Cancer mortality in workers at risk of occupational exposure to ionizing radiation in a company in the nuclear sector headquarters in São Paulo.

OBJECTIVE: To compare cancer mortality among workers exposed to gamma and X radiation and the general population of the city of São Paulo, as well as that of the subgroup monitored with those not monitored for gamma and X radiation in a work unit with ionizing radiation based in the city of São Paulo. METHODS: Between 2016 and 2021, a retrospective open cohort study was carried out with workers who were employed from 08/31/1956 to 12/31/2016 based on data collected at the company and in official institutions. Standardized mortality ratios (SMR) were calculated by sex, age and calendar period of cancers grouped according to type, risk factor and organ system in two analyses: in the external analysis, the mortality of the study population was compared with that of the general population of the city of São Paulo; In the internal analysis, the mortality of the monitored subgroup was compared with that of the subgroup not monitored for gamma and X radiation. RESULTS: The external mortality analysis showed SMR=0.224 (95%CI 0.208-0.240) and the healthy worker effect, while the internal mortality analysis showed SMR=0.685 (95%CI 0.618-0.758). CONCLUSION: This study showed lower cancer mortality among exposed workers when compared to mortality in the general population and the healthy worker effect. Among workers monitored for gamma and X radiation, cancer mortality was lower when compared to those not monitored.

Cancer mortality in workers at risk of occupational exposure to ionizing radiation in a company in the nuclear sector headquarters in São Paulo / Mortalidade por câncer em trabalhadores com risco de exposição ocupacional à radiação ionizante em empresa do setor nuclear sediada em São Paulo

ABSTRACT Objective: To compare cancer mortality among workers exposed to gamma and X radiation and the general population of the city of São Paulo, as well as that of the subgroup monitored with those not monitored for gamma and X radiation in a work unit with ionizing radiation based in the city of São Paulo. Methods: Between 2016 and 2021, a retrospective open cohort study was carried out with workers who were employed from 08/31/1956 to 12/31/2016 based on data collected at the company and in official institutions. Standardized mortality ratios (SMR) were calculated by sex, age and calendar period of cancers grouped according to type, risk factor and organ system in two analyses: in the external analysis, the mortality of the study population was compared with that of the general population of the city of São Paulo; In the internal analysis, the mortality of the monitored subgroup was compared with that of the subgroup not monitored for gamma and X radiation. Results: The external mortality analysis showed SMR=0.224 (95%CI 0.208-0.240) and the healthy worker effect, while the internal mortality analysis showed SMR=0.685 (95%CI 0.618-0.758). Conclusion: This study showed lower cancer mortality among exposed workers when compared to mortality in the general population and the healthy worker effect. Among workers monitored for gamma and X radiation, cancer mortality was lower when compared to those not monitored.

RESUMO Objetivo: Comparar a mortalidade por câncer entre trabalhadores expostos à radiação gama e X e a população geral do município de São Paulo, bem como a do subgrupo monitorado com o não monitorado para radiação gama e X em uma unidade de trabalho sediada no município de São Paulo. Métodos: Entre 2016 e 2021 foi realizado estudo de coorte aberta retrospectiva com trabalhadores que tiveram vínculo empregatício desde 31/08/1956 até 31/12/2016 a partir de dados coletados na empresa e em instituições oficiais. Foram calculadas as razões de mortalidade padronizadas (RMP) por sexo, idade e período calendário de cânceres agrupados segundo o tipo, o fator de risco e o sistema orgânico em duas análises: na análise externa, comparou-se a mortalidade da população de estudo com a da população geral do município de São Paulo; já na análise interna, comparou-se a mortalidade do subgrupo monitorado com a do subgrupo não monitorado para radiação gama e X. Resultados: A análise externa de mortalidade mostrou RMP=0,224 (IC95% 0,208-0,240) e o efeito do trabalhador sadio, enquanto a análise interna de mortalidade mostrou RMP = 0,685 (IC95% 0,618-0,758). Conclusão: Este estudo mostrou menor mortalidade por câncer entre os trabalhadores expostos quando comparada com a mortalidade da população geral e o efeito do trabalhador sadio. Entre os trabalhadores monitorados para radiação gama e X, a mortalidade por câncer foi menor quando comparada com a dos não monitorados.

Overview of SARS-COV-2 infection at the Butantan Penitentiary Progression Center / Panorama da infecção pelo SARS-COV-2 no Centro de Progressão Penitenciária do Butantan

ABSTRACT OBJECTIVE To estimate the prevalence of exposure to the SARS-CoV-2 virus among individuals living in restricted freedom. METHODS A seroprevalence survey was carried out with the population of the female penitentiary of the Centro de Progressão Penitenciária (CPP) in Butantan (municipality of São Paulo), between June 24 and August 20, 2020. During this period, according to the Secretariat of Penitentiary Administration (SAP), the positivity of rapid tests among inmates ranged from 65% to 78%. The evaluation method used in the study was the "One Step COVID-19" rapid test (chromatography), from the company Wondfo, also using the RT-PCR method in symptomatic participants to confirm the viral condition. The study population consisted of 879 female inmates and 170 employees of the institution. RESULTS The prevalence of total antibodies (IgG/IgM) against the SARS-CoV-2 virus in the total population of 1049 study participants was 6.1%; among the population of 879 inmates,a prevalence of 5.8% was observed, and among the institution's employees, 7.5%. CONCLUSIONS The prevalence of covid-19 at the Butantan CPP was low, which is due to the implementation of simple prevention measures at the institution, such as the use of masks (with appropriate changes), emphasis on hygiene, hand washing and social distancing, in addition to other strategies, such as suspending inmates' visits from relatives and friends and cutting back on elective medical appointments and outside work.

RESUMO OBJETIVO Estimar a prevalência da exposição ao vírus SARS-CoV-2 entre indivíduos vivendo em restrição de liberdade. MÉTODOS Foi realizado inquérito de soroprevalência com a população da penitenciária feminina do Centro de Progressão Penitenciária (CPP) do Butantan (município de São Paulo), entre 24 de junho e 20 de agosto de 2020. Nesse período, segundo a Secretaria de Administração Penitenciária (SAP), a positividade dos testes rápidos entre detentos variou de 65 a 78%. O método de avaliação utilizado no estudo foi o teste rápido "One Step COVID-19" (cromatografia), da empresa Wondfo, empregando-se também o método RT-PCR em participantes sintomáticos para confirmação do quadro viral. A população do estudo foi constituída por 879 reeducandas e 170 funcionários da instituição. RESULTADOS A prevalência de anticorpos totais (IgG/IgM) contra o vírus SARS-CoV-2 na população total de 1.049 participantes do estudo foi de 6,1%; entre a população de 879 reeducandas foi observada prevalência de 5,8% e entre os servidores da instituição, 7,5%. CONCLUSÃO Houve baixa prevalência de covid-19 no CPP do Butantan, o que se deve à implementação de medidas de prevenção simples na instituição, como o uso de máscaras (com trocas adequadas), ênfase na higiene, lavagem das mãos e distanciamento social, além de outras estratégias, como suspensão de visitas de familiares e amigos das reeducandas, cortes de consultas médicas eletivas e do trabalho externo.

Violência contra professores da rede pública e esgotamento profissional / Violence against public school teachers and burnout

Resumo A expansão da rede escolar, as mudanças no modelo educacional e os problemas de financiamento mudaram profundamente o trabalho docente no Brasil, intensificando as exigências dirigidas aos profissionais. Problemas de saúde, como o esgotamento profissional, são comuns na categoria. Levantamos a exposição dos professores ao esgotamento profissional e analisamos sua potencial associação aos elementos do contexto ocupacional, inclusive a violência. Os dados foram coletados por meio de entrevistas em profundidade, com uso de dois instrumentos específicos (MBI e CESQT) e analisados estatisticamente com o Programa Stata, v.13.0. Participaram 93 professores da rede pública municipal de São Paulo com indicação de psicoterapia, das diversas regiões da cidade. O esgotamento foi associado ao sofrimento de agressão na escola (p<0,001), ao incômodo nos contatos interpessoais no trabalho (p<0,001) e ao ruído (p<0,001), entre outras 11 variáveis do contexto escolar. Entre os que apresentaram esgotamento grave, 60% haviam sofrido agressão na escola no último ano. Questões coletivas e ocupacionais se associaram ao esgotamento profissional entre os participantes. Entre elas, os conflitos interpessoais e o fenômeno da violência, que surge como elemento novo e frequente, impactam a saúde dos profissionais.

Abstract School expansion, changes in the educational model and funding problems have profoundly changed teaching in Brazil, intensifying demands on teachers. Health problems such as burnout are common in the profession. We investigated teacher burnout and its association with occupational factors, including violence. Data were collected using in-depth interviews and two specific instruments (the Maslach Burnout Inventory and Spanish Burnout Inventory). Statistical analysis was performed using Stata, version 13.0. Ninety-three teachers referred to psychotherapy from public schools in different regions of the city of São Paulo participated in the study. Burnout was associated with 11 school setting variables, including having suffered violence in the school (p <0.001), discomfort with interpersonal contact at work (p <0.001) and noise (p <0.001). Sixty percent of the teachers with severe burnout had suffered violence at school in the last year. Both collective and occupational issues were associated with teacher burnout. Among these, interpersonal conflict and violence, which appears as a new and common problem, adversely affect the health of these professionals.

Residential traffic exposure and lymphohematopoietic malignancies among children in the city of São Paulo, Brazil: An ecological study.

BACKGROUND: Despite widespread evidence that air pollution is carcinogenic, there is little evidence from low-middle income countries, especially related to childhood malignancies. We examined the role of traffic related pollution on lymphohematopoietic malignancies among under-14 s in Sao Paulo. METHODS: All incident cases between 2002 and 2011 were collected from a population-based registry. Exposures were assigned on residential address at diagnosis via traffic density database (for the year 2008) and a satellite derived NO2 land use regression model (averaged between 1997 and 2011). Incidence rate ratios (IRRs) were calculated via Poisson Regression adjusted by age, gender and socioeconomic status (SES), with additional stratification by SES. RESULTS: A positive association between traffic and NO2 with some lymphohematopoietic malignancies was observed with the degree of effect differing by SES. For example, lymphoid leukemia IRRs in the lower SES group were 1.21 (95 % CI: 1.06, 1.39) for traffic density and 1.38 (95 % CI: 1.13, 1.68) for NO2. In the higher group they were 1.06 (95 % CI: 1.00, 1.14) and 1.37 (95 % CI: 1.16, 1.62). CONCLUSION: NO2 and traffic density were associated with Hodgkin lymphoma and lymphoid leukemia among children in São Paulo. Differing IRRs by gender and SES group indicate differences in underlying risk and/or exposure profiles.

Sampling plan and methodological aspects: a household healthcare survey in Piauí / Plano de amostragem e aspectos metodológicos: inquérito de saúde domiciliar no Piauí

ABSTRACT OBJECTIVE To describe the methodological aspects of the Piauí home healthcare survey (ISAD-PI) and assess the relation between sampling plan, precision, and design effects, assuming that population health surveys are relevant instruments for health monitoring. METHODS ISAD-PI was a population-based cross-sectional study that analyzed the living conditions and health status of the population residing in urban areas in the municipalities of Teresina and Picos, in Piauí. Sampling was carried out by conglomerates in two stages: Primary Sampling Units and households. To calculate the sample size, we considered the stratification of the population in both cities, according to the age of the individuals. We evaluated the "non-response" rate (NRR) and estimated the proportions according to sex and age, as well as the prevalence of social determinants of health in order to assess the compliance of the sampling plan. Analyses related to the precision according to the coefficient of proportion variation of the standard error (Cv-pˆ) and the design effect (deff). Cv-pˆ less than 20% and deff less than 1.5 were considered adequate. The total NRR of households was 38.2% in Teresina and 38.3% in Picos. We carried out twenty-four proportion estimates in relation to age and sex and 48 prevalence of social and health determinants estimates, totaling 72 estimates. Among them, 71 had Cv-pˆ less than 20% and 61 had deff less than or equal to 1.5. CONCLUSION Data generated from the ISAD-PI may contribute to the assessment of health and morbidity conditions in the population. Furthermore, methodological aspects employed in this research may serve as a basis for studies carried out in other cities in Brazil.

RESUMO OBJETIVO Descrever os aspectos metodológicos do Inquérito de Saúde Domiciliar no Piauí (ISAD-PI), bem como avaliar a conformidade do plano amostral em relação à precisão e aos efeitos do desenho, dado que os inquéritos populacionais de saúde constituem instrumentos importantes para o monitoramento da situação de saúde da população. MÉTODOS O ISAD-PI foi um estudo de base populacional, transversal, que analisou as condições de vida e situação de saúde da população residente nas áreas urbanas dos municípios de Teresina e Picos, no Piauí. A amostragem foi realizada por conglomerados, em dois estágios: Unidades Primárias de Amostragem e domicílios. Para o cálculo do tamanho da amostra, considerou-se a estratificação da população de ambas as cidades, de acordo com a idade dos indivíduos, para ambos os sexos. Para avaliação da conformidade do plano amostral, foi avaliada a taxa de "não-resposta" (TNR) e, além disso, as estimativas de proporções segundo sexo e idade, bem como as prevalências de determinantes sociais de saúde, que foram analisadas em relação à precisão por meio do coeficiente de variação da proporção do erro padrão (Cv-pˆ) e do efeito do delineamento (deff). Foram considerados adequados Cv-pˆ menores que 20%, e deff menores que 1,5. A TNR-Total dos domicílios foi de 38,2% em Teresina e de 38,3% em Picos. Foram realizadas 24 estimativas de proporção em relação à idade e ao sexo e 48 estimativas de prevalência de determinantes sociais e de saúde, totalizando 72 estimativas, das quais 71 apresentaram Cv-pˆ menor que 20% e 61 apresentaram deff menor ou igual a 1,5. CONCLUSÃO Dados gerados a partir do ISAD-PI poderão contribuir para a avaliação das condições de saúde e morbidade na população. Ademais, aspectos metodológicos empregados nesta pesquisa poderão servir de base para estudos realizados em outras cidades do Brasil.

Sampling plan and methodological aspects: a household healthcare survey in Piauí / Plano de amostragem e aspectos metodológicos: inquérito de saúde domiciliar no Piauí

ABSTRACT OBJECTIVE To describe the methodological aspects of the Piauí home healthcare survey (ISAD-PI) and assess the relation between sampling plan, precision, and design effects, assuming that population health surveys are relevant instruments for health monitoring. METHODS ISAD-PI was a population-based cross-sectional study that analyzed the living conditions and health status of the population residing in urban areas in the municipalities of Teresina and Picos, in Piauí. Sampling was carried out by conglomerates in two stages: Primary Sampling Units and households. To calculate the sample size, we considered the stratification of the population in both cities, according to the age of the individuals. We evaluated the "non-response" rate (NRR) and estimated the proportions according to sex and age, as well as the prevalence of social determinants of health in order to assess the compliance of the sampling plan. Analyses related to the precision according to the coefficient of proportion variation of the standard error (Cv-pˆ) and the design effect (deff). Cv-pˆ less than 20% and deff less than 1.5 were considered adequate. The total NRR of households was 38.2% in Teresina and 38.3% in Picos. We carried out twenty-four proportion estimates in relation to age and sex and 48 prevalence of social and health determinants estimates, totaling 72 estimates. Among them, 71 had Cv-pˆ less than 20% and 61 had deff less than or equal to 1.5. CONCLUSION Data generated from the ISAD-PI may contribute to the assessment of health and morbidity conditions in the population. Furthermore, methodological aspects employed in this research may serve as a basis for studies carried out in other cities in Brazil.

RESUMO OBJETIVO Descrever os aspectos metodológicos do Inquérito de Saúde Domiciliar no Piauí (ISAD-PI), bem como avaliar a conformidade do plano amostral em relação à precisão e aos efeitos do desenho, dado que os inquéritos populacionais de saúde constituem instrumentos importantes para o monitoramento da situação de saúde da população. MÉTODOS O ISAD-PI foi um estudo de base populacional, transversal, que analisou as condições de vida e situação de saúde da população residente nas áreas urbanas dos municípios de Teresina e Picos, no Piauí. A amostragem foi realizada por conglomerados, em dois estágios: Unidades Primárias de Amostragem e domicílios. Para o cálculo do tamanho da amostra, considerou-se a estratificação da população de ambas as cidades, de acordo com a idade dos indivíduos, para ambos os sexos. Para avaliação da conformidade do plano amostral, foi avaliada a taxa de "não-resposta" (TNR) e, além disso, as estimativas de proporções segundo sexo e idade, bem como as prevalências de determinantes sociais de saúde, que foram analisadas em relação à precisão por meio do coeficiente de variação da proporção do erro padrão (Cv-pˆ) e do efeito do delineamento (deff). Foram considerados adequados Cv-pˆ menores que 20%, e deff menores que 1,5. A TNR-Total dos domicílios foi de 38,2% em Teresina e de 38,3% em Picos. Foram realizadas 24 estimativas de proporção em relação à idade e ao sexo e 48 estimativas de prevalência de determinantes sociais e de saúde, totalizando 72 estimativas, das quais 71 apresentaram Cv-pˆ menor que 20% e 61 apresentaram deff menor ou igual a 1,5. CONCLUSÃO Dados gerados a partir do ISAD-PI poderão contribuir para a avaliação das condições de saúde e morbidade na população. Ademais, aspectos metodológicos empregados nesta pesquisa poderão servir de base para estudos realizados em outras cidades do Brasil.

Mortality trend due to Hepatitis B and C in the city of São Paulo, 2002-2016.

OBJECTIVE: To describe mortality due to hepatitis B and C as underlying cause in the municipality of São Paulo, verifying the trend of these rates, and to assess the association of these diseases with others, from 2002 to 2016. METHODS: This is a time series study on mortality due to hepatitis B and C according to sex, with data from the Sistema de Informação de Mortalidade (SIM - Mortality Information Sistem). Prais Winsten regression was used in rate trend analysis. RESULTS: The findings of this study showed a trend of decline of mortality from hepatitis B and C in recent years, particularly among males. These infections were important associated causes of liver cell carcinoma and HIV. The proportion of deaths under 70 years of age stands out. CONCLUSIONS: The study provides a baseline for research on mortality trend and the impact of interventions, given the history of expanded detection and supply of treatments, including the most recent antivirals in Brazil, since 2015.

Prevalence of hot flashes in women of 40 to 65 years of age with metabolic syndrome

SUMMARY OBJECTIVE: Hot flashes have a negative impact on the quality of life of women during the menopausal transition and thereafter. The progressive reduction in gonadal estrogen levels associated with aging promotes an accumulation of abdominal fat, dyslipidemia, and arterial hypertension, all of which are components of metabolic syndrome (MetS). The objective of the present study was to estimate the prevalence of hot flashes and evaluate their relationship with MetS in women ≥ 40 years of age. METHODS: This was a cross-sectional study involving women aged between 40 and 65 years. We used the Kupperman index to quantify the climacteric symptoms and the National Cholesterol Education Program Adult Treatment Panel III criteria for the diagnosis of MetS. RESULTS: 1,435 women were initially selected, and we obtained information from 647. The mean age at menopause was 45.99 years (SD 6.61 years) and the prevalence of hot flashes and MetS were 55.83% (95% CI: 52.35-59.25%) and 46.29% (95% CI: 44.75-52.53%), respectively. We identified a positive association between MetS and hot flashes (OR 1.16; 95% CI: 1.01-1.33). CONCLUSIONS: In women ≥ 40 years of age, hot flashes are highly prevalent and appear to be associated with MetS.

RESUMO OBJETIVO: As ondas de calor têm um impacto negativo na qualidade de vida das mulheres no climatério. A redução progressiva dos níveis de estrogênio gonadal associada ao envelhecimento promovem o acúmulo de gordura abdominal, dislipidemia e hipertensão arterial, componentes da síndrome metabólica (SM). O objetivo do presente estudo foi estimar a prevalência de ondas de calor e avaliar sua relação com SM em mulheres com idade ≥40 anos. MÉTODOS: Estudo transversal envolvendo mulheres entre 40 e 65 anos de idade. Utilizamos o índice de Kupperman para quantificar os sintomas climatéricos e os critérios do National Cholesterol Education Program Adult Treatment Panel III para o diagnóstico de SM. RESULTADOS: Mil, quatrocentas e trinta e cinco mulheres foram selecionadas inicialmente e obtivemos informações de 647. A idade média da menopausa foi de 45,99 anos (DP 6,61 anos) e a prevalência de ondas de calor e SM foi de 55,83% (95% CI: 52,35-59,25%) e 46,29% (95% CI: 44,75-52,53%), respectivamente. Identificamos uma associação positiva entre SM e ondas de calor (OR 1,16; IC95%: 1,01-1,33). CONCLUSÕES: Em mulheres com idade ≥40 anos, as ondas de calor são altamente prevalentes e parecem estar associadas a SM.

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.

Mortality trend due to Hepatitis B and C in the city of São Paulo, 2002-2016 / Tendência de mortalidade por hepatites B e C no município de São Paulo, 2002-2016

ABSTRACT OBJECTIVE: To describe mortality due to hepatitis B and C as underlying cause in the municipality of São Paulo, verifying the trend of these rates, and to assess the association of these diseases with others, from 2002 to 2016. METHODS: This is a time series study on mortality due to hepatitis B and C according to sex, with data from the Sistema de Informação de Mortalidade (SIM - Mortality Information Sistem). Prais Winsten regression was used in rate trend analysis. RESULTS: The findings of this study showed a trend of decline of mortality from hepatitis B and C in recent years, particularly among males. These infections were important associated causes of liver cell carcinoma and HIV. The proportion of deaths under 70 years of age stands out. CONCLUSIONS: The study provides a baseline for research on mortality trend and the impact of interventions, given the history of expanded detection and supply of treatments, including the most recent antivirals in Brazil, since 2015.

RESUMO OBJETIVO: Descrever a mortalidade por hepatites B e C como causa básica no município de São Paulo, verificando a tendência dessas taxas, e avaliar a associação dessas doenças a outras no período de 2002 a 2016. MÉTODOS: Trata-se de um estudo de série temporal sobre mortalidade por hepatites B e C segundo sexo, com dados do Sistema de Informação de Mortalidade. A regressão de Prais Winsten foi usada na análise de tendência das taxas. RESULTADOS: Os achados do presente estudo mostraram tendência de declínio da mortalidade por hepatites B e C nos últimos anos, particularmente entre pessoas do sexo masculino. Essas infecções foram causas associadas importantes ao carcinoma de células hepáticas e ao HIV. Destaca-se a proporção de óbitos com menos de 70 anos de idade. CONCLUSÕES: O estudo fornece uma linha de base para pesquisas de tendência de mortalidade e de impacto de intervenções, visto o histórico de ampliação da detecção e oferta de tratamentos, incluindo os mais recentes antivirais no Brasil, desde 2015.

Increase in fall-related hospitalization, mortality, and lethality among older adults in Brazil / Internação hospitalar, mortalidade e letalidade crescentes por quedas em idosos no Brasil

ABSTRACT OBJECTIVE To estimate the trends of fall-related hospitalization, mortality, and lethality among older adults in Brazil and regions. METHODS This is a descriptive study based on data from the Hospital Information System of the Brazilian Unified Health System. We included records of every older adult, aged 60 years or older, hospitalized for accidental fall from January, 1998 to November, 2015 in all Brazilian regions. We selected the codes E885, E886, E880, E884, E884 from the International Classification of Diseases, 9th revision, and W01, W03, W10, W17, W18 from the 10th revision, and calculated fall-related hospitalization and mortality rates per 100,000 inhabitants, as well as lethality. To estimate trends, we applied the Prais-Winsten regression for time series analysis. RESULTS During the period, 1,192,829 fall-related hospitalizations occurred, among which 54,673 had a fatal outcome; lethality was 4.5%. Hospitalization rates showed upward trends, with seasonality, in Brazil (11%), and in the Northeast (44%), Midwest (13%), and South regions (14%). The North showed a decreasing hospitalization rate (48%), and the Southeast a stationary one (3%). CONCLUSIONS In Brazil, fall-related hospitalizations, mortality, and lethality among older adults showed an upward trend from 1998 to 2015, with seasonal peaks in the second and third quarters. Considering we are in plain demographic transition, to improve hospital healthcare and encourage falls prevention programs among older adults is essential.

RESUMO OBJETIVO Estimar as tendências de internação, mortalidade e letalidade por quedas em idosos no Brasil e regiões. MÉTODOS Estudo descritivo realizado a partir de dados do Sistema de Informações Hospitalares do Sistema Único de Saúde. Foram incluídos os registros de todos os idosos, a partir de 60 anos, internados por quedas acidentais entre janeiro de 1998 e novembro de 2015 em todas regiões do Brasil. Foram selecionados os códigos E885, E886, E880, E884, E888 e W01, W03, W10, W17, W18 da Classificação Internacional de Doenças (CID), 9ª e 10ª revisão respectivamente, e calculadas as taxas de internação e mortalidade por quedas por 100.000 habitantes, além da letalidade. Para cálculo de tendências, usou-se o procedimento de Prais-Winsten de autorregressão para análise de séries temporais. RESULTADOS Foram realizadas 1.192.829 internações por quedas no período, ocorreram 54.673 desfechos fatais, e a letalidade foi de 4,5%. As taxas de internação apresentaram tendências crescentes, com sazonalidade, no Brasil e nas regiões Nordeste, Centro-Oeste e Sul (taxas de crescimento de 11%, 44%, 13% e 14%, respectivamente). No Norte, a taxa de internação foi decrescente, e no Sudeste foi estacionária (taxas de crescimento: 48% e 3%). CONCLUSÕES Houve tendência crescente de internações, mortalidade e letalidade por quedas em idosos entre 1998 e 2015 no Brasil, com picos sazonais no segundo e terceiro trimestres. É necessário aprimorar tanto a assistência hospitalar quanto incentivar programas de prevenção de quedas em idosos, visto que estamos em plena transição demográfica.

[Influence of vehicular traffic density on hospital admissions due to respiratory tract cancer in the city of São Paulo, Brazil]. / Influência da densidade de tráfego veicular na internação por câncer do aparelho respiratório no Município de São Paulo, Brasil.

Pollution related to traffic is a major problem in urban centers and a large portion of the population is vulnerable to its health effects. This study sought to identify a potential association between hospital admissions due to respiratory tract cancer and vehicular traffic density in the city of São Paulo, Brazil. It is an ecological study of the public (Hospital Inpatient Authorization - AIH, in Portuguese) and private (Hospital Inpatient Communication - CIH, in Portuguese) health care systems, from 2004 to 2006, geocoded by individuals' residential addresses. Using a Besag-York-Mollié ecological model, we initially evaluated the relationship between number of cases of hospital admission due to respiratory tract cancer in each weighting area and the standardized co-variables: traffic density and Municipal Human Development Index (MHDI) as indicator of socioeconomic status. Using a classic Poisson model, we then evaluated the risk associated with growing traffic density categories. The Besag-York-Mollié model estimated a RR = 1.09 (95%CI: 1.02-1.15) and RR = 1.19 (95%CI: 1.10-1.29) of admission due to respiratory tract cancer for each increase of one standard deviation of traffic and MHDI, respectively. The Poisson model also showed a clear exposure-response gradient for admission due to respiratory tract cancer (IRR = 1.11; 95%CI: 1.07-1.15, for each 10 units of added traffic density). This study suggests that there is an association between residing in areas with high traffic density and hospital admissions due to respiratory tract cancer in the city of São Paulo.

A poluição relacionada ao tráfego é um grande problema nos centros urbanos, e uma grande parcela da população fica vulnerável aos seus efeitos à saúde. Este trabalho teve como objetivo identificar potencial associação entre as internações hospitalares por câncer do aparelho respiratório com a densidade de tráfego veicular no Município de São Paulo, Brasil. É um estudo ecológico com dados de internações hospitalares por câncer dos sistemas público (Autorização de Internação Hospitalar - AIH) e particular (Comunicação de Internação Hospitalar - CIH), de 2004 a 2006, geocodificados por endereço de residência do indivíduo. Mediante um modelo ecológico de Besag-York-Mollié foi avaliada inicialmente a relação entre o número de casos de internação por câncer do aparelho respiratório em cada área de ponderação e as covariáveis padronizadas: densidade de tráfego e Índice de Desenvolvimento Humano Municipal (IDHM) como indicador de status socioeconômico. Sequencialmente, com um modelo clássico de Poisson, procedeu-se uma avaliação do risco associado às categorias crescentes de densidade de tráfego. O modelo de Besag-York-Mollié estimou um RR = 1,09 (IC95%: 1,02-1,15) e RR = 1,19 (IC95%: 1,10-1,29) de internação por câncer do aparelho respiratório, para cada aumento de um desvio padrão da densidade de tráfego e IDHM, respectivamente. Foi também evidenciado pelo modelo de Poisson um claro gradiente de exposição-resposta para internação por câncer respiratório (IRR = 1,11; IC95%: 1,07-1,15, para cada dez unidades de acréscimo da densidade de tráfego). Este trabalho sugere que há associação entre residir em áreas com alta densidade de tráfego e internação por câncer do aparelho respiratório no Município de São Paulo.

La contaminación relacionada con el tráfico es un gran problema en los centros urbanos, y una gran parte de la población es vulnerable a sus efectos para la salud. El objetivo de este trabajo fue identificar la potencial asociación entre los internamientos hospitalarios por cáncer del aparato respiratorio con la densidad del tráfico vehicular en el Municipio de São Paulo, Brasil. Es un estudio ecológico con datos de internamientos hospitalarios por cáncer de los sistemas público (Autorización de Internación Hospitalaria - AIH) y particular (Comunicación de Internación Hospitalaria - CIH), de 2004 a 2006, geocodificados por dirección de residencia del individuo. Mediante el modelo ecológico de Besag-York-Mollié se evaluó inicialmente la relación entre el número de casos de internamiento por cáncer del aparato respiratorio en cada área de ponderación y covariables estandarizadas: densidad de tráfico e Índice de Desarrollo Humano Municipal (IDHM), como indicador de estatus socioeconómico. Secuencialmente, con un modelo clásico de Poisson, se procedió a una evaluación del riesgo asociado a las categorías crecientes de densidad de tráfico. El modelo de Besag-York-Mollié estimó un RR = 1,09 (IC95%: 1,02-1,15) y RR = 1,19 (IC95%: 1,10-1,29) de internamiento por cáncer del aparato respiratorio, para cada aumento de un desvío estándar de la densidad de tráfico e IDHM, respectivamente. Se evidenció también, a través del modelo de Poisson, un claro gradiente de exposición-respuesta para el internamiento por cáncer respiratorio (IRR = 1,11; IC95%: 1,07-1,15, para cada 10 unidades de incremento de la densidad de tráfico). Este trabajo sugiere que existe una asociación entre residir en áreas con alta densidad de tráfico y el internamiento por cáncer del aparato respiratorio en el Municipio de São Paulo.

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.

Influência da densidade de tráfego veicular na internação por câncer do aparelho respiratório no Município de São Paulo, Brasil / Influence of vehicular traffic density on hospital admissions due to respiratory tract cancer in the city of São Paulo, Brazil / Influencia de la densidad de tráfico vehicular en el internamiento por cáncer del aparato respiratorio en el Municipio de São Paulo, Brasil

A poluição relacionada ao tráfego é um grande problema nos centros urbanos, e uma grande parcela da população fica vulnerável aos seus efeitos à saúde. Este trabalho teve como objetivo identificar potencial associação entre as internações hospitalares por câncer do aparelho respiratório com a densidade de tráfego veicular no Município de São Paulo, Brasil. É um estudo ecológico com dados de internações hospitalares por câncer dos sistemas público (Autorização de Internação Hospitalar - AIH) e particular (Comunicação de Internação Hospitalar - CIH), de 2004 a 2006, geocodificados por endereço de residência do indivíduo. Mediante um modelo ecológico de Besag-York-Mollié foi avaliada inicialmente a relação entre o número de casos de internação por câncer do aparelho respiratório em cada área de ponderação e as covariáveis padronizadas: densidade de tráfego e Índice de Desenvolvimento Humano Municipal (IDHM) como indicador de status socioeconômico. Sequencialmente, com um modelo clássico de Poisson, procedeu-se uma avaliação do risco associado às categorias crescentes de densidade de tráfego. O modelo de Besag-York-Mollié estimou um RR = 1,09 (IC95%: 1,02-1,15) e RR = 1,19 (IC95%: 1,10-1,29) de internação por câncer do aparelho respiratório, para cada aumento de um desvio padrão da densidade de tráfego e IDHM, respectivamente. Foi também evidenciado pelo modelo de Poisson um claro gradiente de exposição-resposta para internação por câncer respiratório (IRR = 1,11; IC95%: 1,07-1,15, para cada dez unidades de acréscimo da densidade de tráfego). Este trabalho sugere que há associação entre residir em áreas com alta densidade de tráfego e internação por câncer do aparelho respiratório no Município de São Paulo.

Pollution related to traffic is a major problem in urban centers and a large portion of the population is vulnerable to its health effects. This study sought to identify a potential association between hospital admissions due to respiratory tract cancer and vehicular traffic density in the city of São Paulo, Brazil. It is an ecological study of the public (Hospital Inpatient Authorization - AIH, in Portuguese) and private (Hospital Inpatient Communication - CIH, in Portuguese) health care systems, from 2004 to 2006, geocoded by individuals' residential addresses. Using a Besag-York-Mollié ecological model, we initially evaluated the relationship between number of cases of hospital admission due to respiratory tract cancer in each weighting area and the standardized co-variables: traffic density and Municipal Human Development Index (MHDI) as indicator of socioeconomic status. Using a classic Poisson model, we then evaluated the risk associated with growing traffic density categories. The Besag-York-Mollié model estimated a RR = 1.09 (95%CI: 1.02-1.15) and RR = 1.19 (95%CI: 1.10-1.29) of admission due to respiratory tract cancer for each increase of one standard deviation of traffic and MHDI, respectively. The Poisson model also showed a clear exposure-response gradient for admission due to respiratory tract cancer (IRR = 1.11; 95%CI: 1.07-1.15, for each 10 units of added traffic density). This study suggests that there is an association between residing in areas with high traffic density and hospital admissions due to respiratory tract cancer in the city of São Paulo.

La contaminación relacionada con el tráfico es un gran problema en los centros urbanos, y una gran parte de la población es vulnerable a sus efectos para la salud. El objetivo de este trabajo fue identificar la potencial asociación entre los internamientos hospitalarios por cáncer del aparato respiratorio con la densidad del tráfico vehicular en el Municipio de São Paulo, Brasil. Es un estudio ecológico con datos de internamientos hospitalarios por cáncer de los sistemas público (Autorización de Internación Hospitalaria - AIH) y particular (Comunicación de Internación Hospitalaria - CIH), de 2004 a 2006, geocodificados por dirección de residencia del individuo. Mediante el modelo ecológico de Besag-York-Mollié se evaluó inicialmente la relación entre el número de casos de internamiento por cáncer del aparato respiratorio en cada área de ponderación y covariables estandarizadas: densidad de tráfico e Índice de Desarrollo Humano Municipal (IDHM), como indicador de estatus socioeconómico. Secuencialmente, con un modelo clásico de Poisson, se procedió a una evaluación del riesgo asociado a las categorías crecientes de densidad de tráfico. El modelo de Besag-York-Mollié estimó un RR = 1,09 (IC95%: 1,02-1,15) y RR = 1,19 (IC95%: 1,10-1,29) de internamiento por cáncer del aparato respiratorio, para cada aumento de un desvío estándar de la densidad de tráfico e IDHM, respectivamente. Se evidenció también, a través del modelo de Poisson, un claro gradiente de exposición-respuesta para el internamiento por cáncer respiratorio (IRR = 1,11; IC95%: 1,07-1,15, para cada 10 unidades de incremento de la densidad de tráfico). Este trabajo sugiere que existe una asociación entre residir en áreas con alta densidad de tráfico y el internamiento por cáncer del aparato respiratorio en el Municipio de São Paulo.

Blood lead and cadmium levels in preschool children and associated risk factors in São Paulo, Brazil.

In Brazil, there are scarce data on lead (Pb) and cadmium (Cd) contamination, especially for more vulnerable populations such as preschool children. In this paper, we answer two questions: (1) What are the exposure levels of lead and cadmium in preschool children, in Sao Paulo, Brazil? and (2) What are the risk factors associated with this exposure? This cross-sectional study included 50 day care centers (DCCs), totaling 2463 children aged 1-4 years. Venous blood samples were analyzed by ICP-MS. Questionnaires were administered to the parents. Multiple logistic regression models were used to identify associations between blood lead levels (BLLs) and blood cadmium levels (BCLs) and potential risk factors. The geometric mean for BLLs was 2.16 µg/dL (95% CI: 2.10-2.22 µg/dL), and the 97.5th percentile was 13.9 µg/dL (95% CI: 10.0-17.3 µg/dL). For cadmium exposure, the geometric mean for BCLs was 0.48 µg/L (95% CI: 0.47-0.50 µg/L), and the 95th percentile was 2.57 µg/L (95% CI: 2.26-2.75 µg/L). The DCCs' geographic region was associated with high BLLs and BCLs, indicating hot spots for lead and cadmium exposures. In addition, it was found that the higher the vehicles flow, the higher were the BLLs in children. Red lead in household gates was also an important risk factor for lead exposure. Comparing these results with the findings of the Fourth National Report on Human Exposure to Environmental Chemicals by CDC-2013, it was found that in Brazilian preschool children the BLLs are almost three times higher (97.5th percentile) and the BCLs are almost twelve times higher (95th percentile) than those in U.S. children. This information is essential to formulate public health policies.

High blood lead levels are associated with lead concentrations in households and day care centers attended by Brazilian preschool children.

BACKGROUND: A previous study observed high blood lead levels (BLL) in preschool children attending 50 day care centers (DCC) in São Paulo, Brazil. OBJECTIVE: To identify whether lead levels found in both homes and DCC environments are associated with high blood lead levels. METHODS: Children attending 4 DCCs, quoted here as NR, VA, PS and PF, were divided into two groups according to BLL: high exposure (HE: ≥13.9 µg/dL; 97.5 percentile of the 2013 year sample) and low exposure (LE: <5 µg/dL). For in situ lead measurements (lead paint mode: mg/cm2 and ROHS mode: µg/g) in the children's households and in the DCC environments, a field portable X-ray-fluorescence analyzer was used. Multiple logistic regressions were performed to control for confounding factors. Odds ratios were adjusted for age, sex, day care center's measured lead, and tobacco. RESULTS: In an NR DCC building, 33.8% of the measurements had lead levels >600 µg/g, whereas such levels were observed in 77.1% of NR playground measurements. In VA DCC, 22% and 23% of the measurements in the building and in the playgrounds had levels higher than 600 µg/g, respectively. The percentage of high lead levels in the children's houses of the LE group was 5.9% (95% CI: 4.3-7.6%) and 13.2 (95% CI: 8.3-18.0%) in the HE group. Moreover, a significant association was found between high BLLs and lead levels found both in households and DCCs (p < 0.001). Most of the high lead measurements were found in tiles and playground equipment. CONCLUSIONS: Lead exposure estimated from the DCCs, where children spend about 10 h/day, can be as relevant as their household exposure. Therefore, public authorities should render efforts to provide a rigorous surveillance for lead-free painting supplies and for all objects offered to children.

Can in vivo surface dental enamelmicrobiopsies be used to measure remote lead exposure?

Measuring lead in the surface dental enamel (SDE) using biopsies is a rapid, safe, and painless procedure. The dental enamel lead levels (DELLs) decrease from the outermost superficial layer to the inner layer of dental enamel, which becomes crucial for the biopsy depth (BD) measurement. However, whether the origin of lead found in SDE is fully endogenous is not yet established. There is also controversy about the biopsy protocol. The aims of this study were to investigate if DELLs are altered by extrinsic contamination (A) and to evaluate the real geometric figure formed by the erosion provoked by biopsy procedure and the respective BD in SDE (B). To accomplish the aim A, lead from 90 bovine incisor crowns lead was determined by graphite furnace atomic absorption spectrometer as a function of exposure time and lead concentration. Two biopsies were performed in each tooth, before and after lead exposure. Six 15-tooth groups differed by exposure time (1 or 30 min) and lead concentrations (A. 0 mg/L-placebo, B. 0.01 mg/L-standard for drinking water, or C. 0.06 mg/L-concentration found in contaminated groundwater). Phosphorus was determined by an inductively coupled plasm optical emission spectrometer to quantify the enamel removed. To compare intakes/losses of lead in SDE among the groups, values of DELL differences between before and after lead exposure were compared by ANOVA (p < 0.05). To attain the objective B, one extracted human permanent tooth was studied by confocal Raman microscopy. Lead measurements and the surface profile were determined. There was no difference in DELL among the groups (p = 0.964). The biopsy bottom surface area, analyzed by microscopy, showed an irregular area, with regions of peaks and valleys, where areas with depth ranging from 0.2 (peaks) to 1.8 µm (valleys) (± 0.1 µm) could be found. BD carried out in vivo is commonly calculated using the cylinder height formula. The real BD was shown to be very similar to already published data. In conclusion, the SDE of erupted teeth does not seem to be susceptible to environmental lead intake, being thus reliable to measure remote exposures to lead.

Prevalence and factors associated with urinary incontinence in climacteric / Prevalência e fatores associados à incontinência urinária no climatério

SUMMARY Objective: To estimate the prevalence and identify associated factors to urinary incontinence (UI) in climacteric women. Method: In a cross-sectional study with a stratified random sample, 1,200 women aged between 35 and 72 years were studied, enrolled in the Family Health Strategy in the city of Pindamonhangaba, São Paulo. Urinary incontinence was investigated using the International Consultation of Incontinence Questionnaire - Short Form, while associated factors were assessed based on a self-reported questionnaire with socio-demographic, obstetric and gynecological history, morbidities and drug use. The prevalence of urinary incontinence was estimated with a 95% confidence interval (95CI) and the associated factors were identified through multiple logistic regression model performed using Stata software, version 11.0. Results: Women had a mean age of 51.9 years, most were in menopause (59.4%), married (87.5%), Catholic (48.9%), and declared themselves black or brown (47.2%). The mean age of menopause of women with UI was 47.3 years. The prevalence of UI was 20.4% (95CI: 17.8-23.1%). The factors associated with UI were urinary loss during pregnancy (p=0.000) and after delivery (p=0.000), genital prolapse (p=0.000), stress (p=0.001), depression (p=0.002), and obesity (p=0.006). Conclusion: The prevalence of UI was lower but similar to that found in most similar studies. Factors associated with the genesis of UI were urinary loss during pregnancy and after delivery, genital prolapse and obesity.

RESUMO Objetivo: estimar a prevalência e identificar os possíveis fatores associados à incontinência urinária (IU) em mulheres no climatério. Método: em estudo analítico transversal com amostra aleatória estratificada, foram estudadas 1.200 mulheres, entre 35 e 72 anos, cadastradas na Estratégia de Saúde da Família do município de Pindamonhangaba, SP. A IU foi investigada por meio do International Consultation of Incontinence Questionnaire – Short Form e os fatores associados, por meio de questionário autorreferido, contendo informações sociodemográficas, história ginecológica e obstétrica, morbidades e uso de medicamentos. Estimou-se a prevalência da incontinência urinária com intervalo de confiança de 95% (IC95%), e os fatores associados foram identificados por meio de um modelo de regressão logística múltipla realizada no Programa Stata, versão 11.0. Resultados: as mulheres apresentavam média etária de 51,9 anos, estavam na menopausa (59,4%), eram casadas (87,5%), católicas (48,9%) e declararam-se negras ou pardas (47,2%). A média de idade da menopausa das mulheres com IU foi de 47,3 anos. A prevalência de IU foi de 20,4% (IC95%: 17,8-23,1). Os fatores associados à IU foram perda urinária na gestação (p=0,000) e no pós-parto (p=0,000), prolapso genital (p=0,000), estresse (p=0,001), depressão (p=0,002) e obesidade (p=0,006). Conclusão: a prevalência de IU foi inferior, mas semelhante à encontrada na maioria dos estudos análogos. Os fatores associados à gênese da IU foram perda urinária na gestação e no pós-parto, prolapso genital e obesidade.

[Association between the degree of implementation of the Brazilian Breastfeeding Network and breastfeeding indicators]. / Associação entre o grau de implantação da Rede Amamenta Brasil e indicadores de amamentação.

This study aimed to evaluate the implementation of the Brazilian Breastfeeding Network and its impact on breastfeeding indicators. Implementation was analyzed according to type, including 56 primary healthcare units from three Brazilian municipalities. For evaluation of the degree of implementation, a score was created for each unit based on compliance with Ministry of Health certification criteria. Effects of implementation were analyzed according to exclusive and overall breastfeeding rates. Eighteen (32.1%) of the units met the four criteria for certification. The study sample included 1,052 children less than one year of age, of whom 563 were less than six months old. Units that met the four criteria for certification showed higher rates of exclusive breastfeeding (44%) when compared to the other units. Difficulties in implementing the Brazilian Breastfeeding Network were identified, and breastfeeding indicators varied according to the number of certification criteria met by the primary healthcare unit.