Epidemiologia e Servicos de Saude最新文献

Objective: To analyze the reliability of records held on the National Immunization Program Information System (SI-PNI) in a subsample of children included in the national vaccination coverage survey in Brazilian state capitals and Federal District in 2020.

Methods: This was a study of agreement between data recorded on vaccination cards (doses and dates) and on the SI-PNI for 4050 children with full coverage at 24 months.

Results: Data on 3587 children were held on the SI-PNI, with losses of 11% (95%CI: 10;12). Total agreement between doses and dates in the two sources was 86% (95%CI: 86;87), however taking each dose and vaccine individually, variation was greater, with 32% of data in only one source.

Conclusion: Part of the information was not recorded, but the discrepancy can be considered small. Nonetheless, underrecording of doses and children can compromise vaccination coverage estimates, altering the numerator and denominator data.

Main results: Subsample of 4,050 children, among those completing the full schedule at 24 months studied in the national survey, 11% had not been recorded on the SI-PNI, 32% had unrecorded doses (doses or dates) and there was 8% disagreement between vaccination cards and SI-PNI records.

Implications for services: Recognizing the difficulties faced by the SI-PNI and the discrepancies between sources is essential for adopting initiatives to improve data quality, so as to avoid inaccurate estimates of childhood vaccination coverage.

Perspectives: This study is expected to contribute to improving the quality of records and the usability of data for monitoring vaccination coverage of the immunization program from the local to the national level.

Objective: To evaluate vaccination coverage and delay in vaccine dose administration in infants in six municipalities in the Southern region of Brazil.

Methodology: National Vaccination Coverage Survey 2020, with infants born alive in 2017 and 2018, carried out from September 2020 to March 2022. Coverage of doses administered, doses administered on time and delay in dose administration were evaluated.

Results: For 4681 infants analyzed, coverage for vaccines recommended up to 24 months was 68.0% (95%CI 63.9;71.8%) for doses administered and 3.9% (95%CI 2.7%;5.7%) for doses administered on time. Delay time for the majority of late vaccinations was ≤ 3 months. For some boosters, 25% of vaccine administration was delayed by ≥ 6 months.

Conclusion: In addition to tracking vaccine defaulters, strategies are needed to encourage compliance with the vaccination schedule at the recommended ages.

Main results: Vaccination coverage for the set of vaccines recommended up to 24 months was 68.0% and 3.9% for on-time doses. Delay time for some doses exceeded six months in up to 25% of infants with delayed vaccination.

Implications for services: Monitoring vaccine administration at the recommended ages is necessary, with the adoption of strategies that reinforce routine vaccination to prevent vaccination delays and abandonment.

Perspectives: Primary care in surveillance and care for infants needs to reinforce actions to ensure timely vaccination. Studies to deepen knowledge of vaccination delay, determinants and strategies for their reduction are necessary.

Objective: To analyze vaccination coverage according to social strata in children up to 24 months old, living in the municipality of Londrina (PR), Brazil.

Methods: This was a population-based survey conducted between 2021 and 2022, in which vaccination coverage and sociodemographic aspects of mothers and families were evaluated using Pearson's chi-square test.

Results: In a sample of 456 children, complete vaccination coverage varied according to social strata, being 36.0% (95%CI 26.8;57.8); in stratum A; 59.5% (95%CI 26.1;86); in stratum B; 66.2% (95%CI 51.7;78.1); in stratum C; and 70.0% (95%CI 56.1;81.0) in stratum D.

Conclusion: The analysis of vaccination coverage indicated that social stratum A is at highest risk for vaccine-preventable diseases.

Main results: The results of the study showed low full vaccination coverage in children up to 24 months of age in Londrina, being higher in the less financially advantaged social stratum, compared to the most advantaged.

Implications for services: The results found can support the qualification of the immunization program and enable, based on planning and ongoing health education, the definition of unique strategies to improve vaccination coverage.

Perspectives: Future perspectives point to the importance of carrying out investigations into the challenges inherent to vaccination, as well as qualitative and quantitative research addressing health professionals to better understand the data.

Objective: To describe the methods for requesting, extracting data, processing and analyzing the consistency of anthropometric and food consumption data of adolescents monitored by Sisvan Web.

Methods: Methodological study with individualized data from Sisvan web between 2008 and 2018. The modules of anthropometry and consumption, made available by the Ministry of Health, had a unique identifier for linkages. Implausible values and individuals outside the age range were excluded. Consistency analyses, with corrections for imputations and descriptive statistics, were performed using Stata 16.0 software.

Results: A database was obtained with 18,812,232 observations of anthropometric data between 2008 and 2018 and 440,534 records of food consumption between 2015 and 2018; after merging the banks, 64,976 observations were obtained.

Conclusion: The combination of anthropometry and food consumption databases made it possible to link individual adolescent data and build a database with information for future analyzes relating to the dietary and nutritional profile of the same individual.

Main results: The proposal for processing individual data from the Food and Nutrition Surveillance System (Sisvan Web) generated 18 million observations for anthropometric data and 65,000 observations after merging the anthropometry and food consumption databases.

Implications for services: This work will enable replication of the methodology for processing data available in Sisvan Web, allowing for enhanced analyzes by healthcare teams and researchers in the field of public health.

Perspectives: It is expected that these procedures will assist researchers, managers and healthcare professionals in handling and analyzing the information generated by Sisvan Web.

Objective: To estimate the prevalence of factors associated with drinking and driving in Northeastern Brazil.

Methods: This was a cross-sectional study conducted with participants from the 2019 National Health Survey, aged ≥ 18 years; the analysis of the association between sociodemographic variables and the outcome, stratified by sex, was performed using Poisson regression.

Results: The prevalence of drinking and driving was 21.0% ( 95%CI 19.9;23.2), with 24.6% ( 95%CI 22.7;26.5), in males and 10.1 % ( 95%CI 7.9;12.7), in females (p-value < 0.001); among men, younger age groups (PR = 1.70 - 95%CI 1.29;2.24), higher household income (PR = 1.74 - 95%CI 1.33;2.28), rural residence (PR = 1.48 - 95%CI 1.26;1.74) and motorcycle riding (PR = 1.29 - 95%CI 1.05;1.58) were associated with the event, while no association was observed among women.

Conclusion: Prevalence of drinking and driving was high in the Northeast region, especially among the male population; preventive measures targeting this group and intensified enforcement are necessary.

Main results: The prevalence of drinking and driving was high, significantly greater in males when compared to females; positive associations between sociodemographic variables and the event were observed only in the male population.

Implications for services: Intersectoral actions, involving health services and regulatory bodies, are essential to reduce the habit of drinking and driving, especially among males, in addition to promoting a safer road environment in the Northeast region.

Perspectives: It is necessary to strengthen enforcement measures for alcohol consumption and driving, especially in rural areas and among motorcycle riders, in addition to implementing traffic education programs and awareness campaigns.

Objective: To assess factors associated with hospital self-discharge of patients with tuberculosis in the state of Rio de Janeiro, Brazil, 2011-2018.

Methods: This was a retrospective cohort study in a referral hospital. Clinical and epidemiological characteristics were compared according to hospitalization outcome (self-discharge, formal discharge, or death). Hazard ratios (HR) with 95% confidence intervals (95%CI) for the association of self-discharge with explanatory variables were estimated using Cox regression.

Results: Of the 1429 hospitalizations, 10.4% ended in self-discharge. Female sex (HR = 1.47; 95%CI 1.03;2.11), age ≤ 42 years (HR = 2.01; 95%CI 1.38; 2.93), substance use (HR = 1.62; 95%CI 1.12; 2.34), hospitalization after treatment dropout (HR = 2.04; 95%CI 1.37; 3.04), and homelessness (HR = 2.5; 95%CI 1.69; 3.69) were associated with self-discharge.

Conclusion: Patients with social vulnerability require more careful monitoring during hospitalization.

Main results: Homeless people, illicit drug use, female sex and history of dropout from previous treatment showed association with hospital self-discharge in patients with tuberculosis admitted to a reference hospital in the state of Rio de Janeiro.

Implications for services: Need for more comprehensive support for vulnerable patients, in addition to promoting treatment adherence and training health professionals to deal with the complex psychosocial issues related to tuberculosis.

Perspectives: It is crucial to develop public policies that consider social factors in tuberculosis management, as well as promoting cooperation and multisectoral approaches to address both tuberculosis and underlying social issues.

Objective: To analyze the temporal trend and the spatial distribution of reported cases of sexual violence against male children and adolescents, and their relationship with municipal development in Brazil.

Methods: This is an ecological study with data from the Notifiable Health Conditions Information System and the Municipal Human Development Indexes (MHDIs), from 2013-2022. Prais-Winsten regression was used for temporal analysis and the Moran Index for spatial analysis.

Results: There were 39,967 reports of sexual violence against male children and adolescents. An increasing trend was found for Brazil as a whole (annual percentage change = 6.8; 95%CI 3.8;10.0). Spatial distribution showed direct correlation between high rates of violence and low MHDIs (p < 0.001).

Conclusion: We found a rising temporal trend in Brazil and spatial dependence of the rates of reported sexual violence in the municipalities.

Main results: The trend of reported cases of sexual violence against male children and adolescents was rising in Brazil. The spatial analysis showed a direct correlation between high rates of violence and low human development indexes.

Implications for services: The identification of underreported areas requires the structuring of health surveillance services. Territories with the highest number of reports require prevention and coping strategies to attend to these victims.

Perspectives: Strategies for prevention, coping and improvement of the surveillance process must be adopted. These include: reception, psychosocial support, comprehensive health care and training of health professionals to notify and report the problem.

Objective: To describe vaccination coverage and hesitation for the basic children's schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil.

Methods: Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy.

Results: Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy.

Conclusion: Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities.

Main results: Vaccination coverage of children up to 4 years old was 50.2% in Belo Horizonte, and 64.9% in Sete Lagoas. Fear of severe reactions and believing that vaccination against eradicated diseases is unnecessary were the main reasons for vaccination hesitancy.

Implications for services: Recovery of high vaccination coverage among children, considering public health service access conditions and socioeconomic inequities. Acting on reasons for hesitancy that can assist in targeting actions.

Perspectives: The multifactorial context of vaccination hesitancy demands the development of health education strategies to raise awareness about child immunization.

Objective: To analyze bed demand and occupancy within the Brazilian National Health System (Sistema Único de Saúde - SUS) for the main types of cancer in Brazil, from 2018 to 2021.

Methods: This was a descriptive cross-sectional study, using data from the Hospital Information System. Queuing theory model was used for calculating average admission rate, average hospitalization rate, probability of overload, and average number of people in the queue.

Results: The Southeast and South regions showed the highest average hospitalization rates, while the North region showed the lowest rates. The Southeast region presented a high probability of surgical bed overload, especially in the states of São Paulo (99.0%), Minas Gerais (97.0%) and Rio de Janeiro (97.0%). São Paulo state showed an overload above 95.0% in all types of beds analyzed.

Conclusion: There was a high probability of oncology bed occupancy within the Brazilian National Health System, especially surgical and medical beds, and regional disparities in bed overload.

Main results: The study found a high demand for hospital admissions to oncological bed in the Southeast region and a high probability of system overload in the states of the Southeast and Northeast regions of Brazil, thus highlighting the inequities in access to healthcare services in the country.

Implications for services: This study presents a methodology for the improved allocation of resources and management of surgical and medical bed flows in areas with the highest bed overload and regions with low service availability.

Perspectives: It is necessary to promote public policies that ensure the equitable supply of beds for oncological treatment within the SUS, especially in states with bed overload and healthcare service gaps.

Objectives: To analyze factors associated with delayed initiation of breast cancer treatment at an oncology referral center in Juiz de Fora, Minas Gerais state, between 2010 and 2019.

Methods: This was a cohort study using data from the Hospital-based Cancer Registry. The probability of not starting treatment within 60 days, in accordance with Brazilian law, was estimated using Kaplan-Meier, method and its association with the factors studied was assessed using the Cox model, presenting hazard ratios (HR) and respective 95% confidence intervals (95%CI).

Results: Among the 911 participants, the probability of delayed treatment initiation was 18.8% (95%CI 16.4;21.5). Those who underwent treatment at a health service other than the one where the cancer was diagnosed had a significantly higher risk (HR: 3.49; 95%CI 3.00;4.07).

Conclusion: Receiving a diagnosis and treatment at the same institution may help reduce waiting time to initiate cancer treatment.

Main results: The probability of study participants not initiating treatment within 60 days was 18.8%. Undergoing treatment at a healthcare service other than the one where the diagnosis was made was the main factor associated with delay.

Implications for services: Organizing healthcare services based on strategies that optimize referral flows and avoid transitions of care, can be crucial in reducing the time to initiation of breast cancer treatment.

Perspectives: It is essential to improve the workflows at the different stages of health care to ensure timely initiation of oncological treatment.