Primary Health Care and Cervical Cancer Mortality Rates in Brazil: A Longitudinal Ecological Study.
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SUBMITTER: Rocha TA
PROVIDER: S-EPMC5338880 | biostudies-literature | 2017 Apr/Jun
REPOSITORIES: biostudies-literature
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Primary Health Care and Cervical Cancer Mortality Rates in Brazil: A Longitudinal Ecological Study.
Rocha Thiago Augusto Hernandes TA Silva Núbia Cristina da NC Thomaz Erika Bárbara Abreu Fonseca EB Queiroz Rejane Christine de Sousa RC Souza Marta Rovery de MR Lein Adriana A Rocha João Victor Muniz JV Alvares Viviane V Almeida Dante Grapiuna de DG Barbosa Allan Claudius Queiroz AC Thumé Elaine E Staton Catherine C Vissoci João Ricardo Nickenig JR Facchini Luiz Augusto LA
The Journal of ambulatory care management 20170401
Cervical cancer is a common neoplasm that is responsible for nearly 230 000 deaths annually in Brazil. Despite this burden, cervical cancer is considered preventable with appropriate care. We conducted a longitudinal ecological study from 2002 to 2012 to examine the relationship between the delivery of preventive primary care and cervical cancer mortality rates in Brazil. Brazilian states and the federal district were the unit of analysis (N = 27). Results suggest that primary health care has co ...[more]
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Project description:ObjectivesTo evaluate the impact of Brazil's recently implemented Family Health Program (FHP), the largest primary health care programme in the world, on heart and cerebrovascular disease mortality across Brazil from 2000 to 2009.DesignEcological longitudinal design, evaluating the impact of FHP using negative binomial regression models for panel data with fixed effects specifications.SettingNationwide analysis of data from Brazilian municipalities covering the period from 2000 to 2009.Data sources1622 Brazilian municipalities with vital statistics of adequate quality.Main outcome measuresThe annual FHP coverage and the average FHP coverage in previous years were used as main independent variables and classified as none (0%), incipient (<30%), intermediate (30-69%), or consolidated (≥ 70%). Age standardised mortality rates from causes in the group of cerebrovascular (ICD-10 codes I60-69), ischaemic (ICD-10 I20-25), and other forms of heart diseases (ICD-10 I30-52), which were included in the national list of ambulatory care-sensitive conditions, were calculated for each municipality for each year. They accounted for 40% of all deaths from these groups during the study period.ResultsFHP coverage was negatively associated with mortality rates from cerebrovascular and heart diseases (ambulatory care-sensitive conditions) in both unadjusted and adjusted models for demographic, social, and economic confounders. The FHP had no effect on the mortality rate for accidents, used as a control. The rate ratio for the effect of consolidated annual FHP coverage on cerebrovascular disease mortality and on heart disease mortality was 0.82 (95% confidence interval 0.79 to 0.86) and 0.79 (0.75 to 0.80) respectively, reaching the value of 0.69 (0.66 to 0.73) and 0.64 (0.59 to 0.68) when the coverage was consolidated during all the previous eight years. Moreover, FHP coverage increased the number of health education activities, domiciliary visits, and medical consultations and reduced hospitalisation rates for cerebrovascular and heart disease. Several complementary analyses showed quantitatively similar results.ConclusionsComprehensive and community based primary health care programmes, such as the FHP in Brazil, acting through cardiovascular disease prevention, care, and follow-up can contribute to decreased cardiovascular disease morbidity and mortality in a developing country such as Brazil.
| S-EPMC4080829 | biostudies-literature
Project description:Primary health care has been recognized as a critical strategy for improving population health in developing countries. This paper investigates the effect of primary care physicians on the infant mortality rate in Brazil using a dynamic panel data approach. This method accounts for the endogeneity problem and the persistence of infant mortality over time. The empirical analysis uses an eight-year panel of municipalities between 2005 and 2012. The results indicate that primary care physician supply contributed to the decline of infant mortality in Brazil. An increase of one primary care physician per 10,000 population was associated with 7.08 fewer infant deaths per 10,000 live births. This suggests that, in addition to other determinants, primary care physicians can play an important role in accounting for the reduction of infant mortality rates.
| S-EPMC6544253 | biostudies-literature
Project description:OBJECTIVE:To evaluate the association among characteristics of primary health care center (PHCC) with hospitalizations for primary care sensitive conditions (PCSC) in Brazil. METHOD:In this study, a cross-sectional ecological study was performed. This study analyzed the 27 capitals of Brazil's federative units. Data were aggregated from the following open access databases: National Program for Access and Quality Improvement in Primary Care, the Hospital Information System of Brazilian Unified Health System and Annual Population Census conducted by the Brazilian Institute of Geography and Statistics. Associations were estimated among characteristics of primary care with the number of three PCSC as the leading causes of hospitalization in children under-5 population in Brazil: asthma, diarrhea, and pneumonia. RESULTS:In general, PHCC showed limited structural adequacy (37.3%) for pediatric care in Brazil. The capitals in South and Southeast regions had the best structure whereas the North and Northeast had the worst. Fewer PCSC hospitalizations were significantly associated with PHCC which presented appropriate equipment (RR: 0.98; 95%CI: 0.97-0.99), structural conditions (RR: 0.98; 95%CI: 0.97-0.99), and signage/identification of professionals and facilities (RR: 0.98; 95%CI: 0.97-0.99). Higher PCSC hospitalizations were significantly associated with PHCC with more physicians (RR: 1.23, 95%CI: 1.02-1.48), it forms (RR: 1.01, 95%CI: 1.01-1.02), and more medications (RR: 1.02, 95%CI: 1.01-1.03). CONCLUSION:Infrastructural adequacy of PHCC was associated with less PCSC hospitalizations, while availability medical professional and medications were associated with higher PCSC hospitalizations.
| S-EPMC7100948 | biostudies-literature
Project description:BackgroundUniversal health coverage (UHC) can play an important role in achieving Sustainable Development Goal (SDG) 10, which addresses reducing inequalities, but little supporting evidence is available from low- and middle-income countries. Brazil's Estratégia de Saúde da Família (ESF) (family health strategy) is a community-based primary healthcare (PHC) programme that has been expanding since the 1990s and is the main platform for delivering UHC in the country. We evaluated whether expansion of the ESF was associated with differential reductions in mortality amenable to PHC between racial groups.Methods and findingsMunicipality-level longitudinal fixed-effects panel regressions were used to examine associations between ESF coverage and mortality from ambulatory-care-sensitive conditions (ACSCs) in black/pardo (mixed race) and white individuals over the period 2000-2013. Models were adjusted for socio-economic development and wider health system variables. Over the period 2000-2013, there were 281,877 and 318,030 ACSC deaths (after age standardisation) in the black/pardo and white groups, respectively, in the 1,622 municipalities studied. Age-standardised ACSC mortality fell from 93.3 to 57.9 per 100,000 population in the black/pardo group and from 75.7 to 49.2 per 100,000 population in the white group. ESF expansion (from 0% to 100%) was associated with a 15.4% (rate ratio [RR]: 0.846; 95% CI: 0.796-0.899) reduction in ACSC mortality in the black/pardo group compared with a 6.8% (RR: 0.932; 95% CI: 0.892-0.974) reduction in the white group (coefficients significantly different, p = 0.012). These differential benefits were driven by greater reductions in mortality from infectious diseases, nutritional deficiencies and anaemia, diabetes, and cardiovascular disease in the black/pardo group. Although the analysis is ecological, sensitivity analyses suggest that over 30% of black/pardo deaths would have to be incorrectly coded for the results to be invalid. This study is limited by the use of municipal-aggregate data, which precludes individual-level inference. Omitted variable bias, where factors associated with ESF expansion are also associated with changes in mortality rates, may have influenced our findings, although sensitivity analyses show the robustness of the findings to pre-ESF trends and the inclusion of other municipal-level factors that could be associated with coverage.ConclusionsPHC expansion is associated with reductions in racial group inequalities in mortality in Brazil. These findings highlight the importance of investment in PHC to achieve the SDGs aimed at improving health and reducing inequalities.
| S-EPMC5448733 | biostudies-literature
Project description:INTRODUCTION:Hospitalisation for ambulatory care-sensitive conditions (HACSCs) is frequently used as an indicator of the quality and effectiveness of primary healthcare (PHC) services around the world. The aim of the present study was to evaluate whether the PHC model (family health strategy (FHS) x conventional) and the availability of specialised PHC physicians is associated or not with total hospitalisation or HACSCs in the National Health System (SUS) of the municipality of Curitiba, Paraná state (PR), Brazil. METHODOLOGY:This is a cross-sectional ecological study using multiple linear regression with socioeconomic and professional data from municipal health units (MHUs) between 1 April 2014 and 31 March 2015. RESULTS:After adjustment for age and sex and control of socioeconomic variables, the FHS model was associated with six fewer HACSCs a year per 10?000 inhabitants in relation to the conventional model and the availability of one family physician at each FHS model MHU per 10?000 inhabitants was associated with 1.1 fewer HACSCs for heart failure a year per 10?000 inhabitants. Basic specialists (clinicians, paediatricians and obstetrician/gynaecologists) and subspecialists showed no significant association with HACSC rates. CONCLUSION:These results obtained in a major Brazilian city reinforce the role of FHS as a priority PHC model in the country and indicate the potentially significant impact of specialising in family medicine on improving the health conditions of the population.
| S-EPMC5719282 | biostudies-literature
Project description:OBJECTIVE:The objective of this study was to verify whether the inclusion of professionals who completed a specialized distance learning course in family health teams is associated with rates of hospitalization for primary healthcare-sensitive conditions and better monitoring of chronic conditions in municipalities within the state of Mato Grosso do Sul, Brazil. METHODS:Negative binomial regression models with fixed effects were used for the 79 municipalities in the state, with repeated observations for the selected years (2009-2015). For our reference, the parameter "Municipality Ratio" was the number of professionals who completed the course divided by the total number of PHC professionals in the municipality. This ratio has been cumulative over the years. No reference values were found in the scientific literature, so three cutoff points were used for tertile distribution: T3:high (0.35-1.00), T2:intermediate (0.02-0.33), and T1:Low (0.00-0.01). In order to avoid capturing biased results, the analysis was also performed for the years before the specialization course was offered (2009 and 2010). RESULTS:Indicators of the share of hospitalizations for primary care-sensitive conditions (overall rate and specific rates for asthma, gastroenteritis, and heart failure) decreased during the study period when related to a high and intermediate proportion of professionals who completed the specialization course, and the same was seen for indicators of chronic conditions (diabetic and hypertensive patients) who were registered, monitored and group care. CONCLUSION:The specialization course impacted important indicators related to the attributions of primary health care professionals, considering that decreases in hospitalizations for primary care sensitive causes (overall rate of sensitive causes, specific rates for asthma, gastroenteritis and heart failure) were seen in the territories where professionals who completed this course worked, along with increased registration and monitoring of diabetic and hypertensive patients.
| S-EPMC6435161 | biostudies-literature
Project description:OBJECTIVE:To explore the association between Particulate Matter (PM)2.5 (particles with an aerodynamic diameter less than 2.5?µm) and lung cancer mortality rates and to estimate the potential risk of lung cancer mortality related to exposure to high PM2.5 concentrations. DESIGN:Geographically weighted regression was performed to evaluate the relation between PM2.5 concentrations and lung cancer mortality for males, females and for both sexes combined, in 2008, based on newly available long-term data. Lung cancer fatalities from long-term exposure to PM2.5 were calculated according to studies by Pope III et al and the WHO air quality guidelines (AQGs). SETTING:31 provinces in China. RESULTS:PM2.5 was associated with the lung cancer mortality of males, females and both sexes combined, in China, although there were exceptions in several regions, for males and females. The number of lung cancer fatalities calculated by the WHO AQGs ranged from 531,036 to 532,004, whereas the number calculated by the American Cancer Society (ACS) reached 614,860 after long-term (approximately 3-4?years) exposure to PM2.5 concentrations since 2008. CONCLUSIONS:There is a positive correlation between PM2.5 and lung cancer mortality rate, and the relationship between them varies across the entire country of China. The number of lung cancer fatalities estimated by ACS was closer to the actual data than those of the WHO AQGs. Therefore, the ACS estimate of increased risk of lung cancer mortality from long-term exposure to PM2.5 might be more applicable for evaluating lung cancer fatalities in China than the WHO estimate.
| S-EPMC4663405 | biostudies-literature
Project description:This cross-sectional study aims to describe the primary dental care procedures performed by Oral Health Teams (OHTs), adhering to the third cycle of the "National Program for Improving Access and Quality of Primary Care" (PMAQ-AB) in Brazil. A descriptive analysis was performed through 26 dental procedures, including spontaneous, preventive, restorative/prosthetic and surgical procedures, and actions of cancer monitoring. Each conducted procedure assigned a score to the OHT, the final score being the sum of the number of procedures performed by the OHTs. These scores were then compared among the geographic regions of the country. Most OHTs perform basic dental procedures, such as supragingival scaling, root planning and coronal polishing (98.1%), composite filling (99.0%), and permanent tooth extraction (98.6%). The frequency related to dental prosthesis and monitoring of oral cancer decreased. Only 12.9% of the OHTs carries out biopsies, 30.9% monitor patients undergoing biopsy, 15.1% carry out impression for prostheses, and 13.6% carry out prostheses' installation. The scores reveal that OHT's performed, on average, 19.45 (±3.16) dental procedures. The OHTs in the South, Southeast, and Northeast had a higher number of primary dental procedures, while the teams in the North and Midwest performed, on average, fewer procedures. The Brazilian regions with the highest dental need have the lowest number of dental procedures. It is necessary to increase the range of procedures offered by OHT and reduce regional inequalities, adapting to the needs of the population in order to achieve comprehensive oral health.
| S-EPMC8797223 | biostudies-literature
Project description:ObjectiveIdentify the factors associated with the age-standardised breast cancer mortality rate in the municipalities of State of São Paulo (SSP), Brazil, in the period from 2006 to 2012.DesignEcological study of the breast cancer mortality rate standardised by age, as the dependent variable, having each of the 645 municipalities in the SSP as the unit of analysis.SettingsThe female resident population aged 15 years or older, by age group and municipality, in 2009 (mid-term), obtained from public dataset (Informatics Department of the Unified Health System).ParticipantsWomen 15 years or older who died of breast cancer in the SSP were selected for the calculation of the breast cancer mortality rate, according to the municipality and age group, from 2006 to 2012.Main outcome measuresMortality rates for each municipality calculated by the direct standardisation method, using the age structure of the population of SSP in 2009 as the standard.ResultsIn the final linear regression model, breast cancer mortality, in the municipal level, was directly associated with rates of nulliparity (p<0.0001), mammography (p<0.0001) and private healthcare (p=0.006).ConclusionsThe findings that mammography ratio was associated, in the municipal level, with increased mortality add to the evidence of a probable overestimation of benefits and underestimation of risks associated with this form of screening. The same paradoxical trend of increased mortality with screening was found in recent individual-level studies, indicating the need to expand informed choice for patients, primary prevention actions and individualised screening. Additional studies should be conducted to explore if there is a causality link in this association.
| S-EPMC5629728 | biostudies-literature
Project description:To characterize the workforce in the pharmaceutical services in the primary care of the Brazilian Unified Health System (SUS). METHODS This is a cross-sectional and quantitative study, with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). For the analysis, we considered the data stratification into geographical regions. We analyzed the data on workers in the municipal pharmaceutical services management and in the medicine dispensing units, according to the country's regions. For the statistical association analysis, we carried out a Pearson correlation test for the categorical variables.We analyzed 1,175 pharmacies/dispensing units, 507 phone interviews (495 pharmaceutical services coordinators), and 1,139 professionals responsible for medicine delivery. The workforce in pharmaceutical services was mostly constituted by women, aged from 18 to 39 years, with higher education (90.7% in coordination and 45.5% in dispensing units), having permanent employment bonds (public tender), being for more than one year in the position or duty, and with weekly work hours above 30h, working both in municipal management and in medicine dispensing units. We observed regional differences in the workforce composition in dispensing units, with higher percentage of pharmacists in the Southeast and Midwest regions.The professionalization of municipal management posts in primary health care is an achievement in the organization of the workforce in pharmaceutical services. However, significant deficiencies exist in the workforce composition in medicine dispensing units, which may compromise the medicine use quality and its results in population health.
| S-EPMC5676380 | biostudies-literature