Introdução: As doenças cardiovasculares (DCV) são consideradas a principal causa de morte no mundo, sendo considerada um problema de saúde pública, a preocupação aumenta à medida que atualmente o número de mortes em indivíduos mais jovens e em grupos vulneráveis. O objetivo do estudo foi determinar a associação entre o nível de escolaridade e a morte prematura por doenças cardiovasculares em adultos. Metodologia: Trata-se de um estudo transversal de caráter analítico, resultante de dados provenientes do Sistema de informação de mortalidade do Brasil em 2018. Para análise estatística realizou-se uma análise bivariada pelo de teste de Qui-quadrado e posteriormente foram submetidas a uma análise multivariada mediante modelo de regressão logística para o controle de fatores de confusão e modificação, ajustando-se os valores de razão de mortalidade proporcional (RMP). Resultado: foram analisados 452.282 óbitos; 16,7% dos quais foram atribuídos a doenças cardiovascular, em relação ao nível de escolaridade, observou-se uma maior prevalência de óbito por doenças DCV (17,3%) em analfabetos ou com ensino fundamental e do sexo masculino (62,8%). Após o ajuste completo para os possíveis fatores de confusão, o analfabetismo ou possuir apenas o ensino fundamental, permaneceu fortemente associada ao risco de morrer prematuramente por DCV (RMP =1,31; 95% IC 1,27-1,24, p<0,000). O sexo interagiu com o nível de escolaridade: onde indivíduos do sexo feminino (RMP=1,30, 95% IC1,27-1,35). Conclusão: A taxa de mortalidade por doenças cardiovasculares é elevada entre pessoas pouco grau de instrução, sugerindo uma abordagem multisetorial (acesso a educação e a saúde) dirigida às pessoas vulneráveis.
Introduction Birth weight is described as one of the main determinants of newborns’ chances of survival. Among the associated causes, or risk factors, the mother’s nutritional status has a strong influence on fetal growth and “birth weight” outcomes of the concept. This study evaluates the association between food deserts in small for gestational age (SGA), large for gestational age (LGA) and low birth weight (LBW) newborns. Design This is a cross-sectional population study, resulting from individual data from the Live Birth Information System (SINASC), and municipal data from mapping food deserts (CAISAN) in Brazil. The newborn’s size was defined as follows: appropriate for gestational age (between 10 th and 90 th percentile), SGA (<10 th percentile), LGA (>90 th percentile), and low birth weight <2,500g. To characterize food environments, we used tertiles of the density of establishments which sell in natura and ultra-processed foods. Logistic regression modeling was conducted, in order to investigate the associations of interest. Results We analyzed 2,632,314 live births in Brazil in 2016. Following due adjustment, it was observed that women from municipalities in which there was a limited supply of in natura foods presented a higher chance of a SGA [OR 2nd tertile :1.06 (1.05-1.07)] and LBW [OR 2nd tertile : 1.11(1.09-1.12)] newborn. On the other hand, municipalities in which there was a greater supply of ultra-processed foods presented higher chances for a SGA [OR 3rd tertile :1.04 (1.02-1.06)] and LBW [OR 2nd tertile :1.13 (1.11-1.16)] newborn. Stratification showed that black and mixed-race women were associated with SGA [OR 3rd tertile : 1.09 (1.01-1.18)] and [OR 3rd tertile :1.06 (1.04-1.09)], respectively, and mixed-race women were also associated with LBW [OR 3rd tertile :1.17 (1.14-1.20)], while indigenous women were associated with LGA [OR 3rd tertile : 1.20(1.01-1.45)]. Conclusions Living in areas with limited access to healthy foods was associated with an increased chance of SGA and low weight newborns, especially in black and mixed-race women. Initiatives focused on minimizing the effects of these food environments, and which aim to reduce social inequalities are urgently required in the Brazilian context.
Introdução: A insegurança alimentar é um problema de saúde púbica, devido aos seus efeitos na saúde de pessoas infectadas pelo HIV, apesar dos benefícios indiscutíveis do tratamento antirretroviral. Objetivo: analisar a prevalência e fatores associados à insegurança alimentar em pessoas que vivem com HIV/AIDS. Metodologia: Trata-se de um estudo transversal, realizado com 206 pacientes atendidos, em maio-julho de 2022. Foram coletados dados socioeconômicos, demográficos, de estilo de vida e de segurança alimentar. Avaliou-se a insegurança alimentar por meio da Escala Brasileira de Insegurança Alimentar, e as suas associações através do teste qui-quadrado de Pearson/teste exato de Fisher e razão de prevalência. Resultados: A prevalência de insegurança alimentar (grave) foi mais elevada em homens (78,9%), com idade de 18-30 anos (88,9%), sem nenhum nível de escolaridade (82,4%), desempregados (72,3%), casados (73,1%), em agregados de 4 a 6 membros (77,3%) e morando em condições de habitação inadequada (70,2%), com estádio II da doença (78,4%), não fumantes (71,9%), consumidores regulares de bebidas alcoólicas (73,7%) e que praticavam atividade física (76,4%). Encontrou-se associações estatísticas entre insegurança alimentar e faixa etária (p = 0,001), escolaridade (p = 0,001), situação de emprego (p < 0,011), número de pessoas por domicílio (p < 0,028), ser fumante (p < 0,013) e estádio da doença (p < 0,017). Conclusão: estes resultados, sugerem a investimentos em políticas que visam a melhoria da produção agrícola, da renda, escolaridade, acesso a emprego e redução dos níveis de pobreza são necessárias para aumentar a disponibilidade, melhoria de acesso e utilização dos alimentos.
Resumo Introdução O artigo discute as disparidades espaciais em saúde ao investigar pessoas brancas e negras, tomando como ponto de partida a trajetória de desenvolvimento do sistema global do capitalismo racial. Objetivo Investigar as diferenças existentes entre pessoas brancas e negras nos agravos de HIV, tuberculose e sífilis na escala de distritos sanitários na cidade de Porto Alegre, Rio Grande do Sul. Método Estudo ecológico, com uso de banco de dados secundários e de acesso público, disponibilizados a partir da Secretaria Municipal de Saúde de Porto Alegre. Inclui a análise espacial, a estatística descritiva e o uso de medidas de associação. Resultados A partir dos distritos sanitários, desvela-se a materialização de geografias de desigualdades e de condições de iniquidade entre pessoas brancas e negras, o que está entrelaçado com o processo histórico de ocupação da cidade de Porto Alegre. Conclusão O quesito raça/cor e a sua investigação escalar tornaram-se potência para corroborar as diferenças de qualidade de vida que desfrutam pessoas brancas e negras. Em Porto Alegre, são inequívocas evidências do racismo estrutural em saúde que denotam a urgência de ações no Sistema Único de Saúde, como as políticas de equidade.
Introduction: Globally, low birth weight (LBW) is prevalent in low-income countries. Although the economic assessment of interventions to reduce this burden is essential to guide health policies, research that illustrates the magnitude of LBW by country and region as a way to support the design of public policies is still relatively scarce. Objective: To analyze the temporal trend of fetal growth of newborns in Brazil, in the period from 2010 to 2020. Methods: A time series study, whose data source was the Live Births Information System (SINASC), of the Department of Information and Informatics of the Unified Health System (DATASUS), linked to the Ministry of Health, Brazil. The Prais-Winsten linear model was applied to analyse the annual proportions of LBW. The annual percentage changes (APC) and its respective 95% confidence intervals (95%CI) were calculated. To visualize the dynamics of evolution in each Federation Unit (FU), prevalence rate averages of LBW were calculated and displayed on thematic maps. Results: Between 2010 and 2020, there was a trend toward stabilization of the increasing proportions of low birth weight in the North, Northeast and Centre-West regions. In Brazil and the other regions these tendencies remained stable. Conclusion: To improve the living conditions of the population, public policies and actions aimed at reducing social inequalities and inequity is health are necessary, such as strengthening the Unified Health System (SUS), income transfer programs, quota policies for vulnerable groups, and gender to improve access to education for women and the labour sector.
Objective: Stroke is the second leading cause of death worldwide. The prevalence of hypertension (the major risk factor for stroke) in Mozambique increased from 33.1% in 2005 to 38.9% in 2014/2015, although awareness and control remained at very low levels (15% and 3%, respectively). The aim of this study is to characterize the demographic and clinical pattern of stroke in Maputo Central Hospital (MCH), Mozambique. Methods: A cross-sectional hospital-based study was carried out in MCH, collecting secondary data from hospitalized patients with stroke. Using systematic probabilistic sampling, clinical records were used to analyze data for the period 2014-18. Results: Of the 402 clinical records, 53.5% were female. The mean age was 60.68 years (13.98 SD). Around 96% was an acute stroke event, and 91% was first-ever episode. Thirty one percent did not receive a CT scan for confirmation. Of the 247 CT scanned patients, 50.2% were ischemic. The area of middle cerebral artery was affected in 83.4% patients. The most common co-morbidity was hypertension (87.1%). Near 96% of hemorrhagic stroke were associated with hypertension (Ischemic = 78.7%, p < 0.001). The overall case-fatality was 22.9%. Confirmed hemorrhagic stroke patients were 6.47 years younger than ischemic (56.40 vs 62.87 years; p < 0.001). Younger ages and female were associated with clinical improvement (aOR = 0.964; p = 0.002 and aOR = 1.890; p = 0.044, respectively). Hemorrhagic stroke were 56.8 percent points more likely associated with death (aOR = 0.432; p = 0.010). The likelihood of clinical improvement was 20.5 percent points better over the years (aOR = 1.205; p = 0.086) Conclusions: Stroke associated with hypertension is common in MCH, mostly likely due to an increase in hypertension prevalence and extremely low awareness and control. Favorable clinical outcome improved over the years. Efforts for CT scan to all stroke episodes should be emphasized by MCH managers.
Background: Although not a communicable disease, the term “stroke epidemic” is being used widely in the literature. The “epidemic” of stroke might be due to over the time social transmission of unhealthy activities such as unhealthy diet, physical inactivity, and smoking. The aim of this study is to determine the endemic/epidemic pattern of stroke in Maputo Central Hospital in the first semester of 2019. Methods: A cross-sectional study was carried out collecting secondary data (registered cases) from hospitalized patients with stroke. Data from 2014-18 were used to generate the epidemic thresholds. Four threshold epidemic detection methods were used: mean + 2SD; C-SUM; C-SUM + 1.96SD; and the 3rd quartile. Data from January to June 2019 were used to analyze the 2019 trend over the thresholds. Results: An epidemic pattern of stroke was observed during the first semester of 2019 when 3rd quartile and C-SUM threshold epidemic method was used. This epidemic pattern of stroke was not observed when mean+2SD and C-SUM+1.96SD threshold epidemic method was used. A relatively stable pattern of stroke occurrence with high registered cases was observed during the study period. Conclusions: Stroke is an endemic disease for the Maputo Central Hospital, with an epidemic pattern during the first semester of 2019. Adoption of threshold methods for stroke surveillance might well add value for the control of the stroke epidemics.
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