Temporal trend, space risk and factors associated with the occurrence of dengue in northeast Brazil, 2009-2018.

BACKGROUND: Dengue is an acute viral disease of major relevance and impact on public health, causing major epidemics around the world, especially in tropical regions. Here we aimed to analyse the temporal trend and spatial risk, as well as social vulnerability factors, associated with the occurrence of dengue in the state of Bahia, Brazil between 2009 and 2018. METHODS: This is an ecological study carried out with all suspected cases of dengue in Bahia between 2009 and 2018. The data were obtained from the National Notifiable Diseases Information System, available on the website of the Health Department of the State of Bahia, and from the Brazilian Institute of Geography and Statistics. We used the Joinpoint regression model, local empirical Bayesian model for smoothing, global and local Moran statistics and spatial scanning statistics. The relationship between the dengue incidence rate and social determinants was tested using Moran's bivariate correlation. RESULTS: During the study period, 451 847 probable dengue cases were registered in Bahia. A declining trend was observed in 39.28% (n=11) of the state's health regions and 60.71% (n=17) showed a stationary tendency. The spatiotemporal scanning statistic showed nine clusters of dengue occurrence. The largest cluster had a radius of 342.14 km, consisting of 160 municipalities, 120 094 cases (710.20 cases/100 000 inhabitants) and a relative risk of 2.80. In the multivariate regression model, 11 variables showed a significant association: Social Vulnerability Index (SVI), Municipal Human Development Index (MHDI), SVI urban infrastructure, SVI human capital, MHDI longevity, MHDI education, proportion of people living in households with per capita income less than half the minimum wage (in 2010) and who spend more than 1 h commuting, proportion of mothers who are heads of household who did not complete elementary school and with children <15 y of age, activity rate of persons ages 10-14 y and per capita income. CONCLUSIONS: In the analysis of the spatial distribution, areas of risk of disease transmission throughout the state were identified. These results can provide subsidies for the strategic planning of actions, as well as for the implementation of programs and/or public policies in order to control the incidence of dengue in the population.

Impact of the COVID-19 pandemic on the diagnosis of new leprosy cases in Northeastern Brazil, 2020.

This study analyzed the impact of the COVID-19 pandemic on the detection of new cases of leprosy in the state of Bahia, Brazil. The periods January-September 2019 and January-September 2020 were compared. There was a 44.40% reduction in the diagnosis of leprosy when comparing the two periods (1,705 in 2019 and 948 in 2020). There was a reduction in the number of municipalities with reported cases: 251 municipalities in 2019 and 202 in 2020, expressing a reduction of 24.25%. Considering only the months following the arrival of the virus (April-September), the reduction was 51.10%. An inverse correlation was observed between the number of new cases of leprosy and the cumulative number of cases of COVID-19 (Spearman's correlation coefficient = -0.840; P < 0.001) and the number of new monthly cases of COVID-19 (Spearman's correlation coefficient = -0.817; P < 0.001). A slight increase was also observed in the proportion of multibacillary cases in the state (70.38% in 2019 and 72.69% in 2020) as well as in the proportion of individuals with the degree of physical disability not assessed at diagnosis, whose proportion rose from 16.39% in 2019 to 22.53% in 2020. The negative impact of COVID-19 in tackling leprosy should be seen as a warning sign for health and political authorities.

Dual-task training with progression from variable- to fixed-priority instructions versus dual-task training with variable-priority on gait speed in community-dwelling older adults: A protocol for a randomized controlled trial : Variable- and fixed-priority dual-task for older adults.

BACKGROUND: Functional independence and safe mobility, especially in older people, mostly rely on the ability to perform dual tasks, particularly during activities with variable- and fixed-priority attention. The aim of this study is to compare the dual-task training with progression from variable- to fixed-priority instructions versus dual-task training with variable-priority on gait speed in community-dwelling older adults. METHODS: This is an assessor- and participant-blinded, two-arm, randomized controlled trial with 60 community-dwelling male and female older adults between the ages of 60 and 80 years old. Participants will be randomly allocated into either the intervention group or the control group using a computer-generated permuted block randomization schedule. The intervention group will undertake a progressive dual-task training in which the participants will be progressively submitted to dual-task walking and postural balance exercises with variable- to fixed-priority instructions. The control group will be submitted to dual-task training with variable-priority attention exercises. Both groups will receive 48 sessions lasting for 60 min each over 24 weeks. The primary outcome will be the gait speed under single- and dual-task conditions. Secondary outcomes will include spatiotemporal gait parameters, functional balance, executive function, falls, quality of life, and depression symptoms. All the analyses will be based on the intention-to-treat principle. DISCUSSION: This is the first assessor- and participant-blinded, two-arm, randomized controlled trial with 6 months of intervention and an additional 6-month post-training follow up aiming to evaluate the effectiveness of training with progression from variable- to fixed-priority instructions on gait biomechanics, postural balance, falls episodes, executive functioning, and quality of life in community-dwelling older adults. If our hypotheses are confirmed, this training protocol can be implemented widely to improve gait speed and other functional activities and quality of life in community-dwelling older adults. This study protocol can be used to improve these functional aspects of community-dwelling older adults. This study may also contribute to future guidelines for the improvement of these clinical and biomechanical aspects in older people. TRIAL REGISTRATION: ClinicalTrials.gov Identifier - NCT03886805, Registered 22 March 2019.

Prevalence of cervicobrachial discomforts in elementary school teachers.

OBJECTIVE: To determine the incidence of cervicobrachial order discomforts in Elementary Public School teachers from 1st to 4th years in the city of Pato Branco - PR. METHODS: Cross-sectional study made with 160 public school teachers from 1st to 4th years in the city of Pato Branco - PR. Data collection was made from a structured questionnaire, and a physical examination with manual palpation and orthopedic tests. RESULTS: The obtained data showed the presence of pain in the trapezius muscle region, on the left side, in 52.5%; and, on the right side, in 50.6%. The analysis also showed that there is a strong relationship between the cervicobrachial problems presented and the labor activity. The final evaluation of this study demonstrates the great need of primary care for these workers, that is, carrying out activities to prevent musculoskeletal diseases developed through work, either to preserve the individuals' physical integrity or the quality of education. CONCLUSIONS: The prevalence of musculoskeletal disorders was high among teachers. There is evidence that the prevalence was connected to job demands.

Congenital peribronchial myofibroblastic tumor: a case report.

We describe a rare occurrence of congenital peribronchial myofibroblastic tumor of the lung presenting in early fetal life. A female patient in the 24th week of gestation who presented with polyhydramnios was admitted for examination. Ultrasound examination revealed a mass compromising the lungs. Because the intrauterine fetal death was revealed by the ultrasound, delivery was induced. Necropsy revealed a pulmonary lesion compromising the left lower pulmonary lobe together with hepatomegaly. Microscopic analysis of the lung showed a lesion with a storiform arrangement of spindle cells with focal peribronchial distribution. Hepatic architecture was diffusely altered by fibrotic tissue. Immunohistochemical analysis on the pulmonary lesion showed high vimentin positivity in the fusocellular components, pointing to the mesenchymal nature of the lesion. Significant differentiation of smooth muscle tissue, as indicated by high HHF35 positivity, was also observed. Electron microscopy on the pulmonary lesion revealed elongated cells with some cytoplasmatic processes, a finding that is also compatible with mesenchymal differentiation.