Deaths and hospitalizations of victims of non-drug toxicological events in Brazil, 2009 to 2018. / Óbitos e internações de vítimas de eventos toxicológicos não medicamentosos no Brasil, 2009 a 2018.

OBJECTIVE: to determine the rate of hospitalizations due to acute non-drug poisoning (NDP) events and to analyze mortality arising from these health conditions in Brazil from 2009 to 2018. METHODS: this was a time-series study using Prais-Winsten regression to analyze records of hospitalizations for "treatment of intoxication or poisoning due to exposure to non-drug substances" held on the Hospital Information System. RESULTS: there were 125,570 hospitalizations due to NDP. The average hospitalization rate was 6.3/100,000 inhabitants, although it was higher in males (8.0/100,000 inhab.) compared to females (4.6/100,000 inhab.). The hospitalization rate and the overall mortality rate due NDP to fell from 9.4 to 4.5/100,000 inhab. and from 2.5 to 1.6/1 million inhab., respectively. CONCLUSIONS: there was a reduction in the NDP hospitalization rate and in mortality due to NDP during the decade analyzed.

Incidence, aetiology and serotype coverage for pneumococcal vaccines of community-acquired pneumonia in adults: a population-based prospective active surveillance study in Brazil.

OBJECTIVES: To determine the incidence, aetiology and pneumococcal serotype distribution of community-acquired pneumonia (CAP) in Brazilian adults during a 2-year period. DESIGN: Prospective population-based surveillance study. SETTING: Patients from two emergency hospitals in Brazil were consecutively included in this study. PARTICIPANTS: A total of 111 adults aged 50 years and older with radiographically-confirmed CAP requiring an emergency department visit were prospectively enrolled between January 2018 and January 2020. MAIN OUTCOME MEASURES: Incidence rates of CAP were calculated according to age and pathogen. Pathogens were identified by conventional microbiological methods. Additionally, a novel, Luminex-based serotype specific urinary antigen detection assay was used to detect serotypes included in pneumococcal vaccines. RESULTS: Mean age of participants was 64 years and 31% were aged ≥70 years. Aetiology was established in 61 (57%) patients; among identified cases, the most common pathogens were Streptococcus pneumoniae (42/61, 69%) and influenza (4/61, 7%). Among serotypes identified from the 42 cases of pneumococcal CAP, estimated coverage ranged by pneumococcal vaccine formulations from 47.6% (13-valent), 59.5% (20-valent, licenced in the USA only) and 71.4% (23-valent). In patients with CAP, 20-valent pneumococcal vaccine serotypes were identified 2.5 times more frequently than 10-valent pneumococcal vaccine serotypes (22.5% vs 9.0%). The incidence rate for CAP in adults aged ≥50 years was 20.1 per 10 000 person-years. In general, the incidence of CAP increased consistently with age, reaching 54.4 (95% CI 36.8 to -76.6) per 10 000 in adults 80 years or older. CONCLUSIONS: We observed a high burden of pneumococcal CAP among adults in Brazil. Despite the routine immunisation of children and high-risk adults against pneumococcal disease in the Brazilian national vaccination programme, a persistent burden of pneumococcal CAP caused by vaccine serotypes remains in this population.

Óbitos e internações de vítimas de eventos toxicológicos não medicamentosos no Brasil, 2009 a 2018 / Muertes y hospitalizaciones de víctimas de eventos toxicológicos no medicamentosos en Brasil, 2009 a 2018 / Deaths and hospitalizations of victims of non-drug toxicological events in Brazil, 2009 to 2018

Objetivo: determinar a taxa de internações por eventos agudos de intoxicação não medicamentosa (NMx) e analisar a mortalidade decorrente desses agravos no Brasil, de 2009 a 2018. Métodos: estudo de série temporal, no qual se analisaram registros de internações por "tratamento de intoxicação ou envenenamento por exposição a substâncias de uso não medicamentoso" no Sistema de Informações Hospitalares (SIH), por regressão de Prais-Winsten. Resultados: ocorreram 125.570 internações em virtude de intoxicação NMx. A taxa média de internações foi de 6,3/100 mil habitantes, sendo maior no sexo masculino (8,0/100 mil hab.) comparado ao feminino (4,6/100 mil hab.). A taxa de internações e a mortalidade geral de internações por intoxicação NMx diminuíram de 9,4 para 4,5/100 mil hab. e de 2,5 para 1,6/1 milhão de hab., respectivamente. Conclusões: houve redução da taxa de internações e da mortalidade por intoxicações NMx durante a década analisada.

Objetivo: determinar la tasa de hospitalizaciones por eventos agudos de intoxicación no medicamentosa (NMx) y analizar la mortalidad resultante en Brasil de 2009 a 2018. Métodos: estudio de serie temporal en el que se analizaron los registros de hospitalizaciones por "tratamiento de intoxicación o envenenamiento por exposición a sustancias de uso no farmacológico" del Sistema de Información Hospitalaria (SIH) por la regresión de Prais-Winsten. Resultados: hubo 125.570 hospitalizaciones por intoxicación NMx. La mortalidad promedio de hospitalizaciones fue de 6,3/100 mil hab., siendo más alta en el sexo masculino (8,0/100 mil hab.) en comparación con el femenino (4,6/100 mil hab.). La tasa de hospitalizaciones y la mortalidad global de las hospitalizaciones por NMx disminuyeron de 9,4 a 4,5 por 100 mil hab. y de 2,5 a 1,6 por 1 millón de hab., respectivamente. Conclusiones: hubo reducción en la tasa de hospitalizaciones y en la mortalidad por intoxicaciones NMx durante la década analizada.

Objective: to determine the rate of hospitalizations due to acute non-drug poisoning (NDP) events and to analyze mortality arising from these health conditions in Brazil from 2009 to 2018. Methods: this was a time-series study using Prais-Winsten regression to analyze records of hospitalizations for "treatment of intoxication or poisoning due to exposure to non-drug substances" held on the Hospital Information System. Results: there were 125,570 hospitalizations due to NDP. The average hospitalization rate was 6.3/100,000 inhabitants, although it was higher in males (8.0/100,000 inhab.) compared to females (4.6/100,000 inhab.). The hospitalization rate and the overall mortality rate due NDP to fell from 9.4 to 4.5/100,000 inhab. and from 2.5 to 1.6/1 million inhab., respectively. Conclusions: there was a reduction in the NDP hospitalization rate and in mortality due to NDP during the decade analyzed.

Deaths and hospitalizations resulting from poisoning by prescription and over-the-counter drugs in Brazil.

OBJECTIVE: To estimate the incidence of hospitalizations considering drug intoxication and the mortality of these diseases in Brazil, given trends from 2009 to 2018. METHODS: Data on hospital admissions and deaths come from DATASUS and demographic data from the Brazilian Institute of Geography and Statistics (IBGE). Hospital admissions with Autorização para Internação Hospitalar (AIH - Authorization for Hospital Admission) indicated as a procedure "treatment of intoxication or poisoning due to exposure to drugs and substances for non-drug use" were selected, with only cases of hospitalization due to drug intoxication being analyzed. The incidence of hospitalization and mortality were calculated separately for intoxications caused by medicamentos com prescrição (MRx - prescription drugs) and medicamentos isentos de prescrição (MIP - over-the-counter drugs). Rates were further stratified by sex, age group, and region of residence in Brazil. Trend analysis was performed by generalized linear regression using the Prais-Winsten method. RESULTS: MRx caused most hospitalizations (97%), with mortality approximately 50 times higher when compared to hospitalizations for MIP. The incidence trend in hospitalizations for MRx was stationary and mortality increased during the study period, whereas the trend in mortality and in the incidence of hospitalizations for MIP decreased. CONCLUSIONS: Hospitalizations for drug intoxication, especially those caused by MRx, have a great impact and importance on public health considering that prevention is possible.

Deaths and hospitalizations resulting from poisoning by prescription and over-the-counter drugs in Brazil / Óbitos e internações decorrentes de intoxicações por medicamentos com prescrição e isentos de prescrição, no Brasil

ABSTRACT OBJECTIVE: To estimate the incidence of hospitalizations considering drug intoxication and the mortality of these diseases in Brazil, given trends from 2009 to 2018. METHODS: Data on hospital admissions and deaths come from DATASUS and demographic data from the Brazilian Institute of Geography and Statistics (IBGE). Hospital admissions with Autorização para Internação Hospitalar (AIH - Authorization for Hospital Admission) indicated as a procedure "treatment of intoxication or poisoning due to exposure to drugs and substances for non-drug use" were selected, with only cases of hospitalization due to drug intoxication being analyzed. The incidence of hospitalization and mortality were calculated separately for intoxications caused by medicamentos com prescrição (MRx - prescription drugs) and medicamentos isentos de prescrição (MIP - over-the-counter drugs). Rates were further stratified by sex, age group, and region of residence in Brazil. Trend analysis was performed by generalized linear regression using the Prais-Winsten method. RESULTS: MRx caused most hospitalizations (97%), with mortality approximately 50 times higher when compared to hospitalizations for MIP. The incidence trend in hospitalizations for MRx was stationary and mortality increased during the study period, whereas the trend in mortality and in the incidence of hospitalizations for MIP decreased. CONCLUSIONS: Hospitalizations for drug intoxication, especially those caused by MRx, have a great impact and importance on public health considering that prevention is possible.

RESUMO OBJETIVO: Estimar a incidência de hospitalizações por intoxicação medicamentosa e a mortalidade desses agravos no Brasil, descrevendo as tendências de 2009 a 2018. MÉTODOS: Os dados de internações hospitalares e óbitos originam-se do DATASUS e os dados demográficos, do Instituto Brasileiro de Geografia e Estatística (IBGE). Foram selecionadas as internações hospitalares cuja Autorização para Internação Hospitalar (AIH) indicasse como procedimento "tratamento de intoxicação ou envenenamento por exposição a medicamento e substâncias de uso não medicamentoso", sendo analisados apenas os casos de hospitalização por intoxicação medicamentosa. A incidência de hospitalização e a mortalidade foram calculadas separadamente para intoxicações causadas por medicamentos com prescrição (MRx) e isentos de prescrição (MIP). As taxas foram ainda estratificadas por sexo, faixa etária e região de residência no Brasil. A análise de tendência foi realizada por regressão linear generalizada pelo método de Prais-Winsten. RESULTADOS: A maioria das internações foi causada por MRx (97%), com mortalidade aproximadamente 50 vezes maior, quando comparada às internações por MIP. A tendência da incidência das internações por MRx foi estacionária, mas a mortalidade aumentou durante o período estudado, enquanto a tendência na mortalidade e na incidência de internações por MIP foi decrescente. CONCLUSÕES: As internações por intoxicação medicamentosa, sobretudo aquelas causadas por MRx, têm grande impacto e importância na saúde pública, especialmente porque esses agravos podem ser prevenidos.

Low coverage of HPV vaccination in the national immunization programme in Brazil: Parental vaccine refusal or barriers in health-service based vaccine delivery?

BACKGROUND: The World Health Organization has recommended the introduction of HPV vaccines into national immunization programme (NIP), but vaccination coverage remains low worldwide. We assessed the coverage and the parental acceptance of female and male HPV vaccination in Brazil after its introduction into the NIP. METHODS: We conducted a random-digit-dial survey of parents in seven major Brazilian cities from July-2015 to October-2016. A knowledge, attitude and practices questionnaire was developed and validated by expert analysis, semantic analysis, and pre-testing. RESULTS: 826 out of 2,324 (35.5%) eligible parents completed the interview. Parental acceptance of the HPV vaccine for daughters and sons 18 years of age or less was high (92% and 86%, respectively). Parents refusing vaccination were less likely to know that: HPV is sexually transmitted and causes genital warts, HPV vaccination is more beneficial before sexual debut, and HPV vaccine reactions are minor, and they were more likely to believe HPV vaccination can cause severe adverse events. Parents accepting HPV vaccine for daughters but not forsons were more likely to ignore that the vaccine is recommended for boys. Attitudes associated with HPV vaccine acceptance included: general belief in vaccines, trust in the NIP and in the HPV vaccine efficacy. Among girls eligible for HPV vaccination through the NIP, 58.4% had received a two-dose scheme and 71.1% at least one dose. "No vaccination/missed vaccination at school" was the most common reason for missed HPV vaccination in theNIP. CONCLUSIONS: One year after introduction in the NIP, most parents surveyed in Brazil accepted HPV vaccination for their daughters and sons. Low coverage in the NIP seemed to be due to challenges in adolescent vaccine delivery and HPV vaccination barriers at health-care centers, rather than to vaccine refusal.

Sexual difficulties and help-seeking among mature adults in Australia: results from the Global Study of Sexual Attitudes and Behaviours.

BACKGROUND: The Global Study of Sexual Attitudes and Behaviours was a survey of 27 500 men and women in 29 countries. Here we report the sexual activity, the prevalence of sexual difficulties and related help-seeking behaviour among participants in Australia. METHODS: A telephone survey was conducted in Australia in 2001-2002, with interviews based on a standardised questionnaire. A total of 1500 individuals (750 men and 750 women) aged 40 to 80 years completed the survey. The questionnaire covered demographic information, overall health, and sexual behaviours, attitudes and beliefs. RESULTS: Overall, 83% of men and 74% of women had engaged in sexual intercourse during the 12 months preceding the interview, and 38% of all men and 29% of all women engaged in sexual intercourse more than once a week. Early ejaculation (23%), erectile difficulties (21%) and a lack of sexual interest (18%) were the most common male sexual difficulties. The most frequently reported female sexual difficulties were: lack of sexual interest (33%), lubrication difficulties (26%) and an inability to reach orgasm (25%). Older age was a significant predictor of male erectile difficulties and of lubrication difficulties in women. Only a minority of men and women had sought help for their sexual difficulty(ies) from a health professional. CONCLUSIONS: Many middle-aged and older adults in Australia report continued sexual interest and sexual activity. Several sexual difficulties are highly prevalent in this population, but those experiencing these difficulties rarely seek medical help. This may be because they do not perceive such difficulties as serious or sufficiently upsetting.