Desigualdades de renda na saúde bucal e no acesso aos serviços odontológicos na população Brasileira : pesquisa nacional de saúde, 2013

Despite the improvement in oral health conditions observed in the Brazilian population, there are still high social inequalities that must be monitored. To evaluate income inequality in oral hygiene practices, oral health status and the use of dental services in the adult and senior Brazilian population. Data from the National Health Survey conducted in 2013 (Pesquisa Nacional de Saúde – PNS 2013) were used for the population aged 18 years old or older. Inequalities were found among the income strata in most of the oral health indicators evaluated. The greatest inequalities were observed in the use of dental floss, in hygiene practices (PR = 2.85 in adults and PR = 2.45 in seniors), and in total tooth loss (PR = 6.74 in adults and PR = 2.24 in seniors) and difficulty in chewing (PR = 4.49 in adults and PR = 2.67 in seniors) among oral condition indicators. The magnitude of inequalities was high in both groups in most oral condition indicators. Income was a factor that persisted in limiting access to dental services, and even the lower income segments had high percentages that paid for dental consultations. Based on data from the first PNS, the findings of this study enabled the identification of oral health and dental care aspects more compromised by income differentials, thus, contributing to the planning of dental care in Brazil and to stimulate the monitoring of these disparities with data from future surveys222CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQ817122/2015Apesar da melhora das condições de saúde bucal constatada na população brasileira, persistem elevadas desigualdades sociais que precisam ser monitoradas. Avaliar a desigualdade de renda nas práticas de higiene bucal, nas condições bucais e no uso de serviços odontológicos na população brasileira de adultos e idosos. Foram utilizados dados da Pesquisa Nacional de Saúde realizada em 2013 (PNS 2013) referentes à população de 18 anos ou mais. Detectaram-se desigualdades entre os estratos de renda na maioria dos indicadores de saúde bucal avaliados. As desigualdades de maior magnitude foram verificadas no uso de fio dental, nas práticas de higiene (RP = 2,85 nos adultos e RP = 2,45 nos idosos), e na perda de todos os dentes (RP = 6,74 nos adultos e RP = 2,24 nos idosos) e dificuldade de mastigar (RP = 4,49 nos adultos e RP = 2,67 nos idosos) entre os indicadores de condições bucais. Na maioria dos indicadores de condições bucais a magnitude das desigualdades foi elevada em ambos os grupos. A renda mostrou-se um fator que persiste limitando o acesso aos serviços odontológicos e, mesmo os segmentos de menor renda apresentaram elevados percentuais que pagam por consulta odontológica. Por meio dos dados da primeira PNS, os achados do estudo permitiram identificar aspectos de saúde e de atenção bucais mais comprometidos pelos diferenciais de renda, podendo, nesse sentido, contribuir para o planejamento da assistência odontológica no país e para estimular o monitoramento destas disparidades com dados das próximas pesquisa

Fontes De Obtenção De Medicamentos Para Hipertensão E Diabetes No Brasil: Resultados De Inquérito Telefônico Nas Capitais Brasileiras E No Distrito Federal, 2011

This study aimed to analyze differences between patients with diabetes and hypertension in drug treatment and their sources for obtaining medication. This was a cross-sectional study with data from the VIGITEL telephone survey in 2011 in Brazil’s state capitals and Federal District. Some 72% of the 15,027 hypertensive patients and 78.2% of the 4,083 diabetics were on medication; 45.8% of the hypertensive patients obtained their medications from public health units, 15.9% from the Popular Pharmacy program, and 38.3% from drugstores, pharmacies, and other sources. The rates among diabetics were 54.4%, 16.2%, and 29.4%, respectively. In the public health units the percentages were highest among individuals with less schooling, black or brown skin, and without private health plans, while the percentages in the Popular Pharmacy program and drugstores/pharmacies and other sources were higher among individuals with more schooling, white skin, and private health plans. Access to different sources of medicines showed disparities between Brazil’s regions and state capitals and between social segments of the population. © 2016, Fundacao Oswaldo Cruz. All rights reserved.32

Comparison Of Estimates For The Self-reported Chronic Conditions Among Household Survey And Telephone Survey - Campinas (sp), Brazil [comparação De Estimativas Para O Autorrelato De Condições Crônicas Entre Inquérito Domiciliar E Telefônico - Campinas (sp), Brasil]

Objective: To compare the estimates obtained by different methods of population-based surveys for self-reported chronic conditions among adults living in Campinas in the year 2008. Methods: Data from ISACamp Survey, conducted by the Faculty of Medical Sciences from Universidade Estadual de Campinas (UNICAMP) with support from the County Health Department and VIGITEL (Campinas), a telephone survey conducted by the Brazilian Ministry of Health toward Surveillance of Risk and Protective Factors for Chronic non-communicable Diseases in the adult population (18 years and over) were analyzed. Estimates of self-reported hypertension, diabetes, osteoporosis, and asthma/bronchitis/emphysema were evaluated and compared by the independent (two-sample) Student's t-test. Results: For global estimates, a higher prevalence of hypertension and osteoporosis was ascertained by the telephone survey. Diabetes and asthma/bronchitis/ emphysema results showed no statistically significant differences. According to sociodemographic variables, a higher prevalence of hypertension was obtained by VIGITEL for men, among people aged 18 to 59 years, and those who reported nine or more years of schooling. A higher prevalence of osteoporosis among adults (18 to 59 years) was verified by VIGITEL. Concerning asthma/ bronchitis/emphysema in the elderly, ISACamp survey showed a higher prevalence. Conclusion: Except for the hypertension prevalence, the telephone survey has proven to be a rapid alternative to provide global prevalence estimates of health conditions in the adult population of Campinas.14SUPPL. 1515Viacava, F., Informações em saúde: A importância dos inquéritos populacionais (2002) Ciênc Saúde Coletiva, 7 (4), pp. 607-621Cesar, C.L.G., Barata, R.B., (2008) Editorial Rev Bras Epidemiol, 11 (SUPPL. 1), pp. 3-5Lavrakas, P.J., (1990) Telephone Survey Methods: Sampling, Selection and Supervision, , London: Sage PublicationsMonteiro, C.A., Moura, E.C., Jaime, P.C., Lucca, A., Florindo, A.A., Figueiredo, I.C.R., Monitoramento de fatores de risco para as doenças crônicas por entrevistas telefônicas (2005) Rev Saúde Pública, 39 (1), pp. 47-57Nelson, D.E., Powell-Griner, E., Town, M., Kovar, M.G., A comparison of national estimates from the National Health Interview Survey and the Behavioral Risk Factor Surveillance System (2003) Am J Public Health, 93 (8), pp. 1335-1341Bernal, R., Silva, N.N., Cobertura de linhas telefônicas residenciais e vícios potenciais em estudos epidemiológicos (2009) Rev Saude Publica, 43 (3), pp. 421-426(2002) Reducing Risks, Promoting Healthy Life, p. 2002. , The World Health Report, Geneva: World Health Organization(2007) Guia Metodológico De Avaliação E Definição De Indicadores: Doenças Não Transmissíveis E Rede Carmem, , Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde, Brasília: Ministério da SaúdeChrestani, M.A., Santos, I.S., Matijasevich, A.M., Hipertensão arterial sistêmica auto-referida: Validação diagnóstica em estudo de base populacional (2009) Cad Saúde Pública, 25 (11), pp. 2395-2406Barros, M.B.A., Inquéritos domiciliares de saúde: Potencialidades e desafios (2008) Rev Bras Epidemiol, 11 (SUPPL. 1), pp. 6-19Cesar, C.L.G., Carandina, L., Alves, M.C.G.P., Barros, M.B.A., Goldbaum, M., (2005) Saúde E Condição De Vida Em São Paulo: Inquérito Multicêntrico De Saúde No Estado De São Paulo -ISA-SP, p. 212. , São Paulo: USP/FSP(2006) Vigilância De Fatores De Risco E Proteção Para Doenças Crônicas Por Inquérito Telefônico: Estimativas Sobre Freqüência E Distribuição Sócio-demográfica De Fatores De Risco E Proteção Para Doenças Crônicas Nas Capitais Dos 26 Estados Brasileiros E No Distrito Federal Em 2006, p. 2007. , Ministério da Saúde. VIGITEL Brasil, Brasília: Ministério da SaúdeLwanga, S.K., Lemeshow, S., (1991) Sample Size Determination In Health Studies: A Practical Manual, , Geneva: World Health Organization(2008) Vigilância De Fatores De Risco E Proteção Para Doenças Crônicas Por Inquérito Telefônico, p. 2009. , Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Secretaria de Gestão Estratégia e Participativa. VIGITEL Brasil, Brasília: Ministério da SaúdeLee, S., Davis, W.W., Nguyen, H.A., McNeel, T.S., Brick, J.M., Flores-Cervantes, I., Examining Trends and Averages Using Combined Cross-sectional Survey Data From Multiple Years, , http://www.chis.ucla.edu/pdf/paper_trends_averages.pdf, CHIS Methodology Paper, 2007. [cited 2011 Jun 02]. Available fromKish, L., (1965) Survey Sampling, , New York: John Wiley and SonsFahimi, M., Link, M., Schwartz, D.A., Levy, P., Mokdad, A., Tracking chronic disease and risk behavior prevalence as survey participation declines: Statistics from the Behavioral Risk Factor Surveillance System and other national surveys (2008) Prev Chronic Dis, 5 (3), pp. A80Cricelli, C., Mazzaglia, G., Samani, F., Marchi, M., Sabatini, A., Nardi, R., Prevalence estimates for chronic diseases in Italy: Exploring the differences between self-report and primary care databases (2003) J Public Health Med, 25 (3), pp. 254-257Okura, Y., Urban, L.H., Mahoney, D.W., Jacobsen, S.J., Rodeheffer, R.J., Agreement between self-reported questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure (2004) J Clin Epidemiol, 57 (10), pp. 1096-1103Barros, M.B.A., Cesar, C.L.G., Carandina, L., Torre, G.D., Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003 (2006) Ciênc Saúde Coletiva, 11 (4), pp. 911-926Molenaar, E.A., van Ameijden, E.J., Grobbee, D.E., Numans, M.E., Comparison of routine care self-reported and biomedical data on hipertension and diabetes: Results of the Utrecht Health Project (2007) Eur J Public Health, 17 (2), pp. 199-205Lima-Costa, M.F., Peixoto, S.V., Firmo, J.O.A., Uchoa, E., Validade do diabetes auto-referido e seus determinantes: Evidências do projeto Bambuí (2007) Rev Saúde Pública, 41 (6), pp. 947-953Vargas, C.M., Burt, V.L., Gllum, R.F., Pamuk, E.R., Validity of self-reported hypertension in the National Health and Nutrition Examination Survey III, 1988-1991 (1997) Prev Med, 26 (5), pp. 678-685Lima-Costa, M.F., Peixoto, S.V., Firmo, J.O.A., Validade da hipertensão arterial auto-referida e seus determinantes (projeto Bambuí) (2004) Rev Saúde Pública, 38 (5), pp. 637-642Frazão, P., Naveira, M., Prevalência de osteoporose: Uma revisão crítica (2006) Rev Bras Epidemiol, 9 (2), pp. 206-214Martini, L.A., Moura, E.C., Santos, L.C., Malta, D.C., Pinheiro, M.M., Prevalência de diagnóstico auto-referido de osteoporose, Brasil, 2006 (2009) Rev Saúde Pública, 43 (SUPPL. 2), pp. 107-116Hasselgren, M., Arne, M., Lindahl, A., Janson, S., Lundbäck, B., Estimated prevalences of respiratory symptoms, asthma and chronic obstructive pulmonary disease related to detection rate in primary health care (2001) Scand J Prim Health Care, 19 (1), pp. 54-57Mullerova, H., Wedzicha, J., Soriano, J.B., Vestbo, J., Validation of a chronic obstructive pulmonary disease screening questionnaire for population surveys (2004) Respir Med, 98 (1), pp. 78-83Lima-Costa, M.F., Barreto, S.M., Giatti, L., Condições de saúde, capacidade funcional, uso de serviços de saúde e gastos com medicamentos da população idosa brasileira: Um estudo descritivo baseado na Pesquisa Nacional por Amostra de Domicílios (2003) Cad Saúde Pública, 19 (3), pp. 735-743Goldman, N., Lin, I.F., Weinstein, M., Lin, Y.H., Evaluating the quality of self-reports of hypertension and diabetes (2003) J Clin Epidemiol, 56 (2), pp. 148-15

The fraction of cancer attributable to ways of life, infections, occupation, and environmental agents in Brazil in 2020

Many human cancers develop as a result of exposure to risk factors related to the environment and ways of life. The aim of this study was to estimate attributable fractions of 25 types of cancers resulting from exposure to modifiable risk factors in Brazil. The prevalence of exposure to selected risk factors among adults was obtained from population-based surveys conducted from 2000 to 2008. Risk estimates were based on data drawn from metaanalyses or large, high quality studies. Population-attributable fractions (PAF) for a combination of risk factors, as well as the number of preventable deaths and cancer cases, were calculated for 2020. The known preventable risk factors studied will account for 34% of cancer cases among men and 35% among women in 2020, and for 46% and 39% deaths, respectively. The highest attributable fractions were estimated for tobacco smoking, infections, low consumption of fruits and vegetables, excess weight, reproductive factors, and physical inactivity. This is the first study to systematically estimate the fraction of cancer attributable to potentially modifiable risk factors in Brazil. Strategies for primary prevention of tobacco smoking and control of infection and the promotion of a healthy diet and physical activity should be the main priorities in policies for cancer prevention in the country. \ua9 2016 Azevedo e Silva et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Current methods to analyze lysosome morphology, positioning, motility and function

Since the discovery of lysosomes more than 70 years ago, much has been learned about the functions of these organelles. Lysosomes were regarded as exclusively degradative organelles, but more recent research has shown that they play essential roles in several other cellular functions, such as nutrient sensing, intracellular signalling and metabolism. Methodological advances played a key part in generating our current knowledge about the biology of this multifaceted organelle. In this review, we cover current methods used to analyze lysosome morphology, positioning, motility and function. We highlight the principles behind these methods, the methodological strategies and their advantages and limitations. To extract accurate information and avoid misinterpretations, we discuss the best strategies to identify lysosomes and assess their characteristics and functions. With this review, we aim to stimulate an increase in the quantity and quality of research on lysosomes and further ground-breaking discoveries on an organelle that continues to surprise and excite cell biologists.Medical Biochemistr

Future and potential spending on health 2015-40: Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods: We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings: We estimated that global spending on health will increase from US$9.21 trillion in 2014 to$24.24 trillion (uncertainty interval [UI] 20.47-29.72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5.3% (UI 4.1-6.8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4.2% (3.8-4.9). High-income countries are expected to grow at 2.1% (UI 1.8-2.4) and low-income countries are expected to grow at 1.8% (1.0-2.8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and$195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Interpretation: Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential

Mapping child growth failure across low- and middle-income countries

Childhood malnutrition is associated with high morbidity and mortality globally1. Undernourished children are more likely to experience cognitive, physical, and metabolic developmental impairments that can lead to later cardiovascular disease, reduced intellectual ability and school attainment, and reduced economic productivity in adulthood2. Child growth failure (CGF), expressed as stunting, wasting, and underweight in children under five years of age (0�59 months), is a specific subset of undernutrition characterized by insufficient height or weight against age-specific growth reference standards3�5. The prevalence of stunting, wasting, or underweight in children under five is the proportion of children with a height-for-age, weight-for-height, or weight-for-age z-score, respectively, that is more than two standard deviations below the World Health Organization�s median growth reference standards for a healthy population6. Subnational estimates of CGF report substantial heterogeneity within countries, but are available primarily at the first administrative level (for example, states or provinces)7; the uneven geographical distribution of CGF has motivated further calls for assessments that can match the local scale of many public health programmes8. Building from our previous work mapping CGF in Africa9, here we provide the first, to our knowledge, mapped high-spatial-resolution estimates of CGF indicators from 2000 to 2017 across 105 low- and middle-income countries (LMICs), where 99 of affected children live1, aggregated to policy-relevant first and second (for example, districts or counties) administrative-level units and national levels. Despite remarkable declines over the study period, many LMICs remain far from the ambitious World Health Organization Global Nutrition Targets to reduce stunting by 40 and wasting to less than 5 by 2025. Large disparities in prevalence and progress exist across and within countries; our maps identify high-prevalence areas even within nations otherwise succeeding in reducing overall CGF prevalence. By highlighting where the highest-need populations reside, these geospatial estimates can support policy-makers in planning interventions that are adapted locally and in efficiently directing resources towards reducing CGF and its health implications. © 2020, The Author(s)

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

BackgroundHuman immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico.MethodsWe performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017.ResultsAll countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries-apart from Ecuador-across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups-the median age group among decedents ranged from 30 to 45years of age at the municipality level in Brazil, Colombia, and Mexico in 2017.ConclusionsOur subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.Peer reviewe

Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000–17 : analysis for the Global Burden of Disease Study 2017

Background Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. Methods We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. Findings The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1–65·8), 17·4% (7·7–28·4), and 59·5% (34·2–86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. Interpretation By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health