Changing perception and improving knowledge of leprosy: An intervention study in Uttar Pradesh, India.

INTRODUCTION: Since ancient times leprosy has had a negative perception, resulting in stigmatization. To improve the lives of persons affected by leprosy, these negative perceptions need to change. The aim of this study is to evaluate interventions to change perceptions and improve knowledge of leprosy. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a pre-post intervention study in Fatehpur and Chandauli districts, Uttar Pradesh, India. Based on six steps of quality intervention development (6SQuID) two interventions were designed: (1) posters that provided information about leprosy and challenged misconceptions, and (2) meetings with persons affected by leprosy, community members and influential people in the community. The effect of the interventions was evaluated in a mixed-methods design; in-depth interviews, focus group discussions, and questionnaires containing a knowledge measure (KAP), two perception measures (EMIC-CSS, SDS) and an intervention evaluation tool. 1067 participants were included in Survey 1 and 843 in Survey 2. The interventions were effective in increasing knowledge of all participant groups, and in changing community and personal attitudes of close contacts and community members (changes of 19%, 24% and 13% on the maximum KAP, EMIC-CSS and SDS scores respectively, p<0.05). In Survey 1, 13% of participants had adequate knowledge of leprosy versus 53% in Survey 2. Responses showed stigmatizing community attitudes in 86% (Survey 1) and 61% (Survey 2) of participants and negative personal attitudes in 37% (Survey 1) and 19% (Survey 2). The number of posters seen was associated with KAP, EMIC-CSS and SDS scores in Survey 2 (p<0.001). In addition, during eight post-intervention focus group discussions and 48 interviews many participants indicated that the perception of leprosy in the community had changed. CONCLUSIONS/SIGNIFICANCE: Contextualized posters and community meetings were effective in changing the perception of leprosy and in increasing leprosy-related knowledge. We recommend studying the long-term effect of the interventions, also on behavior.

Solubility Determination, Hansen Solubility Parameters and Thermodynamic Evaluation of Thymoquinone in (Isopropanol + Water) Compositions.

This article studies the solubility, Hansen solubility parameters (HSPs), and thermodynamic behavior of a naturally-derived bioactive thymoquinone (TQ) in different binary combinations of isopropanol (IPA) and water (H2O). The mole fraction solubilities (x3) of TQ in various (IPA + H2O) compositions are measured at 298.2-318.2 K and 0.1 MPa. The HSPs of TQ, neat IPA, neat H2O, and binary (IPA + H2O) compositions free of TQ are also determined. The x3 data of TQ are regressed by van't Hoff, Apelblat, Yalkowsky-Roseman, Buchowski-Ksiazczak λh, Jouyban-Acree, and Jouyban-Acree-van't Hoff models. The maximum and minimum x3 values of TQ are recorded in neat IPA (7.63 × 10-2 at 318.2 K) and neat H2O (8.25 × 10-5 at 298.2 K), respectively. The solubility of TQ is recorded as increasing with the rise in temperature and IPA mass fraction in all (IPA + H2O) mixtures, including pure IPA and pure H2O. The HSP of TQ is similar to that of pure IPA, suggesting the great potential of IPA in TQ solubilization. The maximum molecular solute-solvent interactions are found in TQ-IPA compared to TQ-H2O. A thermodynamic study indicates an endothermic and entropy-driven dissolution of TQ in all (IPA + H2O) mixtures, including pure IPA and pure H2O.

Threshold effect of government subsidy, corporate social responsibility and brand value using the data of China's top 500 most valuable brands.

An increasing number of firms have begun to attach importance to corporate social responsibility (CSR) to obtain sustainable strategic advantages in the competitive market. On the basis of nonlinear perspective, panel data of A-share listed companies in the ranking list of China's Top 500 Most Valuable Brands in 2012-2018 and Hansen panel threshold regression technology were adopted. With government subsidy and CSR being threshold variables, the internal mechanism about the influence of government subsidy and CSR on brand value was explored. Results show that the following. (1) CSR has a significantly inverted U-type threshold effect on brand value. (2) Government subsidy facilitates CSR with diminishing marginal utility. (3) When a difference exists in the strength of government subsidy, the influence of CSR on brand value presents a significant N-type law. Furthermore, threshold regression method was used to innovatively explore the complex nonlinear relationship among government subsidy, CSR, and brand value. This relationship has a significantly practical significance for listed firms for weighing the business decisions regarding the input of CSR and brand value, as well as subsidy policies for enterprises by the government.

Supercritical Fluid Chromatography development of a predictive analytical tool to selectively extract bioactive compounds by supercritical fluid extraction and pressurised liquid extraction.

Selective extraction is a great concern in the field of natural products. The interest is to apply specific conditions favouring the solubility of targeted secondary metabolites and avoiding the simultaneous extraction of unwanted ones. Different ways exist to reach selective extractions with suited conditions. These conditions can be determined from experimental studies through experimental design, but a full experimental design takes time, energy, and uses plant samples. Prediction from varied solubility models can also be applied allowing a better understanding of the final selected conditions and eventually less experiments. The aim of this work was to develop and use a chromatographic model to determine optimal extraction conditions without the need for numerous extraction experiments. This model would be applied on the selective extraction of the desired antioxidant compounds in rosemary leaves (rosmarinic and carnosic acids) vs chlorophyll pigments to limit the green colour in extracts. This model was achieved with Supercritical Fluid Chromatography (SFC) and then applied to Supercritical Fluid Extraction (SFE) and Pressurised Liquid Extraction (PLE) assays. SFC models predicted low solubility of chlorophylls for low (5%) and high (100%) percentage of solvent in carbon dioxide. Also, low solubility was predicted with acetonitrile solvent compared to methanol or ethanol. This was confirmed with different extractions performed using SFE with different percentages of solvent (5, 30, and 70%) and with the three solvents used in the SFC models (acetonitrile, methanol and ethanol). Also extractions using PLE were carried out using the same neat solvents in order to confirm the SFC models obtained for 100% of solvent. Globally, extractions validated the SFC models. Only some differences were observed between ethanol and methanol showing the complexity of plant extraction due to matrix effect. For all these extracts, the content of carnosic acid and rosmarinic acid was also monitored and selective extraction conditions of bioactive compounds could be determined.

Epidemiological monitoring of leprosy indicators in Sergipe (2001-2015): segmented regression analysis

Abstract This study analyzed the trend of leprosy indicators in Sergipe, between 2001 and 2015. It was a time series study that analyzed the trend for general detection coefficient, children under 15 years of age, and new cases with grade 2 disability. The joinpoint model was used. Two (2.6%) municipalities had an increasing trend in general detection coefficient, five (6.6%) had an increasing trend in detection rate in children under 15, and 19 (25.3%) had an increasing trend in detection coefficient of new leprosy cases with grade 2 disability. The findings suggest maintenance of the chain of transmission.

Epidemiological monitoring of leprosy indicators in Sergipe (2001-2015): segmented regression analysis.

This study analyzed the trend of leprosy indicators in Sergipe, between 2001 and 2015. It was a time series study that analyzed the trend for general detection coefficient, children under 15 years of age, and new cases with grade 2 disability. The joinpoint model was used. Two (2.6%) municipalities had an increasing trend in general detection coefficient, five (6.6%) had an increasing trend in detection rate in children under 15, and 19 (25.3%) had an increasing trend in detection coefficient of new leprosy cases with grade 2 disability. The findings suggest maintenance of the chain of transmission.

[Orientation of primary care in actions to control leprosy: factors relating to professionals]. / Orientación de la atención primaria en las acciones contra la lepra: factores relacionados con los profesionales.

OBJECTIVE: To identify factors of professionals that relate to the degree of primary health care orientation in the control of leprosy. METHOD: Study carried out in 70 units of Family Health Strategy of a capital of Brazil, between July and September 2014. An evaluation instrument applied to 408 health professionals was used. The multiple linear regression-bootstrap model was applied to analyze the association of the general, essential and derived score with the explanatory factors of the professionals (work time in the unit and in primary care services, control actions, case care and leprosy training). RESULTS: In the descriptive analysis most of the professionals did not attend cases and did not receive training to perform leprosy actions. A strong orientation was observed in the essential and general score of primary care and the association with leprosy education. In the derived score, weak orientation and association were observed with training in the disease for doctors and community health agents. CONCLUSION: Professional experience in the Family Health Strategy and leprosy care is crucial for the service to be a provider of control actions oriented according to the essential and derived attributes of primary health care. Brazil has made progress in reducing the incidence of leprosy; however, it is necessary to increase the effectiveness of health surveillance, as a means of early detection and training of professionals.

Assisted reproductive technology treatment and risk of ovarian cancer-a nationwide population-based cohort study.

STUDY QUESTION: Does hormone stimulation during assisted reproductive technology (ART) treatment increase the risk of ovarian cancer? SUMMARY ANSWER: No increased risk of ovarian cancer was found among ART-treated women, with the exception of ART-treated women with endometriosis. WHAT IS KNOWN ALREADY: Previous studies on the association between ovarian stimulation during ART and ovarian cancer have shown conflicting results. The risk of ovarian cancer varies according to the cause of infertility, and only a few studies on ART treatment and risk of ovarian cancer have had sufficient data to address this issue. Endometriosis has been linked to an increased risk of ovarian cancer. STUDY DESIGN, SIZE, DURATION: Women undergoing ART treatment during 1994-2015 were registered in the Danish IVF register. Data were linked with data from the Danish Cancer Register and socio-demographic population registers using an individual person identification number assigned to people residing in Denmark. PARTICIPANTS/MATERIALS, SETTING, METHODS: All women undergoing ART treatment were age-matched with a random sample of the female background population and followed for up to 22 years. After relevant exclusions, the population consisted of 58 472 ART-treated women and 625 330 untreated women, all with no previous malignancies. Ovarian cancer risk was assessed using multivariable cox regression analyses with adjustment for educational level, marital status, parity and treatment year. Results are shown as hazard ratios (HRs) with corresponding CIs. MAIN RESULTS AND THE ROLE OF CHANCE: In total, 393 (0.06%) women were diagnosed with ovarian cancer during follow-up (mean 9.7 years). Women treated with ART had an increased risk of ovarian cancer (HR 1.20, 95% CI 1.10-1.31), which diminished over time. The increased risk was apparent among women with female factor infertility (HR 1.36, 95% CI 1.25-1.48), whereas no female factor infertility was associated with a lower risk (HR 0.87, 95% CI 0.76-1.00). The risk was increased among women with endometriosis (HR 3.78, 95% CI 2.45-5.84), whereas no increased risk was found among ART-treated women with polycystic ovary syndrome, other female causes of infertility and unexplained infertility. LIMITATIONS, REASONS FOR CAUTION: The association between ART treatment and ovarian cancer is likely influenced by increased detection due to multiple ultrasound scans during ART treatment. WIDER IMPLICATIONS OF THE FINDINGS: Undergoing ART treatment without the presence of endometriosis was not associated with an increased risk of ovarian cancer, which is reassuring. Whether ART treatment increases the risk of ovarian cancer among women with endometriosis needs further investigation. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by a PhD grant to D.V. from the Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. Funding for establishing the Danish National ART-couple II cohort was achieved from Ebba Rosa Hansen Foundation. The funders had no influence on data collection, analyses or results presented. The authors have no conflicts of interest to declare.

Hansen's disease in children under 15 years old in the state of Tocantins, Brazil, 2001-2012: epidemiological patterns and temporal trends. / Hanseníase em menores de 15 anos no estado do Tocantins, Brasil, 2001-2012: padrão epidemiológico e tendência temporal.

INTRODUCTION: Tocantins is the most hyperendemic state for leprosy in Brazil. OBJECTIVE: To describe the epidemiological characteristics and temporal trends of leprosy indicators in children under 15 years old in Tocantins between the years of 2001 and 2012. METHODOLOGY: Data analysis of the Notification of Injury Information System (SINAN). New cases under the age of 15 have been included in the state. The indicators were calculated and the temporal trends were analyzed through the join-point regression. RESULTS: There were 1,225 cases in children, mean age of 10.8 years, and male predominated (52%). The mode of detection by spontaneous demand prevailed (55.8%) and more than 9% had some physical disability. Detection in < 15 years was significantly increased between 2001 and 2008 (anual percent change - APC = 3.8%; confidence interval of 95% - 95%CI 0.1 - 7.6), and showed significant decline between 2008 and 2012 (APC = -9.4%; 95%CI -17.2 - -0.8). There was stability for the detection of grade 2 cases (APC = 4.2%; 95%CI -6.7 - 16.3), proportion of grade 2 cases (APC = 4.1%; 95%CI 6.7 - 16.3), proportion of grade 1 cases (APC = 1.3%; 95%CI -6.2 - 9.3), multibacillary ratio (APC = 2.9%; 95%CI -1.7 - 7.7), and proportion of paucibacillary (APC = 2.9%; 95%CI -1.7 - 7.7). CONCLUSION: Leprosy remains an important public health problem in Tocantins, with active transmission and persistence of transmission foci. The stability of the indicators points out the permanence of the late diagnosis and the repressed demands.

INTRODUÇÃO: O Tocantins é o estado mais hiperendêmico para hanseníase no Brasil. OBJETIVO: Descrever as características epidemiológicas e tendências temporais dos indicadores da hanseníase em menores de 15 anos de idade no Tocantins entre 2001-2012. METODOLOGIA: Análise de dados do Sistema de Informação de Agravos de Notificação (SINAN). Incluíram-se casos novos de menores de 15 anos residentes no estado. Calcularam-se os indicadores e analisaram-se as tendências temporais por meio da regressão joinpoint. RESULTADOS: Houve registro de 1.225 casos em crianças, a média de idade foi de 10,8 anos, e o sexo masculino predominou (52%). O modo de detecção por demanda espontânea prevaleceu (55,8%) e mais de 9% tinha alguma incapacidade física. A detecção em < de 15 anos foi significativamente crescente entre 2001 a 2008 (anual percent change - APC = 3,8%; intervalo de confiança de 95% - IC95% 0,1 - 7,6) e apresentou declínio significativo entre 2008 e 2012 (APC = -9,4%; IC95%: -17,2 - -0,8). Houve estabilidade para a detecção de casos com grau 2 (APC = 4,2%; IC95% -6,7 - 16,3), proporção de casos com grau 2 (APC = 4,1%; IC95% -6,7 - 16,3), proporção de casos com grau 1 (APC = 1,3%; IC95% -6,2 - 9,3), proporção de multibacilares (APC = 2,9%; IC95% -1,7 - 7,7) e proporção de paucibacilares (APC = 2,9%; IC95% -1,7 - 7,7). CONCLUSÃO: A hanseníase permanece como um importante problema de saúde pública no Tocantins, com transmissão ativa e persistência de focos de transmissão. A estabilidade dos indicadores aponta a permanência do diagnóstico tardio e as demandas represadas.

Improving Product Specificity of Whole-Cell Alkane Oxidation in Nonconventional Media: A Multivariate Analysis Approach.

Two-liquid-phase reaction media have long been used in bioconversions to supply or remove hydrophobic organic reaction substrates and products to reduce inhibitory and toxic effects on biocatalysts. In case of the terminal oxyfunctionalization of linear alkanes by the AlkBGT monooxygenase the excess alkane substrate is often used as a second phase to extract the alcohol, aldehyde, and acid products. However, the selection of other carrier phases or surfactants is complex due to a large number of parameters that are involved, such as biocompatibility, substrate bioavailability, and product extraction selectivity. This study combines systematic high-throughput screening with chemometrics to correlate physicochemical parameters of a range of cosolvents to product specificity and yield using a multivariate regression model. Partial least-squares regression shows that the defining factor for product specificity is the solubility properties of the reaction substrate and product in the cosolvent, as measured by Hansen solubility parameters. Thus the polarity of cosolvents determines the accumulation of either alcohol or acid products. Whereas usually the acid product accumulates during the reaction, by choosing a more polar cosolvent the 1-alcohol product can be accumulated. Especially with Tergitol as a cosolvent, a 3.2-fold improvement in the 1-octanol yield to 18.3 mmol L-1 is achieved relative to the control reaction without cosolvents.

Leprosy transmission in Bahia, 2001-2015: modeling based on Jointpoint regression and spatial scan statistics. / Transmissão da hanseníase na Bahia, 2001-2015: modelagem a partir de regressão por pontos de inflexão e estatística de varredura espacial.

OBJECTIVE: to describe the trend and the spatial distribution of leprosy in the state of Bahia, Brazil, 2001-2015. METHODS: this was a mixed ecological study of epidemiological indicators of leprosy; Jointpoint regression was used for the temporal analysis, while spatial scan statistics were used to identify clusters of the disease; the trend was classified as stationary, increasing or decreasing; we calculated the annual percent change (APC) and average annual percent change (AAPC). RESULTS: there was a reduction in prevalence (AAPC = -5.6; p<0,001), treatment dropout (AAPC = -13.7; p<0.001), and females with leprosy (AAPC = -0.6; p<0.001); the new grade II case coefficient (AAPC = 2.7; p<0.001) and the proportion of multibacillary cases (AAPC = 2,2; p<0.001) showed a growing trend; spatial distribution was heterogeneous and concentrated in three regions in particular (north, west and south of the state), with variation between the indicators. CONCLUSION: persisting leprosy transmission in the state, late diagnosis and high hidden prevalence is suggested.

Hanseníase em menores de 15 anos no estado do Tocantins, Brasil, 2001-2012: padrão epidemiológico e tendência temporal / Hansen's disease in children under 15 years old in the state of Tocantins, Brazil, 2001-2012: epidemiological patterns and temporal trends

RESUMO: Introdução: O Tocantins é o estado mais hiperendêmico para hanseníase no Brasil. Objetivo: Descrever as características epidemiológicas e tendências temporais dos indicadores da hanseníase em menores de 15 anos de idade no Tocantins entre 2001-2012. Metodologia: Análise de dados do Sistema de Informação de Agravos de Notificação (SINAN). Incluíram-se casos novos de menores de 15 anos residentes no estado. Calcularam-se os indicadores e analisaram-se as tendências temporais por meio da regressão joinpoint. Resultados: Houve registro de 1.225 casos em crianças, a média de idade foi de 10,8 anos, e o sexo masculino predominou (52%). O modo de detecção por demanda espontânea prevaleceu (55,8%) e mais de 9% tinha alguma incapacidade física. A detecção em < de 15 anos foi significativamente crescente entre 2001 a 2008 (anual percent change - APC = 3,8%; intervalo de confiança de 95% - IC95% 0,1 - 7,6) e apresentou declínio significativo entre 2008 e 2012 (APC = -9,4%; IC95%: -17,2 - -0,8). Houve estabilidade para a detecção de casos com grau 2 (APC = 4,2%; IC95% -6,7 - 16,3), proporção de casos com grau 2 (APC = 4,1%; IC95% -6,7 - 16,3), proporção de casos com grau 1 (APC = 1,3%; IC95% -6,2 - 9,3), proporção de multibacilares (APC = 2,9%; IC95% -1,7 - 7,7) e proporção de paucibacilares (APC = 2,9%; IC95% -1,7 - 7,7). Conclusão: A hanseníase permanece como um importante problema de saúde pública no Tocantins, com transmissão ativa e persistência de focos de transmissão. A estabilidade dos indicadores aponta a permanência do diagnóstico tardio e as demandas represadas.

ABSTRACT: Introduction: Tocantins is the most hyperendemic state for leprosy in Brazil. Objective: To describe the epidemiological characteristics and temporal trends of leprosy indicators in children under 15 years old in Tocantins between the years of 2001 and 2012. Methodology: Data analysis of the Notification of Injury Information System (SINAN). New cases under the age of 15 have been included in the state. The indicators were calculated and the temporal trends were analyzed through the join-point regression. Results: There were 1,225 cases in children, mean age of 10.8 years, and male predominated (52%). The mode of detection by spontaneous demand prevailed (55.8%) and more than 9% had some physical disability. Detection in < 15 years was significantly increased between 2001 and 2008 (anual percent change - APC = 3.8%; confidence interval of 95% - 95%CI 0.1 - 7.6), and showed significant decline between 2008 and 2012 (APC = -9.4%; 95%CI -17.2 - -0.8). There was stability for the detection of grade 2 cases (APC = 4.2%; 95%CI -6.7 - 16.3), proportion of grade 2 cases (APC = 4.1%; 95%CI 6.7 - 16.3), proportion of grade 1 cases (APC = 1.3%; 95%CI -6.2 - 9.3), multibacillary ratio (APC = 2.9%; 95%CI -1.7 - 7.7), and proportion of paucibacillary (APC = 2.9%; 95%CI -1.7 - 7.7). Conclusion: Leprosy remains an important public health problem in Tocantins, with active transmission and persistence of transmission foci. The stability of the indicators points out the permanence of the late diagnosis and the repressed demands.

Analysis of Social Determinants of Health and Disability Scores in Leprosy-Affected Persons in Salem, Tamil Nadu, India.

A consistent relationship has been found between leprosy and inequities in social determinants of health. It, however, remains unclear which aspect of these social determinants contributes most to the risk of infection, and even less clear are the risk factors for the development of leprosy-related disabilities. The objective of this study was to elicit the differential impact of social determinants of health in leprosy-affected persons, and determine whether structural inequities in accessibility to societal resources and lower socioeconomic parameters correlated with higher severity of disabilities. This analysis was based on a sampled population affected by leprosy in Salem, Tamil Nadu, India. Persons enrolled in the study were covered by a nongovernmental lifelong care program, had completed a multidrug therapy for leprosy and/or were slit-skin-smear negative, and showed Grade 1 or higher disabilities due to leprosy. Multiple stepwise linear regression analysis was performed. The Eyes-Hands-Feet (EHF) score was the outcome variable, and gender, age, time after release from treatment, monthly income, and living space were explanatory variables. There were 123 participants, comprised of 41 (33.33%) women and 82 (66.67%) men. All study participants belonged to India's Backward classes; 81.30% were illiterate and the average monthly income was 1252 Indian rupee (INR) (US$19.08 or €17.16). The average EHF score was 7.016 (95% CI, 6.595 to 7.437). Stepwise multiple linear regression analysis built a significant model, where F(2, 120) = 13.960, p ≤ 0.001, effect size (Cohen's f2) = 0.81, explaining 18.9% of the variance in EHF scores (R² = 0.189). Significant predictors of a higher EHF score in persons affected by leprosy were found to be higher age (beta = 0.340, 95% CI, 0.039 to 0.111, p < 0.001), as well as less living space (beta = -0.276, 95% CI, -0.041 to -0.011, p = 0.001). Our results suggest that inequalities in social determinants of health correspond to higher disability scores, which indicates that poor living standards are a common phenomenon in those living with leprosy-related disabilities. Further research is needed to dissect the exact development of impairments after release from treatment (RFT) in order to take targeted actions against disability deterioration.

[Leprosy trends following implementation of an intervention project in a state capital in the North of Brazil, 2002-2016]. / Tendências da hanseníase após implementação de um projeto de intervenção em uma capital da Região Norte do Brasil, 2002-2016.

The project Palmas Free of Leprosy was implemented to improve indicators and deal with the disease, since the capital of Tocantins State is the most hyperendemic state capital in Brazil. This study measures the impact of the project's intervention through trend analysis of the priority indicators in Palmas, from 2002 to 2016. The study was based on an analysis of data from the Brazilian Information System for Notifiable Diseases (SINAN) and reports of applied training courses with problem-solving methodology. The indicators for new leprosy cases in Palmas residents were investigated, and the trends were identified by joinpoint regression analysis to assess the results. In the year the intervention project was implemented (2016), the detection rate for new cases in the overall population was 236.3/100,000 inhabitants, and this indicator showed a significant decrease of -7.5% from 2002 to 2014. From 2014 to 2016, there was a significant increase of 104.6% in overall detection. The detection rate in individuals under 15 years of age also showed a reduction of -4.6%, but in the years 2014, 2015, and 2016 there was an increase of 111.1%, together with detection rates for grades 0, 1, and 2, with 59.3%, 225.2%, and 121.7%, respectively. The proportion of cases detected by contact assessment showed a significant increase of 201.1% from 2014 to 2016. The data proved the effectiveness and potentiality of the project's intervention strategy for the diagnosis and control of leprosy in Palmas. The study provided evidence that timely diagnosis by primary care services results in indicators that reflect the real incidence of cases.

O projeto Palmas Livre da Hanseníase foi implementado para o incremento dos indicadores e o enfrentamento da doença, visto que a capital do Tocantins é a mais hiperendêmica do país. Este estudo mede o impacto da intervenção do projeto por meio da análise da tendência de indicadores prioritários em Palmas, 2002-2016. Baseia-se em análise de dados advindos do Sistema de Informação de Agravos de Notificação (SINAN) e de relatórios de capacitações aplicadas com metodologia de problematização. Os indicadores dos casos novos de hanseníase residentes em Palmas foram investigados, e suas tendências foram identificadas por análise de regressão joinpoint para avaliação dos resultados. No ano de implementação do projeto de intervenção (2016), o coeficiente de detecção de casos novos na população geral foi de 236,3/100 mil habitantes, e esse indicador apresentava decréscimo significativo de -7,5% no período de 2002 a 2014. Nos anos entre 2014 e 2016, houve aumento significativo de 104,6% para a detecção geral. O coeficiente de detecção em menores de 15 anos também apresentava queda de -4,6%, mas nos anos de 2014, 2015 e 2016, houve aumento de 111,1%, juntamente com os coeficientes de detecção de casos com grau 0, 1 e 2, com 59,3%, 225,2% e 121,7%, respectivamente. A proporção de casos detectados por avaliação de contatos teve acréscimo significativo de 201,1% no período de 2014 a 2016. Os dados comprovaram a efetividade e potencialidade da estratégia de intervenção do projeto para as ações de diagnóstico e controle da hanseníase em Palmas. Trouxe evidências de que a agilidade diagnóstica dos serviços de atenção primária resulta em indicadores que refletem a incidência real de casos.

El proyecto Palmas Libre de Hanseniasis se implementó para el incremento de indicadores y combate a la enfermedad, dado que la capital de Tocantins es la más hiperendémica de Brasil. Este estudio mide el impacto de la intervención del proyecto, mediante el análisis de la tendencia de indicadores prioritarios en Palmas, 2002-2016. Se basa en un análisis de datos procedentes del Sistema de Información sobre Enfermedades de Notificación Obligatoria (SINAN por sus siglas en portugués) y de informes de capacitaciones, aplicadas con metodología de problematización. Se investigaron los indicadores de casos nuevos de hanseniasis, en residentes de Palmas, y se identificaron sus tendencias mediante análisis de regresión joinpoint para la evaluación de los resultados. En el año de implementación del proyecto de intervención (2016), el coeficiente de detección de casos nuevos en la población general fue de 236,3/100 mil habitantes, y ese indicador presentaba una disminución significativa de un -7,5%, durante el período de 2002 a 2014. Entre los años de 2014 a 2016, hubo un aumento significativo de un 104,6% en la detección general. El coeficiente de detección en menores de 15 años también presentaba una bajada de -4,6%, pero durante los años de 2014, 2015 y 2016, hubo un aumento de 111,1%, junto a los coeficientes de detección de casos con grado 0, 1 y 2, con un 59,3%, 225,2% y 121,7%, respectivamente. La proporción de casos detectados por la evaluación de contactos tuvo un aumento significativo de un 201,1%, durante el período de 2014 a 2016. Los datos comprobaron la efectividad y potencialidad de la estrategia de intervención del proyecto para las acciones de diagnóstico y control de la hanseniasis en Palmas. Hubo evidencias de que la agilidad diagnóstica de los servicios de atención primaria se traduce en indicadores que reflejan la incidencia real de casos.

Short-Term Outcomes and Influencing Factors After Ankle Fracture Surgery.

The present study investigated the factors influencing the early clinical outcomes after ankle fracture surgery. We included 88 patients, who had undergone implant removal surgery at 1 year after ankle fracture surgery, with ankle computed tomographic (CT) scans obtained before ankle fracture surgery and at implant removal available. We collected demographic information, including age, sex, the presence of diabetes mellitus, level of trauma energy, and fracture classification from the medical records. We also recorded the fracture height using the radiographs and CT images. The medial joint space and articular incongruity were assessed on the follow-up radiographs and CT scans. Bone attenuation was measured by placing a circular region of interest around the ankle joint on the preoperative CT image. The postimplant removal outcomes were assessed using 2 functional questionnaires, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and Foot and Ankle Outcome Score (FAOS). Significant factors related to the AOFAS ankle-hindfoot scale scores and FAOS were identified through univariate analysis using age, sex, radiographic measurements, and CT findings as explanatory variables, followed by multiple regression analysis. On multiple regression analysis, the total FAOS was independently related to the AO classification (p = .003) and Lauge-Hansen classification (p = .003). The total AOFAS ankle-hindfoot scale score was related to articular incongruity (p = .044). The early clinical outcomes after ankle fracture surgery were affected by involvement of the ankle joint fracture rather than the lateral malleolus fracture height. Female sex and the presence of postoperative articular incongruity correlated with inferior early clinical outcomes.

[Leprosy trends in children under 15 years of age in Brazil, 2001-2016]. / Tendência da hanseníase em menores de 15 anos no Brasil, 2001-2016.

The aim of this study was to analyze trends in the detection rate of leprosy in children under 15 years of age in Brazil from 2001 to 2016. A time series study used the Prais-Winsten procedure for generalized linear regression analysis, with significance set at 5%. The mean detection rate was 5.77 per 100,000 inhabitants. However, a downward trend was observed in this rate, with an annual percent change (APC) of -5% (95%CI: -6.7; -3.3). There was a downward trend in all regions of Brazil. Among the regions, the North maintained a hyperendemic mean detection rate (≥ 10.00 per 100,000 inhabitants). The time series was downward in 19 states of Brazil. However, many states maintained a hyperendemic mean rate, such as Mato Grosso, Pará, Maranhão, Rondônia, Roraima, Pernambuco, Piauí, and Acre. Among the eight states that maintained a stationary trend, Tocantins had a hyperendemic mean rate during the period analyzed. Of the 24 Brazilian state capitals included in the study, 14 showed downward trends and 10 stationary trends. Despite the downward trend in new cases, some state capitals maintained hyperendemic mean rates (Teresina, Recife, Cuiabá, Boa Vista, Rio Branco, and Belém). Despite stationary trends, the state capital cities Palmas and São Luís recorded hyperendemic mean rates. In conclusion, although the analysis showed a downward trend in Brazil, there were stationary trends and hyperendemicity in some states and in some state capitals, highlighting the persistence of sources of transmissibility and difficulty in eliminating leprosy from the country.

O objetivo foi analisar a tendência das taxas de detecção de hanseníase em menores de 15 anos no Brasil, no período de 2001 a 2016. Trata-se de um estudo de série temporal, utilizando o procedimento de Prais-Winsten para análise de regressão linear generalizada com nível de significância de 5%. A média da taxa de detecção foi de 5,77 por 100 mil habitantes. Entretanto, observou-se uma tendência decrescente dessa taxa, com annual percent change (APC) de -5% (IC95%: -6,7; -3,3). Verificou-se tendência decrescente em todas as regiões do país. Entre as regiões, a Norte foi a que manteve a média hiperendêmica (≥ 10,00 por 100 mil habitantes) da taxa de detecção. A série temporal em 19 Unidades da Federação (UF) foi decrescente. Todavia, entre elas, muitas mantiveram média hiperendêmica, como: Mato Grosso, Pará, Maranhão, Rondônia, Roraima, Pernambuco, Piauí e Acre. Entre as oito UF que apresentaram tendência estacionária, Tocantins manteve média hiperendêmica no período. Das 24 capitais brasileiras incluídas no estudo, 14 delas foram decrescentes e 10 estacionárias. Embora com tendência decrescente dos casos novos, algumas capitais mantiveram a média hiperendêmica como: Teresina, Recife, Cuiabá, Boa Vista, Rio Branco e Belém. Apesar de apresentarem tendência estacionária, as capitais Palmas e São Luís registraram média hiperendêmica. Conclui-se que, embora a análise da tendência foi decrescente no Brasil, houve presença de tendências estacionárias e hiperendemicidade em algumas UF e capitais brasileiras, o que demonstra a permanência de fontes de transmissibilidade e dificuldade na eliminação da hanseníase no país.

El objetivo fue analizar la tendencia de las tasas de detección de hanseniasis en menores de 15 años en Brasil, durante el período de 2001 a 2016. Se trata de un estudio de serie temporal, utilizando el procedimiento de Prais-Winsten para el análisis de regresión lineal generalizada con un nivel de significancia de un 5%. La media de la tasa de detección fue de un 5,77 por 100 mil habitantes. No obstante, se observó una tendencia decreciente de esa tasa, con el annual percent change (APC) de -5% (IC95%: -6,7; -3,3). Se verificó la tendencia decreciente en todas las regiones del país. Entre las regiones, la Norte fue la que mantuvo la media hiperendémica (≥ 10,00 por 100 mil habitantes) de la tasa de detección. La serie temporal en 19 Unidades de la Federación (UF) fue decreciente. Todavía, entre ellas, muchas mantuvieron una media hiperendémica, como: Mato Grosso, Pará, Maranhão, Rondônia, Roraima, Pernambuco, Piauí y Acre. Entre las ocho UF que presentaron una tendencia estacionaria, Tocantins mantuvo una media hiperendémica en este período. De las 24 capitales brasileñas incluidas en el estudio, 14 de ellas fueron decrecientes y 10 estacionarias. Pese a la tendencia decreciente de los nuevos casos, algunas capitales mantuvieron una media hiperendémica como: Teresina, Recife, Cuiabá, Boa Vista, Rio Branco y Belém. A pesar de que presentaron una tendencia estacionaria, las capitales Palmas y São Luís registraron una media hiperendémica. Se concluyó que, aunque el análisis de la tendencia fue decreciente en Brasil, hubo presencia de tendencias estacionarias e hiperendemicidad en algunas UF y capitales brasileñas, lo que demuestra la permanencia de fuentes de transmisibilidad y dificultad en la eliminación de la hanseniasis en el país.

[Programmatic vulnerability in leprosy control: gender-related patterns in Bahia State, Brazil]. / Vulnerabilidade programática no controle da hanseníase: padrões na perspectiva de gênero no Estado da Bahia, Brasil.

The aim of this study was to analyze operational indicators and time trends in leprosy control from a gender perspective in Bahia State, Brazil, from 2001 to 2014. This was a time series study based on epidemiological data on leprosy from the Brazilian National System of Diseases of Notification, using joinpoint Poisson and polynomial regression. Of the 40,054 new cases of leprosy, 47.1% of the recorded contacts were not examined, with a significant upward trend, especially in women (average annual percentage change - AAPC = 5.6; 95%CI: 3.5; 7.7) when compared to men (AAPC = 3.0; 95%CI: 0.5; 5.6). The proportion of cure in the 2003-2014 cohort was 85%, with a downward trend, especially in men (AAPC = -0.5; 95%CI: -0.9; 0.0), compared to women (AAPC = -0.4; 95%CI: -0.7; -0.1). Treatment dropout rate was 5.5%, with a more significant downward trend in women (AAPC = -4.9; 95%CI: -8.7; -1.1) than in men (AAPC = -2.7; 95%CI: -4.4; -1.0). Relapse was recorded in 3.8% of all the entries during the same period; women showed a significant downward trend (AAPC = -2.2; 95%CI: -3.3; -1.0) and men a significant upward trend (AAPC = 4.9; 95%CI: 2.9; 6.8). Polynomial regression analysis was consistent with joinpoint regression. Leprosy in Bahia State shows operational indicators with significant magnitude and time trends, especially in the male population. Health services' insufficient performance in conducting contact surveillance and longitudinal care reveal various dimensions of vulnerability.

O objetivo deste estudo foi analisar indicadores operacionais de controle da hanseníase e sua tendência temporal, na perspectiva de gênero, no Estado da Bahia, Brasil, de 2001 a 2014. Trata-se de estudo de série temporal baseado em dados epidemiológicos da hanseníase no Sistema de Informação de Agravos de Notificação, com análise de regressão de Poisson por joinpoints e de regressão polinomial. Dos 40.054 casos novos de hanseníase analisados, 47,1% dos contatos registrados não foram examinados, mas com tendência significativa de aumento, de forma mais acentuada entre as mulheres (variação percentual anual média - AAPC = 5,6; IC95%: 3,5; 7,7) em comparação aos homens (AAPC = 3,0; IC95%: 0,5; 5,6). A proporção de cura na coorte 2003-2014 foi de 85%, com tendência de redução mais acentuada nos homens (AAPC = -0,5; IC95%: -0,9; 0,0), comparados às mulheres (AAPC = -0,4; IC95% -0,7; -0,1). A proporção de casos em abandono de tratamento no período foi de 5,5%, com tendência de redução mais significativa entre mulheres (AAPC = -4,9; IC95%: -8,7; -1,1) do que em homens (AAPC = -2,7; IC95%: -4,4; -1,0). Recidiva foi verificada em 3,8% de todas as entradas do período; as mulheres apresentaram tendência de redução significativa (AAPC = -2,2; IC95%: -3,3; -1,0) e os homens, de crescimento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). A análise por regressão polinomial foi consistente com a análise de joinpoints. A hanseníase no Estado da Bahia apresenta indicadores operacionais com magnitude e tendência temporal significativas, em especial entre a população masculina. O desempenho insuficiente dos serviços de saúde em realizar a vigilância de contatos e a longitudinalidade do cuidado revelam diferentes dimensões de vulnerabilidade.

El objetivo de este estudio fue analizar indicadores operacionales de control de la lepra y su tendencia temporal, desde la perspectiva de género, en el estado de Bahía, Brasil, de 2001 a 2014. Se trata de un estudio de serie temporal, basado en datos epidemiológicos de la lepra en el Sistema Nacional de Enfermedades de Notificación Obligatoria, con análisis de regresión de Poisson por joinpoints y de regresión polinomial. De los 40.054 casos nuevos de hanseniasis analizados, un 47,1% de los contactos registrados no fueron examinados, pero con una tendencia significativa de aumento, de forma más acentuada entre las mujeres (AAPC = 5,6; IC95%: 3,5; 7,7), en comparación a los hombres (AAPC = 3,0; IC95%: 0,5; 5,6). La proporción de cura en la cohorte 2003-2014 fue de un 85%, con una tendencia de reducción más acentuada en los hombres (AAPC = -0,5; IC95%: -0,9; 0,0), comparados con las mujeres (AAPC = -0,4; IC95%: -0,7; -0,1). La proporción de casos en abandono de tratamiento durante el período fue de un 5,5%, con tendencia de reducción más significativa entre mujeres (AAPC = -4,9; IC95%: -8,7; -1,1) que en hombres (AAPC = -2,7; IC95%: -4,4; -1,0). La recidiva se verificó en un 3,8% de todas las entradas del período; las mujeres presentaron una tendencia de reducción significativa (AAPC = -2,2; IC95%: -3,3; -1,0) y los hombres, de crecimiento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). El análisis por regresión polinomial fue consistente con el análisis de joinpoints. La hanseniasis en el estado de Bahía presenta indicadores operacionales con magnitud y tendencia temporal significativas, en especial entre la población masculina. El desempeño insuficiente de los servicios de salud al realizar la vigilancia de contactos y la longitudinalidad del cuidado revelan diferentes dimensiones de vulnerabilidad.

Treatment outcomes of tuberculosis patients under directly observed treatment short-course at Debre Tabor General Hospital, northwest Ethiopia: nine-years retrospective study.

BACKGROUND: Data regarding tuberculosis (TB) treatment outcomes, proportion of TB/HIV co-infection and associated factors have been released at different TB treatment facilities in Ethiopia and elsewhere in the world as part of the auditing and surveillance service. However, these data are missing for the TB clinic offering directly observed treatment short-course (DOTs) at Debre Tabor General Hospital (DTGH). METHODS: The authors analysed the records of 985 TB patients registered at the DTGH from September 2008 to December 2016. Data on patients' sex, age, type of TB, and treatment outcomes were extracted from the TB treatment registration logbook. The treatment outcome of patients was categorized according to the National TB and Leprosy Control Program guidelines: cured, treatment completed, treatment failed, died, and not evaluated (transferred out and unknown cases). RESULTS: Around half of the registered patients were males (516, 52.4%). In terms of TB types, 381 (38.7%), 241 (24.5%), and 363 (36.9%) patients had smear-negative pulmonary TB, smear-positive pulmonary TB, and extra pulmonary TB, respectively. Six hundred and seventy-two patients (90.1%) had successful treatment outcomes (cured and treatment completed), while 74 patients (9.9%) had unsuccessful treatment outcomes (death and treatment failure).TB treatment outcome was not associated with age, sex, type and history of TB, or co-infection with HIV (P > 0.05). The proportion of TB/HIV co-infection was at 24.2%, and these were found to be significantly associated with the age groups of 25-34, 35-44 and ≥65 years:(aOR: 0.44; 95% CI: 0.25-0.8), (aOR: 0.39; 95% CI: 0.20-0.70), (aOR: 4.2; 95% CI: 1.30-12.9), respectively. CONCLUSIONS: The proportion of patients with successful treatment outcomes was above the World Health Organization target set for Millennium Development Goal of 85% and in line with that of the global milestone target set at > 90% for 2025. Relatively higher proportions of transfer-out cases were recorded in the present study. Similarly, the proportion of TB/HIV co-infection cases was much higher than the national average of 8%.Thus, the health facility under study should develop strategies to record the final treatment outcome of transfer-out cases. In addition, strategies to reduce the burden of TB/HIV co-infection should be strengthened.

Vulnerabilidade programática no controle da hanseníase: padrões na perspectiva de gênero no Estado da Bahia, Brasil / Programmatic vulnerability in leprosy control: gender-related patterns in Bahia State, Brazil / Vulnerabilidad programática en el control de la lepra: padrones desde la perspectiva de género en el Estado de Bahía, Brasil

O objetivo deste estudo foi analisar indicadores operacionais de controle da hanseníase e sua tendência temporal, na perspectiva de gênero, no Estado da Bahia, Brasil, de 2001 a 2014. Trata-se de estudo de série temporal baseado em dados epidemiológicos da hanseníase no Sistema de Informação de Agravos de Notificação, com análise de regressão de Poisson por joinpoints e de regressão polinomial. Dos 40.054 casos novos de hanseníase analisados, 47,1% dos contatos registrados não foram examinados, mas com tendência significativa de aumento, de forma mais acentuada entre as mulheres (variação percentual anual média - AAPC = 5,6; IC95%: 3,5; 7,7) em comparação aos homens (AAPC = 3,0; IC95%: 0,5; 5,6). A proporção de cura na coorte 2003-2014 foi de 85%, com tendência de redução mais acentuada nos homens (AAPC = -0,5; IC95%: -0,9; 0,0), comparados às mulheres (AAPC = -0,4; IC95% -0,7; -0,1). A proporção de casos em abandono de tratamento no período foi de 5,5%, com tendência de redução mais significativa entre mulheres (AAPC = -4,9; IC95%: -8,7; -1,1) do que em homens (AAPC = -2,7; IC95%: -4,4; -1,0). Recidiva foi verificada em 3,8% de todas as entradas do período; as mulheres apresentaram tendência de redução significativa (AAPC = -2,2; IC95%: -3,3; -1,0) e os homens, de crescimento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). A análise por regressão polinomial foi consistente com a análise de joinpoints. A hanseníase no Estado da Bahia apresenta indicadores operacionais com magnitude e tendência temporal significativas, em especial entre a população masculina. O desempenho insuficiente dos serviços de saúde em realizar a vigilância de contatos e a longitudinalidade do cuidado revelam diferentes dimensões de vulnerabilidade.

The aim of this study was to analyze operational indicators and time trends in leprosy control from a gender perspective in Bahia State, Brazil, from 2001 to 2014. This was a time series study based on epidemiological data on leprosy from the Brazilian National System of Diseases of Notification, using joinpoint Poisson and polynomial regression. Of the 40,054 new cases of leprosy, 47.1% of the recorded contacts were not examined, with a significant upward trend, especially in women (average annual percentage change - AAPC = 5.6; 95%CI: 3.5; 7.7) when compared to men (AAPC = 3.0; 95%CI: 0.5; 5.6). The proportion of cure in the 2003-2014 cohort was 85%, with a downward trend, especially in men (AAPC = -0.5; 95%CI: -0.9; 0.0), compared to women (AAPC = -0.4; 95%CI: -0.7; -0.1). Treatment dropout rate was 5.5%, with a more significant downward trend in women (AAPC = -4.9; 95%CI: -8.7; -1.1) than in men (AAPC = -2.7; 95%CI: -4.4; -1.0). Relapse was recorded in 3.8% of all the entries during the same period; women showed a significant downward trend (AAPC = -2.2; 95%CI: -3.3; -1.0) and men a significant upward trend (AAPC = 4.9; 95%CI: 2.9; 6.8). Polynomial regression analysis was consistent with joinpoint regression. Leprosy in Bahia State shows operational indicators with significant magnitude and time trends, especially in the male population. Health services' insufficient performance in conducting contact surveillance and longitudinal care reveal various dimensions of vulnerability.

El objetivo de este estudio fue analizar indicadores operacionales de control de la lepra y su tendencia temporal, desde la perspectiva de género, en el estado de Bahía, Brasil, de 2001 a 2014. Se trata de un estudio de serie temporal, basado en datos epidemiológicos de la lepra en el Sistema Nacional de Enfermedades de Notificación Obligatoria, con análisis de regresión de Poisson por joinpoints y de regresión polinomial. De los 40.054 casos nuevos de hanseniasis analizados, un 47,1% de los contactos registrados no fueron examinados, pero con una tendencia significativa de aumento, de forma más acentuada entre las mujeres (AAPC = 5,6; IC95%: 3,5; 7,7), en comparación a los hombres (AAPC = 3,0; IC95%: 0,5; 5,6). La proporción de cura en la cohorte 2003-2014 fue de un 85%, con una tendencia de reducción más acentuada en los hombres (AAPC = -0,5; IC95%: -0,9; 0,0), comparados con las mujeres (AAPC = -0,4; IC95%: -0,7; -0,1). La proporción de casos en abandono de tratamiento durante el período fue de un 5,5%, con tendencia de reducción más significativa entre mujeres (AAPC = -4,9; IC95%: -8,7; -1,1) que en hombres (AAPC = -2,7; IC95%: -4,4; -1,0). La recidiva se verificó en un 3,8% de todas las entradas del período; las mujeres presentaron una tendencia de reducción significativa (AAPC = -2,2; IC95%: -3,3; -1,0) y los hombres, de crecimiento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). El análisis por regresión polinomial fue consistente con el análisis de joinpoints. La hanseniasis en el estado de Bahía presenta indicadores operacionales con magnitud y tendencia temporal significativas, en especial entre la población masculina. El desempeño insuficiente de los servicios de salud al realizar la vigilancia de contactos y la longitudinalidad del cuidado revelan diferentes dimensiones de vulnerabilidad.

Tendência da hanseníase em menores de 15 anos no Brasil, 2001-2016 / Leprosy trends in children under 15 years of age in Brazil, 2001-2016 / Tendencia de la hanseniasis en menores de 15 años en Brasil, 2001-2016

O objetivo foi analisar a tendência das taxas de detecção de hanseníase em menores de 15 anos no Brasil, no período de 2001 a 2016. Trata-se de um estudo de série temporal, utilizando o procedimento de Prais-Winsten para análise de regressão linear generalizada com nível de significância de 5%. A média da taxa de detecção foi de 5,77 por 100 mil habitantes. Entretanto, observou-se uma tendência decrescente dessa taxa, com annual percent change (APC) de -5% (IC95%: -6,7; -3,3). Verificou-se tendência decrescente em todas as regiões do país. Entre as regiões, a Norte foi a que manteve a média hiperendêmica (≥ 10,00 por 100 mil habitantes) da taxa de detecção. A série temporal em 19 Unidades da Federação (UF) foi decrescente. Todavia, entre elas, muitas mantiveram média hiperendêmica, como: Mato Grosso, Pará, Maranhão, Rondônia, Roraima, Pernambuco, Piauí e Acre. Entre as oito UF que apresentaram tendência estacionária, Tocantins manteve média hiperendêmica no período. Das 24 capitais brasileiras incluídas no estudo, 14 delas foram decrescentes e 10 estacionárias. Embora com tendência decrescente dos casos novos, algumas capitais mantiveram a média hiperendêmica como: Teresina, Recife, Cuiabá, Boa Vista, Rio Branco e Belém. Apesar de apresentarem tendência estacionária, as capitais Palmas e São Luís registraram média hiperendêmica. Conclui-se que, embora a análise da tendência foi decrescente no Brasil, houve presença de tendências estacionárias e hiperendemicidade em algumas UF e capitais brasileiras, o que demonstra a permanência de fontes de transmissibilidade e dificuldade na eliminação da hanseníase no país.

The aim of this study was to analyze trends in the detection rate of leprosy in children under 15 years of age in Brazil from 2001 to 2016. A time series study used the Prais-Winsten procedure for generalized linear regression analysis, with significance set at 5%. The mean detection rate was 5.77 per 100,000 inhabitants. However, a downward trend was observed in this rate, with an annual percent change (APC) of -5% (95%CI: -6.7; -3.3). There was a downward trend in all regions of Brazil. Among the regions, the North maintained a hyperendemic mean detection rate (≥ 10.00 per 100,000 inhabitants). The time series was downward in 19 states of Brazil. However, many states maintained a hyperendemic mean rate, such as Mato Grosso, Pará, Maranhão, Rondônia, Roraima, Pernambuco, Piauí, and Acre. Among the eight states that maintained a stationary trend, Tocantins had a hyperendemic mean rate during the period analyzed. Of the 24 Brazilian state capitals included in the study, 14 showed downward trends and 10 stationary trends. Despite the downward trend in new cases, some state capitals maintained hyperendemic mean rates (Teresina, Recife, Cuiabá, Boa Vista, Rio Branco, and Belém). Despite stationary trends, the state capital cities Palmas and São Luís recorded hyperendemic mean rates. In conclusion, although the analysis showed a downward trend in Brazil, there were stationary trends and hyperendemicity in some states and in some state capitals, highlighting the persistence of sources of transmissibility and difficulty in eliminating leprosy from the country.

El objetivo fue analizar la tendencia de las tasas de detección de hanseniasis en menores de 15 años en Brasil, durante el período de 2001 a 2016. Se trata de un estudio de serie temporal, utilizando el procedimiento de Prais-Winsten para el análisis de regresión lineal generalizada con un nivel de significancia de un 5%. La media de la tasa de detección fue de un 5,77 por 100 mil habitantes. No obstante, se observó una tendencia decreciente de esa tasa, con el annual percent change (APC) de -5% (IC95%: -6,7; -3,3). Se verificó la tendencia decreciente en todas las regiones del país. Entre las regiones, la Norte fue la que mantuvo la media hiperendémica (≥ 10,00 por 100 mil habitantes) de la tasa de detección. La serie temporal en 19 Unidades de la Federación (UF) fue decreciente. Todavía, entre ellas, muchas mantuvieron una media hiperendémica, como: Mato Grosso, Pará, Maranhão, Rondônia, Roraima, Pernambuco, Piauí y Acre. Entre las ocho UF que presentaron una tendencia estacionaria, Tocantins mantuvo una media hiperendémica en este período. De las 24 capitales brasileñas incluidas en el estudio, 14 de ellas fueron decrecientes y 10 estacionarias. Pese a la tendencia decreciente de los nuevos casos, algunas capitales mantuvieron una media hiperendémica como: Teresina, Recife, Cuiabá, Boa Vista, Rio Branco y Belém. A pesar de que presentaron una tendencia estacionaria, las capitales Palmas y São Luís registraron una media hiperendémica. Se concluyó que, aunque el análisis de la tendencia fue decreciente en Brasil, hubo presencia de tendencias estacionarias e hiperendemicidad en algunas UF y capitales brasileñas, lo que demuestra la permanencia de fuentes de transmisibilidad y dificultad en la eliminación de la hanseniasis en el país.