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Try out PMC Labs and tell us what you think. Learn More. Health services utilization is an indirect measure of the rights and equity of a health system. 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 This survey will be conducted in the first half of with participants who will be interviewed at home, selected from a probabilistic sampling in 3 stages census tracts, household, and dwellerand stratified by sex and age quotas based on official estimates. The participants will be interviewed using ly 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 de correction.
will be reported according to the strengthening the reporting of observational studies in epidemiology statement. All participants will an informed consent before the interview. The will be disseminated in peer-reviewed manuscripts, reports, conference presentations, and through the media. The use of health services is an indirect method of measuring the access and equity of the health system. It can be measured in a general way — use of any health service — or specifically, by the most common health services. The organization of the health system influences the health status of a population, which, in turn, affects the use of health services.
Investigation of the health situation Adult Manaus women sex the use of these services are paramount to identify aspects that require improvement. In areas where this situational diagnosis is poor, like the Amazon, such efforts represent research priorities. In these geographically and economically disadvantaged settings, the system performance may be more vulnerable to unfavorable context.
Ina first local effort was undertaken in the Manaus metropolitan region to better understand the health situation of the area. The survey also estimated the utility score quality of life in the population, which was higher in men and the richest individuals; this score provides useful data for clinical and economic evaluations of health outcomes in Adult Manaus women sex. Political and economic crises occurred in Brazil during the period after the survey had taken place, and austerity policies are currently ongoing. Along with these major structural changes in the health system, social protection, food security, and fighting poverty programs are being dismantled.
These societal changes are expected to affect health services utilization and the health status of the population. A new population-based survey in would be useful to assess the early effects of ongoing austerity measures at the population level. This protocol states the planned methods for a cross-sectional, population-based study that aims to estimate the prevalence of health services usage and the health situation of adults residing in Manaus.
This is a protocol for a cross-sectional, population-based study to be held in Manaus in the first semester of The sample de will allow the representativeness of the adult population.
Manaus is the capital of Amazonas, the largest Brazilian state by territory. All participants will be selected by probabilistic sampling in 3 steps and stratified by sex and age quotas defined by the official census. A between 1 and 20 will be drawn to determine the first household to visit; after this, 1 out of every 20 households will be visited until reaching the planned of interviews in each census tract, which was based on the population of the neighborhood. For closed households or those that refuse to participate, the house to the right will be approached, and if this house is also unavailable, the same procedure will be performed with the house to the left.
In the third step, 1 dweller from each household will be randomly selected. In each selected household, all dwellers of 18 years old or more will be listed, and 1 dweller will be chosen and interviewed based on sex and age quotas obtained from official estimates.
Field sampling will continue until reaching this sample size. The primary outcome will be the prevalence of health service usage in the 15 days prior to the interview. To assess the prevalence of dependent variables, dummy variables will be built from the responses. Health situation variables comprise self-reported health status very good, good, fair, poor, very poorquality of life in utility scores[ 25 ] anxiety disorder, [ 26 ] depressive symptoms, [ 2728 ] and self-reported diseases hypertension, diabetes, hypercholesterolemia, heart problems, stroke, respiratory problems, arthritis, chronic back pain, mood disorders, cancer, kidney disease, dengue, and malaria.
For chronic diseases, the Adult Manaus women sex of limitation to usual activities Adult Manaus women sex be recorded to better assess morbidity and multimorbidity. Health risks will consist tobacco use, [ 29 ] alcohol use, [ 30 ] life-threatening events, [ 31 ] and food insecurity. The model contemplates contextual and individual variables related to healthcare access. Hypothesized relationship of the outcomes to be assessed on the Manaus population-based survey, Experienced interviewers will be contracted and trained by research team.
The tablets will be synchronized over the internet to compile the database online on real time. A pilot survey will be held with interviews to assess questionnaire comprehensiveness, which will compose the final sample. The interview will be georeferenced and partially recorded. As similarity of the options may desensitize the respondent, especially the latter questions, multiple response options will be ranked randomly at each interview to bring more consistency to responses.
Descriptive statistics will be obtained for overall independent variables to describe the sample. When relevant, will be stratified by sex and age. The data will be compared to the survey. To identify the factors related to health services usage, a bivariate analysis will be conducted to calculate the prevalence ratio. Multicollinearity will be investigated by the tolerance indicator. To investigate the independent effect of the factors under investigation, a Poisson regression with robust variance will be adopted based on a hierarchical model including first distal and then proximal variables and compiled in blocks of analysis.
To investigate the association of secondary outcomes and independent variables, the nature of the dependent variable will be considered continuous, ordinal, dichotomic, or multinomial[ 34 ] and a linear regression, Tobit regression, ordinal regression, or multinomial logistic regression will be performed on a hierarchical or multilevel model, taking variables of the neighborhoods and individuals into consideration to better explain contextual influence. The survey will begin after reading, comprehending, and ing the consent form.
The will be presented in aggregate form, making it impossible to identify any of the participants. The survey maybe interrupted in case of major abnormality in the city like environmental disasters, tragedies, or catastrophe that thwarts the interviews. The researchers are experienced in population-based surveys. will be disseminated on peer-reviewed manuscripts, conference presentations, and through the media. Unidentifiable data will be made available through in data repositories after each accepted manuscript. The contact with the public will be performed only in the recruitment of participants.
The research questions and outcome measures were based in governmental surveys that were ly validated to Brazilian Portuguese. will be shared to the public by press releases to reach the lay media newspapers, radio, and television. The authors have no conflicts of interest to disclose. National Center for Biotechnology InformationU. Journal List Medicine Baltimore v. Medicine Baltimore. Published online May Find articles by Tais Freire Galvao. Author information Article notes Copyright and information Disclaimer. Received Apr 28; Accepted Apr Published by Wolters Kluwer Health, Inc.
This is an open access article distributed under the Creative Commons Attribution 4. This article has been cited by other articles in PMC. Abstract Introduction: Health services utilization is an indirect measure of the rights and equity of a health system.
Keywords: cross-sectional, diagnosis of health situation, population, surveys and questionnaires. Introduction The use of health services is an indirect method of measuring the access and equity of the health system.
Methods 2. Study de This is a protocol for a cross-sectional, population-based study to be held in Manaus in the first semester of Setting Manaus is the capital of Amazonas, the largest Brazilian state by territory.
Recruitment and sample size All participants will be selected by probabilistic sampling in 3 steps and stratified by sex and age quotas defined by the official census. Outcomes The primary outcome will be the prevalence of health service usage in the 15 days prior to the interview. Table 1 Outcomes, assessment, and measurement of the Manaus population-based survey, Open in a separate window. Figure 1. Measurements Experienced interviewers will be contracted and trained by research team. Data analysis plan Descriptive statistics will be obtained for overall independent variables to describe the sample.
Patient and public involvement The contact with the public will be performed only in the recruitment of Adult Manaus women sex. Funding acquisition: Marcus Tolentino Silva. SUS: supply, access to and use of health services over the last 30 years. Cien Saude Adult Manaus women sex ; 23 — Inequalities in healthy life expectancy by Brazilian geographic regions: findings from the National Health Survey, Int J Equity Health ; 15 Burden of disease in Brazil, a systematic subnational analysis for the Global Burden of Disease Study Lancet ; — Use of health services among adults living in Manaus metropolitan region, Brazil: population-based survey, Prevalence of health services usage and associated factors in the Amazon region of Brazil: a population-based cross-sectional study.
BMJ Open ; 7 :e Prevalence of health services utilization in Brazil: a systematic review and meta-analysis. Epidemiol Serv Saude ; 26 —Adult Manaus women sex
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Prevalence of self-reported asthma in adults in the Brazilian Amazon: a population-based cross-sectional study