RESUMO

Resumen: El objetivo de este estudio fue estimar la asociación entre la discapacidad del jefe de familia y la severidad de la inseguridad alimentaria de su hogar, en pobladores de Colombia, durante el 2017. Se realizó un análisis secundario de los datos de la Encuesta Nacional de Calidad de Vida del 2017 (ECV 2017) de Colombia. La variable independiente fue la discapacidad evaluada con las preguntas del grupo de Washington y la variable dependiente fue la inseguridad alimentaria medida con la Escala Latinoamericana y Caribeña de Seguridad Alimentaria (ELCSA). Se incluyeron variables de confusión sociodemográficas y relacionadas con la inseguridad alimentaria. Para demostrar la asociación se utilizó la regresión logística ordinal y se estimaron odds ratio (OR) con sus intervalos de 95% de confianza (IC95%). En todos los cálculos se consideró el muestreo complejo de la ECV 2017. Se incluyeron los datos de 8.488 jefes de familia. El 9,2% admitió que tenía alguna discapacidad y el 41,8% refirió que su hogar presentaba algún nivel de inseguridad alimentaria. Los hogares con un jefe de familia con discapacidad tuvieron 30% más probabilidad de mayor severidad de inseguridad alimentaria, en comparación con los hogares con un jefe de familia sin discapacidad (OR = 1,30; IC95%: 1,07-1,59), ajustado por múltiples variables de confusión. En conclusión, en Colombia, durante el 2017, la discapacidad de los jefes de familia aumentó la probabilidad de mayor severidad de la inseguridad alimentaria en sus hogares. Es necesaria la creación de programas de asistencia nutricional enfocados en las poblaciones vulnerables como las personas con discapacidad.

Abstract: This study investigated the association between head of household disability and the severity of food insecurity in Colombian households during 2017. A secondary data analysis was conducted based on 2017 Colombian National Quality of Life Survey (ECV 2017). As the independent variable, disability was assessed using questions from the Washington group, whereas the dependent variable - food insecurity - was measured by the Latin American and Caribbean Food Security Scale (ELCSA). Sociodemographic confounding variables and variables related to food insecurity were included. Association was analyzed by ordinal logistic regression, and the odds ratio (OR) was estimated with its 95% confidence intervals (95%CI). All calculations considered the complex sampling of ECV 2017. Data from 8,488 heads of household were included. A total of 9.2% of the participants had some type of disability and 41.8% reported some level of household food insecurity. Households with a head of household with some disability were 30% more likely to develop severe food insecurity compared with households with a head of household without disabilities (OR = 1.30; 95%CI: 1.07-1.59), adjusted for multiple confounding variables. In 2017, Colombian households with heads of household with disabilities were more likely to develop severe food insecurity. It is essential to implement nutritional assistance programs aimed at vulnerable populations, such as people with disabilities.

Resumo: Este estudo busca determinar a associação entre a deficiência do chefe de família e a gravidade da insegurança alimentar em domicílios colombianos durante 2017. Foi realizada uma análise secundária dos dados da Pesquisa Nacional de Qualidade de Vida de 2017 (ECV 2017) da Colômbia. A variável independente foi a deficiência, avaliada por meio de perguntas do grupo de Washington, e a variável dependente foi a insegurança alimentar, medida pela Escala de Segurança Alimentar da América Latina e do Caribe (ELCSA). Foram incluídas variáveis de confusão sociodemográficas e relacionadas à insegurança alimentar. A regressão logística ordinal foi utilizada para analisar a associação, e a razão de probabilidades (OR) foi estimada com seus intervalos de 95% de confiança (IC95%). Em todos os cálculos foi considerada a amostragem complexa da ECV 2017. Foram incluídos dados de 8.488 chefes de família. Houve 9,2% dos participantes com algum tipo de deficiência e 41,8% relataram que seu domicílio apresentava algum nível de insegurança alimentar. Os domicílios com chefe de família com deficiência tiveram 30% mais chances de desenvolver insegurança alimentar mais grave, em comparação com as famílias com chefe de família sem deficiência (OR = 1,30; IC95%: 1,07-1,59), ajustado para múltiplas variáveis de confusão. Em 2017, os domicílios colombianos com chefes de família com deficiência tiveram maior probabilidade de desenvolver insegurança alimentar grave. É necessária a implementação de programas de assistência nutricional voltados para populações vulneráveis como as pessoas com deficiência.

RESUMO

Cardiovascular diseases (CVD) are the leading cause of death worldwide. From this perspective, the role of vitamin E and its metabolites in preventing CVD has been studied, being supported by the findings that low vitamin E concentrations are associated with an increased risk of cardiovascular events. Despite this, no studies have analysed the co-existence of vitamin E deficiency (VED) and CVD on the basis of population studies. Facing that, this study summarises information on the relationship between vitamin E status and CVD, providing a basis for understanding the determining and protective factors for its development. VED may be a public health problem since it has been observed to vary from 0·6% to 55·5% worldwide, with higher percentages in Asia and Europe, where CVD mortality rates stand out. Intervention studies with α-tocopherol supplementation do not confirm cardioprotective action of vitamin E, which may reflect that α-tocopherol alone does not provide cardiovascular protection to individuals, but the consumption of all isomers found in food. Considering that low concentrations of α-tocopherol can lead to a higher susceptibility to diseases involving oxidative stress in the population, in addition to the high and growing prevalence of CVD and VED, it is essential to investigate or reinterpret the mechanisms of action of vitamin E and its metabolites in the cardiovascular process to better understand the co-existence of CVD and VED. It is also important to implement public health policies and programmes aimed at promoting the consumption of natural food sources of vitamin E and healthy fats.

RESUMO

Objectives: The objective of this study was to investigate the prevalence of the following risk behaviors: experimentation with cigarettes, electronic cigarettes, alcohol, substances, delinquent behavior, and sex at age 15, stratified by sex and socioeconomic position. We also investigated the prevalence of cigarette and alcohol experimentation at age 11 and the persistence and cumulative incidence of these behaviors between 11 and 15 years of age. Methods: In this cohort study, we included 3,491 11-year-olds and 1,949 15-year-olds from the 2004 Pelotas Birth Cohort. All outcomes were identified via confidential questionnaires and were analyzed as binary variables. Results: At age 11, there was a higher prevalence of cigarette experimentation among boys. At age 15, there was a higher prevalence of experimentation with alcohol, cigarettes, and substances among girls; experimentation with cigarettes and sex were more prevalent among those in a low socioeconomic position. We found a high cumulative incidence of alcohol experimentation, as well as persistent alcohol experimentation, in both boys and girls. Conclusions: Further research should clarify causal paths of the high prevalence of risk behaviors during adolescence and its increase among girls.

RESUMO

Intimate partner violence (IPV) is a challenge in Brazil. The country holds one of the highest rates of femicide in the world, most of which are preceded by IPV. We conducted a cross-sectional study with 34,334 women, aged 18 to 59 years, from the 2019 Brazilian National Health Survey to analyze the prevalence of IPV and its subtypes among the Brazilian adult women in the last 12 months, encompassing their health consequences and the use of health services resulting from IPV. We also used logistic regression models to estimate the association of sociodemographic characteristics and self-perceived health status with IPV. The prevalence of IPV among Brazilian adult women in the last 12 months was 7.6% (95% confidence interval [CI] [7.0, 8.2]). Women aged 18 to 39 years, not married, and with income of up to 1 minimum wage (MW), had higher odds of suffering IPV. Among those who reported health consequences due to IPV, 69% reported psychological consequences, and 13.9% sought health care, mostly in primary or secondary health care services in the Brazilian Unified Health System (41.9%). Regarding the self-perceived health variables, women who reported eating problems (odds ratio [OR] = 1.29; [1.01, 1.65]), lack of interest/absence of pleasure (OR = 1.41; [1.11, 1.79]), depressive feelings (OR = 1.39; [1.03, 1.88]), feeling of failure (OR = 1.75; [1.36, 2.24]), and suicidal thoughts (OR = 1.73; [1.25, 2.41]) had greater odds of reporting IPV compared to those who did not report these same perceptions. The results show that younger, divorced or single, low-income women with eating problems and mental health disorders were more likely to suffer IPV. IPV often led to health problems, and many abused women sought support from public health services. Health professionals must be trained to identify and care for these women, thereby acting as allies in preventing and reducing IPV.

Assuntos

RESUMO

OBJECTIVES: The objective of this study was to investigate the prevalence of the following risk behaviors: experimentation with cigarettes, electronic cigarettes, alcohol, substances, delinquent behavior, and sex at age 15, stratified by sex and socioeconomic position. We also investigated the prevalence of cigarette and alcohol experimentation at age 11 and the persistence and cumulative incidence of these behaviors between 11 and 15 years of age. METHODS: In this cohort study, we included 3,491 11-year-olds and 1,949 15-year-olds from the 2004 Pelotas Birth Cohort. All outcomes were identified via confidential questionnaires and were analyzed as binary variables. RESULTS: At age 11, there was a higher prevalence of cigarette experimentation among boys. At age 15, there was a higher prevalence of experimentation with alcohol, cigarettes, and substances among girls; experimentation with cigarettes and sex were more prevalent among those in a low socioeconomic position. We found a high cumulative incidence of alcohol experimentation, as well as persistent alcohol experimentation, in both boys and girls. CONCLUSION: Further research should clarify causal paths of the high prevalence of risk behaviors during adolescence and its increase among girls.

Assuntos

RESUMO

Objective To analyze the diabetes mellitus (DM) temporal trend and hospitalization costs in Brazil, by region, Federative Units (FUs) and population characteristics, from 2011 to 2019. Methods This was an ecological study with data from the Hospital Information System, analyzing the annual trend in hospitalization rates for DM according to sex, age, race/skin color and region/FU by Prais-Winsten generalized linear regression. Results A total of 1,239,574 DM hospitalizations were recorded in the country and the hospitalization rates was 6.77/10,000 inhabitants in the period. The DM hospitalization rates trend was falling for both sexes and in most regions, while it was rising in the younger population and for length of stay (average 6.17 days). Total expenditure was US$ 420,692.23 and it showed a rising trend. Conclusion The temporal trend of hospitalization rates due to DM was falling, with differences according to region/FU and age group. Average length of stay and expenditure showed a rising trend.

Objetivo Analizar la tendencia temporal y los costos de las internaciones por diabetes mellitus (DM) en Brasil, por región, Unidades Federativas (UF) y características poblacionales, de 2011 a 2019. Métodos Estudio ecológico con datos del Sistema de Información Hospitalaria, analizando la tendencia anual de las tasas de hospitalización (TH) por DM según sexo, edad, raza/color y región/UF mediante regresión de Prais-Winsten. Resultados Se registraron 1.239.574 hospitalizaciones por DM en el país y la TH fue de 6,77/10 mil habitantes en el período. La tendencia de TH por DM fue decreciente en ambos sexos y en la mayoría de las regiones y creciente en la población más joven y en la duración de la estancia. El gasto total fue de 420.692.238 dólares y fue creciente. Conclusión La tendencia temporal de TH por DM fue decreciente, con diferencias según región/UF y grupo de edad. La duración media de la estancia y los gastos mostraron una tendencia creciente.

Objetivo Analisar a tendência temporal e gastos das internações por diabetes mellitus (DM) no Brasil, por região, Unidades da Federação (UFs) e características populacionais, de 2011 a 2019. Métodos Estudo ecológico com dados do Sistema de Informações Hospitalares, analisando a tendência anual das taxas de internação (TIs) por DM segundo sexo, idade, raça/cor e região/UF pela regressão linear generalizada de Prais-Winsten. Resultados Foram registradas 1.239.574 internações por DM no país e a TI foi de 6,77/10 mil habitantes, no período. A tendência das TIs por DM foi decrescente nos dois sexos e na maioria das regiões, e crescente na população mais jovem e no tempo de internação (média de 6,17 dias). O gasto total foi de US$ 420.692,23 e apresentou tendência crescente. Conclusão A tendência temporal da TI por DM foi decrescente, com diferenças segundo região/UF e grupo etário. O tempo médio de internação e os gastos apresentaram tendência de aumento.

RESUMO

Objetivo: analisar indicadores de monitoramento do rastreamento do câncer de mama na população feminina usuária do Sistema Único de Saúde, Brasil, no período 2018-2019. Métodos: estudo descritivo, a partir do Sistema de Informação do Câncer; foram calculados indicadores de rastreamento após relacionamento determinístico das bases de dados de mamografia e histopatologia. Resultados: em 2018, 807.430 mulheres na faixa etária de 50-69 anos foram rastreadas, e dessas, 91% apresentaram resultado benigno, 1,8% provavelmente benigno, 6,7% inconclusivo e 0,5% sugestivo de câncer; a taxa de mamografia positiva foi de 9,0%; estimou- -se indicação de biópsia para 1,6% das mulheres, resultado maligno para 33,9% delas, e taxa de confirmação de câncer de 5,4 por 1 mil mulheres. Conclusão: identificou-se elevada perda de seguimento das lesões benignas; a taxa de mamografias positivas foi inferior ao parâmetro internacional; contudo, a taxa de detecção de câncer foi adequada, e o percentual de mamografias inconclusivas, aceitável.

Objetivo: analizar indicadores del tamizaje de cáncer de mama en población femenina atendida por Sistema Único de Salud Brasileño, de 2018-2019. Métodos: estudio descriptivo basado en Sistema de Información del Cáncer (Siscan). Los indicadores de detección se calcularon después de vinculación determinista de bases de datos de mamografía e histopatología. Resultados: en 2018, 807.430 mujeres de 50-69 años examinaram cáncer de mama. De estos, 91% tuvo resultado benigno, 1,8% probablemente benigno, 6,7% resultado no concluyente y 0,5% sugestivo de cáncer. La tasa de mamografías positivas fue 9,0%. Se estimó indicación de biopsia en 1,6% de las mujeres, resultado maligno en 33,9% y tasa de confirmación de cáncer de 5,4 por 1.000 mujeres. Conclusión: se identificó alta pérdida de seguimiento de las lesiones benignas. La tasa de mamografías positivas fue inferior al parámetro internacional, pero la tasa de detección de cáncer fue adecuada y el porcentaje de mamografías no concluyentes aceptable.

Objetive: to analyze breast cancer screening monitoring indicators in the female population using the Brazilian National Health System, from 2018 to 2019. Methods: this was a descriptive study based on Cancer Information System (SISCAN) data; screening indicators were calculated following deterministic linkage of the mammography and histopathology databases. Results: in 2018, 807,430 women aged 50 to 69 years were screened for breast cancer, 91% of whom had a benign result, 1.8% probably benign, 6.7% inconclusive results and 0.5% results suggestive of cancer; the positive mammogram rate was 9.0%; biopsy was estimated to be indicated for 1.6% of the women, 33.9% of whom had a malignant result, and the cancer confirmation rate was 5.4 per 1,000 women. Conclusion: high benign lesion loss to follow-up was identified; the positive mammogram rate was lower than the international parameter, but the cancer detection rate was adequate and the percentage of inconclusive mammograms was acceptable.

Assuntos

RESUMO

ABSTRACT This book analysis some features and consequences of the emerging field of Population Health Science, which some authors define as Public Health 3.0. It is a mode of reaction against the biomedical model of health which was hegemonic in the twentieth century. It recognizes the World Health Organization's (WHO) definition of health 'as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity', that health is empirically social and most of its determinants are social and economic ones; population health interventions are ethically inseparable from social empowerment and health research and health promotion must, coherently with these ideas, contemplate health as a social phenomenon too. Community-based participatory research is a pressing need for a change in the field of public/population health.

RESUMO Este livro analisa alguns aspectos e consequências do campo emergente da Ciência da Saúde Populacional, o que alguns autores definem como Saúde Pública 3.0. É um modo de reagir contra o modelo biomédico hegemônico durante o século XX. Ele reconhece a definição de saúde da Organização Mundial da Saúde (OMS) 'como estado de completo bem-estar físico, mental e social e não simplesmente ausência de doença ou enfermidade', que a saúde é empiricamente social e a maioria de seus determinantes são sociais ou econômicos; as intervenções de saúde populacional são eticamente inseparáveis do empoderamento social e a pesquisa em saúde e a promoção de saúde devem, de modo coerente com essas ideias, contemplar saúde como fenômeno social. Pesquisa participativa de base comunitária é uma necessidade premente para viabilizar mudanças no campo da saúde pública/populacional.

RESUMO

To compare the prevalence and characteristics of hypertension in women experiencing incarceration (WEI) to the general population in Brazil: (1) a prison survey conducted from January 2014 to December 2015 in 15 states, with 1,327 WEI; and (2) a household survey in the 26 states and the Federal District of Brazil administered to women in the general population (WGP). Data analysis used SPSS® version 20.0. The point estimates and the prevalence ratio with their respective confidence intervals were calculated using Poisson regression. Ages in the two populations differed, 27.9% of WGP were over 50, while 7.3% of WEI were. The overall prevalence of arterial hypertension was 31.3% (95% CI: 28.6-34.0) in the WEI and 38.9% (95% CI: 37.8-39.9) for WGP. For individuals under 30, hypertension was found in 22.4% of WEI and 13.4% of WGP. WEI have a higher prevalence of hypertension at an earlier age than the GP. Less education, obesity, using illegal drugs, previous pregnancy, and not using contraceptives were more frequent in this group, revealing the need to implement policies aimed at treating both their hypertension and other health issues in prison.

Assuntos

RESUMO

Resumo Objetivou estimar a relação de fatores pessoais e ambientais com a prevalência de deficiência física adquirida em adultos e idosos brasileiros. Realizado um estudo transversal com dados da Pesquisa Nacional de Saúde (PNS) 2013. A variável resposta foi: autorrelato deficiência física adquirida. As variáveis explicativas de interesse foram: sexo, raça/cor, escolaridade, classe social, trabalho remunerado, plano de saúde, água canalizada e rede de esgoto. As magnitudes das associações e seus respectivos intervalos de confiança (95%) foram estimadas utilizando a Regressão de Poisson. O autorrelato de deficiência física foi encontrado em 1,25% dos 55.369 participantes. Após completo ajustamento, o sexo masculino, raça/cor não branca, menores níveis de escolaridade, viver sozinho, não ter trabalho remunerado, plano de saúde, água canalizada e rede de esgoto foram associados a maiores prevalências de deficiência física adquirida. Esses achados evidenciam que a população mais vulnerável apresenta maior prevalência de deficiência física e os fatores pessoais e ambientais são importantes de serem avaliados em nível populacional.

Abstract The aim of this study was to estimate the relationship between personal and environmental factors and the prevalence of acquired physical impairment in adults and older persons in Brazil. We conducted a cross-sectional study using data from the 2013 National Health Survey. The response variable was self-reported acquired physical impairment. The explanatory variables were sex, race/skin color, education level, social class, paid employment, private health insurance, running water, and connection to a sewer network. The strength of association between the explanatory variables and response variable and respective 95% confidence intervals were estimated using Poisson Regression. Physical impairment was reported by 1.25% of the study population (n=55,369). After complete adjustment, being male and non-white, having a lower level of education, living alone, not being in paid employment, not having private health insurance, not having running water, and not living in a house connected to a sewer network were associated with higher prevalence of acquired physical impairment. The findings show that prevalence of physical impairment was higher among vulnerable groups and that personal and environmental factors are important elements that need to be assessed at the population level.

RESUMO

Background: In Brazil, secondary data for epidemiology are largely available. However, they are insufficiently prepared for use in research, even when it comes to structured data since they were often designed for other purposes. To date, few publications focus on the process of preparing secondary data. The present findings can help in orienting future research projects that are based on secondary data. Objective: Describe the steps in the process of ensuring the adequacy of a secondary data set for a specific use and to identify the challenges of this process. Methods: The present study is qualitative and reports methodological issues about secondary data use. The study material was comprised of 6,059,454 live births and 73,735 infant death records from 2004 to 2013 of children whose mothers resided in the State of São Paulo - Brazil. The challenges and description of the procedures to ensure data adequacy were undertaken in 6 steps: (1) problem understanding, (2) resource planning, (3) data understanding, (4) data preparation, (5) data validation and (6) data distribution. For each step, procedures, and challenges encountered, and the actions to cope with them and partial results were described. To identify the most labor-intensive tasks in this process, the steps were assessed by adding the number of procedures, challenges, and coping actions. The highest values were assumed to indicate the most critical steps. Results: In total, 22 procedures and 23 actions were needed to deal with the 27 challenges encountered along the process of ensuring the adequacy of the study material for the intended use. The final product was an organized database for a historical cohort study suitable for the intended use. Data understanding and data preparation were identified as the most critical steps, accounting for about 70% of the challenges observed for data using. Conclusion: Significant challenges were encountered in the process of ensuring the adequacy of secondary health data for research use, mainly in the data understanding and data preparation steps. The use of the described steps to approach structured secondary data and the knowledge of the potential challenges along the process may contribute to planning health research.

Assuntos

RESUMO

ABSTRACT BACKGROUND: Abdominal wall hernia is one of the most common surgical pathologies. The advent of minimally invasive surgery raised questions about the best technique to be applied, considering the possibility of reducing postoperative pain, a lower rate of complications, and early return to usual activities. OBJECTIVE: To evaluate the frequency of open and laparoscopic hernioplasties in Brazil from 2008 to 2018, analyzing the rates of urgent and elective surgeries, mortality, costs, and the impact of laparoscopic surgical training on the public health system. METHODS: Nationwide data from 2008 to 2018 were obtained from the public health registry database (DATASUS) for a descriptive analysis of the selected data and parameters. RESULTS: 2,671,347 hernioplasties were performed in the period, an average of 242,850 surgeries per year (99.4% open, 0.6% laparoscopic). The economically active population (aged 20-59) constituted the dominant group (54.5%). There was a significant reduction (P<0.01) in open surgeries, without a compensatory increase in laparoscopic procedures. 22.3% of surgeries were urgent, with a significant increase in mortality when compared to elective surgeries (P<0.01). The distribution of laparoscopic surgery varied widely, directly associated with the number of digestive surgeons. CONCLUSION: This study presents nationwide data on hernia repair surgeries in Brazil for the first time. Minimally invasive techniques represent a minor portion of hernioplasties. Urgent surgeries represent a high percentage when compared to other countries, with increased mortality. The data reinforce the need for improvement in the offer of services, specialized training, and equalization in the distribution of procedures in all regions.

RESUMO CONTEXTO: Hérnias de parede abdominal são patologias cirúrgicas frequentes. O surgimento da cirurgia minimamente invasiva levantou questionamentos sobre a melhor técnica a ser aplicada, considerando a possível redução de dor pós-operatória e de complicações, e retorno precoce às atividades habituais. OBJETIVO: Avaliar frequência de hernioplastias abertas e laparoscópicas no Brasil entre os anos de 2008 e 2018, analisar taxas de cirurgias urgentes e eletivas, mortalidade, custos e o impacto do treinamento em cirurgia laparoscópica no sistema público de saúde. MÉTODOS Análise de banco de dados do registro de saúde pública (DATASUS) entre 2008 e 2018 para coleta dos dados e parâmetros selecionados. RESULTADOS: Foram realizadas 2.671.347 hernioplastias no período, média de 242.850 cirurgias/ano (99,4% abertas, 0,6% laparoscópicas). Predominou a faixa etária economicamente ativa (20-59 anos), 54,5% do total. Houve redução significativa das cirurgias abertas (P<0,01), sem aumento compensatório da laparoscopia. 22,3% das cirurgias foram de urgência, com aumento significativo da mortalidade em relação às cirurgias eletivas (P<0,01). Observou-se distribuição heterogênea da videolaparoscopia, diretamente relacionada com o número de cirurgiões digestivos. CONCLUSÃO: Este estudo apresenta pela primeira vez os dados populacionais das cirurgias de hérnia no Brasil. As técnicas minimamente invasivas representam uma parcela pouco significativa das hernioplastias. As cirurgias urgentes apresentam percentual elevado comparado a outros países, com aumento significativo na mortalidade, reforçando a necessidade de políticas que permitam aumento da oferta do serviço, treinamento especializado e equalização na distribuição dos procedimentos em todas as regiões.

Assuntos

RESUMO

ABSTRACT: Objective: Antidepressant use is increasing worldwide, but national data on psychotropic drug use by depressed patients in Brazil is lacking. Methodology: Between 2013 and 2014, a representative sample of urban adult individuals were asked if they had a diagnosis of chronic disease, had a medical indication for drug treatment, and were taking chronic medications at the time for each reported diagnosis. We analyzed the frequencies of reported depression and the medications related to this disease. Results: Overall, 6.1% of respondents reported depression. The prevalence increased with age - 9.5% among the elders - was higher among women (8.9%) and in the south of the country (8.9%). As a single disease, the prevalence of depression was higher among young people (17.6%). Among those with multimorbidity, the prevalence of depression rose to 25.7%. Of those who reported depression, 81.3% had medical indication for treatment and 90.3% were under treatment - this proportion was lower among young people (84.5%) and those living in the poorest region (78.6%). Antidepressants accounted for 47.2% of psychotropic drugs taken by respondents with depression, with regional differences - only 30% used antidepressants in the North. Polypharmacy was reported by 22% of those with depression and other chronic diseases. Conclusion: Depression in Brazil, is common among young adults as a single chronic disease and highly prevalent among people with chronic multimorbidity, especially the young. The treatment gap was larger among young people and in the less developed regions of the country.

RESUMO: Objetivo: O uso de antidepressivos está aumentando em todo o mundo, mas faltam dados nacionais sobre o uso de drogas psicotrópicas por pacientes deprimidos no Brasil. Metodologia: Entre 2013 e 2014, uma amostra representativa de indivíduos adultos urbanos foi questionada sobre a presença diagnóstica de doença crônica, a indicação médica para tratamento medicamentoso e o uso de medicamentos crônicos à época de cada diagnóstico relatado. Foram analisadas as frequências de depressão relatada e os medicamentos relacionados a essa doença. Resultados: No geral, 6,1% dos entrevistados relataram depressão. A prevalência aumentou com a idade (9,5% entre os idosos) foi maior entre as mulheres (8,9%) e no sul do país (8,9%). Como doença única, a prevalência de depressão foi maior entre os jovens (17,6%). Entre aqueles com multimorbidade, a prevalência de depressão subiu para 25,7%. Dos que relataram depressão, 81,3% tinham indicação médica para tratamento e 90,3% estavam em tratamento - essa proporção foi menor entre os jovens (84,5%) e os que moram na região mais pobre (78,6%). Os antidepressivos representaram 47,2% dos medicamentos psicotrópicos tomados pelos entrevistados com depressão, com diferenças regionais - apenas 30% usavam antidepressivos no Norte. Polifarmácia foi relatada por 22% das pessoas com depressão e outras doenças crônicas. Conclusão: A depressão no Brasil é comum entre adultos jovens como doença crônica única e altamente prevalente entre as pessoas com multimorbidade crônica, principalmente os jovens. A lacuna de tratamento foi maior entre os jovens e nas regiões menos desenvolvidas do país.

Assuntos

RESUMO

El objetivo de la presente investigación es determinar la presencia de anticuerpos contra el virus de la hepatitis C en la población general de la zona sur de Manabí-Ecuador. Se demostró la ausencia de anticuerpos contra VHC en la población estudiada, se necesitan estudios adicionales que abarquen una población mayor

The objective of this research is to determine the presence of antibodies against hepatitis C virus in the general population of the southern area of Manabí-Ecuador. The absence of HCV antibodies was demonstrated in the studied population, additional studies covering a larger population are needed

RESUMO

Objetivo: identificar o perfil sociodemográfico e de saúde de idosos dos municípios numa regional de Minas Gerais. Método: estudo transversal de base populacional, realizado em 24 cidades com 3430 idosos. Aplicou-se: Mini exame do Estado Mental, instrumento de perfil sociodemográfico, Mini avaliação Nutricional, WHOQOL-BREF e WHOQOL-OLD. Para a análise se usou SPSS versão 20.0. Resultados: sexo feminino (61,5%), 60 a 69 anos (52,6%), sem escolarização/analfabeto ou fundamental incompleto (83,5%), recebendo até um salário mínimo (39,7%), aposentados (80,7%) média de 3,17 (dp=1,92) doenças por idoso, uso em média de 2,47 medicamentos (dp=1,37), risco para desnutrição (29,1%), excesso de peso (62,9%), etilismo (15,7%), tabagismo (15%), sedentarismo (43,1%), qualidade de vida com menores escores no domínio meio ambiente (62,0/dp=13,2) e, na faceta autonomia (66,8/dp=16,4). Conclusão: sexo feminino, baixa renda, média de três doenças por pessoa, excesso de peso, sedentarismo e qualidade de vida com menores escores no domínio meio ambiente e faceta autonomia caracterizam a população pesquisada.

Objective: to identify the sociodemographic and health profile of older adults in municipalities of the Uberaba Health Region in Minas Gerais, Brazil. Method: in this cross-sectional, population-based study, the Mini-Mental State Examination, a demographic and health profile instrument, the Mini Nutritional Assessment, WHOQOL-BREF and WHOQOL-OLD were applied to 3430 older adults in 24 cities, between 2012 and 2013. Data were analyzed using SPSS version 20.0. Results: female (61.5%), 60 to 69 years old (52.6%), no schooling or incomplete basic schooling (83.5%), income of one minimum wage or less (39.7%), pensioners (80.7%), mean 3.17 illnesses (SD = 1.92), use of 2.47 medicines (DP = 1.37), at risk for malnutrition (29.1%), overweight (62.9%), alcohol use (15.7%), smoking (15%), sedentary (43.1%), and with lowest quality of life scores in the environment domain (62.0%; DP = 13.2) and autonomy facet (66.8%; DP = 16.4). Conclusion: the study population was characteristically female, low-income, overweight, sedentary, had three diseases, and lowest quality of life scores in the environment domain and autonomy facet.

Objetivo: identificar el perfil sociodemográfico y de salud de ancianos de las ciudades en una Regional de Salud de Minas Gerais, Brasil. Método: estudio transversal de base poblacional, realizado en 24 ciudades junto a 3430 ancianos, entre 2012 y 2013. Se aplicó: mini-examen del estado mental, instrumento del perfil del sociodemográfico, mini-evaluación nutricional, WHOQOL-BREF y WHOQOL-OLD. Para el análisis se utilizó SPSS versión 20.0. Resultados: sexo femenino (61,5%), 60 a 69 años (52,6%), sin escolarización/analfabeto o secundario incompleto (83,5%), recibiendo hasta un salario mínimo (39,7%), jubilados (80,7%), promedio de 3,17 (dp=1,92) enfermedades por anciano, uso de 2,47 remedios (dp=1,37) en promedio, riesgo para la desnutrición (29,1%), exceso de peso (62,9%), alcoholismo (15,7%), tabaquismo (15%), sedentarismo (43,1%), calidad de la vida con menores puntuaciones en el dominio medio ambiente (62,0/dp=13,2) y, en el área autonomía (66,8/dp=16,4). Conclusión: sexo femenino, bajos ingresos, promedio de tres enfermedades por persona, exceso de peso, sedentarismo y calidad de la vida, con menores puntuaciones en el dominio medio ambiente y el área autonomía, caracterizan la población encuestada.

Assuntos

RESUMO

This study aimed at highlighting socioeconomic and demographic conditions, clinical characteristics, disease trajectory and disability level among people with Hansen's disease. Observational, transversal and quantitative study. Developed in the city of Uberaba (MG) during september and octuber of 2014. The population of this study was composed by all patients diagnosed with Hansen's disease who have been being treated for the illness for at least 30 days (n=32). Most respondents were male (59.4%). Their age averaging at 49.28 years. 46.9% were brown skinned, 40.6% were single, and 40.6% had completed basic education. Skin patches were the most perceived symptom (43.8%). 81.3% of patients are multibacillary and 18.8% are paucibacillary. The degree of the physical disability was 0 for 18.8% people, and 1 for 37.5% of people, while 18.8% had the second degree. Correlations were found regarding age, familial income, and current status regarding both profession and education, all of those to the second degree of physical disability. The evaluation of patients should be routinely conducted, as would help in the achievement of early diagnoses, which would help to avoid the physical disabilities which significantly compromise the quality of life of this population

Esse estudo possuiu como objetivo destacar as condições socioeconômicas e demográficas, as características clínicas, a trajetória da doença e o grau de incapacidade física de pessoas com hanseníase. Métodos: Foi um estudo observacional, transversal e quantitativo. Desenvolvido na cidade de Uberaba/MG durante setembro e agosto de 2014. A população do estudo foi composta por todos os pacientes diagnóstico com Hanseníase, que estavam em tratamento por pelo menos 30 dias (n=32). Resultados: A maioria dos indivíduos era do sexo masculino (59,4%). Média de 49,28 anos. 46,9% eram pardos, 40,6% eram solteiros e 40,6% tinham ensino fundamental completo. Manchas na pele foi o sintoma mais percebido (43,8%). 81,3% dos pacientes apresentava a forma multibacilar e 18,8% a paucibacilar. O grau de incapacidade física foi de 18.8% para grau 0, 37,5% para grau 1 e 18,8% para grau 2. Correlações foram encontradas entre idade, renda familiar e o estado atual de ocupação e escolaridade, com o grau 2 de incapacidade física. Conclusões: A avaliação dos pacientes deveria ser conduzido de forma rotineira, pois poderia auxiliar no diagnóstico precoce, que por sua vez poderia minimizar as sequelas e incapacidades físicas que influenciam significativamente a qualidade de vida dessa população.

Assuntos

RESUMO

Introdução: A saúde pública no Brasil apresenta demanda de procedimentos dermatológicos superior à atual oferta, resultando em fila de espera de pacientes com dermatoses a abordar cirurgicamente. Foi realizado mutirão de procedimentos cirúrgicos em serviço terciário de atendimento público para reduzir essa fila, sendo os dados dos pacientes e suas lesões aqui apresentados. Objetivo: Analisar o perfil dos pacientes que aguardam a realização de procedimentos dermatológicos bem como suas dermatoses. Métodos: Realizou-se análise descritiva simples do perfil dos pacientes, de suas dermatoses abordadas e dos procedimentos realizados. Resultados: Foram atendidos 31 pacientes com idade entre 21 e 95 anos (média de 63,7 anos), sendo 17 (54,83%) do sexo feminino e 14 (45,17%) do sexo masculino. Foram abordadas 38 lesões, sendo 21 neoplásicas (carcinomas e melanoma), oito pré-neoplásicas (queratoses actínicas) e nove não neoplásicas (nevos, queloide e neurofibroma). Conclusões: Este artigo torna-se relevante por identificar casos e pacientes que aguardam procedimentos cirúrgicos dermatológicos no serviço público. Com ele, estratégias de saúde pública na área dermatológica podem ser mais bem programadas, além de destacar a importante ação do dermatologista na saúde pública diagnosticando e tratando lesões pré-neoplásicas e neoplásicas.

Introduction: In the Brazilian public health system, the current demand for dermatological procedures is greater than the offer, resulting in a waiting list of patients bearing dermatoses to be treated surgically. Aimed at reducing that waiting list, a collective effort of surgical procedures was carried out in the tertiary public health service. The corresponding data on the patients and lesions is disclosed in the present study. Objective: To assess the profile of the patients ­ and respective skin lesions ­ who are awaiting to undergo dermatological procedures. Methods: A simple descriptive profile analysis of the patients, treated dermatoses and procedures performed was carried out. Results: Thirty-one patients (aged between 21 and 95 years, mean = 63.7 years). Seventeen (54.83%) were women and 14 (45.17%) were men. Thirty-eight lesions were treated: 21 neoplastic (carcinomas and melanomas), 8 pre-neoplastic (actinic keratoses) and 9 non-neoplastic (nevi, keloid and neurofibroma). Conclusions: The present article is relevant due to the fact it identifies cases and patients awaiting dermatological surgical procedures in the public health system. Based on it, a better planning of public health strategies in the dermatological field should be possible. Also, it highlights the importance of the dermatologist physician's action in the public health, diagnosing and treating pre-neoplastic and neoplastic lesions.

RESUMO

ABSTRACT Among ischemic strokes, cardioembolic (CE) stroke has the worst outcome. We measured the incidence of atrial fibrillation (AF) and non-AF related CE strokes, previous anticoagulant use, and the 90-day functional outcome. Using multiple overlapping sources, we included all CE strokes that occurred in 2015 in Joinville, Brazil. Of the 374 ischemic strokes, 23% (84) were CE. The CE age-adjusted incidence, per 1,000 person-years, was 0.14 (0.11–0.17). Of the 26 patients with known prior AF, 73% (19) were not anticoagulated, 77% (20) had a CHA2DS2VASc score ≥ 3 and 81% (21) had a HAS-BLED score < 3. After three months, approximately one third of those 26 patients died or became disabled. The incidence of CE stroke in our sample was lower than in other population-based studies. The opportunity for anticoagulation was missed in one third of cases.

RESUMO Entre todos os subtipos de AVC isquêmico, os eventos cardioembólicos (CE) apresentam os piores prognósticos. Determinamos a incidência de AVC isquêmico CE, associada ou não à fibrilação atrial (FA), o uso prévio de anticoagulantes e os desfechos funcionais em Joinville, Brasil. Utilizando múltiplas e sobrepostas fontes de informação, registramos todos os primeiros eventos CE ocorridos em 2015. Entre 374 eventos isquêmicos, 23% (84) foram CE. A incidência ajustada, para qualquer fonte cardioembólica, foi 0.14 (0.11–0.17) por 1000 pessoas-ano. Entre 26 pacientes com FA previamente conhecida, 73% (19) não estavam anticoagulados, 77% (20) tinham ≥ 3 pontos na escala CHA2DS2VASc e 81 % (21) < 3 pontos na escala HAS-BLED. Após 3 meses, um terço destes 26 pacientes morreram ou ficaram dependentes. A incidência de AVC I CE em Joinville é menor do que em outros estudos de base populacional. Um terço dos casos de AVC I CE com FA previamente conhecida perderam a oportunidade de anticoagulação.

Assuntos

RESUMO

A transição da estrutura etária no Brasil ocorre de forma rápida e em ambiente socioeconômico desfavorável. O Nordeste brasileiro, historicamente, destacado pela presença de profundas desigualdades sociais apresenta-se como a terceira região mais envelhecida do país e tal fato ganha importância, considerando sua extensa dimensão territorial, bem como o contexto sócio-ambiental desfavorável. O objetivo deste estudo foi analisar a relação entre o contexto e o envelhecimento populacional na região Nordeste do Brasil. Trata-se de um estudo ecológico, cujo cenário corresponde à região Nordeste, composta por 9 estados e 1.794 municípios. Foram coletados dados demográficos e de indicadores socioeconômicos, nas bases eletrônicas do Instituto Brasileiro de Geografia e Estatística ­ IBGE, do Instituto de Pesquisa Econômica e Aplicada ­ IPEA, do Atlas de Desenvolvimento Humano do Programa das Nações Unidas para o Desenvolvimento ­ PNUD e do Departamento de Informática do SUS ­ DATASUS. O desfecho do estudo consistiu nos níveis de envelhecimento populacional, definidos a partir de análise de conglomerados que agrupou os municípios, considerando cinco indicadores demográficos de envelhecimento (percentual de idosos, índice de envelhecimento, sobreenvelhecimento, dependência senil e índice de substituição da população em idade ativa). Foi utilizada a análise de componentes principais para obtenção de fatores socioeconômicos e demográficos, que representaram as variáveis independentes do estudo. Outras variáveis de importância teórica para o desfecho também foram selecionadas. Realizou-se o georreferenciamento dos dados da variável dependente, utilizando TabWin 3.6b, para identificação visual do perfil de envelhecimento da região, segundo os níveis de envelhecimento. Nas análises de associação utilizou-se o teste ANOVA, para os fatores e demais variáveis quantitativas, e o teste do Qui-quadrado, para as variáveis categóricas. Em ambos os testes considerou-se um nível de significância de 5%. Utilizou-se a análise de regressão logística ordinal para verificar as associações finais com o desfecho. Observou-se que o envelhecimento populacional no Nordeste apresenta um padrão de distribuição espacial heterogêneo, com concentração de maiores níveis na região do semiárido, atingindo o sertão e centro-sul do Ceará, partes das regiões oeste, central e agreste do Rio Grande do Norte, e quase a totalidade do estado da Paraíba, à exceção da região litorânea. Os altos níveis de envelhecimento associaram-se a bons níveis de educação, dependência de renda governamental, ao saldo migratório da população geral, à razão urbano-rural e a alguns estados da região, tomando como referência para comparação, o estado da Paraíba. Considera-se importante o estudo situacional do envelhecimento no Nordeste brasileiro que, embora desigual, destaca-se pela presença de grandes contingentes de idosos. O entendimento de tal distribuição, por sua vez, pode levar à identificação de fatores determinantes locais e/ou gerais do envelhecimento das populações, a serem abordados nas políticas públicas pró-envelhecimento (AU).

The changing age distribution in Brazil occurs quickly and in an unfavorable environment socio-economically. The Brazilian Northeast, historically, highlighted by the presence of deep social inequality appears as the third most aged region of the country and this fact becomes important, considering its extensive territorial dimension as well as an unfavorable socio-environmental context. The aim of this study was to analyze the relationship between the context and the aging population in the Northeast of Brazil. This is an ecological study, whose scenario corresponds to the Northeast region, consisting of nine states and 1,794 municipalities. We collected demographic data and several socioeconomic indicators in the electronic databases of the Brazilian Institute of Geography and Statistics (IBGE), Applied Economic Research Institute (IPEA), the Human Development Atlas of the United Nations Development Programme (PNUD) and the SUS Department of Informatics (DATASUS). The outcome of the study was the levels of population aging, defined from cluster analysis that grouped municipalities, considering five demographic aging indicators (percentage of elderly, aging index, "over-aging", senile dependence and population replacement in active age index). The principal component analysis was used to obtain socioeconomic-demographics factors, which represented the independent variables of the study. Other variables with theoretical importance for the outcome were also selected. It was held georeferencing of the outcome variable data using TabWin 3.6b, for visual identification of Northeast aging profile, according to the levels of aging. In association analyzes used the ANOVA test for the factors and others quantitative variables and the chi-square test for categorical variables. In both tests it was considered a 5% significance level. We used the ordinal logistic regression analysis to verify the actual associations with the outcome. It was observed that aging in the Northeast shows a pattern of heterogeneous distribution, with concentration higher levels in the region belonging to the semi-arid region, covering the interior and south-central of the Ceará state, parts of the western, central and harsh regions of Rio Grande do Norte state, and almost all of the area of Paraiba state, except the coastal region. The high levels of aging were associated with good levels of education, dependence on government income, the net migration of the general population, the reason urban/rural and some states of the region, taking as reference for comparison, the state of Paraiba. It is important the aging situational study in Northeast Brazil, a region that, although unequally, has a large contingent of elderly. The understanding of such distribution, in turn, can lead to the identification of local and/or general determinants of the population aging, to be addressed in the pro-aging policies (AU).

Assuntos

RESUMO

Prostate cancer mortality projections at the nationwide and regional levels to the year 2025 are carried out in this ecological study that is based on an analysis of Brazilian trends between 1996 and 2010. The predictions were made for the period 2011-2025 utilizing the Nordpred program based on the period of 1996-2010, using the age-period-cohort model. A significant increase was observed in the Brazilian rates between 1996 and 2006, followed by a non-significant decrease. The projections indicate a decrease in rates at a national level as well as for the Central, South and Southeast regions. Increases are expected for the North and Northeast regions. In conclusion, a reduction in the mortality rates for prostate cancer in Brazil is expected to the year 2025, as well as for the Central, South and Southeast regions. However, an increase in the absolute number of deaths in all regions is expected due to the anticipated aging of the population.

Este estudo ecológico realiza projeções de mortalidade por câncer de próstata no Brasil e suas regiões até o ano 2025, com base nas tendências observadas no período de 1996 a 2010. As projeções foram realizadas para o período 2011-2025 mediante o programa Nordpred, baseado no período 1996-2010, usando o modelo idade-período-coorte. Observou-se um aumento significativo das taxas no Brasil entre 1996 e 2006, seguido de um descenso não significativo. As projeções indicam uma diminuição das taxas em nível nacional e nas regiões Centro-oeste, Sul e Sudeste, enquanto nas regiões Norte e Nordeste se espera um incremento das taxas. É esperada uma redução das taxas de mortalidade por câncer de próstata até o ano 2025 no Brasil em conjunto, assim como nas regiões Centro-oeste, e Sul e Sudeste, e um incremento nas regiões Norte e Nordeste. Contudo, prevê-se um aumento do número absoluto de mortes pela doença em todas as regiões devido ao envelhecimento populacional previsto no país.

Este estudio ecológico presenta proyecciones de mortalidad por cáncer de próstata en Brasil y sus regiones para el año 2025, en base a las tendencias observadas en el período 1996-2010. Las proyecciones se realizaron para el período 2011-2025, mediante el programa NORDPRED, con base en el período 1996-2010, utilizando el modelo edad-período-cohorte. Hubo un aumento significativo en las tasas en Brasil entre 1996 y 2006, seguido de una disminución no significativa. Las proyecciones indican una disminución de las tasas, tanto a nivel nacional, como en las regiones Centro-oeste, Sur y Sudeste, mientras que en las regiones Norte y Nordeste se espera un incremento de las tasas. Se prevé una disminución de la mortalidad por cáncer de próstata para el año 2025 en Brasil en su conjunto, así como en las regiones Centro-oeste, Sur y Sudeste, y un aumento en las regiones Norte y Nordeste. Sin embargo, se espera un aumento del número absoluto de muertes de la enfermedad en todas las regiones, debido al envejecimiento de la población previsto en el país.