regression analysis confirmed the association between black and brown race/color and individual barriers in the search for post-abortion care, even after adjusting for all the selected variables. The results confirmed the situation of vulnerability for black women and brown women in Brazil. Racial discrimination in health services and abortion-related stigma can act simultaneously, delaying women's access to health services, a limitation that can further complicate their post-abortion condition.
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Affiliation(s)
| | - Greice M S Menezes
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | | | | | | | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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Fonseca SC, Domingues RMSM, Leal MDC, Aquino EML, Menezes GMS. Legal abortion in Brazil: systematic review of the scientific production, 2008-2018. CAD SAUDE PUBLICA 2020; 36Suppl 1:e00189718. [PMID: 32049121 DOI: 10.1590/0102-311x00189718] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 08/28/2019] [Indexed: 11/22/2022] Open
Abstract
Previous reviews on the subject of abortion in Brazil have estimated one million procedures per year but did not address legal abortion. This systematic review sought to update knowledge regarding legal abortion in terms of service and women's profile, student and doctor knowledge, situations of anencephaly and severe malformations. We searched MEDLINE and LILACS for articles published in all languages between 2008 and 2018. Article quality was assessed using the Joanna Briggs Institute instruments. Search, selection, quality assessment and data extraction were carried out independently by two researchers. We selected 20 articles, 11 on the knowledge and opinion of medical professionals (4 articles) and students (7 articles) revealing a less-than-ideal level of knowledge and a high degree of objection of conscience. Six studies on women who use legal abortion services found that they are young, single and that the main demand was for pregnancy resulting from rape. When women were younger and single and when the aggressor was someone close to them, there were delays in seeking care. Three studies on severe malformation found around 40% of court authorizations. In cases for which no authorization was given, the evolution of pregnancies was complicated and deliveries were done through cesarean sections. Only one article addressed legal abortion services, showing that 37 of the 68 that had been registered were active, lack of services in seven states and concentration in capitals. Knowledge regarding legal abortion is still scarce, the demand for the procedure is repressed and medical training is deficient with regard to this subject.
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Affiliation(s)
- Sandra Costa Fonseca
- Instituto de Saúde Coletiva, Universidade Federal Fluminense, Rio de Janeiro, Brasil
| | | | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | - Greice M S Menezes
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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Reis APD, Góes EF, Pilecco FB, Almeida MDCCD, Diele-Viegas LM, Menezes GMDS, Aquino EML. Desigualdades de gênero e raça na pandemia de Covid-19: implicações para o controle no Brasil. Saúde debate 2020. [DOI: 10.1590/0103-11042020e423] [Citation(s) in RCA: 2] [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] [Indexed: 01/10/2023] Open
Abstract
RESUMO Esta revisão narrativa sintetizou evidências científicas sobre desigualdades de gênero e raça na pandemia de Covid-19, enfocando o trabalho produtivo/reprodutivo das mulheres, a violência de gênero e o acesso aos Serviços de Saúde Sexual e Reprodutiva (SSR). Os resultados confirmam que as desigualdades sociais devem ser consideradas para o efetivo controle da pandemia e para a preservação de direitos. Para além dos efeitos diretos do SARS-CoV-2, discute-se que barreiras de acesso a serviços de SSR podem ocasionar o aumento de gravidezes não pretendidas, abortos inseguros e mortalidade materna. O distanciamento social tem obrigado muitas mulheres a permanecer confinadas com seus agressores e dificultado o acesso a serviços de denúncia, incorrendo no aumento da violência de gênero e em desfechos graves à saúde. Como principais responsáveis pelo cuidado, as mulheres estão mais expostas a adoecer nas esferas profissional e doméstica. A conciliação trabalho-família tornou-se mais difícil para elas durante a pandemia. A literatura naturaliza as diferenças de gênero, raça e classe, com ênfase em fatores de risco. Uma agenda de pesquisa com abordagem interseccional é necessária para embasar a formulação de políticas que incorporem os direitos humanos e atendam às necessidades dos grupos mais vulneráveis à Covid-19.
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Affiliation(s)
- Ana Paula dos Reis
- Universidade Federal da Bahia (UFBA), Brasil; Rede CoVida - Ciência, Informação e Solidariedade, Brasil
| | - Emanuelle Freitas Góes
- Rede CoVida - Ciência, Informação e Solidariedade, Brasil; Fundação Oswaldo Cruz (Fiocruz), Brasil
| | - Flávia Bulegon Pilecco
- Rede CoVida - Ciência, Informação e Solidariedade, Brasil; Universidade Federal de Minas Gerais (UFMG), Brasil
| | | | - Luisa Maria Diele-Viegas
- Rede CoVida - Ciência, Informação e Solidariedade, Brasil; Universidade de Maryland, Estados Unidos da América
| | | | - Estela M. L. Aquino
- Universidade Federal da Bahia (UFBA), Brasil; Rede CoVida - Ciência, Informação e Solidariedade, Brasil
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Domingues RMSM, Fonseca SC, Leal MDC, Aquino EML, Menezes GMS. Aborto inseguro no Brasil: revisão sistemática da produção científica, 2008-2018. CAD SAUDE PUBLICA 2020; 36Suppl 1:e00190418. [DOI: 10.1590/0102-311x00190418] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 08/28/2019] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste estudo é atualizar o conhecimento sobre o aborto inseguro no país. Foi realizada uma revisão sistemática com busca e seleção de estudos via MEDLINE e LILACS, sem restrição de idiomas, no período 2008 a 2018, com avaliação da qualidade dos artigos por meio dos instrumentos elaborados pelo Instituto Joanna Briggs. Foram avaliados 50 artigos. A prevalência de aborto induzido no Brasil foi estimada por método direto em 15% no ano de 2010 e 13% no ano de 2016. Prevalências mais elevadas foram observadas em populações socialmente mais vulneráveis. A razão de aborto induzido por 1.000 mulheres em idade fértil reduziu no período 1995-2013, sendo de 16 por 1.000 em 2013. Metade das mulheres referiu a utilização de medicamentos para a interrupção da gestação e o número de internações por complicações do aborto, principalmente complicações graves, reduziu no período 1992-2009. A morbimortalidade materna por aborto apresentou frequência reduzida, mas alcançou valores elevados em contextos específicos. Há um provável sub-registro de óbitos maternos por aborto. Transtornos mentais comuns na gestação e depressão pós-parto foram mais frequentes em mulheres que tentaram induzir um aborto sem sucesso. Os resultados encontrados indicam que o aborto é usado com frequência no Brasil, principalmente nas regiões menos desenvolvidas e por mulheres socialmente mais vulneráveis. O acesso a métodos mais seguros provavelmente contribuiu para a redução de internações por complicações e para a redução da morbimortalidade por aborto. Entretanto, metade das mulheres ainda recorre a outros métodos e o número de internações por complicações do aborto é ainda elevado.
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Girianelli VR, Tomazelli JG, Nogueira MC, Corrêa CSL, Souza EOD, Gabrielli L, Aquino EML, Guerra MR, Stavola BLD, Dos-Santos-Silva I, Silva GAE. Interobserver reliability in the classification of pairs of records formed by probabilistic linkage of SISMAMA databases. Rev Bras Epidemiol 2019; 22:e190045. [PMID: 31482984 DOI: 10.1590/1980-549720190045] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 07/12/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The study assessed interobserver reliability in the classification of record pairs formed during probabilistic linkage of health-related databases, a key step in the methodology validation to be used in a larger on-going study on inequalities in the access to breast and cervical cancer control activities in Brazil (DAAC-SIS). METHODOLOGY The RecLink software was used to link two databases of the Breast Cancer Control Information System (SISMAMA) in the state of Minas Gerais, Brazil: a reference database, which included 301 screening mammograms with probable benign diagnosis (BI-RADS 3 category) recorded in October 2010, and a database comprising 158,517 mammograms registered in 2011. Subsequently, the 215 pairs of records that were not assigned the maximum RecLink score were independently classified as being true or false by ten independent evaluators from four participating centers. RESULTS The Kappa coefficient ranged from 0.87 to 1.00. Six evaluators were in perfect agreement with one or more evaluators from the other centers. The global Kappa was 0.96 (95% confidence interval - 95%CI 0.94 - 0.99). DISCUSSION Assessment of interobserver reliability is key to ensuring the quality of the record linkage, and it should be routine practice in studies of this nature. The disclosure of such results contributes to transparency in the conduct of such studies and in the reporting of their findings. CONCLUSION Interobserver reliability in this study was excellent, indicating satisfactory team consistency in the classification of record pairs.
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Affiliation(s)
- Vania Reis Girianelli
- Departamento de Direitos Humanos, Saúde e Diversidade Cultural, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz - Campo Grande (MS), Brasil
| | - Jeane Glaucia Tomazelli
- Divisão de Detecção Precoce e Apoio a Organização de Rede, Coordenação Geral de Prevenção e Vigilância, Instituto Nacional de Câncer José Alencar Gomes da Silva - Rio de Janeiro (RJ), Brasil
| | - Mário Círio Nogueira
- Departamento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brasil
| | - Camila Soares Lima Corrêa
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brasil
| | | | - Ligia Gabrielli
- Instituto de Saúde Coletiva, Universidade Federal da Bahia - Salvador (BA), Brasil
| | - Estela M L Aquino
- Programa Integrado em Gênero e Saúde, Instituto de Saúde Coletiva, Universidade Federal da Bahia - Salvador (BA), Brasil
| | - Maximiliano Ribeiro Guerra
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brasil
- Centre de Recherche U900, Epidémiologie des Cancer, Institut Curie - Paris, França
| | - Bianca Lucia De Stavola
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health - Londres, Inglaterra
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine - Londres, Inglaterra
| | - Gulnar Azevedo E Silva
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
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Chor D, Pereira A, Pacheco AG, Santos RV, Fonseca MJM, Schmidt MI, Duncan BB, Barreto SM, Aquino EML, Mill JG, Molina MD, Giatti L, Almeida MD, Bensenor I, Lotufo PA. Context-dependence of race self-classification: Results from a highly mixed and unequal middle-income country. PLoS One 2019; 14:e0216653. [PMID: 31095585 PMCID: PMC6522012 DOI: 10.1371/journal.pone.0216653] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/25/2019] [Indexed: 02/07/2023] Open
Abstract
Ethnic-racial classification criteria are widely recognized to vary according to historical, cultural and political contexts. In Brazil, the strong influence of individual socio-economic factors on race/colour self-classification is well known. With the expansion of genomic technologies, the use of genomic ancestry has been suggested as a substitute for classification procedures such as self-declaring race, as if they represented the same concept. We investigated the association between genomic ancestry, the racial composition of census tracts and individual socioeconomic factors and self-declared race/colour in a cohort of 15,105 Brazilians. Results show that the probability of self-declaring as black or brown increases according to the proportion of African ancestry and varies widely among cities. In Porto Alegre, where most of the population is white, with every 10% increase in the proportion of African ancestry, the odds of self-declaring as black increased 14 times (95%CI 6.08-32.81). In Salvador, where most of the population is black or brown, that increase was of 3.98 times (95%CI 2.96-5.35). The racial composition of the area of residence was also associated with the probability of self-declaring as black or brown. Every 10% increase in the proportion of black and brown inhabitants in the residential census tract increased the odds of self-declaring as black by 1.33 times (95%CI 1.24-1.42). Ancestry alone does not explain self-declared race/colour. An emphasis on multiple situational contexts (both individual and collective) provides a more comprehensive framework for the study of the predictors of self-declared race/colour, a highly relevant construct in many different scenarios, such as public policy, sociology and medicine.
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Affiliation(s)
- Dóra Chor
- Department of Epidemiology and Quantitative Methods, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
- * E-mail:
| | - Alexandre Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo, São Paulo, SP, Brazil
| | - Antonio G. Pacheco
- Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, RJ Brazil
| | - Ricardo V. Santos
- Department of Epidemiology and Quantitative Methods, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
- Department of Anthropology, Museu Nacional, Rio de Janeiro, RJ Brazil
| | - Maria J. M. Fonseca
- Department of Epidemiology and Quantitative Methods, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Maria I. Schmidt
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Bruce B. Duncan
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Sandhi M. Barreto
- Faculty of Medicine & Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Estela M. L. Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, BA Brazil
| | - José G. Mill
- Department of Physiological Sciences, Federal University of Espirito Santo, Vitória, ES Brazil
| | - Maria delCB Molina
- Department of Physiological Sciences, Federal University of Espirito Santo, Vitória, ES Brazil
| | - Luana Giatti
- Faculty of Medicine & Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | | | - Isabela Bensenor
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, SP Brazil
| | - Paulo A. Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, SP Brazil
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Patrão AL, Almeida MDC, Matos SMA, Goes EF, Nogueira C, Aquino EML. Association Between Perceived Discrimination and Alcohol and Tobacco Consumption in ELSA-Brasil Cohort: Focusing on Gender Differences. Subst Use Misuse 2019; 54:1214-1225. [PMID: 30799670 DOI: 10.1080/10826084.2019.1573838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND Discrimination is detrimental to physical and mental health, particularly insofar as health-risk behaviors are concerned. Particular attention has been paid to excess alcohol consumption and smoking in view of the ready availability of these substances in Western societies. OBJECTIVES To determine whether an association exists between perceived discrimination and excess alcohol intake and smoking in women and men enrolled in the ELSA-Brasil cohort study. METHODS The sample included in the ELSA-Brasil cohort consisted of 15,105 civil servants. Data from waves 1 and 2 of the study were used. A multidimensional questionnaire was used to collect sociodemographic characteristics and evaluate perceived discrimination, alcohol consumption, and smoking. RESULTS An association was found between excess alcohol intake and perceived discrimination only in the men, with this association remaining significant in the youngest age group, in university-educated individuals, and in the group classified as middle-class. An association was found between smoking and lifetime perceived discrimination in women, particularly in those ≥60 years of age, brown-skinned women, those who had completed elementary school, and those classified as upper social class. This same association was found in the men, mainly those of 50-59 years of age, white-skinned males, those who had completed high school, those with a university education, and those classified as upper social class. Conclusions/Importance: Investing in public health policies aimed at combating the different forms of discrimination would appear essential. Not only does discrimination contribute to social injustice, but it also encourages health-risk behaviors such as excess alcohol intake and smoking.
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Affiliation(s)
- Ana Luísa Patrão
- a Institute of Collective Health , Federal University of Bahia , Salvador , Brazil
| | | | - Sheila M Alvim Matos
- a Institute of Collective Health , Federal University of Bahia , Salvador , Brazil
| | | | - Conceição Nogueira
- c c Faculty of Psychology and Educational Sciences , Porto University , Porto , Portugal
| | - Estela M L Aquino
- a Institute of Collective Health , Federal University of Bahia , Salvador , Brazil
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Pinto KA, Griep RH, Rotenberg L, Almeida MDCC, Barreto RS, Aquino EML. Correction: Gender, time use and overweight and obesity in adults: Results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). PLoS One 2018; 13:e0198380. [PMID: 30089108 PMCID: PMC6082505 DOI: 10.1371/journal.pone.0198380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0194190.].
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Araújo TVBD, Aquino EML, Menezes GMS, Alves MTSSDBE, Almeida MDCC, Alves SV, Coimbra L, Campbell OMR. Delays in access to care for abortion-related complications: the experience of women in Northeast Brazil. CAD SAUDE PUBLICA 2018; 34:e00168116. [PMID: 29952404 DOI: 10.1590/0102-311x00168116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/04/2017] [Indexed: 11/22/2022] Open
Abstract
Around 18 million unsafe abortions occur in low and middle-income countries and are associated with numerous adverse consequences to women's health. The time taken by women with complications to reach facilities where they can receive appropriate post-abortion care can influence the risk of death and the extent of further complications. All women aged 18+ admitted for abortion complications to public-sector hospitals in three capital cities in the Northeastern Brazil between August-December 2010 were interviewed; medical records were extracted (N = 2,804). Nearly all women (94%) went straight to a health facility, mainly to a hospital (76.6%); the rest had various care-seeking paths, with a quarter visiting 3+ hospitals. Women waited 10 hours on average before deciding to seek care. 29% reported difficulties in starting to seek care, including facing challenges in organizing childcare, a companion or transport (17%) and fear/stigma (11%); a few did not initially recognize they needed care (0.4%). The median time taken to arrive at the ultimate facility was 36 hours. Over a quarter of women reported experiencing difficulties being admitted to a hospital, including long waits (15%), only being attended after pregnant women (8.9%) and waiting for a bed (7.4%). Almost all women (90%) arrived in good condition, but those with longer delays were more likely to have (mild or severe) complications. In Brazil, where access to induced abortion is restricted, women face numerous difficulties receiving post-abortion care, which contribute to delay and influence the severity of post-abortion complications.
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Affiliation(s)
| | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | - Greice M S Menezes
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | | | | | | | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, U.K
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Abstract
Various behaviors are considered health enhancing. Nevertheless, according to the current scientific literature, four health behaviors are considered particularly risky in view of their association with a group of chronic diseases: 1) smoking; 2) excessive alcohol consumption; 3) poor diet; and 4) lack of physical activity. Theoretically, it should be possible to make improvements to one's health by maximizing the number of healthy behaviors and minimizing the unhealthy ones. However, in reality, the different behaviors interconnect to create more complex lifestyles. Therefore, the objective of this paper is to present the construction of a lifestyle indicator based on health behaviors selected in the ELSA-Brazil study. This indicator revealed two lifestyles: less healthy and healthier lifestyles. The model proved adequate and was confirmed using latent class analysis (LCA). Agreement was 83.2 between the indicator and the LCA results, with a kappa coefficient of 0.65. Women were more likely to have a healthier lifestyle than men, reinforcing the scientific consistency of the indicator, since this finding is in agreement with data from the scientific literature. The indicator created to define lifestyle was found to have scientific consistency and validity; therefore, its use can be recommended for future population-based studies concerning the promotion of health and healthy lifestyles.
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Affiliation(s)
- Ana Luísa Patrão
- Institute of Collective Health - Federal University of Bahia, Brazil
| | | | - Sheila Alvim
- Institute of Collective Health - Federal University of Bahia, Brazil
| | - Dora Chor
- Oswaldo Cruz Foundation - Fiocruz (Rio de Janeiro), Brazil
| | - Estela M L Aquino
- Institute of Collective Health - Federal University of Bahia, Brazil
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Pinto KA, Griep RH, Rotenberg L, Almeida MDCC, Barreto RS, Aquino EML. Gender, time use and overweight and obesity in adults: Results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). PLoS One 2018. [PMID: 29534115 PMCID: PMC5849321 DOI: 10.1371/journal.pone.0194190] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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] [Indexed: 12/21/2022] Open
Abstract
Perceived time constraints have been highlighted in sociological studies as representing a core issue in determining quality of life. The objective of this study was to test the hypothesis that gender inequalities regarding insufficiency of time play a role in the development of overweight and obesity in adults. The study used baseline data (2008–2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), which monitors a cohort of 15,105 civil servants of 35 to 74 years of age. Insufficient time for personal care and leisure due to professional and domestic duties, as detailed in a structured questionnaire, comprised the main exposure variable. The outcome variable was overweight/obesity measured according to body mass index. Prevalence ratios were calculated using multinomial logistic regression. A greater proportion of women compared to men reported insufficient time for personal care and leisure (34.5% versus 23.8%, respectively). The prevalence of overweight was greater in men, while obesity was more common in women. Insufficient time for personal care and leisure was associated with overweight (PR = 1.29; 95% CI: 1.04–1.61) and obesity (PR = 1.65; 95% CI: 1.28–2.12) only in women working over 40 hours/week. No significant association was found for males. These results suggest that the length of the working week influences factors underlying weight gain, possibly issues linked to behavior and/or stress mechanisms. The fact that such an association was restricted to women suggests that the results originate from gender inequalities involving relationships between time and health. The findings of this study provide data on which to base public policies aimed at encouraging the redistribution of domestic responsibilities in the direction of gender equity, as well as macrosocial policies such as providing public schools for workers’ children.
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Affiliation(s)
| | - Rosane Harter Griep
- Laboratory of Health and Environmental Education, Oswaldo Cruz Institute (Fiocruz), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucia Rotenberg
- Laboratory of Health and Environmental Education, Oswaldo Cruz Institute (Fiocruz), Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rosane Sousa Barreto
- Climério de Oliveira Maternity Hospital, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Estela M L Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
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Pitanga FJG, Matos SMA, Almeida MDC, Barreto SM, Aquino EML. Leisure-Time Physical Activity, but not Commuting Physical Activity, is Associated with Cardiovascular Risk among ELSA-Brasil Participants. Arq Bras Cardiol 2018; 110:36-43. [PMID: 29412240 PMCID: PMC5831300 DOI: 10.5935/abc.20170178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 11/24/2016] [Accepted: 07/04/2017] [Indexed: 12/04/2022] Open
Abstract
Background Despite reports in the literature that both leisure-time physical activity
(LTPA) and commuting physical activity (CPA) can promote health benefits,
the literature lacks studies comparing the associations of these domains of
physical activity with cardiovascular risk scores. Objective To investigate the association between LTPA and CPA with different
cardiovascular risk scores in the cohort of the Longitudinal Study of Adult
Health ELSA-Brasil. Methods Cross-sectional study with data from 13,721 participants of both genders,
aged 35-74 years, free of cardiovascular disease, from ELSA Brazil. Physical
activity was measured using the International Physical Activity
Questionnaire (IPAQ). Five cardiovascular risk scores were used: Framingham
score - coronary heart disease (cholesterol); Framingham score - coronary
heart disease (LDL-C); Framingham score - cardiovascular disease
(cholesterol); Framingham score - cardiovascular disease (body mass index,
BMI); and pooled cohort equations for atherosclerotic cardiovascular disease
(ASCVD). Associations adjusted for confounding variables between physical
activity and different cardiovascular risk scores were analyzed by logistic
regression. Confidence interval of 95% (95%CI) was considered. Results LTPA is inversely associated with almost all cardiovascular risk scores
analyzed, while CPA shows no statistically significant association with any
of them. Dose-response effect in association between LTPA and cardiovascular
risk scores was also found, especially in men. Conclusions LTPA was shown to be associated with the cardiovascular risk scores analyzed,
but CPA not. The amount of physical activity (duration and intensity) was
more significantly associated, especially in men, with cardiovascular risk
scores in ELSA-Brasil.
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Fonseca MDJMD, Juvanhol LL, Rotenberg L, Nobre AA, Griep RH, Alves MGDM, Cardoso LDO, Giatti L, Nunes MA, Aquino EML, Chor D. Using Gamma and Quantile Regressions to Explore the Association between Job Strain and Adiposity in the ELSA-Brasil Study: Does Gender Matter? Int J Environ Res Public Health 2017; 14:ijerph14111404. [PMID: 29149021 PMCID: PMC5708043 DOI: 10.3390/ijerph14111404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 11/16/2022]
Abstract
This paper explores the association between job strain and adiposity, using two statistical analysis approaches and considering the role of gender. The research evaluated 11,960 active baseline participants (2008-2010) in the ELSA-Brasil study. Job strain was evaluated through a demand-control questionnaire, while body mass index (BMI) and waist circumference (WC) were evaluated in continuous form. The associations were estimated using gamma regression models with an identity link function. Quantile regression models were also estimated from the final set of co-variables established by gamma regression. The relationship that was found varied by analytical approach and gender. Among the women, no association was observed between job strain and adiposity in the fitted gamma models. In the quantile models, a pattern of increasing effects of high strain was observed at higher BMI and WC distribution quantiles. Among the men, high strain was associated with adiposity in the gamma regression models. However, when quantile regression was used, that association was found not to be homogeneous across outcome distributions. In addition, in the quantile models an association was observed between active jobs and BMI. Our results point to an association between job strain and adiposity, which follows a heterogeneous pattern. Modelling strategies can produce different results and should, accordingly, be used to complement one another.
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Affiliation(s)
- Maria de Jesus Mendes da Fonseca
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil.
| | | | - Lúcia Rotenberg
- Laboratory of Health and Environment Education, Oswaldo Cruz Fundation, Rio de Janeiro 21040-900, Brazil.
| | - Aline Araújo Nobre
- Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil.
| | - Rosane Härter Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Fundation, Rio de Janeiro 21040-900, Brazil.
| | | | - Letícia de Oliveira Cardoso
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil.
| | - Luana Giatti
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte 30310-100, Brazil.
| | - Maria Angélica Nunes
- Pos graduate program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil.
| | - Estela M L Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador 40110-040, Brazil.
| | - Dóra Chor
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil.
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de Matos SMA, Pitanga FJG, Almeida MDCC, Queiroz CO, dos Santos CA, de Almeida RT, da Silva ITM, Griep RH, Amorim LDAF, Patrão AL, Aquino EML. What Factors Explain Bicycling and Walking for Commuting by ELSA-Brasil Participants? Am J Health Promot 2017; 32:646-656. [DOI: 10.1177/0890117117738400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: To analyze the factors associated with commuting by bicycling and walking in adult participants from ELSA-Brasil (Longitudinal Study of Adult Health). Design: Cross-sectional. Setting: Six teaching/research institutions throughout Brazil. Participants: A total of 15 105 civil servants. Measures: Commuting by bicycling and walking was analyzed using the long-form International Physical Activity Questionnaire. Analysis: A hierarchical model containing possible factors associated with commuting by bicycling and walking was constructed. Crude and adjusted odds ratios were calculated using multinomial logistic regression. Results: Considering the 2 forms of commuting, 66% of the participants were being considered inactive or insufficiently active. In women, being “heavier,” feeling unsafe practicing physical activity, and being a former smoker were factors negatively associated with commuting by bicycling and walking. In men, active commuting was less common among those who were overweight or had abdominal obesity, those with a negative perception of safety, and those reporting that there was nowhere suitable in the neighborhood to practice physical activity. Conclusion: Obesity and negative perceptions in the neighborhood are associated with inactive or insufficiently active commuting. The relevance of this finding for public health is reinforce developing policies aimed at promoting health in Brazil and in other countries with similar characteristics.
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Affiliation(s)
| | | | | | | | - Clarice Alves dos Santos
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
- Department of Biological Sciences, State University of Southwestern Bahia (UESB), Jequié, Bahia, Brazil
| | - Rogerio Tosta de Almeida
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
- Department of Health, State University of Feira de Santana (UEFS), Feira de Santana, Bahia, Brazil
| | | | - Rosane Harter Griep
- Laboratory of Education in Environment and Health, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Ana Luísa Patrão
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Estela M. L. Aquino
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
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Patrão AL, Almeida MDC, Matos SMA, Chor D, Aquino EML. Gender and psychosocial factors associated with healthy lifestyle in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort: a cross-sectional study. BMJ Open 2017; 7:e015705. [PMID: 28851775 PMCID: PMC5724152 DOI: 10.1136/bmjopen-2016-015705] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES It has been estimated that over 50% of the premature deaths occurring in Western countries can be attributed to causes rooted in lifestyle. In turn, leading a healthy lifestyle has also been associated with a wide range of psychosocial factors. Today, it is known that these differ among men and women. The present article aimed to identify, from a gender-based perspective, the psychosocial factors associated with healthy lifestyles in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort, the largest study concerning adult health conducted in Latin America to date. DESIGN This cross-sectional study was conducted using ELSA-Brasil baseline data, collected between 2008 and 2010. SETTING Six Brazilian public higher education and research institutions. PARTICIPANTS The ELSA-Brasil cohort consists of approximately 15 000 employees (8218 women and 6887 men), both currently working and retired. MAIN OUTCOME MEASURES The lifestyle indicator was constructed by summing the scores attributed to four different behaviours. RESULTS The women of the ELSA-Brasil cohort have healthier lifestyles than men. In women, strong associations were found between a healthy lifestyle and age 60 years or older, Asian race and university level of education or higher. In men, being 60 years or older, of Asian or Caucasian race, having a high-school equivalent level of education or higher, being retired, having a housekeeper, having a good or very good self-perception of health and being satisfied with body image were the psychosocial factors associated with leading a healthy lifestyle. CONCLUSIONS The factors that influenced healthy lifestyles were found to differ among men and women, a fact that must be addressed when developing programmes designed to promote health.
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Affiliation(s)
- Ana Luísa Patrão
- Institute of Collective Health, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | - Dora Chor
- FIOCRUZ, Oswaldo Cruz Foundation, National School of Public Health, Rio de Janeiro, Brazil
| | - Estela M L Aquino
- Institute of Collective Health, Universidade Federal da Bahia, Salvador, Brazil
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Burgard S, de Pina Castiglione D, Lin KY, Nobre AA, Aquino EML, Pereira AC, Martins Bensenor IJ, Barreto SM, Chor D. Differential reporting of discriminatory experiences in Brazil and the United States. CAD SAUDE PUBLICA 2017; 33Suppl 1:e00110516. [PMID: 28492709 PMCID: PMC10497239 DOI: 10.1590/0102-311x00110516] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/28/2016] [Accepted: 11/07/2016] [Indexed: 11/22/2022] Open
Abstract
There has been little cross-national comparison of perceived discrimination, and few studies have considered how intersectional identities shape perception of discriminatory treatment in different societies. Using data from the ELSA-Brasil, a study of Brazilian civil servants, and the Americans' Changing Lives Study, a nationally-representative sample of U.S. adults, we compare reports of lifetime discrimination among race-by-gender groups in each society. We also consider whether educational attainment explains any group differences, or if differences across groups vary by level of education. Results reveal higher lifetime discrimination experiences among Black respondents in both countries, especially Black men, than among Whites, and lower reports among White women than White men. Brown men and women also reported higher levels than White men in Brazil. For all race-by-gender groups in both countries, except Brazilian White men, reports of discrimination were higher among the more educated, though adjusting for educational differences across groups did not explain group differences. In Brazil, we found the greatest racial disparities among the college educated, while U.S. Black men were more likely to report discrimination than White men at all levels of education. Results reveal broad similarities across countries, despite important differences in their histories, and an intersectional approach contributed to identification of these similarities and some differences in discrimination experiences. These findings have implications for social and public health surveillance and intervention to address the harmful consequences of discrimination.
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Affiliation(s)
- Sarah Burgard
- Department of Sociology, University of Michigan, Ann Arbor, U.S.A
| | | | - Katherine Y. Lin
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, U.S.A
| | - Aline A. Nobre
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Estela M. L. Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | - Alexandre C. Pereira
- Laboratório de Cardiologia Genética e Molecular, Universidade de São Paulo, São Paulo, Brasil
| | | | - Sandhi M. Barreto
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Dora Chor
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Pinto KA, Menezes GMDS, Griep RH, Lima KTRDS, Almeida MDC, Aquino EML. Work-family conflict and time use: psychometric assessment of an instrument in ELSA-Brazil. Rev Saude Publica 2016; 50:S0034-89102016000100704. [PMID: 27384968 PMCID: PMC4926953 DOI: 10.1590/s1518-8787.2016050005892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 10/01/2014] [Accepted: 09/04/2015] [Indexed: 11/28/2022] Open
Abstract
In this study, we evaluated the psychometric properties of the items to measure the work-family conflict and the time use for personal care and leisure, included in the baseline questionnaire of the Longitudinal Study of Adult Health (ELSA-Brazil). We evaluated temporal stability (7-14 days) using kappa statistic and the validity of the construct by the correlation of Kendall’s tau with other variables. Test-retest stability was discreet to moderate and the correlations were compatible with the underlying theory. Future studies in the context of ELSA-Brazil and in other populations will complement the assessment of its relevance.
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Affiliation(s)
| | - Greice Maria de Souza Menezes
- MUSA Programa Integrado em Gênero e Saúde. Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil
| | - Rosane Härter Griep
- Laboratório de Educação em Ambiente e Saúde. Instituto Oswaldo Cruz. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | | | - Maria da Conceição Almeida
- MUSA Programa Integrado em Gênero e Saúde. Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil
| | - Estela M L Aquino
- MUSA Programa Integrado em Gênero e Saúde. Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil
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Pitanga FJG, Matos SMA, Almeida MDC, Molina MDCB, Aquino EML. Factors associated with leisure time physical activity among ELSA-Brasil participants: Ecological model. Prev Med 2016; 90:17-25. [PMID: 27343402 DOI: 10.1016/j.ypmed.2016.06.020] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 11/28/2022]
Abstract
The main objective of the study was identify the prevalence and factors associated with leisure time physical activity (LTPA) in adult participants of the Longitudinal Study of Adult Health (ELSA-Brasil). The LTPA was measured using the International Physical Activity Questionnaire (IPAQ), long version. A hierarchical ecological model was built with the possible factors associated with LTPA distributed across blocks. We estimated crude and adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) using logistic regression. In men, being more educated, having a high family income, living in environments with conditions and opportunities for PA, being retired and being overweight were positively associated, while current smoking, obesity and abdominal obesity were associated negatively with the LTPA. Among women, being over 60years old, being more educated, having a high family income, living in an environment with conditions and opportunities for PA practice and being retired were positively associated, while being overweight, obese and having abdominal obesity were associated negatively with the LTPA. The proposed ecological model explains the LTPA through the social, physical and personal environment and highlights gender differences in physical activity.
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Affiliation(s)
| | | | | | | | - Estela M L Aquino
- Instituto de Saúde Coletiva. Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
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Chor D, Cardoso LO, Nobre AA, Griep RH, Fonseca MDJM, Giatti L, Bensenor I, del Carmen Bisi Molina M, Aquino EML, Diez-Roux A, de Pina Castiglione D, Santos SM. Association between perceived neighbourhood characteristics, physical activity and diet quality: results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). BMC Public Health 2016; 16:751. [PMID: 27506819 PMCID: PMC4977638 DOI: 10.1186/s12889-016-3447-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/05/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The study explores associations between perceived neighbourhood characteristics, physical activity and diet quality, which in Latin America and Brazil have been scarcely studied and with inconsistent results. METHODS We conducted a cross-sectional analysis of 14,749 individuals who participated in the Brazilian Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil) baseline. The study included current and retired civil servants, aged between 35 and 74 years, from universities and research institutes in six Brazilian states. The International Physical Activity Questionnaire (IPAQ) long form was used to characterize physical activity during leisure time and commuting; additional questions assessed how often fruit and vegetables were consumed, as a proxy for diet quality. Neighbourhood characteristics were evaluated by the "Walking Environment" and "Availability of Healthy Foods" scales originally used in the Multi-Ethnic Study of Atherosclerosis (MESA). Associations were examined using multinomial logistic regression. RESULTS Perceiving a more walkable neighbourhood was positively associated with engaging in leisure time physical activity and doing so for longer weekly. Compared with those who saw their neighbourhood as less walkable, those who perceived it as more walkable had 1.69 (95 % CI 1.57-1.83) and 1.39 (1.28-1.52) greater odds of engaging in leisure time physical activity for more than 150 min/week or up to 150 min/week (vs. none), respectively. Perceiving a more walkable neighbourhood was also positively associated with transport-related physical activity. The same pattern was observed for diet: compared with participants who perceived healthy foods as less available in their neighbourhood, those who saw them as more available had odds 1.48 greater (1.31-1.66) of eating fruits, and 1.47 greater (1.30-1.66) of eating vegetables, more than once per day. CONCLUSIONS Perceived walkability and neighbourhood availability of healthy food were independently associated with the practice of physical activity and diet quality, respectively, underlining the importance of neighbourhood-level public policies to changing and maintaining health-related habits.
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Affiliation(s)
- Dóra Chor
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ Brazil
| | | | - Aline Araújo Nobre
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, RJ Brazil
| | - Rosane Härter Griep
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, 21040–360 RJ Brazil
| | | | - Luana Giatti
- Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, MG Brazil
| | - Isabela Bensenor
- Hospital Universitário, Universidade de São Paulo, São Paulo, SP Brazil
| | | | - Estela M. L. Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia Brazil
| | - Ana Diez-Roux
- School of Public Health, Drexel University, Philadelphia, PA USA
| | | | - Simone M. Santos
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ Brazil
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Campbell OMR, Aquino EML, Vwalika B, Gabrysch S. Signal functions for measuring the ability of health facilities to provide abortion services: an illustrative analysis using a health facility census in Zambia. BMC Pregnancy Childbirth 2016; 16:105. [PMID: 27180000 PMCID: PMC4868015 DOI: 10.1186/s12884-016-0872-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 05/13/2015] [Accepted: 04/14/2016] [Indexed: 11/26/2022] Open
Abstract
Background Annually, around 44 million abortions are induced worldwide. Safe termination of pregnancy (TOP) services can reduce maternal mortality, but induced abortion is illegal or severely restricted in many countries. All abortions, particularly unsafe induced abortions, may require post-abortion care (PAC) services to treat complications and prevent future unwanted pregnancy. We used a signal-function approach to look at abortion care services and illustrated its utility with secondary data from Zambia. Methods We refined signal functions for basic and comprehensive TOP and PAC services, including family planning (FP), and assessed functions currently being collected via multi-country facility surveys. We then used the 2005 Zambian Health Facility Census to estimate the proportion of 1369 health facilities that could provide TOP and PAC services under three scenarios. We linked facility and population data, and calculated the proportion of the Zambian population within reach of such services. Results Relevant signal functions are already collected in five facility assessment tools. In Zambia, 30 % of facilities could potentially offer basic TOP services, 3.7 % comprehensive TOP services, 2.6 % basic PAC services, and 0.3 % comprehensive PAC services (four facilities). Capability was highest in hospitals, except for FP functions. Nearly two-thirds of Zambians lived within 15 km of a facility theoretically capable of providing basic TOP, and one-third within 15 km of comprehensive TOP services. However, requiring three doctors for non-emergency TOP, as per Zambian law, reduced potential access to TOP services to 30 % of the population. One-quarter lived within 15 km of basic PAC and 13 % of comprehensive PAC services. In a scenario not requiring FP functions, one-half and one-third of the population were within reach of basic and comprehensive PAC respectively. There were huge urban-rural disparities in access to abortion care services. Comprehensive PAC services were virtually unavailable to the rural population. Conclusions Secondary data from facility assessments can highlight gaps in abortion service provision and coverage, but it is necessary to consider TOP and PAC separately. This approach, especially when combined with population data using geographic coordinates, can also be used to model the impact of various policy scenarios on access, such as requiring three medical doctors for non-emergency TOP. Data collection instruments could be improved with minor modifications and used for multi-country comparisons.
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Affiliation(s)
- Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Estela M L Aquino
- Universidade Federal da Bahia, Instituto de Saúde Coletiva, MUSA-Programa Integrado em Gênero e Saúde, Salvador, Bahia, Brazil
| | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, University of Zambia, Lusaka, Zambia
| | - Sabine Gabrysch
- Institute of Public Health, Ruprecht-Karls-Universität, Heidelberg, Germany
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48
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Aquino EML, Almeida MDCC, Menezes GMS, de Figueiredo RC, Bensenor IM, Mengue SS, da Fonseca MDJM, Gabrielli L. Postmenopausal hormone therapy in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): who still uses it? Pharmacoepidemiol Drug Saf 2016; 25:609-17. [DOI: 10.1002/pds.3992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 01/26/2016] [Accepted: 02/08/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Estela M. L. Aquino
- Instituto de Saúde Coletiva; Universidade Federal da Bahia; Salvador Bahia Brazil
| | | | - Greice M. S. Menezes
- Instituto de Saúde Coletiva; Universidade Federal da Bahia; Salvador Bahia Brazil
| | | | | | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina; Universidade Federal do Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | | | - Ligia Gabrielli
- Instituto de Saúde Coletiva; Universidade Federal da Bahia; Salvador Bahia Brazil
- Centro de Diabetes e Endocrinologia do Estado da Bahia; Secretaria de Saúde do Estado da Bahia; Salvador Bahia Brazil
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49
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Azevedo E Silva G, Bustamante-Teixeira MT, Aquino EML, Tomazelli JG, Dos-Santos-Silva I. [Access to early breast cancer diagnosis in the Brazilian Unified National Health System: an analysis of data from the Health Information System]. CAD SAUDE PUBLICA 2015; 30:1537-50. [PMID: 25166949 DOI: 10.1590/0102-311x00156513] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/09/2014] [Indexed: 11/21/2022] Open
Abstract
The recent reduction in breast cancer mortality in high-income countries resulted from improvements in early detection and treatment. Breast cancer is the most common cancer in Brazilian women. Since 2004, the government has recommended annual clinical breast examination for women aged ≥ 40 years and biannual mammograms for those aged 50-69. This article investigates the degree of implementation of these guidelines using data from the Brazilian Unified National Health System for 2010 according to major geographic region and age group. The findings showed low national mammogram coverage in the target population (32% in the 50-59-year group; 25% from 60 to 69 years). The percentage of women with abnormal radiological findings who underwent biopsy was also low (27% for 50-59 years; 63% for 60-69 years). The number of breast cancer surgeries exceeded the number of cases detected by mammography but was well below the estimated number of incident breast cancer cases in 2010. There are striking regional inequalities in access to early detection and surgery, being the lowest access in the North Region and the highest in the South Region.
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Affiliation(s)
- Gulnar Azevedo E Silva
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
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Abstract
OBJECTIVE The measurement of excess body hair is not straightforward. As the modified Ferriman-Gallwey (mFG) score is unsuitable for self-assessment and requires specialist training, a short, self-administered questionnaire to identify hirsutism was constructed and validated for large-scale application, particularly targeting population-based studies. DESIGN A validation study was conducted to assess a new hirsutism questionnaire. METHODS A total of 90 women aged 35-72 years who were enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were evaluated. A self-administered instrument containing four questions was designed to evaluate five body areas: upper lip, chin, chest, lower abdomen, and thighs with respect to the current distribution of body hair and that before 35 years of age. A score of 0-4 was attributed to each region based on drawings provided in the instrument. Test-retest reliability was evaluated by reformulating the initial questions. An independent medical examination was conducted to apply the gold standard, the mFG score. RESULTS The area under the receiver operating characteristic curve was 0.93 (95% CI: 0.87-0.99). A cut-off score of 5 showed the best balance between sensitivity (85%) and specificity (90%), with 88.9% accuracy. Spearman's correlation between current and past body hair score was calculated at 0.82 (P=0.000), and showed a test-retest reliability of 0.49, with a trend toward similar answers regarding changes in the quantity of body hair over time, irrespective of how the questions were asked (P=0.000). CONCLUSION The accuracy and internal consistency of this self-administered questionnaire for the identification of hirsutism were good. Therefore, this questionnaire represents a useful tool for self-assessment of hirsutism in population-based studies.
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Affiliation(s)
- Ligia Gabrielli
- Institute of Collective HealthFederal University of Bahia, Rua Basílio da Gama, s/n, Campus Universitário do Canela, 40110-040 Salvador, Bahia, BrazilBahia State Center for Diabetes and EndocrinologyAvenida ACM, s/n, Iguatemi, 40275-350 Salvador, Bahia, Brazil Institute of Collective HealthFederal University of Bahia, Rua Basílio da Gama, s/n, Campus Universitário do Canela, 40110-040 Salvador, Bahia, BrazilBahia State Center for Diabetes and EndocrinologyAvenida ACM, s/n, Iguatemi, 40275-350 Salvador, Bahia, Brazil
| | - Estela M L Aquino
- Institute of Collective HealthFederal University of Bahia, Rua Basílio da Gama, s/n, Campus Universitário do Canela, 40110-040 Salvador, Bahia, BrazilBahia State Center for Diabetes and EndocrinologyAvenida ACM, s/n, Iguatemi, 40275-350 Salvador, Bahia, Brazil
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