Precision assessment of a hypertension prevalence survey.

BACKGROUND: Population surveys are crucial for public policy planning and provide valuable representative data. In the health sector studies to identify and assess the prevalence of Arterial Hypertension (AH), a chronic non-communicable disease (NCD), along with its associated risk factors have been conducted. OBJECTIVES: This study aims to assess the effectiveness of a population health survey in estimating the prevalence of arterial hypertension (AH) in the Sorocaba municipality between August 2021 and June 2023. METHODS: The analyzed performance indicator is the precision (design effect - deff) of AH prevalence in adults (≥ 18 years) and their exposure to primary risk factors. The total sample included 1,080 individuals from the urban area, deemed sufficient to estimate a deff of 1.5. This cluster-based study utilized census sectors as clusters, with data collected through household interviews, standardized questionnaires, and measurements of blood pressure and biometric parameters. The deff calculation formula used was weighted variance / raw variance. The Research Ethics Committee approved this study, with registration CAAE 30538520-1-0000-5373. RESULTS: The deff values ranged from 0.44 for chronic obstructive pulmonary disease to 1.63 for asthma, with a deff of 1.00 for AH prevalence. CONCLUSION: The study demonstrated good precision in its results, with high receptivity and cooperation from participants. The cost-effectiveness of the research deemed appropriate. The technique of selecting households within clusters (census sectors) based on detailed mapping and demographic data from the Instituto Brasileiro de Geografia e Estatística (IBGE) proved to be practical and efficient, suitable for replication in other municipalities and for studying other NCDs.

Lack of knowledge about the human papillomavirus vaccine among Brazilian adolescents: A cross-sectional study.

To analyze the distribution and factors associated with lack of knowledge about the human papillomavirus (HPV) vaccine among Brazilian adolescents.Cross-sectional study using the 2019 National School Health Survey among 17,805 Brazilian students of public and private schools, aged 13-17 years. The outcome variable was "lack of knowledge about the HPV vaccine" and the explanatory variables were sociodemographic, behaviors, knowledge, and health conditions. Logistic regression model was used to calculate Odds Ratio (OR) and 95% confidence intervals (95%CI). Spatial analysis techniques were used to determine the formation of clusters in the federated units with similar proportions of adolescents who were unaware of the vaccine. The lack of knowledge about the HPV vaccine was reported by 45.54% of Brazilian students. There was a higher chance of lack of knowledge having had sexual intercourse (OR 1.43; 95% CI 1.20-1.70); attending public school (OR 1.72; 95%CI 1.47-2.02) and located in the Northeast Region (OR 1.35; 95%CI 1.08-1.69). The lower chance of lack of knowledge were female gender (OR 0.41; 95% CI 0.35-0.48), higher maternal education (OR 0.62; 95% CI 0.50-0.77) self-rated health as Poor/very poor (OR 0.64; 95% CI 0.49-0.86) and receiving contraceptive counseling (OR 0.77; 95% CI 0.65-0.91). The proportion of lack of knowledge about the HPV vaccine was higher with the formation of High-High spatial clusters in the states of Maranhão, Piauí, and Pernambuco. Sociodemographic, health, and behavioral conditions and knowledge of students, as well as school characteristics, were associated with lack of knowledge about the HPV vaccine. A higher frequency of lack of knowledge about the HPV vaccine among adolescents was found in the states of the Northeastern Region.

Clear aligner therapy practices among orthodontists practicing in Canada.

BACKGROUND: The acceptability and preference for clear aligner therapy (CAT) has been increasing among orthodontists, but there is still a lack of consensus regarding CAT best practices. Consequently, this study aimed to investigate CAT practices among orthodontists practicing in Canada. METHODS: The survey was conducted among orthodontists practicing in Canada using a modified previously published survey. Sixty orthodontists participated (6.1% response rate). It consisted of 11 sections with open and closed questions related to demographic information and particularities about using or not using CAT. The survey responses were exported from REDCap to a Microsoft Excel (Microsoft, Redmond, Wash) spreadsheet, then statistically analyzed using SPSS software (SPSS for Windows, version 21.0; IBM Inc., Armonk, NY, USA). The comments were categorized under themes and subthemes. Data were organized in descriptive statistics, expressing frequencies and percentages. RESULTS: Almost 30% of the orthodontist's annual caseload was treated with CAT, most frequently prescribed to adult patients. Case complexity and patient cooperation were the factors that most influenced the decision to prescribe CAT. Almost half of orthodontists reported sometimes combining CAT with adjunctive fixed appliances. CONCLUSIONS: Most orthodontists prescribe CAT, and its use is based on the malocclusion's complexity. Orthodontists who do not prescribe CAT believe that fixed appliance therapy has superior treatment outcomes.

Tobacco smoking and tooth loss in adults and elderly in Brazil: a populational-based cross-sectional study.

OBJECTIVES: To determine the association between smoking and tooth loss in individuals aged 18 years or more living in Brazil. METHODS: Secondary analysis of the 2019 Brazilian National Health Survey data. The outcome was self-reported tooth loss, and the main independent variable was tobacco smoking. Family income, schooling, sex and age were covariates. Multiple linear regression analysis determined the association between tobacco smoking and the number of missing teeth and then the average number of missing teeth was predicted according to smoking status. RESULTS: The mean number of missing teeth in 88,531 individuals aged 18 or more was 7.7 (95%CI: 7.6-7.8). At least one missing tooth was identified in 72.0% (95%CI: 71.4-72.6) of the population, 21.3% (95%CI: 20.9-21.7) had a non-functional dentition, 14.2% (95%CI: 13.9-14.6) had severe tooth loss and 10.3% (95%CI: 10.0-10.6) were edentulous. The adjusted regression coefficients for number of missing teeth showed that current or former smokers, individuals with low family income and schooling, older age and females exhibited higher tooth loss. Current and former smokers had 1.40 (95%CI: 1.35-1.46) and 1.13 (95%CI: 0.54-0.98) times more lost teeth than never smokers, respectively. CONCLUSIONS: Both tooth loss and smoking are common in Brazilians and are associated. Unfavorable socioeconomic status and demographic factors also predict tooth loss.

Associação entre avaliação elevada da Atenção Primária à Saúde, estado de saúde e uso dos serviços de saúde no Brasil / Association between high assessment of Primary Health Care and health state and use of health services in Brazil

RESUMO O estudo descreveu as características dos indivíduos que utilizam os serviços da Atenção Primária à Saúde (APS) e avaliou a associação entre a avaliação elevada dos atributos da APS, sob a ótica dos usuários, com o estado de saúde e o uso dos serviços de saúde no Brasil. Trata-se de um estudo transversal que analisou dados da Pesquisa Nacional de Saúde 2019, com amostra de 9.562 adultos que responderam ao Primary Care Assessment Tool (PCATool). Foi testada a associação entre avaliação elevada da APS (escore geral ≥ 6,6) e estado de saúde e uso dos serviços. Verificou-se que os usuários adultos que mais utilizam a APS pública têm entre 40 e 59 anos, são mulheres, de baixa escolaridade e pardos. Os que melhor avaliaram a APS foram indivíduos que utilizaram o mesmo serviço, procuraram serviços nas últimas duas semanas e se internaram. Maior uso dos serviços aponta para melhor avaliação da APS.

ABSTRACT The present study described the characteristics of individuals who use Primary Health Care (PHC) services and evaluated the association between the high assessment of PHC attributes, from the perspective of users, with health conditions and the use of health services in Brazil. This work is a cross-sectional study that analyzed data from the 2019 National Health Survey, in which 9,562 adults responded to the Primary Care Assessment Tool (PCATool). The association between high PHC assessment (general score ≥ 6.6) and health conditions and the use of services was tested, and it was found that the adult users who most use public PHC are between 40 and 59 years of age, women, with a low level of education, and brown. Those who best evaluated PHC were individuals who used the same service, who sought out services in the last 2 weeks, and who had been hospitalized. The greater use of health services points to a better assessment of PHC.

Who is getting COVID-19 boosters? A latent class analysis in a nationally representative sample of Mexican adults 60 years and over.

OBJECTIVE: Estimate COVID-19 vaccine booster uptake and identify sociodemographic profiles associated with vaccine booster uptake in Mexican adults aged 60 and older. METHODS: Using data from the 2022 National Health and Nutrition Survey, we estimated COVID-19 booster uptake in Mexican adults 60 and older. We conducted a latent class analysis using sociodemographic characteristics and then estimated group-specific booster prevalence. RESULTS: Adults aged 60 and older with a completed vaccination schedule had 80.3% booster coverage. Two groups showed the lowest coverage: 1) unemployed and informal working men with elementary education with low socioeconomic status (73.8% boosted), and 2) female homekeepers with elementary education or less living in rural areas (77.0% boosted). CONCLUSIONS: Our analysis points to the need to reach out to men and women with elementary education or less who live in rural areas to strengthen booster campaigns in the future.

Atividade física insuficiente e consumo de alimentos ultraprocessados em adultos brasileiros / Insufficient physical activity and ultra-processed foods consumption in Brazilian adults

To estimate the prevalence of simultaneous insufficient physical activity (IPA) and excessive con-sumption of ultra-processed foods (UPF), and to verify the association between IPA and dietary habits (in natura/minimally processed foods, ultra-processed foods and food consumption markers) in Brazilian adults. Cross-sectional study with data from the Vigitel Telephone Survey 2018. 51,064 adults (≥ 20 years) were studied. IPA covered three domains: leisure, commuting and work (< 150 minutes/week). The scores for in natura/minimally processed foods and UPF (number of subgroups mentioned/previous day) were calculated; ≥ 5 UPF: excessive consumption. Questions on weekly and daily frequency of food consumption were used. Prevalence ratios (PR) were estimated by Poisson regression. The simultaneity of IPA and consumption of UPF was 7.0% (95% CI: 6.50 - 7.55), higher among women (PR = 1.26; 95% CI: 1.08 - 1.47), in residents of the Southeast (PR = 1.23; 95% CI: 1.00 - 1.51) and South (PR = 1.50; 95% CI: 1.22 - 1.84), and was lower in individuals aged ≥ 40 years (40-49: PR = 0.71; 95% CI: 0.56 - 0.88; 50-59: PR = 0.46; 95% CI: 0.36 - 0.58; ≥ 60: PR = 0.45; 95% CI: 0.36 - 0.56) and with health insurance (PR = 0.84; 95% CI: 0.72 - 0.99). IPA was associated with lower consumption of in natura/minimally processed foods and higher consumption of UPF. There was lower regular consumption (≥ 5 days/week) of raw vegetables (PR = 0.82; 95% CI: 0.78 - 0.85), cooked vegetables (PR = 0.88; 95% CI: 0.84 - 0.92), fruit (PR = 0.78; 95% CI: 0.75 - 0.82) and juice (PR = 0.93; 95% CI: 0.89 - 0.97), and higher consumption of soft drinks (≥ 3 days/week: PR = 1.17; 95% CI: 1.11 - 1.23) among individuals with IPA. They also had lower consumption of raw vegetables (2 times/day: PR = 0.93; 95% CI: 0.88 - 0.98), fruit (2 times/day: PR = 0.89; 95% CI: 0.85 - 0.94; ≥ 3 times: PR = 0.84; 95% CI: 0.79 - 0.89) and juice (≥ 2 glasses/day: PR = 0.93; 95% CI: 0.89 - 0.98). An association was identified between IPA and inadequate eating habits, the subgroups most affected by both risk behaviors, which should be prioritized in health promotion and disease prevention strategies.

Estimar a prevalência de simultaneidade de atividade física insuficiente (AFI) e consumo excessivo de alimentos ultraprocessados (AUP), bem como verificar a associação entre AFI e hábitos alimentares (alimentos in natura/minimamente processados, ultraprocessados e marcadores de consumo alimentar) em adultos brasileiros. Estudo transversal com dados do inquérito telefônico Vigitel 2018. Foram estudados 51.064 adultos (≥ 20 anos). AFI abarcou três domínios: lazer, deslocamento, trabalho (< 150 minutos/semana). Calcularam-se os escores de alimentos in natura/minimamente processados e AUP (número de subgrupos referidos/dia anterior); ≥ 5 AUP: consumo excessivo. Foram utilizadas questões sobre a frequência semanal e diária de consumo alimentar. Estimaram-se razões de prevalência (RP) com regressão de Poisson. A simultaneidade de AFI e consumo de AUP foi de 7,0% (IC 95%: 6,50 - 7,55), maior nas mulheres (RP = 1,26; IC 95%: 1,08 - 1,47), nos residentes do Sudeste (RP = 1,23; IC 95%: 1,00 - 1,51) e Sul (RP = 1,50; IC 95%: 1,22 - 1,84), e foi menor nos indivíduos com idade ≥ 40 anos (40-49: RP = 0,71; IC 95%: 0,56 - 0,88; 50 - 59: RP = 0,46; IC 95%: 0,36 - 0,58; ≥ 60: RP = 0,45; IC 95%: 0,36 - 0,56) e com plano de saúde (RP = 0,84; IC 95%: 0,72 - 0,99). A AFI associou-se ao menor consumo de alimentos in natura/minimamente processados e ao maior consumo de AUP. Observou-se menor consumo regular (≥ 5 dias/semana) de hortaliças cruas (RP = 0,82; IC 95%: 0,78 - 0,85), cozidas (RP = 0,88; IC 95%: 0,84 - 0,92), frutas (RP = 0,78; IC 95%: 0,75 - 0,82), suco (RP = 0,93; IC 95%: 0,89 - 0,97), e maior de refrigerante (≥ 3 dias/semana: RP = 1,17; IC 95%: 1,11 - 1,23) entre os indivíduos com AFI. Estes também apresentaram menor consumo de hortaliças cruas (2 vezes/dia: RP = 0,93; IC 95%: 0,88 - 0,98), frutas (2 vezes/dia: RP = 0,89; IC 95%: 0,85 - 0,94; ≥ 3 vezes/dia: RP = 0,84; IC 95%: 0,79 - 0,89) e suco (≥ 2 copos/dia: RP = 0,93; IC 95%: 0,89 - 0,98). Identificou-se associação entre AFI e hábitos alimentares inadequados, os subgrupos mais acometidos por ambos os comportamentos de risco, que devem ser priorizados em estratégias de promoção da saúde e prevenção de agravos.

Child immunization status according to number of siblings and birth order in 85 low- and middle-income countries: a cross-sectional study.

Background: Identification of unvaccinated children is important for preventing deaths due to infections. Number of siblings and birth order have been postulated as risk factors for zero-dose prevalence. Methods: We analysed nationally representative cross-sectional surveys from 85 low and middle-income countries (2010-2020) with information on immunisation status of children aged 12-35 months. Zero-dose prevalence was defined as the failure to receive any doses of DPT (diphtheria-pertussis-tetanus) vaccine. We examined associations with birth order and the number of siblings, adjusting for child's sex, maternal age and education, household wealth quintiles and place of residence. Poisson regression was used to calculate zero-dose prevalence ratios. Findings: We studied 375,548 children, of whom 13.7% (n = 51,450) were classified as zero-dose. Prevalence increased monotonically with birth order and with the number of siblings, with prevalence increasing from 11.0% for firstborn children to 17.1% for birth order 5 or higher, and from 10.5% for children with no siblings to 17.2% for those with four or more siblings. Adjustment for confounders attenuated but did not eliminate these associations. The number of siblings remained as a strong risk factor when adjusted for confounders and birth order, but the reverse was not observed. Among children with the same number of siblings, there was no clear pattern in zero-dose prevalence by birth order; for instance, among children with two siblings, the prevalence was 13.0%, 14.7%, and 13.3% for firstborn, second, and third-born, respectively. Similar results were observed for girls and boys. 9513 families had two children aged 12-35 months. When the younger sibling was unvaccinated, 61.9% of the older siblings were also unvaccinated. On the other hand, when the younger sibling was vaccinated, only 5.9% of the older siblings were unvaccinated. Interpretation: The number of siblings is a better predictor than birth order in identifying children to be targeted by immunization campaigns. Zero-dose children tend to be clustered within families. Funding: Gavi, the Vaccine Alliance.

Prevalence and factors associated with driving under the influence of alcohol in Brazil.

OBJECTIVES: To estimate the prevalence and factors associated with Driving Under the Influence of Alcohol (DUIA) among car drivers and motorcyclists in Brazil and to evaluate the association between DUIA and self-reported Road Traffic Injuries (RTIs) in these groups. METHODS: A cross-sectional study was conducted using data from adults aged 18 or older who participated in the 2019 National Health Survey. Probability sampling was used to recruit participants, and data collection was carried out through home visits. Data from 31,246 car drivers and 21,896 motorcyclists were analyzed. Key indicators included the proportion (%) of car drivers who consumed alcohol and then drove in the past 12 months and the proportion (%) of motorcyclists who consumed alcohol and then drove in the past 12 months. Multiple Poisson regression was used to determine factors associated with DUIA and the association of this variable with RTIs in both groups. RESULTS: DUIA prevalence was 9.4% (95% Confidence Interval [95% CI] = 8.8-10.0) among car drivers and 11.2% (95% CI = 10.4-12.1) among motorcyclists. Among car drivers, DUIA prevalence was higher in men, young adults, those without a spouse/partner, and lower in individuals with lower income and education level. Among motorcyclists, DUIA prevalence was higher in men, young adults, those living outside the capitals and metropolitan regions, and lower in individuals with lower income. DUIA increased the prevalence of self-reported RTIs in the previous 12 months among car drivers and motorcyclists. CONCLUSIONS: A high prevalence of DUIA was evident among drivers, particularly motorcyclists. The DUIA was more prevalent among men and young adults. The DUIA was associated with an increased magnitude of self-reported RTIs among car drivers and motorcyclists. Despite the extensive legislation for zero tolerance toward DUIA in the country, actions need stricter enforcement.

Prevalence of trachoma in indigenous and non-indigenous areas, Northeastern Brazil, 2019-2021.

Objective: To estimate the prevalence of trachoma in indigenous and non-indigenous populations in selected areas of the state of Maranhão, in northeastern Brazil. Methods: This was a population-based survey with probabilistic sampling. For the diagnosis of trachoma, external ocular examination was performed using head magnifying loupes, at 2.5X magnification. The prevalence of trachomatous inflammation - follicular (TF) in children aged 1-9 years and the prevalence of trachomatous trichiasis (TT) in the population aged ≥15 years were estimated. Relative frequencies of sociodemographic and environmental characteristics were obtained. Results: The study included 7 971 individuals, 3 429 from non-indigenous populations and 4 542 from indigenous populations. The prevalence of TF in non-indigenous and indigenous populations was 0.1% and 2.9%, respectively, and the prevalence of TT among indigenous populations was 0.1%. Conclusions: The prevalence of TF and TT in the two evaluation units in the state of Maranhão were within the limits recommended for the elimination of trachoma as a public health problem. However, the prevalence of TF was higher in the indigenous evaluation unit, indicating a greater vulnerability of this population to the disease. The prevalence of TF of below 5.0% implies a reduction in transmission, which may have resulted from improved socioeconomic conditions and/or the implementation of the World Health Organization SAFE strategy.

Using Standardised International Oral Health-Related Datasets in 6 Countries.

INTRODUCTION: Oral diseases affect a significant proportion of the world's population, yet international comparisons involving oral health outcomes have often been limited due to differences in the way country-level primary data are collected. In response to this, the World Dental Federation (FDI) Oral Health Observatory project was launched with the goal of collecting and producing standardised international data on oral health across countries. The aim of this descriptive cross-sectional study was to examine associations between self-reported general health and a range of factors (sociodemographics, oral health-related behaviours, oral impacts, clinical variables) using these standardised international datasets. METHODS: Dentists within FDI member National Dental Associations who chose to take part in the project were selected using a multistage sampling method. The number of dentists in each cluster was set according to the proportion of the national population living in the area, and 50 patients per dentist were systematically approached to take part. Patients and dentists completed 2 separate questionnaires on a mobile app. Ordinal logistic regression (conducted in December 2022) was used to analyse the linked patient and dentist data from 6 countries: China (n = 2242); Colombia (n = 1029); India (n = 999); Italy (n = 711); Japan (n = 1271); and Lebanon (n = 798). Self-reported general health was the dependent variable, with age, sex, education, self-reported oral health-related behaviours, self-reported oral impacts, and clinical variables acting as the independent variables. RESULTS: The results demonstrated a different pattern of associations in the different countries. Better self-reported general health was associated with degree-level education in all 6 countries and with reporting no oral impact and no sensitive teeth in 4 countries. Several country-specific patterns were also found, including the importance of tooth brushing in Colombia, periodontal health in Italy, and differing associations with sugary drinks consumption in India and Japan. CONCLUSIONS: These descriptive findings provide a basis for further research and, importantly, for advocacy in identifying patient oral health care needs according to both person-reported and clinical aspects. This can facilitate optimisation of service provision and potentially influence policy and investments.

Relationship between oral health and depression: data from the National Health Survey 2016-2017.

OBJECTIVE: To evaluate the relationship between oral health status, self-perception of oral health, and depression. METHODS: This cross-sectional study included 2953 individuals that were ≥ 18 years of age and participated in the Chilean National Health Survey (NHS), 2016-2017. Information on oral, dental, and mental health, and the presence or absence of depressive symptoms was collected. Secondary data analysis was carried out using STATA and included logistic regression models adjusted for sex, age, and educational level. The analyses factored in the expansion weights to estimate representative prevalences of the entire population. RESULTS: Participants experiencing frequent dental or prosthesis-related discomfort while speaking (OR: 1.57; 95% CI: 1.01-2.43) were related with exhibiting suspected depression. Removable upper denture users were at a higher risk of exhibiting suspected (OR: 2.04; 95% CI: 1.11-3.74) than those not using them. Participants diagnosed with depression in the past 12 months had a similar number of teeth (median = 24) compared to those without depression (median = 25) (OR: 0.99; 95% CI: 0.96-1.02). CONCLUSION: Experiencing dental or prosthesis-related difficulties in speaking is related to suspected depression or a diagnosis of depression. These findings highlight the importance of developing comprehensive healthcare approaches that consider mental health in the context of oral health.

Associação entre domínios da atividade física e sintomas depressivos em adultos brasileiros: todo movimento conta? / Asociación entre dominios de actividad física y síntomas depresivos en adultos brasileños: ¿cada movimiento cuenta? / Association between physical activity domains and depressive symptoms among Brazilian adults: does every move count?

Resumo: O objetivo desta pesquisa foi investigar a relação da prática de atividade física nos quatro domínios (tempo livre, deslocamento, doméstico e trabalho) e a prevalência de sintomas depressivos em adultos brasileiros, de maneira geral e estratificando-se por sexo, escolaridade e ter ou não diagnóstico referido de depressão. Estudo transversal, com dados de 88.531 indivíduos de 18 anos ou mais, respondentes da Pesquisa Nacional de Saúde de 2019. Os sintomas depressivos foram avaliados pelo Patient Health Questionnaire-9 (Questionário de Saúde do Paciente-9, PHQ-9). Foram considerados fisicamente ativos aqueles que referiram realizar atividade física pelo menos uma vez por semana no respectivo domínio. Adicionalmente, foi realizado o cálculo de tempo de prática semanal, sendo posteriormente divididos em quartis em cada domínio. Para as análises de associação, foram calculados o odds ratio bruto (ORbruto) e ajustado (ORajustado), no total e nas análises estratificadas. Os fisicamente ativos no tempo livre tiveram menor chance de apresentar sintomas depressivos, no total (ORajustado = 0,74; IC95%: 0,64-0,86) e em todas as estratificações, menos naqueles com depressão autorreferida. As associações na atividade física no tempo livre foram mais frequentes naqueles que praticavam entre 121 e 360 minutos semanais. Os indivíduos ativos nos domínios de deslocamento, doméstico e trabalho tiveram maior chance de apresentar sintomas depressivos em alguns grupos, com resultados mais consistentes para a atividade física doméstica. Os resultados evidenciaram que a relação da atividade física com a depressão em brasileiros varia conforme o domínio e a duração da atividade física, e que a ideia de que "todo movimento conta" parece adequada apenas para o domínio de tempo livre.

Resumen: Este estudio tuvo como objetivo investigar la práctica de actividad física en cuatro dominios (ocio, desplazamiento, actividad doméstica y trabajo) y la prevalencia de síntomas depresivos en adultos brasileños, en general y estratificada por sexo, escolaridad y diagnóstico de depresión autoinformado. Se trata de un estudio transversal con datos de 88.531 individuos de 18 años o más, que respondieron la Encuesta Nacional de Salud en el 2019. Los síntomas depresivos se evaluaron mediante el Cuestionario sobre la Salud del Paciente-9 (PHQ-9). Aquellos que realizan actividad física al menos una vez por semana en un dominio determinado se consideraron físicamente activos. Además, se calculó el tiempo de actividad física y luego se dividió en cuartiles para cada dominio. Para los análisis de asociación, se calcularon el odds ratio crudo (ORcrudo) y el odds ratio ajustado (ORajustado) para los análisis total y estratificado. Los individuos que son físicamente activos en durante el ocio presentaron menos probabilidades de tener síntomas depresivos, en el total (ORajustado = 0,74; IC95%: 0,64-0,86) y en todas las estratificaciones, excepto los individuos con depresión autoinformada. Las asociaciones de actividad física en el tiempo libre fueron más frecuentes en quienes practicaban de 121 a 360 minutos/semana. Los individuos que eran activos en los dominios desplazamiento, actividad doméstica y trabajo tuvieron más probabilidades de presentar síntomas depresivos en algunos grupos, con resultados más consistentes para las actividades domésticas. Los resultados mostraron que la relación entre actividad física y depresión entre los brasileños varía según el dominio y la duración, y el concepto de que "cada movimiento cuenta" parece ser correcto solo para el dominio del ocio.

Abstract: This study aimed to investigate the practice of physical activities in the four domains (leisure time, transportation, household, and work) and the prevalence of depressive symptoms in Brazilian adults, in general and stratified by sex, schooling level, and having or not a self-reported diagnosis of depression. This is a cross-sectional study with data from 88,531 individuals aged 18 years or older, who responded to the Brazilian National Health Survey in 2019. The depressive symptoms were evaluated by the Patient Health Questionnaire-9 (PHQ-9). Those who practice physical activities at least once a week in a given domain were considered physically active. Additionally, the calculation of physical activities duration was conducted and later divided into quartiles for each domain. For the association analyses, the crude odds ratio (crudeOR) and adjusted odds ratio (adjustedOR) were calculated for the total and stratified analyses. Individuals who are physically active during leisure time showed a lower chance of presenting depressive symptoms, in total (adjustedOR = 0.74; 95%CI: 0.64-0.86) and in all stratifications, except for individuals with self-reported depression. The associations of leisure-time physical activity were most frequent in those who practice from 121 to 360 minutes/week. The individuals who were active in the transportation, household, and work domains had a higher chance of presenting depressive symptoms in some groups, with more consistent results for household physical activities. The results showed that the relationship between physical activities and depression among Brazilians varies according to domain and duration, and that the concept that "every move counts" seemed to be correct only for the leisure-time domain.

Prevalence of immunization against influenza in elderly Brazilians: National Health Survey, 2019

SUMMARY OBJECTIVE: The aim of this study was to estimate the prevalence of influenza immunization in elderly people in Brazil in 2019. METHODS: This is a population-based cross-sectional study. The Brazilian individuals (≥60 years) who participated in the 2019 National Health Survey were included. The survey was conducted in permanent households in Brazil from August 2019 to March 2020. The prevalences of influenza vaccination and their respective confidence intervals (95%CI) were estimated according to sociodemographic characteristics and the diagnosis of chronic diseases. RESULTS: The prevalence of influenza vaccination was 72.4% (95%CI 71.5-73.2), with statistically significant differences observed between genders (p=0.001), age groups (p=0.001), and those living with a spouse/partner (p=0.002). Significant differences were found in groups with arterial hypertension (75.2%, p<0.001), diabetes (77.2%, p<0.001), and arthritis or rheumatism (75.5%, p<0.001). CONCLUSION: A global prevalence of influenza vaccination of 72.4% was estimated among elderly people in Brazil.

Prevalência e fatores associados à violência contra as mulheres rurais: um estudo transversal, Pesquisa Nacional de Saúde, 2019 / Prevalence of violence against women living in rural areas and associated factors: a cross-sectional study based on the 2019 National Health Survey

Resumo Este estudo transversal objetivou estimar a prevalência e os fatores associados à violência contra as mulheres rurais e descrever os casos positivos segundo autoria, local e frequência, com dados da Pesquisa Nacional de Saúde (2019). Calcularam-se as prevalências brutas e ajustadas de violência contra as mulheres rurais de todo o Brasil nos últimos 12 meses, segundo perfil demográfico, apoio e saúde por meio da regressão de Poisson. A violência psicológica foi de 18%, a física, de 4,4% e a sexual, de 1,5%. Os principais autores eram pessoas conhecidas, a maior parte dos casos ocorreu na residência e as agressões eram recorrentes. As maiores prevalências: mulheres adultas jovens (24,2%), solteiras e divorciadas (20% cada), com ensino fundamental completo ao superior incompleto (22%),, percepções de saúde muito ruim (34%), ruim (30%) e aquelas com problema de saúde mental (30%). Após o ajuste, permaneceram no modelo as de 30-39 anos e de 40 a 49 anos, casadas, com estado de saúde muito ruim, ruim e regular e com problema de saúde mental. Aponta-se para a alta prevalência de violência contra as mulheres rurais.

Abstract The aim of this cross-sectional study was to estimate the prevalence of violence against women living in rural areas, explore associated factors, and characterize cases of violence according to perpetrator, place of occurrence, and frequency. Based on data from the 2019 National Health Survey, using Poisson's regression we calculated crude and adjusted prevalence ratios for violence committed during the last 12 months against women living in rural areas across Brazil, focusing on the following variables: sociodemographic characteristics, income, social support, and self-reported health status. The prevalence of psychological, physical, and sexual violence was 18%, 4.4%, and 1.5%, respectively. Perpetrators were mainly people known to the victim and violence was mainly committed at home and repeated over time. Prevalence was highest among young women (24.2%), single and divorced women (20% each), women who had complete elementary school till not complete higher education (22% each), women with very poor (34%) and poor (30%) self-perceived health status; and women with a mental health problem (30%). After adjustment, the following variables were retained in the model: women aged 30-39 years and 40-49 years; married women; women with very poor, poor, and fair perceived health; and women diagnosed with a mental health problem.

O que os adolescentes do município do Rio de Janeiro, Brasil, têm feito para reduzir sua exposição à violência comunitária? / What have adolescents in Rio de Janeiro city, Brazil, done to reduce their community violence exposure?

Resumo O objetivo do estudo é conhecer as estratégias individuais mais utilizadas por adolescentes de escolas públicas e privadas da IX Região Administrativa do município do Rio de Janeiro para evitar a exposição à violência comunitária, bem como investigar o perfil de coocorrência e sua prevalência em subgrupos populacionais específicos. Trata-se de um estudo seccional com 693 indivíduos. As informações referentes às estratégias para evitar a exposição à violência comunitária foram coletadas por meio de questionário multidimensional autopreenchido em sala de aula. As estratégias mais utilizadas foram: evitar passar onde há pessoas armadas (55,5%), evitar andar sozinho (30,5%) e evitar voltar para casa de madrugada (24,7%). Observou-se que as meninas adotam mais todos (concomitantemente) os quatro tipos de comportamento limitantes para reduzir sua exposição à violência comunitária (53% vs. 32%). Ressalta-se que a adoção de tais estratégias diferiu segundo os indicadores socioeconômicos, sendo maior entre os adolescentes oriundos de família de estratos de renda mais baixos. Tais achados chamam a atenção para a alta frequência de utilização de tais estratégias por adolescentes, o que pode cercear e limitar o pleno desenvolvimento de suas habilidades sociais e culturais.

Abstract This study aims to identify the individual community strategies to avoid violence exposure most used by adolescents from public and private schools in the IX Administrative Region of Rio de Janeiro and investigate the profile of co-occurrence and its prevalence in specific population subgroups. This is a cross-sectional study with 693 individuals. A multidimensional questionnaire collected information regarding strategies to avoid community violence exposure and was self-completed in the classroom. The most used strategies were avoiding walking close to armed people (55.5%), avoiding walking alone (30.5%), and avoiding returning home at dawn (24.7%). Girls adopt more of all (concurrently) the four limiting behaviors to reduce their community violence exposure (53% vs. 32%). Notably, the adoption of such strategies differed by socioeconomic indicators and was higher among adolescents from lower-income households. These findings point to the high frequency of use of such strategies by adolescents, which may hinder and limit the full development of their social and cultural skills.

Prevalence of trachoma in indigenous and non-indigenous areas, Northeastern Brazil, 2019-2021 / Prevalencia del tracoma en zonas de población indígena y no indígena del nordeste de Brasil, 2019-2021 / Prevalência de tracoma em áreas indígenas e não indígenas, Nordeste do Brasil, 2019-2021

ABSTRACT Objective. To estimate the prevalence of trachoma in indigenous and non-indigenous populations in selected areas of the state of Maranhão, in northeastern Brazil. Methods. This was a population-based survey with probabilistic sampling. For the diagnosis of trachoma, external ocular examination was performed using head magnifying loupes, at 2.5X magnification. The prevalence of trachomatous inflammation - follicular (TF) in children aged 1-9 years and the prevalence of trachomatous trichiasis (TT) in the population aged ≥15 years were estimated. Relative frequencies of sociodemographic and environmental characteristics were obtained. Results. The study included 7 971 individuals, 3 429 from non-indigenous populations and 4 542 from indigenous populations. The prevalence of TF in non-indigenous and indigenous populations was 0.1% and 2.9%, respectively, and the prevalence of TT among indigenous populations was 0.1%. Conclusions. The prevalence of TF and TT in the two evaluation units in the state of Maranhão were within the limits recommended for the elimination of trachoma as a public health problem. However, the prevalence of TF was higher in the indigenous evaluation unit, indicating a greater vulnerability of this population to the disease. The prevalence of TF of below 5.0% implies a reduction in transmission, which may have resulted from improved socioeconomic conditions and/or the implementation of the World Health Organization SAFE strategy.

RESUMEN Objetivo. Estimar la prevalencia del tracoma en poblaciones indígenas y no indígenas en determinadas zonas del estado de Maranhão, en el nordeste de Brasil. Métodos. Se trató de una encuesta de ámbito poblacional con muestreo probabilístico. Para el diagnóstico del tracoma, se realizó un examen ocular externo con una lupa frontal de 2,5X aumentos. Se estimó la prevalencia de la inflamación tracomatosa folicular (TF) en la población infantil de 1 a 9 años y la prevalencia de la triquiasis tracomatosa (TT) en la población de 15 años o más. Se obtuvieron las frecuencias relativas de las características sociodemográficas y ambientales. Resultados. En el estudio participaron 7 971 personas, 3 429 de poblaciones no indígenas y 4 542 de poblaciones indígenas. La prevalencia de la TF en las poblaciones no indígenas e indígenas fue de 0,1% y 2,9%, respectivamente, en tanto que la de la TT en las poblaciones indígenas fue de 0,1%. Conclusiones. La prevalencia de la TF y la TT en las dos unidades de evaluación del estado de Maranhão estuvo dentro de los límites recomendados para la eliminación del tracoma como problema de salud pública. Sin embargo, la prevalencia de la TF fue mayor en la unidad de evaluación indígena, lo que indica una mayor vulnerabilidad de esta población a la enfermedad. La prevalencia de la TF inferior al 5,0% implica una reducción de la transmisión, que puede haber sido consecuencia tanto de la mejora de las condiciones socioeconómicas como de la aplicación de la estrategia SAFE de la Organización Mundial de la Salud.

RESUMO Objetivo. Estimar a prevalência do tracoma em populações indígenas e não indígenas em áreas selecionadas do estado do Maranhão, na região Nordeste do Brasil. Métodos. Inquérito de base populacional com amostragem probabilística. Para o diagnóstico de tracoma, foi realizado exame ocular externo com o auxílio de lupas binoculares com ampliação de 2,5×. Foram estimadas a prevalência de inflamação tracomatosa folicular (TF) em crianças de 1 a 9 anos de idade e a prevalência de triquíase tracomatosa (TT) na população com idade ≥15 anos. Foram obtidas as frequências relativas das características sociodemográficas e ambientais. Resultados. O estudo incluiu 7 971 indivíduos (3 429 de populações não indígenas e 4 542 de populações indígenas). A prevalência de TF nas populações não indígenas e indígenas foi de 0,1% e 2,9%, respectivamente, e a prevalência de TT entre as populações indígenas foi de 0,1%. Conclusões. A prevalência de TF e TT nas duas unidades de avaliação no estado do Maranhão ficou dentro dos limites recomendados para a eliminação do tracoma como problema de saúde pública. No entanto, a prevalência de TF foi maior na unidade de avaliação indígena, indicando uma maior vulnerabilidade dessa população à doença. A prevalência de TF abaixo de 5,0% implica uma redução na transmissão, que pode ter sido resultado de melhores condições socioeconômicas e da implementação da estratégia SAFE da Organização Mundial da Saúde.

Surveillance system for Healthcare-associated endophthalmitis at state level in a middle-income country: preliminary results / Sistema de vigilância epidemiológica para endoftalmites em nível estadual em um país de renda média: resultados preliminares

ABSTRACT Purpose: To describe the implementation pro cess and the preliminary results of a surveillance system for healthcare-associated endophthalmitis. Methods: This is a case study of the implementation of a surveillance system for healthcare-associated endophthalmitis. The system for healthcare-associated endophthalmitis is a structured system that enables surveillance of cases of healthcare-associated endophthalmitis after intraocular procedures, developed and coordinated by the Division of Hospital Infection at the State Health Department, São Paulo, Brazil. The implementation process included a pilot phase, followed by a scaling-up phase. Data were reported monthly to the Division of Hospital Infection by participating healthcare facilities that performed intraocular procedures in the state of São Paulo, Brazil, from September 2017 to December 2019. Results: Among the 1,483 eligible healthcare facilities, 175 engaged in the study (participation rate of 11.8%), reporting 222,728 intraocular procedures performed, of which 164,207 were cataract surgery and 58,521 were intravitreal injections. The overall incidence rate of endophthalmitis was reported to be 0.05% (n=105; 80 cases after cataract surgery and 25 cases after intravitreal injections). The incidence rates for healthcare facilities ranged from 0.02% to 4.55%. Most cases were caused by gram-positive bacteria, mainly Staphylococcus spp. In 36 (46.2%) of the cases, there was no bacterial growth; no sample was collected in 28 (26.7%) cases. This system for healthcare-associated endophthalmitis enabled the identification of an outbreak of four cases of endophthalmitis after intravitreal injections. Conclusion: The system for healthcare-associated endophthalmitis proved to be operationally viable and efficient for monitoring cases of endophthalmitis at the state level.

RESUMO Objetivo: Descrever o processo de implementação e os resultados preliminares de um sistema de vigilância epidemiológica para endoftalmites associada à assistência à saúde. Métodos: Trata-se de um estudo de caso de implementação de um sistema de vigilância epidemiológica para endoftalmites. O sistema de vigilância epidemiológica para endoftalmites é um sistema estruturado que possibilita a vigilância de casos de endoftalmite associados à assistência à saúde após procedimentos oftalmológicos invasivos, desenvolvido e coordenado pela Divisão de Infecção Hospitalar da Secretaria de Estado da Saúde, São Paulo, Brasil. O processo de implementação incluiu uma fase piloto, seguida pela fase de expansão. Os dados foram enviados mensalmente à Divisão de Infecção Hospitalar pelos estabelecimentos de saúde participantes que realizaram procedimentos oftalmológicos no estado de São Paulo, Brasil no período de setembro de 2017 a dezembro de 2019. Resultados: Entre os 1.483 estabelecimentos de saúde elegíveis, 175 participaram do estudo (taxa de adesão de 11,8%), relatando 222.728 procedimentos oftalmológicos realizados, sendo 164.207 cirurgias de catarata e 58.521 injeções intravítreas. A taxa de incidência global de endoftalmite relatada foi de 0,05% (n=105; 80 casos após cirurgia de catarata e 25 casos após injeção intravítrea). As taxas de incidência entre os estabelecimentos de saúde variaram de 0,02% a 4,55%. A maioria dos casos foi causada por bactérias gram-positivas, principalmente Staphylococcus spp. Em 36 (46,2%) casos não houve crescimento bacteriano; nenhuma amostra foi coletada em 28 (26,7%) casos. O sistema de vigilância epidemiológica para endoftalmites possibilitou a identificação de um surto de quatro casos de endoftalmite após injeção intravítrea. Conclusão: O sistema de vigilância epidemiológica para endoftalmites mostrou-se operacionalmente viável e eficiente para o monitoramento de casos de endoftalmite em nível estadual.

Occupational inequalities and gender differences: work accidents, Brazil, 2019 / Desigualdades ocupacionais e diferenças de gênero: acidentes de trabalho, Brasil, 2019

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

RESUMO OBJETIVO Analisar a distribuição e associação de fatores sociodemográficos e ocupacionais a acidentes de trabalho (AT) autorrelatados em uma amostra representativa da população brasileira, com ênfase na classe ocupacional, e examinar as diferenças de gênero nessa distribuição. MÉTODOS Estudo transversal de base populacional, com dados da Pesquisa Nacional de Saúde (PNS) de 2019, analisou as respostas de uma amostra de adultos com 18 anos ou mais de idade. Fatores associados a AT foram investigados por regressão logística binária e análise hierarquizada por meio de blocos (variáveis sociodemográficas e ocupacionais). O modelo final foi ajustado pelas variáveis de todos os blocos, adotando-se o nível de significância de 5%. Obtiveram-se os valores das razões de chance (RC) e respectivos intervalos de confiança. RESULTADOS Entre os participantes, 2,69% relataram ter sofrido AT, sendo mais alta a prevalência em homens (3,37%; IC95% 2,97-3,82%), se comparados às mulheres (1,86%; IC95% 1,55-2,23%). A análise identificou que faixa etária, trabalho noturno, jornada de trabalho e exposição a riscos laborais foram associados a AT, com destaque para as diferenças de gênero. A classe de trabalhadores manuais, tanto qualificados (RCmulheres = 2,87; IC95% 1,33-6,21 e RChomens = 2,46; IC95% 1,37-4,40) quanto não qualificados (RCmulheres = 2,55; IC95% 1,44-4,50 e RChomens = 3,70; IC95% 1,95-7,03), apresentaram maior chance de AT em comparação à classe de gerentes/profissionais. CONCLUSÃO Fatores ocupacionais contribuíram significativamente para o aumento na probabilidade de AT para homens e mulheres, com maior magnitude entre aqueles posicionados nos estratos inferiores da estrutura ocupacional. Os resultados obtidos são pistas para a elaboração de ações de prevenção de AT.

Protocolo do Nascer no Brasil II: Pesquisa Nacional sobre Aborto, Parto e Nascimento / Protocolo del Nacer en Brasil II: Encuesta Nacional sobre Aborto, Parto y Nacimiento / Protocol of Birth in Brazil II: National Research on Abortion, Labor and Childbirth

Resumo: Com o passar do tempo, o Brasil vem apresentando avanços na assistência obstétrica em hospitais públicos e privados; no entanto, ainda existem pontos frágeis que necessitam de atenção. O Ministério da Saúde, ciente dessa necessidade, financiou a segunda versão da pesquisa Nascer no Brasil. Os objetivos gerais são: avaliar a assistência pré-natal, ao parto e nascimento, ao puerpério e ao aborto, comparando com os resultados do Nascer no Brasil I, e analisar os principais determinantes da morbimortalidade perinatal; avaliar a estrutura e processos assistenciais dos serviços de obstetrícia e neonatologia das maternidades; analisar os conhecimentos, atitudes e práticas de profissionais de saúde que prestam assistência ao parto e ao aborto; e identificar as principais barreiras e facilitadores para essa assistência no país. Com escopo nacional e amostra probabilística em dois estágios (1-hospitais e 2-mulheres), dividida em 59 estratos, foram selecionados 465 hospitais com total planejado de, aproximadamente, 24.255 mulheres, 2.205 por motivo de aborto e 22.050 por motivo de parto. A coleta de dados, realizada por meio de seis instrumentos eletrônicos, ocorre durante a internação hospitalar para o parto ou aborto, com duas ondas de seguimento, aos dois e quatro meses. Com o intuito de expandir o número de casos de morbidade materna grave, mortalidade materna e perinatal, três estudos caso controle foram incorporados ao Nascer no Brasil II. O trabalho de campo foi iniciado em novembro de 2021 com término previsto para 2023. Os resultados permitirão comparar a atenção atual ao parto e ao nascimento com a retratada no primeiro inquérito e, com isso, avaliar os avanços alcançados no decorrer desses 10 anos.

Resumen: Aunque Brasil ha presentado avances en la atención obstétrica en hospitales públicos y privados, todavía hay puntos débiles que necesitan atención. El Ministerio de Salud, consciente de esta necesidad, financió la segunda versión de la encuesta Nacer en Brasil. Los objetivos generales son: evaluar la atención prenatal, el parto y el nacimiento, el puerperio y el aborto, comparando con los resultados del Nacer en Brasil I, y analizar los principales determinantes de la morbimortalidad perinatal; evaluar la estructura y los procesos de atención de los servicios de obstetricia y neonatología en las maternidades; analizar los conocimientos, prácticas y actitudes de los profesionales de la salud que brindan atención para el parto y el aborto; e identificar las principales barreras y facilitadores para esta atención en el país. Tiene un alcance nacional y muestra probabilística en dos etapas (1-hospitales y 2-mujeres), la cual se dividió en 59 estratos; y se seleccionaron 465 hospitales con un total planificado de aproximadamente 24.255 mujeres, de las cuales 2.205 tuvieron procedimientos por aborto y 22.050 por parto. Para la recolección de datos se aplicó seis instrumentos electrónicos, que se realizó durante la hospitalización por parto o aborto, con dos rondas de seguimiento, a los dos y cuatro meses. Con el fin de ampliar el número de casos de morbilidad materna grave, mortalidad materna y perinatal, se incorporaron tres estudios de casos y controles en Nacer en Brasil II. El trabajo de campo comenzó en noviembre de 2021 y finalizará en 2023. Los resultados nos permitirán evaluar la atención al parto y al nacimiento actual con lo que se retrató en la primera encuesta, de esta manera se podrá evaluar los avances alcanzados a lo largo de estos 10 años.

Abstract: Brazil has made advances in obstetric care in public and private hospitals; however, weaknesses in this system still require attention. The Brazilian Ministry of Health, aware of this need, funded the second version of the Birth in Brazil survey. This study aimed to evaluate: prenatal, labor and birth, postpartum, and abortion care, comparing the results with those of Birth in Brazil I; and analyze the main determinants of perinatal morbidity and mortality; evaluate the care structure and processes of obstetrics and neonatology services in maternity hospitals; analyze the knowledge, practices, and attitudes of health professionals who provide birth and abortion care; and identify the main barriers and facilitators related to care of this nature in Brazil. With a national scope and a 2-stage probability sample: 1-hospitals and 2-women, stratified into 59 strata, 465 hospitals were selected with a total planned sample of around 24,255 women - 2,205 for abortion reasons and 22,050 for labor reasons. Data collection was conducted using six electronic instruments during hospital admission for labor or abortion, with two follow-up waves, at two and four months. In order to expand the number of cases of severe maternal morbidity, maternal and perinatal mortality, three case control studies were incorporated into Birth in Brazil II. The fieldwork began in November 2021 and is scheduled to end in 2023. It will allow a comparison between current labor and birth care results and those obtained in the first study and will evaluate the advances achieved in 10 years.