La discapacidad del jefe de familia aumenta la severidad de la inseguridad alimentaria en el hogar: análisis de una encuesta poblacional colombiana / Head of household disability can increase household food insecurity: an analysis of a Colombian population survey / A deficiência do chefe de família pode aumentar a insegurança alimentar domiciliar: análise de uma pesquisa populacional colombiana

Resumen: El objetivo de este estudio fue estimar la asociación entre la discapacidad del jefe de familia y la severidad de la inseguridad alimentaria de su hogar, en pobladores de Colombia, durante el 2017. Se realizó un análisis secundario de los datos de la Encuesta Nacional de Calidad de Vida del 2017 (ECV 2017) de Colombia. La variable independiente fue la discapacidad evaluada con las preguntas del grupo de Washington y la variable dependiente fue la inseguridad alimentaria medida con la Escala Latinoamericana y Caribeña de Seguridad Alimentaria (ELCSA). Se incluyeron variables de confusión sociodemográficas y relacionadas con la inseguridad alimentaria. Para demostrar la asociación se utilizó la regresión logística ordinal y se estimaron odds ratio (OR) con sus intervalos de 95% de confianza (IC95%). En todos los cálculos se consideró el muestreo complejo de la ECV 2017. Se incluyeron los datos de 8.488 jefes de familia. El 9,2% admitió que tenía alguna discapacidad y el 41,8% refirió que su hogar presentaba algún nivel de inseguridad alimentaria. Los hogares con un jefe de familia con discapacidad tuvieron 30% más probabilidad de mayor severidad de inseguridad alimentaria, en comparación con los hogares con un jefe de familia sin discapacidad (OR = 1,30; IC95%: 1,07-1,59), ajustado por múltiples variables de confusión. En conclusión, en Colombia, durante el 2017, la discapacidad de los jefes de familia aumentó la probabilidad de mayor severidad de la inseguridad alimentaria en sus hogares. Es necesaria la creación de programas de asistencia nutricional enfocados en las poblaciones vulnerables como las personas con discapacidad.

Abstract: This study investigated the association between head of household disability and the severity of food insecurity in Colombian households during 2017. A secondary data analysis was conducted based on 2017 Colombian National Quality of Life Survey (ECV 2017). As the independent variable, disability was assessed using questions from the Washington group, whereas the dependent variable - food insecurity - was measured by the Latin American and Caribbean Food Security Scale (ELCSA). Sociodemographic confounding variables and variables related to food insecurity were included. Association was analyzed by ordinal logistic regression, and the odds ratio (OR) was estimated with its 95% confidence intervals (95%CI). All calculations considered the complex sampling of ECV 2017. Data from 8,488 heads of household were included. A total of 9.2% of the participants had some type of disability and 41.8% reported some level of household food insecurity. Households with a head of household with some disability were 30% more likely to develop severe food insecurity compared with households with a head of household without disabilities (OR = 1.30; 95%CI: 1.07-1.59), adjusted for multiple confounding variables. In 2017, Colombian households with heads of household with disabilities were more likely to develop severe food insecurity. It is essential to implement nutritional assistance programs aimed at vulnerable populations, such as people with disabilities.

Resumo: Este estudo busca determinar a associação entre a deficiência do chefe de família e a gravidade da insegurança alimentar em domicílios colombianos durante 2017. Foi realizada uma análise secundária dos dados da Pesquisa Nacional de Qualidade de Vida de 2017 (ECV 2017) da Colômbia. A variável independente foi a deficiência, avaliada por meio de perguntas do grupo de Washington, e a variável dependente foi a insegurança alimentar, medida pela Escala de Segurança Alimentar da América Latina e do Caribe (ELCSA). Foram incluídas variáveis de confusão sociodemográficas e relacionadas à insegurança alimentar. A regressão logística ordinal foi utilizada para analisar a associação, e a razão de probabilidades (OR) foi estimada com seus intervalos de 95% de confiança (IC95%). Em todos os cálculos foi considerada a amostragem complexa da ECV 2017. Foram incluídos dados de 8.488 chefes de família. Houve 9,2% dos participantes com algum tipo de deficiência e 41,8% relataram que seu domicílio apresentava algum nível de insegurança alimentar. Os domicílios com chefe de família com deficiência tiveram 30% mais chances de desenvolver insegurança alimentar mais grave, em comparação com as famílias com chefe de família sem deficiência (OR = 1,30; IC95%: 1,07-1,59), ajustado para múltiplas variáveis de confusão. Em 2017, os domicílios colombianos com chefes de família com deficiência tiveram maior probabilidade de desenvolver insegurança alimentar grave. É necessária a implementação de programas de assistência nutricional voltados para populações vulneráveis como as pessoas com deficiência.

Smokers who were seen by a doctor or other healthcare provider for any health concern in Brazil: what a missed opportunity to encourage smoking cessation!

OBJECTIVES: This study aimed to examine changes in the proportion of smokers who were advised to quit smoking by health professionals as part of routine consultations or interactions with their patients between 2008 and 2019. STUDY DESIGN: Serial cross-sectional study. METHODS: Data from two nationally representative cross-sectional surveys were used to examine changes over time in the proportions of smokers who were seen by a doctor or other healthcare provider for any health concern and were advised to quit smoking ('Advice_HP'). An additional dichotomous variable ('AdviceAccess_HP') was created and included smokers who were not seen by a doctor or other healthcare provider in the past 12 months in the 'no advice' received category. Crude and adjusted absolute differences in prevalence rates of smokers who were advised to quit smoking by health professionals as part of routine consultations or interactions with their patients between 2008 and 2019 were evaluated using a generalised linear model. RESULTS: The proportion of smokers who were seen by a health professional for any health concern increased from 58.8% in 2008 to 88.7% in 2019. The proportion of 'AdviceAccess_HP' increased from 33.6% in 2008 to 45.2% in 2019; however, the proportion of 'Advice_HP' decreased from 57.1% in 2008 to 51.0% in 2019. After adjustment for sociodemographic and smoking behaviour characteristics, differences remained virtually unchanged. In 2019, health professionals missed the opportunity to provide around 10 million smokers with brief advice to stop smoking. CONCLUSIONS: Monitoring the actions needed to encourage smoking cessation is critical for achieving the United Nations sustainable development goals. Primary healthcare workers should serve as role models for patients and provide brief advice that increases the likelihood of successfully quitting tobacco use, particularly in low- and middle-income countries.

Vitamin E and cardiovascular diseases: an interest to public health?

Cardiovascular diseases (CVD) are the leading cause of death worldwide. From this perspective, the role of vitamin E and its metabolites in preventing CVD has been studied, being supported by the findings that low vitamin E concentrations are associated with an increased risk of cardiovascular events. Despite this, no studies have analysed the co-existence of vitamin E deficiency (VED) and CVD on the basis of population studies. Facing that, this study summarises information on the relationship between vitamin E status and CVD, providing a basis for understanding the determining and protective factors for its development. VED may be a public health problem since it has been observed to vary from 0·6% to 55·5% worldwide, with higher percentages in Asia and Europe, where CVD mortality rates stand out. Intervention studies with α-tocopherol supplementation do not confirm cardioprotective action of vitamin E, which may reflect that α-tocopherol alone does not provide cardiovascular protection to individuals, but the consumption of all isomers found in food. Considering that low concentrations of α-tocopherol can lead to a higher susceptibility to diseases involving oxidative stress in the population, in addition to the high and growing prevalence of CVD and VED, it is essential to investigate or reinterpret the mechanisms of action of vitamin E and its metabolites in the cardiovascular process to better understand the co-existence of CVD and VED. It is also important to implement public health policies and programmes aimed at promoting the consumption of natural food sources of vitamin E and healthy fats.

Killer cell immunoglobulin-like receptor (KIR) genes and their HLA ligands in a Brazilian population.

Killer cell immunoglobulin-like receptors (KIR) exhibit extensive diversity, giving rise to different KIR profiles in populations worldwide. This study aimed to investigate the distribution of KIR genes and HLA ligands in a population from Campinas, southeastern Brazil (n = 292), and to compare their results with other populations. A comprehensive analysis of population-specific genes, genotype, and haplotype frequencies of KIR may facilitate a better understanding of their evolution and role in immunity. The genotyping of 16 KIR genes and HLA class I alleles was performed by the reverse sequence-specific oligonucleotide methodology using the Luminex platform (One Lambda, Inc., Canoga Park, CA). The framework genes were present in all individuals, with the most common non-framework KIR genes detected being KIR2DP1(96.6%), KIR2DL1(95.5%), KIR3DL1(94.5%), KIR2DS4(93.8%) and KIR2DL3(87.3%). KIR2DS1, KIR2DS3, KIR2DS5, and KIR3DS1 presented frequencies below 40%. KIR2DL2, KIR2DL5, and KIR2DS2 showed intermediate frequencies (between53% and 58%). The activating gene KIR2DS5 was the least common in this population (30.8%). Forty-five KIR profiles were found with the commonest being the homozygous A haplotype (27.4%). The distribution of KIR genes in the Brazilian population is similar to Caucasian European and Euro-descendant populations.

Prevalence of adolescent risk behaviors at 11 and 15 years of age: data from the 2004 Pelotas birth cohort

Objectives: The objective of this study was to investigate the prevalence of the following risk behaviors: experimentation with cigarettes, electronic cigarettes, alcohol, substances, delinquent behavior, and sex at age 15, stratified by sex and socioeconomic position. We also investigated the prevalence of cigarette and alcohol experimentation at age 11 and the persistence and cumulative incidence of these behaviors between 11 and 15 years of age. Methods: In this cohort study, we included 3,491 11-year-olds and 1,949 15-year-olds from the 2004 Pelotas Birth Cohort. All outcomes were identified via confidential questionnaires and were analyzed as binary variables. Results: At age 11, there was a higher prevalence of cigarette experimentation among boys. At age 15, there was a higher prevalence of experimentation with alcohol, cigarettes, and substances among girls; experimentation with cigarettes and sex were more prevalent among those in a low socioeconomic position. We found a high cumulative incidence of alcohol experimentation, as well as persistent alcohol experimentation, in both boys and girls. Conclusions: Further research should clarify causal paths of the high prevalence of risk behaviors during adolescence and its increase among girls.

Panorama of Intimate Partner Violence Against Women in Brazil and its Association With Self-Perception of Health: Findings From a National Representative Survey.

Intimate partner violence (IPV) is a challenge in Brazil. The country holds one of the highest rates of femicide in the world, most of which are preceded by IPV. We conducted a cross-sectional study with 34,334 women, aged 18 to 59 years, from the 2019 Brazilian National Health Survey to analyze the prevalence of IPV and its subtypes among the Brazilian adult women in the last 12 months, encompassing their health consequences and the use of health services resulting from IPV. We also used logistic regression models to estimate the association of sociodemographic characteristics and self-perceived health status with IPV. The prevalence of IPV among Brazilian adult women in the last 12 months was 7.6% (95% confidence interval [CI] [7.0, 8.2]). Women aged 18 to 39 years, not married, and with income of up to 1 minimum wage (MW), had higher odds of suffering IPV. Among those who reported health consequences due to IPV, 69% reported psychological consequences, and 13.9% sought health care, mostly in primary or secondary health care services in the Brazilian Unified Health System (41.9%). Regarding the self-perceived health variables, women who reported eating problems (odds ratio [OR] = 1.29; [1.01, 1.65]), lack of interest/absence of pleasure (OR = 1.41; [1.11, 1.79]), depressive feelings (OR = 1.39; [1.03, 1.88]), feeling of failure (OR = 1.75; [1.36, 2.24]), and suicidal thoughts (OR = 1.73; [1.25, 2.41]) had greater odds of reporting IPV compared to those who did not report these same perceptions. The results show that younger, divorced or single, low-income women with eating problems and mental health disorders were more likely to suffer IPV. IPV often led to health problems, and many abused women sought support from public health services. Health professionals must be trained to identify and care for these women, thereby acting as allies in preventing and reducing IPV.

Prevalence of adolescent risk behaviors at 11 and 15 years of age: data from the 2004 Pelotas birth cohort.

OBJECTIVES: The objective of this study was to investigate the prevalence of the following risk behaviors: experimentation with cigarettes, electronic cigarettes, alcohol, substances, delinquent behavior, and sex at age 15, stratified by sex and socioeconomic position. We also investigated the prevalence of cigarette and alcohol experimentation at age 11 and the persistence and cumulative incidence of these behaviors between 11 and 15 years of age. METHODS: In this cohort study, we included 3,491 11-year-olds and 1,949 15-year-olds from the 2004 Pelotas Birth Cohort. All outcomes were identified via confidential questionnaires and were analyzed as binary variables. RESULTS: At age 11, there was a higher prevalence of cigarette experimentation among boys. At age 15, there was a higher prevalence of experimentation with alcohol, cigarettes, and substances among girls; experimentation with cigarettes and sex were more prevalent among those in a low socioeconomic position. We found a high cumulative incidence of alcohol experimentation, as well as persistent alcohol experimentation, in both boys and girls. CONCLUSION: Further research should clarify causal paths of the high prevalence of risk behaviors during adolescence and its increase among girls.

Valles SA. Philosophy of Population Health: Philosophy for a New Public Health Era

ABSTRACT This book analysis some features and consequences of the emerging field of Population Health Science, which some authors define as Public Health 3.0. It is a mode of reaction against the biomedical model of health which was hegemonic in the twentieth century. It recognizes the World Health Organization's (WHO) definition of health 'as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity', that health is empirically social and most of its determinants are social and economic ones; population health interventions are ethically inseparable from social empowerment and health research and health promotion must, coherently with these ideas, contemplate health as a social phenomenon too. Community-based participatory research is a pressing need for a change in the field of public/population health.

RESUMO Este livro analisa alguns aspectos e consequências do campo emergente da Ciência da Saúde Populacional, o que alguns autores definem como Saúde Pública 3.0. É um modo de reagir contra o modelo biomédico hegemônico durante o século XX. Ele reconhece a definição de saúde da Organização Mundial da Saúde (OMS) 'como estado de completo bem-estar físico, mental e social e não simplesmente ausência de doença ou enfermidade', que a saúde é empiricamente social e a maioria de seus determinantes são sociais ou econômicos; as intervenções de saúde populacional são eticamente inseparáveis do empoderamento social e a pesquisa em saúde e a promoção de saúde devem, de modo coerente com essas ideias, contemplar saúde como fenômeno social. Pesquisa participativa de base comunitária é uma necessidade premente para viabilizar mudanças no campo da saúde pública/populacional.

Avaliação de indicadores de monitoramento do rastreamento do câncer de mama na população do sexo feminino atendida no Sistema Único de Saúde, Brasil, 2018-2019: estudo descritivo / Evaluación de indicadores del tamizaje de cáncer de mama en la población femenina atendida en el Sistema Único de Salud, Brasil, 2018-2019: estudio descriptivo / Evaluation of breast cancer screening indicators in the female population using the National Health System, Brazil, 2018-2019: a descriptive study

Objetivo: analisar indicadores de monitoramento do rastreamento do câncer de mama na população feminina usuária do Sistema Único de Saúde, Brasil, no período 2018-2019. Métodos: estudo descritivo, a partir do Sistema de Informação do Câncer; foram calculados indicadores de rastreamento após relacionamento determinístico das bases de dados de mamografia e histopatologia. Resultados: em 2018, 807.430 mulheres na faixa etária de 50-69 anos foram rastreadas, e dessas, 91% apresentaram resultado benigno, 1,8% provavelmente benigno, 6,7% inconclusivo e 0,5% sugestivo de câncer; a taxa de mamografia positiva foi de 9,0%; estimou- -se indicação de biópsia para 1,6% das mulheres, resultado maligno para 33,9% delas, e taxa de confirmação de câncer de 5,4 por 1 mil mulheres. Conclusão: identificou-se elevada perda de seguimento das lesões benignas; a taxa de mamografias positivas foi inferior ao parâmetro internacional; contudo, a taxa de detecção de câncer foi adequada, e o percentual de mamografias inconclusivas, aceitável.

Objetivo: analizar indicadores del tamizaje de cáncer de mama en población femenina atendida por Sistema Único de Salud Brasileño, de 2018-2019. Métodos: estudio descriptivo basado en Sistema de Información del Cáncer (Siscan). Los indicadores de detección se calcularon después de vinculación determinista de bases de datos de mamografía e histopatología. Resultados: en 2018, 807.430 mujeres de 50-69 años examinaram cáncer de mama. De estos, 91% tuvo resultado benigno, 1,8% probablemente benigno, 6,7% resultado no concluyente y 0,5% sugestivo de cáncer. La tasa de mamografías positivas fue 9,0%. Se estimó indicación de biopsia en 1,6% de las mujeres, resultado maligno en 33,9% y tasa de confirmación de cáncer de 5,4 por 1.000 mujeres. Conclusión: se identificó alta pérdida de seguimiento de las lesiones benignas. La tasa de mamografías positivas fue inferior al parámetro internacional, pero la tasa de detección de cáncer fue adecuada y el porcentaje de mamografías no concluyentes aceptable.

Objetive: to analyze breast cancer screening monitoring indicators in the female population using the Brazilian National Health System, from 2018 to 2019. Methods: this was a descriptive study based on Cancer Information System (SISCAN) data; screening indicators were calculated following deterministic linkage of the mammography and histopathology databases. Results: in 2018, 807,430 women aged 50 to 69 years were screened for breast cancer, 91% of whom had a benign result, 1.8% probably benign, 6.7% inconclusive results and 0.5% results suggestive of cancer; the positive mammogram rate was 9.0%; biopsy was estimated to be indicated for 1.6% of the women, 33.9% of whom had a malignant result, and the cancer confirmation rate was 5.4 per 1,000 women. Conclusion: high benign lesion loss to follow-up was identified; the positive mammogram rate was lower than the international parameter, but the cancer detection rate was adequate and the percentage of inconclusive mammograms was acceptable.

Tendência temporal e gastos das internações com diagnóstico principal por diabetes mellitus no Sistema Único de Saúde do Brasil, 2011 a 2019 / Time trend and costs of hospitalizations with diabetes mellitus as main diagnosis in the Brazilian National Health System, 2011 to 2019 / Tendencia temporal y costos de las hospitalizaciones con el diagnóstico principal de diabetes mellitus en el Sistema Único de Salud de Brasil, de 2011 a 2019

Objective To analyze the diabetes mellitus (DM) temporal trend and hospitalization costs in Brazil, by region, Federative Units (FUs) and population characteristics, from 2011 to 2019. Methods This was an ecological study with data from the Hospital Information System, analyzing the annual trend in hospitalization rates for DM according to sex, age, race/skin color and region/FU by Prais-Winsten generalized linear regression. Results A total of 1,239,574 DM hospitalizations were recorded in the country and the hospitalization rates was 6.77/10,000 inhabitants in the period. The DM hospitalization rates trend was falling for both sexes and in most regions, while it was rising in the younger population and for length of stay (average 6.17 days). Total expenditure was US$ 420,692.23 and it showed a rising trend. Conclusion The temporal trend of hospitalization rates due to DM was falling, with differences according to region/FU and age group. Average length of stay and expenditure showed a rising trend.

Objetivo Analizar la tendencia temporal y los costos de las internaciones por diabetes mellitus (DM) en Brasil, por región, Unidades Federativas (UF) y características poblacionales, de 2011 a 2019. Métodos Estudio ecológico con datos del Sistema de Información Hospitalaria, analizando la tendencia anual de las tasas de hospitalización (TH) por DM según sexo, edad, raza/color y región/UF mediante regresión de Prais-Winsten. Resultados Se registraron 1.239.574 hospitalizaciones por DM en el país y la TH fue de 6,77/10 mil habitantes en el período. La tendencia de TH por DM fue decreciente en ambos sexos y en la mayoría de las regiones y creciente en la población más joven y en la duración de la estancia. El gasto total fue de 420.692.238 dólares y fue creciente. Conclusión La tendencia temporal de TH por DM fue decreciente, con diferencias según región/UF y grupo de edad. La duración media de la estancia y los gastos mostraron una tendencia creciente.

Objetivo Analisar a tendência temporal e gastos das internações por diabetes mellitus (DM) no Brasil, por região, Unidades da Federação (UFs) e características populacionais, de 2011 a 2019. Métodos Estudo ecológico com dados do Sistema de Informações Hospitalares, analisando a tendência anual das taxas de internação (TIs) por DM segundo sexo, idade, raça/cor e região/UF pela regressão linear generalizada de Prais-Winsten. Resultados Foram registradas 1.239.574 internações por DM no país e a TI foi de 6,77/10 mil habitantes, no período. A tendência das TIs por DM foi decrescente nos dois sexos e na maioria das regiões, e crescente na população mais jovem e no tempo de internação (média de 6,17 dias). O gasto total foi de US$ 420.692,23 e apresentou tendência crescente. Conclusão A tendência temporal da TI por DM foi decrescente, com diferenças segundo região/UF e grupo etário. O tempo médio de internação e os gastos apresentaram tendência de aumento.

Asociación del índice triglicérido-glucosa con colesterol-no-HDL aumentado como indicador de riesgo cardiometabólico en estudios poblacionales / Association of the triglyceride-glucose index with increased non-HDL-cholesterol as an indicator of cardiometabolic risk in population studies / Associação do índice triglicerídeo-glicose com colesterol-não-HDL aumentado como indicador de risco cardiometabólico em estudos populacionais / Reconocimiento a la trayectoria del Prof. Dr. Juan Miguel Castagnino†

Resumen Se propone la asociación de dos indicadores para la detección de personas con riesgo cardiometabólico (RCM) en estudios poblacionales: triglicéridoglucosa (TyG) >8,75 y colesterol-no-HDL (C-no-HDL) ≥160 mg/dL, que se denominará indicador de RCM. La enfermedad cardiovascular aterosclerótica (ECVA) y la diabetes tipo 2 (DT2) son muy frecuentes. TyG aumentado es un estimador de insulinorresistencia y síndrome metabólico (SM) y está relacionado con la detección precoz de riesgo para DT2. C-no-HDL ≥160 mg/ dL ha sido recomendado informarlo en los estudios de laboratorio vinculados con el riesgo para ECVA, sus aumentos están relacionados con todas las lipoproteínas aterogénicas y es de mucho interés en hipertrigliceridemias y SM, por la presencia de lipoproteínas remanentes. En un estudio poblacional sobre 540 personas del sur argentino se halló un aumento significativo de RCM luego de los 20 años y luego de los 40 años de edad un tercio de la población lo tenía presente. El RCM se halló asociado con el índice de masa corporal (IMC), luego de ajustar para edad y género. Después de los 30 años, el RCM estaba presente en un tercio de las personas con IMC ≥27 kg/m2. En otro estudio realizado en personas con riesgo para DT2 con RCM presente, 65,8% tenían HOMA-IR (homeostasis model assessment-insulin-resistance) >2,1 y 61,8% SM. Se concluye que la asociación de TyG >8,75 y C-no-HDL ≥160 mg/dL (RCM) podría ser de interés para la detección de grupos poblacionales con alto riesgo cardiometabólico, en la prevención de ECVA y DT2.

Abstract The association of two indicators was proposed for the detection of people with cardiometabolic risk (CMR) in population studies: triglyceride-glucose (TyG) >8.75 and non-HDL-cholesterol (Non-HDL-C) ≥160 mg/dL, which will be called CMR indicator. Atherosclerotic cardiovascular disease (ACVD) and type 2 diabetes (T2D) are very common. Increased TyG is an estimator of insulin resistance and metabolic syndrome (MS) and is related to the early detection of risk for T2D. Non-HDL-C≥160 mg/dL has been recommended to be reported in laboratory studies related to the risk for CVA and its increases are related to all atherogenic lipoproteins and it is of great interest in hypertriglyceridemia and MS, due to the presence of lipoproteins remnants. In a population study of 540 people from Southern Argentina, a significant increase in CMR was found after 20 years of age, and after 40 years of age; a third of the population had it. CMR was found to be associated with body mass index (BMI), after adjusting for age and gender. After age 30 years, CMR was present in a third of the people with a BMI ≥27 kg/m2. In another study conducted in people at risk for T2D with CMR present, 65.8% had HOMA-IR (homeostasis model assessment-insulin-resistance) >2.1 and 61.8% MS. It is concluded that the association of TyG <8.75 and non-HDL-C ≥160 mg/dL (CMR) could be of interest for the detection of population groups with high cardiometabolic risk, in the prevention of ACVD and T2D.

Resumo A associação de dois índices é proposta para a detecção de pessoas com risco cardiometabólico (RCM) em estudos populacionais: triglicerídeo-glicose (TyG) >8,75 e colesterol-não-HDL (C-não-HDL) ≥160 mg/ dL, que será denominado indicador de RCM. A doença cardiovascular aterosclerótica (DCVA) e o diabetes tipo 2 (DT2) são muito comuns. TyG aumentado é um estimador de resistência à insulina e síndrome metabólica (SM) e está relacionado com a detecção precoce de risco para DT2. C-não-HDL ≥160 mg/dL tem sido recomendado para relatá-lo em estudos laboratoriais vinculados com o risco de DCVA e seus aumentos estão relacionados com todas as lipoproteínas aterogênicas e é de grande interesse na hipertrigliceridemia e SM devido à presença de restos de lipoproteínas. Em um estudo populacional de 540 pessoas do sul da Argentina, foi encontrado um aumento significativo de RCM após os 20 anos de idade e, depois dos 40 anos, um terço da população o apresentava. A RCM foi associada ao índice de massa corporal (IMC), após ajustar para idade e gênero. Após os 30 anos, a RCM estava presente em um terço das pessoas com IMC ≥27 kg/m2. Em outro estudo realizado em pessoas com risco para DT2 com RCM presente, 65,8% tinham HOMA-IR (homeostasis model assessment-insulin-resistance) >2,1 e 61,8% SM. Conclui-se que a associação de TyG >8,75 e C-não-HDL ≥160 mg/dL (RCM) poderia ser de interesse para a detecção de grupos populacionais com alto risco cardiometabolico, na prevenção de DCVA e DT2.

Hypertension among women experiencing incarceration: A comparison with the general female population.

To compare the prevalence and characteristics of hypertension in women experiencing incarceration (WEI) to the general population in Brazil: (1) a prison survey conducted from January 2014 to December 2015 in 15 states, with 1,327 WEI; and (2) a household survey in the 26 states and the Federal District of Brazil administered to women in the general population (WGP). Data analysis used SPSS® version 20.0. The point estimates and the prevalence ratio with their respective confidence intervals were calculated using Poisson regression. Ages in the two populations differed, 27.9% of WGP were over 50, while 7.3% of WEI were. The overall prevalence of arterial hypertension was 31.3% (95% CI: 28.6-34.0) in the WEI and 38.9% (95% CI: 37.8-39.9) for WGP. For individuals under 30, hypertension was found in 22.4% of WEI and 13.4% of WGP. WEI have a higher prevalence of hypertension at an earlier age than the GP. Less education, obesity, using illegal drugs, previous pregnancy, and not using contraceptives were more frequent in this group, revealing the need to implement policies aimed at treating both their hypertension and other health issues in prison.

An updated hip fracture incidence rate for Brazil: the Brazilian Validation Osteoporosis Study (BRAVOS).

Hip fracture incidence rates in three representative geographic areas in Brazil over a period of 2 years (2010-2012) were assessed for the first time. Estimated incidence rates varied regionally, and markedly differed from those previously reported. Thus, national guidelines as well as FRAX Brazil should be revised in light of this new data. PURPOSE: To determine the annual incidence of hip fractures in individuals aged 50 years and over, living in 3 cities located in different regions of the country. To investigate the age, gender, and regional differences in fracture rates. Based on the obtained data, to estimate the national incidence of hip fractures resulting from osteoporosis, in order to improve prevention strategies. METHODS: Retrospective, observational study including all patients aged ≥ 50 years admitted in hospitals because of a hip fracture in three cities (Belem, Joinville, and Vitoria) from representative geographic areas in Brazil from 2010 to 2012. Data were obtained from medical records in those cities. We analyzed incidence rates (crude and age- and gender-standardized rates) for hip fractures. RESULTS: There were 1025 (310 in men and 715 in women) hip fractures in the over 50-year-old merged population from the three cities. The crude incidence rate for hip fracture was 103.3/100,000 (95% confidence interval [CI = 97.0; 109.7), in men 77.4/100,000 (95% CI = 68.8; 86.0), and in women 125.2/100,000 (95% CI = 116.0; 134.4). Incidence standardized for age and gender was 105.9 cases per 100,000 persons per year (95% CI = 99.4; 112.4); 78.5 cases per 100,000 (95% CI = 69.8; 87.3) in men and 130.6 cases 100,000 in women (95% CI = 121.0, 140.2) per year. Belem, located in the equatorial region (latitude 1° 27' S), had significantly lower crude and age-adjusted incidence than Joinville (latitude 26° 18' S) and Vitoria (latitude 20° 19' S), which were no different from each other. The incidence of fractures increased exponentially with age, and women had about twice the risk of fractures than men. CONCLUSIONS: Hip fracture mainly affects elderly women and presents great variability in incidence between the different regions in Brazil. The incidence of hip fractures in Brazil differed markedly from that reported previously, so that national guidelines and the FRAX model for Brazil should be revised.

Relação de fatores pessoais e ambientais com a prevalência de deficiências físicas adquiridas no Brasil - estudo de base populacional / Relationship between personal and environmental factors and prevalence of acquired physical impairment in Brazil - a population-based study

Resumo Objetivou estimar a relação de fatores pessoais e ambientais com a prevalência de deficiência física adquirida em adultos e idosos brasileiros. Realizado um estudo transversal com dados da Pesquisa Nacional de Saúde (PNS) 2013. A variável resposta foi: autorrelato deficiência física adquirida. As variáveis explicativas de interesse foram: sexo, raça/cor, escolaridade, classe social, trabalho remunerado, plano de saúde, água canalizada e rede de esgoto. As magnitudes das associações e seus respectivos intervalos de confiança (95%) foram estimadas utilizando a Regressão de Poisson. O autorrelato de deficiência física foi encontrado em 1,25% dos 55.369 participantes. Após completo ajustamento, o sexo masculino, raça/cor não branca, menores níveis de escolaridade, viver sozinho, não ter trabalho remunerado, plano de saúde, água canalizada e rede de esgoto foram associados a maiores prevalências de deficiência física adquirida. Esses achados evidenciam que a população mais vulnerável apresenta maior prevalência de deficiência física e os fatores pessoais e ambientais são importantes de serem avaliados em nível populacional.

Abstract The aim of this study was to estimate the relationship between personal and environmental factors and the prevalence of acquired physical impairment in adults and older persons in Brazil. We conducted a cross-sectional study using data from the 2013 National Health Survey. The response variable was self-reported acquired physical impairment. The explanatory variables were sex, race/skin color, education level, social class, paid employment, private health insurance, running water, and connection to a sewer network. The strength of association between the explanatory variables and response variable and respective 95% confidence intervals were estimated using Poisson Regression. Physical impairment was reported by 1.25% of the study population (n=55,369). After complete adjustment, being male and non-white, having a lower level of education, living alone, not being in paid employment, not having private health insurance, not having running water, and not living in a house connected to a sewer network were associated with higher prevalence of acquired physical impairment. The findings show that prevalence of physical impairment was higher among vulnerable groups and that personal and environmental factors are important elements that need to be assessed at the population level.

Sun protection as a protective factor for actinic cheilitis: Cross-sectional population-based study.

OBJECTIVE: To determine whether sun protection is associated with lower occurrence of actinic cheilitis in adults living in a city from southern Brazil. MATERIALS AND METHODS: A multi-stage proportional sample of 404 individuals 18 years and older was obtained. Interviews and clinical examinations were conducted in participants' households. Four categories of self-reported use of sun protection were determined. Multivariable Poisson regression was used to assess the associations. RESULTS: Prevalence of actinic cheilitis was 47.1%. In the first main-effects multivariable model, AC was significantly associated with sex, age, skin colour and duration of sun exposure, but not with sun protection. However, the association between sun protection and actinic cheilitis was modified by the time of sun exposure. Among those exposed ≥4 hr/day to sun, individuals using physical protection or physical + chemical protection were 33% (prevalence ratio = 0.67, 95% confidence interval [CI] 0.47-0.94, p = .02) and 36% (PR = 0.64, 95% CI 0.47-0.94, p = .02), respectively, less likely to have actinic cheilitis than those who did not use any sun protection, adjusting for sex, age and skin colour. CONCLUSIONS: Physical and chemical sun protection were associated with lower occurrence of actinic cheilitis in individuals with greater exposure to sun.

Operational Challenges in the Use of Structured Secondary Data for Health Research.

Background: In Brazil, secondary data for epidemiology are largely available. However, they are insufficiently prepared for use in research, even when it comes to structured data since they were often designed for other purposes. To date, few publications focus on the process of preparing secondary data. The present findings can help in orienting future research projects that are based on secondary data. Objective: Describe the steps in the process of ensuring the adequacy of a secondary data set for a specific use and to identify the challenges of this process. Methods: The present study is qualitative and reports methodological issues about secondary data use. The study material was comprised of 6,059,454 live births and 73,735 infant death records from 2004 to 2013 of children whose mothers resided in the State of São Paulo - Brazil. The challenges and description of the procedures to ensure data adequacy were undertaken in 6 steps: (1) problem understanding, (2) resource planning, (3) data understanding, (4) data preparation, (5) data validation and (6) data distribution. For each step, procedures, and challenges encountered, and the actions to cope with them and partial results were described. To identify the most labor-intensive tasks in this process, the steps were assessed by adding the number of procedures, challenges, and coping actions. The highest values were assumed to indicate the most critical steps. Results: In total, 22 procedures and 23 actions were needed to deal with the 27 challenges encountered along the process of ensuring the adequacy of the study material for the intended use. The final product was an organized database for a historical cohort study suitable for the intended use. Data understanding and data preparation were identified as the most critical steps, accounting for about 70% of the challenges observed for data using. Conclusion: Significant challenges were encountered in the process of ensuring the adequacy of secondary health data for research use, mainly in the data understanding and data preparation steps. The use of the described steps to approach structured secondary data and the knowledge of the potential challenges along the process may contribute to planning health research.

Uric acid: A new marker for metabolic syndrome? Results of a population-based study with adults.

BACKGROUND AND AIMS: Recently, studies have shown a positive association between serum uric acid (UA) and metabolic syndrome (MS). To evaluate the predictive capacity and the association of serum UA with pre-MS and MS, by sex, in adults. METHODS AND RESULTS: Cross-sectional study with 932 adults, of both sexes, from Viçosa, Minas Gerais (MG), Brazil. Sociodemographic and behavioral data were obtained through a questionnaire and anthropometric, clinical, and biochemical evaluation. We used multinomial logistic regression and the area under receiver operating characteristic curve (AUC). The prevalence of pre-MS was 17.8% and of MS was 26.5%. The fitted models showed positive association of serum UA with pre-MS (OR = 1.62, 95% CI = 1.09-2.40) and MS (OR = 2.61, 95% CI = 1.99-3.42) among men. For women, similar results were found for MS (OR = 2.59, 95% CI = 1.81-3.73). The optimal cutoff points obtained by AUC for pre-MS and MS were 4.7 and 4.9 mg/dL among men and 3.1 and 3.4 mg/dL among women, respectively. CONCLUSION: The results point to a positive association of UA with pre-MS and MS, with no significant differences between sexes. Therefore, UA can be used as an additional marker in the screening of these conditions.

Reparo das hérnias abertas e laparoscópicas no Sistema Público de Saúde brasileiro. Estudo nacional baseado em dados populacionais em período de 11 anos / Open vs laparoscopic hernia repair in the brazilian public health system. an 11-year nationwide population-based study

ABSTRACT BACKGROUND: Abdominal wall hernia is one of the most common surgical pathologies. The advent of minimally invasive surgery raised questions about the best technique to be applied, considering the possibility of reducing postoperative pain, a lower rate of complications, and early return to usual activities. OBJECTIVE: To evaluate the frequency of open and laparoscopic hernioplasties in Brazil from 2008 to 2018, analyzing the rates of urgent and elective surgeries, mortality, costs, and the impact of laparoscopic surgical training on the public health system. METHODS: Nationwide data from 2008 to 2018 were obtained from the public health registry database (DATASUS) for a descriptive analysis of the selected data and parameters. RESULTS: 2,671,347 hernioplasties were performed in the period, an average of 242,850 surgeries per year (99.4% open, 0.6% laparoscopic). The economically active population (aged 20-59) constituted the dominant group (54.5%). There was a significant reduction (P<0.01) in open surgeries, without a compensatory increase in laparoscopic procedures. 22.3% of surgeries were urgent, with a significant increase in mortality when compared to elective surgeries (P<0.01). The distribution of laparoscopic surgery varied widely, directly associated with the number of digestive surgeons. CONCLUSION: This study presents nationwide data on hernia repair surgeries in Brazil for the first time. Minimally invasive techniques represent a minor portion of hernioplasties. Urgent surgeries represent a high percentage when compared to other countries, with increased mortality. The data reinforce the need for improvement in the offer of services, specialized training, and equalization in the distribution of procedures in all regions.

RESUMO CONTEXTO: Hérnias de parede abdominal são patologias cirúrgicas frequentes. O surgimento da cirurgia minimamente invasiva levantou questionamentos sobre a melhor técnica a ser aplicada, considerando a possível redução de dor pós-operatória e de complicações, e retorno precoce às atividades habituais. OBJETIVO: Avaliar frequência de hernioplastias abertas e laparoscópicas no Brasil entre os anos de 2008 e 2018, analisar taxas de cirurgias urgentes e eletivas, mortalidade, custos e o impacto do treinamento em cirurgia laparoscópica no sistema público de saúde. MÉTODOS Análise de banco de dados do registro de saúde pública (DATASUS) entre 2008 e 2018 para coleta dos dados e parâmetros selecionados. RESULTADOS: Foram realizadas 2.671.347 hernioplastias no período, média de 242.850 cirurgias/ano (99,4% abertas, 0,6% laparoscópicas). Predominou a faixa etária economicamente ativa (20-59 anos), 54,5% do total. Houve redução significativa das cirurgias abertas (P<0,01), sem aumento compensatório da laparoscopia. 22,3% das cirurgias foram de urgência, com aumento significativo da mortalidade em relação às cirurgias eletivas (P<0,01). Observou-se distribuição heterogênea da videolaparoscopia, diretamente relacionada com o número de cirurgiões digestivos. CONCLUSÃO: Este estudo apresenta pela primeira vez os dados populacionais das cirurgias de hérnia no Brasil. As técnicas minimamente invasivas representam uma parcela pouco significativa das hernioplastias. As cirurgias urgentes apresentam percentual elevado comparado a outros países, com aumento significativo na mortalidade, reforçando a necessidade de políticas que permitam aumento da oferta do serviço, treinamento especializado e equalização na distribuição dos procedimentos em todas as regiões.

Nationwide use of psychotropic drugs for treatment of self-reported depression in the Brazilian urban adult population / Uso nacional de drogas psicotrópicas no tratamento da depressão autorreferida na população adulta urbana brasileira

ABSTRACT: Objective: Antidepressant use is increasing worldwide, but national data on psychotropic drug use by depressed patients in Brazil is lacking. Methodology: Between 2013 and 2014, a representative sample of urban adult individuals were asked if they had a diagnosis of chronic disease, had a medical indication for drug treatment, and were taking chronic medications at the time for each reported diagnosis. We analyzed the frequencies of reported depression and the medications related to this disease. Results: Overall, 6.1% of respondents reported depression. The prevalence increased with age - 9.5% among the elders - was higher among women (8.9%) and in the south of the country (8.9%). As a single disease, the prevalence of depression was higher among young people (17.6%). Among those with multimorbidity, the prevalence of depression rose to 25.7%. Of those who reported depression, 81.3% had medical indication for treatment and 90.3% were under treatment - this proportion was lower among young people (84.5%) and those living in the poorest region (78.6%). Antidepressants accounted for 47.2% of psychotropic drugs taken by respondents with depression, with regional differences - only 30% used antidepressants in the North. Polypharmacy was reported by 22% of those with depression and other chronic diseases. Conclusion: Depression in Brazil, is common among young adults as a single chronic disease and highly prevalent among people with chronic multimorbidity, especially the young. The treatment gap was larger among young people and in the less developed regions of the country.

RESUMO: Objetivo: O uso de antidepressivos está aumentando em todo o mundo, mas faltam dados nacionais sobre o uso de drogas psicotrópicas por pacientes deprimidos no Brasil. Metodologia: Entre 2013 e 2014, uma amostra representativa de indivíduos adultos urbanos foi questionada sobre a presença diagnóstica de doença crônica, a indicação médica para tratamento medicamentoso e o uso de medicamentos crônicos à época de cada diagnóstico relatado. Foram analisadas as frequências de depressão relatada e os medicamentos relacionados a essa doença. Resultados: No geral, 6,1% dos entrevistados relataram depressão. A prevalência aumentou com a idade (9,5% entre os idosos) foi maior entre as mulheres (8,9%) e no sul do país (8,9%). Como doença única, a prevalência de depressão foi maior entre os jovens (17,6%). Entre aqueles com multimorbidade, a prevalência de depressão subiu para 25,7%. Dos que relataram depressão, 81,3% tinham indicação médica para tratamento e 90,3% estavam em tratamento - essa proporção foi menor entre os jovens (84,5%) e os que moram na região mais pobre (78,6%). Os antidepressivos representaram 47,2% dos medicamentos psicotrópicos tomados pelos entrevistados com depressão, com diferenças regionais - apenas 30% usavam antidepressivos no Norte. Polifarmácia foi relatada por 22% das pessoas com depressão e outras doenças crônicas. Conclusão: A depressão no Brasil é comum entre adultos jovens como doença crônica única e altamente prevalente entre as pessoas com multimorbidade crônica, principalmente os jovens. A lacuna de tratamento foi maior entre os jovens e nas regiões menos desenvolvidas do país.

Detección de anticuerpos contra el virus de la hepatitis C en habitantes de la zona sur de Manabí-Ecuador / Antibodies detection against hepatitis C virus in inhabitants of the South of Manabí-Ecuador

El objetivo de la presente investigación es determinar la presencia de anticuerpos contra el virus de la hepatitis C en la población general de la zona sur de Manabí-Ecuador. Se demostró la ausencia de anticuerpos contra VHC en la población estudiada, se necesitan estudios adicionales que abarquen una población mayor

The objective of this research is to determine the presence of antibodies against hepatitis C virus in the general population of the southern area of Manabí-Ecuador. The absence of HCV antibodies was demonstrated in the studied population, additional studies covering a larger population are needed