Juliana Vaz de Melo Mambrini

To examine the association between age at menarche and general and/or abdominal obesity in Brazilian women aged ≥ 50 years. Cross-sectional study conducted with data from the second wave of the Brazilian Longitudinal Study of Aging (Estudo Longitudinal da Saúde dos Idosos Brasileiros(ELSI-Brazil, 2019-2021), in a nationally representative sample of community-dwelling individuals aged ≥ 50 years. Self-reported age at menarche was categorized as ≤ 12 years, 13-15 years, and ≥ 16 years. General obesity was defined as a body mass index of ≥ 30 kg/m2, and abdominal obesity as a waist circumference of ≥ 88 cm. The variables were combined into "general or abdominal obesity" and "general and abdominal obesity". Multinomial logistic regression adjusted for sociodemographic and lifestyle characteristics was used. Among the 4,229 participants, 41.1% (95% confidence interval -95%CI 37.9-44.3) reported menarche at ≤ 12 years and 9.3% (95%CI 8.0-10.9) at ≥ 16 years. The prevalence of general or abdominal obesity was 36.6% (95%CI 33.7-39.5), while the prevalence of general and abdominal obesity was 35.0% (95%CI 32.5-37.7). After adjustments, women with age at menarche of ≤ 12 and 13-15 years had, respectively, 84% (odds ratio - OR = 1.84; 95%CI 1.14-2.98) and 64% (OR = 1.64; 95%CI 1.04-2.57) greater odds of general and abdominal obesity compared with those with menarche at ≥ 16 years. There was no significant association between age at menarche and general or abdominal obesity. Menarche before age 16 is associated with a higher odds of general and abdominal obesity combined, but not in isolation, suggesting its potential as a relevant marker for the formulation of public policies aimed at preventing obesity in girls from school age onwards.

The aim was to compare the performance of the oral health teams participating in the 2nd and 3rd cycles of the PMAQ-AB. A longitudinal study with data from the external evaluation phase of the second (18,115 OHT) and the third (22,994) cycles of PMAQ-AB was carried out. The OHT participating in the two cycles were matched using the National Team Identifier, resulting in a sample of 15,734 OHT. Eleven procedures related to preventive, surgical-restorative, prosthetic, and oral cancer prevention or diagnosis procedures were selected and analyzed by a questionnaire. Item response theory estimated the performance scores of the OHT based on the items. The Wilcoxon test (p ≤ 0.05) was used to compare the OHT performance between cycles. The mean score in Brazil went from -0.125 (2nd cycle) to 0.149 (3rd cycle). In the North, the average score went from -0.429 to -0.237; Northeast from -0.203 to 0.222; Midwest from -0.259 to 0.007; South from 0.011 to 0.114; Southeast from 0.067 to 0.199, with a greater difference between cycles in the Northeast, Midwest, and North. Brazil and the Brazilian regions showed improvement in the scores between the two cycles analyzed, with regional differences.

RESUMO Objetivo: Avaliar a associação entre o contexto socioeconômico e indicadores de uso dos serviços de saúde entre mulheres com 50 anos ou mais, segundo a fonte de atenção (usuárias exclusivas do Sistema Único de Saúde [SUS] versus de plano de saúde). Métodos: Estudo transversal com dados da linha de base do Estudo Longitudinal da Saúde dos Idosos Brasileiros (2015-2016), com amostra representativa da população com 50 anos ou mais. Foram analisados os seguintes indicadores de uso dos serviços de saúde: realização de mamografia, Papanicolau, dosagem de colesterol e glicemia e aferição da pressão arterial. A condição socioeconômica contextual foi medida pelo Índice Brasileiro de Privação (IBP). Utilizou-se modelo logístico multinível, bruto e ajustado, depois de constatar variabilidade significativa entre setores censitários. Resultados: A amostra incluiu 5.314 mulheres, sendo 54,2% com 60 anos ou mais. Observou-se um gradiente socioeconômico na realização de exames de glicemia e colesterol, com menor probabilidade de realização entre mulheres de áreas de maior privação. Esse padrão persistiu independentemente da fonte de atenção, sendo identificado tanto entre usuárias exclusivas do SUS quanto entre beneficiárias de plano privado (glicemia: odds ratio - OR 0,82, intervalo de confiança de 95% - IC95% 0,69-0,96 e OR 0,91, IC95% 0,87-0,96; colesterol: OR 0,71, IC95% 0,59-0,87 e OR 0,89, IC95% 0,85-0,95, respectivamente). Conclusão: Os resultados revelam iniquidades nas dosagens de glicemia e colesterol por mulheres com 50 anos ou mais, especialmente entre aquelas que dependem do SUS e vivem em áreas de pior contexto socioeconômico. Reforça-se a necessidade de políticas públicas focadas nas mulheres para reduzir as iniquidades presentes na utilização dos serviços de saúde.

Objective: To evaluate the association between contextual socioeconomic conditions and indicators of health service use among women aged 50 years or older, according to source of care (Brazilian Unified Health System-SUS vs. private health insurance). Methods: A cross-sectional study was conducted using baseline data from the Brazilian Longitudinal Study of Aging (2015-2016), a nationally representative survey of the population aged 50 years and older. The following indicators of health service use were analyzed: mammogram, Pap smear, measurements of cholesterol, blood glucose, and blood pressure. Contextual socioeconomic condition was assessed using the Brazilian Deprivation Index (Índice Brasileiro de Privação - IBP). Crude and adjusted multilevel logistic models were fitted after significant between-census-tract variability was confirmed. Results: The sample included 5,314 women, 54.2% of whom were aged 60 years or older. A socioeconomic gradient was observed in blood glucose and cholesterol testing, with lower odds of undergoing these tests among women living in areas of greater deprivation. This pattern was observed among both SUS users and private health insurance beneficiaries (blood glucose: OR 0.82, 95%CI 0.69-0.96 and OR 0.91, 95%CI 0.87-0.96; cholesterol: OR 0.71, 95%CI 0.59-0.87 and OR 0.89, 95%CI 0.85-0.95, respectively). Conclusion: The findings highlight socioeconomic inequities in cholesterol and blood glucose testing among women aged 50 years or older, particularly among SUS users living in areas with higher levels of deprivation. These results reinforce the need for public policies aimed at reducing socioeconomic inequities in healthcare utilization among women.

Resumen Considerando el escenario de envejecimiento poblacional en Brasil, marcado por la feminización de la vejez y la persistente desigualdad social en el acceso y uso de los servicios de salud, este estudio tiene como objetivo investigar la asociación entre las variables socioeconómicas y los exámenes preventivos de salud entre las mujeres mayores (+50), según la fuente de atención de salud. Se trata de un estudio transversal que utiliza datos de ELSI-Brasil (2015-2016). Los resultados fueron pruebas de Papanicolaou, mamografías, niveles de colesterol y glucosa en sangre y medición de la presión arterial, y las exposiciones de interés fueron la escolarización, el color autodeclarado y el ingreso familiar per cápita. Se ajustaron modelos logísticos, con estimación de odds ratios (α=5%). El color autodeclarado, la escolarización y los ingresos se asociaron con frecuencia a los resultados de las mujeres con y sin seguro médico privado, y se realizaron más pruebas entre las mujeres blancas y las que tenían una mayor escolarización e ingresos. La implementación de políticas públicas y acciones multisectoriales que actúen sobre los determinantes estructurales de la salud y mejoren las condiciones de vida y de trabajo es esencial para reducir las desigualdades en salud y garantizar el derecho universal a la salud.

Resumo Considerando o cenário de envelhecimento populacional brasileiro, marcado pela feminização da velhice e pela persistente desigualdade social no acesso e uso dos serviços de saúde, este trabalho tem como objetivo investigar a associação entre variáveis socioeconômicas e realização de exames preventivos de saúde entre mulheres mais velhas (+50), segundo fonte de atenção à saúde. Trata-se de estudo transversal utilizando dados do ELSI-Brasil (2015-2016). Os desfechos foram a realização de exame de Papanicolau, mamografia, dosagem de colesterol e glicemia e aferição da pressão arterial, e as exposições de interesse foram escolaridade, cor autorreferida e renda domiciliar per capita. Foram ajustados modelos logísticos, com estimativa de razões de chance (α = 5%). Cor autorreferida, escolaridade e renda foram frequentemente associadas aos desfechos para mulheres com e sem afiliação aos planos privados de saúde, com maior realização dos exames entre as brancas e de maior escolaridade e renda. Implementação de políticas públicas e ações multisetoriais que atuem nos determinantes estruturais da saúde e melhorem as condições de vida e trabalho são essenciais para reduzir as iniquidades em saúde e garantir o direito universal a saúde.

Considering the scenario of Brazilian population aging, marked by the feminization of old age and persistent social inequality in access to and use of health services, this study aims to investigate the association between socioeconomic variables and preventive healthcare among older women (50+), according to the source of health care. This is a cross-sectional study, based on ELSI-Brazil (2015-2016) baseline data. The outcomes were Pap smear; mammography; measurements of cholesterol, blood glucose, and blood pressure; and the exposures of interest were educational level, self-reported skin color, and per capita household income. Odds ratio (OR) were estimated in Logistic regression models. Self-reported skin color, educational level, and per capita household income were frequently associated with outcomes for women with and without private health plans, with a higher prevalence of exams among those who were white and those who had higher educational and income levels. The implementation of public policies and multisectoral actions that tackle the structural determinants of health and improve people’s living and working conditions is essential to reducing health inequalities and ensuring the universal right to health.

Resumo Os objetivos foram avaliar as diferenças do perfil nutricional entre 2015/2016 e 2019/2021 e estimar o número de brasileiros (≥ 50 anos) com inadequações do perfil nutricional. Trata-se de um estudo transversal que utilizou dados de participantes das ondas 1 (2015/2016; n = 8.724) e 2 (2019/2021; n = 7.729) do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). Os parâmetros antropométricos incluíram índice de massa corporal e circunferência da cintura (CC) e consumo alimentar semanal de frutas, hortaliças, peixes, aves e carnes vermelhas nas duas ondas. Foram analisados sete critérios de inadequação do perfil nutricional. Houve aumento na prevalência de CC elevada [70,0% (IC95% 68,5-71,5) e 75,5% (IC95% 72,8-78,0)] e do consumo de frutas em 3-4 dias da semana [16,5% (IC95% 15,4-17,6) e 23,0% (IC95% 20,1-26,1)] entre as ondas 1 e 2, respectivamente. As prevalências de baixo peso e excesso de peso (em torno de 2% e 70%, respectivamente) se mantiveram estáveis nesse período. Estimou-se que, em 2022, cerca de 29 milhões de brasileiros com ≥ 50 anos tinham ≥ 4 critérios inadequados do perfil nutricional. Conclui-se que o perfil nutricional dos participantes apresentou mudanças discretas no período. Ações de saúde pública são necessárias para melhorar os parâmetros antropométricos e o consumo alimentar dessa população.

Objective: To assess duplication, completeness and internal consistency of records of accidents involving exposure to biological material in dental settings in Belo Horizonte from 2006 to 2019. Method: This is a descriptive study using Notifiable Health Conditions Information System data, including identification, sociodemographic and occupational data, accident circumstances, use of protective equipment, laboratory test, accident response and outcome variables. Duplication was identified by deterministic and probabilistic combinations. Completeness was classified as excellent (≥95%), good (90%-94.9%), fair (70%-89.9%), poor (50%-69.9%), and very poor (<50%). Consistency was evaluated in pairs of variables and classified as excellent (≥90%), fair (70%-89%), and poor (<70%). Results: 1,054 records were investigated, with no duplicates identified. Among the 17 mandatory variables analyzed, 15 showed excellent completeness; the "pregnant" (80.4%) and "issuance of work accident report" (75.5%) variables were classified as fair. Among the essential variables, the fields related to personal protective equipment achieved fair completeness (78.0%-89.9%), while the "injured person laboratory test" and the "source patient" fields, as well as the "response at the time of the accident" and "case evolution" fields, showed very poor completeness (<50%). In terms of consistency, the "source patient known/source patient test results" and the "type of exposure/causative agent" pair were classified as fair, while "case evolution" showed low consistency (55.1%). Conclusion: Although the system adequately records the occurrence of accidents, weaknesses in clinical and occupational variables reduce its usefulness for surveillance, as they restrict assessment of infection risk and clinical follow-up of exposed workers.