Epidemiologia e Servicos de Saude最新文献

Objective: To analyze vaccination coverage up to 24 months of age according to race/ skin color in the 2017-2018 live birth cohort in Natal, Rio Grande do Norte, Brazil.

Methods: Population-based survey conducted in 2020 and 2021. Vaccination coverage up to 24 months of age was estimated according to administered, valid and timely doses. Crude association of race/skin color was estimated by calculating the crude Prevalence Ratio and respective 95% Confidence Intervals, using Poisson regression.

Results: Of the 688 children in the selected cohort, there was greater coverage among Black children for administered doses (White 30.5%; Black 47.8%; 95%CI) and valid doses (White 25.8%; Black 40.1%; 95%CI), although without statistical significance, and lower coverage for timely doses, in the full schedule excluding yellow fever (PR = 0.21; 95%CI 0.04;0.90).

Conclusion: There was lower timely coverage among Black children compared to White children.

Main results: It was found that racial inequalities and social disparities were reflected in vaccination coverage of Black children in the state of Rio Grande do Norte, showing lower prevalence of timely and full vaccination schedules among those children.

Implications for services: The results demonstrate the need to strengthen equitable public policies and the implementation of practices that seek to improve vaccination coverage, thus reducing racial inequalities in child immunization.

Perspectives: Health service managers will be able to plan actions and strategies in childhood immunization services, in order to increase vaccination coverage and reduce vaccination hesitancy among Black people and people from lower socioeconomic strata.

Objective: To investigate knowledge, attitudes and practices of primary health care professionals regarding breastfeeding and complementary feeding, in accordance with the recommendations of the food guide for Brazilian children up to 2 years old.

Methods: This is a descriptive study undertaken from October to December 2023, with a self-administered online questionnaire, aimed at physicians, nurses and community health agents in primary health care in Botucatu, São Paulo, Brazil. We performed descriptive analysis and used Pearson's chi-squared test to analyze association between professional categories and their knowledge, attitudes and practices in relation to the content of the food guide.

Results: 74 professionals participated, including 37 community health agents, 19 nurses and 18 physician. Half the professionals had low knowledge about the content of the guide, getting less than half the answers right, in particular those related to complementary foods, for which 57 professionals got less than half of them right. Physicians and nurses were the professionals who believed they were more qualified to provide information related to the content of the guide, when compared to community health agents (p-value<0.001). Regarding practices, 18 professionals stated they sometimes provide guidance on breastfeeding, 24 reported never doing breastfeeding assessments during consultations and home visits and 22 provided guidance on introduction of complementary feeding.

Conclusion: Knowledge of physician, nurses and community health workers was deficient regarding the content of the guide. Attitudes and practices regarding the content were also compromised.

Objective: To describe the epidemiological profile and analyze the temporal trend of deaths due to Parkinson's disease among the elderly in Brazil from 2002 to 2021.

Methods: Descriptive and temporal trend study using data from the Mortality Information System. Annual percent change (APC) and 95% confidence intervals (95% CI) were estimated using the Prais-Winsten regression model.

Results: Among the 57,723 deaths, there was a higher frequency in males (54.7%), individuals aged ≥ 80 years (57.7%), and White individuals (75.0%). Mortality trends increased in both males (APC = 3.32; 95%CI 2.49; 4.16) and females (APC = 2.81; 95%CI 1.80; 3.82); across all age groups, particularly ages 70-79 (APC = 4.93; 95%CI 2.98; 6.91); and in all Brazilian regions, especially the Northeast (APC = 6.79; 95%CI 4.35; 9.30).

Conclusion: Deaths due to Parkinson's disease were more frequent among males and the oldest age groups, with an increasing mortality trend observed over the period.

Main results: An increasing trend in mortality due to Parkinson's disease was found among elderly people of both sexes, of all age groups and in all Brazilian regions in the period.

Implications for services: The increase in mortality due to Parkinson's disease implies greater demand for health care services and, consequently, contributes to the financial burden related to diagnosis and treatment of people with the disease.

Perspectives: Investing in research and technologies for timely diagnosis, treatment and health recovery are crucial. Furthermore, the need exists to promote health policies that guarantee equitable access to specialized services.

Objective: To analyze spatio-temporal evolution of stroke mortality in Minas Gerais state, Brazil, 1980-2021.

Methods: Ecological study with aggregated data by micro-region. Segmented linear regression was used for trend analysis; maps with rates per five-year period and scan statistics were used for spatial analysis.

Results: There were 392,521 stroke-related deaths (rate of 52.6/100,000-year). All rates (crude, adjusted, by age group) showed a decreasing trend, less so in the crude rate (Annual Percent Change [APC] = -0.70) and a faster decrease in the 20-39 age group (APC = -4.48). A high-rate cluster was identified in the southern region (1980-1999; Relative Risk [RR] = 2.06), and a low-rate cluster in the northwest (2008-2021; RR = 0.59). The most significant decrease occurred in the south (APC = -3.64).

Conclusion: Stroke mortality showed a decreasing trend. Clusters and areas with higher rates identified in the northeast in recent years require attention by service managers.

Main results: Decreasing trend in stroke mortality, a cluster was found in the south with high rates (1980-1999; relative risk [RR] = 2.06) and another in the northwest with low rates (2008-2021; RR = 0.59).

Implications for services: For health service managers, greater attention is suggested in the micro-regions and respective municipalities in the northeast that have presented a higher risk of mortality from stroke in recent years, with the aim of improving the regulation of health care service and network regulation, as well as optimizing access to these services.

Perspectives: It is necessary to monitor the spatio-temporal evolution of stroke mortality and conduct new studies on different scales (for example, on the municipal scale) and methodologies (for example, multilevel analysis), to estimate risk factors and the social context of vulnerable populations.

Objective: To estimate prevalence and analyze factors associated with body image dissatisfaction among Brazilian adolescent school students.

Methods: Cross-sectional study with data from the 2019 National School Health Survey (PeNSE). Prevalence of self-reported body image dissatisfaction and respective 95% confidence intervals (95%CI) and its association with individual characteristics were estimated via odds ratios (OR) and 95% CI using logistic regression.

Results: Of the 159,245 students, 30.2% (95%CI 29.2;31.1) reported body image dissatisfaction, which was associated with all factors analyzed. Likelihood of dissatisfaction was greater among females (OR = 3.86; 95%CI 3.45;4.32), having internet at home (OR = 8.68; 95%CI 6.83;11.03), thinking that no one cares about them (OR = 3.02; 95%CI 2.60;3.50), that life is not worth it (OR = 3.27; 95%CI 2.88;3.72) and feeling irritated (OR = 2.87; 95%CI 2.53;3.26).

Conclusion: Body image dissatisfaction is associated with various factors and requires an intersectoral approach.

Main results: Prevalence of body image dissatisfaction was 30.2%. The greatest likelihood of dissatisfaction was more related to being female, having internet at home, frequently feeling that no one cares about them, that life is not worth it, and feeling irritated.

Implications for services: We suggest that projects be carried out in schools encouraging physical activity, less screen time and good eating habits, in addition to providing psychological support to students, in order to guide care for their mental health.

Perspectives: Projects are needed to encourage and instruct good physical and psychological health practices at school, involving the entire school community, training of education professionals and encouragement of adolescent mental health self-care.

Objective: To analyze the recommendations for exclusion of health technologies in the Brazilian National Health System (SUS), made by the National Commission for the Incorporation of Technologies in the Brazilian National Health System (CONITEC) from 2012 to 2023, and to identify the disinvestment criteria used.

Methods: Documentary, descriptive and retrospective analysis of CONITEC reports that assessed technology exclusion requests.

Results: We identified 24 reports on 74 technologies, whereby the requests predominantly involved medications (95.9%). CONITEC favorably recommended 95% of the exclusions, prioritizing the absence of registration with the National Health Surveillance Agency and the existence of therapeutic alternatives.

Conclusion: Low demand for exclusions compared to incorporations reveals challenges in identifying obsolescence and resistance to exclusion of technologies. The sustainability of the SUS requires greater monitoring of incorporated technologies, to optimize resources and promote the efficiency of the health system.

Main results: The study identified that demands for exclusion of technologies in the Brazilian National Health System (Sistema Único de Saúde - SUS) are significantly lower than demands for incorporation, highlighting the need to pay greater attention to the disinvestment process, in order to guarantee the sustainability of the health system.

Implications for services: The findings of this study point to the importance of structuring disinvestment assessment methods, with the aim of improving monitoring of health technology obsolescence and promoting more efficient allocation of resources in the SUS.

Perspectives: We suggest that criteria be established for the periodic re-assessment of incorporated technologies, in order to guarantee regular reviews and the fluidity of CONITEC's work in assessing health technologies.

Objective: To investigate the prevalence of psychiatric medication use and sociodemographic factors, including gender identity, age, race/skin color, education level, formal employment, and access to Primary Health Care (PHC) centers, among individuals receiving care at a transgender outpatient clinic in Southern Brazil.

Methods: : This was a cross-sectional study using administrative data from the information systems of the Municipal Health Department of Porto Alegre, the capital city of Rio Grande do Sul state, collected between 2021 and 2022.

Results: : This study analyzed 629 records of individuals who accessed the outpatient clinic and found a 29% prevalence (95%CI 25;32) of psychiatric medication use, with the most frequent class being psychoanaleptics (45%), especially fluoxetine (31%).

Conclusion: In addition to a trend toward mixed-race race/skin color and incomplete elementary school, transgender people aged 40 to 49 years and with access to a Primary Health Care center were more likely to use psychiatric medications.

Main results: Prevalence of 29% (95%CI 25;32) of psychiatric medication use was observed, with a higher likelihood among individuals aged 40 to 49 years, with access to primary healthcare centers. Low education level and mixed-race/skin color showed significant effect sizes. The most frequently dispensed drug class was psychoanaleptics (45%), with fluoxetine (31%) standing out.

Implications for services: This study can be replicated in other transgender outpatient clinics across Brazil and should contribute to broadening the discussion on mental healthcare for the transgender population.

Perspectives: The findings highlight the importance of interdisciplinary approaches to healthcare and underscore the need to assess the effectiveness of public mental health policies for the transgender population.

Objective: To analyze factors associated with detectable HIV viremia among transgender women/transvestites (TWT) in five Brazilian capitals.

Methods: : This was a cross-sectional study using data from a sample of TWT with HIV-positive serology and detectable viral load (VL), between 2019 and 2021. The dependent and independent variables were, respectively: viral load measurement, socioeconomic/demographic characteristics; alcohol/drug use; and self-perceived mental health. Poisson regression with robust variance was used.

Results: : A total of 425 TWT tested positive for HIV and underwent VL measurement, 179 (42.0%) presented detectable viremia. Factors positively associated with detectability were: younger age (PR=2.26; 95%CI 1.13;4.51), poorer housing conditions (PR=2.72; 95%CI 1.30;5.68) and poor/very poor mental health (PR=1.70; 95%CI 1.08;2.66). The use of antiretroviral drugs was a protective factor against detectability (PR=0.29; 95%CI 0.30;0.61).

Conclusion: The factors associated with unsuppressed viral load highlight vulnerability related to gender identity that have a negative impact, despite the majority of participants being on antiretroviral therapy (ART).

Main results: People aged 20-29 who were homeless or unstable and those who reported poor or very poor mental health were more likely to have a detectable viral load. ARV drug use was a protective factor.

Implications for services: The identification of predictors for detectable viral load enables the design of appropriate strategies for monitoring and linking vulnerable people to health services, ensuring effective implementation.

Perspectives: It is necessary to develop educational strategies that take into account important social issues to improve awareness about undetectable viral load in HIV prevention among the transgender population, especially among younger people.

Objective: To assess the previous history of syphilis in transgender women and travestis (TWTs) and identify factors associated with treatment incompleteness.

Methods: : This was a multicenter cross-sectional study conducted between 2019 and 2021, with participants recruited through respondent-driven sampling, in five Brazilian capitals. Dependent variable: "reported syphilis treatment in the last year", "no/incomplete" or "complete". A multivariate-logistic model was used to identify factors associated with completeness.

Results: : Of the 1,317 participants, 16.0% reported previous history of syphilis. Of these, 68.9% were Black, 54.6% earned up to 1 minimum wage and 61.1% completed the treatment. Treatment completion was lower in São Paulo (42.7%) and among those who experienced verbal abuse (53.6%; ORa 0.46; 95%CI 0.25;0.85).

Conclusion: In this sample, both the prevalence of self-reported syphilis and the proportion of participants who reported not having started/completed treatment were high. It is essential to identify the barriers faced by TWTs that hinder healthcare access, and identify their needs in order to ensure adequate diagnosis and treatment.

Main results: Of the 16% of participants who reported a previous diagnosis of syphilis, only one-third completed the treatment. Residents of São Paulo were less likely to complete it compared to those from other cities, and those who had experienced verbal abuse.

Implications for services: There is a need for healthcare professionals to receive training focused on specific needs of TWTs , including respect for their social names, extended opening hours, point-of-care strategy and alternatives for the administration of intramuscular benzathine penicillin injections.

Perspectives: It is crucial to develop new, more effective therapeutic methods for syphilis treatment and deepen research on the impacts of discrimination and stigma on transgender women and travestis' access to healthcare, especially diagnosis and treatment of sexually transmitted infections.

Objective: To analyze the temporal trend and characteristics of notifications of violence among the transgender population from 2015 to 2022 in Brazilian municipalities.

Methods: This was a repeated panel epidemiological study, based on violence incidents reported among the transgender population aged 20 to 59 years, available in the Notifiable Health Conditions Information System. An annual temporal trend analysis was performed by means of generalized linear regression, using the Prais-Winsten method and spatial distribution of notifying municipalities in Brazil.

Results: Notifications of violence in the transgender population decreased during the period (1.7%; β = -0.07; p = 0.010), but there was an increase in the number of notifying municipalities (45.8%), self-inflicted violence (28.9%; β = 2.21; p < 0.001) and sexual violence (β = 0.79; p < 0.001). The majority of perpetrators were male and in an affective relationship, especially with transgender women (43.4%; p < 0.001).

Conclusion: Notification of violence does not yet fully reflect the reality of this population, but it represents the first step towards visibility and addressing the issue.

Main results: Notifications of violence against transgender people accounted for 1.7% of the total. Self-inflicted and sexual violence increased from 2015 to 2022. Almost half of Brazilian municipalities have already been reporting cases of violence against this population.

Implications for services: Continuous and high-quality notification will contribute to monitoring and understand violence in this population group, enabling the adaptation of services to meet their specific needs.

Perspectives: The development of research on the transgender population will allow for a better understand and guidance of specific health actions for this group. Information on violence against this population is crucial for informing public policies.