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Dynamics of HIV self-testing uptake among sexual and gender minorities: pre and during COVID-19. 性少数群体和性别少数群体接受艾滋病毒自我检测的动态:COVID-19 之前和期间。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI: 10.11606/s1518-8787.2024058006011
Laio Magno, Dulce Ferraz, Eliana Miura Zucchi, Jony Arrais Junior Pinto, Fabiane Soares, Alexandre Grangeiro, Dirceu Greco, Ines Dourado

Objective: To identify the factors associated with HIV self-testing (HIVST) uptake among adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW) before and during the COVID-19 pandemic.

Methods: A cross-sectional HIVST uptake study was conducted among AMSM and ATGW. Peer educators and health professionals began providing HIVST in February 2019. The outcome was the HIVST uptake before and during the COVID-19 pandemic. The association between each predictor and outcome in each period was analyzed using simple and multiple logistic regressions, estimating odds ratios, and their respective 95% confidence intervals.

Results: The uptake was 229/510 (44.9%) and 382/1,075 (35.5%) before and during the pandemic. During the pre-pandemic period, HIVST uptake was higher in participants who reported receptive anal sex. During the pandemic, uptake was lower in participants with a steady sexual partner and higher in those with frequent oral sex with a steady partner in the previous three months. Before and during the pandemic, HIVST uptake was lower in ATGW and higher in those aged 18-19 years and in participants who lived alone.

Conclusions: Uptake decreased during the pandemic. Sexual behavioral factors associated with HIVST uptake changed during the COVID-19 pandemic, showing the fluid dynamics of sexuality in AMSM and ATGW during this period. HIV programs can optimize the implementation of HIVST among adolescents and young people by incorporating effective and differentiated service delivery models to increase HIV testing uptake and to reach undiagnosed individuals effectively.

目的在 COVID-19 大流行之前和期间,确定与青少年男男性行为者(ASM)和青少年变性女性(ATGW)接受 HIV 自我检测(HIVST)相关的因素:在男男性行为者(ASM)和变性青少年女性(ATGW)中开展了一项横断面 HIVST 感染率研究。同伴教育者和卫生专业人员于 2019 年 2 月开始提供 HIVST。研究结果是在 COVID-19 大流行之前和期间的 HIVST 感染率。使用简单和多重逻辑回归分析了每个预测因子与每个时期结果之间的关联,估算了几率比及其各自的 95% 置信区间:大流行前和大流行期间的接受率分别为 229/510(44.9%)和 382/1,075(35.5%)。在大流行前,报告接受过肛交的参与者接受艾滋病毒检测的比例较高。在大流行期间,有固定性伴侣的参与者接受艾滋病毒检测的比例较低,而在过去三个月中与固定性伴侣频繁发生口交的参与者接受艾滋病毒检测的比例较高。在大流行之前和期间,ATGW 的 HIVST 感染率较低,而 18-19 岁人群和独居参与者的感染率较高:结论:大流行期间的接受率有所下降。在 COVID-19 大流行期间,与接受 HIVST 相关的性行为因素发生了变化,这表明在此期间,ASM 和 ATGW 的性行为发生了变化。艾滋病项目可以通过采用有效和差异化的服务提供模式,在青少年和年轻人中优化 HIVST 的实施,从而提高 HIV 检测的接受率,并有效覆盖未确诊的人群。
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引用次数: 0
Prep provision in community organizations: a comparative study with conventional services. 社区组织提供的准备工作:与传统服务的比较研究。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI: 10.11606/s1518-8787.2024058005914
Alexandre Grangeiro, Paula Andrea Massa, Maria Mercedes Escuder, Eliana Miura Zucchi, Eliane Aparecida Sala, Eduardo Araujo de Oliveira, Raphaela Fini, Inês Dourado, Laio Magno, Beo Oliveira Leite, Katia Bruxvoort, Sarah MacCarthy, Marcia Thereza Couto, Maria Fernanda Tourinho Peres

Objective: To evaluate whether adolescents from sexual minorities who initiated pre-exposure prophylaxis (PrEP) in community-based organizations (COs) are more socially and HIV-vulnerable compared with their counterparts from a conventional health service. In addition, to evaluate whether these adolescents had more timely access to prophylaxis.

Methods: A PrEP demonstration study was conducted in the city of São Paulo in two COs, located in the center (CO-center) and the outskirts (CO-outskirts), and a conventional HIV testing service (CTA-center). Between 2020 and 2022, cisgender male adolescents who have sex with men (aMSM), transgender and gender diverse adolescents (aTTrans) aged 15 to 19 years, HIV-negative, with higher-risk practices for HIV were eligible for PrEP. Indicators of timely access and vulnerabilities of adolescents initiating PrEP in COs were analyzed using CTA-center as a reference and multinomial logistic regression.

Results: 608 adolescents initiated PrEP in COs and CTA-center. Adolescents from COs were associated with a shorter time to PrEP initiation (1-7 days; CO-outskirts: ORa = 2.91; 95%CI 1.22-6.92; CO-center: ORa = 1.91; 95%CI 1.10-3.31); and a lower housing Human Development Index (HDI) (CO-center: ORa = 0.97; 95%CI 0.94-1.00; CO-outskirts: ORa = 0.82; 95%CI 0.78-0.86). In CO-outskirts, there was an increased chance of adolescents being younger (ORa = 3.06; 95%CI 1.63-5.75) and living closer to the service (ORa = 0.82; 95%CI 0.78-0.86, mean 7.8 km). While adolescents from the CO-center were associated with greater prior knowledge of PrEP (ORa = 2.01; 95%CI 1.10-3.91) and high-risk perception (ORa = 2.02; 95%CI 1.18-3.44), adolescents from the COs were not associated with higher-risk sexual practices and situations of vulnerability to HIV.

Conclusion: The provision of PrEP in the COs facilitated access for vulnerable adolescents and may contribute to reducing inequities.

目的评估在社区组织(COs)中开始接触前预防(PrEP)的性少数群体青少年与在传统医疗服务机构中开始接触前预防的青少年相比,是否更容易受到社会和艾滋病病毒的侵害。此外,还要评估这些青少年是否能更及时地获得预防措施:方法:在圣保罗市中心(CO-center)和郊区(CO-outskirts)的两家 CO 和一家常规 HIV 检测服务机构(CTA-center)开展了一项 PrEP 示范研究。2020 至 2022 年间,年龄在 15 至 19 岁之间、艾滋病毒阴性、有较高艾滋病毒感染风险的男性同性性行为青少年(aMSM)、变性和性别多元化青少年(aTTrans)有资格接受 PrEP。以CTA-center为参考,采用多项式逻辑回归分析了在社区卫生服务中心及时获得PrEP的指标和青少年的易感性:结果:608 名青少年在国家卫生机构和 CTA 中心启动了 PrEP。来自郊区县的青少年启动 PrEP 的时间较短(1-7 天;郊区县:1-7 天;郊区县:1-7 天;郊区县:1-7 天;郊区县:1-7 天):ORa=2.91;95%CI 1.22-6.92;CO-中心:ORa = 1.91;95%CI 1.10-3.31);住房人类发展指数(HDI)较低(中部非洲区域:ORa = 0.97;95%CI 1.10-3.31):ORa = 0.97; 95%CI 0.94-1.00; CO-outskirts:ORa = 0.82;95%CI 0.78-0.86)。在原籍地郊区,青少年年龄较小(ORa = 3.06;95%CI 1.63-5.75)且居住地距离服务机构较近(ORa = 0.82;95%CI 0.78-0.86,平均 7.8 公里)的几率增加。虽然来自社区服务中心的青少年对 PrEP 有更多的了解(ORa = 2.01;95%CI 1.10-3.91),并具有高风险认知(ORa = 2.02;95%CI 1.18-3.44),但来自社区服务中心的青少年与高风险性行为和易感染艾滋病毒的情况无关:结论:在社区中心提供 PrEP 有助于易感染艾滋病的青少年接受治疗,并有助于减少不平等现象。
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引用次数: 0
Gay and bisexual adolescents and other men who have sex with men: intersectionality and the PrEP care continuum. 男同性恋和双性恋青少年及其他男男性行为者:交叉性与 PrEP 护理的连续性。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI: 10.11606/s1518-8787.2024058005705
Eduardo Araújo de Oliveira, Lorruan Alves Dos Santos, Eliana Miura Zucchi, Paula Massa, Alexandre Grangeiro, Marcia Thereza Couto

Objective: To analyze the impact of intersecting systems of oppression on the continuum of PrEP care among adolescent gays, bisexuals, and other men who have sex with men (aGBMSM), and to examine how health professionals (HP) identify and address these challenges to provide sexual health care and HIV prevention.

Methods: This qualitative exploratory study was part of a cohort research project involving aGBMSM, travesties, and transgender women (aTrTW) using PrEP. Data analyzed consisted of 16 interviews with aGBMSM and eight with health professionals (HPs) in São Paulo study site. The methodological and theoretical framework for the interactive categorization of thematic analysis was based on an intersectional approach.

Results: The knowledge of aGBMSM about PrEP was influenced by the adverse effects of systems of oppression, particularly among Black adolescents, who acquired knowledge in a less technical manner compared to White adolescents. Most professionals recognized oppression and its impact on the PrEP care continuum (PrEPCC), especially noting the presence of racism. However, few articulated how different social markers compound barriers to the success of the PrEPCC.

Conclusion: Social oppression affects the success of the PrEP care continuum (PrEPCC) in multiple ways. Health professionals (HPs) play a crucial role in mitigating and not perpetuating these negative experiences within health services, as well as in PrEP access, use, and adherence.

目的分析相互交叉的压迫系统对青少年男同性恋、双性恋和其他男男性行为者(aGBMSM)中 PrEP 护理连续性的影响,并研究医疗专业人员(HP)如何识别和应对这些挑战,以提供性健康护理和 HIV 预防:这项定性探索性研究是一个队列研究项目的一部分,该项目涉及使用 PrEP 的男男性行为者、人妖和变性女性 (aTrTW)。所分析的数据包括对圣保罗研究地点的 16 名女同性恋、男同性恋、双性恋和变性者(aGBMSM)以及 8 名医疗专业人员(HPs)进行的访谈。专题分析互动分类的方法和理论框架以交叉方法为基础:黑人青少年对 PrEP 的了解受到了压迫制度不良影响的影响,尤其是在黑人青少年中,与白人青少年相比,他们获取知识的技术性较低。大多数专业人员认识到压迫及其对 PrEP 护理连续性(PrEPCC)的影响,尤其注意到种族主义的存在。然而,很少有人能清楚地说明不同的社会标记是如何加剧 PrEPCC 的成功障碍的:结论:社会压迫以多种方式影响着 PrEPCC 的成功实施。医疗卫生专业人员(HPs)在医疗卫生服务中以及在 PrEP 的获取、使用和坚持方面发挥着至关重要的作用,以减轻这些负面经历并避免其长期存在。
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引用次数: 0
HIV prevention among marginalized adolescents: PrEP1519 results and perspectives. 边缘化青少年的艾滋病毒预防:PrEP1519 的结果和观点。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-11 DOI: 10.11606/s1518-8787.2024058supl1ed
João Luiz Bastos, Tonantzin Ribeiro Gonçalves, Eliseu Alves Waldman
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引用次数: 0
New horizons in sexual health: exploring PrEP and HIV incidence in adolescents. 性健康的新视野:探索 PrEP 与青少年艾滋病发病率。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-11 DOI: 10.11606/s1518-8787.2024058supl1ap
Alexandre Grangeiro, Eliane Miura Zucchi, Laio Magno, Unai Tupinambás, Dirceu Bartolomeu Greco, Inês Dourado
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引用次数: 0
Trans/Travesti/+: PrEP in specialized services before and during the COVID-19 pandemic. Trans/Travesti/+:在 COVID-19 大流行之前和期间,在专门服务中开展 PrEP。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI: 10.11606/s1518-8787.2024058005719
Ramiro Andres Fernandez Unsain, Eliana Miura Zucchi, Lorruan Alves Dos Santos, Dulce Ferraz, Paula Massa, Júlia Clara de Pontes, Alexandre Grangeiro, Marcia Thereza Couto

Objective: To understand the perceptions and experiences of transsexual and travesti women and non-binary or gender-fluid people (TGWT+) in health services where they took pre-exposure prophylaxis (PrEP) in the periods before and during the pandemic, focusing on the resignification in the relationship with services and the continuity of HIV prevention via PrEP.

Methods: Qualitative research and analysis of empirical material generated in the context of broader studies were conducted. A total of 45 semi-structured interviews were conducted with TGWT+ PrEP users in the city of São Paulo and analyzed using iterative thematic content analysis.

Results: The TGWT+ interviewees gave new meanings to their struggles, daily lives and ways of caring for their health and played a central role within them. With its particularities, the COVID-19 pandemic became one more event among all the others that TGWT+ face daily. Alongside the COVID-19 pandemic, the TGWT+ were faced with the HIV epidemic, but with the possibility of prevention via PrEP.

Conclusion: Based on a situated and conscious perspective, more explicit in the context of the health crisis, the TGWT+ intertwined conscious actions and care practices in dialog with health services. Further research on these groups from a spatiotemporal dynamic situated in specific contexts of meaning production would make it possible to advance prevention and care strategies, especially in times of health crisis.

目的了解变性和易性妇女以及非二元或性别流变者(TGWT+)在大流行之前和期间接受接触前预防疗法(PrEP)的医疗服务中的看法和经历,重点关注与服务机构关系的转变以及通过 PrEP 预防艾滋病的连续性:方法:对更广泛的研究中产生的经验材料进行了定性研究和分析。共对圣保罗市的 TGWT+ PrEP 用户进行了 45 次半结构式访谈,并采用迭代式主题内容分析法对访谈结果进行了分析:TGWT+受访者为他们的斗争、日常生活和关爱健康的方式赋予了新的意义,并在其中扮演了核心角色。由于其特殊性,COVID-19 大流行成为了 TGWT+ 每天面对的所有其他事件中的又一个事件。除了 COVID-19 大流行之外,TGWT+ 还面临着艾滋病毒的流行,但他们有可能通过 PrEP 进行预防:TGWT+ 在健康危机的背景下,基于情景和意识的视角,更加明确地将意识行动和护理实践交织在一起,与医疗服务进行对话。从时空动态的角度对这些群体进行进一步的研究,将有助于推进预防和护理战略,尤其是在健康危机时期。
{"title":"Trans/Travesti/+: PrEP in specialized services before and during the COVID-19 pandemic.","authors":"Ramiro Andres Fernandez Unsain, Eliana Miura Zucchi, Lorruan Alves Dos Santos, Dulce Ferraz, Paula Massa, Júlia Clara de Pontes, Alexandre Grangeiro, Marcia Thereza Couto","doi":"10.11606/s1518-8787.2024058005719","DOIUrl":"10.11606/s1518-8787.2024058005719","url":null,"abstract":"<p><strong>Objective: </strong>To understand the perceptions and experiences of transsexual and travesti women and non-binary or gender-fluid people (TGWT+) in health services where they took pre-exposure prophylaxis (PrEP) in the periods before and during the pandemic, focusing on the resignification in the relationship with services and the continuity of HIV prevention via PrEP.</p><p><strong>Methods: </strong>Qualitative research and analysis of empirical material generated in the context of broader studies were conducted. A total of 45 semi-structured interviews were conducted with TGWT+ PrEP users in the city of São Paulo and analyzed using iterative thematic content analysis.</p><p><strong>Results: </strong>The TGWT+ interviewees gave new meanings to their struggles, daily lives and ways of caring for their health and played a central role within them. With its particularities, the COVID-19 pandemic became one more event among all the others that TGWT+ face daily. Alongside the COVID-19 pandemic, the TGWT+ were faced with the HIV epidemic, but with the possibility of prevention via PrEP.</p><p><strong>Conclusion: </strong>Based on a situated and conscious perspective, more explicit in the context of the health crisis, the TGWT+ intertwined conscious actions and care practices in dialog with health services. Further research on these groups from a spatiotemporal dynamic situated in specific contexts of meaning production would make it possible to advance prevention and care strategies, especially in times of health crisis.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 suppl 1","pages":"12s"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reconciling advantages and difficulties: knowledge and perceptions of event-driven PrEP among young people. 兼顾优势与困难:年轻人对事件驱动的 PrEP 的了解和看法。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI: 10.11606/s1518-8787.2020054005729
Luiz Fabio Alves de Deus, Dulce Ferraz, Lorruan Alves Dos Santos, Alexandre Grangeiro, Inês Dourado, Marcia Thereza Couto, Ramiro Fernandez Unsain, Eliana Miura Zucchi

Objective: This study aims to analyze the knowledge about the HIV event-driven pre-exposure prophylaxis (event-driven PrEP) scheme and the perception of its potential use among young men who have sex with men (MSM), travestis, and transgender women (TrTW) who were followed up in the cohort.

Methods: This qualitative study included 50 interviews with participants from the municipalities of Salvador and São Paulo, aged 15 to 19 years, who made daily use of PrEP or other preventive methods. They were addressed by different demand creation strategies. The in-depth interviews covered topics such as sexual practices, event-driven PrEP knowledge, acceptability, and motivations for its use. A two-stage thematic analysis was carried out on Nvivo, version 12.

Results: Most participants were unaware of event-driven PrEP, and many questioned its effectiveness and safety when receiving information about it. However, on learning about the program, many young people saw advantages, such as not having to take daily medication and the possibility of using it only at times of greater risk. Participants also found barriers to using event-driven PrEP, such as the unpredictability of sexual relations and the difficulty in administering dosages in this modality.

Conclusion: Limited knowledge and experiences with daily oral PrEP influenced interest in event-driven PrEP, which highlights the need for information strategies that enable young MSM and TrTW to read about event-driven PrEP. Young people valued the autonomy and management of preventive methods provides by this new modality, which is more in line with the dynamics of their sexual lives, but they face challenges in managing event-driven PrEP.

研究目的本研究旨在分析队列随访的年轻男男性行为者(MSM)、男男性行为者(Travestis)和变性女性(TrTW)对艾滋病毒事件驱动的暴露前预防(事件驱动的 PrEP)计划的了解程度以及对其潜在用途的看法:这项定性研究包括 50 次访谈,访谈对象来自萨尔瓦多和圣保罗两市,年龄在 15 至 19 岁之间,日常使用 PrEP 或其他预防方法。研究人员通过不同的需求创造策略来满足他们的需求。深度访谈涉及的主题包括性行为、事件驱动的 PrEP 知识、可接受性以及使用动机。访谈结果通过 Nvivo 12.0 版进行了两阶段主题分析:结果:大多数参与者对事件驱动型 PrEP 一无所知,许多人在获得相关信息时对其有效性和安全性提出了质疑。然而,在了解到该计划后,许多年轻人看到了它的优点,例如无需每天服药,以及只在风险较大时才使用。参与者还发现了使用事件驱动型 PrEP 的障碍,如性关系的不可预测性和这种方式在剂量上的困难:结论:对日常口服 PrEP 的有限了解和经验影响了对事件驱动型 PrEP 的兴趣,这突出表明需要制定信息策略,使年轻的 MSM 和 TrTW 能够了解事件驱动型 PrEP。年轻人重视这种新模式所提供的预防方法的自主性和管理,因为它更符合他们的性生活动态,但他们在管理事件驱动型 PrEP 方面面临挑战。
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引用次数: 0
Determining RE-AIM indicators for evaluating the Estratégia Amamenta e Alimenta Brasil (EAAB - Brazilian Breastfeeding and Complementary Feeding Strategy). 确定 RE-AIM 指标,用于评估巴西母乳喂养和辅助喂养战略(EAAB)。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-23 eCollection Date: 2024-01-01 DOI: 10.11606/s1518-8787.2024058005875
Daiane Sousa Melo, Sonia Isoyama Venancio, Gabriela Buccini

Objective: To confirm the diagram of the program's impact pathways and Estratégia Amamenta e Alimenta Brasil (EAAB - Brazilian Breastfeeding and Complementary Feeding Strategy) core functions, and to determine indicators for evaluating EAAB.

Methods: This is a qualitative study within the field of implementation research. Data collection included two focus groups with EAAB implementers, document analysis, and literature review. The analysis included a review of the participants' suggestions and two stages of reviewing the diagram and the names of the impact pathways and core functions. Questions for evaluating the EAAB were then constructed based on the confirmed diagram. The indicators of the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance) were adapted to the EAAB context. The evaluation questions were revised according to the RE-AIM domains and, finally, indicators were determined for each evaluation question.

Results: This study advanced the analysis of EAAB implementation, defining 22 indicators for its monitoring and evaluation. Most of the indicators are already used in implementation, however, the analysis with the RE-AIM framework allowed the indicators to be updated to be more specific, measurable, and relevant to the desired objectives.

Conclusion: The results of the study support the pragmatic application of RE-AIM evaluation in health programs and encourage the planning of evaluation indicators for other child health and development programs in primary care.

目标:确认该计划的影响途径图和巴西母乳喂养和补充喂养战略(EAAB--巴西母乳喂养和补充喂养战略)的核心功能,并确定评估 EAAB 的指标:这是一项实施研究领域的定性研究。数据收集包括与 EAAB 实施者进行的两次焦点小组讨论、文件分析和文献综述。分析包括对参与者建议的审查,以及对图表和影响途径与核心功能名称的两个阶段审查。然后,根据确认的图表构建了评估 EAAB 的问题。RE-AIM 框架的指标(覆盖面、有效性、采用、实施、维护)根据 EAAB 的情况进行了调整。根据 RE-AIM 领域修订了评估问题,最后确定了每个评估问题的指标:这项研究推进了对 EAAB 实施情况的分析,确定了 22 项监测和评估指标。大多数指标已在实施过程中使用,但是,通过使用 RE-AIM 框架进行分析,对指标进行了更新,使其更加具体、可衡量,并与预期目标相关:研究结果支持在健康计划中务实地应用 RE-AIM 评估,并鼓励为其他初级保健中的儿童健康和发展计划规划评估指标。
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引用次数: 0
Fiscal austerity and municipal health spending: an interrupted time series study. 财政紧缩与市政卫生支出:间断时间序列研究。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-23 eCollection Date: 2024-01-01 DOI: 10.11606/s1518-8787.2024058005772
Leo Ramos Maia, Mônica Rodrigues Campos, Débora Castanheira

Objective: To analyze the impact of the fiscal austerity policy (PAF) on health spending in Brazilian municipalities, considering population size and source of funds.

Methods: The interrupted time series method was used to analyze the effect of the PAF on total expenditure, resources transferred by the Federal Government, and own/state per capita resources allocated to health in the municipalities. The time series analyzed covered the period from 2010 to 2019, every six months. The first semester of 2015 was adopted as the start date of the intervention. The municipalities were grouped into small (up to 100,000 inhabitants), medium (101,000 to 400,000 inhabitants), and large (over 400,000 inhabitants). The data was obtained from the Sistema de Informações sobre Orçamentos Públicos em Saúde (Information System on Public Health Budget).

Results: The results for the national average of municipalities show that the PAF had a negative impact on the level of total expenditure and own/state resources allocated to health in the first half of 2015, without causing statically significant changes in the trends of any of the indicators analyzed in the period after 2015. Small municipalities saw a drop in total expenditure, while large municipalities saw a drop in own/state resources, and medium-sized municipalities saw a drop in both variables. There was no statistically significant drop in the volume of funds transferred by the Federal Government in the immediate aftermath of the implementation of the PAF in any of the municipal groups analyzed. In the medium-term, the PAF only had a negative impact on the large municipalities, which saw significant reductions in the trends of own/state resources and those transferred by the Union for health.

Conclusion: In general, the impact of the PAF on health financing in municipalities was immediate and based on the decrease in own/state resources allocated to health. In large municipalities, however, the impact lasted from 2015 to 2019, mainly affecting health expenditure from federal funds.

目的:分析财政紧缩政策(PAF)对巴西各市医疗开支的影响:分析财政紧缩政策(PAF)对巴西各市卫生支出的影响,同时考虑人口规模和资金来源:采用间断时间序列法分析 PAF 对各市卫生总支出、联邦政府划拨资源和州/市人均卫生资源的影响。分析的时间序列涵盖 2010 年至 2019 年,每六个月一次。2015 年上半年作为干预的开始日期。市镇被分为小型市镇(不超过 10 万居民)、中型市镇(10.1 万至 40 万居民)和大型市镇(超过 40 万居民)。数据来自公共卫生预算信息系统(Sistema de Informações sobre Orçamentos Públicos em Saúde):全国各市的平均结果显示,2015 年上半年,公共卫生预算框架对卫生领域的总支出和自有/国家资源分配水平产生了负面影响,但在 2015 年之后的时期内,没有对任何分析指标的趋势造成统计意义上的显著变化。小城市的总支出有所下降,大城市的自有/国家资源有所下降,而中等城市的两个变量均有所下降。在所分析的任何市镇群体中,联邦政府在实施 PAF 后立即划拨的资金量在统计上都没有显著下降。从中期来看,PAF 只对大市镇产生了负面影响,这些市镇的自有/国家资源以及联邦为卫生事业划拨的资源都出现了大幅减少:总的来说,公共财政援助框架对各市的卫生筹资产生了直接影响,其基础是分配给卫生事业的自有/国家资源的减少。然而,在大城市,影响从 2015 年持续到 2019 年,主要影响来自联邦基金的卫生支出。
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引用次数: 0
Development of a machine learning model to estimate length of stay in coronary artery bypass grafting. 开发机器学习模型,估算冠状动脉旁路移植术的住院时间。
IF 2.1 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-16 eCollection Date: 2024-01-01 DOI: 10.11606/s1518-8787.2024058006161
Renato Camargos Couto, Tania Pedrosa, Luciana Moreira Seara, Vitor Seara Couto, Carolina Seara Couto

Objective: To develop and validate a predictive model utilizing machine-learning techniques for estimating the length of hospital stay among patients who underwent coronary artery bypass grafting.

Methods: Three machine learning models (random forest, extreme gradient boosting and neural networks) and three traditional regression models (Poisson regression, linear regression, negative binomial regression) were trained in a dataset of 9,584 patients who underwent coronary artery bypass grafting between January 2017 and December 2021. The data were collected from hospital discharges from 133 centers in Brazil. Algorithms were ranked by calculating the root mean squared logarithmic error (RMSLE). The top performing algorithm was validated in a never-before-seen database of 2,627 patients. We also developed a model with the top ten variables to improve usability.

Results: The random forest technique produced the model with the lowest error. The RMLSE was 0.412 (95%CI 0.405-0.419) on the training dataset and 0.454 (95%CI 0.441-0.468) on the validation dataset. Non-elective surgery, admission to a public hospital, heart failure, and age had the greatest impact on length of hospital stay.

Conclusions: The predictive model can be used to generate length of hospital stay indices that could be used as markers of efficiency and identify patients with the potential for prolonged hospitalization, helping the institution in managing beds, scheduling surgeries, and allocating resources.

目的:开发并验证一种利用机器学习技术估算冠状动脉搭桥术患者住院时间的预测模型:开发并验证一种利用机器学习技术估算冠状动脉旁路移植术患者住院时间的预测模型:在2017年1月至2021年12月期间接受冠状动脉旁路移植术的9584名患者的数据集上训练了三种机器学习模型(随机森林、极端梯度提升和神经网络)和三种传统回归模型(泊松回归、线性回归和负二项回归)。这些数据来自巴西 133 个中心的出院数据。通过计算均方根对数误差(RMSLE)对算法进行排名。性能最佳的算法在一个包含 2627 名患者的前所未见的数据库中进行了验证。我们还开发了一个包含前十个变量的模型,以提高可用性:结果:随机森林技术建立的模型误差最小。训练数据集的 RMLSE 为 0.412(95%CI 0.405-0.419),验证数据集的 RMLSE 为 0.454(95%CI 0.441-0.468)。非选择性手术、入住公立医院、心力衰竭和年龄对住院时间的影响最大:该预测模型可用于生成住院时间指数,这些指数可作为效率的标志,并能识别出有可能延长住院时间的患者,从而帮助医院管理床位、安排手术和分配资源。
{"title":"Development of a machine learning model to estimate length of stay in coronary artery bypass grafting.","authors":"Renato Camargos Couto, Tania Pedrosa, Luciana Moreira Seara, Vitor Seara Couto, Carolina Seara Couto","doi":"10.11606/s1518-8787.2024058006161","DOIUrl":"10.11606/s1518-8787.2024058006161","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate a predictive model utilizing machine-learning techniques for estimating the length of hospital stay among patients who underwent coronary artery bypass grafting.</p><p><strong>Methods: </strong>Three machine learning models (random forest, extreme gradient boosting and neural networks) and three traditional regression models (Poisson regression, linear regression, negative binomial regression) were trained in a dataset of 9,584 patients who underwent coronary artery bypass grafting between January 2017 and December 2021. The data were collected from hospital discharges from 133 centers in Brazil. Algorithms were ranked by calculating the root mean squared logarithmic error (RMSLE). The top performing algorithm was validated in a never-before-seen database of 2,627 patients. We also developed a model with the top ten variables to improve usability.</p><p><strong>Results: </strong>The random forest technique produced the model with the lowest error. The RMLSE was 0.412 (95%CI 0.405-0.419) on the training dataset and 0.454 (95%CI 0.441-0.468) on the validation dataset. Non-elective surgery, admission to a public hospital, heart failure, and age had the greatest impact on length of hospital stay.</p><p><strong>Conclusions: </strong>The predictive model can be used to generate length of hospital stay indices that could be used as markers of efficiency and identify patients with the potential for prolonged hospitalization, helping the institution in managing beds, scheduling surgeries, and allocating resources.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"41"},"PeriodicalIF":2.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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