Epidemiologia e Servicos de Saude最新文献

Objective: To describe the profile of medication use in women with triple-negative breast cancer treated between 2018 and 2019 in a Brazilian public hospital.

Methods: Descriptive and retrospective study, with data obtained from the Hospital Cancer Registry and physical and electronic medical records from a public hospital that is a reference in cancer treatment, in Rio de Janeiro. Descriptive analyses and analyses of time to treatment failure and overall survival were performed using the Kaplan Meier method.

Results: Of the 176 patients, 39.0% were under 50 years of age and 47.7% were diagnosed at an advanced stage. Use of 12 chemotherapy regimens was identified, with neoadjuvant or adjuvant intent, for treatment of triple-negative breast cancer. The most commonly used treatment regimen included doxorubicin, cyclophosphamide and taxanes (docetaxel or paclitaxel). After 180 days, 76.1% of patients remained on the initial treatment. Average time until treatment failure was 7.6 months for those who followed the main regimen. Median overall survival was 34 months, and 55.7% of patients died by the end of the follow-up period (48 months).

Conclusion: The results showed that treatment with doxorubicin, cyclophosphamide and taxanes (docetaxel or paclitaxel) was the most used in the patients analyzed, that average time to treatment failure using this regimen was less than one year and that more than half of the patients died within four years after diagnosis.

Objective: To assess association between sociodemographic factors, presence of licit or illicit psychoactive substances, and types of legal death in Ceará state, Brazil.

Methods: Cross-sectional study based on autopsy data and toxicology tests on victims of cases registered by the Ceará Forensic Expert service, from 2015 to 2019.

Results: Of the 4,198 cases analyzed, 55.6% were positive for licit and/or illicit substances, with greater frequency of benzodiazepines (22.4%) and cocaine (21.7%) among males (45.0%), young adults (58.7%), single people (49.0%), and those with low education levels (52.8%). Association was found between benzodiazepines (29.5%) and tricyclic antidepressants (15.6%) and suicides; cocaine (28.1%) and cannabis (27.1%) and homicides; and cocaine (28.2%) and tricyclic antidepressants (5.9%) and suspicious deaths.

Conclusion: Sociodemographic factors were associated with the use of psychoactive substances and types of legal death. Benzodiazepines and cocaine were the most frequent substances in suicide and homicide cases, respectively.

Objective: To investigate the evolution of prevalence of catastrophic health expenditure in the Brazilian Federal District at three different times (2003, 2009 and 2018), as well, to identify the composition of outof- pocket expenditure in the respective years.

Method: Time series study, using descriptive data from the Family Budget Survey. Prevalence was stratified by consumption quintiles.

Results: 754 households were selected as a sample in 2003, 695 in 2009 and 1,000 in 2018. Taking a 10% consumption threshold, prevalence of catastrophic expenditure was 12.3% (95%CI 9.6;14.9) in 2003, 15.3% (95%CI 12.1;18.3) in 2009 and 14.1% (95CI% 11.8;16.2) in 2018. Households with lower income had higher prevalence of catastrophic expenditure. Medicines have a greater burden on expenditure of low-income families.

Conclusions: There was an increase in prevalence of catastrophic expenditure in the Federal District. Medicines were the main expense for the poorest families.

Objective: To analyze trends of syphilis during pregnancy and congenital syphilis, based on reported cases in São Paulo, Brazil, from 2011 to 2023.

Methods: Ecological time series study, based on data from Notifiable Health Conditions Information System records. The Prais-Winsten method was used to verify trends.

Results: 125,776 cases of syphilis during pregnancy and 42,418 cases of congenital syphilis were reported. Average annual percentage change (95%CI) in the syphilis during pregnancy incidence rate was 18.68 (95%CI 16.57; 20.84), pvalue < 0.001; while for congenital syphilis it was 11.99 (95%CI 7.00; 17.22), p-value < 0.001.

Conclusion: Incidence rates of syphilis during pregnancy and congenital syphilis showed significant increasing trends, which may be related to the increase in the former during the diagnosis period (1st trimester), demonstrating increased testing among pregnant women, clinical classification at the time of diagnosis (latent syphilis), as well as inefficiency of adequate treatment when diagnosis is late.

Objective: To describe the mortality profile and analyze the spatiotemporal distribution of COVID-19 mortality among international migrants residing in Brazil from 2020 to 2022.

Methods: This is a descriptive and ecological cross-sectional study using secondary data. Absolute and relative frequencies of the sociodemographic profile and mortality coefficients (MCs) were analyzed. Excess risk and global and local spatial autocorrelation were calculated.

Results: A total of 7,737 deaths were recorded during the period, with the highest frequency in 2021 (3,952). Brazil's overall MC was 515/100,000, with higher MCs in the Southeast (751/100,000) and Midwest (525/100,000) macroregions. The predominant death profile was for males (5,041); those aged ≥ 81 years (3,612); those of White race/skin color (5,685); married (3,406); born in Portugal (2,437). Global spatial autocorrelation was identified in 2022, and local spatial autocorrelation throughout the period.

Conclusion: The high MC indicates a need for health policy interventions in regions with high migrant population concentrations.

Objective: To analyze the social network of mothers, fathers or guardians of transgender children or adolescents.

Methods: This was a qualitative study, based on the theoretical framework of social network, with a focus on the primary network. The study was conducted in Brazil through online interviews between August and October 2021. A total of 30 mothers, two fathers and one grandmother of transgender children or adolescents participated in the study. The thematic content analysis was performed using IraMuTeQ software.

Results: The theme "The family as the center of the network and the challenges in achieving transgender autonomy" emerged from the analyses. The family was identified as the first network, bearing the greatest responsibility. Weak and conflicted ties with relatives, friends, classmates and neighbors, highlighting the role of men.

Conclusion: The networks showed limitations in providing support and the need for strengthening. The analysis is an important tool for improving care, structuring policies and developing transgender-specific care pathways.

Objective: To assess adherence to and completeness of vaccination schedules against human papillomavirus (HPV) and hepatitis A and B among transgender women and travestis in São Paulo, capital city of São Paulo state.

Methods: This was a secondary data analysis of the multicenter TransOdara study. Data were collected from 403 transgender women and travestis aged 18 years or older, recruited through respondent-driven sampling between December 2019 and October 2020.

Results: High adherence to vaccines was observed (88.8%), but completeness of the analyzed vaccination schedules was low: 12% (95%CI 8.0; 17.3) for hepatitis A, 7.2% (95%CI 3.5; 12.8) for hepatitis B and 8.1% (95%CI 3.0; 16.6) for HPV, with no statistically significant differences between them.

Conclusion: Despite high adherence, the low completion of vaccination schedules highlighted the need for diversified strategies to improve vaccination coverage and reduce the prevalence of vaccine-preventable sexually transmitted infections in this population.

Objective: To develop and validate a simulated scenario for post-suicide attempt care for a person undergoing gender transition.

Method: This was a methodological study conducted in two stages: (i) development of the scenario based on the literature and clinical simulation recommendations; (ii) validation by ten experts, through an online assessment using a Likert scale and suggestions. Descriptive analyses and content validity index were applied.

Results: : All items met the minimum acceptance criterion (≥0.70), and adjustments were made to incorporate a more inclusive approach and reflect the diversity of gender identities.

Conclusion: The study developed and validated a clinical simulation scenario for post-suicide attempt care for a person undergoing gender transition. The expert validation indicated agreement on the scenario's items, which can be applied in accessible training and qualification for healthcare professionals across different categories and contexts.