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Accuracy of abdominal circumference for diagnosing overweight in six-to-seven-years-old children
(2022-01) Traebert, Eliane; Leão, Graziela; Traebert, Guilherme de Azevedo; Flôres, Altaiana Portella da Rosa; Traebert, Jefferson
Objective: To estimate the accuracy of abdominal circumference measurement as a method of diagnosing overweight in six-to-seven-years-old children. Methods: A cross-sectional study involving 1026 six-to-seven-years-old schoolchildren in southern Brazil was carried out. Children’s weight and height were collected at schools. Body mass index were calculated and categorized in z-score in eutrophy, overweight and obesity. Abdominal circumference was measured in centimeters with a tape with children in standing position at midpoint between the lower ribs margin and the iliac crest. Correlation between abdominal circumference and body mass index was performed through Pearson's correlation coefficient. Sensitivity, specificity, positive and negative predictive values of abdominal circumference were estimated. The Receiver Operating Characteristic Curve was used to measure the accuracy. Results: A positive linear correlation value of 0.582 and a determination coefficient 0.39 were observed. The accuracy value of 0.859 was observed. Sensitivity, specificity, positive and negative predictive values varied according to each value in centimeters of abdominal circumference. Conclusion: Abdominal circumference measure showed to be an accurate method for detecting overweight and obesity in six-to-seven-years-old children.
Adenovirus 36 prevalence and association with human obesity: a systematic review
(2021-03) da Silva Fernandes, Jaime; Schuelter-Trevisol, Fabiana; Lobor Cancelier, Ana Carolina; Gomes de Sousa, Daiana; L. Atkinson, Richard; Trevisol, Daisson José
ntroduction Obesity has numerous etiologies and includes biological factors. Studies have demonstrated that the human adenovirus subtype 36 (Adv36) is an adipogenic agent and causes metabolic alterations. Study results on the prevalence of Adv36 and clinical effects in humans vary substantially. This was a systematic review to summarize the studies on the prevalence of Adv36 infection and its association with human obesity. Methods A systematic literature review was conducted using the preferred reporting items for systematic reviews and meta analysis (PRISMA). Observational or experimental studies found in the Medline, Embase, LILACS, Science Direct and SciELO databases that presented results on the prevalence of Adv36 in humans were included. Results Thirty-seven studies were screened. A total of 10,300 adults aged 18–70 years and 4585 children and adolescents aged 3–18 years were assessed. The average prevalence of Adv36 among adults was 22.9%, ranging from 5.5% to 49.8%. Among children and adolescents, the average prevalence of Adv36 was 28.9%, ranging from 7.5% to 73.9%. There was a positive statistical relationship between Adv36 and weight gain, obesity, or metabolic changes in 31 studies. However, in four studies there was no association with obesity, and in one, no association was described. One of the studies showed an inverse correlation, i.e., Adv36 was a protective factor against obesity. Conclusion Strong evidence suggested a positive association between viral infection and obesity. However, due to the multi causality of obesity and heterogeneity of studies, diagnostic tests should be standardized and easily accessible by the population to estimate the overall prevalence of Adv36 infection and its association with obesity.
Adhesive Systems inOrthodontics
(2021) Claudino, Dikson
The article by Arinelli and colleagues1 published in the latest edition of your journal provides relevant information about adhesive systems currently used in dentistry. The focus of their study is on the clinical practice of restorative dentistry. However, it is worth mentioning that the development and application of adhesive systems extrapolate the standardized treatment protocols of this specialty, encompassing different management procedures and related clinical difficulties.
Adverse birth outcomes and oral health
(2016) Traebert, Eliane; Martins, Luiz Gustavo Teixeira; Lunardelli, Sandra Espíndola; Lunardelli, Abelardo Nunes; Traebert, Jefferson
It is vital to improve the understandingof early child’s oral health determinants and conse-quent identiﬁcation of interventions and behaviorsthat can be modiﬁed with health promotion activi-ties since birth. Authors have suggested that proper fetal growth and adequate development in the ﬁrst two years of life are determinants ofhealth, not only at childhood but also in later life.David Barker’s studies conducted in the 1980s have suggested that the events of the intrauterineperiod or during early childhood have long-termeffects on morbidity and mortality from chronicdiseases.On the other hand, the Life-Course Theory emphasizes the infancy period, based on the accu-mulation of environmental, social, and behavioralrisks in life, without disregarding Barker’s pre-mises, to strengthen the interaction between bio-logical and social factors of the different stages of life, more than the current adult lifestyle. However, little research has been carried outfocusing on these ideas to determine children’s oralhealth. There is a scarcity of longitudinal studies,such as population-based cohort studies, that aimto understand the determination of the oral health-disease process and the complex interactionbetween social environment and biological and behavioral aspects. The study published by thisimportant journal has contributed to bring thisissue to the agenda.
Aleitamento materno e causas de desmame precoce em crianças nascidas em um Hospital Amigo da Criança
(2019) Nascimento, Diego Zapelini do; Silva, Denise Fragnani Luiz da; Perdoná, Vanessa de Castro; Marques, Gabriela Moreno; Schuelter-Trevisol, Fabiana; Martins, Ana Luísa Oenning
Introduction: The importance of breastfeeding lies in the presence of numerous immunological factors that are only obtained through human milk, which protect children against the most varied infections. The aim of this study was to identify the prevalence and causes of early weaning in babies born in a municipality in southern Santa Catarina. Methods: A quantitative prevalence study nested within a prospective cohort study was conducted. The population studied was 169 children born at Hospital Nossa Senhora da Conceição between Jun and Sept 2012. Data collection was by interviews with the children's mothers, filling out diaries with information about the babies' health, and telephone contact with mothers. Mean, median and standard deviation were calculated for continuous variables and proportions for categorical variables. Pearson's chi-square test was used for the association between variables and Student's t test was used to compare the means. Results: 168 mothers were interviewed, 93 (55.4%) breastfeeding their children until the sixth month of life, and of these, only 29 (31.2%) breastfed exclusively. Conclusions: The prevalence of early weaning was 75 (44.6%) and the reasons most reported by mothers for the occurrence of weaning were absence of milk, work outside the home, child's crying and nipple cracks. Half of the studied population weaned before the sixth month of life and less than a third of the children were exclusively breastfed.
Alternativas para identificar interações medicamentosas entre as reações adversas a medicamentos em unidades hospitalares
(2019) Nascimento, Diego Zapelini; Marques, Gabriela Moreno; Schuelter-Trevisol, Fabiana
Carta sem resumo
Assessing the overall medication use by elderly people in a Brazilian hospital using the star/stopp criteria version 2
(2019) Pereira, Thayná Ferreira Furtado; Soares, Alessandra de Sá; Trevisol, Daisson José; Trevisol, Fabiana Schuelter
To estimate the frequency of the use of medicines listed in the Screening Tool to Alert Doctors to the Right Treatment (START) and Screening Tool of Older Person’s Prescriptions (STOPP) criteria version 2 among the elderly. A cross-sectional study was conducted on elderly who were attended in medical clinic and cardiology sectors in a hospital in southern Brazil attended at a hospital from February through September 2016. A data-collection tool was used to obtain information on variables, such as demographic and clinical data, and medications used before and during the hospitalization period. The adequacy of the medicines taken was examined with regard to omission (START) or inappropriate use (STOPP). This study was approved by the Research Ethics Committee of the University of Southern Santa Catarina. A total of 307 subjects were included in the final sample. The mean age was 75.2 years (SD = 8; range 65-102). Of the total, 93.5% had had at least one potential prescribing omission (PPO) listed in the START criteria, whereas 95.4% used at least one medicine of the STOPP criteria. PPO was significantly associated with lower mean age (74.9 years, SD = 7.9 versus 79.0 years, SD = 8.8) among the elderly who did not have PPOs detected by the START criteria (p-value=0.03). Furthermore, PPO was associated with longer hospital stay (18 versus 9 days; p-value=0.03). This study revealed inadequate prescription affecting 99.3% of the participating patients. To the best of our knowledge, this was the first to use the START and STOPP criteria, version 2, in Brazil.
Association between prenatal and neonatal factors and occurrence of asthma symptoms in six-year-old children
(2022-01) Esmeraldino, Leonardo; Traebert, Eliane; Nunes, Rodrigo Dias; Traebert, Jefferson
The objective was to estimate association between prenatal and neonatal factors and asthma symptoms in children at six years of age. A cross-sectional study using secondary data from a cohort study with a sample of 578 children was carried out. Data were analyzed using three levels hierarchical Poisson Regression. Of the 578 children included in the study, 43.4% (95% CI 39.4; 47.4) had asthma symptoms. The variables with significantly higher prevalence of symptoms and asthma at six years of age were: male gender, with 5% higher prevalence (PR = 1.05 95% CI 1.01; 1.11) (p = 0.043); children of pregnant women presenting infectious diseases with 7% higher prevalence (PR = 1.07; 95% CI 1.02; 1.13) (p = 0.011); children who were not breastfed, with a 12% higher prevalence (PR = 1.12; 95% CI 1.02; 1.24) (p = 0.022) and children with respiratory problems in the first month of life, with a 14% higher prevalence (PR = 1.14; 95% CI 1.01; 1.29) (p = 0.033). It could be concluded that male gender, time-independent breastfeeding deprivation and respiratory problems in the first month of life were independently associated with asthma symptoms at six years of age. The occurrence of infectious diseases during pregnancy was the only factor with intrauterine physiology that was associated with the occurrence of asthma symptoms at six years of age.
Association between the use of magnesium sulfate as neuroprotector in prematurity and the neonatal hemodynamic effects
(2017) Nunes, Rodrigo Dias; Schutz, Flávia Duarte; Traebert, Jefferson
Purpose: Cerebral palsy is often associated with prematurity and magnesium sulfate (MgSO4) has been used as a neuroprotector, with favorable results. However, its mechanism of action has not been fully elucidated. This study aimed to evaluate the association between MgSO4 at the imminent premature delivery and neonatal hemodynamic effects. Materials and methods: A cross-sectional study involving 94 newborns (NB) between 24 and 32weeks at a Brazilian hospital was performed. Bivariate analysis between the use or the non- use of MgSO4 and hemodynamic characteristics was performed, using the Chi-square test. Results: NB were evaluated between those who received MgSO4 (27.7) and those who did not (72.3%). Normal heart rate was verified in 62.8% of NB, normal respiratory rate in 70.2%, and nor- mal temperature in 22.3%. Oxygen saturation higher or equal than 95% was evidenced in 85.1% of NB, normal hemoglucotest in 74.5%, and hemoglobin greater or equal than 16.4g/dL in 30.9%. Non-invasive ventilation was performed in 48.9% of NB, while 51.1% were submitted to endotracheal ventilation. There was no significance relation detected between the use of MgSO4 and the hemodynamic characteristics. Conclusions: MgSO4 does not appear to influence hemodynamic factors as a cause of the neu- roprotection in premature NB.
Aumento da incidência de sífilis congênita no Estado de Santa Catarina no período de 2007-2017: análise da tendência temporal
(2020) Vescovi, Julia Souza; Schuelter-Trevisol, Fabiana
Objective: To estimate the incidence of congenital syphilis and temporal trends of the reported cases of the disease in the state of Santa Catarina between 2007 and 2017. Methods: Observational study with retrospective cohort design, with secondary data from the Injury of Notification Information System (SINAN). Linear trend test and geoprocessing were performed to verify the behavior of the cases in the period. Results: There were 2,898 reported cases of congenital syphilis in the period, with an average of 2.9 per 1,000 live births in the period. There was an exponential increase of 0.9 percentage points per year, considered statistically significant (p<0.001). There was no difference between the incidences of cases in the different regions of the State. The fatality rate was 8.5%, considering deaths from syphilis, miscarriages and stillbirths. The profile was predominant of white mothers, with low schooling and 11.8% did not perform prenatal care. For this reason, 26.9% of them had a diagnosis of syphilis at the time of delivery. Most of the pregnant women (51.9%) had inadequate pharmacological treatment and 65.1% of the partners were not treated. Conclusions: There was an exponential increase tendency in cases of congenital syphilis in the State of Santa Catarina in the period studied in all regions of the State, which reveals the failure of prenatal care, late diagnosis and inadequate treatment of the pregnant woman and her partner.
Autoestima e cárie dentária em adolescentes: um estudo seccional
(2016) Lunardelli, Sandra Espíndola; Traebert, Eliane; Lunardelli, Abelardo Nunes; Martins, Luiz Gustavo Teixeira; Traebert, Jefferson
Introduction: Dental caries in adolescents remains an important public health problem, but its relationship with psychological factors are poorly studied. Objective: To study the possible association between aspects of self-esteem and dental caries in adolescents. Material and method: A cross-sectional study involving a sample of 409 adolescents from 13 Southern Brazilian municipalities was carried out. Dental caries status was assessed through the World Health Organization criteria. For questions related to self-esteem the Rosenberg Self-Esteem Scale was used. The outcomes were each question of the scale. The chi-square test was used to determine statistical significance of associations. To adjust for confounding variables, the Poisson loglinear with robust estimator was used. Result: Positive associations were observed for the presence of decayed teeth and “At times, I think I am no good at all” (p<0.001), “I wish I could have more respect for myself ” (p= 0.016), “I certainly feel useless at times” (p= 0.022) and negative association with “On the whole, I am satisfied with myself ” (p= 0.022). In the adjusted analysis, adolescents with decayed teeth had a higher prevalence of positive responses to “At times, I think I am no good at all” [(PR= 1.23 (CI 95% 1.05; 1.44)], and negative responses for “On the whole, I am satisfied with myself ” [(PR= 1.12 (CI 95% 1.02; 1.24)]. Conclusion: Aspects of self-esteem were significantly and independently associated with the presence of decayed teeth.
Avaliação da condição de saúde e da qualidade de vida no pós-operatório tardio de pacientes submetidos à cirurgia bariátrica
(2018) Santos, Mariana Mantovani Meira; Orth, Larissa Chaiane; Prá, Morgana; Uberti, Marcela Fornari; Schuelter-Trevisol, Fabiana
Introduction: Obesity is a chronic disease of multifactorial origin and associated with numerous comorbidities, being a public health problem. Conventional treatment has shown to be ineffective because most patients regain their original weight. Bariatric surgery has been shown as an effective alternative for weight loss, control of comorbidities and improvement in patient's quality of life. Objectives: To evaluate the health status and quality of life without late postoperative of patients undergoing bariatric surgery in 2011. Materials and methods: Patients were interviewed about sociodemographic, anthropometric data, life habits and comorbidities, and how the same preoperative information was obtained by reviewing the medical records. Questionnaires were applied to the System of Results of Analysis and Bariatric Analysis, and Whoqol Abbreviated. Results: 59 patients were interviewed; 81.3% were women, most of them between the ages of 30 and 39, and 78% were married; 90% of the patients presented grade II or III obesity, and only 6% remained in the condition after 60 months of surgery. There was a reduction in the prevalence of obstructive sleep apnea syndrome, dyslipidemia and systemic arterial hypertension among patients, and an increase in adherence to physical activity. For both questionnaires, the majority of patients were classified as "good". Conclusion: The present study reinforces the benefits of weight loss, based on the observation of bariatric surgery for the quality of the individual's health. However, the importance of evaluation and follow-up of patients for the effective and long-term outcome is reinforced.
Avaliação da influência do ciclo lunar e da sazonalidade na prematuridade e na rotura prematura de membranas
(2019) Carvalho, Heloise Martins de; Kretzer, Marcia; Traebert, Jefferson; Nunes, Rodrigo Dias
O ciclo lunar sempre foi alvo de crenças populares, principalmente relacionado a ocorrência de maior número de nascimentos durante a fase de lua cheia. Influências externas como baixa pressão atmosférica estão ligadas à rotura de membrana corioamniótica e parece existir um mecanismo biológico para o desencadeamento do trabalho de parto prematuro. Este estudo tem como objetivo estudar a influência do ciclo lunar e da sazonalidade na ocorrência de rotura prematura de membranas e de trabalho de parto prematuro. Realizado um estudo transversal envolvendo dados do livro de partos de uma maternidade localizada no sul do Brasil por um período de 4 anos, totalizando 13.291 nascimentos. Utilizados dois sites, um para estimativa do ciclo lunar à época do nascimento e outro para determinar o dia da semana. Um banco de dados foi criado e exportado para o SPSS18.0 onde foi analisado. Utilizada a análise de Poisson. As variáveis que apresentaram p < 0,25 foram incluídas em uma análise multivariada para observar a independência das associações. A significância estatística estabelecida foi p < 0,05. Houveram maior prevalência de nascimentos durante a fase de lua crescente, meses de novembro e junho, estação de verão e terças-feiras. Encontrada associação estatisticamente significativa entre rotura prematura de membranas, mês de outubro e sexta-feira. Não encontrou-se associação entre a fase do ciclo lunar com rotura prematura de membranas e prematuridade, assim como, fatores sazonais e prematuridade. Observou-se menor prevalência de rotura prematura de membranas no mês de outubro e na sexta feira.
Avaliação de solução à base de NaOCl 0,2% na desinfecção das tubulações de água dos equipos odontológicos
(2021) Claudino, Dikson; Lima, Amanda de Moraes Teixeira; Botega, Talita Anacleto; Serratine, Ana Claudina Prudêncio
Objetivo: Avaliar o efeito do hipoclorito de sódio a 0,2% na desinfecção da tubulações de água de equipos odontológicos, previamente contaminadas. Método: Foram obtidas amostras de água dos reservatórios, das mangueiras que suprem as turbinas de alta-rotação e das seringas tríplice de 34 equipos com tubulações desinfetadas com hipoclorito de sódio a 0,2% e de 31 equipos do grupo controle. As amostras foram semeadas em “Plate Count Agar” (ACOMIDIA® ) e incubadas em aerobiose a 35o C, durante 48 horas, para avaliar a presença e contagem das unidades formadoras de colônias (UFC) de bactérias heterotróficas por mililitro de água.Utilizou-se como parâmetro para a avaliação das amostras as normatizações do Ministério da Saúde referentes à presença dessas bactérias na água de consumo para humanos. Foram comparados os níveis de contaminação da água dos diversos pontos de coleta e entre os equipos com e sem sistema de desinfecção, através do teste qui-quadrado de Pearson com significância de 5%. Resultados: Nos equipos que sofreram desinfecção das tubulações de água, as amostras estavam contaminadas em 41,2% dos reservatórios, 67,7% das mangueiras alta-rotação e 64,7% das seringas tríplices. Não houve diferença significativa na contaminação entre os diversos pontos de coleta e entre os equipamentos com e sem sistema de desinfecção (p>0,05). Conclusão: O método proposto foi ineficaz na desinfecção das tubulações de água de equipos odontológicos, previamente contaminadas. Com base nos resultados obtidos, sugere-se novos estudos para o desenvolvimento de um protocolo padrão para a desinfecção das tubulações de água de equipos odontológicos.
Avaliação do conhecimento sobre o vírus do papiloma humano (HPV) e sua vacinação entre agentes comunitários de saúde na cidade de Tubarão, Santa Catarina, em 2014
(2017) Manoel, André Luciano; Rodrigues, Andreia Bittencourt; Piva, Elisa Zanatta; Warpechowski, Thainá Paola; Schuelter-Trevisol, Fabiana
Objective: to evaluate the knowledge of Community Health Agents (CHA) about the Human Papilloma Virus (HPV) and its vaccination. Methods: this is a cross-sectional study with CHA who worked in Tubarão-SC, Brazil, in 2014; data were collected through an evaluation tool about HPV and its vaccination, validated for English language and translated and adapted into Portuguese. Results: 124 CHA participated in this study; all of them had already heard about HPV, but only 25.0% had heard about HPV testing; 72.6% answered correctly less than 70.0% of the questions; those who answered correctly more than 70.0% were, in general, younger than the other CHA (p=0.010). Conclusion: CHA demonstrated little knowledge on HPV, which may affect their work as multipliers in the prevention of diseases and in education in health.
Avaliação do risco cardiovascular segundo os critérios de Framingham em adultos
(2016) Della Júnior, Afonso Possamai; Schuelter-Trevisol, Fabiana; Sebold, Fábio Jean Goulart; Nakashima, Leandro; Pereira, Márcia Regina; Trevisol, Daisson José
Objective: To estimate the risk of a major cardiovascular event within a 10-year period, as well as identify associated risk factors in adults from Tubarão, Santa Catarina, Brazil. Material and Methods: This was a cross-sectional, population-based study applying the Framingham score in 358 adults from Tubarão, Santa Catarina. We aimed to assess the degree of risk and its correlation with variables that may influence cardiovascular risk, such as alcoholism, sedentariness, lifestyle, educational level, in addition to sex, age and smoking habits. The data were analyzed using Pearson’s Chi-square test (÷2) and Fisher’s exact test. The prevalence ratio was used as a measure of association. Results: Among the 358 people surveyed, most were women, Caucasian (87%), with schooling higher than eight years of study (51%), with a steady partner (68.7%), sedentary (60.6%), non-smokers (69.3%), and non-users of alcohol (91.8%). The prevalence of obesity was 26.5%. The mean risk percentage was 2.6% ± 3.7%, with most subjects reaching the low-risk category (94.9%). Male gender (PR = 1.13 [1.07 to 1.20] p <0.001), advanced age (PR = 1.01 [1.00 to 1.01] p = 0.012) and educational level (PR = 0, 99 [0.98 to 1.00] p = 0.039) were factors associated with medium and high risk for cardiovascular events regardless of the outcome. Conclusion: The studied population had a low risk for cardiovascular events. However, the association between potentially modifiable moderate and high risk factors suggests that modification of lifestyle should happen early in this population in order to reduce cardiovascular risks.
Avaliação dos fatores associados aos pólipos endometriais
(2018) Tomazonni, Júlia Michelon; Nunes, Rodrigo Dias; Traebert, Jefferson
Background: Endometrial polyps are benign lesions with low malignancy potential, identified as endometrial protrusions, which appear to be related to some sociodemographic and clinical factors. Objective: To identify the factors associated with the occurrence of endometrial polyp in patients submitted to videohysteroscopy. Methods: A case-control study that included 162 women who underwent videohysteroscopy at a private diagnostic imaging clinic between January and June of 2016. Data collection was done through medical records. The association of the variables was calculated by odds ratio and confidence interval, with significance level p < 0.05. Results: Patients were divided into 81 cases and 81 controls. The mean age of the women was 49.6 (± 12.5) years. The most frequent histological type of endometrial polyps was the hyperplastic (34.7%), followed by the functional type (33.3%). Only one case of endometrial carcinoma was detected. The age of thepatients, number of previous vaginal deliveries and caesarean sections, age of menarche, menopause, use of hormonal therapy or hormonal contraception, and comorbidities such as hypertension and diabetes, were not associated with the appearance of endometrial polyp at videohysteroscopic examination. The multivariate analysis also showed no association between outcome and skin color (p = 0.137), body mass index (p = 0.154), number of previous abortions (p = 0.869), abnormal uterine bleeding (p = 0.486) and its duration (p = 0.157). Conclusion: The clinical and sociodemographic characteristics assessed in the present study were not associated with the appearance of endometrial polypoid formations, identified by videohysteroscopy.
Avaliação dos fatores determinantes à realização da episiotomia no parto vaginal
(2019) Nunes, Rodrigo Dias; Mapelli, Amanda de Vasconcelos; Nazário, Nazaré Otília; Traebert, Eliane; Seemann, Mayara; Traebert, Jefferson
Objetivo: O estudo objetiva conhecer os fatores associados à realização da episiotomia no parto vaginal. Metodologia: Estudo transversal envolvendo 330 partos, de janeiro/2012 a dezembro/2013. Estudou-se a associação das variáveis independentes com a realização da episiotomia por meio de cálculo de razões de prevalência e seus respectivos intervalos de confiança, com nível de significância p < 0,05. Resultados: Na amostra estudada, 224 (67,9%) pacientes não realizaram episiotomia e 106 (32,1%) realizaram o procedimento. A idade média foi de 22,9 (± 5,9) anos e a episiotomia foi mais realizada naquelas com idade inferior a 20 anos [RP 1,61 (IC 95% 1,15; 2,25)] (p = 0,005). As mulheres com mais de 8 anos completos de estudo foram significativamente mais submetidas à episiotomia que as demais [RP 2,34 (IC 95% 1,70; 3,22)] (p < 0,001). Conclusão: A realização da episiotomia nesta população ocorreu com maior prevalência nas parturientes mais jovens e com maior escolaridade.
Brazil's Family Health Strategy
(2015) Trevisol, Daisson José; Traebert, Jefferson; Schuelter-Trevisol, Fabiana
o the Editor: The Perspective article by Macinko and Harris (June 4 issue)1 encourages us to contribute to the debate over health care in Brazil in order to clarify several key points. First, Brazil's community health agents have no specialized technical training, which prevents them from fully exercising the functions intended for them. Second, both physical facilities and human resources are inadequate, and examination quotas are insufficient to meet the demand. Health care coverage is often inefficient and provides low-quality services.2 Third, poor integration between primary care and secondary and tertiary care overloads emergency departments. Fourth, underfunding by the federal . . .
Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016
(2018) GBD 2016 Brazil Collaborators; Traebert, Jefferson
Background: Political, economic, and epidemiological changes in Brazil have affected health and the health system. We used the Global Burden of Disease Study 2016 (GBD 2016) results to understand changing health patterns and inform policy responses. Methods: We analysed GBD 2016 estimates for life expectancy at birth (LE), healthy life expectancy (HALE), all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors for Brazil, its 26 states, and the Federal District from 1990 to 2016, and compared these with national estimates for ten comparator countries. Findings: Nationally, LE increased from 68·4 years (95% uncertainty interval [UI] 68·0–68·9) in 1990 to 75·2 years (74·7–75·7) in 2016, and HALE increased from 59·8 years (57·1–62·1) to 65·5 years (62·5–68·0). All-cause agestandardised mortality rates decreased by 34·0% (33·4–34·5), while all-cause age-standardised DALY rates decreased by 30·2% (27·7–32·8); the magnitude of declines varied among states. In 2016, ischaemic heart disease was the leading cause of age-standardised YLLs, followed by interpersonal violence. Low back and neck pain, sense organ diseases, and skin diseases were the main causes of YLDs in 1990 and 2016. Leading risk factors contributing to DALYs in 2016 were alcohol and drug use, high blood pressure, and high body-mass index. Interpretation Health improved from 1990 to 2016, but improvements and disease burden varied between states. An epidemiological transition towards non-communicable diseases and related risks occurred nationally, but later in some states, while interpersonal violence grew as a health concern. Policy makers can use these results to address health disparities.

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