OBJECTIVE:To estimate daily maximum temperature markers for defining heat wave alert levels in Belo Horizonte, Minas Gerais, Brazil. METHODS:the association between daily maximum temperature and mortality was estimated using quasi-Poisson regression with distributed lag non-linear models, considering lags from 0 to 21 days and adjustment for temporal trend, seasonality, and day of the week. The minimum mortality temperature was used as the reference for estimating relative risks, and high percentiles supported the definition of operational thresholds. RESULTS:The minimum mortality temperature was 29.3°C. Mortality risk increased at higher percentiles, with relative risks of 1.04 at the 90th percentile; 1.09 at the 95th percentile; 1.17 at the 98th percentile; and 1.26 at the 99th percentile. Four levels based on maximum temperature and thermal persistence were proposed: Alert 1, mild heat wave (32.0-33.1°C/3 days); Alert 2, moderate heat wave (33.2-34.6°C/3 days); Alert 3, intense heat wave (34.7-35.8°C/3 days); and Alert 4, extreme heat wave (>35.8°C/2 days). A higher frequency of heat waves was observed in years associated with El Niño. CONCLUSION:Markers based on high percentiles of maximum temperature produced levels consistent with the increased mortality risk, with potential application in public health surveillance and response.
OBJECTIVE:To analyze the temporal evolution of epidemiological indicators related to HIV/AIDS in the state of Tocantins between 2015 and 2023 and to assess potential changes associated with the COVID-19 pandemic. METHODS:An ecological time-series study was conducted using secondary data from national health information systems. Annual rates per 100,000 inhabitants were calculated. Trends were estimated using Prais-Winsten regression, and pandemic-associated changes were assessed using interrupted time-series analysis. RESULTS:Between 2015 and 2023, 1,854 HIV cases, 2,026 AIDS cases, and 511 AIDS-related deaths were recorded in Tocantins. The mean annual rates were 13.09 HIV cases, 14.32 AIDS cases, and 3.61 AIDS-related deaths per 100,000 inhabitants. Prais-Winsten analysis indicated stationary trends for HIV detection, AIDS detection, and AIDS mortality rates. In the interrupted time-series analysis, no significant immediate changes were observed after 2020. A significant increase was observed only in the trend of the AIDS detection rate during the post-interruption period (β = 2.67; 95%CI 0.26; 5.09; p=0.036), whereas HIV detection and AIDS mortality rates remained stable. CONCLUSION:Trends in HIV detection, AIDS detection, and AIDS mortality rates remained stable in Tocantins between 2015 and 2023. However, an increase in the trend of the AIDS detection rate was observed after the onset of the COVID-19 pandemic, suggesting potential repercussions of this period on the dynamics of disease diagnosis and reporting.
ABSTRACT Objective: This study aimed to estimate the prevalence of indicators related to experimentation and use of tobacco products among Brazilian students aged 13–17 years in 2024 and to compare them with values observed in 2015 and 2019 in the country. Methods: A cross-sectional study was conducted, with prevalence estimates according to sociodemographic variables and temporal analysis of the indicators. Results: An increase was observed in lifetime experimentation (from 16.8 to 29.6%) and electronic cigarette use in the past 30 days (from 2.8 to 8.7%). Conversely, a reduction was observed in cigarette, hookah, and overall tobacco product use in the past 30 days. Conclusion: The increase in electronic cigarette use among students highlights the need to maintain their prohibition, expand educational actions, and strengthen surveillance and enforcement measures.
RESUMO Objetivo: O estudo teve como objetivo estimar as prevalências de indicadores relacionados à experimentação e ao uso de produtos derivados do tabaco entre escolares de 13 a 17 anos de idade brasileiros em 2024 e compará-las aos valores observados em 2015 e 2019 no país. Métodos: Estudo transversal, com cálculo das prevalências segundo variáveis sociodemográficas e análise temporal dos indicadores. Resultados: Observou-se aumento da experimentação na vida (16,8% para 29,6%) e no uso de cigarro eletrônico nos últimos 30 dias (2,8% para 8,7%). Em contrapartida, houve redução do uso de cigarros, narguilé e de todos os produtos do tabaco nos últimos 30 dias. Conclusão: Conclui-se que o crescimento do uso de cigarros eletrônicos entre escolares reforça a necessidade de manter sua proibição, ampliar ações educativas e fortalecer a fiscalização.
OBJECTIVE:To investigate individual and contextual factors associated with seeking and access to oral health services among Brazilian adolescents and young adults. METHODS:This cross-sectional study was based on data from the 2023 Brazilian National Oral Health Survey (SB Brasil 2023). The sample comprised 12-year-old adolescents and young adults aged 15 to 19 years (n=14,757). Four outcomes structured into two stages (seeking and access) were assessed, subdivided into general oral health services and public services specifically. Binary logistic regression models were fitted to estimate odds ratios (ORs), and a 5% significance level was adopted (p<0.05). RESULTS:All associations were statistically significant (p<0.001). Black race/skin color and income below the poverty line reduced the odds of seeking general oral health services (OR=0.86 and OR=0.84, respectively). For general access, socioracial inequities were more pronounced, intensifying the barrier for Black individuals (OR=0.79). Conversely, in the context of public services, the most vulnerable groups had the highest odds of both seeking and effectively accessing services, particularly Black individuals (ORseeking=2.72; ORaccess=2.57) and those with low income (ORseeking=2.31; ORaccess=2.38). CONCLUSIONS:Seeking and access to oral health services are influenced by socioeconomic and racial inequities. The public system acts as a compensatory resource for vulnerable groups but remains insufficient to overcome access barriers.
OBJETIVE:In this study, we aimed to perform the cross-cultural adaptation and psychometric evaluation of the Quality of Life Impact of Refractive Correction (QIRC) questionnaire for European Portuguese. METHODS:International guidelines for the adaptation of questionnaire-based assessment instruments were followed, and the study was conducted in two phases: 1) Cross-cultural adaptation, involving translation, back-translation, and pretesting for semantic equivalence; 2) Psychometric evaluation of the scale. A convenience sample was selected from secondary and higher education institutions. Reliability was assessed using Cronbach's alpha (α) and McDonald's omega (ω), while temporal stability was evaluated by the intraclass correlation coefficient (ICC). The evaluation of the instrument's dimensional structure was performed using exploratory factor analysis (EFA). RESULTS:The sample consisted of 373 students, aged between 16 and 35 years. Internal consistency was high (α=0.848 and ω=0.862) and temporal stability was considered excellent (ICC=0.951). We identified three factors (Difficulties and Concerns - 11 items; Comfort and Well-being - 7 items; and Function and Symptoms - 2 items), according to the EFA, which explained 66.82% of the total variance. Internal consistency was excellent for Difficulties and Concerns (α=0.970), good for Comfort and Well-being (α=0.830); and low for Function and Symptoms (α=0.253), the latter being composed of only two items. CONCLUSION:The results support the evaluation of the instrument's dimensional structure and reliability of the Portuguese version of the QIRC, adapted for European Portuguese. It is a suitable tool for assessing the impact of refractive correction on the quality of life among young populations in Portugal.
RESUMO Objetivo: Descrever o ambiente alimentar varejista das regiões metropolitanas brasileiras com indicadores socioeconômicos intramunicipais, utilizando a classificação Locais-Nova. Métodos: Foram utilizados dados da Relação Anual de Informações Sociais de 2023, tendo como unidade de análise as Unidades de Desenvolvimento Humano (UDH). Os estabelecimentos de alimentos foram georreferenciados e associados às UDH. Aplicou-se a metodologia Locais-Nova, que classifica os locais de aquisição de alimentos de acordo com o grau de processamento e propõe cinco indicadores do ambiente alimentar. Calculou-se o percentual de cada indicador para as UDH, estratificado em tercis do Índice de Desenvolvimento Humano Municipal (IDHM), segundo a distribuição das UDH, as macrorregiões e entre capitais e não capitais. Foi criado um indicador de saudabilidade do ambiente alimentar que mede a competição entre locais saudáveis e não saudáveis, utilizado para descrição espacial por meio de mapas. Resultados: Foram avaliadas 8.977 UDH em 24 regiões metropolitanas, com IDHM médio de 0,76 e média de 42,8 estabelecimentos de alimentos por UDH. A maioria dos locais de aquisição foi classificada como fonte de ultraprocessados (64,9%), com maior proporção no primeiro tercil de IDHM (67,5%) em relação ao 3º (63,1%). Observou-se menor presença de locais fonte de in natura no primeiro tercil de IDHM comparado ao 3º (25,8 vs. 32,3%). O Sudeste apresentou maior percentual de locais fonte de processados (17,3%). As não capitais concentraram maior proporção de locais fonte de processados em relação às capitais. Conclusão: Constatou-se elevada prevalência de locais fonte de alimentos ultraprocessados, sobretudo em territórios com piores situações socioeconômicas.
ABSTRACT Objective: To describe the retail food environment of Brazilian metropolitan regions using intramunicipal socioeconomic indicators, applying the Locais–NOVA classification. Methods: Data from the 2023 Annual Social Information Report were used, with Human Development Units (HDUs) as the unit of analysis. Food establishments were geocoded and assigned to HDUs. The Locais-NOVA methodology was applied, which classifies food acquisition outlets according to the degree of food processing and proposes five food environment indicators. The percentage of each indicator was calculated for HDUs and stratified into tertiles of the Municipal Human Development Index (MHDI), considering the distribution of HDUs, Brazilian macroregions, and capitals versus non-capitals. A food environment healthiness indicator was created to measure the competition between healthy and unhealthy outlets and was used for spatial description through maps. Results: A total of 8,977 HDUs across 24 metropolitan regions were assessed, with a mean MHDI of 0.76 and an average of 42.8 food establishments per HDU. Most food outlets were classified as sources of ultra-processed foods (64.9%), with a higher proportion in the first MHDI tertile (67.5%) compared with the third tertile (63.1%). A lower presence of outlets sourcing fresh and minimally processed foods was observed in the first MHDI tertile compared with the third (25.8 vs. 32.3%). The Southeast showed the highest percentage of outlets sourcing processed foods (17.3%). Non-capital concentrated a higher proportion of outlets sourcing processed foods compared with capitals. Conclusion: A high prevalence of outlets sourcing ultra-processed foods was observed, particularly in territories with worse socioeconomic conditions.
RESUMEN Objetivo: La carga de enfermedad por diabetes mellitus muestra una tendencia ascendente a nivel global. Dado el potencial de las estructuras físicas de creación de oportunidades para la adopción de comportamientos individuales, el objetivo fue analizar la relación entre el entorno alimentario y los espacios verdes de los barrios y la prevalencia de diabetes mellitus en el aglomerado Mar del Plata-Batán de Argentina, considerando además características individuales, en 2013-2018. Métodos: Se utilizó un diseño transversal con enfoque multinivel. Se vincularon datos individuales de la Encuesta Nacional de Factores de Riesgo con datos sobre entorno alimentario y espacios verdes agregados a nivel de radio censal. Se utilizaron modelos de regresión logística multinivel con individuos anidados en radios censales; se estimaron odds ratio para las variables independientes con intervalos de confianza del 95%. Resultados: Se trabajó con 946 observaciones distribuidas en 81 radios censales. Luego de ajustar por variables individuales, residir en radios con alta densidad de comercios de alimentos saludables se asoció con una disminución de la chance de tener diabetes del 43% [OR 0,57 (0,35–0,93)]. La superficie verde pública por habitante del barrio no mostró asociación significativa con la chance de diabetes. La proporción de variabilidad atribuible al nivel contextual fue entre el 2,35 y el 1,20%. Conclusiones: el entorno alimentario del barrio se asoció con la diabetes mellitus en el aglomerado estudiado. Estos resultados podrían impulsar el desarrollo de investigaciones con diseños longitudinales, de mayor potencia en la demostración del rol causal del entorno alimentario en la ocurrencia de diabetes.
OBJECTIVES:To evaluate the clinical-epidemiological profile of patients with oropharyngeal cancer (OPC) positive for human papillomavirus (HPV+) and negative for human papillomavirus (HPV-), and to compare differences in the development of second primary tumors (SPT). METHODS:Retrospective cohort with patients diagnosed with OPC. Sociodemographic/clinical data, p16-status, alcohol/tobacco consumption were extracted. Absolute/relative frequencies, odds ratios (OR), prevalence of HPV and SPT were calculated. RESULTS:Of 538 patients with OPC, 59.8% (n=322) were HPV+; 40.2% (n=216) HPV-. The prevalence of SPTs was higher among HPV- (21.8%; n=47) than HPV+ (13.0%; n=42). Non-smokers were 4.5 times more likely to have HPV+ OPC (OR 4.58; confidence interval - CI 2.48-8.67), and non-drinkers were 2.06 times more likely (OR=2.06; CI 1.15-3.72). Nodal involvement was associated with a 2.77-fold higher likelihood of HPV+ (OR 2.77; CI 1.70-4.56); lymphoepithelial topographies with a 2.13-fold higher likelihood (OR 2.13; CI 1.37-3.31). SPTs occurred most in the skin (17.3%, n=9) and penis/prostate (15.4%, n=8) in HPV+, whereas in HPV- in head and neck (36.2%, n=22) and respiratory tract (18.0%, n=11). The interval between OPC diagnosis and SPT diagnosis was shorter in the HPV+ (median: 40 months). CONCLUSION:SPT pattern in OPC is not equal across HPV-groups. HPV- showed a higher prevalence of SPTs, more often involving the head and neck/respiratory tract, which may reflect the cumulative effect of tobacco/alcohol exposure. In HPV+, the lower SPT prevalence and different tumor distribution may indicate a more limited field cancerization effect. The shorter time to SPT diagnosis in HPV+ suggests that surveillance strategies may need to consider distinct risk profiles according to HPV-status.
ABSTRACT Objective: The burden of disease due to diabetes mellitus has shown an increasing trend worldwide. Given the potential of physical structures to create opportunities for the adoption of individual behaviors, this study aimed to analyze the relationship between neighborhood food environments and green spaces and the prevalence of diabetes mellitus in the Mar del Plata-Batán urban agglomeration in Argentina, while also considering individual characteristics, from 2013 to 2018. Methods: A cross-sectional design with a multilevel approach was used. Individual data from the National Risk Factor Survey were linked to data on food environments and green spaces aggregated at the census tract level. Multilevel logistic regression models were used, with individuals nested within census tracts; odds ratios were estimated for independent variables with 95% confidence intervals. Results: A total of 946 observations distributed across 81 census tracts were analyzed. After adjustment for individual variables, living in census tracts with a high density of healthy food outlets was associated with a 43% reduction in the odds of having diabetes [OR 0.57 (0.35–0.93)]. Public green space area per inhabitant in the neighborhood was not significantly associated with the odds of diabetes. The proportion of variability attributable to the contextual level ranged from 2.35 to 1.20%. Conclusions: The neighborhood food environment was associated with diabetes mellitus in the studied agglomeration. These results may encourage the development of longitudinal studies with greater power to demonstrate the causal role of the food environment in the occurrence of diabetes.
ABSTRACT Objective: The study aimed to analyze the trends in mortality and disease burden due to Diabetes Mellitus in Argentina from 1990 to 2022. Methods: A longitudinal descriptive time-series study was conducted. Age-standardized mortality rates (ASMRs) and age-adjusted potential years of life lost (AAYPLL) were calculated. Trend analysis was performed using segmented regression (Joinpoint). Results: Between 1990 and 2022, a total of 270,394 deaths from diabetes mellitus were recorded in Argentina, of which 52.1% occurred among men and 48.8% among women. ASMRs and AAYPLL analyses consistently showed higher values among men than among women. The average annual percent change (AAPC) for both ASMRs and AAYPLL indicated a plateau among men and a significant decrease among women. Conclusion: The findings suggest a slight trend toward a decrease in the age at death among men, whereas the opposite pattern was observed among women. These findings have important implications for public health and policymaking. The high number of DM-related deaths among older age groups underscores the need for healthcare services tailored to the aging population. Furthermore, gender differences in mortality, with women tending to die at older ages than men, suggest that healthcare strategies should address gender-specific needs and risks.
ABSTRACT Objective: To evaluate the association between water fluoridation and the maintenance of functional dentition (≥20 teeth) and tooth loss in Brazilian adults aged 35 to 44, considering individual and contextual factors. Methods: This study employed a cross-sectional design using data from SB Brasil 2023 (n=9,019). The main exposure was the availability of fluoridated water in municipalities, obtained from national sanitation information systems. The outcomes analyzed were (i) functional dentition (binary) and (ii) number of missing teeth (count). To reduce confounding bias, inverse probability weighting was used to balance individual (age, sex, education, and income) and contextual (municipal development index and dental service coverage) covariates. The analysis was performed using multilevel Poisson models for functional dentition and multilevel negative binomial models for missing teeth. The robustness of the results was assessed using E-values, estimating sensitivity to potential unmeasured confounders. Results: After adjustment, fluoridation showed no significant association with functional dentition (PR 1.24; 95%CI 0.91-1.68). However, it was significantly associated with a lower rate of missing teeth (RR 1.30; 95%CI 1.01-1.67). Sensitivity analysis (E-value) indicated high susceptibility to unmeasured confounders for the count outcome. Conclusion: In the context of widespread use of fluoridated dentifrice, water fluoridation demonstrated a significant protective effect against tooth loss in adults, although it was totally or partially confounded by socioeconomic variables. These findings reinforce the importance of universal fluoridation policies, which should be combined with strategies targeting vulnerable groups, aiming to reduce inequalities and promote oral health in the adult population.
RESUMO Objetivo: Avaliar a associação entre a fluoretação da água, manutenção da dentição funcional e perdas dentárias em adultos brasileiros de 35 a 44 anos, considerando fatores individuais e contextuais. Métodos: Trata-se de estudo transversal utilizando dados da Pesquisa Nacional de Saúde Bucal (SB Brasil) 2023 (n = 9.019). A exposição principal foi a disponibilidade de água fluoretada nos municípios, obtida de sistemas de informação sobre saneamento. Os desfechos analisados foram (i) dentição funcional (binário) e (ii) número de dentes perdidos (contagem). Para reduzir viés de confusão, utilizou-se ponderação por probabilidade inversa para balancear covariáveis individuais (idade, sexo, escolaridade e renda) e contextuais (índice de desenvolvimento municipal e cobertura de serviços odontológicos). A análise foi realizada com modelos multinível de Poisson para dentição funcional e modelos multinível binomial negativa para dentes perdidos. A robustez dos resultados foi avaliada por meio de E-values, estimando a sensibilidade a potenciais confundidores não medidos. Resultados: Após ajuste, a fluoretação não apresentou associação significativa com dentição funcional (RP 1,24; IC95% 0,91-1,68). No entanto, associou-se significativamente a menor taxa de dentes perdidos (RT 1,30; IC95% 1,01-1,67). A análise de sensibilidade (E-values) indicou elevada suscetibilidade a confundidores não medidos para o desfecho de contagem. Conclusão: Em um contexto de uso disseminado de creme dental fluoretado, a fluoretação da água demonstrou efeito protetor significativo contra a perda dentária em adultos, ainda que confundida total ou parcialmente pelas variáveis socioeconômicas. Estes achados reforçam a importância de políticas universais de fluoretação, que devem ser combinadas com estratégias direcionadas a grupos vulneráveis, visando reduzir desigualdades e promover saúde bucal à população adulta.
ABSTRACT Objective: To analyze patterns of modifiable health risk behaviors among Brazilian older adults (≥60 years) using data from the 2013 and 2019 National Health Surveys. Methods: A cross-sectional study was conducted based on secondary data from the 2013 and 2019 National Health Surveys. Behavior patterns were defined using Latent Class Analysis according to four main domains: smoking, alcohol consumption, physical activity, and diet. Relative frequencies and their 95% confidence intervals (95%CI) were calculated for lifestyle variables, as well as for independent variables associated with socioeconomic and demographic factors. Results: Five behavior patterns were identified for each year. In 2013, patterns related to unhealthy habits (smoking), physical inactivity, and dietary patterns (including bean, vegetable, legume, and fish consumption) were identified. In 2019, the findings also involved the same patterns found in 2013, with the difference that fish consumption showed greater relevance in differentiating between classes, although its population prevalence decreased over the period. Physical inactivity was associated with harmful habits, including inadequate diet, smoking, and alcohol consumption. Age, sex, education level, and race significantly influenced these patterns. Conclusion: In Brazil, unhealthy aging overlaps with multiple modifiable risk factors. Understanding these patterns and their determinants enables the development of strategies to reduce health inequalities and promote quality of life and well-being among older adults. A combined approach to risk factors contributes to more effective public policies.
ABSTRACT Objective: The study evaluated the association between COVID-19 vaccination and in-hospital mortality among immunocompromised older adults hospitalized for COVID-19 in Brazil during the 2024 epidemiologic year. Methods: This retrospective hospital-based surveillance study used data from the Brazilian SIVEP-Gripe database. All hospitalized cases of COVID-19-related severe acute respiratory syndrome in immunocompromised individuals aged ≥60 years reported during epidemiological weeks 1–52 of 2024 were included. Multivariable logistic regression was used to estimate odds ratio (OR) and 95% confidence interval (95%CI) for the association between COVID-19 vaccination (number of doses) and in-hospital mortality, adjusting for clinical and sociodemographic covariates. Results: Among 474 patients, in-hospital mortality was 36% (171/474). Only 56 (12%) were unvaccinated. Compared with unvaccinated individuals, adjusted ORs for mortality were 0.67 (95%CI 0.32–1.39) for 1–2 doses, 0.67 (95%CI 0.31–1.42) for 3 doses, 0.54 (95%CI 0.26–1.15) for 4 doses, and 0.56 (95%CI 0.26–1.17) for 5–6 doses. Mechanical ventilation (OR 12.55; 95%CI 6.39–26.33) and lower educational attainment (elementary education: OR 2.94; 95%CI 1.39–6.44) were independent predictors of death. COVID-19 vaccination was not significantly associated with reduced in-hospital mortality among immunocompromised older adults hospitalized for the disease in Brazil in 2024. However, all adjusted ORs were below unity, suggesting a trend toward protection with increasing doses. Conclusions: The strong association of mortality with mechanical ventilation and social determinants highlights the need for timely boosters and comprehensive preventive strategies for this vulnerable population.
RESUMEN Objetivo: El trabajo propone analizar la tendencia de mortalidad y de la carga de enfermedad por Diabetes Mellitus en Argentina en el periodo 1990-2022. Métodos: Se realizó un estudio descriptivo longitudinal de series temporales. Se calcularon tasas de mortalidad ajustadas por edad (TAM) y Años de Vida Potencialmente Perdidos ajustados por edad (APVP-AE). El análisis de tendencia se desarrolló mediante regresión segmentada (jointpoint). Resultados: Entre 1990 y 2022 fueron registrados en Argentina 270 394 óbitos por Diabetes Mellitus (DM), siendo el 52,1% varones y el 48,8% mujeres. Las TAM y el análisis de los APVP-AE muestra valores consistentemente más altos en varones que en mujeres. El porcentaje promedio de cambio anual (AAPC) de las TAM y de los APVP-AE muestran un estancamiento en varones y en mujeres una disminución significativa. Conclusión: Los resultados obtenidos indicarían una leve tendencia hacia la disminución en la edad de fallecimiento de los varones ocurriendo una situación inversa para las mujeres. Los hallazgos tienen importantes implicaciones para la salud pública y la formulación de políticas. El número de muertes por DM en los grupos etarios mayores subraya la necesidad de servicios de salud adecuados a la población adulta mayor. Además, las diferencias de sexo en la mortalidad, con mujeres que tienden a morir a una edad más avanzada que los hombres, sugieren que las estrategias de atención de salud deben considerar necesidades y riesgos específicos contemplando aspectos de género.
RESUMO Objetivo: Analisar os padrões de comportamentos de risco à saúde modificáveis em pessoas idosas brasileiras (≥60 anos) utilizando dados da Pesquisa Nacional de Saúde 2013 e 2019. Métodos: Estudo transversal com base nos dados secundários provenientes da Pesquisa Nacional de Saúde de 2013 e 2019. Os padrões de comportamento foram definidos pela Análise de Classes Latentes de acordo com quatro domínios principais: tabagismo, consumo de álcool, atividade física e alimentação. Foram calculadas as frequências relativas e seus Intervalos de Confiança de 95% (IC95%) para as variáveis de estilo de vida, bem como para as variáveis independentes associadas a fatores socioeconômicos e demográficos. Resultados: Foram identificados cinco padrões de comportamento em cada ano. Em 2013, identificaram-se padrões relacionados a hábitos não saudáveis (fumo), inatividade física e padrões alimentares (incluindo consumo de feijão, vegetais, legumes e peixes). Em 2019, os achados também envolveram os mesmos padrões encontrados em 2013, com o diferencial de que o consumo de peixe apresentou maior relevância na diferenciação entre classes, embora sua prevalência populacional tenha diminuído no período. A inatividade física foi associada a hábitos prejudiciais: alimentação inadequada, tabagismo e consumo de álcool. Idade, sexo, escolaridade e raça influenciaram significativamente esses padrões. Conclusão: No Brasil, o envelhecimento não saudável sobrepõe-se a múltiplos fatores de risco modificáveis. A compreensão desses padrões e seus determinantes permite elaborar estratégias que reduzam desigualdades em saúde e promovam qualidade de vida e bem-estar entre pessoas idosas. A abordagem combinada de fatores de risco contribui para políticas públicas mais efetivas.
RESUMO Objetivo: Avaliar a evolução temporal dos atendimentos por transtornos mentais na Atenção Primária à Saúde (APS) do Sistema Único de Saúde (SUS) no Brasil e estimar os efeitos do distanciamento social, da pandemia e do período pós-pandêmico de covid-19. Métodos: Estudo ecológico nacional de séries temporais interrompidas utilizando dados do Sistema de Informação em Saúde para a Atenção Básica, do Departamento de Informação e Informática do SUS (Sisab/DataSUS). Analisaram-se as taxas mensais proporcional e de incidência populacional de atendimentos por transtornos mentais (CID-10 F00-F99) na APS. Ajustaram-se modelos de regressão segmentada com distribuição binomial negativa e estrutura autorregressiva. Resultados: Foram analisados 38,7 milhões de atendimentos. No período pré-pandemia, observou-se tendência crescente da participação dos transtornos mentais nos atendimentos da APS (exp(β)Tendência=1,011; IC95% 1,008-1,014). Durante o distanciamento social, ocorreu aumento abrupto da proporção desses atendimentos (exp(β)Nível=1,241; IC95% 1,149-1,339), em grande parte associado à redução do volume total de atendimentos na APS. No restante da pandemia, a elevação proporcional estagnou. Houve heterogeneidade regional (p<0,001), com maior elevação de nível no Nordeste. Já no período pós-pandêmico, observou-se retomada do crescimento tanto da proporção dos atendimentos quanto da incidência populacional de atendimentos por transtornos mentais; entre os grupos diagnósticos, destacou-se o crescimento dos transtornos ansiosos, do desenvolvimento e infantojuvenis. Conclusão: A participação dos transtornos mentais nos atendimentos da APS brasileira aumentou ao longo do período analisado. O distanciamento social produziu elevação proporcional abrupta em contexto de retração de outros atendimentos, seguida de recomposição heterogênea entre regiões e grupos diagnósticos. Os achados indicam aumento recente da demanda por cuidado em saúde mental na APS.
ABSTRACT Objective: To analyze the classification of the risk of transmission of vaccine-preventable diseases among children under 2 years of age in a large Brazilian municipality in 2022 and 2023. Method: Ecological epidemiological study using secondary data on vaccination coverage (VC) for nine immunobiologicals recommended in the vaccination schedule for children under 2 years of age. Immunobiological dose data were obtained from the National Immunization Program Information System (Sistema de Informações do Programa Nacional de Imunizações - SI-PNI), while data were collected from the Ministry of Health website and filtered by place of residence. Data were analyzed using the R software package. Results: In 2022, 100% of the Health Surveillance Units (Unidades de Vigilância em Saúde - UVIS) showed low VC for the second dose of the measles-mumps-rubella (MMR) vaccine. In the same year, 61% and 54% of the UVIS achieved adequate VC for the hepatitis A and human rotavirus vaccines, respectively. In 2023, improvements in VC were observed for most vaccines, except for the meningococcal C and varicella vaccines, which showed a reduction in the number of UVIS achieving adequate VC. Regarding the classification of the risk of reintroduction of vaccine-preventable diseases, the proportion classified as “low and very low” increased from 0% in 2022 to 10.7% in 2023. Conclusion: VC improved in 2023 for most vaccines analyzed across the UVIS. However, variations in VC were observed according to vaccine type and year. These findings reinforce the need to maintain regional actions aimed at achieving vaccination targets, given the indications of a recovery in VC.
