Revista brasileira de epidemiologia = Brazilian journal of epidemiology最新文献

Objective: To examine the effect of Primary Health Care (PHC) on the association between multimorbidity and emergency service utilization among adults in Brazil.

Methods: This is a cross-sectional, nationwide household-based study using data from the 2019 National Health Survey. Poisson regression was used to assess emergency service utilization among individuals with multimorbidity. The interaction of variables such as Family Health coverage and orientation to PHC in these associations was also evaluated.

Results: The prevalence of multimorbidity was 31.2% (95%CI 30.9-31.5), Family Health coverage was 71.8% (95%CI 71.4-72.0), and low orientation of services toward PHC was 70% (95%CI 69.1-70.9). Emergency service utilization had a prevalence of 2.0% (95%CI 1.9-2.0), being twice as high among individuals with multimorbidity (3.1; 95%CI 2.9-3.3) compared to those without this condition (1.4; 95%CI 1.3-1.5). However, individuals with multimorbidity and Family Health coverage had a 20% lower prevalence of emergency service utilization than those without Family Health coverage (PR 0.8; 95%CI 0.6-0.9). The association between emergency service utilization and multimorbidity was not modified by the evaluation of the service as highly oriented toward PHC (p=0.956).

Conclusion: The study showed that Family Health coverage exerted a positive effect on the association between multimorbidity and emergency service utilization.

Objective: To evaluate the heterogeneity in the consumption of fresh or minimally processed foods (FMPF) and ultra-processed foods (UPF) in the Brazilian population ≥10 years of age.

Methods: Cross-sectional study that used data from the food consumption and resident module from the 2017-2018 edition of the Family Budget Survey. Variables relating to sex, region of residence, household status and per capita family income in minimum wages were used. The outcomes were dietary participation in percentage of FMPF and UPF. Heterogeneity was assessed using random effects produced by linear mixed-effects models.

Results: Thirty-two random effects were obtained for the consumption of FMPF and 34 for UPF. Living in the urban area of the South and Southeast regions, as well as having a higher income were driving factors in the consumption of UPF and reducing the consumption of FMPF. Living in a rural area and having low income were mainly reducing factors in the consumption of UPF and driving factors in the consumption of FMPF.

Conclusions: The consumption of UPF and FMPF was determined by the set of factors that represented easy access to these foods, whether geographic or economic such as income.

Objective: to present a comprehensive analysis of YF occurrence of in the state of São Paulo since its reemergence, and the ongoing process of structuring the surveillance of epizootics in non-human primates in a one health approach.

Methods: descriptive study of human cases and epizootics in non-human primates, structuring actions and the one health approach used in the state of São Paulo for yellow fever surveillance from 2000 to 2023.

Results: from 2000 to 2023, 679 human cases and 857 epizootics in NHPs confirmed for yellow fever were recorded. There was an intensification of epizootic surveillance actions in non-human primates from 2017, when the virus circulated in areas without vaccine recommendations in the state.

Conclusion: Five outbreaks were registered during the evaluated period, and the surveillance of epizootics in non-human primates played a fundamental role in implementing disease prevention and control measures in areas without vaccination recommendation, guiding vaccination actions, and serving as an example of how a one health approach can be adopted within epidemiological surveillance, making it more resilient to emerging threats.

The term "health surveillance" encompasses a wide range of activities, including the monitoring and observation of harms and diseases. We will investigate the most well-known aspect of health surveillance, namely the monitoring of communicable diseases. To illustrate our discussion, we will use the pandemic caused by the SARS-CoV-2 virus as a case study. As the text progresses, the focus shifts to an examination of technologies, models, and the structure of the system. The most severe epidemic of our era, classified as a pandemic due to its global impact, has compelled us to reflect on a multitude of areas of knowledge. The resulting suffering should preclude any association with positive images, despite the opportunity to learn and, in some instances, observe the capacity of humans to act in solidarity. It is often observed that few things are as didactic as tragedies and mistakes. Therefore, it is worth investigating them carefully to extract the necessary feedback to correct the course of action in health. In this text, we will discuss the conditions that led health surveillance in Brazil to fail miserably in its mission in the face of the emergency triggered by the 2019 new coronavirus disease. We will also present points that deserve attention in a restructuring of the health surveillance system.

Objective: This study describes the methodology used in the development of MonitoraSB, an innovation in the field of evaluating and monitoring oral health services in primary health care (PHC) in Brazil, and it discusses its characteristics and possible uses.

Methods: MonitoraSB includes a matrix of indicators and digital tools, developed in collaboration with oral health team dentists and oral health managers. The indicators evaluate the provision and management of oral health services and were developed on the basis of the model for evaluating the effectiveness of oral health care. The dashboard and calculator were developed to facilitate the operational use of the indicators.

Results: The 54 indicators in the matrix, with demonstrated content validity and measurability, cover various aspects of oral health care in PHC, from the organization and capacity of services to the profile of care and resolution. The dashboard offers navigation and interactivity, allowing regional, state and municipal analysis and making geographical and temporal comparisons. The calculator allows indicators to be obtained at the local level.

Conclusion: The implementation of MonitoraSB could promote the strengthening of PHC, supporting informed decision-making and the consolidation of the universal, comprehensive and equitable oral health care model.

Objective: To estimate the prevalence of participation of aged Brazilians in Advanced Activities of Daily Living and associated factors.

Methods: Cross-sectional study developed with secondary data from the National Health Survey. Aged people (60 years old or older) were included. The dependent variable consisted of questions from the National Health Survey regarding the performance of Advanced Activities of Daily Living, related to work, leisure, and social participation. Descriptive analysis, Rao-Scott test, and standardized residual analysis were performed. Effect measures were calculated using simple and multiple multinominal logistic regression models.

Results: The majority of Brazilian aged people have low participation in Advanced Activities of Daily Living. Aged males, between 60 and 69 years old, white, from the Southeast, South and Central-West regions, with higher educational levels, absence of chronic diseases, monthly alcohol consumption, regular physical activity, frequent intake of vegetables, use of glasses and independence when moving, were more likely to perform Advanced Activities of Daily Living.

Conclusion: These results reinforce the significant influence of demographic, socioeconomic, clinical factors, linked to lifestyle and intrinsic capacity in the execution of Advanced Activities of Daily Living. In a broader sense, such discoveries can strengthen public policies for active and healthy aging.

Objective: To evaluate the performance of satellite-derived PM2.5 concentrations against ground-based measurements in the municipality of Salvador (state of Bahia, Brazil) and the implications of these estimations for the associations of PM2.5 with daily non-accidental mortality.

Methods: This is a daily time series study covering the period from 2011 to 2016. A correction factor to improve the alignment between the two data sources was proposed. Effects of PM2.5 were estimated in Poisson generalized additive models, combined with a distributed lag approach.

Results: According to the results, satellite data underestimated the PM2.5 levels compared to ground measurements. However, the application of a correction factor improved the alignment between satellite and ground-based data. We found no significant differences between the estimated relative risks based on the corrected satellite data and those based on ground measurements.

Conclusion: In this study we highlight the importance of validating satellite-modeled PM2.5 data to assess and understand health impacts. The development of models using remote sensing to estimate PM2.5 allows the quantification of health risks arising from the exposure.

Objective: To evaluate the association between burden of disease and multimorbidity and absenteeism in Brazil.

Methods: This is a cross-sectional study using data from the National Survey of Health 2019. The assessed outcome was absenteeism from work. The burden of disease was assessed by simply counting a list of 14 morbidities and multimorbidity was defined as: ≥two chronic diseases. Poisson regression models stratified by sex were used to estimate crude and adjusted prevalence ratios and their respective 95% confidence intervals.

Results: Of the 96,131,029 employed individuals, 38.5% reported absenteeism (95%CI 32.9-44.3). The most prevalent morbidities among women who reported absenteeism were back problems (50.8%), depression (42.9%), and hypertension (41.6%); and among men, hypertension (39.7%), chronic back pain (34.1%), and dyslipidemia (19.9%), among those who reported absenteeism. Having multimorbidity increased the report of absenteeism among women by 73% (95%CI 1.01-2.96); among men, there was no association after progressive adjustment for sociodemographic and health factors [PR 1.27 (95%CI 0.96-1.71)].

Conclusion: The burden of disease and multimorbidity are highly prevalent among employed individuals and are strongly related to absenteeism from work, especially among women. In this sense, workers must be the target of interventions to reduce the impact of chronic noncommunicable diseases.

Objective: To analyze the impact of the Covid-19 pandemic on the occurrence of work accidents involving biological materials (ATBio) and to assess changes in the epidemiological profile of these cases.

Methods: An ecological time-series study with a cross-sectional component was conducted using ATBio notifications in Brazil from 2015 to 2022 in the Information System for Notifiable Diseases (Sinan). Interrupted time-series analyses were performed using Prais-Winsten regression models, temporal predictions, and multiple logistic regression to identify changes in the profile between the pandemic and pre-pandemic periods.

Results: A total of 499,916 ATBio cases were recorded between 2015 and 2022, with an increasing trend from 2015 to 2019. During the first year of the pandemic, 57,731 (11.5%) accidents were reported, with an estimated reduction of 791.8 ATBio notifications per month during this period. There was a change in the accident profile, with a higher occurrence of ATBio during the first year of the pandemic among workers with 1 to 8 and 9 to 11 years of education, and a lower occurrence among pregnant women. There was also a higher occurrence of exposure to non-categorized biological materials, increased use of masks and face shields, and higher post-accident seroconversion rates.

Conclusion: The occurrence of ATBio was impacted by the Covid-19 pandemic, leading to a reduction in notifications and a change in the event profile on a national scale.

Objective: To identify clusters of high and low risk for the occurrence of leptospirosis in space and space-time in Acre, between 2001 and 2022, as well as to characterize temporal trends and epidemiological profiles of the disease in the state.

Methods: An ecological study of cases mandatorily reported by health services in Brazil. For the analysis of clusters in space and space-time, the SaTScan software was used, which calculated the relative risks (RR). Additionally, temporal trends were obtained using Prais-Winsten linear regression and epidemiological profiles estimated by incidences by sex and age group.

Results: A high-risk spatial cluster was identified in Rio Branco, Bujari, and Porto Acre (RR=2.94), occurring mainly between 2013 and 2015, according to the space-time cluster (RR=9.51). The municipality of Cruzeiro do Sul also showed a high-risk spatial cluster (RR=1.31). This municipality and contiguous municipalities showed an increasing temporal trend in cases, while the other municipalities in the state showed a stationary temporal trend. The disease mainly affected men between 20 and 59 years old, followed by young people aged 10 to 19 years. However, the RR of leptospirosis in older women was 2.1 times higher than in older men (95%CI 1.6-2.9).

Conclusion: The findings indicated that leptospirosis, although endemic in the state, had a more significant incidence in certain municipalities and years. Therefore, it is necessary to act with greater or lesser intensity in specific locations and periods, both for the prevention and control of the disease.