Impact of inclusion of varicella vaccine into the immunization program on the incidence of varicella / 上海预防医学

ObjectiveTo analyze the epidemiological characteristics of varicella in Minhang District， Shanghai from 2013 to 2022， and to evaluate the impact of adjusting the varicella vaccination program to a two-dose regimen and its inclusion in the Shanghai immunization program on the incidence of varicella. MethodsData on reported varicella cases from 2013 to 2022 in Minhang District were collected. Interrupted time series analysis and segmented regression models were used to analyze the changes in varicella incidence before and after the adjustment of varicella immunization strategies. ResultsFrom 2013 to 2022， the average annual incidence of varicella was 76.58/100 000， with the highest incidence in 2017 （119.21/100 000） and the lowest in 2022 （27.02/100 000）. The varicella incidence exhibited seasonal patterns with peaks occurring from March to June and October to January of the following year. Prior to the adjustment of varicella immunization strategies （2013‒2017）， the varicella incidence showed an upward trend （z=2.20， P=0.03）， while after the adjustment （2018‒2022）， a adownward trend was observed （2018‒2022） （z=-2.25， P=0.02）. Interrupted time series analysis showed that following the adjustment of varicella immunization strategies， an immediate change of -33.91/100 000 （t=-4.35， P<0.001） in varicella incidence was observed， and the incidence slope was -17.59/100 000 with a decline of 28.61/100 000 （t=-12.16， P<0.001） compared to before inclusion. ConclusionThe incidence of varicella in Minhang District， Shanghai from 2013 to 2022 exhibits distinct seasonal patterns. After adjusting the varicella vaccination program to a two-dose regimen and incorporating it into the immunization program， the second dose of varicella vaccine administration substantially increases. As a result， the rising trend of varicella incidence is effectively controlled， and the incidence level decreases significantly， showing a sustained downward trend.

A pandemia de covid-19 e a morbidade hospitalar por transtorno mental e comportamental no Brasil: uma análise de série temporal interrompida, janeiro de 2008 a julho de 2021 / La pandemia de covid-19 y la morbilidad hospitalaria por trastornos mentales y del comportamiento en Brasil: un análisis de series temporales interrompidas, de enero de 2008 a julio de 2021 / The covid-19 pandemic and hospital morbidity due to mental and behavioral disorders in Brazil: an interrupted time series analysis, from January 2008 to July 2021

Objective: to analyze records of hospitalizations due to mental and behavioral disorders before and after the beginning of the covid-19 pandemic in Brazil, from January 2008 to July 2021. Methods: this was a descriptive ecological interrupted time series study, using secondary data retrieved from the Brazilian National Health System Hospital Information System; a time series analysis of hospitalizations was conducted based on a population-weighted Poisson regression model; relative risk (RR) and respective 95% confidence intervals (95%CI) were calculated. Results: we identified 6,329,088 hospitalizations due to mental and behavioral disorders; hospitalization rates showed an 8% decrease (RR = 0.92; 95%CI 0.91;0.92) after the start of the pandemic, compared to the pre-pandemic period. Conclusion: the pandemic changed the trend of hospitalizations due to mental and behavioral disorders in Brazil; the drop observed in the period is evidence that the pandemic affected the mental health care network.

Objetivo: analizar las hospitalizaciones por trastornos mentales y del comportamiento antes y después del inicio de la pandemia de covid-19 en Brasil, desde enero 2008 hasta julio 2021. Método: estudio ecológico descriptivo de series temporales interrumpidas, con datos registrados en el Sistema de Informações Hospitalares del Sistema Único de Saúde; se realizó un análisis de series temporales de hospitalizaciones basado en modelo de regresión de Poisson, ponderado por la población; calculado el riesgo relativo (RR), con intervalo de confianza del (IC95%). Resultados: se identificaron 6.329.088 hospitalizaciones por trastornos mentales y del comportamiento; las tasas de hospitalización mostraron disminución del 8% (RR = 0,92; IC95% 0,91;0,92) tras el inicio de la pandemia, en relación con el periodo prepandémico. Conclusión: la pandemia cambió la tendencia de hospitalizaciones por trastornos mentales y del comportamiento en Brasil; la caída observada en el período evidencia que la pandemia afectó la cadena asistencial estructurada para la salud mental.

Objetivo: analisar as internações por transtorno mental e comportamental, antes e após o início da pandemia de covid-19 no Brasil, de janeiro de 2008 a julho de 2021. Métodos: estudo ecológico descritivo de série temporal interrompida, com dados registrados no Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS); realizada análise da série temporal das internações baseada em um modelo de regressão de Poisson, ponderado pela população; calculado o risco relativo (RR), com intervalo de confiança de 95% (IC95%). Resultados: foram identificadas 6.329.088 internações por transtornos mentais e comportamentais; as taxas de internação apresentaram um decréscimo de 8% (RR = 0,92; IC95% 0,91;0,92) após o início da pandemia, em relação ao período pré-pandemia. Conclusão: a pandemia modificou a tendência das internações por transtornos mentais e comportamentais no Brasil; a queda observada no período é evidência de que a pandemia afetou a cadeia de cuidado estruturada para saúde mental.

Efeitos da pandemia de COVID-19 nos serviços odontológicos da atenção primária no Maranhão, Brasil / Effects of the COVID-19 pandemic on dental services in primary care in Maranhão, Brazil

Resumo O objetivo deste artigo é analisar indicadores de uso de serviços de saúde bucal da atenção primária à saúde no Maranhão antes e durante a pandemia de COVID-19. Estudo ecológico de série temporal interrompida cuja unidade de análise foi o Maranhão. A exposição foi a pandemia de COVID-19, dicotomizada em pré e pandemia. Os desfechos foram calculados pela razão da quantidade de procedimentos preventivos (RPP), de urgência (RPU) e procedimentos curativos (RPC), e a projeção censitária da população do estado, multiplicada por mil, mensalmente. Os dados foram coletados do Sistema de Informação em Saúde para a Atenção Básica e do Instituto Brasileiro de Geografia e Estatística, no período de 2015.1 a 2022.2. As análises foram realizadas por meio do modelo autorregressivo, integrado e de médias móveis com sazonalidade. Houve tendência crescente dos três indicadores até jan./2019. A pandemia causou redução significativa na RPP (Xreg = -6,55; p-valor = 0,0008) e na RPC (Xreg = -4,74; p-valor = 0,0005), mas não influenciou a RPU (Xreg = -0,03; p-valor = 0,12) desde o primeiro semestre de 2020, persistindo até o segundo semestre de 2022. A pandemia de COVID-19 provocou redução nos serviços preventivos e curativos de saúde bucal no Maranhão.

Abstract This article aims to analyze indicators of the utilization of oral health services (UOHS) in primary health care in the state of Maranhão, Brazil, before and during the COVID-19 pandemic. We conducted an ecological time series study. The unit of analysis was the state of Maranhão, and the exposure variable was the COVID-19 pandemic, dichotomized into pre-pandemic and pandemic. The outcome variables were the monthly rates per 1,000 population of three UOHS indicators: rate of preventive procedures (RPP-PHC); rate of urgent procedures (RUP-PHC), and rate of curative procedures (RCP-PHC). The data were collected from the Primary Health Care Information System (SISAB) and the Brazilian Institute of Geography and Statistics (IBGE) for the period from 2015-2022. The analyses were performed using the Seasonal Autoregressive Integrated Moving Average (SARIMA) model. The three indicators showed an upward trend up to January 2019. The pandemic caused a significant reduction in the RPP (Xreg = -6.55; p-value = 0.0008) and RCP (Xreg = -4.74; p-value = 0.0005), starting in the first semester of 2020 and continuing into the second semester of 2022, but did not influence the RUP (Xreg = -0.03; p-value = 0.12). The COVID-19 pandemic caused a reduction in preventive and curative oral health services in Maranhão.

Social inequalities in the temporal trend of mortality from sickle cell disease in Brazil, 1996-2019 / Desigualdades sociais na tendência temporal de mortalidade por doença falciforme no Brasil, 1996-2019 / Desigualdades sociales en la tendencia temporal de la mortalidad por enfermedad de células falciformes en Brasil, 1996-2019

Contrary to international trends, the mortality rate of sickle cell disease increased in Brazil after the implementation of the neonatal screening program, probably due to improving access to diagnosis. This study aimed to assess differences in the temporal trend of the mortality rate and median age at death from sickle cell disease in Brazil, considering implemented measures to expand diagnosis, and improve health care access in-country and in the international scenario. Time series were extracted from the Brazilian Mortality Information System from 1996 to 2019. Changes in the mortality rate and median age at death were verified via segmented regression models, which were stratified by sex, region of residence, and age. Most deaths occurred in non-white people, young adults, and the Southeast and Northeast population. Sickle cell disease mortality rate increased until 2010 (13.31%; 95%CI: 6.37; 20.70), particularly in individuals aged 30 years or more (12.78%; 95%CI: 2.98; 23.53) and in the Northeast (12.27%; 95%CI: 8.92; 15.72). Most deaths occurred in the second decade of life (3.01 deaths/million), with a 59% increase in the median age of death in Brazil, from 27.6 to 30.3 years, more pronounced in females and the North Region. The observed gain in the survival of sickle cell disease in Brazil is still much lower than in developed countries and presents regional disparities, probably due to the lack of access to health care and recent treatments, such as hydroxyurea, still restricted to hematological referral centers in Brazilian capitals.

Ao contrário dos estudos internacionais, houve um aumento da taxa de mortalidade por doença falciforme no Brasil após a implantação do programa de triagem neonatal, provavelmente devido à melhoria do acesso ao diagnóstico. O objetivo deste estudo foi avaliar as diferenças na tendência temporal da taxa de mortalidade por doença falciforme e idade mediana ao morrer no Brasil, considerando as medidas implementadas para ampliar o diagnóstico e melhorar o acesso à saúde no país e no cenário internacional. As séries temporais foram extraídas do Sistema de Informação sobre Mortalidade de 1996 a 2019. Mudanças na magnitude da taxa de mortalidade e na idade mediana ao morrer foram verificadas via modelos de regressão segmentada, estratificados por sexo, região de residência e idade. A maioria dos óbitos ocorreu entre jovens, pretos ou pardos, e habitantes das regiões Sudeste e Nordeste. Houve um aumento da taxa de mortalidade por doença falciforme até 2010 (13,31%; IC95%: 6,37; 20,70), especialmente em indivíduos com 30 anos ou mais (12,78%; IC95%: 2,98; 23,53) e habitantes do Nordeste (12,27%; IC95%: 8,92; 15,72). A maioria dos óbitos ocorreu durante a segunda década de vida (3,01 óbitos/milhão), com um aumento de 59% na idade mediana ao morrer no Brasil (de 27,6 para 30,3 anos), mais acentuada entre mulheres e na Região Norte. O aumento observado na sobrevivência da doença falciforme no Brasil ainda é muito menor do que em países desenvolvidos e com disparidades regionais, provavelmente pela falta de acesso aos serviços de saúde e aos tratamentos recentes, como a hidroxiureia, que ainda é restrita aos centros de referência hematológicos das capitais brasileiras.

A diferencia de los estudios internacionales, en Brasil se produjo un aumento de la tasa de mortalidad por enfermedad de células falciformes tras la implantación del programa de tamizaje neonatal, probablemente debido a la mejora del acceso al diagnóstico. El objetivo del estudio es determinar las diferencias en la tendencia temporal de la tasa de mortalidad y la edad media de muerte por enfermedad de células falciformes en Brasil, teniendo en cuenta las medidas implementadas para ampliar el diagnóstico y mejorar el acceso a la atención sanitaria en el país y en el escenario internacional. Las series temporales fueron extraídas del Sistema de Información sobre de Mortalidad de 1996 a 2019. Los cambios en la magnitud de la tasa de mortalidad y la edad media de la muerte se identificaron con modelos de regresión segmentados, estratificados por sexo, región de residencia y edad. La mayoría de las muertes ocurrieron en personas de color, adultos jóvenes y los habitantes del sureste y noreste. Hubo un aumento de la tasa de mortalidad por enfermedad de células falciformes hasta 2010 (13,31%; IC95%: 6,37; 20,70), sobre todo en individuos de 30 años o más (12,78%; IC95%: 2,98; 23,53) y en el Noreste (12,27%; IC95%: 8,92; 15,72). La mayoría de las muertes ocurrió en la segunda década de la vida (3,01 muertes/millón), con un aumento del 59% en la edad media de muerte en Brasil, de 27,6 a 30,3 años, más pronunciado en las mujeres y en el Norte. La ganancia observada en la supervivencia de la enfermedad de células falciformes en Brasil es todavía muy inferior a la de los países desarrollados y con disparidades regionales, probablemente debido a la falta de acceso a la asistencia sanitaria y a los tratamientos recientes, como la hidroxiurea, todavía restringidos a los centros de referencia hematológica de las capitales brasileñas.

Impact of COVID-19 on the antenatal care services utilization in the region of Guelmim Oued Noun, Morocco

Background: Globally, the covid-19 pandemic has seriously impacted access to healthcare facilities across the world, although there is little evidence on how the pandemic affects the use of essential healthcare in the world. Objective: This study sought to evaluate the impact of the covid-19 pandemic on antenatal indicators in the region of Guelmim Oued Noun, Morocco. Methods: The aggregated data was delivered by regional health authorities covering the period from January 2017 to December 2020. The interrupted time series was mobilized to conduct statistical analysis. Results: The descriptive results revealed a steady decline after the Covid-19 pandemic in Antenatal indicators. The results of the regression model showed a negative impact of the pandemic on the antenatal recruitment rate (ß2 = - 16.14; p < 0.01), recruitment rate of women in antenatal visits the 1st quarter of pregnancy (ß2 = -2.09; p < 0.01), antenatal visit completion rate (ß2 = -18.10, p>0.05), average number of visits/pregnancies (ß2 = -15.65, p<0,05). Conclusion: The effect of the covid-19 pandemic on antenatal rates was significant for almost the indicators studied. Future studies should be focused on the impact of the pandemic on postnatal and immunization services on the national scale.

Effects of centralized volume-based procurement policy on the use of drugs for non-small cell lung cancer in a third-grade class-A cancer hospital / 中国药房

OBJECTIVE To analyze the effects of centralized volume-based procurement policy （hereinafter referred to as “centralized procurement”） on the use of anti-tumor drugs in medical institutions. METHODS The interrupted time series model was used to analyze the changes in the monthly purchase volume and purchase amount of docetaxel， gemcitabine and pemetrexed disodium in a third-grade class-A cancer hospital in Shanxi province from January 2018 to December 2021. RESULTS & CONCLUSIONS After the implementation of the centralized procurement policy， both the selected drugs and the non-selected drugs had different degrees of price reduction， and the price reduction of the selected drugs was far greater than that of the non- selected drugs； average monthly purchase volume and amount of docetaxel decreased significantly in that month after the implementation of the policy， while those of gemcitabine and pemetrexed disodium increased significantly （P＜0.05 or P＜0.01）. After the implementation of the policy， the average monthly purchase volume and amount of gemcitabine showed a downward trend， while those of docetaxel and pemetrexed disodium showed an upward trend （P＜0.05 or P＜0.01）. It is suggested that hospitals should strengthen pharmaceutical administration， and avoid adopting a “one size fits all” approach to non-selected drugs； relevant departments should further expand the collection range of anti-tumor drugs or carry out special collection of anti-tumor drugs， so as to save medical insurance funds and reduce medical expenses.

Effects of the national centralized drug procurement policy on drug availability and the structure of hospital drug use / 中国药房

OBJECTIVE To analyze the effects of the national centralized drug procurement （NCDP） policy on drug availability and the structure of drug use in public hospitals. METHODS Using hypoglycemic， lipid-lowering， antiviral drugs， and psychiatric drugs for the treatment of mental illness and depression as objects， the interrupted time series model was used to quantitatively evaluate the changes in consumption sum of drugs， consumption amount and daily cost of the target drugs in national sample hospitals as well as the changes in per capita medication frequency， outpatient prescription amount， and medical insurance surplus of target drugs in a third grade class A hospital before and after the implementation of NCDP policy. RESULTS After the implementation of the NCDP policy， the volume for the four bid-winning drugs increased significantly （P＜0.01 for the remaining three categories except for hypoglycemic drugs）， but DDDc （P＜0.01） and the amount of related drugs （P＜0.001） decreased significantly. The volume for the non-winning drugs （except for lipid-lowering drugs） decreased significantly （P＜0.05）， and DDDc also decreased significantly （P＜0.05 for other 3 categories except for psychiatric drugs）； the volume （P＜0.01） and DDDc （P＜0.01 only for psychiatric drugs） for alternative drugs all increased except for antiviral drugs. The structure of drug use for different drugs was affected differently by the NCDP policy，and that of hypoglycemic drugs was affected obviously； the proportion of alternative drugs increased after centralized procurement. The outpatient prescription amount of each hospital significantly decreased after centralized procurement，and the decrease in the cost paid by the patients using lipid-lowering and antiviral drugs related to centralized procurement was greater than 0.60； the remaining medical insurance amount for bid-winning drugs was approximately 1.252 5 million yuan. CONCLUSIONS NCDP policy effectively alleviates the burden of medical expenditure and also drives the structure changes of drug use such as the substitution of generic drugs for original drugs， the growth of the volume of alternative drugs.

Effects of the economic recession on suicide mortality in Brazil: interrupted time series analysis / Efectos de la recesión económica en la mortalidad por suicidio en Brasil: análisis de series de tiempo interrumpido / Efeitos da recessão econômica na mortalidade por suicídio no Brasil: análise com séries temporais interrompidas

ABSTRACT Objectives: to analyze trends in suicide rates in Brazil in the period before and after the start of the economic recession. Methods: interrupted time series research using national suicide data recorded in the period between 2012 and 2017 with socioeconomic subgroups analyses. Quasi-Poisson regression model was employed to analyze trends in seasonally adjusted data. Results: there was an abrupt increase in the risk of suicide after economic recession in the population with less education (12.5%; RR = 1.125; 95%CI: 1.027; 1.232) and in the South Region (17.7%; 1.044; 1.328). After an abrupt reduction, there was a progressive increase in risk for the black and brown population and for those with higher education. In most other population strata, there was a progressive increase in the risk of suicide. Conclusions: the Brazilian economic recession caused different effects on suicide rates, considering social strata, which requires health strategies and policies that are sensitive to the most vulnerable populations.

RESUMEN Objetivos: analizar tendencias de tasas de suicidio en Brasil, antes y después del inicio de la recesión económica. Métodos: estudio de series de tiempo interrumpido utilizando datos nacionales de suicidio registrados entre 2012 y 2017 con análisis por subgrupos socioeconómicos. Modelo de regresión quasi-Poisson empleado para analizar tendencias de datos ajustados estacionalmente. Resultados: observado aumento abrupto en el riesgo de suicidio pos recesión económica en la población con menor escolaridad (12,5%; RR = 1,125; IC95%:1,027; 1,232) y en la Región Sur (17,7%; 1,044; 1,328). Pos reducción abrupta, ocurrió aumento progresivo en el riesgo para la población de negros y pardos y de mayor escolaridad. En la mayoría de los demás estratos poblacionales, verificado aumento progresivo en el riesgo de suicidio. Conclusiones: la recesión económica brasileña produzco efectos diferentes en las tasas de suicidio, considerando los estratos sociales, lo que demanda estrategias de salud y políticas sensibles a poblaciones más vulnerables.

RESUMO Objetivos: analisar as tendências nas taxas de suicídio no Brasil, no período antes e depois do início da recessão econômica. Métodos: estudo de séries temporais interrompidas utilizando dados nacionais de suicídio registrados no período entre 2012 e 2017 com análises por subgrupos socioeconômicos. Modelo de regressão quasi-Poisson foi empregado para analisar as tendências dos dados ajustados sazonalmente. Resultados: observou-se aumento abrupto no risco de suicídio após recessão econômica na população com menor escolaridade (12,5%; RR = 1,125; IC95%:1,027; 1,232) e na Região Sul (17,7%; 1,044; 1,328). Após redução abrupta, ocorreu aumento progressivo no risco para a população de pretos e pardos e na de maior escolaridade. Na maioria dos demais estratos populacionais, verificou-se aumento progressivo no risco de suicídio. Conclusões: a recessão econômica brasileira produziu efeitos diferentes nas taxas de suicídio, considerando os estratos sociais, o que demanda estratégias de saúde e políticas sensíveis às populações mais vulneráveis.

Temporal trend of accidents due to percutaneous exposure in a public hospital in Brazil, 2007-2019 / Tendencia temporal de los accidentes por exposición percutánea en un hospital público en Brasil, 2007-2019 / Tendência temporal dos acidentes por exposição percutânea em um hospital público no Brasil, 2007-2019

ABSTRACT Objectives: to analyze the temporal trend of accidents due to percutaneous exposure in a public hospital in Brazil, between 2007 and 2019, according to sociodemographic and professional characteristics. Methods: analysis of time series of accidents due to percutaneous exposure that occurred in health workers. Sociodemographic and professional variables, accident profile, post-accident behavior and accident incidence rates were evaluated. The Prais Winsten regression was used for trend analysis and calculation of the annual percentage change, with a significance level of 5%. Results: 761 occupational accidents were recorded. There was a downward trend in the rate of percutaneous injuries among female workers (-0.012%; p=0.009), who had secondary education (-0.011%; p=0.035) and among all health professional categories (-0.010%; p =0.019). There was an increasing trend (0.018%; p= 0.050) among workers with ≥ 61 months of professional experience. Conclusions: the analysis showed a decreasing incidence of percutaneous accidents, which can be explained by multiple factors.

RESUMEN Objetivos: analizar tendencia temporal de accidentes por exposición percutánea en un hospital público brasileño, entre 2007 y 2019, segundo características sociodemográficas y profesionales. Métodos: análisis de series temporales de los accidentes por exposición percutánea ocurridos en trabajadores de salud. Fueron evaluadas las variables sociodemográficas, profesionales, perfil de los accidentes, conductas post-accidentes y tasas de incidencia de los accidentes. La regresión de Prais-Winsten fue empleada para análisis de tendencia y cálculo de la variación porcentual anual, con nivel de significación de 5%. Resultados: fueron registrados 761 accidentes ocupacionales. Hubo tendencia decreciente de la tasa de accidente percutáneo en trabajadores del sexo femenino (-0,012%; p=0,009), que poseían enseñanza media (-0,011%; p=0,035) y entre todas categorías profesionales de salud (-0,010%; p=0,019). Observado tendencia creciente (0,018%; p= 0,050) entre trabajadores con tiempo ≥ 61 meses de experiencia profesional. Conclusiones: el análisis evidenció incidencia decreciente de accidentes percutáneos, que puede ser explicada por múltiples factores.

RESUMO Objetivos: analisar a tendência temporal dos acidentes por exposição percutânea em um hospital público no Brasil, entre 2007 e 2019, segundo características sociodemográficas e profissionais. Métodos: análise de séries temporais dos acidentes por exposição percutânea ocorridos em trabalhadores de saúde. Foram avaliadas as variáveis sociodemográficas, profissionais, perfil dos acidentes, condutas pós-acidentes e as taxas de incidência dos acidentes. A regressão de Prais Winsten foi empregada para análise de tendência e cálculo da variação percentual anual, com nível de significância de 5%. Resultados: foram registrados 761 acidentes ocupacionais. Houve tendência decrescente da taxa de acidente percutâneo nos trabalhadores do sexo feminino (-0,012%; p=0,009), que possuíam ensino médio (-0,011%; p=0,035) e entre todas as categorias profissionais de saúde (-0,010%; p=0,019). Observou-se tendência crescente (0,018%; p= 0,050) entre trabalhadores com tempo ≥ 61 meses de experiência profissional. Conclusões: a análise evidenciou incidência decrescente de acidentes percutâneos, que pode ser explicada por múltiplos fatores.

Evaluation of mobile emergency service with the use of mixed method / Avaliação do serviço móvel de urgência com o uso de método misto / Evaluación de la atención móvil de urgencias con el uso del método mixto

This is an evaluative study, with sequential explanatory mixed methods, aimed at evaluating the performance of the Brazilian Mobile Emergency Medical Service (SAMU) in the Grande ABC region, located in the state of São Paulo, Brazil. In the quantitative approach, an analysis of interrupted time series was performed to evaluate the immediate and gradual effects of the SAMU on hospital mortality due to acute myocardial infarction. The qualitative approach was conducted via semi-structured interviews and a thematic analysis was applied for the interpretation of the results, exploring the attitudes and values of the interviewees regarding the performance of SAMU in the Grande ABC region. Interrupted time series analysis showed a -0.04% reduction in the underlying mortality rate since SAMU implementation (95%CI: -0.0816; -0.0162; p-value = 0.0040) and a reduction in the mortality level, -2.89 (95%CI: -4.3293; -1.4623; p-value = 0.0001), both with statistical significance. To improve the robustness of the results, a control region was used, showing a statistically significant difference in the post-intervention result of -0.0639 (95%CI: -0.1060; -0.0219; p-value = 0.0001). The interviews revealed that the SAMU has the potential to intervene in the prognosis of transported cases, however, challenges related to the availability of beds, expansion of telemedicine, and continuous training of professionals for qualified emergency care in the event of a heart attack must be overcome. The results indicate that the studied intervention is part of a set of factors that, together, generate more conditions to achieve a better result.

Estudo avaliativo com uso de métodos mistos na tipologia explanatória sequencial cujo objetivo foi avaliar o desempenho do Serviço de Atendimento Móvel de Urgência (SAMU) na região do Grande ABC, Estado de São Paulo, Brasil. Na abordagem quantitativa, foi realizada análise de séries temporais interrompidas para testar os efeitos imediatos e graduais da intervenção sobre a mortalidade hospitalar por infarto agudo do miocárdio. A abordagem qualitativa foi realizada através de entrevistas semi-estruturadas, e a análise temática foi aplicada para a interpretação dos resultados, explorando as atitudes e valores dos entrevistados em relação ao desempenho do SAMU no Grande ABC. A análise de série temporal interrompida mostrou uma redução de -0,04% na taxa de mortalidade subjacente desde a implementação do SAMU (IC95%: -0,0816; -0,0162; p = 0,0040) e uma redução no nível de mortalidade, de -2,89 (IC95%: -4,3293; -1,4623; p = 0,0001), ambas estatisticamente significativas. Para melhorar a robustez dos resultados, foi utilizada uma região de controle, o que mostrou uma diferença estatisticamente significativa na tendência pós-intervenção de -0,0639 (IC95%: -0,1060; -0,0219; p = 0,0001). De acordo com as entrevistas, o SAMU tem o potencial de intervir no prognóstico dos pacientes transportados; entretanto, em casos de infarto agudo do miocárdio, diversos desafios precisam ser superados, relacionados à disponibilidade de leitos, expansão da telemedicina e capacitação permanente das equipes de atendimento qualificado em emergências. Os resultados indicam que a intervenção faz parte de um conjunto de fatores que, conjuntamente, geram mais condições para alcançar melhores resultados.

Investigación evaluativa, utilizando métodos mixtos explicativos secuenciales, cuyo objetivo fue evaluar el desempeño del Servicio de Atención Móvil de Urgencia (SAMU) en una región de Brasil, denominada Grande ABC, estado de São Paulo, Brasil. En el enfoque cuantitativo, se realizó un análisis de series temporales interrumpidas para comprobar los efectos inmediatos y graduales de la intervención sobre la mortalidad intrahospitalaria por infarto agudo de miocardio. El enfoque cualitativo se llevó a cabo a través de entrevistas semiestructuradas y para la interpretación de los resultados se aplicó un análisis temático, investigando las actitudes y valores de los entrevistados sobre el desempeño del SAMU en la región Grande ABC. Los análisis de series de tiempo interrumpido mostraron una reducción -0,04% en la tasa de mortalidad subyacente desde la implementación del SAMU (IC95%: -0,0816; -0,0162; p = 0,0040) y una reducción en el nivel de mortalidad, -2,89 (IC95%: -4,3293; -1,4623; p = 0,0001), ambos con significación estadística. Con el fin de mejorar la solidez de los resultados, se utilizó un control de región, que mostró una diferencia estadísticamente significativa en la tendencia del resultado post intervención de -0,0639 (IC95%: -0,1060; -0,0219; p = 0,0001). Las entrevistas revelaron que el SAMU tiene el potencial de intervenir en la prognosis de los casos trasportados, sin embargo, deben superarse los desafíos relacionados con la disponibilidad de camas, expansión de la telemedicina y el entrenamiento continuo de profesionales para la asistencia cualificada en emergencias, en caso de un ataque al corazón. Los resultados indican que la intervención estudiada es parte de un conjunto de condiciones que, juntas, generan más condiciones para alcanzar un mejor resultado.

Monitoramento e projeções das metas de fatores de risco e proteção para o enfrentamento das doenças crônicas não transmissíveis nas capitais brasileiras / Monitoring and projection of targets for risk and protection factors for coping with noncommunicable diseases in Brazilian capitals

Resumo Monitorar as tendências e as projeções das metas de fatores de risco e proteção para o enfrentamento das doenças crônicas não transmissíveis nas capitais brasileiras e verificar se a crise econômica e as políticas de austeridade interferiram no comportamento dessas metas. Estudo de série temporal com dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico. Foram analisadas as tendências das prevalências de fumantes, obesidade, prática de atividade física, consumo de frutas e hortaliças e de bebidas alcoólicas, e suas projeções até 2025. Empregou-se a regressão de Prais-Winsten. Utilizou-se a Série Temporal Interrompida de 2006 a 2014 e 2015 a 2019. Entre 2006 e 2014, houve redução de fumantes e aumento da obesidade, do consumo de frutas e hortaliças, de atividade física e do uso de álcool. A maioria dos indicadores demonstrou pior desempenho a partir de 2015. Pelas projeções, as metas de deter a obesidade e reduzir o uso de álcool não seriam atingidas. Houve mudanças no comportamento dos indicadores, o que reforça a importância do monitoramento contínuo, e da sustentabilidade das ações, políticas e programas de promoção a saúde e de controle dessas doenças e seus fatores de risco.

Abstract This study aimed to monitor the trends and projections of targets of risk and protection factors for coping with noncommunicable diseases in Brazilian capitals and verify whether the economic crisis and austerity policies have interfered with these targets' behavior. This is a time-series study with data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey. We analyzed the trends in the prevalence of tobacco use, obesity, physical activity, consumption of fruits and vegetables, and alcohol abuse, and their projections until 2025. The Prais-Winsten regression was employed. We adopted the Interrupted Time-Series, considering the 2006-2014 and 2015-2019 periods. A reduction in tobacco use, increase in obesity, consumption of fruits and vegetables, physical activity, and alcohol use was observed between 2006 and 2014. Most indicators have shown worse performance since 2015. Projections foresee that targets for curbing obesity and alcohol abuse will not be achieved. Some changes were identified in the indicators profiles, reinforcing the importance of the continuous monitoring and sustainability of actions, policies, and programs to promote health and control these diseases and their risk factors.

Impacto da Lei Seca sobre a mortalidade no trânsito nas unidades federativas do Brasil: uma análise de série temporal interrompida / Impact of the Dry Law on road traffic mortality in Brazilian states: an interrupted time series analysis

RESUMO: Objetivo: Analisar o impacto da Lei 11.705, conhecida por "Lei Seca" (LS-08), sobre a mortalidade por acidentes de trânsito (AT) em cada uma das 27 unidades federativas (UF) do Brasil. Método: Estudo ecológico de séries temporais interrompidas com dados de AT entre 2002 a 2015, totalizando 168 meses. Os dados foram obtidos do Sistema de Informações sobre Mortalidade, do Instituto Brasileiro de Geografia e Estatística e do Departamento Nacional de Trânsito. Foram ajustados modelos auto-regressivos integrados de médias móveis (ARIMA) para analisar o impacto da LS-08 em cada UF. Resultados: Após a implantação da LS-08, a mortalidade por AT diminuiu significativamente no estado de Santa Catarina (pré-LS-08 = 2,60 ± 0,30 e pós-LS-08 = 2,32 ± 0,35; p < 0,001) e no Distrito Federal (pré-LS-08 = 2,22 ± 0,40 e pós-LS-08 = 1,76 ± 0,35; p = 0,002), aumentou significativamente nos estados do Acre, Amazonas, Rondônia, Maranhão, Piauí, Ceará, Rio Grande do Norte, Paraíba, Pernambuco, Alagoas, Sergipe e Mato Grosso e permaneceu estável nos demais. Análise de sensibilidade conduzida sob uma série temporal mais curta, com 24 meses, apresentou resultados semelhantes aos obtidos com a série de 168 meses para a maioria das 27 UF. Conclusão: A LS-08 exerceu impacto heterogêneo sobre a mortalidade por AT entre as UF.

ABSTRACT: Objective: To assess the impact of 2008 Public Law number 11,705, also known as Dry Law (DL-08), on mortality from road traffic accidents (RTA), in each of the 27 Brazilian Federative Units (BFUs). Methods: Ecological study of interrupted time series with RTA data from 2002 to 2015, totalizing 168 months. Data were obtained from the Mortality Information System, the Brazilian Institute of Geography and Statistics, and from the National Traffic Department. Autoregressive integrated moving average (ARIMA) models were adjusted to assess the impact of DL-08 in each BFUs. Results: After the implementation of the DL-08, there was a significant decrease in mortality from RTA in the state of Santa Catarina (pre DL-08 = 2.60 ± 0.30 and post DL-08 = 2.32 ± 0.35; p < 0.001) and in the Federal District (pre DL-08 = 2.22 ± 0.40 and post DL-08 = 1.76 ± 0.35; p = 0.002), a significant increase in mortality in the states of Acre, Amazonas, Rondônia, Maranhão, Piauí, Ceará, Rio Grande do Norte, Paraíba, Pernambuco, Alagoas, Sergipe and Mato Grosso, and a stability in the other states. The sensitivity analysis conducted over a shorter time series with 24 months showed results similar to those obtained with the 168-month series for most of the 27 BFUs. Conclusion: The DL-08 had a heterogeneous impact on mortality from traffic accidents on BFUs.

Phased study on the impact of diagnosis-intervention packet payment on hospitalization expenses / 中华医院管理杂志

Objective:To explore the change trend of average hospitalization expense and cost structure of inpatients after the implementation of diagnosis-intervention packet (DIP) payment reform in Zhuhai.Methods:The data of hospitalization expense and the proportion of each classification cost (i.e. the value of a classification cost per thousand yuan of medical cost) in Zhuhai before and after the reform were analyzed by interrupted time series method, and the changes of per capita hospitalization cost and cost structure were studied.Results:The average hospitalization expense showed a linear change trend before and after the reform, and the immediate level and the slope of regression line did not change significantly after the reform, which was basically consistent with the trend before the reform. After the implementation of DIP, the proportion of various categories of expenses changed. Among them, the proportion of comprehensive medical services, treatment, traditional Chinese medicine, western medicine, blood and blood products, and other categories changed significantly, P values were less than 0.05. There was no obvious change in the proportion of expenses of diagnosis, rehabilitation and traditional Chinese medicine, but there was a change in the immediate level. The change in the level of diagnosis was -13.649 ( P< 0.001), the change in the level of rehabilitation was -1.053 ( P< 0.001), and the change in the level of traditional Chinese medicine was 2.781 ( P< 0.001). The immediate level and trend change of the proportion of consumables after the reform was not obvious. Conclusions:After the implementation of DIP payment in Zhuhai, the average expense of inpatients has not changed significantly, but the expense structure has changed significantly.

Impacts of the clinics-pharmacy separation reform on outpatient CT utilization in Beijing / 中华医院管理杂志

Objective:To analyze the impacts of the clinics-pharmacy separation reform on outpatient CT utilization and provide policy recommendations for the rational use, refined management and subsequent price adjustment for large-scale imaging equipments.Methods:The number of outpatient CT examinations of a tertiary public hospital in Beijing from January 1st, 2015 to April 30th, 2019 was collected. Data were analyzed using single-and multi-group interrupted time series analysis model(ITS), along with qualitative interviews.Results:The number of CT examinations increased by 0.216 per 100 visits after the reform( P<0.001). The trend of changes(slope)in the number of CT examinations increased by 0.012 person-times/month( P<0.001). There were no statistically significant differences in the slope change of CT examinations between patients under Urban Employee Basic Medical Insurance and those under Urban Resident Basic Medical Insurance( P=0.504). Conclusions:The reform has significantly increased the utilization of outpatient CT examinations. However, the impacts of the reform may be similar among patients covered by different insurance systems. The qualitative interviews imply it as necessary to pay attention to the overworking status of relevant practitioners and be alert to the excessive use of large-scale imaging equipments.

Study on the impact of county medical community reform on the medical insurance fund expenditure in M county, Lincang city of Yunnan province / 中华医院管理杂志

Objective:To evaluate the impact of the reform of the county medical community on the expenditure of medical insurance funds, and to provide references for maintaining the stability of the medical insurance fund and deepening the reform of the medical community.Methods:Medical insurance data of urban and rural residents in M County, Yunnan province from 2016 to 2019 were collected, and a discontinuous time series model was used to analyze the impact of county medical community reform on medical insurance fund expenditures.Results:Since the reform, the number of patients discharged from county-level hospitals has shown a downward trend, averaging a decrease of 25.996 people per month; yet increases have emerged with the average hospitalization expenditure, the average hospitalization overall fund expenditure, and the average outpatient overall fund expenditure, averaging a monthly increase of 90.931 yuan, 50.014 yuan and 1.528 yuan respectively. The average hospitalization expenditure, the average hospitalization overall fund expenditure, and the average outpatient overall fund expenditure of the township hospitals all showed an upward trend, averaging a monthly increase of 31.191 yuan, 38.678 yuan and 0.085 yuan respectively. The flow of external medical insurance funds of the medical community has shown a continuous upward trend, averaging a monthly increase of hospitalization fund expenditures of 33.005 yuan, and a monthly increase of outpatient overall fund expenditures of 4.896 yuan overall.Conclusions:The M County medical community should further strengthen the top-level design, explore the reform of medical insurance payment methods, improve the regional information platform, standardize the referral system, and strengthen supervision to deepen the construction of the medical community to ensure the sustainable operation of medical insurance funds.

Interrupted time series analysis for impacts of the inclusion of group A and C meningococcal polysaccharide vaccine in the Expanded Program on Immunization on the incidence of meningococcal meningitis / 公共卫生与预防医学

Objective To evaluate the impact of the inclusion of (MPSV-AC) vaccine in the Expanded Program on Immunization (EPI) on the incidence of meningococcal meningitis. Methods Data on the incidence of meningococcal meningitis in Liaoning from 1995 to 2019 were collected, Interrupted time series (ITS) analysis was used to assess the level and slope change of the incidence of meningococcal meningitis before and after the inclusion of MPSV-AC vaccine in the EPI. Results Before the MPSV-AC vaccine was included in the EPI, the average annual incidence rate of meningococcal meningitis was 0.3442/100 000, the incidence rate showed a descending trend with an annual decrement of 0.0319/100 000. After the MPSV-AC vaccine was included in the EPI, the average annual incidence rate of meningococcal meningitis was 0.0151/100 000 and he incidence of meningococcal meningitis showed a descending trend with an annual decrement of 0.0042/100 000. Conclusion The incidence of meningococcal meningitis reduced after the inclusion of MPSV-AC vaccine in EPI，and the EPI strategy had a continuous effect on the decreasing trend of meningococcal meningitis incidence.

Spatial and temporal characteristics of reported schistosomiasis cases in China based on a Bayesian interrupted time-series model / 中国血吸虫病防治杂志

Objective To investigate the spatial-temporal characteristics of reported schistosomiasis cases in China from 2004 to 2017, so as to provide insights into the development of different schistosomiasis control strategies at various stages. Methods The monthly data of reported schistosomiasis cases at a provincial level of China from 2004 to 2017 were collected from the Public Health Science Data Center, and the spatial-temporal distribution of reported schistosomiasis cases was preliminarily identified using a descriptive statistical method. According to the goals at different stages proposed by the National Mid- and Long-term Program for Schistosomiasis Prevention and Control in China (2004—2015), a Bayesian interrupted time-series model was established to analyze the provincial reported incidence, time trend and seasonal variations of schistosomiasis in China at different stages. Results The reported schistosomiasis cases were mainly concentrated in 5 provinces of Anhui, Jiangsu, Jiangxi, Hubei and Hunan and 2 provinces of Sichuan and Yunnan in China from 2004 to 2017, and the number of reported cases in endemic areas decreased gradually. The incidence of reported schistosomiasis cases predominantly peaked during the period from May to September in the marshland and lake regions, while no regular seasonality was seen in hilly regions. Bayesian interrupted time-series analysis showed the peak incidence of reported schistosomiasis cases in 4 provinces of Anhui, Hubei, Hunan and Jiangxi between May and September and in Jiangsu Province from July to November; however, no regular seasonal cycle was identified in hilly regions. The number of reported schistosomiasis cases showed a tendency towards an increase in 2 provinces of Hubei and Hunan from 2008 to 2014, with a minor peak during the period between March and April, and since 2015, the seasonality was not remarkable any longer in 3 provinces of Anhui, Jiangsu and Jiangxi with a decline in the incidence of reported schistosomiasis cases, while the seasonality remained in Hubei Province. Conclusions The spatial-temporal characteristics of schistosomiasis in China, notably seasonality, vary at different control stages. Bayesian interrupted time-series model is effective to identify the spatial-temporal changes of schistosomiasis, and the schistosomiasis control strategy may be adjusted according to the spatial-temporal changes to improve the schistosomiasis control efficiency.

Application Management of Carbapenems in Tuberculosis Patients of Our Hospital Based on Multi-disciplinary Team / 中国药房

OBJECTIVE：To provide reference for the ra tional use of carbap enems in tuberculosis patients. METHODS ：Totally 12 576 tuberculosis inpatients were collected from our hospital. Multi-disciplinary team （MDT） model was adopted for carbapenems management in aspects of policy intervention ，technical support and staff training. Average hospitalization duration ， mortality，nosocomial infective rate ，use and drug resistance of carbapenems were compared before （Mar. 2016-Mar. 2017）and after management （Apr. 2017 to Mar. 2019）. Interrupted time series （ITS）analysis was used to analyze the utilization rate of carbapenems，DDDs，the proportion of carbapenems ’DDDs in the total antibiotics ’DDDs，the proportion of carbapenems ’cost in the total antibiotics ’cost before and after management. Pearson correlation analysis was conducted for DDDs of carbapenems with medical quality indicators and detection rate of carbapenems-resistant bacteria. RESULTS ：After the management ，average hospitalization stay ，the cost of antibiotics ，DDDs of carbapenems ，the proportion of carbapenems ’DDDs in the total antibiotics ’ DDDs，the proportion of carbapenems ’cost in the total antibiotics ’cost，the utilization rate of carbapenems ’，and the drug resistance rate of some bacteria to carbapenems were significantly lower than those before the management （P＜0.05）. ITS analysis results showed that after management ，the utilization rate of carbapenems ，DDDs，the proportion of com carbapenems’DDDs in the total antibiotics ’DDDs and the proportion of carbapenems ’cost in the total antibiotics ’cost hhyyzj@126.com were decrease d by 4.491％ ，220.276，6.535％ ，11.747％ ， with statistical significance （P＜0.05）. Co mpared with before management ，above indexes were decreased by 0.330％，17.625， 0.308％，0.304％ monthly，among which the utilization rate and DDDs of carbapenems were decreased significantly （P＜0.05）. Before management ，drug resistance rate of Pseudomonas aeruginosa to carbapenems was 21.80％，and those of Acinetobacter baumannii to meropenem and imipenem were both 4.60％；after management ，drug resistance rate of P. aeruginosa to imipenem was 13.00％，and those of A. baumannii to meropenem and imipenem were both 16.30％，with statistical significance before and after management （P＜0.05）. There was no statistical significance in drug resistance rate of Enterobacteriaceae （P＞0.05）. Pearson correlation analysis showed that carbapenems ’DDDs was significantly positively correlated with average hospitalization duration and antibiotics ’cost（P＜0.05）；imipenem’s DDDs was positively correlated with drug resistance rate of P. aeruginosa （P＜0.05）. CONCLUSIONS： MDT management can effectively standardize the use of carbapenem in tuberculosis patients ， shorten hospitalization duration ，and reduce drug cost ，DDDs and drug resistance rate of some bacteria.

The impact of ceasing mutual blood donation on voluntary blood donation in Guangzhou / 中国输血杂志

【Objective】 To investigate the impact of ceasing mutual blood donation on voluntary blood donation in Guangzhou. 【Methods】 The data of blood donation from July 2016 to December 2019 (42-month before and after the official cease of mutual blood donation) in the Blood Collection and Supply System of Guangzhou Blood Center, including whole blood donations and apheresis platelets donations, were collected for interrupted time series analysis by month. Blood donors who donated (either whole blood or platelets) during 2016 were followed up until December 31, 2019, and the re-donation rate was analyzed by Chi-square test, t test and logistic regression analysis. 【Results】 The results showed that ceasing mutual blood donation had a significantly positive effect on the increase of platelet donations, but had no significant effect on whole blood donation. In 2016, whole blood donations and platelet donations were mainly voluntary (86.4% and 60.8%, respectively). In comparison of voluntary blood donation, the overall blood deferral rate(by dual assays) of mutual blood donation was higher (P<0.01), but the difference diminished as they donated twice or more. The re-donation rate of blood donors (mutual non-remunerated, voluntary, or both) all increased after the ceasing of mutual blood donation (mutual non-remunerated, : 4.7% vs 4.0%, χ2=29.8, P<0.01; voluntary: 24.8% vs 9.9%, χ2=17295.3, P<0.01; both: 36.3% vs 28.1%, χ2=29.3, P<0.01). The re-donation rate of mutual platelet donors decreased after the ceasing of mutual blood donation, but the number of voluntary platelet donors increased. 【Conclusion】 The ceasing of mutual blood donation was in favour of voluntary blood donation in Guangzhou since various means had been previously adopted by Guangzhou Blood Center to create a long-term mechanism of voluntary blood donation. The number of voluntary blood donors has increased, and the clinical use of blood has been further guaranteed.

Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units

Abstract Background Infection control interventions can be erroneously interpreted if outcomes are assessed in short periods. Also, statistical methods usually applied to compare outcomes before and after interventions are not appropriate for analyzing time series. Aims To analyze the impact of a bundle directed at reducing the incidence of ventilator-associated pneumonia (VAP) and other device-associated infections in two medical-surgical intensive care units (ICU) in Brazil. Methods Our study had a quasi-experimental design. Interrupted time series analyses (ITS) was performed assessing monthly rates of overall healthcare-associated infections (HCAI), VAP, laboratory-confirmed central line associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI), from January 2007 through June 2019. Moreover, multivariate ITS was adjusted for seasonality in Poisson regression models. An intervention based on a bundle for VAP prevention was introduced in August 2010. Findings The intervention was followed by sustained reduction in overall HCAI, VAP and CLABSI in both ICU. Continuous post-intervention trends towards reduction were detected for overall HCAI and VAP. Conclusion Interventions aimed at preventing one specific site of infection may have sustained impact on other HCAI, which can be documented using time series analyses.