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Malta DC, Romero-Sandoval N, Cardoso LSDM, Arcos P, Gualán M, Pescarini JM, Brickley EB, Veloso GA, Bernal RTI, Gomes CS, Kerr LRFS, Naghavi M, Cooper PJ, Barreto ML, Leyland AH. Sustainable Development Goals' health-related indicators for Brazil and Ecuador: an analysis for the period of 1990-2019. Public Health 2024; 231:88-98. [PMID: 38653016 DOI: 10.1016/j.puhe.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE This article aims to analyse the evolution of 40 Sustainable Development Goals' (SDGs) health-related indicators in Brazil and Ecuador from 1990 to 2019. STUDY DESIGN Epidemiological study of long-term trends in 40 SDGs' health-related indicators for Brazil and Ecuador from 1990 to 2019, using estimates from the Global Burden of Disease Study. METHODS Forty SDGs' health-related indicators and an index from 1990 to 2017 for Brazil and Ecuador, and their projections up to 2030 were extracted from the Institute for Health Metrics and Evaluation's Global Burden of Disease website and analysed. The percent annual change (PC) between 1990 and 2019 was calculated for both countries. RESULTS Both countries have made progress on child stunting (Brazil: PC = -38%; Ecuador: PC = -43%) and child wasting prevalences (Brazil: PC = -42%; Ecuador: PC = -41%), percent of vaccine coverage (Brazil: PC = +215%; Ecuador: PC = +175%), under-5 (Brazil: PC = -75%; Ecuador: PC = -60%) and neonatal mortality rates (Brazil: PC = -69%; Ecuador: PC = -51%), health worker density per 1000 population (Brazil: PC = +153%; Ecuador: PC = +175%), reduction of neglected diseases prevalences (Brazil: PC = -40%; Ecuador: PC = -58%), tuberculosis (Brazil: PC = -27%; Ecuador: PC = -55%) and malaria incidences (Brazil: PC = -97%; Ecuador: PC = -100%), water, sanitation and hygiene mortality rates (Brazil and Ecuador: PC = -89%). However, both countries did not show sufficient improvement in maternal mortality ratio to meet SDGs targets (Brazil: PC = -37%; Ecuador: PC = -40%). Worsening of indicators were found for violence, such as non-intimate partner violence for both countries (Brazil: PC = +26%; Ecuador: PC = +18%) and suicide mortality rate for Ecuador (PC = +66%), child overweight indicator for Brazil (PC = -67%), disaster mortality rates (Brazil: PC = +100%; Ecuador: PC = +325%) and alcohol consumption (Brazil: PC = +46%; Ecuador: PC = +35%). CONCLUSIONS Significant improvements are necessary in both countries requiring the strengthening of health and other policies, particularly concerning the prevention and management of violence and alcohol consumption, and preparedness for dealing with environmental disasters.
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Affiliation(s)
- D C Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - N Romero-Sandoval
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador.
| | - L S de M Cardoso
- Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - P Arcos
- Universidad Internacional del Ecuador, Quito, Ecuador.
| | - M Gualán
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador.
| | - J M Pescarini
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Oswaldo Cruz Foundation, Salvador, Brazil.
| | - E B Brickley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - G A Veloso
- Departamento de Estatística, Instituto de Matemática e Estatística, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
| | - R T I Bernal
- Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - C S Gomes
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - L R F S Kerr
- Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
| | - M Naghavi
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA.
| | - P J Cooper
- Institute of Infection and Immunity St. George's University of London. School of Medicine, Universidad Internacional del Ecuador, Ecuador.
| | - M L Barreto
- Centre for Data and Knowledge Integration for Health, Fiocruz Bahia, Salvador, Brazil.
| | - A H Leyland
- Social and Public Health Sciences Unit, University of Glasgow, United Kingdom.
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de Abreu MM, Monticielo OA, Fernandes V, Rodrigues DLAS, da Silva CAL, Maiorano AC, Beserra FDS, Lamarão FRM, de Veras BMG, David N, Araújo M, Alves MCR, Stocco MA, Lima FM, Borret E, Gasparin AA, Chapacais GF, Bulbol GA, da Silva Lima D, da Silva NJM, Freitas MMC, Bica BERG, de Lima DSN, das Chagas Medeiros MM. Characterization of the patterns of care, access, and direct cost of systemic lupus erythematosus in Brazil: findings from the Macunaíma study. Adv Rheumatol 2024; 64:30. [PMID: 38641825 DOI: 10.1186/s42358-024-00369-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/30/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND A cost of illness (COI) study aims to evaluate the socioeconomic burden that an illness imposes on society as a whole. This study aimed to describe the resources used, patterns of care, direct cost, and loss of productivity due to systemic lupus erythematosus (SLE) in Brazil. METHODS This 12-month, cross-sectional, COI study of patients with SLE (ACR 1997 Classification Criteria) collected data using patient interviews (questionnaires) and medical records, covering: SLE profile, resources used, morbidities, quality of life (12-Item Short Form Survey, SF-12), and loss of productivity. Patients were excluded if they were retired or on sick leave for another illness. Direct resources included health-related (consultations, tests, medications, hospitalization) or non-health-related (transportation, home adaptation, expenditure on caregivers) hospital resources.Costs were calculated using the unit value of each resource and the quantity consumed. A gamma regression model explored cost predictors for patients with SLE. RESULTS Overall, 300 patients with SLE were included (92.3% female,mean [standard deviation (SD)] disease duration 11.8 [7.9] years), of which 100 patients (33.3%) were on SLE-related sick leave and 46 patients (15.3%) had stopped schooling. Mean (SD) travel time from home to a care facility was 4.4 (12.6) hours. Antimalarials were the most commonly used drugs (222 [74.0%]). A negative correlation was observed between SF-12 physical component and SLE Disease Activity Index (- 0.117, p = 0.042), Systemic Lupus International CollaboratingClinics/AmericanCollegeofRheumatology Damage Index (- 0.115, p = 0.046), medications/day for multiple co-morbidities (- 0.272, p < 0.001), SLE-specific drugs/day (- 0.113, p = 0.051), and lost productivity (- 0.570, p < 0.001). For the mental component, a negative correlation was observed with medications/day for multiple co-morbidities (- 0.272, p < 0.001), SLE-specific medications/day (- 0.113, p = 0.051), and missed appointments (- 0.232, p < 0.001). Mean total SLE cost was US$3,123.53/patient/year (median [interquartile range (IQR)] US$1,618.51 [$678.66, $4,601.29]). Main expenditure was medication, with a median (IQR) cost of US$910.62 ($460, $4,033.51). Mycophenolate increased costs by 3.664 times (p < 0.001), and inflammatory monitoring (erythrocyte sedimentation rate or C-reactive protein) reduced expenditure by 0.381 times (p < 0.001). CONCLUSION These results allowed access to care patterns, the median cost for patients with SLE in Brazil, and the differences across regions driven by biological, social, and behavioral factors. The cost of SLE provides an updated setting to support the decision-making process across the country.
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Affiliation(s)
- Mirhelen Mendes de Abreu
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil.
- MAPEAR Laboratory, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Odirlei Andre Monticielo
- Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | | | | | | | | | | | - Marcelly Cristinny Ribeiro Alves
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
| | - Matheus Amaral Stocco
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
| | - Fernando Mello Lima
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
| | - Emilly Borret
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
| | - Andrese Aline Gasparin
- Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gustavo Flores Chapacais
- Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | - Blanca Elena Rios Gomes Bica
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
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Costa MM, Schmitz CAA, Almeida da Silveira M, Bakos RM, Umpierre RN, Gonçalves MR. Clinical Features Associated with the Demand of In-Person Care by Dermatologists: An Observational Cross-Sectional Study. Telemed J E Health 2024; 30:754-762. [PMID: 37843919 DOI: 10.1089/tmj.2023.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
Background: The factors necessitating the need for referrals for in-person evaluations by a dermatologist are not adequately understood and have not been studied using automated text mining so far. The objective of this study was to compare the prevalence of required in-person dermatologist care in the presence or absence of certain clinical features. Methods: Observational cross-sectional study of 11,661 teledermatology reports made from February 2017 to March 2020. Results: The need for dermoscopy was associated with a 348% increase in the possibility of referral for in-person dermatologist evaluations (prevalence ratio [PR]: 4.48, 95% confidence interval [CI]: 4.17-4.82). Infectious diseases were associated with a 64% lower possibility of referral (PR: 0.36, 95% CI: 0.30-0.43). Discussion: Some lesions and poorly documented cases are challenging to assess remotely. This study presents a different approach to research more detailed data from teledermatology reports, using text mining, and points out the risk magnitude for demanding dermatologic in-person care of which feature analyzed. As limitations, the variables related to lesion location, size, and extension were not analyzed and the dictionaries used were originally in Brazilian Portuguese. Conclusions: Teledermatology seems sufficient for the management of 75% of clinical cases, especially acute in young patients with inflammatory or infectious lesions. Referrals for in-person dermatologist consultations were not only strongly associated with the need for dermoscopy, but also for therapeutic reasons like surgical procedures, phototherapy, and the use of some systemic medications.
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Affiliation(s)
- Manuela Martins Costa
- Epidemiology Postgraduation Program, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Dermatology Department, Clinical Director's Office, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carlos André Aita Schmitz
- Public Health Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Primary Care Unit, Clinical Director's Office, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Renato Marchiori Bakos
- Dermatology Department, Clinical Director's Office, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Medical Sciences Postgraduation Program, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Roberto Nunes Umpierre
- Public Health Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Primary Care Unit, Clinical Director's Office, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marcelo Rodrigues Gonçalves
- Epidemiology Postgraduation Program, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Outpatient Clinical Director's Office, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Malta DC, Saltarelli RMF, Veloso GA, Gomes CS, Soares Filho AM, Vieira EWR, Felisbino-Mendes MS, Naghavi M, Ribeiro ALP. Mortality by avoidable causes in Brazil from 1990 to 2019: data from the Global Burden of Disease Study. Public Health 2024; 227:194-201. [PMID: 38237315 DOI: 10.1016/j.puhe.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/07/2023] [Accepted: 12/06/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVES The aim of this study was to analyse the trends of avoidable mortality in Brazil from 1990 to 2019 and its correlation with sociodemographic indexes (SDIs). STUDY DESIGN Epidemiological mortality trends. METHODS This study analysed data from the Global Burden of Disease database. The list of causes of avoidable death, as proposed by Nolte and McKee, was applied and included 32 causes. The current study used age-standardised mortality rates and the rates of change, in addition to a correlation analysis between avoidable death and the SDI. RESULTS Mortality rates decreased from 343.90/100,000 inhabitants in 1990 to 155.80/100,000 inhabitants in 2019. Infectious diseases showed the largest decline in mortality rates, but notable decreases were also found for diarrhoeal diseases (-94.9%), maternal conditions (-66.5%) and neonatal conditions (-60.5%). Mortality rates for non-communicable diseases (NCDs) also decreased (-48%) but maintained a similar absolute number of deaths in 2019 compared with 1990. Decreased mortality rates were also found for ischaemic heart disease (-49.1%), stroke (-61.4%) and deaths due to adverse effects caused by medical treatments (-26.2%). Avoidable mortality rates declined in all of the 27 Brazilian states, and a high correlation was found between deaths and SDI (R = -0.74; P < 0.000001). CONCLUSIONS A reduction in avoidable deaths was found throughout Brazil over the study period, although major regional inequalities were revealed. Richer states presented the best overall reduction in mortality rates. The biggest decreases in mortality were seen in maternal and paediatric infectious diseases in the poorest states due to the expansion of the Primary Health System and improvements in sanitation. Today, NCDs predominate and efforts should be made to formulate public policies for the prevention and control of NCDs.
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Affiliation(s)
- D C Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - R M F Saltarelli
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - G A Veloso
- Departamento de Estatística, Instituto de Matemática e Estatística, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - C S Gomes
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Belo Horizonte, Minas Gerais, Brazil
| | - A M Soares Filho
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Belo Horizonte, Minas Gerais, Brazil
| | - E W R Vieira
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - M S Felisbino-Mendes
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - M Naghavi
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - A L P Ribeiro
- Faculdade de Medicina, Hospital das Clínicas da UFMG, Belo Horizonte, Minas Gerais, Brazil
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Marinho MR, Garcez A, Theodoro H, Dias da Costa JS, Olinto MTA. Prevalence of Abdominal Obesity and Associated Factors in Urban Brazilian Women: A Comparison Between Two Population-Based Cross-Sectional Studies in 2003 and 2015. Metab Syndr Relat Disord 2024; 22:59-68. [PMID: 37862560 DOI: 10.1089/met.2023.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Background: Abdominal fat accumulation is a known risk factor for cardiometabolic diseases and mortality, particularly in women. This study aimed to compare the prevalence of abdominal obesity and its associated factors in 2003 and 2015. Methods: Two cross-sectional, population-based surveys were conducted, including representative and independent samples of adult women 20-60 years of age residing in the urban area of São Leopoldo/RS municipality in 2003 (n = 981) and 2015 (n = 984). Abdominal obesity was assessed using waist circumference, with a measurement of ≥88 cm indicating its presence. Factors, such as demographics, socioeconomic status, reproductive health, family history, morbidity, and behavioral characteristics, were studied. Poisson regression was used to assess the associations. Results: The mean age of individuals in the samples was 38.5 years (±11.1 years) and 40.3 years (±11.4 years) in 2003 and 2015, respectively. The prevalence of abdominal obesity doubled from 23.3% (95% confidence interval [CI]: 20.7-26.0) in 2003 to 46.9% (95% CI: 43.7-50.0) in 2015. After adjustment, the prevalence of abdominal obesity remained higher in both 2003 and 2015 with increasing age, low family income, higher number of pregnancies, earlier age at menarche, and presence of a family history of obesity in the father and mother and in women with a history of hypertension. Conclusions: This study demonstrates an increase in the prevalence of abdominal obesity in women between 2003 and 2015 and highlights the sociodemographic, reproductive, family history, and comorbidity aspects associated with its occurrence.
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Affiliation(s)
- Marcélia Ribeiro Marinho
- Postgraduate Program in Nutrition and Food, University of Vale do Rio dos Sinos, UNISINOS, São Leopoldo, Brazil
| | - Anderson Garcez
- Postgraduate Program in Nutrition Sciences, Federal University of Health Science of Porto Alegre, UFCSPA, Porto Alegre, Brazil
| | - Heloísa Theodoro
- Postgraduate Program in Department of Health Science, University of Caxias do Sul, UCS, Caxias do Sul, Brazil
| | | | - Maria Teresa Anselmo Olinto
- Postgraduate Program in Food, Nutrition, and Health, and Federal University of Rio Grande do Sul State, UFRGS, Porto Alegre, Brazil
- Postgraduate Program in Medical Sciences: Endocrinology, Federal University of Rio Grande do Sul State, UFRGS, Porto Alegre, Brazil
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Chen J, Zhu Y, Li Z, Chen X, Chen X, Xie R, Zhang Y, Ye G, Luo R, Shen X, Lin L, Zhuo Y. Temporal trends and projection of blindness and vision loss prevalence in older adults in BRICS countries. J Am Geriatr Soc 2024; 72:544-550. [PMID: 37960928 DOI: 10.1111/jgs.18672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Blindness and vision loss (BVL) is a major global health issue affecting older adults, but its burden in transition countries has received limited attention. Therefore, we aimed to assess the trends in the burden of BVL among older adults between 1990 and 2019 across Brazil, Russia, India, China, and South Africa (BRICS), and predict the burden by 2040. METHODS Data on BVL and its related causes were obtained from the Global Burden of Disease 2019 study. We investigated the temporal trends by calculating the average annual percentage change using joinpoint regression analysis. Subsequently, we performed Bayesian age-period-cohort modeling to estimate the burden of BVL and its related causes by 2040. RESULTS Most BRICS countries experienced a significant decline (p < 0.05) in age-standardized prevalence rates, and the decreasing trends tend to continue. However, by 2040, the number of BVL cases is expected to increase by approximately 50% across BRICS, with an estimated approximately 192, 170, 25, 17, and 7 million cases in China, India, Russia, Brazil, and South Africa, respectively. The related ranks of BVL causes are also estimated to change in the future, particularly in India. CONCLUSIONS The different burdens and trends of BVL across BRICS reflected the different stages of population health transition. Effective eye disease prevention requires appropriate public health interventions. Developing effective health policies and services for older adults is urgently needed in BRICS countries.
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Affiliation(s)
- Jianqi Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Zhidong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xuhao Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xiaohong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Rui Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yuan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Guitong Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Ruiyu Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xinyue Shen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Lifeng Lin
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
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de Goes ACG, Souza KAS, Tunes G, Alencar AP, Varella AC, Gooden TE, Thomas NG, Lip GY, Santos IS, Lotufo PA, Benseñor IM, Goulart AC. Predictive value of functional disability scales among stroke survivors: A long-term mortality evaluation in a Brazilian stroke cohort. J Stroke Cerebrovasc Dis 2024; 33:107487. [PMID: 37980846 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/06/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023] Open
Abstract
OBJECTIVE To assess the influence of two functional scales- Modified Rankin Scale (m-RS) and Modified Katz Index (m-Katz Index) on long-term mortality in a stroke cohort. MATERIAL AND METHODS Among 760 stroke survivors (median age: 66 (IQR:56-75), 56.4 % women) m-Katz Index and m-RS scales applied at 1 and 6 months after stroke, were investigated in relation to 12-years of all-cause mortality. Kaplan-Meier survival curves were computed, and time-varying covariate Cox regression models were fitted to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs) in all sample and by sex. The prognostic ability of the fitted models was computed for each model by six different measures. RESULTS After 12 years of follow-up (median survival time: 7.3 years), 311 participants died. Overall survival curves show lower survival rates among those with the highest levels of disability/dependence (all log-rank p-values <0.0001). These findings were confirmed in all regression models for both sexes, particularly in men who had higher levels of dependence on Activities of Daily Living (ADLs) by m-Katz Index and severe disability by m-RS and presented the highest HR of dying (HR: 3.34 (95 %CI: 2.27-4.92) and HR: 4.94 (95 % CI: 3.15-7.75), respectively). CONCLUSIONS Both the m-Katz Index and the m-RS scale were good predictors of long-term mortality, which is of importance for guiding the functional rehabilitation of stroke patients. Besides, high levels of disability and dependence were implicated with high mortality risks, regardless of sex.
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Affiliation(s)
- Ana Cristina G de Goes
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, Butantan - Cidade Universitária, São Paulo, SP CEP 05508-900, Brazil.
| | - Karla A S Souza
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, Butantan - Cidade Universitária, São Paulo, SP CEP 05508-900, Brazil
| | - Gisela Tunes
- Institute of Mathematics and Statistics, Universidade de São Paulo, Brazil
| | - Airlane P Alencar
- Institute of Mathematics and Statistics, Universidade de São Paulo, Brazil
| | - Ana C Varella
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, Butantan - Cidade Universitária, São Paulo, SP CEP 05508-900, Brazil
| | - Tiffany E Gooden
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Neil G Thomas
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gregoy Yh Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
| | - Itamar S Santos
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, Butantan - Cidade Universitária, São Paulo, SP CEP 05508-900, Brazil; School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, Butantan - Cidade Universitária, São Paulo, SP CEP 05508-900, Brazil; School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, Butantan - Cidade Universitária, São Paulo, SP CEP 05508-900, Brazil; School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, Butantan - Cidade Universitária, São Paulo, SP CEP 05508-900, Brazil; Department of Epidemiology, School of Public Health, Universidade de São Paulo, São Paulo, Brazil
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Fonseca EPD, Cruz AJS, Pereira-Junior EA, Palmier AC, Abreu MHNG. The Role of Socioeconomic and Health Services Organizational Factors on Infection Control Structure Score, Brazil. Cien Saude Colet 2024; 29:e19572022. [PMID: 38198337 DOI: 10.1590/1413-81232024291.19572022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/13/2023] [Indexed: 01/12/2024] Open
Abstract
This study aimed to analyze possible associations between the Infection Control Structure Score (ICSS), health services, and social characteristics of the municipalities in Brazil. Secondary data from the third cycle 2017-2018 of the Brazilian National Program for Improving Primary Care Access and Quality (PMAQ) was analyzed. Six independent variables - FIRJAN Index of Municipal Development, number of inhabitants, number of family health teams receiving a financial incentive from the federal government, healthcare expenditure per capita, and number of Oral Health Teams modalities 1 and 2 - were included to assess their influence on ICSS, measured for each Brazilian town. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25. A total of 4,900 municipalities were included, and the mean ICSS was 0.905 (±0.092). A positive relationship was observed between healthcare expenditure per capita, municipal development, and the outcome. Conversely, towns with a higher number of family health teams receiving a financial incentive from the federal government showed lower mean ICSS. The findings suggest that inequalities in the infection control structures exist within the country, and they were related to the health services and social characteristics of the municipalities.
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Affiliation(s)
- Emilio Prado da Fonseca
- Departamento de Odontologia Comunitária e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais (UFMG). Av. Antonio Carlos 6627, Pampulha. 31270-800 Belo Horizonte MG Brasil.
| | - Alex Junio Silva Cruz
- Departamento de Odontologia Comunitária e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais (UFMG). Av. Antonio Carlos 6627, Pampulha. 31270-800 Belo Horizonte MG Brasil.
| | | | - Andréa Clemente Palmier
- Departamento de Odontologia Comunitária e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais (UFMG). Av. Antonio Carlos 6627, Pampulha. 31270-800 Belo Horizonte MG Brasil.
| | - Mauro Henrique Nogueira Guimarães Abreu
- Departamento de Odontologia Comunitária e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais (UFMG). Av. Antonio Carlos 6627, Pampulha. 31270-800 Belo Horizonte MG Brasil.
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dos Santos AB, Bezerra ADM, Machado LDS, de Souza NKM, Pessoa VLMDP. Temporal-spatial analysis of mortality from cardiovascular diseases in the State of Ceará, Brazil, between 2009-2019. Rev Bras Epidemiol 2023; 26:e230060. [PMID: 38088719 PMCID: PMC10715321 DOI: 10.1590/1980-549720230060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To analyze the spatial distribution of mortality from cardiovascular diseases in the municipalities of the state of Ceará, Brazil, between 2009-2019. METHODS This is an ecological study with a spatial focus on the state of Ceará, considering the period from 2009 to 2019. Death data from the Brazilian Mortality Information System and population data from the Brazilian Institute of Geography and Statistics were used to calculate crude and standardized mortality rates from cardiovascular diseases. Temporal analysis was carried out using the Joinpoint Regression Program 4.9.0 software and spatial analysis of the municipalities' average mortality. The values were smoothed by the local empirical Bayesian method using QGIS 3.16. For spatial clusters, the Global and Local Moran Index was used through Moran Map and LISA Map, with analyses carried out in TerraView 4.2.2. RESULTS A total of 132,145 deaths from cardiovascular diseases were recorded in the period, with an average increase of 3% per year. Higher mortality rates were observed in men, people aged ≥80 years, mixed-race ethnicity/skin color, married, and with lower level of education. There was the formation of clusters of municipalities with high mortality rates in the regions of Vale do Jaguaribe, Sertão Central, Centro Sul, Sertão dos Inhamuns and Serra da Ibiapaba. CONCLUSION This study identified municipalities with high mortality and exposed the need for strategies aligned with the reality and particularities of these locations.
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Schramm A, Hacon SDS, Périssé ARS. Health Impact Assessment in protected areas: a proposal for urban contexts in Brazil. CAD SAUDE PUBLICA 2023; 39:e00087223. [PMID: 38055545 DOI: 10.1590/0102-311xen087223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/05/2023] [Indexed: 12/08/2023] Open
Abstract
The use of Health Impact Assessment (HIA) in the establishment of an urban protected area can enhance the positive impacts and mitigate the negative impacts resulting from its implementation. Brazil hosts some of the most important biodiversity hotspots in the world and the HIA may benefit biodiversity and human health. These areas are commonly created without any preceding survey to assess their impacts on health. Protected areas located in urban zones are essential to maintain environmental balance and quality of life in cities. It promotes positive impacts on health, providing ecosystem services and salutogenic benefits. However, they can generate negative impacts such as the violation of human rights, property speculation, spread of vectorial diseases, and psychosocial stress. Based on the identification of the potential impacts of urban protected areas on health and best practices, this qualitative and exploratory study justifies the use of HIA in urban protected areas, especially in the Brazil, and indicates the main elements for the construction of a methodological approach to contribute to the Sustainable Development Goals and one of its alternatives, the Buen Vivir approach.
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Affiliation(s)
- Ana Schramm
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Sandra de Souza Hacon
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Patriota P, Ko Maung K, Marques-Vidal P. Reported recommendations to address cardiovascular risk factors differ by socio-economic status in Brazil. Results from the Brazilian National Health Survey 2019. Prev Med Rep 2023; 36:102527. [PMID: 38116250 PMCID: PMC10728434 DOI: 10.1016/j.pmedr.2023.102527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/17/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023] Open
Abstract
Background Management of cardiovascular risk factors (high cholesterol, diabetes, and hypertension) should start by implementing a healthy lifestyle. Whereas lifestyle recommendations are provided irrespective of the patient's socio-economic status has not been recently assessed in the Brazilian population. Aims To assess the preventive measures against cardiovascular risk factors according to educational level and income in the Brazilian population. Methods Survey data of the 2019 Brazilian National Health Survey (PNS). The PNS is a nationwide household-based survey carried out by the Brazilian Ministry of Health. The PNS included face-to-face interviews and collected information on lifestyle management of high cholesterol, diabetes, and hypertension by a healthy diet, an adequate weight, exercise, and quitting smoking. The participant's educational level and income (in multiples of the basic salary per capita) was collected. Results Of the 88,052 participants included, 13,151 (14.9%), 6,986 (7.9%) and 22,516 (25.6%) reported being diagnosed with high cholesterol, diabetes, or hypertension, respectively. Dietary recommendations were the most frequently provided (94.5%, 94.6% and 88.1% for high cholesterol diabetes, and hypertension, respectively), while recommendations to quit smoking to current smokers were the least frequently provided (74.9%, 85.8% and 81.1% for high cholesterol, diabetes, and hypertension, respectively). After multivariable adjustment, participants with a higher educational level or a higher income had a higher likelihood of reporting receipt lifestyle recommendations for high cholesterol or hypertension, while no associations were found for most recommendations for diabetes. Conclusion Better-educated, wealthier Brazilians report receiving more lifestyle recommendations regarding high cholesterol and hypertension management more frequently than lower-educated or with low-income.
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Affiliation(s)
- Pollyanna Patriota
- Pôle Santé Vallée de Joux – Joux Valley Health Center, Le Sentier, Switzerland
| | - Ko Ko Maung
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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12
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Soares GH, Bado FMR, Lopes AG, Biazevic MGH, Michel-Crosato E, Mialhe FL. Structure and replicability of oral health-related quality of life networks across patients with schizophrenia and the general community. Community Dent Oral Epidemiol 2023; 51:1216-1224. [PMID: 37166109 DOI: 10.1111/cdoe.12865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/31/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Schizophrenia is a disabling mental disorder associated with severe social dysfunction. Individuals with long-term mental conditions have poorer Oral Health-Related Quality of Life (OHRQoL) compared to the general population, but little is known about the measurement properties of OHRQoL instruments in this group of patients. This study aimed to examine the replicability of OHRQoL networks across samples of the general community (GC) and patients with schizophrenia (PWS). METHODS Data were obtained from 603 community-dwelling participants and 627 patients with schizophrenia. OHRQoL was measured using the short form of the Oral Health Impact Profile (OHIP-14) questionnaire. A regularized partial correlation network was estimated for each sample. The number of dimensions and structural stability were assessed using Exploratory Graph Analysis. Global strength, edge weights and centrality estimates were compared. Network replicability was examined fitting the PWS data to the GC network structure. RESULTS A single OHIP-14 dimension was identified in the GC sample, whereas three dimensions were detected in the PWS sample. Structural consistency was perfect in the network of GC participants (1), and considerably low in at least two dimensions of the PWS network (0.28; 0.65; 0.16). A moderate correlation for node strength estimates was observed (τ: 0.43; 95% CI: 0.13, 0.72), although edge weights were not correlated (τ: 0.025; 95% CI: -0.11, 0.16). The fit of the PWS data to the GC network structure was deemed unacceptable. CONCLUSION Network models of OHRQoL did not replicate across samples of the general community and outpatients with schizophrenia. Prudent use of OHIP-14 to compare measures of OHRQoL between groups with significant cognitive impartment and the general population is recommended.
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Affiliation(s)
- Gustavo Hermes Soares
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | | | | | | | | | - Fabio Luiz Mialhe
- Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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Radfard M, Hashemi H, Baghapour MA, Samaei MR, Yunesian M, Soleimani H, Azhdarpoor A. Prediction of human health risk and disability-adjusted life years induced by heavy metals exposure through drinking water in Fars Province, Iran. Sci Rep 2023; 13:19080. [PMID: 37925586 PMCID: PMC10625539 DOI: 10.1038/s41598-023-46262-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023] Open
Abstract
Exposure to heavy metals in contaminated drinking water is strongly correlated with various cancers, highlighting the burden of disease. This study aimed to assess the non-carcinogenic and carcinogenic risks associated with exposure to heavy metals (As, Pb, Cd, and Cr) in drinking water of Fars province and evaluate the attributed burden of disease. Non-carcinogenic risk assessment was performed using the hazard quotient (HQ) method, while the carcinogenic risk assessment utilized the excess lifetime cancer risk approach. The burden of disease was evaluated in terms of years of life lost, years lived with disability, and disability-adjusted life years (DALY) for three specific cancers: skin, lung, and kidney cancer. The average drinking water concentrations of arsenic (As), cadmium (Cd), chromium (Cr) and lead (Pb) were determined to be 0.72, 0.4, 1.10 and 0.72 μg/L, respectively. The total average HQ of heavy metals in drinking water in the study area were 0.127, 0.0047, 0.0009 and 0.0069, respectively. The average ILCRs of heavy metal in the entire country were in the following order: 1.15 × 10-5 for As, 2.22 × 10-7 for Cd and 3.41 × 10-7 for Cr. The results also indicated that among the various counties analyzed, Fasa experiences the greatest burden of disease in terms of DALYs, with a value of 87.56, specifically attributed to cancers caused by exposure to arsenic. Generally, it can be said that the burden of disease is a critical aspect of public health that requires comprehensive understanding and effective intervention.
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Affiliation(s)
- Majid Radfard
- Department of Environmental Health Engineering, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Hashemi
- Department of Environmental Health Engineering, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Baghapour
- Department of Environmental Health Engineering, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Samaei
- Department of Environmental Health Engineering, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Soleimani
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abooalfazl Azhdarpoor
- Department of Environmental Health Engineering, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran.
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Cerci RJ, Fernandes-Silva MM, Vitola JV, Cerci JJ, Pereira Neto CC, Masukawa M, Gracia APW, Silvello LL, Prado P, Guedes M, Hino AAF, Baena CP. Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability. Arq Bras Cardiol 2023; 120:e20220844. [PMID: 38055417 DOI: 10.36660/abc.20220844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/16/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability Association of ischemic heart disease (adjusted for traditional risk factors and socioeconomics variables) and income level (A), and walkability z-score (B), and association of walkability z-score and income level (C). BACKGROUND Socioeconomic status has been linked to ischemic heart disease (IHD). High-income neighborhoods may expose individuals to a walking-promoting built environment for daily activities (walkability). Data from the association between income and IHD is lacking in middle-income countries. It is also uncertain whether walkability mediates this association. OBJECTIVES To investigate whether income is associated with IHD in a middle-income country and whether neighborhood walkability mediates the income-IHD association. METHODS This cross-sectional study evaluated 44,589 patients referred for myocardial perfusion imaging (SPECT-MPI). Income and walkability were derived from participants' residential census tract. Walkability quantitative score combined 4 variables: street connectivity, residential density, commercial density, and mixed land use. IHD was defined by abnormal myocardial perfusion during a SPECT-MPI study. We used adjusted mixed effects models to evaluate the association between income level and IHD, and we performed a mediation analysis to measure the percentage of the income-IHD association mediated by walkability. We considered p values below 0.01 as statistically significant. RESULTS From 26,415 participants, those living in the lowest-income tertile census tract were more physically inactive (79.1% versus 75.8% versus 72.7%) when compared to higher-income tertile census tracts (p < 0.001). Income was associated with IHD (odds ratio: 0.91 [95% confidence interval: 0.87 to 0.96] for each 1,000.00 international dollars increase in income) for both men and women equally (p for interaction = 0.47). Census tracts with a higher income were associated with better walkability (p < 0.001); however, walkability did not mediate the income-IHD association (percent mediated = -0.3%). CONCLUSIONS Income was independently associated with higher prevalence of IHD in a middle-income country irrespective of gender. Although walkability was associated with census tract income, it did not mediate the income-IHD association.
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Affiliation(s)
- Rodrigo Julio Cerci
- Quanta Diagnóstico por Imagem - Cardiovascular CT, Curitiba, PR - Brasil
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | - Miguel Morita Fernandes-Silva
- Quanta Diagnóstico por Imagem - Cardiovascular CT, Curitiba, PR - Brasil
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | | | | | | | - Margaret Masukawa
- Quanta Diagnóstico por Imagem - Cardiovascular CT, Curitiba, PR - Brasil
| | | | | | - Pedro Prado
- Quanta Diagnóstico por Imagem - Cardiovascular CT, Curitiba, PR - Brasil
| | - Murilo Guedes
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
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Zhang C, Shen Y, Wang A, Wang D, Cao L, Yue W. Cardiovascular Disease in China: Socioeconomic Status Variation in Prevalence. Risk Manag Healthc Policy 2023; 16:2077-2084. [PMID: 37841077 PMCID: PMC10575027 DOI: 10.2147/rmhp.s429224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Cardiovascular disease is the single largest contributor to global mortality and the leading cause of both death and premature death in China. Data on the association between cardiovascular disease and socioeconomic status are sparse, especially for Asian countries. Our study collected data to describe the socioeconomic status variation across cardiovascular disease using a large nationwide cross-sectional study. Methods We chose participants using the cluster sampling method, prepared a face-to-face questionnaire interview for the selected community residents, and collected information on health conditions, socioeconomic status, demographics, and comorbidities. All collected data were reported as frequencies and corresponding percentages. Linear regression and simple and multivariable logistic regression were performed to identify the prevalence variation. All statistical analyses were performed using SPSS version 26 software. Results Socioeconomic information was available for 394,688 participants (covering most provincial districts). The prevalence of cardiovascular disease was 7.9%. The prevalence was higher in rural areas than that in urban areas (rural, 8.4%; urban, 7.5%). There was a negative relationship between urbanization and cardiovascular disease prevalence. Furthermore, cardiovascular disease prevalence had a negative relationship with average earnings. Conclusion This cross-sectional analysis of socioeconomic status variation in the prevalence of cardiovascular disease in China showed a significant negative relationship between regional and individual socioeconomic status and cardiovascular disease. The results imply that governments would benefit communities by focusing on effective and targeted interventions for prevention, screening, and treatment in individuals who may be in the socioeconomic status with a high risk for cardiovascular disease.
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Affiliation(s)
- Chao Zhang
- Department of Neurology, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin University, Tianjin, People’s Republic of China
| | - Ying Shen
- Department of Traditional Chinese Medicine, Beijing Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Anxin Wang
- Department of Epidemiology, National Clinical Research Center for Neurological Diseases, Beijing TianTan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Da Wang
- Department of Medical Administration, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, People’s Republic of China
| | - Lei Cao
- Department of Neurology, Nation Project Office of Stroke Prevention and Control, Beijing, People’s Republic of China
| | - Wei Yue
- Department of Neurology, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin University, Tianjin, People’s Republic of China
- Department of Medical Administration, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, People’s Republic of China
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Parajára MDC, Machado ÍE, Verly-Junior E, Menezes MCD, Nilson EAF, Meireles AL. Burden of ischemic heart disease attributable to trans fatty acids, 1990-2019. Clin Nutr ESPEN 2023; 57:272-280. [PMID: 37739668 DOI: 10.1016/j.clnesp.2023.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIM The impact of cardiovascular disease attributable to trans fatty acids (TFAs) in the Brazilian population has not been systematically evaluated. This study aims to analyze the burden of ischemic heart disease (IHD) attributable to TFAs in Brazil between 1990 and 2019. METHODS Data from the Global Burden of Disease Study 2019 were used to investigate the attributable burden in Brazil and its 27 federative units, for both sexes-pooled adults aged ≥25 years. Mortality and disability-adjusted life years (DALYs) from IHD attributable to TFAs were expressed as crude and age-standardized rates and differences from 1990 to 2019 by percentage and annualized rate of change. Linear regression was used to investigate trends. National voluntary and regulatory policies for industrial TFAs (iTFAs) implemented until 2019, summary exposure value (SEV) and sociodemographic index (SDI) were examined. RESULTS Between 1990 and 2019, crude and age-standardized mortality rates from IHD attributable to TFAs decreased by -15.9% and -58.0%, respectively, in Brazil. A decrease in crude (-23.3%) and age-standardized (-56.4%) DALY rates of IHD attributable to TFAs was also noticed in the country. States of the South, Southeast, and the Federal District had the largest declines of IHD attributable to TFAs, while states of the Northeast and North had the smallest or even an increase. The policies already adopted had little effect on the IHD burden. A lower SEV and higher SDI value seemed to reduce the burden of IHD. CONCLUSIONS Although a downward trend in IHD attributable to TFAs and a reduction in exposure to TFAs were observed, this burden is still relevant in Brazil, reinforcing the importance of diet policies, such as banning iTFAs.
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Affiliation(s)
- Magda do Carmo Parajára
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Ísis Eloah Machado
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil; Department of Family Medicine, Mental and Collective Health, Medical School, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Eliseu Verly-Junior
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana Carvalho de Menezes
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil; Department of Clinical and Social Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | | | - Adriana Lúcia Meireles
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil; Department of Clinical and Social Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
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Brant LCC, Pinheiro PC, Passaglia LG, de Souza MFM, Malta DC, Banerjee A, Ribeiro ALP, Nascimento BR. Cardiovascular mortality in Brazil during the COVID-19 pandemic: a comparison between underlying and multiple causes of death. Public Health 2023; 224:131-139. [PMID: 37776607 DOI: 10.1016/j.puhe.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has differentially impacted cardiovascular disease (CVD) mortality worldwide. Causes of death misclassification may be one of the reasons. We evaluated the impact of the pandemic on CVD mortality in Brazil, comparing underlying causes (UCs) and multiple causes (MCs) of death. STUDY DESIGN Ecological time-series study. METHODS An ecological, time-series study was conducted analysing age-standardised death rates for CVD, from epidemiological week (EW) 10/2020 to 39/2021, using data from the Mortality Information System, Brazil. CVD was defined using the International Classification of Diseases (ICD-10) coding, if reported as UC or MC of death. Observed and expected data (mean for the same EW, 2017-2019) were compared. Risk ratios (RiRs) were analysed, and 95% confidence intervals (CIs) were calculated. RESULTS Age-standardised mortality rate for CVD as UC of death was 165.8 (95%CI: 165.4-166.3) per 100,000 inhabitants, similar to what was expected (165.6/100,000, 95%CI: 165.2-166.1, RiR = 1.00). There was increased out-of-hospital mortality (RiR = 1.18; 95%CI: 1.17-1.19) and deaths of ill-defined causes (RiR = 1.43; 95%CI: 1.42-1.44). The increase in out-of-hospital deaths was more pronounced in the North (RiR = 1.33; 95%CI 1.30-1.36) region, with a less resilient health system. Conversely, as MCs of death, there was a 10% increase in CVD mortality (observed: 243.2 [95%CI: 242.7-243.7], expected: 221.6 [95%CI: 221.1-222.1] per 100,000). An increase also occurred in the North and Central West regions (RiR = 1.16; 95%CI: 1.15-1.18), among men (RiR = 1.11; 95%CI: 1.11-1.12) and individuals aged ≥60 years (RiR = 1.11; 95%CI: 1.10-1.11). CONCLUSIONS During the pandemic, mortality rates for CVD as MCs of death increased in Brazil, whereas as UC mortality rates did not change. Higher out-of-hospital mortality, misclassification, and competing causes of death may explain this pattern.
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Affiliation(s)
- L C C Brant
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - P C Pinheiro
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - L G Passaglia
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - M F M de Souza
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Vital Strategies, São Paulo, SP, Brazil
| | - D C Malta
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - A Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - A L P Ribeiro
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - B R Nascimento
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Serviço de Hemodinâmica do Hospital Madre Teresa, Belo Horizonte, MG, Brazil
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Gomes CLR, Cleto-Yamane TL, Ruzani F, Suassuna JHR. Socioeconomic Influences on the Outcomes of Dialysis-Requiring Acute Kidney Injury in Brazil. Kidney Int Rep 2023; 8:1772-1783. [PMID: 37705894 PMCID: PMC10496017 DOI: 10.1016/j.ekir.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/03/2023] [Accepted: 06/05/2023] [Indexed: 09/15/2023] Open
Abstract
Introduction Although research suggests that socioeconomic deprivation is linked to a higher incidence of acute kidney injury (AKI) and worse outcomes in high-income countries, there is limited knowledge about these epidemiologic factors in developing countries. In addition, the impact of medical institution administration (private versus public) on AKI outcomes remains to be determined. Methods We studied 15,186 pediatric and adult patients with dialysis-requiring AKI (AKI-D) admitted to private and public hospitals in Rio de Janeiro, Brazil. According to Brazil's demographic census, socioeconomic indicators were derived from patient zip codes. Propensity score matching analysis and a mixed-effect Cox regression were used to assess the impact of socioeconomic indicators and hospital governance on patient survival. Results Crude mortality rates were higher in private hospitals than in public hospitals (71.8% vs. 59.5%, P < 0.001) and were associated with significant differences in age (75 years, interquartile range [IQR]: 61-83 vs. 53 years, IQR: 31-66), baseline renal function (prevalence of chronic kidney disease [CKD]: 33.2% vs. 23%, P < 0.001), comorbidities (Charlson score: 2.03 ± 0.87 vs. 1.72 ± 0.75, P < 0.001), and severity of presentation (mechanical ventilation: 76.5% vs. 58% and vasopressors: 72.8% vs. 50.5%, P < 0.001). After adjustments and propensity score matching, we found no effect of different hospital administrations or socioeconomic factors on mortality. Baseline characteristics and the severity of presentation primarily influenced AKI-D prognosis. Conclusions Despite significant racial and socioeconomic differences in hospital governance, these indicators had no independent influence on mortality. Future epidemiologic studies should investigate these relevant assumptions to allow healthcare systems to manage this severe syndrome promptly.
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Affiliation(s)
- Conrado Lysandro Rodrigues Gomes
- Clinical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Faculty of Medical Sciences, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Kidney Assistance Ltd., Rio de Janeiro, Brazil
| | - Thais Lyra Cleto-Yamane
- Clinical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Faculty of Medical Sciences, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Frederico Ruzani
- Clinical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Faculty of Medical Sciences, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Kidney Assistance Ltd., Rio de Janeiro, Brazil
| | - José Hermógenes Rocco Suassuna
- Clinical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Faculty of Medical Sciences, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Kidney Assistance Ltd., Rio de Janeiro, Brazil
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GBD 2019 Australia Collaborators. The burden and trend of diseases and their risk factors in Australia, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Public Health 2023; 8:e585-99. [PMID: 37516475 DOI: 10.1016/S2468-2667(23)00123-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND A comprehensive understanding of temporal trends in the disease burden in Australia is lacking, and these trends are required to inform health service planning and improve population health. We explored the burden and trends of diseases and their risk factors in Australia from 1990 to 2019 through a comprehensive analysis of the Global Burden of Disease Study (GBD) 2019. METHODS In this systematic analysis for GBD 2019, we estimated all-cause mortality using the standardised GBD methodology. Data sources included primarily vital registration systems with additional data from sample registrations, censuses, surveys, surveillance, registries, and verbal autopsies. A composite measure of health loss caused by fatal and non-fatal disease burden (disability-adjusted life-years [DALYs]) was calculated as the sum of years of life lost (YLLs) and years of life lived with disability (YLDs). Comparisons between Australia and 14 other high-income countries were made. FINDINGS Life expectancy at birth in Australia improved from 77·0 years (95% uncertainty interval [UI] 76·9-77·1) in 1990 to 82·9 years (82·7-83·1) in 2019. Between 1990 and 2019, the age-standardised death rate decreased from 637·7 deaths (95% UI 634·1-641·3) to 389·2 deaths (381·4-397·6) per 100 000 population. In 2019, non-communicable diseases remained the major cause of mortality in Australia, accounting for 90·9% (95% UI 90·4-91·9) of total deaths, followed by injuries (5·7%, 5·3-6·1) and communicable, maternal, neonatal, and nutritional diseases (3·3%, 2·9-3·7). Ischaemic heart disease, self-harm, tracheal, bronchus, and lung cancer, stroke, and colorectal cancer were the leading causes of YLLs. The leading causes of YLDs were low back pain, depressive disorders, other musculoskeletal diseases, falls, and anxiety disorders. The leading risk factors for DALYs were high BMI, smoking, high blood pressure, high fasting plasma glucose, and drug use. Between 1990 and 2019, all-cause DALYs decreased by 24·6% (95% UI 21·5-28·1). Relative to similar countries, Australia's ranking improved for age-standardised death rates and life expectancy at birth but not for YLDs and YLLs between 1990 and 2019. INTERPRETATION An important challenge for Australia is to address the health needs of people with non-communicable diseases. The health systems must be prepared to address the increasing demands of non-communicable diseases and ageing. FUNDING Bill & Melinda Gates Foundation.
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Loret de Mola C, Carpena MX, Dias IM, Meucci R, Goicochea-Romero A, Cesar J. Sleep and its association with depressive and anxiety symptoms during the last weeks of pregnancy: A population-based study. Sleep Health 2023; 9:482-488. [PMID: 37391279 DOI: 10.1016/j.sleh.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 04/21/2023] [Accepted: 05/03/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To evaluate the association between sleep characteristics and depressive and anxiety symptoms during the immediate postpartum period. METHODS People who had hospital births during 2019 in the municipality of Rio Grande (southern Brazil) were assessed with a standardized questionnaire concerning sociodemographic (eg, age and self-reported skin color) and health-related variables (eg, parity and stillbirth) (n = 2314) 24-48 hours after birth. We used the Munich Chronotype Questionnaire to assess sleep latency, inertia, duration, and chronotype; the Edinburgh Postpartum Depression Scale for depressive symptoms; and the General Anxiety Disorder 7-Item Scale to evaluate anxiety symptoms. We used logistic regression models to calculate odds ratios. RESULTS The prevalence of depressive symptoms was 13.7%, and of anxiety symptoms was 10.7%. Depressive symptoms were more likely in those with vespertine chronotype (odds ratios = 1.63; 95% CI: 1.14-2.35) and those with a sleep latency of more than 30 minutes (OR = 2.36; 95% CI: 1.68-3.32). The probability of depressive symptoms decreased by 16% for each additional hour of sleep (OR = 0.84; 95% CI: 0.77-0.92). Sleep inertia of 11-30 minutes increased the probability of anxiety on free days (OR = 1.73; 95% CI: 1.27-2.36) and increased the probability of depressive (OR = 2.68; 95% CI: 1.82-3.83) and anxiety symptoms (OR = 1.69; 95%CI: 1.16-2.44) on workdays. CONCLUSION Participants with vespertine chronotype or shorter sleep duration were more likely to have depressive symptoms. Those who took more time to fall asleep or get out of bed were more likely to have both anxiety and depressive symptoms, but the association was stronger for depressive symptoms.
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Affiliation(s)
- Christian Loret de Mola
- Programa de Pós-Graduação em Saúde Pública, FURG, Rio Grande, RS, Brazil; Grupo de Pesquisa e Inovação em Saúde, Universidade Federal do Rio Grande (FURG), Rio Grande, RS, Brazil; Universidad Cientifica del Sur, Lima, Peru.
| | - Marina X Carpena
- Grupo de Pesquisa e Inovação em Saúde, Universidade Federal do Rio Grande (FURG), Rio Grande, RS, Brazil; Programa de Pós-Graduação em Epidemiologia da Universidade Federal de Pelotas (UFPel), Pelotas, RS, Brazil
| | - Ingrid Moura Dias
- Programa de Pós-Graduação em Saúde Pública, FURG, Rio Grande, RS, Brazil
| | - Rodrigo Meucci
- Programa de Pós-Graduação em Saúde Pública, FURG, Rio Grande, RS, Brazil
| | | | - Juraci Cesar
- Programa de Pós-Graduação em Saúde Pública, FURG, Rio Grande, RS, Brazil
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Henriques Franca M, Bharat C, Novello E, Hwang I, Medina-Mora ME, Benjet C, Andrade LH, Vigo DV, Viana MC. Towards measuring effective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in São Paulo metropolitan area, Brazil. Int J Ment Health Syst 2023; 17:19. [PMID: 37328832 DOI: 10.1186/s13033-023-00583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/18/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) contributes to a significant proportion of disease burden, disability, economic losses, and impact on need of treatment and health care in Brazil, but systematic information about its treatment coverage is scarce. This paper aims to estimate the gap in treatment coverage for MDD and identify key bottlenecks in obtaining adequate treatment among adult residents in the São Paulo Metropolitan area, Brazil. METHODS A representative face-to-face household survey was conducted among 2942 respondents aged 18+ years to assess 12-month MDD, characteristics of 12-month treatment received, and bottlenecks to deliver care through the World Mental Health Composite International Diagnostic Interview. RESULTS Among those with MDD (n = 491), 164 (33.3% [SE, 1.9]) were seen in health services, with an overall 66.7% treatment gap, and only 25.2% [SE, 4.2] received effective treatment coverage, which represents 8.5% of those in need, with a 91.5% gap in adequate care (66.4% due to lack of utilization and 25.1% due to inadequate quality and adherence). Critical service bottlenecks identified were: use of psychotropic medication (12.2 percentage points drop), use of antidepressants (6.5), adequate medication control (6.8), receiving psychotherapy (19.8). CONCLUSIONS This is the first study demonstrating the huge treatment gaps for MDD in Brazil, considering not only overall coverage, but also identifying specific quality- and user-adjusted bottlenecks in delivering pharmacological and psychotherapeutic care. These results call for urgent combined actions focused in reducing effective treatment gaps within services utilization, as well as in reducing gaps in availability and accessibility of services, and acceptability of care for those in need.
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Affiliation(s)
- Mariane Henriques Franca
- Post-Graduate Program in Public Health, Federal University of Espirito Santo, Vitória, ES, Brazil.
- National Drug & Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Chrianna Bharat
- National Drug & Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | | | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | | | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Laura Helena Andrade
- Nucleo de Epidemiologia Psiquiatrica, Departamento e Instituto de Psiquiatria, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo-LIM 23, Sao Paulo, Brazil
| | - Daniel V Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Maria Carmen Viana
- Department of Social Medicine and Post-Graduate Program in Public Health, Federal University of Espirito Santo, Vitoria, ES, Brazil
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Pereira CC, Pedroso CF, Batista SRR, Guimarães RA. Prevalence and factors associated with multimorbidity in adults in Brazil, according to sex: a population-based cross-sectional survey. Front Public Health 2023; 11:1193428. [PMID: 37342274 PMCID: PMC10278573 DOI: 10.3389/fpubh.2023.1193428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/12/2023] [Indexed: 06/22/2023] Open
Abstract
Introduction Multimorbidity, defined as the coexistence of two or more chronic diseases in the same individual, represents a significant health challenge. However, there is limited evidence on its prevalence and associated factors in developing countries, such as Brazil, especially stratified by sex. Thus, this study aims to estimate the prevalence and analyze the factors associated with multimorbidity in Brazilian adults according to sex. Methods Cross-sectional population-based household survey carried out with Brazilian adults aged 18 years or older. The sampling strategy consisted of a three-stage conglomerate plan. The three stages were performed through simple random sampling. Data were collected through individual interviews. Multimorbidity was classified based on a list of 14 self-reported chronic diseases/conditions. Poisson regression analysis was performed to estimate the magnitude of the association between sociodemographic and lifestyle factors with the prevalence of multimorbidity stratified by sex. Results A total of 88,531 individuals were included. In absolute terms, the prevalence of multimorbidity was 29.4%. The frequency in men and women was 22.7 and 35.4%, respectively. Overall, multimorbidity was more prevalent among women, the older people, residents of the South and Southeast regions, urban area residents, former smokers, current smokers, physically inactive, overweight, and obese adults. Individuals with complete high school/incomplete higher education had a lower prevalence of multimorbidity than those with higher educational level. The associations between education and multimorbidity differed between sexes. In men, multimorbidity was inversely associated with the strata of complete middle school/incomplete high school and complete high school/incomplete higher education, while in women, the association between these variables was not observed. Physical inactivity was positively associated with a higher prevalence of multimorbidity only in men. An inverse association was verified between the recommended fruit and vegetable consumption and multimorbidity for the total sample and both sexes. Conclusion One in four adults had multimorbidity. Prevalence increased with increasing age, among women, and was associated with some lifestyles. Multimorbidity was significantly associated with educational level and physical inactivity only in men. The results suggest the need to adopt integrated strategies to reduce the magnitude of multimorbidity, specific by gender, including actions for health promotion, disease prevention, health surveillance and comprehensive health care in Brazil.
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Affiliation(s)
| | | | - Sandro Rogério Rodrigues Batista
- Department of Internal Medicine, School of Medicine, Federal University of Goiás, Goiânia, Brazil
- Federal District Health Department, Brasília, Brazil
| | - Rafael Alves Guimarães
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
- Faculty of Nursing, Federal University of Goiás, Goiânia, Brazil
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Einsfeld L, do Canto Olegário I, Fagundes ML. Intersecting care through specialized pharmacists: A case report of residency rotation focused on the new horizon of cardio-oncology. Curr Pharm Teach Learn 2023:S1877-1297(23)00084-9. [PMID: 37183144 DOI: 10.1016/j.cptl.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 02/27/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND PURPOSE Cardio-oncology is a nascent discipline in the synergy of clinical cardiology and oncology, aiming to improve antineoplastic therapies, whilst minimizing cardiovascular toxicities. It requires a multidisciplinary approach with particular knowledge to build individualized care for patients. As part of multidisciplinary teams, pharmacists are uniquely positioned to play a role in the management of these patients, being responsible for monitoring adverse reactions and having an active approach in preventing drug-related morbidity. However, despite the existence of oncology and cardiology residency pharmacy programs, and the burden of cancer and cardiovascular diseases, there is a lack of data regarding pharmacists training focusing on cardio-oncology. EDUCATIONAL ACTIVITY AND SETTING A 15-days rotation was built to develop knowledge and clinical skills on pharmacological cardiovascular management of patients in a hemato-oncology residency program. The hospital where the rotation was offered is a 900-bed university hospital in Porto Alegre, south of Brazil. The rotation was designed for a postgraduate year 2 (PGY2) onco-hematology pharmacy resident and mentored by two staff clinical pharmacists from the cardiology field. The rotation schedule was distributed to reach three different approaches of learning: theoretical, practical-theoretical and practical. Activities were proposed aiming to provide experiences in cardiac care for the PGY2 resident, and clinical activities with patients were developed in both inpatient and outpatient settings. After the end of the 15 days rotation period, an evaluation was carried out by the PGY2 resident together with the staff menthors. FINDINGS This is the first cardio-oncology pharmacist rotation described in our country. The rotation was considered positive by residents evaluation on providing a clinical experience through cardiotoxicity management of oncology protocols. SUMMARY Collaborations between cardiology and oncology clinical pharmacy teams, and the multidisciplinary teams as well, can help provide structured cardio-oncology rotation opportunities for pharmacy residents.being the team's specialist on antineoplastic agents monitoring and preventable drug related morbidity, the pharmacist can contribute to achieve better outcomes to patients with cancer.
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Affiliation(s)
- Lidia Einsfeld
- Clinical Pharmacy Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350 - room 935 A block, Porto Alegre, RS 90035-903, Brazil.
| | - Isadora do Canto Olegário
- Oncology Pharmacy, Hospital Santa Rita, Irmandade da Santa Casa de Misericórdia Porto Alegre, Porto Alegre, RS, Brazil
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Lei Y, Wang J, Wang Y, Xu C. Geographical evolutionary pathway of global tuberculosis incidence trends. BMC Public Health 2023; 23:755. [PMID: 37095497 PMCID: PMC10123998 DOI: 10.1186/s12889-023-15553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUNDS Tuberculosis (TB) remains a serious public health and human development problem, especially in developing countries. Despite the effectiveness of directly observed therapy, short course programs in reducing transmission and progression of TB, poverty reduction and socioeconomic development remain crucial factors in decreasing TB incidence. However, the geographical pathway on the planet is not yet clear. OBJECTIVES This study was to reconstruct the geographical evolutionary process of TB in 173 countries and territories from 2010 to 2019 to analyze the socioeconomic determinants that impact the global TB epidemic. In addition, the TB incidence in 2030 was predicted. METHODS This study analyses TB incidence data from 173 countries and territories between 2010 and 2019. The Geotree model would be used to reconstruct the geographical evolutionary process of TB, which provides a simplified schema for geo-visualizing the trajectories of TB incidence and their socioeconomic drivers. Additionally, to estimate the future TB incidence in 2030, a multilevel model was utilized in conjunction with the hierarchical nature of the Geotree based on a stratified heterogeneity analysis. RESULTS Global TB incidence was found to be associated with the country type and development stages. Between 2010 and 2019, the average TB incidence rate in 173 countries and territories was -27.48%, with marked spatially stratified heterogeneity by country type and development stage. Low-income and lower-middle-income countries were most vulnerable to TB. Upper-middle-income countries experienced a faster decline in TB incidence than high-income countries, and TB incidence generally decreased as the development stage increased, except for the lower-middle development stage in 2019.The highest average rate of decline in TB incidence was observed in the upper-middle development stage of high-income countries, with a reduction of 45.24%. Meanwhile, 37 high-income countries in the high development stage demonstrated an average rate of change of -13.93%. Socioeconomic determinants, including gross domestic product per capita, urbanization rate, and sociodemographic index, were found to inhibit TB incidence. Based on current trends, the predicted average global TB incidence in 2030 is 91.581 per 100,000 population. CONCLUSIONS The trajectories of the global TB incidence have been reconstructed to formulate targeted public health responses. To eliminate TB, countries at similar development stage can draw on the experiences of countries at higher development stages that are tailored to their unique characteristics. By learning from successful TB control strategies, countries can take strategic steps toward eradicating TB and improving public health outcomes.
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Affiliation(s)
- Yanhui Lei
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jinfeng Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Yang Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Chengdong Xu
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
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Fonseca SF, Ribeiro ALP, Cimini CCR, Soares TBDC, Delfino-Pereira P, Nogueira LT, Moura RMF, Motta-Santos D, Ribeiro LB, Camargos MCS, Paixão MC, Pires MC, Batchelor J, Marcolino MS. Scale up of implementation of a multidimensional intervention to enhance hypertension and diabetes care at the primary care setting: A protocol for a cluster-randomized study in Brazil. Am Heart J 2023; 262:119-130. [PMID: 37044364 DOI: 10.1016/j.ahj.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Hypertension and diabetes mellitus (DM) are highly prevalent in low and middle-income countries (LMICs), and the proportion of patients with uncontrolled diseases is higher than in high-income countries. Innovative strategies are required to surpass barriers of low sources, distance and quality of health care. Our aim is to assess the uptake and effectiveness of the implementation of an integrated multidimensional strategy in the primary care setting, for the management of people with hypertension and diabetes mellitus in Brazil. METHODS This scale up implementation study called Control of Hypertension and diAbetes in MINas Gerais (CHArMING) Project has mixed-methods, and comprehends 4 steps: (1) needs assessment, including a standardized structured questionnaire and focus groups with health care practitioners; (2) baseline period, 3 months before the implementation of the intervention; (3) cluster randomized controlled trial (RCT) with a 12-months follow-up period; and (4) a qualitative study after the end of follow-up. The cluster RCT will randomize 35 centers to intervention (n = 18) or usual care (n = 17). Patients ≥18 years old, with diagnosis of hypertension and/or DM, of 5 Brazilian cities in a resource-constrained area will be enrolled. The intervention consists of a multifaceted strategy, with a multidisciplinary approach, including telehealth tools (decision support systems, short message service, telediagnosis), continued education with an approach to issues related to the care of people with hypertension and diabetes in primary care, including pharmacological and non-pharmacological treatment and behavioral change. The project has actions focused on professionals and patients. CONCLUSIONS This study consists of a multidimensional strategy with multidisciplinary approach using digital health to improve the control of hypertension and/or DM in the primary health care setting. We expect to provide the basis for implementing an innovative management program for hypertension and DM in Brazil, aiming to reduce the present and future burden of these diseases in Brazil and other LMICs. CLINICAL TRIAL IDENTIFIER This study was registered in ClinicalTrials.gov. (NCT05660928).
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Affiliation(s)
- Sueli Ferreira Fonseca
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri. Diamantina, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Cardiology Service, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil.; Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS). Porto Alegre, Brazil
| | - Christiane Correa Rodrigues Cimini
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri. Teófilo Otoni, Brazil
| | | | - Polianna Delfino-Pereira
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS). Porto Alegre, Brazil
| | - Lucas Tavares Nogueira
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil
| | - Regina Marcia Faria Moura
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil
| | - Daisy Motta-Santos
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil
| | - Leonardo Bonisson Ribeiro
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil
| | | | - Maria Cristina Paixão
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil
| | - Magda Carvalho Pires
- Department of Statistics, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil
| | - James Batchelor
- Clinical Informatics Research Unit, University of Southampton, Southampton United Kingdom
| | - Milena Soriano Marcolino
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais. Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS). Porto Alegre, Brazil.
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Parisotto G, Reis LFF, Junior MS, Papathanasiou J, Lopes AJ, Ferreira AS. Association of Multiple Cardiovascular Risk Factors with Musculoskeletal Function in Acute Coronary Syndrome Ward Inpatients. Healthcare (Basel) 2023; 11:healthcare11070954. [PMID: 37046881 PMCID: PMC10093940 DOI: 10.3390/healthcare11070954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
This study explored the association of multiple risk factors with musculoskeletal function in adults hospitalized for acute coronary syndrome. Sixty-nine inpatients (55 ± 6 years; 67% male) admitted to the cardiology ward within <12 h were assessed regarding stress, smoking, alcoholism, hypertension, diabetes mellitus, and obesity. The musculoskeletal function was assessed by predicted values of handgrip strength of the dominant hand (HGS-D%) and maximal inspiratory and expiratory pressures (MIP% and MEP%, respectively). After adjustment by age and sex, drinking habits showed the strongest linear association with the total number of cardiovascular disease risk factors [standardized ß, p-value] (ß = 0.110, p < 0.001), followed by smoking load (ß = 0.028, p = 0.009). Associations were also observed for HGS-D% with mean blood pressure (ß = 0.019 [0.001; 0.037], p = 0.048); MIP% with mean blood pressure (ß = 0.025 [0.006; 0.043], p = 0.013); and MEP% with drinking habits (ß = 0.009 [0.002; 0.016], p = 0.013) and body mass index (ß = 0.008 [0.000; 0.015], p = 0.035). Peripheral and respiratory muscle strength must be interpreted in the context of its association with cardiovascular disease risk factors in adults hospitalized for acute coronary syndrome.
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Affiliation(s)
- Gabriel Parisotto
- Postgraduate Program of Rehabilitation Sciences, Augusto Motta University Center/UNISUAM, Rio de Janeiro 21032-060, Brazil; (G.P.); (L.F.F.R.); (A.J.L.)
| | - Luis Felipe Fonseca Reis
- Postgraduate Program of Rehabilitation Sciences, Augusto Motta University Center/UNISUAM, Rio de Janeiro 21032-060, Brazil; (G.P.); (L.F.F.R.); (A.J.L.)
| | | | - Jannis Papathanasiou
- Department of Medical Imaging, Allergology & Physiotherapy, Faculty of Dental Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
- Department of Kinesitherapy, Faculty of Public Health, Medical University of Sofia, 1431 Sofia, Bulgaria
| | - Agnaldo José Lopes
- Postgraduate Program of Rehabilitation Sciences, Augusto Motta University Center/UNISUAM, Rio de Janeiro 21032-060, Brazil; (G.P.); (L.F.F.R.); (A.J.L.)
| | - Arthur Sá Ferreira
- Postgraduate Program of Rehabilitation Sciences, Augusto Motta University Center/UNISUAM, Rio de Janeiro 21032-060, Brazil; (G.P.); (L.F.F.R.); (A.J.L.)
- Correspondence: ; Tel.: +55-2138-829-797 (ext. 2012)
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Yuan M, Ren BC, Wang Y, Ren F, Gao D. Development of a novel tool: a nomogram for predicting in-hospital mortality of patients in intensive care unit after percutaneous coronary intervention. BMC Anesthesiol 2023; 23:5. [PMID: 36609220 PMCID: PMC9817262 DOI: 10.1186/s12871-022-01923-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/22/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUNDS Increased risk of in-hospital mortality is critical to guide medical decisions and it played a central role in intensive care unit (ICU) with high risk of in-hospital mortality after primary percutaneous coronary intervention (PCI). At present,most predicting tools for in-hospital mortality after PCI were based on the results of coronary angiography, echocardiography, and laboratory results which are difficult to obtain at admission. The difficulty of using these tools limit their clinical application. This study aimed to develop a clinical prognostic nomogram to predict the in-hospital mortality of patients in ICU after PCI. METHODS We extracted data from a public database named the Medical Information Mart for Intensive Care (MIMIC III). Adult patients with coronary artery stent insertion were included. They were divided into two groups according to the primary outcome (death in hospital or survive). All patients were randomly divided into training set and validation set randomly at a ratio of 6:4. Least absolute shrinkage and selection operator (LASSO) regression was performed in the training set to select optimal variables to predict the in-hospital mortality of patients in ICU after PCI. The multivariate logistical analysis was performed to develop a nomogram. Finally, the predictive efficiency of the nomogram was assessed by area under the receiver operating characteristic curve (AUROC),integrated discrimination improvement (IDI), and net reclassification improvement (NRI), and clinical net benefit was assessed by Decision curve analysis (DCA). RESULTS A total of 2160 patients were recruited in this study. By using LASSO, 17 variables were finally included. We used multivariate logistic regression to construct a prediction model which was presented in the form of a nomogram. The calibration plot of the nomogram revealed good fit in the training set and validation set. Compared with the sequential organ failure assessment (SOFA) and scale for the assessment of positive symptoms II (SAPS II) scores, the nomogram exhibited better AUROC of 0.907 (95% confidence interval [CI] was 0.880-0.933, p < 0.001) and 0.901 (95% CI was 0.865-0.936, P < 0.001) in the training set and validation set, respectively. In addition, DCA of the nomogram showed that it could achieve good net benefit in the clinic. CONCLUSIONS A new nomogram was constructed, and it presented excellent performance in predicting in-hospital mortality of patients in ICU after PCI.
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Affiliation(s)
- Miao Yuan
- grid.43169.390000 0001 0599 1243Cardiology diseases department, Xi’an Jiaotong University Second Affiliated Hospital, NO.157 Xiwu Rd, Xi’an, China
| | - Bin Cheng Ren
- grid.43169.390000 0001 0599 1243Cardiology diseases department, Xi’an Jiaotong University Second Affiliated Hospital, NO.157 Xiwu Rd, Xi’an, China
| | - Yu Wang
- grid.43169.390000 0001 0599 1243Cardiology diseases department, Xi’an Jiaotong University Second Affiliated Hospital, NO.157 Xiwu Rd, Xi’an, China
| | - Fuxian Ren
- grid.440747.40000 0001 0473 0092Department of Cardiology, Meishan Brach of the Third Affiliated Hospital, Yanan University School of Medical, Meishan, Sichuan People’s Republic of China
| | - Dengfeng Gao
- grid.43169.390000 0001 0599 1243Cardiology diseases department, Xi’an Jiaotong University Second Affiliated Hospital, NO.157 Xiwu Rd, Xi’an, China
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Ferreira PC, Marcon SS, Teston EF, Vieira VCDL, Souza RRD, Lopes MCDL, Marquete VF, Rossi RM. Factors associated with demand for emergency medical services by people with hypertension and diabetes. Rev Bras Enferm 2023; 76:e20220147. [PMID: 37162044 PMCID: PMC10165965 DOI: 10.1590/0034-7167-2022-0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 11/17/2022] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVES to analyze the association between recurrence of emergency service visits due to lack of blood pressure and/or glycemic control with sociodemographic variables and disease registration in Primary Care. METHODS quantitative study, which consulted medical records of people who attended these services two or more times for 26 months. Descriptive statistics and multiple logistic regression models were used in analysis. RESULTS most people did not have hypertension and/or diabetes record in their Primary Care records. The absence of this record was more frequent in males, aged between 18 and 59 years, with low education and lack of blood pressure. There was association between greater number of people seeking these services in the same year and not monitoring the chronic condition in specialized care. CONCLUSIONS people who do not follow up hypertension and/or diabetes in Primary Care are more likely to need assistance due to blood pressure and/or glycemic management.
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Affiliation(s)
| | | | - Elen Ferraz Teston
- Universidade Federal de Mato Grosso do Sul. Campo Grande, Mato Grosso do Sul, Brazil
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Nilson EAF, Gianicchi B, Ferrari G, Rezende LFM. The projected burden of non-communicable diseases attributable to overweight in Brazil from 2021 to 2030. Sci Rep 2022; 12:22483. [PMID: 36577769 PMCID: PMC9795442 DOI: 10.1038/s41598-022-26739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
Although studies have quantified the current burden of diseases attributable to overweight and obesity in Brazil, none have estimated its burden in the future. The study aimed to estimate the potential impact of different scenarios of changes in the prevalence of overweight on non-communicable diseases (NCD) in the Brazilian adult population until 2030. We developed a multistate life table model including 11 body mass index (BMI) related diseases to estimate attributable NCDs cases and deaths under the following scenarios of changes in overweight over a 10-year simulation: (1) the continuity of the current trajectory of BMI increases, (2) reducing the rate of increase by half, (3) stopping future BMI increases, and (4) the reduction of the prevalence of overweight by 6.7%. In Brazil, if the current trends of BMI increase are maintained from 2021 to 2030, approximately 5.26 million incident cases and 808.6 thousand deaths from NCDs may occur due to overweight. If the annual increase in overweight was reduced by half until 2030, 1.1% of new NCD cases and 0.2% of deaths could be prevented (respectively, 29,600 cases and 1900 deaths). Alternatively, if the current prevalence of overweight is maintained, as set as a national goal in Brazil until 2030, the incident NCD cases and the deaths could be reduced by respectively 3.3% (92,900) and 1.5% (12,100) compared to continuation of current trends. If the prevalence of overweight is reduced by 6.7% until 2030, 6.5% (182,200) of NCD cases and 4.2% (33,900) of deaths could be prevented. The epidemiologic burden of overweight in Brazil tends to increase if bold policy interventions are not adopted in Brazil.
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Affiliation(s)
- Eduardo A. F. Nilson
- grid.11899.380000 0004 1937 0722Center for Epidemiological Research in Nutrition and Public Health, University of São Paulo, São Paulo, Brazil
| | - Beatriz Gianicchi
- grid.411249.b0000 0001 0514 7202Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gerson Ferrari
- grid.412179.80000 0001 2191 5013Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile (USACH), Las Sophoras 175, Estación Central, Santiago, Chile
| | - Leandro F. M. Rezende
- grid.411249.b0000 0001 0514 7202Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Tanisaka LS, Oliveira FR, de Alcantara Sousa LV, de Abreu LC, Adami F, da Silva Paiva L. Changes in childhood stroke mortality from 1990 to 2019 in Brazil and its federative units. Sci Rep 2022; 12:20757. [PMID: 36456606 PMCID: PMC9715677 DOI: 10.1038/s41598-022-24761-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
This research analyzed the temporal trend of stroke mortality in children aged 0-14 years, from 1990 to 2019, in Brazil and its federative units. This ecological study used data from the Global Burden of Disease, a study led by the Institute for Health Metrics and Evaluation. Stroke definition considered the International Classification of Diseases according to codes G45, G46, and I60-I69. Age-standardized mortality rates and the mean annual percentage change (APC) in mortality rates were estimated. Stroke mortality trends decreased, with an APC of - 3.9% (95% CI - 4.5; - 3.3; p < 0.001). Reducing trends were found in all but two states, where they were stationary. Maranhão (- 6.5%; 95% CI - 7.6; - 5.4; p < 0.001) had the greatest reduction and Rondônia, the smallest (- 1.2%; 95% CI - 2.3; - 0.1, p = 0.027). Decrease was more important in children < 5 (- 5.8%; 95% CI - 6.3; - 5.2; p < 0.001) compared to 5-14 years old (- 2.1%; 95% CI - 2.9; - 1.3; p < 0.001); additionally, it was greater in girls (- 4.1%; 95% CI - 4.6; - 3.5; p < 0.001) than in boys (- 3.8%; 95% IC - 4.5; - 3.1; p < 0.001). Ischemic stroke had the highest APC (- 6.1%; 95% CI - 6.8; - 5.3; p < 0.001), followed by intracranial hemorrhage (- 5.3%; 95% CI - 6.1; - 4.5; p < 0.001) and subarachnoid hemorrhage (- 2.7%; 95% CI - 3.3; - 2.1; p < 0.001). Largest reductions were seen in states with more vulnerable socioeconomic contexts. The stationary trends and lowest APCs were concentrated in the northern region, which had greater impact of diseases and less favorable outcomes.
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Affiliation(s)
- Laura Silveira Tanisaka
- Present Address: Laboratório de Epidemiologia e Análise de Dados do Centro Universitário FMABC, Avenida Lauro Gomes, 2000 – Vila Sacadura Cabral, Santo André, SP 09060-870 Brazil
| | - Fernando Rocha Oliveira
- grid.11899.380000 0004 1937 0722Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP Brazil
| | - Luiz Vinicius de Alcantara Sousa
- Present Address: Laboratório de Epidemiologia e Análise de Dados do Centro Universitário FMABC, Avenida Lauro Gomes, 2000 – Vila Sacadura Cabral, Santo André, SP 09060-870 Brazil
| | - Luiz Carlos de Abreu
- grid.10049.3c0000 0004 1936 9692School of Medicine, University of Limerick, Limerick, Ireland ,Present Address: Laboratório de Epidemiologia e Análise de Dados do Centro Universitário FMABC, Avenida Lauro Gomes, 2000 – Vila Sacadura Cabral, Santo André, SP 09060-870 Brazil
| | - Fernando Adami
- Present Address: Laboratório de Epidemiologia e Análise de Dados do Centro Universitário FMABC, Avenida Lauro Gomes, 2000 – Vila Sacadura Cabral, Santo André, SP 09060-870 Brazil
| | - Laércio da Silva Paiva
- grid.11899.380000 0004 1937 0722Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP Brazil
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Sandri P, Rosa LA, Almeida ESD, Silva SGD. Cardiovascular Diseases Mortality Rates in Nine Cities of Rio Grande do Sul from 2009 to 2019: Temporal Trends and Demographic Differences. International Journal of Cardiovascular Sciences 2022. [DOI: 10.36660/ijcs.20220062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Gustani-Buss EG, Buss CE, Cavalli LR, Panis C, Tuon FF, Telles JP, Follador FAC, Wendt GW, Lucio LC, Ferreto LED, de Oliveira IM, Carraro E, David LE, Simão ANC, Boldt ABW, Luiza Petzl-Erler M, Silva WA, Figueiredo DLA. Cross-sectional study for COVID-19-related mortality predictors in a Brazilian state-wide landscape: the role of demographic factors, symptoms and comorbidities. BMJ Open 2022; 12:e056801. [PMID: 36253047 PMCID: PMC9577275 DOI: 10.1136/bmjopen-2021-056801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The Brazilian state of Paraná has suffered from COVID-19 effects, understanding predictors of increased mortality in health system interventions prevent hospitalisation of patients. We selected the best models to evaluate the association of death with demographic characteristics, symptoms and comorbidities based on three levels of clinical severity for COVID-19: non-hospitalised, hospitalised non-ICU ward and ICU ward. DESIGN Cross-sectional survey using binomial mixed models. SETTING COVID-19-positive cases diagnosed by reverse transcription-PCR of municipalities located in Paraná State. PATIENTS Cases of anonymous datasets of electronic medical records from 1 April 2020 to 31 December 2020. PRIMARY AND SECONDARY OUTCOME MEASURES The best prediction factors were chosen based on criteria after a stepwise analysis using multicollinearity measure, lower Akaike information criterion and goodness-of-fit χ2 tests from univariate to multivariate contexts. RESULTS Male sex was associated with increased mortality among non-hospitalised patients (OR 1.76, 95% CI 1.47 to 2.11) and non-ICU patients (OR 1.22, 95% CI 1.05 to 1.43) for symptoms and for comorbidities (OR 1.89, 95% CI 1.59 to 2.25, and OR 1.30, 95% CI 1.11 to 1.52, respectively). Higher mortality occurred in patients older than 35 years in non-hospitalised (for symptoms: OR 4.05, 95% CI 1.55 to 10.54; and for comorbidities: OR 3.00, 95% CI 1.24 to 7.27) and in hospitalised over 40 years (for symptoms: OR 2.72, 95% CI 1.08 to 6.87; and for comorbidities: OR 2.66, 95% CI 1.22 to 5.79). Dyspnoea was associated with increased mortality in non-hospitalised (OR 4.14, 95% CI 3.45 to 4.96), non-ICU (OR 2.41, 95% CI 2.04 to 2.84) and ICU (OR 1.38, 95% CI 1.10 to 1.72) patients. Neurological disorders (OR 2.16, 95% CI 1.35 to 3.46), neoplastic (OR 3.22, 95% CI 1.75 to 5.93) and kidney diseases (OR 2.13, 95% CI 1.36 to 3.35) showed the majority of increased mortality for ICU as well in the three levels of severity jointly with heart disease, diabetes and CPOD. CONCLUSIONS These findings highlight the importance of the predictor's assessment for the implementation of public healthcare policy in response to the COVID-19 pandemic, mainly to understand how non-pharmaceutical measures could mitigate the virus impact over the population.
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Affiliation(s)
- Emanuele Gustani Gustani-Buss
- Bioinformatics Laboratory, Institute for Cancer Research, IPEC, Guarapuava, Brazil
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- New Arrangements for Research and Innovation - Genomics-Novos Arranjos de Pesquisa e Inovação - Genômica (NAPI-Genômica), Araucária Foundation - FAAP-PR, Curitiba, Parana, Brazil
| | - Carlos E Buss
- Bioinformatics Laboratory, Institute for Cancer Research, IPEC, Guarapuava, Brazil
- New Arrangements for Research and Innovation - Genomics-Novos Arranjos de Pesquisa e Inovação - Genômica (NAPI-Genômica), Araucária Foundation - FAAP-PR, Curitiba, Parana, Brazil
- MindFlow Genomics, Guarapuava, Brazil
| | - Luciane R Cavalli
- Postgraduate Program in Biotechnology Applied to Child and Adolescent Health at FPP, Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - Carolina Panis
- Laboratory of Tumor Biology, Western Paraná State University-UNIOESTE, Cascavel, Brazil
| | - Felipe F Tuon
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Joao P Telles
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Franciele A C Follador
- Department of Life Sciences,Postgraduate Program in Applied Health Sciences, Western Paraná State University-UNIOESTE, Francisco Beltrão, Brazil
| | - Guilherme W Wendt
- Department of Life Sciences,Postgraduate Program in Applied Health Sciences, Western Paraná State University-UNIOESTE, Francisco Beltrão, Brazil
| | - Léia C Lucio
- Department of Life Sciences,Postgraduate Program in Applied Health Sciences, Western Paraná State University-UNIOESTE, Francisco Beltrão, Brazil
| | - Lirane E D Ferreto
- Department of Life Sciences,Postgraduate Program in Applied Health Sciences, Western Paraná State University-UNIOESTE, Francisco Beltrão, Brazil
| | - Isabela M de Oliveira
- New Arrangements for Research and Innovation - Genomics-Novos Arranjos de Pesquisa e Inovação - Genômica (NAPI-Genômica), Araucária Foundation - FAAP-PR, Curitiba, Parana, Brazil
- Institute for Cancer Research IPEC, Guarapuava, Brazil
| | - Emerson Carraro
- New Arrangements for Research and Innovation - Genomics-Novos Arranjos de Pesquisa e Inovação - Genômica (NAPI-Genômica), Araucária Foundation - FAAP-PR, Curitiba, Parana, Brazil
- Virology Laboratory, Midwestern Parana State University-UNICENTRO, Guarapuava, Brazil
| | - Lualis E David
- Virology Laboratory, Midwestern Parana State University-UNICENTRO, Guarapuava, Brazil
| | - Andréa N C Simão
- Laboratory of Research in Applied Immunology, Department of Pathology, Clinical Analysis and Toxicology, State University of Londrina-UEL, Londrina, Brazil
| | - Angelica B W Boldt
- New Arrangements for Research and Innovation - Genomics-Novos Arranjos de Pesquisa e Inovação - Genômica (NAPI-Genômica), Araucária Foundation - FAAP-PR, Curitiba, Parana, Brazil
- Postgraduate Program in Genetics, Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná-UFPR, Curitiba, Brazil
| | - Maria Luiza Petzl-Erler
- New Arrangements for Research and Innovation - Genomics-Novos Arranjos de Pesquisa e Inovação - Genômica (NAPI-Genômica), Araucária Foundation - FAAP-PR, Curitiba, Parana, Brazil
- Postgraduate Program in Genetics, Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná-UFPR, Curitiba, Brazil
| | - Wilson A Silva
- Institute for Cancer Research IPEC, Guarapuava, Brazil
- Ribeirão Preto Medical School and Center for Cell-Based Therapy (CEPID/FAPESP), University of São Paulo (USP), Ribeirão Preto, Brazil
| | - David L A Figueiredo
- New Arrangements for Research and Innovation - Genomics-Novos Arranjos de Pesquisa e Inovação - Genômica (NAPI-Genômica), Araucária Foundation - FAAP-PR, Curitiba, Parana, Brazil
- Institute for Cancer Research IPEC, Guarapuava, Brazil
- Department of Medicine, Midwestern Paraná State University-UNICENTRO, Guarapuava, Brazil
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Giuberti Coutinho J, Feldenheimer da Silva AC, de Castro IRR, Recine EGIG, Makuta G, Rocha NC, Johns P, Barbosa RBDC. The challenges of front-of-package labeling in Brazil. Front Nutr 2022; 9:921421. [PMID: 36313104 PMCID: PMC9608328 DOI: 10.3389/fnut.2022.921421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/13/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Janine Giuberti Coutinho
- Alliance for Adequate and Healthy Diets, Brasília, Brazil,Brazilian Institute of Consumer Protection (Idec), São Paulo, Brazil,*Correspondence: Janine Giuberti Coutinho
| | - Ana Carolina Feldenheimer da Silva
- Alliance for Adequate and Healthy Diets, Brasília, Brazil,Department of Social Nutrition, Rio de Janeiro State University (UERJ), Rio de Janeiro, Paraná, Brazil
| | - Inês Rugani Ribeiro de Castro
- Alliance for Adequate and Healthy Diets, Brasília, Brazil,Department of Social Nutrition, Rio de Janeiro State University (UERJ), Rio de Janeiro, Paraná, Brazil
| | - Elisabetta Gioconda Iole Giovanna Recine
- Alliance for Adequate and Healthy Diets, Brasília, Brazil,Observatory on Food Security Policies and Nutrition (OPSAN), Brasília University (UnB), Brasília, Brazil
| | - Glenn Makuta
- Alliance for Adequate and Healthy Diets, Brasília, Brazil,Slow Food Brazil, São Paulo, Brazil
| | - Nayara Cortês Rocha
- Alliance for Adequate and Healthy Diets, Brasília, Brazil,Food the Right to Food and Nutrition Brazil, Brasília, Brazil
| | - Paula Johns
- Alliance for Adequate and Healthy Diets, Brasília, Brazil,ACT Health Promotion, Rio de Janeiro, Brazil
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Andrade ALM, Passos MAZ, Vellozo EP, Schoen TH, Kulik MA, Niskier SR, de Souza Vitalle MS. The Contextual Factors Associated with Co-occurring Substance and Problematic Internet Use in Adolescence: a Network Approach. Trends in Psychol 2022. [DOI: 10.1007/s43076-022-00232-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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dos Santos E, Wollmann GM, Nagel V, Ponte HMS, Furtado LETA, Martins-Filho RKV, Weiss G, Martins SCO, Ferreira LE, de França PHC, Cabral NL. Incidence, lethality, and post-stroke functional status in different Brazilian macro-regions: The SAMBA study (analysis of stroke in multiple Brazilian areas). Front Neurol 2022; 13:966785. [PMID: 36188387 PMCID: PMC9520622 DOI: 10.3389/fneur.2022.966785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/12/2022] [Indexed: 11/14/2022] Open
Abstract
Background Stroke is the second leading cause of death in Brazil. The social and financial burden of stroke is remarkable; however, the epidemiological profile remains poorly understood. Objective The aim of this study was to report the incidence, lethality, and functional status at 30 and 90 days post-stroke in the cities of different Brazilian macro-regions. Methods This is an observational, prospective, and population-based study, led in Canoas (South), Joinville (South, reference center), Sertãozinho (Southeast), and Sobral (Northeast) in Brazil. It was developed according to the three-step criteria recommended by the World Health Organization to conduct population-based studies on stroke. Using different sources, all hospitalized and ambulatory patients with stroke were identified and the same criteria were kept in all cities. All first events were included, regardless of sex, age, or type of stroke. Demographic and risk factor data were collected, followed by biochemical, electrocardiographic, and radiological test results. Functional status and lethality were obtained using the mRankin scale through telephonic interview (validated Brazilian version). Results In 1 year, 932 stroke cases were registered (784 ischemic stroke, 105 hemorrhagic stroke, and 43 subarachnoid hemorrhage). The incidence rates per 100,000 inhabitants, adjusted for the world population, were 63 in Canoas, 106 in Joinville, 72 in Sertãozinho, and 96 in Sobral. The majority (70.8%) were followed for 90 days. Kaplan-Meier curves showed that 90-day survival was different among cities. Sobral, which has the lowest socioeconomic indexes, revealed the worst results in terms of lethality and functional status. Conclusion This study expands the knowledge of stroke epidemiology in Brazil, a middle-income country with enormous socioeconomic and cultural diversity. The discrepancy observed regarding the impact of stroke in patients from Joinville and Sobral highlights the need to improve the strategic allocation of resources to meet the health priorities in each location.
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Affiliation(s)
- Emily dos Santos
- Postgraduate Program on Health and Environment, University of the Region of Joinville–Univille, Joinville, Brazil
| | - Giulia M. Wollmann
- Department of Medicine, University of the Region of Joinville–Univille, Joinville, Brazil
| | - Vivian Nagel
- Joinville Stroke Registry, Hospital Municipal São José, Joinville, Brazil
| | | | | | - Rui K. V. Martins-Filho
- Hospital das Clínicas de Ribeirão Preto, University of São Paulo–USP, Ribeirão Preto, Brazil
| | - Gustavo Weiss
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Sheila C. O. Martins
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Leslie E. Ferreira
- Postgraduate Program on Health and Environment, University of the Region of Joinville–Univille, Joinville, Brazil
- Department of Medicine, University of the Region of Joinville–Univille, Joinville, Brazil
| | - Paulo H. C. de França
- Postgraduate Program on Health and Environment, University of the Region of Joinville–Univille, Joinville, Brazil
- Department of Medicine, University of the Region of Joinville–Univille, Joinville, Brazil
| | - Norberto L. Cabral
- Postgraduate Program on Health and Environment, University of the Region of Joinville–Univille, Joinville, Brazil
- Department of Medicine, University of the Region of Joinville–Univille, Joinville, Brazil
- Joinville Stroke Registry, Hospital Municipal São José, Joinville, Brazil
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Luz TCB, de Castro AKS, Marques IC, Cota BB, Alves JDC, Law MR. Performance of a pharmaceutical services regionalization strategy policy in Minas Gerais, Brazil: Pre-post analysis from ERAF project. Front Pharmacol 2022; 13:953990. [PMID: 36120343 PMCID: PMC9478725 DOI: 10.3389/fphar.2022.953990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background: In 2016, the Brazilian state of Minas Gerais (∼20 million people), implemented the ERAF policy (“Regionalization Strategy of Pharmaceutical Services”) in an effort to improve medicine procurement and distribution within primary care. We evaluated the impact of the policy on three main goals: price reductions, volume increases, and expansion of therapeutic options. Methods: We analyzed the procurement data from the Integrated System of Management of Pharmaceutical Services database in 2012 and 2018. We estimated the volume, drug mix, and expenditure indicators for all major therapeutic classes, and, in detail, for cardiovascular and nervous system drugs. We evaluated the expenditure drivers using decomposition analyses. Results: Overall, the expenditure increased by 14.5%, drug mix almost doubled, while the volume decreased by a third. Cardiovascular and neurological system drugs followed similar patterns. Decomposition analyses showed that prices and drug mix had positive effects while the volume had negative effects, resulting in an overall increase in expenditure. Conclusion: Our findings suggest that the ERAF policy cannot be considered effective as it has not fulfilled its intended purposes so far. Strategies to address the identified problems and to build a platform for a more sustainable long-lasting policy should be put in place by the government.
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Affiliation(s)
- Tatiana Chama Borges Luz
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), René Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
- Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow, United Kingdom
- *Correspondence: Tatiana Chama Borges Luz, ,
| | - Ana Karine Sarvel de Castro
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), René Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Isabela Cristina Marques
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), René Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Betania Barros Cota
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), René Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Jèssica de Castro Alves
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), René Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Michael Robert Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, CO, Canada
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Fioratti I, Miyamoto GC, Fandim JV, Ribeiro CPP, Batista GD, Freitas GE, Palomo AS, Reis FJJD, Costa LOP, Maher CG, Saragiotto BT. Feasibility, Usability, and Implementation Context of an Internet-Based Pain Education and Exercise Program for Chronic Musculoskeletal Pain: Pilot Trial of the ReabilitaDOR Program. JMIR Form Res 2022; 6:e35743. [PMID: 35776863 PMCID: PMC9472033 DOI: 10.2196/35743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/23/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Internet-based self-management programs and telerehabilitation initiatives have increased and have been extensively used for delivering health care in many areas. These programs overcome common barriers that patients face with traditional face-to-face health care, such as travel expenditures, lack of time, and high demand on the public health system. During the COVID-19 pandemic, this mode of web-based health care delivery had become more popular. However, there is still a lack of studies testing this mode of delivery in low- and middle-income countries. To gain a better understanding of the context, feasibility, and factors involved in the implementation of a web-based program, pilot and implementation studies are necessary. These studies can better inform whether a strategy is feasible, acceptable, and adequate for its purposes and for optimizing resource allocation. Objective This study aims to evaluate the feasibility, usability, and implementation context of a self-management internet-based program based on exercises and pain education (ReabilitaDOR) in people with chronic musculoskeletal pain and to compare this program with a program using only a web-based self-management booklet. Methods The study design was a parallel pilot study of a prospectively registered, assessor-blinded, 2-arm randomized controlled trial with economic evaluation. This study was performed using waiting lists of physiotherapy and rehabilitation centers and advertisements on social media networks. The participants were 65 patients with chronic musculoskeletal pain aged between 18 and 60 years. The effects of an 8-week telerehabilitation program based on exercises and pain education (intervention group) were compared with those of a program based only on a web-based self-management booklet (control group). The main outcome measures were implementation outcomes of patients’ perceptions of acceptability, appropriateness, feasibility, and usability of the program and the societal costs and feasibility of the main trial at 8-week posttreatment follow-up. Adverse events were also analyzed. Results In total, 56 participants were analyzed at the 8-week follow-up. The intervention group showed responses with a mean of 4.5 (SD 0.6) points for acceptability, 4.5 (SD 0.5) points for appropriateness, and 4.5 (SD 0.6) points for feasibility measured on a 1 to 5 scale. All patients in the intervention group showed satisfactory responses to the system usability outcome. There is satisfactory evidence for the feasibility of the main trial. For costs related to the interventions, health care, patients, and loss of productivity at 8 weeks, we found a total expenditure of US $278.30 per patient in the intervention group and US $141.52 per patient in the control group. No adverse events were reported during the intervention period. Conclusions We found that the ReabilitaDOR program is feasible, appropriate, and acceptable from the users’ implementation perspective. This system was considered usable by all the participants, and the main trial seemed feasible. Cost data were viable to be collected, and the program is likely to be safe. Trial Registration ClinicalTrials.gov NCT04274439; https://clinicaltrials.gov/ct2/show/NCT04274439
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Affiliation(s)
- Iuri Fioratti
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Gisela Cristiane Miyamoto
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands
| | - Junior Vitorino Fandim
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | | | - Geovana Domingues Batista
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | | | - Andressa Santos Palomo
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Felipe José Jandré Dos Reis
- Physical Therapy Department, Instituto Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Postgraduation Program, Clinical Medicine Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Christopher G Maher
- Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
| | - Bruno Tirotti Saragiotto
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
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Holm AE, Gomes LC, Wegener A, Lima KO, Matos LO, Vieira IVM, Kaagaard MD, Pareek M, de Souza RM, Marinho CRF, Biering-Sørensen T, Silvestre OM, Brainin P. Is self-rated health associated with cardiovascular risk factors and disease in a low-income setting? A cross-sectional study from the Amazon Basin of Brazil. BMJ Open 2022; 12:e058277. [PMID: 36041756 PMCID: PMC9438027 DOI: 10.1136/bmjopen-2021-058277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Prior studies have suggested that self-rated health may be a useful indicator of cardiovascular disease. Consequently, we aimed to assess the relationship between self-rated health, cardiovascular risk factors and subclinical cardiac disease in the Amazon Basin. DESIGN Cross-sectional study. SETTING, PARTICIPANTS AND INTERVENTIONS In participants from the Amazon Basin of Brazil we obtained self-rated health according to a Visual Analogue Scale, ranging from 0 (poor) to 100 (excellent). We performed questionnaires, physical examination and echocardiography. Logistic and linear regression models were applied to assess self-rated health, cardiac risk factors and cardiac disease by echocardiography. Multivariable models were mutually adjusted for other cardiovascular risk factors, clinical and socioeconomic data, and known cardiac disease. OUTCOME MEASURES Cardiovascular risk factors and subclincial cardiac disease by echocardiography. RESULTS A total of 574 participants (mean age 41 years, 61% female) provided information on self-rated health (mean 75±21 (IQR 60-90) points). Self-rated health (per 10-point increase) was negatively associated with hypertension (OR 0.87 (95% CI 0.78 to 0.97), p=0.01), hypercholesterolaemia (OR 0.89 (95%CI 0.80 to 0.99), p=0.04) and positively with healthy diet (OR 1.13 (95%CI 1.04 to 1.24), p=0.004). Sex modified these associations (p-interaction <0.05) such that higher self-rated health was associated with healthy diet and physical activity in men, and lower odds of hypertension and hypercholesterolaemia in women. No relationship was found with left ventricular ejection fraction <45% (OR 0.97 (95% CI 0.77 to 1.23), p=0.8), left ventricular hypertrophy (OR 0.97 (95% CI 0.76 to 1.24), p=0.81) or diastolic dysfunction (OR 1.09 (95% CI 0.85 to 1.40), p=0.51). CONCLUSION Self-rated health was positively associated with health parameters in the Amazon Basin, but not with subclinical cardiac disease by echocardiography. Our findings are of hypothesis generating nature and future studies should aim to determine whether assessment of self-rated health may be useful for screening related to policy-making or lifestyle interventions. TRIAL REGISTRATION NUMBER Clinicaltrials.gov: NCT04445103; Post-results.
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Affiliation(s)
- Anna Engell Holm
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Laura Cordeiro Gomes
- Department of Parasitology, University of São Paulo, Institute of Biomedical Sciences, São Paulo, Brazil
| | - Alma Wegener
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Karine O Lima
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Luan O Matos
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Isabelle V M Vieira
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Molly D Kaagaard
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Manan Pareek
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rodrigo Medeiros de Souza
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | | | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Odilson M Silvestre
- Health and Sport Science Center, Federal University of Acre, Rio Branco, Acre, Brazil
| | - Philip Brainin
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
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de Almeida-Pititto B, Eliaschewitz FG, de Paula MA, Ferreira GC. BrazIliaN Type 1 & 2 DiabetEs Disease Registry (BINDER): longitudinal, real-world study of diabetes mellitus control in Brazil. Front Clin Diabetes Healthc 2022; 3:934629. [PMID: 36992732 PMCID: PMC10012111 DOI: 10.3389/fcdhc.2022.934629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022]
Abstract
IntroductionThis study aimed at assessing the patterns of care and glycemic control of patients with diabetes (DM) in real life during a follow-up of 2 years in the public and private health sectors in Brazil.MethodsBINDER was an observational study of patients >18 years old, with type-1 (T1DM) and type-2 DM (T2DM), followed at 250 sites from 40 cities across the five regions of Brazil. The results for the 1,266 participants who were followed for 2 years are presented.Main resultsMost patients were Caucasians (75%), male (56.7%) and from the private health sector (71%). Of the 1,266 patients who entered the analysis, 104 (8.2%) had T1DM and 1162 (91.8%) had T2DM. Patients followed in the private sector represented 48% of the patients with T1DM and 73% of those with T2DM. For T1DM, in addition to insulins (NPH in 24%, regular in 11%, long-acting analogues in 58%, fast-acting analogues in 53%, and others in 12%), the patients received biguanide (20%), SGLT2-I (4%), and GLP-1Ra (<1%). After 2 years, 13% of T1DM patients were using biguanide, 9% SGLT2-I, 1% GLP-1Ra, and 1% pioglitazone; the use of NPH and regular insulins decreased to 13% and 8%, respectively, while 72% were receiving long-acting insulin analogues, and 78% fast-acting insulin analogues. Treatment for T2DM consisted of biguanide (77%), sulfonylureas (33%), DPP4 inhibitors (24%), SGLT2-I (13%), GLP-1Ra (2.5%), and insulin (27%), with percentages not changing during follow-up. Regarding glucose control, mean HbA1c at baseline and after 2 years of follow-up was 8.2 (1.6)% and 7.5 (1.6)% for T1DM, and 8.4 (1.9)% and 7.2 (1.3)% for T2DM, respectively. After 2 years, HbA1c<7% was reached in 25% of T1DM and 55% of T2DM patients from private institutions and in 20.5% of T1DM and 47% of T2DM from public institutions.ConclusionMost patients did not reach the HbA1c target in private or public health systems. At the 2-year follow-up, there were no significant improvements in HbA1c in either T1DM or T2DM, which suggests an important clinical inertia.
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Affiliation(s)
- Bianca de Almeida-Pititto
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- *Correspondence: Bianca de Almeida-Pititto,
| | - Freddy G. Eliaschewitz
- Centro de Pesquisas Clinicas (CPCLIN)/Diagnósticos da América S.A (DASA), Centro de Pesquisas Clínicas, São Paulo, Brazil
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Alves RM, Santos EGDO, Barbosa IR. Factors associated with common mental disorders among farmers in a medium-sized municipality in Northeastern Brazil. Rev Saude Publica 2022; 56:74. [PMID: 35946674 PMCID: PMC9388066 DOI: 10.11606/s1518-8787.2022056003522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 09/29/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To identify the prevalence and factors associated with common mental disorders among farmers living in a medium-sized municipality in Northeastern Brazil between 2019 and 2020. METHODS Trained interviewers applied the standardized questionnaire in 450 participants. Sociodemographic, health, income and working characteristics were assessed. The screening of common mental disorders was performed using the Self-Reporting Questionaire, with the cutoff point ≥ 7 for women and ≥ 5 for men. Poisson regression with robust estimation was applied to verify the prevalence ratios in the bivariate and multivariate analysis. RESULTS The prevalence of common mental disorders among farmers was 55.1% (95%CI: 50.4–59.6). The variables that remained significant and associated with common mental disorders were: men (PR = 1.7), > 60 years old (PR = 0.5), poor or very poor self-assessment of health (PR = 1.4), previous mental health treatment (PR = 1.2), alcohol abuse (PR = 1.2) and loss of production (PR = 1.3). CONCLUSION These results indicate that common mental disorders are associated with individual factors and with the farmers’ context of life and work, which shows the importance of social, economic and health services support to this group of workers.
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Affiliation(s)
- Roberta Machado Alves
- Universidade Federal do Rio Grande do Norte . Centro de Ciências da Saúde . Departamento de Saúde Coletiva . Natal , RN , Brasil
| | | | - Isabelle Ribeiro Barbosa
- Universidade Federal do Rio Grande do Norte . Centro de Ciências da Saúde . Departamento de Saúde Coletiva . Natal , RN , Brasil
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Brandão PDC, Lanzoni GMDM, Pinto ICDM. Network professional interaction in the care of patients with stroke. Rev Bras Enferm 2022; 75:e20210533. [PMID: 35920513 DOI: 10.1590/0034-7167-2021-0533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/12/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to understand the professional interaction in the Emergency Care Network in the care of patients with acute ischemic stroke in the city of Salvador/Bahia. METHODS the Grounded Theory methodological framework, Straussian strand, and the health networks theoretical framework were used. An in-depth interview was used, between October 2019 and October 2020, with 75 professionals from the Mobile Emergency Care Service, Emergency Care Units and reference hospital. RESULTS 5 categories and 24 subcategories point to shared goals among professionals, but they show elements of fragmentation of connections between services, such as the absence of a single language and conduct, obstacles to professional relationships and lack of knowledge of the other's role. CONCLUSIONS to improve network relationships and care of patients with stroke, there is a need for well-established connecting elements, such as flows and protocols, supported by continuing education actions.
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Moreira RO, Vianna AGD, Ferreira GC, de Paula MA. Determinants of glycemic control in type 2 diabetes mellitus in Brazil: A sub-analysis of the longitudinal data from the BrazIian type 1 & 2 diabetes disease registry (BINDER). Prim Care Diabetes 2022; 16:562-567. [PMID: 35527171 DOI: 10.1016/j.pcd.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Data on glycemic control and its determinants among Brazilian patients with type-2 diabetes (DM2) are scarce. The BrazIliaN Type 1 & 2 DiabetEs Disease Registry (BINDER) is a multicenter, longitudinal study, designed to investigate the glycemic control in a real-word scenario. METHODS 1142 patients participated in the five visits of the BINDER study between April/2017 and October/2019. For each visit, glycemic control was assessed using the last measure available for HbA1c. Sociodemographic and anthropometric characteristics were also analyzed. RESULTS At baseline, the median HbA1c level was 7.1% (4.1-15.0%); 259 (31.4%) participants had HbA1c ≤ 6.5% and 396 (48.2%) had HbA1c ≤ 7.0%. Younger age (p = 0.014), low educational level (p = 0.025) and the type of healthcare service (public sector; p = 0.0058) were independently associated with the elevated HbA1c. After 2 years, there were no statistically significant differences in HbA1c median values in relation to baseline. CONCLUSIONS In this sample of DM2 patients, younger age, low educational level and being treated at the public service were associated with worse glycemic control. Over a 2-year follow-up, there was no significant change in the median HbA1c. These findings suggest that strategies are needed to improve glycemic control, especially in those treated in the public service.
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Affiliation(s)
- Rodrigo O Moreira
- Instituto Estadual de Diabetes e Endocrinologia Luis Capriglione (IEDE), Rio de Janeiro, RJ, Brazil.
| | - André G D Vianna
- Curitiba Diabetes Centre, Department of Endocrine Diseases, Hospital Nossa Senhora das Graças, Curitiba, Brazil
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Yu P, Xu R, Li S, Coelho MSZS, Saldiva PHN, Sim MR, Abramson MJ, Guo Y. Loss of life expectancy from PM 2.5 in Brazil: A national study from 2010 to 2018. Environ Int 2022; 166:107350. [PMID: 35749993 DOI: 10.1016/j.envint.2022.107350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Long-term exposure to PM2.5 is proved to be linked with mortality. However, limited studies have estimated the PM2.5 related loss of life expectancy (LLE) and its changing trends. How much life expectancy would be improved if PM2.5 pollution is reduced to the new WHO air quality guideline (AQG) level is unclear. METHODS Data on deaths from all-causes, cancer, cardiovascular and respiratory diseases were collected from 5,565 Brazilian municipalities during 2010-2018. A difference-in-differences approach with quasi-Poisson regression was applied to examine the PM2.5-years of life lost (YLL) associations and PM2.5 associated LLE. RESULTS The annual PM2.5 concentration in each municipality from 2010 to 2018 was 7.7 µg/m3 in Brazil. Nationally, with each 10 μg/m3 increase in five-year-average (current and previous four years) concentrations of PM2.5, the relative risks (RRs) were 1.18 (95% CI: 1.15-1.21) for YLL from all-causes, 1.22 (1.16-1.28) from cancer, 1.12 (1.08-1.17) from cardiovascular and 1.17 (1.10-1.25) from respiratory diseases. Life expectancy could be improved by 1.09 (95% CI: 0.92-1.25) years by limiting PM2.5 concentration to the national lowest level (2.9 µg/m3), specifically, 0.20 (0.15-0.24) years for cancer, 0.16 (0.11-0.22) years for cardiovascular and 0.09 (0.05-0.13) years for respiratory diseases, with significant disparities across regions and municipalities. Life expectancy would be improved by 0.78 (0.66-0.90) years by setting the new WHO AQG PM2.5 concentration level of 5 μg/m3 as an acceptable threshold. CONCLUSIONS Using nationwide death records in Brazil, we found that long-term exposure to PM2.5 was associated with reduced life expectancy from all-causes, cancer, cardiovascular and respiratory diseases with regional inequalities and different trends. PM2.5 pollution abatement to below the WHO AQG level would improve this loss of life expectancy in Brazil.
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Affiliation(s)
- Pei Yu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rongbin Xu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Micheline S Z S Coelho
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Paulo H N Saldiva
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Malcolm R Sim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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de Almeida Prado J, Santos JLF. Psychosocial functionality in depressive workers: A study on associated factors. Int J Soc Psychiatry 2022; 68:958-968. [PMID: 33863245 DOI: 10.1177/00207640211011195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Major Depressive Disorder (MDD) has been shown a high prevalence and debilitating mental health. Most of the burden comes from reduced work functioning and frequent or long-term absenteeism. AIMS Describe psychosocial functionality in sample of workers with MDD and observe associated factors with sick-leave. METHODS Cross-sectional study. Participants were 172 formal workers with MDD according to Mini International Neuropsychiatric Interview. They were classified as active (n = 76) or in sick leave (n = 96). Functionality Assessment Short Test (FAST) was used and the variables were: personal, clinical, and occupational characteristics. Descriptive, bivariate and hierarchical multivariate analyses were conducted; significant with p < .05. RESULTS Most of the sample was female and <50. Workers in sick leave were older, less physically active, and presented worse scores in global and in each domain of functionality (FAST). High autonomy at working process, perceived stressing work, do not enjoy the work and low resilience to work adversities were significantly associated with sick leave (p < .05). Regarding clinical characteristics of MDD, severity, clinical comorbidity and recidivate subtype were associated with sick leave outcome (p < .05). CONCLUSION Sick leave is an important indicator of global functionality. Effective strategies to reduce MDD burden ought to involve some perspectives: (1) Diagnosis and efficient treatment; (2) Promotion and monitoring of functionality and rehabilitation programs; (3) Subject-centered actions that help workers cope with adversities, mitigate stress, and increase satisfaction at work.
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Sachetti CG, Júnior AB, de Carvalho ACC, Angulo-Tuesta A, da Silva EN. Landscape of Brazilian research and development public funding in advanced therapies: lessons learned and a roadmap for middle-income economies. Cytotherapy 2022; 24:1158-1165. [DOI: 10.1016/j.jcyt.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/03/2022]
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Quadra MR, Santos LPD, Schäfer AA, Meller FDO. [Influence of sleep and chrononutrition on hypertension and diabetes: a population-based study]. CAD SAUDE PUBLICA 2022; 38:e00291021. [PMID: 35894369 DOI: 10.1590/0102-311xpt291021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/09/2022] [Indexed: 11/21/2022] Open
Abstract
The objective is to evaluate the influence of sleep and chrononutrition on hypertension and diabetes in the adult population (18 years or older) in a municipality in Southern Brazil. This is a population-based cross-sectional study, developed in Criciúma, State of Santa Catarina, in 2019. The exposure variables were sleep duration and quality, and two of the main aspects of chrononutrition, the number of daily meals and the presence of breakfast. The outcomes studied were diabetes mellitus and systemic arterial hypertension. Crude and adjusted Poisson regression with robust variance was used to evaluate the associations between exposures and outcomes. For all analyses, the effect of the sample design was considered, and the significance level adopted was 5%. In total, 820 patients were evaluated. The prevalence of diabetes and hypertension was of 19.9% and 44.1%, respectively. Individuals with worse sleep quality had a higher prevalence of 33% for diabetes and 17% for hypertension, compared to those with good quality of sleep. Those who had four or more meals per day had a 16% lower prevalence of hypertension, when compared to those who had less than four meals. We concluded that the quality of sleep and the number of daily meals, a feeding behavior related to chrononutrition, were related to hypertension and diabetes. These results highlight the importance of public health actions that address new strategies for coping with these diseases focused on sleep quality and chrononutrition.
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Meller FDO, Santos LPD, Miranda VIA, Tomasi CD, Soratto J, Quadra MR, Schäfer AA. [Inequalities in risk behaviors for chronic noncommunicable diseases: Vigitel, 2019]. CAD SAUDE PUBLICA 2022; 38:e00273520. [PMID: 35766632 DOI: 10.1590/0102-311xpt273520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/25/2022] [Indexed: 11/22/2022] Open
Abstract
This study analyzes the economic, racial, and geographic inequalities in risk behaviors for chronic non-communicable diseases of Brazilian adults. This is a cross-sectional study conducted with data from the 2019 Vigitel (Risk and Protective Factors Surveillance System for Chronic Noncomunicable Diseases Through Telephone Interview). The analyzed risk behaviors were smoking, alcohol abuse, physical inactivity, overweight, regular consumption of soft drinks or artificial juice drinks, and non-regular consumption of fruits, legumes, and vegetables. Inequalities in risk behaviors were assessed considering Brazilian's schooling level and their dwelling region, via the slope index of inequality (SII). Equiplots graphs were also built to better illustrate the inequalities. Stata svy command was used for all analyses due to the complexity of the sampling process. In total, 52,395 patients were evaluated. Significant inequalities in risk behaviors for chronic non-communicable diseases were observed: most risk behaviors were concentrated in those with low schooling. Smoking and soft drinks consumption were more observed in the Southern region of Brazil. Public policies are necessary to reduce the inequalities found, allowing for improvement in health indicators of the Brazilian population.
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Affiliation(s)
| | | | | | | | - Jacks Soratto
- Universidade do Extremo Sul Catarinense, Criciúma, Brasil
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Bobbili SJ, Carrara BS, Fernandes RHH, Ventura CAA. A situational analysis of primary health care centers in Brazil: challenges and opportunities for addressing mental illness and substance use-related stigma. Prim Health Care Res Dev 2022; 23:e37. [PMID: 35775359 DOI: 10.1017/S1463423622000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The detrimental impact of stigma toward people with mental illness and substance use problems (MISUP) is well documented. However, studies focusing on stigma reduction in Latin American primary health care (PHC) contexts are limited. This situational analysis incorporating a socioecological framework aims to provide a comprehensive understanding of MISUP-related stigma in PHC centers in Brazil. The objectives of this analysis are twofold: (1) to understand the current mental health and substance use service delivery context and (2) identify challenges and opportunities for addressing MISUP-related stigma in PHC centers in Ribeirão Preto, Brazil. Methods: Environmental scans of four Family Health Units were conducted in early 2018 to explore population needs and service delivery for individuals with MISUP. In addition, a symposium was organized in October 2018 to consult with diverse stakeholders and gather local perspectives about MISUP-related stigma conveyed in PHC settings. NVivo 12 software was used to conduct a thematic analysis of the qualitative data collected from the environmental scans and the symposium consultation. Results: Themes identified at the national level in the socioecological framework indicate that political support for national policies related to reducing stigma is limited, particularly regarding social inclusion and the decentralization of mental health services. Themes at the regional, organizational, and interpersonal levels include insufficient mental health expertise and the limited involvement of those with lived experience in decision-making. Suggestions for stigma interventions were provided, including increased contact with individuals with lived experience outside of client-patient interactions, capacity building for professionals, and public education campaigns. Conclusion: Increased government support, capacity building, and promoting social inclusion will provide opportunities to reduce stigma and reach marginalized populations. These findings will assist with addressing current gaps in PHC mental health service provision and may inform anti-stigma strategies for Brazil and other Latin American low- and middle-income countries.
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Clarsen B, Nylenna M, Klitkou ST, Vollset SE, Baravelli CM, Bølling AK, Aasvang GM, Sulo G, Naghavi M, Pasovic M, Asaduzzaman M, Bjørge T, Eggen AE, Eikemo TA, Ellingsen CL, Haaland ØA, Hailu A, Hassan S, Hay SI, Juliusson PB, Kisa A, Kisa S, Månsson J, Mekonnen T, Murray CJL, Norheim OF, Ottersen T, Sagoe D, Sripada K, Winkler AS, Knudsen AKS. Changes in life expectancy and disease burden in Norway, 1990–2019: an analysis of the Global Burden of Disease Study 2019. The Lancet Public Health 2022; 7:e593-e605. [PMID: 35779543 PMCID: PMC9253891 DOI: 10.1016/s2468-2667(22)00092-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 01/04/2023] Open
Abstract
Background Methods Findings Interpretation Funding
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de Souza IMB, Merini LR, Rodrigues RDSP, do Espírito Santo ADS, Marques AP. Association of Functional Disability and Biopsychosocial Factors in Older Adults With Low Back Pain Who Live in the Amazonas State Brazil: A Cross-Sectional Study. J Manipulative Physiol Ther 2022; 45:45-56. [PMID: 35753876 DOI: 10.1016/j.jmpt.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to identify social and clinical factors associated with levels of functional disability (FD) in older adults with low back pain (LBP) in the city of Manaus, Amazonas, Brazil. METHODS A cross-sectional study of 557 adults with LBP aged ≥60 years was completed. Sociodemographic and clinical features, pain intensity (Numeric Rating Scale), FD (Roland Morris Disability Questionnaire), physical activity (International Physical Activity Questionnaire-short version), body mass index, educational level, health perception, emotional level, and self-reported diseases were evaluated. Statistical analysis was used to verify the association between quantitative variables and a group; Student t test or Mann-Whitney test, and analysis of variance (normality assumption) or Kruskal-Wallis test (non-parametric), P value of less than .05. RESULTS There were 81.3% female participants, 54.9% self-reported their race and/or skin color as brown, and 37.8% were sedentary. Pain intensity scores were 6.26 ± 2.19 in female participants and 5.82 ± 1.84 in male participants. Mean FD scores were 11.68 ± 6.08 for female participants and 9.61 ± 5.76 for males participants, although 39.7% of the total group presented with severe disability (score ≥14) and FD was associated with female sex (P = .001), physical activity (P≤ 0.001), body mass index (P≤ .001), emotional level (P < .001), and health perception (P < .001). CONCLUSION In this group of older adults with LBP, FD was associated with female sex, level of physical activity, body mass index, emotional level, and health perception. Many factors that were identified with FD are modifiable; therefore, interventions, such as nutrition education and re-conceptualization of self-emotional and health perception, may have potential to help in preventing and reducing FD.
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Affiliation(s)
- Ingred Merllin Batista de Souza
- Department of Physiotherapy, Speech-Language Pathology and Audiology, and Occupational Therapy, Program in Rehabilitation Sciences, Faculty of Medicine at University of São Paulo, São Paulo, São Paulo, Brazil.
| | - Lilian Regiani Merini
- Department of Faculty of Physical Education and Physical Therapy at Federal University of Amazonas, Manaus, Amazonas, Brazil
| | | | - Adriana de Sousa do Espírito Santo
- Department of Physiotherapy, Speech-Language Pathology and Audiology, and Occupational Therapy. Faculty of Medicine at University of São Paulo, São Paulo, São Paulo, Brazil
| | - Amélia Pasqual Marques
- Department of Physiotherapy, Speech-Language Pathology and Audiology, and Occupational Therapy, Program in Rehabilitation Sciences, Faculty of Medicine at University of São Paulo, São Paulo, São Paulo, Brazil
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