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Gomez DVF, de Almeida WDS, de Souza Junior PRB, Lopes MDFC, Luna EJDA, Zimmermann IR, Tavares NUL, Gutierrez MMU, Szwarcwald CL. Prevalence of trachoma in indigenous and non-indigenous areas, Northeastern Brazil, 2019-2021. Rev Panam Salud Publica 2024; 48:e19. [PMID: 38464869 PMCID: PMC10924615 DOI: 10.26633/rpsp.2024.19] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/08/2024] [Indexed: 03/12/2024] Open
Abstract
Objective To estimate the prevalence of trachoma in indigenous and non-indigenous populations in selected areas of the state of Maranhão, in northeastern Brazil. Methods This was a population-based survey with probabilistic sampling. For the diagnosis of trachoma, external ocular examination was performed using head magnifying loupes, at 2.5X magnification. The prevalence of trachomatous inflammation - follicular (TF) in children aged 1-9 years and the prevalence of trachomatous trichiasis (TT) in the population aged ≥15 years were estimated. Relative frequencies of sociodemographic and environmental characteristics were obtained. Results The study included 7 971 individuals, 3 429 from non-indigenous populations and 4 542 from indigenous populations. The prevalence of TF in non-indigenous and indigenous populations was 0.1% and 2.9%, respectively, and the prevalence of TT among indigenous populations was 0.1%. Conclusions The prevalence of TF and TT in the two evaluation units in the state of Maranhão were within the limits recommended for the elimination of trachoma as a public health problem. However, the prevalence of TF was higher in the indigenous evaluation unit, indicating a greater vulnerability of this population to the disease. The prevalence of TF of below 5.0% implies a reduction in transmission, which may have resulted from improved socioeconomic conditions and/or the implementation of the World Health Organization SAFE strategy.
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Szwarcwald CL, Lopes MDFC, Borges de Souza Junior PR, Vaz Ferreira Gómez D, Luna EJDA, da Silva de Almeida W, Damacena GN, Ribeiro Favacho JDF, Germano de Frias P, Butcher R, Boyd S, Bakhtiari A, Willis R, Jimenez C, Harding-Esch E, Saboyá-Díaz MI, Solomon AW. Population Prevalence of Trachoma in Nine Rural Non-Indigenous Evaluation Units of Brazil. Ophthalmic Epidemiol 2023; 30:561-570. [PMID: 34711133 PMCID: PMC10581672 DOI: 10.1080/09286586.2021.1941127] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 09/26/2020] [Revised: 05/20/2021] [Accepted: 06/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the contemporary prevalence of trachoma in Brazil's non-indigenous population, surveys of those thought to be at greatest risk of disease were conducted. METHODS Rural census tracts of non-indigenous population from nine mesoregions were selected to compose the survey evaluation units (EUs) by considering previously endemic municipalities at greatest risk of trachoma. In each of the nine EUs, we conducted a population-based prevalence survey. Every resident of selected households aged ≥ 1 year was examined for trachomatous inflammation - follicular (TF) and trachomatous trichiasis (TT). Additionally, data were collected on household-level access to water, sanitation, hygiene (WASH) and education. RESULTS A total of 27,962 individuals were examined across nine EUs. The age-adjusted TF prevalence in 1-9-year-olds was <5% in each EU. The age- and gender-adjusted prevalence of TT unknown to the health system in ≥15-year-olds was <0.2% in eight EUs; in one EU, it was 0.22%. The median number of households surveyed per EU with access to an improved drinking water source within a 30-minute roundtrip of the house was 66%. School attendance was >99% of surveyed children. CONCLUSIONS The prevalence of TF was well below the target for elimination as a public health problem in all EUs. Because EUs surveyed were selected to represent the highest-risk non-indigenous areas of the country, TF prevalence is unlikely to be ≥5% in non-indigenous populations elsewhere. In one EU, the prevalence of TT was above the target threshold for elimination. Further investigation and possibly improvement in TT surgical provision are required in that EU.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria de Fátima Costa Lopes
- Coordination of Surveillance of Zoonoses and Vector Transmission Diseases, Department of Immunization and Communicable Diseases, Health Surveillance Secretariat, Ministry of Health, Brasília, Brazil
| | | | - Daniela Vaz Ferreira Gómez
- Coordination of Surveillance of Zoonoses and Vector Transmission Diseases, Department of Immunization and Communicable Diseases, Health Surveillance Secretariat, Ministry of Health, Brasília, Brazil
| | | | - Wanessa da Silva de Almeida
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Giseli Nogueira Damacena
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Paulo Germano de Frias
- Board of Education and Research, Study Group on Health Assessment and Management, Professor Fernando Figueira Integral Medicine Institute (IMIP), Recife, Brazil
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Rebecca Willis
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | | | - Emma Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Martha Idalí Saboyá-Díaz
- Neglected, Tropical, and Vector-Borne Diseases Unit, Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization (PAHO), Washington, DC, USA
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Romero DE, Muzy J, Maia LR, Almeida WDSD, Silva DRPD, Malta DC, Souza Junior PRBD. Factors associated with the incidence and worsening of back pain during the first wave of COVID-19 in Brazil. Ciênc saúde coletiva 2023. [DOI: 10.1590/1413-81232023283.13042022en] [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: 03/08/2023] Open
Abstract
Abstract The article aims to estimate the incidence and worsening of back pain (BP) during the first wave of COVID-19 in Brazil, as well as to investigate demographic, socioeconomic factors and associated changes in living conditions. ConVid - Behavior Research, applied between April and May 2020, was used as data source. The number and distribution of respondents who developed BP and those who had a worsening of the preexisting problem, their 95% confidence intervals and Pearson’s Chi-square test were estimated. The odds ratio of developing BP or worsening a preexisting problem was also estimated using multiple logistic regression models. Pre-existing BP was reported by 33.9% (95%CI 32.5-35.3) of respondents and more than half (54.4%; 95%CI 51.9-56.9) had worsened. The cumulative incidence of BP in the first wave of the pandemic was 40.9% (95%CI 39.2-42.7). Being a woman, the perceived increase in housework and the frequent feeling of sadness or depression were associated with both outcomes. Socioeconomic factors were not associated with any of outcome. The high incidence and worsening of BP during the first wave reveal the need for studies in more recent periods, given the long duration of the pandemic.
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Romero DE, Muzy J, Maia LR, Almeida WDSD, Silva DRPD, Malta DC, Souza Junior PRBD. Factors associated with the incidence and worsening of back pain during the first wave of COVID-19 in Brazil. Cien Saude Colet 2023; 28:771-784. [PMID: 36888861 DOI: 10.1590/1413-81232023283.13042022] [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: 03/30/2022] [Accepted: 09/15/2022] [Indexed: 03/08/2023] Open
Abstract
The article aims to estimate the incidence and worsening of back pain (BP) during the first wave of COVID-19 in Brazil, as well as to investigate demographic, socioeconomic factors and associated changes in living conditions. ConVid - Behavior Research, applied between April and May 2020, was used as data source. The number and distribution of respondents who developed BP and those who had a worsening of the preexisting problem, their 95% confidence intervals and Pearson's Chi-square test were estimated. The odds ratio of developing BP or worsening a preexisting problem was also estimated using multiple logistic regression models. Pre-existing BP was reported by 33.9% (95%CI 32.5-35.3) of respondents and more than half (54.4%; 95%CI 51.9-56.9) had worsened. The cumulative incidence of BP in the first wave of the pandemic was 40.9% (95%CI 39.2-42.7). Being a woman, the perceived increase in housework and the frequent feeling of sadness or depression were associated with both outcomes. Socioeconomic factors were not associated with any of outcome. The high incidence and worsening of BP during the first wave reveal the need for studies in more recent periods, given the long duration of the pandemic.
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Affiliation(s)
- Dalia Elena Romero
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. 21040-900 Rio de Janeiro RJ Brasil.
| | - Jessica Muzy
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. 21040-900 Rio de Janeiro RJ Brasil.
| | - Leo Ramos Maia
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. 21040-900 Rio de Janeiro RJ Brasil.
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. 21040-900 Rio de Janeiro RJ Brasil.
| | | | | | - Paulo Roberto Borges de Souza Junior
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. 21040-900 Rio de Janeiro RJ Brasil.
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Szwarcwald CL, Boccolini CS, da Silva de Almeida W, Soares Filho AM, Malta DC. COVID-19 mortality in Brazil, 2020-21: consequences of the pandemic inadequate management. Arch Public Health 2022; 80:255. [PMID: 36536434 PMCID: PMC9762984 DOI: 10.1186/s13690-022-01012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic brought countless challenges to public health and highlighted the Brazilian health system vulnerabilities in facing the emergency. In this article, we analyze data on COVID-19-related deaths in 2020-21 to show the epidemic consequences in Brazil. METHODS The Mortality Information System and the Live Birth Information System were the primary information sources. We used population estimates in 2020-21 to calculate COVID-19 specific mortality rates by age, sex, and educational level. Considering the total number of COVID-19 deaths in 2020-21, the COVID-19 proportional mortality (%) was estimated for each age group and sex. A graph of the daily number of deaths from January 2020 to December 2021 by sex was elaborated to show the temporal evolution of COVID-19 deaths in Brazil. In addition, four indicators related to COVID-19 mortality were estimated: infant mortality rate (IMR); maternal mortality ratio (MMR); number and rate of orphans due to mother's COVID-19 death; the average number of years lost. RESULTS The overall COVID-19 mortality rate was 14.8 (/10,000). The mortality rates increase with age and show a decreasing gradient with higher schooling. The rate among illiterate people was 38.8/10,000, three times higher than a college education. Male mortality was 31% higher than female mortality. COVID-19 deaths represented 19.1% of all deaths, with the highest proportions in the age group of 40-59 years. The average number of years lost due to COVID-19 was 19 years. The MMR due to COVID-19 was 35.7 per 100,000 live births (LB), representing 37.4% of the overall MMR. Regarding the number of orphans due to COVID-19, we estimated that 40,830 children under 18 lost their mothers during the epidemic, with an orphans' rate of 7.5/10,000 children aged 0-17 years. The IMR was 11.7 per 1000 LB, with 0.2 caused by COVID-19. The peak of COVID-19 deaths occurred in March 2021, reaching almost 4000 COVID-19 deaths per day, higher than the average number of deaths per day from all causes in 2019. CONCLUSIONS The delay in adopting public health measures necessary to control the epidemic has exacerbated the spread of the disease, resulting in several avoidable deaths.
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Affiliation(s)
- Célia Landmann Szwarcwald
- grid.418068.30000 0001 0723 0931Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cristiano Siqueira Boccolini
- grid.418068.30000 0001 0723 0931Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Wanessa da Silva de Almeida
- grid.418068.30000 0001 0723 0931Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Adauto Martins Soares Filho
- grid.8430.f0000 0001 2181 4888Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - Deborah Carvalho Malta
- grid.8430.f0000 0001 2181 4888School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais Brazil
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Souza Júnior PRBD, Szwarcwald CL, Almeida WDSD, Damacena GN, Pedroso MDM, Sousa CAMD, Morais IDS, Saldanha RDF, Lima J, Stopa SR. Comparison of sampling designs from the two editions of the Brazilian National Health Survey, 2013 and 2019. CAD SAUDE PUBLICA 2022; 38Suppl 1:e00164321. [PMID: 35857956 DOI: 10.1590/0102-311x00164321] [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: 07/01/2021] [Accepted: 04/11/2022] [Indexed: 11/21/2022] Open
Abstract
Our objective is to describe the differences in the sampling plans of the two editions of the Brazilian National Health Survey (PNS 2013 and 2019) and to evaluate how the changes affected the coefficient of variation (CV) and the design effect (Deff) of some estimated indicators. Variables from different parts of the questionnaire were analyzed to cover proportions with different magnitudes. The prevalence of obesity was included in the analysis since anthropometry measurement in the 2019 survey was performed in a subsample. The value of the point estimate, CV, and the Deff were calculated for each indicator, considering the stratification of the primary sampling units, the weighting of the sampling units, and the clustering effect. The CV and the Deff were lower in the 2019 estimates for most indicators. Concerning the questionnaire indicators of all household members, the Deffs were high and reached values greater than 18 for having a health insurance plan. Regarding the indicators of the individual questionnaire, for the prevalence of obesity, the Deff ranged from 2.7 to 4.2, in 2013, and from 2.7 to 10.2, in 2019. The prevalence of hypertension and diabetes per Federative Unit had a higher CV and lower Deff. Expanding the sample size to meet the diverse health objectives and the high Deff are significant challenges for developing probabilistic household-based national survey. New probabilistic sampling strategies should be considered to reduce costs and clustering effects.
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Affiliation(s)
| | - Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Marcel de Moraes Pedroso
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Igor da Silva Morais
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Raphael de Freitas Saldanha
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Jefferson Lima
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Szwarcwald CL, Almeida WDSD, Souza Júnior PRBD, Rodrigues JM, Romero DE. Socio-spatial inequalities in healthy life expectancy in the elderly, Brazil, 2013 and 2019. CAD SAUDE PUBLICA 2022; 38Suppl 1:e00124421. [PMID: 35544919 DOI: 10.1590/0102-311x00124421] [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: 05/15/2021] [Accepted: 09/09/2021] [Indexed: 11/22/2022] Open
Abstract
The growth in longevity in Brazil has drawn attention to more useful population health measures to complement mortality. In this paper, we investigate socio-spatial differences in life expectancy and healthy life expectancy based on information from the Brazilian National Health Survey (PNS), 2013 and 2019. A three-stage cluster sampling with stratification of the primary sampling units and random selection in all stages was used in both PNS editions. Healthy life expectancy was estimated by Sullivan's method by sex, age, and Federated Units (UF). Severe limitations to at least one noncommunicable chronic disease (NCD) or poor self-rated health were used to define the unhealthy state. Inequality indicators and a Principal Component analysis were used to investigate socio-spatial inequalities. From 2013 to 2019, both life expectancy and healthy life expectancy increased. The analysis by UF show larger disparities in healthy life expectancy than in life expectancy, with healthy life expectancy at age 60 varying from 13.6 to 19.9 years, in 2013, and from 14.9 to 20.1, in 2019. Healthy life expectancy in the wealthiest quintile was 20% longer than for those living in the poorest quintile. Wide socio-spatial disparities were found with the worst indicators in the UF located in the North and Northeast regions, whether considering poverty concentration or health care utilization. The socio-spatial inequalities demonstrated the excess burden of poor health experienced by older adults living in the less developed UF. The development of strategies at subnational levels is essential not only to provide equal access to health care but also to reduce risk exposures and support prevention policies for adoption of health behaviors.
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Affiliation(s)
- Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Jéssica Muzy Rodrigues
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Dalia Elena Romero
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Barros MBDA, Lima MG, Malta DC, Azevedo RCSD, Fehlberg BK, Souza Júnior PRBD, Azevedo LO, Machado ÍE, Gomes CS, Romero DE, Damacena GN, Werneck AO, Silva DRPD, Almeida WDSD, Szwarcwald CL. Mental health of Brazilian adolescents during the COVID-19 pandemic. Psychiatry Res Commun 2022; 2:100015. [PMID: 34977912 PMCID: PMC8695311 DOI: 10.1016/j.psycom.2021.100015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/06/2021] [Accepted: 12/10/2021] [Indexed: 01/27/2023]
Abstract
We aimed to assess the factors associated with frequent sadness and nervousness in Brazilian adolescents, during the Covid-19 pandemic, in 9470 adolescents (aged 12-17 years), interviewed from June 27 to September 17, 2020. Prevalences and prevalence ratios were estimated according to socio-demographic variables and factors related to family, school, friends, and health. Brazilian adolescents often felt sad (32.4%) and nervous (48.7%). Higher prevalences of these feelings were related to: being female; aged 15-17 year; from families with financial difficulties; having learned little or nothing with remote education; missing friends; having few friends; family disagreements; having regular/bad health before the pandemic; and worsened health and sleep during the pandemic. Higher prevalence of nervousness was also found in adolescents who worked before the pandemic and those who reported lack of concentration and not knowing if they had COVID-19. Sadness and nervousness in Brazilian adolescents is high and the need for action by the government, schools, health services, and parents to mitigate the impact of the pandemic on the physical and mental health of adolescents. Special attention must be paid to adolescents with previous health problems and those belonging to the most socially vulnerable population.
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Affiliation(s)
| | | | | | | | | | | | - Luiz Otávio Azevedo
- Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation. Rio de Janeiro, RJ, Brazil
| | - Ísis Eloah Machado
- School of Medicine, Federal University of Ouro Preto. Ouro Preto, MG, Brazil
| | - Crizian Saar Gomes
- School of Nursing. Federal University of Minas Gerais. Belo Horizonte, MG, Brazil
| | - Dália Elena Romero
- Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation. Rio de Janeiro, RJ, Brazil
| | - Giseli Nogueira Damacena
- Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation. Rio de Janeiro, RJ, Brazil
| | | | | | - Wanessa da Silva de Almeida
- Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation. Rio de Janeiro, RJ, Brazil
| | - Célia Landmann Szwarcwald
- Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation. Rio de Janeiro, RJ, Brazil
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Almeida WDSD, Szwarcwald CL, Souza Júnior PRBD. Housing conditions and coverage of the Family Health Strategy in Brazil: a comparison of the results of the National Health Survey 2013 and 2019. Rev Bras Epidemiol 2021; 24:e210005. [PMID: 34910059 DOI: 10.1590/1980-549720210005.supl.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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/12/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study sought to evaluate information about the characteristics of households and coverage of the Family Health Strategy (FHS), produced in the National Health Survey, and to describe the changes occurred between 2013 and 2019. METHODS Information on households and FHS coverage from the two editions of the National Health Survey (2013 and 2019) was used. Differences between proportions found were assessed, relating to the availability of basic supply and sanitation services, as well as the adequacy of materials used in the building of households, distribution of households' adequacy, and coverage by the FHS according to regions and census situation. The complex sampling design was considered in the analysis, so the t-test for independent samples was used to assess the statistical significance of differences between the proportions found in 2013 and 2019. RESULTS Upward trends were observed in the percentage of households with adequate finishing, as well as of households with piped water in at least one room, and with adequate basic sanitation (sewage and garbage). The FHS coverage also increased in the period. Regional differences prevail according to urban or rural situation of households. CONCLUSION Despite the increases observed both in the adequacy of households, in the availability of basic services and water/sanitation supply and in access to primary health care, many challenges still persist when it comes to ensuring that such services reach the most vulnerable places.
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Affiliation(s)
- Wanessa da Silva de Almeida
- Institute for Scientific and Technological Communication and Information in Health, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | - Célia Landmann Szwarcwald
- Institute for Scientific and Technological Communication and Information in Health, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
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Malta DC, Gomes CS, Prates EJS, Santos FPD, Almeida WDSD, Stopa SR, Pereira CA, Szwarcwald CL. Analysis of demand and access to services in the last two weeks previous to the National Health Survey 2013 and 2019. Rev Bras Epidemiol 2021; 24:e210002. [PMID: 34910056 DOI: 10.1590/1980-549720210002.supl.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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/16/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Compare the demand and use of health services between 2013 and 2019, and analyze the associated sociodemographic and health variables in 2019. METHODS Cross-sectional study with data from the National Health Survey (PNS) 2013 and 2019. The prevalence and 95% confidence intervals (95% CI) for the demand and use of health services were estimated. In 2019, the differences in the indicators were analyzed according to sociodemographic variables and the crude and adjusted by sex and age prevalence ratios (RP) were estimated. RESULTS There was an increase of 22% in the demand for health care in the last two weeks, going from 15.3% (95%CI 15.0-15.7) in 2013 to 18.6% (95%CI 18.3-19.0) in 2019. There was a reduction in use in the last two weeks, from 97% (95%CI 96.6-97.4) in 2013 to 86.1% (95%CI 85.4-86.8) in 2019, which was observed for most Federation Units. In 2019, the demand for care was greater among women, the elderly, those with high schooling, individuals with health insurance and poor self-rated health. They obtained greater access to health services in the fifteen days prior to the survey: men, children or adolescents up to 17 years of age, people with health insurance and poor health self-assessment. CONCLUSION The demand for health services has grown and reduced access in the last 15 days between 2013 and 2019. These differences may have been exacerbated by the austerity measures implemented in the country.
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Affiliation(s)
- Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Crizian Saar Gomes
- Postgraduate Program in Public Health, School of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | | | | | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | - Sheila Rizzato Stopa
- Department of Health Analysis and Surveillance of Chronic Non-communicable Diseases, Secretariat of Health Surveillance, Ministry of Health - Brasília (DF), Brazil
| | - Cimar Azeredo Pereira
- Directorate of Research, Instituto Brasileiro de Geografia e Estatística - Rio de Janeiro (RJ), Brazil
| | - Célia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
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Szwarcwald CL, Stopa SR, Damacena GN, Almeida WDSD, Souza Júnior PRBD, Vieira MLFP, Pereira CA, Sardinha LMV, Macário EM. Changes in the pattern of health services use in Brazil between 2013 and 2019. Cien Saude Colet 2021; 26:2515-2528. [PMID: 34133631 DOI: 10.1590/1413-81232021266.1.43482020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/01/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to investigate changes in the health service use pattern based on information from the 2013 and 2019 National Health Surveys (PNS). The two outcomes, "Seeking health-related care in the past two weeks" and "Medical visit in the last twelve months", were analyzed according to socioeconomic, geographic and health conditions characteristics. Multivariate Poisson regression models were used to investigate the factors associated with seeking care due to a health problem or prevention. The prevalence of chronic diseases increased from 15.0% to 22.5% between 2013 and 2019. The proportion of seeking care increased from 15.3 to 18.6%, and medical visits from 71.2% to 76.2%, ranging from 61.4 to 75.8% and 68.0 to 80.6% between the North and Southeast regions. There was no significant association of seeking care due to a health problem with per capita income, after controlling for the other covariates. We conclude by saying that, despite the expanded coverage of health service use, the persistent regional inequalities indicate unmet health needs among residents of the less developed regions. Health care models focused on prevention and health promotion are required.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fiocruz. Av. Brasil 4365, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
| | - Sheila Rizzato Stopa
- Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Brasília DF Brasil
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fiocruz. Av. Brasil 4365, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fiocruz. Av. Brasil 4365, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
| | - Paulo Roberto Borges de Souza Júnior
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fiocruz. Av. Brasil 4365, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
| | | | - Cimar Azeredo Pereira
- Diretoria de Pesquisas, Instituto Brasileiro de Geografia e Estatística. Rio de Janeiro RJ Brasil
| | - Luciana Monteiro Vasconcelos Sardinha
- Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Brasília DF Brasil
| | - Eduardo Marques Macário
- Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Brasília DF Brasil
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Souza Júnior PRBD, Szwarcwald CL, Damacena GN, Stopa SR, Vieira MLFP, Almeida WDSD, Oliveira MMD, Sardinha LMV, Macário EM. Health insurance coverage in Brazil: analyzing data from the National Health Survey, 2013 and 2019. Cien Saude Colet 2021; 26:2529-2541. [PMID: 34133632 DOI: 10.1590/1413-81232021266.1.43532020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/02/2020] [Indexed: 11/22/2022] Open
Abstract
This paper aimed to describe health insurance coverage in Brazil. Data from the 2013 and 2019 editions of the National Health Survey (PNS) were analyzed. The medical or dental health insurance coverage was analyzed according to demographic and socioeconomic characteristics, work status, urban/rural area, and Federation Unit. Coverage of medical or dental health insurance was 27.9% (95% CI: 27.1-28.8) for 2013 and 28.5% (95% CI: 27.8-29.2) for 2019. The results show coverage is still concentrated in large urban centers, in the Southeast and South, among those with better socioeconomic status and some formal employment. In 2019, only 30.7% of formal workers reported the monthly payment is made directly to the providers, while 72.7% of informal workers reported this information. About 92% of medical health insurance covers hospitalization, and almost 20% of women with health insurance are not covered for labor. Only 11.7% of women aged between 15 and 44 are covered for childbirth by health insurance. The results show the health insurance coverage is still quite unequal, reinforcing the Unified Health System (SUS) importance for the Brazilian population.
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Affiliation(s)
- Paulo Roberto Borges de Souza Júnior
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4635, Manguinhos, Pavilhão Haity Moussatché. 21045-360 Rio de Janeiro RJ Brasil.
| | - Célia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4635, Manguinhos, Pavilhão Haity Moussatché. 21045-360 Rio de Janeiro RJ Brasil.
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4635, Manguinhos, Pavilhão Haity Moussatché. 21045-360 Rio de Janeiro RJ Brasil.
| | - Sheila Rizzato Stopa
- Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Brasília DF Brasil
| | | | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4635, Manguinhos, Pavilhão Haity Moussatché. 21045-360 Rio de Janeiro RJ Brasil.
| | - Max Moura de Oliveira
- Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Brasília DF Brasil
| | - Luciana Monteiro Vasconcelos Sardinha
- Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Brasília DF Brasil
| | - Eduardo Marques Macário
- Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Brasília DF Brasil
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13
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Malta DC, Gomes CS, Barros MBDA, Lima MG, Silva AGD, Cardoso LSDM, Werneck AO, Silva DRPD, Ferreira APDS, Romero DE, Freitas MIDF, Machado ÍE, Souza Júnior PRBD, Damacena GN, Azevedo LO, Almeida WDSD, Szwarcwald CL. The COVID-19 pandemic and changes in the lifestyles of Brazilian adolescents. Rev Bras Epidemiol 2021; 24:e210012. [PMID: 34105593 DOI: 10.1590/1980-549720210012] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/01/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze changes in the lifestyles of Brazilian adolescents during the COVID-19 pandemic. METHODS Cross-sectional study carried out with adolescents who participated in the survey "ConVid Adolescentes - Pesquisa de Comportamentos". The indicators related to lifestyles before and during the COVID-19 pandemic were evaluated: consumption of healthy and unhealthy foods, physical activity and sedentary behavior, smoking and consumption of alcohol. Prevalence and 95% confidence intervals were calculated for the total population and according to sex and age group. RESULTS A total of 9,470 adolescents participated in the study. During the period of social distancing, there was an increase in the prevalence of vegetables consumption (from 27.34 to 30.5%), frozen foods (from 13.26 to 17.3%), chocolates and sweets (from 48.58 to 52.51%), and time in front of screens (from 44.57 to 70.15%). On the other hand, there was a decrease in the practice of physical activity (from 28.70 to 15.74%) and in the consumption of alcohol (from 17.72 to 12.77%). Differences were observed according to sex and age group. CONCLUSION The results show changes in the lifestyle of adolescents and an increase in health risk behaviors.
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Affiliation(s)
- Deborah Carvalho Malta
- Postgraduate Program in Public Health, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil.,Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Crizian Saar Gomes
- Postgraduate Program in Public Health, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | | | | | - Alanna Gomes da Silva
- Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | | | | | | | - Arthur Pate de Souza Ferreira
- Institute of Communication and Scientific and Technological Information in Health, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | - Dália Elena Romero
- Institute of Communication and Scientific and Technological Information in Health, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | | | - Ísis Eloah Machado
- School of Medicine, Universidade Federal de Ouro Preto - Ouro Preto (MG), Brazil
| | | | - Giseli Nogueira Damacena
- Institute of Communication and Scientific and Technological Information in Health, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | - Luiz Otávio Azevedo
- Institute of Communication and Scientific and Technological Information in Health, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | - Wanessa da Silva de Almeida
- Institute of Communication and Scientific and Technological Information in Health, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | - Célia Landmann Szwarcwald
- Institute of Communication and Scientific and Technological Information in Health, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
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14
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Malta DC, Gomes CS, Barros MBDA, Lima MG, Almeida WDSD, Sá ACMGND, Prates EJS, Machado ÍE, Silva DRPD, Werneck ADO, Damacena GN, Souza Júnior PRBD, Azevedo LOD, Montilla DER, Szwarcwald CL. Noncommunicable diseases and changes in lifestyles during the COVID-19 pandemic in Brazil. Rev Bras Epidemiol 2021; 24:e210009. [PMID: 33950138 DOI: 10.1590/1980-549720210009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/14/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To compare lifestyle changes during the COVID-19 pandemic according to the presence or absence of noncommunicable diseases (NCDs) in Brazilian adults. METHODS Cross-sectional study, using data from the ConVid survey, between April and May 2020. The following variables were evaluated: lifestyle and presence of one or more NCDs (diabetes, hypertension, respiratory disease, heart disease, and cancer). Sociodemographic characteristics were used as adjustment. Relative frequencies and confidence intervals (CI) of 95% of the explanatory variables were calculated before and during the pandemic. For the comparison of groups, with or without NCDs, crude and adjusted (PRadj) prevalence ratios were estimated by Poisson regression. RESULTS There was a reduction in physical activity (60% in those without NCDs and 58% in those with NCDs) and in vegetable consumption (10.8% in those without NCDs and 12.7% in those with NCDs). On the other hand, there was an increase in the time spent watching television and on screens of computer/tablet (302% and 43.5% in those without NCDs and 196.5% and 30.6% with NCDs, respectively); consumption of frozen meals (43.6% in those without NCDs and 53.7% with NCDs), snacks (42.3% without NCDs and 31.2% with NCDs), and chocolate (14.8% without NCDs). During the pandemic, patients with NCDs were less active (PRadj = 0.77; 95%CI 0.65 - 0.92), had greater habit of watching TV (PRadj = 1.16; 95%CI 1.08 - 1.26), and consumed less vegetables (PRadj = 0.88; 95%CI 0.81 - 0.96). CONCLUSION It was evident that adults with NCDs had their lifestyles more altered during the COVID-19 pandemic.
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Affiliation(s)
- Deborah Carvalho Malta
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Crizian Saar Gomes
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | | | - Margareth Guimarães Lima
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Campinas (SP), Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
| | | | | | - Ísis Eloah Machado
- Departamento de Medicina de Família, Saúde Mental e Coletiva, Escola de Medicina, Universidade Federal de Ouro Preto - Ouro Preto (MG), Brasil
| | | | - André de Oliveira Werneck
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
| | | | - Luiz Otávio de Azevedo
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
| | - Dalia Elena Romero Montilla
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
| | - Célia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
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15
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Szwarcwald CL, Souza Júnior PRBD, Damacena GN, Malta DC, Barros MBDA, Romero DE, Almeida WDSD, Azevedo LO, Machado ÍE, Lima MG, Werneck AO, Silva DRPD, Gomes CS, Ferreira APDS, Gracie R, Pina MDFD. ConVid - Behavior Survey by the Internet during the COVID-19 pandemic in Brazil: conception and application methodology. CAD SAUDE PUBLICA 2021; 37:e00268320. [PMID: 33950078 DOI: 10.1590/0102-311x00268320] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023] Open
Abstract
The ConVid - Behavior Survey was conducted in Brazil from April 24 to May 24, 2020, aiming to investigate changes in lifestyles and health conditions during the COVID-19 pandemic. In this article, we present the conception and methodology of the research. We used a cross-sectional study using an Internet questionnaire, with questions validated in previous health surveys. The sampling method "virtual snowball" was used, as well as post-stratification procedures. The results related to chronic non-communicable diseases and pre-pandemic lifestyles were compared with estimates from the 2013 Brazilian National Health Survey and 2019 Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Survey. The total sample was 45,161 people. After data weighing, the sample distributions of demographic variables were similar to population variables. Only people with a low schooling level were underrepresented. The comparison with the previous results showed similarity in most estimates: recommended consumption of fruits and vegetables (22.1%), recommended physical activity (35.2%), tobacco smoking habit (12.3%), frequent and abusive alcohol consumption (6.7%), obesity (21.2%), self-reported prevalence of hypertension (18.6%), diabetes (7.1%), and heart disease (4.4%). The online survey made it possible to know the population's health conditions during the pandemic. The similarity of the indicators with those obtained in traditional research allowed the validation of the mean estimates. Studies are needed to investigate how the endogenous effects of virtual social networks can be considered when estimating variance.
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Affiliation(s)
- Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | - Dalia Elena Romero
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Luiz Otávio Azevedo
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ísis Eloah Machado
- Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, Brasil
| | | | | | | | - Crizian Saar Gomes
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Arthur Pate de Souza Ferreira
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Renata Gracie
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Maria de Fátima de Pina
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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16
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Romero DE, Muzy J, Damacena GN, Souza NAD, Almeida WDSD, Szwarcwald CL, Malta DC, Barros MBDA, Souza Júnior PRBD, Azevedo LO, Gracie R, Pina MDFD, Lima MG, Machado ÍE, Gomes CS, Werneck AO, Silva DRPD. Older adults in the context of the COVID-19 pandemic in Brazil: effects on health, income and work. CAD SAUDE PUBLICA 2021; 37:e00216620. [PMID: 33825801 DOI: 10.1590/0102-311x00216620] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022] Open
Abstract
The goal of this study is to characterize the population of older adults in Brazil during the COVID-19 pandemic with regard to health, socioeconomic conditions, gender inequality, adherence to social distancing and feelings of sadness or depression. It is a cross-sectional study carried out with Brazilian older adults who responded to an online health survey (N = 9,173), using a "virtual snowball" sampling method. Data were collected online via a self-administered questionnaire. Prevalence and confidence interval estimates were performed and verified for independence using Pearson's chi-square test. During the pandemic there was a fall in household income among almost half of older adults. Extreme social distancing was practiced by 30.9% (95%CI: 27.8; 34.1) and 12.2% (95%CI: 10.1; 14.7) did not adhere to it. Older adults who were not working before the pandemic adhered in greater numbers to extreme social distancing measures. Most of them presented comorbidities associated with a higher risk of developing the severe form of COVID-19. Feelings of loneliness, distress and sadness were frequent among older adults, especially women. The COVID-19 pandemic widened the inequality gap by affecting the most vulnerable older people. Strategies to mitigate loneliness and social distancing should consider social vulnerability and the marked difference between men and women in terms of household composition and socioeconomic and working conditions. The development of representative surveys of Brazilian older adults is recommended, investigating the impact of the pandemic on this population.
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Affiliation(s)
- Dalia Elena Romero
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Jéssica Muzy
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Nathalia Andrade de Souza
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | | | - Luiz Otávio Azevedo
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Renata Gracie
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Maria de Fátima de Pina
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Ísis Eloah Machado
- Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, Brasil
| | - Crizian Saar Gomes
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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17
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Marques AP, Szwarcwald CL, Pires DC, Rodrigues JM, Almeida WDSD, Romero D. [Factors associated with arterial hypertension: a systematic review]. Cien Saude Colet 2020; 25:2271-2282. [PMID: 32520271 DOI: 10.1590/1413-81232020256.26972018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/03/2018] [Indexed: 01/11/2023] Open
Abstract
A systematic review of demographic, socioeconomic, behavioral and anthropometric factors associated with hypertension. We included observational studies, of populations aged 18 or older, from the past ten years, published in English, Portuguese or Spanish from Pubmed, Web of Science, Scopus and Lilacs bases. The most found factors related to the greater chance of having hypertension were age and the Body Mass Index (BMI). Other factors associated with the disease were: gender (male), education (lower education), income (lower income) and waist circumference (high). Never having smoked, never having consumed alcohol and white skin color were characteristics related to a lower chance of having hypertension. As demonstrated, demographic, socioeconomic, behavioral and anthropometric characteristics are important factors associated with a greater chance of having hypertension in the adult population. However, while most of the factors associated with it are amenable to intervention, broader health promotion policies will be needed to reduce socioeconomic inequalities in the prevalence of the disease.
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Affiliation(s)
- Aline Pinto Marques
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-900, Rio de Janeiro, RJ, Brasil.
| | - Célia Landmann Szwarcwald
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-900, Rio de Janeiro, RJ, Brasil.
| | - Débora Castanheira Pires
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-900, Rio de Janeiro, RJ, Brasil.
| | - Jéssica Muzy Rodrigues
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-900, Rio de Janeiro, RJ, Brasil.
| | - Wanessa da Silva de Almeida
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-900, Rio de Janeiro, RJ, Brasil.
| | - Dalia Romero
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-900, Rio de Janeiro, RJ, Brasil.
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18
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Almeida WDSD, Szwarcwald CL, Malta DC, Barros MBDA, Souza Júnior PRBD, Azevedo LO, Romero D, Lima MG, Damacena GN, Machado ÍE, Gomes CS, Pina MDFD, Gracie R, Werneck AO, Silva DRPD. Mudanças nas condições socioeconômicas e de saúde dos brasileiros durante a pandemia de COVID-19. Rev bras epidemiol 2020; 23:e200105. [DOI: 10.1590/1980-549720200105] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/25/2020] [Indexed: 01/07/2023] Open
Abstract
RESUMO: Objetivo: Descrever as mudanças nas condições socioeconômicas e de saúde dos brasileiros durante a pandemia de COVID-19. Métodos: Estudo transversal com dados de pesquisa de comportamentos realizada pela internet de 24 de abril a 24 de maio de 2020 com 45.161 participantes recrutados por amostragem em cadeia. Foi feita uma análise descritiva de temas abordados na pesquisa: adesão às medidas de restrição social, diagnóstico do novo coronavírus, situação de trabalho e rendimentos, dificuldades nas atividades de rotina, presença de comorbidades, estado de ânimo e acesso aos serviços de saúde. Foram estimados as prevalências e os intervalos de 95% de confiança. Resultados: Aproximadamente 75% dos brasileiros aderiram à restrição social. Quanto aos sintomas de gripe, 28,1% relatou ter apresentado algum sintoma, mas apenas 5,9% realizou teste para COVID-19. Em relação à situação socioeconômica, 55,1% relatou diminuição do rendimento familiar, e 7% ficou sem rendimento; 25,8% dos indivíduos ficaram sem trabalhar, sendo o grupo de trabalhadores informais o mais afetado (50,6%). Quanto às condições de saúde, 29,4% avaliou que a sua saúde piorou; 45% teve problemas no sono, 40% apresentou, frequentemente, sentimento de tristeza e 52,5% de ansiedade/nervosismo; 21,7% procurou serviço de saúde e, entre estes, 13,9% não conseguiu atendimento. Conclusão: Os achados mostram a importância do controle da pandemia de COVID-19 no Brasil, para mitigar os efeitos adversos na situação socioeconômica e nas condições de saúde relacionados às medidas de restrição social.
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Malta DC, Machado ÍE, Pereira CA, Figueiredo AW, Aguiar LKD, Almeida WDSD, Souza MDFMD, Rosenfeld LG, Szwarcwald CL. Evaluation of renal function in the Brazilian adult population, according to laboratory criteria from the National Health Survey. Rev Bras Epidemiol 2019; 22Suppl 02:E190010.SUPL.2. [PMID: 31596381 DOI: 10.1590/1980-549720190010.supl.2] [Citation(s) in RCA: 14] [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: 12/19/2018] [Accepted: 02/12/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the renal function of the Brazilian adult population, according to laboratory criteria of the National Health Survey (Pesquisa Nacional de Saúde - PNS). METHODOLOGY A descriptive study was carried out with laboratory data from the PNS, which was collected between the years 2014 and 2015. Population prevalence of the serum creatinine (CR) and estimated glomerular filtration rate (GFR) according to sociodemographic variables, were analyzed from the PNS laboratory data. RESULTS The sample consisted of 8,535 individuals aged 18 years old or older for the study of CR and 7,457 for the study of GFR. The GFR prevalence < 60 mL/min/1.73 m2 was 6.7% (95%CI 6.0 - 7.4), higher in women (8.2% 95%CI 7.2 - 9.2) than in men (5.0% 95%CI 4.2 - 6.0) p < 0.001, and in elderly > 60 years old it was 21.4%. For the values of CR ≥ 1.3 mg/dL in men were 5.5% (95%CI 4.6 - 6.5), and in women values of CR ≥ 1.1 mg/dL were 4.6% (95%CI 4.0 - 5.4), with no diference between the genders, p = 0.140. CONCLUSION Results from the PNS laboratory identified a higher prevalence of chronic kidney disease in the Brazilian population than that estimated in self-reported studies, with higher GFR < 60 mL/min/1.73 m2 in women, and reaching one fifth of the elderly. These tests may be useful for the purpose of identifying the disease early on and thus preventing the progression of renal damage and reduce the risk of cardiovascular events and mortality.
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Affiliation(s)
- Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais-Belo Horizonte (MG), Brasil.,Programa de Pós-graduação em Enfermagem, Escola de Enfermagem Universidade Federal de Minas Gerais - Belo Horizonte(MG), Brasil
| | - Ísis Eloah Machado
- Programa de Pós-graduação em Enfermagem, Escola de Enfermagem Universidade Federal de Minas Gerais - Belo Horizonte(MG), Brasil
| | - Cimar Azeredo Pereira
- Diretoria de Pesquisas, Instituto Brasileiro de Geografia e Estatística - Rio de Janeiro (RJ), Brasil
| | - André Willian Figueiredo
- Diretoria de Pesquisas, Instituto Brasileiro de Geografia e Estatística - Rio de Janeiro (RJ), Brasil
| | - Lilian Kelen de Aguiar
- Programa de Pós-graduação em Enfermagem, Escola de Enfermagem Universidade Federal de Minas Gerais - Belo Horizonte(MG), Brasil.,Universidade do Estado do Amazonas - Manaus (AM), Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
| | | | | | - Célia Landman Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
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Szwarcwald CL, Malta DC, Souza Júnior PRBD, Almeida WDSD, Damacena GN, Pereira CA, Rosenfeld LG. Laboratory exams of the National Health Survey: methodology of sampling, data collection and analysis. Rev Bras Epidemiol 2019; 22Suppl 02:E190004.SUPL.2. [PMID: 31596375 DOI: 10.1590/1980-549720190004.supl.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/20/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION This article aims at describing the National Health Survey (Pesquisa Nacional de Saúde- PNS) methodology of collecting laboratory exams data. METHODOLOGY A subsample of 25% of the census tracts was selected, according to the stratification of the PNS sample, with a probability inversely proportional to the difficulty of collection. The collection of blood and urine was done in the households by a laboratory agent, among residents selected for individual interview. Due to the difficulties found in the field work, the sample did not reach the minimum expected number in some strata, and a post-stratification procedure was proposed for the data analysis. RESULTS The collection of biospecimens was performed in 8,952 individuals. Laboratory tests were: glycated hemoglobin; total cholesterol; LDL cholesterol; HDL cholesterol; serology for dengue; red blood cell count (erythrogram) and white series count (leukogram); high performance liquid chromatography (HPLC) for diagnosis of hemoglobinopathies; creatinine. Theexcretion of potassium, salt and sodium and creatinine was estimated in the urine. The database of laboratory exams was weighed and made publicly available on the Oswaldo Cruz Foundation's PNS website and can be accessed without prior authorization. CONCLUSION The total subsample of laboratory exams is of great value, since it allowed us to establish national reference parameters adequate to sociodemographic and geographic characteristics of the Brazilian population, providing relevant and complementary information for the analysis of the health situation of Brazil.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
| | - Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais- Belo Horizonte (MG), Brasil
| | | | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
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Damacena GN, Szwarcwald CL, Souza Júnior PRBD, Ferreira Júnior ODC, Almeida WDSD, Pascom ARP, Pimenta MC. Application of the Respondent-Driven Sampling methodology in a biological and behavioral surveillance survey among female sex workers, Brazil, 2016. Rev Bras Epidemiol 2019; 22Suppl 1:e190002. [PMID: 31576978 DOI: 10.1590/1980-549720190002.supl.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/03/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Respondent-Driven Sampling (RDS) has been used in surveys with key populations at risk of HIV infection, such as female sex workers (FSW). This article describes the application of the RDS method among FSW in 12 Brazilian cities, during a survey carried out in 2016. METHODOLOGY A biological and behavioral surveillance study carried out in 12 Brazilian cities, with a minimum sample of 350 FSW in each city. Tests were performed for HIV, syphilis, and hepatitis B and C infections. A social-behavioral questionnaire was also applied. RESULTS The sample was comprised of 4,328 FSW. For data analysis, the sample was weighted according to each participant's network size (due consideration to the implications of RDS complex design and to the effects of homophilia are recommended). DISCUSSION Although RDS methods for obtaining a statistical sample are based on strong statistical assumptions, allowing for an estimation of statistical parameters, with each new application the method has been rethought. In the analysis of whole-sample data, estimators were robust and compatible with those found in 2009. However, there were significant variations according to each city. CONCLUSION The achieved sample size was of great relevance for assessing progress and identifying problems regarding the prevention and treatment of Sexually Transmitted Infections. New RDS studies with more time and operational resources should be envisaged. This could further network development.
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Affiliation(s)
- Giseli Nogueira Damacena
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation - Rio de Janeiro (RJ), Brazil
| | - Célia Landmann Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation - Rio de Janeiro (RJ), Brazil
| | | | | | - Wanessa da Silva de Almeida
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation - Rio de Janeiro (RJ), Brazil
| | - Ana Roberta Pati Pascom
- Department of Chronic Condition Diseases and Sexually Transmitted Infections, Ministry of Health - Brasília (DF), Brazil
| | - Maria Cristina Pimenta
- Department of Chronic Condition Diseases and Sexually Transmitted Infections, Ministry of Health - Brasília (DF), Brazil
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Szwarcwald CL, Leal MDC, Esteves-Pereira AP, Almeida WDSD, Frias PGD, Damacena GN, Souza Júnior PRBD, Rocha NM, Mullachery PMH. Avaliação das informações do Sistema de Informações sobre Nascidos Vivos (SINASC), Brasil. CAD SAUDE PUBLICA 2019; 35:e00214918. [DOI: 10.1590/0102-311x00214918] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/07/2019] [Indexed: 11/22/2022] Open
Abstract
Resumo: Neste trabalho, avaliam-se quantitativa e qualitativamente as informações do Sistema de Informações sobre Nascidos Vivos (SINASC). A cobertura das informações por município foi estimada pela razão entre nascidos vivos informados e estimados. Para avaliação da qualidade das informações do SINASC, relacionou-se o sistema à base de dados do estudo Nascer no Brasil, 2011-2012, e foram estimados coeficientes kappa de concordância. Em 2013, a cobertura das informações foi alta e homogênea em todas as Unidades da Federação. Entretanto, a análise por município brasileiro apresentou maior heterogeneidade espacial. Quanto à qualidade de preenchimento das informações do SINASC, os coeficientes kappa de concordância foram estatisticamente diferentes de zero para todas as variáveis testadas (p < 0,001), e as distribuições marginais para todas as variáveis consideradas foram semelhantes nas duas bases de dados. A idade gestacional foi a variável que mostrou pior concordância, com valor de kappa de 0,461. O indicador que descreve as inconsistências, medido pela soma do quadrado das diferenças entre os percentuais de prematuridade informados e esperados por faixa de peso ao nascer, teve o valor mais alto na Região Norte e o menor na Região Sul, apontando para desigualdades geográficas na mensuração da idade gestacional.
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Szwarcwald CL, Malta DC, Pereira CA, Figueiredo AW, Almeida WDSD, Machado IE, Bacal NS, Silva AGD, Silva Júnior JBD, Rosenfeld LG. Valores de referência para exames laboratoriais de colesterol, hemoglobina glicosilada e creatinina da população adulta brasileira. Rev bras epidemiol 2019; 22Suppl 02:e190002.supl.2. [DOI: 10.1590/1980-549720190002.supl.2] [Citation(s) in RCA: 5] [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: 01/08/2019] [Accepted: 03/19/2019] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Introdução: Este artigo teve o objetivo de estimar valores de referência de exames laboratoriais de colesterol, hemoglobina glicosilada e creatinina para a população adulta brasileira. Métodos: Estudo descritivo realizado com os dados laboratoriais da Pesquisa Nacional de Saúde (PNS). Foram coletadas amostras de sangue e urina em subamostra da PNS constituída de 8.952 indivíduos de 18 anos ou mais. Para determinar os valores de referência, aplicaram-se critérios de exclusão, como a presença de doenças prévias e dos outliers, definidos pelos valores fora do intervalo estimado pela média ± 1,96 × desvio padrão. Posteriormente, foram calculados os valores de referência segundo sexo, faixa etária e raça/cor. Resultados: Observaram-se diferenças nos valores de referência de acordo com o sexo. O colesterol total, a lipoproteína de baixa densidade colesterol (LDL-c) e a lipoproteína de alta densidade colesterol (HDL-c) apresentaram valores mais elevados entre as mulheres. A hemoglobina glicosilada alcançou valores semelhantes segundo sexo, e a creatinina foi mais elevada entre os homens. Os valores médios de referência foram mais altos na população idosa, de 60 anos ou mais. A média e os limites inferiores e superiores do colesterol total e frações dos indivíduos não brancos foram ligeiramente mais baixos. Não houve diferença segundo raça/cor para hemoglobina glicosilada nem para creatinina. Conclusão: O estabelecimento de parâmetros nacionais de referência de exames laboratoriais, adaptados às características sociodemográficas e geográficas, fornece subsídios relevantes para a avaliação do diagnóstico e tratamento de doenças crônicas no Brasil.
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Ferreira-Júnior ODC, Guimarães MDC, Damacena GN, de Almeida WDS, de Souza-Júnior PRB, Szwarcwald CL. Prevalence estimates of HIV, syphilis, hepatitis B and C among female sex workers (FSW) in Brazil, 2016. Medicine (Baltimore) 2018; 97:S3-S8. [PMID: 29912817 PMCID: PMC5991541 DOI: 10.1097/md.0000000000009218] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Female sex workers (FSW) bear a high burden of sexually transmitted infections (STI). In this paper, we estimate the prevalence of human immunodeficiency virus (HIV), HBV = hepatitis B virus (HBV), HCV = hepatitis C virus (HCV), syphilis and co-infections in the second Biological and Behavioral Surveillance Survey among FSW in Brazil. METHOD The survey was conducted in 12 Brazilian cities from July to November 2016. We used respondent-driven sampling (RDS) to recruit 350 FSW in each city. Rapid tests were used for screening HIV, syphilis, HCV, and HBV. Confirmatory tests were performed on all samples with reactive rapid test result. All testing algorithms and interpretations were done according to the recommendations of the Department of STI/AIDS and viral hepatitis, Ministry of Health. The STI diagnoses were given by: confirmed HIV infection by a positive result on Western blot; active syphilis infection, defined by a RPR titer equal or greater than 1/8; viremia period of HBV and HCV infections, characterized by a detectable (or quantifiable) viral load. Prevalence estimates and standard errors were calculated using statistical procedures suitable for data collected by RDS. RESULTS Excluding the seeds, 4245 FSW were enrolled. Prevalence estimates were: HIV 5.3% (95% CI: 4.4%-6.2%); active syphilis 8.5% (95% CI: 7.3%-9.7%); HBV 0.4% (95% CI: 0.2%-0.7%); and, HCV 0.9% (95% CI: 0.6%-1.3%). Among the 4154 FSW tested for the 4 infections, 13.3%; (95% CI 12.0%-14.8%) were diagnosed with at least one of the infections, of which 87.6% (95% CI: 83.3%-90.9%) had single infections. The prevalence of HIV/syphilis co-infection was 1.09% (95% CI: 0.7%- 1.6%) and of HIV/HCV or HBV infections was 0.4% (95% CI: 0.2%-0.7%). CONCLUSIONS Our results reveal the need to conduct more studies to estimate the prevalence of STI and co-infections among FSW in Brazil. Longitudinal trends in the prevalence estimates of HIV and other STI provide information to monitor changes in this high-risk population. Additionally, the study highlights the importance of measuring the hepatitis burden among FSW living with HIV, and the need of including FSW in all aspects of STI prevention, care, and treatment programs.
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Affiliation(s)
| | | | - Giseli Nogueira Damacena
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Wanessa da Silva de Almeida
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Paulo Roberto Borges de Souza-Júnior
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Célia Landmann Szwarcwald
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Szwarcwald CL, Damacena GN, de Souza-Júnior PRB, Guimarães MDC, de Almeida WDS, de Souza Ferreira AP, Ferreira-Júnior ODC, Dourado I. Factors associated with HIV infection among female sex workers in Brazil. Medicine (Baltimore) 2018; 97:S54-S61. [PMID: 29912814 PMCID: PMC5991538 DOI: 10.1097/md.0000000000009013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) are one of the most-at-risk population groups for human immunodeficiency virus (HIV) infection. This paper aims at identifying the main predictors of HIV infection among FSW recruited in the 2nd Biological and Behavioral Surveillance Survey in 12 Brazilian cities in 2016. METHOD Data were collected on 4245 FSW recruited by respondent driven sampling (RDS). Weights were inversely proportional to participants' network sizes. To establish the correlates of HIV infection, we used logistic regression models taking into account the dependence of observations resultant from the recruitment chains. The analysis included socio-demographic sex work characteristics, sexual behavior, history of violence, alcohol and drug use, utilization of health services, and occurrence of other sexually transmitted infections (STIs). RESULTS HIV prevalence was estimated as 5.3% (4.4%-6.2%). The odds ratio (OR) of an HIV-positive recruiter choosing an HIV-positive participant was 3.9 times higher than that of an HIV-negative recruiter (P < .001). Regarding socio-demographic and sex work characteristics, low educational level, street as the main work venue, low price per sexual encounter, and longer exposure time as a sex worker were found to be associated with HIV infection, even after controlling for the homophily effect. The OR of being HIV infected among FSW who had been exposed to sexual violence at least once in a lifetime (OR = 1.5, P = .028) and the use of illicit drugs at least once a week were highly significant as well, particularly for frequent crack use (OR = 3.6, P < .001). Among the sexual behavior indicators, not using condoms in some circumstances were significantly associated with HIV infection (OR = 1.8, P = .016). Regarding the occurrence of other STI, the odds of being HIV infected was significantly higher among FSW with a reactive treponemal test for syphilis (OR = 4.6, P < .001). CONCLUSIONS The main factors associated with HIV infection identified in our study characterize a specific type of street-based sex work in Brazil and provided valuable information for developing interventions. However, there is a further need of addressing social and contextual factors, including illicit drug use, violence, exploitation, as well as stigma and discrimination, which can influence sexual behavior.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | - Giseli Nogueira Damacena
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | - Paulo Roberto Borges de Souza-Júnior
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | | | - Wanessa da Silva de Almeida
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | - Arthur Pate de Souza Ferreira
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | | | - Inês Dourado
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
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Szwarcwald CL, de Almeida WDS, Damacena GN, de Souza-Júnior PRB, Ferreira-Júnior ODC, Guimarães MDC. Changes in attitudes, risky practices, and HIV and syphilis prevalence among female sex workers in Brazil from 2009 to 2016. Medicine (Baltimore) 2018; 97:S46-S53. [PMID: 29893747 PMCID: PMC5991537 DOI: 10.1097/md.0000000000009227] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The present study aims at investigating the progress made toward controlling the human immunodeficiency virus (HIV)/AIDS epidemic among female sex workers (FSW) from 2009 to 2016. METHODS The baseline of respondent-driven sampling (RDS) study among FSW was carried out in 2009, in 10 Brazilian municipalities. In 2016, information on FSW were collected in 12 municipalities. The analyses took into account the dependence among observations, resulting from the recruitment chains, and the unequal probabilities of selection, resulting from the different network sizes. We analyzed changes in attitudes and risky behavior practices as well as variations in HIV and syphilis prevalence based on the comparison of 95% confidence intervals for each estimate. RESULTS Information on 2523 (2009) and 4245 (2016) FSW were analyzed. Commercial sex debut shifted to younger ages: while in 2009 the proportion of women who started sex work under 18 years old was 28.3%, in 2016 this percentage rose to 38.3%. The proportion of FSW affiliated to a nongovernmental organization (NGO) in defense of their rights (14.0%), in 2009, decreased to 7.8%, in 2016, as well as the proportion of FSW who received counseling on sexually transmitted infections (STI) in the past 6 months, from 47.5% to 24.4%. Relevant improvements were found for HIV testing in the last 12 months (from 20.3% to 39.3%). The proportions of those who were never tested for syphilis dropped from 57.9% to 48.5%. However, an opposite decreasing trend was found for the Pap smear examination in the last 12 months, decreasing from 43.6% to 31.5%. Regular condom use with clients significantly increased in the period. Regarding HIV prevalence, the 5% level was sustained and no significant differences were found, but syphilis prevalence was found to be more than 3 times higher in 2016 (8.5%) than in 2009 (2.4%). DISCUSSION Many are the challenges to be faced in attempting to reverse the upward trend of syphilis among FSW in Brazil. Despite the progress in condom distribution free of charge, it is necessary to increase awareness campaigns, emphasize the use, reaffirm STI counseling, and reiterate the need of regular syphilis screening in this key population group.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
| | - Wanessa da Silva de Almeida
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
| | - Giseli Nogueira Damacena
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
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Almeida WDSD, Szwarcwald CL. Adequação das informações de mortalidade e correção dos óbitos informados a partir da Pesquisa de Busca Ativa. Ciênc saúde coletiva 2017; 22:3193-3203. [DOI: 10.1590/1413-812320172210.12002016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/07/2017] [Indexed: 11/22/2022] Open
Abstract
Resumo O objetivo deste artigo é propor indicadores de adequação e estimar fatores de correção para os óbitos informados ao SIM. Em 2014, foi realizada uma Pesquisa de Busca Ativa para captar óbitos ocorridos no ano de 2012 em uma amostra de municípios das regiões Norte e Nordeste, e dos estados de Minas Gerais, Mato Grosso e Goiás. Para caracterizar a cobertura das informações de óbitos, foram propostos indicadores de adequação por município. Os fatores de correção foram estimados para indivíduos com um ano ou mais de idade e para crianças menores de 1 ano. Entre os óbitos de 1 ano ou mais, as coberturas são superiores a 90% em 12 estados. Já para óbitos infantis, a cobertura foi inferior a 80% em 7 estados. Os resultados dos modelos de regressão mostraram associação entre os fatores de correção estimados e os indicadores de adequação propostos. Verificou-se grande precariedade das informações em 227 municípios, para os quais o número informado de óbitos infantis, mesmo corrigido, não conseguiu atingir o mínimo esperado. Embora os avanços conseguidos na informação dos dados vitais no Brasil sejam reconhecidos, os resultados mostram que o nosso maior desafio está em alcançar municípios rurais e remotos, que ainda não dispõem de informações vitais adequadas.
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Szwarcwald CL, Damacena GN, de Souza Júnior PRB, de Almeida WDS, de Lima LTM, Malta DC, Stopa SR, Vieira MLFP, Pereira CA. Determinants of self-rated health and the influence of healthy behaviors: results from the National Health Survey, 2013. Rev Bras Epidemiol 2017; 18 Suppl 2:33-44. [PMID: 27008601 DOI: 10.1590/1980-5497201500060004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/13/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate the determinants of self-rated health in Brazil and the influence of healthy lifestyles. METHODS We used data from the National Health Survey (PNS), 2013. The self-rated health was categorized as very good/good, fair, and poor/very poor. Differences in the distribution of self-rated health according to the age group and sex were tested. Logistic regression models were used to test the effects of educational level, race/skin color, and the presence of at least one noncommunicable chronic disease on poor/very poor health perception. In addition, the influence of healthy behaviors was tested controlling for the effects of sociodemographic factors and the presence of at least one chronic disease. RESULTS We analyzed 60,202 individuals; about 66.1% rated their health as very good/good and 5.9% as poor/very poor; about 47.1% reported the diagnosis of at least one noncommunicable chronic disease; and only 9.3% reported a "healthy lifestyle" (do not use tobacco products, consume fruits and vegetables properly, and do physical activity during leisure time). Among the sociodemographic factors, age, sex, educational level, and race were significantly associated with self-rated health and the presence of at least one chronic disease. The effects of all healthy behaviors were statistically significant even after controlling for the other determinants. CONCLUSION Although the adoption of healthy lifestyles in Brazil is still insufficient, the association of healthy practices with self-perception of health found in this study is an indication that the Brazilian population is beginning to relate healthy behaviors to their well-being and better health evaluation.
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Affiliation(s)
- Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Deborah Carvalho Malta
- Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brazil
| | - Sheila Rizzato Stopa
- Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brazil
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Szwarcwald CL, de Souza Júnior PRB, Damacena GN, de Almeida WDS, Malta DC, Stopa SR, Vieira MLFP, Pereira CA. Recommendations and practice of healthy behaviors among patients with diagnosis and diabetes in Brazil: National Health Survey (PNS), 2013. Rev Bras Epidemiol 2017; 18 Suppl 2:132-45. [PMID: 27008609 DOI: 10.1590/1980-5497201500060012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/23/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze healthy life style recommendations given in health care and the adoption of healthy behaviors among hypertension and diabetes patients. METHODS We analyzed the recommendations according to the place of the last health care visit (primary health care, other public facilities, and private health care facilities). The effects of having a diagnosis of hypertension or diabetes on the adoption of healthy practices were analyzed by multivariate logistic regression models, using sex, age, and educational level as control variables, and the following outcomes: current use of tobacco products; regular physical activity during leisure time; recommended intake of fruits and vegetables; perception of low salt intake; frequent consumption of sweets; and excessive alcohol consumption. RESULTS Approximately 88% of hypertension patients received recommendations to have a healthy diet, 91% to eat less salt, 83% to practice regular physical activity, and 76% to not to smoke. Among diabetic patients, all recommendations related to nutrition were very frequent, reaching 95% for the habit of having fruits and vegetables regularly. The effect of having a diagnosis of hypertension was significant for non-use of tobacco products and perception of low salt intake. The diagnosis of diabetes mainly influenced the habit of not consuming sweets often. CONCLUSION Results evidenced that people with diagnosis of hypertension and diabetes give priority to not use (stop) harmful health behaviors than to adopt practices that will bring benefits to their health. It is necessary to promote not only the adverse effects of harmful habits, but also the benefits of healthy behaviors to aging well.
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Affiliation(s)
- Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Deborah Carvalho Malta
- Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brazil
| | - Sheila Rizzato Stopa
- Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brazil
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Szwarcwald CL, Montilla DER, Marques AP, Damacena GN, Almeida WDSD, Malta DC. Inequalities in healthy life expectancy by Federated States. Rev Saude Publica 2017; 51:7s. [PMID: 28591354 PMCID: PMC5676373 DOI: 10.1590/s1518-8787.2017051000105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/23/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To estimate the healthy life expectancy at 60 years by sex and Federated States and to investigate geographical inequalities by socioeconomic status. METHODS Healthy life expectancy was estimated by the Sullivan method, based on the information of the National Survey on Health, 2013. Three criteria were adopted for the definition of “unhealthy state”: self-assessment of bad health, functionality for performing the activities of daily living, and the presence of noncommunicable disease with intense degree of limitation. The indicator of socioeconomic status was built based on the number of goods at household and educational level of the head of household. To analyze the geographical inequalities and socioeconomic level, inequality measures were calculated, such as the ratio, the difference, and the angular coefficient. RESULTS Healthy life expectancy among men ranged from 13.8 (Alagoas) to 20.9 (Espírito Santo) for the self-assessment criterion of bad health. Among women, the corresponding estimates were always higher and ranged from 14.9 (Maranhão) to 22.2 (São Paulo). As to the ratio of inequality by Federated State, the medians were always higher for healthy life expectancy than for life expectancy, regardless of the definition adopted for healthy state. Regarding the differences per Federated State, the healthy life expectancy was seven years higher in one state than in another. By socioeconomic status, differences of three and four years were found, approximately, between the last and first fifth, for men and women, respectively. CONCLUSIONS Despite the association of the mortality indicators with living conditions, the inequalities are even more pronounced when the welfare and the limitations in usual activities are considered, showing the necessity to promote actions and programs to reduce the socio-spatial gradient.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Dália Elena Romero Montilla
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Aline Pinto Marques
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública. Escola de Enfermagem. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
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Almeida WDSD, Szwarcwald CL, Frias PGD, Souza Júnior PRBD, Lima RBD, Rabello Neto DDL, Escalante JJC. Captação de óbitos não informados ao Ministério da Saúde: pesquisa de busca ativa de óbitos em municípios brasileiros. Rev bras epidemiol 2017; 20:200-211. [DOI: 10.1590/1980-5497201700020002] [Citation(s) in RCA: 7] [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: 02/16/2016] [Accepted: 11/28/2016] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Introdução: A busca ativa de óbitos é uma estratégia de captação de eventos que não foram informados ao Sistema de Informações sobre Mortalidade (SIM) do Ministério da Saúde (MS). Sua importância na redução do sub-registro de óbitos e na avaliação da operacionalização do sistema de informações é amplamente conhecida. Objetivo: Descrever a metodologia e os principais achados da pesquisa de busca ativa de óbitos realizada em 2013, estabelecendo a contribuição das diferentes fontes de informação. Métodos: A pesquisa foi realizada em 79 municípios brasileiros. Foram investigadas diversas fontes oficiais e não oficiais de informações sobre óbitos de residentes nesses municípios. Todas as fontes de informações investigadas e os casos encontrados foram digitados em um painel on-line. A segunda etapa da pesquisa foi de confirmação dos casos para verificar as informações sobre o ano do óbito e o município de residência, assim como para completar informações faltantes. Resultados: Foram encontrados 2.265 óbitos que não foram informados ao SIM. Desses, 49,3% foram encontrados em fontes não oficiais, cemitérios e funerárias. Em alguns municípios rurais, condições precárias de sepultamento foram encontradas em cemitérios no meio da mata, sem registro do falecido. Os fatores de correção foram inversamente associados ao nível de adequação das informações de mortalidade. Conclusão: Os achados confirmam a associação entre o nível de adequação das informações e a cobertura do registro de óbitos, e indicam que a aplicação de pesquisas de busca ativa é um método efetivo para capturar óbitos não informados ao MS.
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Frias PGD, Szwarcwald CL, Morais OLD, Leal MDC, Cortez-Escalante JJ, Souza PRBD, Almeida WDSD, Silva JBD. [Use of vital data to estimate mortality indicators in Brazil: from the active search for events to the development of methods]. CAD SAUDE PUBLICA 2017; 33:e00206015. [PMID: 28380150 DOI: 10.1590/0102-311x00206015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 06/02/2016] [Indexed: 01/30/2023] Open
Abstract
The article addresses Brazil's historical development in the use of vital data, incorporating procedures for the evaluation of such data and research with active search of births and deaths, resulting in the proposal of methods for calculating birth and mortality indicators through the use of continuous records. In addition to research to capture vital events from the years 2000 and 2008, the article presents procedures for the correction of events reported to the information systems and the paradigm shift in the method for calculating mortality indicators, resulting from such initiatives. The study also features advances in the adequacy of information on deaths and live births in Brazil, changes in the estimates on infant mortality resulting from the proposed methods, and the challenge of estimating the indicator for subnational geographic areas with lower population contingents, mostly consisting of municipalities (counties) with low and irregular data coverage.
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Affiliation(s)
| | - Célia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Paulo Roberto Borges de Souza
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Damacena GN, Malta DC, Boccolini CS, Souza Júnior PRBD, Almeida WDSD, Ribeiro LS, Szwarcwald CL. Consumo abusivo de álcool e envolvimento em acidentes de trânsito na população brasileira, 2013. Ciênc saúde coletiva 2016; 21:3777-3786. [DOI: 10.1590/1413-812320152112.25692015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/10/2015] [Indexed: 11/21/2022] Open
Abstract
Resumo O objetivo deste artigo é analisar o consumo abusivo e frequente de álcool segundo características sociodemográficas e investigar o risco de maior envolvimento em acidentes de trânsito, utilizando dados da Pesquisa Nacional de Saúde, 2013, Brasil. Eventos investigados: consumo abusivo e frequente de álcool (ingestão semanal igual ou superior de 8 doses para mulheres e 15 para homens por semana) e envolvimento em acidente de trânsito com lesões corporais nos últimos 12 meses. Os dois eventos foram investigados segundo características sociodemográficas e a associação entre eles verificada por meio de regressão logística multivariada. A prevalência do consumo abusivo e frequente de álcool foi 6,1% para a população de 18 anos ou mais, sendo 8,9% entre os homens e 3,6% entre as mulheres. A prevalência de envolvimento em acidente de trânsito foi 3,1% na população geral e 6,1% entre os que referiram consumo abusivo e frequente de álcool. Após o controle por fatores sociodemográficos o consumo abusivo e frequente de álcool manteve associação estatisticamente significativa com o acidente de trânsito. Com o maior risco de envolvimento em acidentes de trânsito dentre os indivíduos que referiram consumo abusivo e frequente de álcool, monitorar a alcoolemia dos motoristas passa a ser uma possibilidade estratégica de intervenção.
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Szwarcwald CL, Souza Júnior PRBD, Marques AP, Almeida WDSD, Montilla DER. Inequalities in healthy life expectancy by Brazilian geographic regions: findings from the National Health Survey, 2013. Int J Equity Health 2016; 15:141. [PMID: 27852270 PMCID: PMC5112675 DOI: 10.1186/s12939-016-0432-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/02/2016] [Indexed: 11/15/2022] Open
Abstract
Background The demographic shift and epidemiologic transition in Brazil have drawn attention to ways of measuring population health that complement studies of mortality. In this paper, we investigate regional differences in healthy life expectancy based on information from the National Health Survey (PNS), 2013. Methods In the survey, a three-stage cluster sampling (census tracts, households and individuals) with stratification of the primary sampling units and random selection in all stages was used to select 60,202 Brazilian adults (18 years and over). Healthy life expectancies (HLE) were estimated by Sullivan’s method according to sex, age and geographic region, using poor self-rated health for defining unhealthy status. Logistic regression models were used to investigate socioeconomic and regional inequalities in poor self-rated health, after controlling by sex and age. Results Wide disparities by geographic region were found with the worst indicators in the North and Northeast regions, whether considering educational attainment, material deprivation, or health care utilization. Life expectancy at birth for women and men living in the richest regions was 5 years longer than for those living in the less wealthy regions. Modeling the variation across regions for poor self-rated health, statistically significant effects (p < 0.001) were found for the North and Northeast when compared to the Southeast, even after controlling for age, sex, diagnosis of at least one non-communicable chronic disease, and schooling or socioeconomic class. Marked regional inequalities in HLE were found, with the loss of healthy life much higher among residents of the poorest regions, especially among the elderly. Conclusions By combining data on self-rated health status and mortality in a single indicator, Healthy Life Expectancy, this study demonstrated the excess burden of poor health experienced by populations in the less wealthy regions of Brazil. To mitigate the effects of social exclusion, the development of strategies at the regional level is essential to provide health care to all persons in need, reduce risk exposures, support prevention policies for adoption of healthy behaviors. Such strategies should prioritize population groups that will experience the greatest impact from such interventions.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Institute of Communication and Information Science and Technology in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | | | - Aline Pinto Marques
- Institute of Communication and Information Science and Technology in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Wanessa da Silva de Almeida
- Institute of Communication and Information Science and Technology in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Dalia Elena Romero Montilla
- Institute of Communication and Information Science and Technology in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Marques AP, Montilla DER, Almeida WDSD, Andrade CLTD. Hospitalization of older adults due to ambulatory care sensitive conditions. Rev Saude Publica 2015; 48:817-26. [PMID: 25372173 PMCID: PMC4211570 DOI: 10.1590/s0034-8910.2014048005133] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 06/01/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the temporal evolution of the hospitalization of older adults due to ambulatory care sensitive conditions according to their structure, magnitude and causes. METHODS Cross-sectional study based on data from the Hospital Information System of the Brazilian Unified Health System and from the Primary Care Information System, referring to people aged 60 to 74 years living in the state of Rio de Janeiro, Souhteastern Brazil. The proportion and rate of hospitalizations due to ambulatory care sensitive conditions were calculated, both the global rate and, according to diagnoses, the most prevalent ones. The coverage of the Family Health Strategy and the number of medical consultations attended by older adults in primary care were estimated. To analyze the indicators’ impact on hospitalizations, a linear correlation test was used. RESULTS We found an intense reduction in hospitalizations due to ambulatory care sensitive conditions for all causes and age groups. Heart failure, cerebrovascular diseases and chronic obstructive pulmonary diseases concentrated 50.0% of the hospitalizations. Adults older than 69 years had a higher risk of hospitalization due to one of these causes. We observed a higher risk of hospitalization among men. A negative correlation was found between the hospitalizations and the indicators of access to primary care. CONCLUSIONS Primary healthcare in the state of Rio de Janeiro has been significantly impacting the hospital morbidity of the older population. Studies of hospitalizations due to ambulatory care sensitive conditions can aid the identification of the main causes that are sensitive to the intervention of the health services, in order to indicate which actions are more effective to reduce hospitalizations and to increase the population’s quality of life.
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Abstract
Objectivos: propor um método para estimação do Coeficiente de Mortalidade Infantil (CMI) por município, levando em consideração a subenumeração de óbitos e a estimação do CMI em áreas de pequeno porte populacional. Métodos: o método foi desenvolvido a partir da estimação de fatores de correção de óbitos e nascidos vivos por município, no triênio 2009-2011, através de indicadores construídos para caracterizar a cobertura das informações vitais. Foi proposto um procedimento para verificar se o número corrigido de óbitos infantis atingiu o valor mínimo esperado de acordo com o porte populacional do município. No caso de insuficiência do fator de correção, foram usados os valores preditos de uma regressão multivariada para estimar o CMI. Resultados: os modelos de estimação dos fatores de correção das estatísticas vitais mostraram correlações inversas e significativas com os indicadores que caracterizam a cobertura dos dados vitais. Os valores preditos dos fatores de correção foram aplicados para todos os municípios localizados nos estados que não têm informações vitais completas. Em apenas 230 municípios, a correção foi considerada insuficiente. Conclusões: os achados evidenciam que existem, ainda, grandes problemas a superar, como as persistentes desigualdades relacionadas ao desenvolvimento socioeconómico, o acesso à assistência de saúde e à omissão da informação de óbito, que compromete o dimensionamento da situação local.
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de Frias PG, Szwarcwald CL, Souza Junior PRBD, Almeida WDSD, Lira PIC. [Correcting vital information: estimating infant mortality, Brazil, 2000-2009]. Rev Saude Publica 2014; 47:1048-58. [PMID: 24626543 PMCID: PMC4206109 DOI: 10.1590/s0034-8910.2013047004839] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 07/30/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To propose a simplified method of correcting vital information and estimating
the coefficient of infant mortality in Brazil. METHODS Vital data in the information systems on mortality and live births were
corrected using correction factors, estimated based on events not reported
to the Brazilian Ministry of Health and obtained by active search. This
simplified method for correcting vital information for the period 2000-2009
for Brazil and its federal units establishes the level of adequacy of
information on deaths and live births by calculating the overall coefficient
of mortality standardized by age and the ratio between reported and expected
live births, respectively, in each Brazilian municipality. By applying
correction factors to the number of deaths and live births reported in each
county, the vital statistics were corrected, making it possible to estimate
the coefficient of infant mortality. RESULTS The highest correction factors were related to infant deaths, reaching values
higher than 7 for municipalities with very precarious mortality information.
For deaths and live births, the correction factors exhibit a decreasing
gradient as indicators of adequacy of the vital information improve. For the
year 2008, the vital information corrected by the simplified method per
state were similar to those obtained in the research of active search. Both
the birth rate and the infant mortality rate decreased in the period in all
Brazilian regions. In the Northeast, the annual rate of decline was 6.0%,
the highest in Brazil (4.7%). CONCLUSIONS The active search of deaths and births allowed correction factors to be
calculated by level of adequacy of mortality information and live births.
The simplified method proposed here allowed vital information to be
corrected per state for the period 2000-2009 and the progress of the
coefficient of infant mortality in Brazil, its regions and states to be
assessed.
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Szwarcwald CL, Malta DC, Pereira CA, Vieira MLFP, Conde WL, Souza Júnior PRBD, Damacena GN, Azevedo LO, Azevedo E Silva G, Theme Filha MM, Lopes CDS, Romero DE, Almeida WDSD, Monteiro CA. [National Health Survey in Brazil: design and methodology of application]. Cien Saude Colet 2014; 19:333-42. [PMID: 24863810 DOI: 10.1590/1413-81232014192.14072012] [Citation(s) in RCA: 214] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The National Health Survey is a household-based nationwide survey carried out by the Ministry of Health in partnership with the Brazilian Institute of Geography and Statistics. The scope of the survey is to establish the health status and lifestyles of the population - as well as how they look after their health - with regard to access and use of services, preventive actions, continuity of care, and health care financing. The sample size is 80,000 households and enables the calculation of some indicators at different geographic levels, namely states, capitals, metropolitan and rural areas. The questionnaire is divided into three parts. The first two are answered by one resident and include questions on the household characteristics and on the social and economic level and health status of all inhabitants. The individual questionnaire is answered by an adult (aged 18 years or more), selected with equal probability among the adult residents, and focuses on morbidity and lifestyle. For this individual, measurements of weight, height, waist circumference and blood pressure are taken, as well as laboratory exams to characterize the lipid profile and blood glucose level, as well as determine the urine sodium content. The laboratory exams are taken in a subsample of 25% of the census sectors selected.
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Frias PGD, Szwarcwald CL, Souza Junior PRBD, Almeida WDSD, Lira PIC. Correcao de informacoes vitais: estimacao da mortalidade infantil, Brasil, 2000-2009. Rev Saude Publica 2013. [DOI: 10.1590/s0034-89102013000901048] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Almeida WDSD, Szwarcwald CL. Mortalidade infantil e acesso geográfico ao parto nos municípios brasileiros. Rev Saude Publica 2012; 46:68-76. [DOI: 10.1590/s0034-89102012005000003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 07/25/2011] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar o acesso geográfico ao parto hospitalar nos municípios brasileiros. MÉTODOS: Foram analisadas informações de óbitos e nascimentos quanto à sua adequação para o cálculo do coeficiente de mortalidade infantil no período de 2005 a 2007 para os 5.564 municípios brasileiros. O acesso geográfico foi expresso por indicadores de deslocamento, oferta e acesso aos serviços de saúde. A associação entre o acesso geográfico ao parto e o coeficiente de mortalidade infantil em municípios com adequação de suas informações vitais foi avaliada por meio de regressão múltipla. RESULTADOS: Dentre os municípios analisados, 56% apresentaram adequação das informações vitais, correspondendo a 72% da população brasileira. O deslocamento geográfico ao parto mostrou-se inversamente associado ao porte populacional, à renda per capita, e à mortalidade infantil, mesmo controlado por fatores demográficos e socioeconômicos. CONCLUSÕES: Embora tenham sido desenvolvidas estratégias importantes para a melhoria da qualidade do atendimento às gestantes no Brasil, as ações para garantir o acesso igualitário à assistência ao parto ainda são insuficientes. O maior deslocamento intermunicipal para o parto se mostrou como um fator de risco para a mortalidade infantil, aliado à desigualdade de oferta de serviços qualificados e à falta de integração com a atenção básica de saúde.
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