DEMSC - Artigos publicados em periódicos
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Item Early treatment with pegylated interferon lambda for Covid-19.(2023) Reis, Gilmar; Savassi, Leonardo Cançado Monteiro; Glenn, J. S.BACKGROUND The efficacy of a single dose of pegylated interferon lambda in preventing clinical events among outpatients with acute symptomatic coronavirus disease 2019 (Covid-19) is unclear. METHODS We conducted a randomized, controlled, adaptive platform trial involving predominantly vaccinated adults with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Brazil and Canada. Outpatients who presented with an acute clinical condition consistent with Covid-19 within 7 days after the onset of symptoms received either pegylated interferon lambda (single subcutaneous injection, 180 μg) or placebo (single injection or oral). The primary composite outcome was hospitalization (or transfer to a tertiary hospital) or an emergency department visit (observation for >6 hours) due to Covid-19 within 28 days after randomization. RESULTS A total of 933 patients were assigned to receive pegylated interferon lambda (2 were subsequently excluded owing to protocol deviations) and 1018 were assigned to receive placebo. Overall, 83% of the patients had been vaccinated, and during the trial, multiple SARS-CoV-2 variants had emerged. A total of 25 of 931 patients (2.7%) in the interferon group had a primary-outcome event, as compared with 57 of 1018 (5.6%) in the placebo group, a difference of 51% (relative risk, 0.49; 95% Bayesian credible interval, 0.30 to 0.76; posterior probability of superiority to placebo, >99.9%). Results were generally consistent in analyses of secondary outcomes, including time to hospitalization for Covid-19 (hazard ratio, 0.57; 95% Bayesian credible interval, 0.33 to 0.95) and Covid-19–related hospitalization or death (hazard ratio, 0.59; 95% Bayesian credible interval, 0.35 to 0.97). The effects were consistent across dominant variants and independent of vaccination status. Among patients with a high viral load at baseline, those who received pegylated interferon lambda had lower viral loads by day 7 than those who received placebo. The incidence of adverse events was similar in the two groups. CONCLUSIONS Among predominantly vaccinated outpatients with Covid-19, the incidence of hospitalization or an emergency department visit (observation for >6 hours) was significantly lower among those who received a single dose of pegylated interferon lambda than among those who received placebo.Item Depression in Brazilian farmers : prevalence and associated factors.(2022) Petarli, Glenda Blaser; Cattafesta, Monica; Viana, Maria Carmen Moldes; Bezerra, Olívia Maria de Paula Alves; Zandonade, Eliana; Salaroli, Luciane BrescianiBackground: The unique characteristics of rural areas and agricultural work can contribute to the genesis of diseases, including mental disorders such as depression. Aims: To estimate the prevalence of and factors associated with depression symptoms in Brazilian farmers. Methods: A cross-sectional epidemiological study involving 784 farmers of the state of Espırito Santo/Brazil was carried out. Depression was identified using the Mini-International Neuropsychiatric Interview. Hierarchical logistic regression was used to assess the associated factors. Results: The prevalence of depression symptoms among farmers was 16.8% (n 1⁄4 132). Of those experiencing symptoms, 6.1% (n 1⁄4 48) we’re currently experiencing a depressive episode, and 10.7% (n 1⁄4 84) a recurrent depressive episodes. The associated factors were: female gender (OR 1.63; 95% CI 1.04–2.54), not owning the land (OR 1.79; 95% CI 1.11–2.89), professional dissatisfaction (OR 1.99; 95% CI 1.18–3.35), previous pesticide poisoning (OR 2.87; 95% CI 1.45–5.67), complex multimorbidity (OR 1.95; 95% CI 1.15–3.31) and occurrence of previous depressive episodes (OR 9.83; 95% CI 4.39–21.99). Conclusions: A high prevalence of depression symptoms was identified among rural workers. Sociodemographic, occupational, clinical, and professional dissatisfaction factors were associated with a higher risk of depression symptoms in this population.Item Cut points of the conicity index and associated factors in brazilian rural workers.(2022) Prado, Camila Bruneli do; Martins, Cleodice Alves; Cremonini, Ana Clara Petersen; Ferreira, Júlia Rabelo Santos; Cattafesta, Monica; Souza, Juliana Almeida de; Zandonade, Eliana; Bezerra, Olívia Maria de Paula Alves; Salaroli, Luciane BrescianiBackground: Metabolic syndrome is associated with cardiovascular complications. Therefore, this study aims to establish cut points for the conicity index based on the components of metabolic syndrome and to associate it with characteristic sociodemographic, food consumption and occupational factors in Brazilian rural workers; (2) Methods: A cross-sectional study carried out with farmers. The receiver operating characteristic curve was calculated and the cut-off points for the conicity index were identified by the area under the curve, sensitivity and specificity. The variables included in the binary logistic regression analysis were selected by considering p < 0.20 in the bivariate test; (3) Results: The cut points were similar in females according to both criteria, resulting in a single cut-off of 1.269. In males, the cut points showed differences, resulting in 1.272 according to the NCEP-ATP III and 1.252 according to the IDF. We have shown that younger people, those who work more than 40 h a week and the lowest contribution of culinary ingredients are associated with increased odds of abdominal obesity, while the consumption of the products they sell or produce decreases these chances; (4) Conclusions: The conicity index showed high discriminatory power for the identification of abdominal obesity in rural workers. Therefore, there is a need to improve eating habits and promote healthier eating environments for individuals, respecting traditional food culture, mainly to contain the advance of MS in rural areas.Item Prevalência de uso de medicamentos em população rural brasileira.(2022) Mendes, Samila Breder Emerich; Petarli, Glenda Blaser; Cattafesta, Monica; Zandonade, Eliana; Bezerra, Olívia Maria de Paula Alves; Mill, José Geraldo; Salaroli, Luciane BrescianiIntrodução: Apesar da vulnerabilidade social existente na população rural brasileira, o uso de medicamentos entre agricultores é um tema ainda pouco estudado no país. Objetivo: Analisar o uso de medicamentos e sua associação com características sociodemográficas, laborais, comportamentais e autoavaliação do estado de saúde em agricultores. Método: Estudo epidemiológico transversal com 790 agricultores de 18 a 59 anos, de ambos os sexos, do município de Santa Maria de Jetibá. Os medicamentos foram agrupados segundo o Sistema de Classificação Anatômico-Terapêutico-Químico (ATC) nos níveis 1 e 2. Foram realizadas análise descritiva (frequências absolutas e relativas) e associações entre as variáveis e o uso de medicamentos pelo teste de qui-quadrado. As variáveis que se mostraram associadas com o desfecho com nível de significância de 5% no teste de qui-quadrado foram testadas por regressão logística binária. Resultados: A prevalência de uso de medicamentos foi de 44,2%, sendo menor no sexo masculino (30,3%) do que no feminino (59,4%). Após a análise ajustada, o uso de medicamentos esteve associado ao sexo feminino, à faixa etária de 40 anos ou mais e à pior autoavaliação do estado de saúde. A prevalência de polifarmácia foi de 6,6%. Os medicamentos mais utilizados foram os anti-hipertensivos (19,3%). Conclusão: O estudo evidenciou a importância de se avaliar populações rurais a fim de subsidiar políticas e recursos em saúde pública.Item Insulin resistance by the triglyceride-glucose index in a rural Brazilian population.(2022) Ferreira, Júlia Rabelo Santos; Zandonade, Eliana; Bezerra, Olívia Maria de Paula Alves; Salaroli, Luciane BrescianiObjective: The aim of this study was to estimate the prevalence of insulin resistance (IR) in a rural population in Brazil, to verify its association with sociodemographic, labor, lifestyle, and health factors. Subjects and methods: This is a cross-sectional study with 790 farmers in the state of Espírito Santo/ Brazil. Triglyceride-glucose (TyG) was calculated and a cut-off point of Ln 4.52 was used. A hierarchical logistic regression for the association of insulin resistance with sociodemographic, labor, lifestyle and health variables of farmers living in Espírito Santo was performed. Results: The prevalence of insulin resistance was 33.7% (n = 266), and the association with insulin resistance was found in the age group 31 to 40 years of age (OR = 1.85; 95% CI 1.19-2.87); in smokers or former smokers (OR = 1.63; 95% CI 1.08-2.48) and overweight (OR = 3.06; 95% CI 2.22-4.23). Conclusion: The prevalence of insulin resistance was high in a rural population of Brazil, and was mainly associated with age, smoking and obesity. The use of TyG as an instrument for assessing the health of individuals living in areas where access to health services is difficult, such as rural areas, can represent an important advance in terms of health promotion, protection and recovery. In addition, by identifying the risk factors associated with IR, as well as their consequences, a more adequate scheme for the prevention and treatment of these comorbidities can be defined.Item Prevalence and determinants of obesity and abdominal obesity among rural workers in Southeastern Brazil.(2022) Cattafesta, Monica; Petarli, Glenda Blaser; Zandonade, Eliana; Bezerra, Olívia Maria de Paula Alves; Abreu, Sandra Marlene Ribeiro de; SalaroliI, Luciane BrescianiThe objectives of this study were to assess the nutritional status of rural workers from a municipality in Southeastern Brazil and estimate the association of sociodemographic, labor, lifestyle, and dietary pattern factors with obesity and abdominal obesity of men and women of this rural area. This is a cross-sectional, epidemiological study of 740 farmers (51.5%, n = 381 males; 48.5%, n = 359 females). The sociodemographic, labor, lifestyle and dietary patterns determinants were assessed. Food intake data were obtained by applying three 24-hour recalls and dietary patterns were determined by Principal Component Analysis with Varimax orthogonal rotation. Poisson regression with robust variance stratified by sex was applied. The general prevalence of overweight status was 31.5% (95% CI 28.2– 34.8%), 19.7% of obesity (95% CI 16.8–22.6%) and 31.5% of abdominal obesity (95% CI 28.2–34.8%), with higher rates in women (P < 0.001). Men of higher socioeconomic class had a 2.3 times higher prevalence of obesity (95% CI 1.08–4.90). In addition, the shorter travel time to purchase food increased the prevalence of abdominal obesity in males. For women, the older the age group, the greater the general and central obesity. A lower adherence to traditional dietary patterns (approximately PR [prevalence ratio] 1.6 for general obesity and PR 1.3 for abdominal obesity) and a greater number of places to buy food were associated with higher rates of obesity in women. Finally, women farmers with a higher workload had a 20% lower prevalence of central obesity (PR 0.80; 95% CI 0.65–0.97). Such findings demonstrate that obesity must be an issue in the health care of remote and rural populations. There is a need to promote healthier environments that respect traditional food culture through multiple approaches that consider the heterogeneity of rural areas and the differences between sexes.Item A saúde do trabalhador na atenção primária à saúde : vivências em uma unidade básica de saúde em Belo Horizonte, Minas Gerais.(2022) Souza Neto, Fábio de; Bezerra, Olívia Maria de Paula AlvesO presente estudo teve como foco a atual relação entre a Saúde do Trabalhador (ST) e a Atenção Primária à Saúde (APS)1 no contexto da Unidade Básica de Saúde (UBS) Confisco, situada na cidade de Belo Horizonte, Minas Gerais. A relevância da pesquisa está no fato de ainda haver lacunas a ser preenchidas em termos das ações em ST no âmbito dos cuidados primários em saúde, conforme definido pela Política Nacional de Saúde do Trabalhador e da Trabalhadora (PNSTT), de 2012. O objetivo principal foi desvelar a interação entre APS e a ST, evidenciando a importância dessa relação, os avanços e, principalmente, os desafios ainda existentes no desenvolvimento das políticas de proteção à saúde do trabalhador. As informações que sustentam esse estudo foram obtidas em pesquisa transversal qualitativa, cuja metodologia incluiu uma roda de pesquisa on-line com profissionais da UBS e de entrevistas semiestruturadas com os profissionais do Centro de Referência em Saúde do Trabalhador (CEREST) e com usuários da UBS1. Qualificar, então, a assistência aos trabalhadores no Sistema Único de Saúde (SUS) foi a principal proposta do estudo.Item Rede de Atenção Psicossocial : desenvolvimento e validação de um instrumento multidimensional para avaliação da implantação (IMAI-RAPS).(2023) Coelho, Vivian Andrade Araújo; Pauferro, Ana Luiza Moreira; Silva, Mariana Arantes e; Guimarães, Denise Alves; Gama, Carlos Alberto Pegolo da; Modena, Celina Maria; Guimarães, Eliete Albano AzevedoTrata-se de um estudo metodológico para desenvolvimento e validação do Instrumento Multidimensional para Avaliação da Implantação da RAPS (IMAI-RAPS) em Minas Gerais (MG)/ Brasil. O estudo foi executado em três etapas: estudo de avaliabilidade, desenvolvimento do IMAI-RAPS, aplicação da Técnica Delphi para validação de conteúdo e aparência das questões. Foram realizados a análise de documentos oficiais, revisão da literatura e um engajamento estruturado com membros do programa para esclarecer sua operacionalização e focalizar os aspectos centrais a serem avaliados. Um modelo teórico-lógico da RAPS foi construído de acordo com a tríade donabediana: estrutura, processo e resultado e organizado em: Unidades Mínimas (Assistência à Saúde Mental e Reabilitação Psicossocial), Conectividade (Articulação da Rede), Integração (Governança e Gestão do Cuidado), Normatividade (Política de Saúde Mental e Participação e Controle Social), Subjetividade e Estrutura (Serviços, Sistema Logístico e Educação em Saúde). Desse modelo derivou-se o IMAI-RAPS que foi validado por 44 experts da área indicando a abordagem de questões relevantes, úteis e viáveis para avaliação da estrutura e processo de implantação do programa em MG. A utilização da Técnica Delphi possibilitou que os produtos desenvolvidos fossem balizados por estudiosos ou profissionais da RAPS de diversas regiões do país aumentando o poder analítico da ferramenta.Item Community mental health care network : an evaluative approach in a Brazilian state.(2023) Coelho, Vivian Andrade Araújo; Gama, Carlos Alberto Pegolo da; Andrade, Leonardo Isolani e; Silva, Mariana Arantes e; Guimarães, Denise Alves; Guimarães, Eliete Albano Azevedo; Modena, Celina MariaIn recent decades, public policies of the Unified Health System (SUS) in Brazil have structured a community mental health care network (RAPS) based on various community actions and services. This study carried out evaluative research on the implementation of the structure and process dimensions of this care network in Minas Gerais, the second most populous state of Brazil, generating indicators that can enhance the strategic management of the public health system in the strengthening the psychosocial care in the state. The application of a multidimensional instrument, previously validated (IMAI-RAPS), in 795 of the 853 municipalities in Minas Gerais was carried out between June and August 2020. Regarding the structural dimension, we noticed an adequate implementation of services like ‘Family Health Strategy,’ ‘Expanded Family Health Center,’ and ‘Psychosocial Care Centers’ but a lack of ‘Beds in General Hospitals’ destinated to mental health care, ‘Unified Electronic Medical Records’ and ‘Mental Health Training Activities for Professionals.’ In the process dimension, adequate implementation of actions such as ‘Multidisciplinary and Joint Care,’ ‘Assistance to Common Mental Disorders by Primary Health Care,’ ‘Management of Psychiatric Crises in Psychosocial Care Centers,’ ‘Offer of Health Promotion Actions,’ and ‘Discussion of Cases by Mental Health Teams’ point to a form of work consistent with the guidelines. However, we detected difficulties in the implementation of ‘Psychosocial Rehabilitation Actions,’ ‘Productive Inclusion,’ ‘User Protagonism,’ ‘Network Integration,’ and practical activities for the effectiveness of collaborative care. We found a better implementation of the mental health care network in more populous, demographically dense, and socioeconomically developed cities, which shows the importance of regional sharing of services that are not possible for small cities. The evaluation practices of mental health care networks are scarce throughout the Brazilian territory, a fact also found in Minas Gerais, highlighting the need for its expansion not only in the scientific sphere but also in the daily life of the various levels of management.Item Dificuldades no trabalho em saúde mental : percepção de trabalhadores do Núcleo de Apoio à Saúde da Família na macrorregião oeste de Minas Gerais.(2023) Guimarães, Denise Alves; Oliveira, Vanessa Cristina de Paiva; Coelho, Vivian Andrade Araújo; Gama, Carlos Alberto Pegolo daNo atual cenário de manobras neoliberais no país, mudanças nas Políticas de Atenção em Saúde alteram formas de organização e financiamento dos serviços, desdobram-se em formas precarizadas de trabalho e ameaçam conquistas da Reforma Psiquiátrica e Atenção Psicossocial. Buscou-se identificar e analisar, na percepção de profissionais de 11 equipes de Núcleo de Apoio a Saúde da Família (NASF), dificuldades no processo de construção de uma política de Saúde Mental (SM) na Atenção Básica em Saúde (ABS). Realizou-se estudo qualitativo, a partir de entrevistas com 11 profissionais de SM dos NASF, e estas foram analisadas considerando-se o referencial da Análise de Conteúdo. As dificuldades identificadas foram: formas precárias de contratação; alta rotatividade; carga horária insuficiente; baixa remuneração; concentração da carga horária em atividades de assistência; falta de compartilhamento e integração de serviços e profissionais; desarticulação da Rede de Atenção Psicossocial (RAPS). O Apoio Matricial não estava incorporado e não havia políticas de Educação Permanente em Saúde (EPS) no conjunto dos municípios estudados. No entanto, os NASF contribuíam para melhorar o cuidado em SM. Conclui-se que as mudanças em curso impõem desafios para a sustentação de conquistas em SM e consolidação da política de SM na ABS dos municípios estudados.