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

Objective: To investigate the relationship between intimate partner violence (IPV) against women and unhealthy weight control practices (UWCP).

Methods: This cross-sectional study was conducted in the metropolitan area of Rio de Janeiro, Brazil. It involved a sample of 847 women aged over 18 years, selected through a probabilistic complex sampling method. The Revised Conflict Tactics Scales were employed to assess psychological and physical IPV, while a single question was used to identify UWCP, namely, whether the respondent had ever used laxatives, diuretics, or vomiting to eliminate excess food, or had not eaten or eaten very little food to lose weight or not gain weight. Multivariate logistic and multinomial regression were employed to examine the relationship between exposure to IPV and the outcomes.

Results: The findings indicated that exposure to any form of IPV increases the likelihood of self-induced vomiting, particularly among those exposed to physical IPV (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.42-2.16). Additionally, physical IPV increases the odds of skipping meals (OR 1.28; 95%CI 1.05-1.57).

Conclusion: It is therefore recommended that health professionals be aware of this relationship and consider the possibility that patients with eating disorders may be victims of IPV. This will ensure that their treatment and approach are comprehensive and targeted for more effective care.

Objective: The aim of this study was to identify barriers and facilitators to smoking cessation among Brazilian cancer patients, considering the perspectives of both patients and healthcare professionals at a leading oncology center in the country.

Methods: A cross-sectional study was conducted, collecting smoking-related data from two groups: cancer patients and healthcare professionals at the Barretos Cancer Hospital (BCH) between 2019 and 2021. The questionnaire for healthcare professionals was adapted from the 2012 International Association for the Study of Lung Cancer and the Global Adult Tobacco Survey. For the cancer patient group, sociodemographic and clinical data were collected, along with the smoking history and consumption patterns of current smokers.

Results: Among oncology patients, the prevalence of former smokers was found to be 37.4%, while current smokers accounted for 16.8%. Most current smokers exhibited low nicotine dependence and high motivation to quit. Key barriers reported by healthcare professionals in providing smoking cessation interventions included patient resistance (86.9%) and lack of training (64.5%). Furthermore, 52.9% of these professionals indicated that they had never discussed cessation strategies during consultations with smoking patients. Regression models revealed that physicians, compared to other professionals, were more likely to address, advise, and offer cessation treatment to smoking patients (p≤0.05).

Conclusion: There is a need to enhance training on smoking cessation for healthcare professionals to improve clinical outcomes and survival rates among cancer patients.

Objective: To analyze temporal trends and state-level clusters of tuberculosis treatment interruption indicators among the homeless population in Brazil.

Methods: This is an ecological study, in which treatment interruption among homeless people with tuberculosis was assessed from 2015 to 2023. Joinpoint regression was used for trend analysis, stratified by sociodemographic and epidemiological variables. State clusters were identified by k-means clustering analysis, based on socioeconomic and programmatic indicators.

Results: Tuberculosis treatment interruption increased among: men (average quarterly percent change - AQPC=0.15; 95% confidence interval - 95%CI 0.04-0.29), individuals aged 40-59 years (AQPC=0.38; 95%CI 0.25-0.53), tobacco users (AQPC=0.72; 95%CI 0.61-0.82), beneficiaries of social programs (AQPC=4.59; 95%CI 3.69-6.02), those without directly observed treatment (AQPC=0.49; 95%CI 0.39-0.63), without HIV coinfection (AQPC=0.38; 95%CI 0.30-0.51), and in the North (AQPC=1.51; 95%CI 0.96-2.21) and Midwest (AQPC=0.83; 95%CI 0.17-1.59) regions. According to the cluster analysis, cluster A had the lowest treatment interruption rate, low AIDS incidence, and better programmatic indicators. Cluster B had high poverty and low level of education and income, but strong primary health care performance. Cluster C stood out for its higher human development, better social indicators, and lower inequality. Cluster D concentrated the worst outcomes: higher treatment interruption, greater inequality, higher AIDS incidence, and weaker primary health care.

Conclusion: Socioeconomic and programmatic inequalities were evident in access and attachment to tuberculosis treatment among people experiencing homelessness in Brazil.

Objective: To analyze data from the Information System for Monitoring the Quality of Water for Human Consumption (Sisagua) to develop an environmental health indicator that assesses the risk of pesticide residues in drinking water.

Methods: This is an ecological epidemiological study using retrospective data. Information on the Limit of Detection (LOD), Limit of Quantification (LOQ), and Maximum Permissible Value (MPV) of pesticide residues in drinking water, recorded by municipalities in the state of Paraná between 2014 and 2020, was analyzed. Descriptive and inferential statistical approaches were employed, including tests of association, correlation, and hypothesis testing, as well as probability analysis, through spatial and temporal analyses.

Results: A Pesticide Threshold Weighting Indicator (iPLA) was developed, with an explanatory capacity of variability greater than 77%. The risk-attributable variable was mainly related to the MPV, which received the highest weighting, while the LOD and LOQ were assigned lower weights.

Conclusion: The iPLA demonstrated the ability to represent pesticide concentration levels in drinking water. The risk categories defined by the indicator - controlled, silent, and alert - represent a highly useful tool for public health surveillance, as they enable the identification of local drinking water risk levels to human health. Moreover, the iPLA supports public management in implementing control actions and improvements in the quality of water for human consumption.

Objective: To explore the association between the Zika virus epidemic, fertility rates, and sociodemographic and behavioral factors influencing birth trends.

Methods: A prospective cohort of 1,497 women aged between 15 and 39 years living in arbovirus-endemic areas in Fortaleza, Brazil, was analyzed. Women were enrolled in February 2018 and followed up two times every six months. The total fertility rate (TFR), age-specific fertility rate (ASFR), and mean age at first birth (MAB) were estimated and a multivariate Poisson regression model was used to explore the main factors associated with fertility.

Results: The TFR was lowest during the epidemic period (2.64, 95%CI 2.06-3.06), increasing in the post-epidemic phase (TFR=3.52, 95%CI 3.18-3.86). Low educational attainment (RR=1.32, TFR=3.69, 95%CI 3.26-4.13), overcrowding (RR=1.27, TFR=3.26, 95%CI 2.98-3.54), and having undergone an abortion (RR=1.85, TFR=4.88, 95%CI 4.31-5.45) were associated with higher fertility rates. Conversely, having had an unwanted pregnancy was associated with reduced fertility (RR=0.81, TFR=2.65, 95%CI 2.41-2.89).

Conclusion: We observed a slowdown in fertility rates during the epidemic period coincident with human Zika virus transmission with large differences by sociodemographic gradients.

Objective: To analyze the antimicrobial dispensing profile in Brazil from 2014 to 2021 based on records from the Brazilian National System of Controlled Products Management (SNGPC) of the Brazilian Health Regulatory Agency (Anvisa).

Methods: A descriptive, time-series ecological study was carried out using data from private pharmacies and drugstores on the sale of antimicrobial drugs. Drugs sold from January 2014 to November 2021 were included, with analysis of the variables of month, year, municipality, state, active ingredient, prescriber's professional council, and patient's sex and age.

Results: During the study period, 532,518,866 sales of special control drugs were recorded in SNGPC, 66.8% of which were antimicrobials. There was an increase in sales up to 2019, with a decrease in 2020, during the COVID-19 pandemic, and a new increase in 2021. The Southeast and Northeast regions concentrated the highest sales, with the Southeast leading. Sales were higher among women, especially in the 30 to 44.9 age group, with an increase in sales among patients aged 60 or older. The best-selling antimicrobials were amoxicillin, azithromycin, ciprofloxacin and cephalexin.

Conclusion: The study reveals differences in consumption by region, sex, and age, and it highlights the importance of educational interventions for the responsible use of antimicrobials. It also points out that the suspension of mandatory data registration in SNGPC may compromise the monitoring necessary to combat bacterial resistance and improve public health in Brazil.

Objective: The aim of this study was to investigate the factors associated with the use of dental services by older people living in São Paulo, Brazil.

Methods: A cross-sectional study was conducted using secondary data analysis from sub-samples of older people in the Health Surveys in the City of São Paulo, Brazil (ISA-Capital), conducted in 2003, 2008 and 2015. Several variables were tested as factors associated with the outcome "dental visit in the last year". Adjusted odds ratios were estimated from three binary logistic regression models, one for each year.

Results: Sex was associated with the outcome only in 2008, with an adjusted odds ratio (ORa) of 0.65 (0.48-0.89) for females. Younger individuals (up to 74 years old) were more likely to have seen a dentist in 2008 and 2015. The variable years of study remained associated with the outcome throughout the entire period, revealing an ORa of 8.22 (4.23-15.99) for individuals with 12 or more years of study in 2003. This measure decreased to 1.77 (1.25-2.51) in 2015. Race remained an associated factor only in 2003 [ORa=1.50 (1.04-2.17)] in favor of self-declared white individuals. On the other hand, monthly income and health insurance were factors associated with the outcome only in 2008 and 2015.

Conclusion: The findings of this study point to critical issues that deserve the attention of managers, on the basis of intersectoral measures that contribute to active and healthy aging.

Objective: To analyze the prevalence of early detection tests for cervical, breast, prostate, and colorectal cancers in the population of Campinas, São Paulo and the presence of social inequalities in access.

Methods: Population-based cross-sectional study using data from ISACamp 2014/15. Dependent variables were the performance of Pap smear, mammogram, prostate-specific antigen (PSA), fecal occult blood test (FOBT) and colonoscopy/sigmoidoscopy within the age ranges recommended by national guidelines. Independent variables included sex, age, schooling, income, race/skin color, and private health insurance. Prevalence and prevalence ratio adjusted for sex and age were estimated using Poisson regression. Analyses were performed using Stata 14, considering sampling weights.

Results: The prevalence of mammography (77.7%) and Pap smear (87.8%) met the targets set by the Brazilian Ministry of Health, while FOBT (22.3%) and colonoscopy/sigmoidoscopy (21.5%) showed low coverage. PSA testing in the previous three years was reported by 55.2% of eligible men. Higher prevalence of test performance was observed among individuals with higher schooling and income levels and those with private health insurance. Inequalities varied by type of test. For instance, individuals with private health insurance had 11 and 162% higher prevalence of Pap test and colonoscopy/sigmoidoscopy, respectively, compared to those without insurance. Racial inequality was observed only for mammography.

Conclusion: The results indicate high coverage and lower inequalities for Pap and mammography, and low coverage with significant disparities for FOBT and colonoscopy/sigmoidoscopy. Findings highlight the need to monitor coverage and to implement public policies aimed at reducing inequities in access to cancer screening.

Objective: Analyze the temporal trend of the prevalences of morbidity and risk and protection factors for non-communicable diseases (NCDs) in adults living in Brazilian capitals between 2006 and 2023.

Methods: A time-series study using data from the Risk and Protection Factor Surveillance System for Chronic Diseases by Telephone Survey - Vigitel. Hypertension and diabetes morbidities were analyzed, as well as risk and protection factors for NCDs (smoking, Binge drinking, insufficient physical activity, overweight, obesity, recommended fruit and vegetable consumption, regular bean consumption and leisure-time physical activity in adults aged 18 years or older living in Brazilian capitals. Linear regression was used to analyze the trends.

Results: There was a reduction in the prevalences of smoking and regular bean consumption, and an increase in physical activity, overweight, obesity, hypertension and diabetes among the total study population and in both sexes. Alcohol consumption increased among women, who also showed a more significant rise in overweight and physical activity.

Conclusions: The results suggests that the trends analyzed were similar between the sexes, except for alcohol consumption, which increased only among women, and physical activity and overweight, which showed greater increases among women.

Objective: To assess demographic and social determinants associated with the prevalence of overweight and obesity from a population survey.

Methods: Cross-sectional study with 28,153 adults participating in the 2017-2018 Household Budget Survey. Self-reported weight and height were used to estimate the prevalence of overweight and obesity, in addition to information on sociodemographic characteristics such as age (continuous), sex (male/female), skin color or race (white, brown, and black), location of residence (urban or rural), and per capita family income (quartile). Linear regression models were used to assess changes in mean BMI according to age and income in each area (urban/rural), stratified by sex and race/skin color.

Results: In men, overweight and obesity were more prevalent in urban than rural areas, but there was no such difference in women. Income was quadratically related to the mean BMI among women, while in men the prevalence increased with income. In women, higher income was associated with lower BMI, except for black women, who did not show variation with income and were the ones with the highest prevalence of obesity. Men in rural areas had a much lower BMI and, respectively, a lower prevalence of obesity.

Conclusion: We found no difference between extreme groups of possible inequality with regard to overweight and obesity. However, the prevalence of grade I obesity in men was different according to the area, being higher in men living in urban areas; and the highest prevalence of obesity according to race/color occurred among black women in the highest income quartile.