Health inequity assessment in Brazil: is EQ-5D-3L sensible enough to detect differences among distinct socioeconomic groups?

BACKGROUND: Multidimensional health-related quality of life (HRQOL) instruments, such as the EQ-5D, are increasingly used to assess inequalities in health. However, it is necessary to explore the ability of these instruments to capture differences between population groups, especially in low/middle-income countries. This study aimed to investigate whether the EQ-5D-3L instrument can detect differences in HRQOL between groups of different socioeconomic status (SES) in Brazil. METHODS: Data collection occurred during the Brazilian EQ-5D-3L valuation study and included respondents aged 18 to 64 years enrolled in urban areas. SES was aggregated into three categories: "higher" (A and B), "intermediate" (C) and "lower" (D and E). EQ-5D-3L index was calculated considering the Brazilian value set. A mixed-effects regression model was estimated with random effects on individuals and marginal effects on SES, sex, and educational attainment. Odds ratios for the chance of reporting problems for each EQ-5D dimension were estimated by logistic regression. RESULTS: A total of 9,148 respondents were included in the study. Mean age was 37.80 ± 13.13 years, 47.4% were men and the majority was ranked as classes B or C (38.4% and 50.7%, respectively). Participants in lower SES classes reported increasingly poorer health compared to individuals in higher classes. The mean EQ-5D-3L index decreased as SES deteriorates being significantly higher for classes A and B (0.874 ± 0.14) compared to class C (0.842 ± 0.15) and classes D and E (0.804 ± 0.17) (p < 0.001). The same was observed for the mean EQ-VAS scores (84.0 ± 13.8 in classes A and B, 81.0 ± 17 in class C and 78.3 ± 18.7 in class C [p < 0.001]). The multivariate analysis confirmed that SES is an independent factor that effects EQ-5D-3L index measures. Participants in intermediate and lower SES classes have a statistically significant lower EQ-5D-3L index compared to participants in classes A and B, regardless of age, sex, and educational attainment. CONCLUSION: In a Brazilian population sample, the EQ-5D-3L instrument was able to detect important differences between groups with distinct socioeconomic statuses (SES). The EQ-5D-3L is useful for exploring inequities in health.

Probiótico e/ou prebiótico sobre as características da leitegada e da matriz lactante / Probiotic and/or prebiotic on litter characteristics and sow breastfeeding

Conduziu-se este trabalho, com o objetivo de verificar o efeito do uso de probiótico e/ou prebiótico na alimentação de matrizes suínas. Foi utilizado um delineamento inteiramente casualizado com 4 tratamentos e 6 repetições (T1= controle; T2= prebiótico; T3= probiótico; e T4= prebiótico + probiótico), sendo cada fêmea considerada uma parcela. A adição de probiótico e/ou prebiótico diminuiu o número de leitões mumificados. A adição de prebiótico na ração das matrizes adicionado ou não de probiótico, elevou a concentração de proteína no leite no 21º dia de lactação. No 14º dia de lactação, as concentrações de Clostridium perfringens foram menores nas fezes de matrizes que se alimentaram de probiótico. No 21º dia de lactação, as concentrações de Bifidobacterium nas fezes das matrizes foram estatisticamente menores no tratamento com prebiótico (T2). As concentrações de Enterobacteriaceae foram maiores nas fezes de matrizes que receberam a adição de probiótico (T3).

The objective of the present study was to in determine the effect of probiotic and/or prebiotic added to feed for sows. An entirely randomized design with 24 sows, 4 treatments and 6 replicates (T1 = control; T2 = prebiotic; T3 = probiotic; and T4 = prebiotic + probiotic) was used. The addition of probiotic and/or prebiotic decreased the number of mummified piglets. The addition of prebiotic to sow´s feed, with or without probiotic, increased the concentration of milk protein on the 21st day of lactation. On the14th day of lactation, the of Clostridium perfringens was smaller in the faeces of sows fed with probiotic (T3 and T4). On the 21st day of lactation, the concentration of Bifidobacterium in the faeces was statistically lower in sow food with prebiotic (T2). Concentrations of Enterobacteriaceae were higher in the faeces of sows that received probiotic (T3).