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

Objective: To identify patterns of characteristics of the perceived neighborhood environment and relate them to the types of physical activity practiced by adolescents.

Methods: Observational epidemiological study with 1,066 adolescents (55.2% female, 10 to 13 years old) from João Pessoa, Paraíba, Brazil. Environmental characteristics were measured using a 16-item scale in three domains (places for practice, urban and traffic safety) and types of physical activity practice (recreation, sports, physical exercise and active commuting - minutes/week) by questionnaire. Latent Class Analysis (LCA) was applied to identify patterns of environmental characteristics and linear regression to relate them to the types of practice.

Results: LCA identified four patterns of environmental characteristics: "not diverse and unsafe" (26.6%), "not diverse and safe" (13.6%), "diverse and unsafe" (30.8%), and "diverse and safe" (29.6%). Perceiving the environment as "diverse and safe" was positively and significantly associated with the time spent practicing recreational activities (β=42.16; 95%CI 4.35-79.97). The patterns of environmental characteristics were not associated with the time spent practicing sports, physical exercise, and active transportation.

Conclusion: adolescents who perceived the neighborhood environment as "diverse and safe" had a longer time practicing recreational activities.

Objective: To compare mortality, intensive care unit (ICU) admission, and use of invasive ventilatory support in hospitalized pregnant and nonpregnant women with severe acute respiratory syndrome due to Coronavirus-2 in Brazil.

Methods: It is a cross-sectional study developed with data from the Brazilian Surveillance of Severe Acute Respiratory Syndrome (SARS), Ministry of Health. Three outcomes were investigated: mortality, ICU admission, and use of invasive ventilatory support among COVID-19 cases. Hospitalized pregnant and nonpregnant women were paired according to age group, geographic region, and epidemiological week (33,113 nonpregnant women; 15,567 pregnant women) from March 2020 to March 2022. Associations between pregnancy status and outcomes were analyzed using conditional logistic regression. For 2021 data, an interaction term with vaccination status (no/yes) was included.

Results: Mortality (17.6 vs 7.9%), ICU admission (30.3 vs 26.1%), and invasive ventilatory support use (46.6 vs 38.5%) were higher among nonpregnant women, respectively. ICU admission was highest in the second trimester of pregnancy (32.6%). Being in the second trimester increased the likelihood of ICU admission (OR=1.26; 95%CI 1.15-1.39) compared to nonpregnant women. The odds of ICU admission was lower among vaccinated pregnant women in the first (OR=0.71; 95%CI 0.51-0.96), second (OR=0.74; 95%CI 0.62-0.88), and third trimesters (OR=0.65; 95%CI 0.57-0.74).

Conclusion: All three outcomes were more frequent among hospitalized nonpregnant women, except for ICU admission in the second trimester. COVID-19 vaccination has proven to be an important protective measure, particularly for pregnant women in the second and third trimesters.

Objective: To present a critical analysis of the teaching of epidemiology in graduate programs in public health in Brazil.

Methods: Descriptive study in two stages, based on a documentary survey (thematic axes of the courses in graduate programs evaluated by CAPES) and a survey with a convenience sample of faculty and students from programs in the field. The evaluation focused on graduate education in public health, aiming to critically examine the curricular proposals, pedagogical practices, and institutional conditions that shape epidemiology training at this level.

Results: Important advances were identified in the teaching of epidemiology in graduate public health programs in Brazil, such as a significant number of courses offered, the consolidation of conceptual courses in academic programs, and the diversity and depth of thematic courses-particularly the topic of health services and systems, present in more than half of both academic and professional programs. Persistent challenges highlight the need to consolidate critical, consistent training that aligns with the contemporary demands of public health in the country and the Unified Health System (SUS).

Conclusion: The reflections and actions outlined may help guide the next steps toward overcoming structures that perpetuate social inequalities and toward strengthening high-quality epidemiological training committed to transforming population health.

The Brazilian Association of Collective Health (Abrasco) has played a leading role in consolidating collective health in Brazil since its foundation. After 19 years, Abrasco's Epidemiology Committee resumed its planning with the development of the Fifth Strategic Plan for the Development of Epidemiology in Brazil (2025-2029). This plan emerged in a challenging context marked by social inequalities, scientific denialism, the COVID-19 pandemic, the climate crisis, and disinvestment in public policies, reinforcing the need to update Brazilian epidemiology. The plan's development occurred in multiple stages, including online surveys, debates, and in-person workshops. Workshop I (Brasília, 2023) identified priority challenges, and Workshop II (Rio de Janeiro, 2024) defined strategies to address them. The construction process was guided by the qualified participation of epidemiologists from all regions of the country and was based on principles of plurality, diversity, gender equity, and race/ethnicity. The plan highlights epidemiology across three thematic areas: education, research, and health policies, programs, and services. The Strategic Plan Working Group of the Epidemiology Committee, supported by the Secretariat of Health and Environment Surveillance of the Ministry of Health, led the process. This supplement of the Brazilian Journal of Epidemiology presents the Fifth Strategic Plan for the Development of Epidemiology in Brazil (2025-2029), contributions to the discussion of some central topics, and a deepening of strategic and operational dimensions. The Fifth Strategic Plan for the Development of Epidemiology in Brazil (2025-2029) presents a collective vision for the future, aiming to strengthen epidemiology as a central discipline within the field of collective health. It reaffirms its commitment to equity, social justice, and the consolidation of the Sistema Único de Saúde in Brazil.

In this article, we discuss the challenges and perspectives of Brazilian Epidemiology based on the reflections presented in the Fifth Strategic Plan for the Development of Epidemiology in Brazil (2025-2029). The importance of a scientific agenda committed to quality, innovation, equity, and social transformation is highlighted. We also ponder that Epidemiology must reaffirm its identity as a critical, collaborative, and socially-referenced field. Brazilian Epidemiology must carry on its mission of contributing to the response to health crises, to the reduction of health inequities, and supporting the construction of a national project of sustainable development. Together with the analysis of the significant advances achieved throughout its history, the challenges of research in Epidemiology are debated, such as the chronic underfunding of research in the country, the regional and thematic inequalities in the distribution of resources, academic productivism, the need to bring science closer to the population, and to expand the theoretical and methodological density of studies. Simultaneously, we highlight that opportunities are emerging related to the expansion of open science, the democratization of access to data, and the expansion of the social relevance of research.

Objective: To critically summarize the key topics addressed by the working group "Epidemiology in Health Policies, Programs, and Services" during the development of the Fifth Strategic Plan for the Development of Epidemiology in Brazil (2025-2029), led by the Brazilian Association of Collective Health.

Methods: A historical-contextual analysis was conducted, based on an analytical and comparative review of institutional documents, including previous versions of the Master Plans, scientific literature, and experiences accumulated within the Brazilian Unified Health System (SUS).

Results: The main themes identified were the limitations and potentialities of national health information systems, the challenges related to the production of reliable and high-quality data; the dilemmas involved in training epidemiologists with strong social and political commitments; the need to expand the scope of public health surveillance; the importance of equity-oriented evaluation processes; and the role of intersectoral and territorial articulation in strengthening the field. These discussions were framed within the context of Brazil's demographic, socioeconomic, and political-institutional transformations, highlighting the relevance of critical and ethical epidemiology committed to human rights.

Conclusion: The Master Plans have played a strategic role in articulating science, policy, and practice, thereby consolidating epidemiology as a field of practice, a critical science, and a tool for social transformation. The Fifth Strategic Plan for the Development of Epidemiology in Brazil (2025-2029) emphasizes the necessity of innovative and intersectional approaches to overcoming structural inequalities, inequities, and forms of oppression. This contributes to strengthening the SUS and consolidating an ethical, critical, and socially committed epidemiology.

Objective: To analyze social inequalities in vaccination coverage for the full immunization schedule with valid doses at 24 months of age, according to socioeconomic strata and family, maternal, and child characteristics.

Methods: This is a retrospective 2017-2018 live birth cohort in capitals, the Federal District, and 12 Brazilian cities, recruited in 2020-2021. Participants were followed up from birth using the vaccination cards, and there were no losses to follow-up. Guardians were interviewed and vaccination cards were photographed. Urban census tracts of the 39 cities were grouped into four strata by cluster analysis of average income, income >20 minimum wage, % literate individuals. The same number of census tracts were drawn from each stratum, and children from cohorts of interest were recruited until sample size was complete. The coverage of the full immunization schedule for each child was calculated considering only valid doses (date and interval between doses). Descriptive, stratified analysis, and Poisson regression were performed using the STATA 17.0 survey module.

Results: A total of 37,801 children were included. Vaccination coverage was below 50% in all strata, with strata A and B as the lowest. The probability of having a full immunization schedule was lower from the second-born child onward, in families with intra-household crowding, and difficulties in accessing health services. Exclusive use of public services was associated with higher full coverage.

Conclusion: Vaccination coverage was lower in strata with better standards of living (A/B). Vaccination coverage by family, maternal, and individual factors vary between strata and it is not possible to establish a common pattern.

Objective: The aim of this study was to investigate the association between life satisfaction and the presence and severity of chronic musculoskeletal pain (CMP).

Methods: In this cross-sectional study, a total of 2,756 participants (mean age: 55.8 years, standard deviation [SD]=8.9 years) at the baseline of the Brazilian Longitudinal Study of Adult Health Musculoskeletal cohort (2012-2014) completed the Satisfaction with Life Scale and were assessed for CMP (duration>6 months) at neck, shoulders, upper back, elbows, lower back, wrists/hands, hips/thighs, knees, and ankles/feet. CMP phenotypes were identified based on measures that considered pain-related disability (non-disabling/disabling), pain demand for a healthcare professional (non-troublesome/troublesome), and body pain spreading according to the number of sites (0, 1-2, and ≥3, multisite) and the number of regions (upper limbs, lower limbs, and axial skeleton) affected (0, 1-2, 3, generalized). The association of life satisfaction with CMP and each CMP phenotype was investigated by binomial and multinomial logistic regression analyses adjusted for sociodemographic lifestyle and clinical confounders.

Results: Greater life satisfaction was associated with lower chances of CMP (odds ratio [OR]=0.95; 95% confidence interval [CI] 0.94-0.97), as well as across all CMP phenotypes. The strength of this association was slightly greater for disabling CMP (OR=0.94; 95%CI 0.92-0.96) compared to non-disabling CMP (OR=0.97; 95%CI 0.95-0.99), and for troublesome CMP (OR=0.96; 95%CI 0.94-0.97) compared to non-troublesome CMP (OR=0.94; 95%CI 0.94-0.98). This association also held true when considering individuals experiencing multisite pain (OR=0.93; 95%CI 0.91-0.95) compared to those with pain at 1-2 sites (OR=0.97; 95%CI 0.95-0.99), and considering generalized pain (OR=0.93; 95%CI 0.90-0.96) compared to pain in 1-2 regions (OR=0.96; 95%CI 0.95-0.98).

Conclusion: Greater life satisfaction seems to decrease the chances of experiencing any, and especially more severe, CMP.

Objective: The aim of this study was to analyze road traffic mortality patterns during pre-pandemic, pandemic, and post-pandemic periods in Campinas, Brazil.

Methods: This is a retrospective observational study conducted in Campinas from 2019 to 2023, analyzing 17,726 road traffic crashes with 406 deaths, using databases from the Campinas Municipal Development Company and São Paulo State Traffic Accident Information System. Multivariate logistic regression analysis was performed to identify independent risk factors associated with road traffic deaths. Risk factors analyzed included alcohol consumption, nighttime driving, gender, crash location, vehicle type, and weekend occurrence. Chi-square tests were used to compare proportions across periods.

Results: Despite a 32.0% reduction in traffic volume, mortality rates increased from 10.46 to 13.76 per 100,000 inhabitants, with a 26.7% increase in years of potential life lost. The frequency of road traffic deaths increased from one death every 2.9 days to one every 2.0 days. Speeding was the main contributing factor for violations, representing 67% during the pandemic period. The highest risk emerged from the combination of alcohol consumption, speeding, and nighttime driving. Motorcyclists accounted for 43.1% of deaths, increasing to 47.0% in the post-pandemic period.

Conclusion: A pandemic paradox emerged where reduced traffic led to increased mortality. Risk behaviors established during the pandemic became entrenched rather than temporary, particularly affecting young male motorcyclists.

Objective: The aim of this study was to analyze the trends in incidence, mortality, and lethality rates due to meningitis in children and teenagers aged 0-19 years in Brazil and its regions by sex from 2002 to 2022.

Methods: This is a time-series study of the cases and deaths due to meningitis with data from the Notifiable Diseases Information System. We estimated the average annual percent change (AAPC) and its 95% confidence interval (95%CI) via Joinpoint regression, in addition to comparing the Brazilian Federative Units' AAPCs by a pairwise coincidence test.

Results: There were 274,500 cases and 17,162 deaths during the analyzed period, with downward trends both in Brazil and its regions regarding the incidence and mortality rates. In Brazil, the lowest AAPC in incidence was among males (AAPC=-5.7, 95%CI -7.1 to -4.2), whereas the lowest AAPC in mortality was among females (AAPC=-8.2, 95%CI -9.1 to -7.3). There were greater reductions in the incidence among males in all regions, except for the Central-West. Regarding the mortality rate, Northeast (AAPC=-9.6, 95%CI -10.6 to -8.5), South (AAPC=-8.1, 95%CI -9.8 to -6.3), and Central-West (AAPC=-8.5, 95%CI -10.7 to -6.3) showed their lowest AAPCs among females. There were significant differences in trends between males and females, mostly regarding incidence rates.

Conclusion: Meningitis remains a concerning disease in Brazil, despite the downward trend in the country and its regions. It highlights the perpetuation of health inequalities, which reverberate in the levels of vaccination coverage and in the success of vaccination campaigns, impeding this disease's proper control.