Epidemiology of smoking in the rural area of a medium-sized city in Southern Brazil

OBJETIVO: Estimar a prevalência de tabagismo e fatores associados entre moradores de zona rural. MÉTODOS: Estudo transversal de base populacional realizado com 1.519 indivíduos, em 2016. Foram aleatoriamente selecionados 24 dos 50 setores censitários que compõem os oito distritos rurais do município de Pelotas, RS. Indivíduos ≥ 18 anos residentes nos domicílios aleatoriamente selecionados eram elegíveis. Foram considerados tabagistas aqueles que fumavam ≥ 1 cigarro/dia há pelo menos um mês ou que declararam haver parado de fumar há menos de um mês. As variáveis independentes incluíram características socioeconômicas, demográficas, comportamentais e de saúde. Foram investigados: idade de início, duração da adição, número de cigarros fumados/dia, carga tabágica e tipos de cigarros consumidos. Foi realizada regressão de Poisson para cálculo das razões de prevalências (RP) ajustadas e intervalos de confiança de 95% (IC95%). RESULTADOS: A prevalência de tabagismo foi 16,6% (IC95% 13,6–20,0), sendo duas vezes maior nos homens do que nas mulheres (RP = 1,99; IC95% 1,44–2,74), na classe econômica D ou E do que na A ou B (RP = 2,23; IC95% 1,37–3,62) e naqueles que consideraram sua saúde ruim ou muito ruim, comparados àqueles que a consideraram muito boa ou boa (RP = 2,02; IC95% 1,33–3,08). Também foi superior em pessoas com 30–59 anos (comparadas àquelas com < 30 anos), com 5–8 anos de escolaridade (comparados às pessoas com ≥ 9 anos), e com rastreio positivo para transtorno relacionado ao consumo de álcool. A prevalência foi menor entre indivíduos com sobrepeso ou obesidade, em comparação aos eutróficos. O tabagismo iniciou em média aos 16,9 anos, com consumo médio de cerca de 14 cigarros/dia e carga tabágica média de 22 maços/ano. O cigarro de papel enrolado à mão foi o mais consumido (57,6%). CONCLUSÕES: Aproximadamente um em cada seis adultos da zona rural de Pelotas é fumante atual. Os achados evidenciam a existência de desigualdades sociais relacionadas à adição tabágica. Ações de prevenção e controle do tabagismo devem continuar sendo estimuladas, sobretudo nos subgrupos mais vulneráveis.OBJECTIVE: To estimate the prevalence of smoking and associated factors among rural residents. METHODS: This is a population-based, cross-sectional study of 1,519 individuals carried out in 2016. We randomly selected 24 of the 50 census tracts that make up the eight rural districts of the city of Pelotas, State of Rio Grande do Sul, Brazil. All individuals aged 18 years or more living in the randomly selected households were eligible. Smokers were all those who smoked ≥ 1 cigarette/day for at least one month or declared that they had stopped smoking for less than one month. The independent variables included socioeconomic, demographic, behavioral, and health characteristics. We investigated age of onset, duration of addiction, number of cigarettes smoked/day, pack-years, and types of cigarettes consumed. Poisson regression was performed to calculate the adjusted prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS: The prevalence of smoking was 16.6% (95%CI 13.6–20.0), and it was twice as high in men in relation to women (PR = 1.99, 95%CI 1.44–2.74), in socioeconomic class D or E in relation to class A or B (PR = 2.23, 95%CI 1.37–3.62), and in those who considered their health poor or very poor in relation those with good or very good health (PR = 2.02, 95%CI 1.33–3.08). It was also higher in persons aged 30–59 years (compared to those aged < 30 years), with 5–8 years of education level (compared to those with ≥ 9 years), and with positive screening for alcohol-related disorder. Prevalence was lower among individuals who were overweight or obese than in those with normal weight. Smoking began on average at 16.9 years, with an average consumption of approximately 14 cigarettes/day and mean pack-years of 22 packs/year. The paper hand-rolled cigarette was the most consumed (57.6%). CONCLUSIONS: Approximately one in six adults in rural Pelotas is a current smoker. The findings show the existence of social inequalities related to smoking addiction. Actions to prevent and control smoking should continue to be stimulated, especially in the most vulnerable subgroups

Impacto da inatividade física e custos de hospitalização por doenças crônicas

OBJECTIVE To evaluate the physical inactivity-related inpatient costs of chronic non-communicable diseases. METHODS This study used data from 2013, from Brazilian Unified Health System, regarding inpatient numbers and costs due to malignant colon and breast neoplasms, cerebrovascular diseases, ischemic heart diseases, hypertension, diabetes, and osteoporosis. In order to calculate the share physical inactivity represents in that, the physical inactivity-related risks, which apply to each disease, were considered, and physical inactivity prevalence during leisure activities was obtained from Pesquisa Nacional por Amostra de Domicílio (Brazil's National Household Sample Survey). The analysis was stratified by genders and residing country regions of subjects who were 40 years or older. The physical inactivity-related hospitalization cost regarding each cause was multiplied by the respective share it regarded to. RESULTS In 2013, 974,641 patients were admitted due to seven different causes in Brazil, which represented a high cost. South region was found to have the highest patient admission rate in most studied causes. The highest prevalences for physical inactivity were observed in North and Northeast regions. The highest inactivity-related share in men was found for osteoporosis in all regions (≈ 35.0%), whereas diabetes was found to have a higher share regarding inactivity in women (33.0% to 37.0% variation in the regions). Ischemic heart diseases accounted for the highest total costs that could be linked to physical inactivity in all regions and for both genders, being followed by cerebrovascular diseases. Approximately 15.0% of inpatient costs from Brazilian Unified Health System were connected to physical inactivity. CONCLUSIONS Physical inactivity significantly impacts the number of patient admissions due to the evaluated causes and through their resulting costs, with different genders and country regions representing different shares.OBJETIVO Avaliar o custo de internações por doenças crônicas não transmissíveis atribuível à inatividade física. MÉTODOS Este estudo utilizou dados de 2013, do Sistema Único de Saúde, referentes ao número e respectivo custo das internações por neoplasia maligna de cólon e mama, doenças cerebrovasculares, doenças isquêmicas do coração, hipertensão, diabetes e osteoporose. Para o cálculo da fração atribuível à inatividade física foram considerados os riscos relativos da inatividade física a cada doença e a prevalência de inatividade física no lazer foi obtida da Pesquisa Nacional por Amostra de Domicílio. A análise foi estratificada por sexo e região do País de indivíduos com idade igual ou superior a 40 anos. O custo das internações de cada causa atribuível à inatividade física foi multiplicado pela respectiva fração a ela atribuível. RESULTADOS Foram realizadas 974.641 internações hospitalares por sete causas de internações no Brasil, em 2013, o que representou custo alto. A região Sul apresentou a maior taxa de internação na maioria das causas estudadas. A maior prevalência de inatividade física ocorreu nas regiões Norte e Nordeste. A maior fração atribuível à inatividade em homens foi encontrada para a osteoporose em todas as regiões (≈ 35,0%), enquanto o diabetes apresentou maior fração atribuível à inatividade em mulheres (variação de 33,0% a 37,0% nas regiões). As doenças isquêmicas do coração foram responsáveis pelos mais altos custos totais e atribuíveis à inatividade física em todas as regiões e em ambos os sexos, seguidas das doenças cerebrovasculares. Aproximadamente 15,0% dos custos ao Sistema Único de Saúde das internações foi atribuível à inatividade física. CONCLUSÕES A inatividade física impacta significativamente o número de internações hospitalares pelas causas avaliadas e nos custos resultantes, com diferenças na ocorrência dependendo do sexo e região do País

Fontes de acesso e utilização de medicamentos na zona rural de Pelotas, Rio Grande do Sul, em 2016: estudo transversal de base populacional

Objective. To analyze the prevalence of medication use, sources of access, and associated factors among rural residents in Pelotas, RS, Brazil. Methods. Cross-sectional study with adults ≥18 years, in 2016. Participants reported on the use and sources of access to medication used in the month prior to the interview. Poisson regression was used. Results. Among the 1,519 respondents, 54.7% (95%CI 48.7;60.5) used some medication and 3.3% (95%CI 2.4;4.5) didn’t use some necessary medication. Higher prevalence of use occurred in: women (PR=1.23 – 95%CI 1.12;1.34), the elderly (PR=2.36 – 95%CI 2.05;2.73), worse self-perception of health (PR=1.29 – 95%CI 1.14;1.46) and higher number of diseases (PR=2.37 – 95%CI 2.03;2.77). A total of 14.0% (95%CI 11.2;17.4) obtained medications exclusively from Health System and the prevalence was higher among those who self-declared non-white and from lower economic classes. Conclusion. A small portion indicated that they didn’t use necessary medications. Free obtaining was higher in groups with lower income.Objetivo. Analisar a prevalência do uso de medicamentos, fontes de acesso e fatores associados, em residentes da zona rural de Pelotas, RS, Brasil. Métodos. Estudo transversal com adultos ≥18 anos, realizado em 2016. Questionou-se o uso e fontes de acesso aos medicamentos no mês anterior à entrevista. Empregou-se regressão de Poisson. Resultados. Dos 1.519 entrevistados, 54,7% (IC95% 48,7;60,5) utilizaram algum medicamento e 3,3% (IC95% 2,4;4,5) deixaram de utilizar medicamento necessário. Exibiram maiores prevalências de utilização: mulheres (RP=1,23 – IC95% 1,12;1,34), idosos (RP=2,36 – IC95% 2,05;2,73), pessoas com pior autopercepção de saúde (RP=1,29 – IC95% 1,14;1,46), com maior número de doenças (RP=2,37 – IC95% 2,03;2,77). Obtiveram medicamentos exclusivamente pelo Sistema Único de Saúde (SUS) 14,0% (IC95% 11,2;17,4), com prevalências maiores entre pessoas de cor da pele autodeclarada não branca e classe econômica inferior. Conclusão. Pequena parcela deixou de usar medicamentos que necessitava. A obtenção gratuita de medicamentos foi maior nos grupos de menor poder aquisitivo

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

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Sleep duration trajectories, body composition and achieved height during infancy: 2004 Pelotas birth Cohort study

The importance of sleep and biological rhythms has been recognized to maintain health and prevent diseases. Sleep duration has been studied as an essential factor concerning physical, mental, and behavioral issues. Evidence suggests that short sleep is a risk factor for overweight and obesity. However, few studies have evaluated its effects on children's body composition, including adipose tissue and lean mass. Some previous studies have also suggested that shorter sleep duration could be related to lower linear growth, but literature on this topic is scarce. Thus, the first objective of this thesis was to describe sleep duration trajectories among children participating in the 2004 Pelotas Birth Cohort. For this purpose, data on sleep duration from the 3, 12, 24, and 48 month follow-ups and socioeconomic, maternal, and children's characteristics were used to assess possible associated factors. Three sleep duration trajectories were identified using a semi-parametric, group-based modeling approach, called “short sleepers,” “typical sleepers,” and “initially longer sleepers”. Wh n compared to the “typical sleepers,” children from less schooled mothers (OR: 1.82; 95%CI: 1.26; 2.62), who claimed to have had depression or nervous problems during pregnancy (OR: 1.31; 95%CI: 1.02; 1.68) and who consumed alcoholic beverages at 3 months after delivery (OR: 1.60; 95%CI: 1.03; 2.50), as well as those children who shared the bedroom with another child at 3 months (OR: 1.41; 95%CI: 1.07; 1.87) presented higher odds to belong to the group of “short sleepers”. The objective of the review article was to locate the existing literature about longitudinal studies evaluating the association of sleep duration with body composition and dietary behaviors in children and adolescents. These behaviors have been considered as potential mediators of the relationship between shorter sleep duration and weight gain. The results of studies evaluating the relationship between sleep duration and body composition were controversial. Some studies have shown a greater accumulation of body fat in short sleepers, others null results and some have presented different directions regarding lean mass. In addition, few longitudinal studies have evaluated similar outcomes in the relationship between sleep duration and dietary behaviors. However, findings suggest that short sleep duration is related to higher energy consumption and unhealthy eating behaviors. Finally, the second original article was developed to investigate whether sleep duration trajectories were associated with anthropometric (including height) and body composition measurements, at 6 and 11 years of age, among children participating in the same cohort. In the unadjusted analysis, it was observed that children belonging to the "short sleepers" group presented lower height at 6 (β: -0.78; 95%CI: -1.42; -0.13) and 11 years (β: -1.07; 95%CI: -1.94; -0.21) and lower heightfor-age z-score at 6 (3: -0.16; 95%CI: -0.29; -0.04) and 11 years (β: -0.14; 95%CI: -0.27; -0.01), when compared to children in the "typical sleepers" group. Nevertheless, after adjusting for potential confounding factors, the associations disappeared. Thus, the sleep duration trajectories of children from 3 to 48 months of age were not associated with any of the anthropometric or body composition variables at 6 and 11 years of age.Sem bolsaCada vez mais tem se reconhecido a importância do sono e dos ritmos biológicos para a manutenção da saúde e prevenção de doenças. A duração do sono tem sido estudada como um fator essencial que pode estar envolvido em questões de ordem física, mental e comportamental. Evidências sugerem que o sono de curta duração é fator de risco para o sobrepeso e obesidade. No entanto, poucos estudos avaliaram seus efeitos sobre a composição corporal na infância, incluindo tecido adiposo e massa magra. Alguns estudos sugeriram ainda que a menor duração do sono estaria relacionada a menor crescimento linear, contudo a literatura sobre essa temática é escassa. Assim, o primeiro objetivo desta tese foi descrever as trajetórias de duração do sono entre crianças participantes da Coorte de Nascimentos de Pelotas de 2004. Para este propósito, foram utilizados dados de duração do sono dos acompanhamentos dos 3, 12, 24 e 48 meses e características socioeconômicas, maternas e das crianças, para avaliar possíveis fatores associados. Foram identificadas três trajetórias de duração de sono através de modelagem semi-paramétrica baseada em grupos, às quais denominou-se “short sleepers”, “typical sleepers” e “initially longer sleepers”. Quando comparadas aos “typical sleepers”, crianças filhas de mães menos escolarizadas (RO: 1,82; IC95%: 1,26; 2,62), que relataram ter tido depressão ou problema de nervos durante a gestação (RO: 1,31; IC95%: 1,02; 1,68) e que consumiam bebidas alcoólicas aos 3 meses após o parto (RO: 1,60; IC95%: 1,03; 2,50), assim como aquelas crianças que dividiam o quarto com outra criança aos 3 meses de idade (RO: 1,41; IC95%: 1,07; 1,87) apresentaram maiores odds de pertencerem ao grupo dos “short sleepers”. Já o objetivo do artigo de revisão foi localizar a literatura existente acerca de estudos longitudinais que avaliaram a associação da duração do sono com composição corporal e comportamentos relacionados à dieta de crianças e adolescentes. Esses comportamentos têm sido evidenciados como potenciais mediadores da relação entre curta duração do sono e ganho de peso. Os resultados dos estudos que avaliaram a relação entre duração do sono e composição corporal foram controversos. Alguns estudos mostraram um maior acúmulo de gordura corporal naqueles que dormiam menos, outros apresentaram resultados nulos e outros, distintas direções no que tange à massa magra. Ademais, poucos estudos longitudinais avaliaram desfechos semelhantes na relação entre duração do sono e comportamentos relacionados à dieta. Porém, os achados sugerem que a curta duração do sono está relacionada com maior consumo energético e comportamentos alimentares menos saudáveis. Por fim, o segundo artigo original foi desenvolvido com o objetivo de investigar se as trajetórias de duração de sono estavam associadas com medidas antropométricas (incluindo altura) e de composição corporal, aos 6 e aos 11 anos, entre as crianças participantes da mesma coorte. Na análise bruta, foi observado que crianças pertencentes ao grupo dos “short sleepers” apresentaram menor altura aos 6 (β: -0,78; IC95%: -1,42; -0,13) e aos 11 anos (β: -1,07; IC95%: -1,94; -0,21) e menor score-z de altura-para-idade aos 6 (β: -0,16; IC95%: -0,29; -0,04) e aos 11 anos (β: -0,14; IC95%: -0,27; -0,01), quando comparadas às crianças do grupo dos “typical sleepers”. Contudo, após ajuste para potenciais fatores de confusão, as associações desapareceram. Dessa forma, as trajetórias de duração de sono das crianças dos 3 aos 48 meses de idade não se associaram a nenhuma das variáveis antropométricas ou de composição corporal aos 6 e aos 11 anos

Smoking epidemiology from rural area of Pelotas

This study is nested within a master consortium of 2015/2016 biennium of the PostGraduate Program in Epidemiology of the Federal University of Pelotas. A crosssectional population-based study was carried-out between January and June 2016 and data were collected from 1,519 individuals aged 18 years or more, living in the rural area of Pelotas, Brazil, to estimate the prevalence of smoking and its relation with socioeconomic, demographic, behavioral and health factors. Twenty-four of the 50 census tracts that compose the eight rural districts of the city were randomly selected. Were considered smokers those who smoked one or more cigarettes per day for at least one month and those who reported having quit smoking less than a month ago. The independent variables included socioeconomic status, schooling, current work, sex, age, skin color, marital status, screening for alcohol-related disorder, physical activity, nutritional status, presence of depressive symptoms and self-perception of health. Some characteristics of current smokers were also investigated, such as: age of onset of addiction, duration, number of cigarettes smoked/day, pack years and types of cigarettes consumed. The prevalence of smoking with 95% confidence interval (95%CI) was calculated. For analysis, Poisson regression was performed to obtain crude and adjusted prevalence ratios with respective 95%CI. The main results are: the prevalence of smoking was 16.6% (95%CI 13.6; 20.0%), higher in male subjects (21.9% vs. 11.6% in women). The prevalence was also higher among individuals belonging to D/E economic class, in those with 5- 8 years of schooling, in the age group of 30-59 years, among those who presented positive screening for alcohol-related disorder and who considered their health bad/very bad. Individuals who were overweight or obese had lower prevalence of smoking when compared to the eutrophic ones. In addition, smoking started on average at 17 years and the average number of cigarettes smoked/day was about 14. The average smoking burden was 22 pack years and the paper hand-rolled cigarette was the most consumed (57.6%) among adults in the rural area of Pelotas. In summary, the observed prevalence was close to that found in the rural area of Brazil as a whole and the findings reinforce the social inequalities related to smoking addiction. According to this study it was possible to draw a tobacco users profile in the rural area of Pelotas and this data may be useful for local health managers to support actions to combat smoking. This volume includes: the research project, followed by the field work report, changes performed at the original research project, an original article, a press release and appendices and annexes, which includes the protocol accepted by the Research Ethics Committee, the informed consent form of the study, the questionnaire used for data collection, the instruction manual and the publication rules of the Revista de Saúde Pública, to which the article of this dissertation will be submitted.Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPqEste estudo está aninhado ao consórcio de Mestrado do biênio 2015/2016 do Programa de Pós-Graduação em Epidemiologia da Universidade Federal de Pelotas. Por meio de um inquérito transversal de base populacional, entre janeiro e junho de 2016 foram coletados dados de 1.519 indivíduos de 18 anos ou mais de idade, residentes na zona rural de Pelotas, com objetivo de estimar a prevalência de tabagismo e sua relação com fatores socioeconômicos, demográficos, comportamentais e de saúde. Foram selecionados aleatoriamente 24 dos 50 setores censitários que compõem os oito distritos rurais do município. Foram considerados tabagistas aqueles que fumavam um ou mais cigarros por dia há pelo menos um mês e os que declararam haver parado de fumar há menos de um mês. As variáveis independentes incluíram nível socioeconômico, escolaridade, trabalho atual, sexo, idade, cor da pele, situação conjugal, rastreio para transtorno relacionado ao consumo de álcool, prática de atividade física, estado nutricional, presença de sintomas depressivos e autopercepção de saúde. Também foram investigadas algumas características dos fumantes atuais, como: idade de início do vício, duração, número de cigarros fumados/dia, carga tabágica e tipos de cigarros consumidos. Foi calculada a prevalência de tabagismo com intervalo de confiança de 95% (IC95%). Para análise foi realizada regressão de Poisson para obtenção das razões de prevalências brutas e ajustadas com IC95%. Como principais resultados, ressaltam-se: a prevalência de tabagismo foi de 16,6% (IC95% 13,6; 20,0%), sendo maior nos homens (21,9% vs. 11,6%, nas mulheres). As prevalências também foram superiores entre os indivíduos de classe econômica D/E, naqueles com 5-8 anos de escolaridade, na faixa etária de 30-59 anos, entre aqueles que apresentavam rastreio positivo para transtorno relacionado ao consumo de álcool e que consideraram sua saúde ruim/muito ruim. Indivíduos que estavam com sobrepeso ou obesidade apresentaram menores prevalências de tabagismo, quando comparados aos eutróficos. Ademais, o tabagismo iniciou em média aos 17 anos e o número médio de cigarros fumados/dia foi cerca de 14. A carga tabágica média foi de 22 maços/ano e o tipo de cigarro mais consumido entre os adultos da zona rural de Pelotas foi o de papel enrolado à mão (57,6%). Em síntese, a prevalência observada esteve próxima à encontrada na área rural do Brasil como um todo e os achados reforçam as desigualdades sociais relacionadas ao vício tabágico. A partir desse estudo foi possível traçar um perfil dos usuários de tabaco na zona rural de Pelotas e esses dados poderão ser úteis para os gestores locais de saúde, para subsidiar ações de combate ao tabagismo. Neste volume constam: o projeto de pesquisa, seguido do relatório de trabalho de campo, as alterações realizadas no projeto original de pesquisa, o artigo original, a nota para a imprensa e os apêndices e anexos, os quais incluem o protocolo de aceite do Comitê de Ética em Pesquisa, o termo de consentimento livre e esclarecido do estudo, o questionário utilizado na coleta de dados, o manual de instruções e as normas de publicação da Revista de Saúde Pública, para a qual será submetido o artigo desta dissertação