Avaliação do impacto da implantação do novo sistema de informações da atenção primária à saúde nos registros de atendimentos e visitas domiciliares no Brasil / Evaluation of the impact of the implementation of the new primary health care information system on records of patient care and home visits in Brazil / Evaluación del impacto de la implantación del nuevo sistema de informaciones de la atención primaria de salud en los registros de atención y visitas domiciliarias en Brasil

Resumo: A substituição do Sistema de Informação da Atenção Básica (SIAB, 1998-2015), a partir de janeiro de 2016, pelo novo Sistema de Informação em Saúde para a Atenção Básica (SISAB) determinou novas formas de coleta, processamento e uso das informações, com possível impacto nos registros das atividades desenvolvidas na atenção primária à saúde no Brasil. O objetivo deste estudo foi avaliar o impacto da implantação do novo sistema de informação sobre registros de atendimentos de médicos e enfermeiros, e de visitas domiciliares de agentes comunitários de saúde (ACS) brasileiros entre 2007 e 2019. Para tal, utilizou-se uma abordagem bayesiana de modelo estrutural para séries temporais, com base em uma regressão difusa de espaço-estado. Ao longo do período de 2016 a 2019, foram registrados 463,47 milhões de atendimentos médicos, 210,61 milhões de atendimentos de enfermagem e 1,28 bilhão de visitas de ACS. Seguindo a tendência registrada antes da implantação, seriam esperados 598,86 milhões, 430,46 milhões e 1,5 bilhão de atendimentos de médicos, enfermeiros e visitas de ACS, respectivamente. Em termos relativos, houve um decréscimo de 25% nos atendimentos médicos, 51% nos atendimentos de enfermagem e 15% nas visitas de ACS quando comparado com o valor esperado pelo método bayesiano. O impacto negativo no registro de atendimentos e de visitas domiciliares identificado neste estudo, seja por dificuldade de adaptação ao novo sistema, seja por diminuição de registros indevidos, merece ser alvo de investigação para que se possa, de forma planejada, compreender e superar o desafio da melhoria do sistema de informação da atenção primária.

Abstract: The replacement of the Primary Care Information System (SIAB, 1998-2015), as of January 2016, by the new Health Information System for Primary Care (SISAB) determined new forms of collecting, processing, and using information, with a possible impact on the records of activities carried out in primary health care in Brazil. This study aimed to evaluate the implementation impact of the new information system on records of physicians' and nurses' patient care and home visits of community health workers (CHW) in Brazil from 2007 to 2019. To this end, a Bayesian structural time-series model approach was used, based on a diffuse state-space regression. From 2016 to 2019, 463.47 million physician care, 210.61 million nursing care, and 1.28 billion CHW visits were recorded. Following the trend recorded before the implementation, 598.86 million, 430.46 million, and 1.5 billion physician and nursing appointments and CHW visits would be expected, respectively. In relative terms, there was a decrease of 25% in physician care, 51% in nursing care, and 15% in CHW visits when compared to the value expected by the Bayesian method. The negative impact on the records of patient care and home visits identified in this study, whether due to difficulties in adapting to the new system or a reduction in improper records, must be investigated so that the challenge of improving the primary care information system can be understood and overcome in a planned way.

Resumen: La sustitución del Sistema de Información de la Atención Básica (SIAB, 1998-2015), desde enero de 2016, por el nuevo Sistema de Información en Salud para la Atención Básica (SISAB) estableció nuevas maneras para recolectar, procesar y utilizar las informaciones, con posibles impactos en los registros de las actividades desarrolladas en la atención primaria de salud en Brasil. El objetivo de este estudio fue evaluar el impacto de la implantación del nuevo sistema de información sobre los registros de atención de médicos y enfermeros y de visitas domiciliarias de agentes comunitarios de salud (ACS) en Brasil entre 2007 y 2019. Para eso, se utilizó un enfoque bayesiano de modelo estructural para series temporales basadas en una regresión difusa de espacio de estado. Entre los años 2016 y 2019, se registraron 463,47 millones de consultas médicas, 210,61 millones de consultas de enfermería y 1,28 mil millones de visitas de ACS. Siguiendo la tendencia registrada antes de la implantación, se esperarían 598,86 millones, 430,46 millones y 1,5 mil millones de consultas médicas y de enfermería y visitas de ACS respectivamente. En términos relativos, hubo una disminución del 25% en las consultas médicas, del 51% en las consultas de enfermería y del 15% en las visitas de ACS en comparación con el valor esperado por el método bayesiano. El impacto negativo en el registro de consultas y visitas domiciliarias identificado en este estudio, ya sea por dificultades en la adaptación al nuevo sistema o por la disminución de los registros indebidos, merece ser objeto de investigación para que se pueda, de manera planificada, comprender y superar el desafío continuo de mejorar el sistema de información de la atención primaria.

Impact of a research-action on vaccination indicators in the state of Minas Gerais, Brazil / Impacto de uma pesquisa-ação nos indicadores vacinais em Minas Gerais

ABSTRACT OBJECTIVE Analyze the impact of the state research-action project on immunization indicators (vaccination coverage - VC, homogeneity of vaccination coverage - HVC, dropout rate - DR, and risk rating) before and after the intervention in municipalities and priority Regional Health Administrations/Regional Health Superintendencies (RHA/RHS). METHODS The state research-action project was a before-after community clinical trial conducted in 212 municipalities belonging to eight RHA/RHS in the state of Minas Gerais, Brazil. The study sample comprised RHA/RHS with a decreasing trend for routine vaccination coverage in children under one year from 2015 to 2020. This study used secondary VC and DR data from 10 immunobiologicals recommended for children younger than two years from January to December 2021 (pre-intervention period, prior to the state research-action project) and from January to December 2022 (post-intervention period). The categorical variables were presented in proportions, and initially, a comparison was made between those of DR, HVC, and the risk rating for the transmission of vaccine-preventable diseases, according to the two periods (2021 and 2022), using the McNemar test. RESULTS All immunization indicators increased after conducting the research-action project. In 2021, 80.66% of the state's municipalities had a risk rating for the transmission of vaccine-preventable diseases as "high and very high." In 2022, the value reduced to 68.40%. CONCLUSIONS Risk rating for the transmission of vaccine-preventable diseases is an important mechanism to assist managers in defining priorities. The state research-action project used a method that enabled the construction and execution of unique action plans for each municipality, directing the improvement of immunization indicators in the state.

RESUMO OBJETIVO Analisar o impacto do projeto estadual de pesquisa-ação nos indicadores de imunização (coberturas vacinais - CV, homogeneidade de cobertura vacinal - HCV, taxa de abandono - TA e classificação de risco) antes e após a intervenção em municípios e Gerências Regionais de Saúde/Superintendências Regionais de Saúde (GRS/SRS) prioritários. MÉTODOS O projeto estadual de pesquisa-ação foi um ensaio clínico comunitário, do tipo antes-depois, realizado em 212 municípios pertencentes a oito GRS/SRS do estado de Minas Gerais, Brasil. Compuseram a amostra do estudo as SRS/GRS com tendência decrescente para a cobertura vacinal de rotina em crianças menores de 1 ano, no período de 2015 a 2020. Neste estudo, foram utilizados dados secundários de CV e TA de 10 imunobiológicos recomendados para crianças menores de 2 anos, no período de janeiro a dezembro de 2021 (período pré-intervenção, anterior ao projeto estadual de pesquisa-ação) e de janeiro a dezembro de 2022 (período pós-intervenção). As variáveis categóricas foram apresentadas em proporções e, inicialmente, realizou-se a comparação entre as de TA, HCV e a classificação de risco para a transmissão de doenças imunopreveníveis, segundo os dois períodos (2021 e 2022), utilizando-se o teste McNemar. RESULTADOS Observou-se um aumento de todos os indicadores de imunização após a realização do projeto de pesquisa-ação. No ano de 2021, 80,66% dos municípios do estado tiveram a classificação de risco para transmissão de doenças imunopreveníveis como "alto e muito alto risco". Em 2022, o valor foi reduzido para 68,40%. CONCLUSÕES A classificação de risco para transmissão de doenças imunopreveníveis é um mecanismo importante para auxiliar os gestores na definição de prioridades. O projeto estadual de pesquisa-ação empregou um método que possibilitou a construção e a execução de planos de ação singulares a cada município, direcionando a melhoria dos indicadores de imunização no estado.

Effects of a Multi-Professional Intervention on Mental Health of Middle-Aged Overweight Survivors of COVID-19: A Clinical Trial.

The present study aimed to investigate the effects of a multi-professional intervention model on the mental health of middle-aged, overweight survivors of COVID-19. A clinical trial study with parallel groups and repeated measures was conducted. For eight weeks, multi-professional interventions were conducted (psychoeducation, nutritional intervention, and physical exercises). One hundred and thirty-five overweight or obese patients aged 46.46 ± 12.77 years were distributed into four experimental groups: mild, moderate, severe COVID, and control group. The instruments were used: mental health continuum-MHC, revised impact scale-IES-r, generalized anxiety disorder-GAD-7, and Patient health questionnaire PHQ-9, before and after eight weeks. The main results indicated only a time effect, with a significant increase in global MHC scores, emotional well-being, social well-being, and psychological well-being, as well as detected a significant reduction in global IES-R scores, intrusion, avoidance, and hyperarousal, in addition to a reduction in GAD-7 and PHQ-9 scores (p < 0.05). In conclusion, it was possible to identify those psychoeducational interventions that effectively reduced anxiety, depression, and post-traumatic stress symptoms in post-COVID-19 patients, regardless of symptomatology, in addition to the control group. However, moderate and severe post-COVID-19 patients need to be monitored continuously since the results of these groups did not follow the response pattern of the mild and control groups.

Cervical cancer prevention program in Mexico disrupted due to COVID-19 pandemic: Challenges and opportunities.

Introduction: The COVID-19 pandemic disrupted the preventive services for cervical cancer (CC) control programs in Mexico, which will result in increased mortality. This study aims to assess the impact of the pandemic on the interruption of three preventive actions in the CC prevention program in Mexico. Methods: This study is a retrospective time series analysis based on administrative records for the uninsured population served by the Mexican Ministry of Health. Patient data were retrieved from the outpatient service information system and the hospital discharge database for the period 2017-2021. Data were aggregated by month, distinguishing a pre-pandemic and a pandemic period, considering April 2020 as the start date of the pandemic. A Poisson time series analysis was used to model seasonal and secular trends. Five process indicators were selected to assess the disruption of the CC program, these were analyzed as monthly data (N=39 pre-pandemic, N=21 during the pandemic). HPV vaccination indicators (number of doses and coverage) and diagnostic characteristics of CC cases were analyzed descriptively. The time elapsed between diagnosis and treatment initiation in CC cases was modeled using restricted cubic splines from robust regression. Results: Annual HPV vaccination coverage declined dramatically after 2019 and was almost null in 2021. The number of positive Papanicolaou smears decreased by 67.8% (90%CI: -72.3, -61.7) in April-December 2020, compared to their expected values without the pandemic. The immediate pandemic shock (April 2020) in the number of first-time and recurrent colposcopies was -80.5% (95%CI:-83.5, -77.0) and -77.9% (95%CI: -81.0, -74.4), respectively. An increasing trend was observed in the proportion of advanced stage and metastatic CC cases. The fraction of CC cases that did not receive medical treatment or surgery increased, as well as CC cases that received late treatment after diagnosis. Conclusions: Our analyses show significant impact of the COVID-19 pandemic with declines at all levels of CC prevention and increasing inequalities. The restarting of the preventive programs against CC in Mexico offers an opportunity to put in place actions to reduce the disparities in the burden of disease between socioeconomic levels.

COVID-19 en Chile: análisis de su impacto por olas y regiones / The impact of the different waves of COVID-19 pandemic in Chile across regions

BACKGROUND: The effects of COVID-19 in Chile changed over time and among regions. Aim: To identify patterns in the impact and evolution of COVID-19 for each wave generated between 2020 and 2022 at the 16 regions of the country. MATERIAL AND METHODS: Several indicators related to the pandemic, their evolution and their consequences for the health system and the health of the population were calculated. RESULTS: There are differences in the evolution of the infection across the regions of the country, as well as heterogeneity between waves. Specifically, the second wave in Chile was identified as the one with the greatest impact, with a national death rate of 123.5 deaths per 100,000 inhabitants and 66.4% intensive care unit occupancy rate due to COVID-19. Performing a geographic analysis, it was possible to find systematic patterns, for example, between regions with higher immunization rates and lower rates of lethality, such as the cases of Ñuble and Atacama regions. Conclusions: These results emphasize the need to consider regional differences and the temporal context for the elaboration of strategies to the efficient management of a pandemic.

Factores asociados a la calidad de vida relacionada con la salud bucal en preescolares de una comunidad andina / Factors associated with oral health related-quality of life in preschoolers from an Andean community

Objective : To analyze the oral health status and its relationship with the quality of life of Andean children of the community of Paucarbamba in Huancavelica, Peru. Material and Methods : The observational, cross-sectional, and correlational study was conducted on a sample of 120 children aged 3-5 years. Early childhood caries was considered using the dmft index. In addition, presence and type of malocclusion were assessed. The oral health-related quality of life was measured by The Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire. Univariate and bivariate analysis were performed. Linear regression and Spearman correlation were conducted to identify the factors that most explained the ECOHIS score. Results : Multiple linear regression by least squares method did not consider gender, age, malocclusion, and simplified oral hygiene index as significant. This analysis only included dmft index as significant (p<0.05) to explicate the ECOHIS score. The estimated regression model was ECOHIS score = 11.67 + 0.79*dmft, in which the score increased by 0,79 for each unit obtained of the dmft index, and the dmft in a R2 = 30% (p<0.001) explained the variability of the ECOHIS score achieved. Conclusions : There is a negative impact of dental caries on the quality of life of preschool children and their families in an Andean community in Paucarbamba, Peru.

Objetivo : Analizar el estado de salud bucal y su relación con la calidad de vida de los preescolares de una comunidad andina y vulnerable del Perú. Material y Métodos : El estudio observacional, correlacional y transversal se realizó en una muestra de 120 niños de 3 a 5 años. La caries de la primera infancia se determinó mediante el índice ceod. También se consideró la presencia y el tipo de maloclusión. El cuestionario Early Childhood Oral Health Impact Scale (ECOHIS) midió la calidad de vida relacionada con la salud bucal. Los factores y variables orales se analizaron de manera univariada y bivariada. Se realizó un análisis de correlación de Spearman y regresión lineal para identificar los factores y en qué medida explicaban la puntuación del cuestionario. Resultados : El análisis de regresión lineal múltiple por el método de mínimos cuadrados solo incluyó como significativa (p <0,05) la contribución de ceod para explicar la puntuación del cuestionario, dejando de lado variables como el sexo, la edad, la maloclusión y el índice de higiene bucal simplificado. El modelo de regresión estimado fue Puntuación del Cuestionario = 11,67 + 0,79*ceod, donde la puntuación del cuestionario aumentó en 0,79 por cada unidad ganada de ceod, y la variabilidad de las puntuaciones obtenidas se explica por el ceod en un R2 = 30% (p<0,001). Conclusiones : Existe un impacto de la caries dental en la calidad de vida de los preescolares de uma comunidade andina del Perú y sus familias.

Effect of particulate matter (PM2.5 and PM10) on health indicators: climate change scenarios in a Brazilian metropolis.

Recife is recognized as the 16th most vulnerable city to climate change in the world. In addition, the city has levels of air pollutants above the new limits proposed by the World Health Organization (WHO) in 2021. In this sense, the present study had two main objectives: (1) To evaluate the health (and economic) benefits related to the reduction in mean annual concentrations of PM10 and PM2.5 considering the new limits recommended by the WHO: 15 µg/m3 (PM10) and 5 µg/m3 (PM2.5) and (2) To simulate the behavior of these pollutants in scenarios with increased temperature (2 and 4 °C) using machine learning. The averages of PM2.5 and PM10 were above the limits recommended by the WHO. The scenario simulating the reduction in these pollutants below the new WHO limits would avoid more than 130 deaths and 84 hospital admissions for respiratory or cardiovascular problems. This represents a gain of 15.2 months in life expectancy and a cost of almost 160 million dollars. Regarding the simulated temperature increase, the most conservative (+ 2 °C) and most drastic (+ 4 °C) scenarios predict an increase of approximately 6.5 and 15%, respectively, in the concentrations of PM2.5 and PM10, with a progressive increase in deaths attributed to air pollution. The study shows that the increase in temperature will have impacts on air particulate matter and health outcomes. Climate change mitigation and pollution control policies must be implemented for meeting new WHO air quality standards which may have health benefits.

Traditional national sports' injuries in college students / Lesões esportivas de esportes nacionais tradicionais em estudantes universitários / Lesiones deportivas en deportes nacionales tradicionales en estudiantes universitarios

ABSTRACT Introduction: There are 56 ethnic groups in China. Many ethnic groups have their sports, which can cause sports injuries to the human body. Objective: This paper analyzes the impact of national sports on college students' physical health, investigates the most common sports injuries in college students, and specifies scientifically-based prevention and intervention measures. Methods: 312 college students who regularly participate in various national sporting events at 10 colleges and universities volunteered to investigate common injuries sustained by participating in national sporting activities. The main injury factors were analyzed using statistical methods. Results: The investigation shows that college students' errors of judgment regarding accidents, risky behaviors, and poor sports facilities are the main causes of sports injuries. Injuries are mainly concentrated in the lower limbs and pelvic girdle. Conclusion: College students' participation in national sports activities is conducive to improving their physical and mental health. However, attention to preventing injury factors in the sports process is needed to ensure safe and healthy participation in national sports. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Existem 56 grupos étnicos na China. Muitos grupos étnicos têm os seus próprios esportes, que podem causar lesões esportivas no corpo humano. Objetivo: Este artigo analisa o impacto dos esportes nacionais na saúde física dos estudantes universitários, investiga as lesões esportivas mais comuns nos estudantes universitários praticantes, além de especificar medidas de prevenção e intervenção com embasamento científico. Métodos: 312 estudantes universitários que participam regularmente em vários eventos esportivos nacionais em 10 faculdades e universidades foram voluntários de uma investigação sobre as lesões esportivas comuns sofridas no processo de participação em atividades esportivas nacionais. Analisou-se os principais fatores de lesão utilizando métodos estatísticos. Resultados: A investigação mostra que os erros de julgamento dos estudantes universitários quanto a acidentes, comportamentos de risco e instalações esportivas deficitárias são as principais causas de lesões esportivas. As lesões concentram-se principalmente nos membros inferiores e na cintura pélvica. Conclusão: A participação dos estudantes universitários em atividades esportivas nacionais é propícia à melhoria da sua saúde física e mental, porém é necessária uma atenção quanto à prevenção de fatores de lesão no processo esportivo para garantir uma participação segura e saudável nos esportes nacionais. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: En China hay 56 grupos étnicos. Muchos grupos étnicos tienen sus propios deportes, que pueden causar lesiones deportivas en el cuerpo humano. Objetivo: Este artículo analiza el impacto del deporte nacional en la salud física de los estudiantes universitarios, investiga las lesiones deportivas más comunes en los estudiantes universitarios y especifica las medidas de prevención e intervención con base científica. Métodos: 312 estudiantes universitarios que participan regularmente en diversos eventos deportivos nacionales en 10 colegios y universidades se ofrecieron como voluntarios para una investigación de las lesiones deportivas comunes sufridas en el proceso de participación en actividades deportivas nacionales. Los principales factores de lesión se analizaron mediante métodos estadísticos. Resultados: La investigación demuestra que los errores de apreciación de los estudiantes universitarios en relación con los accidentes, los comportamientos de riesgo y las malas instalaciones deportivas son las principales causas de las lesiones deportivas. Las lesiones se concentran principalmente en los miembros inferiores y la cintura pélvica. Conclusión: La participación de los estudiantes universitarios en actividades deportivas nacionales favorece la mejora de su salud física y mental, pero es necesario prestar atención a la prevención de los factores de lesión en el proceso deportivo para garantizar una participación segura y saludable en los deportes nacionales. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Health Impact Assessment in protected areas: a proposal for urban contexts in Brazil / Avaliação de Impacto à Saúde em áreas protegidas: uma proposta para contextos urbanos no Brasil / Evaluación del Impacto en la Salud en áreas protegidas: una propuesta para contextos urbanos en Brasil

Abstract: The use of Health Impact Assessment (HIA) in the establishment of an urban protected area can enhance the positive impacts and mitigate the negative impacts resulting from its implementation. Brazil hosts some of the most important biodiversity hotspots in the world and the HIA may benefit biodiversity and human health. These areas are commonly created without any preceding survey to assess their impacts on health. Protected areas located in urban zones are essential to maintain environmental balance and quality of life in cities. It promotes positive impacts on health, providing ecosystem services and salutogenic benefits. However, they can generate negative impacts such as the violation of human rights, property speculation, spread of vectorial diseases, and psychosocial stress. Based on the identification of the potential impacts of urban protected areas on health and best practices, this qualitative and exploratory study justifies the use of HIA in urban protected areas, especially in the Brazil, and indicates the main elements for the construction of a methodological approach to contribute to the Sustainable Development Goals and one of its alternatives, the Buen Vivir approach.

Resumo: O uso da Avaliação de Impacto à Saúde (AIS) na criação de uma área protegida urbana pode potencializar os impactos positivos e mitigar os impactos negativos resultantes de sua implementação. O Brasil abriga alguns dos mais importantes hotspots de biodiversidade do mundo e a implementação da AIS pode beneficiar tanto estas áreas como a saúde humana. As áreas protegidas urbanas são comumente estabelecidas sem qualquer avaliação prévia de seus impactos na saúde e são essenciais para manter o equilíbrio ambiental e a qualidade de vida nas cidades. Além disso, as áreas protegidas impactam positivamente a saúde, fornecendo serviços ecossistêmicos e benefícios salutogênicos. Contudo, podem gerar impactos negativos, como violação de direitos humanos, especulação imobiliária, disseminação de doenças vetoriais e estresse psicossocial. Com base na identificação dos impactos potenciais das áreas protegidas urbanas na saúde e nas melhores práticas para aplicá-las, este estudo qualitativo e exploratório justifica o uso da AIS em áreas protegidas urbanas, especialmente no Brasil, e indica os principais elementos para a construção de uma abordagem metodológica que contribua com os Objetivos de Desenvolvimento Sustentável e uma de suas alternativas, a abordagem Buen Vivir.

Resumen: Usar la Evaluación del Impacto en la Salud (EIS) para crear un área protegida urbana puede potenciar los impactos positivos y mitigar los impactos negativos resultantes de su implementación. En Brasil se pueden encontrar algunos de los hotspots de biodiversidad más importantes del mundo e implementar la EIS puede beneficiar tanto estas áreas como la salud humana. Las áreas protegidas urbanas, en general, se establecen sin cualquier evaluación previa de sus impactos en la salud y son esenciales para mantener el equilibrio ambiental y la calidad de vida en las ciudades. Además, las áreas protegidas tienen un impacto positivo en la salud, proporcionando servicios ecosistémicos y beneficios salutogénicos. Sin embargo, pueden generar impactos negativos, como la violación de los derechos humanos, la especulación inmobiliaria, la propagación de enfermedades vectoriales y el estrés psicosocial. Con base en la identificación de los posibles impactos de las áreas protegidas urbanas en la salud y en las mejores prácticas para aplicarlas, este estudio cualitativo y exploratorio justifica el uso de la EIS en áreas protegidas urbanas, sobre todo en Brasil, e indica los elementos principales para construir un enfoque metodológico que contribuya a los Objetivos de Desarrollo Sostenible y una de sus alternativas, el enfoque Buen Vivir.

Dance sports influence female university students' physical health in ethnic universities / Influência da dança esportiva sobre a saúde física das universitárias em universidades étnicas / Influencia de la danza deportiva en la salud física de las estudiantes en universitarias étnicas

ABSTRACT Introduction Ensuring healthy growth with high cultural quality in the population is an important part of Chinese revitalization. University students, as a group of high cultural quality, have the mission and responsibility entrusted by the state and the people. It is believed that these goals can be achieved by using sports dance, which has a wide range and high demands; dancers should have motor skills, physical qualities, understanding of the art of dress, and psychological balance as basic requirements. Objective To test and evaluate whether sports dance activities in physical education students are conducive to promoting students' healthy physical development. Methods This paper examines the influence of teaching sports dance on the physical health of female college students in Ethnic Colleges and its countermeasures. It also discusses the strategies for teaching sports dance to provide viable suggestions for follow-up dance instruction. Conclusion The combination of sports and femininity in exercise has a good fitness effect, improves the artistic feelings of college women, and is conducive to the healthy development of the physical quality of college women. Level of evidence III; Analysis based on alternatives and limited costs.

RESUMO Introdução Garantir o crescimento saudável com alta qualidade cultural na população é parte importante da revitalização chinesa. Estudantes universitários, como um grupo de alta qualidade cultural, possuem a missão e responsabilidade confiada pelo Estado e pelo povo. Acredita-se que essas metas possam ser alcançadas utilizando a dança esportiva, que tem um vasto leque e altas exigências nesse sentido, os dançarinos devem ter habilidades motoras, qualidades físicas, compreensão na arte de vestuário e equilíbrio psicológico, como requisitos básicos. Objetivo Testar e avaliar se as atividades de dança esportiva nos alunos de educação física são propícias na promoção do desenvolvimento físico saudável dos alunos. Métodos Este artigo analisa a influência do ensino de dança esportiva sobre a saúde física de universitárias em Faculdades Étnicas e suas contramedidas. Também se discute as estratégias de ensino da dança esportiva, a fim de fornecer sugestões viáveis para o ensino de dança de acompanhamento. Conclusão A combinação de esportes e feminilidade no exercício tem um bom efeito de aptidão física, melhora os sentimentos artísticos das universitárias e é propício ao desenvolvimento saudável da qualidade física das Universitárias. Nível de evidência III; Análises baseadas em alternativas e custos limitados.

RESUMEN Introducción Garantizar un crecimiento saludable con una alta calidad cultural en la población es una parte importante de la revitalización de China. Los universitarios, como grupo de alta calidad cultural, tienen la misión y la responsabilidad encomendadas por el Estado y el pueblo. Se cree que estos objetivos pueden alcanzarse mediante el uso de la danza deportiva, que tiene una amplia gama y altas exigencias en este sentido, los bailarines deben tener habilidades motoras, cualidades físicas, la comprensión en el arte de vestir y el equilibrio psicológico como requisitos básicos. Objetivo Comprobar y evaluar si las actividades de danza deportiva en los estudiantes de educación física favorecen el desarrollo físico saludable de los alumnos. Métodos Este trabajo analiza la influencia de la enseñanza de la danza deportiva en la salud física de las estudiantes universitarias de los colegios étnicos y sus contramedidas. También se analizan las estrategias de enseñanza de la danza deportiva con el fin de ofrecer sugerencias viables para el seguimiento de la enseñanza de la danza. Conclusión La combinación de deporte y feminidad en el ejercicio tiene un buen efecto de aptitud física, mejora los sentimientos artísticos de las universitarias y favorece el desarrollo saludable de la calidad física de las universitarias. Nivel de evidencia III; análisis basado en alternativas y costes limitados.

Methodology for a Comprehensive Health Impact Assessment in Water Supply and Sanitation Programmes for Brazil.

Based on the broader concept of health proposed by the Pan-American Health Organization/World Health Organization (PAHO/ WHO), 2018, and the absence in the literature of indices that translate the causal relationship between sanitation and health, a methodology for assessing the health impact of a water and sanitation programmes, known as a Health Impact Assessment (HIA), was developed, specifically in the Brazilian context, and focused on a school in the northeast of the country. Through exploratory and descriptive evidence, and using documentary research as a method, a retrospective survey was carried out from 2000 to 2022 using documents proposing evaluation methodologies. A single document was found to fit the research objective, which was used to develop the proposed HIA methodology. Development of the methodology consisted of two stages: definition of the health dimensions and selection of the indicators making up each dimension. The HIA methodology was then applied to a school in northeast Brazil to test its use, before a water-efficient management intervention was going to be used. The overall score of 46% indicated that there was room for improvement, which the new management approach could facilitate. This methodology is therefore proposed to be an instrument for the evaluation of public water and sanitation policies, thus assisting managers in the decision-making process and in guiding sanitation programs and plans.

Impact of COVID-19 on Tuberculosis Indicators in Brazil: A Time Series and Spatial Analysis Study.

BACKGROUND: We aimed to visualize and classify the time series of COVID-19, tuberculosis (TB) notification, and TB outcomes (cure, treatment abandonment, and death), verify the impact of the new coronavirus pandemic on these indices in Brazil, and verify the presence of spatial autocorrelation between COVID-19 and TB. METHODS: This was an ecological time series study that considered TB and COVID-19 cases. Seasonal Trend Decomposition using Loess (STL) was used to trace the temporal trend, Prais-Winsten was used to classify the temporal trend, Interrupted Time Series (ITS) was used to verify the impact of COVID-19 on TB rates, and the Bivariate Moran Index (Global and Local) was used to verify the spatial autocorrelation of events. RESULTS: Brazil and its macro-regions showed an increasing temporal trend for the notification of TB in the pre-pandemic period. Only the Northeast Region showed a decreasing temporal trend for cured cases. For treatment abandonment, all regions except for the Northeast showed an increasing temporal trend, and regarding death, Brazil and the Northeast Region showed an increasing temporal trend. With the ITS, COVID-19 caused a decline in TB notification rates and TB outcome rates. With the global spatial analysis, it was possible to identify the existence of spatial autocorrelation between the notification rate of COVID-19 and the TB notification rate and deaths. With the local analysis, it was possible to map the Brazilian municipalities and classify them according to the relationship between the rates of both diseases and space. CONCLUSIONS: COVID-19 influenced the follow-up of and adherence to TB treatment and intensified social vulnerability and, consequently, affected the notification of TB since the relationship between the disease and social determinants of health is already known. The restoration and strengthening of essential services for the prevention and detection of cases and treatment of TB in endemic environments such as Brazil have been oriented as a priority in the global health agenda.

Impact assessment of emergency care units on hospitalizations for respiratory system diseases in Brazil / Avaliação do impacto das unidades de pronto atendimento sobre as internações por doenças do aparelho respiratório no Brasil

Abstract Emergency Care Units (UPAs) are part of a national health policy implemented by the Brazilian Government. UPAs are fixed prehospital components of the Brazilian Unified Health System (SUS), whose purpose is to provide resolutive emergency care to patients suffering from acute clinical conditions, and to perform the first care in cases of surgical nature. According to the Ministry of Economy, 750 units are operational throughout the country since 2008, and 332 are under construction. Being a public policy in expansion, it is imperative to assess the impact of such units as part of SUS. However, we found few studies that assessed UPAs' impact, which have examined their specific impact on mortality rates. In our research, we aimed to evaluate the impact of UPAs on hospitalization rates for diseases of the respiratory system. To measure the impact, we used a strategy of Machine Learning through the Bayesian Additive Regression Trees (BART) algorithm. The results point to a decrease in the hospitalization rates by respiratory diseases due to Emergency Care Units. Therefore, these units generate a benefit for the Brazilian health system, being an important element for the care of patients with respiratory diseases.

Resumo As Unidades de Pronto Atendimento 24h (UPAs) compõem a Política de Atenção a Urgências e Emergências (PNAU) implementada pelo Governo Federal. São componentes pré-hospitalares fixos do SUS, cujo objetivo é o atendimento resolutivo de urgência a pacientes que sofrem quadros clínicos agudos, e o primeiro atendimento em casos cirúrgicos. Desde 2008, funcionam 750 unidades no Brasil, e há 332 em construção, conforme dados de 2020 do Ministério da Economia. Diante de uma política em expansão, é indispensável avaliar seus efeitos como parte do SUS. No entanto, foram encontrados poucos trabalhos avaliando o impacto das UPAs, e esses mediram os efeitos sobre taxas de mortalidade. Este trabalho objetiva mensurar o efeito das UPAs nas taxas de internação por doenças do aparelho respiratório. Para isso, utilizou-se uma estratégia de Machine Learning por meio do algoritmo Bayesian Additive Regression Trees (BART). Os resultados apontam uma diminuição nas taxas de internações por doenças do aparelho respiratório devido às UPAs. Assim, as evidências são de que essas unidades geram benefício para o sistema de saúde, sendo uma peça importante na linha de cuidado dos pacientes com doenças respiratórias.

Increment of Maternal Mortality Among Admissions for Childbirth in Low-risk Pregnant Women in Brazil: Effect of COVID-19 Pandemic? / Aumento da taxa de mortalidade materna entre as admissões para parto em gestantes de baixo risco gestacional no Brasil: Efeito da pandemia do COVID-19?

Abstract Objective To assess the possible impact of the COVID-19 pandemic on maternal mortality among admissions for childbirth in 2020 in relation of the last 10 years. Methods An ecological study with pregnant women who underwent hospital births at the Brazilian unified public health service (SUS, in the Portuguese acronym) in Brazil from 2010 to 2020. The mortality among admissions for childbirth was obtained based on the number of admissions for childbirth with reported death as outcome divided by the total number of admissions. The underlying gestational risk and route of delivery were considered based on the national surveillance system. The average mortality for the period between 2010 and 2019 (baseline) was compared with the rate of deaths in 2020 (1st pandemic year); the rate ratio was interpreted as the risk of death in 2020 in relation to the average of the previous period (RR), with 95% confidence intervals (CIs). Results In 2020, the 1st year of the COVID-19 pandemic, 1,821,775 pregnant women were hospitalized for childbirth and 651 deaths were reported, which represents 8.7% of the total hospitalizations and 11.3% of maternal deaths between 2010 and 2020. There was an increase in maternal mortality after births in 2020 compared with the average for the period between 2010 and 2019, specially in low-risk pregnancies, both in vaginal (RR = 1.60; 95%CI:1.39-1.85) and cesarean births (RR = 1.18; 95%CI:1.04-1.34). Conclusion Maternal mortality among admissions for childbirth according to SUS data increased in 2020 compared with the average between 2010 and 2019, with an increment of 40% in low-risk pregnancies. The increase was of 18% after cesarean section and of 60% after vaginal delivery.

Resumo Objetivo Avaliar os possíveis impactos da pandemia de COVID-19 na mortalidade materna nas admissões para o parto em 2020 em relação ao histórico dos últimos 10 anos. Métodos Estudo ecológico com gestantes que realizaram parto hospitalar pelo Sistema Unificado de Saúde do Brasil (SUS) de 2010 a 2020. Para obter-se a taxa de mortalidade entre as admissões para o parto, foi utilizado o número de internações para parto que tiveram óbito como desfecho dividido pelo total de internações. O risco gestacional e o tipo de parto foram considerados a partir do sistema de vigilância nacional. A média de mortalidade no período de 2010 a 2019 (linha de base) foi comparada com a taxa de mortalidade pós-parto de 2020 (1° ano pandêmico); a razão das taxas foi interpretada como risco de óbito em 2020 em relação à média no período anterior (RR), com intervalo de confiança (IC) de 95%. Resultados Em 2020, 1° ano da pandemia de COVID-19, 1.821.775 gestantes foram internadas para o parto e 651 óbitos foram registrados, o que representa 8,7% do total de internações e 11,3% das mortes maternas entre 2010 e 2020. Houve aumento na mortalidade materna após partos em 2020 em relação à média do período entre 2010 e 2019, especialmente em gestações de baixo risco, tanto em partos normais (RR = 1.60; IC95%: 1.39-185) quanto em cesáreas (RR = 1.18; IC95%: 1.04-1.34). Conclusão A mortalidade entre as admissões para o parto pelo SUS aumentou em 2020 em relação à média de óbitos entre 2010 e 2019, com um incremento de 40% em mulheres de baixo risco gestacional. O aumento verificado foi de 18% após cesárea e de 60% após parto vaginal.

Compulsory notification of injuries in aesthetic procedures. Impact on patient safety

Abstract The disparity between the number of aesthetic procedures performed worldwide, and the complications described in the literature is remarkable. Doubts regarding the underreporting are reasonable and should be considered. The aim of this study is to demonstrate the scarcity of scientific publications on complications in aesthetic procedures compared to the abundance of these procedures performed worldwide. Based on this knowledge, it will be demonstrated to the health authorities the importance of compulsory notification of complications in aesthetic procedures that require medical attention so that the available data will allow their prevention. The limitation of knowledge regarding complications was demonstrated in the data collection for the preparation of the thesis ‟Deaths Related to Liposuction in Brazil" presented in 2018 and published in Surgical and Cosmetical Dermatology in 2020. The definition of complication in aesthetic procedures needs to be objective to prevent different and subjective interpretations. With the compulsory notification of complications in aesthetic procedures, it is intended to learn about their causes to develop guidelines for their prevention.

Health impacts of PM2.5-bound metals and PAHs in a medium-sized Brazilian city.

Rio Grande is a medium-sized industrial city located in the extreme south of Brazil, and previous studies in this city have shown contamination by metal(loids) and polycyclic aromatic hydrocarbons (PAHs) in water, soil, and sediment and in the atmosphere. In Brazil, the incorporation of PM2.5 monitoring in environmental legislation is recent (2018) and, like other developing countries, the number of studies is still small. This study aimed to investigate the levels of PM2.5 in the industrial and urban area of Rio Grande, to determine the concentration of metal(loid)s As, Cd, Cu, and Pb and of 16 PAHs in the samples of PM2.5, to perform the health risk assessment for these contaminants and the health impact assessment for two possible scenarios of reduction of PM2.5 levels. Our main findings regarding the PM2.5 samples include the following: (1) The levels of this pollutant in the city of Rio Grande were higher than those allowed in current Brazilian legislation, in both the industrial and urban areas; (2) the existence of non-carcinogenic and carcinogenic risks for metals present in all samples; (3) the absence of carcinogenic risk for the assessed PAHs; and (4) the reduction scenarios proposed pointed to a reduction of up to 22 deaths annually in conjunction with reductions in health-related expenditures. Thus, these results may serve as a basis for the development of public health policies aimed at improving air quality, jointly assisting health surveillance and directing future studies towards a better intrinsic approach to the problem.

Impact of Social Isolation on the Physical and Mental Health of Older Adults: A Follow-Up Study at the Apex of the COVID-19 Pandemic in Brazil.

INTRODUCTION: The COVID-19 pandemic has affected people's lives and caused changes in habits. The World Health Organization recommends social isolation as a way of minimizing the risk of contagion of the disease. OBJECTIVE: The aim of the study was to assess the impact of social isolation due to COVID-19 pandemic on the physical and mental health of older adults and to investigate how anthropometric, functional, and clinical aspects are associated with this process. METHODS: Fifty healthy older adults were followed-up during 5 months. The subjects had their physical and mental health assessed during social isolation (pre-vaccine situation) and after the opening of stores and activities in the municipality (post-vaccine situation). Physical evaluation was performed using the 30-s sit and stand test. Participants' mental health was assessed with the Geriatric Depression Scale and the Loneliness Index. In this methodological design, muscle strength, depressive symptoms, and loneliness index were subject to pre-post analyses. In addition, these variables were included as outcomes in linear regression models. Participants' anthropometric, functional, and clinical factors were included as predictors of the statistical model. RESULTS: Participants' scores at baseline were consistent with mild depressive symptoms and low loneliness. The muscle strength of the subjects was appropriate to their ages. After 5 months of social isolation, all variables declined, but with statistical significance only for depressive symptoms (p = 0.017, effect size of 0.11). Anthropometric, functional, and clinical factors explained 42.8% of depressive symptoms, 22.3% of loneliness, and 30.2% of muscle strength in the elderly. DISCUSSION/CONCLUSION: Older adults presented baseline scores consistent with mild depressive symptoms and low loneliness. The muscular strength of the subjects was appropriate for their ages. After 5 months of social isolation, all variables declined. Anthropometric, functional, and clinical factors explained a substantial part of the depressive symptoms, loneliness, and muscular strength in the elderly. Health care professionals should be aware of performing a wide assessment in subjects' lives to ensure better health status.

[Impact of COVID-19 on mortality in Peru using triangulation of multiple data sourcesImpacto da COVID-19 na mortalidade no Peru por meio da triangulação de várias fontes de dados]. / Impacto de la COVID-19 en la mortalidad en Perú mediante la triangulación de múltiples fuentes de datos.

An analytic cross-sectional study was conducted to quantify the impact of COVID-19 on mortality in Peru. Total excess mortality due to natural and external causes was calculated. The direct and indirect impact of COVID-19 was estimated at two points: when COVID-19 deaths were confirmed by a laboratory test and when they were confirmed by broader criteria (reclassified deaths). This comparison was made in general and by sex, age, and geographical location. The sensitivity of laboratory testing and of death certificates as criteria for confirmation of a COVID-19 death was calculated using reclassified deaths as the gold standard.From epidemiological week (EW) 10 of 2020 to EW 23 of 2021, 349 756 deaths occurred, for an excess of 183 237 deaths, mainly due to natural causes. A total of 100 955 deaths corresponded to deaths confirmed by laboratory tests; however, the reclassification criterion brought this figure to 188 708. Laboratory tests had 53.3% sensitivity; this was lower at the onset of the pandemic (10.6%) and during the first wave (37.8%). The sensitivity of death certificates was higher than laboratory tests (41.7% vs 23.9%) only during the months when little testing was available. These data showed that the impact of COVID-19 on mortality in Peru was mainly direct. Also, in periods with limited access to laboratory testing, death certificates were a useful source for determining deaths directly caused by COVID-19.

Um estudo transversal analítico foi realizado com o objetivo de quantificar o impacto da COVID-19 na mortalidade no Peru. Foi calculada a sobremortalidade total, por causas naturais e externas. O impacto direto e indireto da COVID-19 foi estimado em dois momentos: quando as mortes por COVID-19 foram confirmadas por teste laboratorial e quando foram confirmadas por critérios mais amplos (óbitos reclassificados). Essa comparação foi feita na população geral, por sexo, idade e geografia. Calculou-se a sensibilidade dos critérios laboratoriais e dos atestados de óbito para a confirmação de morte por COVID-19, utilizando os óbitos reclassificados como padrão-ouro.Da semana epidemiológica 10 de 2020 até a 23 de 2021, ocorreram 349.756 óbitos, o que configura um excesso de 183.237 óbitos, principalmente por causas naturais. Considerando os óbitos confirmados por exames laboratoriais, foram encontrados 100.955 óbitos; no entanto, com os critérios de reclassificação, esse número subiu para 188.708. Os exames laboratoriais tiveram uma sensibilidade de 53,3%, sendo menor no início da pandemia (10,6%) e durante a primeira onda (37,8%). A sensibilidade do atestado de óbito foi maior que a do exame laboratorial (41,7% vs 23,9%) apenas nos meses de baixa disponibilidade de exames. Esses dados evidenciaram que, no Peru, o impacto da COVID-19 na mortalidade foi principalmente direto. Além disso, em períodos com acesso limitado a exames laboratoriais, as declarações de óbito foram uma fonte de informação útil para determinar as mortes causadas diretamente pela COVID-19.

Compulsory notification of injuries in aesthetic procedures. Impact on patient safety.

The disparity between the number of aesthetic procedures performed worldwide, and the complications described in the literature is remarkable. Doubts regarding the underreporting are reasonable and should be considered. The aim of this study is to demonstrate the scarcity of scientific publications on complications in aesthetic procedures compared to the abundance of these procedures performed worldwide. Based on this knowledge, it will be demonstrated to the health authorities the importance of compulsory notification of complications in aesthetic procedures that require medical attention so that the available data will allow their prevention. The limitation of knowledge regarding complications was demonstrated in the data collection for the preparation of the thesis "Deaths Related to Liposuction in Brazil" presented in 2018 and published in Surgical and Cosmetical Dermatology in 2020. The definition of complication in aesthetic procedures needs to be objective to prevent different and subjective interpretations. With the compulsory notification of complications in aesthetic procedures, it is intended to learn about their causes to develop guidelines for their prevention.

Acolhimento integral em Centros de Atenção Psicossocial Álcool e Drogas na perspectiva da proteção dos direitos humanos / Integrated embracement in Psychosocial Care Centers for Alcohol and Drugs in the perspective of the protection of human rights

Resumo Este artigo tem por objetivo avaliar se os resultados do acolhimento integral em Centros de Atenção Psicossocial Álcool e Drogas III (CAPS AD III) atendem aos padrões de qualidade para proteção e respeito dos direitos humanos dos usuários. Desenvolvemos um estudo avaliativo, quantitativo e de desenho longitudinal com 122 usuários acolhidos integralmente em dois CAPS AD III, com follow-up após 14 e 90 dias. Os resultados dos indicadores qualidade de vida, consequências da dependência de substâncias e reabilitação psicossocial, foram posteriormente analisados à luz do referencial QualityRights. Três temas e nove padrões foram avaliados. Quatro padrões foram classificados como alcance total, quatro como alcance parcial e um como alcance iniciado. O direito a usufruir do padrão mais elevado possível de saúde física e mental foi o padrão mais atingido pelo acolhimento integral (tema 2). O direito a exercer a capacidade legal e o direito à liberdade pessoal e segurança foi atendido com algumas fragilidades (tema 3). O direito de viver de forma independente e ser incluído na comunidade, necessita de outros recursos sociais, além do cuidado especializado em saúde mental, para ser melhorado (tema 5).

Abstract This article aims to assess whether or not the results of integrated embracement in Psychosocial Care Centers for Alcohol and Drugs III (CAPS AD III) meet the quality standards necessary for the protection of and respect for users' human rights. An evaluative, quantitative, and longitudinal design was developed through a study with 122 users, embraced in two CAPS AD III follow-ups after 14 and 90 days. This study analyzed the quality of life indicators, consequences of substance abuse, and psychosocial rehabilitation in the light of the QualityRights framework. Three themes and nine patterns were evaluated. In this study, four patterns were classified as total reach, four as partial reach, and one as initiated reach. The right to enjoy the highest possible standard of physical and mental health was the standard most achieved by integrated embracement (theme 2). The right to exercise legal capacity and the right to personal freedom and security were achieved, but with some weaknesses (theme 3). The right to live independently and be included in the community requires other social resources, in addition to specialized mental health care in order to be improved (theme 5).