Self-rated health according to sex and associated factors in Manaus, Brazil, 2019: a population-based cross-sectional study / Autoevaluación de la salud según sexo y factores asociados en Manaus, Brasil, 2019: estudio transversal de base poblacional / Autoavaliação de saúde de acordo com sexo e fatores associados em Manaus, 2019: estudo transversal de base populacional

Abstract Objective: To assess the prevalence and factors associated with poor self-rated health according to respondents' sex in Manaus, Brazil. Methods: This was a cross-sectional population-based study with adults in Manaus in 2019. Adjusted prevalence ratios and 95% confidence intervals (95%CI) were calculated using Poisson regression following a hierarchical model. Results: Poor self-rated health occurred in 35.2% (95%CI 33.3;37.2) of the 2,321 participants and was higher in females (PR = 1.27; 95%CI 1.13;1.43). In the general population, among both sexes, poor self-rated health was higher among the oldest, those with moderate and severe food insecurity and with chronic diseases (p-value < 0.05). Among females, poor health was also higher among the evangelical and those with mild food insecurity. Among males, self-rated health was also poorer among the retired and those with education below elementary level (p-value < 0.001). Conclusion: The female sex had the poorest health rating, influenced by morbidity and access to food.

Resumen Objetivo: Analizar la prevalencia y los factores asociados a la mala autoevaluación de salud según sexo en Manaus, Brasil. Métodos: Se trata de un estudio poblacional transversal con adultos residentes en Manaus en 2019. Las razones de prevalencia ajustadas (RP) y los intervalos de confianza del 95% (IC95%) se calcularon mediante regresión jerárquica de Poisson. Resultados: Autoevaluación mala de salud ocurrió en 35,2% (IC95% 33,3;37,2) de los 2.321 participantes y fue mayor en el sexo femenino (RP = 1,27; IC95%1,13;1,43). En la población general, femenina y masculina, la mala autoevaluación de salud fue mayor entre ancianos, con inseguridad alimentaria moderada y grave y con enfermedades crónicas (p-valor < 0,05). En el sexo femenino, la mala salud fue mayor en evangélicas y con inseguridad alimentaria leve. En el sexo masculino, jubilados y con educación inferior al nivel básico también tuvieron una peor autoevaluación (p-valor < 0,001). Conclusión: Personas de sexo femenino tuvieron una peor valoración de salud, influenciada por la morbilidad y el acceso a la alimentación.

Resumo Objetivo: Analisar a prevalência e fatores associados à autoavaliação de saúde ruim segundo o sexo em Manaus. Métodos: Trata-se de estudo transversal de base populacional com adultos residentes em Manaus em 2019. Razões de prevalências (RP) ajustadas e intervalos de confiança de 95% (IC95%) foram calculadas por regressão de Poisson hierarquizada. Resultados: Saúde autoavaliada como ruim ocorreu em 35,2% (IC95% 33,3;37,2) dos 2.321 participantes e foi maior no sexo feminino (RP = 1,27; IC95% 1,13;1,43). Na população geral, em ambos os sexos, saúde autoavaliada como ruim foi maior entre os mais velhos, com insegurança alimentar moderada e grave e com presença de doenças crônicas (p-valor < 0,05). No sexo feminino, saúde ruim foi maior em evangélicas e com insegurança alimentar leve. No masculino, aposentados e com nível de ensino inferior ao fundamental também apresentaram pior autoavaliação (p-valor < 0,001). Conclusão: Pessoas do sexo feminino apresentaram pior avaliação de saúde, influenciada por morbidade e acesso a alimentação.

Prevalence of psychotropic and antidepressant use in a Brazilian Amazon city: analysis of two cross-sectional studies / Prevalência de uso de psicotrópicos e antidepressivos em uma cidade da Amazônia brasileira: análise de dois estudos transversais

Abstract This article aims to assess the prevalence of psychotropic and antidepressant use and associated factors in a Brazilian Amazon city. Two cross-sectional studies conducted in Manaus in 2015 and 2019 with adults selected by probabilistic sampling. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated by Poisson regression with robust variance. 3,479 participants were included in 2015 and 2,321 in 2019; 2.0% used psychotropics in 2015 and 2.7% in 2019. Antidepressants were used by 0.4% (2015) and 1.4% (2019). Psychotropic use was lower in younger (PR = 0.41; 95%CI: 0.19-0.90), partnerless (PR = 0.64; 95%CI: 0.44-0.93), and informal workers (PR=0.47; 95%CI: 0.25-0.86), but higher in people with poor health (PR=2.86; 95%CI: 1.71-4.80), multimorbidity (PR = 3.24; 95%CI: 1.87-5.60), and who visited doctors (PR = 3.04; 95%CI: 1.45-6.38) or dentists (PR = 1.50; 95%CI: 1.08-2.10). Antidepressant use was higher in 2019 (PR = 2.90; 95%CI: 1.52-5.54), people with poor health (PR = 2.77; 95%CI: 1.16-6.62), and multimorbidity (PR = 8.72; 95%CI: 2.71-28.00), while lower in informal workers (PR = 0.33; 95%CI: 0.12-0.87) and unemployed (PR = 0.26; 95%CI: 0.08-0.81). Use of psychotropics remained stable in Manaus from 2015 to 2019, while antidepressant use more than tripled, which was marked by social inequalities.

Resumo O objetivo deste artigo é avaliar a prevalência do uso de psicotrópicos e antidepressivos e fatores associados em uma cidade da Amazônia. Dois estudos transversais foram realizados em Manaus, em 2015 e 2019, com adultos selecionados por amostragem probabilística. Razões de prevalência (RP) e intervalos de confiança de 95% (IC95%) foram calculados por regressão de Poisson. Foram incluídos 3.479 participantes em 2015 e 2.321 em 2019; 2,0% usaram psicotrópicos em 2015 e 2,7% em 2019. Antidepressivos foram usados por 0,4% (2015) e 1,4% (2019). O uso de psicotrópicos foi menor em jovens (RP = 0,41; IC95%: 0,19-0,90), sem companheiros (RP = 0,64; IC95%: 0,44-0,93) e trabalhadores informais (RP = 0,47; IC95%: 0,25-0,86), mas maior em pessoas com saúde ruim (RP = 2,86; IC95%: 1,71-4,80), multimorbidade (RP = 3,24; IC95%: 1,87-5,60) e que visitaram médico (RP = 3,04; IC95%: 1,45-6,38) ou dentista (RP = 1,50; IC95%: 1,08-2,10). O uso de antidepressivos foi maior em 2019 (RP = 2,90; IC95%: 1,52-5,54), e pessoas com saúde ruim (RP = 2,77; IC95%: 1,16-6,62) e multimorbidade (RP = 8,72; IC95%: 2,71-28,00), mas menor em trabalhadores informais (RP = 0,33; IC95%: 0,12-0,87) e desempregados (RP = 0,26; IC95%: 0,08-0,81). O uso de psicotrópicos permaneceu estável em Manaus de 2015 a 2019, enquanto o de antidepressivos triplicou, sendo marcados por desigualdades sociais.

Relationship between depressive symptoms, burnout, job satisfaction and patient safety culture among workers at a university hospital in the Brazilian Amazon region: cross-sectional study with structural equation modeling

ABSTRACT BACKGROUND: Workplaces can be sources of mental distress. In healthcare services, this can also affect patients. OBJECTIVE: To assess the prevalence of and factors associated with depressive symptoms, burnout, job satisfaction and patient safety culture and the relationships between these constructs, among healthcare workers. DESIGN AND SETTING: Cross-sectional study in a university hospital in Manaus, Brazil. METHODS: Randomly selected workers were interviewed based on Brazilian-validated tools. We calculated the prevalence ratio (PR) and 95% confidence interval (CI) of depressive symptoms and burnout using Poisson regression with robust variance; and the β-coefficient of safety culture and job satisfaction using linear regression. Outcome relationships were assessed using partial least-squares structural equation modeling. RESULTS: 300 professionals were included; 67.3% were women. The prevalence of depressive symptom was 19.0% (95% CI: 14.5; 23.5%) and burnout, 8.7% (95% CI: 5.2; 12.3%). Lack of work stability increased depression (PR = 1.88; 95% CI: 1.17; 3.01) and burnout (PR = 2.17; 95% CI: 1.03; 4.57); and reduced job satisfaction (β = -11.93; 95% CI: -18.79; -5.07). Depressive symptoms and burnout were positively correlated, as also were job satisfaction and safety culture (P < 0.001); job satisfaction was negatively correlated with burnout (P < 0.001) and depression (P = 0.035). CONCLUSION: Impermanent employment contracts increased depression and burnout and reduced job satisfaction. Job satisfaction reduced poor mental health outcomes and increased safety culture. Job satisfaction and safety culture were directly proportional (one construct increased the other and vice versa), as also were depression and burnout. Better working conditions can provide a virtuous cycle of patient safety and occupational health.

Prevalência e fatores associados à polifarmácia e potenciais interações medicamentosas em adultos na cidade de Manaus: estudo transversal de base populacional, 2019 / Prevalencia y factores asociados a la polifarmacia y posibles interacciones farmacológicas en adultos en la ciudad de Manaus, Amazonas, Brasil: estudio transversal poblacional, 2019 / Prevalence and factors associated with polypharmacy and potential drug interactions in adults in Manaus, Amazonas state, Brazil: a cross-sectional population-based study, 2019

Objetivo: Analisar a prevalência e fatores associados à polifarmácia e a presença de potenciais interações medicamentosas em Manaus, estado do Amazonas, Brasil, em 2019. Métodos: Estudo transversal de base populacional, com adultos de ≥ 18 anos. Entre pessoas em polifarmácia (≥ 5 medicamentos), pesquisou-se a presença de interações medicamentosas na base Micromedex. Razões de prevalências (RP) com intervalos de confiança de 95% (IC95%) foram calculadas por regressão de Poisson com variância robusta, seguindo análise hierárquica e considerando o delineamento amostral complexo. Resultados: Dos 2.321 participantes, 2,8% (IC95% 2,1;3,6) estavam em polifarmácia e, destes, 74,0% apresentaram interações, sendo mais frequentes quatro ou mais interações por pessoa (40,4%) e gravidade alta (59,5%). Polifarmácia foi maior entre idosos (RP = 3,24; IC95% 1,25;8,42), pessoas com saúde ruim (RP = 2,54; IC95% 1,14;5,67), hospitalização prévia (RP = 1,90; IC95% 1,09;3,32) e multimorbidade (RP = 3,20; IC95% 1,53;6,67). Conclusão: A polifarmácia foi mais frequente entre idosos e pessoas com problemas de saúde, que tiveram mais interações medicamentosas.

Objetivo: Analizar la prevalencia y factores asociados a la polifarmacia y la presencia de posibles interacciones farmacológicas en Manaus, estado de Amazonas, Brasil, en 2019. Métodos: Estudio poblacional transversal realizado con adultos con edad ≥ 18 años. Entre personas en polifarmacia (≥ 5 medicamentos), se investigó la presencia de interacciones farmacológicas en Micromedex. Las razones de prevalencia (RP) con intervalos de confianza de 95% (IC95%) se calcularon mediante la regresión de Poisson con varianza robusta, siguiendo análisis jerárquico y considerando el diseño de muestra complejo. Resultados: De los 2.321 participantes, 2,8% (IC95% 2,1;3,6) se encontraban en polifarmacia, de los cuales 74,0% presentaban interacciones, siendo más frecuentes cuatro o más interacciones por persona (40,4%) y de alta gravedad (59,5%). La polifarmacia fue mayor entre los ancianos (RP = 3,24; IC95% 1,25;8,42), personas con mala salud (RP = 2,54; IC95% 1,14;5,67), hospitalización previa (RP = 1,90; IC95% 1,09;3,32) y multimorbilidade (RP = 3,20; IC95% 1,53;6,67). Conclusión: La polifarmacia fue más frecuente entre los ancianos y personas con problemas de salud, que potencialmente tenían más interacciones farmacológicas.

Objective: To assess the prevalence and factors associated with polypharmacy and the presence of potential drug interactions in Manaus, Amazonas state, Brazil, in 2019. Methods: This was a population-based cross-sectional study conducted with adults aged ≥ 18 years. The presence of drug interactions among people on a polypharmacy regimen (≥ 5 drugs) was investigated on the Micromedex database. Prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated using Poisson regression model with robust variance, following hierarchical analysis and considering the complex sample design. Results: Of the 2,321 participants, 2.8% (95%CI 2.1;3.6) were on polypharmacy regimen, of whom, 74.0% presented drug interactions, usually with four or more drug interactions per person (40.4%) and high severity (59.5%). Polypharmacy was higher among older adults (PR = 3.24; 95%CI 1.25;8.42), people with poor health (PR = 2.54; 95%CI 1.14;5.67), previous hospitalization (PR = 1.90; 95%CI 1.09;3.32) and multimorbidity (PR = 3.20; 95%CI 1.53;6.67). Conclusion: Polypharmacy was more frequent among older adults and people with medical problems, who presented more drug interactions.

Health services utilization in the Brazilian Amazon: panel of two cross-sectional studies

ABSTRACT OBJECTIVE To investigate the use of health services among adults living in Manaus, Amazonas. METHODS This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI). RESULTS The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals - sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06-1.12), health insurance (PR = 1.13; 95%CI 1.09-1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84-0.90) and informal workers (PR = 0.89; 95%CI 0.84-0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05-1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33-2.12) but lower in men (PR = 0.55; 95%CI 0.44-0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51-0.89), and unemployed (PR = 0.72; 95%CI 0.53-0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01-1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65-0.86). CONCLUSIONS From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services.

Prevalence of childhood obesity in Brazil: systematic review and meta-analysis

Abstract Objective: To estimate the prevalence of childhood obesity in Brazil by means of a systematic review of representative studies. Sources: We searched for population-based studies that assessed obesity in Brazilian children aged < 10 years in MEDLINE, EMBASE, Scopus and other sources up to September, 2019. Paired researchers selected studies, extracted data and assessed the quality of these studies. Meta-analysis of prevalence and confidence interval (95% CI) was calculated, weighted by the population sizes using Freeman-Tukey double-arccosine transformation. Heterogeneity (I2) and publication bias were investigated by meta-regression and Egger's test, respectively. Summary of the findings: 53 studies were included (n = 122,395), which were held from 1986 to 2015 and limited mainly due to inadequate response rates. Prevalence of obesity in the threedecade period was of 8.2% ([95% CI]: 8.1-8.4%, I2 = 98.5%). Higher prevalence was observed in boys (9.7% [9.4-9.9%], I2 = 97.4%) than girls (7.3% [7.1 7.5%], I2 = 96.1%). Prevalence increased according to the decade (1990: 6.5% [6.0-7.0 %], I2 = 96.8%; 2000: 7.9% [7.7-8.0 %], I2 = 98.8%; 2010: 12.0% [11.5-12.6 %], I2 = 95.8%), and Brazilian region (Northeast: 6.4% [6.2−6.7%], I2 = 98.1%; North: 6.7% [6.3−7.2%], I2 = 98.8%; Southeast:10.6% [10.2−11.0%], I2 = 98.2%; South: 10.1 [9.7−10.4%], I2 = 97.7%). Heterogeneity was affected by age and region (p < 0.05) and publication bias was discarded (p = 0.746). Conclusion: For every 100 Brazilian children, over eight had obesity in the three-decade period and 12 in each 100 had childhood obesity in more recent estimates. Higher prevalence occurred in boys, recent decades and more developed Brazilian regions.

Availability and storage of hazardous products in households in the metropolitan region of manaus: a population-based survey, 2015 / Disponibilidade e armazenamento de produtos perigosos em domicílios da região metropolitana de manaus: estudo de base populacional, 2015

ABSTRACT Objective: The availability of hazardous products in households increases the risks of poisoning. The present study aimed to assess the frequency and associated factors of the availability and storage of hazardous products in residences in the metropolitan region of Manaus. Methods: Population-based and cross-sectional study conducted in 2015 with adults selected with three-stage probabilistic sampling. Participants were interviewed face-to-face. Prevalence ratio (PR) of the presence of hazardous products (presence of chumbinho [illegal anti-cholinesterase rodenticide], artisanal cleaning products, and unsafe storage of these products and medications) and 95% confidence intervals (95%CI) were calculated with Poisson regression with robust variance, weighted by the complex sampling method adopted. Results: A total of 4,001 participants was included, of which 53.0% (95%CI 51.5-54.6) reported presence of hazardous products in their households, 36.3% (95%CI 34.8-37.8) had unsafe storage, 16.2% (95%CI 15.1-17.4) had artisanal cleaning products, and 8.2% (95%CI 7.4-9.1) had chumbinho. Households with children ≤5 years old had safer storage (PR=0.78; 95%CI 0.71-0.86) and more artisanal products (PR=1.30; 95%CI 1.11-1.51). Presence of artisanal products was higher in lower educational levels (PR=2.20; 95%CI 1.36-3.57) and lower economic classifications (PR=1.63; 95%CI 1.25-2.13). Conclusions: Over half of the households in the metropolitan region of Manaus kept hazardous products; one-third stored them unsafely. Artisanal cleaning products and chumbinho were frequently present. Households with children had safer storage of products, and socioeconomic factors affected the availability of such hazardous products.

RESUMO Objetivo: A disponibilidade de produtos perigosos em domicílios aumenta os riscos de intoxicações. Este estudo objetivou avaliar a frequência e os fatores associados à disponibilidade e armazenamento de produtos perigosos em residências da Região Metropolitana de Manaus. Métodos: Estudo transversal de base populacional realizado em 2015 com adultos selecionados por amostragem probabilística em três estágios. Os participantes foram entrevistados pessoalmente. A razão de prevalência (RP) da presença de produtos perigosos (presença de chumbinho [rodenticida anticolinesterase ilegal], produtos de limpeza artesanais e armazenamento inseguro desses produtos e de medicamentos) e intervalos de confiança de 95% (IC95%) foram calculados por regressão de Poisson com variância robusta, ponderada pela amostragem complexa adotada. Resultados: 4.001 participantes foram incluídos, dos quais 53,0% (IC95% 51,5-54,6) reportaram a presença de produtos perigosos em seus domicílios, 36,3% (IC95% 34,8-37,8) apresentaram armazenamento inseguro, 16,2% (IC95% 15,1-17,4) possuíam produtos de limpeza artesanais e 8,2% (IC95% 7,4-9,1) possuíam chumbinho. Os domicílios com crianças menores de 5 anos apresentaram armazenamento mais seguro (RP=0,78; IC95% 0,71-0,86) e mais produtos artesanais (RP=1,30; IC95% 1,11-1,51). Presença de produtos artesanais foi maior em menores níveis de escolaridade (RP=2,20; IC95% 1,36-3,57) e menores classificações econômicas (RP=1,63; IC95% 1,25-2,13). Conclusões: Mais da metade dos domicílios da Região Metropolitana de Manaus possuía produtos perigosos; um terço os armazenava sem segurança. Produtos de limpeza artesanais e chumbinho estavam frequentemente presentes. Os domicílios com crianças apresentaram armazenamento mais seguro de produtos e fatores socioeconômicos afetaram a disponibilidade de tais produtos perigosos.

Tempo de espera e duração da consulta médica na região metropolitana de Manaus, Brasil: estudo transversal de base populacional, 2015 / Tiempo de espera y duración de la consulta médica en la región metropolitana de Manaus, Brasil: estudio transversal de base poblacional, 2015 / Waiting time and medical consultation length in the Manaus metropolitan region, Brazil: a cross-sectional, population-based study, 2015

Objetivo; Analisar o tempo de espera e a duração de consulta médica na região metropolitana de Manaus, Brasil. Métodos: Estudo transversal, realizado com adultos residentes na região em 2015. O tempo de espera para consulta e a duração da consulta, em minutos, foram referidos pelos participantes. A análise foi realizada por regressão de Tobit e ponderada pelo desenho amostral. Resultados: Foram entrevistados 4.001 indivíduos. O tempo médio de espera foi de 125,4 minutos (IC95% 120,2;130,5), enquanto a consulta durou, em média, 52,5 minutos (IC95% 48,0;57,0). Mulheres, pessoas pobres, pessoas com baixa escolaridade, indígenas, residentes em municípios do interior, sem seguro de saúde e atendidos por ginecologistas esperaram mais pela consulta (p<0,05). O tempo de consulta foi menor em pessoas não brancas, com estado de saúde ruim e com plano de saúde (p<0,05). Conclusão: A consulta médica durou, em média, metade do tempo de espera. Observaram-se iniquidades sociais nesses períodos de tempo.

Objetivo: Analizar el tiempo de espera y la duración de la consulta médica en la región metropolitana de Manaus, Brasil. Métodos: Estudio transversal realizado con adultos que viven en la región en 2015. El tiempo de espera y la duración de la consulta en minutos fueron informados por los participantes. El análisis se realizó mediante regresión de Tobit y ponderado por el diseño amostral. Resultados: 4,001 personas fueron entrevistadas. El tiempo de espera promedio fue de 125,4 minutos (IC95% 120,2;130,5) y la consulta duró un promedio de 52,5 minutos (IC95% 48.0;57.0). Mujeres, personas pobres, con baja educación, indígenas, residentes del interior, sin seguro médico y atendidas por ginecólogos esperaron más tiempo para la consulta (p<0.05). El tiempo de consulta fue más corto con personas no blancas, con mala salud y con seguro de salud (p<0.05). Conclusión: La duración de la consulta médica fue, en promedio, la mitad del tiempo de espera. Se observaron desigualdades sociales en estes tiempos.

Objective: To assess waiting times and length of medical consultations in the Manaus metropolitan region, Brazil. Methods:This was a cross-sectional study conducted with adults living in the region in 2015. Waiting time for consultation and length of consultation in minutes were reported by the participants. Analysis was performed using Tobit regression and weighted by the sample design. Results: 4,001 individuals were interviewed. Average waiting time was 125.4 minutes (95%CI 120.2;130.5), while consultations lasted an average of 52.5 minutes (95%CI 48.0;57.0). Women, poor people, people with less education, indigenous people, people resident in the state interior, people without health insurance, and individuals seen by gynecologists waited longer for their consultation (p <0.05). Consultation time was shorter for non-White people, those with poor health status and those who had health insurance (p <0.05). Conclusion: On average length of medical consultations was half the waiting time. Social inequalities were observed in these lengths of time.

Intoxicações e fatores associados ao óbito por agrotóxicos: estudo caso controle, Brasil, 2017 / Poisoning and associated factors to death from pesticides: case-control study, Brazil, 2017

Resumo: Introdução: As intoxicações por agrotóxicos causam elevada morbimortalidade. A vigilância é necessária da produção até o uso desses produtos. Objetivo: Analisar as intoxicações e os fatores associados à letalidade por agrotóxicos. Método: Trata-se de estudo caso controle baseado nos atendimentos de intoxicação por agrotóxicos realizados em 2017 por centros de informação e assistência toxicológica do Brasil. Pacientes que evoluíram a óbito compuseram o grupo caso, e os sobreviventes, o grupo controle. Calculou-se odds ratio (OR) dos fatores de risco para óbito, com intervalo de confiança (IC) de 95%. Com base no modelo de regressão, desenvolveu-se um modelo preditivo de morte, estratificado por faixa etária, sexo e contexto ocupacional, para investigação do risco dos trabalhadores agropecuários intoxicados por agentes extremamente tóxicos. Resultados: Identificaram-se 3.826 pacientes intoxicados por agrotóxicos, dos quais 146 evoluíram para óbito. Idosos (OR = 4,94; IC95% 2,49 - 9,80), homens (OR = 1,68; IC95% 1,15 - 2,46), trabalhadores do setor agropecuário (OR = 2,20; IC95% 1,15 - 4,24), tentativas de suicídio (OR = 13,27; IC95% 6,48 - 27,19) e exposição a produtos extremamente tóxicos (OR = 2,77; IC95% 1,84 - 4,16) apresentaram mais chances de óbito nas intoxicações por agrotóxicos. Conclusão: Em cada 100 intoxicações por agrotóxicos, quatro evoluíram para óbito. Idosos, homens, trabalho no setor agropecuário, tentativas de suicídio e produtos extremamente tóxicos apresentaram mais chances de óbito.

ABSTRACT: Background: Pesticide poisoning causes high morbidity and mortality. Surveillance is required for post-marketing monitoring of these products. Aim: To assess poisonings and associated factors with lethality by pesticides. Method: This is a case-control study based on the cases of pesticide poisoning assisted in 2017 by Brazilian Poison Control Centers. Patients who died were the cases and the survivors, the control. The odds ratio (OR) of death and 95% confidence interval (CI) were calculated. From the regression model, a predictive model of death was developed, stratified by age, gender and occupational context to investigate the risk of agricultural workers poisoned by extremely hazardous agents. Results: 3,826 patients poisoned by pesticides were identified, of which 146 died. Older people (OR = 4.94; 95%CI 2.49 - 9.80), males (OR = 1.68; 95%CI 1.15 - 2.46), agricultural workers (OR = 2.20; 95%CI 1.15 - 4.24), suicide attempts (OR = 13.27; 95%CI 6.48 - 27.19) and exposure to extremely hazardous products (OR = 2.77; 95%CI 1.84 - 4.16) odds of death from pesticide poisoning. Conclusion: Out of 100 pesticides poisoning, four died. Elderly, males, working in the agricultural sector, suicide attempts and extremely hazardous products had a higher risk of death.

Acesso a planos de saúde na região metropolitana de Manaus em 2015: estudo transversal de base populacional / Acceso a planes de salud en la región metropolitana de Manaus, AM, Brasil, en 2015: estudio transversal de base poblacional / Access to private health insurance in the metropolitan region of Manaus, AM, Brazil, in 2015: a cross-sectional population-based study

Objetivo: analisar a frequência e fatores associados à cobertura por planos privados de saúde na região metropolitana de Manaus, AM, Brasil. Métodos: estudo transversal de base populacional realizado em 2015, por meio de entrevista domiciliar; as razões de prevalência (RP) e intervalos de confiança (IC95%) foram calculadas pela regressão de Poisson, com variância robusta ajustada por sexo e faixa etária. Resultados: foram entrevistados 4.001 indivíduos, dos quais 13% (IC95% 12,0 a 14,1%) tinham plano de saúde; maior cobertura por planos foi observada entre militares (RP=3,18 - IC95% 1,64;6,15), empregados dos setores privado (RP=1,91 - IC95% 1,46;2,52) e público (RP=1,75 - IC95% 1,23;2,49); a cobertura por planos de saúde foi menor entre pessoas mais pobres (RP=0,21 - IC95% 0,13;0,33) e de menor escolaridade (RP=0,66 - IC95% 0,46;0,99). Conclusão: a frequência de planos de saúde foi baixa e associou-se a melhor poder aquisitivo, escolaridade e situação de trabalho.

Objetivo: analizar la frecuencia y los factores asociados a la cobertura por planes de salud en la región metropolitana de Manaus, AM, Brasil. Métodos: estudio transversal de base poblacional por entrevista domiciliar. Las razones de prevalencia (RP) e intervalo de confianza (IC95%) fueron calculadas por regresión de Poisson con varianza robusta, ajustadas por sexo y edad. Resultados: se entrevistaron 4.001 individuos; 13% (IC95%: 12,0 a 14,1%) tenían plan de salud; la mayor cobertura por planes fue observada entre militares (RP=3,18 - IC95% 1,64;6,15), empleados del sector privado (RP=1,91 - IC95% 1,46;2,52) y del sector público (RP=1,75 - IC95% 1,23;2,49); la cobertura fue menor en personas más pobres (RP=0,21 - IC95% 0,13;0,33) y de menor escolaridad (RP=0,66 - IC95% 0,46;0,99). Conclusión: la frecuencia de planes de salud fue baja y se asoció con mejor poder adquisitivo, escolaridad y situación de trabajo.

Objective: to analyze the frequency and factors associated with coverage by health insurance in the metropolitan region of Manaus, AM, Brazil. Method: a cross-sectional population-based study was conducted in 2015, with data collected through household interviews; prevalence ratios (PR) and confidence intervals (95%CI) were calculated using Poisson regression with robust variance adjusted for sex and age. Results: we interviewed 4,001 individuals; 13% (95%CI - 12.0;14.1%) had health insurance; greater insurance coverage was observed among military personnel (PR=3.18 - 95%CI 1.64;6.15), private sector employees (PR=1.91 - 95%CI 1.46;2.52) and public sector employees (PR=1.75 - 95%CI 1.23;2.49); health insurance was lower among poorer people (PR=0.21 - 95%CI 0.13;0.33), and those with less schooling (PR=0.66 - 95%CI 0.46;0.99). Conclusion: frequency of health insurance was low and was associated with better purchasing power, schooling, and employment.

Seroprevalence of cytomegalovirus and its coinfection with Epstein-Barr virus in adult residents from Manaus: a population-based study

Abstract INTRODUCTION: This study assessed the seroprevalence of cytomegalovirus, associated factors, and Epstein-Barr virus coinfection among adult residents of Manaus. METHODS: Using a cross-sectional study design, we collected blood samples from 136 individuals in a household survey in 2016. Prevalence ratios were calculated using Poisson regression. RESULTS: Cytomegalovirus and Epstein-Barr virus seroprevalences were 67.6% (95% CI: 9.7-75.6%) and 97.8% (95% CI: 95.3-100.0%), respectively. Coinfection was observed in 66.2% (95% CI: 58.1-74.2%) of participants. Bivariate analysis showed no statistical association. CONCLUSIONS: Seroprevalences were high among participants and approximately 7 out of 10 individuals had cytomegalovirus and Epstein-Barr virus coinfection.