Determinantes contextuais e individuais da utilização da triagem auditiva neonatal: Pesquisa Nacional de Saúde, 2013 / Contextual and individual determinants of use of newborn hearing screening: the Brazilian National Health Survey, 2013 / Determinantes contextuales e individuales en la utilización del tamizaje auditivo neonatal: Encuesta Nacional de Salud, 2013

O presente estudo avaliou o efeito de determinantes contextuais e individuais da utilização da triagem auditiva neonatal no Distrito Federal e capitais brasileiras. O modelo teórico conceitual proposto por Andersen & Davidson (2014) orientou as análises mediante modelagem logística multinível, com dados da Pesquisa Nacional de Saúde, 2013. A população observada (n = 585) é representativa de 230.112 duplas de mulheres/responsáveis acima de 18 anos e respectivas crianças menores de 2 anos de idade. No nível contextual (Distrito Federal e capitais), a utilização da triagem auditiva neonatal foi determinada pela proporção de indivíduos extremamente pobres (razão de chances - RC = 0,91; intervalo de 95% de confiança - IC95%: 0,83-0,99) e pela cobertura mensal da triagem auditiva neonatal (RC = 1,02; IC95%: 1,01-1,02). No nível individual, verificou-se maior uso de triagem auditiva neonatal na faixa etária entre 25 e 39 anos, em comparação às < 25 anos. A chance de utilização de triagem auditiva neonatal foi menor em respondentes com raça/cor da pele parda (RC = 0,47; IC95%: 0,26-0,83) em comparação com brancas. Quanto à escolaridade, verificou-se que possuir Ensino Superior completo quase triplicou a chance de uso de triagem auditiva neonatal, em contraste com Ensino Fundamental de estudo formal (RC = 2,99; IC95%: 1,15-7,79). O pré-natal predominantemente privado aumentou em 2,18 vezes a chance de utilizar a triagem auditiva neonatal , em comparação ao público (RC = 2,18; IC95%: 1,02-4,64). A aplicação efetiva de leis e políticas de saúde auditiva já existentes e a priorização de práticas de atenção básica e educação em saúde com foco em neonatos em maior vulnerabilidade, conforme as características identificadas nesse estudo, são iniciativas para ensejar um sistema de proteção social equânime.

The current study assessed the effect of contextual and individual determinants of the use of newborn hearing screening in Brazilian state capitals and the Federal District. The conceptual theoretical model proposed by Andersen & Davidson (2014) oriented the analyses using multilevel logistic modeling with data from the Brazilian National Health Survey, 2013. The study population (n = 585) is representative of 230,112 pairs of women/responsible person over 18 years of age and their respective children under 2 years of age. At the contextual level (state capitals and Federal District), the use of newborn hearing screening was determined by the proportion of extremely poor individuals (odds ratio - OR = 0.91; 95% confidence interval - 95%CI: 0.83-0.99) and by monthly coverage of newborn hearing screening (OR = 1.02; 95%CI: 1.01-1.02). At the individual level, use of newborn hearing screening was higher in the maternal age bracket 25 to 39 years, compared to < 25 years. The odds of use of newborn hearing screening were lower in mothers with brown race/color (OR = 0.47; 95%CI: 0.26-0.83) compared to white mothers. As for schooling, complete university education nearly tripled the odds of newborn hearing screening when compared to primary schooling (OR = 2.99; 95%CI: 1.15-7.79). Predominantly private prenatal care increased the odds of using newborn hearing screening by 2.18 times, compared to public prenatal care (OR = 2.18; 95%CI: 1.02-4.64). Effective enforcement of existing hearing health laws and policies and prioritization of primary healthcare and health education practices with a focus on more vulnerable newborns, based on the characteristics identified in this study, are initiatives that can help ensure an equitable social protection system.

El presente estudio evaluó el efecto de determinantes contextuales e individuales en la utilización del tamizaje auditivo neonatal en el distrito federal y capitales brasileñas. El modelo teórico conceptual, propuesto por Andersen & Davidson (2014), orientó los análisis mediante un modelado logístico multinivel, con datos de la Encuesta Nacional de Salud, 2013. La población observada (n = 585) es representativa de 230.112 parejas de mujeres/responsables con más de 18 años y sus respectivos niños menores de 2 años de edad. En el nivel contextual (distrito federal y capitales), la utilización del tamizaje auditivo neonatal estuvo determinada por la proporción de individuos extremadamente pobres (oportunidad relativa - OR = 0,91; intervalo de 95% de confianza - IC95%: 0,83-0,99) y por la cobertura mensual del tamizaje auditivo neonatal (OR = 1,02; IC95%: 1,01-1,02). En el nivel individual, se verificó un mayor uso de tamizaje auditivo neonatal en la franja etaria entre 25 a 39 años, en comparación con las de < 25 años. La oportunidad de utilización de tamizaje auditivo neonatal fue menor en informantes con raza/color de la piel parda (OR = 0,47; IC95%: 0,26-0,83), en comparación con las blancas. Respecto a la escolaridad, se verificó que posee un Nivel Superior completo casi triplicó la oportunidad de uso de tamizaje auditivo neonatal, en contraste con el Nivel Fundamental de estudio formal (OR = 2,99; IC95%: 1,15-7,79). El prenatal, predominantemente privado, aumentó en 2,18 veces la oportunidad de utilizar el tamizaje auditivo neonatal, en comparación con el público (OR = 2,18; IC95%: 1,02-4,64). La aplicación efectiva de leyes y políticas de salud auditiva ya existentes, y la priorización de prácticas de atención básica y educación en salud, centrándose en neonatos de mayor vulnerabilidad, conforme las características identificadas en ese estudio, son iniciativas para exhibir un sistema de protección social ecuánime.

Associations of neighborhood socioeconomic, natural and built environmental characteristics with a 13-year trajectory of non-work physical activity among civil servants in Rio de Janeiro, Brazil: The Pro-Saude Study.

Positive influences of natural and built environment characteristics on human physical activity have been observed mainly in high-income countries, but mixed results exist. We explored these relationships in Rio de Janeiro, Brazil, where exuberant nature coexists with high levels of social inequality and urban violence. Data originated from questionnaires self-administered by 1731 civil servants at university campuses who participated in 4 waves (1999, 2001, 2007, 2012) of a longitudinal study, and had their residential addresses geocoded. In multinomial regression models, adjusted for individual sociodemographic characteristics, mutually adjusted associations were estimated between 13-year trajectories of non-work physical activity and 8 contextual variables: distances from waterfronts, cycle paths, outdoor gym equipment, and squares; 2 indicators of exposure to greenness (a vegetation index - NDVI - derived from satellite images, and trees close to home); an indicator of walkability (street density), and neighborhood average income. Compared to participants living in the upper quartile of distance to waterfronts, those living in its lowest quartile had 2.6-fold higher odds (aOR: 2.62, 95% CI: 1.37-5.01) of reporting non-work PA in all 4 study waves. Similar results were observed in relation to distance to cycle paths; no independent associations were observed with other natural and built environment variables.

Effect of socioeconomic status on the association between air pollution and mortality in Bogota, Colombia / Efecto del nivel socioeconómico sobre la asociación entre contaminantes atmosféricos y mortalidad en Bogotá, Colombia

Objective. To evaluate the modification effect of socioeconomic status (SES) on the association between acute exposure to particulate matter less than 10 microns in aerodynamic diameter (PM10) and mortality in Bogota, Colombia. Materials and methods. A time-series ecological study was conducted (1998-2006). The localities of the cities were stratified using principal components analysis, creating three levels of aggregation that allowed for the evaluation of the impact of SES on the relationship between mortality and air pollution. Results. For all ages, the change in the mortality risk for all causes was 0.76% (95%CI 0.27-1.26) for SES I (low), 0.58% (95%CI 0.16-1.00) for SES II (mid) and -0.29% (95%CI -1.16-0.57) for SES III (high) per 10µg/m³ increment in the daily average of PM10 on day of death. Conclusions. The results suggest that SES significantly modifies the effect of environmental exposure to PM10 on mortality from all causes and respiratory causes.

Objetivo. Evaluar el efecto modificador del nivel socioeconómico (NSE) sobre la asociación entre la exposición aguda a partículas menores de 10 micras de diámetro aerodinámico (PM10) y la mortalidad en Bogotá, Colombia. Material y métodos. Se realizó un estudio ecológico de series de tiempo (1998-2006). Mediante análisis de componentes principales se estableció una estratificación de las localidades de la ciudad, de lo que se generaron tres niveles de agregación que permitieron evaluar el impacto de la variable NSE en la relación mortalidad-contaminación atmosférica. Resultados. En todas las edades, para la mortalidad por todas las causas, el porcentaje de cambio en el riesgo fue 0.76% (IC95% 0.27-1.26) en el NSE I (bajo), 0.58% (IC95% 0.16-1.00) en el NSE II (medio) y -0.29% (IC95% -1.16-0.57) en el NSE III (alto), por incremento de 10µg/m³ en el promedio diario de PM10 en el día del deceso. Conclusiones. Los resultados sugieren que el NSE modifica de manera significativa el efecto de la exposición ambiental a PM10 sobre la mortalidad por todas las causas y causas respiratorias.

Effect of socioeconomic status on the association between air pollution and mortality in Bogota, Colombia.

OBJECTIVE: To evaluate the modification effect of socioeconomic status (SES) on the association between acute exposure to particulate matter less than 10 microns in aerodynamic diameter (PM10) and mortality in Bogota, Colombia. MATERIALS AND METHODS: A time-series ecological study was conducted (1998-2006). The localities of the cities were stratified using principal components analysis, creating three levels of aggregation that allowed for the evaluation of the impact of SES on the relationship between mortality and air pollution. RESULTS: For all ages, the change in the mortality risk for all causes was 0.76% (95%CI 0.27-1.26) for SES I (low), 0.58% (95%CI 0.16-1.00) for SES II (mid) and -0.29% (95%CI -1.16-0.57) for SES III (high) per 10µg/m³ increment in the daily average of PM10 on day of death. CONCLUSIONS: The results suggest that SES significantly modifies the effect of environmental exposure to PM10 on mortality from all causes and respiratory causes.

Investigating the Time Lag Effect between Economic Recession and Suicide Rates in Agriculture, Fisheries, and Forestry Workers in Korea.

Previous studies on the vast increase in suicide mortality in Southeast Asia have indicated that suicide rates increase in parallel with a rise in unemployment or during periods of economic recession. This paper examines the effects of economic recession on suicidal rates amongst agriculture, fisheries, and forestry workers in Korea. Monthly time-series gross domestic product (GDP) data were linked with suicidal rates gathered from the cause of death records between1993-2008. Data were analyzed using generalized additive models to analyze trends, while a polynomial lag model was used to assess the unconstrained time lag effects of changes in GDP on suicidal rate. We found that there were significant inverse correlations between changes in GDP and suicide for a time lag of one to four months after the occurrence of economic event. Furthermore, it was evident that the overall relative risks of suicide were high enough to bring about social concern.

Risk assessment of PM(2.5) to child residents in Brazilian Amazon region with biofuel production.

BACKGROUND: Exposure to fine fractions of particulate matter (PM(2.5)) is associated with increased hospital admissions and mortality for respiratory and cardiovascular disease in children and the elderly. This study aims to estimate the toxicological risk of PM(2.5) from biomass burning in children and adolescents between the age of 6 and 14 in Tangará da Serra, a municipality of Subequatorial Brazilian Amazon. METHODS: Risk assessment methodology was applied to estimate the risk quotient in two scenarios of exposure according to local seasonality. The potential dose of PM(2.5) was estimated using the Monte Carlo simulation, stratifying the population by age, gender, asthma and Body Mass Index (BMI). RESULTS: Male asthmatic children under the age of 8 at normal body rate had the highest risk quotient among the subgroups. The general potential average dose of PM(2.5) was 1.95 µg/kg.day (95% CI: 1.62 - 2.27) during the dry scenario and 0.32 µg/kg.day (95% CI: 0.29 - 0.34) in the rainy scenario. During the dry season, children and adolescents showed a toxicological risk to PM(2.5) of 2.07 µg/kg.day (95% CI: 1.85 - 2 .30). CONCLUSIONS: Children and adolescents living in the Subequatorial Brazilian Amazon region were exposed to high levels of PM(2.5) resulting in toxicological risk for this multi-pollutant. The toxicological risk quotients of children in this region were comparable or higher to children living in metropolitan regions with PM(2.5) air pollution above the recommended limits to human health.

Motivos que justificam a adesão de adolescentes à prática da natação: qual o espaço ocupado pela saúde? / Reasons which justify the engagement of adolescents in swimming practice: what is health importance?

Acredita-se que um dos principais motivos para a adesão à prática da natação sejam os relacionados à saúde. Contudo, a literatura é carente de estudos que confrontam a incidência da saúde com outros motivos que podem justificar a adesão à prática da natação. Considerando este contexto, o presente estudo teve como objetivo identificar os principais motivos que influenciam os adolescentes a iniciar e a permanecer praticando natação, situando o papel da saúde neste contexto. A amostra foi composta por 98 adolescentes não atletas de ambos os sexos, com idades entre 13 e 18 anos. Foi construído um instrumento de coleta de dados composto por questões objetivas de caracterização do respondente, além de uma escala de opinião sobre os motivos que influenciam adolescentes a permanecer praticando natação. O estudo foi desenvolvido em três estabelecimentos de ensino-aprendizagem de natação no município do Rio de Janeiro. Para verificar a confiabilidade do instrumento de coleta de dados foi utilizado o Coeficiente Alfa, enquanto que para a análise dos dados utilizou-se recursos da estatística descritiva (média, desvio-padrão e percentual) e inferencial (ANOVA - p < 0,05). Os resultados revelaram que os motivos relacionados à saúde correspondem a 13 por cento do total. Já a escala de opinião utilizada para verificar os motivos de permanência revelou que as categorias relacionadas à saúde que obtiveram maiores médias de pontuação, numa escala de até 2 pontos, foram: bem-estar (1,86); condicionamento físico (1,70) e prevenção de doença (1,62). A ANOVA não detectou diferenças nas respostas ao questionário atribuídas pelos indivíduos dos dois sexos. Em conclusão, ao menos na amostra estudada, o fator saúde não exerce um peso acentuado na opção de adolescentes para iniciar um programa de natação. Entretanto, motivos relacionados à saúde vão ganhando importância, constituindo-se num dos principais fatores que justificam a permanência dos indivíduos nos programas de natação.

It is believed that one of the main reasons for the engagement in swimming practice is health-related. However, the literature is scarce on studies which compare the incidence of health with other reasons which may justify the engagement in swimming practice. Within this context, the present study had the aim to identify the main reasons which influence adolescents in initiating as well as continuing to practice swimming, placing the role of health in this context. The sample consisted of 98 non-athlete adolescents of both sexes, with age range from 13 and 18 years. A data collection instrument composed of objective questions of characterization of the interviewees was built; besides an opinion scale on the reasons which have influenced adolescents to keep on swimming. The study was developed in three teaching-learning swimming environments in the city of Rio de Janeiro. The Alpha coefficient has been used to verify the reliability of the data collection instrument, while descriptive statistical analysis (mean, standard deviation and percentage) and inferential (ANOVA - p < 0.05) resources have been used for the data analysis. The outcomes revealed that the health-related reasons correspond to 13 percent of the total. The opinion scale used to verify the reasons for remaining, revealed that the categories concerned with health which had the highest punctuation means in a scale up to two points, were: well-being (1.86); physical fitness (1.70) and disease prevention (1.62). ANOVA did not detect differences in the answers to the questionnaire given by the individuals of both sexes. As a conclusion, at least in the studied sample, health is not a crucial element in adolescents' choice in order to engage in a swimming program. However, health-related reasons have become more important and are one of the main reasons which justify the continuous engagement of individuals in swimming programs.