Influence of the COVID-19 pandemic on labor and childbirth care practices in Brazil: a cross-sectional study.

BACKGROUND: It has been hypothesized that the coronavirus disease 2019 (COVID-19) pandemic may have changed the conduct of obstetric practices at the time of labor, delivery, and birth. In Brazil, many practices lacking scientific evidence are implemented in this care, which is charcaterized by excessive use of unnecessary interventions. This scenario may have been worsened by the pandemic. Thus, we analyzed the effects of the pandemic on care during prenatal care and delivery by comparing the results of two surveys (one was administered before the pandemic and the other during the pandemic) in public hospitals in Belo Horizonte - Minas Gerais (MG), Brazil. METHODS: This cross-sectional and comparative study analyzed preliminary data from the study "Childbirth and breastfeeding in children of mothers infected with SARS-CoV-2", which was conducted in three referral maternity hospitals in Belo Horizonte - MG during the pandemic in the first half of 2020 in Brazil. The final sample consisted of 1532 eligible women. These results were compared with data from 390 puerperae who gave birth in the three public hospitals in the study "Birth in Belo Horizonte: labor and birth survey", conducted before the pandemic to investigate the changes in practices of labor and delivery care for the mother and her newborn, with or without COVID-19 infection, before and during the pandemic. In this research, "Birth in Belo Horizonte: labor and birth survey", data collection was performed between November 2011 and March 2013 by previously trained nurses. Between study comparisons were performed using Pearson's chi-square test, with a confidence level of 95%, and using Stata statistical program. RESULTS: We found a significant increase in practices recommended by the World Health Organization during the pandemic including the following: diet offering (48.90 to 98.65%), non-pharmacological pain relief (43.84 to 67.57%), and breastfeeding in the newborn´s first hour of life (60.31 to 77.98%) (p < 0.001). We found a significant reduction of non-recommended interventions, such as routine use of episiotomy (15.73 to 2.09%), the Kristeller maneuver (16.55 to 0.94%), oxytocin infusion misused (45.55 to 28.07%), amniotomy (30.81 to 15.08%), and lithotomy position during labor (71.23 to 6.54%) (p < 0.001). CONCLUSION: Our study revealed a statistically significant increase in the proportion of use of recommended practices and a reduction in non-recommended practices during labor and delivery. However, despite advances in the establishment of World Health Organization recommended practices in labor, delivery, and birth, the predominance of interventionist and medicalized practices persists, which is worsened by events, such as the pandemic.

Long working hours and self-rated health in the national Brazilian working population: gender and employment status differences, 2019.

BACKGROUND: The regulation of working hours is governed by legal standards in formal employment. While the association between long working hours and various health outcomes has been extensively studied, there is limited evidence regarding Brazil. The objective of this study was to investigate the association among working hours, employment status, and self-rated health (SRH), taking into account differences between men and women in a national representative sample of the working population in Brazil. METHODS: A cross-sectional study was conducted among a representative sample of 33,713 workers in Brazil to assess self-rated health (SRH). We examined the associations between working hours and employment status, categorizing working hours as standard (40-44 h per week) or long (> 44 h per week), and employment status as formal or informal. Logistic regression models were employed, adjusting for sociodemographic, occupational characteristics, and health behaviors. Probabilities of negative SRH were calculated for men and women in different exposure profiles. Results were stratified by gender, and 95% confidence intervals (CIs) were applied to the findings. RESULTS: The prevalence of long working hours was higher among informal workers for both men and women. Adjusted odds ratio (AOR) results revealed that informal employment (AORwomen = 1.53; 95% CI: 1.13-2.07 and AORmen = 1.55; 95% CI: 1.22-1.96) and long working hours (AORwomen = 1.23; 95% CI: 1.06-1.43 and AORmen = 1.14; 95% CI: 1.00-1.30) were independently associated with negative SRH. Significant interactions between long working hours and informal employment were observed. Among individuals with the same exposure profile, women who engaged in long working hours had a higher probability of reporting negative SRH compared to men. CONCLUSIONS: The results of this study are in line with the literature, as differences between men and women in the likelihood of negative self-rated health were observed. The adverse health effects underscore the importance of implementing intersectoral actions to inform the revision of regulations concerning weekly working hours and the expansion of informal employment in low- and middle-income countries.

Plasma Levels of Brain-Derived Neurotrophic Factor are Associated with Prognosis in the Acute Phase of Ischemic Stroke.

CONTEXT: Brain-derived neurotrophic factor (BDNF) is a neurotrophin involved in neuronal survival, differentiation, and maturation. PURPOSE: To evaluate the levels of BDNF in the acute phase of stroke and their potential association with neurological impairment. METHODS: Patients in the acute phase of ischemic stroke were evaluated with the following clinical tools: National Institutes of Health Stroke Scale, modified Rankin scale, Gugging Swallowing Screen and Alberta Stroke Program Early CT Score. Blood samples were collected at 3 different moments of hospital stay. BDNF was measured through enzyme-linked immunosorbent assay. RESULTS: Patients who were discharged after 10 days had worse clinical outcomes and higher levels of BDNF since admission. There was correlation between BDNF levels and clinical parameters. CONCLUSION: BDNF levels were associated with clinical prognosis in the acute phase of ischemic stroke.

Occupational inequalities and gender differences: work accidents, Brazil, 2019.

OBJECTIVE: To analyze the distribution and association of sociodemographic and occupational factors with self-reported work accidents (WA) in a representative sample of the Brazilian population, with emphasis on occupational class, and to examine gender differences in this distribution. METHODS: A population-based cross-sectional study, using data from the 2019 National Health Survey (PNS), analyzed the responses of a sample of adults aged 18 or over. Factors associated with WA were investigated using binary logistic regression and hierarchical analysis using blocks (sociodemographic and occupational variables). The final model was adjusted by variables from all blocks, adopting a significance level of 5%. The values of odds ratios (OR) and respective confidence intervals were obtained. RESULTS: Among the participants, 2.69% reported having suffered a WA, with a higher prevalence in men (3.37%; 95%CI 2.97-3.82%) than in women (1.86%; 95%CI 1.55-2.23%). The analysis identified that age group, night work, working hours, and exposure to occupational risks were associated with WA, with emphasis on gender differences. The class of manual workers, both qualified (ORwomen = 2.87; 95%CI 1.33-6.21 and ORmen = 2.46; 95%CI 1.37-4.40) and unskilled (ORwomen = 2.55; 95%CI 1.44-4.50 and ORmen = 3.70; 95%CI 1.95-7.03), had a higher chance of WA than the class of managers/professionals. CONCLUSION: Occupational factors contributed significantly to the increase in the probability of WA for men and women, with greater magnitude among those positioned in the lower strata of the occupational structure. The results obtained are clues for working out WA prevention actions.

How specific are negative symptoms and cognitive impairment in schizophrenia? An analysis of PANSS and SCoRS.

INTRODUCTION: Interview-based scales can be used as coprimary measures to complement the assessment of cognitive impairment in schizophrenia. One major question that arises from the use of such tools is how specific they are in relation to other psychopathological domains. We analyse the specificity of the Positive and Negative Syndrome Scale (PANSS) negative subscale and the Schizophrenia Cognition Rating Scale (SCoRS). METHODS: We performed a principal component analysis (PCA) of PANSS negative subscale, rated by the interviewer, and SCoRS ratings from three different sources (patient, informant, and interviewer) in 101 patients with schizophrenia. Additionally, we correlated mean SCoRS ratings to PANSS negative subscale items to determine whether any PANSS item is particularly related to cognition. RESULTS: The PCA showed that the two first components, which explained approximately 40% of the total variance of the scales, represent the SCoRS ratings and the PANSS negative subscale ratings, respectively. The mean interviewer SCoRS was significantly correlated with the PANSS negative Item 5 (difficulty in abstract thinking) and with the mean PANSS negative subscale. The latter correlation was no longer significant when "difficulty in abstract thinking" was eliminated from PANSS negative subscale. CONCLUSIONS: In general, SCoRS and PANSS negative subscale scores address different constructs; however, the PANSS negative item "difficulty in abstract thinking" seems to address a cognitive dimension.

[Self-rated health and factors related to the work of basic education's teachers in Brazil]. / Autoavaliação de saúde e fatores relacionados ao trabalho dos professores da educação básica no Brasil.

The scope of this article is to analyze the association between teachers' self-rated health and the conditions in which they work in Basic Education schools in Brazil. It involved a cross-sectional study, carried out between 2015 and 2016, representative of Basic Education teachers in the country, the outcome variable of which was self-rated health (SRH). The explanatory variables were the work-related characteristics. To assess the factors associated with SRH, the Proportional Odds Logistic Regression Model was used. The prevalence of poor SRH was 27%. The probability of poor SRH was significantly higher for the group that reported episodes of verbal violence (OR=1.26; 95%CI 1.09-1.44), work pressure (OR=1.18; 95%CI 1, 04-1.33), and a commute to school of more than 50 minutes (OR=1.19; 95%CI 1.03-1.38). The probability of poor SRH was significantly better for those who reported having enough time to complete their tasks (OR=0.77; 95%CI 0.64-0.92), social support (OR=0.79; 95%CI 0.69-0.89) and satisfaction with their workload (OR=0.79; 95%CI 0.69-0.91). Actions on the school environment and organization and improvements in the transport of teachers to work are desirable.

O objetivo deste artigo é analisar a associação entre a autoavaliação de saúde dos professores e as condições que eles encontram para trabalhar nas escolas da Educação Básica no Brasil. Estudo transversal, realizado entre 2015 e 2016, representativo dos professores da Educação Básica do País, cuja variável desfecho foi a autoavaliação de saúde (AAS). As variáveis explicativas foram as características relacionadas ao trabalho. Para avaliar os fatores associados à AAS foi utilizado o Modelo de Regressão Logística de Chances Proporcionais. A prevalência de AAS ruim foi de 27%. A probabilidade de pior AAS foi significativamente maior para o grupo que informou episódios de violência verbal (OR=1,26; IC95% 1,09-1,44), pressão laboral (OR=1,18; IC95% 1,04-1,33), e deslocamento para escola superior a 50 minutos (OR=1,19; IC95% 1,03-1,38). A probabilidade de pior AAS foi significativamente menor para aqueles que relataram dispor de tempo suficiente para cumprir suas tarefas (OR=0,77; IC95% 0,64-0,92), apoio social (OR=0,79; IC95% 0,69-0,89) e satisfação com o próprio trabalho (OR=0,79; IC95% 0,69-0,91). Ações sobre o ambiente e a organização escolar e melhorias no transporte dos professores para o trabalho são desejáveis.

Factors Associated With the Limitation at Work Because of the Voice: Study With Teachers of Basic Education In Brazil.

INTRODUCTION: The voice disorder can cause limitations at work, as it affects the communication and the performance of the teaching function. OBJECTIVE: To analyze the limitation at work because of the voice and to examine possible associations with sociodemographic characteristics, life and health habits and work conditions among Basic Education teachers in Brazil. METHODS: Cross-sectional epidemiological study, with a representative sample, carried out between October 2015 and March 2016, with 6,324 teachers working in Basic Education in Brazil. Data collection was carried out through the application of a questionnaire via telephone with questions regarding health and working conditions. The "limitation at work because of the voice" was considered a dependent variable, whose response options were a scale with four Likert items that varied from frequently to never. The independent variables were grouped in blocks for ordinal logistic regression analysis with hierarchical entry. The magnitude of the association was assessed by the Odds Ratio (OR) with the respective confidence intervals (95% CI). RESULTS: One third of Brazilian teachers (32.7%) reported some frequency of limitation at work (sometimes; rarely, frequently) because of the voice at some moment in the month before the survey and, of these, 5% declared high frequency. The factors that increased the chance of a greater frequency of limitation at work because of the voice were: being female (OR = 1.32; 95% CI = 1.15-1.51); teaching for elementary school (OR = 1.35; 95% CI = 1.02-1.78); use anxiolytic or antidepressant medications (OR = 1.46; 95% CI = 1.20-1.78); losing sleep due to concerns (OR = 1.69; CI = 95% = 1.46-1.95); high noise at school (OR = 2.09; 95% CI = 1.78-2.46); agitated environment by students' indiscipline (OR = 1.37; 95% CI =1.15-1.63); high demands at work (OR = 1.18; 95% CI = 1.02-1.36); not having social support (OR = 1.19; 95% CI = 1.04-1.38); having suffered verbal violence by the students (OR = 1.43; 95% CI = 1.23-1.67). On the other hand, the practice of regular physical activity (OR = 0.86; 95% CI = 0.75-1.00) and the fact of having enough time to complete work tasks (OR = 0.71; 95% CI = 0,62-0.82) decreased the chance of a higher frequency of limitation at work due to vocal problems. The perception that the work limits the teaching performance because of the voice was more frequent among teachers in the North (OR=1.41; 95% CI = 1.17-1.71) and Northeast (OR=1.46; 95% CI = 1.22-1.76) compared to the Southeast region. CONCLUSION: Factors associated with an increase in the chance of higher frequency of reporting work limitations due to the voice: being female, lack of physical activity, losing sleep due to concern, using anxiolytic or antidepressant medication, school location in the North and Northeast, teaching for the elementary school stage, high noise at school and psychosocial aspects of work organization. The Brazilian educational sector needs public policies that take into account regional inequalities and the health and work conditions of teachers.

Symptoms of depression, anxiety and stress in health students and impact on quality of life. / Síntomas de depresión, ansiedad y estrés en estudiantes del área de la salud e impacto en la calidad de vida.

OBJECTIVE: to evaluate the association between quality of life and presence of symptoms of depression, anxiety, and stress in college students in the health area. METHOD: cross-sectional study that included 321 students from undergraduate courses in the health area. Quality of life was measured using the World Health Organization scale, abbreviated version, in the physical, psychological, social relations and environment domains, and symptoms were assessed by the depression, anxiety and stress scale. Multivariate analysis was performed using robust linear regression to evaluate the association between quality of life and symptoms. RESULTS: a negative association was observed between the quality of life and depression symptoms in all domains, while anxiety symptoms showed a negative association in the environment domain, and stress symptoms had a negative association in the psychological domain. Symptom severity was unfavorably associated with quality of life, that is, the greater the symptom severity, the lower the mean scores in all domains. CONCLUSION: symptoms of depression, anxiety, and stress were prevalent and had a negative impact on students' quality of life, especially in the presence of depressive symptoms. The decrease in scores was significantly associated with the severity of symptoms.

Assessment of the quality of life and mental health of healthcare students during the COVID-19 pandemic.

OBJECTIVE: to evaluate the quality of life (QOL) and the presence of symptoms related to depression, anxiety, and stress among students in the healthcare field, in comparison to the period before the COVID-19 pandemic. METHODS: A comparative cross-sectional research was conducted at a Brazilian public university. QOL was assessed using the WHOQOL-bref scale, while symptoms of depression, anxiety, and stress were evaluated using the DASS-21 scale. Descriptive and inferential analyses were employed to compare the two time periods. RESULTS: A total of 355 students participated in this study. During the pandemic, there were significant increases in severe depression symptoms (15.1% versus 24.8%), moderate anxiety (18.3% versus 29.4%), and moderate stress (40.9% versus 53.8%) observed among the participants. Additionally, a significant reduction in QOL was noted, particularly in the domain of social relationships (65.2 versus 59.6, p-value 0.029). CONCLUSION: The study highlights a deterioration in both the quality of life and the mental health of healthcare students during the COVID-19 pandemic.

A cytokine study of adult patients with obsessive-compulsive disorder.

OBJECTIVES: We aimed to determine the plasma levels of cytokines in patients with obsessive-compulsive disorder (OCD) as compared with healthy controls and to investigate whether there is any association between their concentrations and OCD clinical and therapeutic features. METHODS: Forty patients with OCD and 40 healthy controls had their plasmas assessed for a range of cytokines (tumor necrosis factor-α, or TNF-α), chemokines (CCL2, CCL3, CCL11, CCL24, CXCL8, CXCL9, CXCL10), and other mediators (TNF soluble receptors sTNFR1 and sTNFR2 and interleukin-1 receptor antagonist) by enzyme-linked immunosorbent assay. Patients with OCD were further examined with the Mini-International Neuropsychiatric Interview, the Obsessive-Compulsive Inventory-Revised, and the Beck Depression Inventory. RESULTS: Compared with healthy controls, patients with OCD exhibited significantly increased plasma levels of CCL3, CXCL8, sTNFR1, and sTNFR2. Among patients with OCD, there was a positive correlation between relative antidepressant dose and sTNFr2 levels. Furthermore, although the levels of sTNFR1 correlated positively with the severity of washing symptoms, CCL24 levels correlated negatively with the severity of hoarding. CONCLUSIONS: The levels of certain immune markers are increased in adult patients with OCD and seem to vary according to predominant symptoms dimensions. Other studies are required to establish whether our findings truly reflect immunologic dysfunction in OCD or are the result of other hidden confounding factors.

[Individual and contextual factors associated with smoking among young Brazilian adults]. / Fatores individuais e contextuais associados ao tabagismo em adultos jovens brasileiros.

Young people receive special attention regarding smoking as it is a period of life in which the use of this and other substances generally starts and is consolidated. There are no studies on risk factors associated with young adults with a representative sample from Brazil that take into consideration individual and contextual aspects. The objective was to identify factors associated with smoking among young Brazilian adults aged 18 to 24 years, considering the combined influence of individual and contextual factors assessed through the Municipal Human Development Index (MHDI). It involved a cross-sectional, population-based study that used data from the 2019 National Health Survey. Using the Poisson multilevel model with robust variance for estimating the Prevalence Ratio, individual variables were analyzed, and the MHDI as a contextual variable in each Federative Unit. In addition to individual factors, the MHDI was also associated with smoking among young people, with an increase in the prevalence of tobacco consumption among young people as the state's MHDI increases (p<0.001), indicating that living in a state with better conditions according to the MHDI, socioeconomic status is associated with a higher probability of young people smoking when compared to those residing in other states.

Aos jovens é atribuída especial atenção no que tange ao tabagismo por se tratar de um período da vida em que o uso dessa e outras substâncias geralmente inicia e se consolida. Não há estudos sobre fatores de risco associados aos adultos jovens, com amostra representativa do Brasil e que consideram aspectos individuais e contextuais. O objetivo foi identificar fatores associados ao tabagismo em adultos jovens brasileiros de 18 a 24 anos, considerando a influência conjunta de fatores individuais e contextual avaliado por meio do Índice de Desenvolvimento Humano Municipal (IDHM). Estudo transversal, de base populacional, que utilizou dados da Pesquisa Nacional de Saúde de 2019. Por meio do modelo multinível de Poisson com variâncias robustas para estimação da Razão de Prevalência, foram analisadas variáveis individuais, e como variável contextual, o IDHM em cada Unidade Federativa. Além de fatores individuais, o IDHM também se mostrou associado ao tabagismo dos jovens, com aumento da prevalência de consumo de tabaco entre os jovens à medida que se aumenta o IDHM do estado (p<0,001), indicando que residir em UF com melhores condições socioeconômicas segundo o IDHM está associado a maior probabilidade de o jovem fumar se comparados com aqueles que residem nos demais estados.

Impact of the COVID-19 Pandemic on Human Papillomavirus Vaccination in Brazil.

Objective: To analyze the number of applied HPV vaccine doses before (from April 2019 to March 2020) and after (from April 2020 to September 2020) social distancing measures in response to the COVID-19 pandemic in states and regions of Brazil. Methods: Ecological time-series study, using data from the Brazilian National Immunization Program (PNI). Using the Mann-Whitney test, we evaluated the difference between the median number of applied doses during the periods April 2019 to March 2020 and from April 2020 to September 2020. Spatial analysis identified clusters with a high or low percentage reduction in the median applied doses. Prais-Winsten regression models identified temporal trends in the applieddoses from both periods. Results: There was a significant reduction in the median HPV vaccine doses applied, formation of spatial clusters and, after a sharp drop in the number of applieddoses during the months following social distancing. There was a tendency to increase the applied vaccines doses. Conclusion: The COVID-19 pandemic resulted in reduction of the number of HPV vaccine doses applied as a possible effect of restrictive measures caused by the pandemic.

[Influence of family environment and social group on smoking among Brazilian youth aged 15 to 24 years]. / Influência do entorno familiar e do grupo social no tabagismo entre jovens brasileiros de 15 a 24 anos.

OBJECTIVE: To estimate the prevalence of smoking among Brazilian youth, examining individual, family, and social group factors associated with this habit. METHODS: Data from youth aged 15 to 24 years living in 17 Brazilian state capitals and the Federal District, obtained from the Household Survey on Risk Factors for Chronic Diseases and Reported Morbidity carried out in 2002 and 2003 by the National Cancer Institute was analyzed. Individual variables (sex, age, schooling, alcohol consumption, self-rated health, physical activity, current school attendance), family variables (age and education of head of household and father, mother, or sibling smoking), and social group variables (best friend smoking, most friends smoking, boyfriend/girlfriend smoking) were analyzed. Generalized estimating equations (GEE) approach to evaluate the factors associated with smoking were used. RESULTS: Considering the effect of the sampling design, smoking prevalence was 12.8%, ranging from 6.8% in Aracaju to 24.1% in Porto Alegre. The following factors were predictors of smoking: male sex, older age, less schooling, not attending school at the time of the survey, poorer health perception, and alcohol consumption. Peer smoking (friends or boyfriend/girlfriend) and smoking among family members (father/mother or sibling) were associated with smoking. There was an effect of parental birth cohort on smoking, with a higher prevalence of smoking among youth whose parents were born in the 1930s. CONCLUSIONS: Individual characteristics and the influence of peers and family were relevant for smoking by the youth. Increasing the dialogue among teenagers, school, schoolmates, friends, and parents could lead to a reduction of substance use among youth.

Criteria to evaluate the quality of alginate wound dressings.

OBJECTIVES: to validate an instrument with criteria to evaluate the quality of calcium alginate wound dressings to treat skin injuries. METHODS: methodological study, developed in two stages: the elaboration of criteria to evaluate the quality of the alginate wound dressing based on literature; validation of these criteria by a group of evaluators in two moments. Data was analyzed using descriptive statistics, central tendency measures and the Content Validity Index. RESULTS: seven articles were selected, leading to the elaboration of 7 criteria and 11 expected results. The Content Validity Index was 0.98 in stage 1 and 0.93 in stage 2. After adjustments, 8 criteria were validated, and 13 results were expected. FINAL CONSIDERATIONS: the study allowed the validation of criteria to evaluate the quality of calcium alginate wound dressings, helping the nurses to choose with more autonomy and assertiveness.

Factors associated with self-reported exposure to chemical substances at work in Brazil: results from the National Health Survey, 2013.

OBJECTIVE: To describe the prevalence of self-reported exposure to chemical substances at work and its associated factors in a sample of Brazilian adults that participated in the National Health Survey, conducted between 2013 and 2014. METHODS: Our sample consisted of adults aged 18 years or older that answered question E1 of module E: "In the week of July 21-27, 2013 (reference week), did you work as regular employee or intern for at least an hour in any activity paid with cash?" Sociodemographic data, situation and health behaviors were analyzed with single and multivariate binary logistic regression. The model was adjusted by the variables of all groups, adopting a 5% significance level. The values of odds ratio (OR) and respective confidence intervals were obtained. RESULTS: Women (OR = 0.74; 95%CI 0.66-0.82) had a lower chance of exposure to chemicals. The highest chances were observed in groups with no instruction or that attended up to middle-school (OR = 1.77; 95%CI 1.50-2.08), high school (OR = 1.62; 95%CI 1.37-1.91), age between 25 and 54 years (OR = 1.26; 95%CI 1.07-1.48), current smokers (OR = 1.21; 95%CI 1.07-1.37), who reported tiredness (OR = 1.35; 95%CI 1.21-1.50), hearing difficulties (OR = 1.24; 95%CI 1.04-1.48) and who reported having suffered an accident at work (OR = 2.00; 95%CI 1.57-2.54). CONCLUSIONS: The unprecedented results cover the entire workforce. Positive associations with hearing loss, smoking and history of work accidents are consistent, as well as the inverse association with education level and gender differences. The absence of association with asthma was surprising. To fill gaps in investigations on chronic non-communicable diseases, we suggested improving the PNS collection instrument in the occupational dimension.

Reproducibility of the alcoholic beverages and illicit drug modules of the 2015 National Survey of School Health. / Reprodutibilidade dos módulos bebidas alcoólicas e drogas ilícitas da Pesquisa Nacional de Saúde do Escolar 2015.

OBJECTIVE: To evaluate the reproducibility of the modules of use of alcoholic beverages and illicit drugs of the 2015 National Survey of School Health. METHOD: Cross-sectional epidemiological study aimed at evaluating the reproducibility of collection instruments, conducted in the city of Divinópolis, Minas Gerais. The sample consisted of students attending the 9th grade of public and private primary schools in 2017. The reproducibility of the modules of use of alcohol and illicit drugs was applied to the sample and the retest occurred within 15 to 20 days with the same students. In the analysis of the test-retest agreement, the Kappa coefficient was used to analyze the nominal categorical variables; Kappa with linear weighting, in the analysis of ordinal categorical variables; and Intraclass Correlation Coefficient in the analysis of numerical variables. RESULTS: Participation of 303 students. The agreement of responses was between satisfactory and moderate and there was no indicator with reasonable or poor agreement. Frequencies were close between the test-retest. CONCLUSION: The analyzed modules were satisfactory and considered replicable and reliable sources to support Public Policies and programs aimed at adolescents.

Prevalence and factors associated with binge drinking among Brazilian young adults, 18 to 24 years old. / Prevalência e fatores associados ao consumo excessivo episódico de álcool entre adultos jovens brasileiros de 18 a 24 anos.

OBJECTIVE: To evaluate the prevalence and factors associated with binge drinking (BD) among young Brazilians. METHODS: This cross-sectional study used data from the 2013 National Health Survey. The sample consisted of 7,823 young people aged between 18 and 24 years. The outcome was BD: four or more doses on one occasion for women and five doses or more for men. Sociodemographic, health and behavioral explanatory variables were considered. Binary Logistic Regression was used, with estimation of odds ratio (OR) and 95% confidence intervals (95%CI). RESULTS: The prevalence of BD among young Brazilians was 17%, with regional differences. The associated factors with a higher chance of BD were: 21 and 24 years old (OR = 1.35; 95%CI 1.08 - 1.70); employed (OR = 1.27; 95%CI 1.01 - 1.61); report tiredness (OR = 1.53; 95%CI 1.19 - 1.97) and currently smoking (OR = 4.10; 95%CI 2.95 - 5.70). Women (OR = 0.43; 95%CI 0.34 - 0.54) and participating in religious activities (OR = 0.67; 95%CI 0.53 - 0.84) were associated with a lower chance of BD. CONCLUSIONS: A national study evaluating the profile of young Brazilians who present episodes of binge drinking is important to favor the implementation of public prevention policies aimed at this specific population.

OBJETIVO: Avaliar a prevalência e fatores associados ao consumo excessivo episódico de álcool (CEEA) entre jovens brasileiros. MÉTODOS: Neste estudo transversal, utilizaram-se dados da Pesquisa Nacional de Saúde de 2013. A amostra foi de 7.823 jovens com idade entre 18 e 24 anos. O desfecho foi o CEEA de quatro ou mais doses em uma ocasião para mulheres e de cinco doses ou mais para homens. Foram analisadas variáveis explicativas sociodemográficas, de saúde e comportamentais. Utilizou-se regressão logística binária, com estimação do odds ratio (OR) e intervalos de confiança de 95% (IC95%). RESULTADOS: A prevalência de CEEA entre jovens brasileiros foi de 17%, com diferenças regionais. Foram associados a uma maior chance de CEEA: ter entre 21 e 24 anos (OR = 1,35; IC95% 1,08 - 1,70); exercer atividades remuneradas (OR = 1,27; IC95% 1,01 - 1,61); relatar cansaço (OR = 1,53; IC95% 1,19 - 1,97) e fumar atualmente (OR = 4,10; IC95% 2,95 - 5,70). Ser do sexo feminino (OR = 0,43; IC95% 0,34 - 0,54) e participar de atividades religiosas (OR = 0,67; IC95% 0,53 - 0,84) associaram-se a menor chance de CEEA. CONCLUSÃO: Torna-se importante um estudo nacional que avalie o perfil dos jovens brasileiros que apresentam CEEA para favorecer a implantação de políticas públicas de prevenção voltadas para essa população específica.

Clinical and molecular correlates of the ASPECTS in the acute phase of stroke.

BACKGROUND: The Alberta Stroke Program Early CT Score (ASPECTS) scale was developed for monitoring early ischemic changes on CT, being associated with clinical outcomes. The ASPECTS can also associate with peripheral biomarkers that reflect the pathophysiological response of the brain to the ischemic stroke. OBJECTIVE: To investigate the association between peripheral biomarkers with the Alberta Stroke Program Early CT Score (ASPECTS) in individuals after ischemic stroke. METHODS: Patients over 18 years old with acute ischemic stroke were enrolled in this study. No patient was eligible for thrombolysis. The patients were submitted to non-contrast CT in the first 24 hours of admission, being the Alberta Stroke Program Early CT Score and clinical and molecular evaluations applied on the same day. The National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale and the Mini-Mental State Examination for clinical evaluation were also applied to all subjects. Plasma levels of BDNF, VCAM-1, VEGF, IL-1ß, sTNFRs and adiponectin were determined by ELISA. RESULTS: Worse neurological impairment (NIHSS), cognitive (MEEM) and functional (Rankin) performance was observed in the group with changes in the NCTT. Patients with NCTT changes also exhibited higher levels of IL-1ß and adiponectin. In the linear multivariate regression, an adjusted R coefficient of 0.515 was found, indicating adiponectin and NIHSS as independent predictors of ASPECTS. CONCLUSION: Plasma levels of adiponectin are associated with the ASPECTS scores.

Pressure to work, health status, and work conditions of schoolteachers in Basic Education in Brazil. / Pressão laboral, saúde e condições de trabalho dos professores da Educação Básica no Brasil.

Diseases in general and work absenteeism due to illness are prevalent among schoolteachers in Basic Education, whose mission is essential for preparing future citizens. This study study aimed to produce information on demographics, characteristics of the schools and school systems, and health status of the group of teachers that felt pressured to work even when sick. The probabilistic sample was calculated by simple random selection in order to represent the total universe of 2,229,269 Brazilian schoolteachers working in Basic Education (preschool-12). Teachers answered a multi-thematic questionnaire by telephone. The question leading to the outcome variable, "Do you experience difficulty missing work even when you're feeling pain or have some other health problem?", was tested and validated. The answer allowed empirically operationalizing the concept of pressure to work when sick. The multivariate analysis used Pearson's chi-square test and the decision tree method. The final model's fit was assessed by estimating the risk of incorrect classification. The tree's subdivisions pointed to weak social support as the first determinant of pressure to work, 55% reported difficulty missing work when they were feeling pain or having some other health problem, and 70% of the group that rated their health as bad or very bad felt pressured to appear for work even when sick or in pain. The associated factors were: weak social support, an agitated workplace due to unruly students, and health problems that were considered work-related diseases. Given the goals of valuing schoolteachers in Basic Education, attention should be given to gender differences, management styles, and infrastructure in the schools.

[Prevalence of exposure to occupational noise in Brazilian workers: results of the Brazilian National Health Survey, 2013]. / Prevalência de exposição a ruído ocupacional em trabalhadores brasileiros: resultados da Pesquisa Nacional de Saúde, 2013.

The objectives were to describe the prevalence of occupational exposure to noise and to analyze associated factors in the Brazilian population. This cross-sectional population-based study used data from the Brazilian National Health Survey (PNS, 2013). The sample consisted of 36,442 Brazilians 18 years or older. The outcome variable was self-reported exposure to noise during work. To assess possible factors associated with exposure to noise, we used Pearson's chi-square test and the univariate and multivariate Poisson model with robust variance. The results showed 32.1% prevalence of exposure to noise, varying from 40.9% (Santa Catarina, Brazil) to 21.9% (Piauí, Brazil). Prevalence was lower in women (PR = 0.57; 95%CI: 0.55-0.59) and in individuals 55 years or older (PR = 0.70; 95%CI: 0.65-0.76). Higher prevalence was associated with the 25-54-year age bracket (PR = 1.00; 95%CI: 0.95-1.06), middle schooling level (PR = 1.36; 95%CI: 1.29-1.44), self-reported fatigue (PR = 1.35; 95%CI: 1.30-1.40), hearing impairment (PR = 1.27; 95%CI: 1.19-1.35), and history of work-related accident (PR = 1.37; 95%CI: 1.25-1.50). Prevalence of self-reported exposure to occupational noise was higher than in three other Latin American countries. Higher prevalence among men, younger workers, and those with less schooling was expected. The associations with auditory and non-auditory problems suggest the need for systemic interventions. Adjustments to the questions in the PNS are desirable to favor comparability and monitoring.

O objetivo foi descrever a prevalência de exposição ocupacional a ruído e analisar os fatores associados a essa condição na população brasileira. Neste estudo transversal, de base populacional, utilizaram-se dados da Pesquisa Nacional de Saúde (PNS) de 2013. A amostra foi composta de 36.442 brasileiros com 18 anos ou mais de idade. A variável desfecho foi a exposição autorreferida a ruído durante o trabalho. Para avaliar os possíveis fatores associados à exposição a ruído, foi utilizado o teste qui-quadrado de Pearson, assim como o modelo de Poisson, com variâncias robustas, tanto uni quanto multivariado. Os resultados obtidos identificaram prevalência de exposição ao ruído de 32,1%, variando de 40,9% (Santa Catarina) a 21,9% (Piauí). Houve menor prevalência entre as mulheres (RP = 0,57; IC95%: 0,55-0,59) e no grupo com 55 anos ou mais (RP = 0,70; IC95%: 0,65-0,76). Detectou-se maior prevalência na faixa de 25 a 54 anos (RP = 1,00; IC95%: 0,95-1,06), nível médio de instrução (RP = 1,36; IC95%: 1,29-1,44), relato de cansaço (RP = 1,35; IC95%: 1,30-1,40), dificuldade auditiva (RP = 1,27; IC95%: 1,19-1,35), história de acidente de trabalho (RP = 1,37; IC95%: 1,25-1,50). A prevalência de autorrelato de exposição a ruído ocupacional foi superior àquela observada em três países da América Latina. Maior prevalência entre homens, trabalhadores jovens e menos escolarizados era esperada. As associações com problemas auditivos e não auditivos sugerem medidas sistêmicas. Ajustes das perguntas da PNS são desejáveis para favorecer comparabilidade e monitoramento.

El objetivo fue describir la prevalencia de exposición ocupacional al ruido y analizar factores asociados a esta condición en la población brasileña. En este estudio transversal, de base poblacional, se utilizaron datos de la Encuesta Nacional de Salud (PNS) de 2013. La muestra estaba compuesta por 36.442 brasileños con 18 años o más de edad. La variable desenlace fue la exposición autoinformada al ruido durante el trabajo. Para evaluar los posibles factores asociados a la exposición al ruido se utilizó el test chi-cuadrado de Pearson, así como el modelo de Poisson con variancias robustas, tanto uni- como multivariado. Los resultados obtenidos identificaron una prevalencia de exposición al ruido de 32,1%, variando de 40,9% (Santa Catarina) a 21,9% (Piauí). Menor prevalencia entre las mujeres (RP = 0,57; IC95%: 0,55-0,59) y en el grupo con 55 años o más (RP = 0,70; IC95%: 0,65-0,76). Mayor prevalencia en la franja de 25 a 54 años (RP = 1,00; IC95%: 0,95-1,06), nivel medio de instrucción (RP = 1,36; IC95%: 1,29-1,44), relatos de cansancio (RP = 1,35; IC95%: 1,30-1,40), dificultad auditiva (RP = 1,27; IC95%: 1,19-1,35), historia de accidente laboral (RP = 1,37; IC95%: 1,25-1,50). La prevalencia de autoinforme de exposición a ruido ocupacional fue superior a la observada en tres países latinoamericanos. La mayor prevalencia entre hombres, trabajadores jóvenes y menos escolarizados era esperada. Las asociaciones con problemas auditivos y no auditivos sugieren medidas sistémicas. Es deseable que se produzcan ajustes en las preguntas de la PNS para favorecer comparabilidad y el monitoreo.