Complicaciones quirúrgicas: un tema complicado / Surgical complications: A complicated topic

Introducción. Las complicaciones quirúrgicas son un tema relevante, difícil de abordar e inmerso en una cultura punitiva y vergonzosa hacia el médico. La ausencia de una medición sistemática, confiable y socializada es un desafío para los servicios quirúrgicos. El desconocimiento de las medidas de frecuencia y el impacto de las complicaciones quirúrgicas en las instituciones, y a su vez, dentro de los servicios quirúrgicos, evidencia la necesidad de abordar el tema desde una perspectiva de mejoramiento continuo. Métodos. Se hizo un análisis crítico y reflexivo sobre la conceptualización de las complicaciones quirúrgicas, los avances en su proceso de evaluación y su utilidad como indicador de calidad en los servicios quirúrgicos. Se ilustraron las metodologías con ejemplos clínicos que facilitan su entendimiento y aplicabilidad. Resultados. El trabajo inicial de los doctores Clavien & Dindo se ha fortalecido al considerar integralmente el proceso de atención quirúrgica como un indicador de calidad de la atención en salud. El desarrollo del Índice Integral de Complicaciones (CCI), para los eventos en el período posoperatorio, representa un paso adicional en el abordaje del problema. Su potencialidad en el análisis de los eventos ofrece una oportunidad para la implementación y la investigación en el tema. Conclusiones. Las complicaciones quirúrgicas representan un indicador robusto que permite evaluar el desempeño individual y grupal en un servicio quirúrgico. Hay metodologías recientes que deben ser incorporadas en la actividad asistencial de los cirujanos. Representan un insumo en la educación médica a todo nivel e, igualmente, un elemento de crecimiento personal y académico para todo cirujano.

Introduction. Surgical complications are a relevant topic, difficult to address and immersed in a punitive and shameful culture towards the doctor. The absence of systematic, reliable, and socialized measurement is a challenge for surgical services. The lack of knowledge of frequency measurements and the impact of surgical complications in institutions, and in turn, within surgical services, shows the need to address the issue from a perspective of continuous improvement. Methods. A critical and reflective analysis was carried out on the conceptualization of surgical complications, the advances in their evaluation process and their usefulness as an indicator of quality in surgical services. The methodologies were illustrated with clinical examples that facilitate their understanding and applicability. Results. The initial work of doctors Clavien & Dindo has been strengthened by comprehensively considering the surgical care process as an indicator of quality of health care. The development of the Comprehensive Complication Index (CCI), for events in the postoperative period, represents an additional step in addressing the problem. Its potential in the analysis of events offers an opportunity for implementation and research on the topic. Conclusions. Surgical complications represent a robust indicator that allows evaluating individual and group performance in a surgical service. There are recent methodologies that must be incorporated into the care activity of surgeons. They represent an input in medical education at all levels and equally, an element of personal and academic growth for every surgeon.

[Calculation of the alcohol per capita consumption in Brazil: using national dataCálculo del indicador del consumo de alcohol per cápita en Brasil: uso de datos nacionales]. / Cálculo do indicador de consumo de álcool per capita no Brasil: uso de dados nacionais.

Objective: To calculate the alcohol per capita consumption (APC) in Brazil (Brazil APC) using national data and to establish the Brazil APC as gold standard for the country, replacing the indicator previously calculated by the World Health Organization (WHO) based on international data. Method: The Brazilian public data sources necessary for calculating the recorded APC were selected, and the alcohol concentration was defined by beverage category. For the variables of tourist APC and unrecorded APC, which are unavailable in Brazil, estimates from the United Nations (UN) and the WHO were used. The Brazil APC indicator was calculated and compared to the indicator produced by the WHO through analysis of the medians obtained for the period from 2005 to 2020. Results: The national alcohol consumption indicator was 9.2 liters per capita in 2005, reaching 9.8 in 2020. The WHO indicator showed a consumption of 8.4 liters per capita in 2005, decreasing until 2016 and slightly increasing to 7.8 in 2020. Conclusion: The Brazil APC was calculated based on national sources and showed a distinct trend compared to the WHO indicator, which showed a decrease. The regular and transparent provision of this indicator through government channels will support the development of policies to address alcohol consumption in the country.

Objetivo: Calcular el indicador del consumo de alcohol per cápita en Brasil a partir de datos nacionales, con miras a establecerlo como patrón de referencia para el país en sustitución del indicador calculado anteriormente por la Organización Mundial de la Salud a partir de datos internacionales. Métodos: Se seleccionaron las fuentes públicas de datos de Brasil necesarias para estructurar el cálculo del consumo de alcohol per cápita registrado y se definió la concentración de alcohol por clase de bebida. Para las variables de consumo de alcohol per cápita por parte de turistas y consumo per cápita no registrado, que no están disponibles en Brasil, se utilizaron estimaciones de las Naciones Unidas y de la Organización Mundial de la Salud. Se calculó el indicador del consumo de alcohol per cápita en Brasil y se comparó con el indicador elaborado por la OMS mediante un análisis de las medianas correspondientes al período 2005-2020. Resultados: El indicador nacional del consumo de alcohol fue de 9,2 litros per cápita en el 2005, con un aumento a 9,8 en el 2020. El indicador de la Organización Mundial de la Salud mostró un consumo de 8,4 litros per cápita en el 2005, con una reducción hasta el 2016 y un leve aumento a 7,8 en el 2020. Conclusión: Se calculó el consumo de alcohol per cápita en Brasil a partir de fuentes nacionales, lo que mostró una tendencia distinta de la tendencia descendente del indicador de la Organización Mundial de la Salud. La disponibilidad transparente y regular de este indicador por medio de los canales gubernamentales permitirá su seguimiento, con lo cual se podrán formular políticas para enfrentar el consumo de alcohol en el país.

Desigualdades sociais no diagnóstico do câncer do colo do útero no Brasil: um estudo de base hospitalar / Social inequalities in the diagnosis of cervical cancer in Brazil: a hospital-based study

Resumo O estudo visa analisar a prevalência de estadiamento avançado ao diagnóstico do câncer do colo do útero e sua associação com indicadores individuais e contextuais socioeconômicos e de oferta de serviços de saúde no Brasil. Estudo transversal, realizado com casos de câncer do colo do útero em mulheres de 18 a 99 anos, no período de 2006 a 2015, extraídos do Integrador de Registros Hospitalares de Câncer. Variáveis contextuais foram coletadas no Atlas do Desenvolvimento Humano, no Cadastro Nacional de Estabelecimentos de Saúde e no Sistema de Informações Ambulatoriais. Usou-se o modelo de regressão de Poisson multinível com intercepto aleatório. A prevalência de diagnóstico em estádio avançado foi de 48,4%, apresentando associação com idades mais avançadas (RP 1,06; IC 1,01-1,10), raça/cor da pele preta, parda e indígena (RP 1,04; IC 1,01-1,07), menores níveis de escolaridade (RP 1,28; IC 1,16-1,40), ausência de parceiro conjugal (RP 1,10; IC 1,07-1,13), encaminhamento do tipo público ao serviço de saúde (RP 1,07; IC 1,03-1,11) e menor taxa de realização de exame citopatológico (RP 1,08; IC 1,01-1,14). Os resultados reforçam a necessidade de melhorias no programa nacional de prevenção do câncer do colo do útero em áreas com baixa cobertura da citologia oncótica.

Abstract The scope of this study is to analyze the prevalence of advanced stage diagnosis of cervical cancer and its association with individual and contextual socioeconomic and healthcare service indicators in Brazil. A cross-sectional study was conducted using cervical cancer cases in women aged 18 to 99 years, from 2006 to 2015, extracted from the Hospital Cancer Registry (HCR) Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil; the National Registry of Health Institutions (NRHI); and the Outpatient Information System. Multilevel Poisson Regression with random intercept was used. The prevalence of advanced stage diagnosis was 48.4%, revealing an association with older age groups (PR 1.06; CI 1.01-1.10), black, brown, and indigenous race/skin color (PR 1.04; CI 1.01-1.07), lower levels of schooling (PR 1.28; CI 1.16-1.40), no marital partner (PR 1.10; CI 1.07-1.13), public referral to the health service (PR 1.07; CI 1.03-1.11), and lower rates of cytological examination (PR 1.08; CI 1.01-1.14). The results reinforce the need for improvements in the national cervical cancer prevention program in areas with low coverage of oncotic cytology.

Acute predictors of self-rated health in individuals with stroke at 3 and 12 months after hospital discharge.

BACKGROUND: Self-rated health (SRH) is the perception of an individual regarding their health and an indicator of health status. Identifying predictors of SRH allows the selection of evidence-based interventions that mitigate factors leading to poor SRH and the identification of individuals at risk of worse SRH. OBJECTIVE: To determine the acute predictors of general and time-comparative SRH of individuals with stroke at 3 and 12 months after hospital discharge, considering personal, physical, and mental functions. METHODS: A prospective study was developed to assess general and time-comparative SRH at 3 and 12 months after hospital discharge according to 2 questions ("In general, how would you say your health is?" and "Compared to a year ago, how would you rate your general health now?"). Potential acute predictors analyzed were personal (age, sex, comorbidities, socioeconomic status, and family arrangement), physical (stroke severity, motor impairment, and independence for basic activities of daily living [ADLs]), and mental (cognitive) functions. RESULTS: Age (adjusted odds ratio [aOR]=2.10) and independence in basic ADLs (aOR=0.29) were significant predictors of SRH at 3 months; at 12 months, no significant predictor was found. Motor impairment (aOR=3.90) was a significant predictor of time-comparative SRH at 3 months; at 12 months, sex (aOR=0.36) and independence in basic ADLs (aOR=0.32) were significant predictors. CONCLUSIONS: At 3 months, individuals with stroke who were ≥65 years old and dependent on basic ADLs were more likely to have worse general SRH, while those with higher motor impairments were more likely to have worse time-comparative SRH. At 12 months, women and individuals dependent on basic ADLs were more likely to have worse time-comparative SRH.

Maternal and perinatal health indicators in Brazil over a decade: assessing the impact of the COVID-19 pandemic and SARS-CoV-2 vaccination through interrupted time series analysis.

Background: Few studies have evaluated the effects of the Coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, on maternal and perinatal health at a populational level. We investigated maternal and perinatal health indicators in Brazil, focusing on the effects of the COVID-19 pandemic, and SARS-CoV-2 vaccination campaign for pregnant women. Methods: Utilizing interrupted time series analysis (January 2013-December 2022), we examined Maternal Mortality Ratio, Perinatal Mortality Rate, Preterm Birth Rate, Cesarean Section Rate, and other five indicators. Interruptions occurred at the pandemic's onset (March 2020) and pregnant women's vaccination (July 2021). Results were expressed as percent changes on time series' level and slope. Findings: The COVID-19 onset led to immediate spikes in Maternal Mortality Ratio (33.37%) and Perinatal Mortality Rate (3.20%) (p < 0.05). From March 2020 to December 2022, Cesarean Section and Preterm Birth Rates exhibited upward trends, growing monthly at 0.13% and 0.23%, respectively (p < 0.05). Post start of SARS-CoV-2 vaccination (July 2021), Maternal Mortality Ratio (-34.10%) and Cesarean Section Rate (-1.87%) promptly declined (p < 0.05). Subsequently, we observed a monthly decrease of Maternal Mortality Ratio (-9.43%) and increase of Cesarean Section Rate (0.25%) (p < 0.05), while Perinatal Mortality Rate and Preterm Birth Rate showed a stationary pattern. Interpretation: The pandemic worsened all analyzed health indicators. Despite improvements in Maternal Mortality Ratio, following the SARS-CoV-2 vaccination campaign for pregnant women, the other indicators continued to sustain altered patterns from the pre-pandemic period. Funding: No funding.

Mortalidad infantil y condiciones de vida socioeconómicamente adversas: el caso de dos distritos poblacionales en Santiago de Cuba

Introducción: La mortalidad infantil es un fenómeno sanitario relacionado directamente con las condiciones de vida deletéreas, tanto del hogar del infante como de factores socioeconómicos e higiénico-sanitarios adversos. Objetivo: Caracterizar las desigualdades de la mortalidad infantil, según condiciones diferenciales de vida en dos distritos poblacionales de Santiago de Cuba. Métodos: Se llevó a cabo un estudio descriptivo, de tipo ecológico exploratorio, en el municipio Santiago de Cuba, en el trienio 1995-1997. Las unidades de análisis estuvieron constituidas por las áreas de salud enmarcadas en dos distritos poblacionales de la ciudad. Resultados: Se estratificaron ambos distritos poblacionales, según sus condiciones de vida, en asentamientos con condiciones de vida menos desfavorables y más desfavorables. Se estimó mayor mortalidad infantil en el asentamiento con condiciones de vida más desfavorables (8,7 fallecidos por 1000 nacidos vivos), donde predominaron como causas clínicas de muerte las asfixias, la anoxia e hipoxias y causas clínicas reducibles por buena atención en el parto. Conclusiones: Se identificó un perfil diferencial de mortalidad infantil, según las condiciones de vida, al interior de los asentamientos poblacionales de los distritos urbanos de Santiago de Cuba. Los riesgos distintivos de muerte infantil fueron a expensas del componente neonatal, en lo fundamental por causas clínicas reducibles por buena atención en el parto.

Introduction: Infant mortality is a health phenomenon directly related to the deleterious living conditions of both the infant's home and adverse socioeconomic and sanitary factors. Objective: To characterize inequalities in infant mortality according to differential living conditions in two populations districts of Santiago de Cuba. Methods: A descriptive, exploratory ecological study was carried out in the municipality of Santiago de Cuba in 1995-1997. The units of analysis were constituted by the areas framed in two populations districts of the city. Results: Bothe population districts were stratified, according to their living conditions, in settlements with less unfavorable and more unfavorable living conditions. Higher infant mortality was estimated in the settlement with more unfavorable living conditions (8.7 deaths per 1000 live births), where asphyxia, anoxia and hypoxia predominated as clinical causes of death and clinical causes reducible for good care at birth. Conclusions: A differential profile of infant mortality, according to living conditions, was identified within the population settlements of the urban districts of Santiago de Cuba. The distinctive risks of infant death were at the expense of the neonatal component, mainly for clinical causes reducible by good care at birth.

Self-reported neighborhood stressors and sleep quality among Puerto Rican young adults.

OBJECTIVE: To examine the association between changes in self-reported neighborhood stressors and sleep quality and determine whether this varied by sociocultural context among Puerto Rican young adults. METHODS: Data come from the Boricua Youth Study Health Assessment, a sample of Puerto Rican young adults from San Juan, Puerto Rico, and South Bronx, New York (n = 818; mean age=22.9years). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Neighborhood social stressors (disorder, social cohesion, and safety) were parent-reported in childhood and self-reported in young adulthood and categorized into: low in childhood/young adulthood (reference group), high in childhood/low in young adulthood, low in childhood/high in young adulthood, and high in childhood/young adulthood. Sociocultural context was based on participant residence during childhood (San Juan vs. South Bronx). RESULTS: Adjusting for sociodemographic factors, living with high neighborhood stressors in both childhood and young adulthood (prevalence ratios=1.30, 95% CI: 1.01, 1.66) was associated with overall poor sleep (PSQI score >5). Among PSQI components, living with high neighborhood stressors in young adulthood only or in both time periods was associated with worse subjective sleep quality and daytime dysfunction. Additionally, there were various associations between the neighborhood stressor measures and PSQI components. Results did not differ by sociocultural context. CONCLUSION: Findings suggest that living with high levels of neighborhood stressors during childhood and young adulthood may have a cumulative adverse impact on sleep quality in young adulthood.

Sustainable Development Goals' health-related indicators for Brazil and Ecuador: an analysis for the period of 1990-2019.

OBJECTIVE: This article aims to analyse the evolution of 40 Sustainable Development Goals' (SDGs) health-related indicators in Brazil and Ecuador from 1990 to 2019. STUDY DESIGN: Epidemiological study of long-term trends in 40 SDGs' health-related indicators for Brazil and Ecuador from 1990 to 2019, using estimates from the Global Burden of Disease Study. METHODS: Forty SDGs' health-related indicators and an index from 1990 to 2017 for Brazil and Ecuador, and their projections up to 2030 were extracted from the Institute for Health Metrics and Evaluation's Global Burden of Disease website and analysed. The percent annual change (PC) between 1990 and 2019 was calculated for both countries. RESULTS: Both countries have made progress on child stunting (Brazil: PC = -38%; Ecuador: PC = -43%) and child wasting prevalences (Brazil: PC = -42%; Ecuador: PC = -41%), percent of vaccine coverage (Brazil: PC = +215%; Ecuador: PC = +175%), under-5 (Brazil: PC = -75%; Ecuador: PC = -60%) and neonatal mortality rates (Brazil: PC = -69%; Ecuador: PC = -51%), health worker density per 1000 population (Brazil: PC = +153%; Ecuador: PC = +175%), reduction of neglected diseases prevalences (Brazil: PC = -40%; Ecuador: PC = -58%), tuberculosis (Brazil: PC = -27%; Ecuador: PC = -55%) and malaria incidences (Brazil: PC = -97%; Ecuador: PC = -100%), water, sanitation and hygiene mortality rates (Brazil and Ecuador: PC = -89%). However, both countries did not show sufficient improvement in maternal mortality ratio to meet SDGs targets (Brazil: PC = -37%; Ecuador: PC = -40%). Worsening of indicators were found for violence, such as non-intimate partner violence for both countries (Brazil: PC = +26%; Ecuador: PC = +18%) and suicide mortality rate for Ecuador (PC = +66%), child overweight indicator for Brazil (PC = -67%), disaster mortality rates (Brazil: PC = +100%; Ecuador: PC = +325%) and alcohol consumption (Brazil: PC = +46%; Ecuador: PC = +35%). CONCLUSIONS: Significant improvements are necessary in both countries requiring the strengthening of health and other policies, particularly concerning the prevention and management of violence and alcohol consumption, and preparedness for dealing with environmental disasters.

[Quality of health information in Mexico in the OECD context: 2017-2021]. / Calidad de la información en salud de México en el contexto de la OCDE: 2017-2021.

OBJECTIVE: To evaluate the health information system (HIS) of Mexico according to the information reported to the Organization for Economic Co-operation and Development (OECD). The ultimate goal is to identify the improvements that should be considered. METHOD: Health indicators published by the OECD (2017 to 2021) are analyzed according to 11 thematic groups. Coverage (quantity and type of indicators reported by thematic group) and quality of information were assessed, according to OECD guidelines. RESULTS: Mexico reported annually 14 of 378 indicators (3.7%), and discontinuously 204. In no group were all indicators reported annually, except for the two on COVID-19. Three out of 88 were reported annually on use of services; and none on health status, quality of care and pharmaceutical market. Twelve indicators (5.5% of those reported by Mexico, 3.2% of the full OECD set) had optimal quality and annual reporting. 57.7% of the reported indicators had at least one quality defect. CONCLUSIONS: Within the framework of the standards set by the OECD, of which Mexico is a member, the Mexican HIS presents significant deficits in coverage and quality of information. These results should be considered to implement improvement initiatives.

[Caring for people living with HIV in the Colombian Health System: patients, caregivers and health workers perspectives]. / Atención de las personas que viven con VIH en el Sistema de Salud Colombiano: perspectivas de pacientes, cuidadores y personal de salud.

OBJECTIVE: Health policies and programs for people living with HIV have been subordinated to current economic policies based on the neoliberal development model that shapes the current healthcare system. The study's objective was to analyze the influence of the Colombian health system on the care of people who lived with HIV enrolled in the Subsidized Regime through Benefit Plan Administrating Entities and treated in Neiva (Colombia). METHODS: A qualitative study framed within the framework of the Critical Discourse Analysis was conducted. Nineteen people participated, including HIV patients, non-formal caregivers, and health workers. The participants were recruited from two Health Service Providers Institutions in the city of Neiva. In-depth interviews were conducted. Data were coded, categorized and organized in Excel for analysis. RESULTS: The interpersonal relationship and the health system functioning were two phenomena that interfered with caring for people with HIV by favoring or imposing barriers to practices. Failures were found in the informative-educational process from the moment of diagnosis, stigmatization, and discrimination, particularly in non-HIV-specialized health institutions, and multiple barriers to access to health services. 55.5% of the patients expressed having been discriminated against by health personnel at some point since their diagnosis. 100% of the patients interviewed identified different types of barriers to health services, contextualized in improper treatment, untimely care and abuse of power; only 22.2% resorted to the filing of complaints, petition rights or guardianships to claim their right to health. CONCLUSIONS: Health care praxis is carried out regardless of patients' situation, forgetting that those from a lower socioeconomic level have greater structural vulnerability related to poverty. The lack of healthcare exacerbates health inequalities.

OBJECTIVE: Las políticas y programas de atención en salud a las personas que viven con VIH han obedecido a las políticas económicas vigentes, basadas en el modelo de desarrollo neoliberal y que configuran el actual sistema de salud. El objetivo de este trabajo fue analizar la influencia del sistema de salud colombiano en la atención de las personas que vivían con VIH afiliadas a las Entidades Administradoras de Planes de Beneficio del Régimen Subsidiado, atendidos en Neiva (Colombia). METHODS: Se realizó un estudio cualitativo, enmarcado en el Análisis Crítico del Discurso. Participaron diecinueve personas entre pacientes con VIH, cuidadores no formales y personal de salud, captados de dos Instituciones Prestadoras de Servicios de Salud de la ciudad de Neiva, a quienes se les aplicó entrevistas en profundidad. Los datos fueron codificados, categorizados y organizados en Excel para su análisis. RESULTS: La relación interpersonal y el funcionamiento del sistema de salud fueron dos fenómenos que interfirieron en la atención de las personas con VIH, en cuanto a que favoreció o impuso barreras a las prácticas. Se encontraron fallos en el proceso informativo/educativo desde el momento del diagnóstico, estigma y discriminación, profundizado en las instituciones de salud no especializadas en VIH, así como múltiples barreras de acceso a los servicios de salud. El 55,5% de los pacientes expresó haber sido discriminados por el personal de salud en algún momento desde su diagnóstico. El 100% de pacientes entrevistados identificó barreras de diferente tipo para los servicios de salud, contextualizados en trato indebido, inoportunidad en la atención y abuso del poder; solo el 22,2% recurrió a la interposición de quejas, derechos de petición o tutelas para reclamar su derecho a la salud. CONCLUSIONS: La praxis de atención se realiza al margen de la situación de contexto de los pacientes, olvidando que son precisamente los ubicados en un nivel socioeconómico más bajo, quienes tienen mayor vulnerabilidad estructural relacionada con la pobreza, por lo que la falta de atención de salud exacerba las inequidades sanitarias.

The association between BMI and self-reported health among a Brazilian sample: a cross-sectional study.

OBJECTIVE: To examine the association between Body Mass Index (BMI) and self-rated health status among a representative sample of the Brazilian population. METHODS: This study consists of a secondary analysis of the existing 2019 Brazilian National Health Survey (PNS). Logistic regression models were then used to examine the association between self-reported health status and BMI, while controlling for obesity-related medical conditions and socio-demographic characteristics. RESULTS: The representative sample included 34,021 men and 34,430 women, comprising a total sample of 68,451. Men living with obesity (BMI ≥ 30 kg/m2) had, on average, a lower self-reported health status score (OR = 0.69, p < 0.01) compared to men within a healthy weight BMI range (18.5-25 kg/m2). Women living with obesity had, on average, a lower self-reported health status score (OR = 0.56, p < 0.01) compared to women within a healthy weight BMI range (18.5-25 kg/m2). There was also a statistically significant negative association (p < 0.01) between our obesity-related medical conditions and self-reported health for men and women. We also find some evidence of a non-linear association between BMI and health status for men. CONCLUSIONS: The findings indicate that there is a statistically significant negative association between BMI and self-reported health for Brazilian men and women living with obesity. These findings reinforce the importance of addressing this growing public health challenge and the value of preventive measures and effective public health programs that focus on improving overall health and quality of life for individuals living with obesity.

Socioeconomic inequalities in health and healthcare utilization among the elderly in Brazil: results from the 2019 National Health Survey.

OBJECTIVES: To assess socioeconomic-related inequalities in health and healthcare utilization among the elderly in Brazil. STUDY DESIGN: Cross-sectional nationally representative household-based survey. METHODS: We evaluated the Brazilian National Health Survey data collected in 2019. We computed the prevalence of measures of health conditions and healthcare utilization by age-bracket and markers of socioeconomic status-income, educational attainment, and race/ethnicity-among individuals aged 60 or older. We further employed logistic regression models, adjusted for a wide set of covariates, to estimate the relationship between socioeconomic status and those outcomes. RESULTS: Higher-income and more educated individuals exhibit better health conditions compared to their lower-income and less-educated counterparts within each age bracket. Results from regression models showed strong associations with income and educational attainment for most health conditions: health status, physical activity, difficulties with activities of daily living and instrumental activities of daily living, and depression. For most conditions, weaker or no associations with race/ethnicity were found. Individuals in the highest income quintile and that completed higher education also had higher odds of having consulted a physician, while high-income individuals had lower odds of having received emergency care at home. CONCLUSIONS: The findings of this study highlight the significant socioeconomic inequalities in the health of the elderly population in Brazil. The substantial and pervasive nature of these inequalities stresses the need for action to address them.

Elastic tape reduces dyspnea and improves health status in the short term in nonobese COPD males: A randomized controlled trial.

INTRODUCTION AND OBJECTIVES: The elastic tape (ET) is a novel intervention that acutely improves exercise capacity in laboratory tests; however, its effect on a patient's daily life remains unknown. This randomized controlled trial evaluated the effects of ET on daily life physical activity (DLPA), dyspnea symptoms, health status, and health-related quality of life (HRQoL) in individuals with COPD. METHODS: Fifty males with moderate to very severe COPD were randomly assigned to an intervention group (ETG, n = 25), receiving ET on the chest wall and abdomen, or a control group (CG, n = 25). The intervention was for 14 days. DLPA (accelerometry; steps per day, and sedentary time), dyspnea symptoms (transition dyspnea index, TDI; and modified Medical Research Council, mMRC), health status (COPD assessment test, CAT), and health-related quality of life (HRQoL, CRQ) were evaluated at baseline and on Day 21 after the intervention. RESULTS: No change in the DLPA was observed in between-group comparison. CG presented a reduction in step counts after 21days (-707,p <0.05) while ETG. maintained (-114,p > 0.94). However, ET reduced dyspnea symptoms in all TDI domains (functional, task, and effort) and on the mMRC scale after 14 days compared with CG (p < 0.01). Also, the ETG improved CAT score compared to the CG, reaching minimal clinical important difference (MCID) (-4.4 score, p <0.01). The ETG also improved in most CRQ domains reaching MCID after 21 days. CONCLUSIONS: ET does not modify DLPA but reduces dyspnea and improves health status and HRQoL in nonobese males with moderate to very severe COPD in the short term. This novel and low-cost intervention improves COPD symptoms.

Tendência temporal da prevalência de desnutrição em crianças menores de 5 anos assistidas pelo Programa Bolsa Família (2008-2019) / Temporal trend in the prevalence of malnutrition in children under five assisted by the Brazilian Income Transfer Program (2008-2019) / Tendencia temporal de la prevalencia de desnutrición en niños menores de cinco años atendidos por el Programa Bolsa Familia (2008-2019)

O objetivo deste estudo foi analisar a tendência temporal da desnutrição em crianças menores de 5 anos de idade assistidas pelo Programa Bolsa Família entre 2008 e 2019, explorando desigualdades regionais e buscando determinar o impacto das crises econômica e política agravadas em 2014 e da adesão governamental às políticas de austeridade fiscal na tendência. As análises foram realizadas utilizando dados agregados de lactentes (0-23 meses) e pré-escolares (24-59 meses), extraídos do Sistema de Vigilância Alimentar e Nutricional (SISVAN) assistidas pelo Programa Bolsa Família (n = 34.272.024). As tendências foram analisadas por meio de modelos lineares generalizados, com efeitos mistos específicos para as faixas etárias (distribuição binomial negativa e função de ligação log). As desigualdades regionais foram analisadas a partir do agrupamento das Unidades Federativas segundo o Índice de Vulnerabilidade Social (IVS) e a influência das crises e das políticas de austeridade na prevalência de desnutrição por meio da interação entre "ano" e "crise" (2008-2013 vs. 2014-2019). Houve redução na prevalência de desnutrição infantil até meados de 2013, quando as tendências passaram a ser estacionárias para pré-escolares e ascendentes para lactentes. Observou-se, também, maior risco de desnutrição nos estados com média e alta vulnerabilidade social, quando comparadas àqueles com baixa vulnerabilidade social. Os pontos de inflexão nas tendências corroboram a hipótese de que as crises política e econômica, e as respostas governamentais a essas crises, provocaram impacto negativo sobre o estado nutricional de crianças em situação de pobreza e extrema pobreza no Brasil.

This study aimed to analyze the temporal trend of malnutrition in children aged under five years assisted by the Brazilian Income Transfer Program from 2008 to 2019, by exploring regional inequalities and seeking to determine the impact of the economic and political crises aggravated in 2014, and the government's adherence to fiscal austerity policies on the trend. The analyses were performed using aggregated data from infants (0-23 months) and preschoolers (24-59 months), extracted from the Brazilian Food and Nutritional Surveillance System (SISVAN) assisted by the Brazilian Income Transfer Program (n = 34,272,024). Trends were analyzed using generalized linear models with age-specific mixed effects (negative binomial distribution and log linkage function). The regional inequalities were analyzed based on the grouping of Federative Units according to the Social Vulnerability Index (SVI) and the influence of crises and austerity policies on the prevalence of malnutrition by the interaction between "year" and "crisis" (2008-2013 vs. 2014-2019). There was a reduction in the prevalence of child malnutrition until mid-2013, when the trends became stationary for preschoolers and upward for infants. There was also a higher risk of malnutrition in Federative Units with medium- and high-social vulnerability, when compared to those with low-social vulnerability. The inflection points in the trends corroborate the hypothesis that the political and economic crises, and the governmental responses to these crises, negatively impacted the nutritional status of children in poverty and extreme poverty in Brazil.

El objetivo de este estudio fue analizar la tendencia temporal de la desnutrición en niños menores de cinco años atendidos por el Programa Bolsa Familia entre los años 2008 y 2019, explorando desigualdades regionales y buscando determinar el impacto de las crisis económica y política que se intensificaron en 2014, así como la adhesión del gobierno a políticas de austeridad fiscal en esta tendencia. Los análisis se realizaron utilizando datos agregados de lactantes (0-23 meses) y preescolares (24-59 meses), extraídos del Sistema de Vigilancia Alimentaria y Nutricional (SISVAN) atendidos por el Programa Bolsa Familia (n = 34.272.024). Se analizaron las tendencias a través de modelos lineales generalizados con efectos mixtos específicos para los grupos de edad (distribución binomial negativa y función de enlace de logaritmo). Se analizaron las desigualdades regionales a partir del agrupamiento de las unidades federativas conforme el Índice de Vulnerabilidad Social (IVS) y la influencia de las crisis y de las políticas de austeridad en la prevalencia de desnutrición a través de la interacción entre "año" y "crisis" (2008-2013 vs. 2014-2019). Hubo una disminución en la prevalencia de desnutrición infantil hasta mediados de 2013, cuando las tendencias se volvieron estacionarias para preescolares y ascendentes para lactantes. También se observó un riesgo más alto de desnutrición en estados con vulnerabilidad social media y alta, en comparación con aquellos con vulnerabilidad social baja. Los puntos de inflexión en las tendencias corroboran la hipótesis de que las crisis política y económica, y las respuestas del gobierno para estas crisis, tuvieron un impacto negativo en el estado nutricional de niños en situación de pobreza y extrema pobreza en Brasil.

Associação entre iniquidades raciais e condição de saúde bucal: revisão sistemática / Association between racial iniquities and oral health status: a systematic review

Resumo O objetivo deste estudo é investigar a associação entre iniquidades raciais e condição de saúde bucal. Trata-se de revisão sistemática com protocolo cadastrado na plataforma prospero (CRD42021228417), com buscas realizadas em bases de dados eletrônicas e na literatura cinzenta. Identificou-se 3.028 publicações e após aplicação dos critérios de elegibilidade e análise do risco de vieses, 18 estudos foram selecionados. Os resultados indicam que indivíduos de raça/cor da pele preta/parda apresentam condições de saúde bucal desfavorável, representada principalmente pela autoavaliação de saúde bucal, perda dentária, cárie e periodontite. Os resultados evidenciaram iniquidades raciais em saúde bucal em diferentes países, para todos os indicadores analisados, com maior vulnerabilidade da população negra.

Abstract The present study aimed to investigate the association between racial iniquities and oral health status. This is a systematic review with a protocol registered on the Prospero Platform (CRD42021228417), with searches carried out in electronic databases and in gray literature. Our study identified 3,028 publications. After applying the eligibility criteria and risk of bias analysis, 18 studies were selected. The results indicate that individuals of black/brown race/skin color have unfavorable oral health conditions, mainly represented by self-rated oral health, tooth loss, caries, and periodontitis. The results showed racial iniquities in oral health in different countries, for all analyzed indicators, with a greater vulnerability of the black population.

Estimación del riesgo cardiovascular en pacientes con diabetes mellitus tipo 2

Introducción: Las personas diabéticas tienen entre dos y tres veces más riesgo de morbilidad y mortalidad cardiovascular que aquellas que no padecen la enfermedad. Objetivo: Estimar el riesgo cardiovascular en pacientes con diabetes mellitus tipo 2 atendidos en un Área de Salud. Métodos: Se realizó un estudio descriptivo y trasversal de 103 pacientes con diabetes mellitus tipo 2, pertenecientes al Consultorio Médico de la Familia No. 23 del policlínico Carlos J Finlay, municipio Songo-La Maya en la provincia Santiago de Cuba, desde enero hasta diciembre de 2023. Se estudiaron variables cualitativas y cuantitativas (edad, año de diagnóstico y duración de la enfermedad); se estimó el riesgo cardiovascular según el modelo para la predicción del riesgo en personas con diabetes tipo 2. Resultados: Se observó predominio del sexo femenino (58,3 %). La mayoría de los pacientes tenían hipertensión arterial (76 %) y microalbuminuria (31,2 %). La edad media de los pacientes fue de 65,5 años y como promedio tenían un tiempo de evolución de la diabetes de 8,6 años. La evaluación del riesgo cardiovascular ubicó a 43,3 % de la población en un nivel moderado y 25,7 % con alto riesgo. Conclusiones: Los pacientes diabéticos estudiados mostraron un riesgo de moderado a alto de presentar eventos cardiovasculares. Se hace necesario realizar intervenciones educativas en estos pacientes y sus familiares para lograr cambios favorables en los estilos de vida y mejorar el control de la enfermedad, previniendo así complicaciones y la ocurrencia de eventos fatales en los próximos años.

Introduction: Diabetic people have between two and three times more risk of cardiovascular morbidity and mortality than those who do not suffer from the disease. Objective: To estimate cardiovascular risk in patients with type 2 diabetes mellitus treated in a Health Area. Methods: A descriptive and cross-sectional study was carried out on 103 patients with type 2 diabetes mellitus, belonging to the Family Medical Office No. 23 of the Carlos J. Finlay polyclinic, Songo-La Maya municipality, Santiago de Cuba province, from January to December 2023. Qualitative variables and quantitative (age, year of diagnosis and duration of the disease) were studied; Cardiovascular risk was estimated according to the model for predicting cardiovascular risk in people with type 2 diabetes. Results: A predominance of the female sex was observed (58.3%). Most patients had arterial hypertension (76.0%) and microalbuminuria (31.2%). The average age of the patients was 65.5 years and on average they had a duration of diabetes of 8.6 years. The cardiovascular risk evaluation placed 43.3% of the population at a moderate level and 25.7% at high risk. Conclusions: The diabetic patients studied showed a moderate to high risk of presenting cardiovascular events. It is necessary to carry out educational interventions in these patients and their families to achieve favorable changes in lifestyles and improve disease control, thus preventing complications and the occurrence of fatal events in the coming years.

Quality of healthcare services to reduce leprosy in Brazil: a trend analysis from 2001 to 2020 / Qualidade dos serviços de atenção à saúde para redução da hanseníase no Brasil: análise de tendência de 2001 a 2020

ABSTRACT Objective: To analyze the temporal trend of healthcare services quality indicators to reduce leprosy in Brazil, over a 20-year period. Methods: This is an epidemiological study with a temporal trend, whose data were extracted from the Notifiable Diseases Information System. Indicators were constructed from the Ministry of Health Technical-Operational Manual that presents the Guidelines for Surveillance, Care and Elimination of Leprosy as a Public Health Problem. For trend analysis of the selected indicators, the Prais-Winsten model was used and the Average Annual Growth Rate (AAGR) was also calculated. Results: In the 20-year time series investigated here, 732,959 cases of leprosy were reported in Brazil. The trend was stationary for: new leprosy cases cure rate (β=-0.000; p=0.196; AAGR=-0.2), new leprosy cases drop out rate (β=-0.001; p=0.147; AAGR=-0.4), new leprosy cases contact tracing rate (β=-0.001; p=0.112; AAGR=1.6), new cases of leprosy with degree physical disability assessment rate among new cases (β=-0.000; p=0.196; AAGR=-0.2) and cases cured in the year with the degree of physical disability assessed (β=0.002; p=0.265; AAGR=0.5); while the indicator of recurrence rate among cases reported in the year (β=0.019; p<0.001; AAGR=0.5) showed an increasing trend. Conclusion: Based on the evaluation of indicators to assess the quality of healthcare services to reduce leprosy, it was evident that Brazil has major challenges for its full implementation, with improvements being necessary in the quality of care service offered to the population.

RESUMO Objetivo: Analisar a tendência temporal dos indicadores de qualidade dos serviços de atenção à saúde para redução da hanseníase no Brasil, no período de 20 anos. Métodos: Trata-se de um estudo epidemiológico de tendência temporal, cujos dados foram extraídos do Sistema de Informação de Agravos de Notificação (SINAN). Foram construídos indicadores a partir do Manual Técnico-Operacional, que apresenta as Diretrizes para Vigilância, Atenção e Eliminação da Hanseníase como Problema de Saúde Pública do Ministério da Saúde. Para análise de tendência dos indicadores selecionados, utilizou-se o modelo de Prais-Winsten e calculou-se a Taxa de Incremento Anual (TIA). Resultados: Na série temporal de 20 anos aqui investigada, foram notificados no Brasil 732.959 casos de hanseníase. A tendência mostrou-se estacionária para cura de hanseníase entre os casos novos (β=-0,000; p=0,196; TIA=-0,2); casos de hanseníase em abandono de tratamento entre os casos novos (β=-0,001; p=0,147; TIA=-0,4); contatos examinados de casos novos de hanseníase (β=-0,001; p=0,112; TIA=1,6); casos novos de hanseníase com grau de incapacidade física avaliado no diagnóstico (β=-0,000; p=0,196; TIA=-0,2); e casos curados no ano com grau de incapacidade física avaliada (β=0,002; p=0,265; TIA=0,5); enquanto o indicador casos de recidiva entre os casos notificados no ano (β=0,019; p<0,001; TIA=0,5) apresentou tendência crescente. Conclusão: Com base na avaliação dos indicadores para mensurar a qualidade dos serviços de atenção à saúde para redução da hanseníase, ficou evidente que o Brasil possui grandes desafios para sua execução plena, sendo necessárias melhorias na qualidade do serviço ofertado à população.

Avaliação de indicadores sociais e de saúde em municípios de Minas Gerais conforme tipologia rural-urbano / Assessment of social and health indicators in municipalities of Minas Gerais according to the rural-urban typology

RESUMO O presente artigo tem o objetivo de avaliar indicadores sociais e de saúde de municípios conforme a tipologia rural-urbano. Trata-se de estudo ecológico que utilizou dados oficiais de acesso público dos 853 municípios do estado de Minas Gerais, Brasil. Foram conduzidas análises descritivas e bivariadas através da Regressão de Poisson e Teste de Kruskal-Wallis. Do total de municípios, 547 (64,12%) são rurais. A maior média do Índice de Desenvolvimento Humano Municipal (IDH-M) foi observada entre os municípios urbanos. A maior média de cobertura da Estratégia Saúde da Família (ESF) foi verificada entre os municípios rurais, nos quais também foram demonstrados os melhores resultados para os indicadores de mortalidades infantil, prematura e por causas evitáveis, homogeneidade vacinal e prevalência de desnutrição. Os achados deste estudo evidenciam que uma maior cobertura da ESF está associada à ocorrência de melhores condições gerais de vida e de saúde das populações atendidas em municípios de tipologia rural. Recomenda-se aos gestores de saúde o fomento à consolidação da ESF em comunidades com contextos socioeconômicos e culturais desfavoráveis, como localidades rurais remotas e aglomerados urbanos, e o estabelecimento de ações intersetoriais com impacto positivo na saúde.

ABSTRACT This article aims to evaluate social and health indicators of municipalities according to the rural-urban typology. This is an ecological study that used official publicly accessible data from the 853 municipalities in the state of Minas Gerais, Brazil. Descriptive and bivariate analysis were carried out using Poisson Regression and Kruskal-Wallis Test. 547 (64.12%) are rural municipalities. The highest average of the Municipal Human Development Index (MHDI) was observed among urban municipalities. The highest average coverage of the Family Health Strategy (FHS) was found among rural municipalities. In these municipalities, the best results were shown for the indicators of infant mortality, premature mortality and mortality from preventable causes, vaccine homogeneity and prevalence of malnutrition. The findings of this study show that greater FHS coverage is associated with the occurrence of better general living and health conditions in the populations served in rural municipalities. It is recommended that health managers encourage the consolidation of the FHS in communities with unfavorable socioeconomic and cultural contexts, such as remote rural locations and urban agglomerations, and the establishment of intersectoral actions with a positive impact on health.

Translation and cultural adaptation of the Health Utilities Preschool to Brazilian Portuguese

ABSTRACT Introduction: Health research is particularly important in low- and middle-income countries (LMICs), where improvements must be achieved with limited resources, and where the great majority of the world's population, especially children, live. Improvements in public health detection in Brazil have resulted in cancer becoming the most prevalent cause of death by disease in the group aged 1 to 19 years, hence, delivering cost-effective care to the group is a priority. Preference-based measures of health status and health-related quality of life (HRQL) integrate morbidity and mortality and provide utility scores for the estimation of quality-adjusted life years to be used in cost-effectiveness analyses and economic evaluation. The generic preference-based instrument Health Utilities - Preschool (HuPS) measures the health status of young children and is applicable to the age group 2 to 5 years, who carry the highest incidence of cancer in childhood. Methods: The translation of the HuPS classification system followed recommended protocols from published guidelines. Forward and backward translations were performed by a team of six qualified professionals and linguistic validation was undertaken with a sample of parents of preschool children. Main results: Initial disagreements on individual words occurring in 0.5-1.5% were resolved by consensus. A final version of the instrument was validated by the sample of parents. Conclusions: The translation and cultural adaptation of the HuPS into Brazilian Portuguese were accomplished as the first step in the validation of the HuPS instrument in Brazil.

Nurses' perception about their role in reducing health inequalities in community contexts / Percepção dos enfermeiros sobre o seu papel na redução das desigualdades em saúde em contextos comunitários / Percepción de enfermeros sobre su rol en la disminución de desigualdades en salud en contextos comunitarios

Abstract Objective: to understand nurses' perception about their role in reducing health inequalities in community contexts. Method: a qualitative study with a phenomenological approach addressed from Heidegger's Interpretive Theory and the health inequality settings. A total of 18 in-depth interviews were conducted with nurses working in health institutions devoted to community interventions. The following five-phase process was adopted for the qualitative data analysis: Accumulation; Disassembling; Reassembling; Interpretation; and Conclusion. Results: four main topics that nurses mobilize to mitigate health inequalities in community settings were identified, namely: Competences to create, operationalize, monitor and assess health policies; Leadership and management for health and care processes at the individual and collective levels; Professionals that devise care strategies; and Care approach based on characteristics of the territory. Conclusion: nurses perceive that their role contributes significantly to reducing health inequalities in community settings based on the creation, operationalization, monitoring and assessment of health policies. From the sociocultural, economic and political characteristics of the territory, they prioritize actions in disadvantaged human groups in order to improve access, opportunities, continuity and quality in health.

Resumo Objetivo: compreender a percepção dos enfermeiros sobre o seu papel na redução das desigualdades em saúde em contextos comunitários. Método: estudo qualitativo com abordagem fenomenológica abordado a partir da teoria interpretativista de Heidegger e das áreas das desigualdades em saúde. Foram realizadas 18 entrevistas em profundidade com enfermeiros que trabalham em instituições de saúde de intervenção comunitária. Para análise dos dados qualitativos foi adotado um processo de cinco fases: Acumulação, Desmontagem, Remontagem, Interpretação e Conclusão. Resultados: foram identificados quatro temas principais que mobilizam os enfermeiros para mitigar as desigualdades em saúde em ambientes comunitários: Competências para construir, operacionalizar, monitorar e avaliar políticas de saúde; Liderança e gestão de processos de saúde e cuidados em nível individual e coletivo; Profissionais que geram estratégias para o cuidado e Abordagem de cuidado baseada nas características do território. Conclusão: os enfermeiros percebem que o seu papel contribui significativamente para a redução das desigualdades em saúde em ambientes comunitários a partir da concepção, operacionalização, monitoramento e avaliação de políticas de saúde. Com base nas características socioculturais, econômicas e políticas do território, priorizam ações em grupos humanos desfavorecidos, a fim de melhorar o acesso, a oportunidade, a continuidade e a qualidade na saúde.

Resumen Objetivo: comprender la percepción de los enfermeros sobre su rol en la disminución de desigualdades en salud en contextos comunitarios. Método: estudio cualitativo con enfoque fenomenológico abordado desde la teoría interpretativista de Heidegger y los ámbitos de las desigualdades en salud. Se realizaron 18 entrevistas a profundidad con enfermeros que se desempeñan en instituciones sanitarias de intervención comunitaria. Se adoptó el proceso de cinco fases para el análisis de datos cualitativos: Acumulación, Desmontaje, Reensamblaje, Interpretación y Conclusión. Resultados: se identificaron cuatro temas principales que movilizan los enfermeros para mitigar desigualdades en salud en escenarios comunitarios: Competencias para construir, operativizar, monitorear y evaluar la política de salud; Liderazgo y gestión de procesos de salud y del cuidado a nivel individual y colectivo; Profesionales generadores de estrategias para el cuidado y Enfoque de cuidado basado en características del territorio. Conclusión: los enfermeros perciben que su rol aporta de manera significativa a disminuir desigualdades en salud en escenarios comunitarios desde el diseño, la operación, el monitoreo y la evaluación de políticas de salud. A partir de las características socioculturales, económicas y políticas del territorio, priorizan acciones en grupos humanos en desventaja, a fin de mejorar el acceso, la oportunidad, la continuidad y la calidad en salud.