Epidemiologia e Servicos de Saude最新文献

Objective: To analyze trends in epidemiological risk of leprosy in Goiás state, Brazil, and its health macro-regions, between 2010 and 2021.

Method: This is a time series analysis of the composite leprosy epidemiological risk index in Goiás. We used cases held on the Notifiable Health Conditions Information System for calculating indicators separately and risk, classified as high, medium, low and very low. Trends were analyzed using Prais-Winsten linear regression and risk maps were produced.

Results: Goiás showed high leprosy endemicity (24.8 cases/100,000 inhabitants) and medium epidemiological risk between 2019 and 2021 (0.58). A stationary trend was found (annual percentage change, 0.50; 95% confidence interval, -3.04; 4.16) for risk of leprosy in Goiás as a whole and in its Central-West and Central-Southeast macro-regions.

Conclusion: There is need for actions to reduce the epidemiological risk of leprosy, especially where its trend is stationary, this includes early screening for new cases and health education.

Main results: Leprosy persists in Goiás state, Brazil, in an endemic form, with heterogeneous distribution. There has been a reduction in the number of municipalities with high epidemiological risk of leprosy, but challenges include active transmission and late diagnosis.

Implications for services: Long-term strategies for prevention, early detection, treatment and monitoring of people with leprosy and their contacts are needed.

Perspectives: It is crucial to strengthen health policies targeting leprosy in Goiás state, prioritizing continuing education and training programs for health professionals working in the entire territory.

Objective: To identify dietary patterns and analyze factors associated with the consumption profile of socially vulnerable children, Maceió, state of Alagoas, Brazil, August 2019 to December 2021.

Methods: This was a cross-sectional study; sociodemographic, anthropometric and food consumption variables were collected, factor analysis was used to identify dietary patterns; associations were analyzed using Poisson regression.

Results: Among the 567 children studied, two dietary patterns were identified, healthy and unhealthy; age ≥ 24 months (PR = 2.75; 95%CI 1.83;4.14), male gender (PR = 0.66; 95%CI 0.49;0.87) and maternal schooling ≤ 9 years (PR = 0.61; 95%CI 0.46;0.81) was higher in the healthy pattern; the unhealthy pattern was associated with age ≥ 24 months (PR = 1.02; 95%CI 1.01;1.03) and male gender (PR = 1.46; 95%CI 1.08;1.98).

Conclusion: The healthy pattern was more frequent in children aged ≥ 24 months, less frequent in male children and mothers with low level of schooling; children aged ≥ 24 months and males showed a higher prevalence of the unhealthy pattern.

Main results: Two dietary patterns were defined, healthy and "unhealthy", which were associated with male gender, age ≥ 24 months and maternal schooling ≤ 9 years of study.

Implications for services: The study data can assist health professionals dedicated to primary healthcare services, such as nutritionists, in planning interventions to promote healthy eating habits aimed at children.

Perspectives: Prospective studies with these populations are necessary to assess the causality of the associations found in this study, aiming to plan more effective public health actions.

Objective: To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color.

Methods: Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression.

Results: 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers.

Conclusion: There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil.

Main results: Marked racial inequalities were found in the obstacles to vaccination of children under 24 months in Brazil and to timely vaccination at 5 months and in the first year of life.

Implications for services: Racial inequalities in the occurrence of vaccination shortcomings in health services, in the objective restrictions faced by families in taking their children to vaccination centers and in incomplete vaccination in a timely manner need to be addressed by the Brazilian National Health System.

Perspectives: Equal public policies to address barriers to vaccination and qualification of health services need to be implemented. Studies need to deepen understanding of the structural determinants that lead to racial disparities.

Objective: To investigate excess mortality during the COVID-19 pandemic and its spatial distribution in Pernambuco, Brazil.

Methods: This was an ecological, descriptive and analytical study of deaths, by municipality, recorded on the Mortality Information System, in 2020 and 2021. Excess mortality was measured by comparing observed and expected deaths, the latter estimated by calculating standardized mortality ratio (SMR). SMR and respective confidence intervals (95%CI) were calculated. Spatial analysis was performed by calculating the Global and Local Moran Index.

Results: Excess mortality was 20.6% and 27.5%, respectively, in 2020 and 2021, with positive spatial correlation (p-value < 0.05). More populous municipalities (2020: SMR = 1.26; 95%CI 1.24;1.27 and 2021: SMR = 1.34; 95%CI 1.32;1.34), more developed municipalities (2020: SMR = 1.43; 95%CI 1.41;1.44 and 2021: SMR = 1.51;95%CI 1.50;1.53) and municipalities in the Sertão region (2020:SMR = 1.31;95%CI 1.30;1.33 and 2021: SMR = 1.44; 95%CI 1.42;1.46) showed greater excess deaths.

Conclusion: Excess mortality coincided with peak periods of COVID-19 transmission.

Objective: To validate the Brazilian National Health System Hospital Information System (SIH/SUS) for maternal morbidity surveillance.

Methods: This was a cross-sectional study conducted in 2021/2022, taking as its reference a national study on maternal morbidity (MMG) conducted in 50 public and 28 private hospitals; we compared SIH/SUS and MMG data for hospitalization frequency, reason and type of discharge and calculated sensitivity, specificity, positive and negative likelihood ratios for seven diagnoses and four procedures.

Results: Hospitalizations identified on SIH/SUS (32,212) corresponded to 95.1% of hospitalizations assessed by MMG (33,867), with lower recording on SIH/SUS (85.5%) for private hospitals [10,036 (SIH/SUS)]; 11,742 (MMG)]; compared to MMG, SIH/SUS had a lower proportion of hospitalizations due to "complications during pregnancy" (9.7% versus 16.5%) as well as under-recording of all diagnoses and procedures assessed, except "ectopic pregnancy".

Conclusion: Better recording of diagnoses and procedures on SIH/SUS is essential for its use in maternal morbidity surveillance.

Objective: To analyze the trend in mortality from mental and behavioral disorders due to alcohol use in Brazil, 2010-2021.

Methods: This was an time series study using Mortality Information System data. Annual percentage change (APC) and 95% confidence intervals (95% CI) were calculated using Prais-Winsten linear regression.

Results: Mortality showed a stationary trend for Brazil as a whole (APC = 0.6; 95%CI -4.2;3.0), a falling trend in individuals aged 20-29 years in the South (APC = -7.4; 95%CI -10.0;-4.3) and Northeast (APC = -3.4; 95%CI -6.4;-0.4) regions, in people aged 30-39 in the Midwest region (APC = -3,8; 95%CI -7.4;-0.1) and 40-49 in the South (APC = -2.1; 95%CI -3.8;-0.4), North (APC = -3.1; 95%CI -5.7;-0.5) and Midwest (APC = -2.9; 95%CI -5.5;-0.3) regions.

Conclusion: Mortality from mental and behavioral disorders due to alcohol use showed a stationary trend nationally and a falling trend in some age groups regionally.

Objective: To analyze HIV Post-Exposure Prophylaxis (PEP) prescription and return for follow-up appointments.

Methods: This was a descriptive cross-sectional study using data on people who sought PEP in emergency care units (UPAs) and specialized medical services in Salvador, BA, Brazil, between January-December/2018.

Results: Of the 1,525 people who sought PEP at UPAs, 1,273 (83.5%) met PEP eligibility criteria, while 252 (16.5%) did not; of the eligible group, 1,166 (91.6%) had antiretrovirals prescribed, while 107 (8.4%) eligible people did not; of the total number of people with PEP prescriptions, only 226 (19.4%) returned for the first follow-up appointment, 115 (9.9%) for the second, and 33 (2.8%) for the third in order to complete the protocol.

Conclusion: We found a significant proportion of eligible users who did not have PEP prescribed at UPAs and a significant loss of return for specialized service follow-up appointments.

Objective: To assess the epidemiological profile and trend in hospitalizations for mental and behavioral disorders due to alcohol and other psychoactive substance use among Brazilian adolescents, between 2017 and 2022.

Methods: This was a time-series study using data from the Hospital Information System of the Brazilian National Health System; the trend analysis was performed by estimating the annual percentage change (APC) of hospitalization rates per 100,000 inhabitants and respective confidence intervals (95%CI), using the Prais-Winsten method.

Results: A total of 29,991 hospitalizations were recorded in the study period, with a decreasing trend observed, from 16.18/100,000 inhabitants in 2017 to 13.72/100,000 inhab. in 2022 (percent change of -2.65%; 95%CI -4.47;-0.80), a greater decline was found in males (-3.48%; 95%CI -5.20;-1.72), in the age group of 15 to 19 years (-2.79%; 95%CI -4.49;-1.06), in the South (-3.29%; 95%CI -5.37;-1.16) and Midwest (-3.64%; 95%CI -5.75;-1.49) regions of the country.

Conclusion: Hospitalizations showed a decreasing trend in the study period, with sociodemographic disparities.

Objective: To estimate the economic burden associated with COVID-19 in Córdoba, Colombia, 2020 and 2021.

Methods: Economic burden study. Direct costs were analyzed from the third-party payer perspective using healthcare administrative databases and interviews from a cohort of confirmed COVID-19 cases from Córdoba. Costing aggregation was performed by the bottom-up method. Indirect costs were estimated using the productivity loss approach. Contrast tests and statistical models were estimated at 5% significance.

Results: We studied 1,800 COVID-19 cases. The average economic cost of COVID-19 per episode was estimated at US$ 2,519 (95%CI 1,980;3,047). The direct medical cost component accounted for 92.9% of the total; out-of-pocket and indirect costs accounted for 2% and 5.1%, respectively.

Conclusion: COVID-19 economic cost was mainly due to direct medical costs. This study provided evidence of the economic burden faced by households due to COVID-19, with the most vulnerable households bearing much of the burden on their income.