Temporal trend in the incidence of human visceral leishmaniasis in Brazil / Tendência temporal da incidência de leishmaniose visceral humana no Brasil

Abstract It is an ecological study that analyzed the time trend of visceral leishmaniasis incidence rates in Brazil using segmented time regression by joinpoints. There was a decreasing incidence rate of this disease in the country with an average annual percent change (AAPC) of -5 (CI95%: -9.1; -0.6) and a reduction of 1.69 cases/100 thousand inhabitants in 2007, and 0.91/100 thousand inhabitants in 2020. The Central-West region showed the highest reduction percent (AAPC: -9.1; CI95%: -13.8; -4.3), followed by the Southeast region (AAPC: -8.7; -14.6; -2.5). The North and South regions showed the largest number of joinpoints in the time series. The highest incidences were recorded in the male population, however, stable (AAPC: 2.14; CI95%: -8.3; 0). In the age group analysis, the trend was decreasing for the groups from 0 to 4 years old (AAPC: -7.7; CI95%: -12.6; -2.4), 5 to 9 years old (AAPC: -7.3; CI95%: -13.6; -0,4) and 10 to 14 years old (AAPC: -5.5; CI95%: -10.3; -0.3). It was found that although Visceral Leishmaniasis is an endemic disease in Brazil, there was a decrease in its incidence rate from 2007 to 2020.

Resumo Trata-se de um estudo ecológico que analisou a tendência temporal das taxas de incidência de leishmaniose visceral no Brasil mediante regressão temporal segmentada por pontos de inflexão. Observou-se tendência de decréscimo na taxa de incidência dessa patologia no país, com variação variação percentual média anual (average annual percent change - AAPC) de -5 (IC95%: -9,1; -0,6) e redução de 1,69 casos/100 mil habitantes em 2007, para 0,91/100 mil habitantes em 2020. A região Centro-Oeste apresentou a maior redução do AAPC (AAPC: -9,1; IC95%: -13,8; -4,3), seguida da região Sudeste (AAPC: -8,7; -14,6; -2,5). As regiões Norte e Sul apresentaram o maior número de pontos de inflexão (joinpoint) na série temporal. As maiores incidências foram registradas na população masculina, porém com tendência estacionária (AAPC: 2,14; IC95%: -8,3; 0). Na análise por faixa etária, a tendência foi decrescente nos grupos de 0 a 4 anos (AAPC: -7,7; IC95%: -12,6; -2,4), 5 a 9 anos (AAPC: -7,3; IC95%: -13,6; -0,4) e de 10 a 14 anos (AAPC: -5,5; IC95%: -10,3; -0,3). Verificou-se que, apesar de a leishmaniose visceral se tratar de uma doença endêmica no Brasil, houve declínio na sua taxa de incidência no período de 2007 a 2020.

Air pollution on daily outpatient visits for diabetes based on time series model / 公共卫生与预防医学

Objective To analyze the effect of air pollution on daily outpatient visits for diabetes, and to provide reference for the management of outpatients with diabetes. Methods Data on outpatient visits for diabetes in a hospital between July 1, 2018 to July 31, 2022 were collected. The correlation between air quality and daily outpatient visits due to diabetes was analyzed using distributed lag non-linear model (DLNM). Results The results showed that the increase in the concentrations of PM2.5 and PM10 in the air was related to the increase in the daily outpatient visits for diabetes, with a lagging effect. The accumulative effect in high PM2.5 concentration was statistically significant for both males and females, and the number of outpatients reached the maximum value at lag5 for males and at lag6 for females. The accumulative effect was not statistically significant either at low or high concentrations of PM2.5 in the young and middle-aged population. However，it was statistically significant in the elderly population, especially when exposed to high concentration of PM2.5, the daily outpatient visits increased significantly. Conclusion PM2.5, PM10 and other harmful pollutants in the air have an impact on the daily diabetic outpatients and increase their visits.

Características clínico-epidemiológicas e tendência temporal de casos novos de hanseníase com grau 2 de incapacidade física, no estado do Maranhão, 2011-2020 / Clinical-epidemiological characteristics and temporal trend of new cases of grade 2 disability leprosy in the state of Maranhão, Brazil, 2011- 2020 / Características clínico-epidemiológicas y tendencia temporal de los nuevos casos de lepra grado 2 de discapacidad en el estado de Maranhão, Brasil, 2011-2020

Objetivo: descrever as características clínico-epidemiológicas dos casos novos de hanseníase com grau 2 de incapacidade física e analisar sua tendência no estado do Maranhão, Brasil, 2011-2020. Métodos: estudo transversal descritivo e ecológico de série temporal, com dados do Sistema de Informação de Agravos de Notificação; realizou-se análise descritiva do evento segundo características sociodemográficas e clínico-laboratoriais dos casos; a tendência temporal da incidência do evento foi analisada pela regressão de Prais-Winsten. Resultados: dos 2.147 casos notificados, 71,5% foram do sexo masculino, 48,9% possuíam até 8 anos de estudo, 66,5% eram de raça/cor da pele parda, 95,5% da forma multibacilar, 58,8% da forma dimorfa e 32,3% com baciloscopia negativa no diagnóstico; observou-se estacionaridade na tendência no estado, e tendência decrescente na regional de saúde de São Luís (variação anual = -64,4%; intervalo de confiança de 95% -73,7;-51,9). Conclusão: a tendência da incidência foi estável no estado do Maranhão e decrescente em São Luís.

Objective: to describe the clinical and epidemiological characteristics of new cases of grade 2 disability leprosy and to analyze its trend in the state of Maranhão, from 2011 to 2020. Methods: this was a descriptive cross-sectional and ecological time-series study, using data from the Notifiable Health Conditions Information System. A descriptive analysis of the event was carried out according to the sociodemographic and clinical-laboratory characteristics of the cases. The temporal trend of event incidence was analyzed using Prais-Winsten regression. Results: of the 2,147 cases, 71.5% were male, 48.9% had up to 8 years of schooling, 66.5% were of mixed race/color, 95.5% had the multibacillary form, 58.8% were borderline, 32.3% had negative bacilloscopy at diagnosis. There was a stationary trend in the state and a falling trend in the São Luís Health Region (annual percentage change = -64.4%; 95% confidence interval: -73.7;-51.9). Conclusion: incidence trend was stable in the state of Maranhão and falling in São Luís.

Objetivo: describir las características clínicas y epidemiológicas de los nuevos casos de lepra con discapacidad física grado 2 y analizar su tendencia en el estado de Maranhão, de 2011 a 2020. Métodos: estudio transversal descriptivo y ecológico de serie temporal con datos del Sistema de Información de Agravamiento de Notificaciones. Se realizó un análisis descriptivo de características sociodemográficas y clínico-laboratoriales. La tendencia temporal de la incidencia de eventos se analizó mediante la regresión de Prais-Winsten. Resultados: de los 2.147 casos, 71,5% era masculino, 48,9% tenía hasta 8 años de escolaridad, 66,5% era de raza/piel parda, 95,5% de forma multibacilar, 58,8% dimorfa, 32,3% con baciloscopia negativa al diagnóstico. Hubo tendencia estacionaria en el estado y tendencia decreciente en la Región de Salud São Luís (variación anual = -64,4%; intervalo de confianza 95%: -73,7;-51,9). Conclusión: la tendencia de la incidencia se mantuvo estable en el estado de Maranhão y decreciente en São Luís.

High schistosomiasis-related mortality in Northeast Brazil: trends and spatial patterns

ABSTRACT Background: We analyzed the trends and spatial patterns of schistosomiasis-related mortality in Northeast Brazil in 2000-2019. Methods: A mixed population-based ecological study was conducted, using information on the underlying or associated causes of death. We used Joinpoint regression analysis to calculate the trends. The spatial analysis included rates, spatial moving averages, and standardized mortality rates. The spatial dependence analysis was based on Getis-Ord's G and Gi* indices (Gi star) and local Moran's index to check for autocorrelation. Results: A total of 5,814,268 deaths were recorded, of which 9,276 (0.16%) were schistosomiasis-related; 51.0% (n=4,732, adjusted rate 0.90/100,000 inhabitants [95% confidence interval (CI) 0.88-0.93]) were males; 40.0% (n=3,715, adjusted rate 7.40/100.000 inhabitants [95%CI: 7.16-7.64]) were ≥70 years old; 54.8% (n=5,087, crude rate 0.80/100,000 inhabitants) were of mixed/Pardo-Brazilian ethnicity; and 77.9% (n=7,229, adjusted rate 0.86/100,000 inhabitants [95%CI: 0.84-0.88]) lived outside state capitals. The highest proportion of deaths was in the state of Pernambuco (53.9%, n=4,996, adjusted rate 2.72/100,000 inhabitants [95%CI: 2.64-2.79]). Increasing mortality rate was verified in the state of Sergipe. On the coast of the state of Rio Grande do Norte and Bahia, there was spatial dependence of spatio-temporal risk patterns with clusters. Throughout the study period, we found positive spatial autocorrelation and cluster formation. Conclusions: In Northeast Brazil, schistosomiasis persists with a high mortality rate, especially in the coastal region, with heterogeneous spatial and temporal patterns. To eliminate schistosomiasis by 2030, it is necessary to strengthen the financing and management of the unified health system (SUS).

Tendências temporais da mortalidade no município de Lagarto, Nordeste do Brasil / Temporal trends of mortality in the city of Lagarto, Northeast of Brazil / Tendencias temporales de la mortalidad en el municipio de Lagarto, Nordeste de Brasil

Objetivo: Analisar as tendências temporais e o perfil epidemiológico das principais causas de mortalidade em residentes do município de Lagarto, Sergipe, entre 2006 a 2015. Métodos: Estudo epidemiológico, descritivo e de série histórica, através de dados secundários dos óbitos notificados no Sistema de Informação de Mortalidade (SIM). A análise das tendências temporais foi realizada pelo Programa Joinpoint Regression obtendo-se a variação percentual anual (APC) das taxas de mortalidade por meio da regressão Possion. Resultados: Foram notificados 5.586 óbitos, com predomínio do sexo masculino e idosos, 58% e 59,61% respectivamente. Observou-se um aumento da taxa de mortalidade geral de 1,58% ao ano (IC95%: 0,5 a 2,6; p=0,01). Somente as taxas de mortalidade infantil (TMI) e de seus componentes apresentaram tendências decrescentes. Conclusão: Apesar da tendência decrescente das TMI, as mesmas requerem ações especializada, bem como para a redução da mortalidade por doenças crônicas

Objective: The study's purpose has been to analyze the temporal trends and the epidemiological profile of the main causes of mortality in residents of the Lagarto City, Sergipe State, between 2006 and 2015. Methods: This is an epidemiological, descriptive and historical series study, through secondary data on deaths reported in Sistema de Informação de Mortalidade (SIM) [Mortality Information System]. The analysis of temporal trends was performed by the Joinpoint Regression Program, obtaining the Annual Percentage Change (APC) of mortality rates through Possion Regression. Results: 5,586 deaths were reported, with men predominating 58% and the elderly people 59.61%. There was an increase in the overall mortality rate of 1.58% per year (95% CI 0.5 to 2.6, p = 0.01). Only Infant Mortality Rates (IMR) and their components showed declining trends. Conclusion: Despite the decreasing tendency of the IMR, they require specialized actions, as well as the reduction of mortality due to chronic diseases

Objetivo: Analizar las tendencias temporales y el perfil epidemiológico de las principales causas de mortalidad en residentes de la ciudad de Lagarto, Sergipe, entre 2006 y 2015. Método: series epidemiológicas, descriptivas e históricas, a través de datos secundarios sobre muertes relatadas en la Mortalidad Información SIM). El análisis fue realizado por el Programa de Regresión del Joinpoint, obteniendo Variaciones de las tasas de mortalidad a través de la Posibilidad de regresión. Resultados: 5.586 muertes fueron reportadas, con predominio de hombres 58% y ancianos 59.61%. Se observó un aumento en la tasa de mortalidad global del 1,58% anual (IC 95%: 0,5 a 2,6, p = 0,01). Sólo las tasas de mortalidad infantil (IMR) y sus componentes presentaron tendencias en declive. Conclusión: A pesar de la tendencia decreciente del IMR, ellos requieren acciones especializadas, así como la reducción de la mortalidad por enfermedades crónicas

Lagged effect of temperature on non-accidental mortality and years of life lost in Wuxi: a time-series study / 中华疾病控制杂志

Objective To evaluate the effect of air temperature on non-accidental mortality (A00-R99) and years of life lost in Wuxi city. Methods Data on daily non-accidental mortality and meteorology index were collected from 2012 to 2017. Distributed lag non-linear model (DLNM) was used to assess the effect of temperature on non-accidental death and YLL and the cumulative effects between cold and hot temperature on non-accidental mortality and years of life lost with different lag days. Results A V-shaped relationship was noticed between temperature and mortality. Cold effects were delayed by 3 days and persisted for 14 days. Hot effects appeared acute and reached the peak at the same day. Low temperature had stronger gross effect than high temperature had. There were differences of temperature effects between different age and gender groups. Conclusions Low and high temperature were associated with elevated mortality risk. Cold effect had lagged effect and persisted for long time, however, hot effects appeared acute and the impact of low temperature was greater.

Tendência da mortalidade por tuberculose no estado do Paraná, Brasil - 1998 a 2012 / Tuberculosis mortality trend in the state of Paraná, Brazil - 1998-2012

Resumo O objetivo foi analisar a tendência da mortalidade por tuberculose no Paraná, no período de 1998 a 2012, segundo macrorregionais de saúde, sexo e faixa etária. Estudo ecológico de séries temporais, com dados do Sistema de Informações de Mortalidade do Sistema Único de Saúde (SIM/SUS). A análise da tendência dos coeficientes de mortalidade padronizados foi realizada por meio de regressão linear segmentada com identificação dos pontos com modificação da tendência. Houve 847 mortes de residentes no Paraná, no período. Inicialmente, a tendência foi decrescente para o estado, com posterior incremento significativo apenas para a macrorregional Leste. A mortalidade por tuberculose apresentou tendência crescente para as faixas etárias de 20 a 39 anos e 40 a 49 anos, e para o sexo masculino. A tendência crescente da mortalidade por tuberculose, observada a partir de 2010, é um alerta para gestores aprimorarem o atendimento nos diversos níveis de atenção à saúde.

Abstract The objective was to analyze the trend in tuberculosis mortality in Paraná from 1998 to 2012, according to healthcare macro-region-al, gender and age. Ecological study of time series data with the system of the Unified System Mortality Information Health (SIM/SUS). Trend analysis of standardized mortality rates was performed by linear regression segmented identifying the points with the change trend. There were 847 deaths of residents in Paraná in the period. The trend was initially declining to state, with subsequent significant increase only for the macro-regional East. Mortality from tuberculosis showed growing trend for the age groups 20-39 years and 40-49 years and for males. The growing trend in tuberculosis mortality was observed from 2010 is a warning to managers honing the service at different levels of health care.

Mortalidade infantil nas regiões de saúde de Santa Catarina / Infant mortality in Santa Catarina's health regions

O objetivo deste estudo foi verificar a tendência temporal da mortalidade infantil e suas principais causas entre as regiões de saúde de Santa Catarina entre 2004 e 2013. Estudo ecológico de séries temporais em que foram calculadas a Taxa de Mortalidade Infantil (TMI) geral e pelas principais causas de óbito infantil em Santa Catarina e suas Regiões de Saúde. Foi analisada a tendência temporal dos coeficientes por regressão linear simples e verificada possível autocorrelação serial. Houve 10076 óbitos infantis em Santa Catarina no período do estudo; a TMI reduziu de 13,61 para 10,46, sendo as principais causas relacionadas às afecções do período perinatal e às malformações congênitas. No período analisado, doze regiões diminuíram a TMI por afecções do período perinatal e dez regiões aumentaram a TMI por malformações congênitas. Observou-se tendência temporal de redução significativa da TMI geral e da TMI por afecções originadas do período perinatal. Porém, ocorreu aumento da proporção entre a TMI por malformações congênitas, deformidades e anomalias cromossômicas em relação a TMI geral.

Verify the temporal trend of the infant mortality and its main causes among the state's Health Regions of Santa Catarina between 2004 and 2013. Ecological time series study in which were calculated the overall and main causes' Infant Mortality Rate (IMR) in Santa Catarina and its Health Regions; the state's rates were analyzed by simple linear regression. There were 10.076 infant deaths in Santa Catarina during the studied period; the IMR decreased from 13,61 to 10,45, the main causes are related to disorders of the perinatal period and congenital malformations; twelve regions showed a decrease in their IMR for disorders of the perinatal period and ten regions showed an increase in their IMR for congenital malformations. We observed a significant reduction of time trends in general IMR and child mortality rate for conditions originating in the perinatal period. However, there was an increase in the proportion between the infant mortality rate for congenital malformations, deformations and chromosomal abnormalities and the overall infant mortality rate.

Acute effect of air pollutants (carbon monoxide and ozone) on myocardial infarction mortality in Ningbo / 中华流行病学杂志

Objective To explore the effect of carbon monoxide (CO) and ozone (O3) in the air on the myocardial infarction mortality in Ningbo,Zhejiang province,from 2011 to 2015.Methods The data of daily air quality surveillance and the causes of deaths in Ningbo from January 1,2011 to December 31,2015 were collected and the time series study using a generalized additive model was conducted to evaluate the relationship between the mortality of myocardial infarction and the air pollutants after adjustment for the long-term trend of death,weather conditions,"days of the week" and other confounding factors.Results The daily average concentrations of CO and O3 in Ningbo during 2011-2015 were 0.90 (0.02-3.31) mg/m3 and 82.78 (4-236) μg/m3,respectively.A total of 5 388 myocardial infarction deaths occurred,with a daily average of 3 deaths.In single-pollutant model,an increase of 0.1 mg/m3 in average concentration of CO could increase the risk of myocardial infarction mortality by 1.06％ (95％ CI:0.29％-1.93％) in general population,and by 1.26％ (95％ CI:0.28％-2.24％) in aged people aged ≥65 years in lagged 6 days,but the influence was not significant in people aged ＜65 years.The influence had no significant difference in males,but it increased the risk of myocardial infarction mortality by 1.77％ in females (95％ CI:0.44％-3.13％).In multipollutant model,CO did remain robust after adjusting for other co-pollutants.Whereas the effect of O3 had no significant influence.Conclusion These findings suggested that the increased risk of daily myocardial infarction mortality was associated with the increase of CO concentration,but no such association was found for O3 in Ningbo.

Acute effect of air pollutants (carbon monoxide and ozone) on myocardial infarction mortality in Ningbo / 中华流行病学杂志

Objective To explore the effect of carbon monoxide (CO) and ozone (O3) in the air on the myocardial infarction mortality in Ningbo,Zhejiang province,from 2011 to 2015.Methods The data of daily air quality surveillance and the causes of deaths in Ningbo from January 1,2011 to December 31,2015 were collected and the time series study using a generalized additive model was conducted to evaluate the relationship between the mortality of myocardial infarction and the air pollutants after adjustment for the long-term trend of death,weather conditions,"days of the week" and other confounding factors.Results The daily average concentrations of CO and O3 in Ningbo during 2011-2015 were 0.90 (0.02-3.31) mg/m3 and 82.78 (4-236) μg/m3,respectively.A total of 5 388 myocardial infarction deaths occurred,with a daily average of 3 deaths.In single-pollutant model,an increase of 0.1 mg/m3 in average concentration of CO could increase the risk of myocardial infarction mortality by 1.06％ (95％ CI:0.29％-1.93％) in general population,and by 1.26％ (95％ CI:0.28％-2.24％) in aged people aged ≥65 years in lagged 6 days,but the influence was not significant in people aged ＜65 years.The influence had no significant difference in males,but it increased the risk of myocardial infarction mortality by 1.77％ in females (95％ CI:0.44％-3.13％).In multipollutant model,CO did remain robust after adjusting for other co-pollutants.Whereas the effect of O3 had no significant influence.Conclusion These findings suggested that the increased risk of daily myocardial infarction mortality was associated with the increase of CO concentration,but no such association was found for O3 in Ningbo.

Relationship between particulate matters and cardio-cerebrovascular mortality in Ningbo: a time-series study / 中华流行病学杂志

Objective To explore the short-term effect of particulate matters with an aerodynamic diameter of less than or equal to 10 μg (PM10) and aerodynamic diameter of less than or equal to 2.5 μg (PM2.5) on cardio-cerebrovascular mortality in Ningbo city.Methods Daily cardiocerebrovascular mortality data from 2011 to 2014 in Ningbo city were collected and the time series study using a semi-parametric generalized additive model were used to evaluate the relationship between the mortality of cardio-cerebrovascular disease and particulate matters after adjustment for the long-term trend of death,weather conditions,"days of the week" and other confounding factors.Results In single-pollutant model,the short-term effects of particulate matter on cardio-cerebrovascular mortality was strongest in lagged 2 days in Ningbo city,and an increase of 10 μg/m3 in moving average concentrations (lagged 2-3 days and lagged 2-4 days) of PM2.5 and PM10 could increase the cardio-cerebrovascular mortality by 0.55％ (0.23％-0.87％) and 0.53％ (0.28％-0.78％),respectively.In multi-pollutant models,PM10 did remain robust after being adjusted for PM2.5 with 0.58％ (0.09％-1.07％) increase in cardio-cerebrovascular mortality.The effect of PM2.5 had no statistical significantce after being adjusted for other co-pollutants.Conclusion These findings suggested that the concentrations of ambient particulate matters were associated with an increased risk of daily cardio-cerebrovascular mortality in Ningbo city.

Relationship between particulate matters and cardio-cerebrovascular mortality in Ningbo: a time-series study / 中华流行病学杂志

Objective To explore the short-term effect of particulate matters with an aerodynamic diameter of less than or equal to 10 μg (PM10) and aerodynamic diameter of less than or equal to 2.5 μg (PM2.5) on cardio-cerebrovascular mortality in Ningbo city.Methods Daily cardiocerebrovascular mortality data from 2011 to 2014 in Ningbo city were collected and the time series study using a semi-parametric generalized additive model were used to evaluate the relationship between the mortality of cardio-cerebrovascular disease and particulate matters after adjustment for the long-term trend of death,weather conditions,"days of the week" and other confounding factors.Results In single-pollutant model,the short-term effects of particulate matter on cardio-cerebrovascular mortality was strongest in lagged 2 days in Ningbo city,and an increase of 10 μg/m3 in moving average concentrations (lagged 2-3 days and lagged 2-4 days) of PM2.5 and PM10 could increase the cardio-cerebrovascular mortality by 0.55％ (0.23％-0.87％) and 0.53％ (0.28％-0.78％),respectively.In multi-pollutant models,PM10 did remain robust after being adjusted for PM2.5 with 0.58％ (0.09％-1.07％) increase in cardio-cerebrovascular mortality.The effect of PM2.5 had no statistical significantce after being adjusted for other co-pollutants.Conclusion These findings suggested that the concentrations of ambient particulate matters were associated with an increased risk of daily cardio-cerebrovascular mortality in Ningbo city.

Impact of air temperature on years of life lost among residents in Guangzhou and Zhuhai:a ;time-series study / 中华流行病学杂志

Objective To evaluate the impacts of air temperature on years of life lost(YLL) among the residents in Guangzhou and Zhuhai,Guangdong province. Methods Daily mortality and meteorology data in Guangzhou and Zhuhai were collected,and distributed lag non-linear model (DLNM)was used to evaluate the cumulative and delayed effects of daily air temperature on YLL of total non-accident mortality. The accumulative effect of air temperature on mortality under the extreme high temperature(0-1 days)and extreme low temperature(0-13 days)situation in Guangzhou and Zhuhai were analyzed respectively. Results The average YLL was 1 928.0 in Guangzhou and 202.5 in Zhuhai. The exposure-response functions seemed to be non-linear. The hot effect seemed to be acute and reached the peak at the same day,while the cold effect reached the peak at 5th days and lasted for about two weeks. Low temperature had stronger gross effect than high temperature had. The cold effect among males was greater than that among females in Guangzhou. The hot/cold effect on YLL was greater in people aged ≥65 years than in people aged <65 years and in people suffering from respiratory disease than in people suffering from cardiovascular disease in both Guangzhou and Zhuhai. Conclusion The effects of high and low temperatures on YLL were obvious,and the impact of low temperature was greater. The elderly and people suffering from respiratory disease or cardiovascular disease are the vulnerable populations.

Impact of air temperature on years of life lost among residents in Guangzhou and Zhuhai:a ;time-series study / 中华流行病学杂志

Objective To evaluate the impacts of air temperature on years of life lost(YLL) among the residents in Guangzhou and Zhuhai,Guangdong province. Methods Daily mortality and meteorology data in Guangzhou and Zhuhai were collected,and distributed lag non-linear model (DLNM)was used to evaluate the cumulative and delayed effects of daily air temperature on YLL of total non-accident mortality. The accumulative effect of air temperature on mortality under the extreme high temperature(0-1 days)and extreme low temperature(0-13 days)situation in Guangzhou and Zhuhai were analyzed respectively. Results The average YLL was 1 928.0 in Guangzhou and 202.5 in Zhuhai. The exposure-response functions seemed to be non-linear. The hot effect seemed to be acute and reached the peak at the same day,while the cold effect reached the peak at 5th days and lasted for about two weeks. Low temperature had stronger gross effect than high temperature had. The cold effect among males was greater than that among females in Guangzhou. The hot/cold effect on YLL was greater in people aged ≥65 years than in people aged <65 years and in people suffering from respiratory disease than in people suffering from cardiovascular disease in both Guangzhou and Zhuhai. Conclusion The effects of high and low temperatures on YLL were obvious,and the impact of low temperature was greater. The elderly and people suffering from respiratory disease or cardiovascular disease are the vulnerable populations.

Tendência das taxas de mortalidade infantil e de seus componentes em Guarulhos-SP, no período de 1996 a 2011 / Trends in infant mortality rates and its components in Guarulhos, SP, 1996-2011 / Tendencia de las tasas de mortalidad infantil y de sus componentes en Guarulhos-SP, en el período de 1996 a 2011

Objetivo: analisar as tendências das taxas de mortalidade infantil (TMI) e seus componentes em Guarulhos-SP, no período 1996-2011. Métodos: regressão linear segmentada, para estimar as variações percentuais anuais (VPA). Resultados: em 1996, a TMI e de seus componentes neonatal precoce, neonatal tardio e pós-neonatal foram, respectivamente, de 31,6, 16,7, 3,4 e 11,6 por 1000 nascidos vivos; em 2011, essas taxas foram de 12,6, 5,9, 1,6 e 5,1 respectivamente; houve diminuição significativa das TMI em todo o período; de 1996 a 2002, a VPA foi de -9,9, e de 2002 a 2011, foi de -3,7; o componente neonatal apresentou igual padrão; o componente neonatal precoce apresentou diminuição de 1996 a 2002 (VPA: -12,8), permanecendo estável até 2011; verificou-se diminuição do componente neonatal tardio de 1996 a 2009 (VPA: -2,8); o componente pós-neonatal apresentou redução em todo o período (VPA: -5,7). Conclusão: observou-se tendência de diminuição das TMI e de seus componentes...

Objective: to analyze trends in infant mortality rates (IMR) and its components in Guarulhos-SP. Methods: Segmented linear regression was used to estimate annual percentage changes (APC). Results: in 1996, IMR and the rates of its early neonatal, late neonatal and post-neonatal components were, respectively, 31.6, 16.7, 3.4, and 11.6 per 1000 live births compared to 12.6, 5.9, 1.6, and 5.1 in 2011. IMR decreased significantly during the period studied. Between 1996 and 2002, APC was -9.9 compared to -3.7 between 2002 and 2011. The neonatal component maintained the same pattern. The early neonatal component tended to decline between 1996 and 2002 (APC=2.8) and remained stable thereafter. The late neonatal component decreased between 1996 and 2009 (APC=-2.8). The post-neonatal component tended to decrease throughout the period (APC=-5.7). Conclusion: there were decreasing trends in infant mortality rates and infant mortality components...

OBJETIVO: evaluar la tendencia de la prevalencia de diabetes mellitus autorreferida en las capitales brasileñas, entre 2006 y 2012.MÉTODOS: estudio ecológico con datos de la Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas por Encuesta Telefónica (Vigitel) referentes a adultos (≥18 años), analizados por medio de regresión lineal simple.RESULTADOS: en el período estudiado, hubo tendencia de aumento de 5,7% para 7,4% en el conjunto de la población adulta de las capitales (p=0,008), de 4,8% para 6,5% entre hombres (p=0,002) y de 6,4% para 8,1% entre mujeres (p=0,039); la elevación entre mujeres ocurrió en 9 capitales - Belém-PA, Belo Horizonte-MG, Curitiba-PR, Macapá-AP, Maceió-AL, Palmas-TO, Recife-PE, Rio Branco-AC y Vitória-ES -; y entre hombres, en 6 capitales - Boa Vista-RR, Florianópolis-SC, Fortaleza-CE, Rio Branco-AC, Rio de Janeiro-RJ y São Paulo-SP.CONCLUSIÓN: hubo aumento de la prevalencia de la diabetes en diversas capitales brasileñas; el monitoreo de las tendencias y factores de riesgo es útil a la planificación en la salud...

Tendência temporal de afastamento do trabalho por transtornos mentais e comportamentais em enfermeiros (1998-2008) / Time trends of sick leave at work by mental and behavioral disorders of nurses (1998-2008)

O absenteísmo decorrente de doenças relacionadas ao trabalho vem sendo considerado um problema de saúde pública devido ao impacto causado em termos sociais, organizacionais e individuais. O objetivo do presente estudo foi identificar a tendência temporal da prevalência dos afastamentos do trabalho por transtornos mentais e comportamentais relacionados ao trabalho em enfermeiros de um hospital geral. Trata-se de estudo exploratório de séries temporais com utilização de dados secundários. Foram analisados 375 afastamentos de enfermeiros de um hospital no período de 1998 a 2008. A análise de tendência foi realizada pelo procedimento de Prais-Winsten. A tendência de taxas de afastamento foi de aumento, em média, de 1% ao ano. As taxas mais elevadas foram de transtornos do humor (F30-39), 46,7%; e transtornos neuróticos, transtornos relacionados com o estresse e transtornos somatoformes (F40-48), 31,5%. A tendência de aumento reflete mudanças no perfil de morbidade dos enfermeiros. O estudo indica a necessidade de monitoramento da tendência de absenteísmo por transtornos mentais e comportamentais relacionados ao trabalho e sugere a investigação de fatores associados a fim de subsidiar intervenções de promoção, reabilitação e reintegração ao trabalho.

The absenteeism resulting from work-related illnesses has been considered a public health problem due to social, organizational, and individual impacts. This study aimed to identify the trends over time of the prevalence of sick leave for work-related mental and behavioral disorders in nurses at a general hospital. This is an exploratory time-series study using secondary data. The record of 375 sick leave requests from nurses at a hospital, in the period from 1998 to 2008, were analyzed. The trend was analyzed using the Prais-Winsten procedure. The sick leave trend shows an increase of 1% per year on average. The highest levels were from mood disorders (F30-39), 46.7%; and neurotic, stress-related, and somatoform (F40-48) disorders, 31.5%. The trending increase reflects changes in the morbidity profile of the nurses. This study indicates the need to monitor the absenteeism trend caused by work-related mental and behavioral disorders, and suggests fuller investigation of the factors associated with this problem in order to support interventions for promotion, rehabilitation, and work reintegration.

Asma e poluentes ambientais: um estudo de séries temporais / Asthma and ambient pollutants: a time series study

OBJETIVO: O objetivo deste estudo foi estimar o risco para internação por asma em crianças após exposição a poluentes do ar em uma cidade de porte médio do Sudeste do Brasil. MÉTODOS: Foi realizado um estudo ecológico de séries temporais com dados de internação por asma em crianças com até 10 anos de idade residentes em São José dos Campos, SP, e concentrações de material particulado com diâmetro aerodinâmico inferior a 10 micra, dióxido de enxofre e ozônio; foram obtidos dados sobre umidade relativa do ar e temperaturas. Foram estimados os coeficientes de correlação de Pearson para as variáveis do estudo. Para estimar a associação entre as internações por asma e os poluentes do ar, foram construídos modelos aditivos generalizados de regressão de Poisson, segundo defasagens de até sete dias. RESULTADOS: Houve forte correlação entre as internações e os poluentes material particulado e dióxido de enxofre. Exposições a material particulado e dióxido de enxofre estiveram associadas a riscos relativos significativos de 1,01 a 1,04 para internação por asma no mesmo dia e em até três dias após a exposição. Aumentos nas concentrações destes poluentes elevam o risco de internação entre 8% e 19%. CONCLUSÃO: Assim, apresentaram-se evidências da ação de poluentes do ar na internação por asma em uma cidade de porte médio do Sudeste do Brasil.

OBJECTIVE: To estimate the risk of hospitalization for asthma in children after exposure to air pollutants in a medium-sized city in Southeast Brazil. METHODS: An ecological time series study was carried out with hospitalization data for asthma in children under 10 years of age living in São José dos Campos, SP, Brazil, and concentrations of particulate matter with aerodynamic diameter < 10 microns, sulfur dioxide, and ozone; data were also obtained on relative humidity and temperatures. Pearson's coefficient correlation was used for the study variables. To estimate the association between hospitalizations due to asthma and air pollutants, Poisson regression generalized additive models were built, according to lags of up to seven days. RESULTS: There was a strong correlation between hospitalizations and the pollutants particulate matter and sulfur dioxide. Exposure to particulate matter and sulfur dioxide were associated with significant relative risks of 1.01 to 1.04 of hospitalization due to asthma on the same day and within three days after exposure. Increases in the concentrations of these pollutants increase the risk of hospitalization between 8% and 19%. CONCLUSION: There is evidence of the effect of air pollutants on asthma hospitalization in a medium-sized city in Southeast Brazil.

The impact of temperature on cardiovascular disease deaths in 4 cities, China: a time-series study / 中华流行病学杂志

Objective To estimate the effects of temperature on cardiovascular disease (CVD) deaths in 4 cities-Kunming,Changsha,Guangzhou and Zhuhai,from southern part of China.Methods Daily CVD deaths,meteorological and air pollution data were used to explore the association between temperature and mortality.Distributed lag non-linear model was fitted for each city to access the delayed and cumulative effects of low,median and high temperature on CVD deaths.Cold and hot effects of temperature on CVD deaths were then accessed,based on the linear threshold model.Results The city-specific exposure-response functions appeared to be non-linear.Temperatures that associated with the lowest mortality for Changsha,Kunming,Guangzhou and Zhuhai were 22.0 ℃,20.0 ℃,26.0 ℃,and 25.5 ℃.The greatest cumulative RRs (95％CI) for CVD deaths of low temperature during the delayed period of the study in the 4 cities were 1.858 (1.089-3.170),1.537 (1.306-1.809),2.121 (1.771-2.540) and 1.934 (1.469-2.548),while 1.100 (0.816-1.483),1.061 (0.956-1.177),1.134 (1.047-1.230) and 1.259 (1.104-1.436) for high temperatures in Changsha,Kunming,Guangzhou and Zhuhai respectively.The hot effect was greater than the cold effect on the current days.The hot effect was restricted to the first week,whereas the cold effect increased over the lag days,and then last for 3-4 weeks.Conclusion The city-specific exposure-response functions appeared to be non-linear.Both high and cold temperatures were associated with increased CVD deaths,but the impact of low temperature was more notable.Cold effect was delayed by several days but last for a longer period than the hot effect did.

Mortalidade por doenças do aparelho circulatório no município de Ribeirão Preto - SP, de 1980 a 2004 / Mortality rates due to diseases of the circulatory system (DCS) in Ribeirão Preto - SP, from 1980 to 2004 / Mortalidad por enfermedades del aparato circulatorio en el municipio de Ribeirão Preto-SP, del 1980 a 2004

Fundamento: No âmbito da transição epidemiológica, estudos de tendência secular podem subsidiar a formulação de hipóteses para o gerenciamento em Saúde. Objetivo: Identificar o padrão de mortalidade por doenças do aparelho circulatório (DAC) no município de Ribeirão Preto, SP, no período de 1980 a 2004. Métodos: Os óbitos por DAC foram obtidos do Sistema de Informações sobre Mortalidade (SIM). As estimativas populacionais para o município, segundo sexo, faixa etária e anos-calendário, foram obtidas do Instituto Brasileiro de Geografia e Estatística (IBGE). Os coeficientes específicos de mortalidade foram calculados, anualmente, segundo sexo e faixa etária classificada em intervalos de 10 anos, a partir dos 30 anos de idade. O estudo de tendência foi realizado por meio da construção de modelos de regressão polinomial para séries históricas, adotando-se nível de significância < 0,05. Resultados: Os coeficientes específicos de mortalidade por DAC aumentaram com a idade, em ambos os sexos, sendo mais elevados no sexo masculino até a faixa etária de 40 a 49 anos, quando ocorreu aproximação em magnitude, sendo que, na faixa etária de 80 anos ou mais, esses indicadores, no sexo feminino e em alguns anos da série, ultrapassaram os do sexo masculino. Ao longo do período estudado, em ambos os sexos...

Introduction: In terms of epidemiologic transition, century-long trend studies may act as subsidies for health management hypotheses. Objective: Identify mortality rate pattern for diseases of the circulatory system (DCS) in Ribeirão Preto, SP (RP-SP), in the period between 1980 and 2004. Methods: The number of deaths due to DCS were obtained from the Mortality Information System (SIM). Populational estimates for RP-SP - taking gender, age group, and calendar years into account - were obtained from the Brazilian Institute of Geography and Statistics (IBGE). Specific mortality rates were calculated on yearly basis according to gender and age group in 10-year intervals starting at 30 years of age. The trend analysis was conducted through polynomial regression models for time series. Significance level was < 0.05. Results: Specific mortality rates due to DCS increased with age both among males and females, being higher among males in the 40 to 49-year-old range. After that, figures were comparable, although at 80-year-old age groups data for females showed to be higher than that for males in some years of the series. Along the study period, significant reduction was observed for mortality rates among both males and females, and for all age ranges from those causes (p<0.001)...

Fundamento: En el ámbito de la transición epidemiológica, estudios de tendencia secular pueden proveer argumentos a la formulación de hipótesis para el gerenciamiento en la Salud. Objetivo: Identificar el estándar de mortalidad por enfermedades del aparato circultorio (EAC) en el municipio de Ribeirão Preto, SP, en el periodo del 1980 a 2004. Métodos: Se obtuvieron los óbitos EAC en el Sistema de Informaciones sobre Mortalidad (SIM). Se obtuvieron las estimaciones poblacionales para el municipio, según el sexo, el grupo de edad y los años calendarios en el Instituto Brasileiro de Geografia e Estatística (IBGE). Se calcularon anulamente los coeficientes específicos de mortalidad según el sexo y el grupo de edad, clasificados en intervalos de 10 años, a partir de los 30 años de edad. Se realizó un estudio de tendencia a través de la construcción de modelos de regresión polinomial para series históricas, adoptándose el nivel de significancia <0,05. Resultados: Los coeficientes específicos de mortalidad por EAC aumentaron con la edad, en ambos sexos, siendo más elevados en el sexo masculino hasta el grupo de edad de 40 a 49 años, cuando ocorrió aproximación en magnitud, siendo que en el grupo de edad de 80 años y más, esos indicadores, en el sexo femenino y en algunos años...

Effect of air pollution on diabetes and cardiovascular diseases in São Paulo, Brazil

Type 2 diabetes increases the risk of cardiovascular mortality and these patients, even without previous myocardial infarction, run the risk of fatal coronary heart disease similar to non-diabetic patients surviving myocardial infarction. There is evidence showing that particulate matter air pollution is associated with increases in cardiopulmonary morbidity and mortality. The present study was carried out to evaluate the effect of diabetes mellitus on the association of air pollution with cardiovascular emergency room visits in a tertiary referral hospital in the city of São Paulo. Using a time-series approach, and adopting generalized linear Poisson regression models, we assessed the effect of daily variations in PM10, CO, NO2, SO2, and O3 on the daily number of emergency room visits for cardiovascular diseases in diabetic and non-diabetic patients from 2001 to 2003. A semi-parametric smoother (natural spline) was adopted to control long-term trends, linear term seasonal usage and weather variables. In this period, 45,000 cardiovascular emergency room visits were registered. The observed increase in interquartile range within the 2-day moving average of 8.0 µg/m³ SO2 was associated with 7.0 percent (95 percentCI: 4.0-11.0) and 20.0 percent (95 percentCI: 5.0-44.0) increases in cardiovascular disease emergency room visits by non-diabetic and diabetic groups, respectively. These data indicate that air pollution causes an increase of cardiovascular emergency room visits, and that diabetic patients are extremely susceptible to the adverse effects of air pollution on their health conditions.