COVID-19's intra-urban inequalities and social vulnerability in a medium-sized city.

BACKGROUND: Social conditions are related to the impact of epidemics on human populations. This study aimed to investigate the spatial distribution of cases, hospitalizations, and deaths from COVID-19 and its association with social vulnerability. METHODS: An ecological study was conducted in 81 urban regions (UR) of Juiz de Fora from March to November 2020. Exposure was measured using the Health Vulnerability Index (HVI), a synthetic indicator that combines socioeconomic and environmental variables from the Demographic Census 2010. Regression models were estimated for counting data with overdispersion (negative binomial generalized linear model) using Bayesian methods, with observed frequencies as the outcome, expected frequencies as the offset variable, and HVI as the explanatory variable. Unstructured random-effects (to capture the effect of unmeasured factors) and spatially structured effects (to capture the spatial correlation between observations) were included in the models. The models were estimated for the entire period and quarter. RESULTS: There were 30,071 suspected cases, 8,063 confirmed cases, 1,186 hospitalizations, and 376 COVID-19 deaths. In the second quarter of the epidemic, compared to the low vulnerability URs, the high vulnerability URs had a lower risk of confirmed cases (RR=0.61; CI95% 0.49-0.76) and a higher risk of hospitalizations (RR=1.65; CI95% 1.23-2.22) and deaths (RR=1.73; CI95% 1.08-2.75). CONCLUSIONS: The lower risk of confirmed cases in the most vulnerable UR probably reflected lower access to confirmatory tests, while the higher risk of hospitalizations and deaths must have been related to the greater severity of the epidemic in the city's poorest regions.

The increasing burden of pancreatic cancer in Brazil from 2000 to 2019: estimates from the Global Burden of Disease Study 2019.

INTRODUCTION: Pancreatic cancer is increasing worldwide. The burden of pancreatic cancer in Brazil and its states was analyzed and compared with that from the USA and China. METHODS: This is a descriptive study of the incidence and mortality estimates from the Global Burden of Disease 2019 study, from 2000 to 2019. The Brazilian states presenting the highest and lowest socio-demographic index (SDI) were selected from each of the five regions. The SDI consists of the per capita income, education, and fertility rate of each population. RESULTS: A significant increase was found in age-standardized incidence and mortality of pancreatic cancer in all three countries, with differences in magnitude and annual increases. In Brazil, this incidence rose from 5.33 [95% Uncertainty Interval (UI): 5.06- 5.51] to 6.16 (95% UI: 5.68- 6.53) per 100,000 inhabitants. China and the Brazilian states with the lowest SDI, such as Pará and Maranhão, showed lower incidence and mortality rates, although presenting the highest annual increases. No difference was found between the sexes. A higher mortality rate was observed for those individuals of 70+ years, which was three to four times higher than those aged 50 to 69 years. CONCLUSIONS: The increasing burden of pancreatic cancer in the studied countries, and the higher estimates for the elderly in a fast-aging country such as Brazil, indicates that more resources and health policies will be necessary. The greatest increase in the states with lower SDI reflects inequalities in the access to diagnosis and registries of this cancer.

The increasing burden of pancreatic cancer in Brazil from 2000 to 2019: estimates from the Global Burden of Disease Study 2019

Abstract INTRODUCTION: Pancreatic cancer is increasing worldwide. The burden of pancreatic cancer in Brazil and its states was analyzed and compared with that from the USA and China. METHODS: This is a descriptive study of the incidence and mortality estimates from the Global Burden of Disease 2019 study, from 2000 to 2019. The Brazilian states presenting the highest and lowest socio-demographic index (SDI) were selected from each of the five regions. The SDI consists of the per capita income, education, and fertility rate of each population. RESULTS: A significant increase was found in age-standardized incidence and mortality of pancreatic cancer in all three countries, with differences in magnitude and annual increases. In Brazil, this incidence rose from 5.33 [95% Uncertainty Interval (UI): 5.06- 5.51] to 6.16 (95% UI: 5.68- 6.53) per 100,000 inhabitants. China and the Brazilian states with the lowest SDI, such as Pará and Maranhão, showed lower incidence and mortality rates, although presenting the highest annual increases. No difference was found between the sexes. A higher mortality rate was observed for those individuals of 70+ years, which was three to four times higher than those aged 50 to 69 years. CONCLUSIONS: The increasing burden of pancreatic cancer in the studied countries, and the higher estimates for the elderly in a fast-aging country such as Brazil, indicates that more resources and health policies will be necessary. The greatest increase in the states with lower SDI reflects inequalities in the access to diagnosis and registries of this cancer.

A validação da informação autorreferida sobre realização do exame de Papanicolaou em mulheres assistidas na Atenção Primária à Saúde / Accuracy of self-reported pap test in women assisted in Primary Health Care

Contexto: As informações autorreferidas são comumente utilizadas em pesquisas para estimar a cobertura do exame de Papanicolaou. Entretanto, não foram identificados estudos brasileiros que avaliem sua acurácia, o que pode comprometer os resultados encontrados. Objetivo: Avaliar a acurácia da informação autorreferida sobre a realização do último exame de Papanicolaou em mulheres assistidas pela Estratégia de Saúde da Família (ESF). Métodos: A informação autorreferida sobre a realização do exame foi obtida em estudo transversal com mulheres de 20 a 59 anos atendidas em unidades com ESF, mediante aplicação de questionário. A informação padrão-ouro foi obtida por meio da busca de registros médicos de exames de Papanicolaou. A acurácia entre o padrão-ouro e o autorrelato foi analisada por meio do cálculo do percentual de informação autorreferida adequada, da sensibilidade, da especificidade e dos valores preditivos positivos e negativos. Resultados: Foram incluídas na análise 572 mulheres. O percentual de informação autorreferida adequada foi de 92,3%, sensibilidade de 98,2% (IC95% 96,5­99,1), especificidade de 52,0% (IC95% 40,1­63,8) e valores preditivos positivos e negativos, respectivamente, de 93,3% (IC95% 90,8­95,2) e 80,8% (IC95% 66,3­90,3). Ressalta- se que não foi encontrada diferença nas medidas de acurácia em função das variáveis sociodemográficas. Conclusão: A partir dos dados apresentados, pode-se dizer que a informação autorreferida sobre realização do exame de Papanicolaou apresentou medidas de acurácia que garantem a credibilidade da informação e respaldam o uso do autorrelato na avaliação da cobertura do exame e programação do próximo exame de rastreio.

Context: Self-reported information is commonly used in surveys to estimate coverage of the Pap Test. However, it was not found in Brazil studies that evaluated the accuracy of self-report. Objective: To assess the accuracy of self-reported cervical cancer screening in women assisted in Primary Health Care. Methods: The self-reported information about the test was obtained in a cross-sectional study with women aged 20 to 59 years old who attended Primary Health Care units, using a questionnaire. The gold-standard information was obtained through the search in medical records of Pap smears. The validity of the self-report was analyzed by calculating the percentage of adequate self-reported information, sensitivity, specificity, and positive and negative predict values. Results: A total of 572 women were included in the analysis. The percentage of adequate self-reported information was 92.3%, with sensitivity of 98.2% (95% CI 96.5 to 99.1), specificity of 52.0% (95% CI 40.1 to 63.8) and positive and negative predict values, respectively, of 93.3% (95% CI: 90.8-95.2) and 80.8% (95% CI: 66.3-90.3). No difference was found in validity measures between sociodemographics characteristics. Conclusion: The self- reported cervical cancer screening showed validity measures that guarantee the credibility of the information and supports the use of self-report in the evaluation of the exam coverage and in the scheduling of the next Pap test.

Mortality Due to Acute Myocardial Infarction in Brazil from 1996 to 2016: 21 Years of Disparities in Brazilian Regions. / Mortalidade por Infarto Agudo do Miocárdio no Brasil de 1996 a 2016: 21 Anos de Contrastes nas Regiões Brasileiras.

BACKGROUND: Acute myocardial infarction (AMI), the leading cause of death in Brazil, has presented regional disparities in mortality rate time trends in recent years. Previous time trend studies did not correct for cause-of-death garbage codes, which may have skewed the estimates. OBJECTIVE: To analyze regional and gender-based inequalities in the AMI mortality trend in Brazil from 1996-2016. METHODS: A 21-year time series study (1996-2016). Data are from the Mortality Information System and population estimates from the Brazilian Institute of Geography and Statistics. Corrections of deaths due to ill-defined causes of death, garbage codes, and underreporting were made. The time series broken down by major geographic regions, gender, capital cities, and other municipalities was analyzed using the linear regression technique segmented by Jointpoint. Statistical significance level was set at 5%. RESULTS: In the period, mortality decreased more sharply in women (-2.2%; 95% CI: -2.5; -1.9) than in men (-1.7%; 95% CI: - 1.9; -1.4) and more in the capital cities (-3.8%; 95% CI: - 4.3; -3.3) than in other municipalities (-1.5%; 95% CI: - 1.8; -1.3). Regional inequalities were observed, with an increase for men living in other municipalities of the North (3.3; 95% CI: 1.3; 5.4) and Northeast (1.3%; 95% CI: 1.0; 1.6). Statistical significance level was set at 5%. Mortality rates after corrections showed a significant difference in relation to the estimates without corrections, mainly due to the redistribution of garbage codes. CONCLUSIONS: Although AMI-related mortality has decreased in Brazil in recent years, this trend is uneven by region and gender. Correcting the numbers of deaths is essential to obtaining more reliable estimates.

FUNDAMENTO: O infarto agudo do miocárdio (IAM), principal causa de morte no Brasil, apresenta disparidades regionais nas tendências temporais das taxas de mortalidade dos últimos anos. Estudos anteriores de tendências temporais não fizeram correção para os códigos-lixo de causas de mortalidade, o que pode ter enviesado as estimativas. OBJETIVO: Analisar as desigualdades regionais e por sexo na tendência de mortalidade por IAM no Brasil no período de 1996 a 2016. MÉTODOS: Estudo de séries temporais de 21 anos (1996 a 2016). Os dados são do Sistema de Informações sobre Mortalidade (SIM) e das estimativas populacionais do Instituto Brasileiro de Geografia e Estatística (IBGE). Foram feitas correções de óbitos por causas mal definidas, códigos-lixo e sub-registro. As séries temporais desagregadas por grandes regiões, sexo, capitais e interior foram analisadas utilizando a técnica de regressão linear segmentada por Jointpoint. O nível de significância estatística adotado foi de 5%. RESULTADOS: No período, a mortalidade diminuiu mais acentuadamente no sexo feminino (­2,2%; IC 95%: ­2,5; ­1,9) do que no masculino (­1,7%; IC 95%: ­1,9; ­1,4), e mais nas capitais (­3,8%; IC 95%: ­4,3; ­3,3) do que no interior (­1,5%; IC 95%: ­1,8; ­1,3). Foram verificadas desigualdades regionais com aumento para homens residentes no interior do Norte (3,3; IC 95%: 1,3; 5,4) e Nordeste (1,3%; IC 95%: 1,0; 1,6). O nível de significância estatística adotado foi de 5%. As taxas de mortalidade após correções, principalmente pela redistribuição dos códigos-lixo, apresentaram expressiva diferença em relação às estimativas sem correções. CONCLUSÕES: Embora a mortalidade por IAM apresente redução no Brasil nos últimos anos, essa tendência é desigual segundo região e sexo. Desse modo, as correções dos números de óbitos são essenciais para estimativas mais fidedignas.

Mortalidade por Infarto Agudo do Miocárdio no Brasil de 1996 a 2016: 21 Anos de Contrastes nas Regiões Brasileiras / Mortality Due to Acute Myocardial Infarction in Brazil from 1996 to 2016: 21 Years of Disparities in Brazilian Regions

Resumo Fundamento: O infarto agudo do miocárdio (IAM), principal causa de morte no Brasil, apresenta disparidades regionais nas tendências temporais das taxas de mortalidade dos últimos anos. Estudos anteriores de tendências temporais não fizeram correção para os códigos-lixo de causas de mortalidade, o que pode ter enviesado as estimativas. Objetivo: Analisar as desigualdades regionais e por sexo na tendência de mortalidade por IAM no Brasil no período de 1996 a 2016. Métodos: Estudo de séries temporais de 21 anos (1996 a 2016). Os dados são do Sistema de Informações sobre Mortalidade (SIM) e das estimativas populacionais do Instituto Brasileiro de Geografia e Estatística (IBGE). Foram feitas correções de óbitos por causas mal definidas, códigos-lixo e sub-registro. As séries temporais desagregadas por grandes regiões, sexo, capitais e interior foram analisadas utilizando a técnica de regressão linear segmentada por Jointpoint. O nível de significância estatística adotado foi de 5%. Resultados: No período, a mortalidade diminuiu mais acentuadamente no sexo feminino (-2,2%; IC 95%: -2,5; -1,9) do que no masculino (-1,7%; IC 95%: -1,9; -1,4), e mais nas capitais (-3,8%; IC 95%: -4,3; -3,3) do que no interior (-1,5%; IC 95%: -1,8; -1,3). Foram verificadas desigualdades regionais com aumento para homens residentes no interior do Norte (3,3; IC 95%: 1,3; 5,4) e Nordeste (1,3%; IC 95%: 1,0; 1,6). O nível de significância estatística adotado foi de 5%. As taxas de mortalidade após correções, principalmente pela redistribuição dos códigos-lixo, apresentaram expressiva diferença em relação às estimativas sem correções. Conclusões: Embora a mortalidade por IAM apresente redução no Brasil nos últimos anos, essa tendência é desigual segundo região e sexo. Desse modo, as correções dos números de óbitos são essenciais para estimativas mais fidedignas.

Abstract Background: Acute myocardial infarction (AMI), the leading cause of death in Brazil, has presented regional disparities in mortality rate time trends in recent years. Previous time trend studies did not correct for cause-of-death garbage codes, which may have skewed the estimates. Objective: To analyze regional and gender-based inequalities in the AMI mortality trend in Brazil from 1996-2016. Methods: A 21-year time series study (1996-2016). Data are from the Mortality Information System and population estimates from the Brazilian Institute of Geography and Statistics. Corrections of deaths due to ill-defined causes of death, garbage codes, and underreporting were made. The time series broken down by major geographic regions, gender, capital cities, and other municipalities was analyzed using the linear regression technique segmented by Jointpoint. Statistical significance level was set at 5%. Results: In the period, mortality decreased more sharply in women (−2.2%; 95% CI: −2.5; −1.9) than in men (−1.7%; 95% CI: - 1.9; −1.4) and more in the capital cities (−3.8%; 95% CI: - 4.3; −3.3) than in other municipalities (−1.5%; 95% CI: - 1.8; −1.3). Regional inequalities were observed, with an increase for men living in other municipalities of the North (3.3; 95% CI: 1.3; 5.4) and Northeast (1.3%; 95% CI: 1.0; 1.6). Statistical significance level was set at 5%. Mortality rates after corrections showed a significant difference in relation to the estimates without corrections, mainly due to the redistribution of garbage codes. Conclusions: Although AMI-related mortality has decreased in Brazil in recent years, this trend is uneven by region and gender. Correcting the numbers of deaths is essential to obtaining more reliable estimates.

Reproductive factors associated with overweight in adult women attended by the Family Health Strategy. / Fatores reprodutivos associados ao excesso de peso em mulheres adultas atendidas pela Estratégia Saúde da Família.

Overweight stands out as a growing health problem in the population, resulting in individual and societal burdens. This study aimed to identify the association between reproductive factors and overweight in women of reproductive age attended by a Primary Health Care Unit (UAPS).This is a cross-sectional study with home capitation and data collection in two PHC Units, in the city of Juiz de Fora (MG), Brazil, in women aged 20 to 59 years, whose outcome was the overweight measured by the Body Mass Index. The prevalence of overweight was 61.0% among the 2,018 women included in the analysis. In the multivariate analysis, overweight was associated with the variables age at menarche before 12 years of age, having children, age greater than or equal to 30years, and hypertension. The prevalence of overweight in women who had menarche before 12 years of age was 12.4% higher than those who had menarche aged 12 years or more, and the prevalence of overweight in women who had children was 58.2% higher than those who never had any. There was a high prevalence of overweight in the adult female population, emphasizing the influence of reproductive factors.

O excesso de peso se destaca como um problema de saúde crescente na população, resultando em ônus para o indivíduo e para a sociedade. O objetivo deste artigo é identificar a associação entre os fatores reprodutivos e o excesso de peso em mulheres de 20 a 59 anos de áreas cobertas pela Unidade de Atenção Primária à Saúde. Trata-se de um estudo transversal com captação domiciliar e coleta de dados em duas Unidades de Atenção Primária à Saúde, no município de Juiz de Fora, em mulheres de 20 a 59 anos, cujo desfecho foi o Excesso de Peso medido por meio do Índice de Massa Corporal. Entre as 2018 mulheres incluídas na análise, a prevalência de Excesso de Peso foi de 61,0%. Na análise multivariada, o Excesso de Peso apresentou associação com as variáveis idade da menarca antes dos 12 anos, ter filhos, idade maior ou igual a 30 anos e relato de hipertensão arterial. A prevalência de excesso de peso em mulheres que tiveram menarca antes dos 12 anos foi 12,4% maior do que naquelas que a tiveram com 12 anos ou mais; enquanto que a prevalência de Excesso de Peso em mulheres que tiveram filhos foi 58,2% maior do que entre as que nunca tiveram. Foi observada elevada prevalência de Excesso de Peso na população feminina adulta, com ênfase na influência dos fatores reprodutivos.

Fatores reprodutivos associados ao excesso de peso em mulheres adultas atendidas pela Estratégia Saúde da Família / Reproductive factors associated with overweight in adult women attended by the Family Health Strategy

Resumo O excesso de peso se destaca como um problema de saúde crescente na população, resultando em ônus para o indivíduo e para a sociedade. O objetivo deste artigo é identificar a associação entre os fatores reprodutivos e o excesso de peso em mulheres de 20 a 59 anos de áreas cobertas pela Unidade de Atenção Primária à Saúde. Trata-se de um estudo transversal com captação domiciliar e coleta de dados em duas Unidades de Atenção Primária à Saúde, no município de Juiz de Fora, em mulheres de 20 a 59 anos, cujo desfecho foi o Excesso de Peso medido por meio do Índice de Massa Corporal. Entre as 2018 mulheres incluídas na análise, a prevalência de Excesso de Peso foi de 61,0%. Na análise multivariada, o Excesso de Peso apresentou associação com as variáveis idade da menarca antes dos 12 anos, ter filhos, idade maior ou igual a 30 anos e relato de hipertensão arterial. A prevalência de excesso de peso em mulheres que tiveram menarca antes dos 12 anos foi 12,4% maior do que naquelas que a tiveram com 12 anos ou mais; enquanto que a prevalência de Excesso de Peso em mulheres que tiveram filhos foi 58,2% maior do que entre as que nunca tiveram. Foi observada elevada prevalência de Excesso de Peso na população feminina adulta, com ênfase na influência dos fatores reprodutivos.

Abstract Overweight stands out as a growing health problem in the population, resulting in individual and societal burdens. This study aimed to identify the association between reproductive factors and overweight in women of reproductive age attended by a Primary Health Care Unit (UAPS).This is a cross-sectional study with home capitation and data collection in two PHC Units, in the city of Juiz de Fora (MG), Brazil, in women aged 20 to 59 years, whose outcome was the overweight measured by the Body Mass Index. The prevalence of overweight was 61.0% among the 2,018 women included in the analysis. In the multivariate analysis, overweight was associated with the variables age at menarche before 12 years of age, having children, age greater than or equal to 30years, and hypertension. The prevalence of overweight in women who had menarche before 12 years of age was 12.4% higher than those who had menarche aged 12 years or more, and the prevalence of overweight in women who had children was 58.2% higher than those who never had any. There was a high prevalence of overweight in the adult female population, emphasizing the influence of reproductive factors.

Fatores associados ao letramento funcional em saúde de mulheres atendidas pela Estratégia de Saúde da Família / Factors associated with the functional health literacy in women served by the Family Health Strategy

Resumo Introdução O letramento funcional em saúde (LFS) diz respeito à habilidade dos indivíduos em compreender as informações relacionadas à saúde e está relacionado a diversos desfechos de saúde. Objetivo Investigar a associação do LFS com fatores sociodemográficos, apoio social, autoavaliação do estado de saúde e perfil de acesso aos serviços de saúde em mulheres assistidas pela Estratégia de Saúde da Família (ESF). Método Estudo transversal, conduzido em 2015-2016, em duas Unidades de Atenção Primária à Saúde cobertas pela ESF, de um município da região Sudeste do Brasil. A amostra foi composta por 439 mulheres, entre 25 e 64 anos. O LFS foi avaliado por meio do Brief Test of Functional Health Literacy in Adults (B-TOFHLA). Efetuaram-se cálculos da razão de prevalência (RP). Posteriormente, construiu-se um modelo de regressão de Poisson de variância robusta, sendo admitida significância estatística quando p ≤0,05. Resultados Foi constatado que 53,5% das mulheres apresentaram um baixo LFS, o qual associou-se à idade superior aos 40 anos (RP = 1,18; IC 95%: 1,07-1,31), ao grau de instrução inferior ao ensino médio completo (RP = 1,26; IC 95%: 1,15-1,38), à baixa renda (RP = 1,13; IC 95%: 1,04-1,23) e à autodeclaração da cor parda ou preta (RP= 1,06; IC 95%: 1,01-1,12). Conclusão Os resultados acentuaram a importância do LFS como estratégia para a abordagem de populações com maior vulnerabilidade socioeconômica.

Abstract Background Functional health literacy (FHL) concerns the ability of individuals to understand health-related information, which is related to various health outcomes. Objective Investigate the association between FHL and socio-demographic factors, social support, self-assessment of health status and access to health services in women assisted by the Family Health Strategy (FHS). Method A cross-sectional study, conducted in 2015-2016, in two Primary Health Care Units covered by the FHS of a municipality in the Southeast region of Brazil. The sample consisted of 479 participants, aged between 24 and 64 years. FHL was evaluated by the Brief Test of Functional Health Literacy in Adults (B-TOFHLA). Prevalence Ratio (PR), with Confidence Interval (CI) of 95%, was performed. Subsequently, a Poisson regression model of robust variance was constructed, and statistical significance was accepted when p≤0.05. Results It was found that 53.5% of the women had a low FHL, which was associated with age over 40 (RP = 1.18, 95% CI: 1.07-1.31), low education level (RP = 1.26, 95% CI: 1.15-1.38), low income (RP = 1.13, 95% CI 1.04-1.23) and self-declaration brown or black skin color (PR = 1.06, 95% CI 1.01-1.12). Conclusion The results reinforce the importance of FHL use as a strategy for the management of populations with greater socioeconomic vulnerability.

Ambient temperature and mortality due to acute myocardial infarction in Brazil: an ecological study of time-series analyses.

Ambient temperature may lead to decompensation of cardiovascular diseases and deaths by acute myocardial infarction (AMI). Little is known about this relationship in South American countries located in regions of a hot climate. This study aims to investigate the effects of ambient temperature on mortality due to AMI in six Brazilian micro-regions, which present different climates. We analyzed daily records of deaths by AMI between 1996 and 2013. We estimated the accumulate relative and attributable risks with lags of up to 14 days, using distributed non-linear lag model. Micro-regions that were closest to the equator did not show an association between temperature and mortality. The lowest risk temperatures varied between 22 °C and 28 °C, in the Southern region of Brazil and the Midwest region, respectively. Low temperatures associated with the highest mortality risk were observed in the same areas, varying between 5 °C and 15 °C. The number of deaths attributed to cold temperatures varied from 176/year in Brasilia to 661/year in São Paulo and those deaths attributed to hot temperatures in Rio de Janeiro amounted to 115/year. We showed the relative risk and the attributable risk of warmer and colder days in tropical regions. The estimate of the number of deaths due to climate, varying according to each area, is a way of bringing information to those responsible for health policies based on easily-understood measurements.

Mortalidade por doenças do aparelho circulatório e fatores associados: estudo ecológico em municípios de Minas Gerais / Mortality due to circulatory system diseases and associated factors: an ecological study in municipalities of Minas Gerais

Introdução: As doenças do aparelho circulatório (DAC) são responsáveis por 30% das mortes no Brasil, além de gerar incapacidades e altos custos. Apesar disso, pouco se sabe sobre a relação entre a mortalidade por DAC e as condições de vida e assistência à saúde nos municípios brasileiros, especialmente em contextos regionais. Objetivo: Investigar a associação de variáveis de saúde e sociodemográficas com a mortalidade por DAC, em Minas Gerais (MG). Método: Estudo ecológico, a partir de dados secundários, tendo como unidade de análise 418 municípios de MG. A variável dependente foi a taxa de mortalidade por DAC e as variáveis de desfecho foram 32 indicadores de serviços de saúde e 22 indicadores demográficos e socioeconômicos. Realizou-se a análise bivariada dos dados, através do coeficiente de correlação de Pearson, seguida da análise fatorial e, por fim, da regressão linear múltipla. Resultados: As DAC ocasionaram 30,9% da mortalidade total nos municípios analisados, observando-se associação positiva com número de consultórios de clínica básica, população urbana e internações por DAC no SUS; e negativa com valor médio por internação e despesa total com profissionais da saúde. Conclusão: Frente ao elevado número de municípios com pequena estrutura assistencial em MG, as ações de promoção à saúde e prevenção parecem ser as mais adequadas visando à redução das taxas de mortalidade por DAC. Também com este objetivo, os casos mais graves e as complicações devem ser manejados em centros de referência, contando com recursos materiais e profissionais adequados.

Introduction: Circulatory system diseases (CSD) are responsible for 30% of deaths in Brazil, as well as causing disabilities and high costs. Despite that, little is known about the relation between the mortality from CSD and the conditions of life and health care in Brazilian municipalities, especially in regional contexts. Objective: To investigate the association of health and sociodemographic variables with CSD mortality in Minas Gerais (MG). Methodology: Ecological study in which secondary data of 418 municipalities of MG were analyzed. The dependent variable was the mortality rate from CSD and the outcome variables consisted of 32 health services indicators and 22 demographic and socioeconomic indicators. A bivariate analysis of the data was performed by means of the Pearson's correlation coefficient, followed by factorial analysis, and finally, multiple linear regression. Results: CSD caused 30.9% of total mortality among the municipalities analyzed and were found to be positively associated with the number of general medicine clinics, urban population, and hospitalizations due to CSD. A negative association was observed with the average cost of hospitalizations and the total expenses with health professionals. Conclusion: In view of the high number of municipalities in MG having a scarce health care structure, actions aimed at promoting health and preventing disease appear to meet the most appropriate conditions for the reduction of CSD mortality rates. With this same purpose, the more severe cases and complications of CSD must be managed in reference centers, which dispose of adequate material and professional resources.

Prevalência de depressão e fatores associados em mulheres atendidas pela Estratégia de Saúde da Família / Prevalence of depression and associated factors in women covered by Family Health Strategy

RESUMO Objetivo Avaliar a prevalência de depressão e os fatores associados em mulheres de 20 a 59 anos de áreas cobertas pela Estratégia de Saúde da Família de município da Zona da Mata Mineira. Métodos Trata-se de um estudo transversal, com mulheres de 20 a 59 anos cadastradas em duas Unidades de Saúde da Família, que utilizou um questionário contendo variáveis sociodemográficas, apoio social, autoavaliação de estado de saúde, estilo de vida, morbidade e saúde da mulher. O desfecho depressão foi avaliado segundo o Patients Health Questionnaire-9 (PHQ-9). Resultados Das 1.958 mulheres incluídas nesta análise, 28,5% encontram-se na faixa etária entre 30 e 39 anos; 15,4% não concluíram o ensino elementar; 54,5% não trabalham ou nunca trabalharam; 44,2% declararam não ser da raça branca. Fatores associados à ocorrência de depressão na população estudada: possuir baixa escolaridade, trabalhar atualmente e ter doença mental prévia. Como fatores de proteção observaram-se: ser casada ou viver com companheiro, realizar atividades físicas regularmente e relatar autoavaliação positiva de saúde. Conclusão Os resultados deste estudo revelam prevalência de depressão de 19,7% nas mulheres de 20 a 59 anos de áreas cobertas pela Estratégia de Saúde da Família, apontando para a necessidade de um cuidado especial na atenção primária à saúde às mulheres com baixa escolaridade, que trabalham, apresentam doença mental e não praticam exercícios físicos, de modo que se possa reduzir o sofrimento e promover a saúde. Ressalta-se a lacuna na utilização de instrumentos de rastreamento dos casos de depressão na atenção primária.

ABSTRACT Objective To assess the prevalence of depression and its associated factors in women aged 20 to 59 years at some areas with the coverage of Family Health Strategy in a city located at Zona da Mata Mineira. Methods It is a cross-sectional study with women aged 20-59 enrolled in two Primary Health Care Units making use of a questionnaire containing socio-demographic variables, social support, self-assessment of general health status, lifestyle, morbidity and women's health. Depression was evaluated according to Patients Health Questionnaire-9 (PHQ-9). Results From 1,958 women included in this analysis, 28,5% are aged 30-39; 15,4% did not finish High School; 54,5% do not work or have never worked and 44,2% defined themselves as not white. Factors associated with depression episodes in the population studied: lower educational background, currently having a job, previous diagnosis of psychiatric disorders. Protective factors which were observed: being married or living with a partner, practicing physical activities in a regular basis and reporting positive self-assessed health. Conclusion The results of this study reveal a prevalence of depression of 19.7% in women aged 20 to 59 years covered by the Family Health Strategy, pointing to the need for special care in primary health care for women with low schooling, who work, have mental illness, and do not exercise so that they can reduce suffering and promote health. It was observed a significant gap related to managing specific tools designed to screening depressive episodes in primary care.

Fatores associados ao risco de alterações no exame citopatológico do colo do útero / Factores asociados al riesgo de cambios en el examen citopatológico del cuello del útero / Factors associated with the risk of changes in cervical cytopathology examination

Objetivo: analisar os fatores associados ao risco de apresentar alterações no exame citopatológico do colo do útero. Métodos:Estudo transversal, que contemplou mulheres entre 25 a 64 anos. O risco para um exame alterado foi calculado a partir de quatro critérios: primeira relação sexual antes dos 18 anos; mais de quatro parceiros sexuais ao longo da vida; história anterior de doença sexualmente transmissível; mais de três partos. As análises foram efetuadas utilizando-se os testes Qui-quadrado de Pearson, razão de prevalência (RP) e Regressão de Poisson com variância robusta e intervalo de confiança (IC) de 95%. Resultados: A amostra foi composta por 479 mulheres, das quais 30% apresentaram alto risco para um exame citopatológico alterado. Constatou-se que as mulheres com baixa renda (RP = 1,12; IC95%: 1,04-1,21), com percepção negativa da própria saúde (RP = 1,13; IC95%: 1,06-1,20),que faziam uso de tabaco (RP = 1,14; IC95%: 1,05-1,23) ou álcool (RP = 1,09; IC95%: 1,02-1,18) apresentaram alto risco de apresentar um exame alterado, ao passo que a idade elevada (RP = 0,83; IC95%: 0,73–0,95) associou-se à diminuição desse risco.Conclusão: As mulheres jovens, de baixa renda, com percepção negativa da própria saúde e que usavam tabaco ou álcool tinham maior probabilidade de apresentar alterações no exame citopatológico do colo do útero.

Objective: to analyze the factors associated with the risk of presenting changes in the cervical cytopathology examination. Methods: Cross-sectional study that included women between 25 and 64. The risk for an altered examination was calculated fromfour criteria: first sexual intercourse before the age of 18; more than four lifetime sexual partners; previous history of sexually transmitted disease; more than three childbirths. The analyses were performed using Pearson’s Chi-square test, prevalence ratio(PR) and Poisson Regression with gross variance and confidence interval (CI) of 95%. Results: The sample consisted of 479 women,of whom 30% had a high risk for an altered cytopathological examination. The study found that women with low income (PR = 1.12,95%CI: 1.04-1.21), with a negative perception of their own health (PR = 1.13, 95%CI: 1.06–1.20), who used tobacco (PR = 1.14, CI95%: 1.05-1.23) or alcohol (PR = 1.09, CI 95%: 1.02-1.18) presented a high risk for an altered cytopathological examination, whereasthe high age (PR = 0.83, CI 95%: 0.73-0.95) was associated with decrease in this risk. Conclusion: Young, low-income women with anegative perception of their own health, who used tobacco or alcohol, were more likely to present alterations in cervical cytopathology examination.

Objetivo: analizar los factores asociados al riesgo de presentar alteraciones en el examen citopatológico del cuello del útero.Métodos: Estudio transversal que contempló mujeres entre 25 y 64 años. El riesgo para un examen alterado fue calculado segúncuatro criterios: primera relación sexual antes de 18 años; más de cuatro parejas sexuales en la vida; historia de enfermedad de transmisión sexual; más de tres partos. Los análisis se efectuaron utilizando las pruebas Qui-cuadrado de Pearson, razón de prevalencia (RP) y Regresión de Poisson con varianza robusta e Intervalo de Confianza (IC) del 95%. Resultados: Participaron 479 mujeres, siendo que 30% presentó alto riesgo para un examen alterado. Se constató que mujeres con bajos ingresos (RP = 1,12, IC95%: 1,04-1,21), con percepción negativa de la salud (RP = 1,13; IC 95%: 1,01-1,20), que hacían uso de tabaco (RP = 1,14, IC 95%:1,05-1,23) o alcohol (RP = 1,09, IC95%: 1,02-1,18 ) presentaron alto riesgo de presentar un examen modificado, mientras que laedad elevada (RP = 0,83, IC 95%: 0,73-0,95) se asoció a la disminución de este riesgo. Conclusión: Las mujeres jóvenes, de bajarenta, con percepción negativa de la salud, que usaban tabaco o alcohol tenían mayor probabilidad de presentar alteraciones en los exámenes citopatológicos del cuello del útero.

HPV in women assisted by the Family Health Strategy.

OBJECTIVE: Estimate the prevalence of cervical HPV infection among women assisted by the Family Health Strategy and identify the factors related to the infection. METHODS: A cross-sectional study involving 2,076 women aged 20-59 years old residing in Juiz de Fora, State of Minas Gerais, who were asked to participate in an organized screening carried out in units were the Family Health Strategy had been implemented. Participants answered the standardized questionnaire and underwent a conventional cervical cytology test and HPV test for high oncogenic risk. Estimates of HPV infection prevalence were calculated according to selected characteristics referenced in the literature and related to socioeconomic status, reproductive health and lifestyle. RESULTS: The overall prevalence of HPV infection was 12.6% (95%CI 11.16-14.05). The prevalence for the pooled primer contained 12 oncogenic HPV types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) was 8.6% (95%CI 7.3-9.77). In the multivariate analysis, it was observed that the following variables were significantly associated with a higher prevalence of HPV infection: marital status (single: adjusted PR = 1.40, 95%CI 1.07-1.8), alcohol consumption (any lifetime frequency: adjusted PR = 1.44, 95%CI 1.11-1.86) and number of lifetime sexual partners (≥ 3: adjusted PR = 1.35, 95%CI 1.04-1.74). CONCLUSIONS: The prevalence of HPV infection in the study population ranges from average to particularly high among young women. The prevalence of HPV16 and HPV18 infection is similar to the worldwide prevalence. Homogeneous distribution among the pooled primer types would precede the isolated infection by HPV18 in magnitude, which may be a difference greater than the one observed. The identification of high-risk oncogenic HPV prevalence may help identify women at higher risk of developing preneoplastic lesions.

HPV in women assisted by the Family Health Strategy / Infecção por HPV em mulheres atendidas pela Estratégia Saúde da Família

ABSTRACT OBJECTIVE Estimate the prevalence of cervical HPV infection among women assisted by the Family Health Strategy and identify the factors related to the infection. METHODS A cross-sectional study involving 2,076 women aged 20-59 years old residing in Juiz de Fora, State of Minas Gerais, who were asked to participate in an organized screening carried out in units were the Family Health Strategy had been implemented. Participants answered the standardized questionnaire and underwent a conventional cervical cytology test and HPV test for high oncogenic risk. Estimates of HPV infection prevalence were calculated according to selected characteristics referenced in the literature and related to socioeconomic status, reproductive health and lifestyle. RESULTS The overall prevalence of HPV infection was 12.6% (95%CI 11.16-14.05). The prevalence for the pooled primer contained 12 oncogenic HPV types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) was 8.6% (95%CI 7.3-9.77). In the multivariate analysis, it was observed that the following variables were significantly associated with a higher prevalence of HPV infection: marital status (single: adjusted PR = 1.40, 95%CI 1.07-1.8), alcohol consumption (any lifetime frequency: adjusted PR = 1.44, 95%CI 1.11-1.86) and number of lifetime sexual partners (≥ 3: adjusted PR = 1.35, 95%CI 1.04-1.74). CONCLUSIONS The prevalence of HPV infection in the study population ranges from average to particularly high among young women. The prevalence of HPV16 and HPV18 infection is similar to the worldwide prevalence. Homogeneous distribution among the pooled primer types would precede the isolated infection by HPV18 in magnitude, which may be a difference greater than the one observed. The identification of high-risk oncogenic HPV prevalence may help identify women at higher risk of developing preneoplastic lesions.

RESUMO OBJETIVO Estimar a prevalência de infecção do colo do útero pelo HPV entre mulheres assistidas pela Estratégia Saúde da Família e identificar os fatores relacionados à infecção. MÉTODOS Trata-se de estudo transversal, no qual participaram 2.076 mulheres de 20 a 59 anos, residentes em Juiz de Fora, MG, convocadas para rastreamento organizado, realizado em unidades com a Estratégia Saúde da Família implantada. As participantes responderam ao questionário padronizado, realizando exame citológico cervical convencional e teste para HPV de alto risco oncogênico. Foram calculadas estimativas de prevalência de infecção pelo HPV segundo características selecionadas, referenciadas na literatura, relacionadas ao status socioeconômico, saúde reprodutiva e estilo de vida. RESULTADOS A prevalência global de infecção pelo HPV foi 12,6% (IC95% 11,16-14,05). A prevalência para o pooled primer contendo 12 tipos de HPV oncogênicos (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 e 68) foi 8,6% (IC95% 7,3-9,77). Na análise multivariada, observou-se que as seguintes variáveis estavam significativamente associadas a uma maior prevalência de infecção por HPV: estado conjugal (solteira: RP ajustada = 1,40; IC95% 1,07-1,8), consumo de bebidas alcoólicas (qualquer frequência durante a vida: RP ajustada = 1,44; IC95% 1,11-1,86) e número de parceiros sexuais ao longo da vida (≥ 3: RP ajustada = 1,35; IC95% 1,04-1,74). CONCLUSÕES A prevalência de infecção pelo HPV na população estudada varia de média a particularmente alta entre as mulheres jovens. A prevalência de infecção por HPV16 e HPV18 se assemelha às mundiais. Uma distribuição homogênea entre os tipos do pooled primer precederia a infecção isolada pelo HPV18 em magnitude, podendo ser a diferença maior que a observada. A identificação da prevalência de HPV de alto risco oncogênico pode auxiliar na identificação de mulheres sob maior risco de evolução para lesão preneoplásica.

Disease-free survival in patients with non-metastatic breast cancer / Sobrevida livre de doença em pacientes com câncer de mama não metastático

SUMMARY Introduction: Breast cancer is the second most common malignancy in the world and the one with highest incidence in the female population; it is also a major cause of death from cancer among women. Objective: To analyze the disease-free survival (DFS) at 5 years and prognostic factors in women with non-metastatic invasive breast cancer treated at a referral center for cancer care located in a medium-sized city in the Southeast of Brazil. Method: Patients diagnosed with the disease between 2003 and 2005 and identified through the institution’s cancer hospital records were analyzed. The follow-up of cases was carried out through hospital records, and complemented by search in the database of the Mortality Information System (SIM) as well as telephone contact. The variables analyzed were distributed in the following blocks: socio-demographic data, tumor-related characteristics, and treatment-related characteristics. Survival functions were calculated using the Kaplan-Meier method and the prognostic factors were analyzed based on Cox proportional hazard model. Results: The study showed a DFS at 5 years of 72% (95CI 67.6-75.9). The main variables independently associated with DFS were lymph node involvement, use of hormone therapy, and education level. Conclusion: This study reinforces the importance of early diagnosis for DFS, pointing to the role of social aspects in this regard. The relevance of this research in the country is also highlighted, given the scarcity of studies on DFS in the Brazilian population.

RESUMO Introdução: o câncer de mama é o segundo mais frequente no mundo e o de maior incidência na população feminina, além de ser uma das principais causas de óbito por câncer em mulheres. Objetivo: analisar a sobrevida livre de doença (SLD) em 5 anos e fatores prognósticos em mulheres com câncer de mama invasivo não metastático tratadas em centro de referência em assistência oncológica de cidade de porte médio da região Sudeste do Brasil. Método: foram analisadas as pacientes diagnosticadas com a doença entre 2003 e 2005, identificadas por meio do registro hospitalar de câncer da instituição. O seguimento dos casos foi realizado por meio de consulta aos prontuários, complementada por busca no banco do Sistema de Informação sobre Mortalidade (SIM) e contato telefônico. As variáveis analisadas foram distribuídas nos seguintes blocos: sociodemográficas, características relativas ao tumor e características relativas ao tratamento. As funções de sobrevida foram calculadas por meio do método de Kaplan-Meier. O modelo de riscos proporcionais de Cox foi utilizado para avaliação dos fatores prognósticos. Resultados: o estudo mostrou uma SLD em 5 anos de 72% (IC95%: 67,6-75,9). As principais variáveis associadas à SLD, de forma independente, foram o comprometimento linfonodal, a realização de hormonioterapia e o nível de escolaridade. Conclusão: este estudo reforça a importância do diagnóstico precoce para a SLD, apontando para o papel de aspectos sociais. Destaca-se a relevância desta pesquisa haja vista a escassez de estudos a respeito de SLD na população brasileira.

Disease-free survival in patients with non-metastatic breast cancer.

INTRODUCTION: Breast cancer is the second most common malignancy in the world and the one with highest incidence in the female population; it is also a major cause of death from cancer among women. OBJECTIVE: To analyze the disease-free survival (DFS) at 5 years and prognostic factors in women with non-metastatic invasive breast cancer treated at a referral center for cancer care located in a medium-sized city in the Southeast of Brazil. METHOD: Patients diagnosed with the disease between 2003 and 2005 and identified through the institution's cancer hospital records were analyzed. The follow-up of cases was carried out through hospital records, and complemented by search in the database of the Mortality Information System (SIM) as well as telephone contact. The variables analyzed were distributed in the following blocks: socio-demographic data, tumor-related characteristics, and treatment-related characteristics. Survival functions were calculated using the Kaplan-Meier method and the prognostic factors were analyzed based on Cox proportional hazard model. RESULTS: The study showed a DFS at 5 years of 72% (95CI 67.6-75.9). The main variables independently associated with DFS were lymph node involvement, use of hormone therapy, and education level. CONCLUSION: This study reinforces the importance of early diagnosis for DFS, pointing to the role of social aspects in this regard. The relevance of this research in the country is also highlighted, given the scarcity of studies on DFS in the Brazilian population.

Work ability and health of security guards at a public University: a cross-sectional study.

OBJECTIVE: to evaluate the work ability and health status of security guards at a public University. METHODS: a cross-sectional, descriptive, and analytical study was carried with 119 security guards. The following instruments were used: Work Ability Index (WAI), Patient Health Questionnaire (PHQ-9), International Physical Activity Questionnaire (IPAQ, short), Alcohol Use Disorders Identification Test (AUDIT), Medical Outcomes Study (MOS), and Demand-Control-Support (DCS). Descriptive statistics were used to describe the study samples and the Spearman's coefficient correlation was performed to assess the WAI. Significance level was set at 5%. RESULTS: samples were composed by men; the mean age was 54.9 years (SD=5.7); 80% had partners, and 75% had basic education. The majority (95%) had only one job, the average length of service was 24.8 years (SD=11), ranging from 3 to 43 years. 88.9% worked ≤40 hours and 75% did not work at night shift or rotating shifts. The average score given to work ability was good (40.7 points), with significant correlation to social support at work (p-value=0.002), health conditions (p-value=0.094), and depression symptoms (p-value=0.054). CONCLUSION: this study showed that many characteristics might affect the work ability scores. Considering the results, we note that healthy life habits and a reorganization of work environments should be encouraged.

[Opportunistic screening versus missed opportunities: non-adherence to Pap smear testing in women attending prenatal care]. / Rastreamento oportunístico versus perdas de oportunidade: não realização do exame de Papanicolaou entre mulheres que frequentaram o pré-natal.

The objectives were to estimate the prevalence of non-adherence to Pap smear testing in women attending prenatal care and to identify associated factors. This was a cross-sectional population-based study in 308 women from a rural municipality (county) in Minas Gerais State, Brazil. Complex stratified cluster sampling was used. Statistical analysis used the chi-square test and logistic regression model with the variables that presented p-value ≤ 0.05 in the bivariate model. Prevalence of lack of Pap smear test was 21.3%. Among women 25 years or older, prevalence was 15.1%. Non-adherence was more common in young, single women and those with low schooling. Low schooling remained associated with non-performance of Pap smear (OR = 0.41), indicating that women with more schooling enjoyed higher odds of testing. Contact with the prenatal clinic did not determine guaranteed access to the test, thus indicating missed opportunities when opportunistic screening is employed.

Work ability and associated factors of Brazilian technical-administrative workers in education.

BACKGROUND: Studies about work ability have grown in importance owing to the worldwide aging of active populations. Research has shown that measuring work ability has a predictive value in cases of long-term sickness absence and early retirement. Our goal was to analyze the work ability and associated factors of civil servants from a higher education institution in Brazil. The participants in this cross-sectional study were 600 technical-administrative workers at a public university. Work ability was measured using the work ability index. RESULTS: The participants were as follows: 51.8% male; mean age of 45 years (SD = ±11); married or in a stable union (61.5%); holding a graduate degree (56.7%); having only one job (83.3%), working 40 h a week or less (78.6%); not working evenings (79.8%); and having direct contact with the public (58.3%). The prevalence of reduced work ability was 13.9%. The following factors were found to be associated with reduced work ability: age 50 years old or above (PR = 2.58; 95% CI 1.25-5.09); female (PR = 2.77; 95% CI 1.25-3.60); education up to secondary school (PR = 2.37; 95% CI 1.13-3.59); overall poor self-assessed health (PR = 2.96; 95% CI 1.32-3.93); signs and symptoms of depression (PR = 4.86; 95% CI 2.23-6.55); sedentariness (PR = 3.00; 95% CI 1.38-4.68) and poor social support at work (PR = 4.01; 95% CI 1.66-4.37). CONCLUSIONS: Most of the participants showed good work ability, but some subjects had reduced work ability. This study makes a contribution to expanding the discussion about the factors associated with work ability toward proposing actions for maintaining that ability or helping recovery in the case of diminished ability. Such actions can help reduce work absenteeism and early retirement, both of which have a social and economic impact in Brazil. Studying the determinants of work ability and recommendations to address those determinants will help efforts to improve the quality of life of individuals, both at work and personally, and promote healthy aging.