Ana Paula Souto Melo

Cause-specific mortality for 249 causes in Brazil and states during 1990–2015: a systematic analysis for the global burden of disease study 2015

BackgroundReliable data on cause of death (COD) are fundamental for planning and resource allocation priorities. We used GBD 2015 estimates to examine levels and trends for the leading causes of death in Brazil from 1990 to 2015.MethodsWe describe the main analytical approaches focused on both overall and specific causes of death for Brazil and Brazilian states.ResultsThere was an overall improvement in life expectancy at birth from 1990 to 2015, but with important heterogeneity among states. Reduced mortality due to diarrhea, lower respiratory infections, and other infectious diseases contributed the most for increasing life expectancy in most states from the North and Northeast regions. Reduced mortality due to cardiovascular diseases was the highest contributor in the South, Southeast, and Center West regions. However, among men, intentional injuries reduced life expectancy in 17 out of 27 states. Although age-standardized rates due to ischemic heart disease (IHD) and cerebrovascular disease declined over time, these remained the leading CODs in the country and states. In contrast, leading causes of premature mortality changed substantially - e.g., diarrheal diseases moved from 1st to 13th and then the 36th position in 1990, 2005, and 2015, respectively, while violence moved from 7th to 1st and to 2nd. Overall, the total age-standardized years of life lost (YLL) rate was reduced from 1990 to 2015, bringing the burden of premature deaths closer to expected rates given the country’s Socio-demographic Index (SDI). In 1990, IHD, stroke, diarrhea, neonatal preterm birth complications, road injury, and violence had ratios higher than the expected, while in 2015 only violence was higher, overall and in all states, according to the SDI.ConclusionsA widespread reduction of mortality levels occurred in Brazil from 1990 to 2015, particularly among children under 5 years old. Major shifts in mortality rates took place among communicable, maternal, neonatal, and nutritional disorders. The mortality profile has shifted to older ages with increases in non-communicable diseases as well as premature deaths due to violence. Policymakers should address health interventions accordingly.

Cigarette smoking among psychiatric patients in Brazil.

The aim of this study was to estimate tobacco smoking prevalence among psychiatric patients attended in care facilities in Brazil and assess associated factors. A cross-sectional multicenter study was conducted of psychiatric patients (N = 2,475) selected from 26 care facilities. Current and ex-smokers were compared to those who had never smoked. Odds ratios were estimated using logistic regression. The current and past smoking prevalence rates were 52.7% and 18.9%, respectively. Being male, aged 40 years or over, drug and alcohol use, unprotected sex and a history of physical violence were factors associated with both current and past smoking, while a low education level (≤ 8 years of schooling), history of homelessness, not practicing a religion, current or previous psychiatric hospitalization, and main psychiatric diagnosis substance use disorders, were factors only associated with current smoking. Tobacco smoking prevalence among this population was high and was higher than the rate in the general population. Appropriate interventions and smoking prevention policies should be incorporated into mental health services.

Mortalidade por cirrose, câncer hepático e transtornos devidos ao uso de álcool: Carga Global de Doenças no Brasil, 1990 e 2015

Introduction: Alcohol use is one of the main preventable risk factors affecting mortality and premature disability. Objective: To describe the estimates of mortality and years of life lost as a result of premature death (YLL) due to cirrhosis, liver cancer, and disorders attributed to alcohol use in Brazil and its federated units in 1990 and 2015. Methods: Descriptive study using data from the Global Burden of Disease Study (2015) and the Mortality Information System (SIM). Statistical models were used to obtain corrected mortality estimates for selected causes. Rates were standardized by age. Results: In 1990, 16,226 deaths were estimated for the three conditions (17.0/100 thousand inhabitants), while in 2015 there were 28,337 deaths (15.7/100 thousand inhabitants). There was a reduction in mortality (per 100 thousand) due to cirrhosis (from 11.4 to 9.5), stability in mortality rates related to liver cancer (1.5 and 1.9), and stability in mortality rates caused by alcohol use disorders (4.1 and 4.3). Mortality rates were 5.1 times higher among men, and the five states with the highest mortality rates and YLL were from the Northeast Region: Sergipe, Ceará, Pernambuco, Paraíba, and Alagoas. Mortality and YLL rates for the three conditions studied increased in the ranking of causes of death in both sexes, with the exception of cirrhosis in the female population. Conclusion: The three conditions studied are responsible for a significant burden of premature mortality in Brazil, especially among men and residents of the northeast region. These results reinforce the urgent need for public policies that address harmful alcohol consumption in Brazil.

Prevalência do consumo moderado e excessivo de álcool e fatores associados entre residentes de Comunidades Quilombolas de Vitória da Conquista, Bahia, Brasil

The scope of the study was to assess moderate and excessive alcohol consumption and associated factors among residents of Quilombola Communities in Vitória da Conquista in the State of Bahia. It involved a cross-sectional study among 750 individuals aged ≥ 18 years interviewed in 2011 using an adapted version of the National Survey of Health Questionnaire. Alcohol consumption was classified into abstemious, moderate and heavy drinking categories and was analyzed using the multinomial regression model. Consumption was observed among 41.5% of participants (95% CI [37.8, 44.98]); 10.7% being identified in the excessive consumption category and 30.8% in the moderate consumption category. Moderate consumption was inversely associated with age and is more common among whites and mulattoes, the better educated, the gainfully employed and among smokers. Heavy consumption increased with level of education, being more prevalent among those who had at least 8 years of schooling, smokers and the gainfully employed. The study shows that in these communities there are differences in the sociodemographic characteristics among the profiles of alcohol drinkers and these differences should be taken into account when drawing up proposals for the promotion of healthy habits.

A carga dos transtornos mentais e decorrentes do uso de substâncias psicoativas no Brasil: Estudo de Carga Global de Doença, 1990 e 2015

Introduction: Mental and substance use disorders (MD) are highly prevalent and have a high social and economic cost. Objective: To describe the burden of disease attributable to mental and substance use disorders in Brazil and Federated Units in 1990 and 2015. Methods: Descriptive study of the burden of mental and substance use disorders, using age-standardized estimates from the Global Burden of Disease Study 2015: years of life lost due to premature mortality (YLL); years lived with disability (YLD); and disability-adjusted life year (DALY=YLL+YLD). Results: In Brazil, despite low mortality rates, there has been a high burden for mental and substance use disorders since 1990, with high YLD. In 2015, these disorders accounted for 9.5% of all DALY, ranking in the third and first position in DALY and YLD, respectively, with an emphasis on depressive and anxiety disorders. Drug use disorders had their highest increase in DALY rates between 1990 and 2015 (37.1%). The highest proportion of DALY occurred in adulthood and in females. There were no substantial differences in burden of mental and substance use disorders among Federated Units. Conclusion: Despite a low mortality rate, mental and substance use disorders are highly disabling, which indicates the need for preventive and protective actions, especially in primary health care. The generalization of estimates in all the Federated Units obtained from studies conducted mostly in the south and southeast regions probably does not reflect the reality of Brazil, indicating the need for studies in all regions of the country.Introduction: Mental and substance use disorders (MD) are highly prevalent and have a high social and economic cost. Objective: To describe the burden of disease attributable to mental and substance use disorders in Brazil and Federated Units in 1990 and 2015. Methods: Descriptive study of the burden of mental and substance use disorders, using age-standardized estimates from the Global Burden of Disease Study 2015: years of life lost due to premature mortality (YLL); years lived with disability (YLD); and disability-adjusted life year (DALY=YLL+YLD). Results: In Brazil, despite low mortality rates, there has been a high burden for mental and substance use disorders since 1990, with high YLD. In 2015, these disorders accounted for 9.5% of all DALY, ranking in the third and first position in DALY and YLD, respectively, with an emphasis on depressive and anxiety disorders. Drug use disorders had their highest increase in DALY rates between 1990 and 2015 (37.1%). The highest proportion of DALY occurred in adulthood and in females. There were no substantial differences in burden of mental and substance use disorders among Federated Units. Conclusion: Despite a low mortality rate, mental and substance use disorders are highly disabling, which indicates the need for preventive and protective actions, especially in primary health care. The generalization of estimates in all the Federated Units obtained from studies conducted mostly in the south and southeast regions probably does not reflect the reality of Brazil, indicating the need for studies in all regions of the country.

Factors associated with depression: sex differences between residents of Quilombo communities

INTRODUCTION The Quilombola population is subject to numerous sources of social vulnerability, but few studies investigate their physical or mental health conditions. OBJECTIVES To investigate the factors associated with depression in men and women, separately. METHODOLOGY Cross-sectional population-based study with 764 randomly selected participants from five quilombo communities in Vitória da Conquista, Bahia, Brazil. The cutoff point for depression was ≥ 10 points, assessed by the Patient Health Questionnaire score (PHQ-9), and the presence of five or more symptoms. We estimated the prevalence ratio with 95% confidence intervals using Poisson regression models with robust estimators stratified by gender. RESULTS Among men, factors associated with depression were previous diagnosis of chronic illnesses, poor/very poor health self-assessment, and poor access to health services. Among women, the associated factors were previous diagnosis of psychiatric disorders, poor/very poor health self-perception, history of tobacco smoking, and self-declaration of race as not black. CONCLUSION Factors associated with depression differ between men and women and must be considered in interventions to fight depression within this population.

Psychiatric patients' return for HIV/STI test results in mental health centers

OBJECTIVE To assess individual and/or health service factors associated with patients returning for results of HIV or sexually transmitted infection (STI) tests in mental health centers. METHODS Cross-sectional national multicenter study among 2,080 patients randomly selected from 26 Brazilian mental health centers in 2007. Multilevel logistic regression was used to assess the effect of individual (level 1) and mental health service characteristics (level 2) on receipt of test results. RESULTS The rate of returning HIV/STI test results was 79.6%. Among health service characteristics examined, only condom distribution was associated with receiving HIV/STI test results, whereas several individual characteristics were independently associated including living in the same city where treatment centers are; being single; not having heard of AIDS; and not having been previously HIV tested. CONCLUSIONS It is urgent to expand HIV/STI testing in health services which provide care for patients with potentially increased vulnerability to these conditions, and to promote better integration between mental health and health services.

Sífilis na gestação e fatores associados à sífilis congênita em Belo Horizonte-MG, 2010-2013

OBJETIVO: estimar incidencia e fatores associados a sifilis congenita em conceptos de gestantes com sifilis atendidas nas unidades basicas de saude de Belo Horizonte-MG, Brasil. METODOS: estudo de coorte historica, entre novembro/2010 e setembro/2013; dados obtidos dos prontuarios eletronicos; foram calculados riscos relativos (RR) e intervalos de confianca de 95% (IC95%). RESULTADOS: incluiu-se 353 gestantes com sifilis; a incidencia acumulada de sifilis congenita foi de 33,4%; mostraram-se como fatores associados idade materna <20 anos (RR=1,44; IC95% 1,05;1,99), baixa escolaridade (RR=1,64; IC95% 1,02;2,62), inicio tardio do pre-natal (RR=1,65; IC95% 1,21;2,27), consultas de pre-natal <6 (RR=1,37; IC95% 1,02;1,84), nao realizacao do teste nao treponemico (Venereal Disease Research Laboratory [VDRL]) no primeiro trimestre (RR=1,68; IC95% 1,21;2,32), titulo do primeiro (RR=2,86; IC95% 1,85;4,41) e ultimo VDRL ≥1:8 (RR=2,35; IC95% 1,62;3,42). CONCLUSOES: a incidencia de sifilis congenita sugere falhas na assistencia pre-natal e indica serem necessarias novas estrategias para reduzir a transmissao vertical da doenca.

Syphilis in pregnancy and factors associated with congenital syphilis in Belo Horizonte-MG, Brazil, 2010-2013

OBJETIVO: estimar incidencia e fatores associados a sifilis congenita em conceptos de gestantes com sifilis atendidas nas unidades basicas de saude de Belo Horizonte-MG, Brasil. METODOS: estudo de coorte historica, entre novembro/2010 e setembro/2013; dados obtidos dos prontuarios eletronicos; foram calculados riscos relativos (RR) e intervalos de confianca de 95% (IC95%). RESULTADOS: incluiu-se 353 gestantes com sifilis; a incidencia acumulada de sifilis congenita foi de 33,4%; mostraram-se como fatores associados idade materna <20 anos (RR=1,44; IC95% 1,05;1,99), baixa escolaridade (RR=1,64; IC95% 1,02;2,62), inicio tardio do pre-natal (RR=1,65; IC95% 1,21;2,27), consultas de pre-natal <6 (RR=1,37; IC95% 1,02;1,84), nao realizacao do teste nao treponemico (Venereal Disease Research Laboratory [VDRL]) no primeiro trimestre (RR=1,68; IC95% 1,21;2,32), titulo do primeiro (RR=2,86; IC95% 1,85;4,41) e ultimo VDRL ≥1:8 (RR=2,35; IC95% 1,62;3,42). CONCLUSOES: a incidencia de sifilis congenita sugere falhas na assistencia pre-natal e indica serem necessarias novas estrategias para reduzir a transmissao vertical da doenca.

Sífilis gestacional y factores asociados con sífilis congénita en Belo Horizonte-MG, Brasil, 2010-2013

OBJETIVO: estimar incidencia e fatores associados a sifilis congenita em conceptos de gestantes com sifilis atendidas nas unidades basicas de saude de Belo Horizonte-MG, Brasil. METODOS: estudo de coorte historica, entre novembro/2010 e setembro/2013; dados obtidos dos prontuarios eletronicos; foram calculados riscos relativos (RR) e intervalos de confianca de 95% (IC95%). RESULTADOS: incluiu-se 353 gestantes com sifilis; a incidencia acumulada de sifilis congenita foi de 33,4%; mostraram-se como fatores associados idade materna <20 anos (RR=1,44; IC95% 1,05;1,99), baixa escolaridade (RR=1,64; IC95% 1,02;2,62), inicio tardio do pre-natal (RR=1,65; IC95% 1,21;2,27), consultas de pre-natal <6 (RR=1,37; IC95% 1,02;1,84), nao realizacao do teste nao treponemico (Venereal Disease Research Laboratory [VDRL]) no primeiro trimestre (RR=1,68; IC95% 1,21;2,32), titulo do primeiro (RR=2,86; IC95% 1,85;4,41) e ultimo VDRL ≥1:8 (RR=2,35; IC95% 1,62;3,42). CONCLUSOES: a incidencia de sifilis congenita sugere falhas na assistencia pre-natal e indica serem necessarias novas estrategias para reduzir a transmissao vertical da doenca.