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Manuel AP Vilela,1,2 Victor D Castagno,2,3 Rodrigo D Meucci,3,4 Anaclaudia G Fassa3,4 1Postdoctoral Program in Epidemiology, 2Department of Specialized Medicine – Ophthalmology, 3Doctoral Program in Epidemiology, 4Department of Social Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil Objective: To assess asthenopia prevalence and associated factors in schoolchildren aged 6–16. Methods: This was a cross-sectional study of all children attending the first to eighth grades at two public schools in the urban region of a medium-sized town in Southern Brazil between April and December 2012. A questionnaire on socioeconomic and cultural matters was answered by parents, while the children answered a questionnaire on asthenopia-related symptoms. The children underwent a complete visual function examination, including measurement of visual acuity, refraction test, cover test, stereopsis, heterophoria assessment, near point of convergence, and accommodative convergence/accommodation ratio. Results: Asthenopia prevalence was 24.7% in a total sample of 964 children. Visual acuity of 20/25 or better in both eyes was found in 92.8% of the children. The stereopsis test was normal in 99.4% of them, and some kind of strabismus was found in 3.5%. About 37.8% had astigmatism, 71.6% had mild hyperopia, 13.6% had moderate hyperopia, and 6.1% were myopic. Near point of convergence was abnormal in 14.0% of the children, and the accommodative convergence/accommodation ratio was found to be altered in 17.1% of them. Conclusion: Children and adolescents have expressive prevalence of asthenopia. The prevalence of visual function alterations does not differ from the general population, and, therefore, they are not prerequisites. It is very important that its mechanisms and risk factors be better defined. Health professionals need to be on the lookout for complaints of visual fatigue because of its potential to influence learning and school performance. Keywords: asthenopia, eyestrain, fatigue, visual, visual fatigue, eye fatigue

Through sustainable development goals 3 and 8 and other policies, countries have committed to protect and promote workers' health by reducing the work-related burden of disease. To monitor progress on these commitments, indicators that capture the work-related burden of disease should be available for monitoring workers' health and sustainable development. The World Health Organization and the International Labour Organization estimate that only 363 283 (19%) of 1 879 890 work-related deaths globally in 2016 were due to injuries, whereas 1 516 607 (81%) deaths were due to diseases. Most monitoring systems focusing on workers' health or sustainable development, such as the global indicator framework for the sustainable development goals, include an indicator on the burden of occupational injuries. Few such systems, however, have an indicator on the burden of work-related diseases. To address this gap, we present a new global indicator: mortality rate from diseases attributable to selected occupational risk factors, by disease, risk factor, sex and age group. We outline the policy rationale of the indicator, describe its data sources and methods of calculation, and report and analyse the official indicator for 183 countries. We also provide examples of the use of the indicator in national workers' health monitoring systems and highlight the indicator's strengths and limitations. We conclude that integrating the new indicator into monitoring systems will provide more comprehensive and accurate surveillance of workers' health, and allow harmonization across global, regional and national monitoring systems. Inequalities in workers' health can be analysed and the evidence base can be improved towards more effective policy and systems on workers' health., ((c) 2023 The authors; licensee World Health Organization.)

Adherence to antiretroviral therapy (ART) is essential to control HIV infections and avoid clinical complications and the development of resistant HIV strains. Several Brazilian municipalities have committed themselves to the 90-90-90 target, which aims at diagnosing 90% of HIV/AIDS cases, treating 90% of them, and virally suppressing 90% of them. However, only three Brazilian studies have assessed adherence to ART from secondary dispensing data. This study aimed to estimate the prevalence of adherence to treatment in the Municipality of Florianópolis, Santa Catarina State, Brazil, examining its association with demographic, health access, and clinical characteristics. A cross-sectional study was conducted using secondary national data from electronic medical records and Medication Logistic Control System (SICLOM) and Laboratory Test Control System (SISCEL) regarding people living with HIV/AIDS in the municipality from April 2020 to March 2021. We found an about 85% prevalence of adherence to ART. White men with follow-ups both in primary and secondary care showed greater adherence to treatment. Age and number of consultations directly related to adherence. Decentralizing care for users living with HIV/AIDS is the way to more comprehensive care but technical and ethical challenges still require solutions. Professional training, correct network referrals, and attention to confidentiality issues must be reinforced to expand treatment adherence.

Background: Brazil is one of the world's largest pesticide consumers, but information on pesticide poisoning among workers is scarce., Objective: To evaluate acute pesticide poisoning among tobacco growers, according to different criteria., Methods: This was a two-step cross-sectional study with 492 pesticide applicators. It used a 25 question pesticide-related symptoms (PRS) questionnaire and medical diagnosis for comparison with toxicological assessment. Associations were evaluated using Poisson regression., Results: 10.6% reported two or more PRS, while 8.1% reported three or more. Furthermore, 12.2% received a medical diagnosis of poisoning. According to toxicologists, possible cases accounted for 14.2% and probable cases for 4.3%. PRS increased during the period of greater exposure. Those exposed to dithiocarbamates, sulfentrazone, pyrethroids, fipronil and iprodione exhibited more PRS. The number of exposure types, multi-chemical exposure, clothes wet with pesticides and spillage on the body/clothes were associated with acute poisonings. All criteria showed sensitivity greater than 79% for probable cases but only greater than 70% for medical diagnosis when compared to possible cases, presenting substantial Kappa agreement., Conclusion: The prevalence of acute pesticide poisoning is much higher than officially recorded. Trained physicians can screen for pesticide poisoning. It is necessary to improve workers' education to reduce pesticide use and exposure to them.

Objectives: To estimate prevalence and factors associated with major depressive episode (MDE), emphasizing occupational aspects, in workers of a public teaching hospital that is a reference for Covid-19 treatment., Methods: A cross-sectional study was carried out between October and December 2020, after the first peak of the pandemic, interviewing 1,155 workers. The prevalence of MDE was estimated using the Patient Health Questionnaire (PHQ-9) algorithm. Multivariate hierarchical analysis was conducted using Poisson regression to assess associated factors., Results: MDE prevalence was 15.3% (95%CI: 13.3-17.5) and was higher among young, white and female workers, those with a family history of depression, resident professionals, nursing professionals, workers who were exposed to three or more situations of moral dilemma, and those who had to put off a physiological need until later. Having a risk factor for Covid-19, being a smoker and being physically inactive were also positively associated with MDE., Conclusions: The study points to the considerable prevalence of MDE among tertiary health care workers; reviewing work processes is essential to reduce occupational stress and minimize the effects of the pandemic on mental health, preventing those problems from becoming chronic.

The increase in pesticide consumption has a negative health impact. Studies point to an association between exposure to pesticides and cardiovascular disease (CVD), one of the leading causes of world mortality. This review synthesize evidence on the association between occupational exposure and environmental contamination by pesticides with CVDs from 1750 references databases (EBSCO, Medline, Science Direct, Scielo, Lilacs and Ovid) without date or language restriction. Selected 24 articles by PRISMA and Downs & Black methodologies, were included from inclusion criteria: original studies (case-control, cohort or cross-sectional design); clear CVD definition and exposure to pesticides; representative sample of the target population. The results show the occupational exposure to pesticides chlorpyrifos, coumafos, carbofuran, ethylene bromide, mancozeb, ziram, metalaxyl, pendimethalin and trifluralin was associated a risk of 1.8 to 3.2 for acute myocardial infarction. Primaphos, fenitrothion, malathion and deltamethrin pesticides were associated with a blood pressure increase. Environmental contamination by tetrachlorodibenzo-p-dioxin was associated with CVD with risk of 1.09 to 2.78 and organochlorine, 1.19 to 4.54; heavy metals, arsenic, trimethylarsine and dimethylarsinic acid with atherosclerosis and systemic arterial hypertension. These findings point to the association between exposure to pesticides and CVD, signaling the importance of greater rigor in the public policy related to pesticides.

This study aims to evaluate the implementation and describe the actions developed in the School Health Program (PSE) by primary care health teams that joined the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB), in 2012, 2014, and 2018. The participation of the teams in school health activities increased throughout the three evaluation cycles, with the expansion of clinical evaluation, health promotion, and disease prevention actions. In cycle II, 24% of the teams performed the seven clinical evaluation actions, 18% performed the six promotion and prevention actions. However, 6.3% of the teams did not perform any clinical evaluation action and 8.8% did not perform health actions of promotion or prevention. In cycle III, more than 90% of the teams participated in the PSE, 84% of the health teams reported a combined planning for actions in schools, and more than 60% of the teams held joint meetings with the schools. PSE was institutionalized in all regions of the country, being more developed in municipalities with 10,000 to 30,000 inhabitants, lower Municipal Human Development Index (HDI-M) level, and greater coverage of the Family Health Strategy (FHS). Despite the positive evolution, the predominance of clinical evaluation actions in relation to health promotion actions and the proportion of teams that still have limitations in the combined efforts between health and education suggest a certain distancing from the PSE guidelines. To advance the implementation of the PSE, it is necessary to train health and education professionals; deepen intersectoral connection; expand the implementation of information and communication technologies; and maintain policies that allow the evaluation of the PSE, in order to support its development.

Workplace bullying (WB) is associated with Common mental disorders (CMD) in high-income countries, but there is a lack of evidence relating to this subject in low- and middle-income countries. Therefore, this study aimed to investigate the association between bullying and CMD in Brazil. A cross-sectional study with 907 judicial civil servants from Porto Alegre, southern Brazil, was carried out. WB was measured by the Negative Acts Questionnaire (NAQ-r) and CMD by the Self-Reporting Questionnaire (SRQ-20). Logistic regression was used to analyse data and test hypotheses. The overall prevalence of CMD was 32.8%, while the overall prevalence of bullying was 18.3%. WB was strongly associated with CMD, even after controlling for confounders. After adjustment for sociodemographic, personality and occupational confounders, weekly and daily exposures to negative acts increased 4.32 (95% CI: 2.00-9.33) and 6.80 (95% CI: 3.42-13.51) times the risk of CMD, respectively. Considering the operational definition, bullied workers had a 3.45 (95% CI: 2.26-5.25) higher risk of CMD. The results are consistent with studies from high-income countries. Different ways of categorising exposure to WB and testing association with CMD are suggested. Interventions to prevent bullying, focusing on work processes and psychosocial factors at work, could reduce the risk of mental health problems.

This is a cross-sectional study that analysed the association between workplace bullying and LBP. The participants were 894 judicial civil servants from Porto Alegre, southern Brazil. Workplace Bullying was measured by the Negative Acts Questionnaire (NAQ-r) and Low Back Pain by the Nordic Questionnaire for Musculoskeletal Symptoms (NQMS). Logistic Regression was used to analyse data and test hypotheses. The prevalence of LBP in the last 7 days was 50.1%, while the overall prevalence of Chronic LBP was 19.3%. Some psychosocial factors at work were strongly associated with both outcomes. Workplace bullying was strongly associated with LBP, even after adjustment for several covariates. The odds of LBP in the last 7 days among bullied workers was 1.89 (95% CI: 1.31-2.71) times higher, compared to non-bullied. Workplace bullying was also associated with chronic LBP after adjustment for sociodemographic, behavioural and some occupational factors (OR = 1.60; 95% CI: 1.05-2.44). Psychosocial factors at work, and particularly workplace bullying, were strong risk factors for LBP, in contrast to most individual factors, and dose-response patterns were showed. Positive associations between bullying and LBP raise hypotheses on causation, and the role of psychosocial factors at work are discussed. Further longitudinal studies should address these hypotheses, investigating causal paths, mechanisms and possible mediation. PERSPECTIVES: As a psychosocial risk, workplace bullying may play a role in low back pain and can be focus of interventions to prevent LBP. Dose-response patterns on the association between workplace bullying and low back pain are discussed and hypotheses are raised. The paper addresses different ways of measuring and categorising bullying at work, in order to study the relationship between bullying and pain., (Copyright © 2021 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Tobacco farming is considered Hazardous Child Labor in Brazil. This study examined the work of children and adolescents in tobacco farming, characterizing the level of urinary cotinine and the occurrence of Green Tobacco Sickness (GTS), pesticide poisoning, respiratory symptoms, and musculoskeletal disorders. A cross-sectional descriptive study was conducted with a random sample of tobacco growers under 18 years old in Southern Brazil. Ninety-nine young people were interviewed at 79 family farms. The majority began working in agriculture before they were 14 and worked harvesting and tying hands of tobacco; 60% were 16 or 17 years old, and 51.5% were male. During their lifetime, 24.5% reported GTS, and 3% reported pesticide poisoning. In the previous year, 29.3% reported low back pain, 6.1% wheezing, and 16.2% coughing without having a cold. Half of the 12 young people evaluated had over 100 ng/mL of urinary cotinine. The study indicates that child laborers do various activities and present a high prevalence of health problems. Health workers should be trained to identify child laborers and their impacts on health. Full-time farm schools could provide knowledge about sustainable agricultural production, reducing the rates of age-grade mismatch, without taking young people away from rural areas.

Objective: To assess prevalence of suicidal ideation and suicide attempt among South Brazilian tobacco growers and to analyze the associated factors related to the suicidal ideation., Methods: A cross-sectional study was conducted in 2011 with a random sample of 2469 tobacco growers in São Lourenço do Sul/RS. Suicidal ideation was characterized by the question "Has the thought of ending your life been on your mind?". Suicide attempt was assessed by the question "Have you ever tried to kill yourself?". Investigation of factors associated with suicidal ideation was done by means of Poisson regression., Results: Prevalence of suicidal ideation and suicide attempt was 2.5 % and 1.2 % respectively. In the adjusted analysis, suicidal ideation was associated with being female, older age, moderate participation in religious activities and difficulty in paying debts. Those who worked in activities that required inadequate postures (hunched over or other forced positions), as well as farmers who performed 6-9 pesticide-related tasks demonstrated greater risk of suicidal ideation. Regarding health conditions, medical diagnosis of asthma, chronic low back pain, number of lifetime green tobacco sickness episodes and lifetime pesticide poisoning were positively associated with suicidal ideation., Conclusion: Suicidal thoughts and attempts are relevant mental health problems among tobacco growers. Reducing pesticide use, as well as exposure to nicotine and improving socio-economic conditions, can reduce suicidal ideation and improve the mental health of exposed workers., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The objective was to assess the availability of inputs for reproductive planning in basic healthcare units (UBS in Portuguese) that participated in the National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB) and their distribution according to contextual factors. A comparative study was conducted of the three cycles of the PMAQ-AB (2012, 2014, and 2018). The study assessed the availability in the UBS of ethynyl-estradiol + levonorgestrel, norethisterone, norethisterone + estradiol, levonorgestrel, medroxyprogesterone, male and female condoms, IUDs, and rapid pregnancy tests. The study considered the availability and presence of all the inputs. Availability was assessed according to contextual factors in the city where the UBS was located. Availability of total inputs increased from 1.5% to 10.9%. In all the cycles, ethynyl-estradiol + levonorgestrel and male condoms showed the highest availability, and IUDs the lowest. Individual input´s availability also increased, with the highest increase of 36p.p. for female condoms, rapid pregnancy tests, and norethisterone + estradiol and the lowest of 15p.p. for ethynyl-estradiol + levonorgestrel, norethisterone, and IUDs. The North of Brazil showed the worst results. The largest increases were in the UBS in the municipalities with the lowest HDI and in those that participated in all the cycles of the PMAQ. Condoms are the only widely available inputs, and it is important to expand the availability of the other inputs, mainly IUDs and rapid pregnancy tests. The period under study experienced the promotion of equity, but regional inequalities need to be overcome. It is essential to monitor the inputs´ availability in order to improve reproductive planning.

This study aims to assess neck pain prevalence and associated factors among tobacco farm workers. This is a cross-sectional study of 2,469 tobacco farm workers in southern Brazil. An adapted version of the Nordic Questionnaire of Musculoskeletal Symptoms was used to characterize neck pain. Multivariate analysis was performed using Poisson regression, following a hierarchical theoretical model. Neck pain prevalence in the last year among the population studied was 7.4%. Worker age, tobacco smoking, tobacco bundling, use of heavy chainsaws, working at an intense or accelerated pace and green tobacco sickness were variables associated with neck pain in females. Among males, age, use of heavy chainsaws, working in a sitting position on the ground, pesticide poisoning, and green tobacco sickness were associated with the outcome. The study reinforces the importance of ergonomic and physiological workloads in the determination of neck pain. Future studies are needed to understand the role of pesticides and nicotine exposures on musculoskeletal problems. The mechanization of tobacco harvesting could reduce ergonomic and chemical exposure, thereby improving farmers' health.

Objective: To describe the sexual behavior of freshmen undergraduate students according to demographic, economic, psychosocial and behavioral characteristics, and evaluate the prevalence of risky sexual behavior and its associated factors., Methods: A cross-sectional study of the census type with undergraduate students over 18 years old of 80 undergraduate courses of the Universidade Federal de Pelotas (UFPel), in Rio Grande do Sul (RS), who entered in the first semester of 2017 and remained enrolled in the second semester. Undergraduate students who reported having had sex were evaluated. We considered as risky sexual behavior having more than one sexual partner within the last three months and not having used condoms in the last sexual intercourse., Results: The prevalence of risky sexual behavior was 9% (95%CI 7.6-10.5). Men presented more risky behavior than women, with a prevalence of 10.8% and 7.5%, respectively. Of the undergraduate students, 45% did not use condoms in the last sexual intercourse, and 24% had two partners or more within three months before the survey. Smartphone applications for sexual purposes were used by 23% of students within three months before the survey. Risky sexual behavior was associated with gender, age at first sexual intercourse, frequency of alcohol consumption, consumption of psychoactive substances before the last sexual intercourse and use of smartphone applications for sexual purposes., Conclusion: Although undergraduate students are expected to be an informed population, the prevalence of risky sexual behavior was important, indicating the need to expand public investment in sexual education and awareness actions.

Objective: to describe the adequacy of primary health care center structure, requests for tests and prenatal care reported by female health service users within the scope of the Program for Improving Primary Care Access and Quality (PMAQ) in Brazil., Methods: this was a cross-sectional study using PMAQ Cycle II (2014) data., Results: data from 9,909 health centers, 9,905 teams, and 9,945 female health service users were included; 70.1% (95%CI 69.2;71.0) of health centers had adequate structure; 88.0% (95%CI 87.4;88.7) of the teams requested all tests; 59.8% (95%CI 58.8;60.8) of female health service users reported receiving total guidance, and 23.4% of them (95%CI 22.5;24.2) underwent all physical examination procedures; teams that participated in both Cycle I and Cycle II presented better results., Conclusion: in spite of shortcomings in Primary Care structure and work process in Brazil, PMAQ appears to positively affect prenatal care.

Introduction: Depression is the leading cause of disability around the world, and it has been increasingly affecting young people. This study evaluates the prevalence and factors associated with major depression in university students, with emphasis on the influence of the academic field, chosen study area and the environment they are inserted., Methods: A census of students who entered the university in the first semester of 2017 was held at a university in Southern Brazil. The outcome of major depressive episode was evaluated using the Patient Health Questionnaire-9, considered when the individual had five or more depressive symptoms for at least one week. Its prevalence was estimated, and the associated factors were examined by the hierarchical multivariable analysis using the Poisson regression model., Results: A total of 32% (95% confidence interval 29.9-34.2) of university students presented a major depressive episode, and the problem was more frequent among women (prevalence ratio [PR] = 1.59); people aged 21 to 23 years (PR = 1.24); those with a family history of depression (PR = 1.27); minorities' sexual orientation (homosexuals, PR = 1.64, and bisexuals, PR = 1.69); who lived with friends or colleagues (PR = 1.36); students in the area of applied social and human sciences (PR = 1.28), and linguistics, language and literature, and art (PR = 1.25). The worst academic performance (PR = 2.61), alcohol abuse (PR = 1.25), and illicit drug use (PR = 1.30) were also positively associated with major depressive episode., Conclusion: In addition to individual, family, and behavioral aspects, already described as risk factors for major depressive episodes in the general population, academic aspects also influence the occurrence of depression among university students. Considering the high prevalence of major depressive episode and its negative impact on health, public and institutional policies are necessary to focus on students' mental health promotion and care.

Objective : The goal of this study was to systematically review risk factors for workplace bullying. Methods : The search was carried out in two databases. Studies with estimates of risk factors for workplace bullying were included in the review. We assessed the quality of the selected studies using an adapted version of the Downs and Black checklist. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines were used for reporting papers. Results : Fifty-one papers were included, and 70.6% were from European countries. Women were reported to be at higher risk of being bullied in most studies (odds ratio (OR) from 1.17 to 2.77). Authoritarian and laissez-faire leadership styles were positively associated with bullying. Several psychosocial factors, such as stress (OR from 1.37 to 4.96), and occupational risks related to work organization, such as flexible work methods, role conflict, role ambiguity, monotonous or rotating tasks, high demands, pressure of work, and unclarity of duties were strongly associated with bullying. Discussion : The findings highlight the central role of organizational factors in bullying. Policies to prevent bullying must address the culture of organizations, facing the challenge of developing a new management and leadership framework.

Objective: to analyze frailty prevalence and associated factors in the elderly in the city of Pelotas, RS, Brazil, in 2014., Methods: this was a cross-sectional, population-based study of a sample of individuals aged 60 years old or older; a modified version of the Edmonton Frail Scale was used to assess frailty; prevalence ratios (PR) and their 95% confidence intervals (95%CI) were estimated using Poisson regression., Results: frailty prevalence was 13.8% and was higher among individuals aged 75 years or older (PR 4.33 - 95%CI 2.94;6.39), those of the female gender (PR 1.46 - 95%CI 1.06;2.03) and those living without a partner (PR 1.54 - 95%CI 1.16;2.04); epilepsy (PR 3.58 - 95%CI 2.19;5.85), ischemia (PR 2.56 - 95%CI 2.00;3.28), and heart failure (PR 2.48 - 95%CI 1.92;3.19) were the morbidities most highly associated with frailty., Conclusion: frailty was associated with older individuals, the female gender, those living without a partner and those affected by multiple morbidities.

Objective: To identify factors associated with a better quality of the diet of residents of a rural area in Southern Brazil., Methods: This is a population-based, cross-sectional study with individuals aged 18 years or over living in the rural area of Pelotas, State of Rio Grande do Sul, Brazil. Food consumption was evaluated by a food frequency questionnaire of thirteen items, related to the consumption in the last week. We evaluated quality of the diet using the Adult Diet Quality Index (IQD-A). Healthy food received increasing scores while unhealthy food received decreasing scores, according to consumption frequency, amounting to scores from zero to 30. The total score was divided into tertiles. Individuals of the third tertile were classified with better quality of the diet. We investigated the association between quality of the diet and independent variables using multinomial logistic regression., Results: We interviewed 1,519 individuals with mean IQD-A of 17.1 points (SD = 3.3) and a median of 17.0 (range of 10 to 25 points). Although the population studied kept the consumption of staple foods, the intake of industrialized food such as soft drinks, artificial juices, and unhealthy foods such as sweets was high. Older individuals presented seven times (95%CI 4.20-12.48) more chance of having a better quality of the diet. Women, individuals with higher economic status, those who worked in the sale of animals, or those who had diabetes were approximately twice as likely to be in the group with the best quality of the diet. Individuals whose families worked with fishing presented a 70% lower chance of being in the group of better quality of the diet., Conclusions: We identified that men, younger adults, individuals of lower socioeconomic level, and fishing families were in the group of higher vulnerability for the consumption of a diet with worse quality. Thus, public policies, especially educational policies, are needed to promote healthy eating in this group.

Objective: To describe urinary cotinine levels in tobacco farmers., Methods: A cross-sectional study was conducted in 2,570 tobacco farmers. All participants that reported green tobacco sickness in the week prior to the interview plus a subsample of 492 pesticide applicators were included. We collected urinary samples and information about sociodemographic, behavioral, dietary, occupational characteristics, and pesticide poisoning during their lifetime. Stratification by sex and smoking was performed and the Wilcoxon and Kruskal-Wallis non-parametrical tests were used to analyze cotinine means., Results: This study included 582 individuals. There was no difference in urinary cotinine means between green tobacco sickness symptomatic and asymptomatic individuals. Among non-smokers, having picked tobacco in the previous week was associated with higher cotinine means in both genders. Cotinine levels were higher on the first day of symptoms and reduced exponentially with each day in female non-smokers. Male non-smokers had higher levels on the second day and a more gradual reduction. The cotinine level rose up to 15 cigarettes/day of consumption., Conclusions: The urinary cotinine measures exposure to nicotine up to its saturation point; while green tobacco sickness, affected by tolerance, indicates nicotine poisoning. Strategies to reduce nicotine exposure in tobacco production are needed. Mechanization could be an alternative, as long as it overcame the challenge of irregular terrain and did not affect the quality of the leaf. More studies are needed to evaluate the chronic effect of nicotine exposure.

Agriculture has the highest risk of accidents. In Brazil the reality of this situation is unknown owing to scarcity of studies and underreporting of workplace accidents in rural areas. This article aims to evaluate workplace accident prevalence and associated factors among tobacco farm in Sao Lourenco do Sul-RS, Brazil. Cross-sectional study with 488 tobacco farmers, assessing sociodemographic, behavioural, labour characteristics and association with workplace accidents occurring in their lifetime. The injury prevalence was 24%. Being male (PR 1.62; 95%CI 1.04-2.52), and tenant farmer (PR 1.87; 95%CI 1.29-2.72), bundling tobacco leaves (PR 2.00; 95%CI 1.14-3.52) and having minor psychiatric disorders (PR 1.58; 95%CI 1.06-2.35) were positively associated with accidents. 46% of serious injuries caused superficial lesions and 26% caused fractures. Rural workplace accident prevention policies need to be established, particularly for tobacco farming. Larger studies are needed to understand work process-related aspects that increase the risk of accidents.

Results: This study aims to describe the prevalence of heavy drinking, high-risk alcohol consumption and associated factors among tobacco farmers. A cross-sectional study was carried out with 2,469 tobacco farmers over 18 years old in 2011. High-risk alcohol consumption was considered the intake of three or more standard doses per day for men or two or more for women. Heavy drinking was considered the intake of four or more standard doses per day for men and three or more for women. Hierarchical multivariate analysis was performed to investigate the association with socioeconomic, behavioral, and occupational variables. : The prevalence of high-risk and heavy drinking was of 4.7% and 1.09% among women and 30.8% and 4.8% among men, respectively. The factors associated with high-risk drinking for men and women were the percentage of income tobacco accounted for (PR 1.3 and 0.4), being an employee (PR 1.3 and 3.1), and use of pesticides (PR 1.5 and 2.1), respectively. Heavy drinking among men was associated with losing the crop (PR 1.6), attending religious activities (PR 0.3), and hours working in agriculture (PR 0.6). Occupational factors were associated wit high-risk alcohol consumption among men. The associated factors vary according to the pattern of consumption assessed.

The aim of this study was to describe quality indicators for prenatal care in Brazil as part of the Program for the Improvement of Access and Quality (PMAQ-AB). The study analyzed number of prenatal visits, vaccination status, prescription of ferrous sulfate, physical examination, orientation, and laboratory tests, based on which a summary quality indicator was constructed. Data were collected in 2012-2013 during interviews conducted by External Evaluators of the PMAQ-AB, with 6,125 users who had done their last prenatal follow-up in Family Health units. During prenatal follow-up, 89% reported six or more visits, more than 95% received a tetanus booster and prescription of ferrous sulfate, 24% reported having received all the procedures in the physical examination, 60% received all the orientation, and 69% had all the recommended laboratory tests. Only 15% of interviewees had received adequate prenatal care, including all the recommended measures, and there was a significantly higher proportion of "complete" care in pregnant women that were older, with higher income, in the Southeast region of Brazil, in municipalities with more than 300,000 inhabitants, and in those with (HDI) in the upper quartile. There are persist social and individual inequalities that can be targeted by measures to upgrade the teams' work processes.

Purpose: Hofstetter's equations are based on studies of Amplitude of Accommodation (AA) with methodological limitations, particularly in the case of children younger than 10 years of age. The aim of this study is to evaluate AA by age, gender, economic status, and time of day as well as accommodative insufficiency prevalence., Methods: A cross-sectional study was conducted with 867 schoolchildren aged 6-16 years attending two public schools in the urban area of the South Brazilian city of Pelotas. Subjective refraction was performed using a monocular fogging method to standard end point of maximum plus for best visual acuity (20/25). AA was assessed using the push-up method., Results: The median AA value was 14.3D (P25 13.3-P75 16.7) among children aged 6-16 years, being 15.5D (P25 14.3D-P75 16.7) among children aged 6-10 years, 14.2D (P25 12.5D-P75 15.4) among 11-13-year-olds, 13.3D (P25 12.5D-P75 15.4) among children aged 14-15 and 12.9D (P25 11.1D-P75 14.3) among those aged 16. AA variability was 2.4D in those aged 6-8, 3.4D in children aged 9-12, and 2.9D in those aged 13-16. There was no significant difference in median AA according to gender, time of examination, or economic status; 2.8% of children showed AA of less than 2D lower than Hofstetter's minimum reference value., Conclusions: This study reports AA in a large sample of children and therefore may contribute to current knowledge on AA norms. In order to avoid the impact of outliers, it proposes the use of the median and percentiles to define AA standards by specific age. A set of studies using precise AA measurement and large sample size are needed to determine clinical standards for AA.

This article describes the primary health care offered to 8118 service users with diabetes in Brazil based on data from the PMAQ (Program to Improve Primary Care Access and Quality) first survey. Structure, access, service organization and management, and clinical care quality were analyzed. Prevalence of self-reported receipt of appropriate treatment was 14.3% (95% confidence interval [CI]: 13.4-15.2). Following adjustment, it was 26% higher (prevalence ratio [PR] = 1.26; 95% CI: 1.04-1.54) when primary health care centers had all the structure items investigated, it was 13% higher (PR = 1.13; 95% CI: 1.00-1.29) when the teams' work process for service organization and management was adequate and it was 14% higher (PR = 1.14; 95% CI: 1.00-1.30) when the teams' clinical practice was adequate.

The scope of the article is to present the reflections of professionals from the Mais Médicos Program (More Doctors Program) on the significance of the specialization course in Family Health in terms of professional practice and learning the most important concepts. This is an empirically based qualitative study on the statements recorded in the "Critical reflection on their personal learning process" of the final work of the specialization course at the Federal University of Pelotas. For textual analysis, 101 reports were randomly selected from a total of 1,011 reports completed in seven states of the North, Northeast and South of Brazil from June to December 2015. The initial barriers were overcome with tutor support and team integration, with emphasis on teaching tools for the improvement of clinical practice and strategic organization of work and greater understanding of the public health system. Fostering the learning of the Portuguese language and the exchange of experience in the forums were considered valuable positive aspects. Despite the difficulty in Internet access in some municipalities it reaffirmed the central role of ongoing education and the viability of the problem-solving methodology, even from a distance.

This study aimed to describe the prevalence of smoking and associated factors in a cross-sectional population-based sample of 2,464 tobacco farmers in 2011. Multivariate analysis in men assessed the association between smoking and socioeconomic, behavioral, and occupational variables. Some 31.2% of men and 3.1% of women were current smokers. In men, smoking was directly associated with age, schooling, income, heavy drinking, time at work in tobacco farming, and time of exposure to pesticides. Employment relationship was a risk factor for smoking, and participation in religious activities was a protective factor. Male tobacco farmers showed multiple risk behaviors and higher smoking prevalence than other farmers. Ignoring the risk and cultural legacy may be common factors for these behaviors and suggest combined approaches.

This was a cross-sectional study within Brazil's Project for the Expansion and Consolidation of Family Health, 2005, with the objective of universal and free access to the medication prescribed in the last medical appointment for acute health problems and to estimate the degree to which access may have improved with inclusion of the medicines in prevailing policies and programs. The sample included 4,060 adults living in the area of primary health care units in 41 municipalities in South and Northeast Brazil. Access was greater in the South (83.2%) than in the Northeast (71%), and free access was similar (37%), with a greater share by the Family Health Program (FHP) when compared to the traditional model, especially in the Northeast. Some 60% of prescribed medicines and 50% of those on the National List of Essential Medicines (RENAME) were paid for. No variation was observed in the proportion of medicines present on the prevailing RENAME list and access. However, 40% of the medicines that were paid for can currently be obtained through the Popular Pharmacy Program. The latter program appears to emerge as a new way to guarantee access to medicines prescribed in the health system.

Objective: To assess the prevalence and factors associated with the use of the expanded Brazilian People's Pharmacy Program among older adults and the reasons for not using it., Methods: In this population-based cross-sectional study conducted in the urban area of Pelotas, RS, Southern Brazil, we evaluated 1,305 older adults (aged 60 years or over) who had used medication in the last 15 days. Independent variables were socioeconomic factors, economic status, household income in minimum wages, educational attainment in years of schooling and occupational status. Demographic variables were sex, age, marital status, and self-reported skin color/race. Poisson regression was employed to analyze the factors associated with the use of the program., Results: The prevalence of use was 57.0% whilst the prevalence of knowledge of the program was 87.0%. In individuals aged 80 years or over, use of the program was 41.0%. As to the origin of the prescriptions used by older adults, 46.0% were from the Brazilian Unified Health System. The main reasons for not using the program were: difficulty in getting prescriptions, medication shortage, and ignorance about the medications offered and about the program. Higher age, lower income, presence of chronic diseases, and use of four or more medications were associated with use of the program., Conclusions: It is necessary to expand the knowledge and use of the Brazilian People's Pharmacy Program, especially among older adults, and to improve the dissemination of its list of medications to users and physicians. Thus it will be possible to reduce spending on long-term medications, which are especially important for this population.

Background: Tobacco workers are exposed to several respiratory occupational sensitizers., Methods: A representative cross-sectional study was carried out on 2469 tobacco family farming growers. Gender-stratified multivariate analyses evaluated the association between wheezing and socio-demographic, behavioral, and occupational variables., Results: Wheezing prevalence was 11.0% with no difference between genders. Among men, age, smoking, strenuous work, pesticide use, contact with vegetable dust and dried tobacco dust, lifting sticks with tobacco leaves to the curing barns, and green tobacco sickness (GTS) were risk factors for wheezing. Among women, family history of asthma, tying hands of tobacco, strenuous work, contact with chemical disinfectants, and GTS were positively associated with wheezing. Harvesting lower tobacco leaves was a protective factor for the outcome in both genders., Conclusions: Pesticides, dusts exposure, and GTS were risk factors for wheezing. The synergic effect of these factors needs to be better evaluated to improve prevention., (© 2015 Wiley Periodicals, Inc.)

Objective: To estimate the prevalence of asthenopia in 0-18 year-old children through a systematic review and meta-analysis of prevalence studies., Sources: Inclusion criteria were population-based studies from 1960 to May of 2014 reporting the prevalence of asthenopia in children. The search was performed independently by two reviewers in the PubMed, EMBASE, and LILACS databases, with no language restriction. This systematic review was performed in accordance with the Cochrane Collaboration guidelines and the PRISMA Statement. Downs and Black score was used for quality assessment., Summary of Findings: Out of 1692 potentially relevant citations retrieved from electronic databases and searches of reference lists, 26 were identified as potentially eligible. Five of these studies met the inclusion criteria, comprising a total of 2465 subjects. Pooled prevalence of asthenopia was 19.7% (12.4-26.4%). The majority of children with asthenopia did not present visual acuity or refraction abnormalities. The largest study evaluated 1448 children aged 6 years and estimated a prevalence of 12.6%. Associated risk factors were not clearly established., Conclusion: Although asthenopia is a frequent and relevant clinical problem in childhood, with potential consequences for learning, the scarcity of studies about the prevalence and clinical impact of asthenopia hinders the effective planning of public health measures., (Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Hyperopia is the most common refractive condition in childhood. There are few studies on moderate hyperopia and associated factors. This study aims to investigate the prevalence of moderate hyperopia and associated factors among school children. A cross-sectional study comprising 1,032 students attending 1st to 8th grades at two public schools was conducted in a Southern Brazilian urban area in 2012. Cycloplegia was used to examine both eyes and refractive error was measured through auto-refraction. A socioeconomic and cultural questionnaire was administered. Multivariable analysis was performed through Poisson regression. Moderate hyperopia prevalence was 13.4% (95% CI, 11.2-15.4) and 85% of these did not wear glasses. Age was inversely associated with moderate hyperopia, while female gender RP = 1.39 (95%CI, 1.02 - 1.90) and white skin RP = 1.66 (95%CI, 1.04 - 2.66) were risk factors for this outcome. This study makes progress in estimating mild and moderate hyperopia prevalence both by age range and specific age. It emphasizes how the lack of this condition being corrected in southern Brazil is a serious problem. It highlights the importance of detailing and characterizing the amount of time spent on close-range, long-range and outdoor activities.

Background: Despite tobacco farming involving intensive manual labor, chronic low back pain (CLBP) prevalence and associated factors are unknown among this occupational group., Methods: This was a cross-sectional study conducted in southern Brazil. A random sample of tobacco farmers was interviewed. Socioeconomic and individual characteristics, occupational tasks, workloads, and comorbidities were investigated. Chronic low back pain prevalence was described in relation to independent variables, and associations were examined with Poisson regression., Results: Chronic low back pain prevalence was 8·4%. Increasing age, rearing two or more species of livestock (PR 1·65), exposure to tasks that require heavy physical exertion (PR 2·00), working in awkward postures (PR 1·36), green tobacco sickness (GTS) (PR 1·63), pesticide poisoning (PR 2·37), and minor psychiatric disorders (PR 2·55) were associated with CLBP., Conclusions: This study found that CLBP is a relevant health problem among tobacco farmers and highlights understudied risk factors such as pesticide poisoning and GTS. Policies to minimize exposure to physiological and chemical workloads in tobacco planting to prevent CLBP are needed. Health professionals should be trained to diagnose and prevent acute low back pain episodes and thus prevent/minimize limitations and disabilities due to CLBP.

The study sought to estimate the presence of cats and dogs in households in the urban area of the city and assess responsible guardianship and associated factors. A population-based, cross-sectional study was conducted using the multi-stage sampling process and the census sectors of the demographic census of the year 2010 carried out by IBGE were used as conglomerates. The unit under study was the household. The outcome was responsible guardianship, defined by a score that took into account the following variables: sterilization, anti-rabies vaccination, veterinary medical consultation, control of endoparasites, access of animals to public areas, control of ectoparasites and the collection of feces of animals in public areas. Of the 1,558 households investigated, 58.9% had pets (cat or dog). The study reveals that the score of responsible guardianship increases with the education level of the head of the household and is highest among apartment dwellers. The majority of the households investigated met only half of the criteria. The results of this study point to the need for public policies that instruct the population on responsible guardianship, and that offer immunizations and sterilization services for animals.

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.

Background: Studies show great variability in the prevalence of hyperopia among children. This study aimed to synthesize the existing knowledge about hyperopia prevalence and its associated factors in school children and to explore the reasons for this variability., Methods: This systematic review followed PRISMA guidelines. Searching several international databases, the review included population- or school-based studies assessing hyperopia through cycloplegic autorefraction or cycloplegic retinoscopy. Meta-analysis of hyperopia prevalence was performed following MOOSE guidelines and using the random effects model., Results: The review included 40 cross-sectional studies. The prevalence of hyperopia ranged from 8.4% at age six, 2-3% from 9 to 14 years and approximately 1% at 15 years. With regard to associated factors, age has an inverse association with hyperopia. The frequency of hyperopia is higher among White children and those who live in rural areas. There is no consensus about the association between hyperopia and gender, family income and parental schooling., Conclusion: Future studies should use standardized methods to classify hyperopia and sufficient sample size when evaluating age-specific prevalence. Furthermore, it is necessary to deepen the understanding about the interactions among hyperopic refractive error and accommodative and binocular functions as a way of identifying groups of hyperopic children at risk of developing visual, academic and even cognitive function sequelae.

Introduction: The association between pesticide use and an increased suicide risk is a controversial issue. Previous studies have shown higher rates of suicide among agricultural workers and people living in small municipalities, but have not identified the causes of these results., Objective: To investigate the association between pesticide exposure and suicide rates., Methods: Crude suicide rates of a 15-year time series (1996-2010) were examined, followed by an ecological study using age-standardized suicide rates for the period 2006-2010. The unit of analysis was all 558 Brazilian micro-regions. Pesticide exposure was evaluated according to the proportion of farms that used pesticides and had reported cases of pesticide poisonings. The statistics were analysed using Pearson's correlation and multiple linear regression adjusted for socioeconomic, demographic and cultural factors., Results: Among the age group that was analysed, the mean suicide rate was 6.4 cases/100,000 per year in the 2006-2010 period, with a male/female ratio of 4.2. The times series showed that there were higher suicide rates among people aged 35-64 years and among men aged 15-34 years. The ecological analysis showed that the suicide rates were higher in micro-regions with a higher proportion of farms run by 35-64 year olds, female workers and on farms with better economic indicators (higher farming income, level of mechanization and farm area). There was a positive association between the Catholic religion and suicide rates. Micro-regions with a greater use of pesticides, and with a high proportion of pesticide poisoning had the highest suicide rates for all three groups analysed: both genders, men, and women (p ranging from 0.01 to p<0.001)., Conclusion: This study reinforces the hypothesis that pesticide use and pesticide poisoning increase the suicide rates. However, due to the limitations of the study's ecological design, such as ecological fallacy, further appropriately designed studies are needed to confirm the causal relationships., (Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Exposure to pesticides has been associated with psychiatric problems among farm workers, although there is still controversy as to chemical types, intensity and forms of exposure that represent risk factors for neuropsychological problems. Furthermore, tobacco workers are exposed to dermal absorption of nicotine, although its effect on mental health has not yet been studied., Objectives: To identify the prevalence of minor psychiatric disorders (MPD) among tobacco farmers and associated factors, paying special attention to pesticide and nicotine exposure., Methods: This is a cross-sectional study with a representative sample of tobacco growers, characterizing economic indicators of the farms, socio-demographic factors, lifestyle habits and occupational exposures. Multivariate analysis was performed using a hierarchical Poisson regression model., Results: A total of 2400 tobacco farmers were assessed and MPD prevalence was 12%. MPD was higher among women (PR 1.4), workers aged 40 or over, tenants/employees (PR 1.8) and those who reported having difficulty in paying debts (PR 2.0). Low socioeconomic status was inversely associated with MPD prevalence. Tasks involving dermal exposure to pesticides showed risk varying between 35% and 71%, whereas tobacco growers on farms using organophosphates had 50% more risk of MPD than those not exposed to this kind of pesticide. The number of pesticide poisoning and green tobacco sickness episodes showed linear association with MPD., Conclusions: The study reinforces the evidence of the association between pesticide poisoning and mental health disorders. It also points to increased risk of MPD from low socioeconomic status, dermal pesticide exposure as well as from exposure to organophosphates. Furthermore, the study reveals intense nicotine exposure as a risk for tobacco farmers' mental health., (Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Despite being the second largest tobacco producer in the world, Brazil does not have prevalence studies about green tobacco sickness (GTS)., Methods: A cross-sectional study was carried out on a sample of Brazilian tobacco workers. The sample was described according to socio-demographic, behavioral, and occupational variables. Gender-stratified multivariate analyses examined variables associated with GTS., Results: GTS prevalence among men in the previous month was 6.6%, while among women it was 11.9%. Among men, age, being a non-smoker, hanging tobacco sticks in the barn, harvesting wet leaves, and exposure to physical exertion were risk factors for GTS. Among women, tying hands of tobacco, transporting bales, harvesting wet leaves, having had contact with pesticides, and exposure to physical exertion were positively associated with GTS., Conclusion: Research is required to improve methods for GTS screening, as well as the ability to distinguish GTS from pesticide poisoning. Health professionals should be trained to diagnose and treat GTS., (© 2014 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.)

This article addresses food insecurity among urban Brazilian families with children under seven years. A cross-sectional study in areas covered by primary health care centers identified 5,419 families in the Northeast and 5,081 in the South of the country. Food insecurity was assessed by the Brazilian Food Insecurity Scale. Prevalence of moderate or severe food insecurity was 22.9% in the Northeast and 7.5% in the South. According to the adjusted analysis, increased likelihood of moderate or severe food insecurity was associated with families headed by women, black or brown maternal skin color, low maternal education, low family income, and enrollment in the Bolsa Família program (conditional income transfer). Moderate or severe food insecurity would be reduced by 59.5% in the Northeast and 45.4% in the South with a per capita income of at least BRL 175.00 per month. Increased family income for the poorest families and better targeting of Bolsa Família are essential for reducing food insecurity in the country.

Background: Chronic low back pain (CLBP) is a highly disabling morbidity with high social, economic and individual effects. Demographic, occupational and behavioral changes that took place in Brazil over the last decade are related with an increasing burden of chronic conditions. Despite these changes, comparison studies on CLBP prevalence and associated factors, over time are scarce in the literature in general, and unknown in Brazil. The present study compared the CLBP prevalence in a medium sized city in Brazil between the years 2002 and 2010 and examined factors associated with prevalence in 2010., Methods: Two cross-sectional studies with similar methodology were conducted in a medium-sized city in southern Brazil, in 2002 and 2010. 3182 individuals were interviewed in the first study and 2732 in the second one, all adults aged twenty years or more. Those who reported pain for seven weeks or more in the last three months in the lumbar region where considered cases of CLBP., Results: The CLBP prevalence increased from 4.2% to 9.6% in 8 years. In most of the studied subgroups the CLBP prevalence has at least doubled and the increase was even larger among younger individuals with more years of education and higher economic status., Conclusions: Increase in CLBP prevalence is worrisome because it is a condition responsible for substantial social impact, besides being an important source of demand for health services.

The authors examined the associations of shiftwork with overweight and abdominal obesity through a cross-sectional study of 1206 employees 18 to 50 yrs of age who were working on a production line in a poultry processing plant. Night-shift workers (n = 800) were considered exposed, whereas day shiftworkers (n = 406) were considered nonexposed. Overweight was defined as a body mass index ≥ 25 kg/m(2) and abdominal obesity as a waist circumference ≥ 88 cm in women and ≥ 102 cm in men. The mean age of the workers was 30.5 yrs (standard deviation = 8.7 yrs), and 65.2% were women. Nightshift workers compared to dayshift workers showed higher prevalences of overweight (42.2% vs. 34.3%; p= .020) and abdominal obesity (24.9% vs. 19.5%; p = .037). After adjusting for sociodemographics, parental overweight status, behavioral characteristics, and sleep characteristics, including hours of sleep, the prevalence ratios for overweight and abdominal obesity were 1.27 (95% confidence interval [ CI]: 1.00-1.61) and 1.45 (95% CI: 1.10-1.92), respectively, for the nightshift workers compared to the dayshift workers. A consistent finding in our study was the independent contribution of night shiftwork to overweight and abdominal obesity among Brazilian workers. Further studies are needed to understand the biological mechanisms involved and the complex behavioral and social adaptations experienced by night-shift workers.

This study evaluated the demand of emergency health service. It was performed a descriptive analyses of 1647 adults that consulted at emergency public service of Pelotas, Brazil. Older subjects, non white skin color, lower schooling, without partner, and smokers presented higher prevalence of consultations at this service when compared with the general population. Individuals waited, on average, 15 minutes to have their consultations, exams were requested in more than 40% of the visits, and intravenous medication were administered in one third of the visits. Elderly waited longer before searching the service, but they had lowest awaiting time after arriving at emergency service and had higher percentage of regular doctor and social support. Elderly had more diagnosis related to circulatory system, while among the youngest, external causes were the most frequent. The low waiting average for consultation suggest this service provide an immediate care while the great number of ill-defined signs or symptoms indicate that the provided care is provisional. It is necessary to train emergency professionals to reduce the number of tests requested and to assure that either professional as the population is conscious about the importance of a continuity of care.

The study evaluated free access to hypertension and diabetes medicines and the reasons reported for lack of access. The sample included 4,003 elderly people living in Primary Care Unit coverage areas from 41 Southern and Northeastern Brazilian cities. Free access was higher in the Northeast (62.4%). The strategy of the Family Health Program (Programa Saúde da Família - PSF) was more effective in providing access than the traditional model, with higher results in the Northeast (61.2%) than in the South (39.6%). Around 20% of medicines included in the Hypertension and Diabetes Program and 26% of those included in the National Essential Medicines List (RENAME) were paid out of pocket. In the Northeast, 25% of insulin and 32% of oral antidiabetics were paid out of pocket. Unavailability in the public sector and a lack of money determined the lack of access. Although the PSF, Hypertension and Diabetes Program and RENAME expanded free access, supplies were insufficient. A greater connection between programs and a clear definition of responsibilities can improve medicine acquisition process, increasing the effectiveness of pharmaceutical assistance.

Background: Medicine access is an important goal of medicine policy; however the evaluation of medicine access is a subject under conceptual and methodological development. The aim of this study was to describe quantitative methodologies to measure medicine access on household level, access expressed as paid or unpaid medicine acquisition., Methods: Searches were carried out in electronic databases and health institutional sites; within references from retrieved papers and by contacting authors., Results: Nine papers were located. The methodologies of the studies presented differences in the recall period, recruitment of subjects and medicine access characterization., Conclusions: The standardization of medicine access indicators and the definition of appropriate recall periods are required to evaluate different medicines and access dimensions, improving studies comparison. Besides, specific keywords must be established to allow future literature reviews about this topic.

This cross-sectional population-based study investigated the prevalence of eye care services utilization and the association with socioeconomic and demographic factors, need for health care, and type of service payment. The study evaluated 2,960 adults aged 20 and older. In the previous 5 years, 46% of the sample and 30% of those aged 50 and older had not visited an eye care service. Among the persons who used a service, 18% went to an optical store and only 17% used the public health system. The main reason for using eye care services was poor vision (69.5%). Lack of money (29%) and time (24.6%) were the most frequently cited reasons for non-utilization. Age, education, and economic status were directly associated with the outcome. Female gender, cataract, glaucoma, prescription eyewear, and private appointments were also associated with the outcome. It is necessary to increase the public health system's role, integrating ocular health with all levels of health care, expanding participation by other health professionals, and intensifying screening and prevention of eye problems.

This study focused on the prevalence of interpersonal continuity of care and its determinants. A cross-sectional population-based study was conducted with 3,133 individuals 20 years or older in Pelotas, Rio Grande do Sul State, Brazil. Multivariate analysis used Poisson regression, with the first level representing socioeconomic and demographic variables and the proximal level including health care and health needs variables. Prevalence of interpersonal continuity of care was 43.7% (95%CI: 42.0-45.5). Female gender, higher age, higher income, consultation during the previous year, report of chronic disease, and consultation outside the public health system showed higher interpersonal continuity of care. Among individuals that consulted in public primary health care services, female gender, age, and the Family Health Program were associated with interpersonal continuity of care. Some vulnerable groups (low-income and users of the public health system) showed low prevalence of the outcome.

This study aimed to evaluate the prevalence of access to continuous-use medicines for treatment of systemic arterial hypertension, diabetes mellitus, and/or mental health problems, and the associated factors. A cross-sectional study was developed under the Project for the Expansion and Consolidation of the Family Health Program in 41 cities in South and Northeast Brazil. The sample included 4,060 adults and 4,003 elderly living in the coverage areas for primary health care clinics. Prevalence of access to continuous-use medicines was 81% in non-elderly adults and 87% in the elderly. Greater access was associated with the following factors: adults in South Brazil - older age, higher socioeconomic status, type of chronic disease, and participation in support groups in the primary health clinic area; adults in the Northeast - systemic arterial hypertension with or without diabetes mellitus; elderly in the South - more schooling; and elderly in the Northeast - older age, more schooling, non-smoking, enrollment in the primary health care clinic coverage area, and the family health care model. The results show important inequity in health, reinforcing the need for policies to expand access, mainly for lower-income population groups.

Background: The 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., Methods: We 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., Results: The 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., Conclusion: Efforts 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.

In order to collect information on knee pain and associated occupational factors, a systematic review was conducted using the MEDLINE, LILACS, SciELO, and Free Medical Journals databases, from 1990 to 2006. Key words were: gonalgia, knee, knee pain, knee joint, knee dislocation, knee injuries, work, workplace, workload, employment, occupations, industry, occupational, workers, arthrosis, and osteoarthritis. Equivalent terms in Portuguese and Spanish were also used. From the initial 2,263 studies gathered, only 26 met the review's inclusion criteria. Knee pain prevalence in the previous 12 months ranged from 11.2% to 60.9%. The main associated factors were: female gender, older age, high body mass index, kneeling working position, and lifting at work.