Epidemiologia e Servicos de Saude最新文献

Objective: To analyze vaccination coverage and factors associated with incomplete vaccination in inland municipalities of Northeastern Brazil.

Methods: This was a household survey using cluster sampling conducted in Vitória da Conquista, Bahia state, Caruaru, Pernambuco state, Sobral, Ceará state and Imperatriz, Maranhão state between 2020 and 2022. Vaccination coverage by valid doses and vaccine hesitancy were analyzed, with the odds ratio (OR) estimated and adjusted using logistic regression.

Results: Among 1,847 children, complete vaccination coverage was 49.2% (95%CI 43.9;54.5). Factors associated with incomplete vaccination included: higher income (OR 1.53; 95%CI 1.02;2.31), residence in Sobral (OR 4.35; 95%CI 3.04; 6.21) and >1 child (OR 1.20; 95%CI 1.11;1.32). Parental decision not to vaccinate and difficulties in traveling to vaccination centers contributed to vaccine hesitancy.

Conclusion: Low vaccination coverage and incomplete vaccination were associated with social issues in the socioeconomic strata analyzed.

Objective: To assess health-related quality of life and associated factors among trans people.

Methods: This was a cross-sectional study conducted in 2023. The 12-Item Short- Form Health Survey was used with trans women, trans men, travestis, and non-binary people who were users of a health service in Manaus, capital city of Amazonas state.

Results: A total of 71 participants were included: 36 trans women; 29 trans men; 2 travestis; and 4 non-binary people, with a mean age 30.1 years. The physical component scored 44.6±7.8, and the mental component scored 38.4±11.1. The emotional aspect with a score of 16.0±1.1, was the most affected domain. Paid employment was associated with better mental quality of life, while having lived in street situations was associated with worse physical quality of life, with mean differences of 4.4 (95%CI 2.3;6.9) and -3.3 (95%CI -7.7;2.3) respectively.

Conclusion: Among trans people, the mental component was more affected than the physical, with the greatest impairment observed in the emotional aspect. Socioeconomic characteristics were associated with quality of life.

Objective: To estimate measles-mumps-rubella vaccination coverage, delay and loss to follow-up in children up to 24 months old living in Brazilian cities.

Methods: Surveys and questionnaires with a retrospective cohort of live births in 2017-2018, analyzing vaccination coverage and sociodemographic data of children and families, based on vaccination card records and interviews.

Results: Valid coverage of first dose was 90.0% (95%CI 88.9;91.0) and 81.1% for the second dose (95%CI 79.8;82.4). Delay for both doses was 23.2% (95%CI 21.9;24.5) and loss to follow-up was 10.8% (95%CI 9.9;11.8). Socioeconomic stratum A had the lowest vaccination coverage and the higher the child's birth order, the lower the vaccination coverage for the second dose. Children whose mothers had 13 to 15 years of education had higher vaccination coverage.

Conclusion: Coverage did not meet the recommended target. Differentiated strategies to resolve difficulties in access, misinformation, and vaccination hesitancy will help improve vaccination coverage.

Objective: To evaluate opportunity for vaccination in children born alive in Londrina, up to 6 months old and the relationship between socioeconomic stratum and vaccination regularity.

Method: Population survey study based on a retrospective cohort of children born in 2017 and 2018 that identified vaccines not administered in a given session. Vaccination regularity was compared between socioeconomic strata using Pearson's chi-square test.

Results: Out of 456 vaccination cards, the proportion of vaccination opportunities not recovered for doses to be administered at birth and at two, four and six months was 5.0% (95%CI 3.1;7.5), 4. 5% (95%CI 2.8;6.9), 7.2% (95%CI 5.0;10.2) and 2.1% (95%CI 1.0;4.0), respectively. There was no statistical difference in vaccination regularity between the strata.

Conclusion: Missed opportunities for vaccination were found at all ages. Socioeconomic stratum did not influence vaccination regularity.

Objective: To analyze vaccine hesitancy associated factors and repercussions on vaccination coverage.

Methods: Cohort of children born in 2017-2018, living in Brazilian state capitals, Federal District (FD), and 12 inner region cities, stratified by socioeconomic level. National Vaccination Coverage Survey (2020) data on hesitancy, access and programmatic difficulties were obtained by interview and coverage was calculated from vaccination card dose and date records.

Results: 37801 children were studied, 31001 in the capitals/FD, 6800 in the inner cities. Hesitation between 38.8(95%CI 33.6;44.4) and 57.9(95%CI 54.1;61.6) in high versus low stratum; 64.1(95%CI 58.9;68.9) to 41.7(95%CI 38.4;45.8) among mothers with <8 years of schooling versus 16 years or more; 42.1(95%CI 38.2;46.2) to 55.0(95%CI 52.0;54.7) among private service users versus public service only users. Coverage: full=7.2(95%CI 1.0;38.3); 25.3(95%CI 18.7;33.3) for hesitant people; and 44.7(95%CI 43.0;46.4) for the remainder.

Conclusion: High vaccine hesitancy in several groups affecting vaccination coverage and hindering vaccination target achievement. Access problems and programmatic difficulties contribute to low coverage.

Objective: To analyze the first referral service for rare diseases accredited by the Brazilian Ministry of Health, focusing on referral from the primary healthcare network through to diagnosis.

Methods: This is a descriptive study with patients treated between 2016 and 2021 at a referral hospital service located in Curitiba, Paraná, Brazil. Clinical and epidemiological data were obtained from medical records, as were the results of genetic tests at the hospital's clinical analysis laboratory. Qualitative data were expressed as absolute and relative frequencies, while quantitative data were expressed as medians and interquartile ranges and compared using the Kruskal-Wallis test.

Results: The study included 1,751 cases, 34.1% were diagnosed with rare diseases, with average time until diagnosis being 3.0 years, whereby mucopolysaccharidosis type II (4.0%) and tuberous sclerosis (3.9%) were the most common. Greater length of time for obtaining diagnosis (p-value 0.004) and receiving specialized care (p-value<0.001) was found in patients from the interior region of Paraná state, compared to those residing in Curitiba city and its metropolitan region.

Conclusion: Diagnosis of rare diseases occurred in approximately one third of cases. The average time until diagnosis suggests a possible positive impact of implementing the referral service. The longer time until diagnosis and specialized care found among patients from the interior region of Paraná represent challenges regarding adequate referral to specialized services.

Objectives: The aim of this study was to determine the prevalence of HPV and cytological alterations in the transgender population and contribute to the development of public policies.

Methods: A descriptive study was conducted in a transgender outpatient clinic in Vitória, Espírito Santo state, between 2018 and 2021. Data were collected through interviews and information from medical records. Anogenital samples were collected for HPV, trichomoniasis, gonococcus and chlamydia testing, cytology.

Results: Of the 110 participants, 60.9% identified as men and 34.5% as women. The overall prevalence of HPV was 58.3%, being higher in women (48.1%). Among men, cervical HPV was positive in 38%, and anal HPV in 25%, with cytological abnormalities found in 9.5%. Abnormal anal cytology was observed in 23.5% of women. Other sexually transmitted infections: chlamydia (4.1%), trichomoniasis (12.5%) and no cases of gonorrhea.

Conclusion: HPV is a prevalent infection with risks for cytological abnormalities in the transgender population, and further studies on prevalence and impacts on sexual health are needed to support screening and prevention policies.

Main results: Transgender people are susceptible to sexually transmitted infections, with a high prevalence of HPV and, consequently, present cytological abnormalities in the anal and cervical regions, which pose a risk for the development of anogenital neoplasia.

Implications for services: This is an invisible population, often absent from health services due to prejudice and stigma. Data on the health of this population contributes to the formulation of inclusive policies for the prevention, screening and diagnosis of STIs and anogenital neoplasia .

Perspectives: Increased support are for further studies on STIs and anogenital neoplasia in the transgender population is needed, through investments in specialized outpatient clinics and research groups, so that public policies can be discussed and implemented.

Objective: To analyze factors associated with full vaccination coverage with valid doses, in children from four state capitals and three other cities in Southeast Brazil.

Method: Analysis of a population survey conducted in 2020-2021, with a sample stratified according to socioeconomic levels of children born in 2017-2018, with data collected through photographic records of their vaccination cards. Odds ratios (OR) and 95% confidence intervals (95%CI) for full vaccination coverage were estimated based on the characteristics of the family, mother and child.

Results: Among 8703 children, lowest coverage occurred in strata A and B (OR=0.39; 95%CI 0.23;0.67 and OR=0.38; 95%CI 0.25;0.58); in consumption level A/B (OR=0.38; 95CI% 0.28;0.52); among those with income >BRL8000/month (OR=0.23; 95%CI 0.12;0.42); in children of mothers with higher education (OR=0.47; 95%CI 0.32;0.71); in children not vaccinated exclusively in the public service (OR=0.37; 95%CI 0.26;0.51) and in children with a vaccination delay of up to 6 months (OR=0.28; 95%CI 0.22;0.37).

Conclusion: Coverage did not reach the targets for controlling vaccine-preventable diseases and was negatively associated with higher socioeconomic status.

Main results: Vaccination coverage for the full schedule with valid doses was very low, putting the control of vaccine-preventable diseases at risk in the four state capitals and three other cities in the interior region of Southeast Brazil.

Implications for services: Brazilian National Health System managers and workers need to know the factors associated with low vaccination coverage and increased risk of abandoning the schedule, access problems and National Immunization Program difficulties.

Perspectives: Understanding determinants of low vaccination coverage provides support for the discussion and design of effective public policies to address barriers and qualify health services for vaccination.