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

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.

Objective: To estimate the prevalence and to evaluate trends and disparities in the occurrence of smoking among pregnant women living in the municipality of Rio Grande (RS), in the extreme south of Brazil, between 2007 and 2019.

Methods: All pregnant women living in this municipality who had a child in one of the local hospitals between January 1st and December 31st in the years 2007, 2010, 2013, 2016, and 2019 were included in the study. The interviews took place within 48 hours after childbirth. A pregnant woman was considered a smoker if she smoked at least one cigarette per day for 30 consecutive days in any of the pregnancy trimesters. The respective Pearson's χ2 test was used to estimate the proportions and the trend.

Results: The mean prevalence of smoking in the studied period was 17.7% (95%CI 17.0-18.3), dropping from 23.4 (95%CI 21.7-25.0) in 2007 to 12.4% (95%CI 11.1-13.9) in 2019. This decrease occurred in all categories of the studied variables (p>0.001). The greatest disparities in the decrease were observed between the extreme groups for income (75.0 versus 34.4%) and level of education (51.0 versus 32.1%) and living or not with a partner (50.7 versus 27.7%).

Conclusion: There was a sharp and uneven drop in the prevalence of smoking over these 13 years. Pregnant women at higher risk of complications during pregnancy and childbirth were at a clear disadvantage compared to others. Reducing the prevalence of smoking depends on prioritizing interventions among pregnant women with greater social vulnerability.

Objective: To estimate the prevalence of COVID-19 diagnosis and hospital admissions, and to evaluate their correlates in a nationwide Brazilian sample.

Methods: A cross-sectional study was carried out with secondary data from the Telephone Survey of Risk Factors for Chronic Noncommunicable Diseases in Times of Pandemic - Covitel 2022. The Covitel study uses cluster sampling, carried out through random digit dialing on landlines and cell phones, among people aged 18 years or over. The outcome of the "diagnosis of COVID-19" was based on a self-report of a confirmed case through laboratory tests or medical diagnoses. Those who reported COVID-19 were asked about the need for hospital admission due to COVID-19. Independent variables included sex, age, level of education, region, comorbidity, private health insurance plan, self-rated health, and employment status. The odds ratio was estimated using logistic regression models considering the complex sample design.

Results: From the sample of 9000 people, the prevalence of COVID-19 diagnosis was 25.4% (95%CI 23.8-27.1%), ranging from 23.0% (95%CI 20.0-26.3%) in the Northeast region to 28.5% (95%CI 25.3-31.7%) in the South region. Middle-aged adults (35-44 years old) had the highest prevalence of COVID-19 diagnosis. The higher the level of education, the higher the prevalence of COVID-19 diagnosis.

Conclusion: The prevalence of COVID-19 diagnosis is markedly different from that of SARS-CoV-2 infection at the population level. Socioeconomic differences in access to testing are the likely explanation. Older adults and people with comorbidities were more likely to be admitted to hospital due to COVID-19 in Brazil.

Objective: To estimate the death registration coverage of women of childbearing age (WCA) in the Hospital Information System (SIH), according to the hospital of occurrence and to verify the predictors associated with coverage.

Methods: Descriptive ecological study with public data from SIH, Mortality Information System (SIM) and National Registry of Health Establishments (CNES), 2012-2020. Deaths in WCA hospitalizations in SIH were compared to those in SIM. Coverage was calculated by the proportion of deaths in SIH in relation to SIM. Supervised classification models - decision tree and random forest - were used to identify hospital characteristics related to coverage.

Results: WCA death registration coverage was estimated at 78.0 and 71.8% after excluding hospitals with >100% coverage. Lower coverage was observed in the North region (67.7%) and higher in the South (76.9%). There was an increase in coverage from 69.0% to 74.4% in the period examined. The main factors predicting coverage were urgency/emergency facility, administrative management level, hospital complexity, proportion of adult beds covered by SUS and teaching activity, with lower coverage in those with an urgency/emergency facility and greater coverage in those of higher complexity, in federal hospitals, those with teaching activity and higher proportion of adult beds covered by SUS. Flaws in the CNES registration were identified in SIM.

Conclusion: The coverage of WCA death registration in SIH in the country is high and growing. Regional differences reinforce the need for strategies to improve the quality of information systems.

Objective: To investigate the association between family characteristics concerning partners and children and loneliness among Brazilians aged 50 and over, taking into account both the occurrence of loneliness and its severity levels.

Methods: This cross-sectional study used data from 7,163 participants in the second wave of the Brazilian Longitudinal Study of Aging, a nationally representative study conducted in 2019-2021. Loneliness was assessed using the 3-item University of California Loneliness Scale. Family characteristics included: marital status and living with the partner and presence of children and living with them. Statistical analysis employed Zero-Inflated Negative Binomial regression models, allowing the assessment of the outcome in both dichotomous and counting-based forms.

Results: Only family characteristics related to the partner were associated with loneliness prevalence, whether in a living-apart-together arrangement (PR=0.35; 95%CI 0.23-0.53) or cohabiting (PR=0.37; 95%CI 0.30-0.45). Family characteristics concerning the partner [cohabiting (PR=0.80; 95% CI 0.73-0.88)] and children [non-cohabiting (PR=0.86; 95%CI 0.77-0.95) or cohabiting (PR=0.81; 95%CI 0.72-0,92)] were negatively associated with loneliness levels.

Conclusion: Family characteristics play a crucial role in both preventing loneliness and reducing its levels. Public services for improving social support should target older adults with reduced nuclear families.

Objective: To analyze the changes in the methodological aspects of the National Survey of School Health (PeNSE) and its comparability with the Global School-based Student Health Survey (GSHS).

Methods: This evaluative study that utilized the PeNSE questionnaires from 2009, 2012, 2015, and 2019, and the GSHS questionnaires from 2013-2017 e 2018-2020. The variables analyzed included the sample size, representativeness and geographic stratification of PeNSE, the number of questions in PeNSE, the percentage similarity of the PeNSE 2019 relative to the 2015, and its comparability with GSHS.

Results: Over the four editions of PeNSE, the sample size increased (from 63,411 in 2009 to 125,123 in 2019). There were changes in educational levels (exclusion of the 6th grade and inclusion of the 7th and 8th grades of primary and secondary education), geographic stratification (expanded to large regions and federation units), and the number of questions increased by 46%. Regarding the similarity between the 2015 and 2019 editions, 48 questions were added, 35 were excluded, and 4 were changed. In 2019, PeNSE presented 11 modules that were partially comparable and 3 that were potentially not to those of 2015. The PeNSE 2015 edition was more similar to the GSHS, with 10 comparable modules, whereas in 2019, this number was reduced to five.

Conclusion: Since its creation, PeNSE has undergone several changes, including increased sample representativeness and number of questions across editions. However, changes to the questionnaires must be analyzed with caution, as they may compromise comparability with previous editions and international surveys.