Debora Castanheira | Fundação Oswaldo Cruz (original) (raw)
Papers by Debora Castanheira
Plos One, 2024
Abstract Background: Lung cancer screening (LCS) using low-dose computed tomography (LDCT) is a s... more Abstract
Background: Lung cancer screening (LCS) using low-dose computed tomography (LDCT) is a strategy for early-stage diagnosis. The implementation of LDCT screening in countries with a high prevalence/incidence of tuberculosis (TB) is controversial. This systematic review and meta-analysis aim to identify whether LCS using LDCT increases early-stage diagnosis and decreases mortality, as well as the false-positive rate, in regions with a high prevalence of TB.
Methods/design: Studies were identified by searching BVS, PUBMED, EMBASE, and SCOPUS. RCT and cohort studies (CS) that show the effects of LDCT in LC screening on mortality and secondary outcomes were eligible. Two independent reviewers evaluated eligibility and a third judged disagreements. We used the Systematic Review Data Repository (SRDR+) to extract the metadata and record decisions. The analyses were stratified by study design and incidence of TB. We used the Cochrane "Risk of bias" assessment tool.
Results: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) were used. Thirty-seven papers were included, referring to 22 studies (10 RCTs and 12 cohorts). Few studies were from regions with a high incidence of TB (One RCT and four cohorts). Nonetheless, the evidence is compatible with European and USA studies. RCTs and CS also had consistent results. There is an increase in early-stage (I-II) diagnoses and reduced LC mortality in the LCDT arm compared to the control. Although false-positive rates varied, they stayed within the 20 to 30% range.
Discussion: This is the first meta-analysis of LDCT for LCS focused on its benefits in regions with an increased incidence/prevalence of TB. Although the specificity of Lung-RADS was higher in participants without TB sequelae than in those with TB sequelae, our findings point out that the difference does not invalidate implementing LDCT LCS in these regions.
Trial registration: Systematic review registration Systematic review registration PROSPERO CRD42022309581.
Revista de Saúde Pública, 2024
RESUMO OBJETIVO: Analisar o impacto da política de austeridade fiscal (PAF) nas despesas em saúde... more RESUMO OBJETIVO: Analisar o impacto da política de austeridade fiscal (PAF) nas despesas em saúde dos municípios brasileiros, levando em consideração o porte populacional e a fonte dos recursos. MÉTODOS: Utilizou-se o método de séries temporais interrompidas para analisar o efeito da PAF sobre as despesas totais, recursos transferidos pela União e recursos próprios/estaduais per capita destinados à saúde nos municípios. A série temporal analisada compreendeu o período de 2010 a 2019, com periodicidade semestral. Adotou-se o primeiro semestre de 2015 como data de início da intervenção. Os municípios foram agregados em pequenos (até 100 mil habitantes), médios (101 mil a 400 mil habitantes) e grandes (mais de 400 mil habitantes). Os dados foram obtidos no Sistema de Informações sobre Orçamentos Públicos em Saúde.
RESULTADOS: Os resultados para a média nacional dos municípios demonstram que a PAF teve um impacto negativo sobre o nível de despesas totais e de recursos próprios/estaduais destinados à saúde no primeiro semestre de 2015, não provocando mudanças estaticamente significativas nas tendências de nenhum dos indicadores analisados no período posterior a 2015. Municípios pequenos tiveram queda nas despesas totais, enquanto os grandes, nos recursos próprios/estaduais e os médios, em ambas as variáveis. Não houve queda estatisticamente significante no volume de recursos transferidos pela União no momento imediato à implementação da PAF em nenhum dos grupos municipais analisados. No médio prazo, a PAF gerou impacto negativo apenas nos grandes municípios, que tiveram reduções significativas nas tendências de recursos próprios/estaduais e transferidos pela União destinados à saúde. CONCLUSÃO: No geral, o impacto da PAF no financiamento da saúde dos municípios se deu de forma imediata e a partir da queda de recursos próprios/estaduais destinados à saúde. Nos municípios grandes, entretanto, o impacto foi perdurável entre 2015 e 2019, afetando, principalmente, as despesas com saúde oriundas de recursos da União. DESCRITORES: Financiamento dos Sistemas de Saúde. Política Fiscal. Gastos Públicos com Saúde. Cidades.
The Lancet regional health. Americas, Aug 1, 2024
Background Household transmission studies seek to understand the transmission dynamics of a patho... more Background Household transmission studies seek to understand the transmission dynamics of a pathogen by estimating the risk of infection from household contacts and community exposures. We estimated within/extrahousehold SARS-CoV-2 infection risk and associated factors in a household cohort study in one of the most vulnerable neighbourhoods in Rio de Janeiro city. Methods Individuals ≥1 years-old with suspected or confirmed COVID-19 in the past 30 days (index cases) and household members aged ≥1 year were enrolled and followed at 14 and 28 days (study period November/2020-December/2021). RT-PCR testing, COVID-19 symptoms, and SARS-CoV-2 serologies were ascertained in all visits. Chain binomial household transmission models were fitted using data from 2024 individuals (593 households). Findings Extra-household infection risk was 74.2% (95% credible interval [CrI] 70.3-77.8), while within-household infection risk was 11.4% (95% CrI 5.7-17.2). Participants reporting having received two doses of a COVID-19 vaccine had lower extra-household (68.9%, 95% CrI 57.3-77.6) and within-household (4.1%, 95% CrI 0.4-16.6) infection risk. Within-household infection risk was higher among participants aged 10-19 years, from overcrowded households, and with low family income. Contrastingly, extra-household infection risk was higher among participants aged 20-29 years, unemployed, and public transportation users. Interpretation Our study provides important insights into COVID-19 household/community transmission in a vulnerable population that resided in overcrowded households and who struggled to adhere to lockdown policies and social distancing measures. The high extra-household infection risk highlights the extreme social vulnerability of this population. Prioritising vaccination of the most socially vulnerable could protect these individuals and reduce widespread community transmission.
JAMA network open, Dec 10, 2023
IMPORTANCE It is estimated that, from 2023 to 2025, lung cancer (LC) will be the second most freq... more IMPORTANCE It is estimated that, from 2023 to 2025, lung cancer (LC) will be the second most frequent cancer in Brazil, but the country does not have an LC screening (LCS) policy. OBJECTIVE To compare the number of individuals eligible for screening, 5-year preventable LC deaths, and years of life gained (YLG) if LC death is averted by LCS, considering 3 eligibility strategies by sociodemographic characteristics. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness research study assessed 3 LCS criteria by applying a modified version of the LC-Death Risk Assessment Tool (LCDRAT) and the LC-Risk Assessment Tool (LCRAT). Data are from the 2019 Brazilian National Household Survey. Participants included ever-smokers aged 50 to 80 years. Data analysis was performed from February to May 2023. EXPOSURES Exposures included ever-smokers aged 50 to 80 years, US Preventive Services Task Force (USPSTF) 2013 guidelines (ever-smokers aged 55 to 80 years with Ն30 pack-years and <15 years since cessation), and USPSTF 2021 guidelines (ever-smokers aged 50 to 80 years with 20 packyears and <15 years since cessation).
International Journal of Molecular Sciences, Aug 23, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
The Lancet Regional Health - Americas, 2024
Background Household transmission studies seek to understand the transmission dynamics of a patho... more Background Household transmission studies seek to understand the transmission dynamics of a pathogen by estimating the risk of infection from household contacts and community exposures. We estimated within/extrahousehold SARS-CoV-2 infection risk and associated factors in a household cohort study in one of the most vulnerable neighbourhoods in Rio de Janeiro city. Methods Individuals ≥1 years-old with suspected or confirmed COVID-19 in the past 30 days (index cases) and household members aged ≥1 year were enrolled and followed at 14 and 28 days (study period November/2020-December/2021). RT-PCR testing, COVID-19 symptoms, and SARS-CoV-2 serologies were ascertained in all visits. Chain binomial household transmission models were fitted using data from 2024 individuals (593 households). Findings Extra-household infection risk was 74.2% (95% credible interval [CrI] 70.3-77.8), while within-household infection risk was 11.4% (95% CrI 5.7-17.2). Participants reporting having received two doses of a COVID-19 vaccine had lower extra-household (68.9%, 95% CrI 57.3-77.6) and within-household (4.1%, 95% CrI 0.4-16.6) infection risk. Within-household infection risk was higher among participants aged 10-19 years, from overcrowded households, and with low family income. Contrastingly, extra-household infection risk was higher among participants aged 20-29 years, unemployed, and public transportation users. Interpretation Our study provides important insights into COVID-19 household/community transmission in a vulnerable population that resided in overcrowded households and who struggled to adhere to lockdown policies and social distancing measures. The high extra-household infection risk highlights the extreme social vulnerability of this population. Prioritising vaccination of the most socially vulnerable could protect these individuals and reduce widespread community transmission.
Revista de Saúde Pública, 2024
RESUMO INTRODUÇÃO O câncer de pulmão (CP) é um relevante problema de saúde pública no Brasil e no... more RESUMO
INTRODUÇÃO
O câncer de pulmão (CP) é um relevante problema de saúde pública no Brasil e no mundo, dada sua alta incidência e mortalidade. Assim, objetiva-se analisar a distribuição do tabagismo e da carga tabágica segundo características sociodemográficas e disparidades no acesso, no tratamento e na mortalidade por CP no Brasil, em 2013 e 2019.
MÉTODO
Estudo retrospectivo de triangulação de fontes de dados de abrangência nacional: a) análise da distribuição do tabagismo, baseada na Pesquisa Nacional de Saúde (PNS); b) investigação dos registros de CP, via Registros Hospitalares de Câncer (RHC); e c) distribuição da mortalidade por CP, no Sistema de Informação sobre Mortalidade (SIM).
RESULTADOS
Verificou-se redução do percentual de pessoas que nunca fumaram de 2013 (68,5%) para 2019 (60,2%), assim como da carga tabágica (anos-maço). Esta foi observada maior em homens em pessoas de faixas etárias mais avançadas e de menor escolaridade. Em relação aos pacientes registrados no RHC, a entrada no serviço de saúde se dá a partir de 50 anos, e apenas 19% nunca fumaram. Ao passo que os fumantes na população são majoritariamente pardos, os pacientes no RHC são em maioria brancos. Quanto ao estadiamento inicial (I e II), é mais frequente em pessoas brancas e que nunca fumaram. A taxa de mortalidade apresentou variação de 1,00, para pessoas com ensino superior, a 3,36, entre pessoas sem instrução, assim como pessoas brancas têm uma taxa de mortalidade três vezes maior que a de pessoas negras e pardas.
CONCLUSÃO
Este artigo apontou relevantes disparidades sociodemográficas no acesso ao diagnóstico, tratamento e mortalidade do CP. Assim, recomenda-se: fortalecer o Registro de Câncer de Base Populacional; desenvolver e implementar estratégia de screening de CP no Brasil, uma vez que a realização de estratégias de prevenção e diagnóstico precoce combinadas funcionam melhor no controle da mortalidade pela doença; e investimento contínuo nas políticas de prevenção e controle do tabagismo.
Cadernos de Saúde Pública, 2023
This study describes and compares tuberculosis (TB) data among persons deprived of liberty and th... more This study describes and compares tuberculosis (TB) data among persons deprived of liberty and the general Brazilian population, from 2007 to 2019, using the Joinpoint tool to observe changes in trends. This study focuses on women and older adults, for HIV testing, and on the number of detainees according to prison capacity. This is a retrospective, quantitative, and analytical study, which uses methods of regression of time series data from secondary data of unrestricted access collected from the Brazilian Information System for Notifiable Diseases (SINAN), Brazilian Institute of Geography and Statistics (IBGE), and from analytical reports made available by the Brazilian National Penitentiary Department (DEPEN). The results show a considerably higher increase in the prevalence of TB in persons deprived of liberty in all perspectives analyzed; increased HIV testing; and a debatable trend of stability in the number of detainees according to prison capacity. When analyzing trends in prevalence, services, and determinants, it is curious to see the temporal non-coincidence in most cases. Clearly, national policies against TB do not have the same effect within prisons and even the National Policy for Comprehensive Health Care for People Deprived of Liberty in the Prison System (PNAISP) showed restricted effects in view of the health situation herein analyzed. Despite working with secondary data of variable reliability, comparisons were reached that can impact health decisions and actions. Although lacking complete and definitive answers, it was possible to launch a new point-of-view on the evolution of questions for which reflection is essential.
International Journal of Molecular Sciences, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
JAMA Netw Open., 2023
IMPORTANCE It is estimated that, from 2023 to 2025, lung cancer (LC) will be the second most freq... more IMPORTANCE It is estimated that, from 2023 to 2025, lung cancer (LC) will be the second most frequent cancer in Brazil, but the country does not have an LC screening (LCS) policy. OBJECTIVE To compare the number of individuals eligible for screening, 5-year preventable LC deaths, and years of life gained (YLG) if LC death is averted by LCS, considering 3 eligibility strategies by sociodemographic characteristics. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness research study assessed 3 LCS criteria by applying a modified version of the LC-Death Risk Assessment Tool (LCDRAT) and the LC-Risk Assessment Tool (LCRAT). Data are from the 2019 Brazilian National Household Survey. Participants included ever-smokers aged 50 to 80 years. Data analysis was performed from February to May 2023. EXPOSURES Exposures included ever-smokers aged 50 to 80 years, US Preventive Services Task Force (USPSTF) 2013 guidelines (ever-smokers aged 55 to 80 years with Ն30 pack-years and <15 years since cessation), and USPSTF 2021 guidelines (ever-smokers aged 50 to 80 years with 20 packyears and <15 years since cessation).
Introduction Although long-acting injectable cabotegravir (CAB-LA) PrEP has proven efficacious fo... more Introduction Although long-acting injectable cabotegravir (CAB-LA) PrEP has proven efficacious for HIV prevention in clinical trials, additional research is needed to guide effective implementation in real world settings. Methods ImPrEP CAB-Brasil is an implementation study of same-day delivery of CAB-LA PrEP for young sexual and gender minorities (SGM; aged 18-30 years) in six existing oral PrEP public health clinics. We conducted formative research to prepare for the implementation of ImPrEP CAB-Brasil through (1) community mobilization; (2) process mapping; and (3) focus group discussions with young SGM (N=92) and health professionals (N=20) to identify facilitators and barriers to injectable PrEP implementation and request feedback on an mHealth education and decision support tool and WhatsApp appointment reminder intervention. Results Community mobilization team collaborated in developing prototype materials for an mHealth intervention to support PrEP-user decision making, part...
BMJ Open, Jun 1, 2023
Expansion of testing, isolation, quarantine, e-health and telemonitoring strategies in socioecono... more Expansion of testing, isolation, quarantine, e-health and telemonitoring strategies in socioeconomically vulnerable neighbourhoods at primary healthcare in the fight against COVID-19 in Brazil: a study protocol of a multisite testing intervention using a mixed method approach. BMJ Open 2023;13:e068016.
Ciencia & Saude Coletiva, Jun 1, 2020
Resumo Revisão sistemática sobre fatores demográficos, socioeconômicos, comportamentais e antropo... more Resumo Revisão sistemática sobre fatores demográficos, socioeconômicos, comportamentais e antropométricos associados à hipertensão (HAS). Foram incluídos estudos observacionais, de populações com 18 anos ou mais, dos últimos dez anos, publicados em inglês, português ou espanhol das bases Pubmed, Web of Science, Scopus e Lilacs. Ao final, foram incluídos 42 artigos, a maioria do tipo seccional. A idade e o Índice de Massa Corporal (IMC) elevados foram os fatores relacionados à maior chance de ter HAS mais encontrados nos estudos. Outros fatores associados à HAS foram: sexo (masculino), escolaridade (menor escolaridade), renda (menor renda) e circunferência da cintura (elevada). Nunca ter fumado, nunca ter consumido álcool e ter cor branca apareceram como características relacionadas a menor chance de ter HAS. Assim, características demográficas, socioeconômicas, comportamentais e antropométricas são importantes fatores associados a maior chance de ter HAS na população adulta. Entretanto, enquanto a maioria dos fatores associados à HAS for passível de intervenção, serão necessárias políticas de promoção da saúde mais amplas para reduzir as desigualdades socioeconômicas na prevalência de hipertensão. Palavras-chave Fatores de risco, Hipertensão, Revisão
Cadernos De Saude Publica, Mar 1, 2018
The objective was to analyze the epidemiological characteristics of chronic back problems in Braz... more The objective was to analyze the epidemiological characteristics of chronic back problems in Brazil and study the association between their prevalence and demographic and socioeconomic factors, lifestyle, and health conditions. The study used micro-data from the Brazilian National Health Survey (PNS), 2013. The epidemiological indicators were: prevalence, time with chronic back problems, life cycle (from young adults to the elderly), limitations in activities of daily living, and mean age at onset of symptoms, according to sex and age bracket. In order to analyze inequality in chronic back problems according to socioeconomic characteristics and risk factors, a multivariate logistic regression model was used, based on life cycle stages, with the presence of chronic back problems as the dependent variable and the following independent variables: sex, schooling, area of residence, race/color, self-rated health, types of chronic diseases, body mass index (BMI), and physical activity. Prevalence of chronic back problems in Brazil was 18.5%, and was higher in women than in men (21.1%; 95%CI: 20.2-21.9). Mean age at onset of chronic back problems was 35 years. There was an association between chronic back problems and lower schooling, poor self-rated health, and presence of the majority of the selected chronic diseases. Area of residence, BMI, age, and race/color were weakly associated or not associated with chronic back problems. Prevalence of chronic back problems stabilized at 50 years of age, but the severity of limitations increased at older ages. As in other countries, high prevalence and the impact on living conditions revealed the need for epidemiological studies on chronic back problems in Brazil. The results suggest that health promotion and the prevention of chronic back problems should be intensified, especially before 50 years of age, considering the ongoing population aging in Brazil.
Revista Brasileira de Cancerologia, Apr 11, 2023
Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribut... more Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições, desde que o trabalho original seja corretamente citado.
Cadernos Saúde Coletiva, 2021
Resumo Introdução A taxa de mortalidade prematura (TMP) por doenças crônicas não transmissíveis (... more Resumo Introdução A taxa de mortalidade prematura (TMP) por doenças crônicas não transmissíveis (DCNT) é um indicador utilizado pela Organização das Nações Unidas (ONU) para acompanhar uma das metas propostas nos Objetivos de Desenvolvimento Sustentável (ODS). Ela permite medir a eficácia e a efetividade das ações de prevenção, tratamento e promoção da saúde desde que seja estimada com informações confiáveis e de qualidade. Objetivo Este estudo tem como objetivo analisar as potencialidades, as limitações e a completude das informações utilizadas para o cálculo e a análise desse indicador. Método Foram utilizadas as informações de óbitos do Sistema de Informações Sobre obre Mortalidade (SIM) de 2000 a 2016. Foi estimada a proporção de óbitos por causas mal definidas, bem como o percentual de incompletude das variáveis raça/cor, escolaridade, ocupação, estado civil, naturalidade e assistência médica. Resultados Cerca de 68% dos municípios apresentaram qualidade adequada da causa de ób...
Plos One, 2024
Abstract Background: Lung cancer screening (LCS) using low-dose computed tomography (LDCT) is a s... more Abstract
Background: Lung cancer screening (LCS) using low-dose computed tomography (LDCT) is a strategy for early-stage diagnosis. The implementation of LDCT screening in countries with a high prevalence/incidence of tuberculosis (TB) is controversial. This systematic review and meta-analysis aim to identify whether LCS using LDCT increases early-stage diagnosis and decreases mortality, as well as the false-positive rate, in regions with a high prevalence of TB.
Methods/design: Studies were identified by searching BVS, PUBMED, EMBASE, and SCOPUS. RCT and cohort studies (CS) that show the effects of LDCT in LC screening on mortality and secondary outcomes were eligible. Two independent reviewers evaluated eligibility and a third judged disagreements. We used the Systematic Review Data Repository (SRDR+) to extract the metadata and record decisions. The analyses were stratified by study design and incidence of TB. We used the Cochrane "Risk of bias" assessment tool.
Results: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) were used. Thirty-seven papers were included, referring to 22 studies (10 RCTs and 12 cohorts). Few studies were from regions with a high incidence of TB (One RCT and four cohorts). Nonetheless, the evidence is compatible with European and USA studies. RCTs and CS also had consistent results. There is an increase in early-stage (I-II) diagnoses and reduced LC mortality in the LCDT arm compared to the control. Although false-positive rates varied, they stayed within the 20 to 30% range.
Discussion: This is the first meta-analysis of LDCT for LCS focused on its benefits in regions with an increased incidence/prevalence of TB. Although the specificity of Lung-RADS was higher in participants without TB sequelae than in those with TB sequelae, our findings point out that the difference does not invalidate implementing LDCT LCS in these regions.
Trial registration: Systematic review registration Systematic review registration PROSPERO CRD42022309581.
Revista de Saúde Pública, 2024
RESUMO OBJETIVO: Analisar o impacto da política de austeridade fiscal (PAF) nas despesas em saúde... more RESUMO OBJETIVO: Analisar o impacto da política de austeridade fiscal (PAF) nas despesas em saúde dos municípios brasileiros, levando em consideração o porte populacional e a fonte dos recursos. MÉTODOS: Utilizou-se o método de séries temporais interrompidas para analisar o efeito da PAF sobre as despesas totais, recursos transferidos pela União e recursos próprios/estaduais per capita destinados à saúde nos municípios. A série temporal analisada compreendeu o período de 2010 a 2019, com periodicidade semestral. Adotou-se o primeiro semestre de 2015 como data de início da intervenção. Os municípios foram agregados em pequenos (até 100 mil habitantes), médios (101 mil a 400 mil habitantes) e grandes (mais de 400 mil habitantes). Os dados foram obtidos no Sistema de Informações sobre Orçamentos Públicos em Saúde.
RESULTADOS: Os resultados para a média nacional dos municípios demonstram que a PAF teve um impacto negativo sobre o nível de despesas totais e de recursos próprios/estaduais destinados à saúde no primeiro semestre de 2015, não provocando mudanças estaticamente significativas nas tendências de nenhum dos indicadores analisados no período posterior a 2015. Municípios pequenos tiveram queda nas despesas totais, enquanto os grandes, nos recursos próprios/estaduais e os médios, em ambas as variáveis. Não houve queda estatisticamente significante no volume de recursos transferidos pela União no momento imediato à implementação da PAF em nenhum dos grupos municipais analisados. No médio prazo, a PAF gerou impacto negativo apenas nos grandes municípios, que tiveram reduções significativas nas tendências de recursos próprios/estaduais e transferidos pela União destinados à saúde. CONCLUSÃO: No geral, o impacto da PAF no financiamento da saúde dos municípios se deu de forma imediata e a partir da queda de recursos próprios/estaduais destinados à saúde. Nos municípios grandes, entretanto, o impacto foi perdurável entre 2015 e 2019, afetando, principalmente, as despesas com saúde oriundas de recursos da União. DESCRITORES: Financiamento dos Sistemas de Saúde. Política Fiscal. Gastos Públicos com Saúde. Cidades.
The Lancet regional health. Americas, Aug 1, 2024
Background Household transmission studies seek to understand the transmission dynamics of a patho... more Background Household transmission studies seek to understand the transmission dynamics of a pathogen by estimating the risk of infection from household contacts and community exposures. We estimated within/extrahousehold SARS-CoV-2 infection risk and associated factors in a household cohort study in one of the most vulnerable neighbourhoods in Rio de Janeiro city. Methods Individuals ≥1 years-old with suspected or confirmed COVID-19 in the past 30 days (index cases) and household members aged ≥1 year were enrolled and followed at 14 and 28 days (study period November/2020-December/2021). RT-PCR testing, COVID-19 symptoms, and SARS-CoV-2 serologies were ascertained in all visits. Chain binomial household transmission models were fitted using data from 2024 individuals (593 households). Findings Extra-household infection risk was 74.2% (95% credible interval [CrI] 70.3-77.8), while within-household infection risk was 11.4% (95% CrI 5.7-17.2). Participants reporting having received two doses of a COVID-19 vaccine had lower extra-household (68.9%, 95% CrI 57.3-77.6) and within-household (4.1%, 95% CrI 0.4-16.6) infection risk. Within-household infection risk was higher among participants aged 10-19 years, from overcrowded households, and with low family income. Contrastingly, extra-household infection risk was higher among participants aged 20-29 years, unemployed, and public transportation users. Interpretation Our study provides important insights into COVID-19 household/community transmission in a vulnerable population that resided in overcrowded households and who struggled to adhere to lockdown policies and social distancing measures. The high extra-household infection risk highlights the extreme social vulnerability of this population. Prioritising vaccination of the most socially vulnerable could protect these individuals and reduce widespread community transmission.
JAMA network open, Dec 10, 2023
IMPORTANCE It is estimated that, from 2023 to 2025, lung cancer (LC) will be the second most freq... more IMPORTANCE It is estimated that, from 2023 to 2025, lung cancer (LC) will be the second most frequent cancer in Brazil, but the country does not have an LC screening (LCS) policy. OBJECTIVE To compare the number of individuals eligible for screening, 5-year preventable LC deaths, and years of life gained (YLG) if LC death is averted by LCS, considering 3 eligibility strategies by sociodemographic characteristics. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness research study assessed 3 LCS criteria by applying a modified version of the LC-Death Risk Assessment Tool (LCDRAT) and the LC-Risk Assessment Tool (LCRAT). Data are from the 2019 Brazilian National Household Survey. Participants included ever-smokers aged 50 to 80 years. Data analysis was performed from February to May 2023. EXPOSURES Exposures included ever-smokers aged 50 to 80 years, US Preventive Services Task Force (USPSTF) 2013 guidelines (ever-smokers aged 55 to 80 years with Ն30 pack-years and <15 years since cessation), and USPSTF 2021 guidelines (ever-smokers aged 50 to 80 years with 20 packyears and <15 years since cessation).
International Journal of Molecular Sciences, Aug 23, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
The Lancet Regional Health - Americas, 2024
Background Household transmission studies seek to understand the transmission dynamics of a patho... more Background Household transmission studies seek to understand the transmission dynamics of a pathogen by estimating the risk of infection from household contacts and community exposures. We estimated within/extrahousehold SARS-CoV-2 infection risk and associated factors in a household cohort study in one of the most vulnerable neighbourhoods in Rio de Janeiro city. Methods Individuals ≥1 years-old with suspected or confirmed COVID-19 in the past 30 days (index cases) and household members aged ≥1 year were enrolled and followed at 14 and 28 days (study period November/2020-December/2021). RT-PCR testing, COVID-19 symptoms, and SARS-CoV-2 serologies were ascertained in all visits. Chain binomial household transmission models were fitted using data from 2024 individuals (593 households). Findings Extra-household infection risk was 74.2% (95% credible interval [CrI] 70.3-77.8), while within-household infection risk was 11.4% (95% CrI 5.7-17.2). Participants reporting having received two doses of a COVID-19 vaccine had lower extra-household (68.9%, 95% CrI 57.3-77.6) and within-household (4.1%, 95% CrI 0.4-16.6) infection risk. Within-household infection risk was higher among participants aged 10-19 years, from overcrowded households, and with low family income. Contrastingly, extra-household infection risk was higher among participants aged 20-29 years, unemployed, and public transportation users. Interpretation Our study provides important insights into COVID-19 household/community transmission in a vulnerable population that resided in overcrowded households and who struggled to adhere to lockdown policies and social distancing measures. The high extra-household infection risk highlights the extreme social vulnerability of this population. Prioritising vaccination of the most socially vulnerable could protect these individuals and reduce widespread community transmission.
Revista de Saúde Pública, 2024
RESUMO INTRODUÇÃO O câncer de pulmão (CP) é um relevante problema de saúde pública no Brasil e no... more RESUMO
INTRODUÇÃO
O câncer de pulmão (CP) é um relevante problema de saúde pública no Brasil e no mundo, dada sua alta incidência e mortalidade. Assim, objetiva-se analisar a distribuição do tabagismo e da carga tabágica segundo características sociodemográficas e disparidades no acesso, no tratamento e na mortalidade por CP no Brasil, em 2013 e 2019.
MÉTODO
Estudo retrospectivo de triangulação de fontes de dados de abrangência nacional: a) análise da distribuição do tabagismo, baseada na Pesquisa Nacional de Saúde (PNS); b) investigação dos registros de CP, via Registros Hospitalares de Câncer (RHC); e c) distribuição da mortalidade por CP, no Sistema de Informação sobre Mortalidade (SIM).
RESULTADOS
Verificou-se redução do percentual de pessoas que nunca fumaram de 2013 (68,5%) para 2019 (60,2%), assim como da carga tabágica (anos-maço). Esta foi observada maior em homens em pessoas de faixas etárias mais avançadas e de menor escolaridade. Em relação aos pacientes registrados no RHC, a entrada no serviço de saúde se dá a partir de 50 anos, e apenas 19% nunca fumaram. Ao passo que os fumantes na população são majoritariamente pardos, os pacientes no RHC são em maioria brancos. Quanto ao estadiamento inicial (I e II), é mais frequente em pessoas brancas e que nunca fumaram. A taxa de mortalidade apresentou variação de 1,00, para pessoas com ensino superior, a 3,36, entre pessoas sem instrução, assim como pessoas brancas têm uma taxa de mortalidade três vezes maior que a de pessoas negras e pardas.
CONCLUSÃO
Este artigo apontou relevantes disparidades sociodemográficas no acesso ao diagnóstico, tratamento e mortalidade do CP. Assim, recomenda-se: fortalecer o Registro de Câncer de Base Populacional; desenvolver e implementar estratégia de screening de CP no Brasil, uma vez que a realização de estratégias de prevenção e diagnóstico precoce combinadas funcionam melhor no controle da mortalidade pela doença; e investimento contínuo nas políticas de prevenção e controle do tabagismo.
Cadernos de Saúde Pública, 2023
This study describes and compares tuberculosis (TB) data among persons deprived of liberty and th... more This study describes and compares tuberculosis (TB) data among persons deprived of liberty and the general Brazilian population, from 2007 to 2019, using the Joinpoint tool to observe changes in trends. This study focuses on women and older adults, for HIV testing, and on the number of detainees according to prison capacity. This is a retrospective, quantitative, and analytical study, which uses methods of regression of time series data from secondary data of unrestricted access collected from the Brazilian Information System for Notifiable Diseases (SINAN), Brazilian Institute of Geography and Statistics (IBGE), and from analytical reports made available by the Brazilian National Penitentiary Department (DEPEN). The results show a considerably higher increase in the prevalence of TB in persons deprived of liberty in all perspectives analyzed; increased HIV testing; and a debatable trend of stability in the number of detainees according to prison capacity. When analyzing trends in prevalence, services, and determinants, it is curious to see the temporal non-coincidence in most cases. Clearly, national policies against TB do not have the same effect within prisons and even the National Policy for Comprehensive Health Care for People Deprived of Liberty in the Prison System (PNAISP) showed restricted effects in view of the health situation herein analyzed. Despite working with secondary data of variable reliability, comparisons were reached that can impact health decisions and actions. Although lacking complete and definitive answers, it was possible to launch a new point-of-view on the evolution of questions for which reflection is essential.
International Journal of Molecular Sciences, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
JAMA Netw Open., 2023
IMPORTANCE It is estimated that, from 2023 to 2025, lung cancer (LC) will be the second most freq... more IMPORTANCE It is estimated that, from 2023 to 2025, lung cancer (LC) will be the second most frequent cancer in Brazil, but the country does not have an LC screening (LCS) policy. OBJECTIVE To compare the number of individuals eligible for screening, 5-year preventable LC deaths, and years of life gained (YLG) if LC death is averted by LCS, considering 3 eligibility strategies by sociodemographic characteristics. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness research study assessed 3 LCS criteria by applying a modified version of the LC-Death Risk Assessment Tool (LCDRAT) and the LC-Risk Assessment Tool (LCRAT). Data are from the 2019 Brazilian National Household Survey. Participants included ever-smokers aged 50 to 80 years. Data analysis was performed from February to May 2023. EXPOSURES Exposures included ever-smokers aged 50 to 80 years, US Preventive Services Task Force (USPSTF) 2013 guidelines (ever-smokers aged 55 to 80 years with Ն30 pack-years and <15 years since cessation), and USPSTF 2021 guidelines (ever-smokers aged 50 to 80 years with 20 packyears and <15 years since cessation).
Introduction Although long-acting injectable cabotegravir (CAB-LA) PrEP has proven efficacious fo... more Introduction Although long-acting injectable cabotegravir (CAB-LA) PrEP has proven efficacious for HIV prevention in clinical trials, additional research is needed to guide effective implementation in real world settings. Methods ImPrEP CAB-Brasil is an implementation study of same-day delivery of CAB-LA PrEP for young sexual and gender minorities (SGM; aged 18-30 years) in six existing oral PrEP public health clinics. We conducted formative research to prepare for the implementation of ImPrEP CAB-Brasil through (1) community mobilization; (2) process mapping; and (3) focus group discussions with young SGM (N=92) and health professionals (N=20) to identify facilitators and barriers to injectable PrEP implementation and request feedback on an mHealth education and decision support tool and WhatsApp appointment reminder intervention. Results Community mobilization team collaborated in developing prototype materials for an mHealth intervention to support PrEP-user decision making, part...
BMJ Open, Jun 1, 2023
Expansion of testing, isolation, quarantine, e-health and telemonitoring strategies in socioecono... more Expansion of testing, isolation, quarantine, e-health and telemonitoring strategies in socioeconomically vulnerable neighbourhoods at primary healthcare in the fight against COVID-19 in Brazil: a study protocol of a multisite testing intervention using a mixed method approach. BMJ Open 2023;13:e068016.
Ciencia & Saude Coletiva, Jun 1, 2020
Resumo Revisão sistemática sobre fatores demográficos, socioeconômicos, comportamentais e antropo... more Resumo Revisão sistemática sobre fatores demográficos, socioeconômicos, comportamentais e antropométricos associados à hipertensão (HAS). Foram incluídos estudos observacionais, de populações com 18 anos ou mais, dos últimos dez anos, publicados em inglês, português ou espanhol das bases Pubmed, Web of Science, Scopus e Lilacs. Ao final, foram incluídos 42 artigos, a maioria do tipo seccional. A idade e o Índice de Massa Corporal (IMC) elevados foram os fatores relacionados à maior chance de ter HAS mais encontrados nos estudos. Outros fatores associados à HAS foram: sexo (masculino), escolaridade (menor escolaridade), renda (menor renda) e circunferência da cintura (elevada). Nunca ter fumado, nunca ter consumido álcool e ter cor branca apareceram como características relacionadas a menor chance de ter HAS. Assim, características demográficas, socioeconômicas, comportamentais e antropométricas são importantes fatores associados a maior chance de ter HAS na população adulta. Entretanto, enquanto a maioria dos fatores associados à HAS for passível de intervenção, serão necessárias políticas de promoção da saúde mais amplas para reduzir as desigualdades socioeconômicas na prevalência de hipertensão. Palavras-chave Fatores de risco, Hipertensão, Revisão
Cadernos De Saude Publica, Mar 1, 2018
The objective was to analyze the epidemiological characteristics of chronic back problems in Braz... more The objective was to analyze the epidemiological characteristics of chronic back problems in Brazil and study the association between their prevalence and demographic and socioeconomic factors, lifestyle, and health conditions. The study used micro-data from the Brazilian National Health Survey (PNS), 2013. The epidemiological indicators were: prevalence, time with chronic back problems, life cycle (from young adults to the elderly), limitations in activities of daily living, and mean age at onset of symptoms, according to sex and age bracket. In order to analyze inequality in chronic back problems according to socioeconomic characteristics and risk factors, a multivariate logistic regression model was used, based on life cycle stages, with the presence of chronic back problems as the dependent variable and the following independent variables: sex, schooling, area of residence, race/color, self-rated health, types of chronic diseases, body mass index (BMI), and physical activity. Prevalence of chronic back problems in Brazil was 18.5%, and was higher in women than in men (21.1%; 95%CI: 20.2-21.9). Mean age at onset of chronic back problems was 35 years. There was an association between chronic back problems and lower schooling, poor self-rated health, and presence of the majority of the selected chronic diseases. Area of residence, BMI, age, and race/color were weakly associated or not associated with chronic back problems. Prevalence of chronic back problems stabilized at 50 years of age, but the severity of limitations increased at older ages. As in other countries, high prevalence and the impact on living conditions revealed the need for epidemiological studies on chronic back problems in Brazil. The results suggest that health promotion and the prevention of chronic back problems should be intensified, especially before 50 years of age, considering the ongoing population aging in Brazil.
Revista Brasileira de Cancerologia, Apr 11, 2023
Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribut... more Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições, desde que o trabalho original seja corretamente citado.
Cadernos Saúde Coletiva, 2021
Resumo Introdução A taxa de mortalidade prematura (TMP) por doenças crônicas não transmissíveis (... more Resumo Introdução A taxa de mortalidade prematura (TMP) por doenças crônicas não transmissíveis (DCNT) é um indicador utilizado pela Organização das Nações Unidas (ONU) para acompanhar uma das metas propostas nos Objetivos de Desenvolvimento Sustentável (ODS). Ela permite medir a eficácia e a efetividade das ações de prevenção, tratamento e promoção da saúde desde que seja estimada com informações confiáveis e de qualidade. Objetivo Este estudo tem como objetivo analisar as potencialidades, as limitações e a completude das informações utilizadas para o cálculo e a análise desse indicador. Método Foram utilizadas as informações de óbitos do Sistema de Informações Sobre obre Mortalidade (SIM) de 2000 a 2016. Foi estimada a proporção de óbitos por causas mal definidas, bem como o percentual de incompletude das variáveis raça/cor, escolaridade, ocupação, estado civil, naturalidade e assistência médica. Resultados Cerca de 68% dos municípios apresentaram qualidade adequada da causa de ób...