Atenção Primária à Saúde no Norte e Nordeste do Brasil: mapeando disparidades na distribuição de equipes / Primary Health Care in Northern and Northeastern Brazil: mapping team distribution disparities

Resumo Objetiva-se analisar o padrão espacial de implantação de equipes da Atenção Primária à Saúde (APS) no Norte e Nordeste do Brasil em 2017. Estudo ecológico das taxas de Agentes Comunitários de Saúde (ACS), equipes Saúde da Família (eSF), equipes Saúde Bucal (eSB) e Núcleo Ampliado de Saúde da Família (NASF), a partir de dados do Ministério da saúde (MS). A análise dos dados de área permitiu a identificação de padrões de dependência espacial dos municípios para as taxas, utilizando os índices e mapas de Moran para visualizar clusters de áreas críticas (95% de confiança). Os municípios do Norte (n=450) e Nordeste (n=1.794) apresentaram 132,2 mil ACS, 18,4 mil eSF, 13 mil eSB e 2,2 mil NASF. A proporção de municípios com taxas dentro do preconizado pelo MS: ACS (>1,33/mil) 96% no Norte e 98,5% no Nordeste; eSF (>2,9/10 mil) 54% e 80% nas respectivas regiões; eSB (>2,9/10 mil) 28% e 59% nestas respectivas regiões. Equipes NASF foram implantadas em 70% do Norte e 89% do Nordeste. Exceto ACS, a região Norte constituiu-se em área crítica de equipes, principalmente no Pará, Rondônia, Amazonas e Amapá. No Nordeste, essas áreas foram menores e concentradas a oeste da Bahia e leste do Maranhão. O Nordeste exibiu melhor composição de equipes e menor extensão de áreas críticas.

Abstract This study analyzes the spatial pattern of implementation of Primary Health Care (PHC) teams in Northern and Northeastern Brazil. This is an ecological study on the rates of Community Health Workers (ACS), Family Health Team (eSF), Oral Health Team (eSB), and Family Health Extended Center (NASF) based on data from the Ministry of Health (MoH). The analysis of the area data identified patterns of spatial dependence of the municipalities for the rates, using Moran indices and scatterplots to visualize critical areas' clusters (95% confidence). Municipalities of the North (n=450) and Northeast (n=1,794) had 132,174 ACS, 18,405 eSF, 13,017 eSB, and 2,205 NASF. The proportion of municipalities with rates within the recommended by the MoH were: ACS (>1.33), 96% in the North and 98.5% in the Northeast; eSF (>2.9/1,000), 54% and 80% in the respective regions; eSB (>2.9/10,000) 28% and 59% in these respective regions. NASF teams were deployed in 70% of the North and 89% of the Northeast. Except for ACS, the North was a critical team area, mainly in Pará, Rondônia, Amazonas, and Amapá. In the Northeast, these areas were smaller and concentrated mainly in western Bahia and eastern Maranhão. The Northeast showed a better composition of teams and a smaller extent of critical areas.

Elección de un comportamiento urbano responsable a partir del beneficio, la saliencia del anuncio y la probabilidad de recibir aprobación y reproche / Opting for a Responsible Urban Behavior Based on Benefit, Salience of the Advertisement, and Likelihood of Receiving Social Approval or Criticism

Resumen A través de un estudio correlacional, esta investigación explora la influencia de posibles beneficios sociales y sus variables asociadas en la adopción de Comportamientos Urbanos Responsables (CUR). Teniendo en cuenta la complejidad del problema y el número de variables a explorar, se empleó el modelo de Teoría de Facetas. Además, se diseñó un cuestionario derivado de una "frase mapa" que presenta en forma de viñetas situaciones urbanas hipotéticas que exploran las variables en estudio. Participaron 177 individuos que estimaron la probabilidad de que un individuo involucrado en una viñeta adopte o no un CUR, a partir de variables como la distancia temporal y la magnitud del beneficio, la saliencia del anuncio de este beneficio, y la aprobación social y el reproche. Un análisis de distancias mínimas (SSA) mostró que los participantes reconocen estas variables a la hora de optar por un CUR. La distancia temporal para obtener el beneficio y la magnitud grande del beneficio resultaron estar altamente correlacionadas con la mayor estimación sobre la probabilidad de que un individuo elija un CUR. Se sugiere formular estrategias educativas y políticas públicas que conduzcan al desarrollo de la cooperación, la responsabilidad y la autorregulación, con el fin de contribuir a mejorar la calidad de vida urbana y la convivencia en el medio urbano.

Abstract Through a correlational study, this research explores the influence of possible social benefits and associated variables on the adoption of Responsible Urban Behaviors (RUB). Considering the complexity of the problem and the number of variables to be explored, the Facet Theory model was used. Also, a questionnaire was created, which presented hypothetical urban situations in the form of vignettes that explored the variables under study. A total of 177 individuals participated and estimated the likelihood of an individual involved in a vignette adopting or not an RUB, based on variables such as the time and magnitude of the benefit, salience of the advertisement of such benefit, and social approval and criticism. The smallest space analysis showed that participants recognize these variables when it comes to opting for an RUB. The time to obtain the benefit and the magnitude of the benefit turned out to be highly correlated with the highest estimate of the likelihood of an individual choosing an RUB. This research suggests formulating educational strategies and public policies that lead to the development of cooperation, responsibility, and self-regulation, to help improve the quality of urban life and coexistence in the urban environment.

Fatores ambientais e individuais associados à vacinação contra Hepatite B em gestantes / Environmental and individual factors associated with hepatitis B vaccination in pregnant women

Introdução: A vacina contra hepatite B (recombinante) (VCHB) configura-se como a maneira mais eficaz na prevenção da infecção do vírus da Hepatite B (VHB). A situação vacinal sofre influência de fatores intrínsecos aos indivíduos e, também, dos fatores contextuais. Objetivo: Analisar os fatores ambientais e individuais associados à vacinação contra Hepatite B em gestantes. Métodos: Trata-se de uma revisão sistemática de literatura e meta-análise e estudo epidemiológico com delineamento transversal. Em relação à revisão sistemática, a estratégia de busca foi realizada no EMBASE e MEDLINE. A seleção abrangeu: mulheres grávidas; estudos de coorte ou transversais; estudos com dados sobre a taxa de vacinação contra hepatite B e fatores de risco relacionados. Os modelos de efeitos fixos e os de efeitos aleatórios foram aplicados, utilizando o modelo de acordo com a heterogeneidade metodológica entre os estudos. A heterogeneidade entre os estudos foi avaliada usando a estatística Q e o teste do I-quadrado. Para o estudo epidemiológico, utilizaram-se dados de 266 puérperas que participaram da pesquisa: "Nascer em Belo Horizonte: Inquérito sobre o parto e nascimento". A coleta de dados ocorreu em 11 maternidades de Belo Horizonte, Minas Gerais. A presença de registro da VCHB presente na caderneta de pré-natal foi utilizada como medida indireta da imunização da gestante e considerada como desfecho. Para a detecção do cluster de risco para presença de registro ou ausência de VCHB, foi utilizada a técnica de varredura espacial. Posteriormente, procedeu-se à comparação das variáveis individuais e ambientais entre as Áreas de Abrangência da Unidade Básica de Saúde (AA-UBS). Para avaliar a associação entre os fatores que influenciam a VCHB de gestantes realizou-se a regressão logística multinível. Resultados: A revisão sistemática evidenciou 7 estudos que preencheram todos os critérios de inclusão e 4 foram incluídos na meta-análise. A análise conjunta demonstrou uma associação positiva com um maior nível de escolaridade e VCHB (OR: 1,46; IC 95% 1,12-1,92). Não houve heterogeneidade significativa entre os estudos (I2 = 18%). No estudo epidemiológico, a prevalência de não registro nas cadernetas das gestantes para VCHB foi de 88,34%. Na análise de varredura espacial Scan, observou-se um cluster de alta prevalência para registro de VCHB, sendo que a probabilidade de encontrar uma puérpera com registro VCHB no cluster foi 8,33 vezes comparada com as demais AAUBS. Análises comparativas demonstraram que o trabalho remunerado e o número de consultas realizadas no pré-natal associaram-se positivamente ao registro para VCHB. No modelo logístico multinível final, gestantes que residiam em AA-UBS com maior taxa de criminalidade apresentaram maior chance de não registro para VCHB. Conclusão: Fatores ambientais, como residir em área de altas taxas de criminalidade, e fatores individuais, como maior nível educacional, exercer trabalho remunerado e realizar maior número de consulta de pré-natal, foram determinantes para as taxas de registros de VCHB nas cadernetas das gestantes.(AU)

Introduction: Hepatitis B vaccine (recombinant) (HBV) is the most effective way to prevent hepatitis B virus infection. Vaccination status is influenced by intrinsic individual factors and contextual factors. Objective: To analyze the environmental and individual factors associated with hepatitis B vaccination in pregnant women. Methods: This is a systematic review and meta-analysis of the literature, and epidemiological study with a cross-sectional design. Regarding the systematic review, the search strategy was performed in EMBASE and MEDLINE. The selection included: pregnant women; cohort or cross-sectional studies; studies with data on the vaccination rate against hepatitis B and related risk factors. Fixed and random effects models were applied, according to the methodological heterogeneity between the studies. Heterogeneity between the studies was evaluated using the Q statistic and I-square tests. For the epidemiological study, we used the data of 266 postpartum women who participated in the study: "Birth in Belo Horizonte: Birth and Birth Survey". Data were collected in 11 maternity hospitals in Belo Horizonte, Minas Gerais. The presence of HBV registry in the prenatal care booklet was used as an indirect measure of a pregnant woman´s immunization and was considered as an outcome. For the detection of risk cluster for the presence or absence of HBV registry , spatial scanning technique was used. Subsequently, individual and environmental variables were compared between the coverage areas of the Basic Health Units (CAs - BHUs). In order to evaluate the association between the factors influencing HBV vaccination of pregnant women, multilevel logistic regression was performed. Results: The systematic review evidenced 7 studies that met all the inclusion criteria and 4 were included in the meta-analysis. Pooled analysis showed a positive association between higher education level and hepatitis B vaccination rate (OR: 1.46, 95% CI 1.12­1.92). There was no significant heterogeneity between the studies (I2 = 18%). In the epidemiological study, the prevalence of non- HBV was 88.34%. In the spatial scan analysis, a cluster of high prevalence of HBV was observed, and the probability of finding a puerperium with HBV registration in the cluster was 8.33 times compared to other CAs - BHUs. Comparative analysis showed that the paid work and the number of consultations during prenatal care were positively associated with HBV. In the final multilevel logistic model, pregnant women residing in CAs - BHUs with higher crime rate presented a greater chance of non- HBV. Conclusion: Environmental factors, such as residing in an area of high crime rates, and individual factors, such as higher education level, paid work and greater number of prenatal consultations, were determinant for HBV rates in pregnant women.(AU)

Gestión espacial de riesgos entomoecológicos en Santiago de Cuba / Space management of entomoecologic risks in Santiago de Cuba

Se realizó un estudio observacional y descriptivo, de tipo ecológico, en el municipio de Santiago de Cuba, en el año 2015, con el propósito de identificar la existencia de patrones espaciales respecto a la infestación por Stegomyia aegypti y así desarrollar un análisis pronóstico espacial al respecto. Para ello se utilizaron variables simples y complejas, resumidas y con utilización de paradigmas de la complejidad (redes neuronales y gestión geoespacial). Se observó que la dispersión aleatoria de Stegomyia aegypti condiciona patrones difusos de la infestación, mayormente definida por la dinámica social, más que por las propias características biológicas del vector. De igual modo, la utilización de la Epidemiología panorámica proveyó nuevas aristas de conocimientos en el análisis del problema

An observational, descriptive and ecological study was carried out in Santiago de Cuba, in the year 2015, with the purpose of identifying the existence of space patterns regarding the Stegomyia aegypti infestation and in this way developing a space prognosis analysis in this respect. Thus, summarized simple and complex variables were used, as well as complexity paradigms (neuronal nets and geospace management). It was observed that the randomized dispersion of Stegomyia aegypti conditions diffuse patterns of the infestation, mostly defined by the social dynamics, more than by the common biological characteristics of the vector. In the same way, the use of the panoramic Epidemiology provided new edges of knowledge in the analysis of the problem

Correlation between retinal sensitivity and cystoid space characteristics in diabetic macular edema.

Purpose: To evaluate the correlation between retinal sensitivity and cystoid space characteristics in eyes with diabetic macular edema (DME). Materials and Methods: Prospective cross‑sectional study of 22 subjects with DME (32 treatment‑naïve eyes). All study subjects underwent complete ophthalmic examination, including slit‑lamp biomicroscopy and dilated fundus examination. All subjects underwent spectral domain optical coherence tomography (SD‑OCT) and microperimetry (MP). Intraretinal cystoid space (ICS) volume was generated after manual delineation of cystoid space boundaries using the three‑dimensional‑OCT software. Various SD‑OCT parameters, including retinal thickness, retinal volume, cystoid space volume, cystoid space intensity, and outer retinal structure integrity, were correlated with MP parameters and best‑corrected visual acuity (BCVA). Results: Subject’s mean age was 57 ± 9 years. The mean logarithm of minimum angle of resolution BCVA was 0.4 ± 0.2. The intraclass correlation coefficient for inter‑ and intra‑grader assessment of cystoid space volume by manual delineation was 0.99 and 0.99, respectively. Mean total ICS volume was 0.4 ± 0.4 mm3 and for the foveal center, subfield was 0.1 ± 0.1 mm3. Mean retinal sensitivity was 12.89 ± 10 dB; however, foveal retinal sensitivity was 12.3 ± 11.1 dB. We found no significant correlation between BCVA and total cystoid space volume (r = 0.33, P = 0.06). Correlation between total retinal sensitivity and total ICS was negative and nonsignificant (r = −0.17, P = 0.36). Correlation between foveal retinal sensitivity and foveal cystoid space intensity was moderate and marginally significant (r = −0.43, P = 0.05). Conclusion: Total cystoid space volume was not significantly correlated with BCVA or total retinal sensitivity in subjects with DME. Foveal cystoid space optical intensity was negatively correlated with foveal retinal sensitivity. These findings suggest further investigation of cystoid space characteristics in the setting of DME may be of value.

Advance research on space analysis related factors / 医学研究生学报

Orthodontics is the procedure of managing the space .Space analysis is a comprehensive quantitative analysis that can analyze the factors that influence the arch space .It also helps to judge if the treatment goals can be reached , thus helping the treat-ment plan making and guiding clinical orthodontics .And space analysis related factors include crowding , curve of Spee, arch width, arch growth, arch protrusion, mesiodistal angulation, an so on.In this review, we summarizes the above-mentioned factors.

Prediction of the size of unerupted canines and premolars in an Iranian population.

Background and Aim: One of the important aspects of diagnosis and treatment planning in the mixed dentition is estimation of the size of unerupted permanent canines and premolars. One of the most commonly used the prediction methods are Tanaka and Johnston, which are based on data from a sample of Northern European descent children. The accuracy of this method when applied to a different ethnic population is questionable. The aim of this study was to determine the modified equations from Tanaka and Johnston for Iranian population. Materials and Methods: This study was an analytic and cross-sectional investigation with the randomized cluster sampling in Ahwaz. Fifty four students of 14-18 years age (32 girls, 22 boys) were selected between 320 students and plaster models of their maxillary and mandibular arches were prepared. Subjects had fully erupted teeth, class I canine and molar relationship and presented no proximal caries or fillings, morphological anomalies, missing teeth or occlusal abrasion, and bruxism. The mesiodistal crown diameters of the permanent teeth were measured with using the sharpened boley gauge (accuracy 0.01 mm). The data were analyzed by using the regression correlation analyses and t-test. Results: The size of permanent canines and premolars were larger in maxilla than mandible and males than females. These values in Iran were different from other countries. Conclusion: In this study to predict the space (in mm) required for alignment of unerupted canine and premolars in Iranian children, halve the sum of mesiodistal dimension of the four mandibular incisors and add the respective constants 10.5 for upper jaw and 10 for lower jaw.

Inclinación de incisivos: cálculo de la cantidad de desplazamiento bucolingual y sus efectos en la longitud del arco dental / Incisor inclination: estimate of the quantity of bucolingual displacement and their effects on the dental arc lenght

Se presentan métodos para calcular con mayor precisión la cantidad de desplazamiento incisal en los movimientos de inclinación bucolingual, basados en las fórmulas longitud de arco y longitud de cuerda de una circunferencia y la ley del senocon centro de rotación dinámico. Cuando se usan arcos preformados de alambre durante las fases de alineación ortodóncica, la inclinación producida sobre los dientes anteriores afecta la forma y la longitud del arco total. Actualmente, esto es un aspectopoco evaluado. Se ofrecen guías para calcular estas variaciones con el propósito de lograr análisis de espacio más exactos. Representaciones y análisis de casos refuerzan esta propuesta.

Methods are presented to calculate more precisely the quantity of incisor displacement during buccolingual inclination movements. It is based on the arc length and chord length of a circle and law of sines with dynamic rotation center formulas. When preformed archwires are used during the orthodontic alignment phases, the inclination taking place on the anterior teeth affects the form and total arch length. At present this aspect has not been evaluated in depth. Guidelines are offered to calculate these variations with the purpose of achieving a more exact space analysis. Representations and case analysis reinforce this proposal.