HIV and AIDS in the state of Paraná, Brazil, 2007-2022: trends and spatiotemporal distribution.

OBJECTIVE: The aim of this study was to analyze the spatiotemporal evolution of the incidence rates of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the state of Paraná, Brazil. METHODS: An ecological study with an analytical component of time series analysis was conducted in the state of Paraná from 2007 to 2022. The data source was the Notifiable Diseases Information System. To study the trend, the Prais-Winsten generalized linear regression model was used by decomposing the time series, and for spatial analysis, the Moran's index was applied. RESULTS: The total sample consisted of 50,676 HIV/AIDS records. The incidence rate showed an increasing trend, with an average growth of 2.14% [95% confidence interval - 95%CI 1.16-3.13] per month. From 2007 to 2014 and from 2015 to 2022, the average number of cases in the state was 105.64 and 159.20 per 100,000 inhabitants, respectively, with significant variation among municipalities. Spatial clusters of high risk persisted in the metropolitan region, the capital, and coastal areas, and a new cluster was observed in the northern region of the state. CONCLUSION: The incidence rates of HIV/AIDS showed an upward trend over time. The number of cases varied considerably in some municipalities, especially in the coastal region. Spatial analysis revealed geospatial patterns of high risk in the main metropolitan areas of Paraná: Curitiba (including the coastal area), Londrina, and Maringá, which share characteristics such as a high degree of urbanization and ongoing economic development.

Effectiveness of neurolysis as a treatment for complications of leprosy neuritis: a systematic review.

BACKGROUND: Complications of leprosy neuritis are considered serious and apparent, with the potential to disable and/or limit individuals. These complications affect not only a patient's physical functioning, but also their family and social lives, while directly impacting the ability to work and/or maintain financial independence, subsequently interfering with their overall quality of life. The present review, therefore, aimed to analyze the effectiveness of neurolysis as an alternative treatment for the complications associated with leprosy neuritis. METHODS: The present review was performed based on the Joanna Briggs Institute methodology, in an effort to answer the following research question: what is the effectiveness of neurolysis as a treatment for leprosy neuritis complications? This research question was defined using the patient-intervention-outcome (PIO) framework, where leprosy represents 'P', neurolysis for 'I', and neuropathic pain/motor function/sensorial function/physical disability/quality of life for 'O'. Randomized and non-randomized clinical trials and prospective observational cohort studies were included in the present review, with no time or date restrictions. RESULTS: The present review included 1 randomized clinical trial and 10 prospective studies, published between 1976 and 2020. All of the outcomes showed improvement, with relief from neuropathic pain being the primary finding. CONCLUSIONS: The evidence obtained in the present review suggested that neurolysis is an effective alternative for the treatment of physical disabilities, the recovery of sensory and motor function, the restoration of quality of life, and neuropathic pain relief.

"Educational Material on HIV": validity of health educational technology for people living with HIV.

OBJECTIVES: to validate the educational technology "Educational Material on HIV" (INPI - BR 10 2020 003765 0). METHODS: a methodological study with 39 expert judges in HIV/AIDS, using a 5-point Likert scale for assessment. Data were tabulated, processed and analyzed through descriptive analysis. Cronbach's alpha and McDonald's omega tests were performed to analyze internal consistency, and the Intraclass Correlation Coefficient, for reliability. Agreement was established by a Level Content Validity Index greater than 0.90. RESULTS: the assessment instrument showed high internal consistency (Cronbach's alpha of 0.89; McDonald's omega of 0.91) with reliable values. Based on the Intraclass Correlation Coefficient, judges' answers showed acceptable reliability, mean score 0.89 (p<0.001). Agreement among judges was greater than 0.90 in the three assessed dimensions (objectives, presentation and relevance). CONCLUSIONS: the technology was considered a qualified and adequate tool by the judges regarding its objectives, presentation and relevance.

Capacitação profissional em hanseníase na Atenção Primária à Saúde: protocolo de revisão de escopo / Professional training in leprosy in Primary Health Care: a scoping review protocol

OBJETIVO: Descrever a sistematização do desenvolvimento de uma revisão de escopo para mapear evidências científicas relativas à capacitação profissional da equipe de assistência ao paciente em hanseníase na Atenção Primária à Saúde. MÉTODO: Fundamentar-se-á nas recomendações do Preferred Reporting Items for Systematic and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR), atendendo às orientações do Instituto Joanna Briggs. Espera-se que as evidências encontradas na literatura nacional e internacional possam direcionar profissionais e gestores na implementação de ações de controle e eliminação da hanseníase como problema de saúde pública, por meio da educação.

OBJECTIVE: To describe the systematization of a scoping review to map scientific evidence related to the professional training of the members of the leprosy primary health care team. METHOD: The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) will be met, as well as the Joanna Briggs Institute's guidelines. It is expected that the evidence found in the national and international literature can guide professionals and managers in implementing actions to control and eliminate leprosy, a public health problem, through education.

Effectiveness of neurolysis as a treatment for complications of leprosy neuritis: a systematic review

ABSTRACT Background: Complications of leprosy neuritis are considered serious and apparent, with the potential to disable and/or limit individuals. These complications affect not only a patient's physical functioning, but also their family and social lives, while directly impacting the ability to work and/or maintain financial independence, subsequently interfering with their overall quality of life. The present review, therefore, aimed to analyze the effectiveness of neurolysis as an alternative treatment for the complications associated with leprosy neuritis. Methods: The present review was performed based on the Joanna Briggs Institute methodology, in an effort to answer the following research question: what is the effectiveness of neurolysis as a treatment for leprosy neuritis complications? This research question was defined using the patient-intervention-outcome (PIO) framework, where leprosy represents 'P', neurolysis for 'I', and neuropathic pain/motor function/sensorial function/physical disability/quality of life for 'O'. Randomized and non-randomized clinical trials and prospective observational cohort studies were included in the present review, with no time or date restrictions. Results: The present review included 1 randomized clinical trial and 10 prospective studies, published between 1976 and 2020. All of the outcomes showed improvement, with relief from neuropathic pain being the primary finding. Conclusions: The evidence obtained in the present review suggested that neurolysis is an effective alternative for the treatment of physical disabilities, the recovery of sensory and motor function, the restoration of quality of life, and neuropathic pain relief.

"Educational Material on HIV": validity of health educational technology for people living with HIV / "Material Educativo sobre VIH": validación de tecnología educativa en salud para personas que viven con VIH / "Material Educativo sobre HIV": validação de tecnologia educacional em saúde para pessoas vivendo com HIV

ABSTRACT Objectives: to validate the educational technology "Educational Material on HIV" (INPI - BR 10 2020 003765 0). Methods: a methodological study with 39 expert judges in HIV/AIDS, using a 5-point Likert scale for assessment. Data were tabulated, processed and analyzed through descriptive analysis. Cronbach's alpha and McDonald's omega tests were performed to analyze internal consistency, and the Intraclass Correlation Coefficient, for reliability. Agreement was established by a Level Content Validity Index greater than 0.90. Results: the assessment instrument showed high internal consistency (Cronbach's alpha of 0.89; McDonald's omega of 0.91) with reliable values. Based on the Intraclass Correlation Coefficient, judges' answers showed acceptable reliability, mean score 0.89 (p<0.001). Agreement among judges was greater than 0.90 in the three assessed dimensions (objectives, presentation and relevance). Conclusions: the technology was considered a qualified and adequate tool by the judges regarding its objectives, presentation and relevance.

RESUMEN Objetivos: validar la tecnología educativa "Material Educativo sobre VIH" (INPI - BR 10 2020 003765 0). Métodos: estudio metodológico con 39 jueces expertos en VIH/SIDA, utilizando una escala Likert de 5 puntos para evaluación. Los datos fueron tabulados, procesados y analizados mediante análisis descriptivo. Se realizaron las pruebas alfa de Cronbach y omega de McDonald para analizar la consistencia interna y el Intraclass Correlation Coefficient para la confiabilidad. La concordancia fue establecida por un Level Content Validity Index superior a 0,90. Resultados: el instrumento de evaluación mostró alta consistencia interna (alfa de Cronbach de 0,89; omega de McDonald de 0,91) con valores confiables. Con base en el Intraclass Correlation Coefficient, las respuestas de los jueces mostraron una confiabilidad aceptable, puntaje promedio de 0,89 (p<0,001). La concordancia entre jueces fue superior a 0,90 en las tres dimensiones evaluadas (objetivos, presentación y relevancia). Conclusiones: la tecnología fue considerada una herramienta calificada y adecuada por los jueces en cuanto a sus objetivos, presentación y pertinencia.

RESUMO Objetivos: validar a tecnologia educacional "Material Educativo sobre HIV" (INPI - BR 10 2020 003765 0). Métodos: estudo metodológico com 39 juízes experts em HIV/AIDS, utilizando escala Likert de 5 pontos para avaliação. Os dados foram tabulados, processados e analisados mediante análise descritiva. Realizaram-se os Testes alfa de Cronbach e ômega de McDonald para análise da consistência interna, e Intraclass Correlation Coefficient, para confiabilidade. A concordância foi estabelecida pelo Level Content Validity Index maior que 0,90. Resultados: o instrumento de avaliação apresentou alta consistência interna (alfa de Cronbach de 0,89; ômega de McDonald de 0,91) com valores confiáveis. A partir do Intraclass Correlation Coefficient, as respostas dos juízes apresentaram confiabilidade aceitável, escore médio 0,89 (p<0,001). A concordância entre os juízes foi superior a 0,90 nas três dimensões avaliadas (objetivos, apresentação e relevância). Conclusões: a tecnologia foi considerada uma ferramenta qualificada e adequada pelos juízes quanto aos seus objetivos, apresentação e relevância.

Caracterização demográfica, clínica e terapêutica dos casos de pneumonia hospitalar não associada à ventilação mecânica / Demographic, clinical and therapeutic characterization of the cases of hospital-acquired non-ventilator associated pneumonia

Objetivo: Caracterizar os indivíduos adultos internados que desenvolveram Pneumonia Hospitalar Não Associada à Ventilação Mecânica, segundo variáveis demográficas, clínicas e terapêuticas. Métodos: Estudo transversal e descritivo, realizado em hospital terciário do norte do Paraná; considerando as fichas de notificação das Infecções Relacionadas à Assistência à Saúde da Comissão de Controle de Infecção Hospitalar, com idade maior ou igual a 18 anos, internados no período de janeiro de 2017 a dezembro de 2018. Resultados: Em relação ao sexo houve similaridade, com maior prevalência em pacientes acima de 60 anos e com o tempo de permanência prolongado; as variáveis clínicas resultaram em 50,6% de pacientes com hemocultura associada à pneumonia negativa, destes,53,6% evoluíram a óbito. Quanto às culturas de secreção traqueal, obteve-se maior índice de Acinetobacter baumanni, com a utilização do antimicrobiano piperacilina sódica + tazobactam sódico. Conclusão: Os casos de Pneumonia Hospitalar Não Associada à Ventilação Mecânica ocorreram na mesma proporção entre os sexos, com prevalência em idosos e evolução de óbito de mais da metade dos indivíduos. O perfil clínico das secreções traqueais, hemocultura de Staphylo spp, revela que o microrganismo Acinetobacter baumanni foi o mais prevalente, tendo como escolha terapêutica de antimicrobiano a classe das cefalosporinas. Descritores: Pneumonia. Infecção Hospitalar. Pneumonia Associada à Assistência à Saúde. Enfermagem.

Objective: To characterize the hospitalized adult individuals thatdeveloped hospital-acquired non-ventilator associated pneumonia, according to demographic, clinical and therapeutic variables.Methods: A cross-sectional and descriptive study, carried out at a tertiary-level hospital in northern Paraná; considering the notification forms of Healthcare-Associated Infectionsfrom theHospital Infection Control Commissionin patients aged at least 18years old, admitted from January2017 to December2018.Results: There was similarity in relation to gender, with higher prevalence in patients over 60years old and with prolonged hospitalization time; the clinical variables resulted in 50.6% of patients with negative blood cultures associated with pneumonia, with 53.6% of them evolving to death. Regarding the tracheal secretioncultures, a higher index of Acinetobacter baumanniwas obtained, with use of the piperacillin sodium+tazobactam sodiumantimicrobial.Conclusion:The cases of hospital-acquired non-ventilator associated pneumoniaoccurred in the same proportion between the genders, with prevalence in older adults and evolution of death in more than half of the individuals. The clinical profile of the tracheal secretions andStaphylosppblood cultures reveals that the Acinetobacter baumannimicroorganism was the most prevalent, with thecephalosporins class as the antimicrobial therapeutic choice.Descriptors:Pneumonia. Cross Infection. Health-Care Associated Pneumonia. Nursing.

Acquired and Transmitted Multidrug-Resistant Tuberculosis among the Incarcerated Population and Its Determinants in the State of Paraná-Brazil.

(1) Background: Tuberculosis remains a public health problem in the world. The study analyzed the factors associated with drug-resistant tuberculosis in the prison population of the state of Paraná. (2) Methods: Ecological study of drug-resistant tuberculosis cases registered in the Paraná Information System, Brazil (2008 to 2018). We performed descriptive statistics of quantitative parameters calculated with absolute frequencies. Additionally, we used binary regression logistics, where the odds ratio with its respective confidence interval was calculated. (3) Results: Of the 653 cases registered as cases of tuberculosis in the incarcerated population, 98 were drug-resistant tuberculosis. We observed that educational level of up to 8 to 11 years of schooling, negative bacterial culture (test outcome) and no tobacco use were factors associated with the non-development of drug-resistant tuberculosis, while clinically confirmed pulmonary TB and positive sputum smear microscopy in the fourth month of follow-up showed an association for the development of drug resistance. (4) Conclusions: The study showed that clinically confirmed pulmonary TB and a positive sputum smear microscopy in the fourth month of follow-up were associated with drug-resistant tuberculosis.

Trend and Spatial Distribution of Drug-Resistant Tuberculosis in Liberty-Deprived Populations in the State of Paraná, Brazil.

(1) Background: Tuberculosis remains a public health problem in the world. This study evaluated the temporal trends, distribution, and spatial associations of drug-resistant tuberculosis in liberty-deprived populations in the state of Paraná, Brazil. (2) Methods: An ecological study was developed using all cases of drug-resistant tuberculosis in penal establishments reported by the Brazilian Notifiable Diseases Information System between 2008 and 2018. For the time trend, the Prais-Winsten method was used. To verify the spatial association, the Getis-Ord Gi* technique was used. (3) Results: During the study period, 653 cases of tuberculosis were reported in the studied population, of which 98 (15%) were drug-resistant. Prais-Winsten autoregression identified an increasing trend, with APC = 15.08% (95% CI: 0.02-0.09) from 2008 to 2018; when analyzed from 2012 to 2018, the trend increased even more, with APC = 23.31% (95% CI: 0.01-0.16). Hotspots were also noted in the north, east, and west macro-regions of the state. (4) Conclusions: The presence of drug-resistant tuberculosis, as well as an increasing trend of these cases, was evidenced in all regions of the state among liberty-deprived populations,. The spatial analysis revealed priority areas for drug-resistant tuberculosis in penal establishments.

Tuberculosis among People Living on the Street and Using Alcohol, Tobacco, and Illegal Drugs: Analysis of Territories in Extreme Vulnerability and Trends in Southern Brazil.

(1) Background: Tuberculosis presents an epidemiological trend toward inequality, especially among people in social exclusion and situations of vulnerability. This study aimed to analyze territories with a concentration of people diagnosed with tuberculosis in a street situation and who partake in chronic use of alcohol, tobacco, and illicit drugs. We also analyzed trends in this health condition in southern Brazil. (2) Methods: Ecological study, developed in the 399 municipalities of Paraná, southern Brazil, with all tuberculosis cases in the homeless population registered in the Information System of Notifiable Diseases between 2014 and 2018. For data analysis, we used descriptive statistics, the Prais-Winsten autoregression method for the time series, and the Getis-Ord Gi technique* for spatial analysis. (3) Results: in total, 560 cases were reported. We found a predominance of alcohol, smoking, and illicit drug users, with an increasing trend in the state and clusters of spatial risk in the East health macro-region. (4) Conclusions: We observed territories with critical levels of highly vulnerable people who use psychoactive substances and are in a street situation. The results highlight the importance of incorporating public policies of social protection for these individuals and resolutive health services that receive these cases and assist in eradicating TB.

Inequality of gender, age and disabilities due to leprosy and trends in a hyperendemic metropolis: Evidence from an eleven-year time series study in Central-West Brazil.

The present study aimed to investigate the epidemiological situation of leprosy (Hansen's Disease), in a hyperendemic metropolis in the Central-West region of Brazil. We studied trends over eleven years, both in the detection of the disease and in disabilities, analyzing disparities and/or differences regarding gender and age. This is an ecological time series study conducted in Cuiabá, capital of the state of Mato Grosso. The population consisted of patients diagnosed with leprosy between the years 2008 and 2018. The time series of leprosy cases was used, stratifying it according to gender (male and female), disability grade (G0D, G1D, G2D, and not evaluated) and age. The calendar adjustment technique was applied. For modeling the trends, the Seasonal-Trend decomposition procedure based on Loess (STL) was used. We identified 9.739 diagnosed cases, in which 58.37% were male and 87.55% aged between 15 and 59 years. Regarding detection according to gender, there was a decrease among women and an increase in men. The study shows an increasing trend in disabilities in both genders, which may be related to the delay in diagnosis. There was also an increasing number of cases that were not assessed for disability at the time of diagnosis, which denotes the quality of the services.

Caracterização epidemiológica do HIV/AIDS em adolescentes em um município no Sul do Brasil / Epidemiological characterization of HIV/AIDS in adolescents who live in a municipality from southern Brazil

Objetivo: Caracterizar o perfil epidemiológico dos casos de HIV/AIDS em adolescentes. Métodos: Estudo transversal, realizado com dados secundários do Sistema Nacional de Informação de Agravos de Notificação, de 2007 a 2019, de adolescentes residentes em um município no Sul do Brasil. Verificou-se por meio de análise descritiva e medidas de frequência variáveis demográficas, características de transmissão, infecções oportunistas e evolução dos casos. Resultados: Foram notificados 84 casos, com predomínio de idade entre 17 a 19 anos (92,8%); ensino médio completo/incompleto (50,0%); sexo masculino (73,8%) e raça branca (69,0%). Quanto à exposição ao HIV, 75,0% eram homens com relações homoafetivas declaradas. A incidência, por quadriênios, foi a seguinte: 14 casos, 26 casos e 41 casos, e em 2019, 3 casos. O coeficiente de mortalidade foi de 0,35/100.000 habitantes. Dos diagnósticos, 67,9% foram confirmados por teste rápido e 39,3% por exames laboratoriais. No momento do diagnóstico, 42,9%apresentavam AIDS. Os sinais clínicos de maior prevalência foram caquexia (10,7%), astenia (8,3%) e tosse persistente (7,1%). As infecções oportunistas mais presentes foram candidíase oral (6,7%), linfadenopatia (4,4%) e alterações no sistema nervoso central (4,4%). Conclusão: Evidencia-se a vulnerabilidade dos adolescentes e necessidade de intensificar políticas públicas para prevenção e diagnóstico precoce nessa faixa etária.

Objective: To characterize the epidemiological profile of HIV/AIDS cases in adolescents. Method:A cross-sectional study, conducted from 2007 to 2019 with adolescents living in a municipality from southern Brazil, resorting to secondary data from the National System of Information about Notifiable Diseases. The demographic variables, that is, transmission characteristics, opportunistic infections and case evolution, were verified through descriptive analysis and frequency measures. Results: A total of 84 cases were reported, with predominance of the age group between 17 and 19 years old (92.8%), complete/incomplete high school (50.0%), male gender (73.8%), and white race (69.0%). Regarding HIV exposure, 75.0% were men with declared homoaffective relationships. Incidence by quadrennium periods was as follows: 14 cases, 26 cases and 41 cases, with 3 cases in 2019. The mortality rate was 0.35/100,000 inhabitants. Of the diagnoses, 67.9% were confirmed by rapid test and 39.3% by laboratory tests. 42.9% had AIDS at diagnosis. The most prevalent clinical signs were cachexia (10.7%), asthenia (8.3%) and persistent cough (7.1%). The most frequent opportunistic infections were oral candidiasis (6.7%), lymphadenopathy (4.4%) and changes in the central nervous system (4.4%). Conclusion: The adolescents' vulnerability and the need to intensify public policies for prevention and early diagnosis in this age group areevidenced

Fatores relacionados com mortalidade por pneumonia não associada à ventilação mecânica / Factors related to mortality by pneumonia unrelated to mechanical ventilation

RESUMO Objetivos analisar os fatores relacionados com mortalidade por pneumonia hospitalar não associada à ventilação mecânica. Métodos estudo do tipo coorte retrospectiva com amostra obtida por meio das 538 fichas de notificação das infecções relacionadas com a assistência à saúde. Calculado o Risco Relativo e realizada análise multivariável por meio de regressão de Poisson com nível de significância de 5%. Resultados na análise multivariável, percebeu-se que os indivíduos com idade inferior a 59 anos e que receberam apenas um antimicrobiano apresentaram proteção para óbito. Os principais microrganismos responsáveis pelo aumento do risco para óbito foram: Acinetobacter baumannii, Klebsiella pneumoniae e Espécies de Candida (Candida spp). Conclusão foram fatores relacionados com a mortalidade os indivíduos com idade maior que 60 anos, em uso de dois ou mais antimicrobianos, assim como a identificação dos microrganismos Acinetobacter baumannii, Klebsiella pneumoniae e Espécies de Candida (Candida spp).

ABSTRACT Objective to analyze the factors related to mortality by nosocomial pneumonia unrelated to mechanical ventilation. Methods retrospective cohort study with a sample acquired using the 538 notification forms for health care-related infections. The relative risk was calculated and a multivariable analysis was carried out using Poisson regression with a significance level of 5%. Results the multivariable analysis showed that being under 59 years old and taking only one antimicrobial drug were protective factors against death. The main microorganisms responsible for the increase in the risk of death were: Acinetobacter baumannii, Klebsiella pneumoniae and species of Candida (Candida spp). Conclusion the factors related to mortality were being 60 years old or older, using two or more antimicrobial substances, and being affected by the microorganisms Acinetobacter baumannii, Klebsiella pneumonia, and species of Candida (Candida spp).

HIV Care Continuum from diagnosis in a Counseling and Testing Center.

OBJECTIVE: To analyze the HIV care continuum from the diagnosis in an HIV/AIDS Counseling and Testing Center (CTC), and the sociodemographic, clinical, and laboratory characteristics related to gender. METHOD: Epidemiological study, conducted with data of individuals assisted at a Counseling and Testing Center, and followed in an outpatient clinic for HIV/AIDS. Pearson's Chi-square test and binary logistic regression were used to obtain odds ratios, considering alpha value <0.05. RESULTS: The prevalence of HIV among 5,229 users was 5%. The highest chance of positive results was among men, aged 14 to 33 years old, who were not in a domestic partnership. In the analysis of TCD4+ lymphocytes and viral load (VL) of 238 cases, 56.1% had a late diagnosis. We have identified gaps in the care cascade, especially linkage to the care, retention in care, and viral load suppression. CONCLUSION: The results suggest a late diagnosis for both genders, as well as difficulty in reaching the viral suppression goal.

Trends and forecasts of leprosy for a hyperendemic city from Brazil's northeast: Evidence from an eleven-year time-series analysis.

This study's objective was to estimate the temporal trends of leprosy according to sex and age groups, as well as to estimate and predict the progression of the disease in a hyperendemic city located in the northeast of Brazil. This ecological time-series study was conducted in Imperatriz, Maranhão, Brazil. Leprosy cases diagnosed between 2006 and 2016 were included. Detection rates stratified by sex and age groups were estimated. The study of temporal trends was accomplished using the Seasonal-Trend Decomposition method and temporal modeling of detection rates using linear seasonal autoregressive integrated moving average model according to Box and Jenkins method. Trend forecasts were performed for the 2017-2020 period. A total of 3,212 cases of leprosy were identified, the average incidence among men aged between 30 and 59 years old was 201.55/100,000 inhabitants and among women in the same age group was 135.28/100,000 inhabitants. Detection rates in total and by sex presented a downward trend, though rates stratified according to sex and age presented a growing trend among men aged less than 15 years old and among women aged 60 years old or over. The final models selected in the time-series analysis show the forecasts of total detection rates and rates for men and women presented a downward trend for the 2017-2020 period. Even though the forecasts show a downward trend in Imperatriz, the city is unlikely to meet a significant decrease of the disease burden by 2020.

Leprosy in urban space, areas of risk for disability and worsening of this health condition in Foz Do Iguaçu, the border region between Brazil, Paraguay and Argentina.

BACKGROUND: Leprosy is a public health problem and a challenge for endemic countries, especially in their border regions where there are intense migration flows. The study aimed to analyse the dynamics of leprosy, in order to identify areas of risk for the occurrence of the disease and disability and places where this health condition is worsening. METHOD: This ecological study considered the new cases of leprosy reported in the municipality of Foz do Iguaçu from 2003 to 2015. Spatial and spatial-temporal scan statistics were used to identify the risk areas for the occurrence of leprosy, as well as the Getis-Ord Gi and Getis-Ord Gi* methods. Areas of risk for disabilities were identified by the scan statistic and kernel density estimation. RESULTS: A total of 840 cases were reported, of which 179 (21.3%) presented Grade 1 or 2 disabilities at the time of diagnosis. Leprosy risk areas were concentrated in the Southern, Eastern and Northeastern Health Districts of the municipality. The cases of Grade 2 disability were observed with higher intensity in regions characterized by high population density and poverty. CONCLUSION: The results of the study have revealed changes in the pattern of areas at risk of leprosy according to the investigated periods. In addition, it was possible to verify disabilities as a condition present in the investigated cases, or that may be related to the late diagnosis of the disease. In the areas of risk identified, patients have reported worse physical disability after diagnostic confirmation, or indicate inadequate clinical examination, reinforcing the need for structuring leprosy control services in a qualified manner.

Tempo para o diagnóstico da hanseníase e sua relação com fatores sociodemográficos e clínicos / Tiempo para el diagnóstico de lepra y su relación con los factores sociodemográficos y clínicos / Time for leprosy diagnosis and its relation to sociodemographic and clinical factors

RESUMO Objetivo: investigar os fatores associados ao tempo decorrido entre a identificação dos sinais e sintomas relacionados à hanseníase até o diagnóstico dos casos atendidos na atenção primária à saúde. Método: estudo transversal e analítico, realizado na atenção primária à saúde em um município de grande porte localizado no sul do Brasil, com amostra de 245 indivíduos. O período analisado foi de 2009 a 2016, por meio das fichas de notificação e consulta ao prontuário. Para análise do tempo para o diagnóstico de hanseníase (categorizado em 0 a 5 anos ou 6 anos ou mais), conduziram-se análises de frequência relativa simples, bivariada e regressão logística binária aferida pelo OddsRatio (OR) e intervalo de confiança de 95%. Nível de significância estatística estabelecido de 5% para todas as análises. Resultados: o tempo para o diagnóstico variou de 1 mês a 20 anos, sendo necessários, em média, 7,9 consultas e 4,6 anos para obtê-lo. Ter três ou mais hipóteses aumentou a chance de diagnóstico tardio, comparado ao oportuno (OR ajustado=4,82; IC95%: 2,13-10,89; P<0,001). Conclusão: o tempo decorrido para o diagnóstico teve impacto nas características da hanseníase, sendo que quanto maior o número de hipóteses apresentadas, maior o tempo decorrido para o diagnóstico e, consequentemente, maiores as chances de apresentar GIF instalado.

RESUMEN Objetivo: investigar los factores asociados tras el tiempo entre la identificación de las señales y los síntomas relacionados a la lepra hasta el diagnóstico de los casos atendidos en la atención primaria a la salud. Método: estudio transversal y analítico, realizado en la atención primaria a la salud en un municipio de gran tamaño ubicado en el sur de Brasil, con muestra de 245 individuos. El período analizado fue de 2009 a 2016, por medio de las fichas de notificación y consulta al registro médico. Para análisis del tiempo para el diagnóstico de lepra (categorizado en 0 a 5 años o 6 años o más), se condujeron los análisis de frecuencia relativo simple, bivariante y regresión logística binaria probada por elOdds Ratio (OR) e intervalo de confianza de 95%. Nivel de significación estadística establecido de 5% para todos los análisis. Resultados: el tiempo para el diagnóstico varió de 1 mes a 20 años, siendo necesarios, en promedio, 7,9 consultas y 4,6 años para obtenerlo. Tener tres o más hipótesis aumentó la probabilidad de diagnóstico tardío, comparado al oportuno (OR ajustado=4,82; IC95%: 2,13-10,89; P<0,001). Conclusión: el tiempo transcurrido para el diagnóstico tuvo impacto en las características de la lepra, siendo que cuanto mayor el número de hipótesis presentadas, mayor el tiempo transcurrido para el diagnóstico y, consecuentemente, mayores las probabilidades de presentar grado de discapacidad física instalado.

ABSTRACT Objective: to investigate the factors associated with the time that elapsed between the identification of signs and symptoms related to leprosy and the diagnosis of cases seen in primary health care. Method: this is a cross-sectional and analytical study carried out in primary health care in a large city located in southern Brazil, with a sample of 245 individuals. The period analyzed was from 2009 to 2016, through notification forms and consultation of medical records. For analysis of the time for the diagnosis of leprosy (categorized as 0 to 5 years or 6 years or more), we performed analyzes of simple relative bivariate frequency and binary logistic regression measured by Odds Ratio (OR) and a confidence interval of 95 %. The statistical significance level was set at 5% for all analyzes. Results: the time for diagnosis varied from 1 month to 20 years, requiring, on average, 7.9 consultations and 4.6 years to obtain it. Having three or more hypotheses increased the chance of late diagnosis, compared to the opportune one (adjusted OR = 4.82; 95% CI: 2.13-10.89; P <0.001). Conclusion: the time elapsed for the diagnosis had an impact on the characteristics of leprosy, and the greater the number of hypotheses, the longer the time elapsed for the diagnosis and, consequently, the greater the chances of presenting DPD installed.

Fatores que interferem na cicatrização de queimaduras em adultos: Revisão integrativa da literatura / Factors that interfere in the healing of burn wounds on adults: Integrative literature review

OBJETIVO: Analisar os fatores que interferem no processo de cicatrização de adultos queimados. MÉTODO: Revisão integrativa. A busca dos estudos primários foi realizada em dezembro de 2019, sem delimitação de tempo para a seleção, nas bases de dados PubMed, CINAHL, LILACS, Web of Science e Scopus com os descritores: adult, burnt adult, burns, burn wounds, burn scar, cicatrix, scar quality, predictors e patterns. O Cinhal Headings apresentou como descritores: adult, burn patients, burn, burn care, cicatrix e injury pattern. RESULTADOS: A amostra da revisão foi composta de sete estudos primários. Os principais fatores que interferem no processo de cicatrização de queimaduras foram: porcentagem de superfície queimada, profundidade da lesão, idade, sexo e número de intervenções cirúrgicas. CONCLUSÃO: Os elementos encontrados são fatores avaliados frequentemente na prática clínica e, portanto, o conhecimento sobre a influência desses fatores é essencial para a obtenção de um diagnóstico preciso e precoce.

OBJECTIVE: To analyze the factors that interfere with the healing process of burnt adults. METHODS: Integrative review. The search for primary studies was carried out in December 2019, with no time limit for selection, in the databases PubMed, CINAHL, LILACS, Web of Science and Scopus, with the following descriptors: adult, burnt adult, burns, burn wounds, burn scar, cicatrix, scar quality, predictors and patterns. The Cinhal Headings presented the following as descriptors: adult, burn patients, burn, burn care, cicatrix and injury pattern. RESULTS: The revision sample was composed by seven primary studies. The main factors that interfere in the process of cicatrization of burn wounds were: percentage of burnt surface, wound depth, age, sex, and number of surgical interventions. CONCLUSION: The elements found are factors that are frequently evaluated in clinical practice, and therefore the knowledge about the influence of these factors is essential for obtaining an accurate and early diagnosis.

HIV Care Continuum from diagnosis in a Counseling and Testing Center / Cascada del cuidado del VIH a partir del diagnóstico en Centro de Pruebas y Consejo / Cascata do cuidado do HIV a partir do diagnóstico em Centro de Testagem e Aconselhamento

ABSTRACT Objective: To analyze the HIV care continuum from the diagnosis in an HIV/AIDS Counseling and Testing Center (CTC), and the sociodemographic, clinical, and laboratory characteristics related to gender. Method: Epidemiological study, conducted with data of individuals assisted at a Counseling and Testing Center, and followed in an outpatient clinic for HIV/AIDS. Pearson's Chi-square test and binary logistic regression were used to obtain odds ratios, considering alpha value <0.05. Results: The prevalence of HIV among 5,229 users was 5%. The highest chance of positive results was among men, aged 14 to 33 years old, who were not in a domestic partnership. In the analysis of TCD4+ lymphocytes and viral load (VL) of 238 cases, 56.1% had a late diagnosis. We have identified gaps in the care cascade, especially linkage to the care, retention in care, and viral load suppression. Conclusion: The results suggest a late diagnosis for both genders, as well as difficulty in reaching the viral suppression goal.

RESUMEN Objetivo: Analizar la cascada del cuidado del VIH a partir del diagnóstico en Centro de Pruebas y Consejo (CTA); y las características sociodemográficas, clínicas y laboratoriales relacionadas al sexo. Método: Estudio epidemiológico, realizado con datos de indivíduos atendidos en un Centro de Pruebas y Consejo y acompañados en ambulatorio de VIH/sida. Han sido utilizados el test chi cuadrado y regresión logística binaria, para obtención del odds ratio, considerando alfa < 0,05. Resultados: La prevalencia de VIH nos 5.229 usuarios ha sido de 5%, con mayor chance de resultado positivo entre hombres, franja etaria de 14 a 33 años, que no presentaban unión estable. En el análisis de linfocitos TCD4+ y carga viral (CV) de 238 casos, 56,1% realizaron diagnóstico tardío. Han sido identificadas lagunas en la cascada del cuidado, especialmente en la vinculación, retención en el cuidado y supresión de la carga viral. Conclusión: Los resultados sugieren diagnóstico tardío para ambos los sexos, además dificultad en alcanzar la meta de supresión viral.

RESUMO Objetivo: Analisar a cascata do cuidado do HIV a partir do diagnóstico em Centro de Testagem e Aconselhamento (CTA); e as características sociodemográficas, clínicas e laboratoriais relacionadas ao sexo. Método: Estudo epidemiológico, realizado com dados de indivíduos atendidos num Centro de Testagem e Aconselhamento e acompanhados em ambulatório de HIV/aids. Foram utilizados o teste Qui-quadrado e regressão logística binária, para obtenção do odds ratio, considerando alfa < 0,05. Resultados: A prevalência de HIV nos 5.229 usuários foi de 5%, com maior chance de resultado positivo entre homens, faixa etária de 14 a 33 anos, que não apresentavam união estável. Na análise de linfócitos TCD4+ e carga viral (CV) de 238 casos, 56,1% realizaram diagnóstico tardio. Foram identificadas lacunas na cascata do cuidado, especialmente na vinculação, retenção no cuidado e supressão da carga viral. Conclusão: Os resultados sugerem diagnóstico tardio para ambos os sexos, além de dificuldade em alcançar a meta de supressão viral.

Social determinants, their relationship with leprosy risk and temporal trends in a tri-border region in Latin America.

BACKGROUND: Brazil is the only country in Latin America that has adopted a national health system. This causes differences in access to health among Latin American countries and induces noticeable migration to Brazilian regions to seek healthcare. This phenomenon has led to difficulties in the control and elimination of diseases related to poverty, such as leprosy. The aim of this study was to evaluate social determinants and their relationship with the risk of leprosy, as well as to examine the temporal trend of its occurrence in a Brazilian municipality located on the tri-border area between Brazil, Paraguay and Argentina. METHODS: This ecological study investigated newly-diagnosed cases of leprosy between 2003 and 2015. Exploratory analysis of the data was performed through descriptive statistics. For spatial analysis, geocoding of the data was performed using spatial scan statistic techniques to obtain the Relative Risk (RR) for each census tract, with their respective 95% confidence intervals calculated. The Bivariate Moran I test, Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) models were applied to analyze the spatial relationships of social determinants and leprosy risk. The temporal trend of the annual coefficient of new cases was obtained through the Prais-Winsten regression. A standard error of 5% was considered statistically significant (p < 0.05). RESULTS: Of the 840 new cases identified in the study, there was a predominance of females (n = 427, 50.8%), of white race/color (n = 685, 81.6%), age range 15 to 59 years (n = 624, 74.3%), and incomplete elementary education (n = 504, 60.0%). The results obtained from multivariate analysis revealed that the proportion of households with monthly nominal household income per capita greater than 1 minimum wage (ß = 0.025, p = 0.036) and people of brown race (ß = -0.101, p = 0.024) were statistically-significantly associated with risk of illness due to leprosy. These results also confirmed that social determinants and risk of leprosy were significantly spatially non-stationary. Regarding the temporal trend, a decrease of 4% (95% CI [-0.053, -0.033], p = 0.000) per year was observed in the rate of detection of new cases of leprosy. CONCLUSION: The social determinants income and race/color were associated with the risk of leprosy. The study's highlighting of these social determinants can contribute to the development of public policies directed toward the elimination of leprosy in the border region.