Tegumentary leishmaniasis in Brazil: priority municipalities and spatiotemporal relative risks from 2001 to 2020.

Understanding the distribution of tegumentary leishmaniasis (TL) in different periods enables the adequate conduction of actions at the public health level. The present study analyzes the spatiotemporal evolution of TL incidence rates in the municipalities of Brazil and identifies priority areas from 2001 to 2020. Notifications of new cases were analyzed employing space-time scan statistics and Local Indicators of Spatial Association. As TL incidence rates presented a downward trend in most Brazilian municipalities, spatiotemporal clusters of high relative risks (RR) were more frequent in the first decade of the series. There was a concentration of those clusters in the North and Northeast regions, mainly in the Legal Amazon area. More recent high-RR areas were identified in municipalities of different regions. The number of priority municipalities showed a stable trend in Brazil. There was a great concentration of such municipalities in the states of Acre, Mato Grosso, Rondônia, Pará, and Amapá, as well as large areas in Roraima, Amazonas, Maranhão, and Tocantins, and smaller areas in the states of Goiás, Ceará, Bahia, Minas Gerais, São Paulo, and Paraná. The present study contributes to the understanding of the historical evolution of TL in Brazil and subsidizes actions to combat the disease.

Knowledge of prescribed drugs among primary care patients: findings from Prover Project.

Background Evidence on patient medication knowledge and associated factors within primary care patients is limited, especially in developing countries. Objective To estimate the prevalence and investigate the role of individual and contextual factors on insufficient medication knowledge among primary care patients. Setting Public community pharmacies in a health pole city (234,937 inhab.) in Minas Gerais State, Brazil. Methods Exit-survey conducted with a representative sample of 1221 patients (≥ 18 years) interviewed after dispensing. Data collected for medicines included its name, therapeutic indication, dosage, time of administration, treatment duration, side effects and warnings. Information were compared to the prescription and official guidelines. Descriptive statistics and logistic regression analysis were applied. Main outcome measure Insufficient patient medication knowledge. Results Prevalence of insufficient medication knowledge was 30.1%. Side effects (96.3%) and warnings (71.1%) had the highest percentage of misses. Musculoskeletal system drugs presented the lowest knowledge score (mean = 5.9; SD = 1.9). Significant determinants of insufficient medication knowledge with respective odds ratio (OR) were: level of education (≤ 3 years, OR 1.50; 95% CI 1.06-2.11 and 4-7 years, OR 1.37; 95% CI 1.02-1.84), number of comorbidities (≤ 2, OR 1.36; 95% CI 1.04-1.77), use of prescription drugs in the last 15 days (no, OR 2.22; 95% CI 1.31-3.76) and number of people able to lend money (no person, OR 1.34; 95% CI 1.04-1.74). Conclusion Counselling and monitoring practices should be tailored to patients with less schooling, that are initiating treatment and with low disease burden. Equally important is the need to implement strategies to increase the patient's level of social capital to improve treatment knowledge.

Estado nutricional e fatores associados em idosos: evidências com base em inquérito telefônico / Nutritional status and associated factors in the elderly: evidence based on telephone survey / Estado nutricional y factores asociados en ancianos: evidencias basadas en encuesta telefónica

Objetivo: Avaliar o estado nutricional e fatores associados em idosos. Métodos: Trata-se de um estudo transversal, realizado entre junho e outubro de 2016, com 720 idosos. Utilizaram-se informações demográficas, socioeconômicas, comportamentais e de estado de saúde, de indivíduos com idade maior ou igual a 60 anos, provenientes do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por inquérito telefônico (VIGITEL), no ano de 2013. Foram ajustadas as medidas de associação para sobrepeso e obesidade, de acordo com variáveis estudadas, segundo modelo logístico binomial. Resultados: A maioria dos participantes era do sexo feminino (59,7%, n=430), com escolaridade até o ensino fundamental (70,5%, n=508) e não trabalhavam (75,2%, n=541). A prevalência de excesso de peso e de obesidade nos idosos foi de 57,5% (n=414) e 19,9% (n=143), respectivamente. Substituíam refeições principais por lanche (cinco ou mais vezes na semana) 33,8% (n=243) dos idosos. Referiram pressão alta 62,8% (n=452) dos idosos, 21,2% (n=153) eram diabéticos, 35,4% (n=255) apresentavam colesterol alto e 35,4% (n=255) tinham dislipidemia. Ser hipertenso e ter dislipidemia aumentavam a chance de ter excesso de peso. O aumento da idade diminuiu a chance de ter excesso de peso. A obesidade foi positivamente associada à hipertensão arterial, à dislipidemia e ao sexo feminino. Conclusão: Observou-se alto percentual de excesso de peso e obesidade, sendo os idosos com pressão alta, dislipidemia e hábito de substituir as refeições principais por lanche os com maiores chances de apresentar excesso de peso e obesidade.

Objective: To evaluate the nutritional status and associated factors in the elderly. Methods: This is a cross-sectional study, carried out between June and October 2016, with 720 elderly individuals. It used demographic, socioeconomic, behavioral and health status information on individuals aged 60 years or older, originating from the system Surveillance of Risk and Protective Factors for Chronic Diseases through Telephone Survey (VIGITEL), in the year 2013. The measures of association for overweight and obesity were adjusted according to some variables studied, on the binomial logistic model. Results: Most of the participants were women (59.7%, n=430), with education until middle school (70.5%, n=508), and did not work (75.2%, n=541). The prevalence of excess weight and obesity in the elderly was 57.5% (n=414) and 19.9% ​​ (n=143), respectively. Main meals were replaced with snacks (five or more times per week) by 33.8% (n=243) of the elderly. High blood pressure was reported by 62.8% (n=452) of the elderly; 21.2% (n=153) were diabetic, 35.4% (n=255) had high cholesterol, and 35.4% (n=255) had dyslipidemia. Being hypertensive and having dyslipidemia increased the likelihood of being overweight. Increasing age reduced the likelihood of being overweight. Obesity was positively associated with hypertension, dyslipidemia and female gender. Conclusion: A high percentage of excess weight and obesity was observed, and elderly individuals with high blood pressure, dyslipidemia and the habit of replacing main meals with snacks were more likely to be overweight and obese.

Objetivo: Evaluar el estado nutricional y los factores asociados en ancianos. Métodos: Se trata de un estudio transversal realizado entre junio y octubre de 2016 con 720 ancianos. Se utilizaron las informaciones demográficas, socioeconómicas, de conductas y del estado de salud de individuos con 60 años de edad o más provenientes del Sistema de Vigilancia de Factores de Riesgo y Protección para las Enfermedades Crónicas a través de encuesta telefónica (VIGITEL) en al año de 2013. Se ajustaron las medidas de asociación para el sobrepeso y la obesidad según las variables estudiadas del modelo logístico binomial. Resultados: La mayoría de los participantes eran del sexo femenino (59,7%, n=430) con máxima escolaridad de la educación primaria (70,5%, n=508) y sin trabajo (75,2%, n=541). La prevalencia del exceso de peso y de obesidad en los ancianos ha sido del 57,5% (n=414) y 19,9% (n=143), respectivamente. El 33,8% (n=243) de los ancianos sustituían las comidas principales por meriendas (cinco o más veces a la semana). El 62,8% (n=452) de los ancianos refirieron presión arterial alta, el 21,2% (n=153) eran diabéticos, el 35,4% (n=255) presentaban el colesterol alto y el 35,4% (n=255) tenían dislipidemia. El hecho de ser hipertenso y tener dislipidemia aumentaba la oportunidad de tener exceso de peso. El aumento de la edad ha disminuido la oportunidad de tener exceso de peso. La obesidad estuvo asociada de manera positiva a la hipertensión arterial, la dislipidemia y al sexo femenino. Conclusión: Se observó un elevado porcentual de exceso de peso y obesidad y los ancianos con presión alta, dislipidemia y con la costumbre de substituir las principales comidas por meriendas son aquellos con más oportunidades de presentar exceso de peso y obesidad.