A study protocol for a randomized clinical trial on exposure and effects of pesticides consumption - the PEST-EXPO Brazil study.

Randomized clinical trials are considered the gold standard for studies with dietary interventions, which is mainly due to the fact that they can establish causal relationships between food exposure and body composition measures or biomarkers. The aim of this study was to describe the details of a double-blind, randomized, clinical trial protocol to identify, characterize and evaluate the effects of human dietary exposure to pesticide residues in food. Specific aspects of planning (development of a research question, determination of objectives, selection of participants, randomization and blinding) and performance (recruitment of participants, measures to improve adherence, data collection, follow-up and evaluation of results) are addressed in this study. The study design proved effective in characterizing dietary patterns with foods originating from both conventional and organic agriculture. A total of 148 individuals were recruited for the study. The conventional group was represented by 47 % of the sample and the organic group was represented by 53 %. The practice of evidence-based nutrition has demanded that trials be well designed and systematically performed in the field of clinical nutrition. Therefore, this clinical trial emphasizes the importance of improving studies with toxicological nutrition that assess sources of exposure through food.•This double-blind, randomized clinical trial details the protocol for identifying, characterizing, and evaluating the effects of dietary exposure to pesticide residues.•The protocol demonstrates that well-designed and systematically conducted trials emphasize the importance of robust methodologies in evidence-based nutrition.•In the face of the global climate crisis, this clinical trial underscores the importance of enhancing studies in toxicological nutrition, particularly those evaluating sources of exposure through food, to better understand the dietary impacts on health.

Inequalities in access to integrative and complementary health practices in Brazil: National Health Survey, 2019.

Aim: Integrative and complementary practices (PICs) can be important health care strategies, mainly because they consider the integrality of the person. The objective of this article was to verify the inequality in the access to PICs of the Brazilian population based on data from the National Health Survey (PNS). Subject and methods: This is a population-based cross-sectional study, with data from the 2019 PNS. The use of PICs in the past 12 months was investigated. Adjusted analysis was performed using Poisson regression and the Slope Index of Inequality (SII) and the Concentration Index (CIX) were used to assess absolute and relative inequality. Results: The prevalence of PIC use in Brazil was 5.4% (95%CI 5.3; 5.5). Individuals from the richest quintile, with higher education and with health insurance were more likely to use PICs in general, except for medicinal plants/herbal medicine. When observing the magnitude of inequalities, this was more positively accentuated in those with higher education and who had a private health plan. Conclusion: The results reveal social inequalities in the access to integrative practices, where the most elitist are more accessed by people with better socioeconomic conditions.

Aging in a rural area in southern Brazil: designing a prospective cohort study.

INTRODUCTION: This article presents the methods used to design a prospective cohort study with older adults from a rural area in the far south of Brazil (EpiRural Cohort Study), as well as to describe the cohort profile. METHODS: The cohort study began in 2017 and evaluated older adults (≥60 years) living in rural area. The first follow-up of the cohort was carried out between September 2018 and March 2019. Data collection at baseline and first follow-up was performed through an electronic questionnaire containing demographic, socioeconomic and health-related questions, such as alcohol and cigarette consumption, morbidities and self-perceived health status. RESULTS: At baseline, 1130 older adults were sampled, 1029 of whom were interviewed (91.1%). The age of almost 17% was 80 years or more, and 55.2% were male. At first follow-up, 862 individuals were followed (83.8%) and the characteristics of the older adults interviewed compared to those not interviewed at follow-up were similar. Between baseline and follow-up, the proportion of individuals aged 70-79 years increased, as well as the proportion of those who had consumed alcoholic beverages in the previous week and who had hypertension. The male-to-female ratio, those who were living alone, working, smokers, diabetics, who had stroke and who reported their health as being very good/good were comparable between the baseline and follow-up. CONCLUSION: With a reasonable follow-up rate, it was possible to transform a cross-sectional study into a prospective cohort study. However, new strategies will be needed to help locate participants more successfully and ensure a good response rate in future follow-ups.

Regular dental care in preschoolers in rural Southern Brazil.

OBJECTIVE: To evaluate if factors related to the mother's previous guidance on her children's dental health and the school attendance of children influence the regular dental care of preschoolers living in the rural area of a municipality in Southern Brazil. METHODS: A population-based study was conducted with 264 children under five years of age and their mothers. Socioeconomic and behavioral data were collected using a questionnaire, and the children were subjected to dental health tests. The outcome was the regular use of dental services. The main exposure variables were children's care in daycare centers or schools and maternal guidance on the child's dental health. Poisson regression analysis with robust variance adjustment was used to estimate prevalence ratios, considering a 95% confidence interval. RESULTS: The prevalence of regular use was 11.4% (95%CI 7.5-15.2). In the adjusted analysis, the regular use of services was associated with the child attending day care center/school (PR = 2.44; 95%CI 1.38-4.34), and the mother received dental health guidance (PR = 4.13; 95%CI 1.77-9.61), even with control for socioeconomic, maternal and child variables. CONCLUSION: When mothers receive previous information on child dental health care and children attend schools or daycare centers, the likelihood of regular dental appointments in preschoolers living in rural locations increases.

Regular dental care in preschoolers in rural Southern Brazil / Atendimento odontológico regular em pré-escolares da área rural do Sul do Brasil

ABSTRACT OBJECTIVE To evaluate if factors related to the mother's previous guidance on her children's dental health and the school attendance of children influence the regular dental care of preschoolers living in the rural area of a municipality in Southern Brazil. METHODS A population-based study was conducted with 264 children under five years of age and their mothers. Socioeconomic and behavioral data were collected using a questionnaire, and the children were subjected to dental health tests. The outcome was the regular use of dental services. The main exposure variables were children's care in daycare centers or schools and maternal guidance on the child's dental health. Poisson regression analysis with robust variance adjustment was used to estimate prevalence ratios, considering a 95% confidence interval. RESULTS The prevalence of regular use was 11.4% (95%CI 7.5-15.2). In the adjusted analysis, the regular use of services was associated with the child attending day care center/school (PR = 2.44; 95%CI 1.38-4.34), and the mother received dental health guidance (PR = 4.13; 95%CI 1.77-9.61), even with control for socioeconomic, maternal and child variables. CONCLUSION When mothers receive previous information on child dental health care and children attend schools or daycare centers, the likelihood of regular dental appointments in preschoolers living in rural locations increases.

RESUMO OBJETIVO Avaliar se fatores relacionados à orientação prévia da mãe sobre saúde bucal dos seus filhos e a frequência escolar das crianças influenciam o atendimento odontológico regular de pré-escolares moradores da área rural de um município do Sul do Brasil. MÉTODOS Um estudo de base populacional foi conduzido com 264 crianças menores de cinco anos e suas mães. Dados socioeconômicos e comportamentais foram coletados por meio de questionário e as crianças foram submetidas a exames de saúde bucal. O desfecho foi o uso regular de serviços odontológicos. As variáveis de exposição principais foram o atendimento infantil em creches ou escolas e orientação materna sobre a saúde bucal da criança. A análise de regressão de Poisson com ajuste robusto de variância foi utilizada para estimar as razões de prevalência e intervalos de confiança de 95%. RESULTADOS A prevalência de uso regular foi 11,4% (IC95% 7,5-15,2). Na análise ajustada o uso regular de serviços foi associado à criança frequentar creche/escola (RP = 2,44; IC95% 1,38-4,34) e a mãe ter recebido orientação de saúde bucal (RP = 4,13; IC95% 1,77-9,61), mesmo com controle para variáveis socioeconômicas, maternas e da criança. CONCLUSÃO Quando as mães recebem informações prévias sobre os cuidados com a saúde bucal infantil e as crianças frequentam escolas ou creches, aumenta a probabilidade de consultas odontológicas regulares em pré-escolares residentes em localidades rurais.

O processo de trabalho dos serviços de saúde frente a desastre de incêndio em casa noturna / The work process of the health services regarding a nightclub fire disaster

RESUMO Este estudo qualitativo objetivou identificar e descrever a organização dos serviços de saúde e as estratégias de cuidado disponibilizadas às pessoas atingidas por um incêndio em uma casa noturna em Santa Maria (RS). Foram realizadas entrevistas semiestruturadas com trabalhadores de diferentes serviços de saúde no município. Identificaram-se fragilidades nos processos de referência e contrarreferência, comunicação e gestão, situações que existiam e se evidenciaram diante do cenário apresentado, dificultando a constituição de uma linha de cuidado. Pontos positivos foram observados, como a atuação do serviço de saúde mental e o estímulo à atuação multiprofissional, objetivando a integralidade do cuidado prestado às vítimas.

ABSTRACT This qualitative study aimed to identify and describe the organization of health services and care strategies available for people affected by a fire in a nightclub in Santa Maria (RS). Semi-structured interviews were conducted with workers from different health services in the municipality. Fragilities were identified in the referral and counter-referral process, communication and management, situations that existed and were evident in the presented scenario, making it difficult to establish a care line. Positive points were observed, such as the performance of the mental health services and the stimulus to the multiprofessional practice, aiming the integrality of care provided to the victims.