Envelhecimento da população negra de Porto Alegre : pesquisa qualitativa sobre saúde bucal e acesso a serviços de saúde com ênfase na relação racismo/discriminação

Introdução: O envelhecimento populacional brasileiro ocorre de forma dramática, sem, no entanto, ser acompanhado por ações de promoção de saúde para promover qualidade de vida aos idosos. Com isso surge uma preocupação de como a população adulta vivencia esse processo de envelhecimento, e de como percebe as oportunidades para um envelhecimento ativo e saudável. A condição socioeconômica é compreendida como um dos principais determinantes de saúde e doença das populações. Devido às desigualdades sociais e raciais, existe uma clara estratificação na qual camadas mais pobres, e populações negras, em especial, concentram a maior carga de doença. A população negra ainda hoje sofre os efeitos do período da escravidão, e se encontra na base societal brasileira. No entanto, pouco é sabido acerca do envelhecimento da população negra no Brasil, a partir da percepção de idosos negros. Objetivo: Investigar diferentes aspectos do envelhecimento dos idosos negros na cidade de Porto Alegre, com especial ênfase à saúde bucal, e acesso a serviços de saúde bucal. Metodologia: Trata se de um estudo de qualitativo com entrevistas individuais, fazendo uso da técnica de Teoria Fundamentada em Dados (TFD) para produção, análise e interpretação dos resultados, utilizando a técnica de amostragem da bola de neve - onde um participante indica o próximo potencial participante. Foram entrevistados cinco idosas negras da cidade de Porto Alegre. As entrevistas foram gravadas em aparelho digital, e foram transcritas na íntegra. Seu conteúdo foi analisado com base da TFD, a partir da criação de categorias analíticas, domínios temáticos, e do desenvolvimento de uma teoria final com base nas relações entre esses domínios. Resultados e Discussão: Nesta investigação foram classificados sete temas: problema de saúde; privilégios; desvantagem social; condição sócio econômica; racismo; sentimentos e vida saudável. Nomeei as categorias como: emoções, saúde, bens econômicos, doença, estado físico, autoconsciência, falta de oportunidade, posição social, serviço de saúde e relações. Identifiquei a autoconsciência como categoria central, na qual se destaca, devido a relação com as categorias que se encontram em torno dela. Baseado nessa estrutura foi desenvolvido uma teoria final, que traz a autoconsciência e trajetória de vida de idosas negras de Porto Alegre como um fator potencial no enfrentamento de barreiras à saúde e ao acesso aos serviços de saúde impostas pelo racismo. É essencial que essa informação alcance a população negra e seja transmitida a todos os espaços, inclusive acadêmicos. Tomar consciência do efeito do racismo na sua trajetória de vida não é um processo agradável, mas possibilita a pessoa negra a ter protagonismo sobre questões que afetam o seu cuidado, saúde e bem-estarIntroduction: The Brazilian population aging process is taking place in a very fast way, without being accompanied by public policies to promote quality of life for older people. Hence, there are concerns about how the adult population experiences this aging process, and how people perceive the opportunities for an active and healthy aging. Socioeconomic status is understood as one of the main determinants of health and disease in populations. Due to social and racial inequalities, there is a clear stratification, in which poorer strata, and especially African-American populations, concentrate the greatest burden of disease. The African-American population still suffers the effects of the period of slavery, and compose the Brazilian poorer social strata. However, little is known about the aging of the African-American population in Brazil, from the perception of African-American elders. Objective: To investigate different aspects of aging of the African-American elders in the city of Porto Alegre, with special emphasis on oral health, and access to oral health services. Methodology: This is a qualitative study with individual interviews, using the Grounded Theory technique to produce, analyze and interpret the results using the snowball sampling technique - where one participant indicates the next one potential participant. African-American elders from the city of Porto Alegre were interviewed. The interviews were recorded in a digital equipment, and transcribed in verbatim. Its were analyzed from the creation of analytical categories, thematic domains, and through the development of a final theory based on the relations between these domains, and the evidences found in the text. Results and Discussion: In this investigation seven themes emerged: health problems; privileges; social disadvantage; socioeconomic conditions; racism; feelings; and healthy life. I named the categories as: emotions, health, economic goods, illness, physical state, self-awareness, lack of opportunity, social position, health service and relationships. I identified self-awareness as a central category, as it stands out, due to its relationship with the categories with which it relates to. Based on this structure, a final theory was developed, which brings the self-awareness and life trajectory of black elderly women from Porto Alegre as a potential factor in addressing health barriers and access to health services imposed by racism. It is essential that this information reaches the African-American population and is transmitted to all spaces, including universities. Becoming aware of the effect of racism on their life trajectory is not a pleasant process, but it enables black people to play a leading role in issues that affect their care, health and well-bein

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks