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

Objective: To analyze the temporal trend of the burden of breast cancer in Brazilian women under 40 years of age compared to the age group over 40 years of age, between 1996 and 2019.

Methods: An ecological time trend study was conducted in Brazil between 1996 and 2019 using data from the Global Burden of Disease (GBD) study. The segmented regression method (Joinpoint Regression) was applied to analyze rates among women under and over 40 years of age. To capture differences in the level and trend of mortality and DALYs, the rate ratio was calculated for the two groups on a year-by-year basis.

Results: Regarding DALY, an average annual decline of 0.7% (95%CI -0.8 to -0.5, p<0.01) was observed among women over 40 years old, while an annual increase of 1.0% (95%CI 0.9 to 1.1, p<0.001) was noted for women up to 40 years old. For mortality, the decline among older women was 0.3% per year (95%CI -0.4 to -0.2, p<0.001), and the increase among young women was 0.8% per year (95%CI 0.7 to 1.0, p<0.001). The average rate ratio for DAILY was 5.2, while for mortality, the average rate ratio was 8.1.

Conclusion: the analysis reinforces the idea that the magnitude and trend of breast cancer mortality among young women is a health issue requiring attention from health decision-makers. This diagnosis underscores the importance of initiating discussions on the need to review population screening criteria, incorporating clinical prediction rules.

Objective: The latest edition of the Open Drug Scenes Survey in Brazilian Cities (LECUCA) investigated social vulnerability, health, and the use of the Psychosocial Care Network by attendees of open drug scenes (ODSs) involving crack cocaine in São Paulo, Fortaleza, and Brasília between 2021/2022.

Methods: Since 2016, LECUCA has used Time-Location Sampling (TLS) to select probabilistic samples representative of the population of ODS attendees.

Results: We interviewed 579 participants in São Paulo, Fortaleza, and Brasília, obtaining a response rate of 75%. We found no difference in ODS attendees regarding the prevalence of sociodemographic indicators and time living in the ODS. The prevalence values of attendees who had never been homeless before living in the ODS and those living in their homes were equally high in the three capitals. Fortaleza stood out for having lower rates of homelessness and limited access to specialized health services, whereas Brasília had high rates of searching for emergency services due to drug use and greater access to all modalities of health and assistance services. Unprotected sex was prevalent over one third of ODSs attendees, and none of the capitals had more than half of the attendees testing for tuberculosis and sexually transmitted infections. Rates of pregnancy complications were high in all three capitals, with São Paulo accounting for the lowest rates.

Conclusion: LECUCA provides significant subsidies to governmental and institutional managers, aiming at catalyzing the formulation of public policies and care strategies based on data and evidence.

Objective: This study aims to compare calibration methods for weights in the subsample of Laboratory Exams from the 2013 Brazilian National Health Survey (PNS), seeking to assess their representativeness and precision.

Methods: Two alternative proposals for constructing calibrated weights were performed based on post-stratification and raking methods. A comparison between the weights provided for the Laboratory Exams subsample and the two suggested weights was conducted through parameter estimates using the 2013 PNS subsample data. Additionally, seven measures were used to assess the performance of the proposed weighting systems.

Results: The alternative post-stratification and raking weights produced generalizable estimates for the target population of the 2013 PNS, while the original weights did not. The alternative methods showed similar performance to the original method, with a slight advantage for raking in some evaluation measures.

Conclusion: It is recommended that basic design weights be documented and included in the public-use data files of the PNS. Furthermore, it is suggested to cross-reference information between the sample and subsample of the 2013 PNS to enable the exploration of methods such as data imputation, aiming to obtain more accurate and representative estimates. These improvements are essential to ensure the quality and usefulness of PNS data in epidemiological and public health studies.

Objective: To estimate the prevalence of abusive alcohol consumption, drinking and driving habits and reports of alcohol consumption comparing the first quarters of 2022 and 2023.

Methods: A cross-sectional study, with data from the Telephone Survey of Risk Factors for Chronic Noncommunicable Diseases, 2022 and 2023. The study sample included 9 thousand people each year collected using random digit dialing and dialing methods direct distance (DDD) on mobile and fixed telephone lines. Self-reported variables for alcohol abuse, drinking and driving habits, and alcohol consumption were analyzed.

Results: There was no significant change in the prevalence of alcohol abuse in the first quarters of 2022 and 2023. However, differences were observed in drinking and driving behavior, with a reduction in prevalence among those aged 18 to 24 years (9.6% (95%CI 4.4-19.8) to 2.2% (95%CI 1.4-3.6) and increased behavior among those with 12 or more years of education (from 6.9% (95%CI 5.5-8.7) to 11.9% (95%CI 10,3-13,6). Male individuals had a higher prevalence of alcohol consumption, alcohol abuse and drinking and driving habits in all analyzed breakdowns.

Conclusion: The Brazilian policy to reduce the consumption of alcoholic beverages and the Sustainable Development Goals must be treated as a priority in Brazil.

Objective: To investigate the sociodemographic, maternal, and gestational factors associated with the dietary total antioxidant capacity in pregnant Brazilian women.

Methods: A cross-sectional study with 2,232 pregnant women aged 18 years old or older, in the first, second, and third trimesters of pregnancy, from eleven cities in the five Brazilian regions. A semi-structured questionnaire was applied to assess socioeconomic, demographic, and health data, and a 24-hour dietary recall (R24h) was used to assess food consumption and analyze the dietary total antioxidant capacity (DTAC), estimated using the ferric reducing antioxidant power (FRAP) method.

Results: The median of DTAC was 5.32 mmol/day. Aracaju, Sergipe (SE) had the highest median of DTAC (6.44 mmol/day) and Palmas, Tocantins (TO) had the lowest (4.71 mmol/day). Pregnant women aged 20 to 34 years (OR 1.86; 95%CI 1.26-2.76), 35 years old or older (OR 3.68; 95%CI 2.21-6.14) and who were in the second trimester of pregnancy (OR 1.50; 95%CI 1.11-2.01) were more likely to be above the median DTAC. While pregnant women with higher education had a 67% lower chance of being above the median DTAC (OR 0.67; 95%CI 0.48-0.92).

Conclusion: The study demonstrated that there are differences in antioxidant consumption in different cities in Brazil and that associated factors such as age, education, and gestational trimester can impact the intake of foods rich in antioxidants. The profile found draws attention to the importance of an adequate diet rich in antioxidants during prenatal care.

Objective: To analyze the prevalence of bullying practices and associated factors among Brazilian adolescents, according to the National Survey of School Health 2019.

Methods: This is a cross-sectional study with cluster sampling. The outcome variable, bullying practice, was assessed by the question: "In the last 30 days, have you mocked, ridiculed, teased, intimidated, or bullied any of your schoolmates to the point that they felt hurt, upset, offended, or humiliated?" (yes/no). Associations with sociodemographic characteristics, family environment, mental health, and risk behaviors were analyzed using Poisson regression with robust variance.

Results: 12.1% (95%CI 11.7-12.6) of adolescents reported bullying others. Positive associations were found among boys (PR 1.66; 95%CI 1.55-1.77); self-declared Black (PR 1.23; 95%CI 1.11-1.36) and brown (PR 1.1; 95%CI 1.02-1.18) adolescents; private school students (PR 1.29; 95%CI 1.21-1.37); those who felt lonely (PR 1.17; 95%CI 1.09-1.26); thought life was not worth living (PR 1.28; 95%CI 1.19-1.39); were physically assaulted by a family member (PR 1.67; 95%CI 1.55-1.79); skipped classes (PR 1.23; 95%CI 1.15-1.31); used tobacco (PR 1.34; 95%CI 1.22-1.47), alcohol (PR 1.38; 95%CI 1.28-1.50), and drugs (PR 1.17; 95%CI 1.04-1.31) regularly; and had sexual relations (PR 1.26; 95%CI 1.18-1.35). Ages 16 and 17 (PR 0.82; 95%CI 0.76-0.89) and family supervision were protective factors (PR 0.70; 95%CI 0.66-0.75).

Conclusion: Bullying was more likely among boys, younger adolescents, those with family and mental health issues, and those engaged in risk behaviors. The importance of practices, such as family supervision in preventing bullying, is highlighted.

Objective: To analyze the retail food environment and identify the presence of food swamps around public and private higher education institutions (HEIs) in Belo Horizonte, Minas Gerais.

Methods: This is an ecological study with the analysis unit being a 500-meter buffer network around 81 in-person HEI units. The density and proximity between the HEIs and food purchasing establishments for immediate consumption were assessed according to the administrative category and per capita income of the census tract, as well as the presence of food swamps.

Results: In 98.76% of the buffers there was at least one establishment for immediate consumption. Snack bars, restaurants, and bars were the categories most available and closest to the HEIs. The density of establishments was higher around private HEIs and around HEIs located in higher income areas. It was found that 95.06% of HEIs were located in areas classified as food swamps.

Conclusion: Thus, the HEIs evaluated were exposed to neighborhoods with an unhealthy food environment, which may predispose university students to food choices based on the consumption of ultra-processed foods and alcoholic beverages.

Objective: To select indicators of the Sustainable Development Goals (SDGs) that determine child malnutrition (CM) in Brazil and to monitor the achievement of SDG targets by region in 2022.

Methods: This is a cross-sectional, ecological study that used the Brazilian Sustainable Development indices and analyzed the 100 SDG monitoring indicators in the 5,570 Brazilian municipalities. A decision tree was created and sensitivity analysis was performed to predict CM determinants. Data were analyzed using the χ2 test at 5% significance level. Descriptive analyses and the decision tree were carried out using the R software.

Results: The CM determinants according to percentage, most affected regions of the country, and impact order were: illiteracy in the population aged ≥15 years (Northeast), insufficient prenatal care (North), low birth weight (South), young women aged 15-24 years who neither study nor work (North and Northeast), and employed population aged 10-17 years (South). We observed an individual and cumulative effect on the CM prevalence, ranging from 1.73 to 15.1%, in Brazilian municipalities according to the occurrence and overlap of these indicators.

Conclusion: The results denote that Brazil will not achieve the intended reduction of CM by 2025. There must be substantial investments in education and health mainly aimed at the maternal and child population and especially in the North and Northeast regions.

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.