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BACKGROUND: As a reflection of the health emergency caused by COVID-19, many countries adopted guidelines, which included activity restrictions. As a result, some companies maintained their activities with on-site work and telework. OBJECTIVE: Analyzing the morbidity and mortality profile due to COVID-19 of workers in telework and on-site work in an oil and gas company. METHODS: Cross-sectional, quantitative, and analytical study that included 8,394 workers diagnosed with COVID-19 at an oil and gas company in Brazil, from June 2020 to June 2021. The company's Surveillance Program database was used as an information source. RESULTS: The total prevalence of cases was 21.7%. For teleworking and face-to-face workers, they were 20.7% and 23.3%, respectively. There was a predominance of women (19.7%), white ethnicity/colour (64.7%), higher level position (52.6%), age group over 40 years (36.7%), married (53, 8%), working at the company for a period that ranges from 7 to 10 years (17%), administrative activity (68.5%), and a higher number of symptomatic workers and deaths in telework compared to on-site work. CONCLUSIONS: The results suggest that testing is important to refrain the virus spread in the company's work environments, as it allowed asymptomatic workers to be diagnosed with COVID-19. The study suggested that on-site work was not a transmission facilitator in the occupational environment, which points out the importance of preventive measures in the workplace and the adoption of remote work for the largest possible number of workers to improve the safety of employees, workers who remained in the on-site work modality.
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COVID-19 , Teletrabalho , Humanos , COVID-19/epidemiologia , Brasil/epidemiologia , Feminino , Masculino , Adulto , Estudos Transversais , Pessoa de Meia-Idade , Indústria de Petróleo e Gás , SARS-CoV-2 , PrevalênciaRESUMO
BACKGROUND: One of the three main targets of the World Health Organization (WHO) End TB Strategy (2015-2035) is that no tuberculosis (TB) patients or their households face catastrophic costs (defined as exceeding 20% of the annual household income) because of the disease. Our study seeks to determine, as a baseline, the magnitude and main drivers of the costs associated with TB disease for patients and their households and to monitor the proportion of households experiencing catastrophic costs in Brazil. METHODS: A national cross-sectional cluster-based survey was conducted in Brazil in 2019-2021 following WHO methodology. TB patients of all ages and types of TB were eligible for the survey. Adult TB patients and guardians of minors (<18 years old) were interviewed once about costs, time loss, coping measures, income, household expenses, and asset ownership. Total costs, including indirect costs measured as reported household income change, were expressed as a percentage of annual household income. We used descriptive statistics to analyze the cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs. RESULTS: We interviewed 603 patients, including 538 (89%) with drug-sensitive (DS) and 65 (11%) with drug-resistant (DR) TB. Of 603 affected households, 48.1% (95%CI: 43-53.2) experienced costs above 20% of their annual household income during their TB episode. The proportion was 44.4% and 78.5% among patients with DS- and DR-TB, respectively. On average, patients incurred costs of US$1573 (95%CI: 1361.8-1785.0) per TB episode, including pre-diagnosis and post-diagnosis expenses. Key cost drivers were post-diagnosis nutritional supplements (US$317.6, 95%CI: 232.7-402.6) followed by medical costs (US$85.5, 95%CI: 54.3-116.5) and costs of travel for clinic visits during treatment (US$79.2, 95%CI: 61.9-96.5). In multivariate analysis, predictors of catastrophic costs included positive HIV status (aOR = 3.0, 95%CI:1.1-8.6) and self-employment (aOR = 2.7, 95%CI:1.1-6.5); high education was a protective factor (aOR = 0.1, 95%CI:0.0-0.9). CONCLUSIONS: Although the services offered to patients with TB are free of charge in the Brazilian public health sector, the availability of free diagnosis and treatment services does not alleviate patients' financial burden related to accessing TB care. The study allowed us to identify the costs incurred by patients and suggest actions to mitigate their suffering. In addition, this study established a baseline for monitoring catastrophic costs and fostering a national policy to reduce the costs to patients for TB care in Brazil.
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Tuberculose Resistente a Múltiplos Medicamentos , Tuberculose , Adulto , Humanos , Adolescente , Brasil/epidemiologia , Estresse Financeiro , Estudos Transversais , Tuberculose/epidemiologia , Custos e Análise de Custo , RendaRESUMO
BACKGROUND: Self-rated health status can be considered a good predictor of morbidity and mortality and has been used due to its easy assessment and applicability. The instrument is efficient for understanding sociodemographic, environmental and clinical conditions that may be related to the self-rated health status. Thus, this study aims to analyze the self-assessment of health status in rural workers and its association with socioeconomic characteristics, lifestyle, clinical condition and work characteristics. METHODS: This is a cross-sectional study carried out with 787 male and female rural reporting agriculture as their main source of income in the municipality of Santa Maria de Jetibá. A simple and direct question was used "In general, compared to people your age, how do you rate your own state of health?" to see how rural workers rate their current health status. The independent variables analyzed were socioeconomic, clinical, health and work conditions. The magnitude of the associations was evaluated by means of hierarchical logistic regression. RESULTS: It was found that 42.1% of rural workers self-rated their health status as regular or poor. Belonging to socioeconomic classes C (OR = 1.937; 95% CI = 1.009-3.720) or D/E (OR = 2.280; 95% CI = 1.178-4.415), being overweight (or having excess weight) (OR = 1.477; 95% CI = 1.086-2.008), multimorbidity (OR = 1.715; 95% CI = 1.201-2.447) and complex multimorbidity (OR = 1.738; 95% CI = 1.097-2.751) were risk factors for worse self-rated health. CONCLUSION: It was concluded that chronic diseases, socioeconomic status and overweight are risk factors for negative self-rated health. The identification of these determinants through self-rated status can support the planning of actions aimed at improving the health of the rural population. TRIAL REGISTRATION: This study was approved by the Research Ethics Committee of the Health Sciences Center of the Federal University of Espírito Santo (Protocol No. 2091172; CAAE No. 52839116.3.0000.5060). All research participants gave their informed consent.
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Sobrepeso , População Rural , Humanos , Masculino , Feminino , Estudos Transversais , Nível de Saúde , Fatores SocioeconômicosRESUMO
OBJECTIVE: This study aimed to verify risk factors associated with gastroschisis mortality in three neonatal intensive care units located in the state of Espírito Santo, Brazil. METHODS: A retrospective cohort study of neonates with gastroschisis was performed between 2000 and 2018. Prenatal, perinatal, and postsurgical variables of survival or nonsurvival groups were compared using chi-square statistical test, t-test, Mann-Whitney U test, and logistic regression. Tests with p<0.05 were considered statistically determined. RESULTS: A total of 142 newborns were investigated. Mean maternal age, gestational age, and birth weight were lower in the group of nonsurvival (p<0.05). Poor clinical conditions during admission, complex gastroschisis, closure with silo placement, the use of blood products, surgical complications, and short bowel syndrome were more frequent in the nonsurvival group (p<0.05). Complex gastroschisis [adjusted odds ratio (OR) 3.74, 95% confidence interval (95%CI) 1.274-11.019] and short bowel syndrome (adjusted OR 7.55, 95%CI 2.177-26.225) increased the risk of death. Higher birth weight inversely reduced the risk for mortality (adjusted OR 0.99, 95%CI 0.997-1.000). CONCLUSION: Complex gastroschisis and short bowel syndrome increased the risk of death, with greater birth weight being inversely correlated with the risk of mortality. The findings of this research can contribute to the formulation of protocols to improve the quality and safety of care in order to reduce neonatal mortality associated with gastroschisis.
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Gastrosquise , Síndrome do Intestino Curto , Gravidez , Feminino , Humanos , Recém-Nascido , Gastrosquise/complicações , Gastrosquise/cirurgia , Estudos Retrospectivos , Peso ao Nascer , Síndrome do Intestino Curto/complicações , Brasil/epidemiologiaRESUMO
SUMMARY OBJECTIVE: This study aimed to verify risk factors associated with gastroschisis mortality in three neonatal intensive care units located in the state of Espírito Santo, Brazil. METHODS: A retrospective cohort study of neonates with gastroschisis was performed between 2000 and 2018. Prenatal, perinatal, and postsurgical variables of survival or nonsurvival groups were compared using chi-square statistical test, t-test, Mann-Whitney U test, and logistic regression. Tests with p<0.05 were considered statistically determined. RESULTS: A total of 142 newborns were investigated. Mean maternal age, gestational age, and birth weight were lower in the group of nonsurvival (p<0.05). Poor clinical conditions during admission, complex gastroschisis, closure with silo placement, the use of blood products, surgical complications, and short bowel syndrome were more frequent in the nonsurvival group (p<0.05). Complex gastroschisis [adjusted odds ratio (OR) 3.74, 95% confidence interval (95%CI) 1.274-11.019] and short bowel syndrome (adjusted OR 7.55, 95%CI 2.177-26.225) increased the risk of death. Higher birth weight inversely reduced the risk for mortality (adjusted OR 0.99, 95%CI 0.997-1.000). CONCLUSION: Complex gastroschisis and short bowel syndrome increased the risk of death, with greater birth weight being inversely correlated with the risk of mortality. The findings of this research can contribute to the formulation of protocols to improve the quality and safety of care in order to reduce neonatal mortality associated with gastroschisis.
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This work aimed to identify variables associated with increased risk of outcome severity as well as to describe clinical manifestations/symptoms and management of pesticide-related cases reported to a poison center in Brazil. An increased risk of more severe outcomes was observed when exposures occurred in rural areas, involved suicide attempts and moderately to extremely hazardous pesticides. Clinical manifestations with higher frequencies included vomiting, nausea, sialorrhea, headache, miosis and sweating. From the treatment initially applied to the patient, 51.91% encompassed gastric lavage, but this procedure was only recommended in 20.01% of cases by the CIATox. Identifying risk factors associated with poor outcome, describing clinical manifestations, and contrasting initial treatment measures adopted against those recommended by the Poison Center can help determine diagnosis, prognosis and ensure appropriate clinical interventions are used in cases of pesticide poisoning.
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Praguicidas , Intoxicação , Venenos , Humanos , Centros de Controle de Intoxicações , Brasil/epidemiologia , Fatores de Risco , Intoxicação/diagnóstico , Intoxicação/epidemiologia , Intoxicação/terapiaRESUMO
Resumo: Introdução: O déficit quantitativo e as desigualdades na distribuição de médicos agravam a crise global da força de trabalho em saúde. Muitas políticas têm sido adotadas para enfrentamento do problema, destacando-se pela sua abrangência o Programa Mais Médicos. Objetivo: Este estudo objetivou caracterizar, entre graduandos de Medicina do estado da Bahia, as intenções de especialidade médica futura e de fixação em áreas prioritárias definidas pelo Programa Mais Médicos, conforme os preditores apontados na literatura. Método: Trata-se de um estudo de corte transversal com caráter exploratório, realizado com estudantes dos cursos de Medicina de quatro universidades federais da Bahia. Resultado: Predominaram estudantes de 20 a 24 anos, com perfil socioeconômico mais baixo em relação aos estudos anteriores, naturais dos pequenos e médios municípios baianos, que afirmaram, em sua maioria, a opção pela residência médica em especialidades de outras áreas, que não as áreas básicas, após a graduação. Verificou-se uma disparidade entre o percentual de estudantes com intenção de trabalhar na atenção primária à saúde e aqueles que desejaram especialidades básicas, sendo ainda consideravelmente menor a opção pela medicina de família e comunidade. As estudantes do sexo feminino predominaram de modo evidente entre aqueles que desejaram as especialidades de áreas básicas e que vislumbraram um futuro trabalho na atenção primária à saúde, nesse estado. De modo contrário, os estudantes do sexo masculino escolheram, na sua maioria, especialidades de outras áreas, especialmente aqueles que tiveram os aspectos financeiros como motivação principal para escolha de carreira. Conclusão: O estudo acrescentou conhecimento ao corpo de literatura sobre as mudanças na formação médica no país e os efeitos de políticas indutoras de um perfil profissional generalista que atenda às necessidades sociais da população.
Abstract: Introduction: The quantitative deficit and inequalities in the distribution of doctors exacerbate the global health workforce crisis. Many policies have been adopted to face the problem, with the 'Mais Médicos' Program standing out due to its scope. Objective: This study aimed to characterize, among undergraduate medical students in the state of Bahia, the intentions of future medical specialty and professional retention in priority areas defined by the More Doctors Program (PMM), according to the predictors indicated in the literature. Methods: This is a cross-sectional exploratory study conducted with medical students from four federal universities in the state of Bahia. Results: The study predominantly included students aged 20 to 24 years, with a lower socioeconomic profile in relation to previous studies, born in small and medium-sized municipalities in the state of Bahia, who mostly stated their option for medical residency in specialties other than the basic areas after graduation. An inequality was observed between the percentage of students who intended to work in Primary Care and those who wanted basic specialties, with the option for Family and Community Medicine being even lower. Female students clearly predominated among those who desired basic specialties and who envisioned a future employment in Primary Care in this state. Conversely, male students mostly chose specialties in other areas, especially those who had financial aspects as the main motivation for career choice. Final considerations: The study added knowledge to the body of literature on changes in medical training in the country and the effects of policies leading to a generalist professional profile that meets the social needs of the population.
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Resumo O objetivo deste estudo é analisar a tendência das principais causas de óbito de mulheres em idade fértil (MIF) no Brasil, por faixa etária, no período de 2006 a 2019. Utilizaram-se dados do Sistema de Informações sobre Mortalidade (SIM) e do Instituto Brasileiro de Geografia e Estatística (IBGE). As principais causas de morte de MIF (10 a 49 anos) foram classificadas por capítulos da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde (CID-10). Posteriormente realizou-se análise de tendência temporal por meio de modelos de regressão polinomial das principais causas de morte de MIF segundo faixa etária. No Brasil, as maiores taxas de mortalidade por causas p/100 mil MIF deveram-se a neoplasias (25,34), doenças do aparelho circulatório (20,15), causas externas (18,69), doenças infecciosas e parasitárias (8,79) e doenças do aparelho respiratório (6,37). Para o período analisado, após padronização, as taxas de mortalidade por doenças do aparelho circulatório, do aparelho respiratório e infecciosas e parasitárias apresentaram tendência decrescente, com uma queda expressiva de 26,6% para as doenças do aparelho circulatório; já as taxas de mortalidade por causas externas e neoplasias registraram tendência crescente de 2006 a 2012 e decrescente de 2013 em diante. As causas externas e as neoplasias foram as principais causas de óbito, especialmente entre as mulheres mais jovens e com tendência crescente. Sendo este um importante problema de saúde pública, faz-se necessário planejar ações que otimizem os recursos e melhorem a qualidade de vida e saúde das mulheres.
Abstract The aim of this study is to analyze the trend of the main causes of death of women of reproductive age (WRA) in Brazil by age group from 2006 to 2019. Data used are from the Mortality Information System (SIM) and the Brazilian Institute of Geography and Statistics (IBGE) of Brazil. The main causes of death of WRA (10 to 49 years) were divided by chapters as per the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Subsequently, a temporal trend analysis was performed using polynomial regression models for the main causes of death in WRA. In Brazil, the highest mortality rates by cause by 100,000 WRA occurred due to: neoplasms (25.34), diseases of the circulatory system (20.15), external causes (18.69), infectious and parasitic diseases (8.79) and respiratory system diseases (6.37). For the analyzed period, after standardization, the mortality rate due to diseases of the circulatory and respiratory systems, and infectious and parasitic conditions showed a decreasing trend, with a significant drop of 26.6% for diseases of the circulatory system; while external causes and neoplasms showed an increasing trend from 2006 to 2012 and decreasing from 2013 onwards. Identifying the main causes of death of WRA in each age group is required to guide the planning of actions to optimize resources and obtain better results in women's health.
Resumen El objetivo de este estudio es analizar la tendencia de las principales causas de muerte de mujeres en edad fértil (MEF) en Brasil por grupo de edad desde 2006 hasta 2019. Con datos del Sistema de Información de Mortalidad (SIM) y del Instituto Brasileiro de Geografía y Estadísticas (IBGE) de Brasil, las principales causas de muerte de MEF (10 a 49 años) fueron divididas por capítulos de la Clasificación Estadística Internacional de Enfermedades y Problemas Relacionados con la Salud (CIE-10). Luego se hizo un análisis de tendencia temporal mediante modelos de regresión polinomial de las principales causas de muerte en MEF. En Brasil, las mayores tasas de mortalidad por causa en MEF/100.000 mujeres ocurrieron por neoplasias (25,34), enfermedades del aparato circulatorio (20,15), causas externas (18,69), enfermedades infecciosas y parasitarias (8,79) y enfermedades del sistema respiratorio (6,37). Para el período analizado, después de la estandarización, la tasa de mortalidad por neoplasias y por enfermedades de los sistemas circulatorio, respiratorio e infeccioso y parasitario mostró una tendencia decreciente, con una caída significativa del 26,6 % para enfermedades del sistema circulatorio, mientras que las causas externas y neoplasias mostraron una tendencia creciente entre 2006 y 2012 y decreciente desde 2013 en adelante. Identificar las principales causas de muerte en MEF en cada grupo de edad orienta la planificación de acciones para optimizar recursos y obtener mejores resultados en la salud de la mujer.