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o Programa Nacional de Triagem Neonatal preconiza que o rec&#233;m&#8208;nascido receba alta hospitalar com o teste do reflexo&#8208;vermelho &#40;teste do olhinho&#41; e o teste da oximetria de pulso &#40;teste do cora&#231;&#227;ozinho&#41; feitos&#44; al&#233;m do teste do pezinho assegurado entre o 3&#176; e o 5&#176; dia de vida e da triagem auditiva &#40;teste da orelhinha&#41; no primeiro m&#234;s de vida&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> Embora a universaliza&#231;&#227;o desses testes seja almejada pelo programa&#44; observam&#8208;se diferen&#231;as populacionais no seu acesso&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Apenas cerca de um ter&#231;o dos rec&#233;m&#8208;nascidos no mundo s&#227;o submetidos &#224; triagem neonatal&#44; visto que v&#225;rios pa&#237;ses ainda n&#227;o t&#234;m programas nacionais de triagem neonatal&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a> Alguns pa&#237;ses da Am&#233;rica Latina&#44; como Cuba&#44; Chile e Uruguai&#44; abrangeram mais de 99&#37; dos seus rec&#233;m&#8208;nascidos com as pol&#237;ticas de triagem neonatal em 2015&#44; enquanto que o Brasil&#44; em 2013&#44; tinha cobertura nacional de 83&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> Al&#233;m disso&#44; apesar da recomenda&#231;&#227;o da feitura do teste do pezinho at&#233; o 5&#176; dia ap&#243;s o nascimento&#44; importante propor&#231;&#227;o &#233; feita apenas a partir de oito dias de vida&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A realidade nacional ainda demonstra importantes discrep&#226;ncias regionais na feitura dos testes de trigem&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> Al&#233;m disso&#44; Pinheiro et al&#46; &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> descreveram maior preval&#234;ncia de feitura do teste do pezinho nos nascimentos na rede privada de sa&#250;de &#40;99&#44;4&#37; <span class="elsevierStyleItalic">vs&#46;</span> 89&#44;6&#37;&#41;&#46; Tais desigualdades persistem mesmo em momento de amplia&#231;&#227;o da cobertura dos testes de triagem neonatal&#44; fato que tem sido observado desde o in&#237;cio dos anos 2000 no Brasil&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">5&#44;10&#8211;12</span></a> Apesar de sua relev&#226;ncia&#44; as an&#225;lises de vigil&#226;ncia dessas desigualdades t&#234;m sido direcionadas &#224;s varia&#231;&#245;es regionais&#44; n&#227;o h&#225; estudos em n&#237;vel nacional sobre a desigualdade no acesso &#224; triagem neonatal de acordo com caracter&#237;sticas individuais&#44; o que justifica a import&#226;ncia do presente estudo&#46; Ele objetiva analisar as diferen&#231;as na feitura da triagem biol&#243;gica&#44; da triagem auditiva e do teste do reflexo&#8208;vermelho no Brasil segundo caracter&#237;sticas demogr&#225;ficas e socioecon&#244;micas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudo transversal anal&#237;tico que empregou dados provenientes da Pesquisa Nacional de Sa&#250;de &#40;PNS&#41; de 2013&#46; A PNS &#233; uma pesquisa de abrang&#234;ncia nacional e de base domiciliar desenvolvida em parceria pelo Minist&#233;rio da Sa&#250;de e o Instituto Brasileiro de Geografia e Estat&#237;stica &#40;IBGE&#41;&#46; Seus microdados s&#227;o de dom&#237;nio p&#250;blico&#44; est&#227;o dispon&#237;veis no portal do IBGE<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a> e para o presente estudo foram obtidos em mar&#231;o de 2018&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A PNS tem como objetivo analisar a situa&#231;&#227;o de sa&#250;de e o uso dos servi&#231;os de sa&#250;de pela popula&#231;&#227;o&#46; Seu processo de amostragem foi feito por conglomerados e dividido em tr&#234;s est&#225;gios&#46; O conjunto de setores censit&#225;rios&#44; baseados no Censo Demogr&#225;fico de 2010&#44; formou as Unidades Prim&#225;rias de Amostragem &#40;UPAs&#41;&#46; O segundo est&#225;gio foi composto pelos domic&#237;lios e o terceiro por um morador com idade igual ou superior a 18 anos em cada resid&#234;ncia&#46; A partir das UPAs selecionadas&#44; um n&#250;mero fixo de domic&#237;lios particulares foi escolhido por amostragem aleat&#243;ria simples&#46; Por fim&#44; entre os domic&#237;lios selecionados&#44; um morador adulto foi sorteado para responder o question&#225;rio detalhado da PNS&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A coleta de dados ocorreu entre 2013 e 2014&#46; Foram selecionados 81&#46;254 domic&#237;lios e feitas 64&#46;348 entrevistas individuais com o morador adulto selecionado&#46; A partir da amostra da PNS &#233; poss&#237;vel estimar indicadores para as unidades federativas&#44; capitais e regi&#245;es metropolitanas do Brasil&#46; Mais detalhes metodol&#243;gicos da PNS est&#227;o descritos em publica&#231;&#227;o anterior&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> Entre os assuntos investigados na PNS est&#225; a sa&#250;de das crian&#231;as com menos de dois anos&#46; As informa&#231;&#245;es referentes a esse grupo foram obtidas junto &#224;s m&#227;es da crian&#231;a ou respons&#225;veis e trataram do uso de servi&#231;os de assist&#234;ncia &#224; sa&#250;de&#44; alimenta&#231;&#227;o&#44; vacina&#231;&#227;o e testes de triagem neonatal&#46; Para o presente estudo&#44; os desfechos foram calculados a partir das informa&#231;&#245;es oferecidas no M&#243;dulo L e s&#227;o referentes &#224;s crian&#231;as menores de dois anos residentes nos domic&#237;lios selecionados&#46; Os dados relativos a 5&#46;231 crian&#231;as foram coletados&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Os desfechos estudados no presente estudo foram a feitura do teste do pezinho&#44; da orelhinha e do olhinho&#44; em qualquer per&#237;odo&#44; categorizados como &#8220;sim&#8221; e &#8220;n&#227;o&#8221;&#46; Eles foram analisados segundo regi&#245;es de resid&#234;ncia &#40;Norte&#44; Nordeste&#44; Sul&#44; Sudeste&#44; Centro&#8208;Oeste&#41;&#44; cor&#47;etnia autorreferida do respondente &#40;branca&#44; preta&#44; parda&#59; em raz&#227;o da reduzida quantidade de pessoas autor referidas amarelas e ind&#237;genas&#44; esses grupos foram exclu&#237;dos da an&#225;lise&#41;&#44; posse de plano de sa&#250;de no momento da entrevista &#40;sim&#47;n&#227;o&#41; e renda domiciliar <span class="elsevierStyleItalic">per capita</span> &#40;foi considerado o valor total em reais recebido no domicilio no &#250;ltimo m&#234;s&#44; dividido pelo n&#250;mero de pessoas que moram naquele domic&#237;lio&#46; O valor final foi categorizado em quintis&#41;&#46; Em seguida&#44; tamb&#233;m foram estimadas as preval&#234;ncias segundo as vari&#225;veis explorat&#243;rias da feitura dos testes do olhinho e do pezinho na primeira semana de vida e da orelhinha no primeiro m&#234;s&#44; conforme recomenda&#231;&#227;o do Minist&#233;rio da Sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Os dados foram analisados com o pacote estat&#237;stico Stata 14 &#40;StataCorp LP&#44; College Station&#44; Estados Unidos&#41;&#44; consideraram&#8208;se o efeito de delineamento e os pesos amostrais&#46; Para as an&#225;lises&#44; foram calculadas as preval&#234;ncias de feitura dos tr&#234;s testes segundo as caracter&#237;sticas sociodemogr&#225;ficas&#44; com seus respectivos intervalos de confian&#231;a de 95&#37; &#40;95&#37; IC&#41;&#44; e foi usado o teste do qui&#8208;quadrado para verificar diferen&#231;as nas distribui&#231;&#245;es&#46; Em seguida&#44; fez&#8208;se an&#225;lise de regress&#227;o log&#237;stica uni e multivariada&#44; calcularam&#8208;se como medida de associa&#231;&#227;o a <span class="elsevierStyleItalic">odds ratio</span> e seus 95&#37; IC&#46; Foi empregado o procedimento <span class="elsevierStyleItalic">stepwise forward</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> Em todas as an&#225;lises&#44; o n&#237;vel de signific&#226;ncia considerado foi p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A PNS foi aprovada pela Comiss&#227;o Nacional de &#201;tica em Pesquisa &#40;Conep&#41; do Conselho Nacional de Sa&#250;de &#40;CNS&#41; em junho de 2013&#44; sob Certificado de Apresenta&#231;&#227;o para Aprecia&#231;&#227;o &#201;tica &#40;CAAE&#41; n&#176; 10853812&#46;7&#46;0000&#46;0008&#46; Assim&#44; esta pesquisa segue integralmente aos preceitos &#233;ticos constantes na resolu&#231;&#227;o do Conselho Nacional de Sa&#250;de n&#176; 466&#44; de 2012&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0060" class="elsevierStylePara elsevierViewall">Fizeram parte deste estudo 5&#46;231 crian&#231;as menores de dois anos&#46; Em rela&#231;&#227;o aos testes feitos em qualquer per&#237;odo&#44; 96&#44;5&#37; responderam que o beb&#234; fez o teste do pezinho&#46; Em contrapartida&#44; apenas 65&#44;8&#37; das pessoas afirmaram que o beb&#234; fez o teste da orelhinha e 60&#44;4&#37; o teste do olhinho &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; Dois ter&#231;os dos adultos respondentes residiam nas regi&#245;es Sul ou Sudeste&#44; aproximadamente metade era branca e 29&#44;5&#37; tinham plano de sa&#250;de&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Com rela&#231;&#227;o aos testes&#44; observou&#8208;se para todos maior propor&#231;&#227;o de adequa&#231;&#227;o nas regi&#245;es Sul e Sudeste e menor no Norte e Nordeste &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Tamb&#233;m foi identificado que a adequa&#231;&#227;o foi mais elevada entre crian&#231;as cuja m&#227;e ou respons&#225;vel era branca&#44; detentores de plano de sa&#250;de e nos estratos mais ricos da amostra&#44; houve claro efeito dose&#8208;resposta nesse &#250;ltimo caso&#46; Em todas as an&#225;lises&#44; as diferen&#231;as entre as categorias foram maiores nos testes do olhinho e da orelhinha&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Na an&#225;lise univariada &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; observou&#8208;se associa&#231;&#227;o positiva da feitura do teste do pezinho com a renda domiciliar <span class="elsevierStyleItalic">per capita</span>&#44; com a regi&#227;o de moradia e com a posse de planos de sa&#250;de&#46; Para o teste da orelhinha e do olhinho&#44; al&#233;m dessas vari&#225;veis&#44; associou&#8208;se com os desfechos a cor&#47;etnia&#44; foi maior a chance de fazer os testes entre os brancos&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a> apresenta os resultados da an&#225;lise multivariada&#46; Verificou&#8208;se maior chance de feitura do teste do pezinho nas regi&#245;es Sudeste&#44; Sul&#44; Centro&#8208;Oeste e Nordeste em compara&#231;&#227;o com a Norte&#46; O mesmo se observou nos testes da orelhinha e do olhinho&#44; exceto que n&#227;o houve diferen&#231;a estatisticamente significativa entre as regi&#245;es Norte e Nordeste&#46; Em rela&#231;&#227;o &#224; cor de pele&#47;etnia&#44; n&#227;o foram observadas diferen&#231;as nos testes de triagem neonatal&#46; Em todos os testes foram identificadas maiores chances de feitura entre aqueles que referiram ter plano de sa&#250;de&#46; No que diz respeito &#224; renda&#44; houve gradiente econ&#244;mico expressivo com a maior feitura da triagem neonatal entre os mais ricos&#46; A chance de fazer os testes da orelhinha e do olhinho foram 3&#44;78 e 3&#44;50 vezes maiores nos 20&#37; mais ricos em compara&#231;&#227;o com os 20&#37; mais pobres&#44; &#224; exce&#231;&#227;o do teste do pezinho&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discuss&#227;o</span><p id="par0080" class="elsevierStylePara elsevierViewall">O presente estudo observou diferen&#231;a na preval&#234;ncia de feitura dos testes de triagem&#44; a propor&#231;&#227;o de beb&#234;s que fizeram o teste do pezinho foi sensivelmente superior &#224; dos testes da orelhinha e do olhinho&#46; Para os tr&#234;s testes&#44; foram identificadas desigualdades na feitura&#44; as maiores preval&#234;ncias foram observadas entre os residentes das regi&#245;es Sul e Sudeste&#44; de cor&#47;etnia branca&#44; cujas m&#227;es&#47;respons&#225;veis tinham planos de sa&#250;de e entre os mais ricos&#46; As mesmas desigualdades foram observadas em rela&#231;&#227;o &#224; feitura dos testes dentro dos prazos previstos nas diretrizes governamentais&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Alcan&#231;ar a cobertura universal a esses testes tem sido um desafio no Brasil e tamb&#233;m em outros pa&#237;ses&#46; Na China&#44; a regulamenta&#231;&#227;o do programa de triagem neonatal determina a triagem de fenilceton&#250;ria e hipotireoidismo cong&#234;nito&#44; por&#233;m o rastreamento de problemas auditivos neonatais ainda n&#227;o &#233; obrigat&#243;rio&#46; Ainda assim&#44; diretrizes nacionais asseguraram uniforme desempenho de triagem a esses testes&#44; com altas taxas cobertura que chegam a 99&#37; em algumas cidades&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Apesar de alta preval&#234;ncia do teste do pezinho&#44; constata&#231;&#227;o tamb&#233;m evidenciada no presente estudo&#44; a cobertura para o teste da orelhinha ainda pode ser considerada baixa se comparada com a de outros pa&#237;ses que t&#234;m a sua recomenda&#231;&#227;o nas primeiras semanas de vida&#46; Na Pol&#244;nia&#44; a partir de regulamento emitido pelo Minist&#233;rio da Sa&#250;de em 2003 sobre a amplia&#231;&#227;o da triagem auditiva obrigat&#243;ria a todos os rec&#233;m&#8208;nascidos&#44; obteve&#8208;se discreto aumento de cobertura desse teste de 97&#44;8&#37; em 2004 para 98&#44;4&#37; em 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">No Brasil&#44; quando institu&#237;do em 2001&#44; o Programa de Triagem Neonatal englobava apenas o teste do pezinho&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a> Foi mais recentemente que os testes do olhinho e da orelhinha foram inclu&#237;dos nessas recomenda&#231;&#245;es&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> A feitura do teste do pezinho nas Unidades B&#225;sicas de Sa&#250;de&#44; somada &#224; expans&#227;o dos servi&#231;os de Aten&#231;&#227;o Prim&#225;ria &#224; Sa&#250;de no pa&#237;s&#44; pode explicar a maior preval&#234;ncia da feitura desse teste em compara&#231;&#227;o com os da orelhinha e do olhinho&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Ainda&#44; h&#225; de se destacar que o conhecimento diferenciado acerca da import&#226;ncia da feitura de cada teste tamb&#233;m pode ser um fator explicativo para a maior preval&#234;ncia do teste do pezinho&#46; Estudo feito em Minas Gerais entre 2014&#63;2015 demonstrou que 98&#44;7&#37; das pu&#233;rperas consideram o teste do pezinho importante&#44; apesar de apenas 57&#37; afirmarem ter recebido informa&#231;&#245;es sobre esse exame durante o pr&#233;&#8208;natal&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> Em contrapartida&#44; estudo conduzido em Curitiba entre 2013&#63;2014 identificou que somente 30&#44;0&#37; das pu&#233;rperas informaram ter recebido informa&#231;&#245;es sobre a triagem auditiva neonatal no pr&#233;&#8208;natal&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Sobre o teste do olhinho&#44; apesar de sua feitura ser preconizada para antes da alta hospitalar&#44; observam&#8208;se disparidades segundo as regi&#245;es de nascimento&#46; Assim&#44; classific&#225;&#8208;lo e difundir a pr&#225;tica de que seja um dos itens do exame f&#237;sico inicial do rec&#233;m&#8208;nascido ainda na maternidade e&#47;ou imediatamente na aten&#231;&#227;o b&#225;sica poderia vir a ser uma op&#231;&#227;o para aumento de sua abrang&#234;ncia&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1&#44;5</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Estudos que avaliaram o Programa de Triagem Neonatal j&#225; haviam demonstrado aumento da cobertura desses testes&#44; por&#233;m suas preval&#234;ncias seriam vari&#225;veis entre as regi&#245;es brasileiras&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">10&#44;21</span></a> Ainda num recorte brasileiro&#44; os achados do presente estudo corroboram pesquisa nacional que visou a analisar a evolu&#231;&#227;o da triagem auditiva neonatal no &#226;mbito do SUS entre 2008 e 2011&#46; Nela demonstrou&#8208;se que houve crescimento da cobertura desse exame no per&#237;odo&#44; por&#233;m com claras diferen&#231;as regionais&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> Essas disparidades podem ser reflexo da diferen&#231;a financeira e de estrutura para implanta&#231;&#227;o e manuten&#231;&#227;o dos servi&#231;os que envolvem o programa de triagem neonatal no pa&#237;s&#44; desde o financiamento&#44; descentraliza&#231;&#227;o dos servi&#231;os&#44; at&#233; a oferta e capacita&#231;&#227;o de profissionais&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a> Podem refletir&#44; em suma&#44; diferen&#231;as na organiza&#231;&#227;o da rede de aten&#231;&#227;o em sa&#250;de em todos os seus n&#237;veis&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">A cobertura da triagem neonatal foi avaliada em diversos pa&#237;ses&#44; inclusive no Brasil&#44; e demonstrou&#8208;se que as maiores coberturas est&#227;o nos estados credenciados para a feitura de mais testes &#40;hipotireoidismo cong&#234;nito&#44; fenilceton&#250;ria&#44; hemoglobinopatias e fibrose c&#237;stica&#41;&#44; ocorre o inverso naqueles credenciados para triagem apenas para hipotireoidismo cong&#234;nito e fenilceton&#250;ria &#40;valores que variam de 47&#37;&#63;76&#37;&#41;&#44; o que reflete aspectos de oferta e organiza&#231;&#227;o dos servi&#231;os&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">A feitura dos testes no per&#237;odo preconizado foi influenciada pela cor&#47;etnia&#44; regi&#227;o&#44; posse de plano de sa&#250;de e renda&#44; as maiores diferen&#231;as entre as categorias foram observadas para os testes do olhinho e da orelhinha&#44; o que refor&#231;ando os achados de que as condi&#231;&#245;es socioecon&#244;micas est&#227;o associadas com o acesso e o uso dos servi&#231;os de sa&#250;de no pa&#237;s em tempo oportuno&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">22&#44;23</span></a> Pessoas mais pobres t&#234;m m&#250;ltiplas priva&#231;&#245;es e essas est&#227;o relacionadas a n&#237;veis elevados de exposi&#231;&#227;o a doen&#231;as&#44; busca inadequada por cuidados de sa&#250;de e menor probabilidade de receber tratamento efetivo e oportuno&#44; entre eles os testes de triagem&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Ainda que cor&#47;etnia n&#227;o tenha demonstrado associa&#231;&#227;o com qualquer dos tr&#234;s desfechos neste estudo&#44; outros estudos t&#234;m demonstrado predom&#237;nio da cor&#47;etnia branca na feitura dos testes de triagem e essas desigualdades raciais se revelam um desafio para sistemas de sa&#250;de baseados em princ&#237;pios de equidade&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a> No presente estudo&#44; a incorpora&#231;&#227;o da renda no modelo m&#250;ltiplo retirou o efeito da associa&#231;&#227;o dos desfechos com cor&#47;etnia&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Ter plano de sa&#250;de tamb&#233;m foi fator associado para a feitura dos tr&#234;s testes de triagem&#44; independentemente da renda familiar <span class="elsevierStyleItalic">per capita</span>&#46; Estudo de Pilotto et al&#46; &#40;2018&#41;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> entre 1998&#63;2013 j&#225; havia demonstrado incremento do uso dos servi&#231;os m&#233;dicos e odontol&#243;gicos&#44; maior entre as pessoas com plano de sa&#250;de&#46; Para os testes de triagem neonatal&#44; estudo de Pinheiro et al&#46; &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> feito no Rio Grande do Norte&#44; Brasil&#44; em 2010&#44; demonstrou que a diferen&#231;a entre setor p&#250;blico e privado fica evidente quando a maior preval&#234;ncia de feitura do teste do pezinho ocorreu para os nascidos no setor privado &#40;99&#44;4&#37;&#41; se comparados com aqueles nascidos no servi&#231;o p&#250;blico &#40;89&#44;6&#37;&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Silva et al&#46; &#40;2011&#41;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a> observaram que a procura por servi&#231;os de sa&#250;de no Brasil foi mais frequente entre os indiv&#237;duos que tinham planos de sa&#250;de&#46; Isso demonstrando que sua posse pode reduzir a exist&#234;ncia de poss&#237;veis barreiras financeiras no acesso aos servi&#231;os&#44; como tamb&#233;m determina maior uso de servi&#231;os preventivos&#46; O investimento e a qualifica&#231;&#227;o da oferta desses exames no &#226;mbito do SUS configuram&#8208;se como importante estrat&#233;gia na redu&#231;&#227;o de disparidades de acesso a esses servi&#231;os&#44; &#224; medida que um sistema de sa&#250;de fortalecido e eficaz seria capaz de cobrir essas demandas&#44; ao encontro do proposto pelo Minist&#233;rio da Sa&#250;de na busca pela cobertura dos testes junto a 100&#37; nos rec&#233;m&#8208;nascidos no pa&#237;s&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">O presente estudo tamb&#233;m observou associa&#231;&#227;o entre a feitura dos testes e renda da m&#227;e&#47;respons&#225;vel&#44; quanto maior o quintil de renda&#44; maiores as chances de feitura dos testes&#46; Esse resultado est&#225; de acordo com Cavalcanti et al&#46; &#40;2012&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a> que analisaram a triagem auditiva neonatal no Nordeste entre 2007&#63;2009 e identificaram que a menor preval&#234;ncia esteve associada com os menores quintis de renda&#44; menor escolaridade da m&#227;e e menor n&#250;mero de consultas de pr&#233;&#8208;natal&#46; Em pa&#237;ses que ainda apresentam problemas de acesso aos testes&#44; como o caso da S&#233;rvia&#44; Ucr&#226;nia e Cro&#225;cia&#44; observaram&#8208;se diversos obst&#225;culos&#44; que incluem economias pobres e falta de apoio governamental&#44; somadas a diferen&#231;as culturais&#44; al&#233;m de grandes varia&#231;&#245;es geogr&#225;ficas&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Segundo o IBGE &#40;2016&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> a procura por atendimento de sa&#250;de varia de acordo a renda&#44; &#233; maior naquelas do maior quintil de renda&#46; Ainda&#44; em geral&#44; pessoas com maior renda t&#234;m maior grau de escolaridade&#46; Esses dados poderiam justificar a maior propor&#231;&#227;o de feitura dos testes de triagem pela popula&#231;&#227;o de maior renda&#44; associado ao fato de que maior n&#237;vel de instru&#231;&#227;o pode contribuir para o reconhecimento da import&#226;ncia da feitura desses testes&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> Ou seja&#44; esse grupo populacional tem maior conhecimento sobre os benef&#237;cios dos testes&#44; maior oportunidade em termos econ&#244;micos de viabiliz&#225;&#8208;los &#40;seja para se deslocar a uma unidade de sa&#250;de ou para consumi&#8208;los no setor privado&#41; e potencialmente reside em lugares com maior facilidade de acesso aos servi&#231;os de sa&#250;de&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Os testes de triagem neonatal&#44; quando feitos no per&#237;odo recomendado&#44; t&#234;m a capacidade de identificar as doen&#231;as&#8208;alvo ainda em fase pr&#233;&#8208;sintom&#225;tica em rec&#233;m&#8208;nascidos e permitir interven&#231;&#227;o precoce&#44; preven&#231;&#227;o de manifesta&#231;&#245;es e acompanhamento da sa&#250;de da crian&#231;a&#44; seus benef&#237;cios j&#225; s&#227;o consolidados na literatura&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a> Apesar da oferta desses exames no SUS&#44; a car&#234;ncia de profissionais&#44; a falta de estrutura dos servi&#231;os<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> e problemas no acompanhamento pr&#233;&#8208;natal e de puerp&#233;rio imediato podem ser sugeridas como poss&#237;veis causas para a n&#227;o feitura desses testes no per&#237;odo recomendado&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Como limita&#231;&#245;es do estudo&#44; destaca&#8208;se que a PNS &#233; uma pesquisa transversal e usa informa&#231;&#245;es autorreferidas&#46; Para a investiga&#231;&#227;o dos testes de triagem&#44; as informa&#231;&#245;es foram respondidas pela m&#227;e e&#47;ou respons&#225;veis&#44; o que as sujeita a poss&#237;veis erros decorrentes de vi&#233;s de mem&#243;ria&#46; Ainda&#44; a posse de plano de sa&#250;de se referia ao momento da entrevista&#44; o que pode diferir do que ocorreu no momento em que os testes deveriam ser feitos&#44; pode super ou subestimar as estimativas&#46; Entretanto&#44; &#233; necess&#225;rio considerar a import&#226;ncia de inqu&#233;ritos populacionais peri&#243;dicos que espelhem a realidade de sa&#250;de do pa&#237;s&#46; A PNS constitui&#8208;se uma das maiores pesquisas de base domiciliar em &#226;mbito nacional&#44; &#233; reconhecidamente conduzida com rigor metodol&#243;gico e a explora&#231;&#227;o de dados provenientes desse inqu&#233;rito possibilita uma an&#225;lise atual e contextualizada acerca dos desfechos investigados&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Este estudo mostrou que regi&#227;o&#44; posse de plano de sa&#250;de e renda foram fatores associados &#224; feitura dos testes do pezinho&#44; orelhinha e olhinho no Brasil&#44; demonstrou que existem disparidades na feitura dos testes de triagem neonatal no pa&#237;s&#46; Desse modo&#44; pol&#237;ticas intersetoriais devem ser planejadas e implantadas com vistas &#224; articula&#231;&#227;o e &#224; harmoniza&#231;&#227;o entre as diversas esferas governamentais&#44; em que sa&#250;de&#44; educa&#231;&#227;o&#44; economia e &#225;rea social garantam&#44; em conjunto&#44; uma boa estrutura&#231;&#227;o dos servi&#231;os prestados e aten&#231;&#227;o integral ao rec&#233;m&#8208;nascido&#47;crian&#231;a&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">O Programa de Triagem Neonatal Brasileiro apresenta grande magnitude e destaca&#8208;se pela sua inclus&#227;o no SUS&#46; Apesar disso&#44; atingir n&#237;veis mais altos de cobertura e acesso a esses testes no pa&#237;s &#233; um desafio&#44; especialmente em termos de organiza&#231;&#227;o e log&#237;stica&#46; Al&#233;m do tamanho territorial e da descentraliza&#231;&#227;o dos servi&#231;os&#44; o desenvolvimento econ&#244;mico nacional e o baixo gasto p&#250;blico <span class="elsevierStyleItalic">per capita</span> em sa&#250;de tamb&#233;m t&#234;m impacto&#44; &#224; medida que se devem reconhecer essas a&#231;&#245;es como importantes fatores na redu&#231;&#227;o da mortalidade de rec&#233;m&#8208;nascidos e crian&#231;as&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">O SUS &#233; um sistema apoiado no conceito de cidadania ao estabelecer o acesso universal e integral &#224; aten&#231;&#227;o &#224; sa&#250;de&#46; Assim&#44; a garantia desses testes em um sistema universal e p&#250;blico deveria promover a equidade e o acesso &#224; triagem de todos os rec&#233;m&#8208;nascidos&#46; Por&#233;m&#44; disparidades no acesso a esses servi&#231;os evidenciadas refletem a exist&#234;ncia de outras lacunas que perpassam as quest&#245;es da oferta&#46; Fomentar a aten&#231;&#227;o b&#225;sica em sa&#250;de&#44; o pr&#233;&#8208;natal de qualidade e o pr&#243;prio Sistema &#218;nico de Sa&#250;de s&#227;o medidas para se ampliar o acesso aos testes e reduzir as desigualdades existentes&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Nesse sentido&#44; sugere&#8208;se que novos estudos possam ser desenvolvidos com o objetivo de contribuir para a organiza&#231;&#227;o e a amplia&#231;&#227;o da oferta desses servi&#231;os no pa&#237;s&#44; identificar fatores que modulam o acesso aos testes e meios de superar as barreiras descritas&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Financiamento</span><p id="par0180" class="elsevierStylePara elsevierViewall">Conselho Nacional de Desenvolvimento Cient&#237;fico e Tecnol&#243;gico &#40;CNPq&#41;&#44; bolsa do Programa Institucional de Bolsas de Inicia&#231;&#227;o Cient&#237;fica &#40;Pibic &#8211; 2016&#47;2017&#41;&#44; concedida a Mariana Borsa Mallmann&#44; conforme edital Pibic&#47;CNPq &#8211; Pibic&#8208;Af&#47;CNPq &#8211; BIPI&#47;UFSC 2016&#47;2017&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflitos de interesse</span><p id="par0185" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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            0 => "Neonatal screening"
            1 => "Child health"
            2 => "Public health practice"
            3 => "Healthcare inequalities"
            4 => "Socioeconomic factors"
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            0 => "Triagem neonatal"
            1 => "Sa&#250;de da crian&#231;a"
            2 => "Pr&#225;tica de sa&#250;de p&#250;blica"
            3 => "Disparidades em assist&#234;ncia &#224; sa&#250;de"
            4 => "Fatores socioecon&#244;micos"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To identify the prevalence and associated factors with the performance of the Guthrie test&#44; hearing&#44; and red reflex screening tests in Brazil&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a population&#8208;based&#44; cross&#8208;sectional study that analyzed data on 5&#44;231 children under 2 years of age participating in the National Health Survey of 2013&#46; The study described the prevalence and Confidence Intervals &#40;95&#37; CI&#41; of the three neonatal screening tests performed&#44; in any period&#44; and their association with the country&#39;s regions&#44; skin color&#47;ethnicity&#44; private health insurance&#44; and per capita household income&#46; Logistic regression models were used&#44; and odds ratios were calculated by incorporating sample weights&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The prevalence of Guthrie test screening in Brazil at any time of life was 96&#46;5&#37;&#44; that of the newborn hearing screening was 65&#46;8&#37; and that of the red reflex screening test was 60&#46;4&#37;&#46; The performance of the three screening tests was significantly higher among children whose mothers&#47;guardians reported higher per capita household income&#44; who lived in the South and Southeast regions&#44; and who had private health insurance &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; There was no statistically significant difference regarding the performance of the tests according to skin color&#47;ethnicity &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#46;05&#41;&#46; The same inequalities were verified when the tests were performed during the recommended periods&#44; with a strong socioeconomic gradient&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There are inequalities in the performance of neonatal screening tests in the country&#44; and also in the performance of these tests during the periods established in the governmental guidelines&#46; The guarantee of the performance of these tests in a universal and public health system&#44; as in Brazil&#44; should promote equity and access to the entire population&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Identificar preval&#234;ncia e fatores associados &#224; realiza&#231;&#227;o dos testes do pezinho&#44; da orelhinha e do olhinho no Brasil&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal anal&#237;tico de base populacional que analisou os dados de 5&#46;231 crian&#231;as menores de dois anos participantes da Pesquisa Nacional de Sa&#250;de &#40;2013&#41;&#46; Foram descritas preval&#234;ncias e intervalos de confian&#231;a &#40;95&#37; IC&#41; da realiza&#231;&#227;o dos tr&#234;s testes de triagem neonatal&#44; em qualquer per&#237;odo&#44; e sua associa&#231;&#227;o com as regi&#245;es do pa&#237;s&#44; cor&#47;etnia&#44; posse de plano de sa&#250;de e renda domiciliar <span class="elsevierStyleItalic">per capita</span>&#46; Empregaram&#8208;se modelos de regress&#227;o log&#237;stica e calcularam&#8208;se as <span class="elsevierStyleItalic">odds ratio</span> e incorporaram&#8208;se os pesos amostrais&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A preval&#234;ncia de realiza&#231;&#227;o do teste do pezinho no Brasil em qualquer momento de vida foi de 96&#44;5&#37;&#59; do teste da orelhinha de 65&#44;8&#37; e do teste do olhinho de 60&#44;4&#37;&#46; A realiza&#231;&#227;o dos tr&#234;s testes de triagem foi significativamente maior entre as crian&#231;as cujas m&#227;es&#47;respons&#225;veis reportaram maior renda domiciliar <span class="elsevierStyleItalic">per capita</span>&#44; residiam nas regi&#245;es Sul e Sudeste e tinham plano de sa&#250;de &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; N&#227;o houve diferen&#231;a estatisticamente significativa na realiza&#231;&#227;o dos testes segundo cor&#47;etnia &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46; As mesmas desigualdades foram verificadas para a realiza&#231;&#227;o dos testes no per&#237;odo preconizado&#44; com forte gradiente socioecon&#244;mica&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Existem desigualdades na realiza&#231;&#227;o dos testes de triagem neonatal no pa&#237;s e&#44; tamb&#233;m&#44; na realiza&#231;&#227;o desses dentro dos prazos previstos nas diretrizes governamentais&#46; A garantia desses testes em um sistema universal e p&#250;blico como no Brasil deveria promover a equidade e o acesso a toda a popula&#231;&#227;o&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Como citar este artigo&#58; Mallmann MB&#44; Tomasi YT&#44; Boing AF&#46; Neonatal screening tests in Brazil&#58; prevalence rates and regional and socioeconomic inequalities&#46; J Pediatr &#40;Rio J&#41;&#46; 2020&#59;96&#58;487&#8211;94&#46;</p>"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Preval&#234;ncia e intervalo de confian&#231;a 95&#37; da feitura dos testes do pezinho e do olhinho na primeira semana de vida e do teste da orelhinha nos primeiros 28 dias de vida&#46; Pesquisa Nacional de Sa&#250;de&#44; Brasil&#44; 2013&#46; &#40;<span class="elsevierStyleSup">a</span> valor de p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; obtido mediante teste do qui&#8208;quadrado&#41;&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Teste do pezinho &#40;&#37;&#41; &#40;95&#37; IC&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Teste da orelhinha &#40;&#37;&#41; &#40;95&#37; IC&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Teste do olhinho &#40;&#37;&#41; &#40;95&#37; IC&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Regi&#245;es</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Norte&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;569 &#40;30&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#44;0 &#40;86&#44;1&#47;91&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#44;7 &#40;37&#44;3&#47;46&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;1 &#40;32&#44;1&#47;40&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nordeste&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;569 &#40;30&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#44;6 &#40;91&#44;9&#47;94&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;1 &#40;40&#44;4&#47;47&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;7 &#40;32&#44;3&#47;39&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Centro Oeste&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">644 &#40;12&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#44;4 &#40;96&#44;7&#47;99&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;2 &#40;54&#44;4&#47;63&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#44;0 &#40;44&#44;9&#47;55&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sudeste&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">920 &#40;17&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#44;5 &#40;98&#44;5&#47;99&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#44;5 &#40;80&#44;2&#47;86&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#44;0 &#40;79&#44;7&#47;85&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sul&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">529 &#40;10&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#44;4 &#40;98&#44;3&#47;99&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#44;4 &#40;85&#44;0&#47;92&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#44;1 &#40;76&#44;6&#47;84&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cor&#47;etnia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;224 &#40;42&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#44;6 &#40;96&#44;9&#47;98&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#44;6 &#40;73&#44;5&#47;77&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44;8 &#40;68&#44;7&#47;72&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Preta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">278 &#40;5&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#44;7 &#40;94&#44;5&#47; 96&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;5 &#40;51&#44;6&#47;59&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#44;6 &#40;50&#44;2&#47;56&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;690 &#40;51&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#44;4 &#40;94&#44;5&#47;96&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#44;1 &#40;54&#44;3&#47;59&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#44;6 &#40;48&#44;1&#47;53&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Plano de sa&#250;de</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;264 &#40;29&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#44;4 &#40;99&#44;0&#47;99&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#44;5 &#40;87&#44;1&#47;91&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;1 &#40;81&#44;8&#47;86&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;967 &#40;70&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#44;2 &#40;94&#44;3&#47;95&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;6 &#40;53&#44;3&#47;57&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#44;2 &#40;47&#44;9&#47;52&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Renda</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#176; quintil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;824 &#40;30&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#44;9 &#40;90&#44;1&#47;93&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise de regress&#227;o log&#237;stica univariada para feitura em qualquer per&#237;odo dos testes do pezinho&#44; orelhinha e olhinho&#44; segundo vari&#225;veis sociodemogr&#225;ficas&#44; Pesquisa Nacional de Sa&#250;de&#44; Brasil&#44; 2013</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">95&#37; IC&#44; intervalo de confian&#231;a de 95&#37;&#59; OR&#44; <span class="elsevierStyleItalic">odds ratio</span>&#59; p&#44; valor de p obtido por meio da an&#225;lise de regress&#227;o log&#237;stica&#46;</p>"
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            0 => array:2 [
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col">Vari&#225;vel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Teste do pezinho<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Teste do olhinho<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a></th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;95&#37; IC&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;95&#37; IC&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Norte&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;00&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nordeste&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;1&#44;21&#47;2&#44;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;0&#44;85&#47;1&#44;39&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;472&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;0&#44;76&#59; 1&#44;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;700&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sudeste&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">14&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;4&#44;34&#47;48&#44;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;3&#44;33&#47;5&#44;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;4&#44;20&#59; 7&#44;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;3&#44;29&#59; 6&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Centro Oeste&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;2&#44;34&#47;13&#44;47&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">&#40;1&#44;01&#47;1&#44;77&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;0&#44;86&#59; 1&#44;53&#41;&nbsp;\t\t\t\t\t\t\n
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Artigo Original
Neonatal screening tests in Brazil: prevalence rates and regional and socioeconomic inequalities
Realização dos testes de triagem neonatal no Brasil: prevalências e desigualdades regionais e socioeconômicas
Mariana B. Mallmanna, Yaná T. Tomasib, Antonio Fernando Boingc,
Autor para correspondência
antonio.boing@ufsc.br

Autor para correspondência.
a Universidade Federal de Santa Catarina (UFSC), Faculdade de Medicina, Florianópolis, SC, Brasil
b Universidade Federal de Santa Catarina (UFSC), Programa de Pós‐graduação em Saúde Coletiva, Florianópolis, SC, Brasil
c Universidade Federal de Santa Catarina (UFSC), Departamento de Saúde Pública, Florianópolis, SC, Brasil
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o Programa Nacional de Triagem Neonatal preconiza que o rec&#233;m&#8208;nascido receba alta hospitalar com o teste do reflexo&#8208;vermelho &#40;teste do olhinho&#41; e o teste da oximetria de pulso &#40;teste do cora&#231;&#227;ozinho&#41; feitos&#44; al&#233;m do teste do pezinho assegurado entre o 3&#176; e o 5&#176; dia de vida e da triagem auditiva &#40;teste da orelhinha&#41; no primeiro m&#234;s de vida&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> Embora a universaliza&#231;&#227;o desses testes seja almejada pelo programa&#44; observam&#8208;se diferen&#231;as populacionais no seu acesso&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Apenas cerca de um ter&#231;o dos rec&#233;m&#8208;nascidos no mundo s&#227;o submetidos &#224; triagem neonatal&#44; visto que v&#225;rios pa&#237;ses ainda n&#227;o t&#234;m programas nacionais de triagem neonatal&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a> Alguns pa&#237;ses da Am&#233;rica Latina&#44; como Cuba&#44; Chile e Uruguai&#44; abrangeram mais de 99&#37; dos seus rec&#233;m&#8208;nascidos com as pol&#237;ticas de triagem neonatal em 2015&#44; enquanto que o Brasil&#44; em 2013&#44; tinha cobertura nacional de 83&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> Al&#233;m disso&#44; apesar da recomenda&#231;&#227;o da feitura do teste do pezinho at&#233; o 5&#176; dia ap&#243;s o nascimento&#44; importante propor&#231;&#227;o &#233; feita apenas a partir de oito dias de vida&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A realidade nacional ainda demonstra importantes discrep&#226;ncias regionais na feitura dos testes de trigem&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> Al&#233;m disso&#44; Pinheiro et al&#46; &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> descreveram maior preval&#234;ncia de feitura do teste do pezinho nos nascimentos na rede privada de sa&#250;de &#40;99&#44;4&#37; 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A partir das UPAs selecionadas&#44; um n&#250;mero fixo de domic&#237;lios particulares foi escolhido por amostragem aleat&#243;ria simples&#46; Por fim&#44; entre os domic&#237;lios selecionados&#44; um morador adulto foi sorteado para responder o question&#225;rio detalhado da PNS&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A coleta de dados ocorreu entre 2013 e 2014&#46; Foram selecionados 81&#46;254 domic&#237;lios e feitas 64&#46;348 entrevistas individuais com o morador adulto selecionado&#46; A partir da amostra da PNS &#233; poss&#237;vel estimar indicadores para as unidades federativas&#44; capitais e regi&#245;es metropolitanas do Brasil&#46; Mais detalhes metodol&#243;gicos da PNS est&#227;o descritos em publica&#231;&#227;o anterior&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> Entre os assuntos investigados na PNS est&#225; a sa&#250;de das crian&#231;as com menos de dois anos&#46; As informa&#231;&#245;es referentes a esse grupo foram obtidas junto &#224;s m&#227;es da crian&#231;a ou respons&#225;veis e trataram do uso de servi&#231;os de assist&#234;ncia &#224; sa&#250;de&#44; alimenta&#231;&#227;o&#44; vacina&#231;&#227;o e testes de triagem neonatal&#46; Para o presente estudo&#44; os desfechos foram calculados a partir das informa&#231;&#245;es oferecidas no M&#243;dulo L e s&#227;o referentes &#224;s crian&#231;as menores de dois anos residentes nos domic&#237;lios selecionados&#46; Os dados relativos a 5&#46;231 crian&#231;as foram coletados&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Os desfechos estudados no presente estudo foram a feitura do teste do pezinho&#44; da orelhinha e do olhinho&#44; em qualquer per&#237;odo&#44; categorizados como &#8220;sim&#8221; e &#8220;n&#227;o&#8221;&#46; Eles foram analisados segundo regi&#245;es de resid&#234;ncia &#40;Norte&#44; Nordeste&#44; Sul&#44; Sudeste&#44; Centro&#8208;Oeste&#41;&#44; cor&#47;etnia autorreferida do respondente &#40;branca&#44; preta&#44; parda&#59; em raz&#227;o da reduzida quantidade de pessoas autor referidas amarelas e ind&#237;genas&#44; esses grupos foram exclu&#237;dos da an&#225;lise&#41;&#44; posse de plano de sa&#250;de no momento da entrevista &#40;sim&#47;n&#227;o&#41; e renda domiciliar <span class="elsevierStyleItalic">per capita</span> &#40;foi considerado o valor total em reais recebido no domicilio no &#250;ltimo m&#234;s&#44; dividido pelo n&#250;mero de pessoas que moram naquele domic&#237;lio&#46; O valor final foi categorizado em quintis&#41;&#46; Em seguida&#44; tamb&#233;m foram estimadas as preval&#234;ncias segundo as vari&#225;veis explorat&#243;rias da feitura dos testes do olhinho e do pezinho na primeira semana de vida e da orelhinha no primeiro m&#234;s&#44; conforme recomenda&#231;&#227;o do Minist&#233;rio da Sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Os dados foram analisados com o pacote estat&#237;stico Stata 14 &#40;StataCorp LP&#44; College Station&#44; Estados Unidos&#41;&#44; consideraram&#8208;se o efeito de delineamento e os pesos amostrais&#46; Para as an&#225;lises&#44; foram calculadas as preval&#234;ncias de feitura dos tr&#234;s testes segundo as caracter&#237;sticas sociodemogr&#225;ficas&#44; com seus respectivos intervalos de confian&#231;a de 95&#37; &#40;95&#37; IC&#41;&#44; e foi usado o teste do qui&#8208;quadrado para verificar diferen&#231;as nas distribui&#231;&#245;es&#46; Em seguida&#44; fez&#8208;se an&#225;lise de regress&#227;o log&#237;stica uni e multivariada&#44; calcularam&#8208;se como medida de associa&#231;&#227;o a <span class="elsevierStyleItalic">odds ratio</span> e seus 95&#37; IC&#46; Foi empregado o procedimento <span class="elsevierStyleItalic">stepwise forward</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> Em todas as an&#225;lises&#44; o n&#237;vel de signific&#226;ncia considerado foi p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A PNS foi aprovada pela Comiss&#227;o Nacional de &#201;tica em Pesquisa &#40;Conep&#41; do Conselho Nacional de Sa&#250;de &#40;CNS&#41; em junho de 2013&#44; sob Certificado de Apresenta&#231;&#227;o para Aprecia&#231;&#227;o &#201;tica &#40;CAAE&#41; n&#176; 10853812&#46;7&#46;0000&#46;0008&#46; Assim&#44; esta pesquisa segue integralmente aos preceitos &#233;ticos constantes na resolu&#231;&#227;o do Conselho Nacional de Sa&#250;de n&#176; 466&#44; de 2012&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0060" class="elsevierStylePara elsevierViewall">Fizeram parte deste estudo 5&#46;231 crian&#231;as menores de dois anos&#46; Em rela&#231;&#227;o aos testes feitos em qualquer per&#237;odo&#44; 96&#44;5&#37; responderam que o beb&#234; fez o teste do pezinho&#46; Em contrapartida&#44; apenas 65&#44;8&#37; das pessoas afirmaram que o beb&#234; fez o teste da orelhinha e 60&#44;4&#37; o teste do olhinho &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; Dois ter&#231;os dos adultos respondentes residiam nas regi&#245;es Sul ou Sudeste&#44; aproximadamente metade era branca e 29&#44;5&#37; tinham plano de sa&#250;de&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Com rela&#231;&#227;o aos testes&#44; observou&#8208;se para todos maior propor&#231;&#227;o de adequa&#231;&#227;o nas regi&#245;es Sul e Sudeste e menor no Norte e Nordeste &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Tamb&#233;m foi identificado que a adequa&#231;&#227;o foi mais elevada entre crian&#231;as cuja m&#227;e ou respons&#225;vel era branca&#44; detentores de plano de sa&#250;de e nos estratos mais ricos da amostra&#44; houve claro efeito dose&#8208;resposta nesse &#250;ltimo caso&#46; Em todas as an&#225;lises&#44; as diferen&#231;as entre as categorias foram maiores nos testes do olhinho e da orelhinha&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Na an&#225;lise univariada &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; observou&#8208;se associa&#231;&#227;o positiva da feitura do teste do pezinho com a renda domiciliar <span class="elsevierStyleItalic">per capita</span>&#44; com a regi&#227;o de moradia e com a posse de planos de sa&#250;de&#46; Para o teste da orelhinha e do olhinho&#44; al&#233;m dessas vari&#225;veis&#44; associou&#8208;se com os desfechos a cor&#47;etnia&#44; foi maior a chance de fazer os testes entre os brancos&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a> apresenta os resultados da an&#225;lise multivariada&#46; Verificou&#8208;se maior chance de feitura do teste do pezinho nas regi&#245;es Sudeste&#44; Sul&#44; Centro&#8208;Oeste e Nordeste em compara&#231;&#227;o com a Norte&#46; O mesmo se observou nos testes da orelhinha e do olhinho&#44; exceto que n&#227;o houve diferen&#231;a estatisticamente significativa entre as regi&#245;es Norte e Nordeste&#46; Em rela&#231;&#227;o &#224; cor de pele&#47;etnia&#44; n&#227;o foram observadas diferen&#231;as nos testes de triagem neonatal&#46; Em todos os testes foram identificadas maiores chances de feitura entre aqueles que referiram ter plano de sa&#250;de&#46; No que diz respeito &#224; renda&#44; houve gradiente econ&#244;mico expressivo com a maior feitura da triagem neonatal entre os mais ricos&#46; A chance de fazer os testes da orelhinha e do olhinho foram 3&#44;78 e 3&#44;50 vezes maiores nos 20&#37; mais ricos em compara&#231;&#227;o com os 20&#37; mais pobres&#44; &#224; exce&#231;&#227;o do teste do pezinho&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discuss&#227;o</span><p id="par0080" class="elsevierStylePara elsevierViewall">O presente estudo observou diferen&#231;a na preval&#234;ncia de feitura dos testes de triagem&#44; a propor&#231;&#227;o de beb&#234;s que fizeram o teste do pezinho foi sensivelmente superior &#224; dos testes da orelhinha e do olhinho&#46; Para os tr&#234;s testes&#44; foram identificadas desigualdades na feitura&#44; as maiores preval&#234;ncias foram observadas entre os residentes das regi&#245;es Sul e Sudeste&#44; de cor&#47;etnia branca&#44; cujas m&#227;es&#47;respons&#225;veis tinham planos de sa&#250;de e entre os mais ricos&#46; As mesmas desigualdades foram observadas em rela&#231;&#227;o &#224; feitura dos testes dentro dos prazos previstos nas diretrizes governamentais&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Alcan&#231;ar a cobertura universal a esses testes tem sido um desafio no Brasil e tamb&#233;m em outros pa&#237;ses&#46; Na China&#44; a regulamenta&#231;&#227;o do programa de triagem neonatal determina a triagem de fenilceton&#250;ria e hipotireoidismo cong&#234;nito&#44; por&#233;m o rastreamento de problemas auditivos neonatais ainda n&#227;o &#233; obrigat&#243;rio&#46; Ainda assim&#44; diretrizes nacionais asseguraram uniforme desempenho de triagem a esses testes&#44; com altas taxas cobertura que chegam a 99&#37; em algumas cidades&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Apesar de alta preval&#234;ncia do teste do pezinho&#44; constata&#231;&#227;o tamb&#233;m evidenciada no presente estudo&#44; a cobertura para o teste da orelhinha ainda pode ser considerada baixa se comparada com a de outros pa&#237;ses que t&#234;m a sua recomenda&#231;&#227;o nas primeiras semanas de vida&#46; Na Pol&#244;nia&#44; a partir de regulamento emitido pelo Minist&#233;rio da Sa&#250;de em 2003 sobre a amplia&#231;&#227;o da triagem auditiva obrigat&#243;ria a todos os rec&#233;m&#8208;nascidos&#44; obteve&#8208;se discreto aumento de cobertura desse teste de 97&#44;8&#37; em 2004 para 98&#44;4&#37; em 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">No Brasil&#44; quando institu&#237;do em 2001&#44; o Programa de Triagem Neonatal englobava apenas o teste do pezinho&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a> Foi mais recentemente que os testes do olhinho e da orelhinha foram inclu&#237;dos nessas recomenda&#231;&#245;es&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> A feitura do teste do pezinho nas Unidades B&#225;sicas de Sa&#250;de&#44; somada &#224; expans&#227;o dos servi&#231;os de Aten&#231;&#227;o Prim&#225;ria &#224; Sa&#250;de no pa&#237;s&#44; pode explicar a maior preval&#234;ncia da feitura desse teste em compara&#231;&#227;o com os da orelhinha e do olhinho&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Ainda&#44; h&#225; de se destacar que o conhecimento diferenciado acerca da import&#226;ncia da feitura de cada teste tamb&#233;m pode ser um fator explicativo para a maior preval&#234;ncia do teste do pezinho&#46; Estudo feito em Minas Gerais entre 2014&#63;2015 demonstrou que 98&#44;7&#37; das pu&#233;rperas consideram o teste do pezinho importante&#44; apesar de apenas 57&#37; afirmarem ter recebido informa&#231;&#245;es sobre esse exame durante o pr&#233;&#8208;natal&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> Em contrapartida&#44; estudo conduzido em Curitiba entre 2013&#63;2014 identificou que somente 30&#44;0&#37; das pu&#233;rperas informaram ter recebido informa&#231;&#245;es sobre a triagem auditiva neonatal no pr&#233;&#8208;natal&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Sobre o teste do olhinho&#44; apesar de sua feitura ser preconizada para antes da alta hospitalar&#44; observam&#8208;se disparidades segundo as regi&#245;es de nascimento&#46; Assim&#44; classific&#225;&#8208;lo e difundir a pr&#225;tica de que seja um dos itens do exame f&#237;sico inicial do rec&#233;m&#8208;nascido ainda na maternidade e&#47;ou imediatamente na aten&#231;&#227;o b&#225;sica poderia vir a ser uma op&#231;&#227;o para aumento de sua abrang&#234;ncia&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1&#44;5</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Estudos que avaliaram o Programa de Triagem Neonatal j&#225; haviam demonstrado aumento da cobertura desses testes&#44; por&#233;m suas preval&#234;ncias seriam vari&#225;veis entre as regi&#245;es brasileiras&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">10&#44;21</span></a> Ainda num recorte brasileiro&#44; os achados do presente estudo corroboram pesquisa nacional que visou a analisar a evolu&#231;&#227;o da triagem auditiva neonatal no &#226;mbito do SUS entre 2008 e 2011&#46; Nela demonstrou&#8208;se que houve crescimento da cobertura desse exame no per&#237;odo&#44; por&#233;m com claras diferen&#231;as regionais&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> Essas disparidades podem ser reflexo da diferen&#231;a financeira e de estrutura para implanta&#231;&#227;o e manuten&#231;&#227;o dos servi&#231;os que envolvem o programa de triagem neonatal no pa&#237;s&#44; desde o financiamento&#44; descentraliza&#231;&#227;o dos servi&#231;os&#44; at&#233; a oferta e capacita&#231;&#227;o de profissionais&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a> Podem refletir&#44; em suma&#44; diferen&#231;as na organiza&#231;&#227;o da rede de aten&#231;&#227;o em sa&#250;de em todos os seus n&#237;veis&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">A cobertura da triagem neonatal foi avaliada em diversos pa&#237;ses&#44; inclusive no Brasil&#44; e demonstrou&#8208;se que as maiores coberturas est&#227;o nos estados credenciados para a feitura de mais testes &#40;hipotireoidismo cong&#234;nito&#44; fenilceton&#250;ria&#44; hemoglobinopatias e fibrose c&#237;stica&#41;&#44; ocorre o inverso naqueles credenciados para triagem apenas para hipotireoidismo cong&#234;nito e fenilceton&#250;ria &#40;valores que variam de 47&#37;&#63;76&#37;&#41;&#44; o que reflete aspectos de oferta e organiza&#231;&#227;o dos servi&#231;os&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">A feitura dos testes no per&#237;odo preconizado foi influenciada pela cor&#47;etnia&#44; regi&#227;o&#44; posse de plano de sa&#250;de e renda&#44; as maiores diferen&#231;as entre as categorias foram observadas para os testes do olhinho e da orelhinha&#44; o que refor&#231;ando os achados de que as condi&#231;&#245;es socioecon&#244;micas est&#227;o associadas com o acesso e o uso dos servi&#231;os de sa&#250;de no pa&#237;s em tempo oportuno&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">22&#44;23</span></a> Pessoas mais pobres t&#234;m m&#250;ltiplas priva&#231;&#245;es e essas est&#227;o relacionadas a n&#237;veis elevados de exposi&#231;&#227;o a doen&#231;as&#44; busca inadequada por cuidados de sa&#250;de e menor probabilidade de receber tratamento efetivo e oportuno&#44; entre eles os testes de triagem&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Ainda que cor&#47;etnia n&#227;o tenha demonstrado associa&#231;&#227;o com qualquer dos tr&#234;s desfechos neste estudo&#44; outros estudos t&#234;m demonstrado predom&#237;nio da cor&#47;etnia branca na feitura dos testes de triagem e essas desigualdades raciais se revelam um desafio para sistemas de sa&#250;de baseados em princ&#237;pios de equidade&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a> No presente estudo&#44; a incorpora&#231;&#227;o da renda no modelo m&#250;ltiplo retirou o efeito da associa&#231;&#227;o dos desfechos com cor&#47;etnia&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Ter plano de sa&#250;de tamb&#233;m foi fator associado para a feitura dos tr&#234;s testes de triagem&#44; independentemente da renda familiar <span class="elsevierStyleItalic">per capita</span>&#46; Estudo de Pilotto et al&#46; &#40;2018&#41;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> entre 1998&#63;2013 j&#225; havia demonstrado incremento do uso dos servi&#231;os m&#233;dicos e odontol&#243;gicos&#44; maior entre as pessoas com plano de sa&#250;de&#46; Para os testes de triagem neonatal&#44; estudo de Pinheiro et al&#46; &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> feito no Rio Grande do Norte&#44; Brasil&#44; em 2010&#44; demonstrou que a diferen&#231;a entre setor p&#250;blico e privado fica evidente quando a maior preval&#234;ncia de feitura do teste do pezinho ocorreu para os nascidos no setor privado &#40;99&#44;4&#37;&#41; se comparados com aqueles nascidos no servi&#231;o p&#250;blico &#40;89&#44;6&#37;&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Silva et al&#46; &#40;2011&#41;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a> observaram que a procura por servi&#231;os de sa&#250;de no Brasil foi mais frequente entre os indiv&#237;duos que tinham planos de sa&#250;de&#46; Isso demonstrando que sua posse pode reduzir a exist&#234;ncia de poss&#237;veis barreiras financeiras no acesso aos servi&#231;os&#44; como tamb&#233;m determina maior uso de servi&#231;os preventivos&#46; O investimento e a qualifica&#231;&#227;o da oferta desses exames no &#226;mbito do SUS configuram&#8208;se como importante estrat&#233;gia na redu&#231;&#227;o de disparidades de acesso a esses servi&#231;os&#44; &#224; medida que um sistema de sa&#250;de fortalecido e eficaz seria capaz de cobrir essas demandas&#44; ao encontro do proposto pelo Minist&#233;rio da Sa&#250;de na busca pela cobertura dos testes junto a 100&#37; nos rec&#233;m&#8208;nascidos no pa&#237;s&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">O presente estudo tamb&#233;m observou associa&#231;&#227;o entre a feitura dos testes e renda da m&#227;e&#47;respons&#225;vel&#44; quanto maior o quintil de renda&#44; maiores as chances de feitura dos testes&#46; Esse resultado est&#225; de acordo com Cavalcanti et al&#46; &#40;2012&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a> que analisaram a triagem auditiva neonatal no Nordeste entre 2007&#63;2009 e identificaram que a menor preval&#234;ncia esteve associada com os menores quintis de renda&#44; menor escolaridade da m&#227;e e menor n&#250;mero de consultas de pr&#233;&#8208;natal&#46; Em pa&#237;ses que ainda apresentam problemas de acesso aos testes&#44; como o caso da S&#233;rvia&#44; Ucr&#226;nia e Cro&#225;cia&#44; observaram&#8208;se diversos obst&#225;culos&#44; que incluem economias pobres e falta de apoio governamental&#44; somadas a diferen&#231;as culturais&#44; al&#233;m de grandes varia&#231;&#245;es geogr&#225;ficas&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Segundo o IBGE &#40;2016&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> a procura por atendimento de sa&#250;de varia de acordo a renda&#44; &#233; maior naquelas do maior quintil de renda&#46; Ainda&#44; em geral&#44; pessoas com maior renda t&#234;m maior grau de escolaridade&#46; Esses dados poderiam justificar a maior propor&#231;&#227;o de feitura dos testes de triagem pela popula&#231;&#227;o de maior renda&#44; associado ao fato de que maior n&#237;vel de instru&#231;&#227;o pode contribuir para o reconhecimento da import&#226;ncia da feitura desses testes&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> Ou seja&#44; esse grupo populacional tem maior conhecimento sobre os benef&#237;cios dos testes&#44; maior oportunidade em termos econ&#244;micos de viabiliz&#225;&#8208;los &#40;seja para se deslocar a uma unidade de sa&#250;de ou para consumi&#8208;los no setor privado&#41; e potencialmente reside em lugares com maior facilidade de acesso aos servi&#231;os de sa&#250;de&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Os testes de triagem neonatal&#44; quando feitos no per&#237;odo recomendado&#44; t&#234;m a capacidade de identificar as doen&#231;as&#8208;alvo ainda em fase pr&#233;&#8208;sintom&#225;tica em rec&#233;m&#8208;nascidos e permitir interven&#231;&#227;o precoce&#44; preven&#231;&#227;o de manifesta&#231;&#245;es e acompanhamento da sa&#250;de da crian&#231;a&#44; seus benef&#237;cios j&#225; s&#227;o consolidados na literatura&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a> Apesar da oferta desses exames no SUS&#44; a car&#234;ncia de profissionais&#44; a falta de estrutura dos servi&#231;os<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> e problemas no acompanhamento pr&#233;&#8208;natal e de puerp&#233;rio imediato podem ser sugeridas como poss&#237;veis causas para a n&#227;o feitura desses testes no per&#237;odo recomendado&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Como limita&#231;&#245;es do estudo&#44; destaca&#8208;se que a PNS &#233; uma pesquisa transversal e usa informa&#231;&#245;es autorreferidas&#46; Para a investiga&#231;&#227;o dos testes de triagem&#44; as informa&#231;&#245;es foram respondidas pela m&#227;e e&#47;ou respons&#225;veis&#44; o que as sujeita a poss&#237;veis erros decorrentes de vi&#233;s de mem&#243;ria&#46; Ainda&#44; a posse de plano de sa&#250;de se referia ao momento da entrevista&#44; o que pode diferir do que ocorreu no momento em que os testes deveriam ser feitos&#44; pode super ou subestimar as estimativas&#46; Entretanto&#44; &#233; necess&#225;rio considerar a import&#226;ncia de inqu&#233;ritos populacionais peri&#243;dicos que espelhem a realidade de sa&#250;de do pa&#237;s&#46; A PNS constitui&#8208;se uma das maiores pesquisas de base domiciliar em &#226;mbito nacional&#44; &#233; reconhecidamente conduzida com rigor metodol&#243;gico e a explora&#231;&#227;o de dados provenientes desse inqu&#233;rito possibilita uma an&#225;lise atual e contextualizada acerca dos desfechos investigados&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Este estudo mostrou que regi&#227;o&#44; posse de plano de sa&#250;de e renda foram fatores associados &#224; feitura dos testes do pezinho&#44; orelhinha e olhinho no Brasil&#44; demonstrou que existem disparidades na feitura dos testes de triagem neonatal no pa&#237;s&#46; Desse modo&#44; pol&#237;ticas intersetoriais devem ser planejadas e implantadas com vistas &#224; articula&#231;&#227;o e &#224; harmoniza&#231;&#227;o entre as diversas esferas governamentais&#44; em que sa&#250;de&#44; educa&#231;&#227;o&#44; economia e &#225;rea social garantam&#44; em conjunto&#44; uma boa estrutura&#231;&#227;o dos servi&#231;os prestados e aten&#231;&#227;o integral ao rec&#233;m&#8208;nascido&#47;crian&#231;a&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">O Programa de Triagem Neonatal Brasileiro apresenta grande magnitude e destaca&#8208;se pela sua inclus&#227;o no SUS&#46; Apesar disso&#44; atingir n&#237;veis mais altos de cobertura e acesso a esses testes no pa&#237;s &#233; um desafio&#44; especialmente em termos de organiza&#231;&#227;o e log&#237;stica&#46; Al&#233;m do tamanho territorial e da descentraliza&#231;&#227;o dos servi&#231;os&#44; o desenvolvimento econ&#244;mico nacional e o baixo gasto p&#250;blico <span class="elsevierStyleItalic">per capita</span> em sa&#250;de tamb&#233;m t&#234;m impacto&#44; &#224; medida que se devem reconhecer essas a&#231;&#245;es como importantes fatores na redu&#231;&#227;o da mortalidade de rec&#233;m&#8208;nascidos e crian&#231;as&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">O SUS &#233; um sistema apoiado no conceito de cidadania ao estabelecer o acesso universal e integral &#224; aten&#231;&#227;o &#224; sa&#250;de&#46; Assim&#44; a garantia desses testes em um sistema universal e p&#250;blico deveria promover a equidade e o acesso &#224; triagem de todos os rec&#233;m&#8208;nascidos&#46; Por&#233;m&#44; disparidades no acesso a esses servi&#231;os evidenciadas refletem a exist&#234;ncia de outras lacunas que perpassam as quest&#245;es da oferta&#46; Fomentar a aten&#231;&#227;o b&#225;sica em sa&#250;de&#44; o pr&#233;&#8208;natal de qualidade e o pr&#243;prio Sistema &#218;nico de Sa&#250;de s&#227;o medidas para se ampliar o acesso aos testes e reduzir as desigualdades existentes&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Nesse sentido&#44; sugere&#8208;se que novos estudos possam ser desenvolvidos com o objetivo de contribuir para a organiza&#231;&#227;o e a amplia&#231;&#227;o da oferta desses servi&#231;os no pa&#237;s&#44; identificar fatores que modulam o acesso aos testes e meios de superar as barreiras descritas&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Financiamento</span><p id="par0180" class="elsevierStylePara elsevierViewall">Conselho Nacional de Desenvolvimento Cient&#237;fico e Tecnol&#243;gico &#40;CNPq&#41;&#44; bolsa do Programa Institucional de Bolsas de Inicia&#231;&#227;o Cient&#237;fica &#40;Pibic &#8211; 2016&#47;2017&#41;&#44; concedida a Mariana Borsa Mallmann&#44; conforme edital Pibic&#47;CNPq &#8211; Pibic&#8208;Af&#47;CNPq &#8211; BIPI&#47;UFSC 2016&#47;2017&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflitos de interesse</span><p id="par0185" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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            0 => "Neonatal screening"
            1 => "Child health"
            2 => "Public health practice"
            3 => "Healthcare inequalities"
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          "palabras" => array:5 [
            0 => "Triagem neonatal"
            1 => "Sa&#250;de da crian&#231;a"
            2 => "Pr&#225;tica de sa&#250;de p&#250;blica"
            3 => "Disparidades em assist&#234;ncia &#224; sa&#250;de"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To identify the prevalence and associated factors with the performance of the Guthrie test&#44; hearing&#44; and red reflex screening tests in Brazil&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a population&#8208;based&#44; cross&#8208;sectional study that analyzed data on 5&#44;231 children under 2 years of age participating in the National Health Survey of 2013&#46; The study described the prevalence and Confidence Intervals &#40;95&#37; CI&#41; of the three neonatal screening tests performed&#44; in any period&#44; and their association with the country&#39;s regions&#44; skin color&#47;ethnicity&#44; private health insurance&#44; and per capita household income&#46; Logistic regression models were used&#44; and odds ratios were calculated by incorporating sample weights&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The prevalence of Guthrie test screening in Brazil at any time of life was 96&#46;5&#37;&#44; that of the newborn hearing screening was 65&#46;8&#37; and that of the red reflex screening test was 60&#46;4&#37;&#46; The performance of the three screening tests was significantly higher among children whose mothers&#47;guardians reported higher per capita household income&#44; who lived in the South and Southeast regions&#44; and who had private health insurance &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; There was no statistically significant difference regarding the performance of the tests according to skin color&#47;ethnicity &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#46;05&#41;&#46; The same inequalities were verified when the tests were performed during the recommended periods&#44; with a strong socioeconomic gradient&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There are inequalities in the performance of neonatal screening tests in the country&#44; and also in the performance of these tests during the periods established in the governmental guidelines&#46; The guarantee of the performance of these tests in a universal and public health system&#44; as in Brazil&#44; should promote equity and access to the entire population&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Identificar preval&#234;ncia e fatores associados &#224; realiza&#231;&#227;o dos testes do pezinho&#44; da orelhinha e do olhinho no Brasil&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal anal&#237;tico de base populacional que analisou os dados de 5&#46;231 crian&#231;as menores de dois anos participantes da Pesquisa Nacional de Sa&#250;de &#40;2013&#41;&#46; Foram descritas preval&#234;ncias e intervalos de confian&#231;a &#40;95&#37; IC&#41; da realiza&#231;&#227;o dos tr&#234;s testes de triagem neonatal&#44; em qualquer per&#237;odo&#44; e sua associa&#231;&#227;o com as regi&#245;es do pa&#237;s&#44; cor&#47;etnia&#44; posse de plano de sa&#250;de e renda domiciliar <span class="elsevierStyleItalic">per capita</span>&#46; Empregaram&#8208;se modelos de regress&#227;o log&#237;stica e calcularam&#8208;se as <span class="elsevierStyleItalic">odds ratio</span> e incorporaram&#8208;se os pesos amostrais&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A preval&#234;ncia de realiza&#231;&#227;o do teste do pezinho no Brasil em qualquer momento de vida foi de 96&#44;5&#37;&#59; do teste da orelhinha de 65&#44;8&#37; e do teste do olhinho de 60&#44;4&#37;&#46; A realiza&#231;&#227;o dos tr&#234;s testes de triagem foi significativamente maior entre as crian&#231;as cujas m&#227;es&#47;respons&#225;veis reportaram maior renda domiciliar <span class="elsevierStyleItalic">per capita</span>&#44; residiam nas regi&#245;es Sul e Sudeste e tinham plano de sa&#250;de &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; N&#227;o houve diferen&#231;a estatisticamente significativa na realiza&#231;&#227;o dos testes segundo cor&#47;etnia &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46; As mesmas desigualdades foram verificadas para a realiza&#231;&#227;o dos testes no per&#237;odo preconizado&#44; com forte gradiente socioecon&#244;mica&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Existem desigualdades na realiza&#231;&#227;o dos testes de triagem neonatal no pa&#237;s e&#44; tamb&#233;m&#44; na realiza&#231;&#227;o desses dentro dos prazos previstos nas diretrizes governamentais&#46; A garantia desses testes em um sistema universal e p&#250;blico como no Brasil deveria promover a equidade e o acesso a toda a popula&#231;&#227;o&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Como citar este artigo&#58; Mallmann MB&#44; Tomasi YT&#44; Boing AF&#46; Neonatal screening tests in Brazil&#58; prevalence rates and regional and socioeconomic inequalities&#46; J Pediatr &#40;Rio J&#41;&#46; 2020&#59;96&#58;487&#8211;94&#46;</p>"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Preval&#234;ncia e intervalo de confian&#231;a 95&#37; da feitura dos testes do pezinho e do olhinho na primeira semana de vida e do teste da orelhinha nos primeiros 28 dias de vida&#46; Pesquisa Nacional de Sa&#250;de&#44; Brasil&#44; 2013&#46; &#40;<span class="elsevierStyleSup">a</span> valor de p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; obtido mediante teste do qui&#8208;quadrado&#41;&#46;</p>"
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                  \t\t\t\t">35&#44;7 &#40;32&#44;3&#47;39&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Centro Oeste&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">644 &#40;12&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sudeste&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">920 &#40;17&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">99&#44;5 &#40;98&#44;5&#47;99&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">83&#44;5 &#40;80&#44;2&#47;86&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sul&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">99&#44;4 &#40;98&#44;3&#47;99&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">89&#44;4 &#40;85&#44;0&#47;92&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">81&#44;1 &#40;76&#44;6&#47;84&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Cor&#47;etnia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Branca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">75&#44;6 &#40;73&#44;5&#47;77&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Preta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parda&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#176; quintil&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">91&#44;9 &#40;90&#44;1&#47;93&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43&#44;4 &#40;40&#44;6&#47;46&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38&#44;3 &#40;35&#44;6&#47;41&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#176; quintil&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;312 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">97&#44;2 &#40;96&#44;1&#47;97&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">60&#44;2 &#40;57&#44;4&#47;62&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">53&#44;2 &#40;50&#44;6&#47;55&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#176; quintil&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">858 &#40;18&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">99&#44;0 &#40;98&#44;6&#47;99&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">78&#44;5 &#40;75&#44;6&#47;87&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise de regress&#227;o log&#237;stica univariada para feitura em qualquer per&#237;odo dos testes do pezinho&#44; orelhinha e olhinho&#44; segundo vari&#225;veis sociodemogr&#225;ficas&#44; Pesquisa Nacional de Sa&#250;de&#44; Brasil&#44; 2013</p>"
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