Ethnic disparities in cancer mortality in the capital and northeast of the State of São Paulo, Brazil 2001-17.

PURPOSE: There is a paucity of studies investigating cancer disparities in groups defined by ethnicity in transitioning economies. We examined the influence of ethnicity on mortality for the leading cancer types in São Paulo, Brazil, comparing patterns in the capital and the northeast of the state. METHODS: Cancer deaths were obtained from a Brazilian public government database for the Barretos region (2003-2017) and the municipality of São Paulo (2001-2015). Age-standardized rates (ASR) per 100,000 persons-years, by cancer type and sex, for five self-declared racial classifications (white, black, eastern origin (Asian), mixed ethnicity (pardo), and indigenous Brazilians), were calculated using the world standard population. RESULTS: Black Brazilians had higher mortality rates for most common cancer types in Barretos, whereas in São Paulo, white Brazilians had higher rates of mortality from breast, colorectal, and lung cancer. In both regions, lung cancer was the leading cause of cancer death among white, black, and pardo Brazilians, with colorectal cancer deaths leading among Asian Brazilians. Black and pardo Brazilians had higher cervical cancer mortality rates than white Brazilians. CONCLUSION: There are substantial disparities in mortality from different cancers in São Paulo according to ethnicity, pointing to inequities in access to health care services.

Thyroid Cancer Incidence and Mortality by Socioeconomic Level in the State of São Paulo, Brazil 2001-2017.

OBJECTIVE: Thyroid cancer is rising largely due to greater detection of indolent or slow-growing tumors; we sought to compare the incidence and mortality profiles of thyroid cancer in the State of São Paulo by socioeconomic status (SES). METHODS: Data on thyroid cancer cases diagnosed from 2003 to 2017 in the Barretos Region and from 2001 to 2015 in the municipality of São Paulo were obtained from the respective cancer registries. Corresponding death data were obtained from a Brazilian public government database. Age-standardized rates were calculated and presented as thematic maps. The rates were also calculated by SES and spatial autocorrelation was assessed by global and local indices. RESULTS: There were 419 cases of thyroid cancer and 21 deaths in Barretos, contrasting with the highly populated São Paulo, with 30 489 cases and 673 deaths. The overall incidence rates in São Paulo (15.9) were three times higher than in Barretos (5.7), while incidence rates in women were close to five times higher in Barretos and four times higher in São Paulo than in men. Mortality rates were, in relative terms, very low in both regions. A clear stepwise gradient of increasing thyroid cancer incidence with increasing SES was observed in São Paulo, with rates in very high SES districts four times those of low SES (31.6 vs 8.1). In contrast, the incidence rates in Barretos presented little variation across SES levels. CONCLUSION: Thyroid cancer incidence varied markedly by SES in São Paulo, with incidence rates rising with increasing socioeconomic index. Overdiagnosis is likely to account for a large proportion of the thyroid cancer burden in the capital.

Bayesian modeling of hematologic cancer and vehicular air pollution among young people in the city of São Paulo, Brazil.

Traffic-related air pollution is being associated with hematologic cancer in young individuals. This study performed a spatial analysis of the hematologic cancer incidence and mortality among younger people, using a Bayesian approach, to associate with traffic density in the city of São Paulo, Brazil. Two databases were employed: incidence (2002-2011) and mortality (2002-2013). The relationships between the cases of hematologic cancer and the covariates - traffic density, the Municipal Human Development Index (MHDI), and population density - were evaluated using a Besag-York-Mollié ecological model with relative risks (RRs) estimates. Per 1-unit standard-deviation increase in traffic density, in the MHDI, and in population density, the RR for the incidence was 1.06 (95% CI: 0.97-1.14), 1.28 (95% CI: 1.16-1.42), and 1.01 (95% CI: 0.94-1.08), respectively. For mortality, no covariates were considered risk factors. Our findings suggest significant association between living in regions with better socioeconomic conditions, where traffic density is usually higher, and risk of hematologic cancer in younger people.

Incidence and mortality for respiratory cancer and traffic-related air pollution in São Paulo, Brazil.

BACKGROUND: Multiple lines of evidence have associated exposure to ambient air pollution with an increased risk of respiratory malignancies. However, there is a dearth of evidence from low-middle income countries, including those within South America, where the social inequalities are more marked. OBJECTIVES: To quantify the association between exposures to traffic related air pollution and respiratory cancer incidence and mortality within São Paulo, Brazil. Further, we aim to investigate the role of socioeconomic status (SES) upon these outcomes. METHODS: Cancer incidence between 2002 and 2011 was derived from the population-based cancer registry. Mortality data (between 2002 and 2013) was derived from the Municipal Health Department. A traffic density database and an annual nitrogen dioxide (NO2) land use regression model were used as markers of exposure. Age-adjusted Binomial Negative Regression models were developed, stratifying by SES and gender. RESULTS: We observed an increased rate of respiratory cancer incidence and mortality in association with increased traffic density and NO2 concentrations, which was higher among those regions with the lowest SES. For cancer mortality and traffic exposure, those in the most deprived region, had an incidence rate ratio (IRR) of 2.19 (95% CI: 1.70, 2.82) when comparing the highest exposure centile (top 90%) to the lowest (lowest 25%). By contrast, in the least deprived area, the IRR for the same exposure contrast was.1.07 (95% CI: 0.95, 1.20). For NO2 in the most deprived regions, the IRR for cancer mortality in the highest exposed group was 1.44 (95% CI: 1.10, 1.88) while in the least deprived area, the IRR for the highest exposed group was 1.11 (95% CI: 1.01, 1.23). CONCLUSIONS: Traffic density and NO2 were associated with an increased rate of respiratory cancer incidence and mortality in São Paulo. Residents from poor regions may suffer more from the impact of traffic air pollution.

Cancer survival in people with AIDS: A population-based study from São Paulo, Brazil.

Cancer survival among people with AIDS (PWA) has been described in developed countries, but there is lack of data from developing countries. The aim of this study was to evaluate survival after cancer diagnosis in PWA and compare it with people without AIDS (non-PWA) in São Paulo, Brazil. A probabilistic record linkage was carried out between the databases of the Population-based Cancer Registry of São Paulo (PBCR-SP) and the AIDS registry of SP (SINAN) to identify PWA who developed cancer. For comparison, non-PWA were frequency matched from the PBCR-SP by cancer site/type, sex, age, and period. Hazard ratio (HR) stratified by matching variables was estimated using a Cox proportional hazards model. A total of 1,294 PWA (20 patients with two primary site tumors) were included in the site/type-specific analyses. AIDS-defining cancers (ADC) comprised 51.9% of cases assessed. The all-cancer 5-year overall survival in PWA was 49.4% versus 72.7% in non-PWA (HR = 2.64; 95%CI = 2.39-2.91). Survival was impaired in PWA for both ADC (HR = 2.93; 95%CI = 2.49-3.45) and non-ADC (HR = 2.51; 95%CI = 2.21-2.84), including bladder (HR = 8.11; 95% CI = 2.09-31.52), lung (HR = 2.93; 95%CI = 1.97-4.36) and anal cancer (HR = 2.53; 95%CI = 1.63-3.94). These disparities were seen mainly in the first year after cancer diagnosis. The overall survival was significantly lower in PWA in comparison with non-PWA in São Paulo, as seen in high-income countries. Efforts to enhance early diagnosis and ensure proper cancer treatment in PWA should be emphasized.

Sociodemographic, anthropometric and behavioural risk factors for ultra-processed food consumption in a sample of 2-9-year-olds in Brazil.

OBJECTIVE: The present study aimed to identify food patterns among 2-9-year-olds and investigate sociodemographic, anthropometric and behavioural predictors of less healthy dietary patterns. DESIGN: Cross-sectional study. Parents of 2-9-year-olds completed an FFQ and factor analysis was applied to identify dietary patterns. Parents also completed questionnaires assessing sociodemographic, anthropometric and behavioural characteristics of parents and children, including parental feeding practices. SETTING: Participants were recruited from private schools of Campinas and São Paulo, SP, Brazil, between April and June 2014. SUBJECTS: Parents of 2-9-year-olds (n 929). RESULTS: Two dietary patterns emerged: 'traditional food' and 'ultra-processed food'. Lower maternal education (OR=2·05, P=0·010) and higher maternal weight status (OR=1·43, P=0·044) were associated with a greater likelihood of the ultra-processed food pattern. Lower perceived parental responsibility for adequacy of food group intake (OR=2·41, P=0·020), and lower scores on the parental feeding practices of 'Healthy Eating Guidance' (OR=1·83, P<0·001) and 'Monitoring' (OR=2·52, P<0·001), were also associated with the presence of this pattern, as was higher child's screen use during mealtimes (OR=1·61, P=0·004). CONCLUSIONS: The present study is the first to evaluate associations between less healthy dietary patterns of Brazilian 2-9-year-olds and parental feeding practices. Our findings highlight sociodemographic, anthropometric and behavioural factors within families that could be used to target tailored policies to at-risk populations.

Relationships between parent feeding behaviors and parent and child characteristics in Brazilian preschoolers: a cross-sectional study.

BACKGROUND: Eating habits formed in early childhood are influenced by parental feeding behaviors, warranting investigation of predictors and correlates of parent feeding. We aimed to describe relationships between parental feeding practices and parent and child characteristics in a sample of Brazilian preschoolers. METHODS: Four hundred and two parents of preschoolers enrolled in private schools of São Paulo and Campinas, Brazil, completed a Brazilian version of the Comprehensive Feeding Practices Questionnaire, as well as questions about parental attitudes, child food intake, other obesity-associated behaviors, and socioeconomic and demographic characteristics. We ran bivariate logistic regression models examining associations between independent variables and each feeding practice. Next, we ran multiple logistic regression models predicting each parental feeding practice. RESULTS: Greater 'Restriction for Weight Control' and 'Restriction for Health' were associated with lower maternal education (OR = 2.42 (CI 95% 1.07-5.48) and 2.79 (CI 95% 1.25-6.22), respectively), and with higher concern about child overweight (OR = 2.46, CI 95% 1.64-3.69 for 'Restriction for Weight Control', only), while greater 'Pressure' was associated with greater concern about child underweight (OR = 2.30, CI 95% 1.53-3.47) and lower maternal BMI (OR = 0.94, CI 95% 0.88-1.00). Greater use of 'Emotion Regulation/ Food as Reward' was associated with lower maternal education (OR = 2.22, CI 95% 1.05-4.71). In analyses of positive feeding practices, lesser use of 'Healthy Eating Guidance' and 'Monitoring' was associated with greater intake of less healthy foods in children (OR = 1.53 (CI 95% 1.01-2.32) and OR = 1.94 (CI 95% 1.27-2.97), respectively), and greater use of screen devices (OR = 1.59 (CI 95% 1.04-2.44) and OR = 1.57 (CI 95% 1.03-2.39), respectively). Lesser use of 'Healthy Eating Guidance' was additionally associated with higher maternal BMI (OR = 1.09, CI 95% 1.03-1.16), and lesser use of 'Monitoring' with lesser perceived parent responsibility for child feeding (OR = 1.68, CI 95% 1.12-2.52). CONCLUSIONS: Our results demonstrate diverse socioeconomic, anthropometric and behavioral correlates of parent feeding in a large Brazilian sample of parents of preschoolers.

The role of the local retail food environment in fruit, vegetable and sugar-sweetened beverage consumption in Brazil.

OBJECTIVE: To examine the relationship between the local retail food environment and consumption of fruits and vegetables (FV) and sugar-sweetened beverages (SSB) in São Paulo, Brazil, as well as the moderation effects of income in the studied relationships. DESIGN: Cross-sectional study design that drew upon neighbourhood- and individual-level data. For each participant, community (density and proximity) and community food environment (availability, variety, quality and price) measures of FV and SSB were assessed in retail food stores and specialized fresh produce markets within 1·6 km of their homes. Poisson generalized estimating equations (GEE) were used to model the associations of food consumption with food environment measures, adjusted by individual-level characteristics. SETTING: São Paulo, Brazil. SUBJECTS: Adults (n 1842) residing in the same census tracts (n 52) in São Paulo, Brazil as those where the neighbourhood-level measures were taken. RESULTS: FV availability in neighbourhoods was associated with regular FV consumption (≥5 times/week; prevalence ratio=1·41; 95 % CI 1·19, 1·67). Regular FV consumption prevalence was significantly lower among lower-income individuals living in neighbourhoods with fewer supermarkets and fresh produce markets (P-interaction <0·05). A greater variety of SSB was associated with a 15 % increase in regular SSB consumption (≥5 times/week) prevalence, after adjustment for confounding variables. CONCLUSIONS: Our findings suggest that the local retail food environment is associated with FV and SSB consumption in a Brazilian urban sample.

Validation of the comprehensive feeding practices questionnaire in parents of preschool children in Brazil.

BACKGROUND: Recent national surveys in Brazil have demonstrated a decrease in the consumption of traditional food and a parallel increase in the consumption of ultra-processed food, which has contributed to a rise in obesity prevalence in all age groups. Environmental factors, especially familial factors, have a strong influence on the food intake of preschool children, and this has led to the development of psychometric scales to measure parents' feeding practices. The aim of this study was to test the validity of a translated and adapted Comprehensive Feeding Practices Questionnaire in a sample of Brazilian preschool-aged children enrolled in private schools. METHODS: A transcultural adaptation process was performed in order to develop a modified questionnaire (43 items). After piloting, the questionnaire was sent to parents, along with additional questions about family characteristics. Test-retest reliability was assessed in one of the schools. Factor analysis with oblique rotation was performed. Internal reliability was tested using Cronbach's alpha and correlations between factors, discriminant validity using marker variables of child's food intake, and convergent validity via correlations with parental perceptions of perceived responsibility for feeding and concern about the child's weight were also performed. RESULTS: The final sample consisted of 402 preschool children. Factor analysis resulted in a final questionnaire of 43 items distributed over 6 factors. Cronbach alpha values were adequate (0.74 to 0.88), between-factor correlations were low, and discriminant validity and convergent validity were acceptable. CONCLUSIONS: The modified CFPQ demonstrated significant internal reliability in this urban Brazilian sample. Scale validation within different cultures is essential for a more comprehensive understanding of parental feeding practices for preschoolers.

Evolution of hospital spending with drug-related psychiatric hospital admissions. / Evolução dos gastos hospitalares com internações psiquiátricas por drogas.

OBJECTIVE: To analyse the trend of expenditure on drug-related psychiatric hospital admissions in Maringá, Paraná, Brazil, from 1999 to 2012. METHOD: Ecological time series research with secondary data from the hospital information system of the unified health system ("SIH-SUS"). The records of admissions with a main diagnosis of drug abuse were used to calculate average expenditure. Chapter V of the ICD-10 was used to classify the most frequent diagnoses, namely abuse of alcohol, cannabis, cocaine, and psychoactive substances. The trend was expressed using a polynomial regression model. RESULTS: Average expenditure showed an increasing trend for cocaine and other psychoactive substances, and a decreasing trend for cannabis. Average expenditure for illicit drugs increased significantly. CONCLUSION: The scarcity of economic studies on this subject calls for national studies that address expenditure with drug-related hospital admission to promote the implementation of a psychosocial, outpatient and hospital care network in accord with public healthcare expenditure.

[Development and validation of the Family Vulnerability Index to Disability and Dependence (FVI-DD)]. / Desenvolvimento e validação do índice de vulnerabilidade de famílias a incapacidades e dependência (IVF-ID).

This exploratory, descriptive, cross-sectional, and quantitative study aimed to develop and validate an index of family vulnerability to disability and dependence (FVI-DD). This study was adapted from the Family Development Index, with the addition of social and health indicators of disability and dependence. The instrument was applied to 248 families in the city of Sao Paulo, followed by exploratory factor analysis. Factor validation was performed using the concurrent and discriminant validity of the Lawton scale and Katz Index. The descriptive level adopted for the study was p < 0.05. The final vulnerability index comprised 50 questions classified into seven factors contemplating social and health dimensions, and this index exhibited good internal consistency (Cronbach's alpha = 0.82). FVI-DD was validated using both the Lawton scale and Katz Index. We conclude that FVI-DD can accurately and reliably assess family vulnerability to disability and dependence.

Geographic variations in cancer incidence and mortality in the State of São Paulo, Brazil 2001-17.

BACKGROUND: Cancer is a leading cause of morbidity and mortality in Brazil and the burden is rising. To better inform tailored cancer actions, we compare incidence and mortality profiles according to small areas in the capital and northeast region of the State of São Paulo for the leading cancer types. METHODS: New cancer cases were obtained from cancer registries covering the department of Barretos (2003-2017) and the municipality of São Paulo (2001-2015). Cancer deaths for the same period were obtained from a Brazilian public government database. Age-standardized rates per 100,000 persons-years by cancer and sex are presented as thematic maps, by municipality for Barretos region, and by district for São Paulo. RESULTS: Prostate and breast cancer were the leading forms of cancer incidence in Barretos, with lung cancer leading in terms of cancer mortality in both regions. The highest incidence and mortality rates were seen in municipalities from the northeast of Barretos region in both sexes, while elevated incidence rates were mainly found in São Paulo districts with high and very high socioeconomic status (SES), with mortality rates more dispersed. Breast cancer incidence rates in São Paulo were 30 % higher than Barretos, notably in high and very high SES districts, while corresponding rates of cervical cancer conveyed the opposite profile, with elevated rates in low and medium SES districts. CONCLUSIONS: There is substantial diversity in the cancer profiles in the two regions, by cancer type and sex, with a clear relation between the cancer incidence and mortality patterns observed at the district level and corresponding SES in the capital.

Cancer inequalities in incidence and mortality in the State of São Paulo, Brazil 2001-17.

BACKGROUND: Cancer disparities exist between and within countries; we sought to compare cancer-specific incidence and mortality according to area-level socioeconomic status (SES) in the State of São Paulo, Brazil. METHODS: Cancer cases diagnosed 2003-2017 in the Barretos region and 2001-2015 in the municipality of São Paulo were obtained from the respective cancer registries. Corresponding cancer deaths were obtained from a Brazilian public government database. Age-standardized rates for all cancer combined and the six most common cancers were calculated by SES quartiles. RESULTS: There were 14,628 cancer cases and 7513 cancer deaths in Barretos, and 472,712 corresponding cases and 194,705 deaths in São Paulo. A clear SES-cancer gradient was seen in São Paulo, with rates varying from 188.4 to 333.1 in low to high SES areas, respectively. There was a lesser social gradient for mortality, with rates in low to high SES areas ranging from 86.4 to 98.0 in Barretos, and from 99.2 to 100.1 in São Paulo. The magnitude of the incidence rates rose markedly with increasing SES in São Paulo city for colorectal, lung, female breast, and prostate cancer. Conversely, both cervical cancer incidence and mortality rose with lower levels of SES in both regions. CONCLUSIONS: A clear SES association was seen for cancers of the prostate, female breast, colorectum, and lung for São Paulo. This study offers a better understanding of the cancer incidence and mortality profile according to SES within a highly populated Brazilian state.

Survival inequalities in head and neck cancers: A hospital-based cohort study.

BACKGROUND: We investigated whether the socioeconomic status (SES) influenced survival rates in oropharynx cancers (OPC), oral cavity cancers (OCC), and larynx cancers (LC) in Brazilian patients. METHODS: This hospital-based cohort study assessed the age-standardized 5-year relative survival (RS) using the Pohar Perme estimator. RESULTS: Overall, we identified 37 191 cases, and 5-year RS were 24.4%, 34.1%, and 44.9% in OPC, OCC, and LC, respectively. In multiple Cox regression, the highest risk of death occurred in the most vulnerable social strata for all subsites-that is, illiterates or patients relying on publicly funded healthcare services. Disparities increased over time by 34.9% in OPC due to the rising of survival rates in the highest SES, whereas they reduced by 10.2% and 29.6% in OCC and LC. CONCLUSIONS: The potential inequities were more significant for OPC than for OCC and LC. It is urgent to tackle social disparities to improve prognoses in highly unequal countries.

The impact of late diagnosis on the survival of patients following their first AIDS-related hospitalization in Belo Horizonte, Brazil.

The purpose of this study is to estimate the survival probability of patients following their first admission for the treatment of AIDS to an infectious disease reference hospital in Belo Horizonte, Brazil, during 2005. Study subjects were monitored during a 12-month period to identify factors associated with survival probability. Late diagnosis was recorded among many of the 250 study subjects: almost half (44.8%) were diagnosed less than 30 days prior to or during their hospitalization. A high mortality rate was also detected: 39.6% of the subjects died during the 12 months of monitoring. The cumulative survival probability of the cohort group was estimated at 68.0% after 3 months and at 61.2% after 12 months. However, certain patient subgroups analyzed had even lower cumulative survival probabilities after 12 months of monitoring: if diagnosed during hospitalization, it was estimated at only 48.0% and those with no record of antiretroviral treatment had a 48.5% cumulative survival probability. Patients with severe anemia had the lowest survival probability, similar among the two lymphocyte count groups (<1000 mm(3) and ≥1000 mm(3)), the former with a 45.5% survival probability and the latter with a 46.7% one. The proportional death risk was 2.5-fold higher for men residing in other area than the capital city of the State of Minas Gerais and greater metropolitan region when compared with women residing there. The findings of this study highlight the importance of early diagnosis for predicting patient survival and reinforce the necessity of facilitating HIV diagnosis.

Comparison of application times for ice packs used to relieve perineal pain after normal birth: a randomised clinical trial.

AIMS AND OBJECTIVES: To compare the effect of an ice pack applied for 10, 15 and 20 minutes to relieve perineal pain after birth. BACKGROUND: Perineal pain after vaginal birth, with or without vaginal trauma, is one of the most common morbidities reported for postnatal women. Cryotherapy has been used in postpartum period to relieve perineal pain and investigated in several studies. However, cryotherapy treatment protocols in perineal care vary widely regarding temperature, frequency and duration of the application. DESIGN: A controlled trial, randomised for two groups and with a third group as a historical control. METHOD: The intervention was carried out in a maternity hospital in São Paulo, Brazil. The study population consisted of three groups of 38 women who used an ice pack on the perineum, in a single application: group A-10 minutes; group B-15 minutes; group C-20 minutes (historical control from another clinical trial). Participants' perineal pain magnitude was evaluated through a numerical scale (0-10), at four different points: before the cryotherapy; immediately after and at 20 and 40 minutes after cryotherapy. RESULTS: After application of the ice pack, there was no statistical difference when comparing the perineal pain among groups in the second, third and fourth evaluations. Most of the postnatal women reported pain relief, with 72.8% reporting a decrease in pain >50%; 21.9% reported a decrease between 30-50%. All postnatal women subjected to cryotherapy were favourable to the procedure. CONCLUSION: There is no difference in pain scores following ice pack application in three different times (10, 15 and 20 minutes) in women who report moderate or intense perineal pain after normal delivery. RELEVANCE FOR CLINICAL PRACTICE: Ice treatment is safe, and application times of 10 or 15 minutes are as beneficial as an application time of 20 minutes to relieve perineal pain.

Religiosity as a potential mediator for violence in childhood and adulthood: results from a Brazilian nationally representative survey.

OBJECTIVES: Although previous studies have investigated the role of religiosity in violence outcomes, there is a lack of studies including this aspect as a mediator for violence in childhood and adulthood. This study aimed to investigate the relationship between religiosity and violence in childhood, as well as the possible mediating role of religiosity between suffering violence in childhood and suffering and/or perpetrating violence in adulthood. DESIGN: Cross-sectional population-based study carried out from November 2011 to March 2012. SETTING: Face-to-face surveys (at participants' homes) were performed in a Brazilian nationally representative sample. PARTICIPANTS: A total of 3378 adults (aged 19 years and above) were included. PRIMARY AND SECONDARY OUTCOMES MEASURES: The association between suffering violence in childhood and religiosity, and the mediating role of religiosity between childhood and adulthood violence were analysed using logistic regression models. RESULTS: Religiosity was associated with childhood violence, showing that those who suffered less violence in childhood were more religious in adulthood and considered religion more important in their lives. However, while there was a significant association between suffering violence during childhood and suffering and/or perpetrating violence in adulthood, religiosity did not mediate this relationship. CONCLUSIONS: Although religious individuals self-reported less violence suffered in childhood, religiosity did not show evidence of being a potential mediator for childhood and adulthood violence (experienced and/or perpetrated). These results could help researchers explore this phenomenon, and aid health professionals and managers when proposing future interventions.

Factors associated with work ability and intention to leave nursing profession: a nested case-control study.

This study aims to identify factors associated with impaired work ability and intention to leave the nursing profession. This is a case-control nested within a cross-sectional study. Samples were randomly selected for work ability (475 controls and 158 cases) and intention to leave profession (454 controls and 151 cases). Data on demographic, lifestyle, occupational features, work environment, work ability and intention to leave profession were collected. Multiple logistic regression analysis was performed. Factors associated with work ability impairment were: risk for moderate (OR=1.28) and high (OR=2.26) job strain, effort-reward imbalance (OR=2.82), high overcommitment (OR=1.77), situations that may contribute to musculoskeletal pain/injury with moderate (OR=1.82) or high (OR=2.58) exposures, degree level (OR=2.13) or elementary/high school level (OR=1.67), and low physical activity (OR=1.74). Age of 31-40 years (OR=0.26) and ≥41 years (OR=0.27) were protective factors. Factors associated with intention to leave profession were: high risk for job strain (OR=1.81), effort-reward imbalance (OR=3.25), situations that may contribute to musculoskeletal pain/injury with high exposure (OR=1.54), and insomnia symptoms (OR=2.72). Age >40 years was a protective factor (OR=0.50). Individual characteristics and occupational conditions were associated with work ability impairment and intention to leave profession. Measures to improve working conditions and individual resources were recommended.

Temporal trends in leptospirosis incidence and association with climatic and environmental factors in the state of Santa Catarina, Brazil. / Tendência temporal da leptospirose e sua associação com variáveis climáticas e ambientais em Santa Catarina, Brasil.

Leptospirosis is a zoonosis with epidemic potential, especially after heavy rainfall causing river, urban and flash floods. Certain features of Santa Catarina's coastal region influence these processes. Using negative binomial regression, we investigated trends in the incidence of leptospirosis in the six municipalities with the highest epidemic peaks between 2000 and 2015 and the climatic and environmental variables associated with the occurrence of the disease. Incidence was highest in 2008 and 2011, and peaks occurred in the same month or month after disasters. Incidence showed a strong seasonal trend, being higher in summer months. There was a decrease trend in incidence across the six municipalities (3.21% per year). The climatic and environmental factors that showed the strongest associations were number of rainy days, maximum temperature, presence of flash floods, and river flooding. The impact of these variables varied across the municipalities. Significant interactions were found, indicating that the effect of river flooding on incidence is not the same across all municipalities and differences in incidence between municipalities depend on the occurrence of river flooding.

A leptospirose é uma zoonose que apresenta potencial epidêmico, principalmente após fortes chuvas que acarretam inundações, alagamentos e enxurradas. Algumas características da região costeira de Santa Catarina, localizada no Sul do Brasil, influenciam nesses processos. Portanto, a partir do estudo da leptospirose nos seis municípios do estado com as maiores incidências e picos epidêmicos de 2000 a 2015, buscou-se conhecer a tendência dessa doença e as variáveis climáticas e ambientais associadas à sua ocorrência, ajustando dois modelos com resposta binomial negativa. As maiores incidências foram encontradas em 2008 e 2011, com picos no mesmo mês ou no posterior aos eventos de desastres. A incidência apresentou forte comportamento sazonal, sendo maior nos meses do verão. Observou-se tendência de queda na incidência dos municípios estudados, estimada em 3,21% ao ano. Os fatores climáticos e ambientais mais fortemente associados foram o número de dias de chuva, a temperatura máxima e a presença de enxurrada e de inundação, com diferentes impactos entre os municípios. Houve interações significativas, indicando que o efeito de inundações na incidência não é o mesmo em todos os municípios e que as diferenças nas incidências entre os municípios dependem da ocorrência ou não de inundações.

Working conditions are associated with the occurrence of sleepiness of nursing professionals: a case-control study.

Objectives: To identify the factors associated with the occurrence of sleepiness among nursing professionals. Material and Methods: A case-control study nested in a cross-sectional one, conducted with 364 controls and 121 cases. Data on demographic and occupational characteristics were collected, as well as about lifestyle, physical and psychosocial work environment and somnolence. A multiple logistic regression analysis was performed. Results: The independent factors associated with the presence of sleepiness were as follows: imbalance between efforts and rewards (ORa=3.81; p<0.001), high overcommitment (ORa=3.20; p<0.001), workload equal to or greater than 45 hours a week (ORa=2.30; p=0.001), situations that can generate pain/injury with moderate or high exposure (ORa=1.85; p=0.037), and night work (ORa=1.71; p=0.038). The model was adjusted by gender and age group. Conclusion: Individual and historical-occupational characteristics and, mainly, those related to the physical and psychosocial work environment, were associated with the occurrence of sleepiness. Public and institutional preventive policies must include improvements in the conditions of the physical and psychosocial work environment, as well as strengthening of the individual resources.