Anaclaudia Gastal Fassa

Dor lombar crônica em uma população adulta do Sul do Brasil: prevalência e fatores associados

To identify the prevalence of chronic low back pain (CLBP) and examine factors associated with this condition in a Southern Brazilian adult population, a population-based cross-sectional study was conducted, including 3,182 subjects of both sexes, aged 20 years or over, living in the urban area of Pelotas, Rio Grande do Sul State. The questionnaire included socio-demographic, behavioral, and nutritional variables, as well as characterization of exposure to ergonomic factors in daily activities. CLBP prevalence was 4.2%. The variables sex, age, marital status, schooling, smoking, body mass index, working in a lying position, heavy physical work, and repetitive movements were associated with CLBP. Prevalence of CLBP is important as it limits normal activities and increases the use of health care services. There may be differences in the ergonomic risk factors for CLBP and low back pain in general.

Demand for emergency health service: factors associated with inappropriate use

BackgroundThe inappropriate use of emergency room (ER) service by patients with non-urgent health problems is a worldwide problem. Inappropriate ER use makes it difficult to guarantee access for real emergency cases, decreases readiness for care, produces negative spillover effects on the quality of emergency services, and raises overall costs.MethodsWe conducted a cross-sectional study in a medium-sized city in southern Brazil. The urgency of the presenting complaint was defined according to the Hospital Urgencies Appropriateness Protocol (HUAP). Multivariable Poisson regression was carried out to examine factors associated with inappropriate ER use.ResultsThe study interviewed 1,647 patients over a consecutive 13-day sampling period. The prevalence of inappropriate ER use was 24.2% (95% CI 22.1–26.3). Inappropriate ER use was inversely associated with age (P = 0.001), longer stay in the waiting room, longer duration of symptoms and morning shift. However, the determinants of inappropriate ER use differed according age groups (P value for interaction = 0.04). Within the younger age-group (15–49 years), inappropriate ER use was higher among females, patients who reported visiting the ER because there was no other place to go, patients reporting that the doctor at the regular place of care refused to attend to them without a prior appointment, and individuals who reported that the PHC clinic which they use is open for shorter periods during the day. Among older patients (50+ years), those with highest level of education, absence of self-reported chronic diseases and lack of social support were more likely to engage in higher inappropriate ER use.ConclusionEfforts should be made to redirect inappropriate ER demand. Besides expanding access to, and improving the quality of primary and secondary care, it is important to mobilize social support for older patients, to enhance the relationship between different levels of care, as well as to develop campaigns to educate the public about the appropriate use of medical services.

Intoxicação por agrotóxicos no Brasil: os sistemas oficiais de informação e desafios para realização de estudos epidemiológicos

Brazil is one of the world leaders in pesticide consumption and exposed workers are numerous and diversified. Acute poisonings are just the most visible aspect of pesticide impact on human health. An assessment of many official information systems that notify pesticide poisoning concluded that none of them performed appropriately the role of a surveillance system. Only acute and severe cases are notified. One of the main gaps concerns exposure information: the only official source (the Agronomic Prescriptions) has many limitations and is not available for research. A review of published articles in Brazil shows a quantitative and qualitative increase of studies in this area with many different approaches. The impact of such a high chemical burden and the huge numbers of workers exposed are two important reasons for the development of an epidemiological research on pesticide poisoning, an issue that has still a vast field to cover in Brazil.

Acesso a medicamentos de uso contínuo em adultos e idosos nas regiões Sul e Nordeste do Brasil

O objetivo deste estudo foi avaliar a prevalencia de acesso a medicamentos de uso continuo para tratar hipertensao arterial sistemica, diabetes mellitus e/ou problemas de saude mental e fatores associados. Foi desenvolvido estudo transversal no âmbito do Projeto de Expansao e Consolidacao Saude da Familia (PROESF) em 41 municipios do Sul e Nordeste do Brasil. A amostra incluiu 4.060 adultos e 4.003 idosos residentes na area das unidades basicas de saude (UBS). A prevalencia de acesso a medicamentos de uso continuo em adultos foi de 81% e em idosos, 87%. O maior acesso entre os adultos da Regiao Sul esteve associado com maior idade, melhor nivel economico, tipo de morbidade cronica e participacao em grupos na UBS; entre os adultos do Nordeste, com hipertensao arterial sistemica exclusiva ou combinada com diabetes mellitus; entre os idosos do Sul, com maior escolaridade; entre os idosos do Nordeste, com maior idade, maior escolaridade, nao fumantes, vinculo com a UBS e modelo de atencao Programa Saude da Familia (PSF). Os resultados revelam importante iniquidade em saude, reforcando a necessidade de politicas para ampliar o acesso principalmente para populacoes de menor poder aquisitivo.

Child labor and health: problems and perspectives.

Abstract Child labor remains a widespread problem. Although it can have positive effects, in some situations it has negative effects on health and development of the children. Although mainly a problem in developing countries, it is also possible to find child workers, some working in hazardous activities, in developed countries. The authors describe the child labor profiles in developed and developing countries, the principal occupations of children, and their concomitant hazards. They summarize the epidemiologic evidence for a greater impact of some occupational exposures on the health of children as compared with adults, and the theoretical concerns about the impact of child labor on health, and suggest policies that can be used to combat harmful child labor.

Estudo transversal sobre saúde mental de agricultores da Serra Gaúcha (Brasil)

OBJETIVO: Considerando a escassez de estudos rurais de base populacional, buscou-se avaliar as associacoes entre caracteristicas do trabalho rural e a ocorrencia de morbidade psiquiatrica menor- MPM. METODOS: Utilizando delineamento transversal, estudaram-se 1.282 agricultores de 446 estabelecimentos. As informacoes foram coletadas por entrevista direta, a partir da percepcao do trabalhador. O indice de Kappa foi adotado para controle de qualidade. Caracterizaram-se as condicoes produtivas, dados sociodemograficos e indicadores de saude mental. RESULTADOS: A prevalencia de MPM afetou 37,5% dos agricultores. As prevalencias foram maiores entre produtores de feijao e menores entre os de maca. Encontrou-se risco aumentado nos estabelecimentos de 26 a 50 ha, e risco reduzido associado a maior mecanizacao e aumento de escolaridade. A ocorrencia de intoxicacao por agrotoxicos mostrou forte associacao com MPM, embora nao se possa definir a direcao dessa associacao. CONCLUSOES: Os resultados alertam para a dimensao dos problemas e para a urgencia de medidas que visem a proteger a saude dos agricultores.

Estudo populacional de síndrome pré-menstrual

OBJETIVO: Estudar a prevalencia e fatores associados a sindrome pre-menstrual, comparando a frequencia encontrada com a auto-referida. METODOS: Foi realizado um estudo transversal, de base populacional, com 1.395 mulheres de 15 a 49 anos no municipio de Pelotas, Rio Grande do Sul, em 2003. Foram aplicados questionarios para medir a prevalencia da sindrome pre menstrual por meio de um escore, construido a partir de cinco sintomas pre-menstruais que interferiam na vida familiar ou levavam a falta ao trabalho ou a escola. Foram investigadas associacoes entre alguns fatores socioeconomicos, demograficos e comportamentais. A sindrome auto-referida foi investigada quanto a sua sensibilidade e especificidade, considerando o escore como padrao-ouro. As analises estatisticas utilizadas foram chi2 de Pearson, Mantel Haenszel e regressao de Poisson, alem do coeficiente de Kappa para verificar concordância de respostas. RESULTADOS: A prevalencia encontrada foi de 25,2% (IC 95%: 22,5-27,9) e auto-referida 60,3% (IC 95%: 57,4-63,3). Os principais sintomas pre-menstruais foram: irritabilidade, desconforto abdominal, nervosismo, cefaleia, cansaco e mastalgia, todos acima de 50% de prevalencia. Mulheres de melhor nivel economico, maior escolaridade, menores de 30 anos e com pele branca apresentaram risco mais elevado. As usuarias de psicofarmacos e as que nao usavam anticoncepcao hormonal apresentaram maior prevalencia. A sensibilidade do teste foi de 94%, a especificidade 51% e a acuracia 62%. CONCLUSOES: Foi alta a prevalencia da sindrome pre-menstrual encontrada. Embora a percepcao das mulheres seja maior do que aquela medida com o escore, ainda assim, um quarto das mulheres apresentou esse problema de saude.

Prevalence of chronic low back pain: systematic review

OBJECTIVE To estimate worldwide prevalence of chronic low back pain according to age and sex. METHODS We consulted Medline (PubMed), LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pain as an outcome. We also assessed the quality of the selected studies as well as the chronic low back pain prevalence according to age and sex. RESULTS The review included 28 studies. Based on our qualitative evaluation, around one third of the studies had low scores, mainly due to high non-response rates. Chronic low back pain prevalence was 4.2% in individuals aged between 24 and 39 years old and 19.6% in those aged between 20 and 59. Of nine studies with individuals aged 18 and above, six reported chronic low back pain between 3.9% and 10.2% and three, prevalence between 13.1% and 20.3%. In the Brazilian older population, chronic low back pain prevalence was 25.4%. CONCLUSIONS Chronic low back pain prevalence increases linearly from the third decade of life on, until the 60 years of age, being more prevalent in women. Methodological approaches aiming to reduce high heterogeneity in case definitions of chronic low back pain are essential to consistency and comparative analysis between studies. A standard chronic low back pain definition should include the precise description of the anatomical area, pain duration and limitation level.

Trabalho rural e intoxicações por agrotóxicos

Pesticide use is intensive in Brazilian agriculture. Population-based studies on the characteristics of pesticide use and pesticide poisoning are scarce. This study describes the profile of occupational exposure and pesticide poisoning incidence. Farm characteristics and pesticide occupational exposure were evaluated using a cross-sectional design. Among 1,379 farmers/ farm workers, annual incidence of pesticide poisoning was 2.2 episodes per 100 exposed. Based on Poisson regression, applying pesticide, reentering crop fields after spraying, and working with pesticides on more than one farm were the types of exposure that presented a positive correlation with pesticide poisoning. The results may be useful for planning activities aimed at reducing occupational pesticide poisoning among rural workers.

Sintomas de doenças sexualmente transmissíveis em adultos: prevalência e fatores de risco

OBJECTIVE To evaluate the prevalence of sexually transmitted disease (STD) symptoms and associated risk factors in an adult population. METHODS A population-based cross-sectional study was conducted among residents of the metropolitan area of Pelotas, Brazil. Subjects were 20 years old or more. A self-administered questionnaire was used to gather information about sexual behavior and STD symptoms. Multivariate analysis was undertaken using logistic regression. RESULTS The prevalence of STDs was 13.5%. A higher risk of STDs was found in non-white younger women with more sexual partners and who did not use condoms in their last sexual relationship. Among men, early initiation of sexual activity and anal sex were positively associated with the outcome. Higher risks were found among women with lower schooling. CONCLUSIONS The present study identified a significant prevalence of STD symptoms in this population and showed differences in risk factors according to gender. Since many STDs are asymptomatic and symptomatic cases are often either not perceived as disease by patients or not diagnosed in health services, the actual prevalence may be even greater. The study results suggest that cohabitation with a sexual partner does not reduce the risk of STDs in this population and showed sex differences for risk factors, both of which should be taken into account while approaching this issue.