Revista de saude publica最新文献

[This corrects the article doi: 10.11606/s1518-8787.2020054005555].

[This corrects the article doi: 10.11606/s1518-8787.2024058005589] [This corrects the article doi: 10.11606/s1518-8787.2020054005589].

Objective: Investigate the effects of intrauterine growth restriction and socioeconomic status at birth on intellectual development.

Methods: Study conducted with 313 participants from a birth cohort from São Luís, in the state of Maranhão, assessed at birth and between 18 and 19 years of age. Variables at birth and early years of life (maternal age, maternal education, paternal education, occupation of the head of the household, family income, maternal gestational weight gain, intrauterine growth restriction, low birth weight, and breastfeeding duration), and education at 18 and 19 years were tested as determinants of intelligence quotient at 18 and 19 years using structural equation modeling.

Results: Results: Intrauterine growth restriction did not have a total (p-value = 0.957), direct (p-value = 0.184), or indirect (p-value = 0.108) effect on the intelligence quotient at 18 and 19 years of age. Socioeconomic status at birth had a total positive effect of 0.406 standard deviations (p-value < 0.001) on its mean, corresponding to an increase of 4.54 points in the quotient for each increase in socioeconomic level at birth. This effect was not mediated by the other explanatory variables included in the model; however, a direct positive effect of 0.416 (p-value < 0.001) of socioeconomic status on education was identified, which showed a positive correlation (PC = 0.439; p-value < 0.001) with intelligence. Maternal age at birth also had a direct positive effect of 0.116 standard deviations (p-value = 0.042) on the mean intelligence quotient (QI) at 18 and 19 years, corresponding to an increase of 1.30 points for each 1-year increase in maternal age at birth.

Conclusion: Higher socioeconomic levels at birth directly affected the participant's intelligence and education positively, increasing the mean QI and education level at 18 and 19 years. A positive correlation was also identified between the two variables.

[This corrects the article doi: 10.11606/s1518-8787.2025059006197].

To analyze the adherence of adults and older adults in the Brazuca Natal study to the recommendations of the Dietary Guideline for the Brazilian Population and to determine its relation with sociodemographic factors.

This cross-sectional study was carried out with 411 adults and older individuals residing in Natal, Rio Grande do Norte. Participants were selected from a probabilistic sample by clusters in two stages (census tracts and households). Data were collected by an electronic questionnaire on the Epicollect 5 digital platform. The questionnaire contained sociodemographic data and a multidimensional scale to measure adherence to the dietary practices recommended by the Dietary Guidelines for the Brazilian population. The scale consists of 24 questions following a Likert scale (strongly disagree; disagree; agree; and strongly agree). Total scores ranged from 0 to 72, with classifications of low (total score < 32), medium (total score from 32 to 41), and high adherence (total score > 41) to the Dietary Guideline. To verify the association between adherence to the Guide and sociodemographic variables, multiple analysis by unconditional logistic regression were performed.

The mean score equaled 40.5 (7.9), and high adherence to the Guide occurred in 40.8% (95%CI 30.8-51.5) of the population. Women (PR = 1.27; 95%CI 1.03-1.55) and older individuals (PR = 1.46; 95%CI 1.19-1.79) showed a significant association. Individuals who reported a monthly per capita income below one minimum wage were less likely to show high adherence to the Guide, a factor that was intensified for those who earned ≤ 1/4 of the minimum wage (PR = 0.47; 95%CI 0.32-0.68).

The findings of this study indicate that women and older age predict greater adherence to the Dietary Guideline. Conversely, having a low per capita income predicts alower adherence in the evaluated population. Establishing policies to mitigate social inequalities and initiatives to enhance access to dietary practices in line with the Dietary Guideline among adult and older adult populations is imperative.

Objectives: To investigate the relationship between vaccination coverage indicators and the structure of primary care for immunization in Brazilian municipalities.

Methods: This was a time series ecological study using data from the National Immunization Program Information System (SI-PNI) and the National Program for Improving Primary Care Access and Quality (PMAQ) over three evaluation cycles. A total of 13 variables were assessed, five of which related to the structure of basic health units (BHU) and eight to the availability of immunobiologicals. Analyses of comparisons, associations, and longitudinal models were carried out to assess the influence of these indicators on vaccination coverage levels.

Results: The variables and indicators related to the structure of BHUs, the availability of immunobiologicals in Brazilian municipalities and vaccination coverage showed significant variations over the cycles. BHU structures ranged from fair to good, with lower percentages in Cycle 1 and increases in Cycles 2 and 3 for most of the variables analyzed. The availability of immunobiologicals also improved over the cycles, despite a few exceptions. Indicators of adequate vaccination coverage increased from Cycle 1 to Cycle 2 but decreased in Cycle 3. Improvements in the structure of the BHU and the availability of immunobiologicals were associated with higher adequate vaccination coverage. Keeping the availability of immunobiologicals fixed at good, the chance of having adequate coverage is 86.28% higher for a good structure compared to a poor one.

Conclusions: Changes in the structure of municipal BHUs and in the availability of immunobiologicals over the cycles evaluated were identified and were associated with higher vaccination coverage when they occurred simultaneously (good availability of immunobiologicals and regular or good structure in BHUs). This highlights the importance of the quality of primary care in achieving vaccination coverage targets in Brazilian municipalities.

Objective: To analyze efficiency in primary health care in Brazilian state capitals in the period 2008-2019, considering the management model: direct public administration or administration assigned to third parties.

Methods: This is an evaluative study with an analytical objective, using publicly available secondary data, analyzed cross-sectionally (2019) and longitudinally (2008, 2012, 2016, and 2019). Demographic and socioeconomic data and seven indicators related to primary health care were used to characterize the cities and their primary health care (primary care coverage, hospitalizations for primary care-sensitive conditions, tuberculosis cures, infant, maternal, and premature mortality due to chronic conditions, incidence of congenital syphilis). To these indicators were added health and primary health care expenditures and data envelopment analysis focused on outputs (without admitting a reduction in expenditures) to calculate efficiency in 2008, 2012, 2016, and 2019. The Malmquist index was used to identify possible productivity gains between 2008 and 2019.

Results: Four capitals identified as being managed by third parties (São Paulo, Rio de Janeiro, Porto Alegre, and Fortaleza) did not achieve greater efficiency compared to direct public administration, nor did they evolve when comparing their own results over time. In 2019, and in the longitudinal approach, only capitals managed by direct public administration obtained the maximum relative efficiency index in the comparison between capitals. Twelve capitals with direct public administration remained efficient in all years, while those with third-party administration consistently showed weak inefficiency in primary health care, i.e. in the period studied, the relationship between investments in primary health care and results obtained is lower than that achieved by the efficient capitals.

Conclusions: We found no evidence of efficiency gains with the adoption of third-party management. It should be noted that productive efficiency does not necessarily mean that health needs are met.

To investigate the association between unplanned pregnancy and use of modern contraceptive methods at 3-, 12-, and 24-months postpartum using an intersectional approach for examining inequalities, in the 2015 Pelotas birth cohort, Brazil.

We evaluated the use of modern contraceptives after delivery, comparing women who had planned and unplanned pregnancies in 2015. The number of women included in this study was: 4,021, 3,687, and 3,558, at 3-, 12-, and 24-month postpartum follow-ups, respectively. Analyses were restricted to women who needed contraception by the time of each postpartum follow-up interview. Sociodemographic indicators were also investigated. Descriptive (absolute and relative frequencies), bivariate, and multivariate statistical analyses were conducted. These analyses included the main exposure and the sociodemographic variables. In the three follow-up interviews, double stratification was used to investigate for intersectionalities between pregnancy planning and family income, and pregnancy planning and living with partner.

Women who had unplanned pregnancies presented the lowest use of modern contraceptives. A negative association between unplanned pregnancy and use of modern contraception was found at 3- (PR = 0.97, 95%CI: 0.95-0.99) and 24-months postpartum (PR = 0.96, 95%CI: 0.94-0.98). In general, women who did not live with a partner, with lower schooling level, and who were 35 or older presented lower use of modern contraception. Women who had unplanned pregnancies with lower family income and who did not live with a partner presented a lower prevalence of modern contraceptive use.

Despite the possible benefits of the use of modern contraception in the postpartum period, women who had unplanned pregnancies presented the lowest prevalence. No consistent pattern was identified for this association over time. It is necessary to consider important sociodemographic factors such as living with partner as well as possible pathways to reduce inequalities.

To explore the spatial distribution of bacille Calmette-Guerin (BCG) vaccination coverage and tuberculosis cases in Brazilian children under the age of ten in the last two decades.

This is a population-based ecological study using data from the Sistema de Informação de Agravos de Notificação (SINAN - Information System for Notifiable Diseases) from January 2001 to December 2022. We investigated tuberculosis incidence and vaccination coverage in all Brazilian municipalities. Spatial dependence was analyzed by the Global Moran Index and Local Indicators of Spatial Association (LISA). Joinpoint regression was used to assess trends in tuberculosis and BCG rates over time.

The results indicated 39,840 pediatric tuberculosis cases, with 60.65% in children under the age of five. The highest incidence rates were in the states of Amazonas, Mato Grosso, and Rio de Janeiro. Spatial analysis showed significant positive spatial autocorrelation in pediatric tuberculosis cases, with high-high clusters in several states and municipalities. Tuberculosis cases in children under five have been declining since 2000 but rose in 2020 (APC = 26.64; p-value = 0.032). An earlier increase was observed in children up to ten years old, starting six years prior.

The study highlights the decline in BCG vaccination coverage below 90%, with the most significant drop in 2020, particularly in the Northeast. The findings underscore the need for high maintain vaccination coverage and robust public health policies to mitigate tuberculosis in children. Addressing these issues requires targeted public health interventions, especially in regions with higher tuberculosis burdens.

To estimate the prevalence of violence subtypes and analyze some demographic, socioeconomic, and health factors associated with violence against women in Brazil.

Cross-sectional epidemiological study using the 2019 National Survey of Health. The prevalences of some violence subtypes (psychological, physical, and sexual) in the 12 months prior to the interview were estimated in the country, per federative units. The characteristics of each subtype of violence were also analyzed. Additionally, the crude and adjusted prevalence ratios were estimated by a multivariate model according to the following potential demographic, socioeconomic, and health associated factors: age group, education, skin color, place of residence, household income, marital status, social support network, self-rated health, alcohol consumption, depression, and sexually transmitted infections.

In 2019, 19.38% of Brazilian women reported experiencing violence, with psychological violence being the most common subtype both in isolation and in conjunction with other subtypes. The main aggressor was an intimate partner and most of the violent acts occurred at home, with more than half of women reporting at least one consequence of these acts. Younger women, those with worse self-rated health, alcohol consumption, depression, and sexually transmitted infections had a higher prevalence of all violence subtypes.

One in five Brazilian women reported experiencing violence in the past 12 months. Violence against women is positively associated with younger ages, lower education, Black and Brown skin color, smaller support networks, and health-related factors such as self-rated health, alcohol consumption, depression, and sexually transmitted infections.