Desigualdades na prevalência de asma em crianças nas regiões Sul e Nordeste do país: uma análise da Pesquisa Nacional por Amostragem de Domicílios, PNAD, 2003

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Pública, Florianópolis, 2009As prevalências de asma vêm crescendo desde as últimas décadas, de maneira distinta em diferentes grupos sociais. Objetivou-se estimar a prevalência de diagnóstico de asma auto-referida em crianças brasileiras e analisar as desigualdades sociais, demográficas e de uso de serviços de saúde nas regiões Sul e Nordeste. Foram analisados os dados da Pesquisa Nacional de Amostragem por Domicílios (PNAD) de 2003 em crianças com idade menor de 10 anos (n= 69.796). Características socioeconômicas (local de residência, escolaridade do responsável pelo domicílio, renda domiciliar mensal per capita, aglomeração em dormitórios, tipo de material da casa e combustível do fogão), sexo e idade da criança e cor da pele do responsável foram as variáveis independentes analisadas. Utilizou-se a regressão logística não condicional para a identificação dos fatores associados. A prevalência de diagnóstico de asma no Brasil foi de 8,1% (IC95% 7,7;8,5), sendo de 12,6% (IC95% 11,6;13,5) e 4,4% (IC95% 4,0;4,8) no Sul e Nordeste, respectivamente. Após o ajuste, crianças entre 3 e 7 anos de idade e os mais pobres apresentaram maiores chances de asma em ambas regiões. Além disso, foram associadas ao desfecho ser filho de pais de cor da pele preta e viver em aglomeração no Sul; e ser filho de pais com maior escolaridade no Nordeste. Piores indicadores socioeconômicos foram associados à asma principalmente na região Sul sugerindo variações no processo de sua determinação no país. Políticas públicas regionalizadas são importantes para melhor controle e prevenção da doença. In the last decades the prevalence of asthma has been increased and social inequalities among different social strata has also been identified. The aim of this study was to estimate the prevalence of self-reported asthma diagnosis in Brazilian children and to analyze its association with social, demographic and use of health services factors in the South and Northeast regions. We analyzed the Pesquisa Nacional de Amostragem por Domicílios (PNAD), 2003 dataset from children under age 10 years (n= 69,796). Socioeconomic (area of residence, children guardian schooling, monthly family per capita income, number ofpeople per room, house material and type of household stove), sex and children age and children guardian skin colour were the exploratory variables analyzed using unconditional multiple logistic regression. The prevalence of asthma diagnosis was 8.1% in Brazil (CI95% 7.7;8.5), and 12.6% (CI95% 11.6;13.5) and 4.4% (CI95% 4.0;4.8) in the South and Northeast regions, respectively. After adjustment, children aged between 3 and 7 years and those from poorest family were associated to the outcome in the both regions. Black parents and crowded households were associated to the outcome in the South region; and parents with higher schooling were more likely to present children with asthma diagnosis in the Northeast region. Worst socioeconomic indicators were associated with asthma diagnosis mainly in South region, suggesting variation in asthma determinants in different parts of Brazil. Specific health policies aimedto control and prevent asthma in children should be implemented considering regional inequalities

Sleep problems and associated factors in a rural population of a Southern Brazilian city

OBJECTIVE: To estimate the average of a sleep problems score and their associated factors in adults living in rural areas. METHODS: A population-based cross-sectional study with individuals from the rural area of the city of Pelotas, Southern Brazil. Twenty-four of the 50 census tracts that make up the eight rural districts of the city were randomly selected. Individuals of 18 years of age or older residing in the households chosen were considered eligible. Sleep problems were measured using the Mini Sleep Questionnaire, which ranged from 10 to 70 points and the higher the score, the greater the sleep problems. The independent variables evaluated included socioeconomic, demographic, behavioral and health characteristics. In the analysis, linear regression was used, obeying a previous hierarchical model. RESULTS: The sample consisted of 1,421 individuals. The average obtained for sleep problems was 29.4 points (95%CI 28.7–30.1). After adjusted analysis, the following variables were associated factors for greater sleep problems: female sex, age greater than or equal to 40 years, lower schooling level, depressive symptoms, pesticide poisoning, and poorer quality of life. CONCLUSIONS: The Mini Sleep Questionnaire average in this study was 4.4 points above the cut-off point that established sleep problems. The total points found in the score was high for the rural population. Strategies to improve sleep for these individuals should be focused on higher-risk groups such as women and the elderly and those with pesticide poisoning.OBJETIVO: Estimar a média de um escore de problemas de sono e seus fatores associados emadultos residentes da zona rural.MÉTODOS: Estudo transversal de base populacional, realizado com indivíduos da zona ruraldo município de Pelotas, no Sul do Brasil. Foram selecionados aleatoriamente 24 dos 50 setorescensitários que compõem os oito distritos rurais do município. Foram considerados elegíveis osindivíduos com 18 anos ou mais residentes nos domicílios sorteados. Os problemas de sono forammensurados a partir do questionário Mini Sleep Questionnaire, cujo escore varia de 10 a 70 pontose quanto maior a pontuação, maiores os problemas de sono. As variáveis independentes avaliadasincluíram características socioeconômicas, demográficas, comportamentais e de saúde. Naanálise, utilizou-se regressão linear, obedecendo a modelo hierárquico prévio.RESULTADOS: A amostra foi composta por 1.421 indivíduos. A média obtida para problemasde sono foi de 29,4 pontos (IC95% 28,7–30,1). Após análise ajustada, as seguintes variáveisapresentaram-se como fatores associados para maiores problemas de sono: sexo feminino, idademaior ou igual a 40 anos, menor escolaridade, sintomas depressivos, intoxicação por agrotóxicoe pior qualidade de vida.CONCLUSÕES: A média do Mini Sleep Questionnaire neste estudo foi 4,4 pontos acima do pontode corte que estabelece problemas de sono. A pontuação total encontrada no escore foi elevadapara a população rural. Estratégias para melhorar o sono desses indivíduos devem ser focadasem grupos de maior risco como mulheres e idosos e aqueles com intoxicação por agrotóxico

LER/DORT na terceira década da reestruturação bancária: novos fatores associados?

OBJETIVO: Estimar la prevalencia de casos sugerentes de LER/DORT y factores asociados tres décadas posteriores a la restructuración bancaria. MÉTODOS: Estudio transversal con 356 funcionarios de 27 agencias bancarias de las redes públicas y privada de Porto Alegre, Sur de Brasil, entre abril y agosto de 2009. Se utilizó análisis estadístico bruto y ajustado por el modelo de Regresión de Poisson con varianza Robusta, conducida por el modelo jerárquico en tres niveles, incorporándose la estructura del delineamiento y ajuste para los conglomerados. Los resultados fueron estratificados por porte de la agencia y clasificados por dicotomías (&gt;25;OBJECTIVE: To estimate the prevalence of cases suggestive of repetitive strain injury/work-related musculoskeletal disorders (RSI/WRMSD), three decades after restructuring of banking. METHODS: This was a cross-sectional study on 356 employees in 27 bank branches of public and private banks in Porto Alegre, Southern Brazil, between April and August 2009. After crude statistical analysis, adjustments were made using a Poisson regression model with robust variance and a three-level hierarchy that incorporated the design structure and adjustments for the clusters. The results were stratified according to the size of the bank branch and were dichotomized (>; 25; &#8804; 25 employees). RESULTS: The prevalence of cases suggestive of RSI/WRMSD was lower among the men (PR = 0.62; 95%CI: 0.47-0.81). Workers aged 26 to 45 years (PR = 2.51; 95%CI 1.02;6.14) presented greater prevalence of this outcome. Individuals with postgraduate qualifications (PR = 0.45; 95%CI 0.22;0.90) and length of time in the job between 5.1 and 15 years (PR = 0.62; 95%CI 0.47;0.81) presented protection against RSI/WRMSD. On stratifying the analyses according to size, it was found that age, income and length of time in the job remained associated in branches with 25 employees or fewer, while in branches with more than 25 employees, sex and schooling level were associated with the outcome. CONCLUSIONS: The characteristics of importance in relation to bank employees who become ill due to rsi/wrmsd seem to be different today from those that were known historically. greater attention to organizing work and management strategies should be taken into consideration in drawing up illness prevention programs for banking work.OBJETIVO: Estimar a prevalência de casos sugestivos de LER/DORT e fatores associados três décadas após a reestruturação bancária. MÉTODOS: Estudo transversal com 356 funcionários de 27 agências bancárias das redes pública e privada de Porto Alegre, RS, entre abril e agosto de 2009. Foi utilizada análise estatística bruta e ajustada pelo modelo de Regressão de Poisson com variância robusta, conduzida por modelo hierárquico em três níveis, incorporando-se a estrutura do delineamento e ajuste para os conglomerados. Os resultados foram estratificados por porte da agência e dicotomizados (&#8805; 25 e < 25 funcionários). RESULTADOS: A prevalência de casos sugestivos de LER/DORT foi menor nos homens (RP = 0,62 IC95% 0,47;0,81). Trabalhadores com idade entre 26 e 45 anos (RP = 2,51 IC95% 1,02;6,14) apresentaram maior prevalência do desfecho. Indivíduos com pós-graduação (RP = 0,45 IC95% 0,22;0,90) e tempo na função entre 5,1 e 15 anos (RP = 0,62 IC95% 0,47;0,81) apresentaram fator de proteção para os casos sugestivos de LER/DORT. Ao estratificar as análises por porte, nas agências com 25 funcionários ou menos, idade, renda e tempo na função permaneceram associados, enquanto nas agências com mais de 25 funcionários, sexo e escolaridade associaram-se ao desfecho. CONCLUSÕES: Aspectos importantes no adoecimento por LER/DORT entre bancários parecem hoje ser diferentes dos historicamente conhecidos. Atenção maior à organização do trabalho e às estratégias de gestão deveria ser considerada na elaboração de programas de prevenção de adoecimento no trabalho bancário

Respiratory symptoms (COPD Assessment Test and modified Medical Research Council dyspnea scores) and GOLD-ABCD COPD classification: the LASSYC study

Chronic obstructive pulmonary disease; Symptoms; COPDEnfermedad pulmonar obstructiva crónica; Síntomas; EPOCMalaltia pulmonar obstructiva crònica; Símptomes; MPOCObjective To assess the frequency and severity of 24-hour respiratory symptoms according to COPD GOLD-ABCD classification (2017-version), the distribution of the patients with COPD into GOLD categories using mMRC (≥2) or CAT (≥10) scores, and agreement between these cut-off points. Methods In this cross-sectional study (LASSYC study), 24-hour day respiratory symptoms were assessed by the Evaluating Respiratory Symptoms in COPD (E-RS) questionnaire, Nighttime Symptoms of COPD Instrument (NiSCI), Early Morning Symptoms of COPD Instrument (EMSCI), CAT and mMRC scores. Results Among the 734 patients with COPD, 61% were male, age 69.6±8.7 years, FEV1% post-BD 49.1±17.5%, mMRC 1.8±1.0 and CAT 15.3±.8.1. By mMRC 33.7% were group-A, 29.2% group-B, 10.2% group-C and 26.9% group-D. By CAT 22.3% were group-A, 41% group-B, 4.8% group-C and 31.9% group-D. Using the mMRC the severity of E-RS, NiSCI and EMSCI scores increased from group A to D. Using the CAT, the groups B and D had the higher scores. Agreement between mMRC and CAT was 89.5% (Kappa statistics=75.7%). For mMRC score of 2, CAT score of ≥11 showed the maximum Youden’s index (1.34). For mMRC score of 1, CAT score of ≥9 and ≥10 showed the maximum Youden’s index (1.48). Conclusion GOLD COPD classification by CAT seems to better discriminate 24-hour symptoms. Results do not support the equivalent use of CAT≥10 and mMRC≥2 for assessing symptoms.This observational study was funded by AstraZeneca Latin America. The funder had no input into the study design, analysis, or interpretation of the results

Waist circumference and pulmonary function: a systematic review and meta-analysis

BACKGROUND: Studies have reported an impact of central obesity on people’s health. The literature is scarce on the effects of waist circumference (WC) on pulmonary function. Our objective was to review the literature on the association between WC and pulmonary function. METHODS: A systematic review was carried out in the PubMed, CINAHL, Web of Science and Scopus databases. The search included published, in press and online documents up to December 2011. A meta-analysis was carried out to obtain the pooled effect, and a meta-regression was performed to evaluate sources of heterogeneity. RESULTS: From the 547 studies identified, 10 were included. The meta-analysis revealed an inverse relationship between WC and pulmonary function parameters, indicating that the effect was greater among men (forced expiratory volume in 1 second (FEV(1) β = −15.9 (95% confidence interval = −23.2, −8.5); forced vital capacity (FVC) β = −16.6 (95% confidence interval = −21.0, −12.2)) compared with women (FEV(1) β = −5.6 (95% confidence interval = −9.1, −2.1); FVC β = −7.0 (95% confidence interval = −9.1, −4.8)). The meta-regression identified sex as the characteristic that most contributed to the heterogeneity (R(2) = 54.8% for FEV(1) and R(2) = 85.7% for FVC). CONCLUSIONS: There seems to be an inverse relationship between WC and pulmonary function, mainly in men. More population-based studies should be performed, especially among children and adolescents, to confirm these findings

Does IQ influence association between working memory and adhd symptoms in young adults?

Objective: This study examined the association between WM and ADHD symptoms in young adults and whether IQ-score influenced this association. Method: Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed (N = 2,845). Working memory and ADHD symptoms were collected at 22 years. IQ was examined at age 18. Poisson regression with robust variance was used to assess the associations between working memory and ADHD symptoms. We also evaluated whether IQ modified associations between working memory and ADHD symptoms. Results: Working memory was negatively associated with Inattention symptoms of ADHD. The association between working memory and hyperactivity-impulsivity symptoms of ADHD varied by IQ. Conclusions: This study provides new insights to theories about the relationship between WM and ADHD symptoms as well as the development of interventions aimed at improving the performance of WM in ADHD

Socioeconomic position and sedentary behavior in Brazilian adolescents: A life-course approach.

Socioeconomic position (SEP) is a potential correlate of sedentary behavior in adolescents. The aim of this study was to examine the associations between SEP and self-reported and objective measures of sedentary behavior in adolescents, using a life-course approach. Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed (N=5249). Cross-sectional and longitudinal associations between multiple SEP indicators (maternal education, family income, SEP composite, cumulative family income) at birth, 11, 15 and 18years, and five sedentary behavior outcomes (≥4h/day screen time; ≥4h/day TV; ≥2h/day computer; ≥2h/day video game; ≥12.7h/day objectively measured sedentary time) at 11, 15 and 18years, were examined. In cross-sectional analyses, higher SEP was positively associated with more screen time at ages 11 and 15years. There was a consistent and positive association between higher SEP with time spent using a computer, and with sedentary time assessed through accelerometry. SEP at birth had a positive and direct effect on screen, computer and total sedentary time at 18years. Participants in the highest cumulative income group had higher odds of high sedentary behavior in screen (OR: 2.40; 95% CI: 1.50-3.54), computer (OR: 7.35; 95% CI: 4.19-12.89) and total sedentary time (OR: 5.40; 95% CI: 3.53-10.35), respectively, compared with their counterparts with lower cumulative income. Our findings showed that SEP is an early determinant of sedentary behavior in adolescents

Adiposity, depression and anxiety: interrelationship and possible mediators

OBJECTIVES: To explore the association between adiposity, major depressive disorder and generalized anxiety disorder, and to assess the role of inflammation, diet quality and physical activity in this association. METHODS: We used data from 2,977 individuals from the 1993 Pelotas Cohort (Brazil) who attended the 18- and 22-year follow-ups. We assessed general obesity using body mass index, fat mass index, and abdominal obesity using waist circumference. Major Depressive Disorder and generalized anxiety disorder were assessed using the mini-international neuropsychiatric interview. C-reactive protein and interleukin-6 (IL-6) levels were used as a measure of inflammation; diet quality was estimated using the revised diet quality index, and physical activity was assessed by the International physical activity questionnaire (IPAQ, min/day). The association between adiposity and major depressive disorder and generalized anxiety disorder was assessed using logistic regression, and the natural indirect effect via the mediators was estimated using G-computation. RESULTS: General obesity assessed by body mass index (OR: 2.3; 95% CI:1.13; 4.85), fat mass index (OR: 2.6; 95%CI: 1.37; 4.83), and abdominal obesity (OR: 2.5; 95%CI: 1.18; 5.39) were associated with higher odds of major depressive disorder, whereas major depressive disorder was only associated with obesity assessed by body mass index (OR=1.9; 95% CI: 1.09; 3.46). Obesity and generalized anxiety disorder were not associated. C-reactive protein, diet quality and physical activity did not mediate the effect of obesity on major depressive disorder, and C-reactive protein mediated about 25% of the effect of major depressive disorder on adiposity. CONCLUSIONS: Depression, but not generalized anxiety disorder, is associated with adiposity in both directions, with a stronger evidence for the direction obesity-depression. Inflammation explains part of the effect of major depressive disorder on obesity but not the other way around. Further research should explore other mechanisms that could be involved in the association between obesity and depression

Adiposity and depression/ anxiety:Interrelationship and mediators

OBJECTIVES: To explore the association between adiposity, major depressive disorder and generalized anxiety disorder, and to assess the role of inflammation, diet quality and physical activity in this association. METHODS: We used data from 2,977 individuals from the 1993 Pelotas Cohort (Brazil) who attended the 18- and 22-year follow-ups. We assessed general obesity using body mass index, fat mass index, and abdominal obesity using waist circumference. Major Depressive Disorder and generalized anxiety disorder were assessed using the mini-international neuropsychiatric interview. C-reactive protein and interleukin-6 (IL-6) levels were used as a measure of inflammation; diet quality was estimated using the revised diet quality index, and physical activity was assessed by the International physical activity questionnaire (IPAQ, min/day). The association between adiposity and major depressive disorder and generalized anxiety disorder was assessed using logistic regression, and the natural indirect effect via the mediators was estimated using G-computation. RESULTS: General obesity assessed by body mass index (OR: 2.3; 95% CI:1.13; 4.85), fat mass index (OR: 2.6; 95%CI: 1.37; 4.83), and abdominal obesity (OR: 2.5; 95%CI: 1.18; 5.39) were associated with higher odds of major depressive disorder, whereas major depressive disorder was only associated with obesity assessed by body mass index (OR=1.9; 95% CI: 1.09; 3.46). Obesity and generalized anxiety disorder were not associated. C-reactive protein, diet quality and physical activity did not mediate the effect of obesity on major depressive disorder, and C-reactive protein mediated about 25% of the effect of major depressive disorder on adiposity. CONCLUSIONS: Depression, but not generalized anxiety disorder, is associated with adiposity in both directions, with a stronger evidence for the direction obesity-depression. Inflammation explains part of the effect of major depressive disorder on obesity but not the other way around. Further research should explore other mechanisms that could be involved in the association between obesity and depression

Tratamentos utilizados por portadores de DPOC no Brasil: Pesquisa Nacional de Saúde, 2013

OBJETIVO: Estimar a prevalência dos tratamentos utilizados para o manejo da doença pulmonar obstrutiva crônica (DPOC) na população adulta brasileira. MÉTODOS: Estudo transversal de base populacional com dados oriundos da Pesquisa Nacional de Saúde de 2013, incluindo indivíduos com 40 anos ou mais, com diagnóstico médico autorreferido de DPOC, bronquite crônica e/ou enfisema, os quais foram questionados sobre tratamentos utilizados para o manejo da doença. RESULTADOS: Foram entrevistados 60.202 adultos, dos quais 636 tinham 40 ou mais anos de idade e haviam referido diagnóstico médico de DPOC, enfisema ou bronquite crônica. Menos da metade (49,4%) da população diagnosticada relatou utilizar algum tipo de tratamento, havendo diferenças quanto à macrorregião do país (Sul 53,8% – Nordeste 41,2%, p = 0,007). O tratamento medicamentoso foi o mais referido e portadores de enfisema apresentaram a maior proporção de mais de um tipo de tratamento utilizado. Entre os indivíduos que declararam ter apenas bronquite crônica, 55,1% (IC95% 48,7–61,4) usavam medicamento, 4,7% (IC95% 2,6–8,3) realizavam fisioterapia e 6,0% (IC95% 3,6–9,9) oxigenoterapia. Por outro lado, entre os enfisematosos, 44,1% (IC95% 36,8–51,7) realizavam tratamento medicamentoso, 8,8% (IC95% 5,4–14,2) fisioterapia e 10,0% (IC95% 6,3–15,6) oxigenoterapia. CONCLUSÕES: As prevalências de tratamentos para o manejo da DPOC estavam aquém do ideal em 2013. O medicamentoso foi o principal tipo de tratamento, seguido de oxigenoterapia e fisioterapia.OBJECTIVE: To estimate the prevalence of treatments used for the management of chronic obstructive pulmonary disease (COPD) in the Brazilian adult population. METHODS: A population-based cross-sectional study with data from the 2013 Brazilian National Survey of Health, including individuals aged 40 years or older, with a self-reported medical diagnosis of COPD, chronic bronchitis and/or emphysema, who were asked about treatments used for disease management. RESULTS: A total of 60,202 adults were interviewed, of which 636 were 40 years of age or older and had reported a medical diagnosis of COPD, emphysema, or chronic bronchitis. Less than half (49.4%) of the diagnosed population reported using some type of treatment, with differences regarding the macro-region of the country (South 53.8% – Northeast 41.2%, p = 0.007). Pharmacological treatment was the most reported, and emphysema patients had the highest proportion of those undergoing more than one type of treatment. Among the individuals who reported having only chronic bronchitis, 55.1% (95%CI: 48.7–61.4) used medication, 4.7% (95%CI: 2.6–8.3) underwent physical therapy, and 6.0% (95%CI: 3.6–9.9) oxygen therapy. On the other hand, among the emphysema patients, 44.1% (95%CI: 36.8–51.7) underwent drug treatment, 8.8% (95%CI: 5.4–14.2) physical therapy, and 10.0% (95%CI: 6.3–15.6) oxygen therapy. CONCLUSION: The prevalence of treatments for COPD management was below ideal in 2013. The pharmacological treatment was the main type of treatment, followed by oxygen therapy and physical therapy