Change in Rotavirus Vaccine Coverage in Brazil from before (2015-2019) through the COVID-19 Pandemic Period (2020-2021).

During the COVID-19 pandemic, a reduction in vaccination coverage of children and adolescents was observed in several countries. The aim of this study was to assess the impact of the pandemic, in the first two years, on human rotavirus vaccine (HRV) coverage in Brazil compared with previous years. The number of doses of HRV administered in the period from January 2015 to December 2021 and its annual vaccination coverage were analyzed. The vaccination coverage decreased to 77.3% in 2020 and to 70.4% in 2021, substantially lower than the minimum that would be expected (89.2%); the decline was more pronounced in the second year of the pandemic despite the fact that in this period, the circulation restrictions were already less tight. Of the five Brazilian macro-regions, the northeast had the largest decline, and the south had the smallest impact on coverage. At the municipal level, less than half of the Brazilian municipalities managed to achieve vaccination coverage above 90% in either pandemic year. Although there was already a downward trend in coverage in the pre-pandemic years, the present study shows that the values recorded in 2020 and 2021 were significantly lower. Monitoring of vaccination coverage in the coming years should be carried out continuously in order to avoid a possible resurgence of rotavirus-induced diarrhea.

Distribuição espacial e frequência da leishmaniose visceral canina no nordeste brasileiro: uma revisão sistemática / Spatial distribution and frequency of canine visceral leishmaniasis in northeastern Brazil: a systematic review

Introdução:o Brasil está entre os sete países responsáveis por mais de 90% dos casos de leishmaniose visceral humana (LVH), sendo a região Nordeste a mais endêmica. ALV também afeta cães, que apresentam sintomas debilitantes e podem ser fatais. Os cães são os principais os pedeiros desse parasita. No entanto,há carência de dados epidemiológicos sobre leishmaniose visceral canina (LVC) no Brasil, principalmente na região nordeste. Objetivo:realizar uma revisão sistemática para demonstrar a frequência e a distribuição espacial da LVC nos estados do nordeste do Brasil. Métodos:as seguintes bases de dados foram utilizadas para busca eletrônica: Google Scholar, Lilacs, Scopus, Pubmed, Scielo, Web of Science, Cochrane, OpenGrey e OpenThesis. Os descritores de busca foram: leishmaniose visceral canina, nordeste do Brasil, Alagoas, Bahia, Ceará, Maranhão, Paraíba, Pernambuco, Piauí, Rio Grande do Norte e Sergipe. Resultados:a análise dos 73 artigos selecionados demonstrou uma frequência de LVC de 4,1% no Nordeste do Brasil, entre 1973 a 2022. O estado da Bahia apresentou a frequência (43,9%) e o Piauí a menor (1,9%). Conclusão:os dados demonstram, pela primeira vez, o caráter endêmico da LVC em toda a região nordeste e o caráter propício de disseminação de LVC nessa região. Esses dados também destacam a necessidade de ações governamentais e aprofundamento das pesquisas por parte da comunidade científica

Space-time risk clusters of Covid-19 in a tourism area in the northeastern Brazil: an epidemiological overview after two years of pandemic

The world is facing a serious viral infection caused by the new Severe Acute Respiratory Syndrome Coronavirus 2. We aimed to evaluate and map the high-risk clusters of COVID-19 in the State of Alagoas, a touristic area in northeastern Brazil, after two years of pandemic by a population-based ecological study, using COVID-19 cases reported in the State of Alagoas, between March, 2020 and April, 2022. We performed a descriptive and statistical analysis of epidemiological data. We then map high-risk areas for COVID-19, using spatial analysis, considering the incidence rate by municipality. 297,972 positive cases were registered; 56.9% were female and 42.7% aged between 20 and 39 years old. Men (OR = 1.59) and older than 60 years old (OR = 29.64) had a higher risk of death, while the highest incidence rates of the disease occurred in the metropolitan region. Our data demonstrate the impact of COVID-19 in the State of Alagoas, through the two years of pandemic. Although the number of cases were greater among women and young adults, the chance of death was greater among men and older adults. High-risk clusters of the disease initially occur in metropolitan cities and tourist areas.

Hospitalizations for pulmonary embolism in Brazil (2008-2019): an ecological and time series study.

OBJECTIVE: To assess the temporal trends of hospitalizations for pulmonary embolism (PE) in Brazil, its regions, and states between 2008 and 2019. METHODS: An ecological and time series study was conducted. Data were obtained from the Hospital Information System (SIH) of the Brazilian Ministry of Health. The inflection point regression model was applied for temporal trend analyses. Trends were classified as increasing, decreasing, or stationary according to the slope of the regression line. The Annual Percent Charge (APC) and the Average Annual Percent Change (AAPC) were calculated considering a confidence interval of 95% and p-value <0.05. Furthermore, spatial distribution maps of epidemiological indicators related to PE in Brazil were elaborated. RESULTS: There was an increasing trend in the hospitalization rate for PE in Brazil, ranging from 2.57 in 2008 to 4.44/100,000 in 2019 (AAPC=5.6%; p<0.001). Total and average hospitalizations costs also showed increasing trend in the country (AAPC=9.2% and 3.0%, respectively). Still, there was a decrease in the in-hospital mortality rate (from 21.21% to 17.11%; AAPC=-1.9%; p<0.001). Similar trends were observed in most regions. The average hospitalization time in Brazil showed a stationary trend. The hospitalization rate has also increased in 18 states (66.67%). Seven states showed a decrease in the mortality rate (25.93%), except for Roraima, which showed an increasing trend. CONCLUSION: Hospitalizations for PE represent a serious public health problem in Brazil and the temporal patterns observed herein demonstrate an increasing trend in all regions and states of the country.

A time series analysis of detection and mortality of hepatitis C in Brazil, 2008-2018.

BACKGROUND: The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030. In Brazil, efforts have been undertaken to achieve this goal; there are, however, great challenges. It is important to understand the disease profile in different regions of the country in order to design strategies to fight the disease nationwide. The objective of this study was to analyse the time trend of the incidence and mortality of hepatitis C in Brazil during the period from 2008 to 2018 according to sociodemographic and clinical characteristics. METHODS: All newly diagnosed cases of hepatitis C reported between 2008 and 2018, in all regions of Brazil, were included. The indicators were obtained from the databases of the Brazilian Ministry of Health. For the time series analysis, a joinpoint regression model was used. RESULTS: Between 2008 and 2018, 136,759 newly diagnosed cases of hepatitis C were reported considering anti-HCV and HCV RNA positivity, and 271,624 newly diagnosed cases were reported considering one or another positive test. The majority of the records were concentrated in the Southeast (61%) and South (26.2%) Regions. The joinpoint regression model indicated an increasing trend in the detection rate of hepatitis C in Brazil, but there was a decreasing trend in the mortality rate during the period analysed. CONCLUSIONS: Differences were observed in the time trend of hepatitis C and in the sociodemographic and clinical characteristics in different regions of Brazil. These data can provide support to design strategies for the elimination of hepatitis C in Brazil, according to regional particularities.

Hospitalizations for pulmonary embolism in Brazil (2008-2019): an ecological and time series study / Hospitalizações por embolia pulmonar no Brasil (2008-2019): um estudo ecológico e de séries temporais

ABSTRACT Objective To assess the temporal trends of hospitalizations for pulmonary embolism (PE) in Brazil, its regions, and states between 2008 and 2019. Methods An ecological and time series study was conducted. Data were obtained from the Hospital Information System (SIH) of the Brazilian Ministry of Health. The inflection point regression model was applied for temporal trend analyses. Trends were classified as increasing, decreasing, or stationary according to the slope of the regression line. The Annual Percent Charge (APC) and the Average Annual Percent Change (AAPC) were calculated considering a confidence interval of 95% and p-value <0.05. Furthermore, spatial distribution maps of epidemiological indicators related to PE in Brazil were elaborated. Results There was an increasing trend in the hospitalization rate for PE in Brazil, ranging from 2.57 in 2008 to 4.44/100,000 in 2019 (AAPC=5.6%; p<0.001). Total and average hospitalizations costs also showed increasing trend in the country (AAPC=9.2% and 3.0%, respectively). Still, there was a decrease in the in-hospital mortality rate (from 21.21% to 17.11%; AAPC=-1.9%; p<0.001). Similar trends were observed in most regions. The average hospitalization time in Brazil showed a stationary trend. The hospitalization rate has also increased in 18 states (66.67%). Seven states showed a decrease in the mortality rate (25.93%), except for Roraima, which showed an increasing trend. Conclusion Hospitalizations for PE represent a serious public health problem in Brazil and the temporal patterns observed herein demonstrate an increasing trend in all regions and states of the country.

RESUMO Objetivo Avaliar as tendências temporais das hospitalizações por Embolia Pulmonar (EP) no Brasil, assim como suas regiões e estados no período entre 2008 e 2019. Métodos Foi realizado um estudo ecológico e de série temporal. Os dados foram obtidos do Sistema de Informação Hospitalar (SIH) do Ministério da Saúde (MS) do Brasil. O modelo de regressão de pontos de inflexão foi aplicado para análises de tendências temporais. As tendências foram classificadas como crescentes, decrescentes ou estacionárias de acordo com a inclinação da linha de regressão. O percentual de variação anual (APC) e Percentual de Variação Médio do Período (AAPC) foram calculados considerando Intervalo de Confiança de 95% (IC 95%) e significância de 5%. Além disso, foram elaborados mapas de distribuição espacial dos indicadores epidemiológicos relacionados à EP no Brasil. Resultados Houve uma tendência crescente na taxa de hospitalização de EP no Brasil, variando de 2,57 em 2008 a 4,44/100.000 em 2019 (AAPC=5,6%; p<0,001). Os custos totais e médios de hospitalização também mostraram uma tendência crescente no país (AAPC=9,2% e 3,0%, respectivamente). Ainda assim, houve uma diminuição na taxa de mortalidade hospitalar (de 21,21% para 17,11%; AAPC=-1,9%; p<0,001). Tendências similares foram observadas na maioria das regiões. O tempo médio de hospitalização no Brasil mostrou uma tendência estacionária. A taxa de hospitalização também aumentou em 18 estados (66,67%). Sete estados mostraram uma diminuição na taxa de mortalidade (25,93%), exceto Roraima, que mostrou uma tendência crescente. Conclusão As hospitalizações de EP representam um grave problema de saúde pública no Brasil, e os padrões temporais aqui observados demonstraram uma tendência crescente em todas as regiões e estados do país.

Urban mobility and COVID-19 in Brazil: Comparison between 2020 and 2021.

OBJECTIVE: The aim of this study was to analyze and compare the indicators of urban mobility and the number of new cases of COVID-19 recorded daily between 2020 and 2021. METHODS: An observational study was carried out involving new cases of COVID-19 registered daily in the state of Pernambuco, Brazil between March 12, 2020 and March 28, 2021 and six indicators of urban mobility. For analysis, the study was divided into two periods: the first was composed of 295 days and represents the year 2020 and the second was composed of 86 days and represents the year 2021. Spearman's non-parametric correlation was used. RESULTS: In 2021, the greatest reductions in relation to the baseline were observed in parks (-29.0) and in retail and recreation areas (-28.7). However, these reductions were smaller than those observed in the previous year, indicating a greater circulation of people in 2021 when compared with mobility in 2020. In contrast, in residential areas, there was a reduction in the percentage change in relation to the previous year (11.2 in 2019 and 7.6 in 2021). In grocery and pharmacy, there was an increase 1.8 times greater than that observed in 2020 (9.1 in 2020 and 17.0 in 2021). It is also noteworthy that the daily average of new cases almost doubled in value (753.4 in 2020 and 1409.1 in 2021). CONCLUSION: More vigorous measures must be taken to adequately control the pandemic.

Urban mobility and COVID-19 in Brazil: Comparison between 2020 and 2021

SUMMARY OBJECTIVE: The aim of this study was to analyze and compare the indicators of urban mobility and the number of new cases of COVID-19 recorded daily between 2020 and 2021. METHODS: An observational study was carried out involving new cases of COVID-19 registered daily in the state of Pernambuco, Brazil between March 12, 2020 and March 28, 2021 and six indicators of urban mobility. For analysis, the study was divided into two periods: the first was composed of 295 days and represents the year 2020 and the second was composed of 86 days and represents the year 2021. Spearman's non-parametric correlation was used. RESULTS: In 2021, the greatest reductions in relation to the baseline were observed in parks (-29.0) and in retail and recreation areas (-28.7). However, these reductions were smaller than those observed in the previous year, indicating a greater circulation of people in 2021 when compared with mobility in 2020. In contrast, in residential areas, there was a reduction in the percentage change in relation to the previous year (11.2 in 2019 and 7.6 in 2021). In grocery and pharmacy, there was an increase 1.8 times greater than that observed in 2020 (9.1 in 2020 and 17.0 in 2021). It is also noteworthy that the daily average of new cases almost doubled in value (753.4 in 2020 and 1409.1 in 2021). CONCLUSION: More vigorous measures must be taken to adequately control the pandemic.

Nephrotoxic Effects Caused by Occupational Exposure to Agrochemicals in a Region of Northeastern Brazil: A Cross-Sectional Study.

The objective of the present study was to evaluate the renal function of rural workers in a city of northeastern Brazil. A cross-sectional study was carried out with 208 workers in Boquim, Sergipe, Brazil. Renal function markers and butyrylcholinesterase (BChE) were evaluated and the glomerular filtration rate (GFR) was determined. The sample consisted mainly of illiterate males with a low usage of personal protective equipment and no training. Approximately 40% had some level of renal failure. Relative risk (1.59) of GFR alteration was higher in workers with more than 5 yr of exposure, mainly to organophosphates. Workers more than 60 yr of age presented a 17.06 greater risk for manifesting acute intoxication. Butyrylcholinesterase reduction was associated with reports of intoxication (relative risk of 11.36). We concluded that exposure to pesticides represented a risk factor for the development of nephrotoxic effects and alteration of renal function, which reinforced the need to implement measures to protect rural workers. Environ Toxicol Chem 2021;40:1132-1138. © 2020 SETAC.

Primary school educational intervention r egarding schistosomiasis in a riverside community, northeastern Brazil

Schistosomiasis is still a serious public health concern in Brazil and Sergipe State presents the highest prevalence rate of the disease. Brazil implemented the Schistosomiasis Control Program (PCE) with several strategies to control the disease, including health education actions in endemic areas. Herein, we assessed the impact of an educational intervention on knowledge concerning schistosomiasis in students from a riverside village of Sergipe, Northeastern Brazil. The study was carried out in 3 phases. 1) A questionnaire was applied to assess the students' knowledge about the biological, clinical, and epidemiological aspects of schistosomiasis mansoni (pre-test). 2) Next, an educational intervention was conducted. Pamphlets about schistosomiasis were distributed to the entire school community, who were then invited to a lecture. 3) A post-test was performed using the questionnaire to assess acquired knowledge. 151 elementary school students were interviewed. 2.6% of the pre-test students and 4.3% of the post-test group had already been diagnosed with schistosomiasis. In the pre-test, only 24.5% knew the cause of the disease and 48.3% the transmission sites. In the post-test, 74.3% (OR= 8.9; p-value<0.0001) knew the etiology and 77.1% the possible transmission sites (OR= 3.6; p-value<0.0001). There was also significant improvement in knowledge regarding signs, symptoms and prophylactic measures. Most students were unaware of the risk of reinfection by Schistosoma mansoni after treatment. The educational intervention proved quite effective in increasing information on schistosomiasis. These results reinforce the importance of health education as an auxiliary tool in the control of schistosomiasis.

Spatial patterns and temporal tendency of mortality related to Chagas disease in an endemic area of northeastern Brazil.

OBJECTIVE: To analyse spatial patterns and the temporal tendency of mortality related to Chagas disease, in order to identify priority control areas in the state of Sergipe, Northeast Brazil. METHODS: We conducted an ecological and time-series study with spatial analysis techniques on deaths from Chagas disease in the state of Sergipe (1996-2016). We used data from the Mortality Information System (SIM). The temporal analysis was performed using a statistical technique capable of describing changes in the trend pattern for the period. Thematic maps were elaborated from point and polygonal analyses. RESULTS: There were 247 deaths related to Chagas disease, with a mean of 11.7 deaths/year, most of them male (64%), and aged 50-59 years (21%) and 60-69 years (26%). Two segments with increasing, non-constant and significant trends were identified: 1996-2005 (APC = 21.6%; P = 0.01) and 2005-2016 (APC = 4.4%; P = 0.01), with APPC = 11.8% (P = 0.01). A positive and significant spatial autocorrelation with areas of higher risk of death was found in the southern region of the state. CONCLUSIONS: The trend of mortality related to Chagas disease in the state of Sergipe was increasing during the period analysed, with a heterogeneous distribution of cases. A main risk area was identified in the southern region of the state.

OBJECTIF: Analyser les profils spatiaux et la tendance temporelle de la mortalité liée à la maladie de Chagas, afin d'identifier les domaines de priorité de lutte dans l'Etat de Sergipe, dans le nord-est du Brésil. MÉTHODES: Nous avons mené une étude écologique et de séries chronologiques avec des techniques d'analyse spatiale sur les décès dus à la maladie de Chagas dans l'état de Sergipe (1996-2016). Nous avons utilisé les données du système d'information sur la mortalité (SIM). L'analyse temporelle a été réalisée à l'aide d'une technique statistique capable de décrire les changements dans le profil de tendance pour la période. Des cartes thématiques ont été élaborées à partir d'analyses ponctuelles et polygonales. RÉSULTATS: Il y a eu 247 décès liés à la maladie de Chagas, avec une moyenne de 11,7 décès/an, pour la plupart de sexe masculin (64%), et âgés de 50 à 59 ans (21%) et de 60 à 69 ans (26%). Deux segments avec des tendances à la hausse, non constantes et significatives ont été identifiés: 1996-2005 (APC = 21,6%; p = 0,01) et 2005-2016 (APC = 4,4%; p = 0,01), avec APPC = 11,8% (p = 0,01). Une autocorrélation spatiale positive et significative avec des zones à haut risque de décès a été trouvée dans la région sud de l'Etat. CONCLUSIONS: La tendance de la mortalité liée à la maladie de Chagas dans l'état de Sergipe a augmenté au cours de la période analysée , avec une répartition hétérogène des cas. Une principale zone à risque a été identifiée dans la région sud de l'Etat.

Coronavirus disease and basic sanitation: too early to be worried?

INTRODUCTION: Considering that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in feces, this study aimed to verify a possible relationship between basic sanitation indices and coronavirus disease (COVID-19) numbers/rates. METHODS: Data of COVID-19 cases registered in Brazil until May 28, 2020, and independent variables associated with basic sanitation were analyzed. RESULTS: A significant correlation between the number of cases and sewage treatment index/population density was observed. In addition, COVID-19 incidence and mortality rates were significantly associated with the total water service index and lethality rate was significantly associated with the sewage treatment index. CONCLUSIONS: Precarious basic sanitation infrastructure may potentially increase the SARS-CoV-2 transmission in Brazil.

Coronavirus disease and basic sanitation: too early to be worried?

Abstract INTRODUCTION: Considering that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in feces, this study aimed to verify a possible relationship between basic sanitation indices and coronavirus disease (COVID-19) numbers/rates. METHODS: Data of COVID-19 cases registered in Brazil until May 28, 2020, and independent variables associated with basic sanitation were analyzed. RESULTS: A significant correlation between the number of cases and sewage treatment index/population density was observed. In addition, COVID-19 incidence and mortality rates were significantly associated with the total water service index and lethality rate was significantly associated with the sewage treatment index. CONCLUSIONS: Precarious basic sanitation infrastructure may potentially increase the SARS-CoV-2 transmission in Brazil.

Tendências temporais da mortalidade no município de Lagarto, Nordeste do Brasil / Temporal trends of mortality in the city of Lagarto, Northeast of Brazil / Tendencias temporales de la mortalidad en el municipio de Lagarto, Nordeste de Brasil

Objetivo: Analisar as tendências temporais e o perfil epidemiológico das principais causas de mortalidade em residentes do município de Lagarto, Sergipe, entre 2006 a 2015. Métodos: Estudo epidemiológico, descritivo e de série histórica, através de dados secundários dos óbitos notificados no Sistema de Informação de Mortalidade (SIM). A análise das tendências temporais foi realizada pelo Programa Joinpoint Regression obtendo-se a variação percentual anual (APC) das taxas de mortalidade por meio da regressão Possion. Resultados: Foram notificados 5.586 óbitos, com predomínio do sexo masculino e idosos, 58% e 59,61% respectivamente. Observou-se um aumento da taxa de mortalidade geral de 1,58% ao ano (IC95%: 0,5 a 2,6; p=0,01). Somente as taxas de mortalidade infantil (TMI) e de seus componentes apresentaram tendências decrescentes. Conclusão: Apesar da tendência decrescente das TMI, as mesmas requerem ações especializada, bem como para a redução da mortalidade por doenças crônicas

Objective: The study's purpose has been to analyze the temporal trends and the epidemiological profile of the main causes of mortality in residents of the Lagarto City, Sergipe State, between 2006 and 2015. Methods: This is an epidemiological, descriptive and historical series study, through secondary data on deaths reported in Sistema de Informação de Mortalidade (SIM) [Mortality Information System]. The analysis of temporal trends was performed by the Joinpoint Regression Program, obtaining the Annual Percentage Change (APC) of mortality rates through Possion Regression. Results: 5,586 deaths were reported, with men predominating 58% and the elderly people 59.61%. There was an increase in the overall mortality rate of 1.58% per year (95% CI 0.5 to 2.6, p = 0.01). Only Infant Mortality Rates (IMR) and their components showed declining trends. Conclusion: Despite the decreasing tendency of the IMR, they require specialized actions, as well as the reduction of mortality due to chronic diseases

Objetivo: Analizar las tendencias temporales y el perfil epidemiológico de las principales causas de mortalidad en residentes de la ciudad de Lagarto, Sergipe, entre 2006 y 2015. Método: series epidemiológicas, descriptivas e históricas, a través de datos secundarios sobre muertes relatadas en la Mortalidad Información SIM). El análisis fue realizado por el Programa de Regresión del Joinpoint, obteniendo Variaciones de las tasas de mortalidad a través de la Posibilidad de regresión. Resultados: 5.586 muertes fueron reportadas, con predominio de hombres 58% y ancianos 59.61%. Se observó un aumento en la tasa de mortalidad global del 1,58% anual (IC 95%: 0,5 a 2,6, p = 0,01). Sólo las tasas de mortalidad infantil (IMR) y sus componentes presentaron tendencias en declive. Conclusión: A pesar de la tendencia decreciente del IMR, ellos requieren acciones especializadas, así como la reducción de la mortalidad por enfermedades crónicas

Spatial and temporal analysis of tuberculosis in an area of social inequality in Northeast Brazil.

BACKGROUND: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It is a disease known worldwide for its vulnerability factors, magnitude and mortality. The objective of the study was to analyze the spatial and temporal dynamics of TB in the area of social inequality in northeast Brazil between the years 2001 and 2016. METHODS: An ecological time series study with the use of spatial analysis techniques was carried out from 2001 to 2016. The units of analysis were the 75 municipalities in the state of Sergipe. Data from the Notification of Injury Information System were used. For the construction of the maps, the cartographic base of the state of Sergipe, obtained at the Instituto Brasileiro de Geografia e Estatística, was used. Georeferenced data were analysed using TerraView 4.2.2 software (Instituto Nacional de Pesquisas Espaciais) and QGis 2.18.2 (Open Source Geospatial Foundation). Spatial analyses included the empirical Bayesian model and the global and local Moran indices. The time trend analyses were performed by the software Joinpoint Regression, Version 4.5.0.1, with the variables of sex, age, cure and abandonment. RESULTS: There was an increasing trend of tuberculosis cases in patients under 20 years old and 20-39 years old, especially in males. Cured cases showed a decreasing trend, and cases of treatment withdrawal were stationary. A spatial dependence was observed in almost all analysed territories but with different concentrations. Significant spatial correlations with the formation of clusters in the southeast and northeast of the state were observed. The probability of illness among municipalities was determined not to occur in a random way. CONCLUSION: The identification of risk areas and priority groups can help health planning by refining the focus of attention to tuberculosis control. Understanding the epidemiological, spatial and temporal dynamics of tuberculosis can allow for improved targeting of strategies for disease prevention and control.

Clinical and epidemiological indicators and spatial analysis of leprosy cases in patients under 15 years old in an endemic area of Northeast Brazil: an ecological and time series study.

OBJECTIVE: This study aimed to analyse the clinical and epidemiological indicators, temporal trends and the spatial distribution of leprosy in patients under 15 years old in an endemic area of Northeast Brazil. DESIGN: Regional surveillance study of all reported cases. SETTING: State of Sergipe, endemic area of Northeast Brazil. METHODS: An ecological and time series study was conducted, based on secondary data reported by the Brazilian Information System on Notifiable Diseases for leprosy cases diagnosed in Sergipe state (2002-2015). The analysis of temporal trends was performed using the Joinpoint Regression Programme through Poisson regression. We performed spatial analysis by Kernel estimator and Moran index. RESULTS: The incidence rate was reduced from 6.29 to 3.78 cases per 100 000 inhabitants in 2002 and 2015, respectively. However, Sergipe was still classified as highly endemicity in 2015. The mean number of household contacts (HHC) examined was significantly lower than those registered. Clinical data indicated that 21.4% of the patients developed leprosy reactions, and 31.3% presented with some physical disability in the multibacillary groups. Patients diagnosed by examination within the HHC presented better indicators, such as lower percentage of leprosy reaction and physical disability. Spatial analysis showed the most risk areas distributed on the northeast and cities around the capital, Aracaju. CONCLUSION: The data indicate that there is a persistence of active Myobacterium leprae transmission and a delay in disease detection, following a pattern of high endemicity in many municipalities. The early detection by HHC examination is important to stop transmission and also to detect the cases in a less severe state.

Spatial analysis and temporal trends of suicide mortality in Sergipe, Brazil, 2000-2015 / Análise espacial e tendência temporal da mortalidade por suicídio em Sergipe, Brasil, 2000-2015

Abstract Background The World Health Organization defines suicide as the act of deliberately killing oneself. It is the second leading cause of death among 15-29 year olds globally. Objective To analyze the epidemiological profile and the spatial distribution of suicide deaths in the state of Sergipe. Methods We performed an ecological time-series study with data from the Brazilian Mortality Information System (Sistema de Informações sobre Mortalidade - SIM) about deaths by suicide occurring between 2000 and 2015. We considered as suicide deaths cases recorded as voluntary self-inflicted injuries. Suicide rates were estimated and age-adjusted in the population above 9 years. We analyzed temporal trends by sex and age groups using the simple linear regression model. For the spatial analysis, we performed Kernel density estimation with the software TerraView version 4.2.2. Results We identified 1,560 suicide cases in the state of Sergipe between 2000 and 2015, with a mean of 97.5 cases per year. We also observed that suicide rates in the state increased 102.3% (from 2.69/100,000 population in 2000 to 5.44 in 2015). Suicides occurred predominantly among males (1,160 cases; 74.35%), single people (1,010 cases; 64.7%), and brown-skinned people (1,039 cases; 66.6%). We observed significantly growing temporal trends in the general population, especially among male adults. Spatial analysis allowed us to draw a map that showed the regions with the highest occurrence of suicide. Conclusion We observed growing suicide trends in the state of Sergipe and the spatial analysis was an important tool that showed the areas with higher incidences of suicide.

Resumo Introduçao A Organização Mundial da Saúde define o suicídio como o ato de se matar deliberadamente. É a segunda principal causa de morte entre jovens de 15 a 29 anos no mundo. Objetivo Analisar o perfil epidemiológico e a distribuição espacial dos óbitos por suicídio no estado de Sergipe. Métodos Foi realizado estudo ecológico e de série temporal com dados do Sistema de Informações sobre Mortalidade (SIM) dos óbitos por suicídio ocorridos entre 2000 e 2015. Foram considerados suicídio os casos de mortes registrados como lesões voluntárias autoinfligidas. As taxas de suicídio foram estimadas e ajustadas por idade na população acima de 9 anos. Foram analisadas as tendências temporais por sexo e grupos etários usando o modelo de regressão linear simples. Para a análise espacial, foi realizada a estimativa de Kernel com o software TerraView 4.2.2. Resultados Foram identificados 1.560 casos de suicídio no estado de Sergipe entre 2000 e 2015, com média de 97,5 casos por ano. Observou-se um aumento de 102,3% das taxas de suicídio no estado (de 2,69/100.000 habitantes em 2000 para 5,44 em 2015). Os suicídios ocorreram predominantemente no sexo masculino (1.160 casos; 74,35%), em solteiros (1.010 casos; 64,7%) e pardos (1.039 casos; 66,6%). Foram observadas tendências temporais crescentes na população geral, especialmente entre adultos do sexo masculino. A análise espacial permitiu a construção de mapas exibindo as regiões com maiores concentrações de suicídio. Conclusão Observaram-se tendências crescentes de suicídio no estado de Sergipe e a análise espacial foi uma importante ferramenta ao mostrar áreas com maiores incidências de suicídio.

Spatial analysis and temporal trends of suicide mortality in Sergipe, Brazil, 2000-2015.

BACKGROUND: The World Health Organization defines suicide as the act of deliberately killing oneself. It is the second leading cause of death among 15-29 year olds globally. OBJECTIVE: To analyze the epidemiological profile and the spatial distribution of suicide deaths in the state of Sergipe. METHODS: We performed an ecological time-series study with data from the Brazilian Mortality Information System (Sistema de Informações sobre Mortalidade - SIM) about deaths by suicide occurring between 2000 and 2015. We considered as suicide deaths cases recorded as voluntary self-inflicted injuries. Suicide rates were estimated and age-adjusted in the population above 9 years. We analyzed temporal trends by sex and age groups using the simple linear regression model. For the spatial analysis, we performed Kernel density estimation with the software TerraView version 4.2.2. RESULTS: We identified 1,560 suicide cases in the state of Sergipe between 2000 and 2015, with a mean of 97.5 cases per year. We also observed that suicide rates in the state increased 102.3% (from 2.69/100,000 population in 2000 to 5.44 in 2015). Suicides occurred predominantly among males (1,160 cases; 74.35%), single people (1,010 cases; 64.7%), and brown-skinned people (1,039 cases; 66.6%). We observed significantly growing temporal trends in the general population, especially among male adults. Spatial analysis allowed us to draw a map that showed the regions with the highest occurrence of suicide. CONCLUSION: We observed growing suicide trends in the state of Sergipe and the spatial analysis was an important tool that showed the areas with higher incidences of suicide.

Correlation among three non-invasive methods (APRI, FIB-4 and Transient elastography) to evaluate liver function and stiffness in patients with viral hepatitis c or schistosomiasis mansoni

Both chronic viral hepatitis and schistosomiasis are potentially serious causes of liver fibrosis. Several studies suggest, however, that hepatic fibrosis may be reversible, which highlights the importance, not only of early diagnosis, but, above all, observing this while monitoring the disease. This study aimed to evaluate the correlation between three non-invasive methods for classification of hepatic fibrosis in patients with viral hepatitis or schistosomiasis. The sample consisted of 45 patients with chronic hepatitis with HCV and 17 with schistosomiasis. Medical records were analyzed for data collection related to sex, body mass index (BMI) and laboratory testing for biochemical markers. The evaluation was carried out by means of the following hepatic diagnostic methods: APRI, FIB-4 and Transient Elastography (Fibroscan), and the subsequent correlation analysis by Spearman test (r). There was a predominance of males among patients with HCV (64.4%). HCV patients also presented the highest average age (54.8 years) and high levels of AST and ALT. Positive correlation was noted between APRI and FIB-4 results in patients of both groups; positive correlation between APRI and Transient Elastography in patients with HCV; and positive correlation between FIB-4 and Elastography in patients with HCV or schistosomiasis. Our data suggest that the non-invasive methods for diagnosis and monitoring of hepatic fibrosis present a high degree of acceptance, especially in patients with HCV.

Spatial analysis of viral hepatitis and schistosomiasis coinfection in an endemic area in Northeastern Brazil.

INTRODUCTION:: This cross-sectional study analyzed the spatial distribution of hepatitis B or C virus (HBV/HBC) and schistosomiasis coinfection. METHODS:: Serum samples were collected from patients with Schistosoma mansoni infection. These were tested for serological markers of HBV/HCV infection. The spatial distribution of coinfection was analyzed using intensity kernel estimation. RESULTS:: Overall, 9.4% of individuals had contact with HBV and 1.7% of samples tested positive for anti-HCV antibodies. We identified clusters of risk located in the central region. CONCLUSIONS:: Spatial analysis allowed visualization of high-risk areas, leading to a definition of priority areas to be targeted for intensification of control interventions.