We analyzed the relationship between Metabolic Equivalent of Task (MET) and body composition indicators in fishermen in northern Brazil. This cross-sectional study was conducted between 2016 and 2017 in three fishing communities in the state of Tocantins, northern Brazil. Participants were recruited through local fishing colonies using a convenience sampling strategy. Fishermen and fisherwomen aged 18 years or older were included. Data were collected through face-to-face interviews by previously trained researchers. Body composition was assessed using anthropometric measurements (body weight, height, body mass index [BMI], and abdominal perimeter) and tetrapolar bioelectrical impedance analysis (body fat percentage, fat mass, lean mass, and basal metabolic rate). Physical activity was estimated using METs derived from the International Physical Activity Questionnaire (IPAQ), short version, considering walking, moderate, and vigorous activities. Spearman’s correlation and interquartile regression analyses were performed, with a significance level set at 5

Objective: To analyze the survival rate of adult patients who underwent bronchoaspiration while hospitalized in a public university hospital with oncology care characteristics. Methods: A 12-month retrospective longitudinal study was carried out using bronchoaspiration risk management and event notification analysis forms filled out in the medical records of patients admitted to this hospital. Results: The 34 patients who presented the adverse event of bronchoaspiration had their survival rate reduced by 30% in the first month, and only 29.6% of them survived the second month post-event. Women were more vulnerable to clinical complications originating from the general health status decline as well as to acute pulmonary complications arising from sepsis, consequently presenting a greater reduction in survival. Conclusion: Bronchoaspiration events corroborate an abrupt decrease in patient survival. Level of evidence: Level III.

Resumo Esse estudo avalia a viabilidade de recém-nascidos prematuros, no Brasil, de 2012 a 2019. Trata-se de um estudo observacional, ecológico, de base populacional. A amostra foi composta por recém-nascidos com 22 a 31 semanas de idade gestacional, registrados no Sinasc no período estudado. Para avaliação da viabilidade foi utilizada a associação com a base do SIM. Aplicou-se o método de linkage para associação entre fatores de mortalidade e assistência ao parto. O estudo possibilitou o desenvolvimento de ferramenta útil para o acesso facilitado aos dados coletados. Esse é o primeiro estudo que avalia a viabilidade de recém-nascidos prematuros severos e extremos, na totalidade do Brasil, sendo encontrada uma viabilidade de 26 semanas, com variação entre as regiões. Conclui-se que há necessidade urgente de investimentos na atenção à saúde perinatal, pois está aquém de outros países, como Estados Unidos e Japão, que apresentam medidas de reanimação neonatal proativas com sucesso desde 22 semanas. É necessário um aconselhamento adequado aos pais durante o pré-natal para que seja tomada uma decisão conjunta sobre se esses recém-nascidos devem ser reanimados ou receber cuidados paliativos.

Female breast cancer (FBC) is a well-known public health issue worldwide. However, male breast cancer (MBC), though rare, may be overlooked by both public health authorities and clinicians. Both diseases exhibit similarities, and understanding their behavior over time is crucial to grasping their annual impact on many citizens. Furthermore, analyzing if medical personnel are well allocated and influence disease outcomes in a limited setting such as the Public Health System (PHS) is of utmost importance. This ecological study utilized secondary data from 2008 to 2020 to explore the relationship between the number of doctors per 100,000 inhabitants and mortality from FBC and MBC in Brazil. All data were sourced from Brazil’s PHS. Mortality rates were analyzed by age and standardized according to the World Health Organization’s population figures. The number of physicians was calculated per 100,000 inhabitants. A linear regression analysis was performed using a stepwise selection/backward elimination approach. Between 2008 and 2020, Brazil recorded 195,969 breast cancer-related deaths among adults, including 2,220 male victims. The majority of these deaths occurred in the Southeast region among patients older than 50 years. Although both MBC and FBC demonstrated increasing trends over the study period, no correlation was found between the number of physicians and mortality rates for MBC. Conversely, an increase in primary care physicians over the years was positively correlated with mortality rates for FBC (p < 0.05). In addition, the number of physicians in the PHS (β = -0.163; 95

To determine how lung cancer mortality differ by region in Brazil and whether these differences correlate with patient sex, income inequality and number of physicians involved in lung cancer treatment. Female sex, year of death and higher number of broncoesophalogists were all associated with lower mortality (p < 0.05), whereas a higher number of family medicine doctors, thoracic surgeons, pneumologists and a higher average income were associated with higher mortality rates (p < 0.05).

This is a cross-sectional study, with secondary data from Brazilian hospitals in the state of Paraíba, between January 2021 and January 2022. The evolution of clinical cases configured the dependent variable (cure or death), while the predictive variables were sociodemographic data, risk factors, use of ventilatory support, and vaccination against COVID-19. With the help of R software, the following tests were used: chi-square, Pearson’s chi-square, and Fisher’s exact adherence. Simple logistic regression models were constructed, and odds ratios (95% CI) were estimated using the LR test and Wald test. 7373 cases were reported, with a mean age of 58.1. Of the reported cases, 63.8% died. The most frequent sociodemographic profile included male people, of mixed race, with less than eight years of schooling. Chronic cardiovascular disease (OR 1.28; 95% CI: 1.13–1.45), diabetes (OR 1.41; 95% CI: 1.24–1.61), lung disease (OR 1.52; 95% CI: 1.11–2.09), and the use of invasive ventilatory support (OR 14.1; 95% CI: 10.56–18.59) were all associated with increased mortality. Nonvaccination was associated with a decreased risk of death (OR 0.74; 95% CI: 0.65–0.84). Male patients, nonwhite, and those with low education were more likely to have a worse clinical outcome. The risk factors studied were related to deaths, and those who did not require ventilatory support were related to cure.

e22532 Background: Female breast cancer (FBC) is a well-known public health issue worldwide. However, male breast cancer (MBC) is a rare condition, which might be overlooked by public health authorities and clinicians alike. Methods: Ecological study conducted with secondary data from 2008-2020 to examine the relationship between the amount of doctors per inhabitant on FBC and MBC mortality in Brazil and its federative regions. All data were gathered from Brazil’s public health system. For each cancer, mortality was analyzed by age and standardized by the World Health Organization’s population. The number of physicians was obtained from the Unified Health System and was calculated as the rate per 100,000 inhabitants. Linear regression was performed using stepwise selection/backward elimination. Results: Despite not reaching statistical significance, the total amount of physicians that work in the Unified Health System (UHS) was positively associated with MBC mortality (β 0.00003, IC95% -5,77 x 10 -6 ; 0.00007, p = 0.097), whereas there was a clear trend on FBC mortality reduction over the years (β -0.157, IC95% -0.2355;, p < 0.001) and with higher number of gynecologists (β -0.0400, IC95% -0.577; -0.2236, p < 0.001). Also, FBC mortality rates were positively associated with higher availability of physicians in general (β 0.0088, IC95% 0.0079; 0.0098, p < 0.001) in the UHS. Conclusions: Trends on FBC and MBC mortality rates differ in Brazil. Whereas higher mortality was associated with a greater amount of doctors per inhabitant, perhaps due to more diagnosis, trends on lower mortality rates were found only for FBC – in those cases, it was associated with more gynecologists available. For both neoplasms, there was no association between mortality rates and the amount of clinical oncologists nor primary care physicians available in the country. [Table: see text]

Descrever conhecimento e aceitabilidade dos profissionais de saúde na Amazônia Ocidental da vacina para Papillomavírus Humano (HPV). Estudo descritivo realizado no Sistema Assistencial à Saúde da Mulher e da Criança, no Acre entre janeiro e março/2017. Participaram do estudo 196 profissionais de saúde, com aplicação de instrumento de coleta contendo 31 questões divididas em seis domínios. Estatística descritiva foi realizada pelo programa Stata® 11.0. Os profissionais de saúde entrevistados eram 73% do sexo feminino e 41,3% da área médica. Demonstraram 98% (IC95% 94,5; 99,3) de conhecimento sobre o HPV ser causa câncer de colo do útero. Houve lacuna de conhecimento sobre a vacina para o HPV em relação ao esquema vacinal com 61,2% (IC95% 54,0; 68,0) de acerto e sobre a relação entre tabagismo e risco de câncer do colo do útero com 71,9% (IC95% 65,0; 78,0) acertos. Não foram identificadas barreiras à vacinação, onde 95,4% (IC 95% 91,2; 97,7) referem que a vacina não estimula o início precoce da vida sexual. Nas questões: “pacientes que vivem com HIV podem tomar a vacina?” e “pacientes gestantes podem tomar a vacina?”, evidenciaram-se lacunas de conhecimento com 48,5% (IC95% 41,3; 55,7) e 39,8% (IC95% 33,0; 47,0) de acertos, respectivamente. A aceitabilidade e o conhecimento sobre o HPV e sua vacina foram adequados entre profissionais de saúde com lacunas de conhecimentos específicos em relação ao esquema vacinal, uso em indivíduos que vivem com HIV e de cofatores não virais (tabagismo) relacionados à etiologia do câncer do colo uterino.

The Quilombola population has precarious living conditions and a risk of obesity. In addition, this population has been little studied in the health area, resulting in a gap in scientific evidence and a lack of policies to promote, protect, and restore health in Tocantins state. Objective: This study aimed to describe the Physical Activity Level (PAL) and body composition of a Quilombola community in the Tocantins state, Brazil. Methods: A cross-sectional study. We study 73 individuals between 10 and 81 years old. The instruments used were: Questionnaire on PAL and sedentary behavior and the International Physical Activity Questionnaire. Body composition was assessed by bioimpedance. The statistics analysis was performed using Stata software version 11.0. Results: Sedentary individuals were not found. Among children under 13 years old, 47.8% had a low PAL. The body composition, children and adolescents obtained better results 65.3% and 31.6% respectively. Conclusion: The children’s body fat indexes are within the recommendations (but the PAL is not). PAL of adolescents, adults, and the elderly is not sufficient to cause physiological adaptations in changing body fat levels. Although the Quilombola community maintains some cultural habits, complications of modern life regarding health are concerning, as they seem to be reaching these communities, leading to a lifestyle change, as observed in large cities. Keywords: Exercise; Body Composition; Vulnerable; Public Health.

Objective: To evaluate the association of conditional cash transfer policies to mitigate the food insecurity (FI) among families living in poverty during the COVID-19 pandemic in Ceará, Brazil. Methods: An analytical cross-sectional study was carried out through telephone contact during the period of May–July 2021, during the second wave of the COVID-19 pandemic in Ceará. Families in a situation of high social and economic vulnerability participated in this study (monthly per capita income of less than US$16.50). FI was assessed using the EBIA, a Brazilian validated questionnaire. The participation of families in government programs and public policies was also investigated. Logistic regression models were used to assess the association of the several factors assessed with food insecurity. Results: The prevalence of any food insecurity in this sample was 89.1% (95% Confidence interval (95% CI: 86.2 – 92.1) and of severe food insecurity, 30.3% (95% CI: 26.0 – 34.6). The Mais Infância card program, adopted as a cash transfer supplement in the state of Ceará, was significantly associated with food insecurity (OR 4.2 (95% CI: 1.7 – 10.2), with a p-value of 0.002. In addition, families affected by job losses due to the COVID-19 pandemic presented higher odds of FI. Conclusions: In this study, 89% of evaluated families presented food insecurity. Conditional cash transfer programs were associated with FI. We highlight the need for policies and interventions to reduce the impact of the COVID-19 pandemic on food insecurity. Such policies can adopt appropriate criteria for defining the participants, as well as connect the participants to an appropriate set of broader social protection measures.

Background: Alongside the rising prevalence of overweight and obesity in Brazil, there is expected to be increased direct healthcare costs of cancers. Herein, we estimated the economic costs of cancer attributable to overweight in the Brazilian Unified Health System (SUS), according to sex, type of cancer and geographic location (Federative Units). Methods: The population attributable fraction (PAF) of fifteen types of cancer were estimated using body mass index (BMI) data of 85,715 adults (>= 20 years) involved in the 2019 National Health Survey and relative risks of cancers from a meta-analysis. Inpatients and outpatient procedures and costs of cancer treatment were obtained from the SUS systems. Results: Costs of cancers included in this study were Int$ 1 billion in 2019, of which 9 % or Int$ 95 million were attributable to overweight and obesity. PAFs were higher in men (11 %) than in women (8 %), while the attributable cancer costs were higher in women (Int$ 55 million) than in men (Int$ 40 million). Cancers with the highest PAFs were endometrial cancer (40 %) and esophageal cancer (26 %), whereas cancers with the highest attributable costs were colorectal cancer (Int$ 25 million) and breast cancer (Int$ 24 million). Conclusion: Overweight was responsible for approximately Int$ 95 million (9 %) cancer direct healthcare cost in Brazil. Public policies and programs aimed at encouraging healthy diets and physical activity may decrease the economic burden of cancer in Brazil.

Background: Globally, stroke remains an important cause of death and long-term disability, and the impact of coronavirus disease (COVID-19) on the health system may have impaired stroke care. Previous studies suggest significant reduction in hospital admissions for stroke after COVID-19 onset as patients may hesitate seeking medical help due to fear of exposure. Methods: This cross-sectional study included cases of hospital admissions for stroke, identified from the Hospital Information System of the Unified Health System (Sistema Único de Saúde), which contains official and public data in Brazil. Data were collected in duplicate, then categorized according to the International Classification of Diseases, tenth revision (ICD-10), considering codes I60–I69. Linear regression was used to estimate the variation in hospital admissions for stroke in the city of São Paulo (SP) – the largest and most populous city in Brazil and Latin America, between January and June of each analyzed year (2017–2020). The percentage variation between June and January 2020 was also compared. The level of significance was set at 5%, and the statistical program used was Stata, version 14.0. Results: In the city of SP, during the first wave of COVID-19, from January to June 2020, there were registered decreases in absolute numbers and mean monthly admissions for stroke. Compared to January 2020, data from June 2020 showed 17% reduction in hospitalizations for intracerebral hemorrhage, 32% for cerebral infarction, 26% for stroke unspecified, and 47% for other cerebrovascular diseases. Conclusion: We argue for policies aimed at improving stroke care and developing awareness campaigns regarding the importance of early diagnosis and treatment, as even in less severe presentations, stroke can trigger an increase in mortality, cost, and long-term disability.

Objetivo: avaliar a associação entre as características socioeconômicas, demográficas e clínicas com a concentração de Vitamina D em adultos quilombolas no norte do Brasil. Métodos: estudo transversal realizado em cinco comunidades quilombolas do Estado do Tocantins. A amostra final contou com 34 sujeitos. As variáveis estudadas foram: características socioeconômicas e demográficas; sobrepeso e hipertensão arterial sistêmica. Resultados: a maioria dos participantes eram mulheres (76,5%, n=26); apenas 16% tinham emprego fixo; quase metade apresentava sobrepeso (47,1%, n=16) e somente 10% (n=3) apresentavam hipertensão arterial sistêmica. A taxa de indivíduos com alteração de vitamina D foi de 20,6% (n=7). Conclusão: os dados apontam baixa taxa de prevalência de deficiência de vitamina D em residentes quilombolas, podendo esse resultado estar associado à exposição constante ao sol.

Introduction: Stroke is one of the major causes of morbidity and mortality worldwide, difficult to treat and recover. The risk of developing stroke may be associated with environmental factors. Objective: To analyze the association between ambient temperature, air humidity and atmospheric pollution with the incidence of hospital admissions for stroke in the city of São Paulo in 2016. Methods: This is an ecological study, carried out by secondary data collection in the city of São Paulo in 2016. The definition of Stroke was according to the tenth revision of the International Classification of Diseases in codes: I60, I61, I63 and I64. Results: There was a positive correlation between the incidence of hospital admissions for stroke and in SO2 in air (rho: 0.80, p=0002) in women. In men there was a positive correlation between the number of hospital admission and SO2 concentration (rho: 0.570, p=0.005). Conclusion: We observed a positive correlation between the incidence of stroke and the concentration of the atmospheric pollutant SO2, an important fact for the intervention in the dispersion of pollutants.

Introduction: cardiovascular diseases are the leading causes of death in the world. Despite the reduction in CVD incidence and mortality in the 20th century, the values remain high in the 21st century. In Brazil, there is a gap in population studies that estimated standardized mortality rates from cardiovascular diseases in young adults. Objective: to assess the trend in mortality from cardiovascular diseases in young adults, according to sex, age group and regions of Brazil. Methods: ecological time series study using official secondary data from Mortality Information Systems (SIM). All deaths from cardiovascular diseases (I00-I-99) in young adults aged 20-49 years, residing in Brazil, in the period from January 1, 2008 to December 31, 2017, were considered. Data were extracted from the Department of Informatics of the SUS (DATASUS). The Prais-Winsten regression model was used and the Annual Percentage Variation (APV) was calculated. All analyzes were performed in STATA 14.0 software. Results: during the period 2008-2017, 294,232 deaths (8.7%) from cardiovascular disease were identified in young adults aged 20-49 years. A reduction in CVD mortality was identified in all regions of Brazil, except for individuals aged 20-24 years, residing in the Northeast region, which showed an increase (APC: 2.45%) (p<0.05) 2013 -2017. The greatest variation in the mortality trend occurred in the South region (APC: -25.2%). While the smallest change in mortality trend occurred in the Northeast region (APC: -8.8%). The annual decline was smaller in the second quinquennium (2013-2017) compared to the first (2008-2012). Furthermore, the decline was more pronounced among women (APC: -2.51%) (p<0.05) 2008-2012 and in young adults aged 40-44 years (APC: -2.91%) (p<0.05) 2008-2012. Furthermore, the trend in CVD mortality stabilized from 2013 onwards in males (p>0.05). Conclusion: the results demonstrate a decreasing trend in mortality from Cardiovascular Disease in young adults in Brazil, between 2008-2017. It is concluded that there is inequality in the trend of mortality from CVD according to sex, age group and regions of Brazil.

Objective: To investigate the perception of elderly people on living groups. Method: An exploratory study with qualitative approach, performed in six living groups in the city of Cajazeiras-PB, Brazil, in September and October 2010, using the discourse of the collective subject. Results: Of the 60 study participants, 48 (80%) were women, 21 (35%) were between 65-69 years, 30 (50%) were widowed, 46 (77%) were retired, 32 (53%) have not completed primary education, 40 (67%) lived with relatives, 25 (42%) between six and ten years of participation groups, 33 (55%) and 30 (50%) participated spontaneously pointed to the dance as the best activity developed in the group. Through the collected data we obtained the main ideas and the collective discourses represented by three themes: reasons/motives for elderly seek living groups; importance of meetings with the group for the elderly; life changes after joining the group. From the themes we extracted the main ideas: solitude, leisure, coexistence, freedom, everything changed, will to live. Conclusion: Groups provide benefits for the elderly, emphasizing among these the right to age with dignity and improving the quality of life.

No âmbito das políticas públicas para a primeira infância, têm-se instituído programas cujo objetivo é melhorar a qualidade de vida das famílias que vivem em situação de vulnerabilidade social, visando assegurar uma melhor atenção às crianças nos primeiros anos de vida. O programa Mais Infância Ceará possui uma abordagem e coordenação intersetorial, composta por secretarias do Estado em articulação com diversas políticas setoriais, com uma visão abrangente de todos os direitos da criança, constituindose um instrumento por meio do qual o Estado e os municípios asseguram o atendimento dos direitos da criança. Este relato de experiência tem o objetivo de descrever como ocorreu a implantação do programa Mais Infância Ceará e como ocorre o monitoramento e as principais inovações desenvolvidas a partir dele. No âmbito da governança e análise de dados, duas plataformas foram desenvolvidas para auxiliar na gestão, divulgação e tomada de decisão, são elas: Big Data Social e Plataforma Mais Infância

OBJECTIVEThe aim of this study was to assess the quality of primary health care services through self-reports by caregivers of children and adolescents living in quilombola communities in Brazil.METHODSThis is a cross-sectional study in accordance with the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology). Exposure variables included sociodemographic characteristics; and outcome variable was the quality of primary health care offered to quilombola children and adolescents.RESULTSA total of 68 individuals participated in the survey. Quilombolas have a low income, a lower level of education, do not work, and receive government benefits. Our results showed that the quality of primary health care, measured by the experience of caregivers of quilombola children and adolescents, generally presents satisfactory values.CONCLUSIONThe quality of primary health care has generally satisfactory values. However, as these results differ from most studies, more research should be conducted.

We aimed, through an ecological survey of cervical cancer outcomes in Brazil, to analyze the influence of socioeconomic and care indicators of social vulnerability. The study sample (2010–2015) is composed of women diagnosed with cervical cancer, in different regions of the country. Data were collected from the Department of Health, in addition to searching the social vulnerability database of the Institute of Applied Economic Research. The incidence of age-standardized hospital admission declined over the years of the study in almost all regions but only one region showed a significant decline in indices of social vulnerability. In two other regions, one important indicator (human capital) significantly decreased. There was a positive correlation between vulnerability indices and age-standardized hospital admissions in most of the country. Decreasing vulnerability by easy access to cancer screening and early treatment improves cervical cancer outcomes.