Revista de saude publica最新文献

Objective: To investigate home visits by physicians or nurses for consultations and procedures and associated factors in families with people with mobility difficulties and need for home care.

Methods: A cross-sectional study was carried out with data from Ciclo III do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (Cycle III of the National Program for Access and Quality Improvement in Primary Care) from September 2017 to June 2018, interviewing over 140,000 users in 28,939 basic health units in 5,312 municipalities. This study analyzed home visits to individuals with mobility difficulties and the need for home care according to internal and external factors via a Poisson regression.

Results: Of all primary healthcare service users, 7.8% stated that someone in their home had mobility difficulties and needed home care. About 70% received home visits. The highest prevalence of home visits, after adjusted analysis, occurred in the Brazilian Northeast. The greater the social vulnerability, the lower the prevalence of home visits in the case of mobility difficulties. Municipalities with 100% coverage from the family health strategy showed a higher prevalence of home visits than those with coverage below 50%.

Conclusion: External factors, such as income and social vulnerability index (which have a greater relation with macrosocial determinants), continue to point toward inequalities in care; whereas internal factors, such as family health coverage, community health agent coverage in all micro-areas, and the possibility of receiving care without prior appointments indicated better results. This study reinforces the importance of public policies that encourage complete family health teams to provide comprehensive care to the population.

Objective: To analyze the association between the presence of post-COVID-19 syndrome after six months and health-related quality of life 6 and 12 months after hospital discharge.

Method: An ambidirectional cohort study was conducted with individuals discharged from three of the main hospitals in Cuiabá (in the state of Mato Grosso) between October 2021 and March 2022. After collecting data from medical records, individuals were interviewed via telephone 6 months (n = 189) and 12 months (n = 159) after hospital discharge, evaluating the presence of at least one persistent post-COVID-19 symptom at 6 months (post-COVID-19 syndrome) and health-related quality of life (EQ-5D-3L) at 6 and 12 months, as well as specific dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). The association was assessed via Poisson regression with robust variance, adjusted for sociodemographic, health, and hospitalization characteristics.

Results: Of the individuals assessed, 88.4% answered that they had COVID-19 symptoms in the interview after 6 months. At 6 and 12 months after hospital discharge, 55.0% and 74.2% of individuals, respectively, had some impairment in quality of life. In the multiple model, post-COVID-19 syndrome remained associated with having any quality of life issue (RR = 2.43; 95%CI: 1.06-5.57) and specifically with the anxiety/depression domain (RR = 2.74; 95%CI: 1.08-7.01) at 6 months after discharge. The association was no longer significant after 12 months.

Conclusion: These results show the long-term negative repercussions of post-COVID-19 syndrome on cognitive, emotional, and physical functions, exposing the negative impact on the quality of life of those affected.

Objective: To analyze the time elapsed in the post-incorporation process of procedures, orthoses, prostheses, and special materials, with a focus on compliance with the legal deadline of 180 days established for the provision of the technology.

Methods: The analysis was conducted with procedures and orthoses, prostheses, and special materials recommended for incorporation by the National Commission for the Incorporation of Technologies from 2012 to 2022, and the technology identification code created in the Management System for the Table of Procedures, Medicines, Orthoses, Prostheses and Special Materials of the Brazilian Unified Health System, after incorporation. For the technologies identified, we calculated the median periods (Q1-Q3) of the days elapsed during the incorporation and post-incorporation periods. In addition, the proportion of technologies offered according to the legal deadline was verified, and the influence of variables on the post-incorporation period was analyzed.

Results: Among 41 reports on procedures, orthoses, prostheses, and special selected materials, 79 technologies were analyzed. The coding period, defined as the benchmark for the supply of the technology, had a median of 204 (57-425) days. This period was longer than 180 days in 64% of the technologies assessed. Variables such as the organization group to which the technology belongs, indication of the need to adapt for implementation in the incorporation report, and delay in the evaluation period for incorporation seem to influence the period for providing the technology.

Conclusions: The effective provision of technologies incorporated into the health system in Brazil has not occurred within the expected period of 180 days in most cases, which limits their accessibility to the population. Anticipating the need for adaptation before implementation, even during incorporation, seems to be a way of reducing the post-incorporation period.

Objective: To investigate the temporal trends and regional clusters of tuberculosis treatment outcomes among people with HIV in Brazil, as well as their relationship with socioeconomic and programmatic indicators.

Methods: Ecological study with data from people living with HIV who initiated and completed tuberculosis treatment from 2015 to 2021 in Brazil. We described the semiannual trends of cure, treatment interruption, and death rates in Brazilian states using joinpoint regression models. Cluster analyses stratified by three population sizes were conducted using the k-means method to identify clusters in 510 immediate geographic regions. Socioeconomic and programmatic indicators related to treatment interruption and death were included in multivariate negative binomial regression models.

Results: A total of 54,362 tuberculosis treatments in people with HIV were analyzed, with cure rates of 55.51%, interruption rates of 23.33%, and death rates of 21.16% for the period. Nationally, cure rates remained stable, while treatment interruption increased by 2.54% per semester (ranging from 1.59% to 3.70%) and death increased by 9.31% (ranging from 7.41% to 17.24%). The states of Ceará and Amapá showed the worst trends for treatment interruption and death. Regions with greater income inequality, higher percentages of workers with only primary education, higher household density, and broader private health coverage had higher rates of treatment interruption and death. Conversely, regions with higher expected years of schooling and hospitalizations for primary care-sensitive conditions had lower probabilities of these outcomes.

Conclusion: Nationally, despite stable cure rates, tuberculosis treatment interruption and death among people with HIV increased. Regional disparities in the relationship between socioeconomic and programmatic indicators and outcomes suggest inequities in access to and adherence to tuberculosis treatment across Brazil.

Objectives: To present the profile of graduates from a blended learning course in auriculotherapy and their perception of user acceptance and clinical outcomes of this integrative and complementary health practice, currently the most widely implemented in the Brazilian Unified Health System. The course is offered free of charge to primary health care professionals.

Method: A digital questionnaire was sent in 2023 by email to all graduates to date (n = 13,581), addressing their professional profile, their perception of user acceptance and the clinical outcomes of auriculotherapy. Data were analyzed using descriptive statistics.

Results: A total of 5,461 professionals responded (41.34% of graduates from nine editions of the course, each with multiple classes of around 50 to 100 students). Most were women (87.82%), nurses (33.55%), physical therapists (11.59%), psychologists (5.40%), pharmacists (9.65%), nutritionists (8.05%), dentists (7.57%), and physicians (5.57%); aged 30 to 49 years (77.7%); working in primary health care (80.44%); without prior experience in integrative and complementary health practice (73.58%). After the course, 56.31% reported practicing auriculotherapy. User acceptance was reported as high or very high by 73.6% and as moderate by 22.14% of practitioners. Clinical outcomes were reported as very good or good by 79.72% and as moderate by 18.35%. of practitioners.

Conclusion: The graduates of the auriculotherapy course who responded to the survey are mostly women, family health professionals and members of multi-professional teams working in primary health care, who report higher user acceptance and perceive good clinical outcomes from the use of auriculotherapy.

Objective: To describe the health profile and patterns of exposure to mining waste over the period of three years in a cohort of children living in areas affected by the collapse of a mining tailings dam in Brumadinho, Minas Gerais State, Brazil, in 2019.

Methods: This prospective cohort study included all children aged 0 to six years residing in four selected locations: three in the disaster zone (Parque da Cachoeira, Córrego do Feijão, and Tejuco - exposed areas) and one located 10 km away (Aranha - non-exposed area). Assessments included anthropometric growth, neuromotor and cognitive development, and respiratory conditions. Urine samples were collected and analyzed for lead, arsenic, cadmium, mercury, and manganese using inductively coupled plasma mass spectrometry (ICP-MS).

Results: The average percentage of children assessed in the period was 80% of the projected population. There was an increase in the percentage of children with urinary arsenic levels above the reference value over the three-year period (2021 = 42%; 2022 = 44%; 2023 = 57%), as well as in detection rates of lead (88.9%) and mercury (63.9%) in 2021, both reached 100% in 2023. The median urinary arsenic concentration increased from 2021 (9.35 μg/g; IQR = 5.45-13.9) to 2023 (10.8 μg/g; IQR = 7.0-15.3) in the total sample of children (p = 0.064), with a statistically significant increase among those living in exposed areas (p = 0.015; Parque da Cachoeira). Over the three-year period, there was a decrease in the percentage of neurodevelopmental alterations and overweight/obesity, and an increase in reports of respiratory alterations in the total population, although these changes were not related to metal exposure.

Conclusion: The findings indicate ongoing exposure of the metals analyzed in the study population; however, no associated health effects have been identified thus far. It is essential that the Brazilian Unified Health System be structured according to specificities of the productive processes in each territory.

Objective: To investigate the effect of Zika virus on the locomotor activity of a Brazilian population of Aedes albopictus under laboratory conditions.

Methods: Females of Aedes albopictus were infected with Zika virus orally or by intrathoracic injection. The locomotor activity was monitored using a Drosophila activity monitor under controlled conditions of 25°C and a 12h light/dark cycle. The infection status was determined using reverse transcription followed by real-time polymerase chain reaction (RT-qPCR). Statistical analyses were conducted using generalized linear mixed models (GLMMs).

Results: The locomotor activities of Zika virus-infected and uninfected Aedes albopictus females were diurnal and bimodal, with peaks at lights on and off. The infection did not significantly alter the total activity, diurnal and nocturnal, or the light-on and light-off peaks of infected females compared with uninfected females, regardless of the method of infection (intrathoracic injection or orally).

Conclusion: This finding indicates that Zika virus infection does not affect the daily activity pattern of this species under laboratory conditions, which reinforces the importance of this species as a competent and adaptable vector in urban and rural areas, confirming the importance of ongoing surveillance and control strategies.

Objective: To evaluate the intra- and between-group (control and intervention) effect of counseling during pregnancy on pregnant women's food consumption and physical activity.

Methods: This randomized, parallel, two-arm clinical trial was carried out in primary health care in a Brazilian municipality from 2018 to 2021. Adult pregnant women with pre-gestational overweight (n = 350) were randomly assigned to the control or intervention groups. The intervention consisted of three counseling sessions based on the NOVA food classification system and encouragement toward physical activity. Then, 24-hour dietary records were obtained, and physical activity was assessed using a structured questionnaire. The Wilcoxon test was used for intra-group differences between assessments and the Mann-Whitney test, for differences between groups.

Results: Women in the control group consumed less minimally and unprocessed foods (%E) (Δ = -4.08; -13.58 to 4.34; p = 0.006) and more ultra-processed foods (%E) (Δ = 3.74; -5.86 to 12.86; p = 0.009), with no difference between groups. The intervention group showed an increase in commuting-related physical activity (min/week) between assessments (Δ = 9.00; -30.00 to 70.00; p = 0.02), with no difference between groups. The other parameters showed no differences.

Conclusions: The intervention failed to affect outcomes. However, intragroup changes showed that the control consumed less minimally and unprocessed foods and more ultra-processed foods and the intervention group increased their commuting-related physical activities.

Objective: To investigate the impact of prenatal care on the reduction of maternal-child mortality in Brazilian municipalities following the new primary health care financing model, the Previne Brasil program.

Methods: This study comprised a nationwide cross-sectional observational analysis, utilizing secondary data from Departamento de Informática do Sistema Único de Saúde (Datasus - Information Technology Department of the Unified Health System), Sistema de Informação sobre Mortalidade (SIM - Mortality Information System), Sistema de Informação sobre Nascidos Vivos (Sinasc - Live Birth Information System), Sistema de Informação em Saúde para a Atenção Básica (Sisab - Primary Health Care Information System), and Instituto Brasileiro de Geografia e Estatística (IBGE - Brazilian Institute of Geography and Statistics). Medians of maternal mortality, infant mortality, and prenatal care rates were calculated for Brazilian municipalities from 2016 to 2022. Logistic regression analyses were conducted to assess associations between independent variables (primary care coverage, population size, Gross Domestic Product, and Gini index) and outcomes (variations in maternal and infant mortality rates). Both crude and adjusted odds ratios were estimated, with a significance level of 5%.

Results: Prenatal care rates increased by 86.7%, while maternal mortality rates decreased by 30.9%, with no association between them. Region, primary care coverage, municipal Gross Domestic Product, and population size were associated with variations in maternal mortality rates. The Southern region had a higher likelihood of reducing maternal mortality. No association was found between increased prenatal care rates and reduced infant mortality. Regional location, primary care coverage, population size, and the Gini index were associated with variations in infant mortality rates, with greater reductions observed in more populous municipalities and in the Northeast, Southeast, and Midwest.

Conclusion: The Previne Brasil program led to an increase in prenatal care consultations in Brazilian municipalities but did not significantly impact the reduction of maternal-child mortality.

Objective: To evaluate the efficacy of auricular acupuncture in reducing insomnia symptoms among individuals with depression compared with non-specific auricular acupuncture, at four weeks, six weeks, and three months after the intervention began.

Methods: A randomized, blinded clinical trial assessed sleep quality using the Pittsburgh Sleep Quality Index in 74 adults equally divided into two groups: specific auricular acupuncture and non-specific auricular acupuncture. Both groups underwent 12 auricular acupuncture sessions performed twice a week.

Results: After three months, the intention-to-treat analysis found no statistically significant difference in achieving good sleep quality between groups (33.3% versus 26.1%, p > 0.05). However, a trend toward statistical significance occurred after 4 weeks, with 50% of participants in the experimental group and 24.1% in the control group achieving good sleep quality (p = 0.057).

Conclusions: We observed no statistically significant difference in sleep quality between individuals with depressive symptoms undergoing specific auricular acupuncture compared with non-specific after three months. However, a significant trend (p = 0.057) confirmed by the per-protocol analysis (p = 0.038) indicated that participants receiving specific auricular acupuncture had a 69% higher chance of achieving good sleep quality after four weeks. These findings should be interpreted with caution, as they did not reach statistical significance; rather, they reflect a trend toward significant improvement and are subject to the study's limitations.