Epidemiologia e Servicos de Saude最新文献

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 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.

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 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.