Mortality due to visceral leishmaniasis in Brazil by municipalities, 2001-2018: a spatial-temporal analysis of estimates from the Global Burden of Disease study.

OBJECTIVES: In the American regions, Brazil accounts for 97% of visceral leishmaniasis (VL) cases, with a case fatality rate of approximately 10%. This study aimed to investigate the VL mortality distribution in Brazil and identify high-priority and high-risk areas for intervention strategies. STUDY DESIGN: This was an ecological study that analysed the spatial-temporal patterns of VL mortality in Brazilian municipalities. METHODS: Age-standardised VL mortality rates from the Global Burden of Disease study from 2001 to 2018 were used. The distribution of mortality in the municipalities was assessed, and subsequently the Local Index of Spatial Autocorrelation (LISA) analysis was conducted to identify contiguous areas with high mortality rates. Scan analysis identified clusters of high spatial-temporal risks. RESULTS: The highest mortality rates and clusters were in municipalities located in the Northeast region and in the states of Tocantins and Roraima (North region), Mato Grosso do Sul (Central-West region), and Minas Gerais (Southeast region). According to LISA, there was an increase in the number of municipalities classified as high priority from the first 3-year period (n = 434) to the last 3-year period (n = 644). The spatio-temporal analysis identified 21 high-risk clusters for VL mortality. CONCLUSION: Areas with a high risk of VL mortality should prioritise preventing transmission, invest in early diagnosis and treatment, and promote the training of healthcare professionals.

Exploring Dengue Dynamics: A Multi-Scale Analysis of Spatio-Temporal Trends in Ibagué, Colombia.

Our study examines how dengue fever incidence is associated with spatial (demographic and socioeconomic) alongside temporal (environmental) factors at multiple scales in the city of Ibagué, located in the Andean region of Colombia. We used the dengue incidence in Ibagué from 2013 to 2018 to examine the associations with climate, socioeconomic, and demographic factors from the national census and satellite imagery at four levels of local spatial aggregation. We used geographically weighted regression (GWR) to identify the relevant socioeconomic and demographic predictors, and we then integrated them with environmental variables into hierarchical models using integrated nested Laplace approximation (INLA) to analyze the spatio-temporal interactions. Our findings show a significant effect of spatial variables across the different levels of aggregation, including human population density, gas and sewage connection, percentage of woman and children, and percentage of population with a higher education degree. Lagged temporal variables displayed consistent patterns across all levels of spatial aggregation, with higher temperatures and lower precipitation at short lags showing an increase in the relative risk (RR). A comparative evaluation of the models at different levels of aggregation revealed that, while higher aggregation levels often yield a better overall model fit, finer levels offer more detailed insights into the localized impacts of socioeconomic and demographic variables on dengue incidence. Our results underscore the importance of considering macro and micro-level factors in epidemiological modeling, and they highlight the potential for targeted public health interventions based on localized risk factor analyses. Notably, the intermediate levels emerged as the most informative, thereby balancing spatial heterogeneity and case distribution density, as well as providing a robust framework for understanding the spatial determinants of dengue.

Geographical coverage of SARS-CoV-2 screening and care centers in Haiti: what do national surveillance data tell us?

BACKGROUND: In Haiti, reported incidence and mortality rates for COVID-19 were lower than expected. We aimed to analyze factors at communal and individual level that might lead to an underestimation of the true burden of the COVID-19 epidemic in Haiti during its first two years. METHODS: We analyzed national COVID-19 surveillance data from March 2020 to December 2021, to describe the epidemic using cluster detection, time series, and cartographic approach. We performed multivariate Quasi-Poisson regression models to determine socioeconomic factors associated with incidence and mortality. We performed a mixed-effect logistic regression model to determine individual factors associated with the infection. RESULTS: Among the 140 communes of Haiti, 57 (40.7%) had a COVID-19 screening center, and the incidence was six times higher in these than in those without. Only 22 (15.7%) communes had a COVID-19 care center, and the mortality was five times higher in these than in those without. All the richest communes had a COVID-19 screening center while only 30.8% of the poorest had one. And 75% of the richest communes had a COVID-19 care center while only 15.4% of the poorest had one. Having more than three healthcare workers per 1000 population in the commune was positively associated with the incidence (SIR: 3.31; IC95%: 2.50, 3.93) and the mortality (SMR: 2.73; IC95%: 2.03, 3.66). At the individual level, male gender (adjusted OR: 1.11; IC95%: 1.01, 1.22), age with a progressive increase of the risk compared to youngers, and having Haitian nationality only (adjusted OR:2.07; IC95%: 1.53, 2.82) were associated with the infection. CONCLUSIONS: This study highlights the weakness of SARS-CoV-2 screening and care system in Haiti, particularly in the poorest communes, suggesting that the number of COVID-19 cases and deaths were probably greatly underestimated.

[Space-time heterogeneity of measles, mumps, and rubella vaccination indicators in children from BrazilHeterogeneidad espaciotemporal de los indicadores de inmunización con la vacuna triple viral en la población infantil de Brasil]. / Heterogeneidade espaço-temporal dos indicadores de imunização da vacina tríplice viral em crianças no Brasil.

Objective: To evaluate immunization coverage and dropout rates of the measles, mumps, and rubella vaccine across Brazilian regions. Methods: This ecological study employing a space-time approach used data from the National Immunization Program (PNI) and the Live Births Information System (SINASC). We estimated the annual variation (2014 to 2021) in immunization coverage and dropout rate of the measles, mumps, and rubella vaccine in children aged 12 and 15 months in the 5 570 Brazilian municipalities. Statistical analysis was conducted for the municipalities contained in each Brazilian region using the space-time scan technique, considering the Poisson probabilistic model and the hypothesis that municipalities with lower immunization coverage or high dropout rates would form space-time clusters. Results: From 2014 to 2021, 38.3% and 12.9% of municipalities achieved a coverage ≥ 95.0% in the first and second doses respectively; 53.6% of municipalities had a high dropout rate (20.0% to 49.9%) and 37.2% had a very high dropout rate. The Northeast region had primary clusters for low coverage of the first (2018 to 2021) and second vaccine doses (2020 to 2021) with higher relative risks (RR) compared to other primary clusters. The RR for high dropout rate was elevated in all Brazilian regions (1.57 to 26.23). Conclusions: In some Brazilian regions, the dropout rate has been high since 2014, signaling a risk of measles resurgence. In turn, space-time analysis indicated lower vaccination coverage in 2020, suggesting the influence of the COVID-19 pandemic.

Objetivo: Evaluar la cobertura de vacunación y las tasas de incumplimiento del esquema de vacunación triple viral en las macrorregiones de Brasil. Métodos: En este estudio ecológico, con un enfoque espaciotemporal, se utilizaron datos del Programa Nacional de Inmunización y del Sistema de Información sobre Recién Nacidos Vivos. Se estimó la variación anual de la cobertura de vacunación y la tasa de incumplimiento del esquema de vacunación triple viral en niños de 12 y 15 meses en 5570 municipios brasileños (en el período 2014-2021). El análisis estadístico se realizó en el conjunto de municipios de cada macrorregión brasileña mediante la técnica de barrido espaciotemporal, con un modelo probabilístico de Poisson y con la hipótesis de que los municipios con menor cobertura de vacunación o tasas altas de incumplimiento formarían conglomerados espaciotemporales. Resultados: En el período 2014-2021, el 38,3% y el 12,9% de los municipios alcanzó una cobertura ≥95,0% para la primera y la segunda dosis de la vacuna triple viral, respectivamente; el 53,6% de los municipios tuvo una tasa de incumplimiento alta (del 20,0% al 49,9%) y el 37,2% una tasa extremadamente alta. En la zona del nordeste se observaron los conglomerados primarios de cobertura baja de la primera y la segunda dosis de la vacuna triple viral (administradas en los períodos 2018-2021 y 2020-2021, respectivamente) con un mayor riesgo relativo (RR), en comparación con los demás conglomerados primarios. Se observó un RR alto de tener una tasa elevada de incumplimiento en todas las macrorregiones de Brasil (de entre 1,57 y 26,23). Conclusiones: En algunas macrorregiones, la tasa de incumplimiento había sido elevada desde el 2014, lo cual indica un riesgo de resurgimiento del sarampión. A su vez, en el análisis espaciotemporal se observó una menor cobertura de vacunación en el 2020, lo que denota la influencia de la pandemia de COVID-19.

Spatial and temporal trends of dengue infections in Curaçao: A 21-year analysis.

Dengue viruses are a significant global health concern, causing millions of infections annually and putting approximately half of the world's population at risk, as reported by the World Health Organization (WHO). Understanding the spatial and temporal patterns of dengue virus spread is crucial for effective prevention of future outbreaks. By investigating these patterns, targeted dengue surveillance and control measures can be improved, aiding in the management of outbreaks in dengue-affected regions. Curaçao, where dengue is endemic, has experienced frequent outbreaks over the past 25 years. To examine the spatial and temporal trends of dengue outbreaks in Curaçao, this study employs an interdisciplinary and multi-method approach. Data on >6500 cases of dengue infections in Curaçao between the years 1995 and 2016 were used. Temporal and spatial statistics were applied. The Moran's I index identified the presence of spatial autocorrelation for incident locations, allowing us to reject the null hypothesis of spatial randomness. The majority of cases were recorded in highly populated areas and a relationship was observed between population density and dengue cases. Temporal analysis demonstrated that cases mostly occurred from October to January, during the rainy season. Lower average temperatures, higher precipitation and a lower sea surface temperature appear to be related to an increase in dengue cases. This effect has a direct link to La Niña episodes, which is the cooling phase of El Niño Southern Oscillation. The spatial and temporal analyses conducted in this study are fundamental to understanding the timing and locations of outbreaks, and ultimately improving dengue outbreak management.

Spatio-temporal analysis of the visceral leishmaniasis in the state of Alagoas, Brazil

Abstract Visceral leishmaniosis is a neglected tropical disease. We evaluated the spatial distribution of cases of visceral leishmaniosis in the state of Alagoas, Brazil. All cases of VL, registered by the health department, were analyzed and georeferenced. Results: Between 2008 and 2017, 97.1% of the municipalities presented sporadic classification of transmission. With temporal evolution, the incidence of cases of visceral leishmaniosis was concentrated in most municipalities in the microregion of Santana do Ipanema-AL. Space-time analysis, if considered, may promote the improvement of surveillance and control actions of visceral leishmaniosis.

Resumo A leishmaniose visceral é uma doença tropical negligenciada. Foram avaliadas a distribuição espacial dos casos de leishmaniose visceral no estado de Alagoas. Todos os casos de LV, registrados pela secretaria de saúde, foram analisados e georreferenciados. Entre 2008 e 2017, 97,1% dos municípios apresentaram classificação esporádica de transmissão. Com a evolução temporal, a incidência de casos de leishmaniose visceral se concentrou na maioria dos municípios da microrregião de Santana do Ipanema-AL. A análise espaço-tempo, se considerada, pode promover o aprimoramento das ações de vigilância e controle da leishmaniose visceral.

Was the COVID-19 epidemic synchronous in space? An analysis in the health regions of the Rio de Janeiro state, 2020-2022 / A epidemia de COVID-19 foi síncrona no espaço? Uma análise nas regiões de saúde do estado do Rio de Janeiro, 2020-2022

ABSTRACT Objective: To analyze the spatio-temporal dynamics of COVID-19 in the Rio de Janeiro state within the nine health regions, between March 2020 and December 2022. Methods: The Poisson model with random effects was used to smooth and estimate the incidence of COVID-19 hospitalizations reported in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) to verify the synchronicity of the epidemic in the state. Results: The COVID-19 epidemic in the state is characterized by the presence of seven peaks during the analyzed period corresponding to seven found. An asynchrony in hospitalizations was identified, varying according to the different virus variants in the nine health regions of the state. The incidence peaks of hospitalizations ranged from 1 to 12 cases per 100,000 inhabitants during the pandemic. Conclusion: This spatio-temporal analysis is applicable to other scenarios, enabling monitoring and decision-making for the control of epidemic diseases in different areas.

RESUMO Objetivo: Analisar a dinâmica espaço-temporal de COVID-19 no estado do Rio de Janeiro nas nove regiões de saúde, entre março de 2020 e dezembro de 2022. Métodos: Utilizou-se o modelo de Poisson com efeitos aleatórios para suavizar a curva de incidência de hospitalizações por COVID-19 notificadas no Sistema de Informação da Vigilância Epidemiológica da Gripe (Sivep-Gripe) para verificar a sincronicidade da epidemia no estado. Resultados: A epidemia de COVID-19 no estado é caracterizada pela presença de sete picos no período analisado correspondentes a sete variantes encontradas. Identificou-se uma assincronicidade nas hospitalizações, variando de acordo com as diferentes variantes do vírus nas nove regiões de saúde do estado. Os picos de incidência das hospitalizações variaram de 1 a 12 casos por 100 mil habitantes no decorrer da pandemia. Conclusão: Essa análise espaço-temporal é extensível em outros cenários, sendo possível o monitoramento e a tomada de decisões de controle de doenças epidêmicas em várias áreas.

Heterogeneidade espaço-temporal dos indicadores de imunização da vacina tríplice viral em crianças no Brasil / Space-time heterogeneity of measles, mumps, and rubella vaccination indicators in children from Brazil / Heterogeneidad espaciotemporal de los indicadores de inmunización con la vacuna triple viral en la población infantil de Brasil

RESUMO Objetivo. Avaliar a cobertura vacinal e as taxas de abandono da vacina tríplice viral nas macrorregiões brasileiras. Métodos. Este estudo ecológico, com abordagem espaço-temporal, utilizou dados do Programa Nacional de Imunizações e do Sistema de Informação sobre Nascidos Vivos. Estimou-se a variação anual (2014 a 2021) da cobertura vacinal e da taxa de abandono da vacina tríplice viral em crianças de 12 meses e 15 meses de idade nos 5 570 municípios brasileiros. A análise estatística foi realizada para o conjunto de municípios de cada macrorregião brasileira usando a técnica de varredura espaço-temporal, considerando o modelo probabilístico de Poisson e a hipótese de que os municípios com menores coberturas vacinais ou altas taxa de abandono formariam aglomerados (clusters) espaço-temporais. Resultados. De 2014 a 2021, 38,3% e 12,9% dos municípios alcançaram cobertura da vacina tríplice viral ≥ 95,0% na primeira e segunda doses, respectivamente; 53,6% dos municípios tiveram alta taxa de abandono (20,0% a 49,9%) e 37,2% tiveram altíssima taxa de abandono. O Nordeste apresentou os clusters primários para baixa cobertura da primeira (2018 a 2021) e da segunda doses (2020 a 2021) da vacina tríplice viral com maiores riscos relativos (RR) em relação aos demais clusters primários. O RR para alta taxa de abandono foi elevado em todas as macrorregiões brasileiras (1,57 a 26,23). Conclusões. Em algumas macrorregiões, a taxa de abandono era alta desde 2014, sinalizando risco de ressurgimento do sarampo. Por sua vez, a análise espaço-temporal indicou mais baixas coberturas vacinais em 2020, sugerindo influência da pandemia de covid-19.

ABSTRACT Objective. To evaluate immunization coverage and dropout rates of the measles, mumps, and rubella vaccine across Brazilian regions. Methods. This ecological study employing a space-time approach used data from the National Immunization Program (PNI) and the Live Births Information System (SINASC). We estimated the annual variation (2014 to 2021) in immunization coverage and dropout rate of the measles, mumps, and rubella vaccine in children aged 12 and 15 months in the 5 570 Brazilian municipalities. Statistical analysis was conducted for the municipalities contained in each Brazilian region using the space-time scan technique, considering the Poisson probabilistic model and the hypothesis that municipalities with lower immunization coverage or high dropout rates would form space-time clusters. Results. From 2014 to 2021, 38.3% and 12.9% of municipalities achieved a coverage ≥ 95.0% in the first and second doses respectively; 53.6% of municipalities had a high dropout rate (20.0% to 49.9%) and 37.2% had a very high dropout rate. The Northeast region had primary clusters for low coverage of the first (2018 to 2021) and second vaccine doses (2020 to 2021) with higher relative risks (RR) compared to other primary clusters. The RR for high dropout rate was elevated in all Brazilian regions (1.57 to 26.23). Conclusions. In some Brazilian regions, the dropout rate has been high since 2014, signaling a risk of measles resurgence. In turn, space-time analysis indicated lower vaccination coverage in 2020, suggesting the influence of the COVID-19 pandemic.

RESUMEN Objetivo. Evaluar la cobertura de vacunación y las tasas de incumplimiento del esquema de vacunación triple viral en las macrorregiones de Brasil. Métodos. En este estudio ecológico, con un enfoque espaciotemporal, se utilizaron datos del Programa Nacional de Inmunización y del Sistema de Información sobre Recién Nacidos Vivos. Se estimó la variación anual de la cobertura de vacunación y la tasa de incumplimiento del esquema de vacunación triple viral en niños de 12 y 15 meses en 5570 municipios brasileños (en el período 2014-2021). El análisis estadístico se realizó en el conjunto de municipios de cada macrorregión brasileña mediante la técnica de barrido espaciotemporal, con un modelo probabilístico de Poisson y con la hipótesis de que los municipios con menor cobertura de vacunación o tasas altas de incumplimiento formarían conglomerados espaciotemporales. Resultados. En el período 2014-2021, el 38,3% y el 12,9% de los municipios alcanzó una cobertura ≥95,0% para la primera y la segunda dosis de la vacuna triple viral, respectivamente; el 53,6% de los municipios tuvo una tasa de incumplimiento alta (del 20,0% al 49,9%) y el 37,2% una tasa extremadamente alta. En la zona del nordeste se observaron los conglomerados primarios de cobertura baja de la primera y la segunda dosis de la vacuna triple viral (administradas en los períodos 2018-2021 y 2020-2021, respectivamente) con un mayor riesgo relativo (RR), en comparación con los demás conglomerados primarios. Se observó un RR alto de tener una tasa elevada de incumplimiento en todas las macrorregiones de Brasil (de entre 1,57 y 26,23). Conclusiones. En algunas macrorregiones, la tasa de incumplimiento había sido elevada desde el 2014, lo cual indica un riesgo de resurgimiento del sarampión. A su vez, en el análisis espaciotemporal se observó una menor cobertura de vacunación en el 2020, lo que denota la influencia de la pandemia de COVID-19.

Tendência Temporal no Implante Percutâneo de Bioprótese Aórtica: Análise de 10 Anos do Registro TAVIDOR / Temporal Trends in Transcatheter Aortic Valve Implantation: 10-Year Analysis of the TAVIDOR Registry

Resumo Fundamento O implante percutâneo de bioprótese valvar aórtica (TAVI) consolidou-se como opção terapêutica da estenose aórtica de grau importante. Dados sobre as características evolutivas dos procedimentos e dos resultados obtidos com a técnica ao longo da última década, em escala nacional, são desconhecidos. Objetivos Analisar a tendência temporal referente ao perfil demográfico, características dos procedimentos e desfechos hospitalares de pacientes submetidos a TAVI na Rede D'Or São Luiz. Métodos Registro observacional envolvendo 29 instituições nacionais. Comparou-se características dos procedimentos realizados de 2012 a 2017 (Grupo 1) e de 2018 a 2023 (Grupo 2). Foram considerados significantes os resultados com valor de p < 0,05. Resultados Foram analisados 661 casos, 95 pertencentes ao Grupo 1 e 566 ao Grupo 2. A média de idade foi 81,1 anos. Observou-se no Grupo 1 maior prevalência de pacientes em classe funcional III ou IV e escore de risco > 8%. Foi mais frequente o emprego de anestesia geral, monitorização ecocardiográfica transesofágica e via de acesso por dissecção. Maior taxa de sucesso do procedimento (95,4% versus 89,5%; p = 0,018) foi aferida em implantes efetivados a partir de 2018, assim como menor mortalidade (3,9% versus 11,6%; p = 0,004) e necessidade de marcapasso definitivo (8,5% versus 17,9%; p = 0,008). Conclusões A análise temporal de 10 anos do Registro TAVIDOR demonstra uma queda na complexidade clínica dos pacientes. Além disso, o avanço para técnicas de implante minimalistas, somadas à evolução tecnológica dos dispositivos, podem ter contribuído para desfechos favoráveis dentre aqueles cujo implante ocorreu no último quinquênio.

Abstract Background Transcatheter aortic valve implantation (TAVI) has established itself as the preferential strategy to approach severe aortic stenosis. Information on procedural improvements and nationwide results obtained with the technique throughout the past decade are unknown. Objectives To assess the temporal variation of the demographic profile, procedural characteristics, and in-hospital outcomes of patients undergoing TAVI procedures at the Rede D'Or São Luiz. Methods Observational registry comprising 29 national institutions, comparing the characteristics of the TAVI procedures performed from 2012 to 2017 (Group 1) to those performed from 2018 to 2023 (Group 2). The statistical significance level adopted was p < 0.05. Results This study assessed 661 patients, 95 in Group 1 and 566 in Group 2, with a mean age of 81.1 years. Group 1 patients had a higher prevalence of New York Heart Association functional class III or IV and STS risk score > 8%. In addition, they more often underwent general anesthesia, transesophageal echocardiographic monitoring, and access through femoral dissection. Group 2 patients had a higher success rate of the TAVI procedure (95.4% versus 89.5%; p = 0.018), lower mortality (3.9% versus 11.6%; p = 0.004), and less often needed permanent pacemaker implantation (8.5% versus 17.9%; p = 0.008). Conclusions The 10-year temporal trends analysis of the TAVIDOR Registry shows a reduction in patients' clinical complexity over time. Furthermore, the advance to minimalistic implantation techniques, added to the technological evolution of the devices, may have contributed to the favorable outcomes observed among those whose implantation occurred in the last 5 years studied.

Impact of the improvement of living conditions on tuberculosis mortality in Brazil: an ecological study

ABSTRACT BACKGROUND: The risk of death due to tuberculosis (TB) in Brazil is high and strongly related to living conditions (LC). However, epidemiological studies investigating changes in LC and their impact on TB are lacking. OBJECTIVES: To evaluate the impact of LC on TB mortality in Brazil. DESIGN AND SETTING: This ecological study, using panel data on spatial and temporal aggregates, was conducted in 1,614 municipalities between 2002 and 2015. METHODS: Data were collected from the Mortality Information System and the Brazilian Institute of Geography and Statistics. The proxy variable used for LC was the Urban Health Index (UHI). Negative binomial regression models were used to estimate the effect of the UHI on TB mortality rate. Attributable risk (AR) was used as an impact measure. RESULTS: From 2002 to 2015, TB mortality rate decreased by 23.5%, and LC improved. The continuous model analysis resulted in an RR = 0.89 (95%CI = 0.82-0.96), so the AR was −12.3%. The categorized model showed an effect of 0.92 (95%CI = 0.83-0.95) in municipalities with intermediate LC and of 0.83 (95%CI = 0.82-0.91) in those with low LC, representing an AR for TB mortality of −8.7% and −20.5%, respectively. CONCLUSIONS: Improved LC impacted TB mortality, even when adjusted for other determinants. This impact was greater in the strata of low-LC municipalities.

Spatio-temporal analysis of the visceral leishmaniasis in the state of Alagoas, Brazil / Análise espacial-temporal da leishmaniose visceral no estado de Alagoas

Visceral leishmaniosis is a neglected tropical disease. We evaluated the spatial distribution of cases of visceral leishmaniosis in the state of Alagoas, Brazil. All cases of VL, registered by the health department, were analyzed and georeferenced. Results: Between 2008 and 2017, 97.1% of the municipalities presented sporadic classification of transmission. With temporal evolution, the incidence of cases of visceral leishmaniosis was concentrated in most municipalities in the microregion of Santana do Ipanema-AL. Space-time analysis, if considered, may promote the improvement of surveillance and control actions of visceral leishmaniosis.

A leishmaniose visceral é uma doença tropical negligenciada. Foram avaliadas a distribuição espacial dos casos de leishmaniose visceral no estado de Alagoas. Todos os casos de LV, registrados pela secretaria de saúde, foram analisados e georreferenciados. Entre 2008 e 2017, 97,1% dos municípios apresentaram classificação esporádica de transmissão. Com a evolução temporal, a incidência de casos de leishmaniose visceral se concentrou na maioria dos municípios da microrregião de Santana do Ipanema-AL. A análise espaço-tempo, se considerada, pode promover o aprimoramento das ações de vigilância e controle da leishmaniose visceral.

Distribution of cases of congenital heart disease in a hospital in Oeste Paulista / Distribuição dos casos de cardiopatias congênitas em um hospital do Oeste Paulista

The aim of this research was to conduct a comprehensive spatial-temporal analysis of the population affected by congenital heart anomalies assisted at the Pediatric Cardiology Outpatient Department at the distinguished Western Paulista reference hospital. We conducted a retrospective study involving the analysis of electronic database records and patient medical charts for individuals diagnosed with congenital heart disease during the period from July 2013 to July 2018. A total of 298 medical records were selected for the analysis of variables encompassing the ICD-10 codes, gender, spatial distribution, and temporal trends. It was possible to observe that septal defects were the most prevalent congenital heart abnormalities, and there was no gender-based difference. An increase in diagnoses was noted from 2014, coinciding with the implementation of the "heart test," and 51% of the cases were from Presidente Prudente, with a higher concentration of cases in the industrial park area. There is an association between cardiac congenital malformations and an adverse environmental context. The findings can inform public health policies aimed at reducing the exposure of the most vulnerable population in pursuit of improving health indicators (AU).

O objetivo deste trabalho foi analisar a distribuição espaço-temporal dos pacientes com cardiopatias congênitas aten-didos no Ambulatório de Cardiologia Pediátrica do Hospital de referência do Oeste Paulista. Realizamos um estudo retrospectivo com análise de dados de base eletrônica e prontuários dos pacientes diagnosticados com cardiopatia congênita entre os períodos de julho de 2013 a julho de 2018. Foram selecionados 298 prontuários para análise das variáveis de CID-10, gênero, distribuição espacial e série temporal. Foi possível observar que os defeitos septais foram as cardiopatias mais prevalentes, não houve diferença entre os gêneros. Notou-se aumento do diagnóstico a partir de 2014, com implementação do teste do coraçãozinho e 51% dos casos eram da cidade de Presidente Prudente, com maior concentração de casos na região do parque industrial. Há uma relação na incidência das malformações cardíacas com o meio ambiente desfavorável. Os resultados encontrados podem guiar políticas de saúde pública, visando reduzir a exposição da população mais vulnerável, na busca da melhora nos índices de saúde (AU).

Spatio-Temporal Cluster Detection of Dengue, Chikungunya, and Zika Viruses' Infection in Rio de Janeiro State from 2010 to 2019.

Dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) virus infections are widespread throughout the Rio de Janeiro state. The co-circulation of these emergent arboviruses constitutes a serious public health problem, resulting in outbreaks that can spatially and temporally overlap. Environmental conditions favor the presence, maintenance, and expansion of Aedes aegypti, the primary vector of these urban arboviruses. This study assessed the detection of clusters of urban arboviruses in the Rio de Janeiro state from 2010 to 2019. Notified cases of dengue, chikungunya, and Zika were grouped by year according to the onset of symptoms and their municipality of residence. The study period recorded the highest number of dengue epidemics in the state along with the simultaneous circulation of chikungunya and Zika viruses. The analyzes showed that the central municipalities of the metropolitan regions were associated with higher risk areas. Central municipalities in metropolitan regions were the first most likely clusters for dengue and Zika, and the second most likely cluster for chikungunya. Furthermore, the northwest and north regions were comprised clusters with the highest relative risk for the three arboviruses, underscoring the impact of these arboviruses in less densely populated regions of Brazil. The identification of high-risk areas over time highlights the need for effective control measures, targeted prevention and control interventions for these urban arboviral diseases.

Spatial Analysis of Dengue Clusters at Department, Municipality and Local Scales in the Southwest of Colombia, 2014-2019.

Dengue is an arbovirus transmitted by mosquitoes of the genus Aedes and is one of the 15 main public health problems in the world, including Colombia. Where limited financial resources create a problem for management, there is a need for the department to prioritize target areas for public health implementation. This study focuses on a spatio-temporal analysis to determine the targeted area to manage the public health problems related to dengue cases. To this end, three phases at three different scales were carried out. First, for the departmental scale, four risk clusters were identified in Cauca (RR ≥ 1.49) using the Poisson model, and three clusters were identified through Getis-Ord Gi* hotspots analysis; among them, Patía municipality presented significantly high incidence rates in the time window (2014-2018). Second, on the municipality scale, altitude and minimum temperature were observed to be more relevant than precipitation; considering posterior means, no spatial autocorrelation for the Markov Chain Monte Carlo was found (Moran test ˂ 1.0), and convergence was reached for b1-b105 with 20,000 iterations. Finally, on the local scale, a clustered pattern was observed for dengue cases distribution (nearest neighbour index, NNI = 0.202819) and the accumulated number of pupae (G = 0.70007). Two neighbourhoods showed higher concentrations of both epidemiological and entomological hotspots. In conclusion, the municipality of Patía is in an operational scenario of a high transmission of dengue.

A non-expensive bidimensional assessment can detect subtle alterations in gait performance in people in the early stages of Parkinson's disease.

Background: Gait is one of the activities most affected by the symptoms of Parkinson's disease and may show a linear decline as the disease progresses. Early assessment of its performance through clinically relevant tests is a key factor in designing efficient therapeutic plans and procedures, which can be enhanced using simple and low-cost technological instruments. Objective: To investigate the effectiveness of a two-dimensional gait assessment to identify the decline in gait performance associated with Parkinson's disease progression. Methods: One hundred and seventeen people with Parkinson's disease, classified between early and intermediate stages, performed three clinical gait tests (Timed Up and Go, Dynamic Gait Index, and item 29 of the Unified Parkinson's Disease Rating Scale), in addition to a six-meter gait test recorded by a two-dimensional movement analysis software. Based on variables generated by the software, a gait performance index was created, allowing a comparison between its results with the results obtained by clinical tests. Results: There were differences between sociodemographic variables directly related to the evolution of Parkinson's disease. Compared to clinical tests, the index proposed to analyze gait showed greater sensitivity and was able to differentiate the first three stages of disease evolution (Hoehn and Yahr I and II: p = 0.03; Hoehn and Yahr I and III: p = 0.00001; Hoehn and Yahr II and III: p = 0.02). Conclusion: Based on the index provided by a two-dimensional movement analysis software that uses kinematic gait variables, it was possible to differentiate the gait performance decline among the three first stages of Parkinson's disease evolution. This study offers a promising possibility of early identification of subtle changes in an essential function of people with Parkinson's disease.

Spatial diffusion of COVID-19 in Algeria during the third wave.

The differential geographic impact of the third wave of COVID-19 is unknown in Algeria. We thus analyze the spatiotemporal variations of cases and deaths of COVID-19 in Algeria, between January and mid-August 2021. Cases and deaths due to COVID-19 were aggregated at the wilaya (province) level. The space-time permutation scan statistic was applied retrospectively to identify spatial-temporal clusters of COVID-19 cases and deaths. We detected 14 spatio-temporal clusters of COVID-19 cases, with only one high risk cluster. Among the 13 low risk clusters, 7 clusters emerged before the start of the third wave and were mostly located in wilayas with lower population density compared to the clusters that emerged during the third wave. For deaths, the largest geographic low-risk cluster emerged in southern Algeria, between April and early July 2021. Northern and coastal wilayas should be prioritized when allocating resources and implementing various quarantine and isolation measures to slow viral transmission.

Análise temporal de indicadores da Estratégia Saúde da Família sob o olhar da Política Nacional da Atenção Básica / Análisis temporal de los indicadores de la Estrategia Salud de la Familia desde la perspectiva de la Política Nacional de la Atención Básica / Temporal analysis of Family Health Strategy indicators from the perspective of the Brazilian National Primary Health Care Policy

Ao longo das três versões da Política Nacional de Atenção Básica (PNAB) alterações foram realizadas em relação à estruturação da Estratégia Saúde da Família (ESF), com destaque para modificações em relação ao caráter prioritário da ESF como estratégia de organização e de cuidado na atenção básica. O objetivo foi analisar tendências temporais de indicadores referentes à ESF sob o olhar das três versões da PNAB 2006, 2011 e 2017. Estudo descritivo de tendência temporal de indicadores selecionados a partir de modelo lógico construído por componentes referentes à ESF nas três versões da PNAB. O modelo lógico foi elaborado baseado nos componentes Território/Adscrição, Equipes, Processo de Trabalho, Planejamento e Gestão do Território, e Cuidados à Grupos Prioritários pelas Equipes de Saúde da Família, sendo cada um representado por indicadores selecionados. A construção das séries temporais entre 2007 e 2020, nacional e regionais, foi realizada utilizando o software Joinpoint. A maioria dos indicadores apresentou tendência de crescimento nos primeiros segmentos temporais identificados pelos modelos, seguidos por seguimentos de estabilidade ou queda, principalmente após o ano de 2017. Destaca-se o indicador Número de Agentes Comunitários de Saúde que apresentou queda após 2017 na maioria das regiões geográficas e no Brasil. A PNAB 2017 pode ter proporcionado um desestimulo à continuidade e ampliação da ESF como modelo prioritário da atenção básica, ao permitir e financiar novos arranjos e processos de trabalhos de equipes.

A lo largo de las tres versiones de la Política Nacional de Atención Básica (PNAB) alteraciones fueron realizadas en relación con la estructuración de la Estrategia Salud de la Familia (ESF), con destaque para modificaciones en relación con el carácter prioritario de la ESF como estrategia de organización y de cuidado en la atención básica. El objetivo fue analizar tendencias temporales de los indicadores referentes a la ESF desde la perspectiva de las tres versiones de la PNAB, 2006, 2011 y 2017. Estudio descriptivo de la tendencia temporal de los indicadores seleccionados a partir del modelo lógico construido por componentes referentes a la ESF en las tres versiones de la PNAB. El modelo lógico fue elaborado basado en los componentes Territorio/Adscripción, Equipos, Proceso de Trabajo, Planificación y Gestión del Territorio y Atención a Grupos Prioritarios por Equipos de Salud de la Familia, siendo cada uno representado por indicadores seleccionados. La construcción de las series temporales entre 2007 y 2020, nacional y regional, se realizó utilizando el software Joinpoint. La mayoría de los indicadores presentaron una tendencia de crecimiento en los primeros segmentos temporales identificados por los modelos, seguidos por segmentos de estabilidad o la caída, principalmente después del año 2017. Se destaca el indicador Número de Agentes Comunitarios de Salud que presentó una caída después de 2017 en la mayoría de las regiones geográficas y en Brasil. La PNAB 2017 puede haber proporcionado un desaliento a la continuidad y ampliación de la ESF como modelo prioritario de la atención básica, al permitir y financiar nuevos arreglos y procesos de trabajo de los equipos.

Throughout the three editions of the Brazilian National Primary Health Care Policy (PNAB), changes were made in relation to the structure of the Family Health Strategy (FHS), with emphasis on modifications concerning the priority nature of the FHS as an organization and care strategy in primary health care. The objective was to analyze temporal trends in indicators related to the FHS from the perspective of the three PNAB editions: 2006, 2011, and 2017. This is a descriptive study of the temporal trend of indicators selected from a logical model constructed by components related to the FHS in the three editions of the PNAB. The logical model was developed based on the components Territory/Enrollment, Teams, Work Process, Territory Planning and Management, and Care for Priority Groups by Family Health Teams, each one being represented by selected indicators. The construction of the national and regional time series between 2007 and 2020 was carried out using the Joinpoint software. Most of the indicators showed an upward trend in the first time segments identified by the models, followed by segments of stability or decrease, especially after the year 2017. The indicator Number of community health workers stands out, which decreased after 2017 in most geographical regions and in Brazil. The 2017 PNAB may have discouraged the continuation and expansion of the FHS as the priority model of primary health care, by allowing and financing new teamwork arrangements and processes.

Recent changes in trends of mortality from cervical cancer in Southeastern Brazil / Mudanças recentes nas tendências da mortalidade por câncer de colo do útero no Sudeste do Brasil

ABSTRACT OBJECTIVE To analyze the trends of cervical cancer mortality in Brazilian Southeastern states, and to compare them to Brazil and other regions between 1980 and 2020. METHODS Time series study based on data from the Sistema de Informações de Mortalidade (Brazilian Mortality Information System). Death data were corrected by proportional redistribution of deaths from ill-defined causes and cervical cancer of unspecified portion. Age-standardized and age-specific rates were calculated by screening target (25-39 years; 40-64 years) and non-target (65 years or older) age groups. Annual percentage changes (APC) were estimated by linear regression model with breakpoints. The coverage of Pap Smear exam in the Unified Health System (SUS) was evaluated between 2009 and 2020 according to age group and locality. RESULTS There were increases in corrected mortality rates both in 1980 and in 2020 in all regions, with most evident increments at the beginning of the series. There was a decrease in mortality nationwide between 1980-2020; however, the state of São Paulo showed a discrete upward trend in 2014-2020 (APC=1.237; 95%CI 0.046-2.443). Noteworthy is the trend increment in the 25-39 year-old group in all study localities, being sharper in the Southeast region in 2013-2020 (APC=5.072; 95%CI 3.971-6.185). Screening coverage rates were highest in São Paulo and lowest in Rio de Janeiro, with a consistent decline from 2012 onwards at all ages. CONCLUSIONS São Paulo is the first Brazilian state to show a reversal trend in mortality from cervical cancer. The changes in mortality patterns identified in this study point to the need for reorganization of the current screening program, which should be improved to ensure high coverage, quality, and adequate follow-up of all women with altered test results.

RESUMO OBJETIVO Analisar as tendências da mortalidade por câncer de colo de útero nos estados da região Sudeste e compará-las com o Brasil e demais regiões entre 1980 e 2020. MÉTODOS Estudo de série temporal com base nos dados do Sistema de Informações de Mortalidade. Os dados de óbito foram corrigidos por redistribuição proporcional das mortes por causas mal definidas e por câncer de útero de porção não especificada. Foram calculadas taxas padronizadas por idade e específicas por faixas etárias alvo de rastreamento (25-39 anos; 40-64 anos) e não alvo (65 anos ou mais). Variações percentuais anuais foram estimadas por modelo de regressão linear com pontos de quebra. A cobertura do exame Papanicolaou no Sistema Único de Saúde (SUS) foi avaliada entre 2009 e 2020 segundo faixa etária e localidade. RESULTADOS Foram verificados aumentos das taxas de mortalidade corrigidas tanto em 1980 como em 2020 em todas as regiões, com incrementos mais evidentes no início da série. Houve queda da mortalidade em todo o país entre 1980-2020, entretanto, o estado de São Paulo apresentou discreta tendência de aumento em 2014-2020 (APC=1,237; IC95% 0,046-2,443). Destaca-se o incremento da tendência no grupo de 25-39 anos em todas as localidades de estudo, mostrando-se mais acentuado na região Sudeste em 2013-2020 (APC=5,072; IC95% 3,971-6,185). As taxas de cobertura de rastreamento foram mais elevadas em São Paulo e mais baixas no Rio de Janeiro, com queda consistente a partir de 2012 em todas as idades. CONCLUSÕES São Paulo é o primeiro estado brasileiro a apresentar inversão de tendência da mortalidade por câncer de colo do útero. As mudanças nos padrões de mortalidade identificadas neste estudo apontam para a necessidade de reorganização do atual programa de rastreamento, que deve ser aperfeiçoado para garantir alta cobertura, qualidade e seguimento adequado de todas as mulheres com exames alterados.

Trend of morbidity and mortality indicators due to acute diarrheal disease in children under five years old in the State of Piauí (2000-2019) / Tendência de indicadores de morbimortalidade por doenças diarreicas agudas em menores de cinco anos no estado do Piauí (2000-2019)

Abstract Objectives: to analyze the trend of morbidity and mortality indicators due to acute diarrheal diseases in children under five years old in Piauí. Methods: ecological study with data from the Information Technology Department at the Public Health System. The indicators of hospitalization rate and coefficient of mortality from the disease between 2000 and 2019 were calculated. A descriptive analysis of the indicators was carried out in the studied period and by the macro-regions in the State. For trend analysis, the simple linear regression model with log-transformation was used. Trends were classified as increasing, decreasing and stable, with a significance level of 5%. Results: the average on hospitalization rate was higher in the semi-arid macro-region (36.6/1000 children under five years old) and lower in Teresina (14.9/1000 children under five years old). The mean mortality coefficients were higher in the coastal macro-region (0.98/1000 live births) and lower in Teresina (0.47/1000 live births). The indicators showed a downward trend in all analyzed locations (p<0.05). A turning point was noted from 2009, with a significant reduction in hospitalization rates in the savanna and semi-arid macro-regions. Conclusion: indicators of morbidity and mortality due to acute diarrheal diseases in children under five years old showed a downward trend in Piauí between 2000 and 2019, with differences in trends between the evaluated macro-regions.

Resumo Objetivos: analisar a tendência de indicadores de morbimortalidade por doenças diarreicas agudas em menores de cinco anos no Piauí. Métodos: estudo ecológico com dados do Departamento de Informática do Sistema Único de Saúde. Calculou-se os indicadores taxa de internação e coeficiente de mortalidade pela doença entre 2000 e 2019. Realizou-se análise descritiva dos indicadores no período estudado e pelas macrorregiões do estado. Para análise da tendência, foi utilizado o modelo de regressão linear simples com log-transformação. As tendências foram classificadas como crescentes, decrescentes e estáveis, com nível de significância de 5%. Resultados: a média das taxas de internação foi maior na macrorregião semiárido (36,6/1000 menores de cinco anos) e menor em Teresina (14,9/1000 menores de cinco anos). A média dos coeficientes de mortalidade foi maior na macrorregião litoral (0,98/1000 nascidos vivos) e menor em Teresina (0,47/1000 nascidos vivos). Os indicadores mostraram tendência de redução em todos os locais analisados (p<0,05). Notou-se um ponto de inflexão a partir de 2009, com redução significativa das taxas de internação nas macrorregiões cerrados e semiárido. Conclusão: os indicadores de morbimortalidade por doenças diarreicas agudas em menores de cinco anos mostraram tendência de redução no Piauí entre 2000 e 2019, com diferenças das tendências entre as macrorregiões avaliadas.

La inteligencia artificial y la video-vigilancia en la predicción y detección de delitos en espacio-tiempo: una revisión sistemática / Artificial intelligence and video surveillance in space-time crime prediction and detection: a systematic review / Inteligência artificial e vídeo-vigilância na previsão e detecção de crimes no espaço-tempo: uma revisão sistemática

En la sociedad de hoy los delitos vienen incrementándose y particularmente en la ciudad de Bogotá, lo que ha causado muchos inconvenientes a la Policía Nacional de Colombia, así como también a los centros de seguridad ciudadana. Ante esta situación, se ha propuesto una predicción de tiempo-espacio en los puntos críticos de crímenes y delitos, con la ayuda de inteligencia artificial. Por consiguiente, este trabajo tiene como objetivo analizar, resumir, interpretar y evaluar las distintas técnicas de predicción espacio-temporal de la delincuencia con un panorama inteligente. Por la propia naturaleza de la investigación, se utilizó una metodología de enfoque descriptivo-cualitativo, con la cual se diseñaron fichas de observación estructurada para sistematizar información de cinco bases de datos: Scopus, Web of Science, IEEE, ACM, Springer; dichas publicaciones comprenden desde 2019 hasta junio de 2021. En consecuencia, se encontraron en total 3015 estudios, después del proceso de cribado y verificación de los criterios de exclusión e inclusión, se seleccionaron 132 artículos, luego se aplicaron preguntas Psicólogo Interno Residente (PIR), quedando así 18 artículos. Los principales hallazgos encontrados indican que los algoritmos de redes neuronales resultaron ser uno de los métodos más eficaces para la detección de puntos críticos de delincuencia, dado que los grandes avances de la tecnología coadyuvarían en los próximos años a predecir de forma rápida y eficaz los actos delictivos y los crímenes ubicados en cualquier región del continente latinoamericano.

In today's society, crimes are increasing, particularly in the city of Bogota, which has caused many inconveniences to the National Police of Colombia, as well as to the citizen security centers. Given this situation, a time-space prediction of crime and crime hotspots has been proposed with the help of artificial intelligence. Therefore, this paper aims to analyze, summarize, interpret and evaluate the various techniques of space-time prediction of crime with an intelligent view. Due to the very nature of the research, a descriptive-qualitative approach methodology was used, with which structured observation sheets were designed to systematize information from five da-tabases: Scopus, Web of Science, IEEE, ACM, Springer; these publications span from 2019 to June 2021. Consequently, a total of 3015 studies were found, after the screening process and verification of exclusion and inclusion criteria, 132 articles were selected, then questions were applied Psychologist Internal Resident (PIR), thus leaving 18 articles. The main findings indicate that neural network algorithms proved to be one of the most effective methods for the detection of crime hotspots, given that the great advances in technology would help in the coming years to quickly and effectively predict criminal acts and crimes located in any region of the Latin American continent.

Na sociedade de hoje, a criminalidade está aumentando, particularmente na cidade de Bogotá, o que tem causado muitos inconvenientes para a Polícia Nacional Colombiana, bem como para os centros de segurança do cidadão. Diante desta situação, foi proposta uma previsão tempo-espacial de hotspots de crime com a ajuda da inteligência artificial. Portanto, este documento visa analisar, resumir, interpretar e avaliar as diversas técnicas de previsão espaço-temporal do crime com uma visão inteligente. Devido à própria natureza da pesquisa, foi utilizada uma metodologia de abordagem descritiva-qualitativa, com a qual foram elaboradas fichas de observação estrutura-das para sistematizar informações de cinco bancos de dados: Scopus, Web of Science, IEEE, ACM, Springer; estas publicações abrangem o período de 2019 a junho de 2021. Consequentemente, foi encontrado um total de 3015 estudos, após o processo de triagem e verificação dos critérios de exclusão e inclusão, 132 artigos foram selecionados, depois foram aplicadas perguntas ao Psicólogo em Residência (PIR), deixando 18 artigos. As principais descobertas indicam que os algoritmos de redes neurais provaram ser um dos métodos mais eficazes para a detecção de hotspots de crime, dado que os grandes avanços na tecnologia ajudarão nos próximos anos a prever rápida e efetivamente atos criminosos e crimes localizados em qualquer região do continente latino-americano.