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

Objectives: To understand the pattern of snakebite envenomation, the objective was to describe accidents and deaths by snake genus, age group, sex, race/ethnicity, education level, place of residence and occurrence, seasonality, vegetation cover, and to identify spatial clusters with a higher risk of accidents in the state of São Paulo.

Methods: A descriptive study using data from the Notifiable Diseases Information System (SINAN) on snakebite accidents between 2010 and 2022. The Getis-Ord Gi* index was applied to identify high- and low-risk clusters.

Results: Bothropic accidents predominated (61.5%), affecting men (78.7%), whites (64.7%), adults aged 20-59 years (67.1%), and individuals with low education levels (63.4%). Most accidents occurred in urban areas (55.7%), while deaths were more frequent in rural areas (68.1%), with longer treatment delays. Incidence remained stable, increasing during hot and rainy periods. Many cases were not autochthonous, and vegetation type influenced accident patterns: Bothrops in dense and humid areas, Crotalus in dry and open regions, and Micrurus in both. Spatial analysis highlighted areas of higher and lower risk, varying by accident type.

Conclusions: Identifying the most affected population, seasonality, and high-risk areas provides essential support for preventive actions and effective management. The findings can guide efforts towards vulnerable populations, anticipate preventive strategies during high-incidence periods, and optimize resources, such as professional training and antivenom serum distribution in high-risk regions.

Objective: This study compared treatments and outcomes between patients younger than 70 years and those aged 70 years or older (elderly) with laryngeal cancer (LC).

Methods: Data were collected from Brazilian hospital records between 2000 and 2017.

Results: A total of 38,978 patients were analysed, of whom 8,803 (22.6%) were ≥70 years old. Elderly patients were more frequently diagnosed at early stages (39.3% vs. 28.9%; p<0.001). However, these patients were 15% less likely to undergo surgery, 46% less likely to receive chemotherapy, and 33% less likely to receive combined treatments. In addition, elderly patients were 35% more likely to receive supportive care only.

Conclusions: Despite early diagnosis, elderly patients received fewer oncological treatments and more palliative care.

Objective: To estimate the prevalence of psychological violence among employed adults aged 18-69 years; to verify the distribution of sociodemographic and lifestyle characteristics within those who have reported psychological violence in the workplace; and to estimate the number of individuals who have reported this type of violence perpetrated by the employer/boss in the workplace.

Methods: This is a descriptive study with data from the National Survey of Health (2019). Employed people were selected in relation to the workforce. Psychological violence was defined as follows: in the last 12 months, "has anyone offended, humiliated, or mocked you in front of other people?". For those who reported violence, the location of the incident and who the aggressor was were verified. The prevalence of psychological violence was estimated and the characteristics of those who suffered this type of violence were described by absolute and relative frequencies.

Results: The prevalence of psychological violence reached 11% (95% confidence interval [CI]: 10.5-11.6) of the employed adult population, was higher among women, individuals between 18-29 years old, Black people, single, and among those with income up to 0.5 minimum wage. Of the individuals who suffered psychological violence in the workplace, 57.6% were men, 31.9% were between 30-39 years old, 47% were mixed-race, 44.4% completed high school, 39.8% had an income between one and two minimum wages, 13.5% were smokers, 37.6% consumed alcoholic beverages, and 23.8% consumed alcohol excessively. As for the aggressor, 28.8% (around two million people) reported that psychological violence in the workplace was committed by the employer/boss.

Conclusion: According to the study results, among the employed Brazilian population, 11% reported psychological violence in the last year; we identified the segments most affected by psychological violence in the workplace and measured this violence having the boss/employer as the aggressor.

In this manuscript we discuss the importance of monitoring the analyses on health inequalities in women's and children's health. Data from the Brazilian Live Birth Information System were used to introduce the main inequality measures. The years from 2020 to 2022 were combined and at least one and eight or more antenatal care visits were considered as outcomes. As inequality measures, simple (ratios and differences) and complex measures for ordered (slope index of inequality and concentration index) and unordered (weighted and unweighted mean absolute difference from the mean) outcomes were presented. We discuss the strengths, limitations, and importance of inequality monitoring for researchers and policymakers.

Objective: To analyze the effect of cumulative adverse childhood experiences and depressive symptoms on adolescence and to identify direct and indirect relationships between the variables and the mediating role of social support.

Methods: This is a cross-sectional study with a sample of 1,117 school-aged adolescents aged 13 to 19 years. The Children's Depression Inventory and Adverse Childhood Experiences scales were used, organized into socioeconomic, family, community, and total dimensions. Descriptive analysis was carried out and the structural equation model was used, with probit estimation, applying social support as mediator.

Results: The prevalence of depressive symptoms among school-aged adolescents was 8.2%. We observed that the accumulation of socioeconomic, family, and community factors increases the occurrence of depressive symptoms, adjusted for sex, skin color, and social support. Mediation by social support explains 16.7% of the total effect of exposure to the analyzed factors. In the socioeconomic dimension, the depression probit increases by 0.033 for each category, with 21.2% mediated by social support. In the family dimension, the increase is 0.020 (25% mediated); in the community, 0.018 (16.7% mediated); and in the total dimension, 0.012 (17% mediated).

Conclusion: The observation of the effect of the accumulation of Adverse Childhood Experiences on depressive symptoms in adolescence requires actions in vulnerable groups, with social support helping to mitigate the risk of depression.

Objective: To analyze the spatial distribution of neonatal near miss and socioeconomic and healthcare indicators in the state of Paraná.

Methods: Ecological, cross-sectional study of neonatal near miss rates in municipalities in the state of Paraná, from 2020 to 2022, obtained through data from the Live Birth Information System (SINASC) and the Mortality Information System (SIM), connected through deterministic linkage. The spatial distribution of neonatal near miss rates, socioeconomic indicators (maternal age and race/ethnicity), and healthcare indicators (type of delivery and number of prenatal consultations) were performed. Global and Local Moran's Index were used for spatial analysis.

Results: The neonatal near miss rate in Paraná was 28.46 per thousand live births. Health regions (HR) 4th HR - Irati, 3rd HR - Ponta Grossa, 6th HR - União da Vitória, and 17th HR - Londrina stood out with high rates of neonatal near miss. Concerning the indicators, significant rates were evident among women of black, yellow, and indigenous race/color, as well as inadequacies in prenatal.

Conclusions: The results highlight priorities in the Eastern and Northern macro-regions, where high-high clusters indicate an urgent need to assess access and quality of care. Additionally, there is a need to investigate neonatal near miss in Black, Yellow, and Indigenous women, as well as low prenatal adherence or coverage.

Objective: To evaluate the percentage variation of the different therapeutic modalities used in new cases of cancer, before and during the pandemic, in Ceará.

Methods: Descriptive study with information from records of the Hospital Information System and Authorization of Highly Complex Procedures, and Cancer Information Systems in the state of Ceará, Brazil.

Results: There was a reduction of 2,575 (-30.85%) new cases in 2020 and 2,368 (-28.37%) in 2021. Regarding the therapeutic modalities, it was possible to observe that there were decreases in the numbers of all institutions in the first cancer treatment, except for isolated radiotherapy and for combined surgery+iodine therapy+radiotherapy. Surgery was the modality most often performed in a timely manner (<30 days) and chemotherapy in an untimely manner (>60 days). The impact on the initiation of timely treatment (<30 days after diagnosis) was greater in 2021 than in 2020. In general, late treatments (>60 days) were lower than in 2019. The period of 31-60 days was shown to be above 2019 almost the entire year, in 2020 and 2021.

Conclusion: The number of new cancer cases in Ceará may occur during the pandemic. This situation impacted the reduction of all therapeutic modalities, except for radiotherapy alone and associated with surgery+iodine therapy. However, it did not harm the number of new cases treated in a timely manner.

Objectives: To estimate the prevalence of HIV infection in pregnant women; analyze the gestational and maternal outcomes of women with HIV; and evaluate process indicators for the prevention of vertical transmission of HIV according to type of financing for hospital admission in the state of Rio de Janeiro (RJ).

Methods: cross-sectional study with 1,923 women, conducted between 2021-2023. Interviews were carried out with women, and data was extracted from the pregnancy booklet and hospital records. The prevalence of HIV infection, gestational and maternal outcomes, and the adequacy of process indicators for the management of HIV infection were estimated with respective 95% confidence intervals (95%CI) according to the type of financing - public or private - for hospital admission for childbirth or abortion.

Results: Coverage of prenatal care (PNC), HIV testing during PNC (one and two tests), and testing during hospital admission was 93.7, 79.7, 45.8, and 79.2%, respectively. The prevalence of HIV infection was estimated at 0.79% (95%CI 0.31-1.99). Only 40% of women with HIV had registered antiretroviral treatment and 26% had registered viral load tests in their pregnancy booklet. Women with public funding were more socially vulnerable and had less coverage of PNC and testing with two tests.

Conclusion: Missed opportunities were identified in the management of pregnant women with HIV in public and private services in RJ. The detection rate was higher than that of the Notifiable Diseases Information System and suggests underreporting of cases.

Objective: To evaluate the impact of dental caries on daily activities, assessed by the Oral Impacts on Daily Performances (OIDP) and Child-OIDP in adolescents.

Methods: Studies published in any language mentioning the relationship between dental caries and OIDP or Child-OIDP were included. PubMed, Scopus, Web of Science, LILACS/BBO, and grey literature were assessed to identify relevant studies published up until March 2024. The quality of the studies was assessed using the Joanna Briggs Institute tool for cross-sectional studies. For the meta-analysis and the leave-one-out sensitivity analysis, the R software was used. The subgroup analysis was conducted considering the version of the tool (OIDP or Child-OIDP) and the outcome (presence or experience of dental caries).

Results: Of the 1,663 studies, 20 were included, all cross-sectional, with 17 of them conducted in schools. A total of 16 studies were considered to have high methodological quality. Individuals in the Child-OIDP and experience of dental caries subgroups showed a worse impact (PR=1.66; 95%CI 1.19-2.31; and PR=1.72; 95%CI 1.23-2.43, respectively). The heterogeneity of the studies was high (I2=97%; T2=0.17; p<0.01), and we did not identify any single study as the main source for this fact in the sensitivity analysis.

Conclusion: Dental caries negatively affect adolescents' daily activities. Despite nonsignificant differences between instruments and dental caries classifications, variations in effect estimates highlight the need for further research. New studies are suggested to confirm these findings, given the high heterogeneity found (PROSPERO CRD42021247951).