Active aging and its interface with social determinants of health

OBJECTIVE: To analyze the relationship between active aging and social determinants of health in older people living in the catchment area of a primary health care facility. METHODS: A cross-sectional study was conducted to assess exposure variables of the schematic model by Dahlgren and Whitehead; the outcome variable active aging was created by means of latent class analysis. Participants were categorized as highly, moderately, and minimally active. Data analysis was performed using a forward multinomial regression model. RESULTS: Overall, 155 elderly people participated in the study, most of them classified as highly active. Older subjects had a higher chance for being minimally active (OR = 5.72) and moderately active (OR = 3.27). Lack of a family life (OR = 3.90) and education level of 4 years or less (OR = 2.90) were shown to be risk factors for moderate levels of active aging. CONCLUSION: The present study demonstrated that advanced age, lack of family life, and an education level of 4 years or less were associated with a higher chance for elderly attending Family Health Strategy units to present low levels of active aging. It is suggested that these factors should be taken into account when directing public policies aimed at active aging.</p

Associated factors for treatment delay in pulmonary tuberculosis in HIV-infected individuals: a nested case-control study.

BACKGROUND: The delay in initiating treatment for tuberculosis (TB) in HIV-infected individuals may lead to the development of a more severe form of the disease, with higher rates of morbidity, mortality and transmissibility. The aim of the present study was to estimate the time interval between the onset of symptoms and initiating treatment for TB in HIV-infected individuals, and to identify the factors associated to this delay. METHODS: A nested case-control study was undertaken within a cohort of HIV-infected individuals, attended at two HIV referral centers, in the state of Pernambuco, Brazil. Delay in initiating treatment for TB was defined as the period of time, in days, which was greater than the median value between the onset of cough and initiating treatment for TB. The study analyzed biological, clinical, socioeconomic, and lifestyle factors as well as those related to HIV and TB infection, potentially associated to delay. The odds ratios were estimated with the respective confidence intervals and p-values. RESULTS: From a cohort of 2365 HIV-infected adults, 274 presented pulmonary TB and of these, 242 participated in the study. Patients were already attending 2 health services at the time they developed a cough (period range: 1 - 552 days), with a median value of 41 days. Factors associated to delay were: systemic symptoms asthenia, chest pain, use of illicit drugs and sputum smear-negative. CONCLUSION: The present study indirectly showed the difficulty of diagnosing TB in HIV-infected individuals and indicated the need for a better assessment of asthenia and chest pain as factors that may be present in co-infected patients. It is also necessary to discuss the role played by negative sputum smear results in diagnosing TB/HIV co-infection as well as the need to assess the best approach for drug users with TB/HIV

Indicadores de desempenho do Sistema Único de Saúde: uma análise de tendência

Objective: To analyze the temporal trend of health services performance indicators. Methods: This is a quantitative ecological study of time series. We analyzed health services performance indicators in the regions belonging to the III Macro-region of the state of Pernambuco, namely Arcoverde (VI), Afogados da Ingazeira (X) and Serra Talhada (XI), in the period from 2008 to 2017. Simple linear regression was performed in the R software version 3.5.0. The indicators analyzed represent the dimensions of effectiveness, access, adequacy and acceptability of the model for assessment of the performance of the Brazilian health system. Results: An increasing trend was observed in the percentage of diabetic users who underwent lower limb amputation in the X and XI region, incidence of tuberculosis in the VI region, new cases of congenital syphilis, coverage of the Family Health Strategy, percentage of patients with stroke who underwent computed tomography, live births with more than 6 prenatal consultations, and cesarean deliveries in the VI, X and XI health regions (pObjetivo: Analizar la tendencia temporal de los indicadores de desempeño de los servicios de salud. Métodos: Estudio cuantitativo y ecológico de series temporales. Se analizaron indicadores de desempeño de los servicios de salud de las regiones de la III Macro región del estado de Pernambuco: Arcoverde (VI), Ahogados de la Ingazeira (X) y Sierra Tallada (XI) en el periodo entre 2008 y 2017. Se realizó la regresión linear simple en el software estadístico R versión 3.5.0. Los indicadores evaluados representan las dimensiones de la efectividad, el acceso, la adecuación y la aceptabilidad del modelo de evaluación de desempeño del sistema de salud brasileño. Resultados: Se observó una tendencia creciente en el porcentual de usuarios con diabetes que realizaron la amputación de miembros inferiores en las X y XI regiones, la incidencia de tuberculosis en la VI región, los casos nuevos de sífilis congénita, la cobertura de la Estrategia Salud de la Familia, el porcentual de pacientes con accidente cerebrovascular que realizaron la tomografía computadorizada, de nacidos vivos con más de 6 consultas prenatal y de partos cesáreos en las VI, X y XI regiones de salud (pObjetivo: Analisar a tendência temporal dos indicadores de desempenho dos serviços de saúde. Métodos: Estudo ecológico de séries temporais e quantitativo. Analisaram-se indicadores de desempenho dos serviços de saúde das regiões pertencentes à III Macrorregião do estado de Pernambuco: Arcoverde (VI), Afogados da Ingazeira (X) e Serra Talhada (XI), no período de 2008 a 2017. Realizou-se regressão linear simples no software estatístico R, versão 3.5.0. Os indicadores avaliados representam as dimensões de efetividade, acesso, adequação e aceitabilidade do modelo de avaliação de desempenho do sistema de saúde brasileiro. Resultados: Observou-se tendência crescente no percentual de usuários diabéticos que realizaram amputação de membros inferiores na X e XI regiões, incidência de tuberculose na VI região, casos novos de sífilis congênita, cobertura da Estratégia Saúde da Família, percentual de pacientes com acidente vascular encefálico que realizaram tomografia computadorizada, de nascidos vivos com mais de 6 consultas de pré-natal, e de partos cesáreos na VI, X e XI regiões de saúde (

Bases de dados orçamentários e qualidade da informação: uma avaliação do Finanças do Brasil (Finbra) e do Sistema de Informações sobre Orçamentos Públicos em Saúde (Siops)

O artigo caracteriza e avalia o sistema Finanças do Brasil (Finbra) e o Sistema de Informações sobre Orçamentos Públicos em Saúde (Siops) nas dimensões de qualidade de acessibilidade, oportunidade e clareza metodológica. Fez-se uma pesquisa descritiva com abordagem quantitativa e qualitativa mediante fontes bibliográficas e documentais. Constatou-se que o Finbra e o Siops surgiram no contexto de descentralização das políticas públicas brasileiras, que exigiu, além do acesso às informações, maior controle das contas públicas. Os sistemas apresentam semelhantes vantagens quanto à acessibilidade e oportunidade, mas o Siops revelou-se com melhor clareza metodológica. Aponta-se que há necessidade de ampliar o conhecimento sobre essas importantes fontes de registro contábil dos entes subnacionais, com vista a seu melhoramento e aperfeiçoamento

Histórico de violência entre mulheres que fazem uso de crack no estado de Pernambuco, Brasil

RESUMO Neste artigo, abordou-se o histórico de violência contra mulheres em contexto de uso abusivo de crack. Trata-se de um estudo transversal, envolvendo 243 usuárias de crack atendidas pelo Programa Atitude, em Pernambuco, entre 2014 e 2015. Observou-se que a maioria era jovem, negra, com baixa escolaridade e renda, início precoce da vida sexual, em uso compulsivo de crack, morando na rua e comercializando o corpo como a principal fonte de renda. A maioria (96,2%) relatou histórico de violência: psicológica (83,5%), física (87,7%) e sexual (55,1%), praticadas por parentes/amigos. Fatores como desigualdades sociais e de gênero foram relevantes nas situações de violência observadas

Social conditions and immune response in human immunodeficiency virus-seropositive pregnant women: a cross-sectional study in Brazil

Abstract INTRODUCTION The functioning of the immune system during pregnancy is altered in both human immunodeficiency virus (HIV)-infected and uninfected women. Unfavorable socioeconomic conditions have been indicative of higher morbidity and mortality and worsening of the immune system. The aim of this study was to correlate social status with levels of interleukin (IL)-10 (non-inflammatory) and interferon-gamma (IFN-γ; inflammatory) cytokines. METHODS A cross-sectional study was conducted with three groups of women: 33 pregnant HIV-infected (G1); 40 non-pregnant, HIV-infected (G2); and 35 pregnant, HIV-uninfected. To measure the social status, a compound indicator called the social status index (SSI), was established using sociodemographic variables (i.e., education level, housing conditions, per capita income, and habitation and sanitary conditions). RESULTS The HIV-infected women had a higher proportion of unfavorable SSI (73% and 75% of G1 and G2, respectively). There were significantly lower IL-10 levels in the G1 group with both unfavorable and favorable SSI than in the other groups. No significant difference in IFN-γ levels was observed among groups. However, the G1 group had higher IFN-γ values among both favorable and unfavorable SSI groups. CONCLUSIONS Higher rates of unfavorable conditions, including lower education levels, IL-10 levels, and a trend for higher IFN-γ levels, were identified among HIV-infected women, pregnant and non-pregnant. These factors may interfere in health care and lead to poor outcomes during pregnancy. Therefore, we suggest that health policies could be created to specifically address these factors in this population

Social conditions and immune response in human immunodeficiency virus-seropositive pregnant women: a cross-sectional study in Brazil

<div><p>Abstract INTRODUCTION The functioning of the immune system during pregnancy is altered in both human immunodeficiency virus (HIV)-infected and uninfected women. Unfavorable socioeconomic conditions have been indicative of higher morbidity and mortality and worsening of the immune system. The aim of this study was to correlate social status with levels of interleukin (IL)-10 (non-inflammatory) and interferon-gamma (IFN-γ; inflammatory) cytokines. METHODS A cross-sectional study was conducted with three groups of women: 33 pregnant HIV-infected (G1); 40 non-pregnant, HIV-infected (G2); and 35 pregnant, HIV-uninfected. To measure the social status, a compound indicator called the social status index (SSI), was established using sociodemographic variables (i.e., education level, housing conditions, per capita income, and habitation and sanitary conditions). RESULTS The HIV-infected women had a higher proportion of unfavorable SSI (73% and 75% of G1 and G2, respectively). There were significantly lower IL-10 levels in the G1 group with both unfavorable and favorable SSI than in the other groups. No significant difference in IFN-γ levels was observed among groups. However, the G1 group had higher IFN-γ values among both favorable and unfavorable SSI groups. CONCLUSIONS Higher rates of unfavorable conditions, including lower education levels, IL-10 levels, and a trend for higher IFN-γ levels, were identified among HIV-infected women, pregnant and non-pregnant. These factors may interfere in health care and lead to poor outcomes during pregnancy. Therefore, we suggest that health policies could be created to specifically address these factors in this population.</p></div

Variation sites at the HLA-G 3' untranslated region confer differential susceptibility to HIV/HPV co-infection and aneuploidy in cervical cell.

Post-transcriptional regulatory elements associated with transcript degradation or transcript instability have been described at the 3' untranslated region (3'UTR) of the HLA-G gene. Considering that HPV infection and aneuploidy, which causes gene instability, are associated with cervical cell malignancy, as well as the fact that HIV infection and HLA-G may modulate the immune response, the present study aimed to compare the frequencies of HLA-G 3'UTR polymorphic sites (14-base pair insertion/deletion, +3142C/G, and +3187A/G) between 226 HIV+ women co-infected (n = 82) or not with HPV (n = 144) and 138 healthy women. We also evaluated the relationship between those HLA-G 3'UTR variants and aneuploidy in cervical cells. HPV types and HLA-G polymorphisms were determined by PCR and sequencing of cervical samples DNA. Aneuploidy in cervical cell was measured by flow cytometry. The HLA-G 3'UTR 14-bp ins/del was not associated with either HIV nor HIV/HPV co-infection. The +3142G allele (p = 0.049) and +3142GG genotype (p = 0.047) were overrepresented in all HIV-infected women. On the other hand, the +3187G allele (p = 0.028) and the +3187GG genotype (p = 0.026) predominated among healthy women. The +3142G (p = 0.023) and +3187A (p = 0.003) alleles were associated with predisposition to HIV infection, irrespective of the presence or not of HIV/HPV co-infection. The diplotype formed by the combination of the +3142CX (CC or CG) and +3187AA genotype conferred the highest risk for aneuploidy in cervical cell induced by HPV. The HLA-G 3'UTR +3142 and +3187 variants conferred distinct susceptibility to HIV infection and aneuploidy