Epidemiologia e Servicos de Saude最新文献

Objective: To analyze association of visual, hearing, mental/intellectual, physical and multiple impairments with health conditions and health risk behaviors in Brazil.

Methods: This was a cross-sectional study, using data from the 2019 National Health Survey; associations between impairments and presence of cardiovascular disease (CVD), hypertension, diabetes mellitus (DM), high cholesterol, alcohol abuse and smoking were estimated using logistic regression, thus obtaining the odds ratios (OR).

Results: Impairment was reported by 7.6% of the 90,846 participants. Having a impairment was associated with greater odds of reporting chronic conditions, especially CVD (OR = 2.11; 95%CI 1.76;2.54) and DM (OR = 1.78; 95%CI 1.56;2.02 ); visual impairment was associated with greater odds of smoking (OR = 1.52; 95%CI 1.28;1.81); mental/intellectual impairment was inversely related to smoking (OR = 0.45; 95%CI 0.30;0.67) and alcohol abuse (OR = 0.13; 95%CI 0.06;0.26).

Conclusion: Having any of the impairments studied may be associated with greater odds of having chronic health conditions.

Main results: Positive association was identified between having one or more impairments, and health conditions and health risk behaviors. The higher the prevalence of mental/intellectual, physical and multiple impairments, the lower alcohol abuse and smoking.

Implications for services: As this population is vulnerable to chronic health conditions, health services need strategies to reduce barriers to access, as well as health promotion actions, such as health education, adapted for people with impairments.

Perspectives: Topics for future studies, examining the inverse relationship between impairments and alcohol abuse and smoking, in addition to acting on the causal chain, so as to prevent health conditions and health risk behaviors.

Objective: To investigate association between depressive symptoms and receipt of retirement pensions or other pensions in the Brazilian population aged 50 years or older.

Method: This was a cross-sectional study with participants from the baseline (2015-2016) of the Longitudinal Study of the Health of Elderly Brazilians. Depressive symptoms were measured by the eight-item Center for Epidemiologic Studies Depression Scale. Prevalence ratios (PR) were obtained by Poisson regression.

Results: Among the total 8,469 participants, 33.9% (95%CI 32.8;34.9) reported depressive symptoms and 52.8% (95%CI 51.8;53.9) of the participants received a retirement or other pension. Prevalence of depressive symptoms was lower among participants receiving a retirement or other pension (PR = 0.79; 95%CI 0.73;0.86). Association remained significant after adjustments for sociodemographic and health indicators (PR = 0.84; 95%CI 0.76;0.92).

Conclusion: Participants who receive retirement or other pensions are less likely to report depressive symptoms.

Main results: Prevalence of depressive symptoms was 33.9% in the population studied and, after adjusted analysis, it remained statistically lower among participants who received retirement or other pensions.

Implications for services: Prevalence of depressive symptoms was higher in individuals who do not receive retirement or other pensions, which demands attention from health services in caring for this public in vulnerable situations regarding social security.

Perspectives: Carrying out longitudinal studies capable of assessing the temporality of association between receiving retirement or other pensions and the mental health of the elderly, thus contributing to better knowledge about the social determinants of mental health.

This article aimed to present an overview of national health surveys, sampling techniques, and components of statistical analysis of data collected using complex sampling designs. Briefly, surveys aimed at assessing the nutritional status of Brazilians and maternal and child health care were described. Surveys aimed at investigating access to and use of health services and funding, those aimed at surveillance of chronic noncommunicable diseases and associated behaviors, and those focused on risk practices regarding sexually transmitted infections were also addressed. Health surveys through social networks, including online networks, deserved specific attention in the study. The conclusion is that the development of health surveys in Brazil, in different areas and using different sampling methodologies, has contributed enormously to the advancement of knowledge and to the formulation of public policies aimed at the health and well-being of the Brazilian population.

Objective: To analyze chronic kidney disease mortality in Brazil according to sex, age group and region of residence, from 2009 to 2020.

Methods: This was a time series study having deaths as its unit of analysis, based on Mortality Information System data. The mortality rate was standardized using the direct method and the temporal trend was analyzed using the Prais-Winsten method.

Results: There was a rising trend in chronic kidney disease mortality, ranging from 2.82, in 2009, to 3.24 in 2020 (average annual increase 1.29%; 95%CI 0.73;1.85), with a greater increase in males (1.14% per year; 95%CI 0.52;1.76), those aged 75 years and over (2.23% per year; 95%CI 1.87; 2.60) and in the Northern Region (3.86% per year; 95%CI 1.86;5.90) and Northeast Region (3.36% per year; 95%CI 2.24;4.50).

Conclusion: Chronic kidney disease mortality showed a rising trend in the period, with sociodemographic disparities.

Main results: A rising mortality trend was found for both sexes, with a greater increase in males, those aged over 75 years and in the North and Northeast regions of Brazil; mortality was highest in the Midwest region throughout the entire period.

Implications for services: The results point to the need to implement public policies with guidelines for addressing chronic kidney disease, focused on strengthening Primary Health Care (PHC).

Perspectives: Expanding access to health services, health education and integration between PHC, health surveillance and specialized care are strategies that would possibly prove to be efficient in managing this chronic health condition.

Objective: To evaluate the measles epidemiological surveillance system, before and during the COVID-19 pandemic in Pernambuco, Brazil.

Methods: This was a descriptive evaluation of the quality (duplicity; completeness; consistency), timeliness and usefulness attributed, classified as excellent ≥ 90.0%, regular ≥ 70.0% and < 90.0%, and poor (< 70.0%). Data from the Notifiable Health Conditions Information System and Laboratory Environment Management System were used, before (03/11/2018-03/10/2020) and during (03/11/2020-03/10/2022) the pandemic.

Results: 1,548 suspected measles cases were registered (1,469 before and 79 during the pandemic). In the two periods studied, there were 11 and 1 duplicate records, average completeness in filling out the variables was 99.2% and 95.7%, while average consistency was 96.7% and 97.5%, respectively. Timeliness (receipt of samples, 16.2% and 33.0%. Release of results, 1.3% and 1.3%) and usefulness (43.5% and 24.4%) were poor.

Conclusion: Quality was classified as excellent in the periods studied, timeliness and usefulness were classified as poor, signaling non-compliance with the purpose of the system.

Main results: The quality of data from the measles epidemiological surveillance system in Pernambuco was excellent, while its timeliness and usefulness were poor during both periods.

Implications for services: The limited timeliness and, therefore, the low usefulness of the measles epidemiological surveillance system must be discussed in the three government spheres of health service management, with the aim of training the professionals involved, as well as monitoring and evaluating the system.

Perspectives: Systematic monitoring and evaluation generates evidence that supports health service managers and workers in the timely identification of gaps that compromise the full fulfillment of the objectives proposed.

Objective: To describe the prevalence of health service use due to multimorbidity according to sociodemographic and health characteristics of the Brazilian population; to analyze the relationship between multimorbidity and the use of health services.

Methods: This was a cross-sectional study using data from the 2019 National Health Survey. The outcomes were seeking health services in the last 15 days, medical consultation and hospitalization in the previous 12 months. Multimorbidity was defined as ≥ 2 chronic diseases. Associations were assessed using Poisson regression.

Results: Of the 81,768 individuals, prevalence of seeking health services among individuals with multimorbidity was 38.0% higher (95%CI 1.31;1.45), medical appointments, 11.0% higher (95%CI 1.10;1.12), and 56.0% higher for hospitalizations (95%CI 1.44;1.70), compared to those without multimorbidity. This relationship was higher for seeking health services and medical appointments among male.

Conclusion: The use of health services was higher among those with multimorbidity, but different between the types of health services used and sexes.

Main results: Having multimorbidity increased the use of health services, even after progressive adjustment by sociodemographic characteristics and health needs. This relationship was greater among males for medical consultations.

Implications for services: Greater use of health services by individuals with multiple non-communicable diseases (NCDs) points to the need for changes in care models, with focus on continuity of care.

Perspectives: Health services should focus on continuous, coordinated and comprehensive approaches to the care of people with multimorbidity, thus seeking to increase the efficiency and quality of care provided to this population.

Objective: To analyze the spatio-temporal pattern of maternal mortality and associated factors in Northeast Brazil, from 2009 to 2019.

Methods: This was an ecological study using the joinpoint method for temporal analysis and spatial autocorrelation and scan tests to identify clusters; regression models using the ordinary least squares and geographically weighted regression methods were used to identify factors associated with mortality, considering p-value < 0.05.

Results: Maternal mortality decreased by 1.5% (95%CI; -2.5;-0.5) per year (p-value = 0.009); clusters, of deaths were found, mainly in Piauí and Maranhão, the variables associated with the maternal mortality ratio were Gini Index (β = 105.72; p-value < 0.001), municipal human development index (β = 190.91; p-value = 0.001), per capita income (β = -0.08; p-value = 0.001), Firjan Municipal Development Index-Health (β = -51.28; p-value < 0.001), life expectancy at birth (β = -3.50; p-value < 0.001).

Conclusion: There was a reduction in mortality in the period studied, with a concentration of deaths, primarily in Piauí and Maranhão; socioeconomic indicators were associated with higher mortality in the region.

Main results: There was a decrease in maternal mortality in Northeast Brazil, from 2009 to 2019. Deaths were mainly concentrated in the states of Piauí and Maranhão. Five socioeconomic indicators were associated with higher mortality in the region.

Implications for services: In order to maintain the trend of falling maternal mortality in Northeast Brazil, the need exists to reduce social inequalities and expand access to health services, especially within the scope of Primary Care.

Perspectives: Public policies are needed to expand health services in general as well as comprehensive women's health care in the Brazilian National Health System, especially for women living in contexts of greater social vulnerability.