Vigilância aos agrotóxicos: quantificação do uso e previsão de impactos na saúde-trabalho-ambiente para os municípios brasileiros

OBJECTIVE To estimate the incidence and predicting factors associated with falls among older inpatients.METHODS Prospective cohort study conducted in clinical units of three hospitals in Cuiaba, MT, Midwestern Brazil, from March to August 2013. In this study, 221 inpatients aged 60 or over were followed until hospital discharge, death, or fall. The method of incidence density was used to calculate incidence rates. Bivariate analysis was performed by Chi-square test, and multiple analysis was performed by Cox regression.RESULTS The incidence of falls was 12.6 per 1,000 patients/day. Predicting factors for falls during hospitalization were: low educational level (RR = 2.48; 95%CI 1.17;5.25), polypharmacy (RR = 4.42; 95%CI 1.77;11.05), visual impairment (RR = 2.06; 95%CI 1.01;4.23), gait and balance impairment (RR = 2.95; 95%CI 1.22;7.14), urinary incontinence (RR = 5.67; 95%CI 2.58;12.44) and use of laxatives (RR = 4.21; 95%CI 1.15;15.39) and antipsychotics (RR = 4.10; 95%CI 1.38;12.13).CONCLUSIONS The incidence of falls of older inpatients is high. Predicting factors found for falls were low education level, polypharmacy, visual impairment, gait and balance impairment, urinary incontinence and use of laxatives and antipsychotics. Measures to prevent falls in hospitals are needed to reduce the incidence of this event.

Considering hospitalization as an indicator of seriousness of acute respiratory infection (ARI), this study focuses on the association between some environmental factors with the need for hospitalization of children with a diagnosis of ARI. The study analyzed all the medical records (at the Municipal Emergency Ward in Cuiabá, Mato Grosso State) of children under five years of age (both sexes), collected by month of attendance. Two weather seasons were considered: dry (May-October) and rainy (November-April). Variables included: temperature, relative humidity, and number of fires (due to extensive slashing and burning for agriculture in the region). Prevalence of ARI was 49.8%, and hospitalization was required in 7.6% of cases, with a higher percentage during the dry season. The dry season and lower relative humidity were associated with increased pediatric hospitalization rate due to ARI.

OBJECTIVE:To analyze the effects of exposure to fi ne particulate matter from burning on hospital admissions due to respiratory diseases in children and the elderly. METHODS:This is an ecological time series study that took place in the city of Cuiaba, Mato Grosso, in Brazil's Amazon Region, in 2005. Information on the daily levels of fi ne particulate matter PM 2.5 was made available by the Brazilian National Institute for Spatial Research. The model included variables related to temperature, relative humidity and adjusts for seasonality and calendar effects. Poisson regression with generalized additive models was used. RESULTS:A 10 μg/m 3 increase in the level of exposure to PM 2.5 was associated with increases of 9.1%, 9.2% and 12.1% in hospital admissions due to respiratory diseases in children for moving averages of 1, 2 and 5 days, respectively. For the dry season, the level of exposure to particulate matter was associated with increases of 11.4%, 21.6% and 22.0% in hospital admissions in children for moving averages of 1, 5 and 6 days, respectively. No signifi cant link was noticed in the elderly. CONCLUSIONS:The results show the infl uence of PM 2.5 on hospitalizations for respiratory disease in children under 5 in the region studied.

OBJETIVO: Analisar os fatores preditivos de abandono do tratamento da tuberculose pulmonar. MÉTODOS: Estudo de coorte histórica a partir da análise de 481 pacientes bacilíferos, de um total de 529 casos inscritos no Programa de Controle de Tuberculose de Cuiabá (MT), de 1998 a 2000. Os dados foram obtidos do livro de registro do programa e dos prontuários médicos. Para o cálculo das taxas de incidência utilizou-se o método de densidade de incidência. Na análise bivariada utilizou-se o teste do qui-quadrado para razões de taxas de abandono (risco relativo) - Cornfield, ou o exato de Fisher. Foi construído um modelo de regressão logística multivariada visando a identificar as variáveis mais relevantes como preditoras da variável resposta (p < 0,05). RESULTADOS: A incidência global de abandono foi de 27,3%, equivalente a 5,1 abandonos por 100 pessoas/mês, com maior freqüência entre o segundo e o terceiro meses de tratamento. No modelo final, pela regressão logística, foram considerados preditores para o abandono: tratamento não supervisionado (razão de chance: 2,58; intervalo de confiança 95%: 1,64 - 4,06; p < 0,001), ter realizado tratamento em 1998 e 1999 (razão de chance:1,43; intervalo de confiança 95%:1,14 - 1,80; p = 0,002), ser do sexo masculino (razão de chance:1,39; intervalo de confiança 95%:1,10 - 1,76; p = 0,005) e ter abandonado previamente tratamentos anteriores (razão de chance: 1,37; intervalo de confiança 95%:1,06 - 1,78; p = 0,017). CONCLUSÃO: Os resultados indicam elevada incidência de abandono, sendo considerados preditores: tratamento não supervisionado, ano de tratamento, sexo masculino e abandono prévio.

Resumo Objetivo: analisar a prevalência e os fatores associados ao distúrbio de voz em professores. Métodos: estudo transversal com 317 professores. Utilizou-se o questionário Condição de Produção Vocal do Professor. A variável dependente foi o distúrbio de voz autorreferido. Foram realizadas análises bivariada, estratificada e regressão múltipla de Poisson. Resultados: a prevalência do distúrbio de voz foi de 81%. Para o estrato dos professores do ensino fundamental, apenas a poeira (RP = 1,37; IC = 1,12-1,69) foi associada ao distúrbio de voz. Para o estrato dos demais professores, as variáveis ritmo de trabalho estressante (RP = 1,81; IC = 1,17-2,82), estresse no trabalho (RP = 2,47; IC = 1,20-5,07), trabalho repetitivo (RP = 1,18; IC = 1,01-1,38), levar trabalho para casa (RP = 1,80; IC = 1,01-3,79) e escola ruidosa (RP = 1,41; IC = 1,03-1,92) apresentaram associações com distúrbio de voz. Na análise múltipla, estresse no trabalho (RP = 1,50; IC = 1,05-2,15), poeira (RP = 1,21; IC = 1,06-1,39) e falar carregando peso (RP = 1,16; IC = 1,05-1,28) permaneceram associadas ao distúrbio de voz, exceto o tempo de profissão maior ou igual a 10 anos (RP = 0,88; IC = 0,79-0,98), que apresentou efeito protetor. Conclusão: a prevalência de distúrbio de voz entre os professores é alta e os fatores associados relacionam-se ao ambiente e à organização do trabalho.

Objective: to verify the prevalence of and factors associated with polypharmacy among elderly residents of the city of Cuiabá, in the state of Mato Grosso. Method: a cross-sectional study of 573 people aged 60 and over was performed. Polypharmacy was defined as the use of five or more medications. To investigate the association between polypharmacy and sociodemographic variables, health and access to medication, the Mantel Haenszel chi square test was used in bivariate analysis and Poisson regression was used in multivariate analysis. The significance level adopted was 5%. Result: the prevalence of polypharmacy was 10.30%. Statistically significant associations were found between polypharmacy and living with others, describing suffering from circulatory, endocrine, nutritional and digestive tract diseases, and referring to financial difficulties for the purchase of medicines. Conclusion: some social and health condition factors play an important role in the use of multiple medications among the elderly.

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