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

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 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 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.

Objective: To analyze the association of household composition with risk behaviors in Brazilian adolescents.

Methods: Cross-sectional study, with a nationally representative sample of Brazilian adolescents (n=159,245) aged 13 to 17, enrolled and regularly attending the 7th to 9th year of elementary school and the 1st to 3rd year of high school, participants in the National Survey of School Health in 2019. The risk behaviors were: insufficient physical activity, sedentary behavior, alcohol consumption, smoking, poorer diet quality, skipping breakfast and not having meals with parents/guardians. In the analyses, the sampling weights and study design were considered, stratified by the type of school (public or private) and estimated using Poisson regression models.

Results: Adolescents, from public and private schools, who lived in single-parent households or where parents were absent, had a higher prevalence of alcohol consumption, smoking, poorer diet quality, skipping breakfast and not eating meals with parents/guardians, compared to those who lived with both parents. Additionally, adolescents from public schools showed a higher prevalence of sedentary behavior than those from single-parent households. Adolescents from private schools had a higher prevalence of sedentary behavior among those who lived only with their mother and a higher prevalence of insufficient physical activity among those who lived without either parent.

Conclusion: Brazilian adolescents, from public and private schools, who lived in single-parent households or without parents, showed higher prevalence of risk behaviors.

Objective: To describe and analyze notifications and the temporal trend of violence against women living in rural contexts in Brazil, from 2011 to 2020.

Methods: Ecological time-series study of a descriptive and analytical nature, with data from the Notifiable Diseases Information System on violence against women aged 18 to 59 years, in rural areas, from 2011 to 2020, in Brazil. The analyses were descriptive and trend-related, with the regression model using inflection points (joinpoint) and calculation of the annual percent change (APC) and the average annual percent change (AAPC).

Results: A total of 79,229 notifications of violence against rural women were recorded. The most reported violence was physical (77.6%), psychological/moral (36.5%), and sexual (6.2%). They occurred, above all, among young, Black, married women with low levels of education. They were committed, in most cases, at home and, mainly, by a male partner. APC was statistically increasing throughout the studied period in Brazil, in the North, Midwest, South, and Northeast regions, including 18 states and the Federal District (DF). As for AAPC, all country, region, state, and DF rates showed a statistically increasing trend.

Conclusion: In view of the increasing reported cases of violence against rural women throughout the country, which are mainly committed by people they are related to and in their own home, it is encouraged to reinforce the training of health professionals to improve and expand the process of notification as an instrument of care for women in situations of violence.

Objective: To explore the relationship between different patterns of multimorbidity and the use of sleeping medications in women.

Methods: Population-based cross-sectional study with 1,128 women (aged 20-69 years) in Southern Brazil. Data on sleeping medications were obtained from the question "Do you take/use any medication to be able to sleep?" and identified by the Anatomical Therapeutic and Chemical classification. Multimorbidity patterns were derived by the Principal Component Analysis of 26 chronic conditions and two obesity parameters (≥30 kg/m2; ≥40 kg/m2). The association was analyzed by Poisson regression with robust variance using different adjustment models, stratified by age.

Results: Three multimorbidity patterns were derived: cardiometabolic, endocrine-articular, and psychosomatic. Age stratification showed a change in effect in the relationship investigated. Women under 45 years and high score of cardiometabolic and endocrine-articular patterns were about twice as likely to use sleeping medications [prevalence ratio (PR) 1.85, 95% confidence interval (CI) 1.09-3.12; PR 2.04, 95%CI 1.18-3.51, respectively]. Those with psychosomatic pattern were around five times more likely [PR 4.91, 95%CI 3.00-8.04].

Conclusions: The study provided the first evidence on the association researched and demonstrated that young women (<45 years) with a high score of the identified patterns are up to five times more likely to use sleeping medications, configuring early use. This unprecedented finding suggests the need for greater health promotion for young adults and actions to raise awareness about risks and the clear indication of the use of sleeping medications.

Objective: This cross-sectional study aimed to evaluate the psychometric properties of the reduced version of the Primary Care Assessment Tool (PCATool) for adult patients in the Brazilian National Health Survey 2019, a nationally representative population-based study.

Methods: The reduced version of PCATool-adults measures the presence and extent of the following attributes: degree of affiliation; first-contact access; longitudinality; care coordination; comprehensiveness; family orientation; and community orientation. Exploratory and Confirmatory Factor Analysis were performed.

Results: The final sample consisted of 9,396 individuals. The PCATool latent variable for adults was related to two questionnaire items, one referring to the Degree of Affiliation attribute and the other to the Community Orientation attribute. Additionally, five latent variables, formed by 21 items, identified the other five attributes through standardized factor loadings.

Conclusion: The reduced version of PCATool-Adult has good psychometric properties and captures the attributes of Primary Health Care.

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Objective: The present study aimed to investigate associations between reasons for seeking dental services, considering the last dental appointment of adolescents, and their educational features, socioeconomic and oral health status, and oral health literacy.

Methods: A cross-sectional study was conducted with 746 adolescents aged 15-19 years in Campina Grande (Paraíba), Brazil. Parents/guardians answered a socioeconomic questionnaire. Adolescents answered a questionnaire on oral health and the Brazilian Rapid Estimate of Adult Literacy in Dentistry. Features of the school environment were investigated through cluster analysis, using type of school and school grade retention. Adolescents were clinically examined for dental caries diagnosis by two dentists (κ>0.80), using the Nyvad criteria, in school facilities. Data were submitted to robust multilevel logistic regression for complex samples (α=5%).

Results: At the individual level, low maternal schooling (odds ratio [OR] 1.06; 95%CI 1.01-1.10), low oral health literacy (OR 0.99; 95%CI 0.98-0.99), and dental caries (OR 1.09; 95%CI 1.01-1.18) remained associated with the reasons for the last dental appointment. The school environment was also associated with the outcome (OR 1.07; 95%CI 1.00-1.15).

Conclusion: Maternal schooling of less than eight years of study, low oral health literacy, cavitated caries, and unfavorable school environment were associated with seeking dental treatment.