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A portrait of gestational diabetes mellitus in Brazil: A systematic review and meta-analysis
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Iser, Betine Pinto Moehlecke

; Stein, Caroline

; Alves, Luisia Feichas

; Carvalho, Morgana Lourenço de Souza

; Espinoza, Sergio Angelo Rojas

; Schmidt, Maria Inês

Archives of Endocrinology and Metabolism

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2023, Volume 67 N. 6 elocation e220521

Abstract: En | Text: En | PDF: En

ABSTRACT The diagnostic criteria for gestational diabetes mellitus (GDM), a transient hyperglycemic state during pregnancy, has varied remarkably over time, resulting in a diversity of prevalence rates. The aim of this systematic literature review was to provide estimates of prevalence rates of GDM in Brazil according to different diagnostic criteria. We identified, reviewed, and extracted data from the scientific literature on studies estimating the prevalence of diabetes in pregnant women living in Brazil. The databases searched were PubMed, LILACS, SciELO, Embase, Web of Science, and Cochrane Library. We grouped studies by the source of information assessing GDM, patients’ age, and criteria used to diagnose GDM. When three or more studies were available in a group, we calculated the pooled prevalence. The Joanna Briggs Institute (JBI) appraisal tool was used to assess the risk of bias. The data were reported according to the 2020 PRISMA recommendations. The study protocol was registered in PROSPERO. We identified 1,328 records and selected 21 studies involving 122,635 pregnant women. Studies in adults only, with primary data and laboratory measurements, and using the IADPSG criteria (n = 3) had a GDM prevalence of 18.0% (95% confidence interval [CI]: 16.0-20.1%) and included 6,243 participants. Estimates of self-reported GDM (n = 3; 10,136 participants of all ages) had a pooled GDM prevalence of 2.1% (95% CI: 1.5-5.2%), with high heterogeneity (I2 = 85.0%, p < 0.01). Studies including adolescents had consistently low prevalences. The prevalence of GDM in Brazil varied, was greater when the IADPSG criteria were applied, and depended on the methods used to obtain the GDM information and the age structure of the sample.

https://doi.org/10.20945/2359-4292-2022-0521

Rhinovirus as the main co-circulating virus during the COVID-19 pandemic in children
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Varela, Fernanda Hammes

; Sartor, Ivaine Tais Sauthier

; Polese-Bonatto, Márcia

; Azevedo, Thaís Raupp

; Kern, Luciane Beatriz

; Fazolo, Tiago

; David, Caroline Nespolo de

; Zavaglia, Gabriela Oliveira

; Fernandes, Ingrid Rodrigues

; Krauser, João Ronaldo Mafalda

; Stein, Renato T.

; Scotta, Marcelo Comerlato

Jornal de Pediatria

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dec 2022, Volume 98 N. 6 Pages 579 - 586

Abstract: En | Text: En | PDF: En

Abstract Objective: Changes in the epidemiology of respiratory infections during the restrictions imposed as a response to the coronavirus disease 2019 (COVID-19) pandemic have been reported elsewhere. The present study’s aim was to describe the prevalence of a large array of respiratory pathogens in symptomatic children and adolescents during the pandemic in Southern Brazil. Methods: Hospitalized and outpatients aged 2 months to 18 years with signs and symptoms of acute COVID-19 were prospectively enrolled in the study from May to November 2020 in two hospitals in a large metropolitan area in a Brazilian city. All participants performed a real-time PCR panel assessing 20 respiratory pathogens (three bacteria and 17 viruses). Results: 436 participants were included, with 45 of these hospitalized. Rhinovirus was the most prevalent pathogen (216/436) followed by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, 97/436), with a coinfection of these two viruses occurring in 31/436 participants. The remaining pathogens were found in 24 symptomatic participants (adenovirus, n = 6; Chlamydophila pneumoniae, n = 1; coronavirus NL63, n = 2; human enterovirus, n = 7; human metapneu-movirus, n = 2; Mycoplasma pneumoniae, n = 6). Hospitalization was more common among infants (p = 0.004) and those with pathogens other than SARS-CoV-2 (p = 0.001). Conclusion: During the period of social distancing in response to COVID-19, the prevalence of most respiratory pathogens was unusually low. Rhinovirus remained as the main virus co-circulating with SARS-CoV-2. COVID-19 in symptomatic children was less associated with hospitalization than with other respiratory infections in children and adolescents.

https://doi.org/10.1016/j.jped.2022.03.003

Association between obesity and hospitalization in mild COVID-19 adult outpatients in Brazil: a prospective cohort study
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Sartor, Ivaine Tais Sauthier

; David, Caroline Nespolo de

; Telo, Gabriela Heiden

; Zavaglia, Gabriela Oliveira

; Fernandes, Ingrid Rodrigues

; Kern, Luciane Beatriz

; Polese-Bonatto, Márcia

; Azevedo, Thaís Raupp

; Santos, Amanda Paz

; Almeida, Walquiria Aparecida Ferreira de

; Porto, Victor Bertollo Gomes

; Varela, Fernanda Hammes

; Scotta, Marcelo Comerlato

; Rosa, Regis Goulart

; Stein, Renato T.

Archives of Endocrinology and Metabolism

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aug 2022, Volume 66 N. 4 Pages 512 - 521

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: To evaluate the association between obesity and hospitalization in mild COVID-19 adult outpatients in Brazil. Subjects and methods: Adults with signs and symptoms suggestive of acute SARS-CoV-2 infection who sought treatment in two hospital (public and private) emergency departments were prospectively enrolled. Patients with confirmed COVID-19 at inclusion were followed by phone calls at days D7, D14 and D28. Multivariable logistic regression models were employed to explore the association between obesity and other potential predictors for hospitalization. Results: A total of 1,050 participants were screened, and 297 completed the 28-day follow-up and were diagnosed with COVID-19 by RT-PCR. The median age was 37.2 (IQR 29.7-44.6) years, and 179 (60.0%) were female. The duration of symptoms was 3.0 (IQR 2.0-5.0) days, and 10.0 (IQR 8.0-12.0) was the median number of symptoms at inclusion. Ninety-five (32.0%) individuals had obesity, and 233 (78.5%) had no previous medical conditions. Twenty-three participants (7.7%) required hospitalization during the follow-up period. After adjusting, obesity (BMI ≥ 30.0 kg/m2) (OR = 2.69, 95% CI 1.63-4.83, P < 0.001) and older age (OR = 1.05, 95% CI 1.01-1.09, P < 0.001) were significantly associated with higher risks of hospitalization. Conclusion: Obesity, followed by aging, was the main factor associated with hospital admission for COVID-19 in a young population in a low-middle income country. Our findings highlighted the need to promote additional protection for individuals with obesity, such as vaccination, and to encourage lifestyle changes.

https://doi.org/10.20945/2359-3997000000486

Low performance of a SARS-CoV-2 point-of-care lateral flow immunoassay in symptomatic children during the pandemic
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Scotta, Marcelo Comerlato

; David, Caroline Nespolo de

; Varela, Fernanda Hammes

; Sartor, Ivaine Tais Sauthier

; Polese-Bonatto, Márcia

; Fernandes, Ingrid Rodrigues

; Zavaglia, Gabriela Oliveira

; Ferreira, Charles Francisco

; Kern, Luciane Beatriz

; Santos, Amanda Paz

; Krauzer, João Ronaldo Mafalda

; Pitrez, Paulo Márcio

; Almeida, Walquiria Aparecida Ferreira de

; Porto, Victor Bertollo Gomes

; Stein, Renato T.

Jornal de Pediatria

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apr 2022, Volume 98 N. 2 Pages 136 - 141

Abstract: En | Text: En | PDF: En

Abstract Objective: to evaluate the accuracy of an antibody point-of-care lateral flow immunoassay (LFI -Wondfo Biotech Co., Guangzhou, China) in a pediatric population. Methods: children and adolescents (2 months to 18 years) with signs and symptoms suggestive of acute SARS-CoV-2 infection were prospectively investigated with nasopharyngeal RT-PCR and LFI at the emergency room. RT-PCR was performed at baseline, and LFI at the same time or scheduled for those with less than 7 days of the clinical picture. Overall accuracy, sensitivity and specificity were assessed, as well as according to the onset of symptoms (7-13 or ≥14 days) at the time of the LFI test. Results: In 175 children included, RT-PCR and LFI were positive in 51 (29.14%) and 36 (20.57%), respectively. The overall sensitivity, specificity, positive and negative predictive value was 70.6% (95%CI 56.2-82.5), 96.8% (95%CI 91.9-99.1), 90.0% (95%CI 77.2-96.0), and 88.9% (95%CI 83.9-92.5), respectively. At 7-13 and ≥14 days after the onset of symptoms, sensitivity was 60.0% (95%CI 26.2-87.8) and 73.2% (95%CI 57.1-85.8) and specificity was 97.9% (95%CI 88.7-99.9) and 96.1% (95%CI 89.0-99.2), respectively. Conclusion: Despite its high specificity, in the present study the sensitivity of LFI in children was lower (around 70%) than most reports in adults. Although a positive result is informative, a negative LFI test cannot rule out COVID-19 in children.

https://doi.org/10.1016/j.jped.2021.04.010

Premature mortality due to four main non-communicable diseases and suicide in Brazil and its states from 1990 to 2019: A Global Burden of Disease Study
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Cousin, Ewerton

; Schmidt, Maria Inês

; Stein, Caroline

; Aquino, Érika Carvalho de

; Gouvea, Ellen de Cassia Dutra Pozzetti

; Malta, Deborah Carvalho

; Naghavi, Mohsen

; Duncan, Bruce B.

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 Suppl. 1 elocation e0328-2021

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: The goal of reducing the burden of non-communicable diseases (NCDs) requires close monitoring. Our objective is to characterize the decline of premature NCD mortality in Brazil based on Global Burden of Diseases (GBD) Study 2019 estimates. METHODS: We used GBD 2019 data to estimate death rates of the four main NCDs - cardiovascular diseases, neoplasms, diabetes, and chronic respiratory diseases. We estimated the unconditional probability of death between ages 30 to 69, as recommended by the World Health Organization, as well as premature crude- and age-standardized death rates and disability-adjusted life years (DALYs) lost for these conditions. We also estimated trends in suicide (self-harm) death rates. RESULTS: From 2010 to 2019, the age-standardized unconditional probability of premature death declined -1.4%/year (UI: -1.7%;-1.0%) . Age-standardized death rates declined -1.5%/year (UI: -1.9%; -1.2%), and crude death rates -0.6%/year (UI: (-1.0%; -0.2%). Level of development correlated strongly with the rate of decline, with greatest declines occurring in the Southeast, Center West and South regions. Age-standardized mortality from self-harm declined, most notably in the elderly. CONCLUSIONS: Premature mortality due to the main NCDs has declined from 1990 in Brazil, although at a diminishing rate over time. The unconditional probability of death and the age-standardized mortality rate produced similar estimates of decline for the four main NCDs, and mirror well decline in mortality from all NCDs. Declines, especially more recent ones, fall short of the international goals. Strategic public health actions are needed. The challenge to implement them will be great, considering the political and economic instability currently faced by Brazil.

https://doi.org/10.1590/0037-8682-0328-2021

Exposure to and Burden of Major Non-Communicable Disease Risk Factors in Brazil and its States, 1990-2019: The Global Burden of Disease Study
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Stein, Caroline

; Schmidt, Maria Inês

; Cousin, Ewerton

; Malta, Deborah Carvalho

; Naghavi, Mohsen

; Oliveira, Patrícia Pereira Vasconcelos de

; Ribeiro, Antonio Luiz Pinho

; Duncan, Bruce B.

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 Suppl. 1 elocation e0275-2021

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: Non-Communicable Diseases (NCDs) have become the main cause of disease burden in Brazil. Our objective was to describe trends (1990 to 2019) in prevalence and attributable burden of five modifiable risk factors and related metabolic risk factors in Brazil and its states. METHODS: In Global Burden of Disease 2019 analyses, we described trends in prevalence of modifiable risk factors and their metabolic mediators as percentage change in Summary Exposure Value (SEV). We estimated deaths and disability-adjusted life years (DALYs) attributable to the risk factors. RESULTS: Age-adjusted exposures to alcohol [41.0%, Uncertainty Interval (UI): 24.2 - 63.4], red meat (61.2%, UI: 42.4-92.3), low physical activity (3.9%, UI: -5-17.5) and ambient particulate matter pollution (3.3%, UI: -48.9-128.0) have worsened. Those for smoking (-51.4%, UI: -54.7- - 47.8), diet low in fruits (-28.1%, UI: -39.1- -18.7) and vegetables (-19.6%, UI: -32.7 - -8.7), and household air pollution (-85.3%, UI: -92.9- -74.3) have improved. All mediating metabolic risk factors, except high blood pressure (0.7%, UI: -6.9-8.3), have worsened: BMI (110.2%, UI: 78.6-161.7), hyperglycemia (15.1%, UI: 9.3-21.2), kidney dysfunction (12.0%, UI: 8.4-17.2), and high LDL-c (11.8%, UI: 6.9-17.2). CONCLUSIONS: A variable pattern of progress and failure in controlling modifiable risk factors has been accompanied by major worsening in most metabolic risk factors. The mixed success in public health measures to control modifiable risk factors for NCDs, when gauged by the related trends in metabolic risk factors, alert to the need for stronger actions to control NCDs in the future.

https://doi.org/10.1590/0037-8682-0275-2021

Prevalence, incidence, and years-lived with disability due to oral disorders in Brazil: an analysis of the Global Burden of Disease Study 2019
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Hugo, Fernando Neves

; Bailey, Jordan A

; Stein, Caroline

; Cunha, Amanda Ramos da

; Iser, Betine Pinto Moehlecke

; Malta, Deborah Carvalho

; Giordani, Jessye Melgarejo do Amaral

; Hilgert, Juliana Balbinot

; Abreu, Lucas Guimarães

; Kassebaum, Nicholas J

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 Suppl. 1 elocation e0284-2021

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION Epidemiological surveys revealed that Brazil has a high burden of oral diseases. However, no prior study has reported estimates of untreated dental caries, periodontitis, and edentulism over a three-decade period. The objective of this study is to report the trends of prevalence, incidence, and years-lived with disability (YLDs) due to untreated dental caries in primary and permanent teeth, periodontitis, and edentulism in Brazil between 1990 and 2019. METHODS Estimates of prevalence, incidence, and YLDs due to dental caries in primary and permanent teeth, periodontitis, and edentulism were produced for Brazil, by sex and age, between 1990 and 2019, using Dismod-MR 2.1, as part of the Global Burden of Disease Study 2019 (GBD 2019). Trends of oral disorders were analyzed using generalized linear regression models applying the Prais-Winsten method. RESULTS Almost 100 million Brazilians presented at least one oral disorder in 2019, which was equivalent to a prevalence of 45.3%. All oral diseases combined ranked eighth among all causes of disability, causing more than 970,000 YLDs. Untreated dental caries in primary teeth were estimated to affect 13.5 million children, and untreated dental caries in permanent teeth affected more than 52 million people. Periodontitis affected 29.5 million people, and edentulism affected almost 22 million. The generalized linear regression models revealed a trend of stability of oral disorders between 1990 and 2019. CONCLUSIONS The burden of oral diseases in Brazil is extremely high. Oral disorders, edentulism in particular, caused disability at levels that are comparable to other important chronic diseases.

https://doi.org/10.1590/0037-8682-0284-2021

Incidence and mortality rates of lip, oral cavity, and pharynx cancers in Brazil: time-trend and age-period-cohort analysis from the last 30 years, Global Burden of Disease Study
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Romagna, Daniel Volpato

; Oliveira, Max Moura de

; Abreu, Lucas Guimarães

; Stein, Caroline

; Hugo, Fernando Neves

; Teixeira, Renato

; Malta, Deborah Carvalho

; Naghavi, Mohsen

; Iser, Betine Pinto Moehlecke

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 Suppl. 1 elocation e0286-2021

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: Cancers are the second main cause of morbidity worldwide, but robust information on lip, oral cavity, and pharynx cancers in Brazil is lacking. This study aimed to analyze the trends of incidence and mortality caused by lip, oral cavity, and pharynx cancers and age-period-cohort effects in the Brazilian population of 30 years of age and over, in the period of 1990 to 2019. METHODS: A time series study of the incidence and mortality rates for oral cavity and pharynx cancer (“Lip and oral cavity cancer”, “Nasopharynx cancer”, and “Other pharynx cancer”) was conducted, with corrected data from the Global Burden of Disease Study (GBD) 2019. Age-standardized rates per 100,000 inhabitants, for the global population, were gathered according to the individuals’ sex. The annual average percentage change (AAPC) was estimated, as was the age-period-cohort effects. RESULTS: The incidence and mortality rates were higher for men in the studied anatomical regions. The cancers tended to decrease for men, except for nasopharynx cancer, which increased in individuals of both sexes. Mortality tended to present a decline in most of the groups studied. For men and women, the age-period-cohort model presented a better adjustment for both incidence and mortality. CONCLUSIONS: Incidence and mortality caused by the main head and neck cancers showed a tendency to decline over the past 30 years in Brazil, except for nasopharynx cancer, which showed an increase in incidence and mortality in some segments of the population. Higher rates were found for lip and oral cavity cancers in men.

https://doi.org/10.1590/0037-8682-0286-2021

Diagnostic accuracy of a SARS-CoV-2 rapid test and optimal time for seropositivity according to the onset of symptoms
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David, Caroline Nespolo de

; Varela, Fernanda Hammes

; Sartor, Ivaine Tais Sauthier

; Polese-Bonatto, Márcia

; Fernandes, Ingrid Rodrigues

; Zavaglia, Gabriela Oliveira

; Kern, Luciane Beatriz

; Ferreira, Charles Francisco

; Bastos, Gisele Alsina Nader

; Pitrez, Paulo Márcio

; Almeida, Walquiria Aparecida Ferreira de

; Porto, Victor Bertollo Gomes

; Zavascki, Alexandre Prehn

; Stein, Renato Tetelbom

; Scotta, Marcelo Comerlato

Cadernos de Saúde Pública

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2022, Volume 38 N. 1 elocation e00069921

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Os testes sorológicos no local de atendimento (point-of-care) para a infecção pelo SARS-CoV-2 têm sidos utilizados para o diagnóstico da COVID-19. Entretanto, não está plenamente elucidada a acurácia dos testes ao longo do tempo em relação ao início dos sintomas. Nosso objetivo foi de avaliar a acurácia, no local de atendimento, do imunoensaio de fluxo lateral (LFI). Pacientes com ≥ 18 anos de idade que apresentavam sintomas clínicos sugestivos de infecção aguda pelo SARS-CoV-2 foram testados uma vez com RT-PCR da nasofaringe e orofaringe, além do LFI. A acurácia do LFI foi avaliada com intervalos periódicos de 3 dias a partir do início dos sintomas. O ponto de corte ótimo foi definido como o número necessário de dias para atingir a melhor sensibilidade e especificidade. Esse ponto foi utilizado também para comparar a acurácia do LFI de acordo com a situação do paciente (ambulatorial ou hospitalizado). Foram incluídos 959 pacientes, dos quais 379 (39,52%) testaram positivos para SARS-CoV-2 pelo RT-PCR e 272 (28,36%) pelo LFI. Foi atingido o melhor desempenho para o LFI com 10 dias a partir do início dos sintomas, com sensibilidade e especificidade de 84,9% (IC95%: 79,8-89,1) e 94,4% (IC95%: 91,0-96,8), respectivamente. Embora a especificidade não tenha sido diferente entre os grupos de pacientes (94,6% vs. 88,9%, p = 0,051), a sensibilidade foi mais alta nos pacientes hospitalizados que nos ambulatoriais (91,7% vs. 82,1%, p = 0,032) no dia 10 depois do início dos sintomas. A melhor sensibilidade do LFI no local de atendimento ocorre 10 dias depois do início dos sintomas, o que pode limitar seu uso no atendimento agudo. A especificidade permanece alta, independentemente do número de dias desde o início dos sintomas.

Point-of-care serological tests for SARS-CoV-2 have been used for COVID-19 diagnosis. However, their accuracy over time regarding the onset of symptoms is not fully understood. We aimed to assess the accuracy of a point-of-care lateral flow immunoassay (LFI). Subjects, aged over 18 years, presenting clinical symptoms suggestive of acute SARS-CoV-2 infection were tested once by both nasopharyngeal and oropharyngeal RT-PCR and LFI. The accuracy of LFI was assessed in periodic intervals of three days in relation to the onset of symptoms. The optimal cut-off point was defined as the number of days required to achieve the best sensitivity and specificity. This cut-off point was also used to compare LFI accuracy according to participants’ status: outpatient or hospitalized. In total, 959 patients were included, 379 (39.52%) tested positive for SARS-CoV-2 with RT-PCR, and 272 (28.36%) tested positive with LFI. LFI best performance was achieved after 10 days of the onset of symptoms, with sensitivity and specificity of 84.9% (95%CI: 79.8-89.1) and 94.4% (95%CI: 91.0-96.8), respectively. Although the specificity was similar (94.6% vs. 88.9%, p = 0.051), the sensitivity was higher in hospitalized patients than in outpatients (91.7% vs. 82.1%, p = 0.032) after 10 days of the onset of symptoms. Best sensitivity of point-of-care LFI was found 10 days after the onset of symptoms which may limit its use in acute care. Specificity remained high regardless of the number of days since the onset of symptoms.

Los puestos de atención para pruebas serológicas del SARS-CoV-2 han sido usado para la diagnosis de la COVID-19. No obstante, su precisión a lo largo del tiempo, en lo que respecta a la aparición de los síntomas, no se ha comprendido completamente. Nuestro objetivo fue evaluar la precisión de un puesto de atención de inmunoanálisis de flujo lateral (LFI). Se hizo pruebas a individuos ≥ 18 años, presentando síntomas clínicos compatibles con una infección aguda de SARS-CoV-2, tanto vía nasofaríngea y orofaríngea RT-PCR, como LFI. La precisión de LFI fue evaluada en intervalos periódicos de 3 días con respecto a la aparición de los síntomas. El punto óptimo de corte se definió como el número de días requerido para alcanzar la mejor sensibilidad y especificidad. Este punto también se usó para comparar la precisión del LFI, según el estatus de los participantes: ambulatorios u hospitalizados. Se incluyeron a 959 pacientes, 379 (39,52%) dieron positivo en las pruebas de SARS-CoV-2 RT-PCR, y 272 (28,36%) fueron positivos en los LFI. Se alcanzó el mejor rendimiento de los LFI tras 10 días de la aparición de los síntomas, con una sensibilidad y especificidad de un 84,9% (IC95%: 79,8-89,1) y 94,4% (IC95%: 91,0-96,8), respectivamente. A pesar de que la especificidad no fue diferente (94,6% vs. 88,9%, p = 0,051), la sensibilidad fue mayor en pacientes hospitalizados que en los ambulatorios (91,7% vs. 82,1%, p = 0,032) tras 10 días desde la aparición de los síntomas. La mejor sensibilidad LFI del puesto de cuidado se produce tras 10 días de la aparición de los síntomas, lo que quizás limite su uso en el cuidado de urgencias. La especificidad permanece alta independientemente del número de días desde la aparición de los síntomas.

https://doi.org/10.1590/0102-311x00069921

10.

Diagnostic accuracy of a SARS-CoV-2 rapid test and optimal time for seropositivity according to the onset of symptoms
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David, Caroline Nespolo de

; Varela, Fernanda Hammes

; Sartor, Ivaine Tais Sauthier

; Polese-Bonatto, Márcia

; Fernandes, Ingrid Rodrigues

; Zavaglia, Gabriela Oliveira

; Kern, Luciane Beatriz

; Ferreira, Charles Francisco

; Bastos, Gisele Alsina Nader

; Pitrez, Paulo Márcio

; Almeida, Walquiria Aparecida Ferreira de

; Porto, Victor Bertollo Gomes

; Zavascki, Alexandre Prehn

; Stein, Renato Tetelbom

; Scotta, Marcelo Comerlato

Cadernos de Saúde Pública

Journal Metrics
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2022, Volume 38 N. 1 elocation e00069921

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.1590/0102-311x00069921

11.

Incentivos fiscais como instrumento de política ambiental: uma análise do IPTU Verde de municípios mineiros
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Ortiz, Ana Carolina Tomaz Duarte Tobaruela

; Brandão, Leidielen Peres

; Rabelo, Jordana Stein

; Gama, Lucilene Umbelino

; Malvestio, Anne Caroline

urbe. Revista Brasileira de Gestão Urbana

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2022, Volume 14 elocation e20210181

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O IPTU Verde constitui uma política urbana que visa estimular o desenvolvimento de ações ambientalmente sustentáveis. Com o intuito de conhecer a aplicação desse instrumento, neste trabalho analisaram-se as legislações sobre o IPTU Verde dos municípios de Minas Gerais com mais de 500 mil habitantes: Belo Horizonte, Uberlândia, Contagem e Juiz de Fora. A partir da análise dessas legislações quanto aos objetivos, critérios e benefícios, observou-se que Belo Horizonte é o único município com IPTU Verde cujo objetivo é voltado somente à conservação da biota nativa. No que tange às exigências e forma de avaliação, foram encontradas semelhanças nas leis de Belo Horizonte e Uberlândia para a proteção da flora nativa, e nas leis de Juiz de Fora e Contagem para a adoção de ações e práticas sustentáveis. Nas legislações analisadas, o benefício ocorre mediante isenção e/ou desconto no IPTU, com descontos maiores direcionados a uma proteção mais intensa da flora. Embora Belo Horizonte seja mais populoso que Uberlândia, possui menor quantidade de beneficiários, o que pode estar associado aos critérios estabelecidos em sua lei. Ademais, notou-se que os objetivos, critérios e benefícios do IPTU Verde variam conforme os interesses dos municípios, e inexistem diretrizes para a elaboração dessa política pública.

Abstract The Green IPTU is an urban policy that aims to encourage the development of environmentally sustainable actions. In order to know the application of this instrument, in this work we analyzed the legislation of the Green IPTU on the municipalities of Minas Gerais with more than 500 thousand inhabitants: Belo Horizonte, Uberlândia, Contagem and Juiz de Fora. From the analysis of these legislations regarding to objectives, criteria and benefits, it was observed that Belo Horizonte is the only municipality whose objective of the Green IPTU is aimed only at the conservation of native biota. Regarding to the requirements and form of assessment, similarities were found in the laws of Belo Horizonte and Uberlândia, for the protection of native flora, and in the laws of Juiz de Fora and Contagem, for the adoption of sustainable actions and practices. In the analyzed legislation, the benefit occurs through fiscal exemption or discount in the IPTU, with larger discounts directed to a more intense protection of the flora. Although Belo Horizonte is more populous than Uberlândia, it has a smaller number of beneficiaries, which may be associated with the criteria established in its law. In addition, it was noted that the objectives, criteria and benefits of the Green IPTU changed according to the interests of the municipalities and there are no guidelines for the elaboration of this public policy.

https://doi.org/10.1590/2175-3369.014.e20210181

12.

Acolhimento e ambiência hospitalar: percepção de profissionais da saúde
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Oliveira, Caroline de

; Gomes, Carine Alves

; Pereira, Adriana Dall Asta

; Lomba, Maria de Lurdes Lopes de Freitas

; Poblete, Margarita

; Backes, Dirce Stein

Acta Paulista de Enfermagem

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2022, Volume 35 elocation eAPE03216

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Resumo Objetivo Conhecer a percepção de acolhimento e ambiência para profissionais de saúde, na perspectiva de referenciais da humanização. Métodos Trata-se de um estudo qualitativo realizado entre fevereiro e junho de 2019, com 18 profissionais de uma instituição hospitalar filantrópica de médio porte, localizada na região central do estado do Rio Grande do Sul. Os dados foram coletados com base na técnica de grupo focal e submetidos à análise de conteúdo. Resultados As duas categorias temáticas Acolhimento: da rotina à escuta qualificada; e Ambiência: da individualidade à interatividade denotam compreensões complementares. O acolhimento associa-se aos processos dialógicos e a ambiência relaciona-se às questões de conforto e aos espaços propícios à interação entre usuários, familiares e equipe de colaboradores. Conclusão O acolhimento e a ambiência hospitalar vão além de melhorias físicas e vínculos utilitaristas ou funcionais. Os mesmos podem ser considerados indutores e ampliadores de promoção da saúde, tanto de gestores e colaboradores quanto de usuários. Pressupõe-se, para tanto, processos interativos e dialógicos construídos com base em gestos simples, em atitudes respeitosas e em práticas motivadoras e potencializadoras de cuidado.

Abstract Objective To assess healthcare professionals’ perception of care and ambience, from the perspective of humanization references. Method This is a qualitative study carried out between February and June 2019, with 18 professionals from a medium-sized philanthropic hospital in the central region of the state of Rio Grande do Sul. Data were collected with the focus group technique and submitted to content analysis. Results The two thematic categories Care: from routine to qualified listening; and Ambience: from individuality to interactivity demonstrated complementary understandings. Care is associated with dialogic processes and ambience is related to comfort and to spaces that allow interaction between users, family members and staff. Conclusion Care and hospital environment go beyond physical improvements and professional or functional bonds. They can induce and enhance health promotion for managers, employees and users. They require, therefore, interactive and dialogic processes with simple gestures, respectful attitudes and motivating and health-enhancing practices.

Resumen Objetivo Conocer la percepción de acogida y ambientación para profesionales de la salud, desde la perspectiva del marco referencial de la humanización. Métodos Se trata de un estudio cualitativo realizado entre febrero y junio de 2019, con 18 profesionales de una institución hospitalaria filantrópica de porte mediano, localizada en la región central de estado de Rio Grande do Sul. Los datos fueron recopilados con base en la técnica de grupo focal y fueron sometidos al análisis de contenido. Resultados Las dos categorías temáticas Acogida: de la rutina a la escucha cualificada y Ambientación: de la individualidad a la interactividad denotan comprensiones complementarias. La acogida está asociada a los procesos dialógicos y la ambientación está relacionada con cuestiones de bienestar y con espacios propicios para la interacción entre usuarios, familiares y equipo de colaboradores. Conclusión La acogida y la ambientación hospitalaria van más allá de mejoras físicas y vínculos utilitaristas o funcionales. Estos pueden considerarse inductores y ampliadores de la promoción de la salud, tanto de administradores y colaboradores, como de usuarios. Para eso, se presupone que existan procesos interactivos y dialógicos construidos con base en gestos simples, actitudes respetuosas y prácticas motivadoras y fortalecedoras del cuidado.

https://doi.org/10.37689/acta-ape/2022ao032166

13.

[SciELO Preprints] - Socioeconomic inequalities and use of dental services in Brazil: an analysis of the 2019 National Health Survey
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Fagundes, Maria Laura Braccini Bastos, Lucelen Fontoura Amaral Júnior, Orlando Luiz do Menegazzo, Gabriele Rissotto Cunha, Amanda Ramos da Stein, Caroline Abreu, Lucas Guimarães Hugo, Fernando Neves Giordani, Jessye Melgarejo do Amaral Malta, Deborah Carvalho Iser, Betine Pinto Moehlecke

Journal Metrics
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Publication date: 2021-09-10

Abstract: En Pt

Objective: To describe the prevalence of use of dental services in Brazil according to the states and its association with socioeconomic variables and types of services in the Brazilian Health Survey of 2019. Methods: A population-based, cross-sectional study using data from the Brazilian Health Survey of 2019, including 88,531 individuals with 18 years of age or more. Results: Dental services utilization in the year prior to the study was more frequent among adults (53.2%, 95% CI:52.5-53.9) than in older adults (34.3%, 95% CI: 33.2-34.4). The multivariate analysis revealed that the use of dental services was more in people with more schooling (PR=2.02, 95% CI: 1.87-2.18) and higher income (PR=1.54, 95% CI: 1.45-1.64). The prevalence of dental services utilization in the year prior to the survey was higher among participants of the southeast, south and Midwest regions, ranging between 49.0% and 57.6%. Conclusion: Inequalities in dental services utilization were common in adults and older adults, with important regional differences; women, younger participants, those with more schooling and higher income, people with better oral health-related behaviors, better self-perceived oral health and those who paid for their lasts dental consultation were more likely to have used dental services in the year prior to the study.

Objetivo: Descrever a prevalência do uso de serviços odontológicos no Brasil segundo as Unidades Federadas, sua relação com variáveis socioeconômicas e tipos de serviços, com base na Pesquisa Nacional de Saúde (PNS) de 2019. Métodos: Trata-se de um estudo transversal de base populacional com dados da PNS 2019, incluindo 88.531 participantes de 18 anos ou mais. Foram analisadas variáveis referentes ao uso de serviços de saúde bucal, segundo características sociodemográficas e comportamentais, por meio de análise multivariada, utilizando modelo regressão de Poisson com variância robusta. Resultados: A utilização de serviços odontológicos no ano anterior à entrevista foi maior entre os adultos (53,2%, IC95%: 52,5-53,9) do que entre os idosos (34,3%, IC95% 33,2-34,4). Na análise multivariada, o uso de serviços odontológicos foi maior em pessoas com maior nível educacional (RP:2,02, IC95%: 1,87-2,18) e de maior renda (RP:1,54, IC95%: 1,45-1,64). Os estados das regiões Sudeste, Centro-Oeste e Sul apresentaram as maiores porcentagens de indivíduos que consultaram com dentista no último ano, entre 49,0 a 57,6% da população. Conclusão: Desigualdades no uso dos serviços de saúde bucal foram observadas na população adulta e idosa, com diferenças entre as regiões do país; foi identificado maior uso entre as mulheres, indivíduos mais jovens, escolarizados e de maior renda, e entre a população com melhores comportamentos relacionados à sua saúde, melhor percepção do seu estado de saúde, e aqueles que pagaram pelo último atendimento odontológico.

https://doi.org/10.1590/1980-549720210004.supl.2

14.

Diretrizes brasileiras para o manejo de potenciais doadores de órgãos em morte encefálica. Uma força-tarefa composta por Associação de Medicina Intensiva Brasileira, Associação Brasileira de Transplantes de Órgãos, Brazilian Research in Critical Care Network e Coordenação Geral do Sistema Nacional de Transplantes
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Westphal, Glauco Adrieno

; Robinson, Caroline Cabral

; Cavalcanti, Alexandre Biasi

; Gonçalves, Anderson Ricardo Roman

; Guterres, Cátia Moreira

; Teixeira, Cassiano

; Stein, Cinara

; Franke, Cristiano Augusto

; Silva, Daiana Barbosa da

; Pontes, Daniela Ferreira Salomão

; Nunes, Diego Silva Leite

; Abdala, Edson

; Dal-Pizzol, Felipe

; Bozza, Fernando Augusto

; Machado, Flávia Ribeiro

; Andrade, Joel de

; Cruz, Luciane Nascimento

; Azevedo, Luciano César Pontes

; Machado, Miriam Cristine Vahl

; Rosa, Regis Goulart

; Manfro, Roberto Ceratti

; Nothen, Rosana Reis

; Lobo, Suzana Margareth

; Rech, Tatiana Helena

; Lisboa, Thiago Costa

; Colpani, Verônica

; Falavigna, Maicon

Revista Brasileira de Terapia Intensiva

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jan 2021, Volume 33 N. 1 Pages 1 - 11

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Fornecer recomendações para nortear o manejo clínico do potencial doador em morte encefálica. Métodos: O presente documento foi formulado em dois painéis compostos por uma força tarefa integrada por 27 especialistas de diferentes áreas que responderam a questões dirigidas aos seguintes temas: ventilação mecânica, hemodinâmica, suporte endócrino-metabólico, infecção, temperatura corporal, transfusão sanguínea, e uso de checklists. Os desfechos considerados foram: parada cardíaca, número de órgãos retirados ou transplantados e função/sobrevida dos órgãos transplantados. A qualidade das evidências das recomendações foi avaliada pelo sistema Grading of Recommendations Assessment, Development, and Evaluation. Resultados: Foram geradas 19 recomendações a partir do painel de especialistas. Dessas, 7 foram classificadas como fortes, 11 fracas e uma foi considerada boa prática clínica. Conclusão: Apesar da concordância entre os membros do painel em relação à maior parte das recomendações, o grau de recomendação é fraco em sua maioria.

Abstract Objective: To contribute to updating the recommendations for brain-dead potential organ donor management. Methods: A group of 27 experts, including intensivists, transplant coordinators, transplant surgeons, and epidemiologists, answered questions related to the following topics were divided into mechanical ventilation, hemodynamics, endocrine-metabolic management, infection, body temperature, blood transfusion, and checklists use. The outcomes considered were cardiac arrests, number of organs removed or transplanted as well as function / survival of transplanted organs. The quality of evidence of the recommendations was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system to classify the recommendations. Results: A total of 19 recommendations were drawn from the expert panel. Of these, 7 were classified as strong, 11 as weak and 1 was considered a good clinical practice. Conclusion: Despite the agreement among panel members on most recommendations, the grade of recommendation was mostly weak.

https://doi.org/10.5935/0103-507x.20210001 742 downloads

15.

A pandemia da COVID-19 no Brasil: a série de projeções do Institute for Health Metrics and Evaluation e a evolução observada, maio a agosto de 2020
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Stein, Caroline

; Cousin, Ewerton

; Machado, Ísis Eloah

; Felisbino-Mendes, Mariana Santos

; Passos, Valéria Maria de Azeredo

; Sousa, Tatiane Moraes de

; Schmidt, Maria Inês

; Gallagher, John

; Naghavi, Mohsen

; Duncan, Bruce B.

Epidemiologia e Serviços de Saúde

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2021, Volume 30 N. 1 elocation e2020680

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Resumo Objetivo Descrever as projeções do Institute for Health Metrics and Evaluation (IHME) para a COVID-19 no Brasil e seus estados, apresentar sua acurácia e discutir suas implicações. Métodos As previsões do IHME de maio a agosto de 2020, para o Brasil e alguns estados, foram comparadas ao número de mortes cumulativas observadas. Resultados A projeção prevê 182.809 mortes causadas pela pandemia até 1º de dezembro de 2020 no Brasil. O aumento no uso de máscara poderia poupar ~17 mil óbitos. O erro médio no número acumulado de óbitos em duas, quatro e seis semanas das projeções foi de 13%, 18% e 22% respectivamente. Conclusão Projeções de curto e médio prazo dispõem dados importantes e acurácia suficiente para informar os gestores de saúde, autoridades eleitas e sociedade geral. Após trajeto difícil até agosto, a pandemia, conforme as projeções, terá declínio sustentado, embora demorado, causando em média 400 óbitos/dia no início de dezembro.

Abstract Objective To describe the Institute for Health Metrics and Evaluation (IHME) projections for the COVID-19 pandemic in Brazil and the Brazilian states, present their accuracy and discuss their implications. Methods The IHME projections from May to August 2020 for Brazil and selected states were compared with the ensuing reported number of cumulative deaths. Results The pandemic was projected to cause 182,809 deaths by December 1, 2020 in Brazil. An increase in mask use could reduce the projected death toll by ~17,000. The mean error in the cumulative number of deaths at 2, 4 and 6 weeks after the projections were made was 13%, 18% and 22%, respectively. Conclusion Short and medium-term projections provide important and sufficiently accurate data to inform health managers, elected officials, and society at large. After following an arduous course up until August, the pandemic is projected to decline steadily although slowly, with ~400 deaths/day still occurring in early December.

Resumen Objetivo Describir las proyecciones del Institute for Health Metrics and Evaluation para COVID-19 en Brasil y sus estados, presentar su precisión y discutir sus implicaciones. Métodos Las previsiones del IHME de mayo a agosto de 2020 para Brasil y algunos estados, se compararon con las muertes acumuladas observadas. Resultados La proyección prevé 182.809 muertes por la pandemia hasta el 1º de diciembre de 2020 en Brasil. Un aumento en el uso de mascarillas podría evitar ~17.000 muertes. El error medio en el número acumulado de muertes en 2, 4 y 6 semanas de las proyecciones fue de 13%, 18% y 22%. Conclusión Las proyecciones de corto y medio plazo proporcionan datos importantes y con suficiente precisión para informar a los administradores de salud, autoridades electas y a la sociedad. Después de un camino difícil hasta agosto, la pandemia, según las proyecciones, tendrá una disminución sostenida, pero lenta, y seguirá causando alrededor de 400 muertes/día a principios de diciembre.

https://doi.org/10.1590/s1679-49742021000100017 2366 downloads

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