Showing papers in "Cadernos De Saude Publica in 2016"

Does the knowledge of emergency contraception affect its use among high school adolescents

Abstract: This study aimed to test how knowledge on emergency contraception (according to age at sexual initiation, type of school, and knowing someone that has already used emergency contraception) influences the method’s use. This was a cross-sectional study in a probabilistic sample of students 15-19 years of age enrolled in public and private middle schools in a medium-sized city in Southeast Brazil (n = 307). Data were collected in 2011 using a self-administered questionnaire. A structural equations model was used for the data analysis. Considering age at sexual initiation and type of school, knowledge of emergency contraception was not associated with its use, but knowing someone that had used the method showed a significant mean effect on use of emergency contraception. Peer group conversations on emergency contraception appear to have greater influence on use of the method than knowledge itself, economic status, or sexual experience.

Integralidade e tecnologias de atenção à saúde: uma narrativa sobre contribuições conceituais à construção do princípio da integralidade no SUS

Abstract: Resumo: Dentre os principios do SUS, o de integralidade talvez seja o mais desafiador na construcao da Reforma Sanitaria. E objetivo deste estudo identificar momentos criticos do debate conceitual em torno da integralidade e suas contribuicoes para a reflexao acerca de tecnologias de atencao a saude no âmbito do SUS. O ensaio percorre algumas construcoes conceituais que se aproximam da questao da integralidade como principio norteador de programas e acoes de saude em diversos planos e dimensoes da organizacao da atencao a saude - das interacoes intersubjetivas a organizacao de redes regionais. O estudo se baseou em revisao nao sistematica da literatura sobre o tema da integralidade e afins na producao do campo da Saude Coletiva brasileira nas ultimas cinco decadas. Propoe-se uma cronologia/tipologia que se estende dos anos 1960 a decada de 2010, dividindo-a em quatro periodos/categorias julgados significativos. A narrativa nao pretende ser exaustiva, mas construir uma referencia compreensiva capaz de contribuir para analises, avaliacoes e debates acerca da organizacao da atencao a saude no SUS conforme o principio da integralidade.

Telemedicine: challenges to dissemination in Brazil

Abstract: Telemedicine has been seen as an important tool for facing the challenges of universal health systems. The goal of this article is to discuss the main challenges to its full dissemination in Brazil. Being a somewhat new area, there are not many scientific papers that systematize it. This article is an exploratory paper, as it aims to provide an overall perspective on the subject. From an economic point of view, telemedicine is a strategic area due to its an intrinsic potential of being a source for generating innovation, for requiring and incorporating technological breakthroughs from other areas, and for its interdisciplinary nature and dynamic inter-relations that drive different industries. From the social perspective, it has the potential to make access to health services democratic, by connecting remote regions with health services located in hospitals and centers of reference for prevention, diagnosis and treatment.

Impacts of the new fiscal regime on health and education.

Abstract: Correspondence P. Rossi Rua Lauro Pimentel 914, Campinas, SP 13083-250, Brasil. pedrolrossi@gmail.com The New Fiscal Regime proposal put forward by the Temer administration proposes a rule for primary Federal Government expenditures for the next 20 years, alterable – restricted to the correction factor – in 10 years. This proposal was approved as Constitutional Amendment Proposition 241/2016 (PEC 241) in the House of Representatives and is now under appreciation in the Brazilian Senate as PEC 55. Under its rules, federal expenditures, minus interest payments on the public debt, will be limited to the previous year’s expenditures adjusted by the accumulated inflation, measured by the Extended National Consumer Price Index (IPCA). In short, the New Fiscal Regime will lead to an actual federal government budget freeze, which presupposes a reduction in public expenditures relative to Gross Domestic Product (GDP) and to the number of inhabitants. That is, according to the proposed rule, public expenditures will not follow the growth in income and population. In this short article, we will address two aspects of this proposal. The first is its macroeconomic impact, taking into account the fact that the new fiscal regime presupposes a scenario of fiscal austerity over the next 20 years. The second is its impact on federal education and health spending. We will show that (i) the proposal will not lead to economic growth and (ii) will substantially reduce health and education spending. Twenty years of austerity

Adverse events in the intensive care unit: impact on mortality and length of stay in a prospective study

Abstract: This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patients-day and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence.

Reliability and validity of the Brazilian version of the Hospital Survey on Patient Safety Culture(HSOPSC): a pilot study

Abstract: The evaluation of the culture of patient safety in hospitals is nowadays considered as a management too, since it helps to identify problem areas and provide valuable information for planning improvements. This study explored the reliability and validity of the Brazilian version of the Hospital Survey on Patient Safety Culture, an instrument that evaluates characteristics of patient safety culture among hospital staff. The reliability of the instrument was evaluated by analyzing the internal consistency of each dimension. The validity of the tool was carried out by means of exploratory and confirmatory factor analysis. The sample was made up of 322 questionnaires that were collected in two Brazilian hospitals in 2012. Cronbach's alpha ranged from 0.52 to 0.91 for the different dimensions, with the exception of two, for which it was much lower. After excluding four items, the exploratory factor analysis presented adjusted indices that were appropriate for a 10 factor model.

Dificuldades na execução das diretrizes do Programa de Vigilância e Controle da Leishmaniose Visceral em grandes municípios brasileiros

Abstract: Resumo: A expansao das areas de transmissao de leishmaniose visceral (LV) traz questionamentos sobre as estrategias de controle empregadas no Brasil. As diretrizes do Programa de Vigilância e Controle da Leishmaniose Visceral (PVCLV) estao centradas na diminuicao da morbidade e letalidade, controle do reservatorio e dos vetores e na educacao em saude. Este artigo buscou avaliar as dificuldades na execucao das acoes preconizadas pelo PVCLC, segundo os seus coordenadores em municipios brasileiros de grande porte com transmissao canina e/ou humana (Campinas, Bauru, Goiânia, Campo Grande, Fortaleza e Belo Horizonte). Foram realizadas entrevistas semiestruturadas, sendo os principais problemas identificados: descontinuidade das atividades de controle, resistencia dos proprietarios de caes com indicacao de eutanasia e baixa cobertura do controle quimico. Como conclusao, as entrevistas mostraram que inumeros fatores impedem o cumprimento das atividades propostas pelo PVCLC, ficando clara a necessidade de reavaliacao da politica brasileira de controle de LV.

Determinantes de la equidad en el financiamiento de los medicamentos en Argentina: un estudio empírico

Abstract: Resumen Los medicamentos constituyen un alto porcentaje del gasto en salud de los hogares, por eso, tener un sistema progresivo de financiamiento de medicamentos es fundamental para lograr un sistema de salud equitativo. Se ha propuesto que los determinantes de la equidad en el financiamiento son socioeconomicos, demograficos y asociados a la intervencion publica, sin embargo, se ha avanzado poco en su evaluacion empirica y en la cuantificacion de su importancia relativa. En este trabajo estimamos regresiones por cuantiles a nivel provincial en Argentina y encontramos que la poblacion mayor a 65 anos, el desempleo, la existencia de laboratorios publicos de produccion de medicamentos, las transferencias de tratamientos y la orientacion del sistema de salud a la atencion primaria, son importantes predictores de la progresividad en el esquema de pagos. Ingresos bajos, instituciones debiles, infraestructura y provision de servicios insuficientes redundan en respuestas sociales mas regresivas a las necesidades sanitarias, empeorando las condiciones de vida y limitando las oportunidades de desarrollo.

Estado nutricional de idosos no Brasil: uma abordagem multinível

Abstract: Resumo: O objetivo deste estudo foi diagnosticar o estado nutricional da populacao idosa brasileira, identificando fatores associados. Utilizou-se dados da Pesquisa de Orcamentos Familiares (POF 2008/2009) de 20.114 idosos, cujo perfil nutricional foi avaliado segundo o indice de massa corporal (IMC). As analises de fatores associados foram testadas com base no teste de qui-quadrado de Pearson e modelos lineares multiniveis. Na analise hierarquica constatou-se efeito significativo da Unidade da Federacao na variância do IMC (valor de p = 0,001). Em nivel individual detectou-se associacao negativa (valor de p < 0,001) com: cor/raca amarela, sexo masculino, idosos que residiam sozinhos e idade; e positiva com a renda per capita. Observou-se ainda, maiores prevalencias de baixo peso em idosos residentes no estrato rural (26,3%) e nas regioes Nordeste (23,7%) e Centro-oeste (20,9%), e de obesidade em idosos que residem nas regioes Sul (45,1%) e Sudeste (38,3%) e no estrato urbano (39%). Sugere-se aprofundar o estudo das caracteristicas do estado nutricional de idosos utilizando-se variaveis contextuais.

Preço dos alimentos no Brasil: prefira preparações culinárias a alimentos ultraprocessados

Abstract: Resumo: Estudo com objetivo de descrever o preco dos grupos de alimentos consumidos no Brasil considerando a natureza, a extensao e o proposito de seu processamento. Dados provenientes da Pesquisa de Orcamentos Familiares de 2008-2009 foram utilizados. O preco medio dos grupos (in natura, ingredientes culinarios, processados e ultraprocessados) e seus respectivos subgrupos de alimentos foram estimados para o Brasil segundo renda, regiao e area. Os produtos in natura e ingredientes culinarios apresentaram menor preco por caloria quando comparado aos demais grupos, sugerindo uma vantagem economica no preparo de refeicoes no lar em comparacao a sua substituicao por ultraprocessados. As familias de maior nivel economico pagaram preco mais elevado por suas aquisicoes, enquanto as regioes Nordeste, Norte e a area rural pagaram os menores precos. Enquanto alimentos frescos (como carnes, leite, frutas e hortalicas) tendem a custar mais caro que alimentos ultraprocessados, graos secos (como o arroz e o feijao) despontam como uma alternativa mais economica para adocao de praticas alimentares saudaveis.

[Food prices in Brazil: prefer cooking to ultra-processed foods].

Abstract: This study aims to describe the prices of food groups consumed in Brazil considering the nature, extent, and purpose of their processing. Data were obtained from the Brazilian Household Budget Survey for 2008-2009. The mean prices of the groups (natural, cooking ingredients, processed, and ultra-processed) and their respective food subgroups were estimated for Brazil according to income, region, and area. Natural products and cooking ingredients showed lower prices per calorie when compared to the other groups, suggesting an economic advantage to preparing meals at home when compared to replacing them with ultra-processed foods. Families with the highest income paid the highest prices for their food, while families in the Northeast and North regions and rural areas paid the lowest. While fresh foods (meat, milk, fruit, and vegetables) tend to cost more than ultra-processed foods, dry grains (like rice and beans) are a more economical alternative for adopting healthy eating practices.

Incidência de sífilis congênita e fatores associados à transmissão vertical da sífilis: dados do estudo Nascer no Brasil

Abstract: The objectives were to estimate incidence of congenital syphilis and verify factors associated with vertical transmission. A national hospital-based study was performed in 2011-2012 with 23,894 postpartum women using an in-hospital interview and data from patient charts and prenatal cards. Univariate logistic regression was performed to verify factors associated with congenital syphilis. Estimated incidence of congenital syphilis was 3.51 per 1,000 live births (95%CI: 2.29-5.37) and vertical transmission rate was 34.3% (95%CI: 24.7-45.4). Congenital syphilis was associated with lower maternal schooling, black skin color, higher rate of risk factors for prematurity, late initiation of prenatal care, fewer prenatal visits, and lower rate of prenatal serological testing. Fetal mortality was six times higher in congenital syphilis, and newborns with congenital syphilis showed higher hospital admission rates. Congenital syphilis is a persistent public health problem in Brazil and is associated with greater social vulnerability and gaps in prenatal care.

Age structure of owned dogs under compulsory culling in a visceral leishmaniasis endemic area

Abstract: The age structure of the dog population is essential for planning and evaluating control programs for zoonotic diseases. We analyzed data of an owned-dog census in order to characterize, for the first time, the structure of a dog population under compulsory culling in a visceral leishmaniasis endemic area (Panorama, Sao Paulo State, Brazil) that recorded a dog-culling rate of 28% in the year of the study. Data on 1,329 households and 1,671 owned dogs revealed an owned dog:human ratio of 1:7. The mean age of dogs was estimated at 1.73 years; the age pyramid indicated high birth and mortality rates at the first year of age with an estimated cumulative mortality of 78% at the third year of age and expected life span of 2.75 years. In spite of the high mortality, a growth projection simulation suggested that the population has potential to grow in a logarithmic scale over the years. The estimated parameters can be further applied in models to maximize the impact and minimize financial inputs of visceral leishmaniasis control measures.

Eventos adversos na unidade de terapia intensiva: impacto na mortalidade e no tempo de internação em um estudo prospectivo

Abstract: This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patientsday and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence.

Eating patterns in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): an exploratory analysis

Abstract: The food consumption of 15,071 public employees was analyzed in six Brazilian cities participating in the baseline for Brazilian Longitudinal Study of Adult Health (ELSA-Brasil, 2008-2010) with the aim of identifying eating patterns and their relationship to socio-demographic variables. Multiple correspondence and cluster analysis were applied. Four patterns were identified, with their respective frequencies: "traditional" (48%); "fruits and vegetables" (25%); "pastry shop" (24%); and "diet/light" (5%) The "traditional" and "pastry shop" patterns were more frequent among men, younger individuals, and those with less schooling. "Fruits and vegetables" and "diet/light" were more frequent in women, older individuals, and those with more schooling. Our findings show the inclusion of new items in the "traditional" pattern and the appearance of the "low sugar/low fat" pattern among the eating habits of Brazilian workers, and signal socio-demographic and regional differences.

[Incidence of congenital syphilis and factors associated with vertical transmission: data from the Birth in Brazil study].

Abstract: The objectives were to estimate incidence of congenital syphilis and verify factors associated with vertical transmission. A national hospital-based study was performed in 2011-2012 with 23,894 postpartum women using an in-hospital interview and data from patient charts and prenatal cards. Univariate logistic regression was performed to verify factors associated with congenital syphilis. Estimated incidence of congenital syphilis was 3.51 per 1,000 live births (95%CI: 2.29-5.37) and vertical transmission rate was 34.3% (95%CI: 24.7-45.4). Congenital syphilis was associated with lower maternal schooling, black skin color, higher rate of risk factors for prematurity, late initiation of prenatal care, fewer prenatal visits, and lower rate of prenatal serological testing. Fetal mortality was six times higher in congenital syphilis, and newborns with congenital syphilis showed higher hospital admission rates. Congenital syphilis is a persistent public health problem in Brazil and is associated with greater social vulnerability and gaps in prenatal care.

Association between order of birth and chronic malnutrition of children: a study of nationally representative Bangladeshi sample

Abstract: This paper examines the net effect of birth order on child nutritional status in Bangladesh using data from the Bangladesh Demographic Health Survey, 2011 (BDHS). Analyses were restricted to 4,120 surviving, lastborn singleton children who were younger than 36 months at the time of the survey. Logistic regression was used to assess the association between birth order and child nutritional status. Results indicate 38.1% children are stunted and 8.2% children are fifth or higher order birth. Order of birth is one of the significant predictors of child being stunted. Third order, fourth order, and fifth or higher order children are 24%, 30%, and 72%, respectively, more likely to be stunted after adjusting for all other variables. Besides birth order, results also indicate that child age, size at birth, birth intention, maternal education, maternal body mass index, wealth index, place of residence and mass media access exert strong influences over child malnutrition. Reducing birth rates which limit number of births and birth order as well may reduce child malnutrition in Bangladesh.

Home or community-based pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Abstract: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, and outpatient pulmonary rehabilitation (OPR) has shown positive results. The aim of this study was to investigate the effects of home or community-based pulmonary rehabilitation (HCPR) in individuals with COPD. This systematic review and meta-analysis of randomized clinical trials compared HCPR to controls and HCPR to OPR according to functional capacity, dyspnea, and quality of life in individuals with COPD. 3,172 citations were identified in databases, and 23 were included in this review. HCPR proved superior to controls based on functional capacity in the 6-Minute Walk Test and Incremental Shuttle Walk Test, and based on dyspnea and quality of life in the Saint George's Respiratory Questionnaire and the Chronic Respiratory Questionnaire. When HCPR and OPR were compared, there were no effect differences in functional capacity or quality of life. Improvement was greater in patients with more bronchial obstruction measured by FEV1. HCPR improves functional capacity and quality of life and decreases the sensation of dyspnea. Its benefits in functional capacity and quality of life are comparable to those obtained with OPR in individuals with COPD.

[Use of causal diagrams in Epidemiology: application to a situation with confounding].

Abstract: Epidemiological research still rarely uses causal diagrams, despite growing recognition of their explanatory potential. One possible reason is that many research programs involve themes in which there is a certain degree of uncertainty as to mechanisms in the processes that generate the data. In this study, the relationship between occupational stress and obesity is used as an example of the application of causal diagrams to questions related to confounding. The article presents the selection stages for variables in statistical adjustment and the derivation of a causal diagram's statistical implications. The main advantage of causal diagrams is that they explicitly reveal the respective model's underlying hypotheses, allowing critical analysis of the implications and thereby facilitating identification of sources of bias and uncertainty in the epidemiological study's results.

[Evaluation of the cascade of care in prevention of mother-to-child HIV transmission in Brazil].

Abstract: This study aimed to assess the cascade of care in the reduction of mother-to-child HIV transmission in the states of Amazonas, Ceara, Espirito Santo, Rio de Janeiro, and Rio Grande do Sul and the Distrito Federal, Brazil, using data from the Brazilian Information System on Diseases of Notification (SINAN). From 2007 to 2012, there was an increase (from 7.3% in Distrito Federal to 46.1% in Amazonas) in intra-gestational detection of HIV in 5 states, with a 18.6% reduction in Rio de Janeiro. Fewer than 90% of the women received antiretroviral therapy during their prenatal care, including those that already knew they were HIV-positive. The elective cesarean rate was low. The AIDS detection rate in children under 5 years as a proxy for mother-to-child HIV transmission showed a reduction of 6.3% from 2007 to 2012, and was highest in Rio Grande do Sul (50%), the state with the highest rates in the period, while Espirito Santo showed the highest increase (50%). Evaluation of the cascade of HIV care in pregnant women identified flaws in all the points. A link is needed between primary care and referral centers for HIV/AIDS, organizing care for the family and better outcomes for the children.

Unrestrained outsourcing in Brazil: more precarization and health risks for workers

Abstract: This article discusses the current status of outsourcing in Brazil, with new regulation underway featuring a bill of law under review by the National Congress, aimed at allowing outsourcing for all activities. The authors argue that outsourcing and precarization of work are inseparable phenomena, based on the results of 20 years of research in Brazil that reveals the more precarious working conditions of outsourced workers in different occupational categories. They focus particularly on workers' health: outsourcing of risks has led to more fatal work accidents, invariably at higher rates in outsourced workers. Finally, the article contends that to remove restraints on outsourcing in Brazil amounts to legalizing and legitimizing predatory workforce exploitation, disregarding workers' physical limits, exposing them to risk of fatal accidents, and reverting to forms of work that violate the human condition.

Adverse childhood experiences and consumption of alcohol, tobacco and illicit drugs among adolescents of a Brazilian birth cohort

Abstract: The objective of this study was to investigate the association between adverse childhood experiences (ACEs) and the use of alcohol, tobacco and illicit drugs among adolescents from a Brazilian cohort. The occurrence of five ACEs, the use of alcohol and tobacco and trying illicit drugs were investigated in the 1993 Pelotas birth cohort at the age of 15 (n = 4,230). A score was created for the ACEs and their association with the use of substances was evaluated. Around 25% of adolescents consumed alcohol, 6% smoked and 2.1% reported having used drugs at least once in their lives. The ACEs were associated with the use of alcohol, tobacco and illicit drugs. A dose-response relation between the number of ACEs and the substance use was found, particularly with regard to illicit drugs. The occurrence of ACEs was positively associated with the use of alcohol, tobacco and illicit drugs among adolescents and the risk may be different for men and women. These results point to the fact that strategies for preventing the use of substances should include interventions both among adolescents and within the family environment.

Violência doméstica e familiar contra a mulher: estudo de casos e controles com vítimas atendidas em serviços de urgência e emergência

Abstract: O objetivo deste estudo foi identificar fatores associados ao atendimento por violencia domestica e familiar entre vitimas atendidas em servicos de urgencia e emergencia no Brasil. Realizou-se estudo de casos e controles baseado no Sistema de Vigilância de Violencias e Acidentes (VIVA), 2011. Foram selecionadas mulheres com 18 anos ou mais de idade, vitimas de violencia domestica e familiar (casos) em comparacao com aquelas vitimas de acidentes (controles). As razoes de chances ajustadas foram estimadas por regressao logistica nao condicional. Foram incluidos 623 casos e 10.120 controles. Na analise ajustada, foram fatores de risco: idade mais jovem (18-29 anos), baixa escolaridade, nao exercer atividade remunerada, consumo de bebida alcoolica, procura de atendimento em outro servico, ocorrencia em final de semana e durante a noite ou madrugada. A violencia domestica e familiar teve o consumo de bebida alcoolica como fator fortemente associado. Os dias e horas de maior ocorrencia evidenciam a necessidade de adequacao dos servicos de atendimento as vitimas.

Global precarious employment and health inequalities: working conditions, social class, or precariat?

Abstract: Changes in employment conditions since the 1980s have been referred to as precarious employment, and terms like flexible, atypical, temporary, part-time, contract, self-employed, irregular, or non-standard employment have also been used. In this essay I review some of the current critiques to the precarious employment construct and advance some potential solutions for its use in epidemiology and public health.

Health technology assessment (HTA) organizations: dimensions of the institutional and political framework

Abstract: Health technology assessment (HTA) is consolidated as a scientific and technological practice. The aim of this study is to identify HTA organizations from different settings and analyze their relevant dimensions in terms of effectiveness/impact, in order to address the challenges they face in Brazil. Narrative literature review based on data and websites of HTA organizations. There are well-established activity development processes in all organizations. These activities have specific features in their profile, in the process of technology assessment, decision and implementation of technologies that influence their potential impact on health systems. Agencies share in common the challenges of ranking the technologies to be assessed, and the implementation of their recommendations. Technical and political strengthening of the institutionalization of HTA in Brazil may foster scientific, technological and innovation policies, effectively impacting health policies.