Use of health services by adults in Manaus, 2019

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Abstract

Introduction:

Health services utilization is an indirect measure of the rights and equity of a health system. A 2015 survey conducted in the Manaus metropolitan region showed that in the previous year, over 70% of adults visited the doctor and 1 in 3 had visited a dentist. Socioeconomic factors and inequality played a central role in the usage of healthcare services and health situation in this population. Since then, political and economic crisis are evolving in Brazil. This project aims to estimate the prevalence of use of health services and the health status of the adults residing in Manaus in 2019.

Methods and analysis:

This is a population-based survey of adults (≥18 years old) residing in Manaus. This survey will be conducted in the first half of 2019 with 2300 participants who will be interviewed at home, selected from a probabilistic sampling in 3 stages (census tracts, household, and dweller), and stratified by sex and age quotas based on official estimates. The participants will be interviewed using previously validated tools and questions employed in Brazilian official surveys, which will cover use of health services and supplies, health status, and lifestyle. Primary outcome will be any healthcare usage in the last 15 days. Associations between health services usage and socioeconomic data and health outcomes will be assessed using a Poisson regression with a complex sampling design correction. Results will be reported according to the strengthening the reporting of observational studies in epidemiology statement.

Ethics and dissemination:

This project was approved by the Ethics Committee of the Federal University of Amazonas, Manaus, Amazonas, Brazil. All participants will sign an informed consent before the interview. The results will be disseminated in peer-reviewed manuscripts, reports, conference presentations, and through the media.

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Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis

Brooke Levis, Andrea Benedetti, Brett D. Thombs (2019)

Abstract Objective To determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression. Design Individual participant data meta-analysis. Data sources Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-February 2015). Inclusion criteria Eligible studies compared PHQ-9 scores with major depression diagnoses from validated diagnostic interviews. Primary study data and study level data extracted from primary reports were synthesized. For PHQ-9 cut-off scores 5-15, bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, among studies that used semistructured diagnostic interviews, which are designed for administration by clinicians; fully structured interviews, which are designed for lay administration; and the Mini International Neuropsychiatric (MINI) diagnostic interviews, a brief fully structured interview. Sensitivity and specificity were examined among participant subgroups and, separately, using meta-regression, considering all subgroup variables in a single model. Results Data were obtained for 58 of 72 eligible studies (total n=17 357; major depression cases n=2312). Combined sensitivity and specificity was maximized at a cut-off score of 10 or above among studies using a semistructured interview (29 studies, 6725 participants; sensitivity 0.88, 95% confidence interval 0.83 to 0.92; specificity 0.85, 0.82 to 0.88). Across cut-off scores 5-15, sensitivity with semistructured interviews was 5-22% higher than for fully structured interviews (MINI excluded; 14 studies, 7680 participants) and 2-15% higher than for the MINI (15 studies, 2952 participants). Specificity was similar across diagnostic interviews. The PHQ-9 seems to be similarly sensitive but may be less specific for younger patients than for older patients; a cut-off score of 10 or above can be used regardless of age.. Conclusions PHQ-9 sensitivity compared with semistructured diagnostic interviews was greater than in previous conventional meta-analyses that combined reference standards. A cut-off score of 10 or above maximized combined sensitivity and specificity overall and for subgroups. Registration PROSPERO CRD42014010673.

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Randomized response: a survey technique for eliminating evasive answer bias.

S L Warner (1965)

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Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016

Fatima Marinho, Valéria Maria de Azeredo Passos, Deborah Carvalho Malta … (2018)

Summary Background Political, economic, and epidemiological changes in Brazil have affected health and the health system. We used the Global Burden of Disease Study 2016 (GBD 2016) results to understand changing health patterns and inform policy responses. Methods We analysed GBD 2016 estimates for life expectancy at birth (LE), healthy life expectancy (HALE), all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors for Brazil, its 26 states, and the Federal District from 1990 to 2016, and compared these with national estimates for ten comparator countries. Findings Nationally, LE increased from 68·4 years (95% uncertainty interval [UI] 68·0–68·9) in 1990 to 75·2 years (74·7–75·7) in 2016, and HALE increased from 59·8 years (57·1–62·1) to 65·5 years (62·5–68·0). All-cause age-standardised mortality rates decreased by 34·0% (33·4–34·5), while all-cause age-standardised DALY rates decreased by 30·2% (27·7–32·8); the magnitude of declines varied among states. In 2016, ischaemic heart disease was the leading cause of age-standardised YLLs, followed by interpersonal violence. Low back and neck pain, sense organ diseases, and skin diseases were the main causes of YLDs in 1990 and 2016. Leading risk factors contributing to DALYs in 2016 were alcohol and drug use, high blood pressure, and high body-mass index. Interpretation Health improved from 1990 to 2016, but improvements and disease burden varied between states. An epidemiological transition towards non-communicable diseases and related risks occurred nationally, but later in some states, while interpersonal violence grew as a health concern. Policy makers can use these results to address health disparities. Funding Bill & Melinda Gates Foundation and the Brazilian Ministry of Health.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: May 2019

Publication date (Electronic): 24 May 2019

Volume: 98

Issue: 21

Electronic Location Identifier: e15769

Affiliations

[a ]Faculty of Medicine, Federal University of Amazonas, Manaus

[b ]Post-Graduate Program of Pharmaceutical Sciences, University of Sorocaba, Sorocaba

[c ]Department of Nursing in Public Health, Federal University of Pelotas, Pelotas

[d ]Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil.

Author notes

[∗ ]Correspondence: Marcus Tolentino Silva, Faculty Medicine, Federal University of Amazonas, Rua Afonso Pena, 1053, Manaus, Amazonas, 69020-160, Brazil (e-mail: marcusts@ 123456gmail.com ).

Article

Publisher ID: MD-D-19-03186 Accession ID: 15769

DOI: 10.1097/MD.0000000000015769

PMC ID: 6571251

PubMed ID: 31124966

SO-VID: 3cbfc0f8-d8e9-429e-8a75-58aafcda1a59

License:

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

History

Date received : 28 April 2019

Date accepted : 30 April 2019

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Keywords: cross-sectional,diagnosis of health situation,population,surveys and questionnaires

Data availability:

Keywords: cross-sectional, diagnosis of health situation, population, surveys and questionnaires

Use of health services by adults in Manaus, 2019 : Protocol of a population-based survey

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Artificial Intelligence in Medicine

Most cited references 29

Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis

Randomized response: a survey technique for eliminating evasive answer bias.

Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016

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