Oral health of an indigenous population in northeastern Brazil: a cross-sectional Study of the Fulni-ô ethnic group

ABSTRACT BACKGROUND: There is a lack of studies evaluating the oral health of traditional indigenous communities in Brazil. OBJECTIVES: Thus, the objective of this study was to describe the oral health characteristics of the indigenous Fulni-ô ethnic group in Northeast Brazil. DESIGN AND SETTING: A cross-sectional observational investigation was conducted within the Project on Atherosclerosis among Indigenous Populations. METHODS: This study included participants of both sexes from the Fulni-ô ethnic group. The participants included in this investigation underwent a comprehensive oral health evaluation by a registered and experienced dentist to assess oral health and identify potentially malignant oral lesions. Participants with suspicious lesions were referred for biopsy. Shapiro-Wilk, Mann-Whitney, and Student's t-tests were used, and measures of central tendency and dispersion were described. Statistical significance was 5%. RESULTS: A total of 104 individuals were included in this study. The prevalence of the use of tobacco derivatives was 94.0%, with similarities between sexes. The prevalence of oral changes in this study population was 84.4%. Fifty-one individuals who underwent oral reassessment were referred for oral lesion biopsy. CONCLUSIONS: This study demonstrated a high prevalence of oral alterations in the Fulni-ô population. Histopathological analyses indicated the presence of mild oral epithelial dysplasia in five cases.

Enfrentamento da hanseníase em tempos de COVID-19: uma experiência exitosa de implantação de um sistema de rastreamento em área endêmica do Nordeste / Coping with leprosy in times of COVID-19: a successful experience of implementing a tracking system in an endemic area in the Northeast / Enfrentando la lepra en tiempos de COVID-19: una experiencia exitosa de implementación de un sistema de rastreo en un área endémica del Nordeste

Introdução: A COVID-19 (coronavirus disease 2019) trouxe inúmeros desafios e sobrecarga ao Sistema Único de Saúde (SUS), gerando dificuldades no enfrentamento das outras enfermidades endêmicas e negligenciadas no território brasileiro, entre elas a hanseníase. Objetivo: Relatar a experiência de enfrentamento da prevalência oculta de hanseníase por uma equipe de atenção primária à saúde do interior do estado de Sergipe durante a pandemia de COVID-19. Métodos: O projeto foi desenvolvido entre os meses de setembro de 2020 e janeiro de 2021 e caracterizou-se pela oferta de exame dermatológico aos indivíduos que buscaram atendimento na unidade de saúde do bairro Cidade Nova, em Estância, Sergipe. Confirmado o diagnóstico de hanseníase, foi introduzido o tratamento com esquema de poliquimioterapia da Organização Mundial da Saúde (PQT-OMS) e os contatos foram examinados, respeitando-se as medidas sanitárias de prevenção à contaminação pela COVID-19. Resultados: No período analisado, foram avaliados 235 indivíduos, sendo feitos seis diagnósticos clínicos de hanseníase (2,5%), entre os quais um em menor de 15 anos de idade. No município, durante todo o ano de 2020, registrou-se o total de nove casos novos de hanseníase. Sem o projeto, o coeficiente de detecção de casos novos de hanseníase no município seria de 4,3/100 mil habitantes e, com o projeto, esse coeficiente foi três vezes superior (12,9/100 mil habitantes). Conclusão: A oferta de exame dermatoneurológico durante consultas médicas de rotina em áreas vulneráveis permitiu evidenciar a prevalência oculta de hanseníase no bairro Cidade Nova, Estância. Além disso, ações dessa natureza permitem o diagnóstico precoce, evitando-se a evolução para incapacidades físicas.

Introduction: COVID-19 (coronavirus disease 2019) has brought numerous challenges and burdens on the Unified Health System (SUS, acronym in Portuguese), creating difficulties for the facing of other endemic diseases in the Brazilian territory, such as leprosy. Objective: To report an experience of coping with the hidden prevalence of leprosy by a primary health care team in the countryside of the state of Sergipe during the COVID-19 pandemic. Methods: The project was developed from September 2020 to January 2021 and was characterized for offering a dermatological examination to individuals seeking care at the health unit in the Cidade Nova neighborhood, Estância, Sergipe. For confirmed cases, treatment was instituted and household contacts were examined, respecting the measures to prevent contamination by COVID-19. Results: In the analyzed period, 235 individuals were evaluated, with six diagnoses of leprosy (2.5%), one under the age of 15. In 2020, the municipality registered nine total cases. Without the project, the detection rate of new leprosy cases in the municipality would have been 4.3/100,000 inhabitants and, with the project, this coefficient was three times higher (12.9/100,000 inhabitants). Conclusion: The offer of dermato-neurological exams during routine medical appointments made it possible to show the hidden prevalence of leprosy in the neighborhood of Cidade Nova, Estância. In addition, actions of this nature allow early diagnosis, preventing the occurrence of physical disabilities.

Introducción: La COVID-19 (enfermedad por coronavirus 2019) trajo numerosos desafíos y cargas al Sistema Único de Salud (SUS), creando dificultades para enfrentar otras enfermedades endémicas en el territorio brasileño, como la lepra. Objetivo: Informar una experiencia de afrontamiento de la prevalencia oculta de lepra por parte de un equipo de atención primaria en el interior del estado de Sergipe durante la pandemia de COVID-19. Métodos: El proyecto se desarrolló desde septiembre de 2020 hasta enero de 2021 y se caracterizó por ofrecer un examen dermatológico a las personas que buscaban atención en la unidad de salud del barrio Cidade Nova, en Estância, Sergipe. En caso de confirmarse los casos, se instituyó el tratamiento y se examinaron los contactos domiciliarios, respetando las medidas para prevenir la contaminación por COVID-19. Resultados: En el período analizado se evaluaron 235 individuos, con 06 diagnósticos de lepra (2,5%), uno menor de 15 años. En 2020, el municipio registró nueve casos en total. Sin el proyecto, la tasa de detección de nuevos casos de lepra en el municipio sería de 4,3/100 mil habitantes y, con el proyecto, este coeficiente era tres veces mayor (12,9/100 mil habitantes). Conclusión: La oferta de exámenes dermatoneurológicos durante las consultas médicas de rutina permitió mostrar la prevalencia oculta de la lepra en el barrio Cidade Nova, Estância. Además, acciones de esta naturaleza permiten un diagnóstico precoz, evitando la aparición de discapacidades físicas.

Tecnologia digital como instrumento de saúde em uma comunidade indígena no Vale de São Francisco / Digital technology as a tool for health promotion in an indigenous community in the Vale de São Francisco

Resumo: Introdução: As comunidades tradicionais são grupos de indivíduos socialmente organizados que partilham comportamentos econômicos, socioambientais e culturais comuns. Entre elas, destacam-se as comunidades indígenas no Brasil, que vêm sofrendo o impacto da urbanização, do crescimento de doenças crônicas e epidemias e do aumento da insegurança alimentar. Relato de experiência: Este estudo teve como objetivo descrever as experiências da equipe de saúde, quanto ao uso de uma ferramenta de gestão de dados na assistência, em uma comunidade indígena no Nordeste brasileiro. Trata-se de um relato de experiência do uso de uma ferramenta digital nas ações assistenciais em uma comunidade tradicional. A equipe de saúde foi dividida em dois grupos: agentes comunitários de saúde e estudantes de Medicina. Discussão: A descrição das experiências e a análise das narrativas resultaram na identificação de 258 citações, que foram classificadas em 12 categorias, relacionadas ao objeto de estudo. Dentre estas, as questões ligadas aos benefícios da ferramenta foram as mais mencionadas (43,41%), em que os subgrupos abordaram diferentes reflexões. A segunda categoria mais citada se referia às limitações da ferramenta (15,11%), sendo a necessidade do sinal de internet o ponto crítico. Ou seja, esta pesquisa mostra vantagens da ferramenta na atenção à saúde, mas também explicita fragilidades inerentes ao seu uso, de modo a trazer questões importantes dessa vivência e estimular práticas semelhantes. Conclusão: Esse relato de experiência, como método científico, traz importantes questões vivenciadas, relacionadas à aplicabilidade prática de uma ferramenta digital em uma comunidade indígena. Apesar de ser inegável que há pontos de fragilidade evidentes, eles não comprometeram o resultado afirmativo da vivência, melhorando a assistência.

Abstract: Introduction: Traditional communities are groups of socially organized individuals with common economic, socio-environmental, and cultural behaviors. Brazil's indigenous communities are a prime example of these groups, suffering the impact of urbanization, the growth of chronic diseases, epidemics, and increased food insecurity. Experience report: To describe the health team's experiences in the use of a data management tool for care in an indigenous community in northeastern Brazil. Methodology: This is an experience report on the use of a digital tool to assist actions in a traditional community. The health team was divided into community health agents and medical students. Discussion: The description of the experiences and analysis of the narratives resulted in identifying 258 citations, classified into 12 categories related to the study scope. Of these, issues related to benefits of the tool were the most commonly mentioned (43.41%), where the subgroups addressed different reflections. The second most cited category referred to the tool's limitations (15.11%), with the need for an internet connection being the critical point. This research, therefore, shows the tool's advantages in health care but also explains weaknesses inherent to its use, raising important issues of this experience and stimulating similar practices. Conclusion: This experience report, as a scientific method, addresses essential experienced issues related to the practical applicability of a digital tool in an indigenous community. Although it is undeniable that there are obvious points of weakness, these did not compromise the positive result of the experience, and care was improved.

Blood parasite load by qPCR as therapeutic monitoring in visceral leishmaniasis patients in Brazil: a case series study

ABSTRACT Background: This study aimed to describe the kinetics of Leishmania parasite load determined using kinetoplast DNA (kDNA)-based quantitative polymerase chain reaction (qPCR) in visceral leishmaniasis (VL) patients. Methods: Parasite load in blood was assessed by qPCR at five time points, up to 12 months post-diagnosis. Sixteen patients were followed up. Results: A significant reduction in the parasite load was observed after treatment (P < 0.0001). One patient had an increased parasite load 3 months post-treatment and relapsed clinically at month six. Conclusions: We have described the use of kDNA-based qPCR in the post-treatment follow-up of VL cases.

Excesso de Mortalidade Hospitalar por Doenças Cardiovasculares no Brasil Durante o Primeiro Ano da Pandemia de COVID-19 / In-Hospital Mortality from Cardiovascular Diseases in Brazil during the First Year of The COVID-19 Pandemic

Resumo Fundamento: A pandemia da COVID-19 tem causado um impacto sobre a mortalidade por várias doenças em todo o mundo, especialmente por doenças cardiovasculares (DCVs). O Brasil é um país de dimensões continentais com diferenças significativas na estrutura de saúde entre seus estados. Objetivo: Analisar a mortalidade hospitalar por DCV no sistema público de saúde durante o primeiro ano da pandemia por COVID-19 (2020) no Brasil. Métodos: Este é um estudo ecológico analisando o número absoluto de mortes hospitalares e a taxa de mortalidade hospitalar no Brasil, suas macrorregiões, e unidades federativas. Os dados foram obtidos do Sistema de Informações Hospitalares (SIH) do Ministério da Saúde. O P-escore foi usado para analisar o excesso de mortalidade. O escore compara os eventos observados com os eventos esperados para um dado local e período. O escore-P foi corrigido por um modelo de regressão joinpoint, com um intervalo de confiança de 95% e nível de significância de 5%. Resultados: Houve 93.104 óbitos hospitalares por DCV no Brasil em 2020, o que representa 1495 menos óbitos (escore-P: -1,58) que o esperado. A região centro-oeste apresentou um escore-P positivo, com um aumento de 15,1% no número de mortes. Dez estados apresentaram um maior número de óbitos em 2020. Ainda, observou-se um excesso de 13,3% de mortalidade hospitalar no país como um todo, e um excesso de mortalidade hospitalar em todas as macrorregiões. Conclusões: Houve uma diminuição no número absoluto de óbitos hospitalares, bem como um aumento na taxa de mortalidade por DCV no Brasil em 2020, após o início da pandemia por COVID-19.

Abstract Background: The COVID-19 pandemic has had an impact on mortality from several diseases worldwide, especially cardiovascular diseases (CVD). Brazil is a continent-sized country with significant differences in the health care structure between its federative units. Objective: Analyze in-hospital mortality from CVDs in the Brazilian public health system during the first year of the COVID-19 pandemic (2020). Methods: This is an ecological study analyzing the absolute number of in-hospital deaths and the rate of in-hospital mortality in Brazil, its macro-regions, and federative units. Data were obtained from the Hospital Information System of the Brazilian Ministry of Health. To analyze excess mortality, the P-score was used. It compares the events observed with those expected for a given place and period. The P-score was corrected by the joinpoint regression model, with a 95% confidence interval and 5% significance level. Results: There were 93,104 in-hospital deaths due to CVD in Brazil in 2020, representing 1,495 fewer deaths (P score: −1.58) than expected. The central-west region had a positive P-score, with a 15.1% increase in the number of deaths. Ten federative units showed a greater number of deaths in 2020. There was also a 13.3% excess in-hospital mortality at the country level, and an excess in-hospital mortality in all macro-regions. Conclusions: There was a decrease in the absolute number of in-hospital deaths, as well as an increase in in-hospital mortality from CVD in Brazil, in 2020, after the COVID-19 pandemic onset.

Impact of the COVID-19 pandemic on compulsory notification of meningitis during the first wave of the pandemic in Brazil: an ecological study using P-score

Abstract BACKGROUND: Meningitis is listed as one of the diseases requiring compulsory notification in Brazil. It can affect all age groups and also has no seasonality. Cases can be recorded in all months of the year and in all states of Brazil. Despite its importance, the obligation of immediate notification may have been compromised by the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: To analyze the immediate impact of the COVID-19 pandemic on compulsory notifications of meningitis in Brazil and its states during the first wave of the pandemic. DESIGN AND SETTING: This was an ecological study involving all confirmed cases of meningitis in Brazil, in its regions and in its states. METHODS: Data for the months from 2015 to 2020 were obtained from the database of the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação, SINAN), in the Department of Informatics of the National Health System (Departamento de Informática do Sistema Único de Saúde, DATASUS). The P-score was used to obtain the percentage change in the numbers of cases reported in 2020. RESULTS: A 45.7% reduction in notifications of meningitis in Brazil was observed. Regarding the regions and the states, with the exception of Roraima, all of them showed a negative P-score, with decreasing curves each month. CONCLUSION: The pandemic caused a negative impact on meningitis notifications in Brazil.

Coagulopathy and the humoral response against viral proteins in patients at different stages of COVID-19

BACKGROUND Patients with severe coronavirus disease 2019 (COVID-19) often present with coagulopathies and have high titres of circulating antibodies against viral proteins. OBJECTIVES Herein, we evaluated the association between D-dimer and circulating immunoglobulin levels against viral proteins in patients at different clinical stages of COVID-19. METHODS For this, we performed a cross-sectional study involving patients of the first wave of COVID-19 clinically classified as oligosymptomatic (n = 22), severe (n = 30), cured (n = 27) and non-infected (n = 9). Next, we measured in the plasma samples the total and fraction of immunoglobulins against the nucleoprotein (NP) and the receptor-binding domain (RBD) of the spike proteins by enzyme-linked immunosorbent assay (ELISA) assays. FINDINGS Patients with severe disease had a coagulation disorder with high levels of D-dimer as well as circulating IgG against the NP but not the RBD compared to other groups of patients. In addition, high levels of D-dimer and IgG against the NP and RBD were associated with disease severity among the patients in this study. MAIN CONCLUSIONS Our data suggest that IgG against NP and RBD participates in the worsening of COVID-19. Although the humoral response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is partially understood, and more efforts are needed to clarify gaps in the knowledge of this process.

Clinical characteristics and laboratory parameters associated with the risk of severe COVID-19 in patients from two hospitals in Northeast Brazil

ABSTRACT Background: Although most coronavirus disease 2019 (COVID-19) infections are mild, some patients have severe clinical conditions requiring hospitalization. Data on the severity of COVID-19 in Brazil are scarce and are limited to public databases. This study aimed to investigate the clinical and laboratory factors associated with the severity of COVID-19 in a cohort of hospitalized adults from two hospitals in Northeast Brazil. Methods: Patients over 18 years of age who were hospitalized between August 2020 and July 2021 with a confirmed diagnosis of COVID-19 were included. The patients were classified into two groups: moderate and severe. Clinical, laboratory and imaging parameters were collected and compared between the groups. A multivariate logistic regression model was used to determine the predictors of COVID-19 severity. Results: This study included 495 patients (253 moderate and 242 severe). A total of 372 patients (75.2%) were between 18 and 65 years of age, and the majority were male (60.6%; n = 300). Patients with severe disease had higher levels of leukocytes, neutrophils, platelets, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, blood glucose, C-reactive protein, ferritin, D-dimer, aspartate aminotransferase, creatinine, and urea (p < 0.05). In multivariate logistic regression, the following variables were significant predictors of COVID-19 severity: leukocytes (odds ratio [OR] 3.27; 95% confidence interval [CI] 2.12-5.06), international normalized ratio (INR) (OR 0.22, 95% CI 0.14-0.33), and urea (OR 4.03; 95% CI 2.21-7.35). Conclusions: The present study identified the clinical and laboratory factors associated with the severity of COVID-19 in hospitalized Brazilian individuals.

Hospitalizations for pulmonary embolism in Brazil (2008-2019): an ecological and time series study / Hospitalizações por embolia pulmonar no Brasil (2008-2019): um estudo ecológico e de séries temporais

ABSTRACT Objective To assess the temporal trends of hospitalizations for pulmonary embolism (PE) in Brazil, its regions, and states between 2008 and 2019. Methods An ecological and time series study was conducted. Data were obtained from the Hospital Information System (SIH) of the Brazilian Ministry of Health. The inflection point regression model was applied for temporal trend analyses. Trends were classified as increasing, decreasing, or stationary according to the slope of the regression line. The Annual Percent Charge (APC) and the Average Annual Percent Change (AAPC) were calculated considering a confidence interval of 95% and p-value <0.05. Furthermore, spatial distribution maps of epidemiological indicators related to PE in Brazil were elaborated. Results There was an increasing trend in the hospitalization rate for PE in Brazil, ranging from 2.57 in 2008 to 4.44/100,000 in 2019 (AAPC=5.6%; p<0.001). Total and average hospitalizations costs also showed increasing trend in the country (AAPC=9.2% and 3.0%, respectively). Still, there was a decrease in the in-hospital mortality rate (from 21.21% to 17.11%; AAPC=-1.9%; p<0.001). Similar trends were observed in most regions. The average hospitalization time in Brazil showed a stationary trend. The hospitalization rate has also increased in 18 states (66.67%). Seven states showed a decrease in the mortality rate (25.93%), except for Roraima, which showed an increasing trend. Conclusion Hospitalizations for PE represent a serious public health problem in Brazil and the temporal patterns observed herein demonstrate an increasing trend in all regions and states of the country.

RESUMO Objetivo Avaliar as tendências temporais das hospitalizações por Embolia Pulmonar (EP) no Brasil, assim como suas regiões e estados no período entre 2008 e 2019. Métodos Foi realizado um estudo ecológico e de série temporal. Os dados foram obtidos do Sistema de Informação Hospitalar (SIH) do Ministério da Saúde (MS) do Brasil. O modelo de regressão de pontos de inflexão foi aplicado para análises de tendências temporais. As tendências foram classificadas como crescentes, decrescentes ou estacionárias de acordo com a inclinação da linha de regressão. O percentual de variação anual (APC) e Percentual de Variação Médio do Período (AAPC) foram calculados considerando Intervalo de Confiança de 95% (IC 95%) e significância de 5%. Além disso, foram elaborados mapas de distribuição espacial dos indicadores epidemiológicos relacionados à EP no Brasil. Resultados Houve uma tendência crescente na taxa de hospitalização de EP no Brasil, variando de 2,57 em 2008 a 4,44/100.000 em 2019 (AAPC=5,6%; p<0,001). Os custos totais e médios de hospitalização também mostraram uma tendência crescente no país (AAPC=9,2% e 3,0%, respectivamente). Ainda assim, houve uma diminuição na taxa de mortalidade hospitalar (de 21,21% para 17,11%; AAPC=-1,9%; p<0,001). Tendências similares foram observadas na maioria das regiões. O tempo médio de hospitalização no Brasil mostrou uma tendência estacionária. A taxa de hospitalização também aumentou em 18 estados (66,67%). Sete estados mostraram uma diminuição na taxa de mortalidade (25,93%), exceto Roraima, que mostrou uma tendência crescente. Conclusão As hospitalizações de EP representam um grave problema de saúde pública no Brasil, e os padrões temporais aqui observados demonstraram uma tendência crescente em todas as regiões e estados do país.

Urban mobility and COVID-19 in Brazil: Comparison between 2020 and 2021

SUMMARY OBJECTIVE: The aim of this study was to analyze and compare the indicators of urban mobility and the number of new cases of COVID-19 recorded daily between 2020 and 2021. METHODS: An observational study was carried out involving new cases of COVID-19 registered daily in the state of Pernambuco, Brazil between March 12, 2020 and March 28, 2021 and six indicators of urban mobility. For analysis, the study was divided into two periods: the first was composed of 295 days and represents the year 2020 and the second was composed of 86 days and represents the year 2021. Spearman's non-parametric correlation was used. RESULTS: In 2021, the greatest reductions in relation to the baseline were observed in parks (-29.0) and in retail and recreation areas (-28.7). However, these reductions were smaller than those observed in the previous year, indicating a greater circulation of people in 2021 when compared with mobility in 2020. In contrast, in residential areas, there was a reduction in the percentage change in relation to the previous year (11.2 in 2019 and 7.6 in 2021). In grocery and pharmacy, there was an increase 1.8 times greater than that observed in 2020 (9.1 in 2020 and 17.0 in 2021). It is also noteworthy that the daily average of new cases almost doubled in value (753.4 in 2020 and 1409.1 in 2021). CONCLUSION: More vigorous measures must be taken to adequately control the pandemic.

Prevalência de hipertensão arterial sistêmica e diabetes mellitus em indivíduos com covid-19: um estudo retrospectivo de óbitos em pernambuco, brasil / Prevalence of systemic arterial hypertension and diabetes mellitus in individuals with covid-19: a retrospective study of deaths in pernambuco, brazil

Resumo Hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) são dois dos principais fatores de risco para a mortalidade por COVID-19. Descrever a prevalência e o perfil clínico-epidemiológico de óbito por COVID-19 ocorridos em Pernambuco, Brasil, entre 12 de março e 14 de maio de 2020 entre pacientes que possuíam hipertensão arterial sistêmica e/ou diabetes mellitus como doenças prévias. Estudo observacional transversal. Foram analisadas as seguintes variáveis: município de procedência, sexo, faixa etária, tempo entre o início dos sinais/sintomas e o óbito, sinais/sintomas, tipo de comorbidades e hábitos de vida. Variáveis categóricas foram descritas por meio de frequências e variáveis contínuas por meio de medidas de tendência central e de dispersão. Os testes de Mann-Whitney e Kruskal-Wallis foram utilizados. Dos 1.276 registros incluídos no estudo, 410 apresentavam HAS e/ou DM. A prevalência de HAS foi 26,5% (n=338) e de DM foi 19,7% (n=252). Dos registros, 158 (12,4%) eram de pacientes que possuíam somente HAS, 72 (5,6%) somente DM e 180 (14,1%) apresentavam HAS e DM. Dos indivíduos com HAS, 53,3% apresentavam DM e 71,4% dos diabéticos apresentam HAS. A mediana (em dias) do tempo entre o início dos sinais/sintomas e o desfecho óbito foi 8,0 (IIQ 9,0), sem diferença significativa entre os grupos de comorbidades (p=0,633), sexo (p=0,364) e faixa etária (p=0,111). Observou-se maior prevalência de DM e HAS na população masculina (DM — 61,3% eram homens e 38,9% mulheres; HAS — 53,2% eram homens e 46,8% mulheres). Os sinais/sintomas mais frequentes foram dispneia (74,1%; n=304), tosse (72,2%; n=296), febre (68,5%; n=281) e saturação de O2<95% (66,1%; n=271). Dos hipertensos, 73,3% (n=100) apresentavam outras comorbidades/fatores de risco associados, e 54,2% (n=39) dos diabéticos apresentavam outras comorbidades/fatores de risco associados. Destacaramse as cardiopatias (19,5%; n=80), obesidade (8,3%; n=34), doença respiratória prévia (7,3%; n=30) e nefropatia (7,8%; n=32). A prevalência de tabagismo foi 8,8% (n=36) e de etilismo alcançou 3,4% (n=14). O estudo mostrou que a prevalência de HAS foi superior à prevalência de DM nos indivíduos que foram a óbito por COVID-19. Em idosos, a prevalência foi superior à observada em indivíduos não idosos.

Obesity and the COVID-19: Analysis of the clinical and epidemiological profiles of 138 individuals

SUMMARY INTRODUCTION: Coronavirus disease 2019 (COVID-19) is the disease caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the ongoing obesity pandemic, its coexistence with COVID-19 becomes worrying and has a less favorable outcome. OBJECTIVE: This study aimed to describe the clinical and epidemiological profiles of confirmed cases of COVID-19 in individuals with obesity in the state of Alagoas. METHODS: The observational cross-sectional study involving 138 confirmed cases of COVID-19 who had obesity as a comorbidity reported at the time of notification of the disease. The data were collected from the COVID-19 database in the state of Alagoas, and the variables analyzed were sex, age (and age group), race/color, outcome, clinical manifestations, and associated comorbidities. The Kolmogorov-Smirnov, Mann-Whitney U, χ², or Fisher's exact tests were performed as appropriate. The significance was set at 5 and 95% confidence intervals. RESULTS: There was a predominance of females (55.1%; n=76), aged <60 years (70.3%; n=97) and brown race/color (n=76; 55.1%). The most prevalent symptoms were cough (n=84; 60.9%), fever (n=78; 56.5%), headache (n=36; 26.1%), and adynamia (n=28; 20.3%). The median age was 49 years, with no difference between genders (p=0.340). The lethality rate was 17.4% (n=24), being higher in the male population (22.6% in males and 13.2% in females). Of the 24 deaths, 13 (54.2%) were recorded in the elderly people. In addition to obesity, 54.3% (n=75) had systemic arterial hypertension and 30.4% (n=42) had diabetes mellitus. There was no difference in the prevalence of comorbidity between genders. CONCLUSIONS: The profile studied demonstrates that obesity represents a challenge for coping with COVID-19.

Social determinants of mortality due to visceral leishmaniasis in Brazil (2001-2015): an ecological study

Abstract INTRODUCTION We aimed to analyze the relationship between visceral leishmaniasis mortality and social determinants of health (SDH). METHODS This was an ecological study of all leishmaniasis-related deaths in Brazil, from 2001 to 2015. We analyzed 49 indicators of human development and social vulnerability. The association was tested using the classical and spatial regression model. RESULTS Mortality was associated with indicators that expressed low human development and high social vulnerability: lack of garbage collection, low schooling, unemployment rate, low per capita income, and income inequality (Gini index). CONCLUSIONS: There was an association between high mortality by leishmaniasis and low SDH.

Syphilis among pregnant women in Northeast Brazil from 2008 to 2015: a trend analysis according to sociodemographic and clinical characteristics

Abstract INTRODUCTION: The number of syphilis cases among pregnant women in Brazil has increased. This study aimed to analyze the temporal trend of syphilis indicators among pregnant women in Northeast Brazil. METHODS: A time-series study was performed. RESULTS: We observed an increase in the detection rate of syphilis among pregnant women, those aged 15-19 years, and those of brown ethnicity. A strong correlation was observed between the detection rate of syphilis and family health strategy coverage. CONCLUSIONS: Despite an increase in primary care coverage, The increase in cases of syphilis among pregnant women is still considered a challenge.

Epidemiology of human visceral leishmaniasis in the urban centers of the lower-middle São Francisco Valley, Brazilian semiarid region

Abstract INTRODUCTION: Visceral leishmaniasis (VL) is a zoonosis caused by parasites of the Leishmania genus. VL is present in countries with tropical climates, being endemic in Brazil,, including the region of the lower-middle São Francisco Valley which includes the urban centers of Petrolina (Pernambuco state) and Juazeiro (Bahia state). METHODS: This retrospective and descriptive epidemiological study analyzed secondary data obtained from the mandatory visceral leishmaniasis notification forms of the Ministry of Health, which were compiled in the Information System for Notifiable Diseases (SINAN) database. We analyzed 181 autochthonous cases reported in the two aforementioned cities between 2010 and 2016. Data collection occurred in June 2017. RESULTS: Of the 181 VL cases in the study area, 40.9% (n=74) occurred in Juazeiro and 59.1% (n=107) occurred in Petrolina. The average numbers of cases per year were 9.5 in Juazeiro and 14 in Petrolina; respectively, the incidence ranges were 2-8.6 cases and 2.8-6.1 cases per 100,000 inhabitants. Fever, weakness, weight loss, and pallor were the most commonly observed clinical manifestations. Coinfection with human immunodeficiency virus (HIV) was observed in 16.8% and 5.4% of cases in Petrolina and Juazeiro, respectively. The lethality rates were 2.8% and 5.4% in Petrolina and Juazeiro, respectively. CONCLUSIONS: Both cities had a high incidence of VL during the studied period. The findings of this study contribute to a better understanding of the behavior of VL during recent years and may help to direct regional disease control measures.

Mensuração de sobrecarga emocional em cuidadores de crianças com paralisia cerebral / Emotional overload measurement in caregivers of children with cerebral palsy

Objetivo: O presente estudo tem por objetivo avaliar o nível de sobrecarga emocional em cuidadores de crianças com paralisia cerebral, assim como, os possíveis fatores que influenciarão o aumento dessa sobrecarga. Métodos: Trata-se de um estudo descritivo de corte transversal realizado no período de fevereiro de 2014 a Setembro de 2014, em ambulatórios de fisioterapia de serviços públicos e privados. Resultados: Foram avaliados 41 cuidadores. A média de sobrecarga pela Burden Interview foi de 25,2 ± 10,1, onde 37 desses cuidadores eram mães. A sobrecarga foi maior em indivíduos com renda familiar entre 1 e 2 salários mínimos; idades mais avançadas (33,5 ± 14,77) apresentaram maior tendência à sobrecarga; e indivíduos que apresentaram um maior número de filhos (2 ou 3), tiveram resultado estatístico significante, com p = 0,0091. Conclusão: Os cuidados dispensados às crianças com paralisia cerebral e as condições físicas e socioeconômicas do cuidador são fatores importantes no aumento da sobrecarga emocional destes. Foi possível verificar, ainda, que quanto maior o número de filhos, maior a sobrecarga emocional, e que tal condição está diretamente relacionada à idade do cuidador e a renda familiar

Objective: This study aims to assess the level of emotional burden in caregivers of children with cerebral palsy, as well as the possible factors that influence the growth of that burden. Methods: This is a cross-sectional descriptive study conducted from February 2014 to September 2014, in public and private services physiotherapy clinics. Results: We studied 41 caregivers. The average burden the Burden Interview was 25.2 ± 10.1, where 37 of these caregivers were mothers. The burden was higher in individuals with family income between 1 and 2 minimum wages; older age (33.5 ± 14.77) were more likely to overload; and individuals who had a higher number of children (2 or 3), had a significant statistical results with p = 0.0091. Conclusion: The treatment provided to children with cerebral palsy and physical and socioeconomic conditions of the caregiver are important factors in increasing the emotional burden of these. Furthermore, we found that the greater the number of children, the greater the emotional overload, and that such a condition is directly related to age of the caregiver and the family income