Time trend analysis and impacts of the COVID-19 pandemic on mammography and Papanicolaou test coverage in Brazilian state capitals.

BACKGROUND: Breast and cervical cancer are major public health issues globally. The reduction in incidence and mortality rates of these cancers is linked to effective prevention, early detection, and appropriate treatment measures. This study aims to analyze the temporal trends in the prevalence of mammography and Papanicolaou test coverage among women living in Brazilian state capitals between 2007 and 2023, and to compare the coverage of these tests before and during the Covid-19 pandemic. METHODS: A time series study was conducted using data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey from 2007 to 2023. The variables analyzed included mammography and Papanicolaou test coverage according to education level, age group, race/skin color, regions, and Brazilian capitals. The Prais-Winsten regression model was used to analyze the time series, and Student's t-test was employed to compare the prevalence rates between 2019 and 2023. RESULTS: Between 2007 and 2023, mammography coverage showed a stationary trend (71.1% in 2007 and 73.1% in 2023; p-value = 0.75) with a declining trend observed among women with 12 years or more of education (APC= -0.52% 95%CI -1.01%; -0.02%). Papanicolaou test coverage for all women aged between 25 and 64 exhibited a downward trend from 82% in 2007 to 76.8% in 2023 (APC= -0.45% 95%CI -0.76%; -0.13%). This decline was also noticed among those with 9 years or more of education; in the 25 to 44 age group; among women with white and mixed race; and in the Northeast, Central-West, Southeast, and South regions. When comparing coverage before and during Covid-19 pandemic, a reduction was noted for both tests. CONCLUSIONS: Over the years, there has been stability in mammography coverage and a decline in Papanicolaou test. The COVID-19 pandemic negatively impacted the number of these tests carried out among women, highlighting the importance of actions aimed at increasing coverage, especially among the most vulnerable groups.

Positive changes in breastfeeding and complementary feeding indicators in Brazil are associated with favorable nurturing care environments.

OBJECTIVES: To analyze trends in breastfeeding and complementary feeding indicators for infants and young children receiving primary health care (PHC) services in Brazil, considering the contextual aspects of local nurturing care (NC) environments. STUDY DESIGN: Ecological time-series study. METHODS: Ten feeding indicators were extracted from 1,055,907 food intake records of children aged <2 years reported by PHC facilities from 2015 to 2019. Local NC environments were assessed with the Brazilian Early Childhood Friendly Municipal Index, calculating overall and stratified scores for the NC domains of adequate nutrition, good health, opportunities for early learning, and security and safety. Prais-Winsten regression was used to calculate annual percent changes (APC) by sex and the contrast in APC between the lower and upper quintiles of NC scores. Positive or negative APC with P-values <0.05 represented increasing or decreasing trends. RESULTS: No significant trends of exclusive and continued breastfeeding, food introduction, or minimum dietary diversity were observed, with 2019 prevalences of 54.5%, 45.2%, 92.5%, and 78.2%, respectively. Increasing trends were observed for mixed milk feeding (2019: 19.2%; APC, +2.42%) and minimum meal frequency (2019: 61.1%; APC, +2.56%), while decreasing trends were observed for sweet beverage consumption (2019: 31.9%; APC, -5.92%) and unhealthy foods (2019: 16.1%; APC, -4.69%). Indicator improvements were significantly stronger in environments more favorable for NC. CONCLUSIONS: Although the indicators did not meet global targets for infant feeding practices, the results suggest that the local NC environment encompasses facilitators that may be strategic in the design of early childhood programs and policies to improve nutrition.

Temporal trend in venous thromboembolism hospitalization rates in Brazilian older adults, 2010-2020.

Aging is one of the main risk factors for venous thromboembolism (VTE). Changes in prevention, diagnosis, and treatment strategies for this condition in recent years require an analysis of its rates in health services. The objective of this study was to analyze a temporal trend of hospitalizations for VTE in Brazilian older adults. This ecological time series study used data from the Hospital Information System (HIS) on VTE hospitalizations from 2010 to 2020, selecting admissions with the main diagnosis of pulmonary thromboembolism (PTE) (I.26.0, I.26.9) and deep vein thrombosis (DVT) (I.80.0, I80.1, I80.2, I80.3, I80.8, I80.9). Hospitalization rates were calculated for each year and the Prais-Winsten. In Brazil, the trend of hospitalizations for VTE decreased, with an annual percentage change of - 40.71 (confidence interval [CI] - 50.46; - 29.04). DVT decreased, with an annual percentage change of - 43.14 (95% confidence interval [CI] - 51.36; - 33.54). All Brazilian regions showed a downward trend in hospitalizations for VTE and DVT, except for the Northeast region, which remained stable. Conversely, the trend of hospitalizations for PTE showed an upward in Brazil, with an annual percentage change of 4.33 (95% CI 1.26; 7.48). An upward trend was observed in hospitalizations for PTE in the Northeast region, and a stationary trend was observed in the other regions. The results showed a downward trend in hospitalization rates for DVT and an upward trend for PTE. The study indicates regional differences in rates and trends.

Time trends and social inequalities in infant and young child feeding practices: national estimates from Brazil's Food and Nutrition Surveillance System, 2008-2019.

OBJECTIVE: To describe the time trends and socio-economic inequalities in infant and young child feeding practices in accordance with the Brazilian deprivation index (BDI). DESIGN: This time-series study analysed the prevalence of multiple breast-feeding and complementary feeding indicators based on data from the Brazilian Food and Nutrition Surveillance System, 2008-2019. Prais-Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95 % CI were calculated. SETTING: Primary health care services, Brazil. PARTICIPANTS: Totally, 911 735 Brazilian children under 2 years old. RESULTS: Breast-feeding and complementary feeding practices differed between the extreme BDI quintiles. Overall, the results were more favourable in the municipalities with less deprivation (Q1). Improvements in some complementary feeding indicators were observed over time and evidenced such disparities: minimum dietary diversity (Q1: Δ 47·8-52·2 %, APC + 1·44, P = 0·006), minimum acceptable diet (Q1: Δ 34·5-40·5 %, APC + 5·17, P = 0·004) and consumption of meat and/or eggs (Q1: Δ 59·7-80·3 %, APC + 6·26, P < 0·001; and Q5: Δ 65·7-70·7 %, APC + 2·20, P = 0·041). Stable trends in exclusive breast-feeding and decreasing trends in the consumption of sweetened drinks and ultra-processed foods were also observed regardless the level of the deprivation. CONCLUSIONS: Improvements in some complementary food indicators were observed over time. However, the improvements were not equally distributed among the BDI quintiles, with children from the municipalities with less deprivation benefiting the most.

Trends in tuberculosis incidence and mortality coefficients in Brazil, 2011-2019: analysis by inflection points.

Objective: To analyze the temporal trend of tuberculosis incidence and mortality rates in Brazil between 2011 and 2019. Methods: This was an ecological time series study of tuberculosis incidence and mortality rates in Brazil between 2011 and 2019. Data were extracted from the Notifiable Disease Information System and the Mortality Information System, and population estimates were from the Brazilian Institute of Geography and Statistics. Trends were analyzed by Joinpoint regression, which recognizes inflection points for temporal analysis. Results: The average incidence rate of tuberculosis in Brazil in the period was 35.8 cases per 100 000 population. From 2011 to 2015, this coefficient had an annual percentage change of -1.9% (95% CI [-3.4, -0.5]) followed by an increase of 2.4% (95% CI [0.9, 3.9]) until 2019. The average mortality rate between 2011 and 2019 was 2.2 deaths per 100 000 population, with an average annual percentage change of -0.4% (95% CI [-1.0, 0.2]). Amazonas was the only state with an increase in the annual average percentage variation for the incidence rate (3.2%; 95% CI [1.3, 5.1]) and mortality rate (2.7%; 95% CI [1.0, 4.4]) over the years, while Rio de Janeiro state had an increasing inflection for incidence from 2014 to 2019 (2.4%; 95% CI [1.4, 3.5]) and annual average of decreasing percentage variation (-3.5%; 95% CI [-5.0, -1.9]). Conclusions: During the period analyzed, a decreasing trend in incidence was observed between 2011 and 2015, and an increasing trend for the period from 2015 to 2019. On the other hand, no change in the trend for mortality was found in Brazil.

[Spatial-temporal distribution of visceral leishmaniasis in Brazil from 2007 to 2020Distribución espaciotemporal de la leishmaniasis visceral en Brasil en el período 2007-2020]. / Distribuição espaço-temporal da leishmaniose visceral no Brasil no período de 2007 a 2020.

Objective: To analyze the dynamics of the spatial and temporal distribution of visceral leishmaniasis in Brazil from 2007 to 2020. Method: This ecological study focused on the spatial pattern of visceral leishmaniasis cases in Brazil from 2007 to 2020 using data from the Information System for Notifiable Diseases (SINAN). The variables analyzed were the incidence rate of visceral leishmaniasis and the visceral leishmaniasis composite indicator (VLCI), from which triennial thematic maps were constructed. The global Moran index was calculated to assess the existence of spatial autocorrelation, and the local Moran index was used to identify areas with higher and lower risk of visceral leishmaniasis in Brazil. Results: During the study period, there were 48 705 cases of visceral leishmaniasis, with an incidence rate of 25.53 cases per 100 000 population. There was spatial autocorrelation in all triennial blocks, with municipalities in the North and Northeast regions having an incidence equal to or greater than 50 cases per 100 000 population. Regarding the VLCI there was an increase in the number of municipalities classified as low risk for transmission, and a growing presence of state capitals with a classification of very high risk. Conclusion: The incidence of visceral leishmaniasis varied over the trienniums. The border region between the states of Tocantins, Maranhão, and Pará, along with the state of Ceará, stood out in the spatial distribution of the disease incidence and risk stratification by VLCI. These areas should be a priority for surveillance and control efforts for the disease.

Objetivo: Analizar la dinámica de la distribución espaciotemporal de la leishmaniasis visceral en Brasil en el período 2007-2020. Métodos: En este estudio ecológico del patrón de distribución espacial de los casos de leishmaniasis visceral ocurridos en Brasil en el período 2007-2020 se utilizaron datos del sistema de información de enfermedades de declaración obligatoria (SINAN). Las variables analizadas fueron el coeficiente de incidencia de leishmaniasis visceral y el índice compuesto de leishmaniasis visceral, a partir de los cuales se construyeron mapas temáticos trienales. Se calcularon el índice general de Moran para verificar la existencia de autocorrelación espacial, y el índice local de Moran para delimitar las zonas de mayor y menor riesgo de leishmaniasis visceral en Brasil. Resultados: En el período estudiado, hubo 48 705 casos de leishmaniasis visceral, con una incidencia de 25,53 casos por 100 000 habitantes. En todos los bloques trienales hubo una autocorrelación espacial, en la cual varios municipios de las regiones norte y nordeste registraron una incidencia de 50 casos por 100 000 habitantes o una tasa superior. En relación con el índice compuesto de leishmaniasis visceral, se observó un aumento del número de municipios considerados de riesgo bajo de transmisión y una tendencia ascendente del número de ciudades capitales con clasificación de riesgo muy alto. Conclusión: La incidencia de leishmaniasis visceral varió a lo largo de los períodos trienales. La región fronteriza entre Tocantins, Maranhão y Pará, junto con el estado de Ceará, se destacó en términos de la distribución espacial de la incidencia de la enfermedad y la estratificación del riesgo según el índice compuesto de leishmaniasis visceral. Es preciso dar prioridad a estos lugares en lo referente a las medidas y los servicios de vigilancia y control de esta enfermedad.

Temporal trends and spatial clusters of gastric cancer mortality in Brazil.

Objective: To identify nationwide temporal trends and spatial patterns of gastric cancer-related mortality in Brazil. Methods: An ecological study was performed using death certificates registered from 2000 to 2019 in which gastric cancer was recorded as any cause of death (an underlying or associated cause). Trends over time were assessed using joinpoint regression models. Spatial and spatiotemporal clusters were identified by Kulldorff's space-time scan statistics to identify high-risk areas. Results: In 276 897/22 663 091 (1.22%) death certificates gastric cancer was recorded as any cause of death. Age-adjusted gastric cancer-related mortality increased significantly over time (annual percentage change [APC]: 0.7, 95% confidence interval [CI]: 0.5 to 0.8). The increase in mortality was more pronounced in the less-developed North and Northeast Regions (North Region, APC: 3.1, 95% CI: 2.7 to 3.5; Northeast Region, APC: 3.1, 95% CI: 2.5 to 3.7). Eight spatiotemporally associated high-risk clusters of gastric cancer-related mortality were identified in the North, South, Northeast and Central-West Regions, as well as a major cluster covering a wide geographical range in the South and Southeast Regions of Brazil during the first years of the study period (2000 to 2009). Conclusions: More recently, during 2010 to 2019, clusters of gastric cancer have been identified in the Northeast Region. The nationwide increase in mortality in this analysis of 20 years of data highlights the persistently high burden of gastric cancer in Brazil, especially in socioeconomically disadvantaged regions. The identification of these areas where the population is at high risk for gastric cancer-related mortality emphasizes the need to develop effective and intersectoral control measures.

Maternal mortality in South region of Brazil: an analysis from 2000 to 2018.

This study characterises maternal mortality in southern Brazil and verifies its trends between 2000 and 2018. It is an ecological time-series study, analysing secondary data from the Department of Informatics of the Unified Health System. The trend of the maternal mortality ratio (MMR) was calculated using generalised linear regression, and the ratios of the rates according to women's characteristics, with a confidence interval (CI) of 95%. The MMR in the South region went from 53.4 to 36.8 deaths per 100,000 live births from 2000 to 2018, a reduction trend of 1.2 percentage points per year. Mortality was directly related to increasing age (p < .001) and inversely related to schooling (p < .001) and predominated in non-white women (p < .001). The main cause of death was direct causes, including hypertensive disorders. Despite the reduction trend in maternal mortality in southern Brazil, the MMR observed is constantly above the recommended by the World Health Organisation.Impact StatementWhat is already known on this subject? The Maternal Mortality Ratio (MMR) is an indicator that allows an analysis of women's health in relation to the socio-economic and care characteristics of the region where they live. Between 2000 and 2015, Brazil had presented a high MMR, with around 50 deaths per 100,000 live births, while WHO considers a reasonably adequate MMR of fewer than 20 deaths per 100,000 live births.What do the results of this study add? This study updates data about MMR in the Southern Region of Brazil, the one which has the lowest rates in the country, but with variable values between the states. There was a reduction in MMR in southern Brazil between 2000 and 2018 but higher rates for women over 30 years old and in a situation of social vulnerability, as low-income and non-white women. Santa Catarina State presented stable values in the period and remained below the RMM averages of the other states during all years.What are the implications of these findings for clinical practice and/or further research? Comparing previous and current Maternal Mortality Rates in the regional context is important to adapt public health policies for the most affected population. Maternal death is still a reality for single and low-income women, who have greater difficulty in access to health care. Strategies in the Unified Health System are needed to tackle this problem.

Identification and Estimation of Causal Effects Using a Negative-Control Exposure in Time-Series Studies With Applications to Environmental Epidemiology.

The initial aim of environmental epidemiology is to estimate the causal effects of environmental exposures on health outcomes. However, due to lack of enough covariates in most environmental data sets, current methods without enough adjustments for confounders inevitably lead to residual confounding. We propose a negative-control exposure based on a time-series studies (NCE-TS) model to effectively eliminate unobserved confounders using an after-outcome exposure as a negative-control exposure. We show that the causal effect is identifiable and can be estimated by the NCE-TS for continuous and categorical outcomes. Simulation studies indicate unbiased estimation by the NCE-TS model. The potential of NCE-TS is illustrated by 2 challenging applications: We found that living in areas with higher levels of surrounding greenness over 6 months was associated with less risk of stroke-specific mortality, based on the Shandong Ecological Health Cohort during January 1, 2010, to December 31, 2018. In addition, we found that the widely established negative association between temperature and cancer risks was actually caused by numbers of unobserved confounders, according to the Global Open Database from 2003-2012. The proposed NCE-TS model is implemented in an R package (R Foundation for Statistical Computing, Vienna, Austria) called NCETS, freely available on GitHub.

Tuberculosis forecasting and temporal trends by sex and age in a high endemic city in northeastern Brazil: where were we before the Covid-19 pandemic?

BACKGROUND: The aim of this study was to describe the temporal trend of tuberculosis cases according to sex and age group and evidence the level of disease before the Covid-19 pandemic in a TB high endemic city. METHODS: This was a time series study carried out in a city in northeast Brazil. The population was composed of cases of tuberculosis, excluding those with HIV-positive status, reported between the years 2002 and 2018. An exploratory analysis of the monthly rates of tuberculosis detection, smoothed according to sex and age group, was performed. Subsequently, the progression of the trend and prediction of the disease were also characterized according to these aspects. For the trends forecast, the seasonal autoregressive linear integrated moving average (ARIMA) model and the usual Box-Jenkins method were used to choose the most appropriate models. RESULTS: A total of 1620 cases of tuberculosis were reported, with an incidence of 49.7 cases per 100,000 inhabitants in men and 34.0 per 100,000 in women. Regarding the incidence for both sexes, there was a decreasing trend, which was similar for age. Evidence resulting from the application of the time series shows a decreasing trend in the years 2002-2018, with a trend of stability. CONCLUSIONS: The study evidenced a decreasing trend in tuberculosis, even before the Covid-19 pandemic, for both sex and age; however, in a step really slow from that recommended by the World Health Organization. According to the results, the disease would have achieved a level of stability in the city next years, however it might have been aggravated by the pandemic. These findings are relevant to evidence the serious behavior and trends of TB in a high endemic scenario considering a context prior to the Covid-19 pandemic.

Price elasticity and income elasticity of the demand for beer in Mexico / Elasticidad precio y elasticidad ingreso de la demanda de cerveza en México

Objective: Estimate the price and income elasticities of the demand for beer in Mexico. Materials and methods: Monthly series on beer sales and prices from 2007 to 2019 were used. Long-term elasticity was estimated using ordinary least squares (OLS). Short-term elasticity was estimated using a dynamic ordinary least squares (DOLS) model. Results: The price elasticity was in the long term of -1.40 (95%CI: -2.53 to -0.27) and -1.31 (95%CI: -2.46 to -0.15) in the short term. The income elasticity of demand in the long and short term was estimated at 0.86 (95%CI: 0.44-1.29 and 0.93 (95%CI: 0.51-1.34), respectively. Conclusions: The findings of this study suggest that fiscal policies may have a positive impact on the health of the population by reducing beer consumption.

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.

Temporal trend of leprosy among the elderly in Brazil, 2001 - 2018.

OBJECTIVE: To describe the temporal trends of leprosy indicators among the elderly in Brazil in 2001 - 2018. METHODS: This was an ecological time-series study of new leprosy cases in the elderly reported to the Notifiable Diseases Information System. Prais-Winsten generalized linear regression was used to estimate temporal variations. RESULTS: There were 687 317 new leprosy cases in Brazil from 2001 - 2018, of which 129 214 (18.8%) were among elderly people. Overall detection rates in the elderly and of new cases with grade-2 disability showed a falling trend, with an annual percent change of -4.6% (95%CI = -5.1 to -4.0) and -3.9% (95%CI = -4.6 to -3.2). New case and new multibacillary case proportions showed an increasing trend, with an annual percent change of 2.9% (95%CI = 2.6 to 3.3) and 1.4% (95%CI = 1.0 to 1.7), respectively. Detection rates for new leprosy cases in elderly people in Brazil are decreasing, but the proportion of new cases and multibacillary cases are trending upwards. CONCLUSIONS: New cases are shifting to older age groups, and demographic transition and immunosenescence are an influence. Inadequate reduction of grade-2 disability indicates a high risk of physical disability persists. Improved contact tracing and more effective action are needed in this age group.

[Inequalities in congenital syphilis trends in the city of Niterói, Brazil, 2007-2016Desigualdades en la tendencia de sífilis congénita en la ciudad de Niterói, Brasil, 2007-2016]. / Desigualdades na tendência da sífilis congênita no município de Niterói, Brasil, 2007 a 2016.

OBJECTIVE: To describe the temporal distribution and epidemiologic characteristics of congenital syphilis (CS) cases in the city of Niterói, southeastern Brazil, from 2007 to 2016. METHOD: This descriptive time series analysis of the incidence of CS used data from the Notifiable Diseases Information System (SINAN) and the Live Birth Information System (SINASC). The sample included all notified cases. A probabilistic matching was performed between SINAN and SINASC data to recover ignored information. The time series was estimated using logarithmic regression according to sociodemographic and prenatal care variables. RESULTS: There were 754 identified cases of CS in the study period (mean incidence: 11.9 cases/1 000 live births). The incidence was higher in younger women (10 to 19; 20 to 24 years) and in those with black skin, low schooling, and without prenatal care. Of the overall group, only 57.6% received a diagnosis of syphilis during prenatal care. Treatment was not adequate in 87,7%, and only 12.2% of partners were treated. SC incidence presented a growing trend of 16%/year, reaching 23.2 cases/1 000 living births in 2016. This growth was especially marked in female adolescents (25.2%/year), brown race/skin color (16.8%/year), women with low schooling (57.1%/year) and women who received prenatal care (17.3%/year); and, from 2012 to 2016, in women without information on skin color. CONCLUSIONS: Social inequalities were linked to CS in the present sample. Also, increasing CS incidence was detected in youth. Health care professionals must be trained to manage gestational syphilis, and public policies must effectively address the social determinants of this condition.

OBJETIVO: Describir la distribución temporal y las características epidemiológicas de la sífilis congénita en Niterói, sureste de Brasil, de 2007 a 2016. MÉTODOS: Estudio descriptivo de series temporales sobre la incidencia de la sífilis congénita; se utilizaron datos del Sistema de Información de Enfermedades Notificables (SINAN) y del Sistema de Información de Nacimientos Vivos (SINASC). La muestra incluyó todos los casos reportados. Se realizó además una relación probabilística entre el SINAN y el SINASC para recuperar información ignorada. La serie temporal se estimó mediante regresión logarítmica, según variables sociodemográficas y prenatales. RESULTADOS: En el período estudiado se identificaron 754 casos de sífilis congénita (incidencia media de 11,9 casos/1 000 nacidos vivos). La incidencia fue mayor en las mujeres jóvenes (10-19, 20-24 años), mujeres de raza negra, con baja escolaridad y sin atención prenatal. Del total de mujeres, sólo se realizó el diagnóstico de sífilis durante la atención prenatal en 57,6%. El tratamiento fue inadecuado en 87,7% de las mujeres, solo el 12,2% de las parejas fueron tratadas. La enfermedad presentó una tendencia creciente (16%/año), y alcanzó 23,2 casos/1 000 nacidos vivos en 2016. El aumento fue más pronunciado en las adolescentes (25,2%/año), raza/color de piel morena (16.8%/año), mujeres con baja educación (57,1%/año), mujeres que recibieron atención prenatal (17,3%/año) y, de 2012 a 2016, en mujeres sin información sobre el color de la piel. CONCLUSIONES: En esta muestra se destacaron las desigualdades sociales en la aparición de sífilis congénita, con una incidencia creciente en las jóvenes. Se requiere capacitación de los profesionales de la salud en el manejo de la sífilis gestacional y la acción efectiva de políticas públicas sobre los determinantes sociales de la sífilis.

Testicular Cancer mortality in Brazil: trends and predictions until 2030.

BACKGROUND: Despite the fact that testicular cancer presents good prognosis, wide variations in mortality rates have been reported internationally. In Brazil, mortality trends and estimates have not been fully assessed. The objective of the study presented herein is to analyze the mortality trends for testicular cancer in Brazil in the period 2001-2015 and calculate mortality predictions for the period 2016-2030. METHODS: This is a population-based ecological study that utilized information of the Mortality Information System, on testicular cancer-related deaths in Brazil. Mortality trends were analyzed by Joinpoint regression, and Nordpred was utilized for the calculation of predictions. RESULTS: The mortality rate for men, standardized to the world population, varied between 0.36/100,000 for the year 2001, to 0.41/100,000 for the year 2015. There was an increasing trend for Brazil (APC = 1.3% CI95% 0.6; 2.0) and the Southeast region (APC = 1.5% CI95%0.2; 2.7). When analyzing Brazilian data for the period 2016-2030, predictions indicate 2888 deaths due to testicular cancer, which corresponds to a 26.6% change when compared to the 2011-2015 period. This change is mostly explained by an increase in the risk of death (14.2%) when compared with modifications in the demographic structure (12.4%). CONCLUSIONS: Testicular cancer mortality in Brazil presents increasing trends, and until 2030 these rates continue to increase.

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.

[Mortality from leprosy in highly endemic contexts: integrated temporal-spatial analysis in BrazilMortalidad por lepra en zonas de alta endemicidad: análisis espacio-temporal integrado en Brasil]. / Mortalidade por hanseníase em contextos de alta endemicidade: análise espaço-temporal integrada no Brasil.

OBJECTIVE: To describe temporal trends and spatial patterns of leprosy-related mortality in the North and Northeast of Brazil from 2001 to 2017. METHODS: This population-based, mixed ecological study employed secondary data obtained from the Health Ministry's Mortality Information System. Death certificates were examined for extraction of information on leprosy as underlying or contributing cause of death. RESULTS: In the period of interest, 4 907 leprosy-related deaths were recorded. In 59.3%, leprosy was a contributing cause. "Leprosy, unspecified" (ICD-10 A30.9) was the most common cause recorded (72.7% as underlying cause; 76.1% as contributing cause). Increased risk of mortality by leprosy was observed in males, age ≥ 60 years and brown or black race/color. Joinpoint regression analysis of time trends revealed an increased overall mortality trend in the Northeast and in the states of Tocantins, Maranhão, Alagoas, and Bahia, as well as in the male sex. Regarding the spatial distribution of mortality rates adjusted by age and sex, as well as the analysis of moving spatial means and standardized mortality ratio, patterns that were above the mean for the area under study were identified for the states of Acre and Rondônia, the southern part of Pará, Tocantins, Maranhão, Piauí, south of Ceará, and north and south of Bahia. CONCLUSIONS: Leprosy mortality in the Brazilian North and Northeast is expressive and persistent, with a focal pattern of distribution in more vulnerable territories and populations. Comprehensive leprosy care must be strengthened in the Unified Health System in these regions.

OBJETIVO: Describir las tendencias temporales y los patrones espaciales de la mortalidad relacionada con la lepra en las regiones norte y nordeste de Brasil del 2001 al 2017. MÉTODOS: Estudio ecológico mixto basado en la población, con análisis de las tendencias temporal y espacial, hecho a partir de datos secundarios tomados de las declaraciones de defunción del Sistema de Información de Mortalidad (SIM) del Ministerio de Salud. Dichas declaraciones se examinaron para extraer los registros de lepra como causa básica y asociada de defunción. RESULTADOS: Se registraron 4 907 defunciones relacionadas con la lepra en el período de interés, en 59,3% de las cuales se la citó como causa asociada. La "lepra no especificada" (A30.9) fue la causa más citada en las declaraciones de defunción (causa básica: 72,7%; causa asociada: 76,1%). Se verificó un mayor riesgo de mortalidad por lepra en personas de sexo masculino, mayores de 60 años y de raza o de piel negra o morena. La tendencia temporal por análisis de puntos de inflexión (joinpoints) mostró un incremento en la tendencia general de la mortalidad en la región nordeste y en los estados de Tocantins, Maranhão, Alagoas y Bahía, así como en personas de sexo masculino. En lo referente a la distribución espacial de las tasas de mortalidad ajustadas por edad y sexo, así como a los análisis de las medias móviles espaciales y de la razón de mortalidad normalizada, se identificaron patrones superiores a la media de la zona de estudio en Acre, Rondônia, el Sur del estado de Pará, Tocantins, Maranhão, Piauí, el Sur de Ceará y las regiones del Norte y Sur de Bahía. CONCLUSIONES: La mortalidad por lepra en las regiones norte y nordeste es significativa y persistente, con un patrón focal de incidencia en los territorios y poblaciones con mayor vulnerabilidad. Se hace hincapié en la necesidad de fortalecer la atención integral a esta enfermedad en la red de atención del Sistema Único de Salud de esas regiones.

[Mortality attributable to influenza in pre-vaccination and post-vaccination periods in Argentina: an ecological study (2002-2016)Mortalidade atribuível à gripe no período pré-vacinal e pós-vacinal na Argentina: estudo ecológico (2002-2016)]. / Mortalidad atribuible a gripe en los períodos prevacunación y posvacunación en Argentina: estudio ecológico (2002-2016).

OBJECTIVES: Compare mortality from severe acute respiratory infection (SARI) attributable to influenza between pre-vaccination (pre-V) and post-vaccination (post-V) periods, to determine the historical evolution and seasonality of time series between 2002 and 2016, and to estimate the risk of death in children between 6 and 23 months of age, using a statistical model. METHODS: Time-series study using official mortality data from the official statistical database on deaths. ICD-10 codes between J09-18.9 and J22X were considered to represent SARI. Crude rates and age-adjusted rates (AAR) were calculated, and pre-V (2002-2009) and post-V (2010-2016) periods were compared using the chi-squared (χ2) test. The best statistical model was the one that compared deaths from SARI in children during 2002 with other years. The data were analyzed with R programming (p <0.05). RESULTS: 4.6% of deaths (301,747) were from SARI, with a median age of 82 years. The percentage of deaths under age 2 declined in the post-V period (from 2.34% to 0.99%, p < 0.05). Marked seasonality was observed in winter. The AAR in persons over age 64 rose from 259.8 per 100,000 population (pre-V) to 328.6 (post-V) (p < 0.05). In children, the crude rate dropped significantly. Compared with the year 2002, there was a significantly lower estimated risk of dying from SARI during the three years post-V. CONCLUSIONS: The reduction in mortality from influenza in Argentina was more pronounced in children, with an estimated 3.5 fewer child deaths from SARI per month.

OBJETIVOS: Comparar o índice de mortalidade por infecção respiratória aguda grave atribuível à gripe nos períodos pré-vacinal e pós-vacinal, conhecer a evolução temporal e a sazonalidade da série temporal entre 2002 e 2016 e estimar o risco de morte em crianças entre 6 e 23 meses de idade com o uso de um modelo estatístico. MÉTODOS: Estudo de série histórica com base em dados oficiais de mortalidade obtidos do informe estatístico de óbitos. Os códigos da CID-10 entre J09-18.9 e J22X foram considerados como sendo infecção respiratória aguda grave atribuível à gripe. Foram calculados os índices de mortalidade brutos e ajustados por idade e feita uma comparação entre os períodos pré-vacinal (2002­2009) e pós-vacinal (2010­2016) com o teste de χ2. O melhor modelo estatístico foi o que comparou os índices de mortalidade por infecção respiratória aguda grave atribuível à gripe em crianças em 2002 com os outros anos. Os dados foram analisados com o programa R, a um nível de significância P<0,05. RESULTADOS: Observou-se que 4,6% (301.747) das mortes foram por infecção respiratória aguda grave atribuível à gripe, com idade mediana de 82 anos. Houve queda no percentual de mortes em crianças menores de dois anos no período pós-vacinal (2,34% a 0,99%, P< 0,05). Verificou-se uma acentuada sazonalidade no inverno. Os índices ajustados por idade em idosos variaram entre 259,8 por 100 mil no período pré-vacinal e 328,6 por 100 mil no período pós-vacinal (P<0,05). Nas crianças, houve queda significativa nos índices brutos, estimando-se um risco significativamente menor de morte por infecção respiratória aguda grave atribuível à gripe nos 3 anos pós-vacinais em comparação a 2002. CONCLUSÕES: A redução da mortalidade pela gripe na Argentina foi mais evidente em crianças, com uma redução estimada de 3,5 mortes por mês.

Trend analysis of the quality indicators for the Brazilian cervical cancer screening programme by region and state from 2006 to 2013.

BACKGROUND: Quality indicators for the Brazilian cervical cancer screening programme can provide a perspective on its effectiveness in Brazilian macro-regions and states. The aim of this study was to perform a trend analysis of the cervical cancer screening program's quality indicators, according to Brazilian regions and states, from 2006 to 2013. METHODS: Using information from approximately 62,000,000 exams obtained from the Information System of Cervical Cancer Screening (SISCOLO), joinpoint analysis was used to calculate the Annual Percentage Change (APC). RESULTS: The estimated number of women in the target age group (25-64 years) who underwent Pap testing over a three-year interval was lower than that recommended by international guidelines in the North, Northeast and Midwest regions, and the trends for this indicator remained stationary over the years in all regions of Brazil. Overall, the index of positivity in Brazilian regions and states is below that preconized by the Brazilian National Cancer Institute (INCA). Additionally, the frequencies of unsatisfactory cases are in line with international guidelines but above those preconized by INCA guidelines. All positive cytological diagnoses were lower than those preconized by INCA. CONCLUSIONS: The results show that the cervical cancer screening programme is still far from efficient because most of the quality indicators in Brazilian regions and states are outside of the parameters preconized by national and international organizations.

Prevalence and temporal trend (2005-2015) of anaemia among children in Northeast Brazil.

OBJECTIVE: Anaemia is the main nutritional deficiency in Brazil, and a prevention and control programme (National Program for Iron Supplementation) has been developed since 2005. Studies on the temporal evolution of anaemia prevalence contribute to assessment of the effectiveness of the actions undertaken. The present study aimed to identify the prevalence and temporal trend of anaemia in children. DESIGN: Study based on two cross-sectional household surveys carried out in 2005 and 2015. Anaemia was defined as Hb<11 g/dl (HemoCue®). Trend analysis was performed using the prevalence ratio (PR), calculated by Poisson regression with a robust adjustment of the variance. Differences were significant when P<0·05 in both crude analyses and those adjusted for possible confounding factors (e.g. socio-economic, demographic and health variables). SETTING: Alagoas, Brazil. SUBJECTS: In total, 666 and 782 children in the first and second Alagoas State Health and Nutrition Survey, respectively (probabilistic samples). RESULTS: In 2005 and 2015, anaemia prevalence was 45·1 and 27·4 %, respectively (-39·1 %; PR=0·61; 95 % CI 0·52, 0·70). In both surveys, children aged ≤24 months were more affected (P24 months (67·2 v. 40·7 %; 27·0 v. 19·3 %, respectively). CONCLUSIONS: The prevalence of anaemia reduced significantly in the evaluated period. Thus, it may no longer be a severe public health problem but can instead be considered a problem of moderate magnitude. It remains, however, above the level considered acceptable according to WHO criteria. These results justify the implementation of prevention and control actions.