Spatiotemporal transmission of SARS-CoV-2 lineages during 2020-2021 in Pernambuco-Brazil.

SARS-CoV-2 virus emerged as a new threat to humans and spread around the world, leaving a large death toll. As of January 2023, Brazil is among the countries with the highest number of registered deaths. Nonpharmacological and pharmacological interventions have been heterogeneously implemented in the country, which, associated with large socioeconomic differences between the country regions, has led to distinct virus spread dynamics. Here, we investigate the spatiotemporal dispersion of SARS-CoV-2 lineages in the Pernambuco state (Northeast Brazil) throughout the distinct epidemiological scenarios that unfolded in the first 2 years of the pandemic. We generated a total of 1,389 new SARS-CoV-2 genomes from June 2020 to August 2021. This sampling captured the arrival, communitary transmission, and the circulation of the B1.1, B.1.1.28, and B.1.1.33 lineages; the emergence of the former variant of interest P.2; and the emergence and fast replacement of all previous variants by the more transmissible variant of concern P.1 (Gamma). Based on the incidence and lineage spread pattern, we observed an East-to-West to inner state pattern of transmission, which is in agreement with the transmission of more populous metropolitan areas to medium- and small-size country-side cities in the state. Such transmission patterns may be partially explained by the main routes of traffic across municipalities in the state. Our results highlight that the fine-grained intrastate analysis of lineages and incidence spread can provide actionable insights for planning future nonpharmacological intervention for air-borne transmissible human pathogens.IMPORTANCEDuring the COVID-19 pandemic, Brazil was one of the most affected countries, mainly due its continental-size, socioeconomic differences among regions, and heterogeneous implementation of intervention methods. In order to investigate SARS-CoV-2 dynamics in the state of Pernambuco, we conducted a spatiotemporal dispersion study, covering the period from June 2020 to August 2021, to comprehend the dynamics of viral transmission during the first 2 years of the pandemic. Throughout this study, we were able to track three significant epidemiological waves of transmission caused by B1.1, B.1.1.28, B.1.1.33, P.2, and P.1 lineages. These analyses provided valuable insights into the evolution of the epidemiological landscape, contributing to a deeper understanding of the dynamics of virus transmission during the early years of the pandemic in the state of Pernambuco.

Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil.

This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team's work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceará State, João Pessoa - Paraíba State, Recife - Pernambuco State, Teresina - Piauí State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceará State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25±8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.

Mental health of community health workers in the COVID-19 context. / Saúde mental de agentes comunitários de saúde no contexto da COVID-19.

This study aimed to analyze the factors related to the mental health of Community Health Workers (ACS) in the COVID-19 context. A total of 1,935 ACS from four Northeastern capitals and four cities in the inland region of Ceará participated. The following data were collected: sociodemographic; professional; SRQ-20; WHOQOL-Bref, exposure to violence, General Self-Efficacy Scale (EAEG), Multidimensional Scale of Perceived Social Support (MSPSS), COVID-19-related information, and the coronavirus anxiety scale (EAC). Approximately 40.5% had SRQ > 7, signaling high levels of Common Mental Disorders (CMD)/mental health issues. We adopted the Multiple linear (backward) regression. We observed that the increased risk of CMD was influenced by exposure to violence, EAC, not knowing they had COVID-19, not knowing the variables that reduced the risk, the physical and psychological domains of the WHOQOL-Bref, not having increased working hours, and not having had COVID-19. The data reveal the multidimensional dynamics of mental health and help understand the relationship between community violence, COVID-19, quality of life, age, and ESF working time with the mental health of ACS.

O objetivo deste estudo foi analisar os fatores relacionados à saúde mental dos agentes comunitários de saúde (ACS) no contexto da COVID-19. Participaram 1.935 ACS de quatro capitais nordestinas e de quatro cidades do interior do Ceará. Foram coletados dados sociodemográficos e profissiográficos; SRQ-20; WHOQOL-Bref; exposição à violência; Escala de Autoeficácia Geral (EAEG); Escala Multidimensional de Suporte Social Percebido (MSPSS); informações relacionadas à COVID-19 e Escala de Ansiedade para Coronavírus (EAC). 40,5% exibiram SRQ > 7, sinalizando altos níveis de transtornos mentais comuns (TMC)/problemas de saúde mental. Utilizou-se a regressão linear múltiplas (backward). Observou-se que o aumento de risco de TCM foi influenciado pelos seguintes fatores: exposição à violência; EAC; não saber se teve COVID-19; desconhecer as variáveis que diminuíam o risco; os domínios físico e psicológico do WHOQOL-Bref; não ter aumento da jornada de trabalho; e não ter tido COVID-19. Os dados revelam a dinâmica multidimensional da saúde mental e ajudam a compreender a relação entre violência comunitária, COVID-19, qualidade de vida, idade e tempo de atuação na ESF com a saúde mental dos ACS.

Evaluation of completeness, consistency and non-duplication of leprosy notification data on the Notifiable Health Conditions Information System, João Pessoa, Paraíba, Brazil: a descriptive study, 2001-2019.

OBJECTIVE: to analyze the completeness, consistency and non-duplication of leprosy notification data in João Pessoa, Paraíba, Brazil, 2001-2019. METHODS: this was a descriptive study, conducted with data from the Notifiable Health Conditions Information System, which checked for "duplication" (acceptable: < 5%), "completeness" (excellent = incompleteness ≤ 5%) and "consistency" (excellent: ≥ 90.0%), based on the proportion of complete and consistent fields. RESULTS: the sample consisted of 2,410 notifications. Duplication was acceptable (0.3%). The completeness of the "bacilloscopy", "affected nerves", "examined contacts" and "reactive episode" fields was very poor (more than 50% incomplete). Consistency between the "operational classification" and "initial treatment regimen" fields was excellent (99.6%), while consistency between "operational classification" and "clinical form" was low (50.7%). CONCLUSION: although duplication was acceptable, poor completeness of diagnosis and follow-up fields hinders epidemiological analysis, recognition of the status of the disease and adoption of measures to control it.

Spatial analysis of the natural infection index for Triatomines and the risk of Chagas disease transmission in Northeastern Brazil.

This study aimed to analyze the spatial pattern of natural infection index (NII) for triatomines and the risk of Chagas disease transmission in an endemic area of Northeastern Brazil. An ecological study was conducted, based on 184 municipalities in five mesoregions. The NII for triatomines was evaluated in the Pernambuco State, Brazil, from 2016 to 2018. Spatial autocorrelations were evaluated using Global Moran Index (I) and Local Moran Index (II) and were considered positive when I > 0 and p < 0.05, respectively. In total, 7,302 triatomines belonging to seven different species were detected. Triatoma brasiliensis had the highest frequency (53%; n = 3,844), followed by Triatoma pseudomaculata (25%; n = 1,828) and Panstrongylus lutzi (18.5%; n=1,366). The overall NII was 12%, and the higher NII values were P. lutzi (21%) and Panstrongylus megistus (18%). In the mesoregions of Zona da Mata, Agreste, Sertao, and Sertao do Sao Francisco, 93% of triatomines were detected indoors. The global spatial autocorrelation of I to NII was positive (0.2; p = 0.01), and II values calculated using BoxMap, MoranMap, Lisa Cluster Map were statistically significant for natural infections. With regard to the risk areas for the presence of triatomines, Zone 2 (the Agreste and Sertao regions) presented a relative risk of 3.65 compared to other areas in the state. Our study shows the potential areas of vector transmission of Chagas disease. In this study, the application of different methods of spatial analysis made it possible to locate these areas, which would not have been identified by only applying epidemiological indicators.

Detection of Wuchereria bancrofti in the city of São Luís, state of Maranhão, Brazil: New incursion or persisting problem?

BACKGROUND: The elimination of lymphatic filariasis (LF) from Brazil by 2020 was not accomplished; however, this goal can be achieved in the upcoming years with the assistance of specific strategies. The surveillance of LF can be performed using molecular xenomonitoring (MX), a noninvasive method used to infer the presence of the parasite in the human population. Herein, São Luís (state of Maranhão) was the first city to be investigated to identify whether LF transmission in Brazil has been interrupted and if there were any new incursions. METHODOLOGY/PRINCIPAL FINDINGS: Mosquitoes were collected by aspiration at 901 points distributed among 11 neighborhoods in São Luís with records of patients with microfilaremia. Pools of engorged or gravid Culex quinquefasciatus females were evaluated by WbCx duplex PCR with endogenous control for mosquitoes and target for W. bancrofti for determining the vector infection rate. Among the 10,428 collected mosquitoes, the most abundant species were C. quinquefasciatus (85%) and Aedes aegypti (12%). Significantly larger numbers of mosquitoes were collected from the neighborhoods of Areinha and Coreia (p<0.05). MX performed using PCR validated 705 pools of engorged or gravid females, fifteen of which were positive for Wuchereria bancrofti in two neighborhoods. CONCLUSIONS: The high density of engorged C. quinquefasciatus females per home, inadequate sanitation, and detection of W. bancrofti-infected mosquitoes in the city of São Luís represent a warning of the possible upsurge of LF, a disease that is still neglected; this underscores the need for the ostensive monitoring of LF in Brazil.

Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil / Perspectiva dos agentes comunitários de saúde sobre o impacto da COVID-19 na atenção primária à saúde no Nordeste do Brasil / Perspectiva de los agentes comunitarios de la salud sobre el impacto de pandemia de COVID-19 en la atención primaria a la salud en el Nordeste de Brasil

Abstract: This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team's work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceará State, João Pessoa - Paraíba State, Recife - Pernambuco State, Teresina - Piauí State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceará State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25±8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.

Resumo: Este artigo avalia as repercussões da pandemia da COVID-19 no cotidiano de trabalho da equipe da Estratégia Saúde da Família (ESF) em diversos municípios do Nordeste brasileiro, na perspectiva dos agentes comunitários de saúde (ACS). Um questionário estruturado foi utilizado para coletar informações sobre a COVID-19, atividades dos ACS e equipes da ESF em 2021. Participaram 1.935 ACS de quatro capitais (Fortaleza - Ceará, João Pessoa - Paraíba, Recife - Pernambuco e Teresina - Piauí) e quatro cidades do interior (Crato, Juazeiro do Norte, Barbalha e Sobral, Ceará). A idade média dos ACS era de 46,25±8,54 anos, sendo a maioria mulheres (82,42%). Muitos (39,92%) estavam infectados com COVID-19, dos quais 70,78% acreditavam ter sido infectados no ambiente de trabalho. Ao todo, 77,82% definiam seu papel como linha de frente no combate à COVID-19, 16,07% relataram receber treinamento para a COVID-19 e 13,74% tinham acesso a equipamentos de proteção suficientes contra a COVID-19. A maioria (90,27%) acredita que suas rotinas de trabalho foram modificadas pela pandemia, fortalecendo o espírito de equipe (41,46%) ou enfraquecendo-o (44,41%). Houve uma redução na promoção da saúde nas escolas (75,66%) e na frequência de visitas domiciliares (60,55%), de grupos específicos na comunidade (93,96%) e outros serviços comunitários locais (66,01%). Nos municípios avaliados, observou-se uma heterogeneidade significativa em relação à resposta à pandemia de COVID-19, possivelmente associada à falta de coordenação do Governo Federal. A pandemia levou a uma reconfiguração dos sistemas locais de saúde, fluxos de trabalho e protocolos de atenção primária para as equipes da ESF. A importância do Sistema Único de Saúde (SUS) e seu potencial de reorganização durante as crises devem ser reconhecidos, preservando-se os avanços alcançados até o momento.

Resumen: Este artículo evalúa las repercusiones de la pandemia de COVID-19 en el trabajo cotidiano del equipo de la Estrategia Salud de la Familia (ESF) en diversos municipios del Nordeste brasileño, desde la perspectiva de los agentes comunitarios de salud (ACS). Se utilizó un cuestionario estructurado para recopilar información sobre COVID-19, actividades de los ACS y equipos de la ESF en el 2021. Participaron 1.935 ACS de cuatro capitales (Fortaleza - Ceará, João Pessoa - Paraíba, Recife - Pernambuco y Teresina - Piauí) y cuatro ciudades del interior (Crato, Juazeiro do Norte, Barbalha y Sobral - Ceará). La edad media de los ACS era de 46,25±8,54 años, y la mayoría eran mujeres (82,42%). Muchos (39,92%) estaban infectados con COVID-19, de los cuales el 70,78% creía haberse contagiado en el entorno laboral. En total, el 77,82% definió su papel como línea de frente en el combate a la COVID-19, el 16,07% informó haber recibido capacitación para la COVID-19 y el 13,74% tuvo acceso a equipos de protección suficiente contra la COVID-19. La mayoría (90,27%) cree que sus rutinas de trabajo se vieron modificadas por la pandemia, fortaleciendo el espíritu de equipo (41,46%) o debilitándolo (44,41%). Hubo una reducción en la promoción de la salud en las escuelas (75,66%) y en la frecuencia de las visitas domiciliarias (60,55%), de grupos específicos en la comunidad (93,96%) y otros servicios comunitarios locales (66,01%). En los municipios analizados, se observó una heterogeneidad significativa con relación a la respuesta a la pandemia de COVID-19, posiblemente asociada a la falta de coordinación del Gobierno Federal. La pandemia condujo a una reconfiguración de los sistemas locales de salud, los flujos de trabajo y los protocolos de atención primaria para los equipos de la ESF. Se debe reconocer la importancia del Sistema Único de Salud y (SUS) su capacidad de reorganización durante las crisis, preservando los avances logrados hasta el momento.

Saúde mental de agentes comunitários de saúde no contexto da COVID-19 / Mental health of community health workers in the COVID-19 context

Resumo O objetivo deste estudo foi analisar os fatores relacionados à saúde mental dos agentes comunitários de saúde (ACS) no contexto da COVID-19. Participaram 1.935 ACS de quatro capitais nordestinas e de quatro cidades do interior do Ceará. Foram coletados dados sociodemográficos e profissiográficos; SRQ-20; WHOQOL-Bref; exposição à violência; Escala de Autoeficácia Geral (EAEG); Escala Multidimensional de Suporte Social Percebido (MSPSS); informações relacionadas à COVID-19 e Escala de Ansiedade para Coronavírus (EAC). 40,5% exibiram SRQ > 7, sinalizando altos níveis de transtornos mentais comuns (TMC)/problemas de saúde mental. Utilizou-se a regressão linear múltiplas (backward). Observou-se que o aumento de risco de TCM foi influenciado pelos seguintes fatores: exposição à violência; EAC; não saber se teve COVID-19; desconhecer as variáveis que diminuíam o risco; os domínios físico e psicológico do WHOQOL-Bref; não ter aumento da jornada de trabalho; e não ter tido COVID-19. Os dados revelam a dinâmica multidimensional da saúde mental e ajudam a compreender a relação entre violência comunitária, COVID-19, qualidade de vida, idade e tempo de atuação na ESF com a saúde mental dos ACS.

Abstract This study aimed to analyze the factors related to the mental health of Community Health Workers (ACS) in the COVID-19 context. A total of 1,935 ACS from four Northeastern capitals and four cities in the inland region of Ceará participated. The following data were collected: sociodemographic; professional; SRQ-20; WHOQOL-Bref, exposure to violence, General Self-Efficacy Scale (EAEG), Multidimensional Scale of Perceived Social Support (MSPSS), COVID-19-related information, and the coronavirus anxiety scale (EAC). Approximately 40.5% had SRQ > 7, signaling high levels of Common Mental Disorders (CMD)/mental health issues. We adopted the Multiple linear (backward) regression. We observed that the increased risk of CMD was influenced by exposure to violence, EAC, not knowing they had COVID-19, not knowing the variables that reduced the risk, the physical and psychological domains of the WHOQOL-Bref, not having increased working hours, and not having had COVID-19. The data reveal the multidimensional dynamics of mental health and help understand the relationship between community violence, COVID-19, quality of life, age, and ESF working time with the mental health of ACS.

Spatial analysis of the natural infection index for Triatomines and the risk of Chagas disease transmission in Northeastern Brazil

ABSTRACT This study aimed to analyze the spatial pattern of natural infection index (NII) for triatomines and the risk of Chagas disease transmission in an endemic area of Northeastern Brazil. An ecological study was conducted, based on 184 municipalities in five mesoregions. The NII for triatomines was evaluated in the Pernambuco State, Brazil, from 2016 to 2018. Spatial autocorrelations were evaluated using Global Moran Index (I) and Local Moran Index (II) and were considered positive when I > 0 and p < 0.05, respectively. In total, 7,302 triatomines belonging to seven different species were detected. Triatoma brasiliensis had the highest frequency (53%; n = 3,844), followed by Triatoma pseudomaculata (25%; n = 1,828) and Panstrongylus lutzi (18.5%; n=1,366). The overall NII was 12%, and the higher NII values were P. lutzi (21%) and Panstrongylus megistus (18%). In the mesoregions of Zona da Mata, Agreste, Sertao, and Sertao do Sao Francisco, 93% of triatomines were detected indoors. The global spatial autocorrelation of I to NII was positive (0.2; p = 0.01), and II values calculated using BoxMap, MoranMap, Lisa Cluster Map were statistically significant for natural infections. With regard to the risk areas for the presence of triatomines, Zone 2 (the Agreste and Sertao regions) presented a relative risk of 3.65 compared to other areas in the state. Our study shows the potential areas of vector transmission of Chagas disease. In this study, the application of different methods of spatial analysis made it possible to locate these areas, which would not have been identified by only applying epidemiological indicators.

Avaliação da completitude, consistência e não duplicidade dos dados de notificação da hanseníase no Sistema de Informação de Agravos de Notificação, João Pessoa, Paraíba: estudo descritivo, 2001-2019 / Evaluation of completeness, consistency and non-duplication of leprosy notification data on the Notifiable Health Conditions Information System, João Pessoa, Paraíba, Brazil: a descriptive study, 2001-2019 / Evaluación de la completitud, consistencia y no duplicidad de notificación de lepra en el Sistema de Información e Enfermidades de Declaración Obligatoria, en João Pessoa, Paraíba: estudio descriptivo, 2001-2019

Objetivo: analisar a completitude, consistência e não duplicidade dos dados da notificação da hanseníase em João Pessoa, Paraíba, Brasil, 2001-2019. Métodos: estudo descritivo, com dados do Sistema de Informação de Agravos de Notificação; verificou-se a duplicidade (aceitável quando < 5%), completitude (grau excelente = incompletitude ≤ 5%) e consistência (excelente quando ≥ 90,0%) dos dados, utilizando-se a proporção de campos preenchidos e coerentes. Resultados: a amostra de 2.410 notificações apresentou duplicidade aceitável (0,3%); a completitude dos campos "baciloscopia", "no de nervos afetados", "contatos examinados" e "episódio reacional" foi muito ruim (mais de 50% incompletos); e a consistência entre os campos "classificação operacional" e "esquema terapêutico inicial", excelente (99,6%), enquanto entre "classificação operacional" e "forma clínica" foi baixa (50,7%). Conclusão: embora a duplicidade observada fosse aceitável, a completitude de campos sobre diagnóstico e acompanhamento foi ruim, dificultando a análise epidemiológica, o reconhecimento da situação do agravo e a adoção de medidas de controle da doença.

Objective: to analyze the completeness, consistency and non-duplication of leprosy notification data in João Pessoa, Paraíba, Brazil, 2001-2019. Methods: this was a descriptive study, conducted with data from the Notifiable Health Conditions Information System, which checked for "duplication" (acceptable: ≤5%), "completeness" (excellent = incompleteness ≤ 5%) and "consistency" (excellent: ≤ 90.0%), based on the proportion of complete and consistent fields. Results: the sample consisted of 2,410 notifications. Duplication was acceptable (0.3%). The completeness of the "bacilloscopy", "affected nerves", "examined contacts" and "reactive episode" fields was very poor (more than 50% incomplete). Consistency between the "operational classification" and "initial treatment regimen" fields was excellent (99.6%), while consistency between "operational classification" and "clinical form" was low (50.7%). Conclusion: although duplication was acceptable, poor completeness of diagnosis and follow-up fields hinders epidemiological analysis, recognition of the status of the disease and adoption of measures to control it.

Objetivo: analizar la completitud, consistencia y no duplicidad de los datos de notificación de lepra en João Pessoa, Paraíba, 2001 - 2019. Métodos: estudio descriptivo, realizado con datos del Sistema de Información de Enfermedades de Declaración Obligatoria, que verificó "duplicidad" (aceptable: < 5%). "completitud" (grado excelente: incompletitud ≤ 5%) y "consistencia" (excelente: ≥ 90,0%), utilizando la proporción de campos completos y coherentes. Resultados: se obtuvo una muestra de 2.410 notificaciones. La duplicidad se consideró aceptable (0,3%). La completitud de los campos "baciloscopía", "nervios afectados", "contactos examinados" y "episodio reaccional" fue muy pobre (más del 50% incompleta). La consistencia entre los campos "clasificación operativa" y "régimen terapéutico inicial" fue excelente (99,6%), mientras que "clasificación operativa" y "forma clínica" fue baja (50,7%). Conclusión: aunque la duplicidad es aceptable, la completitud de los campos de diagnóstico y seguimiento fue deficiente, lo que dificulta el análisis epidemiológico, el reconocimiento de la situación de la enfermedad y la adopción de medidas de control de la enfermedad.

Mapping the morbidity and mortality of Chagas disease in an endemic area in Brazil.

Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients' care.

Mapping the morbidity and mortality of Chagas disease in an endemic area in Brazil

ABSTRACT Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients' care.

A violência contra pessoas idosas no Brasil: fatores associados segundo o tipo de agressor / Violence against older people in Brazil: associated factors according to the type of aggressor

Resumo Analisou-se os fatores associados à violência contra pessoas idosas brasileiros segundo o tipo de agressor. Estudo transversal de base populacional com dados secundários, da Pesquisa Nacional de Saúde em 2013, totalizando 11.697 indivíduos com 60 anos ou mais no Brasil. A variável dependente foi ter sofrido violência por agressor conhecido ou desconhecido e as independentes foram divididas em blocos (Socioeconômico e demográfico; Autopercepção e cuidado com a saúde; Utilização do serviço de saúde; Estado de saúde/doença e Funcionalidade). O efeito das variáveis independentes sobre a variável resposta, foi expresso pela "Odds Ratio" com Intervalo de Confiança 95%. Realizou-se modelos hierarquizados de regressão logística multinomial simples e múltipla. Na análise simples foram eletivas para análise múltipla as variáveis com p-valor <0,05. Construiu-se um mapa temático segundo a distribuição espacial da violência, por estado. Cor da pele branca, <68 anos, saber ler e escrever, problemas no sono, não sentir prazer em fazer atividades e ter deficiência física associaram-se ao agressor desconhecido. Saúde ruim, fumar, discriminação no serviço de saúde e sentir-se mal consigo mesmo se associaram ao agressor conhecido. Discriminação por tipo de doença e pequena dificuldade para sair sozinho foram associados para ambos agressores. Estados com maior número de casos de violência encontrados foram Amapá, Paraná, Mato Grosso, Amazonas e Rio Grande do Norte. Desse modo, estimar a prevalência de violência contra pessoas idosas, o tipo de agressor, assim como os fatores associados, é imprescindível para identificação e prevenção do abuso individual, institucional e estrutural.

Abstract Factors associated with violence against older Brazilians were analyzed according to the type of aggressor. Population-based cross-sectional study with secondary data from the National Health Survey in 2013, totaling 11,697 individuals aged 60 years or older in Brazil. The dependent variable was having suffered violence by a known or unknown aggressor, and the independent variables were divided into blocks (Socioeconomic and demographic; Self-perception and health care; Health service use; Health status/disease and Functioning). The effect of the independent variables on the response variable was expressed by the "Odds Ratio" with a 95% Confidence Interval. Hierarchical models of simple and multiple multinomial logistic regression were performed. In the simple analysis, variables with p-value 0.05 were elective for multiple analysis. A thematic map was constructed according to the spatial distribution of violence, by state. White skin color, 68 years, knowing how to read and write, sleep problems, not feeling pleasure in doing activities and having a physical disability were associated with the unknown aggressor. Poor health, smoking, discrimination in the health service and feeling bad about oneself were associated with the known aggressor. Discrimination by type of illness and little difficulty going, out alone were associated for both aggressors. States with the highest number of cases of violence found were Amapá, Paraná, Mato Grosso, Amazonas and Rio Grande do Norte. Thus, estimating the prevalence of violence against older people, the type of aggressor, as well as associated factors, is essential for identifying and preventing individual, institutional and structural abuse.

Análise espacial da mortalidade fetal por sífilis congênita no Município do Recife-PE-Brasil entre 2007 e 2016 / Análisis espacial de la mortalidad fetal por sífilis congénita en el municipio de Recife-PE-Brasil entre 2007 y 2016 / Spatial analysis of fetal mortality from congenital syphilis in the municipality of Recife-PE-Brazil between 2007 and 2016

Resumo Objetivo analisar a distribuição espacial da mortalidade fetal por sífilis congênita entre os bairros do Município do Recife-PE. Método estudo ecológico, realizado a partir do indicador epidemiológico taxa de mortalidade fetal por sífilis congênita, agregado ao nível dos bairros, em dois quinquênios: 2007 a 2011 e 2012 a 2016. O padrão de autocorrelação espacial foi determinado pelos Índices de Moran Global e Local, com significância estatística inferior a 5% e representado em mapas BoxMap e MoranMap que apontaram as áreas com taxas altas, baixas e em transição epidemiológica e os clusters de maior interesse epidemiológico. Resultados foram notificados 208 óbitos fetais. O Índice Global de Moran evidenciou autocorrelação espacial positiva em grau razoável, no primeiro quinquênio (I = 0,351 e p-valor = 0,01) e, em grau fraco, no segundo quinquênio (I = 0,189 e p-valor = 0,02). Os Distritos Sanitários I e VII obtiveram os maiores percentuais de bairros que formaram o cluster de altas taxas do indicador com 63,3% e 38,4% no primeiro e segundo quinquênios, respectivamente. Conclusões e implicações para a Prática a análise espacial apontou as áreas críticas para ocorrência do indicador, podendo contribuir para o investimento nas áreas prioritárias de prevenção da transmissão vertical da sífilis.

Resumen Objetivo Analizar la distribución espacial de la mortalidad fetal por sífilis congénita entre los barrios de Recife-PE. Método Estudio ecológico, basado en el indicador epidemiológico tasa de mortalidad fetal por sífilis congénita, agregada a nivel de barrio, en dos quinquenios: 2007 a 2011 y 2012 a 2016. El patrón de autocorrelación espacial fue determinado por los Índices Moran Global y Local, con significancia estadística menor al 5% y representados en mapas de BoxMap y MoranMap, que indicaron áreas con tasas de transición alta, baja y epidemiológica y conglomerados de mayor interés epidemiológico. Resultados Notificadas 208 muertes fetales. El Índice Global de Moran mostró un grado razonable de autocorrelación espacial positiva en el primer quinquenio (I = 0,351 y p-valor=0,01) y un grado débil en el segundo quinquenio (I = 0,189 y p-valor=0,02). Los Distritos Sanitarios I y VII presentaron los mayores porcentajes de barrios que formaron el cluster de tasas altas del indicador con 63,3% y 38,4% en el primer y segundo quinquenio, respectivamente. Conclusión e Implicación para la Práctica El análisis espacial señaló las áreas críticas para la ocurrencia del indicador, que podrían contribuir a la inversión en áreas prioritarias para la prevención de la transmisión vertical de sífilis.

Abstract Objective To analyze the spatial distribution of fetal mortality due to congenital syphilis among the neighborhoods of the city of Recife-PE. Method Ecological study, based on the epidemiological indicator fetal mortality rate due to congenital syphilis, aggregated at the neighborhood level, in two five-year periods: 2007 to 2011 and 2012 to 2016. The pattern of spatial autocorrelation was determined by the Moran Global and Local Indexes, with statistical significance lower than 5% and represented in BoxMap and MoranMap maps that indicated areas with high, low and epidemiological transition rates and clusters of greater epidemiological interest. Results It was reported 208 fetal deaths. The Moran Global Index showed a reasonable degree of positive spatial autocorrelation in the first five-year period (I = 0.351 and p-value = 0.01) and a weak degree in the second five-year period (I = 0.189 and p-value = 0.02). Sanitary Districts I and VII had the highest percentages of neighborhoods that formed the cluster of high rates of the indicator with 63.3% and 38.4% in the first and second five-year periods, respectively. Conclusions and Implications for Practice The spatial analysis pointed out the critical areas for the occurrence of the indicator, which could contribute to investment in priority areas for the prevention of vertical transmission of syphilis.

Spatial analysis of tuberculosis in children under 15 years of age and socioeconomic risk: an ecological study in Paraíba, Brazil, 2007-2016. / Análise espacial da tuberculose em menores de 15 anos de idade e risco socioeconômico: um estudo ecológico na Paraíba, 2007-2016.

OBJECTIVE: To analyze spatial distribution of tuberculosis in individuals under 15 years old and socioeconomic factors in Paraíba, Brazil, 2007-2016. METHODS: This was an ecological study based on data from the Notifiable Health Conditions Information System (SINAN), taking each municipality to be a unit of analysis. Spatial distribution of incidence was performed, the local empirical Bayesian method and Moran's I were applied. Socioeconomic data were crossed-checked to identify areas of social prosperity. RESULTS: 426 cases were notified, with average incidence of 4.5/100,000 inhabitants. Moran's I was 0.59 (p=0.010). The Moran Map revealed concentration of cases in children under 15 in 38 high priority municipalities, in clusters with high-high and low-low patterns, in the east and northwest of the state, coinciding with areas of low social prosperity. CONCLUSION: There were clusters with greater tuberculosis transmission, indicating priority areas for addressing tuberculosis.

Incidence of congenital syphilis according to inequalities and living conditions in the city of Recife, Pernambuco, Brazil / Incidência de sífilis congênita segundo as desigualdades na condição de vida no município de Recife, Pernambuco, Brasil

Abstract Objectives: to analyze the variation in the incidence rates of congenital syphilis according to the spatial distribution of Life Condition Index (LCI) among neighborhoods in the city of Recife-PE. Methods: an ecological study, developed from 3,234 cases of congenital syphilis notified in the Sistema de Informação de Agravos de Notificação (Severe Disease Notification Information System), between 2007 and 2016. LCI was built from seven variables related to the dimensions of the environment, education and income, aggregated at the neighborhood levels and spatially distributed in four strata: very high, high, low and very low. The correlation between the rates of congenital syphilis in the strata and LCI was investigated by applying the Spearman correlation coefficient and demonstrated by means of scatter graphics. Results: the mean rate on disease incidence was 6.8 cases per thousand live births. There was a higher incidence in the strata of very low and low living conditions, as well as in Districts that presented poor sanitary conditions and low schooling for the head of the family (District VII), higher proportion of illiteracy among 10 and 14 year olds (District II) and low income of the head of the household (Districts I, II and VII). Conclusions: this study showed the persistence of health inequalities in areas with worse living conditions.

Resumo Objetivos: analisar a variação das taxas de incidência de sífilis congênita segundo a distribuição espacial do Índice de Condição de Vida (ICV) entre os bairros do município do Recife-PE. Métodos: estudo ecológico, desenvolvido a partir de 3234 casos de sífilis congênita notificados no Sistema de Informação de Agravos de Notificação, entre 2007 e 2016. O ICV foi construído a partir de sete variáveis relacionadas as dimensões ambiente, educação e renda, agregadas ao nível dos bairros, e distribuído espacialmente em quatro estratos: muito alto, alto, baixo e muito baixo. A correlação entre as taxas de sífilis congênita nos estratos e o ICV foi investigada aplicando-se o coeficiente de correlação de Spearman e demonstrada por meio de gráficos de dispersão. Resultados: a taxa média de incidência da doença foi de 6,8 casos por mil nascidos vivos. Houve maior incidência nos estratos de condição de vida muito baixa e baixa bem como nos Distritos que apresentaram condições sanitárias ruins e baixa escolaridade do chefe da família (Distrito VII), maior proporção de analfabetismo entre 10 e 14 anos (Distrito II) e baixa renda do chefe do domicílio (Distritos I, II e VII). Conclusões: o estudo evidenciou a persistência das desigualdades de saúde nas áreas com piores condições de vida.

Análise espacial da tuberculose em menores de 15 anos de idade e risco socioeconômico: um estudo ecológico na Paraíba, 2007-2016 / Análisis espacial de la tuberculosis en menores de 15 años y riesgo socioeconómico: un estudio ecológico en Paraíba, Brasil, 2007-2016 / Spatial analysis of tuberculosis in children under 15 years of age and socioeconomic risk: an ecological study in Paraíba, Brazil, 2007-2016

Objetivo: Analisar a distribuição espacial da tuberculose em indivíduos menores de 15 anos de idade e fatores socioeconômicos na Paraíba, Brasil, 2007-2016. Métodos: Estudo ecológico, com dados do Sistema de Informação de Agravos de Notificação, sendo o município a unidade de análise. Realizou-se distribuição espacial da incidência, aplicou-se o método bayesiano empírico local e a estatística de Moran. Dados socioeconômicos foram cruzados, para identificação das áreas de prosperidade social. Resultados: Foram notificados 426 casos, com incidência média de 4,5/100 mil habitantes. O índice de Moran foi de 0,59 (p-valor=0,010). O Moran Map revelou concentração de casos em menores de 15 anos em 38 municípios com alta prioridade da atenção, em conglomerados nos padrões alto-alto e baixo-baixo, nas regiões leste e noroeste do estado, coincidindo com áreas de baixa prosperidade social. Conclusão: Houve clusters com maior transmissão da tuberculose, apontando áreas prioritárias para abordagem da tuberculose.

Objetivo: Analizar la distribución espacial de la tuberculosis en menores de 15 años y los factores socioeconómicos en Paraíba, Brasil, 2007-2016. Métodos: Estudio ecológico, con datos de Sistema de Información de Agravamientos de Notificación, considerando el municipio como unidad de análisis. Se realizó la distribución espacial de la incidencia, se aplicó el método empírico local Bayesiano y la estadística de Moran. Se cruzaron datos socioeconómicos para identificar áreas de vulnerabilidad social. Resultados: Se notificaron 426 casos, con una incidencia promedio de 4,5/100 mil habitantes. El índice de Moran = 0,59 (p=0,010). El Mapa de Moran reveló una concentración de casos en menores de 15 años en 38 municipios con alta prioridad de atención, en conglomerados en los patrones alto-alto y bajo-bajo, en las regiones este y noroeste del estado, coincidiendo con áreas de baja prosperidad social. Conclusión: Existían clusters con mayor transmisión de tuberculosis, lo que indica áreas prioritarias para abordar la tuberculosis.

Objective: To analyze spatial distribution of tuberculosis in individuals under 15 years old and socioeconomic factors in Paraíba, Brazil, 2007-2016. Methods: This was an ecological study based on data from the Notifiable Health Conditions Information System (SINAN), taking each municipality to be a unit of analysis. Spatial distribution of incidence was performed, the local empirical Bayesian method and Moran's I were applied. Socioeconomic data were crossed-checked to identify areas of social prosperity. Results: 426 cases were notified, with average incidence of 4.5/100,000 inhabitants. Moran's I was 0.59 (p=0.010). The Moran Map revealed concentration of cases in children under 15 in 38 high priority municipalities, in clusters with high-high and low-low patterns, in the east and northwest of the state, coinciding with areas of low social prosperity. Conclusion: There were clusters with greater tuberculosis transmission, indicating priority areas for addressing tuberculosis.

Áreas prioritárias para controle do abandono do tratamento da tuberculose em Recife, Brasil / Priority areas for the control of tuberculosis treatment abandonment in Recife, Brazil

A tuberculose encontra-se entre as doenças infecciosas do mundo com alta morbimortalidade. Possui a descontinuidade do tratamento como desafio a ser enfrentado para reduzir os casos de resistência aos fármacos e mortalidade. O objetivo foi identificar áreas prioritárias para o controle dos casos de abandono do tratamento da tuberculose (TB) no município de Recife. Tratou-se de estudo ecológico, realizado com casos novos de TB diagnosticados em Recife e registrados no Sistema de Informação e Agravos de Notificação entre 2012 a 2014. A variável desfecho foi a média da proporção de abandono do tratamento da TB por setor censitário. Para composição desta variável foram geocodificados todos os endereços dos casos novos de tuberculose e os de abandono do tratamento no triênio investigado. Para avaliação da autocorrelação espacial foi utilizado o Índice Global de Moran. Foram registrados e geocodificados 641 casos de abandono. O valor do Índice Global de Moran foi 0,0313816 (p=0,03) e, por meio do Moran Map, foram identificados 153 setores com significância estatística espacial, destes 43 com alta prioridade para intervenção em saúde distribuídos em 21 bairros. Identificou-se áreas prioritárias para o monitoramento da adesão ao tratamento da tuberculose. O uso dos setores censitários permite a realização de intervenções em saúde para melhor qualidade da assistência aos doentes e redução dos desfechos desfavoráveis com racionalidade dos recursos públicos por ser o menor nível de desagregado territorial disponível, dinâmica populacional e socioeconômica semelhante entre os residentes.

Tuberculosis is among the world's high morbidity and mortality infectious diseases. The discontinuity of treatment is a challenge to be faced in order to reduce cases of drug resistance and mortality. The objective of this study was to identify priority areas for the control of cases of tuberculosis (TB) treatment abandonment in the city of Recife. This was an ecological study, carried out with new cases of TB diagnosed in Recife and registered in the Information System for Notifiable Diseases between 2012 and 2014. The outcome variable was the average proportion of the abandonment of TB treatment by census sector. To compose this variable, all addresses of new cases of tuberculosis and those of treatment abandonment in the investigated three-year period were geocoded. Moran's Global Index was used to assess spatial autocorrelation. 641 abandonment cases were recorded and geocoded. The value of the Global Moran Index was 0.0313816 (p=0.03) and, through the Moran Map, 153 sectors with spatial statistical significance were identified, of these 43 were high priority for health interventions distributed in 21 neighborhoods. Priority areas were identified for monitoring adherence to tuberculosis treatment. Due to the lower level of available territorial sectors, similar populations, and socioeconomic dynamics among residents, the use of the census sectors allows health interventions to be carried out to improve the quality of care for patients and to reduce the unfavorable outcomes while considering public resources.

Perfil epidemiológico da mortalidade por homicídios intencionais no município de João Pessoa, Paraíba, 2011-2016 / Epidemiological profile of intentional homicide mortality in João Pessoa, Paraíba (2011-2016) / Perfil epidemiológico de mortalidad por homicidios intencionales en el municipio de João Pessoa, Paraíba, en 2011-2016

Analisar o perfil epidemiológico da mortalidade por homicídios intencionais, no município de João Pessoa (PB). Estudo retrospectivo, exploratório e quantitativo. Utilizaram-se dados dos homicídios dolosos, das vítimas residentes no município entre 2011-2016, através do cruzamento do banco de dados do Sistema de Informações de Mortalidade (SIM) e Secretaria de Estado da Segurança e Defesa Social da Paraíba (SESDS-PB). Foram analisadas as variáveis: ano de ocorrência, sexo, estado civil, faixa etária, raça/cor, escolaridade, antecedentes criminais, tipo de arma utilizada pelo agressor, local da ocorrência, modus operandi, turno/horário e dia da semana. Do total de ocorrências (nº = 2628), o perfil predominante das vítimas de homicídios intencionais foi de pessoas do sexo masculino (92,3%), solteiros (76,1%), de cor parda (93,7%), entre 15 e 29 anos (64,2%), com baixa escolaridade (80,0%), vitimadas por arma de fogo (90,0%), com histórico de envolvimento em atividades criminosas (65,0%), ocorridos em via pública (83,5%), no turno da noite e madrugada (61,5%) e nos finais de semana (49,7%). Tendo os homicídios como um grave problema para a saúde pública, faz-se necessário o monitoramento contínuo desses eventos para o estabelecimento de ações adequadas para sua redução.

This study analyzes the epidemiological profile of intentional homicide mortality in the municipality of João Pessoa, Paraíba, Brazil. A retrospective, exploratory, and quantitative research was conducted with data from the intentional homicides committed in the municipality between 2011-2016, obtained by crossing the Mortality Information System (SIM) and the Department of Security and Social Defense of Paraíba (SESDS-PB) databases. Year of occurrence, gender, marital status, age, race/color, schooling level, criminal history, type of weapon used, place of occurrence, modus operandi, time of day and day of the week were the variables analyzed. Of the total occurrences (n = 2628), the predominant profile of intentional homicide victims were men (92.3%), single (76.1%), brown (93.7%), between 15 and 29 years old (64.2%), with low schooling level (80.0%), victimized by firearm (90.0%), with a history of criminal activities (65.0%), occurred on public roads (83.5%), at night and dawn (61.5%), and on weekends (49.7%). As homicide constitute a serious public health issue, it must be continuously monitored to establish appropriate reduction actions.

Este estudio tiene como objetivo analizar el perfil epidemiológico de la mortalidad por homicidios intencionales en el municipio de João Pessoa, Paraíba (Brasil). Este es un estudio retrospectivo, exploratorio y cuantitativo. Se utilizaron datos de los homicidios dolosos, de las víctimas residentes en el municipio entre 2011-2016 a través del cruce con el banco de datos del Sistema de Información de Mortalidad (SIM) y la Secretaría de Estado de Seguridad y Defensa Social de Paraíba (SESDS-PB). Se analizaron las variables: año de ocurrencia, sexo, estado civil, grupo de edad, raza/color, nivel de estudios, antecedentes penales, tipo de arma utilizada por el agresor, lugar de la ocurrencia, modus operandi, turno/horario y día de la semana. Del total de ocurrencias (n = 2628), el perfil predominante de las víctimas de homicidios intencionales fue de personas del sexo masculino (92,3%), solteros (76,1%), de color parda (93,7%), entre 15 y 29 años (64,2%), con bajo nivel de estudios (80,0%), victimizadas por arma de fuego (90,0%), con histórico de involucramiento en actividades criminales (65,0%), ocurridos en vía pública (83,5%), en el turno de la noche y madrugada (61,5%) y los fines de semana (49,7%). Teniendo en cuenta que los homicidios son un grave problema para la salud pública, es necesario el monitoreo continuo de estos eventos para el establecimiento de acciones adecuadas para su reducción.

[Homicides in Brazil in the last decade: an integrative review]. / Homicídios do Brasil na última década: uma revisão integrativa.

Homicide is the most serious form of violence with a negative impact on the population. It is broadly studied in the scientific field and disseminated in print and in the virtual media. The scope of this article is to locate papers in national and international journals, seeking the synthesis of knowledge and the incorporation of the applicability of the results of significant studies. It involved an integrative review of the SciELO, PubMed and LILACS databases of articles published between 2006 and 2016. The following key words were researched: Homicide and Brazil. The publications were selected by the title, abstract and methodology. For homicide and health studies in Brazil, 427 papers were found, of which 98 were selected. There were publications with emphasis on the national scenario, followed by the state of São Paulo and Pernambuco. The quantitative study was the most used, with collection of secondary data. The papers dealt with homicides in the population in general (48%), Femicide (14.3%) and Social Determinants (7.1%). The Brazilian scientific production on homicide and health is on the increase. It is important that researchers, analysts and editors turn their attention to the development of papers in this area, aiming to improve the quality of published articles.