Prevalence and factors associated with the perception of perineal laceration: a cross-sectional study with data from the Nascer no Brasil Survey, 2011 and 2012.

OBJECTIVE: To describe the prevalence of perineal laceration, based on the self-reported perception of postpartum women, and to analyze factors associated with its occurrence in Brazil. METHODS: This was a cross-sectional study conducted with 23,894 postpartum women, excluding twin pregnancies, cesarean sections, and births with episiotomies, between 2011 and 2012. Prevalence ratios (PR) and 95% confidence intervals (95%CI) of association between the event and maternal, fetus/newborn, obstetric and clinical management characteristics were estimated in hierarchical Poisson regression models. RESULTS: Out of 4,606 postpartum women, 49.5% (95%CI 46.1;42.9) self-reported perineal laceration. Being an adolescent (PR = 1.12; 95%CI 1.02;1.25), primipara (PR = 1.47; 95%CI 1.33;1.63), having had excessive gestational weight gain (PR = 1.17; 95%CI 1.07;1.29) and having undergone the Kristeller maneuver (PR = 1.18; 95%CI 1.08;1.29) increased the proportion of the outcome. CONCLUSION: The results found call for prenatal care and adjustments to childbirth care so as to be in accordance with current recommendations. MAIN RESULTS: Prevalence of self-reported perineal laceration was 49.5%. Being in the adolescent age group, primiparity, excessive gestational weight and the Kristeller maneuver were risk factors associated with the event. IMPLICATIONS FOR SERVICES: Studying self-reported prevalence of perineal laceration supports new care practices, highlights the prevention of risk factors considered modifiable and confirms the need to follow current guidelines. PERSPECTIVES: New national studies are needed comparing prevalence of self-reported perineal laceration with that recorded in medical records in order to support care practices and public obstetric policies.

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%, respectiva- mente, 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.

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.

Papanicolaou test in Brazil: analysis of the National Health Survey of 2013 and 2019.

OBJECTIVES: To compare the coverage of cervical cancer screening in Brazil in 2013 and 2019, investigating the factors associated with having the test performed and the reasons given for not doing it. Additionally, a comparison is made concerning the time taken to receive the test result in SUS (Sistema Único de Saúde) and in the private health services. METHODS: Using data from the National Health Survey (Pesquisa Nacional de Saúde - PNS), prevalence rates and corresponding confidence intervals were calculated to determine the frequency of recent cervical cancer screenings among women aged between 25 and 64 years old in Brazil, for both 2013 and 2019. Poisson regression models were employed to compare the prevalence of the outcome according to sociodemographic characteristics. The reasons for not having the test and the time between performing and receiving the result were also analyzed. RESULTS: The findings revealed an increase in the coverage of preventive cervical cancer exams in Brazil from 78.7% in 2013 to 81.3% in 2019. Additionally, there was a decline in the proportion of women who had never undergone the exam, from 9.7% to 6.1%. Prevalence of test uptake was higher among white women, those with higher levels of education and income, and those residing in the South and Southeast regions of the country. The most commonly cited reasons for not taking the test were the impression it was unnecessary (45% in both 2013 and 2019) and never having been asked to undergo the test (20.6% in 2013 and 14.8% in 2019). CONCLUSIONS: Despite the high coverage of screening achieved in the country, there is great inequality in access to the test, and a non-negligible number of women are at greater risk of dying from a preventable disease. Efforts must be made to structure an organized screening program that identifies and captures the most vulnerable women.

[Self-reported morbidities and lifestyles of agricultural and non-agricultural workers in Brazil: a comparative analysis between 2013 and 2019]. / Morbidades autorreferidas e estilos de vida em trabalhadores agrícolas e não agrícolas no Brasil: uma análise comparativa entre 2013 e 2019.

Differences in the profiles of illness and lifestyles among agricultural and non-agricultural workers were investigated using data from the National Health Survey (Brazilian acronym PNS) of 2013 and 2019. The prevalence and 95% CIs were calculated for the following variables: self-reported morbidities, poor self-rated health, limitations of usual activities, number of NCD, major or minor depression and lifestyles. The Poisson model was used to calculate crude and adjusted prevalence ratios, by gender and age. The sample weights and the conglomerate effect in 2013 and 2019 were considered in the analyses. A total of 33,215 non-agricultural workers and 3,797 agricultural workers were evaluated in 2013, whereas 47,849 non-agricultural workers and 4,751 agricultural workers were assessed in 2019. Agricultural workers are more susceptible to poor self-rated health, chronic back problems, excessive physical activity at work, smoking and lower consumption of vegetables and fruit. On the other hand, non-agricultural workers revealed a higher prevalence of asthma/bronchitis, depression and diabetes mellitus and greater consumption of candies and soft drinks. Differentiated NCD prevention and treatment actions for both groups of workers need to be prioritized.

Investigaram-se diferenças no padrão de adoecimento e estilos de vida entre trabalhadores agrícolas e não agrícolas em 2013 e 2019, com os dados da Pesquisa Nacional de Saúde (PNS). Calcularam-se as prevalências e seus IC de 95% para morbidades autorreferidas, autoavaliação de saúde (AAS) não boa, limitação das atividades habituais por DCNT, número de DCNT, depressão maior ou menor e estilos de vida. Utilizou-se o modelo de Poisson para cálculo das razões de prevalências brutas e ajustadas por sexo e idade. Consideraram-se as ponderações amostrais e o efeito do conglomerado em 2013 e 2019. Avaliaram-se 33.215 trabalhadores não agrícolas e 3.796 agrícolas em 2013. Em 2019, foram 47.849 trabalhadores não agrícolas e 4.751 agrícolas. Os trabalhadores agrícolas estão mais propensos a AAS não boa, problemas crônicos na coluna, excesso de atividade física no trabalho, tabagismo e menor consumo de frutas, legumes e verduras (FLV). Enquanto os trabalhadores não agrícolas apresentaram maiores prevalências de asma/bronquite, depressão, diabetes, e consumo de doces e refrigerantes. Ações diferenciadas de prevenção e manejo de DCNT para os dois grupos de trabalhadores devem ser priorizadas.

Factors associated with worsening in the self-rated health status of Brazilian women who lived with dependent elderly people during the first wave of COVID-19. / Fatores associados à piora da autoavaliação da saúde das brasileiras que residiam com idosos dependentes durante a primeira onda da COVID-19.

The objective is to analyze the factors associated with the worsening of the self-rated health (SRH) of Brazilian women who live with elderly people with functional dependence (EFD) during the first wave of COVID-19. ConVid - Behavior Research was used as a data source. For the analysis, the group of women who lived with EFD was compared with those who lived with the elderly without any dependence. Hierarchical prevalence ratio (PR) models were estimated to test the associations between sociodemographic characteristics, changes in income, routine activities and health in the pandemic, with the outcome of worsening SRH. This worsening was more frequent in the group of women living with EFD. After adjusting for hierarchical factors, being black (PR=0.76; 95%CI 0.60-0.96) and having a per capita income lower than minimum wage (PR=0.78; 95%CI 0.64- 0.96) were shown to be protective factors for SRH worsening among EFD co-residents. Indisposition, emergence/worsening of back problems, affected sleep, poor SRH, feeling loneliness and difficulty in carrying out routine activities during the pandemic were positively associated factors. The study demonstrates that living with EFD was associated with a worsening in the health status of Brazilian women during the pandemic, especially among those of higher social status.

O objetivo do artigo é analisar os fatores associados à piora da autoavaliação da saúde (AAS) de brasileiras que residiam com idosos com dependência funcional (IDF) durante a primeira onda da pandemia de COVID-19. Utilizou-se a ConVid - Pesquisa de Comportamentos como fonte de dados. Para a análise comparou-se o grupo de mulheres que moravam com IDF com aquelas que moravam com idosos sem dependência. Estimou-se modelos hierárquicos de razão de prevalência (RP) para testar as associações entre as características sociodemográficas, mudanças na renda, atividades de rotina e saúde na pandemia, tendo como desfecho a piora da AAS. A piora da AAS foi mais frequente no grupo de mulheres que moravam com IDF. Após o ajuste dos fatores hierárquicos, ser negra (RP=0,76; IC95% 0,60-0,96) e ter renda per capita menor que um salário-mínimo (RP=0,78; IC95% 0,64-0,96) foram fatores inversamente associados à piora da AAS entre corresidentes de IDF. O estado de ânimo ruim, o surgimento/piora de problema de coluna, o sono afetado, a AAS ruim, o sentimento de solidão e a dificuldade na realização de atividades rotineiras durante a pandemia foram fatores positivamente associados. O estudo demonstra que morar com IDF esteve associado à piora da saúde das brasileiras na pandemia, especialmente entre aquelas em posição de maior status social.

Morbidades autorreferidas e estilos de vida em trabalhadores agrícolas e não agrícolas no Brasil: uma análise comparativa entre 2013 e 2019 / Self-reported morbidities and lifestyles of agricultural and non-agricultural workers in Brazil: a comparative analysis between 2013 and 2019

Resumo Investigaram-se diferenças no padrão de adoecimento e estilos de vida entre trabalhadores agrícolas e não agrícolas em 2013 e 2019, com os dados da Pesquisa Nacional de Saúde (PNS). Calcularam-se as prevalências e seus IC de 95% para morbidades autorreferidas, autoavaliação de saúde (AAS) não boa, limitação das atividades habituais por DCNT, número de DCNT, depressão maior ou menor e estilos de vida. Utilizou-se o modelo de Poisson para cálculo das razões de prevalências brutas e ajustadas por sexo e idade. Consideraram-se as ponderações amostrais e o efeito do conglomerado em 2013 e 2019. Avaliaram-se 33.215 trabalhadores não agrícolas e 3.796 agrícolas em 2013. Em 2019, foram 47.849 trabalhadores não agrícolas e 4.751 agrícolas. Os trabalhadores agrícolas estão mais propensos a AAS não boa, problemas crônicos na coluna, excesso de atividade física no trabalho, tabagismo e menor consumo de frutas, legumes e verduras (FLV). Enquanto os trabalhadores não agrícolas apresentaram maiores prevalências de asma/bronquite, depressão, diabetes, e consumo de doces e refrigerantes. Ações diferenciadas de prevenção e manejo de DCNT para os dois grupos de trabalhadores devem ser priorizadas.

Abstract Differences in the profiles of illness and lifestyles among agricultural and non-agricultural workers were investigated using data from the National Health Survey (Brazilian acronym PNS) of 2013 and 2019. The prevalence and 95% CIs were calculated for the following variables: self-reported morbidities, poor self-rated health, limitations of usual activities, number of NCD, major or minor depression and lifestyles. The Poisson model was used to calculate crude and adjusted prevalence ratios, by gender and age. The sample weights and the conglomerate effect in 2013 and 2019 were considered in the analyses. A total of 33,215 non-agricultural workers and 3,797 agricultural workers were evaluated in 2013, whereas 47,849 non-agricultural workers and 4,751 agricultural workers were assessed in 2019. Agricultural workers are more susceptible to poor self-rated health, chronic back problems, excessive physical activity at work, smoking and lower consumption of vegetables and fruit. On the other hand, non-agricultural workers revealed a higher prevalence of asthma/bronchitis, depression and diabetes mellitus and greater consumption of candies and soft drinks. Differentiated NCD prevention and treatment actions for both groups of workers need to be prioritized.

Fatores associados à piora da autoavaliação da saúde das brasileiras que residiam com idosos dependentes durante a primeira onda da COVID-19 / Factors associated with worsening in the self-rated health status of Brazilian women who lived with dependent elderly people during the first wave of COVID-19

Resumo O objetivo do artigo é analisar os fatores associados à piora da autoavaliação da saúde (AAS) de brasileiras que residiam com idosos com dependência funcional (IDF) durante a primeira onda da pandemia de COVID-19. Utilizou-se a ConVid - Pesquisa de Comportamentos como fonte de dados. Para a análise comparou-se o grupo de mulheres que moravam com IDF com aquelas que moravam com idosos sem dependência. Estimou-se modelos hierárquicos de razão de prevalência (RP) para testar as associações entre as características sociodemográficas, mudanças na renda, atividades de rotina e saúde na pandemia, tendo como desfecho a piora da AAS. A piora da AAS foi mais frequente no grupo de mulheres que moravam com IDF. Após o ajuste dos fatores hierárquicos, ser negra (RP=0,76; IC95% 0,60-0,96) e ter renda per capita menor que um salário-mínimo (RP=0,78; IC95% 0,64-0,96) foram fatores inversamente associados à piora da AAS entre corresidentes de IDF. O estado de ânimo ruim, o surgimento/piora de problema de coluna, o sono afetado, a AAS ruim, o sentimento de solidão e a dificuldade na realização de atividades rotineiras durante a pandemia foram fatores positivamente associados. O estudo demonstra que morar com IDF esteve associado à piora da saúde das brasileiras na pandemia, especialmente entre aquelas em posição de maior status social.

Abstract The objective is to analyze the factors associated with the worsening of the self-rated health (SRH) of Brazilian women who live with elderly people with functional dependence (EFD) during the first wave of COVID-19. ConVid - Behavior Research was used as a data source. For the analysis, the group of women who lived with EFD was compared with those who lived with the elderly without any dependence. Hierarchical prevalence ratio (PR) models were estimated to test the associations between sociodemographic characteristics, changes in income, routine activities and health in the pandemic, with the outcome of worsening SRH. This worsening was more frequent in the group of women living with EFD. After adjusting for hierarchical factors, being black (PR=0.76; 95%CI 0.60-0.96) and having a per capita income lower than minimum wage (PR=0.78; 95%CI 0.64- 0.96) were shown to be protective factors for SRH worsening among EFD co-residents. Indisposition, emergence/worsening of back problems, affected sleep, poor SRH, feeling loneliness and difficulty in carrying out routine activities during the pandemic were positively associated factors. The study demonstrates that living with EFD was associated with a worsening in the health status of Brazilian women during the pandemic, especially among those of higher social status.

Factors associated with the incidence and worsening of back pain during the first wave of COVID-19 in Brazil. / Fatores associados à incidência e à piora do problema de coluna durante a primeira onda da COVID-19 no Brasil.

The article aims to estimate the incidence and worsening of back pain (BP) during the first wave of COVID-19 in Brazil, as well as to investigate demographic, socioeconomic factors and associated changes in living conditions. ConVid - Behavior Research, applied between April and May 2020, was used as data source. The number and distribution of respondents who developed BP and those who had a worsening of the preexisting problem, their 95% confidence intervals and Pearson's Chi-square test were estimated. The odds ratio of developing BP or worsening a preexisting problem was also estimated using multiple logistic regression models. Pre-existing BP was reported by 33.9% (95%CI 32.5-35.3) of respondents and more than half (54.4%; 95%CI 51.9-56.9) had worsened. The cumulative incidence of BP in the first wave of the pandemic was 40.9% (95%CI 39.2-42.7). Being a woman, the perceived increase in housework and the frequent feeling of sadness or depression were associated with both outcomes. Socioeconomic factors were not associated with any of outcome. The high incidence and worsening of BP during the first wave reveal the need for studies in more recent periods, given the long duration of the pandemic.

O artigo tem como objetivo estimar a incidência e o agravamento do problema de coluna (PC) durante a primeira onda da COVID-19 no Brasil, bem como investigar os fatores demográficos, socioeconômicos e as mudanças nas condições de vida associadas. Utilizou-se a ConVid - Pesquisa de Comportamentos, realizada entre abril e maio de 2020, como fonte de dados. Estimou-se o número e a distribuição dos entrevistados que desenvolveram PC e a dos que tiveram agravamento no problema preexistente, seus intervalos de 95% de confiança e o teste qui-quadrado de Pearson. Estimou-se também a razão de chance de desenvolver PC ou ter piora de problema preexistente por meio de modelos de regressão logística múltipla. O PC preexistente foi reportado por 33,9% (IC95% 32,5-35,3) dos entrevistados e mais da metade (54,4%; IC95% 51,9-56,9) teve piora do quadro. A incidência cumulativa de PC na primeira onda da pandemia foi de 40,9% (IC95% 39,2-42,7). Ser mulher, o aumento percebido do trabalho doméstico e o sentimento frequente de tristeza ou depressão foram associados a ambos os desfechos. Os fatores socioeconômicos não foram associados a nenhum dos desfechos. A alta incidência e agravamento do PC durante a primeira onda revelam a necessidade de estudos em períodos mais recentes, dada a longa duração da pandemia.

Fatores associados à incidência e à piora do problema de coluna durante a primeira onda da COVID-19 no Brasil / Factors associated with the incidence and worsening of back pain during the first wave of COVID-19 in Brazil

Resumo O artigo tem como objetivo estimar a incidência e o agravamento do problema de coluna (PC) durante a primeira onda da COVID-19 no Brasil, bem como investigar os fatores demográficos, socioeconômicos e as mudanças nas condições de vida associadas. Utilizou-se a ConVid - Pesquisa de Comportamentos, realizada entre abril e maio de 2020, como fonte de dados. Estimou-se o número e a distribuição dos entrevistados que desenvolveram PC e a dos que tiveram agravamento no problema preexistente, seus intervalos de 95% de confiança e o teste qui-quadrado de Pearson. Estimou-se também a razão de chance de desenvolver PC ou ter piora de problema preexistente por meio de modelos de regressão logística múltipla. O PC preexistente foi reportado por 33,9% (IC95% 32,5-35,3) dos entrevistados e mais da metade (54,4%; IC95% 51,9-56,9) teve piora do quadro. A incidência cumulativa de PC na primeira onda da pandemia foi de 40,9% (IC95% 39,2-42,7). Ser mulher, o aumento percebido do trabalho doméstico e o sentimento frequente de tristeza ou depressão foram associados a ambos os desfechos. Os fatores socioeconômicos não foram associados a nenhum dos desfechos. A alta incidência e agravamento do PC durante a primeira onda revelam a necessidade de estudos em períodos mais recentes, dada a longa duração da pandemia.

Abstract The article aims to estimate the incidence and worsening of back pain (BP) during the first wave of COVID-19 in Brazil, as well as to investigate demographic, socioeconomic factors and associated changes in living conditions. ConVid - Behavior Research, applied between April and May 2020, was used as data source. The number and distribution of respondents who developed BP and those who had a worsening of the preexisting problem, their 95% confidence intervals and Pearson's Chi-square test were estimated. The odds ratio of developing BP or worsening a preexisting problem was also estimated using multiple logistic regression models. Pre-existing BP was reported by 33.9% (95%CI 32.5-35.3) of respondents and more than half (54.4%; 95%CI 51.9-56.9) had worsened. The cumulative incidence of BP in the first wave of the pandemic was 40.9% (95%CI 39.2-42.7). Being a woman, the perceived increase in housework and the frequent feeling of sadness or depression were associated with both outcomes. Socioeconomic factors were not associated with any of outcome. The high incidence and worsening of BP during the first wave reveal the need for studies in more recent periods, given the long duration of the pandemic.

The habit of drinking and driving in Brazil: National Survey of Health 2013 and 2019.

OBJECTIVE: To assess factors associated with the habit of drinking and driving and estimating the variations in the prevalence of this behavior in 2013 and 2019, considering information from the two editions of the Pesquisa Nacional de Saúde (PNS - National Survey of Health). METHODS: PNS is a nationwide cross-sectional home-based study. In 2013 and 2019, 60,202 and 85,854 individuals were interviewed, respectively. To assess the association between the indicator "drinking and driving" and the study variables, crude and adjusted odds ratios (ORs) were estimated using logistic regression models. To compare the prevalence between the studied years, a Pearson's chi-squared test adjusted by the Rao-Scott correction (which considers the effect of the sampling plan) and converted into an F statistic, tested at a 5% significance level, was used. RESULTS: The prevalence of drinking and driving was higher among men in 2013 (27.4%; 95%CI 25.6-29.3%) and 2019 (20.5%; 95%CI 19.4-21.7%) than among women (11.9%; 95%CI 9.9-14.2% and 7.2%; 95%CI 6.7-9.0%, respectively). Inidviduals aged 30 to 39, who lived without a partner, in rural areas, and were motorcycle drivers had significantly higher estimates. Men with higher income had higher prevalence of drinking and driving. From 2013 to 2019, the act of drinking and driving significantly decreased. Regarding traffic accidents, ORs were significant (p < 0.01) in the studied years for both men and women. DISCUSSION: Results show the need to continue policies to monitor blood alcohol level and traffic education, with specific actions directed to rural areas and motorcycle drivers.

Papanicolaou test in Brazil: analysis of the National Health Survey of 2013 and 2019 / Exame de Papanicolaou no Brasil: análise da Pesquisa Nacional de Saúde em 2013 e 2019

ABSTRACT OBJECTIVES To compare the coverage of cervical cancer screening in Brazil in 2013 and 2019, investigating the factors associated with having the test performed and the reasons given for not doing it. Additionally, a comparison is made concerning the time taken to receive the test result in SUS (Sistema Único de Saúde) and in the private health services. METHODS Using data from the National Health Survey (Pesquisa Nacional de Saúde - PNS), prevalence rates and corresponding confidence intervals were calculated to determine the frequency of recent cervical cancer screenings among women aged between 25 and 64 years old in Brazil, for both 2013 and 2019. Poisson regression models were employed to compare the prevalence of the outcome according to sociodemographic characteristics. The reasons for not having the test and the time between performing and receiving the result were also analyzed. RESULTS The findings revealed an increase in the coverage of preventive cervical cancer exams in Brazil from 78.7% in 2013 to 81.3% in 2019. Additionally, there was a decline in the proportion of women who had never undergone the exam, from 9.7% to 6.1%. Prevalence of test uptake was higher among white women, those with higher levels of education and income, and those residing in the South and Southeast regions of the country. The most commonly cited reasons for not taking the test were the impression it was unnecessary (45% in both 2013 and 2019) and never having been asked to undergo the test (20.6% in 2013 and 14.8% in 2019). CONCLUSIONS Despite the high coverage of screening achieved in the country, there is great inequality in access to the test, and a non-negligible number of women are at greater risk of dying from a preventable disease. Efforts must be made to structure an organized screening program that identifies and captures the most vulnerable women.

RESUMO OBJETIVOS Comparar a cobertura do rastreamento do câncer de colo do útero no Brasil em 2013 e 2019, investigar os fatores associados à realização do exame e os motivos informados para não ter realizado, além de comparar o tempo do recebimento do resultado do exame no SUS e na rede privada. MÉTODOS A partir de dados da Pesquisa Nacional de Saúde (PNS) foram calculadas as prevalências e os respectivos intervalos de confiança de realização do exame preventivo do câncer do colo do útero há menos de três anos, em mulheres de 25 a 64 anos, em 2013 e 2019. Modelos de regressão de Poisson foram utilizados para comparar as prevalências do desfecho segundo características sociodemográficas. Também foram analisados os motivos para não ter feito o exame e o tempo entre a realização e o recebimento do laudo. RESULTADOS Houve aumento na cobertura do exame preventivo no Brasil entre 2013 (78,7%) e 2019 (81,3%) e redução na proporção de mulheres que nunca fizeram o exame de 9,7% para 6,1%. A prevalência de realização do exame foi maior em mulheres brancas, melhor escolaridade e renda mais alta, residentes nas regiões Sul e Sudeste. Os motivos mais frequentes para não realizar o exame foram achar desnecessário (45% em 2013 e em 2019) e nunca ter sido orientada a fazê-lo (20,6% em 2013 e 14,8% em 2019). CONCLUSÕES Apesar das elevadas coberturas de rastreamento alcançadas pelo país, há grande desigualdade no acesso ao exame, e uma parcela não desprezível de mulheres está sob maior risco de morrer por uma doença que pode ser evitada. Esforços devem ser feitos para a estruturação de um programa de rastreamento organizado que identifique e capte as mulheres mais vulneráveis.

Alcohol consumption among adolescents during the COVID-19 pandemic, ConVid Adolescents - Behavior Research / O consumo de bebidas alcoólicas entre adolescentes durante a pandemia de COVID-19, ConVid Adolescentes — Pesquisa de Comportamentos

ABSTRACT Objective: To describe the prevalence of alcohol consumption before and during the COVID-19 pandemic and to analyze the factors associated with this behavior during the period of social distancing among Brazilian adolescents. Methods: Cross-sectional study using data from the ConVid Adolescents survey, carried out via the Internet between June and September 2020. The prevalence of alcohol consumption before and during the pandemic, as well as association with sociodemographic variables, mental health, and lifestyle were estimated. A logistic regression model was used to assess associated factors. Results: 9,470 adolescents were evaluated. Alcohol consumption decreased from 17.70% (95%CI 16.64-18.85) before the pandemic to 12.80% (95%CI 11.85-13.76) during the pandemic. Alcohol consumption was associated with the age group of 16 and 17 years (OR=2.9; 95%CI 1.08-1.53), place of residence in the South (OR=1.82; 95%CI 1.46-2.27) and Southeast regions (OR=1.33; 95%CI 1.05-1.69), having three or more close friends (OR=1.78; 95%CI 1.25-2.53), reporting worsening sleep problems during the pandemic (OR=1.59; 95%CI 1.20-2.11), feeling sad sometimes (OR=1,83; 95%CI 1,40-2,38) and always (OR=2.27; 95%CI 1.70-3.05), feeling always irritated (OR=1,60; 95%CI 1,14-2,25), being a smoker (OR=13,74; 95%CI 8.63-21.87) and a passive smoker (OR=1.76; 95%CI 1.42-2.19). Strict adherence to social distancing was associated with lower alcohol consumption (OR=0.40; 95%CI 0.32-0.49). Conclusions: The COVID-19 pandemic led to a decrease in consumption of alcoholic beverages by Brazilian adolescents, which was influenced by sociodemographic and mental health factors, adherence to social restriction measures and lifestyle in this period. Managers, educators, family and the society must be involved in the articulation of Public Policies to prevent alcohol consumption.

RESUMO Objetivo: Descrever as prevalências do consumo de bebidas alcoólicas por adolescentes brasileiros antes e durante a pandemia de COVID-19 e analisar os fatores associados a esse comportamento no período de distanciamento social. Métodos: Estudo transversal, utilizando dados da pesquisa ConVid Adolescentes, realizado via web entre junho e setembro de 2020. Foi estimada a prevalência do consumo de bebidas alcoólicas antes e durante a pandemia e a associação com variáveis sociodemográficas, de saúde mental e estilos de vida. Foi usado modelo de regressão logística para avaliar os fatores associados. Resultados: Avaliaram-se 9.470 adolescentes. O consumo de bebida alcoólica reduziu de 17,70% (IC95% 16,64-18,85), antes da pandemia, para 12,80% (IC95% 11,85-13,76), durante a pandemia. O consumo de bebidas alcoólicas esteve associado à faixa etária de 16 e 17 anos (OR=2,9; IC95% 1,08-1,53), morar na Região Sul (OR=1,82; IC95% 1,46-2,27) e Sudeste (OR=1,33; IC95% 1,05-1,69), ter três ou mais amigos próximos (OR=1,78; IC95% 1,25-2,53), relatar piora dos problemas de sono (OR=1,59; IC95% 1,20-2,11), sentir-se triste às vezes (OR=1,83; IC95% 1,40-2,38) e sempre (OR=2,27; IC95% 1,70-3,05), irritado sempre (OR=1,60; IC95% 1,14-2,25), ser fumante ativo (OR=13,74; IC95% 8,63-21,87) e fumante passivo (OR=1,76; IC95% 1,42-2,19). A adesão à restrição de forma muito rigorosa associou-se ao menor consumo de bebidas alcoólicas (OR=0,40; IC95% 0,32-0,49). Conclusão: A pandemia causada pela COVID-19 levou à diminuição no consumo de bebidas alcoólicas pelos adolescentes brasileiros, e o consumo durante a pandemia foi influenciado por fatores sociodemográficos, de saúde mental, adesão às medidas de restrição social e estilos de vida. Faz-se necessário o envolvimento de gestores, educadores, família e sociedade na articulação de políticas públicas para evitar o consumo de bebidas alcoólicas.

Alcohol consumption among adolescents during the Covid 19 pandemic, Convid Adolescents ­ Behavior Research / O consumo de bebidas alcóolicas entre adolescentes durante a pandemia do Covid 19, Convid Adolescentes - Pesquisa de Comportamentos

Objective: To describe the prevalence of alcohol consumption before and during the Covid 19 pandemic and to analyze the factors associated with this behavior during the period of social distancing in Brazilian adolescents. Methods: Cross-sectional study, using data from the Convid Adolescents survey, carried out via the web between June and September 2020. The prevalence of alcohol consumption before and during the pandemic and association with sociodemographic variables, mental health, lifestyles was estimated. A logistic regression model was used to assess associated factors. Results: 9,470 adolescents were evaluated. Alcohol consumption decreased from 17.70% (95%CI: 16.64;18.85) before the pandemic to 12.80% (95%CI: 11.85;13.76) during the pandemic. Higher alcohol consumption was associated with the age group of 16 and 17 years (OR=2.9;1.08-1.53), living in the South region (OR=1.82;1.46;2.27) and Southeast (OR=1.33;1.05;1.69), having 03 or more close friends (OR=1.78;1.25;2.53), reporting worsening sleep problems during the pandemic (OR=;1.59;1.20;2.11), feeling sad sometimes and always (OR=2.27;1.70;3.05), always irritated, being a smoker (OR=13, 74;8.63;21.87) and passive smoking (OR=1.76;1.42;2.19) were associated with higher alcohol consumption. Adherence to the restriction in a very strict way was associated with lower alcohol consumption (OR=0.40;0.32;0.49). Conclusions: The pandemic caused by Covid 19 led to a decrease in the consumption of alcoholic beverages by Brazilian adolescents, being influenced by sociodemographic and mental health factors, adherence to social restriction measures and lifestyle. It is necessary to involve managers, educators, family and society in the articulation of Public Policies for the prevention of alcohol consumption.

Objetivo: Descrever as prevalências de consumo de bebidas alcoólicas antes e durante a pandemia de Covid 19 e analisar os fatores associados a esse comportamento durante o período de distanciamento social em adolescentes brasileiros. Métodos: Estudo transversal, utilizando os dados da pesquisa Convid Adolescentes, realizada via web entre junho e setembro de 2020. Foi estimada a prevalência do consumo de álcool antes e durante a pandemia e associação com variáveis sociodemográficas, saúde mental, estilos de vida. Foi utilizado modelo de regressão logística para avaliar os fatores associados. Resultados: Foram avaliados 9.470 adolescentes. O consumo de bebida alcoólica reduziu de 17,70% (IC95%: 16,64;18,85) antes da pandemia, para 12,80% (IC95%: 11,85;13,76) durante a pandemia. O maior consumo de álcool esteve associado a faixa etária de 16 e 17 anos (OR=2,9;1,08-1,53), morar na região Sul (OR=1,82;1,46;2,27) e Sudeste (OR=1,33;1,05;1,69), ter 03 ou mais amigos próximos (OR=1,78;1,25;2,53), relatar piora dos problemas de sono durante a pandemia (OR=;1,59;1,20;2,11), sentir-se triste às vezes e sempre (OR=2,27;1,70;3,05), irritado sempre, ser fumante (OR=13,74;8,63;21,87) e fumante passivo (OR=1,76;1,42;2,19) se associaram ao maior consumo de álcool. A adesão à restrição de forma muito rigorosa associou-se ao menor consumo de álcool (OR=0,40;0,32;0,49). Conclusões: A pandemia causada pela Covid 19 levou à diminuição no consumo de bebidas alcóolicas pelos adolescentes brasileiros, sendo influenciada por fatores sociodemográficos, de saúde mental, adesão as medidas de restrição social e estilo de vida. Faz-se necessário o envolvimento de gestores, educadores, família e sociedade na articulação de Políticas Públicas para prevenção do consumo de álcool.

Brumadinho Health Project: methodological aspects and epidemiological profile of participants in the cohort baseline.

OBJECTIVE: To present the methodological aspects of the Brumadinho Health Project and to describe the epidemiological profile of participants in the baseline cohort. METHODS: Prospective, population-based cohort study in a representative sample of residents (aged 12 and over) of Brumadinho, Minas Gerais, after a mining tailings dam failure. Information for the baseline was collected in 2021, two years after the mining tailings dam collapsed, including sociodemographic, health and service use aspects, among others. Prevalence estimates of health outcomes were described in Brumadinho, as well as in the Metropolitan Region of Belo Horizonte and Minas Gerais, using data from the 2019 National Health Survey. All analyses were performed in the software Stata 17.0, considering the sampling weights and design effect. RESULTS: 3,080 (86.4%) residents participated in the study, most of them being females (56.7%) and with a mean age of 46.1 years. The diseases more frequently reported were arterial hypertension (30.1%), high cholesterol (23.1%) and depression (22.5%), similarly to what was observed in the Metropolitan Region of Belo Horizonte and Minas Gerais, although the prevalence in Brumadinho was higher. At least one medical appointment and one hospitalization occurred in 75.2% and 9.4% of residents in the past year, respectively. CONCLUSION: It is important to monitor health, physical and mental conditions of residents after the occurrence of a disaster of this magnitude. This information can contribute with risk management of these processes, not only in the affected municipality, but also in other areas where populations are at risk of major disasters.

Sociodemographic and residential factors associated with multimorbity: results of Brumadinho Health Project.

OBJECTIVE: To evaluate the prevalence of multimorbidity and sociodemographic and residential factors associated with this condition among adults living in Brumadinho, Minas Gerais. METHODS: Cross-sectional study with baseline data from the Brumadinho Health Project, conducted in 2021 and comprising 2,777 individuals aged 18 years and over. The outcome variable was multimorbidity, defined by the existence of two or more of 20 chronic diseases. The exploratory variables were sex, age group, educational level, skin color and area of residence according to the dam failure. The association between exploratory variables and multimorbidity was assessed by logistic regression. RESULTS: The prevalence of multimorbidity was 53.8% (95%CI 50.6-56.9). A greater chance of multimorbidity was found among women (adjusted OR=2.5; 95%CI 1.9-3.2), in participants aged between 40 and 59 (adjusted OR=2.8; 95%CI 1.8-4.3) or 60 years and older (adjusted OR=7.9; 95%CI 4.7-13.4) and in residents of the areas that were directly affected by the dam failure (adjusted OR=1.6; 95%CI 1.3-2.0). CONCLUSION: The burden of multimorbidity on the population of Brumadinho requires effective preventive measures and actions to the whole population, but mainly to the most vulnerable groups, that is, women, middle-aged and older individuals, and those directly affected by the dam failure, in addition to a timely provision of health care to reverse this situation.

Chronic respiratory diseases and respiratory symptoms after a mining dam rupture: Brumadinho Health Project.

OBJECTIVE: To identify factors associated with asthma and chronic obstructive pulmonary disease (COPD) and respiratory symptoms, in Brumadinho, state of Minas Gerais, Brazil, after a dam rupture. METHODS: This is a cross-sectional study, including a representative sample of adults (aged 18 years and over) in the municipality. Associations were assessed between dependent variables (medical diagnosis of asthma and COPD; symptoms of wheezing, dry cough, and nose irritation) and exploratory variables (sex, age group, smoking habit, having worked at Vale S.A. company before the dam rupture, time and area of residence in relation to the dam rupture). Logistic regression models with odds ratio (OR) calculation and 95% confidence interval were used. RESULTS: We identified a prevalence of 7.2% of asthma; 3.5% of COPD; 8.8% of wheezing; 23.6% of dry cough; and 31.8% of nose irritation. We observed a greater chance of asthma among women and residents in the affected and mining regions, while a greater chance of COPD was observed in smokers and in those with longer time of residence in the municipality. Among the symptoms, we verified a higher chance of nose irritation among women, while a higher chance of wheezing and dry cough were found among smokers (current and former). Residents of regions affected by the mud reported a greater chance of presenting all the analyzed symptoms. Conversely, level of education was negatively associated with wheezing and dry cough. CONCLUSION: We found respiratory changes and identified the groups most vulnerable to developing them, which could contribute to directing actions to reduce the population's respiratory problems.

Factors associated with paid work after the dam failure: Brumadinho Health Project.

OBJECTIVE: To analyze the factors associated with paid work, after the dam failure, based on geographic strata, among men and women residing in Brumadinho, Minas Gerais. METHODS: Baseline data from participants of the Brumadinho Health Project, aged 18 years or older, obtained through a questionnaire, between July and November 2021 (n=2,783) were used. The dependent variable was paid work after the dam failure and the explanatory variables were geographic stratum, age, education, race/skin color, self-perception of health and employment relationship before the event. The adjusted analysis was estimated by logistic regression. All analyses were performed separately for men and women. RESULTS: Paid work after the dam failure was reported by 58.3% (95%CI 55.0-61.6) of the participants, with the highest prevalence among men (71.4%; 95%CI 67.1-75.3) compared to women (48.6%; 95%CI 44.3-52.8) (p<0.001). After adjustments, the results showed that the population who was directly exposed to the disaster was less likely to have a paid work after it, both for women (OR=0.68; 95%CI 0.48-0.95) and for men (OR=0.48; 95%CI 0.30-0.78). In addition, women directly exposed to the disaster and who reported being self-employed before it were less likely to have a paid work, compared to women who reported being employed with or without a formal contract. CONCLUSION: Participation in the labor market is determined by several factors. Thus, intersectoral policies are necessary the population's demands of life and work are met in disaster situations.

Use of psychotropic drugs by population in an area affected by the tailings dam rupture: Brumadinho Health Project.

OBJECTIVE: To describe the consumption of psychotropic drugs in the adult population residing in Brumadinho, Minas Gerais, after the Vale dam collapse, which occurred in 2019. METHODS: This is a cross-sectional study, part of the Brumadinho Health Project, developed in 2021, with a representative population-based sample of adults (18 years and over) residing in Brumadinho. A total of 2,805 adults with information on self-reported use of psychotropic drugs (antidepressants and anxiolytics-hypnotics/sedatives) in the last 15 days were included in the analysis. The prevalence of psychotropic drug use was estimated, and the most used psychotropic drugs were identified. Pearson's chi-square test (with Rao-Scott correction) was used to test associations between exposures and use of psychotropic drugs, considering a significance level of p<0.05. RESULTS: The use of antidepressants (14.2%) was more common than the use of anxiolytics or hypnotics/sedatives (5.2%), with sertraline and fluoxetine being the most used antidepressants. The use of anxiolytics and hypnotics/sedatives was higher among residents who lived in the area directly affected by the dam's mud, and the use of any psychotropic drug was higher among those who lost a relative/friend in the disaster and assessed that their health worsened after the disaster, and among women. CONCLUSION: The results of the study corroborate what was observed in other populations exposed to similar tragedies, regarding the pattern of associations and the of use of psychotropic drugs.

Comparison of sampling designs from the two editions of the Brazilian National Health Survey, 2013 and 2019.

Our objective is to describe the differences in the sampling plans of the two editions of the Brazilian National Health Survey (PNS 2013 and 2019) and to evaluate how the changes affected the coefficient of variation (CV) and the design effect (Deff) of some estimated indicators. Variables from different parts of the questionnaire were analyzed to cover proportions with different magnitudes. The prevalence of obesity was included in the analysis since anthropometry measurement in the 2019 survey was performed in a subsample. The value of the point estimate, CV, and the Deff were calculated for each indicator, considering the stratification of the primary sampling units, the weighting of the sampling units, and the clustering effect. The CV and the Deff were lower in the 2019 estimates for most indicators. Concerning the questionnaire indicators of all household members, the Deffs were high and reached values greater than 18 for having a health insurance plan. Regarding the indicators of the individual questionnaire, for the prevalence of obesity, the Deff ranged from 2.7 to 4.2, in 2013, and from 2.7 to 10.2, in 2019. The prevalence of hypertension and diabetes per Federative Unit had a higher CV and lower Deff. Expanding the sample size to meet the diverse health objectives and the high Deff are significant challenges for developing probabilistic household-based national survey. New probabilistic sampling strategies should be considered to reduce costs and clustering effects.