Effects of heat waves on cardiovascular and respiratory mortality in Rio de Janeiro, Brazil.

BACKGROUND: Heat waves are becoming more intense and extreme as a consequence of global warming. Epidemiological evidence reveals the health impacts of heat waves in mortality and morbidity outcomes, however, few studies have been conducted in tropical regions, which are characterized by high population density, low income and low health resources, and susceptible to the impacts of extreme heat on health. The aim of this paper is to estimate the effects of heat waves on cardiovascular and respiratory mortality in the city of Rio de Janeiro, Brazil, according to sex, age, and heat wave intensity. METHODS: We carried out a time-stratified case-crossover study stratified by sex, age (0-64 and 65 or above), and by sex for the older group. Our analyses were restricted to the hot season. We included 42,926 participants, 29,442 of whom died from cardiovascular and 13,484 from respiratory disease, between 2012 and 2017. The death data were obtained from Rio de Janeiro's Municipal Health Department. We estimated individual-level exposure using the inverse distance weighted (IDW) method, with temperature and humidity data from 13 and 12 stations, respectively. We used five definitions of heat waves, based on temperature thresholds (90th, 92.5th, 95th, 97.5th, and 99th of individual daily mean temperature in the hot season over the study period) and a duration of two or more days. Conditional logistic regression combined with distributed lag non-linear models (DLNM) were used to estimate the short-term and delayed effects of heat waves on mortality over a lag period (5 days for cardiovascular and 10 for respiratory mortality). The models were controlled for daily mean absolute humidity and public holidays. RESULTS: The odds ratios (OR) increase as heat waves intensify, although some effect estimates are not statistically significant at 95% level when we applied the most stringent heat wave criteria. Although not statistically different, our central estimates suggest that the effects were greater for respiratory than cardiovascular mortality. Results stratified by sex and age were also not statistically different, but suggest that older people and women were more vulnerable to the effects of heat waves, although for some heat wave definitions, the OR for respiratory mortality were higher among the younger group. The results also indicate that older women are the most vulnerable to heat wave-related cardiovascular mortality. CONCLUSION: Our results show an increase in the risk of cardiovascular and respiratory mortality on heat wave days compared to non-heat wave ones. These effects increase with heat wave intensity, and evidence suggests that they were greater for respiratory mortality than cardiovascular mortality. Furthermore, the results also suggest that women and the elderly constitute the groups most vulnerable to heat waves.

Short-term association between ambient air pollution and cardio-respiratory mortality in Rio de Janeiro, Brazil.

BACKGROUND: Several epidemiological studies have reported associations between ambient air pollution and mortality. However, relatively few studies have investigated this relationship in Brazil using individual-level data. OBJECTIVES: To estimate the short-term association between exposure to particulate matter <10 µm (PM10) and ozone (O3), and cardiovascular and respiratory mortality in Rio de Janeiro, Brazil, between 2012 and 2017. METHODS: We used a time-stratified case-crossover study design with individual-level mortality data. Our sample included 76,798 deaths from cardiovascular diseases and 36,071 deaths from respiratory diseases. Individual exposure to air pollutants was estimated by the inverse distance weighting method. We used data from seven monitoring stations for PM10 (24-hour mean), eight stations for O3 (8-hour max), 13 stations for air temperature (24-hour mean), and 12 humidity stations (24-hour mean). We estimated the mortality effects of PM10 and O3 over a 3-day lag using conditional logistic regression models combined with distributed lag non-linear models. The models were adjusted for daily mean temperature and daily mean absolute humidity. Effect estimates were presented as odds ratios (OR) with their 95% confidence interval (CI) associated with a 10 µg/m3 increase in each pollutant exposure. RESULTS: No consistent associations were observed for both pollutant and mortality outcome. The cumulative OR of PM10 exposure was 1.01 (95% CI 0.99-1.02) for respiratory mortality and 1.00 (95% CI 0.99-1.01) for cardiovascular mortality. For O3 exposure, we also found no evidence of increased mortality for cardiovascular (OR 1.01, 95% CI 1.00-1.01) or respiratory diseases (OR 0.99, 95% CI 0.98-1.00). Our findings were similar across age and gender subgroups, and different model specifications. CONCLUSION: We found no consistent associations between the PM10 and O3 concentrations observed in our study and cardio-respiratory mortality. Future studies need to explore more refined exposure assessment methods to improve health risk estimates and the planning and evaluation of public health and environmental policies.

Heat waves and mortality in the Brazilian Amazon: Effect modification by heat wave characteristics, population subgroup, and cause of death.

BACKGROUND: The Brazilian Amazon faces overlapping socio-environmental, sanitary, and climate challenges, and is a hotspot of concern due to projected increases in temperature and in the frequency of heat waves. Understanding the effects of extreme events on health is a central issue for developing climate policies focused on the population's health. OBJECTIVES: We investigated the effects of heat waves on mortality in the Brazilian Amazon, examining effect modification according to various heat wave definitions, population subgroups, and causes of death. METHODS: We included all 32 Amazonian municipalities with more than 100,000 inhabitants. The study period was from 2000 to 2018. We obtained mortality data from the Information Technology Department of the Brazilian Public Healthcare System, and meteorological data were derived from the ERA5-Land reanalysis dataset. Heat waves were defined according to their intensity (90th; 92.5th; 95th; 97.5th and 99th temperature percentiles) and duration (≥2, ≥3, and ≥4 days). In each city, we used a time-stratified case-crossover study to estimate the effects of each heat wave definition on mortality, according to population subgroup and cause of death. The lagged effects of heat waves were estimated using conditional Poisson regression combined with distributed lag non-linear models. Models were adjusted for specific humidity and public holidays. Risk ratios were pooled for the Brazilian Amazon using a univariate random-effects meta-analysis. RESULTS: The pooled relative risks (RR) for mortality from total non-external causes varied between 1.03 (95% CI: 1.01-1.06), for the less stringent heat wave definition, and 1.18 (95% CI: 1.04-1.33) for the more stringent definition. The mortality risk rose as the heat wave intensity increased, although the increase from 2 to 3, and 3-4 days was small. Although not statistically different, our results suggest a higher mortality risk for the elderly, this was also higher for women than men, and for cardiovascular causes than for non-external or respiratory ones. CONCLUSIONS: Heat waves were associated with a higher risk of mortality from non-external causes and cardiovascular diseases. Heat wave intensity played a more important role than duration in determining this risk. Suggestive evidence indicated that the elderly and women were more vulnerable to the effects of heat waves on mortality.

Trend in the prevalence of depressive symptoms in Brazil: results from the Brazilian National Health Survey 2013 and 2019.

This study aims to evaluate national variation in depression prevalence and in different sociodemographic groups, health behaviors, and macroregions of Brazil from 2013 to 2019. Data were obtained from two nationwide Brazilian surveys - Brazilian National Health Survey 2013 and 2019. Participants aged 18 years or older were included, totaling 60,202 individuals in 2013 and 88,531 in 2019. Depression was evaluated with the Patient Health Questionnaire-9 (PHQ-9). All estimations accounted for the population weights and the complex sampling. The findings showed that during the six years between the two surveys, the prevalence of depression in Brazil increased by 36.7%, going from 7.9% in 2013 to 10.8% in 2019, and this increase is higher among unemployed young adults, aged 18 to 24 years, with the increase in the prevalence of depression almost tripled (3.7 in 2013 and 10.3 in 2019), an increase of 178.4%. Those dwelling in urban areas had a higher increase in the prevalence of depression in the six-year period (39.8%) when compared to residents in rural areas (20.2%). There was an increase in the prevalence of depression from 2013 to 2019 for the worst categories of the three health behaviors included in the study for both men and women: heavy drinking, smoking, and not exercising the recommended level of physical activity. Our results show a significant increase in the prevalence of depression over the six years between the two surveys, mainly among the younger and unemployed men. The country's economic recession during this period may explain these findings.

Trend in the prevalence of depressive symptoms in Brazil: results from the Brazilian National Health Survey 2013 and 2019 / Tendência na prevalência de sintomas depressivos no Brasil: resultados da Pesquisa Nacional de Saúde, 2013 e 2019 / Tendencia en la prevalencia de síntomas depresivos en Brasil: resultados de las Encuesta Nacional de Salud de 2013 y 2019

This study aims to evaluate national variation in depression prevalence and in different sociodemographic groups, health behaviors, and macroregions of Brazil from 2013 to 2019. Data were obtained from two nationwide Brazilian surveys - Brazilian National Health Survey 2013 and 2019. Participants aged 18 years or older were included, totaling 60,202 individuals in 2013 and 88,531 in 2019. Depression was evaluated with the Patient Health Questionnaire-9 (PHQ-9). All estimations accounted for the population weights and the complex sampling. The findings showed that during the six years between the two surveys, the prevalence of depression in Brazil increased by 36.7%, going from 7.9% in 2013 to 10.8% in 2019, and this increase is higher among unemployed young adults, aged 18 to 24 years, with the increase in the prevalence of depression almost tripled (3.7 in 2013 and 10.3 in 2019), an increase of 178.4%. Those dwelling in urban areas had a higher increase in the prevalence of depression in the six-year period (39.8%) when compared to residents in rural areas (20.2%). There was an increase in the prevalence of depression from 2013 to 2019 for the worst categories of the three health behaviors included in the study for both men and women: heavy drinking, smoking, and not exercising the recommended level of physical activity. Our results show a significant increase in the prevalence of depression over the six years between the two surveys, mainly among the younger and unemployed men. The country's economic recession during this period may explain these findings.

O estudo objetiva avaliar a variação nacional na prevalência geral da depressão e em diferentes grupos sociodemográficos, comportamentos de saúde e macrorregiões do Brasil entre 2013 e 2019. Os dados foram obtidos de dois inquéritos brasileiros de abrangência nacional, a Pesquisa Nacional de Saúde (PNS) 2013 e a 2019. Entre os participantes com idade de 18 anos ou mais, houve 60.202 indivíduos em 2013 e 88.531 em 2019. A depressão foi avaliada com o Questionário de Saúde do Paciente-9 (PHQ-9). Todas as estimativas levaram em conta os pesos populacionais e a amostragem complexa. Os achados mostraram que durante os seis anos entre as duas edições da PNS, a prevalência de depressão no Brasil aumentou em 36,7%, de 7,9% em 2013 para 10,8% em 2019, com um aumento ainda maior em adultos jovens, no grupo etário de 18 a 24 anos, e naqueles que não estavam trabalhando, onde houve um aumento de quase três vezes na prevalência de depressão (3,7% em 2013 e 10,3% em 2019), ou seja, um aumento de 178,4%. Indivíduos residindo em áreas urbanas tiveram um aumento maior na prevalência de depressão ao longo do período de seis anos (39,8%), em comparação com os residentes em áreas rurais (20,2%). Houve um aumento na prevalência de depressão entre 2013 e 2019 para as piores categorias dos três comportamentos de saúde incluídos no estado, tanto em homens quanto em mulheres: etilismo, tabagismo e sedentarismo. Nossos resultados mostram um aumento significativo na prevalência de depressão nos seis anos entre as duas edições da PNS, principalmente entre homens mais jovens e desempregados. A recessão econômica no Brasil durante o período pode explicar esses achados.

El objetivo de este estudio es evaluar la variación nacional en la prevalencia general de depresión, así como en diferentes grupos sociodemográficos, comportamientos de salud, y macrorregiones del país entre 2013-2019. Los datos se obtuvieron de dos encuestas nacionales brasileñas -Encuesta Nacional de Salud 2013 y 2019-. Los participantes con edades entre los 18 años y con más edad incluyeron a 60 202 personas en 2013 y 88 531 en 2019. La depresión se evaluó mediante el Cuestionario de Salud del Paciente-9 (PHQ-9). Todas las estimaciones justificaron los pesos de la población y el muestreo complejo. Los resultados mostraron que durante seis años entre las dos encuestas, la prevalencia de depresión en Brasil se incrementó en un 36,7%, yendo de un 7,9% en 2013 a un 10,8% en el 2019, y este incremento es mayor entre adultos jóvenes, de 18 a 24 años de edad, que no estaban trabajando, donde casi había un incremento tres veces superior en la prevalencia de depresión (3,7 en 2013 y 10,3 en 2019), un incremento de un 178,4%. Aquellos que vivían en áreas urbanas tenían un incremento mayor en la prevalencia de depresión durante el período de seis años (39,8%), cuando se comparó con los residentes en áreas rurales (20,2%). Hubo un incremento en la prevalencia de depresión entre 2013-2019 para las peores categorías de los tres comportamientos de salud incluidos en el estudio para tanto hombres como mujeres: consumo excesivo de alcohol, fumar, y no practicar deporte al nivel recomendado de actividad física. Nuestros resultados muestran un significado incremento en la prevalencia de depresión durante los seis años entre las dos encuestas, principalmente entre los hombres más jóvenes y desempleados. La recesión económica del país durante este periodo puede explicar estos resultados.

[Contextual and individual determinants of use of newborn hearing screening: the Brazilian National Health Survey, 2013]. / Determinantes contextuais e individuais da utilização da triagem auditiva neonatal: Pesquisa Nacional de Saúde, 2013.

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.

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.

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.

Improving geocoding matching rates of structured addresses in Rio de Janeiro, Brazil.

Strategies for improving geocoded data often rely on interactive manual processes that can be time-consuming and impractical for large-scale projects. In this study, we evaluated different automated strategies for improving address quality and geocoding matching rates using a large dataset of addresses from death records in Rio de Janeiro, Brazil. Mortality data included 132,863 records with address information in a structured format. We performed regular expressions and dictionary-based methods for address standardization and enrichment. All records were linked by their postal code or street name to the Brazilian National Address Directory (DNE) obtained from Brazil's Postal Service. Residential addresses were geocoded using Google Maps. Records with address data validated down to the street level and location type returned as rooftop, range interpolated, or geometric center were considered a geocoding match. The overall performance was assessed by manually reviewing a sample of addresses. Out of the original 132,863 records, 85.7% (n = 113,876) were geocoded and validated, out of which 83.8% were matched as rooftop (high accuracy). Overall sensitivity and specificity were 87% (95%CI: 86-88) and 98% (95%CI: 96-99), respectively. Our results indicate that address quality and geocoding completeness can be reliably improved with an automated geocoding process. R scripts and instructions to reproduce all the analyses are available at https://github.com/reprotc/geocoding.

Trend in the prevalence of depression and correlates in Brazil: results from the National Health Surveys 2013 and 2019

This study aims to evaluate national variation in depression prevalence overall and in different socioeconomic and demographic groups, health behaviors, and macro-regions of the country, between 2013 and 2019. Data were obtained from the National Health Surveys ­ PNS 2013 and 2019, which are cross-sectional surveys of the Brazilian general population. Participants aged 18 years and older included 60,202 individuals in 2013 and 88,531 in 2019. Depression was evaluated through the Patient Health Questionnaire-9 (PHQ-9). Calculations were carried out population-weighted. Additional age-standardized analyses were conducted to account for demographic changes. The results showed that in the six-year period between the two surveys, the prevalence of depression in Brazil increased by 36.7%, going from 7.9% in 2013 to 10.8% in 2019, this increase is more marked among young adults, 18 to 24 years old, who were not working, where there was a significant and almost three-fold absolute difference increase in the prevalence of depression (3.7 in 2013 and 10.3 in 2019), an increase of 178.4%. Those living in urban areas of the country had a greater increase in the prevalence of depression in the six-year period (39.8%) when compared to residents in rural areas (20.2%). There was an increase in the prevalence of depression between 2013 and 2019 for the worst categories of the three health behaviors under study, for both sexes: heavy drinking, smoking, and lack of physical activity, following the pattern observed for the general population. Our results show evidence of a significant increase in the prevalence of depression over the six-year period between the two surveys, mainly among the younger and unemployed men. The country´s economic context of recession during this period may be an explanation for this finding.

Projections of excess cardiovascular mortality related to temperature under different climate change scenarios and regionalized climate model simulations in Brazilian cities.

BACKGROUND: There is an urgent need for more information about the climate change impact on health in order to strengthen the commitment to tackle climate change. However, few studies have quantified the health impact of climate change in Brazil and in the Latin America region. In this paper, we projected the impacts of temperature on cardiovascular (CVD) mortality according to two climate change scenarios and two regionalized climate model simulations in Brazilian cities. METHODS: We estimated the temperature-CVD mortality relationship in 21 Brazilian cities, using distributed lag non-linear models in a two-stage time-series analysis. We combined the observed exposure-response functions with the daily temperature projected under two representative concentration pathways (RCP), RCP8.5 and RCP4.5, and two regionalized climate model simulations, Eta-HadGEM2-ES and Eta-MIROC5. RESULTS: We observed a trend of reduction in mortality related to low temperatures and a trend of increase in mortality related to high temperatures, according to all the investigated models and scenarios. In most places, the increase in mortality related to high temperatures outweighed the reduction in mortality related to low temperatures, causing a net increase in the excess temperature-related mortality. These trends were steeper according to the higher emission scenario, RCP8.5, and to the Eta-HadGEM2-ES model. According to RCP8.5, our projections suggested that the temperature-related mortality fractions in 2090-99 compared to 2010-2019 would increase by 8.6% and 1.7%, under Eta-HadGEM2-ES and Eta-MIROC5, respectively. According to RCP4.5, these values would be 0.7% and -0.6%. CONCLUSIONS: For the same climate model, we observed a greater increase trend in temperature-CVD mortality according to RCP8.5, highlighting a greater health impact associated with the higher emission scenario. Our results may be useful to support public policies and strategies for mitigation of and adaptation to climate change, particularly in the health sector.

Temperature and cardiovascular mortality in Rio de Janeiro, Brazil: effect modification by individual-level and neighbourhood-level factors.

BACKGROUND: Many factors related to susceptibility or vulnerability to temperature effects on mortality have been proposed in the literature. However, there is limited evidence of effect modification by some individual-level factors such as occupation, colour/race, education level and community-level factors. We investigated the effect modification of the temperature-cardiovascular mortality relationship by individual-level and neighbourhood-level factors in the city of Rio de Janeiro, Brazil. METHODS: We used a case-crossover study to estimate the total effect of temperature on cardiovascular mortality in Rio de Janeiro between 2001 and 2018, and the effect modification by individual-level and neighbourhood-level factors. Individual-level factors included sex, age, colour/race, education, and place of death. Neighbourhood-level characteristics included social development index (SDI), income, electricity consumption and demographic change. We used conditional Poisson regression models combined with distributed lag non-linear models, adjusted for humidity and public holidays. RESULTS: Our results suggest a higher vulnerability to high temperatures among the elderly, women, non-hospitalised deaths, and people with a lower education level. Vulnerability to low temperatures was higher among the elderly, men, non-white people, and for primary education level. As for neighbourhood-level factors, we identified greater vulnerability to low and high temperatures in places with lower SDI, lower income, lower consumption of electricity, and higher demographic growth. CONCLUSION: The effects of temperature on cardiovascular disease mortality in Rio de Janeiro vary according to individual-level and neighbourhood-level factors. These findings are valuable to inform policymakers about the most vulnerable groups and places, in order to develop more effective and equitable public policies.

Neighborhood physical disorder and common mental disorders in adolescence.

OBJECTIVE: The aim of this study is to estimate the association between observed indicators of neighborhood physical disorder and common mental disorders in adolescents. METHODS: The study population included 2506 adolescents from three Brazilian state capitals (Rio de Janeiro, Porto Alegre, and Fortaleza) who participated in the Cardiovascular Risk Study in Adolescents (ERICA), a cross-sectional school-based study conducted in 2013-2014. Common mental disorders were assessed using the 12-item General Health Questionnaire. Measures of neighborhood physical disorder were based on the 2010 Brazilian census data and were derived using principal component analysis. RESULTS: Although associations were found between some exposure components and CMD, there were no clear or consistent trends across exposure quartiles. CONCLUSION: Overall, there was no evidence of an association between observed indicators of neighborhood physical disorder and common mental disorders. Future studies should explore alternative tools for measuring neighborhood physical disorder to minimize the likelihood of exposure misclassification.

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.

Cancer mortality in the Capitals and in the interior of Brazil: a four-decade analysis.

OBJECTIVE: to describe the trend of mortality from general cancer and more frequent types among men and women living in the Capitals and other municipalities of the five macro-regions of Brazil between 1978 and 2017. METHODS: Time series study with mortality data corrected by redistribution of ill-defined causes. Proportional cancer mortality was calculated for Brazil and regions. The annual percentage change in rates for total cancer and specific types in each segment and in the selected unit of analysis was calculated by generalized linear regression with Gaussian binding. RESULTS: the proportion of cancer increased progressively for both sexes from 1978 to 2017. Important differences between the Capitals and the interior of the macro-regions were seen with disaggregated data. The greatest declines occurred for stomach cancer, except in the northern and interior regions of the Northeast, and for the cervix cancer, with a generalized fall, with the exception of the interior of the northern region. Lung cancer decreased among men in the Southeast and South regions and had a generalized increase among women. Breast and prostate cancers tended to decrease in the Southeast and South regions and among residents of the Capitals but showing an increase in the interior of the North and Northeast regions. Colorectal cancer had a general tendency to increase; with stability among men in the Capitals of the South region and among women of the Southeast and Midwest regions and, since 2007, a decrease among women in the South region. CONCLUSIONS: Cancer mortality showed great variation among residents of capitals and the interior of the country's major regions. Clear decrease in mortality was seen for the main types in the Southeast and South regions. The North and Northeast regions have patterns compatible with cancers associated with poverty, while the large increase of the cancers related to sedentary lifestyle stand out.

Violence against children and adolescents in Manaus, Amazonas State, Brazil: a descriptive study of cases and evaluation of notification sheet completeness, 2009-2016. / Violência contra crianças e adolescentes em Manaus, Amazonas: estudo descritivo dos casos e análise da completude das fichas de notificação, 2009-2016.

OBJECTIVE: to describe cases of violence against children and adolescents and completeness of notification forms registered on the Notifiable Health Conditions Information System (Sinan), Manaus, Amazonas, Brazil, 2009-2016. METHODS: this was a descriptive study based on 38 fields of the notification form held on the information system; analysis of completeness was based on the criteria proposed by the Ministry of Health. RESULTS: 69.3% of the 10,333 reported cases occurred among female children, and parents and step-parents were the perpetrators in 43.0% of cases; among adolescents, about » (24.9%) of cases were committed by friends/acquaintances; sexual violence was the most reported type of violence in both groups; field completeness ranged from 15.1% (occupation) to 100.0% (several fields). CONCLUSION: in contrast to the national scenario, sexual violence was the most reported form of violence in Manaus, indicating that other types of violence are underestimated; data quality points to the need for Sinan improvement in Manaus.

Cancer mortality in the Capitals and in the interior of Brazil: a four-decade analysis / Mortalidade por câncer nas capitais e no interior do Brasil: uma análise de quatro décadas

ABSTRACT OBJECTIVE: to describe the trend of mortality from general cancer and more frequent types among men and women living in the Capitals and other municipalities of the five macro-regions of Brazil between 1978 and 2017. METHODS: Time series study with mortality data corrected by redistribution of ill-defined causes. Proportional cancer mortality was calculated for Brazil and regions. The annual percentage change in rates for total cancer and specific types in each segment and in the selected unit of analysis was calculated by generalized linear regression with Gaussian binding. RESULTS: the proportion of cancer increased progressively for both sexes from 1978 to 2017. Important differences between the Capitals and the interior of the macro-regions were seen with disaggregated data. The greatest declines occurred for stomach cancer, except in the northern and interior regions of the Northeast, and for the cervix cancer, with a generalized fall, with the exception of the interior of the northern region. Lung cancer decreased among men in the Southeast and South regions and had a generalized increase among women. Breast and prostate cancers tended to decrease in the Southeast and South regions and among residents of the Capitals but showing an increase in the interior of the North and Northeast regions. Colorectal cancer had a general tendency to increase; with stability among men in the Capitals of the South region and among women of the Southeast and Midwest regions and, since 2007, a decrease among women in the South region. CONCLUSIONS: Cancer mortality showed great variation among residents of capitals and the interior of the country's major regions. Clear decrease in mortality was seen for the main types in the Southeast and South regions. The North and Northeast regions have patterns compatible with cancers associated with poverty, while the large increase of the cancers related to sedentary lifestyle stand out.

RESUMO OBJETIVO: Descrever a tendência da mortalidade por câncer geral e tipos mais frequentes entre homens e mulheres residentes nas capitais e demais municípios das cinco macrorregiões do Brasil entre 1978 e 2017. MÉTODOS: Estudo de séries temporais com dados de mortalidade corrigidos por redistribuição das causas maldefinidas. Foi calculada a mortalidade proporcional de câncer para Brasil e regiões. A variação percentual anual das taxas para o total de câncer e tipos específicos em cada segmento e na desagregação selecionada foi calculada por regressão linear generalizada com ligação gaussiana. RESULTADOS: A proporção de câncer aumentou progressivamente para ambos os sexos de 1978 a 2017. Diferenças importantes entre as capitais e o interior das macrorregiões foram vistas com dados desagregados. Os maiores declínios ocorreram para o câncer de estômago, exceto nas regiões Norte e interior da Nordeste, e de colo do útero, com queda generalizada, com exceção do interior da região Norte. O câncer de pulmão teve queda entre homens nas regiões Sudeste e Sul e aumento generalizado entre mulheres. Os cânceres de mama e de próstata tenderam a diminuir nas regiões Sudeste e Sul e entre residentes das capitais, mostrando, porém, aumento no interior das regiões Norte e Nordeste. O câncer colorretal teve tendência geral de aumento; nas capitais houve estabilidade entre homens da região Sul e entre mulheres das regiões Sudeste e Centro-Oeste e queda entre mulheres da região Sul a partir de 2007. CONCLUSÕES: A mortalidade por câncer apresentou grande variação entre os residentes de capitais e do interior das grandes regiões do país. Diminuição clara da mortalidade foi vista para os principais tipos nas regiões Sudeste e Sul. As regiões Norte e Nordeste apresentam padrões compatíveis com cânceres associados à pobreza ao mesmo tempo que se destacam pelo grande aumento daqueles relacionados ao estilo de vida sedentário.

Violência contra crianças e adolescentes em Manaus, Amazonas: estudo descritivo dos casos e análise da completude das fichas de notificação, 2009-2016 / Violencia contra niños y adolescentes en Manaus, estado de Amazonas, Brasil: estudio descriptivo de los casos y evaluación de la completitud de las fichas de notificación, 2009-2016 / Violence against children and adolescents in Manaus, Amazonas State, Brazil: a descriptive study of cases and evaluation of notification sheet completeness, 2009-2016

Objetivo: descrever os casos de violência contra crianças e adolescentes e a completude das fichas de notificação registradas no Sistema de Informação de Agravos de Notificação (Sinan), Manaus, Amazonas, Brasil, 2009-2016. Métodos: foi realizado estudo descritivo, considerando-se 38 campos da ficha de notificação no sistema; a análise da completude embasou-se nos critérios propostos pelo Ministério da Saúde. Resultados: dos 10.333 casos registrados, 69,3% ocorreram entre crianças do sexo feminino, e em 43,0% o agressor tinha relação parental com a vítima; entre os adolescentes, aproximadamente » (24,9%) dos agressores foram amigos/conhecidos; a violência sexual foi a mais notificada em ambos os grupos; a completude dos campos variou de 15,1% (ocupação) a 100,0% (vários campos). Conclusão: diferentemente do cenário nacional, a violência sexual foi a mais notificada no município, indicando subestimação dos demais tipos de violência; a qualidade dos dados aponta para a necessidade de aprimoramento do Sinan em Manaus.

Objetivo: describir los casos de violencia contra niños y adolescentes y la integridad de los formularios de notificación registrados en el Sistema de Información de Enfermedades de Notificación (Sinan), Manaus, Amazonas, Brasil, 2009-2016. Métodos: se realizó un estudio descriptivo de 38 campos del formulario de notificación del sistema; el análisis de integridad se basó en los criterios propuestos por el Ministerio de Salud. Resultados: el 69,3% de los 10.333 casos reportados ocurrieron entre niñas, con padres y padrastros como los principales agresores (43,0%); entre los adolescentes, aproximadamente » (24,9%) fue cometido por amigos/conocidos; la violencia sexual fue la más reportada en ambos grupos; la integridad del campo varió de 15,1% (ocupación) a 100,0% (campos múltiples). Conclusión: en contraste con el escenario nacional, la violencia sexual fue la más reportada en la ciudad, lo que indica que también se necesita capacitación para detectar otros tipos de violencia; la calidad de los datos apunta a la necesidad de mejorar el Sinan en Manaus.

Objective: to describe cases of violence against children and adolescents and completeness of notification forms registered on the Notifiable Health Conditions Information System (Sinan), Manaus, Amazonas, Brazil, 2009-2016. Methods: this was a descriptive study based on 38 fields of the notification form held on the information system; analysis of completeness was based on the criteria proposed by the Ministry of Health. Results: 69.3% of the 10,333 reported cases occurred among female children, and parents and step-parents were the perpetrators in 43.0% of cases; among adolescents, about » (24.9%) of cases were committed by friends/acquaintances; sexual violence was the most reported type of violence in both groups; field completeness ranged from 15.1% (occupation) to 100.0% (several fields). Conclusion: in contrast to the national scenario, sexual violence was the most reported form of violence in Manaus, indicating that other types of violence are underestimated; data quality points to the need for Sinan improvement in Manaus.

Lung cancer mortality trends in different urban settings in Brazil, 2000-2015. / Tendência de mortalidade por câncer de pulmão em diferentes contextos urbanos do Brasil, 2000-2015.

OBJECTIVE: to analyze lung cancer mortality trends in Brazil, 2000-2015. METHODS: this was a time series study; lung cancer death records were corrected; linear autoregressive models were used to calculate regression coefficients (ß1) and 95% confidence intervals (95%CI) in trend analysis according to sex, in the 30 and over age group, for 19 metropolitan areas (MAs) and the interior regions of 14 Brazilian states; positive ß1 indicates upward trends while negative ß1 indicates downward trends. RESULTS: increases were found in males from interior regions of North and Northeastern Brazilian states, especially in Rio Grande do Norte state (ß1=1.03 - 95%CI0.47;1.58); downward trends were also found in males, notably in the Porto Alegre MA (ß1=-2.55 - 95%CI-2.79;-2.31); the highest increase in females was found in the interior of Ceará state (ß1=0.86 - 95%CI0.79;0.92). CONCLUSION: differentiated patterns according to location and sex were revealed; cancer control measures should be considered above all for women and the interior regions of Brazil.

Is living near green areas beneficial to mental health? Results of the Pró-Saúde Study.

OBJECTIVE: To investigate the association between exposure to green areas in the surroundings of the residence and the presence of common mental disorders among adults, according to different income strata. METHODS: Cross-sectional study with 2,584 participants from the Pró-Saúde Study (2006), residing in the city of Rio de Janeiro. Common Mental Disorders were measured using the General Health Questionnaire (GHQ-12) and exposure to green areas was measured using the normalized difference vegetation index, in buffers with radiuses between 100 and 1,500 meters around the residence. We used the mean and maximum normalized difference vegetation index categorized into quartiles. The study population was divided into three subgroups, according to the income: low, intermediate, and high. Odds ratios and their 95% confidence intervals were estimated with logistic regression models. The models were adjusted by sex and age, with and without inclusion of physical activity practice. RESULTS: The proportion of common mental disorders was 30% and 39% among men and women, respectively. The results of the adjusted models showed an inverse association between the presence of green areas in the surroundings of the residence and the occurrence of common mental disorders, in the buffer of 200 meters in the intermediate-income group and in the buffers of 400 and 1,500 meters in the low-income group. The odds ratio ranged from 0.52 (buffer of 1,500 meters) to 0.68 (buffer of 200 meters). The association found was independent of physical activity practice. CONCLUSIONS: The evidence found suggests the existence of a beneficial effect of urban green areas on the mental health of lower-income individuals. These findings can help in understanding how the urban environment can affect the mental health of the population.