RCAAP Repository

Abstract This study’s aims are: (i) identifying spatial patterns for the risk of hospitalization due to mental illness and for the potential risk resulting from contextual factors with influence on mental health; and (ii) analyzing the spatial association between risk of hospitalization due to mental illness and potential risk resulting from contextual factors in the metropolitan areas of Lisbon and Porto, Portugal. A cross-sectional ecological study was conducted by applying statistical methods for assessing spatial dependency and heterogeneity. Results reveal a spatial association between risk of hospitalization due to mental illness and potential risk resulting from contextual factors with a statistical relevance of moderate intensity. 20% of the population under study lives in areas with a simultaneously high potential risk resulting from contextual factors and risk of hospitalization due to mental illness. Porto Metropolitan Area show the highest percentage of population living in parishes with a significantly high risk of hospitalization due to mental health, which puts forward the need for interventions on territory-adjusted contextual factors influencing mental health.

Abstract The increasing prevalence of overweight in young people suggests that adolescent nutritional status is influenced by environmental factors. Using hierarchical modelling, this study aimed to analyse the association between individual, household and neighborhood factors and adolescent nutritional status and well-being. The study used data from a population-based household survey conducted in Belo Horizonte, the capital of the State of Minas Gerais, Brazil, between 2008 and 2009. Data was obtained from an adult and adolescent in each household using a confidential questionnaire and anthropometric measurements. Adolescent nutritional status was evaluated using multinomial regression analysis considering distal and proximal influences. The prevalence of overweight and thinness among the sample of 1,030 adolescents was 21.9% and 4.6%, respectively. Although variables from all blocks remained in the final model, head of household education level, family habits and family nutritional status were shown to strongly influence adolescent nutritional status. New approaches to public health are needed which focus on raising awareness and promoting health education targeting teenagers and their social context.

Abstract The aim of this study was to determine and quantify the association between one’s perception of the place of residence and self-rated health. 4,048 adult residents of Belo Horizonte, Minas Gerais State, Brazil, participated in the study in 2008 and 2009. Ordinal logistic regression was used to estimate the magnitude of the association. Health was rated as good or very good, fair, or poor or very poor by 65.7%, 27.8%, and 6.5% of the subjects, respectively. Better self-rated health was associated with the following neighborhood characteristics: positive evaluation of aesthetics and mobility, better quality of public services, less physical and social disorder. The perception of violence had a borderline statistically significant association with worse self-rated health. These associations persisted after controlling for potential confounding demographic, socioeconomic, health, and health behavior variables. The results indicate that public and health policies should incorporate interventions that address the physical and social environment in addition to policies focused on individuals.

Abstract The Ciclovia program (CP) has emerged as an effective initiative to promote active living in urban spaces in Latin America. This study assessed the association between social conditions, the urban environment and participation in the CP among adults living in the city of Cali, Colombia. A cross-sectional study was conducted in 2011 and 2012 among 719 adults aged 18 to 44. Urban environment measures were obtained using Geographic Information Systems. A multilevel logistic regression was used for the analysis. Slightly more than 7% of participants had participated in the CP in the previous four weekends. Being male and having a high school degree were positively associated with participation in the CP. Participation in the CP was positively associated with living in neighborhoods with Ciclovia lanes. In contrast, a negative association was found among those living in neighborhoods with a presence of traffic fatalities. This study provides new insights about a recreational program that has potential health benefits in a region marked by urban inequalities in terms of opportunities for physical activity.

Abstract Public Health Observatories (PHOs) were created in England in 2000 as an important adjunct to the public health system in the country. The observatories were networked together, which allowed pooling of expertise and rapid dissemination of methods and results. The network grew to include the whole of the UK and Ireland and was a very successful force for change until PHOs were subsumed into the new Government Agency Public Health Organization, Public Health England. This paper describes the lessons learnt from their existence in the public health system in England for fourteen years.

Abstract The Belo Horizonte Observatory for Urban Health (OSUBH), housed in an academic setting, was founded in 2002 as part of a broader agenda to strengthen local and national health systems. Its mission is to build the capacity of the workforce in research on population health and to conduct studies on urban issues that can guide the planning of activities aimed at improving the health of populations, especially in heavily urbanized areas, associated with intra-urban inequalities. It focuses on the acquisition of advanced knowledge on urban health (metric) through scientific research, to contribute to public policies that may interfere with health, both at individual and community levels. During its lifetime, many partnerships and studies have been developed, but many challenges still exist in order for it to consolidate its position as a legitimate space and as a tool to generate systematic information for governments and populations.

Abstract Health observatories may differ according to their mission, institutional setting, topical emphasis or geographic coverage. This paper discusses the development of a new urban-focused health observatory, and its operational research and training infrastructure under the academic umbrella of the Department of Epidemiology and the Institute of Urban Health at the Johns Hopkins Bloomberg School of Public Health (BSPH) in Baltimore, USA. Recognizing the higher education mission of the BSPH, the development of a new professional training in public health was an important first step for the development of this observatory. This new academia-based observatory is an innovative public health research and training platform offering faculty, investigators, professional epidemiology students and research partners a physical and methodological infrastructure for their operational research and training activities with both a local urban focus and a global reach. The concept of a public health observatory and its role in addressing social health inequalities in local urban settings is discussed.

Abstract Human contact with solid waste poses biological, chemical, and physical health risks for workers involved in waste collection, transportation, and storage. The potential risk to human health resulting from contact with health services waste or household waste still sparks considerable controversy. The aim of this study was to identify the context of scientific discussions on risk/infection from the hepatitis B and C viruses in workers that collect solid waste from health services or households. The search covered publications up to 2013 in Brazilian and international databases, and 11 articles were selected through a literature review. Of these, six conclude that there is an increased risk of infection in workers that collect household waste when compared to those unexposed to waste, three point to greater risk for workers that collect health services waste as compared to those that collect ordinary waste, and the other two found no difference between exposed and unexposed individuals.

Abstract Dengue cases have increased in younger age groups in Brazil. Maternal anti-dengue antibodies can have a protective effect in the first months of life, but their decline can increase the risk of severe dengue. A prospective birth cohort was established in 2011-2012 in the city of Recife, Pernambuco State, Brazil, to determine the incidence of serotype-specific dengue infection and the kinetics of transferred maternal anti-dengue antibodies in the first years of life. This article describes the design, methods and preliminary results of this cohort study. 354 children underwent clinical and laboratory monitoring for two years, with 15% losses to follow-up. The overall rate of new infections was approximately 10% in the first year of follow-up. Information on the force of serotype-specific dengue infection and the evaluation of transferred maternal antibodies can contribute to understanding dengue etiopathogenesis.

Resumo O relacionamento probabilístico de registros vem sendo cada vez mais empregado na identificação de desfechos em estudos de coorte. O objetivo deste trabalho foi avaliar a acurácia deste método na identificação de óbitos em uma coorte de 450 pacientes admitidos em um hospital universitário por insuficiência cardíaca descompensada, em um período de seis anos. O estado vital dos membros da coorte foi determinado a partir dos registros no prontuário eletrônico dos pacientes (padrão-ouro). O software OpenRecLink foi utilizado para relacionar os registros da coorte com aqueles da base do Sistema de Informações de Mortalidade, visando à identificação de óbitos. Apenas 53,6% pacientes apresentavam estado vital conhecido ao final do seguimento e destes 59,3% haviam falecido. O método apresentou sensibilidade de 97,9%, especificidade de 100%, valor preditivo positivo de 100%, valor preditivo negativo de 97% e acurácia de 98,8%. Esses resultados sugerem que o relacionamento probabilístico de registros é uma valiosa ferramenta na identificação de óbitos para estudos de coorte.

Resumo O objetivo deste trabalho foi estimar a prevalência da percepção de problemas vocais frequentes em professores da educação básica e investigar os fatores ocupacionais associados. Estudo transversal, realizado mediante entrevistas de 967 professores atuantes em 20 escolas estaduais de Londrina, Paraná, Brasil. A percepção de problemas vocais frequentes foi de 25,7%. Análises ajustadas mostraram associação desses problemas com características do vínculo de trabalho (≥ 40 horas/semana, percepção ruim da remuneração e dos benefícios de saúde), características do ambiente de trabalho (quantidade de alunos por sala, exposição a pó de giz e micro-organismos), aspectos psicológicos (menor realização profissional, baixa oportunidade de expressar opiniões, pior relacionamento com superiores e equilíbrio entre vida profissional e pessoal) e situações de violência (insultos e assédio moral). A percepção de transtornos vocais frequentes afeta um em cada quatro professores da educação básica e está associada a diversas características da atividade docente, tanto estruturais como referentes ao processo de trabalho.

Resumo O uso de medicamentos é influenciado por diferentes fatores. O objetivo foi analisar esse uso e identificar as fontes de obtenção e fatores associados. Estudo transversal de base populacional, amostra por conglomerados, em dois estágios, em Campinas, São Paulo, Brasil, 2008. A prevalência de uso de ao menos um medicamento nos três dias prévios foi de 57,2%, a de obtenção no Sistema Único de Saúde (SUS) foi de 30%. Cerca de 47,8% dos indivíduos que não tinham plano precisaram desembolsar para adquirir os medicamentos e 10,9% dos que tinham obtiveram no SUS. Utilizaram com maior frequência os medicamentos do SUS os indivíduos com mais idade, viúvos, pretos/pardos, com menor escolaridade e renda, e que não tinham plano. Apenas 2,1% da população entrevistada referiram não ter conseguido obter o medicamento que lhe havia sido prescrito, e os principais motivos foram não ter no sistema público e a falta de recurso. O estudo identifica os segmentos com maior obtenção de medicamentos do SUS e revela que estes subgrupos apresentam porcentuais baixos de uso no sistema.

Abstract This study aimed to test how knowledge on emergency contraception (according to age at sexual initiation, type of school, and knowing someone that has already used emergency contraception) influences the method’s use. This was a cross-sectional study in a probabilistic sample of students 15-19 years of age enrolled in public and private middle schools in a medium-sized city in Southeast Brazil (n = 307). Data were collected in 2011 using a self-administered questionnaire. A structural equations model was used for the data analysis. Considering age at sexual initiation and type of school, knowledge of emergency contraception was not associated with its use, but knowing someone that had used the method showed a significant mean effect on use of emergency contraception. Peer group conversations on emergency contraception appear to have greater influence on use of the method than knowledge itself, economic status, or sexual experience.

Resumen Los medicamentos constituyen un alto porcentaje del gasto en salud de los hogares, por eso, tener un sistema progresivo de financiamiento de medicamentos es fundamental para lograr un sistema de salud equitativo. Se ha propuesto que los determinantes de la equidad en el financiamiento son socioeconómicos, demográficos y asociados a la intervención pública, sin embargo, se ha avanzado poco en su evaluación empírica y en la cuantificación de su importancia relativa. En este trabajo estimamos regresiones por cuantiles a nivel provincial en Argentina y encontramos que la población mayor a 65 años, el desempleo, la existencia de laboratorios públicos de producción de medicamentos, las transferencias de tratamientos y la orientación del sistema de salud a la atención primaria, son importantes predictores de la progresividad en el esquema de pagos. Ingresos bajos, instituciones débiles, infraestructura y provisión de servicios insuficientes redundan en respuestas sociales más regresivas a las necesidades sanitarias, empeorando las condiciones de vida y limitando las oportunidades de desarrollo.

Resumen El propósito de este trabajo es explorar el perfil del litigio por el acceso a la atención de la salud, tramitado ante la Corte Suprema de Justicia Argentina, y reflexionar sobre su potencial para influir sobre la equidad y el derecho a la salud, en el marco de un proceso de crecimiento de la judicialización. Se llevó a cabo un análisis documental de 125 litigios con sentencias dictadas entre 1994 y 2013. Se observó una preeminencia de la reclamación individual (88% reclamantes personas físicas individuales), y de reclamantes afiliados a la seguridad social o a seguros privados (64%), con un esquema típico del derecho privado (87% reclama cobertura de un servicio médico). El 75% de los fallos ordenaron brindar los servicios de salud reclamados, sin visibilizar los fallos del sistema de salud, ni ordenar acciones para promover la equidad y garantizar el derecho a la salud, que alcancen a otras personas sometidas a la misma situación que el reclamante. La judicialización, hasta el momento, no está promoviendo activamente la equidad, el derecho a la salud y el diálogo interinstitucional.

Abstract Obesity and physical inactivity (PI) are risk factors for chronic diseases and are associated with lifestyle and environmental factors. The study tested the association between PI, body mass index (BMI), and self-rated health in a representative sample of the Spanish adult population (N = 21,486). The sample included 41.5% men, with mean age 52.3 years (± 18.03), and age range 20-82 years. Prevalence of overweight/obesity was 34.2%/12.7% in women and 52.1%/12.7% in men (p < 0.001 for obesity in both sexes). 53% of women and 57.5% of men met recommended levels of physical activity by walking (≥ 150 minutes/week). According to logistic regression analysis, individuals that walked less had higher risk of overweight or obesity. Data from the population-based surveillance study support suggestions that regular walking by adults is associated with positive self-rated health and better BMI profile. Obesity and low/very low self-rated health have low prevalence rates to meet the recommendations.

Resumo O artigo objetiva analisar a prevalência e fatores associados ao uso de drogas ilícitas na gestação. Estudo transversal, aninhado à coorte pré-natal do estudo de coorte BRISA. Utilizou-se medidas de frequência e modelo de regressão logística múltipla hierarquizada. A prevalência estimada foi de 1,45% para o uso de drogas ilícitas, 22,32% para o uso de bebidas alcóolicas e 4,22% para o de cigarro. A população mostrou-se jovem, de 20-34 anos de idade (81%), com escolaridade de 9-11 anos de estudos (75,55%), com mais da metade das mulheres fora da população economicamente ativa (52,18%) e na classe econômica “C” (67,61%). As gestantes apresentaram nível de estresse elevado (24,46%), sintomas de ansiedade de moderada a intensa (40,84%) e sintomas depressivos graves (28,8%). Aproximadamente metade (49,72%) das gestantes relatou ter sofrido algum tipo de violência, tendo a maioria ampla rede (72,77%) e baixo apoio social (65,21%). Uso de drogas lícitas, níveis altos de estresse e monoparentalidade foram os fatores independentemente associados ao uso de drogas ilícitas na gestação.

Resumo Foi testada a hipótese de que os indicadores de saúde bucal, obtidos do Pacto da Atenção Básica de 2006, Pacto pela Saúde do biênio 2010/2011 e indicadores de transição entre o Pacto pela Saúde e Contrato Organizativo da Ação Pública em Saúde de 2012, não diferiam entre as Unidades Federativas (UF) brasileiras com diferentes Índices de Desenvolvimento Humano (IDH). Para isso, foi realizado um estudo longitudinal ecológico comparando as UF do Brasil com extremos de IDH. Os dados foram obtidos dos sistemas de informação do SUS e do Programa das Nações Unidas para o Desenvolvimento, e submetidos à análise de regressão linear de efeitos mistos (alfa = 5%). Todos os indicadores de oportunidade de acesso foram associados negativamente com o IDH. Para os de utilização, a associação ocorreu para apenas dois indicadores. Os resultados evidenciaram uma tendência evolutiva pró-equidade para indicadores de oportunidade de acesso em relação à saúde bucal.

Abstract The objective of this study was to assess the agreement between the Brazilian Healthy Eating Index – Revised (BHEI-R), estimated by a food frequency questionnaire (FFQ) and multiple 24-hour recalls (24h-R). The Wilcoxon paired test, partial correlations (PC), intraclass correlation coefficient (ICC), and Bland-Altman method were used. The total BHEI-R scores and its components (“total fruits”, “whole fruits”, “total vegetables”, “integral cereals”, “saturated fat”, “sodium”, and “energy intake derived from solid fat, added sugar, and alcoholic beverages”) were statistically different, with the ICC and PC indicating poor concordance and correlation. The mean concordance estimated for the total BHEI-R and its components varied from 68% for “integral cereals” to 147% for “whole fruits”. The suitable concordance limits were violated for most of the components of the BHEI-R. Poor concordance was observed between the BHEI-R estimated by the FFQ and by multiple 24h-R, which indicated a strong reliability of the BHEI-R on the instrument used to collect information on food consumption.

Resumo Analisar as diferenças entre diabéticos e hipertensos em relação ao tratamento medicamentoso e suas fontes de obtenção. Trata-se de estudo transversal com dados do VIGITEL, realizado em 2011 nas capitais brasileiras. Cerca de 72% dos 15.027 hipertensos e 78,2% dos 4.083 diabéticos estavam em tratamento medicamentoso; 45,8% dos hipertensos obtiveram medicamento nas unidades de saúde públicas, 15,9% no Farmácia Popular e 38,3% em drogarias/farmácias e outras fontes. Entre os diabéticos, encontrou-se 54,4%; 16,2%; e 29,4%, respectivamente. Nas unidades de saúde os percentuais foram mais elevados entre os menos escolarizados, cor de pele preta ou parda e sem plano privado de saúde, e as prevalências de obtenção na Farmácia Popular, drogarias/farmácias e outras fontes foram mais elevadas entre os mais escolarizados, cor de pele branca e com plano privado. O acesso às diferentes fontes de medicamentos apresentou disparidades entre as regiões e capitais brasileiras e entre os segmentos sociais da população.