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.

Burden of schistosomiasis-related mortality in Brazil: epidemiological patterns and spatial-temporal distribution, 2003-2018.

OBJECTIVE: To characterise the epidemiological patterns and the spatial-temporal distribution of schistosomiasis-related mortality in Brazil from 2003 to 2018. METHODS: A national population-based ecological study that used official data from the Mortality Information System. The data included all deaths recorded in Brazil from 2003 to 2018 in which schistosomiasis was mentioned in the death certificate as an underlying or associated cause of death (multiple causes). The municipalities of residence were used as units of geographic analysis, and standardised and smoothed mortality rates (per 100 000 inhabitants) were calculated using the local empirical Bayes method. Spatial autocorrelation was evaluated using global and local Moran indexes. To analyse the spatial dependence, the Getis-Ord G and Gi* statistics were used. RESULTS: During the study period, 18 421 113 deaths were recorded in Brazil. Schistosomiasis was mentioned in 11 487 deaths (proportional mortality: 0.06%); for 8141 deaths (70.87%), it was listed as the underlying cause, and for 3346 deaths (29.13%), it was listed as an associated cause. The mean mortality rate was 0.38 deaths/100 000 inhabitants. Individuals ≥ 70 years of age (RR: 115.34, 95% CI: 68.56-194.03) and residents in the Northeast region (RR: 10.81, 95% CI: 5.95-19.66) presented higher risks related to schistosomiasis. Municipalities with high mortality rates were identified in all regions, and high-risk clusters were found in municipalities located in the Northeast and Southeast regions of the country. CONCLUSIONS: Schistosomiasis remains an important cause of death in persistently endemic areas in Brazil, particularly in those with a high prevalence of the disease and a marked parasite load.

OBJECTIF: Caractériser les profils épidémiologiques et la distribution spatio-temporelle de la mortalité liée à la schistosomiase au Brésil de 2003 à 2018. MÉTHODES: Une étude écologique nationale basée sur la population qui a utilisé les données officielles du système d'information sur la mortalité. Les données incluaient tous les décès enregistrés au Brésil de 2003 à 2018 dans lesquels la schistosomiase était mentionnée dans le certificat de décès comme cause sous-jacente ou associée (causes multiples) de décès. Les municipalités de résidence ont été utilisées comme unités d'analyse géographique et les taux de mortalité normalisés et lissés (pour 100.000 habitants) ont été calculés à l'aide de la méthode empirique locale de Bayes. L'autocorrélation spatiale a été évaluée à l'aide d'indices de Moran globaux et locaux. Pour analyser la dépendance spatiale, les statistiques de Getis-Ord G et Gi* ont été utilisées. RÉSULTATS: Au cours de la période d'étude, 18.421.113 décès ont été enregistrés au Brésil. La schistosomiase a été mentionnée dans 11.487 décès (mortalité proportionnelle: 0,06%); pour 8.141 décès (70,87%), elle a été répertoriée comme la cause sous-jacente et pour 3.346 décès (29,13%), comme cause associée. Le taux de mortalité moyen était de 0,38 décès/100.000 habitants. Les personnes âgées de ≥70 ans (RR: 115,34 ; IC95%: 68,56 à 194,03) et les résidents de la région du Nord-Est (RR: 10,81 ; IC95%: 5,95 à 19,66) présentaient des risques plus élevés liés à la schistosomiase. Des municipalités présentant des taux de mortalité élevés ont été identifiées dans toutes les régions et des grappes à haut risque ont été trouvées dans des municipalités situées dans les régions du nord-est et du sud-est du pays. CONCLUSIONS: La schistosomiase reste une cause importante de mortalité dans les zones d'endémie persistante du Brésil, en particulier dans celles à forte prévalence de la maladie et à forte charge parasitaire.

Leprosy in the North and Northeast regions of Brazil: an integrated spatiotemporal approach.

OBJECTIVE: To analyse the spatiotemporal patterns of leprosy occurrence in the North and Northeast regions of Brazil from 2001 to 2017. METHODS: Mixed population-based ecological study with spatial and temporal trend analysis of epidemiological indicators based on new cases reported to the Information System for Notifiable Diseases of the Ministry of Health occurring in individuals residing in North and Northeast states of Brazil. RESULTS: A total of 396 987 new cases were analysed; 9.2% of these involved children <15 years of age, and 5.4% involved individuals with grade 2 disability (G2D). The Northeast region recorded 66.4% of the new cases. Most cases involved males between 15 and 59 years of age and of brown race/colour. The temporal trend showed a reduction in most of the indicators and study variables. The G2D rate did not have trends over time in the Northeast Region, in individuals 0-14 years of age, or in municipalities with 'very high' social vulnerability indexes. The spatial and spatiotemporal analysis showed the presence of hyperendemic foci with high detection risk involving municipalities in the states of Tocantins, Pará and Maranhão. CONCLUSION: Leprosy in the North and Northeast regions of Brazil persists as a critical public health problem. Temporal and spatiotemporal patterns identified in this study confirm that leprosy remains epidemiologically relevant in vulnerable areas. Surveillance and control interventions are needed in municipalities with low detection in the general population, in children and in individuals with G2D, to reduce late diagnosis.

OBJECTIF: Analyser les profils spatiotemporels de l'apparition des cas de lèpre dans les régions du nord et du nord-est du Brésil de 2001 à 2017. MÉTHODES: Etude écologique mixte basée sur la population avec analyse des tendances spatiales et temporelles des indicateurs épidémiologiques sur la base des nouveaux cas rapportés dans le Système d'Information sur les Maladies à Déclaration Obligatoire du Ministère de la Santé, survenant chez des individus résidant dans les Etats du nord et du nord-est du Brésil. RÉSULTATS: 396.987 nouveaux cas ont été analysés; 9,2% d'entre eux concernaient des enfants de moins de 15 ans et 5,4% concernaient des personnes avec un handicap de grade 2 (G2D). La région du nord-est a enregistré 66,4% des nouveaux cas. La plupart des cas concernaient des hommes âgés de 15 à 59 ans et de race/couleur noire. La tendance temporelle a montré une réduction dans la plupart des indicateurs et des variables de l'étude. Le taux de G2D n'a pas évolué au cours du temps dans la région du nord-est, chez les individus de 0 à 14 ans ou dans les municipalités avec des indices de vulnérabilité sociale "très élevés". L'analyse spatiale et spatiotemporelle a montré la présence de foyers hyper endémiques à risque élevé de détection impliquant des municipalités dans les Etats de Tocantins, Pará et Maranhão. CONCLUSION: La lèpre dans les régions du nord et du nord-est du Brésil persiste comme problème critique de santé publique. Les schémas temporels et spatiotemporels identifiés dans cette étude confirment que la lèpre reste épidémiologiquement importante dans les zones vulnérables. Des interventions de surveillance et de contrôle sont nécessaires dans les municipalités à faible détection dans la population générale et chez les enfants, ainsi que chez les personnes atteintes de G2D, afin de réduire le diagnostic tardif.

Propensity for COVID-19 severe epidemic among the populations of the neighborhoods of Fortaleza, Brazil, in 2020.

BACKGROUND: The state of Ceará (Northeast Brazil) has shown a high incidence of coronavirus disease (COVID-19), and most of the cases that were diagnosed during the epidemic originated from the capital Fortaleza. Monitoring the dynamics of the COVID-19 epidemic is of strategic importance and requires the use of sensitive tools for epidemiological surveillance, including consistent analyses that allow the recognition of areas with a greater propensity for increased severity throughout the cycle of the epidemic. This study aims to classify neighborhoods in the city of Fortaleza according to their propensity for a severe epidemic of COVID-19 in 2020. METHODS: We conducted an ecological study within the geographical area of the 119 neighborhoods located in the city of Fortaleza. To define the main transmission networks (infection chains), we assumed that the spatial diffusion of the COVID-19 epidemic was influenced by population mobility. To measure the propensity for a severe epidemic, we calculated the infectivity burden (ItyB), infection burden (IonB), and population epidemic vulnerability index (PEVI). The propensity score for a severe epidemic in the neighborhoods of the city of Fortaleza was estimated by combining the IonB and PEVI. RESULTS: The neighborhoods with the highest propensity for a severe COVID-19 epidemic were Aldeota, Cais do Porto, Centro, Edson Queiroz, Vicente Pinzon, Jose de Alencar, Presidente Kennedy, Papicu, Vila Velha, Antonio Bezerra, and Cambeba. Importantly, we found that the propensity for a COVID-19 epidemic was high in areas with differing socioeconomic profiles. These areas include a very poor neighborhood situated on the western border of the city (Vila Velha), neighborhoods characterized by a large number of subnormal agglomerates in the Cais do Porto region (Vicente Pinzon), and those located in the oldest central area of the city, where despite the wealth, low-income groups have remained (Aldeota and the adjacent Edson Queiroz). CONCLUSION: Although measures against COVID-19 should be applied to the entire municipality of Fortaleza, the classification of neighborhoods generated through this study can help improve the specificity and efficiency of these measures.

Unequal burden of mortality from gastric cancer in Brazil and its regions, 2000-2015.

BACKGROUND: Gastric cancer (GC) is an important cause of morbidity and mortality worldwide. However, population-based data on GC mortality dynamics in low and middle income countries are scarce. METHODS: We analyzed GC mortality in Brazil based on all GC-related deaths registered 2000-2015. RESULTS: A total of 17,374,134 deaths were recorded, with GC identified in 214,808 (1.24%) cases-203,941 (94.9%) as underlying cause, and 10,867 (5.1%) as associated cause of death. Adjusted rates for age and sex was 6.85 deaths/100,000 inhabitants [95% confidence interval (CI) 6.73-6.97]. The highest mortality rates were found in males [10.00; rate ratio (RR) 1.85; 95% CI 1.78-1.91; p < 0.0001] and patients ≥ 45 years of age (24.98; RR 3.79; 95% CI 3.55-4.05; p < 0.0001). The South (7.56; RR 1.62; 95% CI 1.50-1.76; p < 0.0001) and Southeast (7.36; RR 1.59; 95% CI 1.48-1.71; p < 0.0001) regions had the highest regional rates. Spatial and spatiotemporal high-risk mortality areas in 2004-2007 were located mainly in the South, Southeast, and Central-West regions. After 2008, the Northeast region became a high-risk area, especially Ceará State. CONCLUSION: GC remains a significant public health problem with high mortality burden and unequal distribution in Brazilian states. The new patterns in poorer regions and the high risk in some specific populations show a clear process of epidemiological transition over time. There is a need to strengthen nationwide epidemiological monitoring, surveillance, prevention, and control for GC in the country.

[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.

Scientometric review of research on Neglected Tropical Diseases: a 31-year perspective from the Journal of the Brazilian Society of Tropical Medicine.

BACKGROUND: To analyze the temporal evolution of research on Neglected Tropical Diseases (NTDs) published by the Journal of the Brazilian Society of Tropical Medicine (JBSTM). METHODS: We performed an analysis of the scientific production in JBSTM on NTDs using an advanced search, which included authors' descriptors, title, and abstract, and by combining specific terms for each NTDs from 1991 to 2021. Data related to authors, countries of origin, institutions, and descriptors, were evaluated and analyzed over time. Bibliographic networks were constructed using VOSviewer 1.6.16. RESULTS: The JBSTM published 4,268 scientific papers during this period. Of these 1,849 (43.3%) were related to NTDs. The number of publications on NTDs increased by approximately 2.4-fold, from 352 (total 724) during 1991-2000 to 841 (total 2,128) during 2011-2021, despite the proportional reduction (48.6% versus 39.5%). The most common singular NTDs subject of publications included Chagas disease (31.4%; 581/1,849), leishmaniasis (25.5%, 411/1,849), dengue (9.4%, 174/1,849), schistosomiasis (9.0%; 166/1,849), and leprosy (6.5%, 120/1,849), with authorship mostly from Brazil's South and Southeast regions. CONCLUSIONS: Despite the proportional reduction in publications, JBSTM remains an important vehicle for disseminating research on NTDs during this period. There is a need to strengthen the research and subsequent publications on specific NTDs. Institutions working and publishing on NTDs in the country were concentrated in the South and Southeast regions, requiring additional investments in institutions in other regions of the country.

Judicialization of the right to health with a focus on neglected tropical diseases: dimensions and challenges in Piauí State, Northeastern Brazil, 2000-2020. / Judicialização do direito à saúde com foco em doenças tropicais negligenciadas: dimensões e desafios no Estado do Piauí, Nordeste do Brasil, 2000-2020.

This article aims to analyse the magnitude and profile of legal demands for public health goods and services, also verifying the presence of legal demands for neglected tropical diseases (NTDs) in the State of Piauí between 2000-2020. Cross-sectional descriptive study based on the databases of the Court of Justice of Piauí on lawsuits demanding from the Direct Public Administration, goods and health services. A total of 6,658 lawsuits were initially identified. After eligibility analysis, 1,384 cases (20.8%) were analysed, with an increase in demand from 2017. We highlight the characteristics: origin in the capital Teresina (614; 44.4%), 40 to 59 years of age (372; 26.9%), female (761; 55.0%), farmers (123; 8.9%), public legal assistance (1,063; 76.8%), upheld (594; 42.9%). Five (5; 0.4%) lawsuits for NTDs, one visceral leishmaniasis requesting transportation, with granting, four for leprosy (two medicines, one granted, other extinguished without resolution of the merit, one consultation and one exam granted). The judicialization of the right to health is expressive and growing in the State of Piauí. The low demand related to NTDs may translate into limited access not only to health care, but also to the judiciary.

O objetivo deste artigo é analisar a magnitude e o perfil das demandas judiciais por bens e serviços de saúde pública, verificando também a presença de demandas judiciais para doenças tropicais negligenciadas (DTNs) no Estado do Piauí entre 2000-2020. Estudo transversal descritivo a partir de bases de dados do Tribunal de Justiça do Piauí acerca de processos judiciais demandando bens e serviços de saúde à administração pública direta. Foram identificados inicialmente um total de 6.658 processos judiciais. Após análise de elegibilidade, 1.384 processos (20,8%) foram analisados, verificando-se aumento da demanda a partir de 2017. Ressalta-se as características: origem na capital Teresina (614; 44,4%), 40 a 59 anos de idade (372; 26,9%), sexo feminino (761; 55,0%), agricultores (123; 8,9%), assistência jurídica pública (1.063; 76,8%), julgados procedentes (594; 42,9%). Cinco (5; 0,4%) demandas judiciais para DTNs, uma leishmaniose visceral solicitando transporte, procedente; quatro para hanseníase (dois medicamentos, um concedido, outro extinto sem resolução do mérito, uma consulta e um exame, ambos concedidos). A judicialização do direito à saúde é expressiva e crescente no estado do Piauí. A baixa demanda relacionada a DTNs pode traduzir limitação de acesso não apenas à saúde, mas ao Poder Judiciário.

Epidemiology and control of trachoma in the state of Ceará, Northeast Brazil, 2007-2021.

BACKGROUND: To analyze the epidemiology, surveillance, and control strategies for trachoma in the state of Ceará, northeast Brazil, from 2007 to 2021. METHODS: This ecological study was based on secondary data from the Information System on Notifiable Diseases of the Secretary of Health of the state of Ceará. Data from school and home surveys for trachoma detection obtained during the study period were analyzed, the percentage of positivity was estimated, and sociodemographic and clinico-epidemiological factors were investigated. RESULTS: The coverage of trachoma surveillance and control actions in Ceará municipalities increased from 12.5% in 2007 to 55.9% in 2019, but with an average restriction of 8.0% during the COVID-19 pandemic. The estimated trachoma positivity (mean overall positivity) was less than 5.0% (2.76%, 95% CI 1.2-5.2), with a higher proportion of cases in the 5-9-year age group (45.0%, 95% CI 44.6-45.4), in females (53.2%, 95% CI 52.8-53.6), and rural areas (52.6%, 95% CI 52.2-53.0). Positivity above 10.0% was observed in the Litoral Leste/Jaguaribe and Sertão Central regions, with a higher occurrence of the follicular inflammatory clinical form (98.1%, 95% CI 98.0-98.2). CONCLUSIONS: Trachoma remains in the state of Ceará and is likely underreported. Despite recent advances, the fragility of health surveillance activities compromises the recognition of the actual magnitude and distribution of trachoma in the state. Accurate information is fundamental for planning, monitoring, and evaluating surveillance and disease control.

Prevalence of trachoma in the non-indigenous Baixo Jaguaribe micro-region, Ceará State, Northeast Brazil.

BACKGROUND: The aim of the current study was to estimate the population prevalence of trachoma in non-indigenous populations in the Baixo Jaguaribe micro-region, in the state of Ceará, northeast region of Brazil, 2021-2022. METHODS: A population-based prevalence survey focusing on detecting cases of trachomatous inflammation-follicular (TF) in children aged 1-9 y and trachomatous trichiasis (TT) 'unknown to the health system' in people aged ≥15 y, was conducted in rural areas of the Baixo Jaguaribe micro-region in the state of Ceará. Indigenous populations will be further researched. RESULTS: There was no detection of cases of TF and TT. In 900 households, 2234 people were examined. In the Baixo Jaguaribe micro-region, females (54.6%; 1219/2234) and the mixed/Pardo-Brazilian ethnicity (68.1%; 1521/2234) predominated. The most commonly reported educational level was elementary and middle school (41.8%; 702/1679). In 56.2% (506/900) of households, there was a source of water within the household. The monthly income range of 50%-100% of the minimum wage predominated in the families of the Baixo Jaguaribe micro-region (43.1%; 388/900). CONCLUSIONS: Although no cases of TF and TT were detected in the Baixo Jaguaribe micro-region in the state of Ceará during the study period, considering the historical endemicity, we emphasise the need for monitoring and sustainability of surveillance actions in areas at risk for trachoma, common contexts for neglected populations.

[Hospital admissions due to neglected tropical diseases in Piauí, in the Northeast region of Brazil: costs, time trends, and spatial patterns, 2001-2018]. / Hospitalizações por doenças tropicais negligenciadas no Piauí, Nordeste do Brasil: custos, tendências temporais e padrões espaciais, 2001-2018.

To characterize the magnitude of hospital admissions and costs of patients with neglected tropical diseases, their time trends, and spatial patterns in Piauí, in the Northeast Region of Brazil, in 2001-2018. Ecological study of mixed designs, with calculation of relative risk (RR), time-trend analysis by Poisson regression, and inflection points, using data from neglected tropical diseases Hospital Admission Authorizations available in the Hospital Information System of the Brazilian Unified National Health System (SIH/SUS). Data showed 49,832 hospital admissions due to neglected tropical diseases in the period (rate: 86.70/100,000 inhabitants; 95%CI: 83.47; 89.93); of these, dengue (78.2%), leishmaniasis (8.6%), and leprosy (6.4%). The total cost was BRL 34,481,815.43, 42.8% of which referred to medium complexity cases. Higher risks of hospitalization occurred among people ≥ 60 years (RR = 1.8; 95%CI: 1.5; 2.2), mixed race/color (RR = 1.7; 95%CI: 1.1; 2.4), residents of municipalities presenting medium social vulnerability (RR = 1.5; 95% CI: 1.3; 1.6), and population size (RR = 1.6; 95%CI: 1.4; 1.9). The time trend showed a reduction in hospital admissions due to neglected tropical diseases, 2003-2018 (annual percent change - APC: -10.3; 95%CI: -14.7; -5.6). The spatial pattern showed clusters with higher rates of hospital admission in border municipalities located south of the Mid-north macroregion, north of the Semiarid macroregion, and south of the Cerrados macroregion. Piauí remains with high hospital admission rates and costs for neglected tropical diseases. Despite the reduction in time trends, knowledge burden, population groups, and municipalities at greater risk and vulnerability reinforce the importance of monitoring and strengthening control actions to maintain the reduction of the burden and costs of hospital admission due to neglected tropical diseases in the state.

Caracterizar a magnitude das internações hospitalares e custos por doenças tropicais negligenciadas, suas tendências temporais e padrões espaciais no Piauí, Nordeste do Brasil, 2001-2018. Estudo ecológico misto, com cálculo de risco relativo (RR) e análise de tendência temporal por regressão de Poisson, pontos de inflexão, utilizando-se dados de Autorizações de Internações Hospitalares por doenças tropicais negligenciadas via Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS). Verificaram-se 49.832 internações hospitalares por doenças tropicais negligenciadas (taxa: 86,70/100 mil habitantes; IC95%: 83,47; 89,93) no período, principalmente dengue (78,2%), leishmanioses (8,6%) e hanseníase (6,4%). O custo total foi de R$ 34.481.815,43, sendo 42,8% de média complexidade. Maiores riscos de hospitalizações ocorreram em: pessoas ≥ 60 anos (RR = 1,8; IC95%:1,5; 2,2), etnia/cor parda (RR = 1,7; IC95%: 1,1; 2,4), residentes em municípios de média vulnerabilidade social (RR = 1,5; IC95%: 1,3; 1,6) e porte populacional (RR = 1,6; IC95%: 1,4; 1,9). A tendência temporal foi de redução nas taxas de internações hospitalares por doenças tropicais negligenciadas, 2003-2018 (variação percentual anual - APC: -10,3; IC95%: -14,7; -5,6). O padrão espacial apresentou aglomerados com maiores taxas de internações hospitalares nos municípios limítrofes ao sul da macrorregião Meio-norte, norte do Semiárido e sul dos Cerrados. O Piauí persiste com elevadas taxas de hospitalizações e custos por doenças tropicais negligenciadas. Apesar da redução nas tendências temporais, o conhecimento de sua carga, seus grupos populacionais e municípios de maior risco e vulnerabilidade reforçam a importância do monitoramento e fortalecimento das ações de controle para manutenção na redução da carga e custos de internações hospitalares por doenças tropicais negligenciadas no estado.

Caracterizar la magnitud de las internaciones hospitalarias y los costos por las enfermedades tropicales desatendidas, sus tendencias temporales y patrones espaciales en Piauí, Nordeste de Brasil, 2001-2018. Estudio ecológico mixto, con cálculo de riesgo relativo (RR), y análisis de tendencia temporal por regresión de Poisson, puntos de inflexión, utilizando datos de Autorizaciones de Internaciones Hospitalarias por enfermedades tropicales desatendidas a través del Sistema de Informaciones Hospitalarias del Sistema Único de Salud (SIH/SUS). Se verificó 49.832 internaciones hospitalarias por enfermedades tropicales desatendidas (tasa: 86,70/100.000 habitantes; IC95%: 83,47; 89,93) en el periodo, las más frecuentes dengue (78,2 %), leishmaniasis (8,6%) y lepra (6,4%). El costo total fue de BRL 34.481.815,43, siendo 42,8 %, fueron de mediana complejidad. Los mayores riesgos de hospitalización se dieron en: personas ≥ 60 años (RR = 1,8; IC95%: 1,5; 2,2), etnia/color pardo (RR = 1,7; IC95%: 1,1; 2,4), residentes en municipios de vulnerabilidad social media (RR = 1,5; IC95%: 1,3; 1,6) y tamaño de la población (RR = 1,6; IC95%: 1,4; 1,9). La tendencia temporal fue de reducción en las tasas de internaciones hospitalarias por enfermedades tropicales desatendidas, 2003-2018 (cambio porcentual anual - APC: -10,3; IC95%: -14,7; -5,6). El patrón espacial presentó conglomerados con mayores tasas de internaciones hospitalarias en los municipios limítrofes al sur de la macrorregión del Medio-norte, el norte del Semiárido, y sur de los Cerrados. El Piauí persiste con elevadas tasas de hospitalizaciones y costos por enfermedades tropicales desatendidas. A pesar de la reducción de las tendencias temporales, el conocimiento de su carga, los grupos poblacionales y los municipios de mayor riesgo y vulnerabilidad refuerzan la importancia del monitoreo y fortalecimiento de las acciones de control para mantenimiento en la reducción de la carga y los costos de internaciones hospitalarias por enfermedades tropicales desatendidas en el estado.

Mortality from neglected tropical diseases in the state of Piauí, Northeast Brazil: temporal trend and spatial patterns, 2001-2018. / Mortalidade por doenças tropicais negligenciadas no Piauí, Nordeste do Brasil: tendência temporal e padrões espaciais, 2001-2018.

OBJETIVE: To analyze temporal trends and spatial patterns of mortality due to neglected tropical diseases (NTDs) in Piauí, Brazil, 2001-2018. METHODS: This was a mixed ecological study, with risk ratio (RR) calculation, spatiotemporal trend analysis, Poisson joinpoint regression, using data from the Mortality Information System. RESULTS: There were 2,609 deaths due to NTDs in the period (4.60/100,000 inhabitants), 55.2% were due to Chagas' disease. There was a higher risk of death in male (RR=1.76; 95%CI 1.25;2.46), being aged ≥60 years (RR=40.71; 95%CI 10.01;165.53), municipalities with medium vulnerability social (RR=1.76; 95%CI 1.09;2.84), smaller population size (RR=1.99; 95%CI 1.28;3.10) and the Cerrados macro-region (RR=4.51; 95%CI 2.51;8.11). There was an upward trend in mortality rates from 2001-2008 and a falling trend from 2009-2018. CONCLUSION: Mortality due to NTDs in Piauí remains high, particularly due to Chagas' disease, among groups with greater vulnerability, with concentration of higher rates in the southwest of the Semiarid macro-region and the northeast and south of the Cerrados macro-region.

Assistance Gaps in Physical Rehabilitation: Spatial Analysis of Physical Therapy Services and Users' Households in a Brazilian Capital. / Vazios assistenciais na reabilitação física: análise espacial dos serviços de fisioterapia e dos domicílios dos usuários em uma capital brasileira.

OBJECTIVE: The aim of this study was to analyze the spatial distribution of outpatient physical therapy rehabilitation services and associate it with the geographic location of users' households. METHODS: The public physical therapy rehabilitation services and addresses of users' households in Campo Grande (MS) were georeferenced in 2017-2019. RESULTS: Five physical therapy clinics were identified to supply the demand of 31,774 scheduled users. Most services are in the most central regions of the city, while most users reside in peripheral areas. CONCLUSION: An assistance gap in Physical therapy care was identified, with a restricted supply of services to meet demands and a geographic barrier, since the services are far from the users' households. Physical rehabilitation must be a priority in the country's public health, especially nowadays, where demands for rehabilitation of a significant number of Brazilians who evolved with sequelae of COVID-19 are so present.

OBJETIVO: O objetivo deste estudo foi analisar a distribuição espacial dos serviços ambulatoriais de reabilitação em fisioterapia e associá-la à disposição geográfica dos domicílios dos usuários da rede pública de reabilitação em uma capital brasileira. MÉTODOS: Foi realizado um georreferenciamento dos serviços públicos de reabilitação fisioterapêutica e dos endereços dos domicílios dos usuários desses serviços em Campo Grande (MS) durante o período de 2017 a 2019. RESULTADOS: Foram identificados cinco serviços de fisioterapia para atender à demanda de 31.774 usuários agendados no período estudado. A maioria dos serviços está nas regiões mais centrais da cidade, enquanto a maioria dos usuários reside nas regiões periféricas. CONCLUSÃO: Evidenciou-se um vazio assistencial na reabilitação fisioterapêutica, com oferta restrita de serviços em função das demandas, e barreira geográfica, uma vez que os serviços estão distantes dos domicílios dos usuários A reabilitação física deve ser colocada na agenda prioritária da saúde pública no país, especialmente no momento atual, com as demandas por reabilitação de um número expressivo de brasileiros que evoluem com sequelas da COVID-19.

Scientometric analysis of research on trachoma in Brazil, 2000-2020.

OBJECTIVE: To analyze the scientometric profile of research on trachoma in Brazil. METHODS: Bibliographic research of publications on trachoma in Brazil indexed by the Scopus database from 2000 to 2020, based on specific criteria. Data on authorship, country of origin, institutions, and keywords were collected and analyzed with analysis of time trends. Bibliographic networks were constructed via a scientometric visualization software-VOSviewer® 1.6.16. RESULTS: We analyzed 42 publications on trachoma in Brazil. The annual average was two articles, with an increase of about 50% during the period. The average number of authors was three per document and school surveys were the most common subject category. Most published articles came from Brazilian institutions (95.2%), mainly those based in Southeast and North Brazil. Of the most productive authors, 10 were mentioned as first author in 26.2% of publications (11/42) and the predominant institutions are based in the state of São Paulo. The term "trachoma" (n = 18) was the most recurrent keyword. CONCLUSION: This first scientometric analysis of research on trachoma in Brazil showed a limited number of studies on this disease. The scientific production slightly increased, although the origin of many studies is geographical areas with lower endemicity of this disease. Greater investments are needed for a better understanding and control of this neglected tropical disease. The analysis of bibliographic production on this topic is important to strengthen the development of research and strategic planning of programs for the control of trachoma and neglected tropical diseases in general.

Limits and possibilities for the development of public health research in the legal system.

OBJECTIVE: To characterize databases of the courts of justice of Brazil as a potential tool for research in Collective Health, in its interface with the legal sciences. METHODS: Cross-sectional study of quantitative and descriptive nature, focusing on analysis of strategic management and judicial systems. RESULTS: Databases used by the Common Justice in the Federation Units to systematize judicial processes were identified and analyzed. A total of 123 databases were found in the courts of justice per state, with emphasis on the South and Northeast regions, in contrast to the North region, which has a smaller number of systems. This large number of judicial systems limits access to legal operators, and hinders the collection of evidence by health researchers and, consequently, impacts the strategic management of the Executive Branch. There were limitations from design to transparent and democratic data extraction by the users themselves, as well as restricted integration between bases. CONCLUSIONS: Although advances have been made in recent years by the courts of justice to unify these databases, the multiplicity of information systems used in the Common State Justice complicates the management of knowledge, limits the development of research, even when carried out by lawyers or researchers in the legal area, as well as generates slow data extraction for public management. It is recognized the need for additional efforts for standardization, as well as for improvement of these databases, expanding access, transparency and integration with a view to a transdisciplinary look between the field of Law and Collective Health.

High schistosomiasis-related mortality in Northeast Brazil: trends and spatial patterns.

BACKGROUND: We analyzed the trends and spatial patterns of schistosomiasis-related mortality in Northeast Brazil in 2000-2019. METHODS: A mixed population-based ecological study was conducted, using information on the underlying or associated causes of death. We used Joinpoint regression analysis to calculate the trends. The spatial analysis included rates, spatial moving averages, and standardized mortality rates. The spatial dependence analysis was based on Getis-Ord's G and Gi* indices (Gi star) and local Moran's index to check for autocorrelation. RESULTS: A total of 5,814,268 deaths were recorded, of which 9,276 (0.16%) were schistosomiasis-related; 51.0% (n=4,732, adjusted rate 0.90/100,000 inhabitants [95% confidence interval (CI) 0.88-0.93]) were males; 40.0% (n=3,715, adjusted rate 7.40/100.000 inhabitants [95%CI: 7.16-7.64]) were ≥70 years old; 54.8% (n=5,087, crude rate 0.80/100,000 inhabitants) were of mixed/Pardo-Brazilian ethnicity; and 77.9% (n=7,229, adjusted rate 0.86/100,000 inhabitants [95%CI: 0.84-0.88]) lived outside state capitals. The highest proportion of deaths was in the state of Pernambuco (53.9%, n=4,996, adjusted rate 2.72/100,000 inhabitants [95%CI: 2.64-2.79]). Increasing mortality rate was verified in the state of Sergipe. On the coast of the state of Rio Grande do Norte and Bahia, there was spatial dependence of spatio-temporal risk patterns with clusters. Throughout the study period, we found positive spatial autocorrelation and cluster formation. CONCLUSIONS: In Northeast Brazil, schistosomiasis persists with a high mortality rate, especially in the coastal region, with heterogeneous spatial and temporal patterns. To eliminate schistosomiasis by 2030, it is necessary to strengthen the financing and management of the unified health system (SUS).

Persistence of Schistosomiasis-Related Morbidity in Northeast Brazil: An Integrated Spatio-Temporal Analysis.

OBJECTIVE: To analyze the temporal trend and spatial patterns of schistosomiasis-related morbidity in Northeast Brazil, 2001-2017. METHODS: Ecological study, of time series and spatial analysis, based on case notifications and hospital admission data, as provided by the Ministry of Health. RESULTS: Of a total of 15,574,392 parasitological stool examinations, 941,961 (6.0%) were positive, mainly on the coastline of Pernambuco, Alagoas and Sergipe states. There was a reduction from 7.4% (2002) to 3.9% (2017) of positive samples and in the temporal trend of the detection rate (APC-11.6*; Confidence Interval 95%-13.9 to -9.1). There was a total of 5879 hospital admissions, with 40.4% in Pernambuco state. The hospitalization rate reduced from 0.82 (2001) to 0.02 (2017) per 100,000 inhabitants. CONCLUSION: Despite the reduction in case detection and hospitalizations, the persistence of focal areas of the disease in coastal areas is recognized. This reduction may indicate a possible positive impact of control on epidemiological patterns, but also operational issues related to access to healthcare and the development of surveillance and control actions in the Unified Health System.

Socio-demographic and clinical factors of leprosy cases associated with the performance of the evaluation of their contacts in Ceará, Brazil, 2008-2019. / Fatores sociodemográficos e clínicos de casos de hanseníase associados ao desempenho da avaliação de seus contatos no Ceará, 2008-2019.

OBJECTIVE: To analyze the effect of sociodemographic and clinical characteristics of new leprosy cases as determinants in the performance of the evaluation of their contacts. METHODS: This was a cross-sectional study, with a temporal approach to the evaluation indicator of 100% of contacts examined of each new case (NC) registered in the state of Ceará, Brazil, on the Notifiable Diseases Information System (SINAN), in 2008-2019. Logistic regression was used to estimate odds ratio (OR) with 95% confidence intervals (95%CI). The temporal trends were analyzed using joinpoint regression. RESULTS: 23,675 NCs, 65.4% with contacts examined were analyzed. It was less likely to evaluate 100% of the registered contacts when the new cases were multibacillary (OR=1.19 - 95%CI 1.11;1.28) and with examination of contacts as an entry mode (OR=1.71 - 95%CI 1.35;2.18). There was an increasing temporal trend of the indicator (Annual Percentage Change: 2.1 - 95%CI 1.2;3.0). CONCLUSION: Distinct dimensions of individual and social vulnerability among new leprosy cases influenced the persistent unsatisfactory performance of the evaluation of contacts.

Seroprevalence and risk factors of Chagas disease in a rural population of the Quixeré municipality, Ceará, Brazil.

INTRODUCTION: This study estimated the seroprevalence and risk factors of Chagas disease (CD) in a population of the Quixeré municipality, Ceará. METHODS: We conducted serological methods to detect the Trypanosoma cruzi infection. The other variables were evaluated by a standardized questionnaire. RESULTS: The estimated prevalence of CD was 3.7%. Male sex, age >40 years, being farmers, low education level, origin from rural areas, and being born in Quixeré were significantly associated with infection. CONCLUSION: CD persists in this rural population of Northeast Brazil. Poverty, low education, and limited information regarding CD are critical issues that need to be addressed.

Low performance of operational indicators for leprosy control in the state of Bahia: spatiotemporal patterns, 2001-2014. / Baixo desempenho de indicadores operacionais de controle da hanseníase no estado da Bahia: padrões espaçotemporais, 2001-2014.

OBJECTIVE: To characterize spatiotemporal patterns of operational indicators for leprosy control in the state of Bahia from 2001 to 2014. METHODS: This is a population-based ecological study, with spatial distribution and autocorrelation of operational indicators for leprosy control. RESULTS: From 2001 to 2007, 42.7% (n=178) of the municipalities presented a cure rate lower than 75%, increasing to 61.4% (n =291) from 2009 to 2014. Between 2001 and 2007, 32.5% (n=54) of the municipalities reported more than 10% of the total number of relapses in the state, increasing to 36.9% (n=75) between 2008 and 2014. From 2001 to 2014, 38% (n=159) of the municipalities presented an assessment index of disability grading at the time of diagnosis within the regular performance parameter. Between 2009 and 2014, the number of municipalities with a high incidence of grade 2 disability (G2D) at the time of diagnosis increased, reaching 55.3% (n=230) of the municipalities. Most municipalities in the state of Bahia showed poor performance in the implementation of planned actions for leprosy control, with little change or relative worsening in the patterns of operational indicators throughout the historical series. CONCLUSION: The operational context in Bahia indicates significant institutional vulnerability, leading to the need for expansion and qualification of the surveillance and health care network in the different regions and conditions analyzed in the public health system (Sistema Único de Saúde - SUS).

OBJETIVO: Caracterizar padrões espaçotemporais de indicadores operacionais de controle da hanseníase no estado da Bahia no período de 2001 a 2014. METODOLOGIA: Estudo ecológico, de base populacional, com distribuição e autocorrelação espacial de indicadores operacionais da hanseníase. RESULTADOS: No período de 2001 a 2007, 42,7% (n = 178) dos municípios apresentaram percentual de cura inferior a 75%, ampliando para 61,4% (n = 291) de 2009 a 2014. De 2001 a 2007, 32,5% (n = 54) dos municípios notificaram mais de 10% do total de casos de recidiva do estado, com aumento para 36,9% (n = 75) dessa situação no período de 2008 a 2014. De 2001 a 2014, em 38% (n = 159) dos municípios, o indicador de avaliação do grau de incapacidade física (GIF) no momento do diagnóstico se encontrava conforme o parâmetro regular de desempenho. Já no período de 2009 a 2014, houve aumento de municípios com alta ocorrência de GIF2 no momento do diagnóstico, atingindo 55,3% (n = 230) dos municípios. A maioria dos municípios do estado da Bahia apresentou desempenho insatisfatório na execução das ações de controle previstas para a hanseníase, com pouca mudança ou relativa piora nos padrões de indicadores operacionais ao longo da série histórica. CONCLUSÃO: O contexto operacional do estado da Bahia sinaliza graves dimensões de vulnerabilidade institucional, o que implica necessariamente a ampliação e a qualificação da rede de vigilância e atenção à saúde nas diferentes regiões e contextos analisados do Sistema Único de Saúde (SUS).