Ricardo Cordeiro

Self-medication in children and adolescents

OBJECTIVE: To determine the prevalence of self-medication in children and adolescents in the municipalities of Limeira and Piracicaba, state of Sao Paulo, and to correlate results with sociodemographic indicators and with the use of health care services (public or private). METHODS: Descriptive population-based study of a simple random sample from the two municipalities, comprised of 772 inhabitants from 85 urban census sectors selected through cluster sampling. Inclusion criteria: age < 18 years; interview with one parent/tutor; consumption of at least one drug in the previous 15 days. Subjects were divided into two study groups according to their pattern of drug use: self-medication (lay advice) and medical prescription. Linear association tests, descriptive analysis of variables and multiple logistic regression tests were carried out to analyze data. RESULTS: The prevalence of self-medication was 56.6%. Mothers (51%) and drugstore employees (20.1%) were most frequently responsible for self-medication. The main groups of self-prescribed drugs were: analgesic/antipyretic and non-hormonal anti-inflammatory drugs (52.9%); drugs acting on the respiratory tract (15.4%) and gastrointestinal drugs (9.6%); and systemic antibiotics (8.6%). The situation that most commonly motivated self-medication were respiratory diseases (17.2%), fever (15%), and headache (14%). Subjects in the age group of 7-18 years (odds ratio = 2.81) and public health care users (odds ratio = 1.52) showed increased risk for self-medication. CONCLUSIONS: The prevalence of self-medication in children and adolescents was high, which reinforces the need for public health interventions aiming at preventing this practice.OBJECTIVE To determine the prevalence of self-medication in children and adolescents in the municipalities of Limeira and Piracicaba, state of São Paulo, and to correlate results with sociodemographic indicators and with the use of health care services (public or private). METHODS Descriptive population-based study of a simple random sample from the two municipalities, comprised of 772 inhabitants from 85 urban census sectors selected through cluster sampling. INCLUSION CRITERIA age < or = 18 years; interview with one parent/tutor; consumption of at least one drug in the previous 15 days. Subjects were divided into two study groups according to their pattern of drug use: self-medication (lay advice) and medical prescription. Linear association tests, descriptive analysis of variables and multiple logistic regression tests were carried out to analyze data. RESULTS The prevalence of self-medication was 56.6%. Mothers (51%) and drugstore employees (20.1%) were most frequently responsible for self-medication. The main groups of self-prescribed drugs were: analgesic/antipyretic and non-hormonal anti-inflammatory drugs (52.9%); drugs acting on the respiratory tract (15.4%) and gastrointestinal drugs (9.6%); and systemic antibiotics (8.6%). The situation that most commonly motivated self-medication were respiratory diseases (17.2%), fever (15%), and headache (14%). Subjects in the age group of 7-18 years (odds ratio = 2.81) and public health care users (odds ratio = 1.52) showed increased risk for self-medication. CONCLUSIONS The prevalence of self-medication in children and adolescents was high, which reinforces the need for public health interventions aiming at preventing this practice.

Fatores associados à vacinação contra influenza em idosos em município do Sudeste do Brasil

OBJETIVO: Mesmo gratuita e disponivel no Brasil desde 1999, a cobertura vacinal contra a influenza ainda e inadequada em diversos municipios do Pais. O objetivo da pesquisa foi estimar a cobertura vacinal e identificar fatores relacionados a vacinacao contra a influenza em idosos. METODOS: Realizou-se inquerito domiciliar em amostra aleatoria sistematica (N=365) da populacao urbana maior de 60 anos em Botucatu, Sao Paulo. Foi aplicado modelo de regressao logistica multipla, cuja variavel dependente foi ter sido vacinado em 2002. Foram testadas no modelo as covariaveis: sexo, idade, socioeconomicas (renda per capita, numero de pessoas por comodo, escolaridade, estado civil, ocupacao, tempo de moradia), antecedentes morbidos, de internacao, habito de fumar, sintomas respiratorios nos ultimos 15 dias e atividades comunitarias (trabalho voluntario, atividades no bairro, igreja). RESULTADOS: Registrou-se cobertura vacinal de 63,2% (IC 95%: 58,3-68,2). Foi observado menor percentual de vacinados entre os idosos na faixa etaria de 60 a 64 anos. As variaveis que se mostraram associadas a vacinacao e permaneceram no modelo final foram: idade (OR=1,09 por ano; IC 95%: 1,06-1,13); hipertensao arterial (OR=1,92; IC 95%: 1,18-3,13); insercao em atividades na comunidade (OR=1,63; IC 95%: 1,01-2,65). A vacinacao em portadores de doencas cronicas nao atingiu niveis adequados conforme esperado para este grupo de risco, com excecao dos hipertensos. A participacao em atividades comunitarias e sociais foi relacionada com o estado vacinal. CONCLUSOES: Condicoes socioeconomicas, habitos e idade nao restringiram o acesso a campanha vacinal. Por outro lado, campanhas especificas, enderecadas a individuos da faixa de 60 a 64 anos, podem ampliar a cobertura da vacinacao.

Associacão entre perda auditiva induzida pelo ruído e zumbidos

The objective of this study was to verify an association between noise-induced hearing loss (NIHL) and tinnitus in workers exposed to occupational noise. Workers with a history of work noise exposure who attended two audiology outpatient clinics were interviewed and evaluated. The statistical association between NIHL and tinnitus was evaluated using an adjusted linear regression model, with tinnitus as the dependent variable and NIHL, classified into six levels, as the independent variable, with age and length of noise exposure as covariates. Data were collected from 284 workers between April and October, 2003, in Bauru, Sao Paulo State, Brazil. Tinnitus was observed to increase with the progression of auditory damage, controlled by age and length of noise exposure. These results suggest that investment in hearing conservation programs is needed, especially for source noise emission control and for intervention in hearing loss progression that is caused by noise exposure, in order to maintain auditory health and reduce the associated symptoms.

Exposição ao ruído ocupacional como fator de risco para acidentes do trabalho

OBJETIVO: Verificar se a exposicao ocupacional ao ruido e fator de risco relevante para acidentes do trabalho. METODOS: Estudo de caso-controle de base populacional. Os dados foram coletados entre 16/5/2002 e 15/10/2002, na cidade de Botucatu, Estado de Sao Paulo. Os casos foram definidos como trabalhadores que sofreram acidentes ocupacionais tipicos nos ultimos 90 dias, identificados por intermedio de amostragem aleatoria sistematica de domicilios residenciais. Os controles foram trabalhadores nao acidentados, aleatoriamente alocados a partir da mesma populacao que originou os casos, emparelhados na razao 3:1 segundo sexo, faixa etaria e setor censitario de moradia. Ajustou-se um modelo de regressao logistica multipla, tendo como variavel independente a exposicao ocupacional ao ruido, controlada por covariaveis de interesse. RESULTADOS: Foram analisados 94 casos e 282 controles. Ajustando-se um modelo de regressao logistica condicional multipla observou-se que trabalhar sempre e as vezes exposto a ruido intenso associou-se a um risco relativo de acidentar-se de 5,0 (IC 95%: 2,8-8,7; p<0,001) e 3,7 (IC 95%: 1,8-7,4; p=0,0003), respectivamente, tendo como referencia trabalhar nao exposto a ruido, controlado para diversas covariaveis. CONCLUSOES: Com base nos resultados encontrados, justifica-se o investimento em programas de conservacao auditiva particularmente voltados para o controle da emissao de ruidos na fonte. Essas medidas objetivam nao apenas a manutencao da saude auditiva, mas tambem a diminuicao da acidentabilidade dos trabalhadores.

Subnotificação de acidentes do trabalho não fatais em Botucatu, SP, 2002

OBJETIVO: A implementacao de politicas de prevencao de acidentes do trabalho tem sido dificultada pela subnotificacao dos eventos que ocorrem entre trabalhadores formais, bem como pela grande desinformacao sobre os trabalhadores da economia informal. O objetivo do estudo foi estimar a subnotificacao de acidentes do trabalho em cidade media do interior do Estado de Sao Paulo. METODOS: Inquerito domiciliar realizado por intermedio de amostra aleatoria sistematica de domicilios residenciais da area urbana de Botucatu. Foram realizadas entrevistas aos moradores sobre a ocorrencia de acidentes relacionados ao trabalho em maiores de nove anos, nos ultimos 90 dias. Para todos os acidentes registrados nas visitas verificou-se no Instituto Nacional de Seguridade Social (INSS) se havia a devida notificacao. RESULTADOS: Foram visitadas 9.626 residencias, onde habitavam 26.751 moradores com idade superior a nove anos, dos quais 13.328 eram trabalhadores ocupados. A subnotificacao de acidentes do trabalho foi estimada em 79,5% (IC 95% 78,8%-80,3%). CONCLUSOES: E precaria a notificacao dos acidentes de trabalho no local estudado, o que pode estar ocorrendo em outras localidades do Pais. Os dados sugerem a necessidade de se construir um sistema de informacao sobre a saude dos trabalhadores brasileiros que contemple pessoal, material e metodos capacitados para o reconhecimento, armazenamento, analise e difusao de informacoes necessarias para apoiar a formulacao de politicas publicas de prevencao de acidentes e promocao da saude dos trabalhadores.

O sistema de vigilância de acidentes do trabalho de Piracicaba, São Paulo, Brasil

The authors report on the development of a work accident monitoring system in Piracicaba, Sao Paulo State, Brazil, with the following characteristics: information feeding the system is obtained in real time directly from accident treatment centers; the system has universal monitoring, covering all work-related accidents in Piracicaba, regardless of the nature of the workers employment conditions, place of work, or place of residence; health surveillance and promotion of health initiatives are triggered by identification of sentinel events; spatial distribution analysis of work-related accidents is a basic tool in designing accident awareness strategies and accident prevention policies. The system was implemented in November 2003 and by October 2004 had identified 5,320 work-related accidents, or a 3.8% annual proportional incidence of work-related accidents in the municipal area. We illustrate spatial analysis of registered work-related accidents and present a detailed investigation of one example of a serious accident.

Spatial distribution of the risk of dengue fever in southeast Brazil, 2006-2007

BackgroundMany factors have been associated with circulation of the dengue fever virus and vector, although the dynamics of transmission are not yet fully understood. The aim of this work is to estimate the spatial distribution of the risk of dengue fever in an area of continuous dengue occurrence.MethodsThis is a spatial population-based case-control study that analyzed 538 cases and 727 controls in one district of the municipality of Campinas, São Paulo, Brazil, from 2006-2007, considering socio-demographic, ecological, case severity, and household infestation variables. Information was collected by in-home interviews and inspection of living conditions in and around the homes studied. Cases were classified as mild or severe according to clinical data, and they were compared with controls through a multinomial logistic model. A generalized additive model was used in order to include space in a non-parametric fashion with cubic smoothing splines.ResultsVariables associated with increased incidence of all dengue cases in the multiple binomial regression model were: higher larval density (odds ratio (OR) = 2.3 (95%CI: 2.0-2.7)), reports of mosquito bites during the day (OR = 1.8 (95%CI: 1.4-2.4)), the practice of water storage at home (OR = 2.5 (95%CI: 1.4, 4.3)), low frequency of garbage collection (OR = 2.6 (95%CI: 1.6-4.5)) and lack of basic sanitation (OR = 2.9 (95%CI: 1.8-4.9)). Staying at home during the day was protective against the disease (OR = 0.5 (95%CI: 0.3-0.6)). When cases were analyzed by categories (mild and severe) in the multinomial model, age and number of breeding sites more than 10 were significant only for the occurrence of severe cases (OR = 0.97, (95%CI: 0.96-0.99) and OR = 2.1 (95%CI: 1.2-3.5), respectively. Spatial distribution of risks of mild and severe dengue fever differed from each other in the 2006/2007 epidemic, in the study area.ConclusionsAge and presence of more than 10 breeding sites were significant only for severe cases. Other predictors of mild and severe cases were similar in the multiple models. The analyses of multinomial models and spatial distribution maps of dengue fever probabilities suggest an area-specific epidemic with varying clinical and demographic characteristics.

Incômodo causado pelo zumbido medido pelo Questionário de Gravidade do Zumbido

OBJETIVO: O Tinnitus Handicap Inventory e um questionario para avaliar as consequencias do zumbido, quantificando os deficits psicoemocionais e funcionais provocados pelo sintoma. O objetivo do estudo foi apresentar e testar a adaptacao para o portugues brasileiro desse questionario, denominado Questionario de Gravidade do Zumbido. METODOS: O questionario traduzido foi aplicado em 135 individuos com queixa de zumbido atendidos em dois ambulatorios de audiologia da cidade de Bauru, SP, encaminhados para avaliacao audiologica. A consistencia interna foi avaliada pelos coeficientes a de Cronbach, comparados aos obtidos para a versao original. RESULTADOS: Obteve-se boa confiabilidade tanto para as escalas (0,76<a<0,85) quanto para todo o questionario, visto que o valor obtido (a=0,93) e identico aquele encontrado na consistencia total do instrumento original. CONCLUSOES: Os resultados sugerem que a adaptacao em portugues do questionario pode ser utilizado na pratica clinica como um instrumento de medida para as dificuldades cotidianas provocadas pelo zumbido naqueles individuos que o percebem.

Home medicine chests and their relationship with self-medication in children and adolescents

OBJECTIVE To investigate the contents of home medicine chests and their relationship with self-medication in children and adolescents in the towns of Limeira and Piracicaba, SP, Brazil. METHODS This is a descriptive population study based on a home survey of a simple random sample from both towns, comprising 705 households from census sectors selected by means of cluster sampling. INCLUSION CRITERIA age <or= 18 years; an obligatory interview with at least one guardian; inventory of medicines kept at home; and having taken at least one medication during the 15 days prior to the interview. The participants were split into two groups based on medication: self-medication (lay advice) and medical prescription. Tests of linear association were performed, in addition to a descriptive analysis of the variables and multiple logistic regression. RESULTS A total of 3,619 medicines were found (mean = 5.1/household; 79.6% were pharmaceutical preparations). The rooms most commonly used to store medications were bedrooms (47.5%), kitchens (29.9%), and bathrooms (14.6%); 76.5% were in cardboard boxes and within easy reach of 142 children aged <or= 6 years. Taking the pharmaceutical preparations in isolation (n = 2,891), the most common were analgesics/antipyretics (26.8%) and systemic antibiotics (15.3%), and the self-medication group had significantly larger stocks of these medications (p < 0.01). Storing medications in the bathroom (odds ratios = 1.59) and legal guardians with <or= 4 years of primary education (odds ratios = 2.40) indicated greater risk of self-medication. CONCLUSIONS Keeping medicines at home is a common practice, and it is important to implement campaigns to encourage rational use, reduced waste and safe storage of medicines.

Exposição ocupacional ao ruído e acidentes do trabalho

The purpose of this study was to verify whether occupational noise exposure is a significant risk factor for work accidents in the city of Piracicaba, São Paulo State, Brazil. This hospital-based case-control study included 600 workers aged 15-60 who suffered typical occupational accidents between May and October 2004 and were seen at the Piracicaba Orthopedics and Trauma Center. The control group comprised 822 workers, aged 15-60, who were also seen at the Center, and either had a non-occupational accident or were accompanying someone who had suffered an accident. A multiple logistic regression model was adjusted with work accident as an independent variable, controlled by covariables of interest such as noise exposure. The risk of having a work accident was about twice as high among workers exposed to noise, after controlling for several covariables. Occupational noise exposure not only affected auditory health status but was also a risk factor for work accidents.