Knowledge, attitude and practice of mammography among women users of public health services

OBJECTIVE: To evaluate knowledge, attitude and practice related to mammography among women users of local health services, identifying barriers to its performance. METHODS: A total of 663 women were interviewed at 13 local health centers in a city of Southeastern Brazil, in 2001. Interviewees were randomly selected at each center and they were representative from different socioeconomic conditions. The number of interviewees at each center was proportional to monthly mean appointments. For data analysis, answers were described as knowledge, attitude, practice and their respective adequacies and then they were correlated with control variables through the chi-square test. RESULTS: Only 7.4% of the interviewees had adequate knowledge on mammography, while 97.1% of women had an adequate attitude. The same was seen for the practice of mammography that was adequate in 35.7% of the cases. The main barrier to mammography was lack of referral by physicians working at the health center (81.8%). There was an association between adequacy of attitude and five years or more of education and being married. There was also an association between adequacy of mammography practice and being employed and family income up to four minimum wages. CONCLUSIONS: Women users of local health services had no adequate knowledge and practice related to mammography despite having an adequate attitude about this exam.

Oral health, hygiene practices and oral cancer

OBJECTIVE: To assess the association between oral health and hygiene practices and oral cancer. METHODS: Hospital-based case-control study in the metropolitan area of São Paulo, southeastern Brazil, from 1998 to 2002. A total 309 patients with squamous cell carcinoma of the mouth and the pharynx and 468 controls matched by sex and age were included in the study. Cases were recruited in seven reference hospitals and controls were selected in five out of the seven participating hospitals. Detailed information on smoking, alcohol consumption, schooling, oral health status and hygiene practices were obtained through interviews. Odds ratios (OR) and 95% confidence intervals (95% CI), adjusted by sex, age, schooling, smoking, alcohol consumption as well as the variables oral health status and hygiene practices were estimated using unconditional logistic regression analyses. RESULTS: The use of complete dental prosthesis was not associated with oral cancer but regular gum bleeding showed a strong association (OR 3.1; 95% CI 1.2-7.9). Those who never attended a dental visit were more likely to have oral cancer (OR 2.5; 95% CI 1.3-4.8). Daily mouthwash use showed a stronger association to pharynx (OR 4.7; 95% CI 1.8-12.5) than mouth cancer (OR 3.2; 95% CI 1.6-6.3). CONCLUSIONS: Gum bleeding, no dental care, and daily mouthwash use were factors associated with oral cancer regardless of tobacco and alcohol consumption.

Comparing the content of instruments assessing environmental factors using the International Classification of Functioning, Disability and Health

Purpose: To describe and compare the content of instruments that assess environmental factors using the International Classification of Functioning, Disability and Health (ICF). Methods: A systematic search of PubMed, CINAHL and PEDro databases was conducted using a pre-determined search strategy. The identified instruments were screened independently by two investigators, and meaningful concepts were linked to the most precise ICF category according to published linking rules. Results: Six instruments were included, containing 526 meaningful concepts. Instruments had between 20% and 98% of items linked to categories in Chapter 1. The highest percentage of items from one instrument linked to categories in Chapters 2–5 varied between 9% and 50%. The presence or absence of environmental factors in a specific context is assessed in 3 instruments, while the other 3 assess the intensity of the impact of environmental factors. Discussion: Instruments differ in their content, type of assessment, and have several items linked to the same ICF category. Most instruments primarily assess products and technology (Chapter 1), highlighting the need to deepen the discussion on the theory that supports the measurement of environmental factors. This discussion should be thorough and lead to the development of methodologies and new tools that capture the underlying concepts of the ICF.

Implementação do rastreio auditivo neonatal universal de surdez no Hospital CUF Porto

A incidência de perda auditiva bilateral é de 1 a 3 por cada recém-nascidos saudáveis e de 30 a 40 por 1000 recém-nascidos de risco. No Hospital Cuf Porto (HCP) o Rastreio Auditivo Neonatal Universal (RANU) teve inicio em Dezembro de 2010 em paralelo com abertura dos serviços de Obstetrícia / Neonatologia. As otoemissões acústicas (OEA) são o teste utilizado pois são reconhecidas como um método de rastreio auditivo simples, seguro e bem aceite. O objectivo deste trabalho é salientar a importância do RANU na identificação da perda auditiva antes da alta hospitalar, apresentando as suas vantagens na detecção e intervenção precoce minimizando as consequências da perda auditiva. Este trabalho, pretende ainda demonstrar as vantagens do RANU como estratégia fundamental no planeamento e na introdução de medidas de diagnóstico e terapêutica. É assim apresentada uma análise retrospectiva dos resultados obtidos nas OEA por produtos de distorção (OEAPD) entre Janeiro de 2011 e Dezembro de 2012, com uma amostra constituída por n=572. Os resultados revelam uma percentagem de “PASS” (OEAPD presentes) na primeira fase do rastreio, com um valor de 88,8% relativamente ao número total de rastreios efectuados. Relativamente à percentagem de “REFER” (OEAPD ausentes) – na mesma fase do rastreio- obtiveram-se 11,2% de situações face ao total de rastreados. Destes – que correspondem a um n=64 – 42.2% das situações referem-se a “REFER” bilateral (n=27). Relativamente às situações de “REFER” unilateral (n=37), encontramos uma percentagem de 57,8% dos casos. De acordo com a casuística apresentada, correspondente aos resultados obtidos e atendendo à realidade da população rastreada (dado que até ao momento não se confirmou perda auditiva em nenhum dos indivíduos rastreados), pode-se concluir que os OEA podem ser um método de rastreio simples e fiável, fundamental para a detecção e intervenção precoce nas perdas auditivas.

Clustering of variables with a three-way approach for health sciences

TPM Vol. 21, No. 4, December 2014, 435-447 – Special Issue © 2014 Cises.

HIV testing among pregnant women in Brazil: rates and predictors

OBJECTIVE: To assess rates of offering and uptake of HIV testing and their predictors among women who attended prenatal care. METHODS: A population-based cross-sectional study was conducted among postpartum women (N=2,234) who attended at least one prenatal care visit in 12 cities. Independent and probabilistic samples were selected in the cities studied. Sociodemographic data, information about prenatal care and access to HIV prevention interventions during the current pregnancy were collected. Bivariate and multivariate analyses were carried out to assess independent effects of the covariates on offering and uptake of HIV testing. Data collection took place between November 1999 and April 2000. RESULTS: Overall, 77.5% of the women reported undergoing HIV testing during the current pregnancy. Offering of HIV testing was positively associated with: previous knowledge about prevention of mother-to-child transmission of HIV; higher number of prenatal care visits; higher level of education and being white. HIV testing acceptance rate was 92.5%. CONCLUSIONS: The study results indicate that dissemination of information about prevention of mother-to-child transmission among women may contribute to increasing HIV testing coverage during pregnancy. Non-white women with lower level of education should be prioritized. Strategies to increase attendance of vulnerable women to prenatal care and to raise awareness among health care workers are of utmost importance.

Comparison of Aspergillus species-complexes detected in different environmental settings

Purpose: Samples from different environmental sources were screened for the presence of Aspergillus, and the distribution of the different species-complexes was determined in order to understand differences among that distribution in the several environmental sources and which of these species complexes are present in specific environmental settings. Methods: Four distinct environments (beaches, poultries, swineries and hospital) were studied and analyzed for which Aspergillus complexes were present in each setting. After plate incubation and colony isolation, morphological identification was done using macro- and microscopic characteristics. The universal fungal primers ITS1 and ITS4 were used to amplify DNA from all Aspergillus isolates, which was sequenced for identification to species complex level. SPSS v15.0 for Windows was used to perform the statistical analysis. Results: Thirty-nine isolates of Aspergillus were recovered from both the sand beach and poultries, 31 isolates from swineries, and 80 isolates from hospital environments, for a total 189 isolates. Eleven species complexes were found total. Isolates belonging to the Aspergillus Versicolores species-complex were the most frequently found (23.8%), followed by Flavi (18.0%), Fumigati (15.3%) and Nigri (13.2%) complexes. A significant association was found between the different environmental sources and the distribution of the several species-complexes (p<0.001); the hospital environment had a greater variability of species-complexes than other environmental locations (10 in hospital environment, against nine in swine, eight in poultries and seven in sand beach). Isolates belonging to Nidulantes complex were detected only in the hospital environment, whereas the other complexes were identified in more than one setting. Conclusion: Because different Aspergillus complexes have different susceptibilities to antifungal drugs, and different abilities in producing mycotoxins, knowledge of the species-complex epidemiology for each setting may allow preventive or corrective measures to be taken toward decreasing professional workers or patient exposure to those agents.

Performance of a Brazilian population on the test of functional health literacy in adults

OBJECTIVE: To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS: The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS: The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS: The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.

Estresse no trabalho e hipertensão arterial em mulheres no Estudo Pró-Saúde: Estudo Pró-Saúde (Pro-Health Study)

Com o objetivo de analisar a associação entre estresse no trabalho e hipertensão arterial na população feminina, foi realizado estudo transversal com 1.819 mulheres participantes do Estudo Pró-Saúde no Rio de Janeiro, RJ, entre 1999 e 2001. Foi utilizada a versão brasileira da escala reduzida de estresse no trabalho (modelo demanda-controle). A prevalência global de hipertensão arterial aferida (>140/90 mmHg e/ou uso de medicação anti-hipertensiva) foi de 24%. Comparadas com participantes com trabalho classificado como de baixa exigência, as razões ajustadas de prevalências de hipertensão arterial de mulheres em trabalhos de alta exigência, passivos e ativos, foram, respectivamente, de 0,93 (IC 95%: 0,72;1,20), 1,06 (IC 95%: 0,86;1,32) e 1,14 (IC 95%: 0,88;1,47). Sugere-se a realização de análises longitudinais para elucidar o papel dessas características psicossociais do ambiente de trabalho na determinação da hipertensão arterial.

Public health and the knowledge industry

Knowledge plays an important role in health care. The production and diffusion of health-related knowledge are increasingly under the control of private commercial interests, which are characterized by conflicts of interests that result in abuses of power. Considerable research has been done on the medical-industrial complex and its role in the production of power imbalances and the consequent abuses, but little attention has been dedicated to the role played by the publishing industry, which can be subject to the same problems. The widely diffused idea that "frequent and major changes" occur in medicine, albeit unsupported by clearcut evidence, is an effective marketing tool for both the pharmaceutical and publishing industries, who feed and thrive on physicians' insecurities. The production and distribution of knowledge should be addressed as a strategic component of public health.

Planeamento e balanceamento de uma linha de montagem universal para formação

Este trabalho teve o intuito de criar uma linha de montagem universal através da qual será dada formação aos atuais operadores e a novos que possam vir a pertencer ao departamento de montagem na empresa Grohe Portugal. Para tal era necessário saber realizar um estudo de métodos e um estudo de tempos sobre os vários processos existentes no departamento de montagem. Com esse intuito foi elaborada uma pesquisa sobre as referidas temáticas, onde ficou evidente a sua importância e a sua imprescindibilidade. Inicialmente houve também um acompanhamento das montagens dos produtos nas várias linhas, de forma a adquirir conhecimento sobre as características dos processos de montagem existentes no departamento. Os pontos mais importantes durante o estudo de métodos e tempos realizado foram a definição de toda a estrutura do processo, das ferramentas e materiais a utilizar, não esquecendo a relação entre o operador e as suas ferramentas e a medição de tempos de todas as tarefas necessárias para cada processo de montagem. A linha de montagem, cujo projeto se desenvolveu, é composta por três bancadas e consiste num conjunto de postos de trabalho onde são executadas as operações através de máquinas, do trabalho humano, ou da sua conjugação, dispostos numa determinada sequência, sendo alguns deles amovíveis. Para a realização e conclusão deste projeto foram superadas diversas etapas, sendo que as mais relevantes foram:  a análise dos processos de montagem;  estudo de tempos de todas as famílias de produtos a serem implementados na linha de formação; - Definição da estrutura da linha de montagem; - Definição das rampas e dos tubos de abastecimento da linha; - Desenho da linha de montagem em 3D no software SolidWorks. Paralelamente foram também desenvolvidos estudos de tempos sobre alguns produtos com o intuito de serem implementadas melhorias, ou apenas para o controlo de tempos necessários para a realização das operações Por último, foi também elaborada uma recolha de ferramentas existentes no departamento de montagem para serem elaborados manuais de instruções das ferramentas fabricadas internamente, com o objetivo de obter a certificação OSHAS 180001 e de criar documentos com a listagem de materiais necessários para cada produto.

Risk factors for cesarean section by category of health service

OBJECTIVE: To analyze the rate of cesarean section and differences in risk factors by category of health service, either public or private. METHODS: A cross-sectional study was carried out including all pregnant women in labor admitted to hospitals in the city of Rio Grande, Southern Brazil, between January 1 and December 31, 2007. A pre-coded and pre-tested questionnaire was used to collect on social, demographic, obstetric and newborn care information. Two regression models were constructed: one for public users and the other one for private ones. Poisson regression was used in each model in the multivariate analysis. Prevalence rates and 95% confidence intervals were calculated for each adjusted factor. RESULTS: The rate of cesarean section was 43% and 86% among public and private users. Sociodemographic factors and twin births have a more significant impact among public users as well as number of pregnancies (25% vs. 13% reduction in public and private users, respectively) and previous cesarean section (86% vs. 24% increase in public and private users, respectively). Prenatal care visits and hospital admissions affected the outcome only in women users of public services. CONCLUSIONS: Cesarean section rates were high in both groups studied, but it was twice as high among women cared in the private sector. Associated factors differ in magnitude by category of service used.

Impact on human health of particulate matter emitted from burnings in the Brazilian Amazon region

OBJECTIVE: To analyze the impact on human health of exposure to particulate matter emitted from burnings in the Brazilian Amazon region. METHODS: This was an ecological study using an environmental exposure indicator presented as the percentage of annual hours (AH%) of PM2.5 above 80 μg/m3. The outcome variables were the rates of hospitalization due to respiratory disease among children, the elderly and the intermediate age group, and due to childbirth. Data were obtained from the National Space Research Institute and the Ministry of Health for all of the microregions of the Brazilian Amazon region, for the years 2004 and 2005. Multiple regression models for the outcome variables in relation to the predictive variable AH% of PM2.5 above 80 μg/m3 were analyzed. The Human Development Index (HDI) and mean number of complete blood counts per 100 inhabitants in the Brazilian Amazon region were the control variables in the regression analyses. RESULTS: The association of the exposure indicator (AH%) was higher for the elderly than for other age groups (β = 0.10). For each 1% increase in the exposure indicator there was an increase of 8% in child hospitalization, 10% in hospitalization of the elderly, and 5% for the intermediate age group, even after controlling for HDI and mean number of complete blood counts. No association was found between the AH% and hospitalization due to childbirth. CONCLUSIONS: The indicator of atmospheric pollution showed an association with occurrences of respiratory diseases in the Brazilian Amazon region, especially in the more vulnerable age groups. This indicator may be used to assess the effects of forest burning on human health.

Household members and health care workers as supervisors of tuberculosis treatment

OBJECTIVE: To compare tuberculosis cure rates among patients supervised by household members or health care workers. METHODS: Prospective cohort study of 171 patients treated by the program in Vitoria, Southeastern Brazil, from 2004 to 2007. Each patient was followed-up for six months until the end of the treatment. Of the patients studied, a household member supervised 59 patients and healthcare workers supervised 112 patients. Patients' sociodemographic and clinic data were analyzed. Differences between groups were assessed using chi-square test or Student's t-test. Significance level was set at 5%. RESULTS: Most patients had smear positive, culture confirmed pulmonary tuberculosis. Two patients were HIV-positive. There were more illiterate patients in the healthcare-supervised group, in comparison to those supervised by their families (p=0.01). All patients supervised by a household member were cured compared to 90% of the patients supervised by health care workers (p = 0.024). CONCLUSIONS: Successful tuberculosis treatment was more frequent when supervised by household members.

Beyond the income inequality hypothesis and human health: a worldwide exploration

OBJECTIVE: To analyze whether the relationship between income inequality and human health is mediated through social capital, and whether political regime determines differences in income inequality and social capital among countries. METHODS: Path analysis of cross sectional ecological data from 110 countries. Life expectancy at birth was the outcome variable, and income inequality (measured by the Gini coefficient), social capital (measured by the Corruption Perceptions Index or generalized trust), and political regime (measured by the Index of Freedom) were the predictor variables. Corruption Perceptions Index (an indirect indicator of social capital) was used to include more developing countries in the analysis. The correlation between Gini coefficient and predictor variables was calculated using Spearman's coefficients. The path analysis was designed to assess the effect of income inequality, social capital proxies and political regime on life expectancy. RESULTS: The path coefficients suggest that income inequality has a greater direct effect on life expectancy at birth than through social capital. Political regime acts on life expectancy at birth through income inequality. CONCLUSIONS: Income inequality and social capital have direct effects on life expectancy at birth. The "class/welfare regime model" can be useful for understanding social and health inequalities between countries, whereas the "income inequality hypothesis" which is only a partial approach is especially useful for analyzing differences within countries.