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Dilélio AS, Natividade M, Facchini LA, Pereira M, Tomasi E. Structure and process in primary health care for children and spatial distribution of infant mortality. Rev Saude Publica 2024; 58:21. [PMID: 38747869 PMCID: PMC11090610 DOI: 10.11606/s1518-8787.2024058005527] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/04/2023] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE To identify the spatial patterns of the quality of the structure of primary health care services and the teams' work process and their effects on infant mortality in Brazil. METHODS An ecological study of spatial aggregates, using the 5,570 municipalities in Brazil as the unit of analysis. Secondary databases from the Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB - National Program for Improving Access and Quality of Primary Care), the Mortality Information System (SIM), and the Live Birth Information System (SINASC) were used. In 2018, the infant mortality rate was the outcome of the study, and the exposure variables were the proportion of basic health units (BHU) with adequate structure and work processes. Global and local Moran's indices were used to evaluate the degree of dependence and spatial autocorrelation. Spatial linear regression was used for data analysis. RESULTS In 2018, in Brazil, the infant mortality rate was 12.4/1,000 live births, ranging from 10.6/1,000 and 11.2/1,000 in the South and Southeast, respectively, to 14.1/1,000 and 14.5/1,000 in the Northeast and North regions, respectively. The proportion of teams with an adequate work process (β = -3.13) and the proportion of basic health units with an adequate structure (β = -0.34) were associated with a reduction in the infant mortality rate. Spatial autocorrelation was observed between smoothed mean infant mortality rates and indicators of the structure of primary health care services and the team's work process, with higher values in the North and Northeast of Brazil. CONCLUSIONS There is a relationship between the structure of primary health care services and the teams' work process with the infant mortality rate. In this sense, investment in the qualification of health care within the scope of primary health care can have an impact on reducing the infant mortality rate and improving child health care.
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Affiliation(s)
- Alitéia Santiago Dilélio
- Universidade Federal de PelotasFaculdade de EnfermagemPrograma de Pós-Graduação em EnfermagemPelotasRSBrasil Universidade Federal de Pelotas. Faculdade de Enfermagem. Programa de Pós-Graduação em Enfermagem. Pelotas, RS, Brasil.
| | - Márcio Natividade
- Universidade Federal da BahiaInstituto de Saúde ColetivaPrograma de Pós-Graduação em Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Programa de Pós-Graduação em Saúde Coletiva. Salvador, BA, Brasil.
| | - Luiz Augusto Facchini
- Universidade Federal de PelotasFaculdade de MedicinaPrograma de Pós-Graduação em EpidemiologiaPelotasRSBrazil Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brazil.
| | - Marcos Pereira
- Universidade Federal da BahiaInstituto de Saúde ColetivaPrograma de Pós-Graduação em Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Programa de Pós-Graduação em Saúde Coletiva. Salvador, BA, Brasil.
| | - Elaine Tomasi
- Universidade Federal de PelotasFaculdade de MedicinaPrograma de Pós-Graduação em EpidemiologiaPelotasRSBrazil Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brazil.
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Bender JD, Facchini LA, Lapão LMV, Tomasi E, Thumé E. Evolution of the availability of Information and Communication Technologies in primary health care in Brazil, 2012 to 2018. Rev Bras Epidemiol 2024; 27:e240021. [PMID: 38655947 PMCID: PMC11027431 DOI: 10.1590/1980-549720240021] [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: 06/20/2023] [Revised: 11/08/2023] [Accepted: 02/05/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE To verify the evolution of the availability of information and communication technology equipment and inputs in primary health care services that participated in the external evaluation of the Access and Quality Improvement Program in Primary Care and its distribution according to context characteristics social and geographic. METHODS Cross-sectional study, analyzed the distribution of information and communication technology equipment in basic health units in Brazil, during the three cycles (2012 to 2018) of the Program for Improving Access and Quality in Primary Care. The variables were examined at the municipal level and stratified by geopolitical region. Univariate analysis was performed, using the chi-square test and testing the distributions of exposures among themselves and between the outcome and exposures. RESULTS The availability of information and communication technology equipment increased from 9.4% (2012) to 17.5% (2018), with emphasis on the Southeast and South regions, in municipalities with a population size of up to 10,000 inhabitants², with greater family health coverage and high/very high HDI-M. Over the period from 2012 to 2018, basic units joined the program and increased availability of information and communication technologies, such as Internet access, which ranged from 45.2% (n=6,249) to 74.0% (n=21,423), with emphasis on the Northeast region, which increased from 19.1% (n=970) to 58.8% (n=7,087). CONCLUSION Investment in technologies and constant evaluation of primary care in the country is necessary, contributing to its strengthening.
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Affiliation(s)
| | | | | | - Elaine Tomasi
- Universidade Federal de Pelotas – Pelotas (RS), Brazil
| | - Elaine Thumé
- Universidade Federal de Pelotas – Pelotas (RS), Brazil
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Bergantini LS, Ichisato SMT, Salci MA, Birolim MM, dos Santos MLA, Höring CF, Rossa R, Facchini LA. Factors associated with hospitalizations and deaths of pregnant women from Paraná due to COVID-19: a cross-sectional study. Rev Bras Epidemiol 2024; 27:e240005. [PMID: 38324869 PMCID: PMC10846414 DOI: 10.1590/1980-549720240005] [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: 08/11/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE To analyze the factors associated with hospitalization in the ward and intensive care unit (ICU), and with death from COVID-19 in pregnant women with confirmed cases. METHODS Observational, cross-sectional study, carried out with data from pregnant women with a confirmed case of COVID-19 from the Influenza Epidemiological Surveillance Information System and the Paraná's state COVID-19 notification system. The association between the independent and dependent variables (hospitalization in the ward and ICU, and death) was investigated using the Poisson regression model with robust variance. RESULTS 4,719 pregnant women comprised the study population. 9.6 and 5.1% were hospitalized in wards and ICU, respectively. 1.9% died. There was an association between advanced maternal age and hospitalization in wards (PR=1.36; 95%CI 1.10-1.62) and ICU (PR=2.25; 95%CI 1.78-2.71), and death (PR=3.22; 95%CI 2.30-4.15). An association was found between the third trimester and hospitalization in wards (PR=5.06; 95%CI 2.82-7.30) and ICU (PR=6.03; 95%CI 3.67-8.39) and death (PR=13.56; 95%CI 2.90-24.23). The second trimester was associated with ICU admission (PR=2.67; 95%CI 1.36-3.99). Pregnant women with cardiovascular disease had a higher frequency of hospitalization in wards (PR=2.24; 95%CI 1.43-3.05) and ICU (PR=2.66; 95%CI 1.46-3.87). Obesity was associated with ICU admission (PR=3.79; 95%CI 2.71-4.86) and death (PR=5.62; 95%CI 2.41-8.83). CONCLUSIONS Advanced maternal age, the end of the gestational period and comorbidities were associated with severe COVID-19.
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Affiliation(s)
- Larissa Silva Bergantini
- Universidade Estadual de Maringá, Postgraduate Program in Physiological Sciences – Maringá (PR), Brazil
| | | | - Maria Aparecida Salci
- Universidade Estadual de Maringá, Postgraduate Program in Nursing – Maringá (PR), Brazil
| | - Marcela Maria Birolim
- Centro Universitário Guairacá, Postgraduate Program in Health Promotion – Guarapuava (PR), Brazil
| | | | | | - Roberta Rossa
- Universidade Estadual de Maringá, Postgraduate Program in Nursing – Maringá (PR), Brazil
| | - Luiz Augusto Facchini
- Universidade Federal de Pelotas, Department of Social Medicine – Pelotas (RS), Brazil
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Inoue LH, Baccon WC, Pesce GB, Pereira ND, Silva IVTC, Salci MA, Vissoci JRN, Facchini LA, Carreira L. Prevalence and factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná. Rev Esc Enferm USP 2024; 57:e20230036. [PMID: 38265117 PMCID: PMC10807406 DOI: 10.1590/1980-220x-reeusp-2023-0036en] [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: 03/13/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE To estimate the prevalence and to analyze the factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná. METHOD Cross-sectional study conducted with secondary data from older people with a positive diagnosis of Covid-19 living in the State of Paraná, collected from March 1, 2020 to August 31, 2021. Prevalence ratios were obtained by adjusting the regression model. RESULTS A total of 16,153 deaths of older people hospitalized in the State of Paraná were analyzed. The adjusted model revealed an association between death and some factors such as: belonging to the age group of 75 to 84 years (PR = 1.28; CI95% = 1.24-1.32) and 85 years or over (PR = 1.52; CI95% = 1.45-1.59); male (PR = 1.17; CI95% = 1.13-1.21); obesity (PR = 1.23; CI95% = 1.16-1.29); other morbidities (PR = 1.25; CI95% = 1.20-1.30); and having used ventilatory support (PR = 2.60; CI95% = 2.33-2.86). Older people vaccinated against influenza had a probability of death reduced by 11% (PR = 0.89; CI95% = 0.86-0.93). CONCLUSION The association of age, sex, and diagnosis of previous comorbidities with unfavorable outcomes from Covid-19 was identified. Having received the flu vaccine provided protection to elderly people who contracted SARS-CoV-2.
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Flores-Quispe MDP, Duro SMS, Facchini LA, Barros NBR, Tomasi E. Trends in the quality of child health care in the first week of life in primary care services in Brazil. Cien Saude Colet 2024; 29:e09192022. [PMID: 38198324 DOI: 10.1590/1413-81232024291.09192022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 03/21/2023] [Indexed: 01/12/2024] Open
Abstract
The aim of this study was to assess temporal trends in the quality of health care during the first-week child check-up in primary care services stratified by municipal, health team and maternal characteristics. We conducted a cross-sectional study using data from the three cycles of the National Program for the Improvement of Access and Quality (PMAQ) (2012, 2014 and 2018). Adult service users with children aged up to 2 were interviewed. The outcome was "good quality health care in the first week of life". Descriptive and time trend analyses were performed using variance-weighted least squares regression. The frequency of good quality care during the first-week check-up was 47.9% (95%CI 46.6-49.3) in 2012, 52.5% (95%CI 51.3-53.7) in 2014 and 53.3% (95%CI 52.2-54.4) in 2018, with an annual increase of 0.73 pp (p<0.001). The annual increase was greater in the Northeast (2.06 pp) and in municipalities with very low/low HDI (1.48 pp) and 100% family health strategy coverage (0.98 pp). Trends in the frequency of good quality health care during the first-week child check-up were favorable.
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Affiliation(s)
- María Del Pilar Flores-Quispe
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas (UFPel). Rua Marechal Deodoro 1160, Centro. 96020-220 Pelotas RS Brasil.
| | | | - Luiz Augusto Facchini
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas (UFPel). Rua Marechal Deodoro 1160, Centro. 96020-220 Pelotas RS Brasil.
- Departamento de Medicina Social, Faculdade de Medicina, UFPel. Pelotas RS Brasil
| | | | - Elaine Tomasi
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas (UFPel). Rua Marechal Deodoro 1160, Centro. 96020-220 Pelotas RS Brasil.
- Departamento de Medicina Social, Faculdade de Medicina, UFPel. Pelotas RS Brasil
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Salci MA, Carreira L, Baccon WC, Marques FRDM, Höring CF, Oliveira MLFD, Milan NS, de Souza FCS, Gallo AM, Covre ER, Dixe MA, Querido A, Vissoci JRN, Facchini LA, Laranjeira C. Perceived quality of life and associated factors in long COVID syndrome among older Brazilians: A cross-sectional study. J Clin Nurs 2024; 33:178-191. [PMID: 36680417 DOI: 10.1111/jocn.16618] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/06/2022] [Accepted: 12/31/2022] [Indexed: 01/22/2023]
Abstract
AIMS AND OBJECTIVES This paper aims to: (a) determine the personal, sociodemographic, clinical, behavioural, and social characteristics of older Brazilians with clinical evidence of long COVID; (b) evaluate perceived quality of life and determine its association with personal, sociodemographic, behavioural, clinical and social variables; and (c) assess significant predictors of high perceived QoL. BACKGROUND Given the inherent vulnerabilities of the ageing process, the older people are an at-risk group for both contagion of SARS-CoV-2 and the perpetuation of residual symptoms after infection, the so-called long COVID or post-COVID syndrome. DESIGN A cross-sectional survey design using the STROBE checklist. METHODS Brazilian older people with long COVID syndrome (n = 403) completed a phone survey measuring personal, sociodemographic, behavioural, clinical, and social characteristics, and perceived Quality of Life (QoL). Data were collected from June 2021-March 2022. A multiple linear regression model was performed to identify salient variables associated with high perceived QoL. RESULTS The mean age of participants was 67.7 ± 6.6 years old. The results of the multivariate regression model showed that race, home ownership, daily screen time, musculoskeletal and anxiety symptoms, and work situation were the significant predictors of QoL among COVID-19 survivors. CONCLUSIONS Knowledge about the persistence of physical, emotional, and social symptoms of COVID-19 can help nurses and other healthcare providers to improve the management of survivors, bringing benefits to the whole society. RELEVANCE TO CLINICAL PRACTICE Given the novelty of long-COVID and its heterogeneous trajectory, interventions focusing on the repercussions and requirements unique to more vulnerable older persons should be developed and these aspects should be included in public health recommendations and policymakers' concerns. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was required to design, to outcome measures or undertake this research. Patients/members of the public contributed only to the data collection.
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Affiliation(s)
- Maria Aparecida Salci
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | - Lígia Carreira
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | - Wanessa Cristina Baccon
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | | | - Carla Franciele Höring
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | | | - Natália Simeão Milan
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | | | - Adriana Martins Gallo
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | - Eduardo Rocha Covre
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | - Maria Anjos Dixe
- School of Health Sciences - Polytechnic of Leiria, Center for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal
| | - Ana Querido
- School of Health Sciences - Polytechnic of Leiria, Center for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal
| | - João Ricardo Nickenig Vissoci
- Emergency Medicine Division, Department of Surgery, Duke University, Durham, North Carolina, USA
- Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Luiz Augusto Facchini
- Departamento de Medicina Social, Faculdade de Medicina e Programa de Pós-Graduação em Epidemiologia e Saúde da Família e Programa de Pós-Graduação em Enfermagem, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Carlos Laranjeira
- School of Health Sciences - Polytechnic of Leiria, Center for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
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Bender JD, Facchini LA, Lapão LMV, Tomasi E, Thumé E. The use of Information and Communication Technologies in Primary Health Care in Brazil - the period of 2014 to 2018. Cien Saude Colet 2024; 29:e19882022. [PMID: 38198338 DOI: 10.1590/1413-81232024291.19882022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/21/2023] [Indexed: 01/12/2024] Open
Abstract
Information and Communication Technologies in Health allow the storage and processing of digital data, access to information and remote communications. The objective of this article was to describe the use of these Technologies to support clinical practice and continuing education by primary health care teams in Brazil the period of 2014 to 2018, within the scope of the Access and Quality Improvement Program Basic, according to characteristics of the geopolitical context. It's a cross-sectional study that analyzed the data collected from the teams of the Basic Health Units. A growing use by the teams of Telehealth resources, the Telemedicine University Network and the Open University of the Unified Health System was observed to aid clinical practice and permanent health education. In the North and Northeast regions, the use of these Technologies doubled, from cycle II to cycle III. The need for investments in infrastructure, human resources in Primary Health Care, qualification and professional training is a way to strengthen the Unified Health System and its Health Care Network, contributing to a continuous flow of care, with quality and access universal.
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Affiliation(s)
- Janaína Duarte Bender
- Universidade Federal de Pelotas. R. Gomes Carneiro nº 01, Centro. 96010610 Pelotas RS Brasil.
| | - Luiz Augusto Facchini
- Universidade Federal de Pelotas. R. Gomes Carneiro nº 01, Centro. 96010610 Pelotas RS Brasil.
| | | | - Elaine Tomasi
- Universidade Federal de Pelotas. R. Gomes Carneiro nº 01, Centro. 96010610 Pelotas RS Brasil.
| | - Elaine Thumé
- Universidade Federal de Pelotas. R. Gomes Carneiro nº 01, Centro. 96010610 Pelotas RS Brasil.
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Silva LAN, Nunes BP, Lima JG, Tomasi E, Facchini LA. [Contextual characteristics and demand for health services among Brazilian adolescents: Brazilian National Health Survey, 2019]. CAD SAUDE PUBLICA 2023; 39:e00070223. [PMID: 38088738 PMCID: PMC10715569 DOI: 10.1590/0102-311xpt070223] [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: 04/11/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 12/18/2023] Open
Abstract
This study aimed to describe the prevalence of demand for health services among Brazilian adolescents and to investigate its association with contextual characteristics of the territory. Study with data from the Brazilian National Health Survey, conducted in 2019, including 43,774 individuals aged from 10 to 19 years. Adolescent's information was obtained through a proxy resident of 18 years or more who answered for all the residents of the household. Poisson regression was used to assess the demand for health services according to geopolitical region, economic status, and type of municipality. The interaction of the health insurance was also evaluated in these associations. Of the total, 11.7% (95%CI: 11.1; 12.3) of the adolescents sought health services in the two weeks prior to the survey. Greater figures of demand were observed in the Southeast (PR = 1.32; 95%CI: 1.15; 1.52) and South regions (PR = 1.31; 95%CI: 1.13; 1.52) compared to the Northern Region of Brazil. Having a health insurance increased the demand for services by adolescents living in rural areas and in capitals and the municipalities of the Metropolitan Areas and/or Integrated Development Regions. The study showed a low prevalence of demand for health services among adolescents and contextual inequalities for the geopolitical region. Having a health insurance was an important marker to understand the disparities in the economic status and in the type of municipality.
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Affiliation(s)
| | | | - Juliana Gagno Lima
- Instituto de Saúde Coletiva, Universidade Federal do Oeste do Pará, Santarém, Brasil
| | - Elaine Tomasi
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
| | - Luiz Augusto Facchini
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
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Volz PM, Dilélio AS, Facchini LA, Quadros LDCMD, Tomasi E, Kessler M, Wachs LS, Machado KP, Soares MU, Thumé E. [Incidence of depression and associated factors in older adults in Bagé, Rio Grande do Sul State, Brazil]. CAD SAUDE PUBLICA 2023; 39:e00248622. [PMID: 37971102 PMCID: PMC10652711 DOI: 10.1590/0102-311xpt248622] [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: 12/28/2022] [Revised: 06/15/2023] [Accepted: 06/23/2023] [Indexed: 11/19/2023] Open
Abstract
To evaluate the cumulative incidence of depression and its associated factors in the older population living in the urban area of the municipality of Bagé, Rio Grande do Sul State, Brazil, a prospective cohort study was conducted from 2008 to 2016/2017. The analysis was restricted to 615 older adults with complete information on the Geriatric Depression Scale (GDS-15), both at baseline and at follow-up, and who did not present depression in 2008. To calculate crude and adjusted incidence ratios and 95% confidence interval, Poisson regression with robust variance adjustment was used, including the baseline variables. A hierarchical model of four levels of determination was used. The variables were controlled for those of the same or of higher levels, and the p-value ≤ 0.20 was established to remain in the analysis model. In 2008, 523 older people did not have depression and 92 had been screened with the disease. In 2016/2017, of the 523 individuals without depression in the baseline measure, 10.3% tested positive at screening (incident cases), whereas 89.7% of the older adults remained free of the condition. Of the 92 older adults with depression in 2008, 32.6% continued to present depressive symptoms at follow-up and 67.3% had remission of symptoms. Leaving home once or never and being incapable of doing functional and instrumental activities of daily living were associated with a higher risk of positive screening for depression. The results reinforce the multidimensional and dynamic character of depression, which alternates short and long episodes, and may become recurrent and chronic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Elaine Thumé
- Universidade Federal de Pelotas, Pelotas, Brasil
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Schenkman S, Bousquat AEM, Facchini LA, Gil CRR, Giovanella L. Performance patterns of primary health care in the face of COVID-19 in Brazil: characteristics and contrasts. CAD SAUDE PUBLICA 2023; 39:e00009123. [PMID: 37729331 PMCID: PMC10511158 DOI: 10.1590/0102-311xpt009123] [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: 01/18/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 09/22/2023] Open
Abstract
The adequate fight against pandemics requires effective coordination between primary health care (PHC) and health surveillance, guaranteed attention to acute and chronic demands, and a bond with the community dimension in the scope of basic health units (UBS, acronym in Portuguese). This study aims to contrast two extreme standards of PHC performance in the fight against COVID-19 in Brazil, comparing them with the profiles of the corresponding municipalities and characteristics of the organization of services. Based on the results of a cross-sectional national survey with a representative sample of UBSs, we created a synthetic index to evaluate how PHC performs against COVID-19 called CPI, composed of axes of health surveillance and social support (collective dimension) and of COVID-19 care and continuity of care (individual dimension). Of the 907 surveyed UBSs, 120 were selected, half of which had the highest indexes (complete standard) and the other half, the lowest ones (restricted standard). The municipalities of the UBSs with a complete standard are predominantly rural, have low Municipal Health Development Index (MHDI), high Family Health Strategy (FHS) coverage, and stand out in the collective dimension, whereas the UBSs in urban municipalities with this same standard have high MHDI, low FHS coverage, and an emphasis on the individual dimension. In the restricted standard, we highlight community health workers' reduced work in the territory. In the Brazilian Northeast, UBSs with complete standard predominate, whereas, in its Southeast, UBSs with restricted standard predominate. The study poses questions that refer to the role and organization of PHC in the health care network under situations that require prompt response to health issues and indicates the greater potential capacity of the FHS program in such situations.
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Affiliation(s)
- Simone Schenkman
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil
| | | | | | | | - Lígia Giovanella
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Brum LW, Thumé E, Dilélio AS, Flores-Quispe MDP, Barros NBR, Facchini LA, Tomasi E. Quality of care for children under two years of age in Brazil's basic network in 2018: indicators and associated factors. Rev Bras Epidemiol 2023; 26:e230005. [PMID: 36629617 PMCID: PMC9838230 DOI: 10.1590/1980-549720230005.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/11/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To evaluate the quality of care for children under two years of age in the primary health care network with data from the external evaluation of the Program for the Improvement of Access and Quality of Primary Care in 2018. METHODS Users who had children under two years of age who were in the unit at the time of data collection were eligible for the study. The quality of care was evaluated using a synthetic indicator built with questions from the users' module. The exposure variables were: region, structure of basic health units, and staff process. A univariate analysis was performed and crude and adjusted prevalence ratios were estimated. RESULTS The sample was composed of 15.745 users who had children under the age of two years. Only 36.8% (95%CI 36,0-37,6) of users were classified as having received good quality care for their children, with a downward trend in prevalence as the child's age increased. Better results were observed in the Northeast region, in units that presented all the inputs and vaccines and for teams that used protocols and materials, kept records, performed active search and healthy eating actions. CONCLUSION The prevalence of good quality of care for children under two years of age was low. These data can be useful for managers' decision-making and for the implementation of actions aimed at professionals, that encourage a higher quality of care to children, mainly the child leaving a consultation with the next appointment scheduled and a first consultation being carried out until their seventh day of life.
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Affiliation(s)
- Letícia Willrich Brum
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia – Pelotas (RS), Brasil
| | - Elaine Thumé
- Universidade Federal de Pelotas, Faculdade de Enfermagem – Pelotas (RS), Brasil
| | | | - Maria del Pilar Flores-Quispe
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia – Pelotas (RS), Brasil.,Fundação Oswaldo Cruz, Centro de Integração de Dados e Conhecimentos para Saúde – Salvador (BA), Brasil
| | | | - Luiz Augusto Facchini
- Universidade Federal de Pelotas, Faculdade de Medicina, Departamento de Medicina Social – Pelotas (RS), Brasil
| | - Elaine Tomasi
- Universidade Federal de Pelotas, Faculdade de Medicina, Departamento de Medicina Social – Pelotas (RS), Brasil
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Delpino FM, Figueiredo LM, Costa ÂK, Carreno I, Silva LND, Flores AD, Pinheiro MA, Silva EPD, Marques GÁ, Saes MDO, Duro SMS, Facchini LA, Vissoci JRN, Flores TR, Demarco FF, Blumenberg C, Chiavegatto Filho ADP, Silva ICD, Batista SR, Arcêncio RA, Nunes BP. Emergency department use and Artificial Intelligence in Pelotas: design and baseline results. Rev Bras Epidemiol 2023; 26:e230021. [PMID: 36921129 PMCID: PMC10000014 DOI: 10.1590/1980-549720230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/09/2023] [Indexed: 03/12/2023] Open
Abstract
OBJETIVO To describe the initial baseline results of a population-based study, as well as a protocol in order to evaluate the performance of different machine learning algorithms with the objective of predicting the demand for urgent and emergency services in a representative sample of adults from the urban area of Pelotas, Southern Brazil. METHODS The study is entitled "Emergency department use and Artificial Intelligence in PELOTAS (RS) (EAI PELOTAS)" (https://wp.ufpel.edu.br/eaipelotas/). Between September and December 2021, a baseline was carried out with participants. A follow-up was planned to be conducted after 12 months in order to assess the use of urgent and emergency services in the last year. Afterwards, machine learning algorithms will be tested to predict the use of urgent and emergency services over one year. RESULTS In total, 5,722 participants answered the survey, mostly females (66.8%), with an average age of 50.3 years. The mean number of household people was 2.6. Most of the sample has white skin color and incomplete elementary school or less. Around 30% of the sample has obesity, 14% diabetes, and 39% hypertension. CONCLUSION The present paper presented a protocol describing the steps that were and will be taken to produce a model capable of predicting the demand for urgent and emergency services in one year among residents of Pelotas, in Rio Grande do Sul state.
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Affiliation(s)
| | | | | | - Ioná Carreno
- Universidade Federal de Pelotas - Pelotas (RS), Brazil
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13
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Brum LW, Thumé E, Dilélio AS, Flores-Quispe MDP, Barros NBR, Facchini LA, Tomasi E. Quality of care for children under two years of age in Brazil’s basic network in 2018: indicators and associated factors. Rev bras epidemiol 2023. [DOI: 10.1590/1980-549720230005] [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: 01/11/2023] Open
Abstract
ABSTRACT Objective To evaluate the quality of care for children under two years of age in the primary health care network with data from the external evaluation of the Program for the Improvement of Access and Quality of Primary Care in 2018. Methods Users who had children under two years of age who were in the unit at the time of data collection were eligible for the study. The quality of care was evaluated using a synthetic indicator built with questions from the users’ module. The exposure variables were: region, structure of basic health units, and staff process. A univariate analysis was performed and crude and adjusted prevalence ratios were estimated. Results The sample was composed of 15.745 users who had children under the age of two years. Only 36.8% (95%CI 36,0–37,6) of users were classified as having received good quality care for their children, with a downward trend in prevalence as the child’s age increased. Better results were observed in the Northeast region, in units that presented all the inputs and vaccines and for teams that used protocols and materials, kept records, performed active search and healthy eating actions. Conclusion The prevalence of good quality of care for children under two years of age was low. These data can be useful for managers’ decision-making and for the implementation of actions aimed at professionals, that encourage a higher quality of care to children, mainly the child leaving a consultation with the next appointment scheduled and a first consultation being carried out until their seventh day of life.
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de Andrade L, Kozhumam AS, Rocha TAH, de Almeida DG, da Silva NC, de Souza Queiroz RC, Massago M, Rent S, Facchini LA, da Silva AAM, Staton CA, Vissoci JRN, Thomaz EBAF. Impact of socioeconomic factors and health determinants on preterm birth in Brazil: a register-based study. BMC Pregnancy Childbirth 2022; 22:872. [PMID: 36424529 PMCID: PMC9685869 DOI: 10.1186/s12884-022-05201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND More than 15 million children are born preterm annually. While preterm survival rates have increased in high-income countries. Low- and middle-income countries, like Brazil, continue to battle high neonatal mortality rates due to a lack of adequate postnatal care. Globally, neonatal mortality is higher for preterm infants compared to those born at term. Our study aims to map and analyze the spatial, socioeconomic, and health coverage determinants related to preterm birth in Brazil in order to understand how spatial variations in demographics and access to primary care may affect preterm birth occurrences. METHODS: Using publicly available national-level data from the Brazilian health system for 2008-2017, we conducted an ecological study to visualize the spatial distributions of preterm birth along with socioeconomic status, the structure of health services, and primary care work process, each consisting of multiple variables reduced via principal component analysis. Regression models were created to determine predictive effects of numeric and spatial variation of these scores on preterm birth rates. RESULTS In Brazil, preterm birth rates increased from 2008-2017, with small and rural municipalities frequently exhibiting higher rates than urban areas. Scores in socioeconomic status and work process were significant predictors of preterm birth rates, without taking into account spatial adjustment, with more positive scores in socioeconomic status predicting higher preterm birth rates (coefficient 0.001145) and higher scores in work process predicting lower preterm birth rates (coefficient -0.002416). Geographically weighted regression showed socioeconomic status to be a more significant predictor in the North, with the work process indicators being most significant in the Northeast. CONCLUSIONS Results support that primary care work process indicators are more significant in estimating preterm birth rates than physical structures available for care. These results emphasize the importance of ensuring the presence of the minimum human resources needed, especially in the most deprived areas of Brazil. The association between social determinants of health and preterm birth rates raises questions regarding the importance of policies dedicated to foster equity in the accessibility of healthcare services, and improve income as protective proxies for preterm birth.
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Affiliation(s)
- Luciano de Andrade
- grid.271762.70000 0001 2116 9989Department of Medicine, State University of Maringa, Block 126, Colombo Avenue, 5790, Parana CEP: 87020-900 Maringa, Brazil
| | - Arthi S. Kozhumam
- grid.26009.3d0000 0004 1936 7961Duke Global Health Institute, Duke University, Durham, NC USA
| | | | - Dante Grapiuna de Almeida
- grid.8430.f0000 0001 2181 4888Federal University of Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - Núbia Cristina da Silva
- grid.26009.3d0000 0004 1936 7961Duke Global Health Institute, Duke University, Durham, NC USA
| | | | - Miyoko Massago
- grid.271762.70000 0001 2116 9989Department of Medicine, State University of Maringa, Block 126, Colombo Avenue, 5790, Parana CEP: 87020-900 Maringa, Brazil
| | - Sharla Rent
- grid.26009.3d0000 0004 1936 7961Duke Global Health Institute, Duke University, Durham, NC USA
| | - Luiz Augusto Facchini
- grid.411221.50000 0001 2134 6519Department of Social Medicine, Federal University of Pelotas, Pelotas, Rio Grande Do Sul Brazil
| | | | - Catherine Ann Staton
- grid.26009.3d0000 0004 1936 7961Duke Global Health Institute, Duke University, Durham, NC USA
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Kessler M, Thumé E, Facchini LA, Tomasi E. Prevalence of not receiving a home visit by Community Health Agents in Brazil and associated factors. Ciênc saúde coletiva 2022. [DOI: 10.1590/1413-812320222711.17072021en] [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: 11/22/2022] Open
Abstract
Abstract This article aimed to identify the prevalence of not receiving a home visit by a community health agent (CHA) and the factors associated with it. This was a cross-sectional study, conducted with 38,865 health teams and 140,444 users in the entire country, who participated in the external evaluation of the Program of Access and Quality Improvement in Primary Health (PMAQ-AB, in Portuguese) in 2017/2018. The association between not receiving a home visit by a CHA and the characteristics of the towns, teams, and individuals were estimated by the prevalence ratio (PR) with 95% confidence intervals. The prevalence of not receiving a home visit by a CHA was 18.6% and the main causes were: CHA did not visit the home, lack of knowledge of the existence of CHAs in the neighborhood or unit, and no one present at the home when the CHA visited. The probability of receiving a home visit was higher in poorer regions like the Northeast Region of the country; in towns with a smaller population; among older age users with a lower income, users with chronic health conditions, or users who have someone with a physical disability at home. The results showed that there is a need to increase the coverage of CHA visits in the country, considering that their home visits improve equity in health care.
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Affiliation(s)
- Marciane Kessler
- Universidade Regional Integrada do Alto Uruguai e das Missões, Brazil; UFPel, Brazil
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Kessler M, Thumé E, Facchini LA, Tomasi E. Prevalência do não recebimento de visita domiciliar pelo Agente Comunitário de Saúde no Brasil e fatores associados. Ciênc saúde coletiva 2022; 27:4253-4263. [DOI: 10.1590/1413-812320222711.17072021] [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: 08/24/2021] [Accepted: 06/30/2022] [Indexed: 11/22/2022] Open
Abstract
Resumo O objetivo do artigo é identificar a prevalência de não recebimento de visita domiciliar por Agente Comunitário de Saúde (ACS) e os fatores associados. Trata-se de um estudo transversal realizado com 38.865 equipes e 140.444 usuários em todo o território nacional, que participaram da avaliação externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica em 2017/2018. A associação de não recebimento de visita domiciliar por ACS e características dos municípios, equipes e indivíduos foi estimada pela razão de prevalência e intervalos de confiança de 95%. A prevalência de não recebimento de visita domiciliar pelo ACS foi de 18,6% e os principais motivos foram: ACS não realiza visita na casa, desconhecimento da existência de ACS no bairro ou unidade, e não tem ninguém em casa para atendê-lo. A probabilidade de receber visita domiciliar foi maior em regiões mais pobres como o Nordeste, em municípios com menor porte populacional, entre usuários com maior idade e menor renda, com condições crônicas de saúde ou que possuem alguém com dificuldade de locomoção no domicílio. Os resultados evidenciam a necessidade de aumento da cobertura de ACS no país, considerando que sua visita domiciliar promove equidade em saúde.
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Affiliation(s)
- Marciane Kessler
- Universidade Regional Integrada do Alto Uruguai e das Missões, Brazil; UFPel, Brazil
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17
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Bof de Andrade F, Thumé E, Facchini LA, Torres JL, Nunes BP. Education and income-related inequalities in multimorbidity among older Brazilian adults. PLoS One 2022; 17:e0275985. [PMID: 36227899 PMCID: PMC9560520 DOI: 10.1371/journal.pone.0275985] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/26/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the existence of socioeconomic inequalities related to the prevalence of multimorbidity in the Brazilian population aged 60 and older. METHODS This was a cross-sectional study with data from the last Brazilian National Health Survey (PNS) collected in 2019. Multimorbidity was the dependent variable and was defined as the presence of two or more chronic diseases. All the diseases were assessed based on a self-reported previous medical diagnosis. Education and per capita family income were the measures of socioeconomic position. Socioeconomic inequalities related to multimorbidity were assessed using two complex measures of inequality; the Slope Index of Inequality (SII) and the Concentration Index (CI). RESULTS The prevalence of multimorbidity in Brazil was 56.5% 95% CI (55.4; 57.6) and varied from 46.9% (44.3; 49.6) in the North region to 59.3% (57.0; 61.5) in the South region. In general, individuals with higher socioeconomic positions had a lower prevalence of multimorbidity. Significant absolute and relative income inequalities were observed in the South region [SII -9.0; CI -0.054], Southeast [SII -9.8; CI -0.06], and Middle-east [SII -10.4; CI -0.063]. Absolute and relative education inequalities were significant for the country and two of its regions (Southeast [SII -12.7; CI -0.079] and South [SII -19.0; CI -0.109]). CONCLUSIONS The prevalence of multimorbidity is high in Brazil and all of its macro-regions. The significant findings concerning the inequalities suggest that the distribution of this condition is more concentrated among those with lower education and income.
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Affiliation(s)
- Fabíola Bof de Andrade
- René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, MG, Brazil
- * E-mail:
| | - Elaine Thumé
- Collective Health Nursing Department, Federal University of Pelotas, Pelotas, RS, Brazil
| | | | - Juliana Lustosa Torres
- Preventive and Social Medicine Department, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Salci MA, Carreira L, Facchini LA, Oliveira MLFD, de Oliveira RR, Ichisato SMT, Covre ER, Pesce GB, Santos JAT, Derhun FM, Hungaro AA, Moura D, Höring CF, Santos MLAD, Oliveira NND, Paiano M, Góes HLDF, Jaques AE, Fernandes CAM, Vissoci JRN. Post-acute COVID and long-COVID among adults and older adults in the State of Paraná, Brazil: protocol for an ambispective cohort study. BMJ Open 2022; 12:e061094. [PMID: 36691205 PMCID: PMC9461084 DOI: 10.1136/bmjopen-2022-061094] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/18/2022] [Accepted: 08/05/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Since 2020, the world has been going through a viral pandemic with a high morbidity and mortality rate along with the potential to evolve from an acute infection to post-acute and long-COVID, which is still in the process of elucidation. Diagnostic and prognostic research is essential to understand the complexity of factors and contexts involving the illness's process. This protocol introduces a study strategy to analyse predictors, sequelae, and repercussions of COVID-19 in adults and older adults with different disease severities in the State of Paraná, Brazil. METHODS AND ANALYSIS A mixed-methods sequential explanatory design. The quantitative data will be conducted by an ambispective cohort study, which will explore the manifestations of COVID-19 for 18 months, with nearly 3000 participants with confirmed diagnoses of COVID-19 (reverse transcription-PCR test) between March and December of 2020, retrieved from national disease reporting databases, over 18 years old, living in a Brazilian State (Paraná) and who survived the viral infection after being discharged from a health service. Data collection will be conducted through telephone interviews, at two different occasions: the first will be a recall 12 months after the acute phase as a retrospective follow-up, and the second will be another prospective interview, with data of the following 6 months. For the qualitative step, Grounded Theory will be used; participants will be selected from the cohort population. The first sample group will be composed of people who were discharged from the intensive care unit, and other sample groups will be composed according to theoretical saturation. The qualitative data will follow the temporal design and classification of the disease provided for in the cohort. ETHICS AND DISSEMINATION Ethics approval was granted by the State University of Maringá, under opinion number: 4 165 272 and CAAE: 34787020.0.0000.0104 on 21 July 2020, and Hospital do Trabalhador (Worker's Hospital), which is accountable for the Health Department of the State of Paraná, under opinion number: 4 214 589 and CAAE: 34787020.0.3001.5225 on 15 August 2020. The participants will verbally consent to the research, their consent will be recorded, and the informed consent form will be sent by mail or email. Outcomes will be widely disseminated through peer-reviewed manuscripts, conference presentations, media and reports to related authorities.
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Affiliation(s)
| | - Ligia Carreira
- Nursing Department, Universidade Estadual de Maringá, Maringa, Brazil
| | - Luiz Augusto Facchini
- Departamento de Medicina Social, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | | | | | | | | | | | | | | | - Débora Moura
- Nursing Department, Universidade Estadual de Maringá, Maringa, Brazil
| | | | | | | | - Marcelle Paiano
- Nursing Department, Universidade Estadual de Maringá, Maringa, Brazil
| | | | | | | | - João Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Wachs LS, Facchini LA, Thumé E, Tomasi E, Fassa MEG, Fassa AG. [Evaluation of the implementation of the School Health Program from the Program for Access and Quality Improvement in Primary Care: 2012, 2014, and 2018]. CAD SAUDE PUBLICA 2022; 38:e00231021. [PMID: 35766631 DOI: 10.1590/0102-311xpt231021] [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: 09/26/2021] [Accepted: 04/01/2022] [Indexed: 11/22/2022] Open
Abstract
This study aims to evaluate the implementation and describe the actions developed in the School Health Program (PSE) by primary care health teams that joined the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB), in 2012, 2014, and 2018. The participation of the teams in school health activities increased throughout the three evaluation cycles, with the expansion of clinical evaluation, health promotion, and disease prevention actions. In cycle II, 24% of the teams performed the seven clinical evaluation actions, 18% performed the six promotion and prevention actions. However, 6.3% of the teams did not perform any clinical evaluation action and 8.8% did not perform health actions of promotion or prevention. In cycle III, more than 90% of the teams participated in the PSE, 84% of the health teams reported a combined planning for actions in schools, and more than 60% of the teams held joint meetings with the schools. PSE was institutionalized in all regions of the country, being more developed in municipalities with 10,000 to 30,000 inhabitants, lower Municipal Human Development Index (HDI-M) level, and greater coverage of the Family Health Strategy (FHS). Despite the positive evolution, the predominance of clinical evaluation actions in relation to health promotion actions and the proportion of teams that still have limitations in the combined efforts between health and education suggest a certain distancing from the PSE guidelines. To advance the implementation of the PSE, it is necessary to train health and education professionals; deepen intersectoral connection; expand the implementation of information and communication technologies; and maintain policies that allow the evaluation of the PSE, in order to support its development.
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Affiliation(s)
| | | | - Elaine Thumé
- Universidade Federal de Pelotas, Pelotas, Brasil
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Kessler M, Volz PM, Bender JD, Nunes BP, Machado KP, Saes MDO, Soares MU, Facchini LA, Thumé E. Efeito da incontinência urinária na autopercepção negativa da saúde e depressão em idosos: uma coorte de base populacional. Ciênc saúde coletiva 2022; 27:2259-2267. [DOI: 10.1590/1413-81232022276.10462021] [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: 01/05/2021] [Accepted: 08/16/2021] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivou-se medir a prevalência de autopercepção negativa da saúde e sintomas depressivos em idosos segundo a presença de incontinência urinária, após nove anos de acompanhamento. Trata-se de um estudo de coorte prospectivo de base populacional intitulado Saúde do Idoso Gaúcho de Bagé, no Rio Grande do Sul. Foram entrevistados 1.593 idosos no estudo de linha de base (2008) e 735 entre setembro de 2016 e agosto de 2017. A exposição “incontinência urinária (IU)” foi avaliada no estudo de linha de base e os desfechos “autopercepção negativa da saúde” e “sintomas depressivos” em 2016/17. A razão de odds e o intervalo de confiança de 95% foram calculados com regressão logística bruta e ajustada para variáveis demográficas, sociais, comportamentais e de condições de saúde. A prevalência de IU foi 20,7% em 2008 e 24,5% em 2016/17; a incidência foi de 19,8%, sendo 23,8% entre as mulheres e 14,6% entre os homens (p = 0,009). Idosos com IU no estudo de linha de base apresentaram chances 4,0 (IC95%:1,8-8,8) e 3,4 (IC95%:1,8-6,2) vezes maior de desenvolver autopercepção negativa da saúde e sintomas depressivos, respectivamente, após nove anos de acompanhamento, comparados àqueles sem IU. Os resultados evidenciam maior chance de problemas mentais entre idosos com IU.
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Affiliation(s)
- Marciane Kessler
- Universidade Regional Integrada do Alto Uruguai e das Missões, Brazil
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Saes MDO, Duro SMS, Gonçalves CDS, Tomasi E, Facchini LA. Assessment of the appropriate management of syphilis patients in primary health care in different regions of Brazil from 2012 to 2018. CAD SAUDE PUBLICA 2022; 38:EN231921. [PMID: 35584428 DOI: 10.1590/0102-311xen231921] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/03/2022] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze the presence of adequate infrastructure and work process in primary health care for the diagnosis, management, and treatment of syphilis in Brazil in 2012, 2014, and 2018. This is a cross-sectional, nationwide study with data from the three cycles of the Program for Improvement of Access and Quality of Basic Healthcare (PMAQ-AB): 2012 (Cycle I), 2014 (Cycle II), and 2018 (Cycle III). Two outcomes were assessed: adequate infrastructure and work process. The independent variables were macroregion, municipality size, Municipal Human Development Index (HDI-M), and coverage of the Family Health Strategy (FHS). Variance-weighted least squares regression was used to estimate annual changes in percentage. In total, 13,842 primary basic health units (UBS) and 17,202 professional health care teams were assessed in Cycle I; 24,055 UBS and 29,778 teams in Cycle II, and 28,939 UBS and 37,350 teams in Cycle III. About 1.4% of UBS had adequate infrastructure in Cycle I; 17.5% had in Cycle II; and 42.7% had in Cycle III. Adequate work process also increased in the three cycles, ranging from 47.3% in Cycle I to 45.5% in Cycle II and 75.4% in Cycle III. However, inequities are observed, considering that richer regions and larger municipalities, with higher HDI-M and lower FHS coverage improved the most. The low prevalence of adequate infrastructure and work process for the care of patients with syphilis in Brazil reflects a significant weakness in the Brazilian health system.
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Neves RG, Saes MDO, Machado KP, Duro SMS, Facchini LA. [Trend in the availability of vaccines in Brazil: PMAQ-AB, 2012, 2014, and 2018]. CAD SAUDE PUBLICA 2022; 38:PT135621. [PMID: 35544878 DOI: 10.1590/0102-311xpt135621] [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: 06/01/2021] [Accepted: 12/28/2021] [Indexed: 11/21/2022] Open
Abstract
The objective was to analyze the trend in the availability of vaccines in Brazil and its various regions and states from 2012 to 2018. This cross-sectional study used data from basic units assessed in cycles I (2012), II (2014), and III (2018) of the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB). We assessed the availability of the dT, hepatitis B, meningococcal C, polio, pneumococcal 10-valent, MMR, DPT, tetravalent/pentavalent, and human rotavirus vaccines. Identification of trend was performed with weighted least squares regression to estimate annual percent changes. We also verified the relative and absolute differences in prevalence of vaccines. The sample consisted of 13,842 basic health units in Cycle I, 19,752 in Cycle II, and 25,152 in Cycle III. An upward trend was seen in the prevalence of availability of all vaccines investigated during the period, with an increase of 16 percentage points from 2012 to 2018, reaching nearly 70% in 2018. The regions with the largest upward trend were the North (2.9p.p.), Central-West (2.1p.p.), and Northeast (2.0p.p.). There was a visible downward trend in both the availability (-3.3p.p.) and absolute and relative difference (-20p.p.; 0.68) in Rio de Janeiro State. The prevalence of availability of vaccines was low in Brazil, with disparities between regions that become even more pronounced when assessing specific states.
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Tomasi E, de Assis TM, Muller PG, da Silveira DS, Neves RG, Fantinel E, Thumé E, Facchini LA. Evolution of the quality of prenatal care in the primary network of Brazil from 2012 to 2018: What can (and should) improve? PLoS One 2022; 17:e0262217. [PMID: 35041716 PMCID: PMC8765636 DOI: 10.1371/journal.pone.0262217] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
The article describes the temporal evolution of prenatal quality indicators in the primary health care network in Brazil and investigates regional differences. This study used data from the external evaluation of Brazil's National Program for Improving Primary Care Access and Quality (PMAQ) with health teams participating in Cycles I, II and III of the Program, carried out respectively in 2012, 2013/14 and 2017/18. The number of visits, physical examination procedures, guidelines and request for laboratory tests were investigated. There was a positive evolution for tests-HIV, syphilis, blood glucose and ultrasound, and for all tests, guidance on feeding and weight gain of the baby and examination of the oral cavity. The indicators that performed the worst were: performance of tetanus vaccine, six or more visits, receiving guidance on exclusive breastfeeding and care for the newborn, and the procedures-all, measurement of uterine height, gynecological exam and cervix cancer prevention. These changes had a varied behavior between the regions of the country.
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Affiliation(s)
- Elaine Tomasi
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
| | | | | | - Denise Silva da Silveira
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Everton Fantinel
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Elaine Thumé
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Luiz Augusto Facchini
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
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Saes MO, Machado KP, Facchini LA, Thumé E. Rheumatic diseases and associated factors in older adults: a Brazilian population-based study. ABCS Health Sci 2021. [DOI: 10.7322/abcshs.2020049.1498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introduction: Rheumatic diseases have high occurrence in older adults, which may lead to a reduction in independence and quality of life. Objective: To calculate prevalence and to identify factors associated with rheumatic diseases in older adults of the urban area of a municipality in Southern Brazil. Methods: Cross-sectional population-based study, conducted in 2008 in the city of Bagé-RS, Brazil with older adults aged 60 years or over. The outcome was defined from the question "Has any doctor told you that you have rheumatism, arthritis or arthrosis?" Poisson regression was used for the crude and adjusted analysis. Results: A total of 1,593 participants were interviewed. 27.3% (95% CI 25.0-29.5) reported having medical diagnosis of at least one of the rheumatic diseases studied. In the adjusted analysis, it was found that female sex (RP=2.86; 95% CI 2.28-3.59; p≤0.001), without schooling (RP=1.24; 95% CI 1.0-1.58; p=0.047), not living alone (RP=1.29; 95% CI 1.03-1.61; p=0.024), poor self-perception of health (PR=1.54; 95% CI 1.63-2.02; p=0.001), spinal problems (PR=1,96; 95% CI 1.67-2.31; p≤0.001), fall in the last year (PR=1.22; 95% CI 1.04-1.43; p=0.013), incapacity for instrumental activities of daily living (PR=1.20; 95% CI 1.02-1.41; p=0.028) and healthcare appointment in the last 3 months (PR=1.20; 95% CI 1.01-1.42; p=0.035) were associated with the presence of rheumatic diseases (rheumatism, arthritis and arthrosis). Conclusion: It is suggested that care of musculoskeletal problems of the spine should be increased, in order to reduce falls and functional disability in older adults, based on actions focused on the prevention of these problems.
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Nunes BP, Vissoci J, Delpino FM, Stolz P, Farias SR, Coelho BB, Viegas IDS, Carvalho Junior DC, Dias CSDS, Almeida APSC, Facchini LA, Chiavegatto Filho ADP. Machine learning analysis to predict health outcomes among emergency department users in Southern Brazil: a protocol study. Rev Bras Epidemiol 2021; 24:e210050. [PMID: 34468543 DOI: 10.1590/1980-549720210050] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Emergency services are essential to the organization of the health care system. Nevertheless, they face different operational difficulties, including overcrowded services, largely explained by their inappropriate use and the repeated visits from users. Although a known situation, information on the theme is scarce in Brazil, particularly regarding longitudinal user monitoring. Thus, this project aims to evaluate the predictive performance of different machine learning algorithms to estimate the inappropriate and repeated use of emergency services and mortality. METHODS To that end, a study will be conducted in the municipality of Pelotas, Rio Grande do Sul, with around five thousand users of the municipal emergency department. RESULTS If the study is successful, we will provide an algorithm that could be used in clinical practice to assist health professionals in decision-making within hospitals. Different knowledge dissemination strategies will be used to increase the capacity of the study to produce innovations for the organization of the health system and services. CONCLUSION A high performance predictive model may be able to help decisionmaking in the emergency services, improving quality of care.
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Affiliation(s)
- Bruno Pereira Nunes
- Postgraduate Program in Nursing, Universidade Federal de Pelotas - Pelotas (RS), Brazil
| | - João Vissoci
- Department of Surgery, Duke University School of Medicine - Durham (NC), United States
| | - Felipe Mendes Delpino
- Postgraduate Program in Nursing, Universidade Federal de Pelotas - Pelotas (RS), Brazil
| | - Pablo Stolz
- Postgraduate Program in Nursing, Universidade Federal de Pelotas - Pelotas (RS), Brazil
| | | | - Bruna Borges Coelho
- Postgraduate Program in Nursing, Universidade Federal de Pelotas - Pelotas (RS), Brazil
| | | | | | | | | | - Luiz Augusto Facchini
- Postgraduate Program in Nursing, Universidade Federal de Pelotas - Pelotas (RS), Brazil.,Postgraduate Program in Epidemiology, Universidade Federal de Pelotas - Pelotas (RS), Brazil
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Könsgen BI, Nunes BP, Facchini LA, Tomasi E. Health service utilization and associated factors, among students at the Federal University of Pelotas, Brazil: a cross-sectional study, 2018. ACTA ACUST UNITED AC 2021; 30:e2020925. [PMID: 34406281 DOI: 10.1590/s1679-49742021000300013] [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: 10/20/2020] [Accepted: 02/22/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze health service utilization and associated factors among university students. METHODS This was a cross-sectional study conducted with a sample of 2,708 students at the Federal University of Pelotas between November 2017 and July 2018. RESULTS Of the 1,865 individuals included in the study, 55.8% used health services in the last 12 months, 39.3% used specialized services, and 22.6% used health centers; 45.9% used services funded by the Brazilian National Health System (SUS); 49.1% used health services for the purposes of prevention. There was greater use among females (prevalence ratio, PR=1.34 - 95%CI 1.23;1.46) and students with health needs (PR=1.51 - 95%CI 1.40;1.63). Greater association was found with SUS-funded services: primary health care center (83.0% [95%CI 77.3;87.5]), accident and emergency (81.3% [95%CI 73.2;87.5]) and urgent care center (83.6% [95%CI 76.2;89.0]). CONCLUSION The analysis indicated that women and people with health needs use health services more and that the SUS is the main service provider.
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Affiliation(s)
- Bruno Iorio Könsgen
- Universidade Federal de Pelotas, Departamento de Medicina Social, Pelotas, RS, Brasil
| | - Bruno Pereira Nunes
- Universidade Federal de Pelotas, Departamento de Enfermagem, Pelotas, RS, Brasil
| | - Luiz Augusto Facchini
- Universidade Federal de Pelotas, Departamento de Medicina Social, Pelotas, RS, Brasil
| | - Elaine Tomasi
- Universidade Federal de Pelotas, Departamento de Medicina Social, Pelotas, RS, Brasil
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Rocha TAH, de Thomaz EBAF, de Almeida DG, da Silva NC, Queiroz RCDS, Andrade L, Facchini LA, Sartori MLL, Costa DB, Campos MAG, da Silva AAM, Staton C, Vissoci JRN. Data-driven risk stratification for preterm birth in Brazil: a population-based study to develop of a machine learning risk assessment approach. Lancet Reg Health Am 2021; 3:100053. [PMID: 36777406 PMCID: PMC9904131 DOI: 10.1016/j.lana.2021.100053] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
Background Preterm birth (PTB) is a growing health issue worldwide, currently considered the leading cause of newborn deaths. To address this challenge, the present work aims to develop an algorithm capable of accurately predicting the week of delivery supporting the identification of a PTB in Brazil. Methods This a population-based study analyzing data from 3,876,666 mothers with live births distributed across the 3,929 Brazilian municipalities. Using indicators comprising delivery characteristics, primary care work processes, and physical infrastructure, and sociodemographic data we applied a machine learning-based approach to estimate the week of delivery at the point of care level. We tested six algorithms: eXtreme Gradient Boosting, Elastic Net, Quantile Ordinal Regression - LASSO, Linear Regression, Ridge Regression and Decision Tree. We used the root-mean-square error (RMSE) as a precision. Findings All models obtained RMSE indexes close to each other. The lower levels of RMSE were obtained using the eXtreme Gradient Boosting approach which was able to estimate the week of delivery within a 2.09 window 95%IC (2.090-2.097). The five most important variables to predict the week of delivery were: number of previous deliveries through Cesarean-Section, number of prenatal consultations, age of the mother, existence of ultrasound exam available in the care network, and proportion of primary care teams in the municipality registering the oral care consultation. Interpretation Using simple data describing the prenatal care offered, as well as minimal characteristics of the pregnant, our approach was capable of achieving a relevant predictive performance regarding the week of delivery. Funding Bill and Melinda Gates Foundation, and National Council for Scientific and Technological Development - Brazil, (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPQ acronym in portuguese) Support of the research project named: Data-Driven Risk Stratification for Preterm Birth in Brazil: Development of a Machine Learning-Based Innovation for Health Care- Grant: OPP1202186.
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Affiliation(s)
- Thiago Augusto Hernandes Rocha
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America,Corresponding author: Thiago Augusto Hernandes Rocha, Duke University
| | | | | | - Núbia Cristina da Silva
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | - Luciano Andrade
- Department of Nursing, State University of the West of Parana, Foz do Iguaçu, Parana, Brazil
| | - Luiz Augusto Facchini
- Department of Social Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Dalton Breno Costa
- The Federal University of Health Sciences of Porto Alegre. Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Catherine Staton
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC USA. Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - João Ricardo Nickenig Vissoci
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC USA. Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Neves RG, Duro SMS, Nunes BP, Facchini LA, Tomasi E. Health care for people with diabetes and hypertension in Brazil: cross-sectional study of Program for Improving Access and Quality of Primary Care, 2014. ACTA ACUST UNITED AC 2021; 30:e2020419. [PMID: 34287554 DOI: 10.1590/s1679-49742021000300015] [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: 07/13/2020] [Accepted: 12/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess health care for people with diabetes and hypertension, comparing the teams according to their participation in both cycles I and II of the Program for Improving Primary Health Care Access and Quality (PMAQ), and to verify its association with the characteristics of service users and municipalities. METHODS This was a cross-sectional study using PMAQ data from 2014. The following variables were used: team organization, request for tests and health care reported by service users. RESULTS Thirty-five percent of the teams presented adequate organization and 88% requested all tests. Among the users, 31% had their feet examined and 18% received adequate health care. Municipalities in the Southeast region, with more than 300,000 inhabitants and the highest human development index, presented the best indicators. The teams that took part in both cycles I and II showed greater prevalence of organization and request for tests. CONCLUSION Health care for people with diabetes and hypertension in primary health care in Brazil needs improvement.
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Affiliation(s)
| | | | | | | | - Elaine Tomasi
- Universidade Federal de Pelotas, Pelotas, RS, Brasil
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Ruivo ACO, Facchini LA, Tomasi E, Wachs LS, Fassa AG. [Availability of inputs for reproductive planning in three cycles of the Program for Improvement of Access and Quality in Basic Healthcare: 2012, 2014, and 2018]. CAD SAUDE PUBLICA 2021; 37:e00123220. [PMID: 34231769 DOI: 10.1590/0102-311x00123220] [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: 06/10/2020] [Accepted: 11/13/2020] [Indexed: 11/22/2022] Open
Abstract
The objective was to assess the availability of inputs for reproductive planning in basic healthcare units (UBS in Portuguese) that participated in the National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB) and their distribution according to contextual factors. A comparative study was conducted of the three cycles of the PMAQ-AB (2012, 2014, and 2018). The study assessed the availability in the UBS of ethynyl-estradiol + levonorgestrel, norethisterone, norethisterone + estradiol, levonorgestrel, medroxyprogesterone, male and female condoms, IUDs, and rapid pregnancy tests. The study considered the availability and presence of all the inputs. Availability was assessed according to contextual factors in the city where the UBS was located. Availability of total inputs increased from 1.5% to 10.9%. In all the cycles, ethynyl-estradiol + levonorgestrel and male condoms showed the highest availability, and IUDs the lowest. Individual input´s availability also increased, with the highest increase of 36p.p. for female condoms, rapid pregnancy tests, and norethisterone + estradiol and the lowest of 15p.p. for ethynyl-estradiol + levonorgestrel, norethisterone, and IUDs. The North of Brazil showed the worst results. The largest increases were in the UBS in the municipalities with the lowest HDI and in those that participated in all the cycles of the PMAQ. Condoms are the only widely available inputs, and it is important to expand the availability of the other inputs, mainly IUDs and rapid pregnancy tests. The period under study experienced the promotion of equity, but regional inequalities need to be overcome. It is essential to monitor the inputs´ availability in order to improve reproductive planning.
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Affiliation(s)
| | | | - Elaine Tomasi
- Departamento de Medicina Social, Universidade Federal de Pelotas, Pelotas, Brasil
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Rocha TAH, Boitrago GM, Mônica RB, Almeida DGD, Silva NCD, Silva DM, Terabe SH, Staton C, Facchini LA, Vissoci JRN. National COVID-19 vaccination plan: using artificial spatial intelligence to overcome challenges in Brazil. Cien Saude Colet 2021; 26:1885-1898. [PMID: 34076129 DOI: 10.1590/1413-81232021265.02312021] [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: 01/28/2021] [Accepted: 02/14/2021] [Indexed: 11/22/2022] Open
Abstract
This article explores the use of spatial artificial intelligence to estimate the resources needed to implement Brazil's COVID-19 immu nization campaign. Using secondary data, we conducted a cross-sectional ecological study adop ting a time-series design. The unit of analysis was Brazil's primary care centers (PCCs). A four-step analysis was performed to estimate the popula tion in PCC catchment areas using artificial in telligence algorithms and satellite imagery. We also assessed internet access in each PCC and con ducted a space-time cluster analysis of trends in cases of SARS linked to COVID-19 at municipal level. Around 18% of Brazil's elderly population live more than 4 kilometer from a vaccination point. A total of 4,790 municipalities showed an upward trend in SARS cases. The number of PCCs located more than 5 kilometer from cell towers was largest in the North and Northeast regions. Innovative stra tegies are needed to address the challenges posed by the implementation of the country's National COVID-19 Vaccination Plan. The use of spatial artificial intelligence-based methodologies can help improve the country's COVID-19 response.
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Affiliation(s)
- Thiago Augusto Hernandes Rocha
- Duke Global Health Institute, Duke University, Global Emergency Medicine Innovation and Implementation Research. 310, Trent Drive, Durham North Carolina USA.
| | | | | | | | - Núbia Cristina da Silva
- Duke Global Health Institute, Duke University, Global Emergency Medicine Innovation and Implementation Research. 310, Trent Drive, Durham North Carolina USA.
| | | | - Sandro Haruyuki Terabe
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Global Emergency Medicine Innovation and Implementation Research. 310, Trent Drive, Durham North Carolina USA.
| | - Luiz Augusto Facchini
- Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas. Pelotas RS Brasil
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Global Emergency Medicine Innovation and Implementation Research. 310, Trent Drive, Durham North Carolina USA.
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Kessler M, Thumé E, Marmot M, Macinko J, Facchini LA, Nedel FB, Wachs LS, Volz PM, de Oliveira C. Family Health Strategy, Primary Health Care, and Social Inequalities in Mortality Among Older Adults in Bagé, Southern Brazil. Am J Public Health 2021; 111:927-936. [PMID: 33734851 DOI: 10.2105/ajph.2020.306146] [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] [Indexed: 11/04/2022]
Abstract
Objectives. To investigate the role of the Family Health Strategy (FHS) in reducing social inequalities in mortality over a 9-year follow-up period.Methods. We carried out a population-based cohort study of individuals aged 60 years and older from the city of Bagé, Brazil. Of 1593 participants at baseline (2008), 1314 (82.5%) were included in this 9-year follow-up (2017). We assessed type of primary health care (PHC) coverage and other variables at baseline. In 2017, we ascertained 579 deaths through mortality registers. Hazard ratios and their 95% confidence intervals modeled time to death estimated by Cox regression. We also tested the effect modification between PHC and wealth.Results. The FHS had a protective effect on mortality among individuals aged 60 to 64 years, a result not found among those not covered by the FHS. Interaction analysis showed that the FHS modified the effect of wealth on mortality. The FHS protected the poorest from all-cause mortality (hazard ratio [HR] = 0.59; 95% confidence interval [CI] = 0.36, 0.96) and avoidable mortality (HR = 0.46; 95% CI = 0.25, 0.85).Conclusions. FHS coverage reduced social inequalities in mortality among older adults. Our findings highlight the need to guarantee universal health coverage in Brazil by expanding and strengthening the FHS to promote health equity.
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Affiliation(s)
- Marciane Kessler
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Elaine Thumé
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Michael Marmot
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - James Macinko
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Luiz Augusto Facchini
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Fúlvio Borges Nedel
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Louriele Soares Wachs
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Pâmela Moraes Volz
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Cesar de Oliveira
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
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Ribeiro AGA, Martins RFM, Vissoci JRN, da Silva NC, Rocha TAH, Queiroz RCDS, Tonello AS, Staton CA, Facchini LA, Thomaz EBAF. Progress and challenges in potential access to oral health primary care services in Brazil: A population-based panel study with latent transition analysis. PLoS One 2021; 16:e0247101. [PMID: 33725008 PMCID: PMC7963056 DOI: 10.1371/journal.pone.0247101] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Compared indicators of potential access to oral health services sought in two cycles of the Program for Improvement of Access and Quality of Primary Care (PMAQ-AB), verifying whether the program generated changes in access to oral health services. METHODS Transitional analysis of latent classes was used to analyze two cross-sections of the external evaluation of the PMAQ-AB (Cycle I: 2011-2012 and Cycle II: 2013-2014), identifying completeness classes for a structure and work process related to oral health. Consider three indicators of structure (presence of a dental surgeon, existence of a dental office and operating at minimum hours) and five of the work process (scheduling every day of the week, home visits, basic dental procedures, scheduling for spontaneous demand and continuation of treatment). Choropleth maps and hotspots were made. RESULTS The proportion of elements that had one or more dentist (CD), dental office and operated at minimum hours varied from 65.56% to 67.13 between the two cycles of the PMAQ-AB. The number of teams that made appointments every day of the week increased 8.7% and those that made home visits varied from 44.51% to 52.88%. The reduction in the number of teams that reported guaranteeing the agenda for accommodating spontaneous demand, varying from 62.41% to 60.11% and in the continuity of treatment, varying from 63.41% to 61.11%. For the structure of health requirements, the predominant completeness profile was "Best completeness" in both cycles, comprising 71.0% of the sets at time 1 and 67.0% at time 2. The proportion of teams with "Best completeness" increased by 89.1%, the one with "Worst completeness" increased by 20%, while those with "Average completeness" decreased by 66.3%. CONCLUSION We identified positive changes in the indicators of potential access to oral health services, expanding the users' ability to use them. However, some access attributes remain unsatisfactory, with organizational barriers persisting.
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Affiliation(s)
- Ana Graziela Araujo Ribeiro
- Dentistry Department, Graduate Program in Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brasil
| | | | - João Ricardo Nickenig Vissoci
- Global Emergency Medicine Innovation and Implementation (GEMINI), Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Research Design and Analysis Core (RDAC), Duke Global Health Institute, Durham, North Carolina, United States of America
| | | | - Thiago Augusto Hernandes Rocha
- Global Emergency Medicine Innovation and Implementation (GEMINI), Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- MATH Consortium, Belo Horizonte, Minas Gerais, Brasil
| | | | - Aline Sampieri Tonello
- Department of Public Health, Center of Biological Sciences of Health, Federal University of Maranhão, São Luís, Maranhão, Brasil
| | - Catherine A. Staton
- Global Emergency Medicine Innovation and Implementation (GEMINI), Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Luiz Augusto Facchini
- Department of Social Medicine, Postgraduate Programs in Epidemiology, Nursing and Family Health, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brasil
| | - Erika Bárbara Abreu Fonseca Thomaz
- Department of Public Health, Graduate Program in Public Health and Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brasil
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Soares MU, Facchini LA, Nedel FB, Wachs LS, Kessler M, Thumé E. Social relationships and survival in the older adult cohort. Rev Lat Am Enfermagem 2021; 29:e3395. [PMID: 33439948 PMCID: PMC7798399 DOI: 10.1590/1518-8345.3844.3395] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 07/15/2020] [Indexed: 12/04/2022] Open
Abstract
Objective: to verify the influence of social relations on the survival of older adults living in southern Brazil. Method: a cohort study (2008 and 2016/17), conducted with 1,593 individuals aged 60 years old or over, in individual interviews. The outcomes of social relations and survival were verified by Multiple Correspondence Analysis, which guided the proposal of an explanatory matrix for social relations, the analysis of survival by Kaplan-Meier, and the multivariate analysis by Cox regression to verify the association between the independent variables. Results: follow-up was carried out with 82.5% (n=1,314), with 46.1% being followed up in 2016/17 (n=735) and 579 deaths (36.4%). The older adults who went out of their homes daily had a 39% reduction in mortality, and going to parties kept the protective effect of 17% for survival. The lower risk of death for women is modified when the older adults live in households with two or more people, in this case women have an 89% higher risk of death than men. Conclusion: strengthened social relationships play a mediating role in survival. The findings made it possible to verify the importance of going out of the house as a marker of protection for survival.
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Affiliation(s)
- Mariangela Uhlmann Soares
- Universidade Federal de Pelotas, Pelotas, RS, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | | | - Fúlvio Borges Nedel
- Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Florianópolis, SC, Brazil
| | - Louriele Soares Wachs
- Universidade Federal de Pelotas, Pelotas, RS, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Marciane Kessler
- Universidade Federal de Pelotas, Pelotas, RS, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Elaine Thumé
- Universidade Federal de Pelotas, Pelotas, RS, Brazil
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Silva WOC, Carvalho MPD, Fassa MEG, Facchini LA, Fassa AG. Habilidades de comunicação clínica dos preceptores de medicina de família e comunidade em Florianópolis, Santa Catarina, Brasil. Rev Bras Med Fam Comunidade 2020. [DOI: 10.5712/rbmfc15(42)2673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Este estudo investigou a autoavaliação dos preceptores (versão resumida do Guia Observacional Calgary-Cambridge) sobre quanto aplicam e ensinam HCC, bem como sobre oportunidades de ensino e qualidade do feedback. Métodos: Realizou-se um estudo transversal com 44 preceptores ativos do internato e da residência de medicina de família e comunidade de Florianópolis, Santa Catarina, Brasil. Resultados: Os preceptores se autoavaliaram positivamente em relação à aplicação e ao ensino de HCC, mas as oportunidades de ensino de HCC são escassas e a qualidade do feedback é mediana. Conclusão: É preciso melhorar a estrutura física e a educação permanente sobre feedback e métodos de ensino, incluindo videogravação de consulta, para ampliar as oportunidades de ensino de HCC.
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Nunes BP, Souza ASSD, Nogueira J, Andrade FBD, Thumé E, Teixeira DSDC, Lima-Costa MF, Facchini LA, Batista SR. Multimorbidity and population at risk for severe COVID-19 in the Brazilian Longitudinal Study of Aging. CAD SAUDE PUBLICA 2020; 36:e00129620. [PMID: 33237250 DOI: 10.1590/0102-311x00129620] [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: 05/18/2020] [Accepted: 08/17/2020] [Indexed: 02/06/2023] Open
Abstract
This study aimed to measure the occurrence of multimorbidity and to estimate the number of individuals in the Brazilian population 50 years or older at risk for severe COVID-19. This was a cross-sectional nationwide study based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015-2016, with 9,412 individuals 50 years or older. Multimorbidity was defined as ≥ 2 chronic conditions based on a list of 15 diseases considered risk conditions for severe COVID-19. The analyses included calculation of prevalence and estimation of the absolute number of persons in the population at risk. Self-rated health status, frailty, and basic activities of daily living were used as markers of health status. Sex, age, region of the country, and schooling were used as covariables. Some 80% of the sample had at least one of the target conditions, which represents some 34 million individuals. Multimorbidity was reported by 52% of the study population, with higher proportions in the Central, Southeast, and South of Brazil. Cardiovascular diseases and obesity were the most frequent chronic conditions. An estimated 2.4 million Brazilians are at serious health risk. The results revealed inequalities according to schooling. The number of persons 50 years or older who presented risk conditions for severe COVID-19 is high both in absolute and relative terms. The estimate is important for planning strategies to monitor persons with chronic conditions and for preventive strategies to deal with the novel coronavirus.
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Affiliation(s)
| | | | - Januse Nogueira
- Universidade Federal de Campina Grande, Campina Grande, Brasil
| | | | - Elaine Thumé
- Faculdade de Enfermagem, Universidade Federal de Pelotas, Pelotas, Brasil
| | | | | | | | - Sandro Rodrigues Batista
- Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, Brasil.,Secretaria de Estado da Saúde de Goiás, Goiania, Brasil
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36
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Batista SR, Souza ASSD, Nogueira J, Andrade FBD, Thumé E, Teixeira DSDC, Lima-Costa MF, Facchini LA, Nunes BP. Protective behaviors for COVID-19 among Brazilian adults and elderly living with multimorbidity: the ELSI-COVID-19 initiative. CAD SAUDE PUBLICA 2020; 36Suppl 3:e00196120. [PMID: 33206836 DOI: 10.1590/0102-311x00196120] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/07/2020] [Indexed: 02/09/2023] Open
Abstract
To measure the occurrence of protective behaviors for COVID-19 and sociodemographic factors according to the occurrence of multimorbidity in the Brazilian population aged 50 or over was the objective of this study. We used data from telephone surveys among participants of ELSI-Brazil (Brazilian Longitudinal Study of Aging), conducted between May and June 2020. The use of non-pharmacological prevention measures for COVID-19, reasons for leaving home according to the presence of multimorbidity and sociodemographic variables were evaluated. among 6,149 individuals. Multimorbidity was more frequent in females, married, aged 50-59 years and residents of the urban area. Most of the population left home between once and twice in the last week, increasing according to the number of morbidities (22.3% no morbidities and 38% with multimorbidity). Leaving home every day was less common among individuals with multimorbidity (10.3%) and 9.3% left home in the last week to access health care. Hand hygiene (> 98%) and always wearing a mask when leaving home (> 96%) were almost universal habits. Greater adherence to social isolation was observed among women with multimorbidity when compared to men (PR = 1.49, 95%CI: 1.23-1.79). This adherence increased proportionally with age and inversely with the level of education. The protective behavior in people with multimorbidity seems to be greater in relation to the others, although issues related to social isolation and health care deserve to be highlighted. These findings can be useful in customizing strategies for coping with the current pandemic.
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Affiliation(s)
- Sandro Rodrigues Batista
- Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, Brasil.,Secretaria de Estado da Saúde de Goiás, Goiânia, Brasil
| | | | - Januse Nogueira
- Universidade Federal de Campina Grande, Campina Grande, Brasil
| | | | - Elaine Thumé
- Departamento de Enfermagem, Universidade Federal de Pelotas, Pelotas, Brasil
| | | | - Maria Fernanda Lima-Costa
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.,Programa de Pós-graduação em Saúde Púbica, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | - Bruno Pereira Nunes
- Departamento de Enfermagem, Universidade Federal de Pelotas, Pelotas, Brasil
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Fassa A, Fantinel EJ, Soares DC, Carret MLV, Linhares R, Maagh S, Pinto LR, Fassa MEG, Facchini LA. Self-learning Courses EaD to qualify clinical practice. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.162] [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
Health service evaluation studies point to the low quality of care, however the permanent education of health professionals is a major challenge. Within the scope of the Open University for the Unified Health System (SUS), the Department of Social Medicine of the Federal University of Pelotas produced open access self-learning courses, for primary health care, based on interactive clinical cases, through distance learning.
Methods
The courses, with 45 hours, provides interactive clinical cases, medical calculators and textual materials for use by the professional or with the community. The cases are presented and followed by multiple choice questions, focusing diagnosis and treatment. The feedback is automatic. An expanded theoretical content ('learn more') that privileges the use of illustrations, images, infographics and flowcharts useful for professional practice can be accessed. Bibliographical references on the subject are also available. The courses are available in a responsive web client app, for various types of devices, providing control of progress and automatic certification. The app allows the work offline, enabling the permanent education of professionals working in remote areas.
Results
Six courses were produced for doctors, nurses and dentists, more than 30,000 users were certified.
Conclusions
This problem-based learning initiative allows the student to have a menu of cases, providing a choice of the subject, decision on the time allocated to the activity, repetition according to its need, access to a large bibliography and reading in the quantity and depth chosen by the student. In addition, the format is challenging and develops clinical reasoning. The proposition of questions promotes the reflection of the student in relation to his knowledge on the subject. Automatic feedback, 'learn more' and selected bibliographies provide formative assessment and subsidize students to define their study needs in each subject.
Key messages
Distance learning expands the possibility of qualifying the clinical practice of health professionals, especially those in remote areas. Interactive clinical cases provide the development of clinical reasoning, content review and promote formative assessment.
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Affiliation(s)
- A Fassa
- Department of Social Medicine, Federal university of Pelotas, Pelotas, Brazil
| | - E J Fantinel
- Department of Social Medicine, Federal university of Pelotas, Pelotas, Brazil
| | - D C Soares
- Nurse Department, Federal University of Pelotas, Pelotas, Brazil
| | - M L V Carret
- Department of Social Medicine, Federal university of Pelotas, Pelotas, Brazil
| | - R Linhares
- Department of Social Medicine, Federal university of Pelotas, Pelotas, Brazil
| | - S Maagh
- Department of Social Medicine, Federal university of Pelotas, Pelotas, Brazil
| | - L R Pinto
- Faculty of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - M E G Fassa
- Department of Social Medicine, Federal university of Pelotas, Pelotas, Brazil
| | - L A Facchini
- Department of Social Medicine, Federal university of Pelotas, Pelotas, Brazil
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Fassa A, Ruivo ACO, Wachs L, Tomasi E, Facchini LA. Availability of family planning supplies in the Brazilian Primary Health Care Units. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1401] [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: 11/14/2022] Open
Abstract
Abstract
Background
The availability of contraceptive methods is a main determinant of their use and diversification is necessary to meet the reproductive health needs of women at different stages of life, in a universal and equitable way. The study aims to evaluate the availability of family planning supplies in Primary Care Units (PCU) in Brazil that adhered to the Program for Improvement of Access and Quality of Primary Care (PMAQ-AB) in three evaluation cycles (2012, 2014, 2018), as well as, its distribution according to the Human Development Index (HDI), population size, Family Health Strategy (FHS) coverage and geographic region.
Methods
A descriptive cross-sectional study, of the more than 10.000 UBS included in the external evaluation of the PMAQ-AB. Availability was assessed by the physical presence of the following supplies: ethinyl estradiol + levonorgestrel, norethisterone, norethisterone + estradiol, levonorgestrel, medroxyprogesterone, male and female condom, IUD and rapid pregnancy test. The availability of all supplies at the PCU was considered adequate availability.
Results
The availability of supplies increased in the evaluated period. The lowest availabilities were IUD, 34.4% and rapid pregnancy test, 41.8%; the greatest were male condoms, 96.9%, and ethinyl estradiol + levonorgestrel, 85.2%. In Cycle III, adequate availability was 10.9%. The North had the worst results, followed by the Midwest region. HDI had little effect and population size had no effect on adequate availability, while FHS coverage was associated with greater availability. The PCUs of municipalities with a lower HDI had the largest increases in adequate availability. Adequate availability was greater in the PCUs that participated in all PMAQ-AB cycles.
Conclusions
Policies aimed at strengthening PHC increased the availability of supplies evaluated with equity promotion, however, regional inequities remain. The availability of a rapid pregnancy test and an IUD should be increased.
Key messages
Policies aimed at strengthening PHC, focusing infrastructure, provision and training professionals and quality monitoring increased the availability of family planning supplies with equity promotion. Monitoring the availability family planning supplies is essential for detecting failures, as the low availability of rapid pregnancy test, an essential supply for the early start of prenatal care.
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Affiliation(s)
- A Fassa
- Department of Social Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - A C O Ruivo
- Department of Social Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - L Wachs
- Department of Social Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - E Tomasi
- Department of Social Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - L A Facchini
- Department of Social Medicine, Federal University of Pelotas, Pelotas, Brazil
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Cristina da Silva N, Rocha TAH, Amaral PV, Elahi C, Thumé E, Thomaz EBAF, Queiroz RCDS, Vissoci JRN, Staton C, Facchini LA. Comprehending the lack of access to maternal and neonatal emergency care: Designing solutions based on a space-time approach. PLoS One 2020; 15:e0235954. [PMID: 32702067 PMCID: PMC7377445 DOI: 10.1371/journal.pone.0235954] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 06/26/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to better understand how the lack of emergency child and obstetric care can be related to maternal and neonatal mortality levels. METHODS We performed spatiotemporal geospatial analyses using data from Brazilian municipalities. An emergency service accessibility index was derived using the two-step floating catchment area (2SFCA) for 951 hospitals. Mortality data from 2000 to 2015 was used to characterize space-time trends. The data was overlapped using a spatial clusters analysis to identify regions with lack of emergency access and high mortality trends. RESULTS From 2000 to 2015 Brazil the overall neonatal mortality rate varied from 11,42 to 11,71 by 1000 live births. The maternal mortality presented a slightly decrease from 2,98 to 2,88 by 100 thousand inhabitants. For neonatal mortality the Northeast and North regions presented the highest percentage of up trending. For maternal mortality the North region exhibited the higher volume of up trending. The accessibility index obtained highlighted large portions of the rural areas of the country without any coverage of obstetric or neonatal beds. CONCLUSIONS The analyses highlighted regions with problems of mortality and access to maternal and newborn emergency services. This sequence of steps can be applied to other low and medium income countries as health situation analysis tool. SIGNIFICANCE STATEMENT Low and middle income countries have greater disparities in access to emergency child and obstetric care. There is a lack of approaches capable to support analysis considering a spatiotemporal perspective for emergency care. Studies using Geographic Information System analysis for maternal and child care, are increasing in frequency. This approach can identify emergency child and obstetric care saturated or deprived regions. The sequence of steps designed here can help researchers, and policy makers to better design strategies aiming to improve emergency child and obstetric care.
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Affiliation(s)
- Núbia Cristina da Silva
- Methods, Analytics and Technology for Health (M.A.T.H) Consortium, Belo Horizonte, Minas Gerais, Brazil
| | | | - Pedro Vasconcelos Amaral
- Centre for Development and Regional Planning, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cyrus Elahi
- Duke Global Neurosurgery and Neurology Division, Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Elaine Thumé
- Post-Graduate Program in Nursing, Faculty of Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | | | - João Ricardo Nickenig Vissoci
- Methods, Analytics and Technology for Health (M.A.T.H) Consortium, Belo Horizonte, Minas Gerais, Brazil
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Catherine Staton
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Luiz Augusto Facchini
- Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Almeida APSC, Nunes BP, Duro SMS, Lima RDCD, Facchini LA. [Lack of access and the trajectory of healthcare use by elderly Brazilians]. Cien Saude Colet 2020; 25:2213-2226. [PMID: 32520266 DOI: 10.1590/1413-81232020256.27792018] [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: 03/18/2018] [Accepted: 11/27/2018] [Indexed: 11/22/2022] Open
Abstract
Populational ageing is a current phenomenon and calls for the reconfiguration of health services and expansion of access for the elderly. This is a cross-sectional study with 6,624 elderly Brazilians over 60 that set out to evaluate access to healthcare by measuring lack of access and by describing the trajectory until recourse to hospitalization, emergency care and medical visits. The variables were analyzed according to the nature of funding to access the service (SUS, private insurance and cash-payment). The prevalence of lack of access was 2.5% (CI95% 1.6;4.0) for hospitalizations, 2.1% (CI95% 1.4; 3.1) for emergency rooms, and 0.6% (CI95% 0.3;0.9) for medical visits. SUS accounted for most of the care provided. Positive aspects of SUS were the higher number of medical visits in the city of residence and less money spent on transport. The private system stands out for the low frequency of long waiting times and higher frequency of referrals to return visits after hospitalization. The findings highlight the importance of SUS in Brazil in promoting equality and universality despite the existing deficiencies. In both public and private systems, greater articulation among the healthcare levels is required for integral healthcare to elderly individuals.
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Affiliation(s)
- Ana Paula Santana Coelho Almeida
- Departamento de Medicina Social, Universidade Federal do Espírito Santo (UFES). Av. Marechal Campos 1468, Bairro Bonfim. 29047-105, Vitória, ES, Brasil.
| | - Bruno Pereira Nunes
- Departamento de Enfermagem em Saúde Coletiva, Universidade Federal de Pelotas (UFPEL). Pelotas, RS, Brasil
| | | | | | - Luiz Augusto Facchini
- Programa de Pós-Graduação em Epidemiologia, Departamento de Medicina Social, Faculdade de Medicina, UFPEL. Pelotas, RS, Brasil
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Lisboa LAS, Queiroz RCDS, Thomaz EBAF, da Silva NC, Rocha TAH, Vissoci JRN, Staton CA, Lein A, Simões VMF, Thumé E, Facchini LA. Characteristics of primary care and rates of pediatric hospitalizations in Brazil. Rev Saude Publica 2020; 54:32. [PMID: 32236383 PMCID: PMC7100948 DOI: 10.11606/s1518-8787.2020054001784] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/19/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To evaluate the association among characteristics of primary health care center (PHCC) with hospitalizations for primary care sensitive conditions (PCSC) in Brazil. METHOD In this study, a cross-sectional ecological study was performed. This study analyzed the 27 capitals of Brazil's federative units. Data were aggregated from the following open access databases: National Program for Access and Quality Improvement in Primary Care, the Hospital Information System of Brazilian Unified Health System and Annual Population Census conducted by the Brazilian Institute of Geography and Statistics. Associations were estimated among characteristics of primary care with the number of three PCSC as the leading causes of hospitalization in children under-5 population in Brazil: asthma, diarrhea, and pneumonia. RESULTS In general, PHCC showed limited structural adequacy (37.3%) for pediatric care in Brazil. The capitals in South and Southeast regions had the best structure whereas the North and Northeast had the worst. Fewer PCSC hospitalizations were significantly associated with PHCC which presented appropriate equipment (RR: 0.98; 95%CI: 0.97-0.99), structural conditions (RR: 0.98; 95%CI: 0.97-0.99), and signage/identification of professionals and facilities (RR: 0.98; 95%CI: 0.97-0.99). Higher PCSC hospitalizations were significantly associated with PHCC with more physicians (RR: 1.23, 95%CI: 1.02-1.48), it forms (RR: 1.01, 95%CI: 1.01-1.02), and more medications (RR: 1.02, 95%CI: 1.01-1.03). CONCLUSION Infrastructural adequacy of PHCC was associated with less PCSC hospitalizations, while availability medical professional and medications were associated with higher PCSC hospitalizations.
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Affiliation(s)
- Lívia Anniele Sousa Lisboa
- Universidade Federal do MaranhãoPrograma de Pos graduação em Saúde PúblicaSão LuísMaranhãoBrasilUniversidade Federal do Maranhão. Programa de Pos graduação em Saúde Pública. São Luís, Maranhão, Brasil.
| | - Rejane Christine de Sousa Queiroz
- Universidade Federal do MaranhãoPrograma de Pos graduação em Saúde PúblicaDepartamento de Saúde PúblicaSão LuísMaranhãoBrasilUniversidade Federal do Maranhão. Programa de Pos graduação em Saúde Pública. Departamento de Saúde Pública. São Luís, Maranhão, Brasil.
| | - Erika Bárbara Abreu Fonseca Thomaz
- Universidade Federal do MaranhãoPrograma de Pos graduação em Saúde PúblicaSão LuísMaranhãoBrasilUniversidade Federal do Maranhão. Programa de Pos graduação em Saúde Pública. São Luís, Maranhão, Brasil.
| | - Núbia Cristina da Silva
- Universidade Federal de Minas GeraisObservatório de Recursos Humanos em SaúdeBelo HorizonteMinas GeraisBrasilUniversidade Federal de Minas Gerais. Observatório de Recursos Humanos em Saúde. Belo Horizonte, Minas Gerais, Brasil.
| | - Thiago Augusto Hernandes Rocha
- Organização Pan Americana de SaúdeBrasíliaDistrito FederalBrasilOrganização Pan Americana de Saúde: OPAS/WHO - Brasília, Distrito Federal, Brasil.
| | - João Ricardo Nickenig Vissoci
- Duke UniversityDuke Global Health InstituteDurhamNorth CarolinaU.SDuke University. Duke Global Health Institute. Durham, North Carolina. U.S.
| | - Catherine Ann Staton
- Duke UniversityDuke Global Health InstituteDurhamNorth CarolinaU.SDuke University. Duke Global Health Institute. Durham, North Carolina. U.S.
| | - Adriana Lein
- Duke UniversityDuke Global Health InstituteDurhamNorth CarolinaU.SDuke University. Duke Global Health Institute. Durham, North Carolina. U.S.
| | - Vanda Maria Ferreira Simões
- Universidade Federal do MaranhãoPrograma de Pos graduação em Saúde PúblicaDepartamento de Saúde PúblicaSão LuísMaranhãoBrasilUniversidade Federal do Maranhão. Programa de Pos graduação em Saúde Pública. Departamento de Saúde Pública. São Luís, Maranhão, Brasil.
| | - Elaine Thumé
- Universidade Federal de PelotasPrograma de Pós-graduação em EnfermagemDepartmento de EnfermagemPelotasRio Grande do SulBrasilUniversidade Federal de Pelotas. Programa de Pós-graduação em Enfermagem. Departmento de Enfermagem. Pelotas, Rio Grande do Sul, Brasil.
| | - Luiz Augusto Facchini
- Universidade Federal de PelotasProgramas de Pós-graduação em Epidemiologia e EnfermagemDepartmento de Medicina SocialPelotasRio Grande do SulBrasilUniversidade Federal de Pelotas. Programas de Pós-graduação em Epidemiologia e Enfermagem. Departmento de Medicina Social. Pelotas, Rio Grande do Sul, Brasil.
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Kessler M, Thumé E, Scholes S, Marmot M, Facchini LA, Nunes BP, Machado KP, Soares MU, de Oliveira C. Modifiable risk factors for 9-year mortality in older English and Brazilian adults: The ELSA and SIGa-Bagé ageing cohorts. Sci Rep 2020; 10:4375. [PMID: 32152345 PMCID: PMC7062886 DOI: 10.1038/s41598-020-61127-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/14/2020] [Indexed: 12/19/2022] Open
Abstract
To quantify and compare 9-year all-cause mortality risk attributable to modifiable risk factors among older English and Brazilian adults. We used data for participants aged 60 years and older from the English Longitudinal Study of Ageing (ELSA) and the Bagé Cohort Study of Ageing (SIGa-Bagé). The five modifiable risk factors assessed at baseline were smoking, hypertension, diabetes, obesity and physical inactivity. Deaths were identified through linkage to mortality registers. For each risk factor, estimated all-cause mortality hazard ratios (HR) and population attributable fractions (PAF) were adjusted by age, sex, all other risk factors and socioeconomic position (wealth) using Cox proportional hazards modelling. We also quantified the risk factor adjusted wealth gradients in mortality, by age and sex. Among the participants, 659 (ELSA) and 638 (SIGa-Bagé) died during the 9-year follow-up. Mortality rates were higher in SIGa-Bagé. HRs and PAFs showed more similarities than differences, with physical inactivity (PAF 16.5% ELSA; 16.7% SIGa-Bagé) and current smoking (PAF 4.9% for both cohorts) having the strongest association. A clear graded relationship existed between the number of risk factors and subsequent mortality. Wealth gradients in mortality were apparent in both cohorts after full adjustment, especially among men aged 60-74 in ELSA. A different pattern was found among older women, especially in SIGa-Bagé. These findings call attention for the challenge to health systems to prevent and modify the major risk factors related to non-communicable diseases, especially physical inactivity and smoking. Furthermore, wealth inequalities in mortality persist among older adults.
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Affiliation(s)
- Marciane Kessler
- Department of Postgraduate Program in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil.
- Department of Epidemiology & Public Health, University College London (UCL), London, United Kingdom.
| | - Elaine Thumé
- Department of Postgraduate Program in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Shaun Scholes
- Department of Epidemiology & Public Health, University College London (UCL), London, United Kingdom
| | - Michael Marmot
- Department of Epidemiology & Public Health, University College London (UCL), London, United Kingdom
| | - Luiz Augusto Facchini
- Department of Postgraduate Program in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
- Department of Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Bruno Pereira Nunes
- Department of Postgraduate Program in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Karla Pereira Machado
- Department of Postgraduate Program in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Mariangela Uhlmann Soares
- Department of Postgraduate Program in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, University College London (UCL), London, United Kingdom
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Neves RG, Flores-Quispe MDP, Facchini LA, Fassa AG, Tomasi E. Prenatal care in Brazil: a cross-sectional study of the Program for Improving Primary Care Access and Quality, 2014. Epidemiol Serv Saude 2020; 29:e2019019. [PMID: 32074198 DOI: 10.5123/s1679-49742020000100008] [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: 02/19/2019] [Accepted: 09/10/2019] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE to describe the adequacy of primary health care center structure, requests for tests and prenatal care reported by female health service users within the scope of the Program for Improving Primary Care Access and Quality (PMAQ) in Brazil. METHODS this was a cross-sectional study using PMAQ Cycle II (2014) data. RESULTS data from 9,909 health centers, 9,905 teams, and 9,945 female health service users were included; 70.1% (95%CI 69.2;71.0) of health centers had adequate structure; 88.0% (95%CI 87.4;88.7) of the teams requested all tests; 59.8% (95%CI 58.8;60.8) of female health service users reported receiving total guidance, and 23.4% of them (95%CI 22.5;24.2) underwent all physical examination procedures; teams that participated in both Cycle I and Cycle II presented better results. CONCLUSION in spite of shortcomings in Primary Care structure and work process in Brazil, PMAQ appears to positively affect prenatal care.
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Affiliation(s)
| | | | | | | | - Elaine Tomasi
- Universidade Federal de Pelotas, Pelotas, RS, Brasil
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Seus TL, Silveira DSD, Tomasi E, Thumé E, Facchini LA, Siqueira FV. Structure for the work and composition of Family Health Support Unit teams: national survey - Program for Improving Primary Health Care Access and Quality (PMAQ), 2013. Epidemiol Serv Saude 2020; 28:e2018510. [PMID: 32022218 DOI: 10.5123/s1679-49742019000300017] [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: 02/08/2019] [Accepted: 09/10/2019] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE to describe the structure of Family Health Support Unit (FHSU) teams with regard to physical space, training received, continuing education and professionals that support Primary Health Care (PHC) teams in Brazil, in 2013. METHODS this is a descriptive study using data from the external evaluation stage of the Program for Improving Primary Health Care Access and Quality (PMAQ). RESULTS the 1,773 FHSU teams mainly used shared clinics at primary health care centers (85.7%); 63.4% of professionals were offered specific training when they started work at their FHSU, while 67.4% were offered continuing education; the teams received support mainly from physiotherapists (87.4%) and Physical Education professionals (87,0%). CONCLUSION the structure available for FHSU teams is in accordance with the guidelines; some FHSU professionals have not received any specific training for the job.
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Affiliation(s)
- Thamires Lorenzet Seus
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Educação Física, Pelotas, RS, Brasil
| | - Denise Silva da Silveira
- Universidade Federal de Pelotas, Faculdade de Medicina, Departamento de Medicinal Social, Pelotas, RS, Brasil
| | - Elaine Tomasi
- Universidade Federal de Pelotas, Faculdade de Medicina, Departamento de Medicinal Social, Pelotas, RS, Brasil
| | - Elaine Thumé
- Universidade Federal de Pelotas, Faculdade de Enfermagem, Programa de Pós-Graduação em Enfermagem, Pelotas, RS, Brasil
| | - Luiz Augusto Facchini
- Universidade Federal de Pelotas, Faculdade de Medicina, Departamento de Medicinal Social, Pelotas, RS, Brasil
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Facchini LA, Florencio ADSR, Nunes BP, Silva MRM, Rosales C, Alfaro G, Rocha TAH, Molina J. Contribuições do Programa Mais Médicos ao desempenho de equipes de Saúde da Família na atenção à hipertensão e ao diabetes no Brasil, 2012 a 2015. Rev Panam Salud Publica 2020. [DOI: 10.26633/rpsp.2020.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bortolotto CC, Hirschmann R, Martins-Silva T, Facchini LA. Exposição a agrotóxicos: estudo de base populacional em zona rural do sul do Brasil. Rev bras epidemiol 2020; 23:e200027. [DOI: 10.1590/1980-549720200027] [Citation(s) in RCA: 4] [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: 10/16/2019] [Accepted: 12/17/2019] [Indexed: 12/26/2022] Open
Abstract
RESUMO: Objetivo: Estimar a prevalência de exposição a agrotóxicos e fatores associados entre moradores de zona rural. Métodos: Estudo transversal de base populacional realizado com 1.518 indivíduos, em 2016. Foram aleatoriamente selecionados 24 setores censitários de oito distritos rurais de Pelotas, RS. Indivíduos ≥ 18 anos residentes nos domicílios aleatoriamente selecionados eram elegíveis. Foi realizada análise descritiva e apresentada prevalência de contato com os agrotóxicos. A associação entre desfecho e variáveis independentes deu-se por regressão de Poisson, conforme modelo hierárquico. As variáveis foram ajustadas para todas do mesmo nível, além daquelas que foram mantidas no modelo do nível anterior e das com valor p < 0,20. Resultados: A prevalência de contato com agrotóxicos no último ano foi de 23,7%, e, entre esses participantes, 5,9% relataram intoxicação por agrotóxicos alguma vez na vida. A probabilidade de contato com agrotóxicos no último ano foi maior entre os homens (razão de prevalência - RP = 2,00; intervalo de confiança de 95% - IC95% 1,56 - 2,56); entre aqueles com idades entre 40 e 49 anos (RP = 1,44; IC95% 1,12 - 1,80); entre os menos escolarizados (RP = 2,06; IC95% 1,39 - 3,10); os que exerciam trabalho rural (RP = 2,87; IC95% 2,05 - 4,01); e aqueles que moraram na zona rural a vida inteira (RP = 1,28; IC95% 1,00 - 1,66). Conclusões: Aproximadamente um em cada quatro adultos da zona rural de Pelotas entrou em contato com agrotóxicos no ano anterior ao estudo. Os achados evidenciam a existência de desigualdades sociais relacionadas à exposição aos agrotóxicos e fornecem informações para ações visando à redução da exposição e intoxicação por esses produtos.
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Corrêa MM, Facchini LA, Thumé E, Oliveira ERAD, Tomasi E. The ability of waist-to-height ratio to identify health risk. Rev Saude Publica 2019; 53:66. [PMID: 31553376 PMCID: PMC6752642 DOI: 10.11606/s1518-8787.2019053000895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 10/15/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the performance of the ratio between the waist circumference and the height in the identification of health risk compared with the correlation matrix between the anthropometric parameters body mass index and waist circumference. METHODS A population-based study presenting a transversal cut in a representative sample of the Brazilian adult and older population. The combination of the body mass index with the waist circumference resulted in health risk categories, and the cutoff points of the ratio between the waist circumference and the height as anthropometric indicator were used for classification of low and increased risk. Poisson regression was used to verify the association of systemic arterial hypertension with the health risk categories. RESULTS The results showed 26% of adult men, 10.4% of adult women and more than 30% of the older adults of both genders classified as without risk by the combination matrix between body mass index and waist circumference presented a ratio between the waist circumference and height that showed increased risk. All risk categories continued to be associated with hypertension after control for confounding factors, being almost two times higher for adults with moderate and high risk according to both methods. When the waist-to-height ratio was used as a risk indicator, the prevalence of hypertension ratios for the older adults was 1.37 (95%CI 1.16–1.63) and 1.35 (95%CI 1.12–1.62) for men and women, respectively, being these values close to the combination matrix body mass index and waist circumference. CONCLUSIONS The waist-to-height ratio identified more individuals at early health risk than the combination matrix between the body mass index and the waist circumference and showed comparable ability to identify health risk, regardless of gender and age, regarding the prevalence ratios for systemic arterial hypertension.
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Affiliation(s)
- Márcia Mara Corrêa
- Universidade Federal de Pelotas. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil.,Universidade Federal do Espírito Santo. Programa de Pós-Graduação em Saúde Coletiva. Vitória, ES, Brasil
| | - Luiz Augusto Facchini
- Universidade Federal de Pelotas. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Elaine Thumé
- Universidade Federal de Pelotas. Programa de Pós-Graduação em Enfermagem. Pelotas, RS, Brasil
| | | | - Elaine Tomasi
- Universidade Federal de Pelotas. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
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Dubeux LS, Jesus RPFSD, Samico I, Mendes MFDM, Wanderley FSO, Tomasi E, Nunes BP, Facchini LA. Evaluation of the Program to Combat Neglected Diseases in controlling schistosomiasis mansoni in three hyperendemic municipalities, Pernambuco, Brazil, 2014. Epidemiol Serv Saude 2019; 28:e2018085. [PMID: 31365687 DOI: 10.5123/s1679-49742019000200008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 02/17/2019] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE to evaluate the implementation of schistosomiasis mansoni control actions under the Program to Combat Neglected Diseases in three municipalities in Pernambuco state, Brazil. METHODS implementation analysis was done in 2014, considering the following components - management, epidemiological surveillance, patient care, laboratorial support and health education -; direct observation and interviews were carried out with managers and technical personnel at the state, regional, and municipal levels. RESULTS partial implementation was found in municipalities A and B 69.7%; 62.2%, while there was full implementation in municipality C 79.5%; contextual weaknesses were found in communication between management levels, insufficient technical-management autonomy of decentralized levels, and professional staff job instability; potentialities identified were - continuing education, political articulation, knowledge about the program, and performance evaluation. CONCLUSION contextual categories related to development and implementation stood out for their positive influence on the degree of implementation in the municipalities; we recommend intervention in the weaknesses found, in order to ensure program sustainability and institutionalization.
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Affiliation(s)
- Luciana Santos Dubeux
- Instituto de Medicina Integral Prof. Fernando Figueira, Grupo de Estudos de Gestão e Avaliação em Saúde, Recife, PE, Brasil
| | | | - Isabella Samico
- Instituto de Medicina Integral Prof. Fernando Figueira, Grupo de Estudos de Gestão e Avaliação em Saúde, Recife, PE, Brasil
| | | | | | - Elaine Tomasi
- Universidade Federal de Pelotas, Departamento de Medicina Social, Pelotas, RS, Brasil
| | - Bruno Pereira Nunes
- Universidade Federal de Pelotas, Departamento de Enfermagem em Saúde Coletiva, Pelotas, RS, Brasil
| | - Luiz Augusto Facchini
- Universidade Federal de Pelotas, Departamento de Medicina Social, Pelotas, RS, Brasil
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Seus TLC, Silveira DSD, Tomasi E, Thumé E, Facchini LA, Siqueira FV. Family Health Support Center: health promotion, physical activity, and chronic diseases in Brazil - national PMAQ survey 2013. Epidemiol Serv Saude 2019; 28:e2018308. [PMID: 31271636 DOI: 10.5123/s1679-49742019000200009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/21/2019] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE to describe reported health promotion actions directed towards chronic non-communicable disease (CNCD) patients, the support of physical education professionals (PEP) and the implementation of actions to promote body practices and physical activity (BPPA) by the Family Health Support Center (FHSC) teams, according to Brazilian municipality context variables. METHODS this was a cross-sectional study, forming part of the 2013/2014 National Primary Health Care Access and Quality Improvement Program (PMAQ), by means of interviews with FHSC professionals. RESULTS the action most reported by the teams was evaluation and rehabilitation of psychosocial conditions (90.8%); promotion of BPPA was the sixth most performed action, and was more prevalent in the Brazilian Southeast region (89.6%), in medium-sized municipalities (88.7%), with medium human development index (HDI) (86.7%); PEP provided support to 87% of the teams. CONCLUSION FHSC were found to make an important contribution to BPPA.
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Affiliation(s)
| | | | - Elaine Tomasi
- Universidade Federal de Pelotas, Departamento de Medicina Social, Pelotas, RS, Brasil
| | - Elaine Thumé
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Enfermagem, Pelotas, RS, Brasil
| | - Luiz Augusto Facchini
- Universidade Federal de Pelotas, Departamento de Medicina Social, Pelotas, RS, Brasil
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Saes MDO, Lopes JDN, Nunes BP, Duro SMS, Facchini LA, Thumé E. [Occurrence of spinal disorders and associated factors among the elderly: a population study in a municipality in the deep south of Brazil]. Cien Saude Colet 2019; 26:739-747. [PMID: 33605348 DOI: 10.1590/1413-81232021262.33542018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/29/2019] [Indexed: 01/05/2023] Open
Abstract
The scope of this study was to estimate the prevalence of spinal disorders among the elderly and analyze potential associated factors. It involved a cross-sectional study of a sample of 1,593 elderly individuals aged 60 years or more residing in the urban area of Bagé, State of Rio Grande do Sul. In addition to the "spinal disorders" outcome, demographic, socioeconomic and behavioral variables, health perception, functional activities and the use of health services were investigated. Data collection was conducted by means of face-to-face interviews. Poisson regression analysis with robust variance was used to verify the factors associated with the outcome analyzed. Of the 1,593 participants, 37.4% reported spinal disorders. The factors related to the outcome were: low level of schooling, poor self-assessment of health, consultation in the last three months and the presence of hypertension, rheumatism and fractures. Interventions for musculoskeletal health can contribute to reduce the damages caused by spinal disorders among the elderly, such as loss of functional capacity, increased demands for health care and reduced quality of life.
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Affiliation(s)
- Mirelle de Oliveira Saes
- Faculdade de Medicina, Universidade Federal do Rio Grande. R. Visconde de Paranaguá 102, Campus da Saúde. 96203-900 Rio Grande RS Brasil.
| | | | - Bruno Pereira Nunes
- Faculdade de Enfermagem, Universidade Federal de Pelotas (UFPel). Pelotas RS Brasil
| | | | | | - Elaine Thumé
- Faculdade de Enfermagem, Universidade Federal de Pelotas (UFPel). Pelotas RS Brasil
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