RESUMO Descreve-se características clínico-epidemiológicas de 655 casos de acidentes botrópicos atendidos e/ou notificados ao Centro de Informações

This study investigated the correlation between the incidence of snakebite and indicators of agricultural development in municipal districts of the State of Bahia, Brazil. An ecological study was conducted with the 27,347 cases of snakebite poisoning reported to the Reportable Diseases National Information System in municipalities from the State of Bahia, Brazil, 2000-2009. The unit of analysis was each one of the 417 State municipalities, and the outcome variable was the average annual incidence of snakebite. Data were analyzed by multiple linear regression technique. The average annual incidence of snakebite ranged from zero to 221.96 per 100,000 inhabitants, according to the municipalities. The incidence of snakebite was positively and strongly associated with municipality characteristics: planted areas of cocoa and coffee, and the size of domestic bred chicken and bovine livestocks. It was concluded that several characteristics related to municipal agricultural profile were strongly associated with the incidence of snakebite.

Objective To analyze the relationship between time to treatment and severity of snakebite envenomation in Brazil. Methods This case-series retrospective study analyzed 144 251 snakebite cases in Brazil between 2007 and 2015, as reported to the Brazilian Notifiable Diseases Information System. The main dependent variable was snakebite envenomation severity (mild/moderate/severe). The main predictor was time to treatment (early (< 6 hours) vs. delayed (≥ 6 hours)). Covariables were snake type ( Bothrops/Crotalus/Micrurus/Lachesis ), patient's age and sex, bite site, and treatment at a specialized care center (center/noncenter). Polytomous logistic regression techniques were used to control the covariates and assess confounding and effect modification. Results The time to treatment variable was strongly associated with the severity of snakebite envenomation. Snake type and treatment at specialized care center modified the main association effect. The association between delayed time to treatment and envenomation severity was consistently stronger among patients treated at specialized care centers than among those who were not treated at such centers. Odds ratios tended to increase significantly from moderate to severe envenomation for cases within the subgroups “Center + Bothrops ” (1.37 to 2.05), “No center + Bothrops ” (1.25 to 1.47), “Center + Crotalus ” (1.35 to 3.03), “No center + Crotalus ” (0.97 to 2.72), and “Center + Lachesis ” (1.22 to 1.89). Discussion This study confirmed the classical hypothesis that the time between snakebite and initiation of medical care is associated with severity of snakebite envenomation. It is therefore necessary to provide snakebite victims early access to specialized medical care, particularly to antivenom therapy.

Este ensaio discute as repercussões da pandemia COVID-19 na relação trabalho e saúde, sob a perspectiva do risco e vulnerabilidade de trabalhadores. A pandemia tem se configurado como uma crise humanitária, uma vez que tanto a doença quanto as medidas de contenção desta geram efeitos socioeconômicos persistentes. Nesse contexto, a categoria trabalho assume um papel relevante, seja pela viabilidade de manutenção do distanciamento social e das condições de vida permitidas pelo vínculo de trabalho, seja pela impossibilidade de adoção das estratégias de proteção devido à precarização do trabalho. A construção do ensaio iniciou com base numa revisão da literatura na interface COVID-19 e saúde dos trabalhadores, realizada de dezembro de 2019 a abril de 2020, nas bases PubMed, BIREME, Cochrane Library, medRxiv e LitCovid, bem como da literatura cinza. Profissionais de saúde são mais acometidos, mas também com maior acesso ao diagnóstico, persistindo lacunas sobre as demais categorias profissionais, bem como sobre os determinantes sociais que implicam uma maior vulnerabilidade relacionada ao trabalho. A pandemia coincide no Brasil com uma conjuntura na qual trabalhadoras(es) acumulam perdas relevantes de direitos trabalhistas e previdenciários, somadas às desigualdades sociais preexistentes, ao exemplo de precariedade de moradia, com maiores exposição e risco. Embora a evolução da pandemia ainda esteja em curso, prevê-se que as desigualdades sociais se intensificarão com a profunda retração da economia, e trabalhadores devem ser alvo prioritário da atenção no controle e disseminação da doença, além de eixo articulador das políticas públicas de proteção social e à saúde.

We investigated the association between fatal snakebite envenoming and agricultural work in Brazil, considering the effects of relevant covariables. A nested case-control study was performed using 1,119 fatal cases of snakebite envenoming among persons aged ³ 10 years, notified to the Brazilian official reporting system, from 2004 to 2015. As controls, 4,476 cases were randomly selected from the 115,723 nonfatal cases of snakebite, without missing data, that occurred in the same time period. The main predictor was occupation in the agriculture sector; the main outcome was death by snakebite envenoming. Logistic regression analysis was used to investigate the main association, controlling for the effects of relevant covariables. Fatal cases had a 20% greater chance (odds ratio [OR] = 1.20; 95% confidence interval [CI]: 1.00-1.39) of being among farmers than the controls. However, late (³ 6 hours) time to treatment (OR = 2.00; 95% CI: 1.70-2.36); adequate antivenom with an insufficient (OR = 1.25; 95% CI: 1.04-1.50) or excessive (OR = 4.89; 95% CI: 4.10-6.03) number of vials; inadequate antivenom and insufficient or excessive number of vials (OR = 3.87; 95% CI: 2.40-6.24); no use of antivenom (OR = 2.05; 95% CI: 1.60-2.64); and age ³ 60 years (OR = 1.98; 95% CI: 1.61-2.44) were more strongly associated with lethality. Lethality was 1.0% in the period, being 0.47% among those receiving early and adequate treatment. We concluded that in Brazil, fatal snakebite envenoming was associated with agricultural work, controlling for relevant covariates. However, quality of health care provided and greater age were much more strongly associated with lethality.

Objective: to investigate the evolution and estimate the shortage of Speech, Language and Hearing professionals in Primary Health Care between 2005 and 2015. Methods: a mixed ecological study using data from the National Registry of Health Facilities and the Primary Health Care Information System. A descriptive analysis regarding the evolution of the number of professionals working in Primary Health Care over this period, in Brazilian states and regions, was conducted. The ratio of professionals per 100,000 inhabitants for the years 2005, 2010 and 2015, and the shortages in 2015, were estimated. Results: in 2005, there were 1,717 professionals working in Primary Health Care, that is, one per 100,000 inhabitants. In 2015, there were 4,124, increasing to 2.1/100,000. In 2015, the shortage in supply was 55.1%, varying widely across the states. Conclusion: the shortage in supply is equivalent to an absence of Speech, Language and Hearing service coverage within Primary Health Care for more than half of the Brazilian population. It is worth noting that a conservative parameter was adopted to conduct this estimate. The results suggest a process of consolidation for the inclusion of Speech, Language and Hearing professionals within Primary Health Care, however, still characterized by insufficient and unequal supply across the nation.

Background Scorpion envenoming is relatively frequent in tropical and subtropical regions and potentially fatal. We aimed to identify risk factors for fatal scorpion envenoming among Brazilian children. Methods A case–control study investigated all fatal cases of scorpion envenoming among children up to 10 y old, reported to the Brazilian Diseases Surveillance System between 1 January 2007 and 18 July 2016. Controls were randomly sampled from children who survived the envenoming over this period. Data were analysed using logistic regression. Results Of the 254 cases and 1083 controls investigated, the identified risk factors were age ≤5 y, occurred in a rural area, time-to-treatment ≥3 h, treatment with scorpion antivenom (SAV) but either excessive or insufficient number of vials, treatment with antivenom that was neither SAV nor anti-spider and no antivenom administered compared with the standard recommended treatment. Treatment effectiveness at preventing fatal scorpion envenoming was 77.0% when time-to-treatment was &lt;3 h and 75% in children 9–10 y of age. SAV was 63% effective at preventing death when administered early at the recommended dosage. Conclusions Fatal scorpion envenoming was associated with younger age, incident occurring in a rural area, late treatment and inadequate antivenom treatment. SAV was effective at preventing death when administered early.

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