Structure and process in primary health care for children and spatial distribution of infant mortality.

OBJECTIVE: To identify the spatial patterns of the quality of the structure of primary health care services and the teams' work process and their effects on infant mortality in Brazil. METHODS: An ecological study of spatial aggregates, using the 5,570 municipalities in Brazil as the unit of analysis. Secondary databases from the Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB - National Program for Improving Access and Quality of Primary Care), the Mortality Information System (SIM), and the Live Birth Information System (SINASC) were used. In 2018, the infant mortality rate was the outcome of the study, and the exposure variables were the proportion of basic health units (BHU) with adequate structure and work processes. Global and local Moran's indices were used to evaluate the degree of dependence and spatial autocorrelation. Spatial linear regression was used for data analysis. RESULTS: In 2018, in Brazil, the infant mortality rate was 12.4/1,000 live births, ranging from 10.6/1,000 and 11.2/1,000 in the South and Southeast, respectively, to 14.1/1,000 and 14.5/1,000 in the Northeast and North regions, respectively. The proportion of teams with an adequate work process (ß = -3.13) and the proportion of basic health units with an adequate structure (ß = -0.34) were associated with a reduction in the infant mortality rate. Spatial autocorrelation was observed between smoothed mean infant mortality rates and indicators of the structure of primary health care services and the team's work process, with higher values in the North and Northeast of Brazil. CONCLUSIONS: There is a relationship between the structure of primary health care services and the teams' work process with the infant mortality rate. In this sense, investment in the qualification of health care within the scope of primary health care can have an impact on reducing the infant mortality rate and improving child health care.

COVID-19 Vaccine Acceptance and Hesitancy among People Living with HIV: Review and Meta-Analysis.

This study aims to estimate the COVID-19 vaccine acceptance and hesitancy among people living with HIV (PLWHA). A search for observational studies was conducted in five databases and preprinted literature. Summary estimates were pooled using a random effects model and meta-regression. Of 150 identified studies, 31 were eligible (18,550 PLWHA). The weighted prevalence of COVID-19 vaccine hesitancy overall was 29.07% among PLWHA (95%CI = 24.33-34.32; I² = 98%,) and that of vaccine acceptance was 68.66% (95%CI = 62.25-74.43; I² = 98%). Higher hesitancy prevalence was identified in low/lower-middle income countries (35.05; 95% CI = 19.38-54.78). The heterogeneity was explained by the risk of bias, region, and year of data collection. The findings conclude that the COVID-19 vaccine hesitancy rate remains high, especially in low-income countries. Evidence-informed interventions aimed at increasing COVID-19 vaccine acceptance at the national and individual levels ought to be designed to increase COVID-19 vaccine acceptance among PLWHA.

Association between racial iniquities and oral health status: a systematic review. / Associação entre iniquidades raciais e condição de saúde bucal: revisão sistemática.

The present study aimed to investigate the association between racial iniquities and oral health status. This is a systematic review with a protocol registered on the Prospero Platform (CRD42021228417), with searches carried out in electronic databases and in gray literature. Our study identified 3,028 publications. After applying the eligibility criteria and risk of bias analysis, 18 studies were selected. The results indicate that individuals of black/brown race/skin color have unfavorable oral health conditions, mainly represented by self-rated oral health, tooth loss, caries, and periodontitis. The results showed racial iniquities in oral health in different countries, for all analyzed indicators, with a greater vulnerability of the black population.

O objetivo deste estudo é investigar a associação entre iniquidades raciais e condição de saúde bucal. Trata-se de revisão sistemática com protocolo cadastrado na plataforma prospero (CRD42021228417), com buscas realizadas em bases de dados eletrônicas e na literatura cinzenta. Identificou-se 3.028 publicações e após aplicação dos critérios de elegibilidade e análise do risco de vieses, 18 estudos foram selecionados. Os resultados indicam que indivíduos de raça/cor da pele preta/parda apresentam condições de saúde bucal desfavorável, representada principalmente pela autoavaliação de saúde bucal, perda dentária, cárie e periodontite. Os resultados evidenciaram iniquidades raciais em saúde bucal em diferentes países, para todos os indicadores analisados, com maior vulnerabilidade da população negra.

Associação entre iniquidades raciais e condição de saúde bucal: revisão sistemática / Association between racial iniquities and oral health status: a systematic review

Resumo O objetivo deste estudo é investigar a associação entre iniquidades raciais e condição de saúde bucal. Trata-se de revisão sistemática com protocolo cadastrado na plataforma prospero (CRD42021228417), com buscas realizadas em bases de dados eletrônicas e na literatura cinzenta. Identificou-se 3.028 publicações e após aplicação dos critérios de elegibilidade e análise do risco de vieses, 18 estudos foram selecionados. Os resultados indicam que indivíduos de raça/cor da pele preta/parda apresentam condições de saúde bucal desfavorável, representada principalmente pela autoavaliação de saúde bucal, perda dentária, cárie e periodontite. Os resultados evidenciaram iniquidades raciais em saúde bucal em diferentes países, para todos os indicadores analisados, com maior vulnerabilidade da população negra.

Abstract The present study aimed to investigate the association between racial iniquities and oral health status. This is a systematic review with a protocol registered on the Prospero Platform (CRD42021228417), with searches carried out in electronic databases and in gray literature. Our study identified 3,028 publications. After applying the eligibility criteria and risk of bias analysis, 18 studies were selected. The results indicate that individuals of black/brown race/skin color have unfavorable oral health conditions, mainly represented by self-rated oral health, tooth loss, caries, and periodontitis. The results showed racial iniquities in oral health in different countries, for all analyzed indicators, with a greater vulnerability of the black population.

Evolution of the Bacillus Calmette-Guérin scar Russia and Moreau strains in newborns: A brazilian cohort.

Background: In Brazil, in 1925, the Moreau strain was introduced, and since its implementation, it has been the routine vaccine for health services. Since 2013, many countries, including Brazil, have been experiencing problems with the production of vaccines. As of January 2018, the country started to use the BCG vaccine with Russia strain, developed by the Serum Institute India. Objective: To describe the evolution of the vaccine scar in neonates vaccinated by BCG-Russia compared to BCG-Moreau. Methods: This was a cohort study was conducted in Salvador city, northeast Brazil. The study population consisted of newborns from the reference maternity hospital, who were vaccinated with BCG-ID strains Moreau or Russia, followed up to assess vaccine lesion evolution. Results: It was observed that regardless of the vaccine strains, the evolution of the lesion was the same: wheal, reddish macula, induration, pustule, ulcer, and scar. The proportion of vaccine scar in the group vaccinated with BCG Russia was lower than that of BCG Moreau, 62.5 % and 90.9 %, respectively, with a statistically significant difference. Conclusion: The evolution of the scar by BCG-Russia was similar to the Moreau scar, however different proportions were observed in different stages of lesion between the groups.

Previous BCG vaccination is associated with less severe clinical progression of COVID-19.

BACKGROUND: BCG vaccination, originally used to prevent tuberculosis, is known to "train" the immune system to improve defence against viral respiratory infections. We investigated whether a previous BCG vaccination is associated with less severe clinical progression of COVID-19 METHODS: A case-control study comparing the proportion with a BCG vaccine scar (indicating previous vaccination) in cases and controls presenting with COVID-19 to health units in Brazil. Cases were subjects with severe COVID-19 (O2 saturation < 90%, severe respiratory effort, severe pneumonia, severe acute respiratory syndrome, sepsis, and septic shock). Controls had COVID-19 not meeting the definition of "severe" above. Unconditional regression was used to estimate vaccine protection against clinical progression to severe disease, with strict control for age, comorbidity, sex, educational level, race/colour, and municipality. Internal matching and conditional regression were used for sensitivity analysis. RESULTS: BCG was associated with high protection against COVID-19 clinical progression, over 87% (95% CI 74-93%) in subjects aged 60 or less and 35% (95% CI - 44-71%) in older subjects. CONCLUSIONS: This protection may be relevant for public health in settings where COVID-19 vaccine coverage is still low and may have implications for research to identify vaccine candidates for COVID-19 that are broadly protective against mortality from future variants. Further research into the immunomodulatory effects of BCG may inform COVID-19 therapeutic research.

Complications related to diabetic foot ulcer and associated social vulnerability factors at a referral centre in Brazil.

OBJECTIVE: To analyse the prevalence and associated social vulnerability factors of complications related to diabetic foot ulcer (DFU) among individuals followed up in a public care centre in Brazil. METHOD: This is a cross-sectional study carried out with individuals followed up at the diabetic foot service of the State Referral Center for Diabetes and Endocrinology Assistance (CEDEBA) between December 2019 and October 2020, during the COVID-19 pandemic. Descriptive analysis and comparison of the prevalence of complications related to DFU were carried out. The factors associated with the outcome variables were verified by hierarchical logistic regression analysis. RESULTS: Among the 253 participants in this study, 30.4% had an active ulcer, 57.1% had a previous ulcer and 45.1% had an amputation. Lower limb ulcers were positively associated with male sex (prevalence ratio (PR): 1.22 (1.04-1.43)) and negatively associated with age >60 years (PR: 0.71 (0.61-0.83)), screening for diabetic foot (PR: 0.79 (0.67-0.92)) and the use of public transport to access CEDEBA (PR: 0.82 (0.71-0.96)). On the other hand, amputations were positively associated with male sex (PR: 1.61 (1.23-2.11)) and not working (PR: 3.83 (1.48-9.95)) and negatively associated with age >60 years (PR: 0.57 (0.45-0.74)) and the use of public transport to access CEDEBA (PR: 0.63 (0.49-0.81)). CONCLUSION: The prevalence of complications was higher than in previous studies, and associated with sociodemographic and clinical characteristics. Further research should be encouraged to investigate the role that determinants of health play in the course of the disease, contributing to the construction of strategies that incorporate formulations developed in the social and economic spheres to broaden the impact of health actions on the prevention of major diabetic foot complications.

Laboratory-based study of drug resistance and genotypic profile of multidrug-resistant tuberculosis isolates in Salvador, Bahia, Brazil.

BACKGROUND: Surveillance of multidrug resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB) is essential to guide disease dissemination control measures. Brazil contributes to a significant fraction of tuberculosis (TB) cases worldwide, but only few reports addressed MDR/XDR-TB in the country. METHODS: This cross-sectional, laboratory-based study describes the phenotypic resistance profiles of isolates obtained between January 2008 and December 2011 in Bahia, Brazil, and sociodemographic, epidemiological, and clinical characteristics (obtained from mandatory national registries) of the corresponding 204 MDR/XDR-TB patients. We analyzed the mycobacterial spoligotyping and variable number of tandem repeats of mycobacterial interspersed repetitive units in 12-loci profiles obtained from Salvador. RESULTS: MDR/XDR-TB patients were predominantly male, had a median age of 43 years, belonged to black ethnicity, and failed treatment before MDR-TB diagnosis. Nearly one-third of the isolates had phenotypic resistance (evaluated by mycobacteria growth indicator tube assay) to second-line anti-TB drugs (64/204, 31%), of which 22% cases (14/64) were diagnosed as XDR-TB. Death was a frequent outcome among these individuals and was associated with resistance to second-line anti-TB drugs. Most isolates successfully genotyped belonged to the Latin-American Mediterranean (LAM) Family, with an unprecedented high proportion of LAM10-Cameroon subfamily bacilli. More than half of these isolates were assigned to a unique cluster by the genotyping methods performed. Large clusters of identical genotypes were also observed among LAM SIT42 and SIT376 strains. CONCLUSIONS: We highlight the need for strengthening local and national efforts to perform early detection of TB drug resistance and to prevent treatment discontinuation to limit the emergence of drug-resistant strains.

Congenital Zika syndrome and living conditions in the largest city of northeastern Brazil.

BACKGROUND: The Zika virus (ZIKV) epidemic hit Brazil in 2015 and resulted in a generation of children at risk of congenital Zika syndrome (CZS). The social vulnerability of certain segments of the population contributed to the disproportional occurrence of CZS in the Brazilian Northeast, the poorest region in the country. Living conditions are essential factors in understanding the social determination of CZS, which is embedded in a complex interaction between biological, environmental, and social factors. Salvador, the biggest city in the region, played a central role in the context of the epidemic and was a pioneer in reporting the ZIKV infection and registering a high number of cases of CZS. The aim of the study was identifying the incidence and spatial distribution pattern of children with CZS in the municipality of Salvador, according to living conditions. METHODS: This is an ecological study that uses the reported cases of ZIKV and CZS registered in the epidemiological surveillance database of the Municipal Secretariat of Health of the city of Salvador between August of 2015 and July of 2016. The neighborhoods formed the analysis units and the thematic maps were built based on the reported cases. Associations between CZS and living conditions were assessed using the Kernel ratio and a spatial autoregressive linear regression model. RESULTS: Seven hundred twenty-six live births were reported, of which 236 (32.5%) were confirmed for CZS. Despite the reports of ZIKV infection being widely distributed, the cases of CZS were concentrated in poor areas of the city. A positive spatial association was observed between living in places with poorer living conditions and births of children with CZS. CONCLUSIONS: This study shows the role of living conditions in the occurrence of births of children with CZS and indicates the need for approaches that recognize the part played by social inequalities in determining CZS and in caring for the children affected.

The triple epidemics of arboviruses in Feira de Santana, Brazilian Northeast: Epidemiological characteristics and diffusion patterns.

Arboviruses are diseases of worldwide importance in the field of communicable diseases. In Brazil, the reemergence of dengue and the emergence of chikungunya and Zika since 2014 have led to epidemic waves of great magnitude and rapid spread. However, their diffusion patterns vary and change over time. This study analyzes the spatial diffusion of the simultaneous circulation of three arboviruses transmitted by the same vector in a large urban space over two epidemic waves in consecutive years. An ecological study of spatial and temporal aggregates on the occurrence of dengue, chikungunya, and Zika, from 2014 to 2019, in Feira de Santana, Bahia State, was carried out using data of cases reported to the national surveillance system. Four different methods were used to analyze the spatial diffusion: Kernel Estimation with sequential maps, cumulative nearest-neighbor ratios (NNI) over time, spatial correlograms and local autocorrelation changes (LISA) over time. From 2014-2019, there were 21,723 confirmed cases of arboviruses. The highest incidences were among women (496.9, 220.2, and 91.0 cases/100,000 women for dengue, chikungunya and Zika respectively). By age group, the highest incidences were from ages 10-19 years old (609.3 dengue cases/100,000), from 60 and more (306.7 chikungunya cases/100,000), and from 0-9 years old (124.1 Zika cases/100,000 inhabitants). The temporal distribution demonstrated two epidemic waves of simultaneous circulation in 2014 and 2015. Kernel maps indicate that arboviruses spread to neighboring areas near the first hotspots, suggesting an expansion diffusion pattern. The NNI, spatial correlograms and LISA changes results suggest expansion patterns for the three arboviruses in all periods. The spatial diffusion pattern of dengue, Zika, and chikungunya in the 2014-2015 epidemics in Feira de Santana was expansion. These findings are useful to guide prevention measures and reduce occurrence in other areas.

Laboratory-based study of drug resistance and genotypic profile of multidrug-resistant tuberculosis isolates in Salvador, Bahia, Brazil

Abstract Background: Surveillance of multidrug resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB) is essential to guide disease dissemination control measures. Brazil contributes to a significant fraction of tuberculosis (TB) cases worldwide, but only few reports addressed MDR/XDR-TB in the country. Methods: This cross-sectional, laboratory-based study describes the phenotypic resistance profiles of isolates obtained between January 2008 and December 2011 in Bahia, Brazil, and sociodemographic, epidemiological, and clinical characteristics (obtained from mandatory national registries) of the corresponding 204 MDR/XDR-TB patients. We analyzed the mycobacterial spoligotyping and variable number of tandem repeats of mycobacterial interspersed repetitive units in 12-loci profiles obtained from Salvador. Results: MDR/XDR-TB patients were predominantly male, had a median age of 43 years, belonged to black ethnicity, and failed treatment before MDR-TB diagnosis. Nearly one-third of the isolates had phenotypic resistance (evaluated by mycobacteria growth indicator tube assay) to second-line anti-TB drugs (64/204, 31%), of which 22% cases (14/64) were diagnosed as XDR-TB. Death was a frequent outcome among these individuals and was associated with resistance to second-line anti-TB drugs. Most isolates successfully genotyped belonged to the Latin-American Mediterranean (LAM) Family, with an unprecedented high proportion of LAM10-Cameroon subfamily bacilli. More than half of these isolates were assigned to a unique cluster by the genotyping methods performed. Large clusters of identical genotypes were also observed among LAM SIT42 and SIT376 strains. Conclusions: We highlight the need for strengthening local and national efforts to perform early detection of TB drug resistance and to prevent treatment discontinuation to limit the emergence of drug-resistant strains.

Epidemiological characteristics and temporal trends of new leprosy cases in Brazil: 2006 to 2017.

Our study aims to describe trends in new case detection rate (NCDR) of leprosy in Brazil from 2006 to 2017 overall and in subgroups, and to analyze the evolution of clinical and treatment characteristics of patients, with emphasis on cases diagnosed with grade 2 physical disabilities. We conducted a descriptive study to analyze new cases of leprosy registered in the Brazilian Information System for Notificable Diseases (SINAN), from 2006-2017. We calculated the leprosy NCDR per 100,000 inhabitants (overall and for individuals aged < 15 and ≥ 15 years) by sex, age, race/ethnicity, urban/rural areas, and Brazilian regions, and estimated the trends using the Mann-Kendall non-parametric test. We analyzed the distributions of cases according to relevant clinical characteristics over time. In Brazil, there was a sharp decrease in the overall NCDR from 23.4/100,000 in 2006 to 10.3/100,000 in 2017; among children < 15 years, from 6.94 to 3.20/100,000. The decline was consistent in all Brazilian regions and race/ethnicity categories. By 2017, 70.2% of the cases were multibacillary, 30.5% had grade 1 (G1D) or 2 (G2D) physical disabilities at diagnosis and 42.8% were not evaluated at treatment completion/discharge; cases with G2D at diagnosis were mostly detected in urban areas (80%) and 5% of cases died during the treatment (leprosy or other causes). Although the frequency of leprosy NCDR decreased in Brazil from 2006 to 2017 across all evaluated population groups, the large number of cases with multibacillary leprosy, physical disabilities or without adequate evaluation, and among children suggest the need to reinforce timely diagnosis and treatment to control leprosy in Brazil.

Seroprevalence of Chikungunya virus and living conditions in Feira de Santana, Bahia-Brazil.

BACKGROUND: Chikungunya is an arbovirus, transmitted by Aedes mosquitoes, which emerged in the Americas in 2013 and spread rapidly to almost every country on this continent. In Brazil, where the first cases were detected in 2014, it currently has reached all regions of this country and more than 900,000 cases were reported. The clinical spectrum of chikungunya ranges from an acute self-limiting form to disabling chronic forms. The purpose of this study was to estimate the seroprevalence of chikungunya infection in a large Brazilian city and investigate the association between viral circulation and living condition. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a population-based ecological study in selected Sentinel Areas (SA) through household interviews and a serologic survey in 2016/2017. The sample was of 1,981 individuals randomly selected. The CHIKV seroprevalence was 22.1% (17.1 IgG, 2.3 IgM, and 1.4 IgG and IgM) and varied between SA from 2.0% to 70.5%. The seroprevalence was significantly lower in SA with high living conditions compared to SA with low living condition. There was a positive association between CHIKV seroprevalence and population density (r = 0.2389; p = 0.02033). CONCLUSIONS/SIGNIFICANCE: The seroprevalence in this city was 2.6 times lower than the 57% observed in a study conducted in the epicentre of the CHIKV epidemic of this same urban centre. So, the herd immunity in this general population, after four years of circulation of this agent is relatively low. It indicates that CHIKV transmission may persist in that city, either in endemic form or in the form of a new epidemic, because the vector infestation is persistent. Besides, the significantly lower seroprevalences in SA of higher Living Condition suggest that beyond the surveillance of the disease, vector control and specific actions of basic sanitation, the reduction of the incidence of this infection also depends on the improvement of the general living conditions of the population.

Associated factors with spatial variation of adolescent pregnancy in Brazil, 2014: an ecological study of spatial clusters. / Fatores associados à variação espacial da gravidez na adolescência no Brasil, 2014: estudo ecológico de agregados espaciais.

OBJECTIVE: To identify socioeconomic and health care determinants of spatial variation in adolescent pregnancy in Brazil in 2014. METHODS: This was a spatial ecological study having municipalities as units of analysis. Spatial linear regression was used to verify association between the fertility rate in 15-19 year-old women and socioeconomic and health variables. RESULTS: The adolescent fertility rate was negatively associated with higher Family Health Strategy coverage (ß = -0.011 - 95%CI -0.017;-0.005), an adequate number of prenatal consultations (ß = -0.122 - 95%CI -0.132;-0.224) and low average family income per capita (ß = -0.104 - 95%CI -0.105;-0.103). Association was positive in relation to the Gini index (ß = 7.031 - 95%CI 4.793;9.269), low income (ß = 0.127 - 95%CI 0.108;0.145), higher household density (ß = 6.292 - 95%CI 5.062;7.522) and less schooling (ß = 0.260 - 95%CI 0.224;0.295). CONCLUSION: Reduced access to primary care and lower income are associated with higher adolescent fertility rates. Poorer socioeconomic and health care indicators are associated with higher adolescent fertility rates.

Perfil epidemiológico e distribuição espacial da hanseníase em Paulo Afonso, Bahia / Perfil epidemiológico y distribucion espacial de la lepra en Paulo Afonso, Bahia / Epidemiological profile and spatial distribution of leprosy in Paulo Afonso, Bahia

Objetivos analisar as características epidemiológicas e distribuição dos casos novos de hanseníase na população de Paulo Afonso, Bahia, entre 2000 e 2015. Método estudo descritivo com todos os casos novos de hanseníase notificados no Sistema de Informações de Agravos de Notificação. Foram utilizadas variáveis sociodemográficas e clínicas e calculados os coeficientes de detecção anuais. Estimativas populacionais foram obtidas no Instituto Brasileiro de Geografia e Estatística. Resultados a maioria dos 1.069 casos novos notificados foi do sexo feminino (57,2%), residiam na zona urbana (92%), raça/cor parda (66,92%), ensino fundamental (67,6%), maiores de quinze anos (92,5%), forma clínica tuberculoide (48,26%), paucibacilares (62,3%), grau de incapacidade física no diagnóstico (45,93%) e na cura (29,75%). Conclusão o perfil epidemiológico da hanseníase em Paulo Afonso é similar ao nacional, houve variações nos coeficientes de detecção da hanseníase entre os anos e a análise espacial evidenciou distribuição heterogênea, com maior concentração de casos nos bairros periféricos.

Objetivos analizar las características epidemiológicas y la distribución de nuevos casos de lepra en la población de Paulo Afonso, Bahía, entre 2000 y 2015. Método estudio descriptivo con todos los nuevos casos de lepra reportados en el Sistema de Información de Enfermedades Notificables. Se utilizaron variables sociodemográficas y clínicas y se calcularon los coeficientes anuales de detección. Las estimaciones de población se obtuvieron del Instituto Brasileño de Geografía y Estadística. Resultados la mayoría de los 1.069 nuevos casos notificados fueron mujeres (57,2%), que viven en el área urbana (92%), raza/color parda (66,92%), escuela primaria (67,6%), con más de quince años (92,5%), forma clínica de tuberculoide (48,26%), paucibacilario (62,3%), grado de discapacidad física al diagnóstico (45,93%) y en la cura (29,75%). Conclusión el perfil epidemiológico de la lepra en Paulo Afonso es similar al nacional, hubo variaciones en los coeficientes de detección de lepra entre años y el análisis espacial mostró una distribución heterogénea, con una mayor concentración de casos en barrios periféricos.

Objectives to analyze the epidemiological characteristics and distribution of new leprosy cases in the population of Paulo Afonso, Bahia, Brazil, between 2000 and 2015. Method descriptive study with all new cases of leprosy reported at the Notifiable Diseases Information System. Sociodemographic and clinical variables were used and annual detection coefficients were calculated. Population estimates were obtained from the Brazilian Institute of Geography and Statistics. Results most of the 1,069 new reported cases were female (57.2%), living in the urban area (92%), brown race/color (66.92%), elementary school (67.6%), over fifteen years of age (92.5%), tuberculoid clinical form (48.26%), paucibacillary (62.3%), degree of physical disability at diagnosis (45.93%) and cure (29.75%). Conclusion the epidemiological profile of leprosy in Paulo Afonso is similar to the national one, with variations in leprosy detection coefficients between years and spatial analysis showing heterogeneous distribution, with a higher concentration of cases in peripheral neighborhoods.

Fatores associados à variação espacial da gravidez na adolescência no Brasil, 2014: estudo ecológico de agregados espaciais / Factores asociados a la variación espacial del embarazo en la adolescencia en Brasil, 2014: estudio ecológico de agregados espaciales / Associated factors with spatial variation of adolescent pregnancy in Brazil, 2014: an ecological study of spatial clusters

Objetivo: Identificar determinantes socioeconômicos e de atenção à saúde na variação espacial da gravidez na adolescência, Brasil, 2014. Métodos: Estudo ecológico espacial com municípios como unidades de análise. Utilizou-se regressão linear espacial para verificar associações entre taxa de fecundidade em adolescentes de 15 a 19 anos e variáveis socioeconômicas e de saúde. Resultados: A fecundidade na adolescência associou-se negativamente a maior cobertura da Estratégia Saúde da Família (ß = -0,011 ­ IC95% -0,017;-0,005), número adequado de consultas de pré-natal (ß = -0,122 ­ IC95% -0,224;-0,132) e menor renda familiar média per capita (ß = -0,104 ­ IC95% -0,105;-0,103); e positivamente, ao índice de Gini (ß = 7,031 ­ IC95% 4,793;9,269), baixa renda (ß = 0,127 ­ IC95% 0,108;0,145), maior densidade domiciliar (ß = 6,292 ­ IC95% 5,062;7,522) e baixa escolaridade (ß = 0,260 ­ IC95% 0,224;0,295). Conclusão: Menores acesso a atenção básica e renda associam-se a maior taxa de fecundidade na adolescência. Piores indicadores socioeconômicos e de atenção à saúde associam-se a maior taxa de fecundidade na adolescência.

Objetivo: Identificar determinantes socioeconómicos y de atención a la salud en la variación espacial del embarazo adolescente en Brasil en 2014. Métodos Estudio espacial ecológico con municipios como unidades de análisis. La regresión lineal espacial se utilizó para verificar la asociación entre la tasa de fecundidad adolescente (15-19 años) y variables socioeconómicas y de salud. Resultados: La tasa de fecundidad adolescente se asoció negativamente con mayor cobertura de la Estrategia de Salud Familiar (ß = -0,011 ­ IC95% -0,017;-0,005), número adecuado de consultas prenatales (ß = -0.122 ­ IC95% -0,132;-0,224) e bajo ingreso familiar promedio per cápita (ß = -0,104 ­ IC95% -0,105;-0,103). Esta asociación fue positiva con el índice de Gini (ß = 7,031 ­ IC95% 4,793; 9,269), bajos ingresos (ß = 0,127 ­ IC95% 0,108; 0,145), mayor densidad familiar (ß = 6,292 ­ IC95% 5,062; 7,522) y baja escolaridad (ß = 0,260 ­ IC95% 0,224; 0,295). Conclusión: El menor acceso a la atención primaria y menores ingresos están asociados con una mayor fecundidad en la adolescencia. Los peores indicadores socioeconómicos y de atención a la salud se asocian con una mayor tasa de fecundidad en la adolescencia.

Objective: To identify socioeconomic and health care determinants of spatial variation in adolescent pregnancy in Brazil in 2014. Methods: This was a spatial ecological study having municipalities as units of analysis. Spatial linear regression was used to verify association between the fertility rate in 15-19 year-old women and socioeconomic and health variables. Results: The adolescent fertility rate was negatively associated with higher Family Health Strategy coverage (ß = -0.011 - 95%CI -0.017;-0.005), an adequate number of prenatal consultations (ß = -0.122 - 95%CI -0.132;-0.224) and low average family income per capita (ß = -0.104 - 95%CI -0.105;-0.103). Association was positive in relation to the Gini index (ß = 7.031 - 95%CI 4.793;9.269), low income (ß = 0.127 - 95%CI 0.108;0.145), higher household density (ß = 6.292 - 95%CI 5.062;7.522) and less schooling (ß = 0.260 - 95%CI 0.224;0.295). Conclusion: Reduced access to primary care and lower income are associated with higher adolescent fertility rates. Poorer socioeconomic and health care indicators are associated with higher adolescent fertility rates.

Epidemiological characteristics and temporal trends of new leprosy cases in Brazil: 2006 to 2017 / Características epidemiológicas e tendências temporais de casos novos de hanseníase no Brasil: 2006 a 2017 / Características epidemiológicas y tendencias temporales de nuevos casos de lepra en Brasil: de 2006 a 2017

Abstract: Our study aims to describe trends in new case detection rate (NCDR) of leprosy in Brazil from 2006 to 2017 overall and in subgroups, and to analyze the evolution of clinical and treatment characteristics of patients, with emphasis on cases diagnosed with grade 2 physical disabilities. We conducted a descriptive study to analyze new cases of leprosy registered in the Brazilian Information System for Notificable Diseases (SINAN), from 2006-2017. We calculated the leprosy NCDR per 100,000 inhabitants (overall and for individuals aged < 15 and ≥ 15 years) by sex, age, race/ethnicity, urban/rural areas, and Brazilian regions, and estimated the trends using the Mann-Kendall non-parametric test. We analyzed the distributions of cases according to relevant clinical characteristics over time. In Brazil, there was a sharp decrease in the overall NCDR from 23.4/100,000 in 2006 to 10.3/100,000 in 2017; among children < 15 years, from 6.94 to 3.20/100,000. The decline was consistent in all Brazilian regions and race/ethnicity categories. By 2017, 70.2% of the cases were multibacillary, 30.5% had grade 1 (G1D) or 2 (G2D) physical disabilities at diagnosis and 42.8% were not evaluated at treatment completion/discharge; cases with G2D at diagnosis were mostly detected in urban areas (80%) and 5% of cases died during the treatment (leprosy or other causes). Although the frequency of leprosy NCDR decreased in Brazil from 2006 to 2017 across all evaluated population groups, the large number of cases with multibacillary leprosy, physical disabilities or without adequate evaluation, and among children suggest the need to reinforce timely diagnosis and treatment to control leprosy in Brazil.

Resumo: O estudo teve com objetivos descrever as tendências na taxa de detecção de casos novos (TDCN) de hanseníase no Brasil em 2006-2017, global e por subgrupos, e analisar a evolução das características clínicas e terapêuticas dos pacientes, com ênfase nos casos diagnosticados com incapacidade física grau 2. Realizamos um estudo descritivo par analisar casos novos de hanseníase registrados no Sistema de Informação de Agravos de Notificação (SINAN), 2006-2017. Calculamos a TDCN de hanseníase por 100.000 habitantes (global e para indivíduos < 15 e ≥ 15 anos de idade) por sexo, idade, raça/etnicidade, área urbana/rural e macrorregião do Brasil e estimamos as tendências com o teste não paramétrico de Mann-Kendall. Analisamos as distribuições de casos de acordo com características clínicas relevantes ao longo do tempo. No Brasil, houve uma queda marcante na TDCN global, de 23,4/100.000 em 2006 para 10,3/100.000 em 2017; entre crianças < 15 anos, de 6,94 para 3,20/100.000. A queda foi consistente em todas a regiões brasileiras e em todas as categorias de raça/etnicidade. Até 2017, 70,2% dos casos eram multibacilares, 30,5% apresentavam incapacidades físicas grau 1 (G1D) ou grau 2 (G2D) ao diagnóstico e 42,8% não foram avaliados ao encerramento do tratamento ou alta; os casos com G2D ao diagnóstico foram detectados majoritariamente nas áreas urbanas (80%), e 5% dos casos faleceram durante o tratamento (devido à hanseníase ou por outras causas). Embora a frequência da TDCN da hanseníase tenha diminuído no Brasil entre 2006 e 2017 em todos os grupos avaliados, o número grande de casos com hanseníase multibacilar, incapacidades físicas ou sem avaliação adequada e entre crianças sugere a necessidade de reforçar o diagnóstico e tratamento oportunos para controlar a hanseníase no Brasil.

Resumen: Se realizó este trabajo con el fin de describir la tendencia general y en subgrupos de la tasa de detección de nuevos casos de lepra (NCDR por sus siglas en inglés) en Brasil, entre 2006-2017, así como para analizar la evolución de las características clínicas y de tratamiento de los pacientes, con énfasis en los casos diagnosticados con un grado 2 de discapacidad física. Realizamos un estudio descriptivo para analizar los nuevos casos de lepra registrados en el Sistema Brasileño de Información de Enfermedades de Notificación (SINAN), 2006-2017. Calculamos la NCDR de lepra por cada 100.000 habitantes (general e individuos con una edad < 15 y ≥ 15 años) por sexo, edad, raza/etnicidad, áreas urbanas/rurales y regiones brasileñas, y estimamos las tendencias usando el test no paramétrico de Mann-Kendall. Analizamos las distribuciones de casos según las características clínicas relevantes a lo largo del tiempo. En Brasil, hubo una drástica disminución en general de NCDR de los 23,4/100.000 en 2006, a los 10,3/100.000 en 2017; entre niños < 15 años, desde los 6,94 a los 3,20/100.000. El decremento fue consistente en todas las regiones brasileñas y categorías de raza/etnicidad. En 2017, un 70,2% de los casos fueron multibacilares, un 30,5% tenían grado 1 (G1D) o 2 (G2D) discapacidad física en el diagnóstico y un 42,8% no fueron evaluados al completar el tratamiento/ser dados de alta; casos con G2D en el diagnóstico fueron en su mayoría detectados en áreas urbanas (80%) y un 5% de los casos murieron durante el tratamiento (lepra u otras causas). A pesar de la frecuencia de lepra los NCDR decrecieron en Brasil de 2006 a 2017, a través de todos los grupos de población evaluados, el elevado número de casos con lepra multibacilar, discapacidad física o sin una adecuada evaluación, y entre niños sugiere la necesidad de reforzar a tiempo el diagnóstico y tratamiento para controlar la lepra en Brasil.

Associated factors to spatial variation of pregnancy in adolescence in Brazil, 2014: ecological study of spatial aggregates / Factores asociados a la variación espacial del embarazo en la adolescencia en Brasil, 2014: estudio ecológico de agregados espaciales / Fatores associados à variação espacial da gravidez na adolescência no Brasil, 2014: estudo ecológico de agregados espaciais

Objective. To identify socioeconomic and health care determinants of the spatial variation of teenage pregnancy in Brazil in 2014. Methods. Spatial ecological study with municipalities as units of analysis. Spatial linear regression was used to verify the association between fertility in adolescence (15-19 years) and socioeconomic and health variables. Results. Fertility rate in adolescence was negatively associated with greater coverage of the Family Health Strategy (ß = -0.011 ­ 95%CI -0.017;-0.005), an adequate number of prenatal consultations (ß = -0.122 ­ 95%CI -0.132;-0.224) and low per capita average family income (ß = -0.104 ­ 95%CI -0.105;-0.103). This association was positive in relation to the Gini index (ß = 7.031 ­ 95%CI 95%CI 4.793;9.269), low income (ß = 0.127 ­ 95%CI 0.108;0.145), household crowding (ß = 6.292 ­ 95%CI 5.062;7.522) and less education (ß = 0.260 ­ 95%CI 0.224;0.295). Conclusion. Lack of access to primary care and lower income are associated with higher fertility in adolescence. Worse socioeconomic and health care indicators are associated with higher fertility rate in adolescence.

Objetivo. Identificar determinantes socioeconômicos e de atenção à saúde na variação espacial da gravidez na adolescência, Brasil, 2014. Métodos. Estudo ecológico espacial com municípios como unidades de análise. Utilizou-se regressão linear espacial para verificar associações entre taxa de fecundidade aos 15-19 anos e variáveis socioeconômicas e de saúde. Resultados. A fecundidade na adolescência associou-se negativamente a maior cobertura da Estratégia Saúde da Família (ß = -0,011 ­ IC95% -0,017;-0,005), número adequado de consultas de pré-natal (ß = -0,122 ­ IC95% -0,224;-0,132) e menor renda familiar média per capita (ß = -0,104 ­ IC95% -0,105;-0,103); e positivamente, ao índice de Gini (ß = 7,031 ­ IC95% 4,793;9,269), baixa renda (ß = 0,127 ­ IC95% 0,108;0,145), maior densidade domiciliar (ß = 6,292 ­ IC95% 5,062;7,522) e baixa escolaridade (ß = 0,260 ­ IC95% 0,224;0,295). Conclusão. Menor acesso a atenção básica e renda associam-se a maior taxa de fecundidade na adolescência. Piores indicadores socioeconômicos e de atenção à saúde associam-se a maior taxa de fecundidade na adolescência.

Social distancing and living conditions in the pandemic COVID-19 in Salvador-Bahia, Brazil. / Distanciamento social e condições de vida na pandemia COVID-19 em Salvador-Bahia, Brasil.

In the current scenario of the COVID-19 pandemic, Brazilian states and municipalities have adopted social distancing measures as a strategy to reduce the number of cases and control the disease. These measures affect populations and territories differently. This study aims to analyze the trend of social distancing in this pandemic and its relationship with the context of living conditions in Salvador, Bahia, Brazil. An ecological study with spatial distribution was conducted. The municipality's Social Distancing Index and the Living Conditions Index were calculated. Global and Local Moran Indices were employed to assess the degree of spatial dependence and autocorrelation. Fluctuations were observed in the social distancing levels during the analyzed period, with higher distancing percentages in neighborhoods with more favorable living conditions. The analysis and interpretation of COVID-19 containment measures, such as social distancing, should consider the profile of local vulnerability of each territory for the correct dimensioning of pandemic mitigation strategies from the perspective of developing social actions enabling greater adherence of the most impoverished populations.

The need for fast-track, high-quality and low-cost studies about the role of the BCG vaccine in the fight against COVID-19.

Bacillus Calmette-Guérin (BCG) vaccination is routine and near-universal in many low- and middle-income countries (LMIC). It has been suggested that BCG can have a protective effect on COVID-19 morbidity and mortality. This commentary discusses the limitations of the evidence around BCG and COVID-19. We argue that higher-quality evidence is necessary to understand the protective effect of the BCG vaccine from existing, secondary data, while we await results from clinical trials currently conducted in different settings.