Population-based study in a rural area: methodology and challenges

OBJETIVO: Descrever o planejamento, a amostragem, os aspectos operacionais do campo e a amostra obtida durante pesquisa realizada na zona rural, especificando e discutindo as principais dificuldades logísticas peculiares a esses locais e as soluções adotadas. MÉTODOS: Entre janeiro e junho de 2016, foi realizado inquérito transversal de base populacional, com amostra representativa da população com 18 anos de idade ou mais residente na zona rural de Pelotas (cerca de 22 mil), RS, Brasil. Foram coletadas informações demográficas, socioeconômicas e relacionadas à saúde, como consumo de bebidas alcoólicas, consumo de cigarros, sintomas depressivos, qualidade da alimentação, qualidade de vida, atividade física, satisfação com a unidade de saúde, excesso de peso ou obesidade e problemas do sono. RESULTADOS: Em 720 domicílios amostrados, 1.697 indivíduos foram identificados e 1.519 foram entrevistados (89,5%). O estudo, inicialmente, sorteou 24 setores e propôs-se a visitar 42 domicílios/setor, mas foram necessárias adequações metodológicas, especialmente a redução do número de domicílios por setor (de 42 para 30) e a identificação de núcleos habitacionais nos setores. As principais razões para as adequações foram dificuldade de acesso aos locais, grandes distâncias entre residências, equívocos nos dados geográficos disponíveis via satélite (não condiziam com a realidade) e alto custo. CONCLUSÕES: O prévio reconhecimento detalhado do ambiente de pesquisa foi fundamental para a tomada de decisão perante às inconsistências geográficas entre mapas e território. As estratégias e técnicas dos estudos na zona urbana não são aplicáveis à zona rural no que tange ao contexto observado em Pelotas. As medidas adotadas, mantendo o rigor metodológico, foram fundamentais para garantir a execução do estudo no tempo planejado e com os recursos financeiros disponíveis.OBJECTIVE: To describe the planning, sampling, operational aspects of the field, and the sample obtained during a research conducted in a rural area, specifying and discussing the main logistical difficulties unique to these places and the solutions adopted. METHODS: We carried out a population-based, cross-sectional survey between January and June 2016, with a representative sample of the population aged 18 years or over living in the rural area of Pelotas (approximately 22,000 individuals), State of Rio Grande do Sul, Brazil. We collected demographic, socioeconomic, and health-related information, such as alcohol consumption, cigarette consumption, depressive symptoms, quality of diet, quality of life, physical activity, satisfaction with the health unit, overweight or obesity, and sleep problems. RESULTS: In the 720 domiciles sampled, 1,697 individuals were identified and 1,519 were interviewed (89.5%). The study initially drew 24 census tracts and proposed the visit to 42 households per tract; however, we need to adjust the method, such as decreasing the number of households per census tract (from 42 to 30) and identifying housing centers in each tract. The main reasons for these changes were difficulty accessing the area, large distances between households, misconceptions in the satellite data available (which did not fit the reality), and high cost of the field work. CONCLUSIONS: The previous detailed recognition of the research environment was crucial for decision making as the maps and territory had geographical inconsistencies. The strategies and techniques used in studies for the urban area are not applicable to the rural area given the outcomes observed in Pelotas. The decisions taken, keeping the methodological rigor, were essential to ensure the timely execution of the study with the financial resources available

Services de santé dans la zone rurale de Pelotas : une évaluation technique par rapport à la vision de l'utilisateur

Objective: To evaluate the association between satisfaction of users of the Basic Health Units (UBS) in the rural area of Pelotas and the attributes of Primary Health Care (PHC). Methods: The study was composed of two different methodologies. To estimate user satisfaction, a cross-sectional population-based study was conducted among adults living in the rural area of a large city in southern Brazil. In order to estimate the compliance with the APS attributes, PCATool instrument was applied to health professionals, doctors and nurses, working in the UBS in the rural area. Results: The prevalence of satisfaction with the UBS was of 64,5 %. The overall APS orientation score of the rural UBS was 7,78. Attendance in UBS with a high degree of orientation to PCH was associated with a 25% increase in user satisfaction (PR 1,25 95% CI 1,10-1,44). The attributes positively associated to satisfaction were first contact access, longitudinality, family orientation and community orientation. Conclusions: The findings evidenced a relative low proportion of satisfaction with UBS in the rural area of the city of Pelotas-RS, and, that health services strongly oriented to APS are positively associated with user satisfaction, which may guide managers in improving services quality.Objetivo: evaluar la asociación entre la satisfacción de los usuarios de las Unidades Básicas de Salud (UBS) de la zona rural de Pelotas y los atributos de la Atención Primaria de Salud (APS). Métodos: Estimar la satisfacción de los usuarios, un estudio transversal de base poblacional. El estudio se llevó a cabo con adultos que viven en el área rural de un gran municipio del sur de Brasil. Para estimar el cumplimiento de los atributos de la APS se utilizó el instrumento PCATool versión profesional, aplicado a médicos y enfermeros que actúan en la UBS del área rural. Resultados: la prevalencia de satisfacción con la UBS fue del 64,5%. El puntaje de orientación general de APS fue de 7,48 (IC95% 7,04 - 7,93). El atributo peor evaluado fue el acceso al primer contacto, que obtuvo un promedio de 4,13 (IC95% 3,66 - 4,59), mientras que el atributo mejor evaluado fue la orientación familiar con un promedio de 8,78 (IC95% 7,88 - 9,53). El servicio en las UBS con un alto grado de orientación a la APS se asoció con un aumento del 25% en la satisfacción del usuario (RP 1,25 IC 95% 1,10-1,44) Los atributos asociados positivamente con la satisfacción fueron el acceso de primer contacto, la longitudinalidad, la orientación familiar y la orientación comunitaria. Conclusiones: los hallazgos mostraron una proporción relativamente baja de satisfacción con la UBS en el área rural de la ciudad de Pelotas-RS y que los servicios de salud fuertemente orientados a la APS están asociados positivamente con la satisfacción de los usuarios, lo que puede orientar a los gestores en la mejora de la calidad de la atención. servicios.Objectif : évaluer l'association entre la satisfaction des utilisateurs des Unités de Santé de Base (UBS) dans la zone rurale de Pelotas et les attributs des Soins de Santé Primaires (SSP). Méthodes : Pour estimer la satisfaction des utilisateurs, une étude transversale basée sur la population L'étude a été réalisée auprès d'adultes vivant dans la zone rurale d'une grande municipalité du sud du Brésil. Pour estimer la conformité aux attributs PHC, l'instrument PCATool version professionnelle a été utilisé, appliqué aux médecins et infirmières qui travaillent à l'UBS dans les zones rurales. Résultats : la prévalence de la satisfaction à l'égard de l'UBS était de 64,5%. Le score général d'orientation en matière de SSP était de 7,48 (IC à 95 % 7,04 - 7,93). L'attribut le moins bien évalué était l'accès au premier contact, qui a obtenu une moyenne de 4,13 (IC à 95 % 3,66 - 4,59), tandis que l'attribut le mieux évalué était l'orientation familiale avec une moyenne de 8,78 (IC à 95 % 7,88 - 9,53). Le service dans l'UBS avec un degré élevé d'orientation vers les soins de santé primaires était associé à une augmentation de 25 % de la satisfaction des utilisateurs (RP 1,25, IC à 95 % 1,10-1,44). Les attributs positivement associés à la satisfaction étaient l'accès au premier contact, la longitudinalité, l'orientation familiale et l'orientation communautaire. Conclusions : les résultats ont montré une proportion relativement faible de satisfaction à l'égard de l'UBS dans la zone rurale de la ville de Pelotas-RS et que les services de santé fortement orientés vers les SSP sont positivement associés à la satisfaction des utilisateurs, ce qui peut guider les gestionnaires dans l'amélioration de la qualité des soins. prestations de service.Sem bolsaObjetivo: avaliar a associação entre a satisfação dos usuários das Unidades Básicas de Saúde (UBS) da zona rural de Pelotas e os atributos da Atenção Primária à Saúde (APS) Métodos: Para estimar a satisfação do usuário foi realizado um estudo transversal de base populacional com adultos residentes na zona rural de um munícipio de grande porte do sul do Brasil. Já para estimar o cumprimento dos atributos da APS foi utilizado o instrumento PCATool versão profissionais aplicado a médicos e enfermeiros que atuam nas UBS da zona rural. Resultados: a prevalência de satisfação com a UBS foi de 64,5%. O escore geral de orientação à APS foi 7,48 (IC95% 7,04 - 7,93). O atributo pior avaliado foi o acesso de primeiro contato que obteve média de 4,13 (IC95% 3,66 - 4,59), enquanto que o atributo melhor avaliado foi a orientação familiar com média 8,78 (IC95% 7,88 - 9,53). O atendimento em UBS com alto grau de orientação à APS esteve associado ao aumento de 25% na satisfação dos usuários (RP 1,25 IC95% 1,10-1,44) Os atributos positivamente associados à satisfação foram acesso de primeiro contato, longitudinalidade, orientação familiar e orientação comunitária. Conclusões: os achados evidenciaram uma relativa baixa proporção de satisfação com as UBS da zona rural do município de Pelotas-RS e que serviços de saúde fortemente orientados à APS estão associados positivamente com a satisfação do usuário, o que pode orientar os gestores na melhoria da qualidade dos serviços

Lifelong robbery victimisation and mental disorders at age 18 years: Brazilian population-based study

Purpose: Urban violence is a major problem in Brazil and may contribute to mental disorders among victims. The aim of this study was to assess the association between robbery victimisation and mental health disorders in late adolescence. Methods: At age 18 years, 4106 participants in the 1993 Pelotas Birth Cohort Study were assessed. A questionnaire about history of robbery victimisation was administered, the Self-Report Questionnaire was used to screen for common mental disorders, and the Mini International Neuropsychiatric Interview was used to assess major depressive disorder and generalised anxiety disorder. Cross-sectional prevalence ratios between lifetime robbery victimisation and mental disorders were estimated using Poisson regression with robust standard errors, adjusting for socioeconomic variables measured at birth and violence in the home and maltreatment measured at age 15. Results: There was a dose–response relationship between frequency of lifetime robberies and risk of mental disorders. Adolescents who had been robbed three or more times had twice the risk (PR 2.04; 95% CI 1.64–2.56) for common mental disorders, over four times the risk for depression (PR 4.59; 95% CI 2.60–8.12), and twice the risk for anxiety (PR 1.93; 95% CI 1.06–3.50), compared with non-victims, adjusting for covariates. Experiencing frequent robberies had greater impact on common mental disorders than experiencing an armed robbery. Population attributable fractions with regard to robbery were 9% for common mental disorders, 13% for depression, and 8% for anxiety. Conclusions: Robberies are associated with common mental disorders in late adolescence, independently of violence between family members. Reducing urban violence could significantly help in preventing common mental illnesses

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved