[Brazilian Ministry of Health strategy to increase vaccination coverage at bordersEstrategia del Ministerio de Salud de Brasil para aumentar las tasas de cobertura de vacunación en las fronteras]. / Estratégia do Ministério da Saúde do Brasil para aumento das coberturas vacinais nas fronteiras.

Objective: Evaluate the implementation of the Ministry of Health's "Action Plan: Border Vaccination Strategy - Agenda 2022" in the Brazil's 33 twin cities and evaluate the increase in the country's vaccination coverage (VC). Methodology: Pre-post community clinical trial. Implementation of the strategy was analyzed, and pre- and post-intervention VC were compared in two stages: P1 (pre-intervention) and P2 (post-intervention). Based on statistical analyses of P1 and P2 coverage, calculations were made of municipal averages, standard deviation, and difference in VC between the two periods. Results: Integration was observed between the primary health care (PHC), surveillance, immunization, and special indigenous health district (DSEI) teams, although there were difficulties, for example, in relation to migratory flows. While immigration flows present challenges in the areas of immunization, PHC, and DSEI, the difficulties are compounded by the polarization of these services, which hinders intersectoral integration. After carrying out the workshops, a total of 50 977 doses were administered in the general population in the 33 twin cities. There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, which may be relevant in terms of increasing VC in Brazil. Conclusion: There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, helping to increase VC in Brazil.

Objetivo: Evaluar la aplicación de la Estrategia de Vacunación en las Fronteras - Agenda 2022, que forma parte del Plan de Acción del Ministerio de Salud en las 33 ciudades hermanas y evaluar el aumento de las tasas de cobertura de vacunación en Brasil. Métodos: Ensayo clínico comunitario realizado antes y después de la intervención correspondiente. Se analizó la aplicación de la estrategia y se compararon las tasas de cobertura de vacunación antes y después de la intervención en dos periodos: P1 (pre-intervención) y P2 (post-intervención). En los análisis estadísticos de la tasa de cobertura de vacunación en P1 y P2 se calcularon los valores de media y desviación estándar de los municipios y la diferencia entre las tasas de cobertura de los dos periodos. Resultados: Se observó una integración entre los equipos de Atención Primaria de Salud, Vigilancia, Inmunización y el Distrito Especial de Salud Indígena (DISEI), pero con dificultades, como las inherentes al flujo migratorio. Cabe destacar que el flujo migratorio es uno de los desafíos en el contexto de la inmunización, la atención primaria de salud y el DISEI, dificultad que se ve agravada por la polarización entre los servicios (inmunización, atención primaria de salud y el DISEI), lo que supone un reto para la integración de los sectores. Por lo que respecta al análisis de las tasas de cobertura de vacunación llevado a cabo después de realizar los talleres, se administró un total de 50 977 dosis a la población general en las 33 ciudades hermanas de Brasil. Hubo un aumento de las tasas de cobertura de vacunación de menores de hasta un año de edad en los lugares evaluados después de la intervención, lo que puede ser importante para aumentar las tasas de cobertura de Brasil. Conclusión: Después de la intervención hubo un aumento de las tasas de cobertura de vacunación de menores de hasta un año de edad en los lugares evaluados, lo cual influyó en el incremento de las tasas de cobertura de Brasil.

Identification of the acid/base catalyst of a glycoside hydrolase family 3 (GH3) beta-glucosidase from Aspergillus niger ASKU28.

BACKGROUND: The commercially important glycoside hydrolase family 3 (GH3) beta-glucosidases from Aspergillus niger are anomeric-configuration-retaining enzymes that operate through the canonical double-displacement glycosidase mechanism. Whereas the catalytic nucleophile is readily identified across all GH3 members by sequence alignments, the acid/base catalyst in this family is phylogenetically variable and less readily divined. METHODS: In this report, we employed three-dimensional structure homology modeling and detailed kinetic analysis of site-directed mutants to identify the catalytic acid/base of a GH3 beta-glucosidase from A. niger ASKU28. RESULTS: In comparison to the wild-type enzyme and other mutants, the E490A variant exhibited greatly reduced k(cat) and k(cat)/K(m) values toward the natural substrate cellobiose (67,000- and 61,000-fold, respectively). Correspondingly smaller kinetic effects were observed for artificial chromogenic substrates p-nitrophenyl beta-D-glucoside and 2,4-dinitrophenyl beta-D-glucoside, the aglycone leaving groups of which are less dependent on acid catalysis, although changes in the rate-determining catalytic step were revealed for both. pH-rate profile analyses also implicated E490 as the general acid/base catalyst. Addition of azide as an exogenous nucleophile partially rescued the activity of the E490A variant with the aryl beta-glucosides and yielded beta-glucosyl azide as a product. CONCLUSIONS AND GENERAL SIGNIFICANCE: These results strongly support the assignment of E490 as the acid/base catalyst in a beta-glucosidase from A. niger ASKU28, and provide crucial experimental support for the bioinformatic identification of the homologous residue in a range of related GH3 subfamily members.

Visual detection of DNA on paper chips.

On-site DNA analysis for diagnostic or forensic purposes is much anticipated in the future of molecular testing. Yet the challenges to achieve this goal remain large with rapid and inexpensive detection and visualization being key factors for any portable analysis system. We have developed a filter paper-based nucleic acid assay, which is able to identify and distinguish dog and human genomic and mitochondrial samples in a forensic setting. The filter paper material allows for transport by capillary force of the sample DNA through the detection surface, allowing the targets to hybridize specifically to their complementary capture sequences. Coupling micrometer-sized beads to DNA allows the results to be visualized by the naked eye, enabling instant, cost-efficient, and on-site detection, while eliminating the need for advanced expensive instrumentation.

[Analysis of the operational conditions to preserve immunobiological products in vaccination rooms in Brazil: a mixed study]. / Análise das condições operacionais para conservação de imunobiológicos nas salas de vacinação do Brasil: estudo misto.

This study aimed to analyze the operational conditions to preserve immunobiological products in Brazil. This mixed-method study with a sequential explanatory design was developed in vaccination rooms in several Brazilian regions from 2021 to 2022. Its quantitative stage developed a descriptive cross-sectional study by applying the Immunobiological Conservation Assessment Scale to nursing professionals. Data were analyzed by descriptive statistics. Its qualitative stage developed a descriptive-exploratory study in cold chain instances with the respective technical managers and nursing professionals. The interviews were evaluated by thematic content analysis. The data were combined by connection, and joint-displays and meta-inferences were elaborated. Overall, 280 rooms were analyzed. Most were for exclusive use (79.6%), had polyurethane boxes (77.8%), and kept their equipment away from sunlight/heat (73.5%). Only 27.5% had batteries/generators and 26.5% had other temperature measuring instruments. In total, 60% had refrigerated rooms and 67.6%, air-conditioned rooms. This study found weaknesses associated with geographical conditions, infrastructure, material inputs, human and financial resources, work organization and management, turnover, and training. These findings showed the plurality of the Brazilian cold chain and identified the potentialities and weaknesses related to the structures and work processes in preserving immunobiological products, which require improvement.

Este estudo objetivou analisar as condições operacionais para conservação de imunobiológicos no Brasil. Trata-se de um estudo de método misto com delineamento explanatório sequencial, desenvolvido nas salas de vacinação de distintas regiões brasileiras entre 2021 e 2022. Na etapa quantitativa, desenvolveu-se um estudo transversal descritivo, com a aplicação da Escala de Avaliação da Conservação de Imunobiológicos aos profissionais de enfermagem. Os dados foram analisados por meio de estatística descritiva. Já na etapa qualitativa, desenvolveu-se um estudo descritivo-exploratório nas instâncias da cadeia de frio, com os respectivos responsáveis técnicos e profissionais de enfermagem. Analisou-se as entrevistas por meio da Análise de Conteúdo na Modalidade Temática. Os dados foram combinados mediante conexão, com elaboração de joint-displays e metainferências. Foram analisadas 280 salas, em que grande parte: era de uso exclusivo (79,6%); utilizava caixas de poliuretano (77,8%); e mantinha seus equipamentos distantes da incidência de luz solar/fontes de calor (73,5%). Apenas 27,5% dispunham de baterias/geradores e 26,5% de outros instrumentos de medição de temperatura. Sessenta por cento detinham câmaras refrigeradas e 67,6% ambientes climatizados. Revelaram-se fragilidades associadas a condições geográficas, infraestrutura, insumos materiais, recursos humanos e financeiros, organização e gestão do trabalho, rotatividade e capacitação. Os achados possibilitaram conhecer a pluralidade da cadeia de frio brasileira e permitiram a identificação de potencialidades e fragilidades na conservação de imunobiológicos relacionadas às estruturas e aos processos de trabalho que requerem aprimoramento.

Este estudio tuvo como objetivo analizar las condiciones operativas para la conservación de inmunobiológicos en Brasil. Estudio de método mixto con diseño explicativo secuencial, desarrollado en las salas de vacunación de las distintas regiones brasileñas, entre 2021 y 2022. En la etapa cuantitativa se desarrolló un estudio transversal descriptivo, con la aplicación de la Escala de Evaluación de la Conservación de Inmunobiológicos a los profesionales de enfermería. Los datos fueron analizados mediante estadística descriptiva. En la etapa cualitativa se desarrolló un estudio descriptivo-exploratorio en las instancias de la cadena de frío, con los respectivos responsables técnicos y profesionales de enfermería. Las entrevistas se analizaron por medio del Análisis de Contenido en la Modalidad Temática. Los datos fueron combinados mediante conexión, con elaboración de joint-displays y metainferencias. Se analizaron 280 salas. Gran parte era de uso exclusivo (79,6%); utilizaba cajas de poliuretano (77,8%) y mantenía sus equipos alejados de la incidencia de la luz solar/fuentes de calor (73,5%). Solo el 27,5% disponía de baterías/generadores y el 26,5% de otros instrumentos de medición de temperatura. El 60% tenía cámaras refrigeradas y el 67,6% ambientes climatizados. Se revelaron debilidades asociadas a las condiciones geográficas, la infraestructura, los insumos de materiales, los recursos humanos y financieros, la organización y gestión del trabajo, la rotación y la capacitación. Los hallazgos posibilitaron conocer la pluralidad de la cadena de frío brasileña y permitieron la identificación de potencialidades y debilidades de la conservación de inmunobiológicos relacionadas con las estructuras y los procesos de trabajo que requieren mejoras.

The impact of implementing the 10-valent pneumococcal conjugate vaccine on hospitalizations for pneumonia among children.

Pneumonia is a major cause of morbidity and mortality in children, with pneumococcus as the main etiologic agent. In Brazil, the 10-valent pneumococcal conjugate vaccine (PCV-10) was introduced into the childhood immunization schedule in 2010. The aim of this study was to assess the impact caused by implementing PCV-10 on the hospitalizations of children with pneumonia, between 2005 and 2015, in the state of Pernambuco, Brazil. An ecological time series study and a forecasting analysis were conducted. A comparison was made between the hospitalizations of children aged between seven months and four years due to pneumonia in the Brazilian Unified Health System, in the 5 years before (2005-2009) and after (2011-2015) implementation of PCV-10. Descriptive analysis included absolute and relative values, means and rates of hospitalization. The chi-square test was used to compare the annual incidence of hospitalizations and the t-Student test to compare the five-year mean values. For the temporal modeling of hospitalizations, an autoregressive integrated moving average was used, adjusted with seasonal-SARIMA (Box-Jenkins methodology), with a prediction of the monthly number of hospitalizations for 2011-2015. The predicted and observed values for 2011-2015 were then compared. The number of hospitalizations after implementing PCV-10 was reduced by 24.5 %. The monthly average of hospitalizations dropped from 681 (2005-2009) to 514 (2011-2015). The hospitalization rate dropped from 56.1 per thousand live births in the five-year period prior to PCV-10 to 43.4 in the following five-year period (a 22.7% reduction). Comparing the values predicted by the SARIMA model for a scenario without PCV-10 in the second five-year period, with those reported after implementing PCV-10, the estimated number of prevented hospitalizations was 8,682 in the five years following the introduction of the vaccine. In conclusion, in the five years following implementation of PCV-10, hospitalizations of children with pneumonia in Pernambuco decrease by 22%.

Temporal analysis of mortality from preventable causes in the first 24 hours of life, 2000-2021. / Análisis temporal de la mortalidad por causas evitables en las primeras 24 horas de vida, 2000-2021.

OBJECTIVE: to analyze the temporal pattern and estimate mortality rates in the first 24 hours of life and from preventable causes in the state of Pernambuco from 2000 to 2021. METHOD: an ecological study, using the quarter as the unit of analysis. The data source was made up of the Mortality Information System and the Live Birth Information System. The time series modeling was conducted according to the Autoregressive Integrated Moving Average Model. RESULTS: 14,462 deaths were recorded in the first 24 hours of life, 11,110 (76.8%) of which being preventable. It is observed from the forecasts that the mortality rate in the first 24 hours of life ranged from 3.3 to 2.4 per 1,000 live births, and the mortality rate from preventable causes ranged from 2.3 to 1.8 per 1,000 live births. CONCLUSION: the prediction suggested progress in reducing mortality in the first 24 hours of life in the state and from preventable causes. The ARIMA models presented satisfactory estimates for mortality rates and preventable causes in the first 24 hours of life.

Digital pathology implementation in a private laboratory: The CEDAP experience.

Introduction: The transition to digital pathology has been carried out by several laboratories across the globe, with some cases described in Portugal. In this article, we describe the transition to digital pathology in a high-volume private laboratory, considering the main challenges and opportunities. Material and methods: Our process started in 2020, with laboratory workflow adaptation and we are currently using a high-capacity scanner (Aperio GT450DX) to digitize slides at 20×. The visualization system, Aperio eSlide Manager WebViewer, is integrated into the Laboratory System. The validation process followed the Royal College of Pathologists Guidelines. Results: Regarding validation, the first phase detected an error rate of 6.8%, mostly due to digitization errors. Phase optimization and collaboration with technical services led to improvements in this process. In the second validation phase, most of the slides had the desired quality for evaluation, with only an error rate of 0.6%, corrected with a new scan. The interpathologist correlation had a total agreement rate of 96.87% and 3.13% partial agreement. Conclusion: The implementation and validation of digital pathology was a success, being ready for prime time. The total integration of all laboratory systems and the acquisition of new equipment will maximize their use, especially with the application of artificial intelligence algorithms.

Activated paper surfaces for the rapid hybridization of DNA through capillary transport.

The development of low-cost, accurate, and equipment-free diagnostic tests is crucial to many clinical, laboratory, and field applications, including forensics and medical diagnostics. Cellulose fiber-based paper is an inexpensive, biodegradable, and renewable resource, the use of which as a biomolecule detection matrix and support confers several advantages compared to traditional materials such as glass. In this context, a new, facile method for the preparation of surface functionalized papers bearing single-stranded probe DNA (ssDNA) for rapid target hybridization via capillary transport is presented. Optimized reaction conditions were developed that allowed the direct, one-step activation of standard laboratory filters by the inexpensive and readily available bifunctional linking reagent, 1,4-phenylenediisothiocyanate. Such papers were thus amenable to subsequent coupling of amine-labeled ssDNA under standard conditions widely used for glass-based supports. The intrinsic wicking ability of the paper matrix facilitated rapid sample elution through arrays of probe DNA, leading to significant, detectable hybridization in the time required for the sample liquid to transit the vertical length of the strip (less than 2 min). The broad applicability of these paper test strips as rapid and specific diagnostics in "real-life" situations was exemplified by the discrimination of amplicons generated from canine and human mitochondrial and genomic DNA in mock forensic samples.

Avoidable deaths in the first 24 hours of life: health care reflexes.

OBJECTIVES: to analyze the risks of deaths in the first 24 hours of life and their preventable causes. METHODS: cross-sectional study carried out in Pernambuco, Northeast of Brazil, between 2000-2019, with mortality and live birth data. The avoidability was analyzed through the Brazilian List of Avoidable Causes of Deaths due to Interventions of the Unified Health System. For the statistical analyses, Pearson's chi-squared test and relative and attributable risks were used. RESULTS: 13,601 deaths were registered, of which 10,497 (77.19%) were from preventable causes. Of the total, 5,513 (40.53%) were reducible through adequate care for women during pregnancy. The lower the gestational age, birth weight and education level, the higher the relative and attributable risk of death in the first 24 hours of life. CONCLUSIONS: most of the deaths were considered avoidable and with high relative and attributable risks. These early deaths suggest care failures and the need to reinforce prevention and treatment measures.

Spatial patterns of the total mortality over the first 24 hours of life and that due to preventable causes.

This is an ecological study analysing spatial patterns of the total mortality over the first 24 hours of life and that due to preventable causes using data from the mortality information system (SIM) and live birth information system (SINASC) based on the municipalities of Pernambuco State, Brazil. The total mortality rates over the first 24 hours and that due to preventable causes were calculated for each municipality for the decades of 2000 to 2009 and for 2010 to 2019 to enable a comparison of the spatial patterns with spatial scan statistic used to identify clusters. Over the first 24 hours of life, a total of 13,571 deaths were reported, out of which 10,476 (77.2%) were preventable. The total mortality rate over the first 24 hours of life decreased from 5.5 in the 2000- 2009 period to 3.7 per 1000 live births in the following decade: a reduction of 32.7%, while the mortality rate due to preventable causes decreased from 4.4 to 2.8 per 1000 live births, a reduction of 36.7%. In the first decade, spatial exploratory analysis found three mortality rate clusters encompassing 56 municipalities over the first 24 hours of life. With respect to preventable causes over the first 24 hours of life, two mortality rate clusters were identified encompassing 41 municipalities. Risk areas for mortality over the first 24 hours of life were detected through spatial scan statistic. This method, directed towards uncovering the geographical distribution of deaths of very premature infants, can act as a tool for identifying priority areas to guide healthcare interventions.

A rapid smartphone-based lactate dehydrogenase test for neonatal diagnostics at the point of care.

There is a growing recognition of the importance of point-of-care tests (POCTs) for detecting critical neonatal illnesses to reduce the mortality rate in newborns, especially in low-income countries, which account for 98 percent of reported neonatal deaths. Lactate dehydrogenase (LDH) is a marker of cellular damage as a result of hypoxia-ischemia in affected organs. Here, we describe and test a POC LDH test direct from whole blood to provide early indication of serious illness in the neonate. The sample-in-result-out POC platform is specifically designed to meet the needs at resource-limited settings. Plasma is separated from whole blood on filter paper with dried-down reagents for colorimetric reaction, combined with software for analysis using a smartphone. The method was clinically tested in newborns in two different settings. In a clinical cohort of newborns of Stockholm (n = 62) and Hanoi (n = 26), the value of R using Pearson's correlation test was 0.91 (p < 0.01) and the R2 = 0.83 between the two methods. The mean LDH (±SD) for the reference method vs. the POC-LDH was 551 (±280) U/L and 552 (±249) U/L respectively, indicating the clinical value of LDH values measured in minutes with the POC was comparable with standardized laboratory analyses.

Estratégia do Ministério da Saúde do Brasil para aumento das coberturas vacinais nas fronteiras / Brazilian Ministry of Health strategy to increase vaccination coverage at borders / Estrategia del Ministerio de Salud de Brasil para aumentar las tasas de cobertura de vacunación en las fronteras

RESUMO Objetivo. Avaliar a implementação de estratégia do "Plano de Ação: Estratégia de Vacinação nas Fronteiras - Agenda 2022" do Ministério da Saúde nas 33 cidades gêmeas e avaliar o incremento das coberturas vacinais (CV) brasileiras. Métodos. Ensaio clínico comunitário, do tipo antes e depois. Analisou-se a realização da estratégia, bem como comparadas as CV pré e pós-intervenção em dois tempos: P1 (pré-intervenção) e P2 (pós-intervenção). Análises estatísticas sobre a CV, no P1 e P2, foram calculados os valores de média entres os municípios, desvio padrão e diferença entre as coberturas dos dois períodos. Resultados. Observou-se integração entre as equipes de Atenção Primária à Saúde (APS), Vigilância, Imunização e Distrito Sanitário Especial Indígena (DSEI), porém com dificuldades, como aquelas inerentes ao fluxo migratório. Ressalta-se que o fluxo imigratório é um dos desafios no contexto da imunização, APS e DSEI, entretanto, a esta dificuldade soma-se a polarização entre os serviços (imunização, APS e DISEI), ocasionando um desafio para a integração dos setores. Em relação à análise das CV, após a realização das oficinas, foram totalizadas 50 977 doses aplicadas na população geral nas 33 cidades-gêmeas do Brasil. Houve incremento das coberturas vacinais de crianças de até um ano de idade nos locais avaliados após a intervenção, o que pode ser importante para aumentar as CV no Brasil. Conclusão. Houve incremento das coberturas vacinais das crianças até um ano de idade nos locais avaliados após a intervenção e isso influenciou no aumento das CV no Brasil.

ABSTRACT Objective. Evaluate the implementation of the Ministry of Health's "Action Plan: Border Vaccination Strategy - Agenda 2022" in the Brazil's 33 twin cities and evaluate the increase in the country's vaccination coverage (VC). Methodology. Pre-post community clinical trial. Implementation of the strategy was analyzed, and pre- and post-intervention VC were compared in two stages: P1 (pre-intervention) and P2 (post-intervention). Based on statistical analyses of P1 and P2 coverage, calculations were made of municipal averages, standard deviation, and difference in VC between the two periods. Results. Integration was observed between the primary health care (PHC), surveillance, immunization, and special indigenous health district (DSEI) teams, although there were difficulties, for example, in relation to migratory flows. While immigration flows present challenges in the areas of immunization, PHC, and DSEI, the difficulties are compounded by the polarization of these services, which hinders intersectoral integration. After carrying out the workshops, a total of 50 977 doses were administered in the general population in the 33 twin cities. There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, which may be relevant in terms of increasing VC in Brazil. Conclusion. There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, helping to increase VC in Brazil.

RESUMEN Objetivo. Evaluar la aplicación de la Estrategia de Vacunación en las Fronteras - Agenda 2022, que forma parte del Plan de Acción del Ministerio de Salud en las 33 ciudades hermanas y evaluar el aumento de las tasas de cobertura de vacunación en Brasil. Métodos. Ensayo clínico comunitario realizado antes y después de la intervención correspondiente. Se analizó la aplicación de la estrategia y se compararon las tasas de cobertura de vacunación antes y después de la intervención en dos periodos: P1 (pre-intervención) y P2 (post-intervención). En los análisis estadísticos de la tasa de cobertura de vacunación en P1 y P2 se calcularon los valores de media y desviación estándar de los municipios y la diferencia entre las tasas de cobertura de los dos periodos. Resultados. Se observó una integración entre los equipos de Atención Primaria de Salud, Vigilancia, Inmunización y el Distrito Especial de Salud Indígena (DISEI), pero con dificultades, como las inherentes al flujo migratorio. Cabe destacar que el flujo migratorio es uno de los desafíos en el contexto de la inmunización, la atención primaria de salud y el DISEI, dificultad que se ve agravada por la polarización entre los servicios (inmunización, atención primaria de salud y el DISEI), lo que supone un reto para la integración de los sectores. Por lo que respecta al análisis de las tasas de cobertura de vacunación llevado a cabo después de realizar los talleres, se administró un total de 50 977 dosis a la población general en las 33 ciudades hermanas de Brasil. Hubo un aumento de las tasas de cobertura de vacunación de menores de hasta un año de edad en los lugares evaluados después de la intervención, lo que puede ser importante para aumentar las tasas de cobertura de Brasil. Conclusión. Después de la intervención hubo un aumento de las tasas de cobertura de vacunación de menores de hasta un año de edad en los lugares evaluados, lo cual influyó en el incremento de las tasas de cobertura de Brasil.

Estratégia do Ministério da Saúde do Brasil para aumento das coberturas vacinais nas fronteiras / Brazilian Ministry of Health strategy to increase vaccination coverage at borders / Estrategia del Ministerio de Salud de Brasil para aumentar las tasas de cobertura de vacunación en las fronteras

[RESUMO]. Objetivo. Avaliar a implementação de estratégia do “Plano de Ação: Estratégia de Vacinação nas Fronteiras – Agenda 2022” do Ministério da Saúde nas 33 cidades gêmeas e avaliar o incremento das coberturas vacinais (CV) brasileiras. Métodos. Ensaio clínico comunitário, do tipo antes e depois. Analisou-se a realização da estratégia, bem como comparadas as CV pré e pós-intervenção em dois tempos: P1 (pré-intervenção) e P2 (pós-intervenção). Análises estatísticas sobre a CV, no P1 e P2, foram calculados os valores de média entres os municípios, desvio padrão e diferença entre as coberturas dos dois períodos. Resultados. Observou-se integração entre as equipes de Atenção Primária à Saúde (APS), Vigilância, Imunização e Distrito Sanitário Especial Indígena (DSEI), porém com dificuldades, como aquelas inerentes ao fluxo migratório. Ressalta-se que o fluxo imigratório é um dos desafios no contexto da imunização, APS e DSEI, entretanto, a esta dificuldade soma-se a polarização entre os serviços (imunização, APS e DISEI), ocasionando um desafio para a integração dos setores. Em relação à análise das CV, após a realização das oficinas, foram totalizadas 50 977 doses aplicadas na população geral nas 33 cidades-gêmeas do Brasil. Houve incremento das coberturas vacinais de crianças de até um ano de idade nos locais avaliados após a intervenção, o que pode ser importante para aumentar as CV no Brasil. Conclusão. Houve incremento das coberturas vacinais das crianças até um ano de idade nos locais avalia- dos após a intervenção e isso influenciou no aumento das CV no Brasil.

[ABSTRACT]. Objective. Evaluate the implementation of the Ministry of Health’s “Action Plan: Border Vaccination Strategy – Agenda 2022” in the Brazil’s 33 twin cities and evaluate the increase in the country’s vaccination coverage (VC). Methodology. Pre-post community clinical trial. Implementation of the strategy was analyzed, and pre- and post-intervention VC were compared in two stages: P1 (pre-intervention) and P2 (post-intervention). Based on statistical analyses of P1 and P2 coverage, calculations were made of municipal averages, standard deviation, and difference in VC between the two periods. Results. Integration was observed between the primary health care (PHC), surveillance, immunization, and special indigenous health district (DSEI) teams, although there were difficulties, for example, in relation to migratory flows. While immigration flows present challenges in the areas of immunization, PHC, and DSEI, the difficulties are compounded by the polarization of these services, which hinders intersectoral integration. After carrying out the workshops, a total of 50 977 doses were administered in the general population in the 33 twin cities. There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, which may be relevant in terms of increasing VC in Brazil. Conclusion. There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, helping to increase VC in Brazil.

[RESUMEN]. Objetivo. Evaluar la aplicación de la Estrategia de Vacunación en las Fronteras - Agenda 2022, que forma parte del Plan de Acción del Ministerio de Salud en las 33 ciudades hermanas y evaluar el aumento de las tasas de cobertura de vacunación en Brasil. Métodos. Ensayo clínico comunitario realizado antes y después de la intervención correspondiente. Se analizó la aplicación de la estrategia y se compararon las tasas de cobertura de vacunación antes y después de la intervención en dos periodos: P1 (pre-intervención) y P2 (post-intervención). En los análisis estadísticos de la tasa de cobertura de vacunación en P1 y P2 se calcularon los valores de media y desviación estándar de los municipios y la diferencia entre las tasas de cobertura de los dos periodos. Resultados. Se observó una integración entre los equipos de Atención Primaria de Salud, Vigilancia, Inmu- nización y el Distrito Especial de Salud Indígena (DISEI), pero con dificultades, como las inherentes al flujo migratorio. Cabe destacar que el flujo migratorio es uno de los desafíos en el contexto de la inmunización, la atención primaria de salud y el DISEI, dificultad que se ve agravada por la polarización entre los servicios (inmunización, atención primaria de salud y el DISEI), lo que supone un reto para la integración de los sectores. Por lo que respecta al análisis de las tasas de cobertura de vacunación llevado a cabo después de realizar los talleres, se administró un total de 50 977 dosis a la población general en las 33 ciudades hermanas de Brasil. Hubo un aumento de las tasas de cobertura de vacunación de menores de hasta un año de edad en los lugares evaluados después de la intervención, lo que puede ser importante para aumentar las tasas de cobertura de Brasil. Conclusión. Después de la intervención hubo un aumento de las tasas de cobertura de vacunación de menores de hasta un año de edad en los lugares evaluados, lo cual influyó en el incremento de las tasas de cobertura de Brasil.

Análisis temporal de la mortalidad por causas evitables en las primeras 24 horas de vida, 2000-2021 / Temporal analysis of mortality from preventable causes in the first 24 hours of life, 2000-2021 / Análise temporal da mortalidade por causas evitáveis nas primeiras 24 horas de vida, 2000-2021

Objetivo: analizar el patrón temporal y estimar las tasas de mortalidad en las primeras 24 horas de vida y por causas evitables en el estado de Pernambuco en el período de 2000 a 2021. Método: estudio ecológico, teniendo como unidad de análisis el trimestre. La fuente de datos se constituyó por el Sistema de Informaciones sobre Mortalidad y el Sistema de Informaciones sobre Nacidos Vivos. El modelado de series temporales se realizó según el Modelo Autorregresivo Integrado de Promedio Móvil. Resultados: se registraron 14.462 óbitos en las primeras 24 horas de vida, siendo 11.110 (el 76,8%) evitables. Se observa para los pronósticos ( forecasts) que la tasa de mortalidad en las primeras 24 horas de vida registro una variación de 3,3 a 2,4 por 1.000 nacidos vivos, y la tasa de mortalidad por causas evitables de 2,3 a 1,8 por 1.000 nacidos vivos. Conclusión: la predicción sugirió avances en la reducción de la mortalidad en las primeras 24 horas de vida en el estado y por causas evitables. Los modelos ARIMA presentaron estimaciones satisfactorias para las tasas de mortalidad y por causas evitables en las primeras 24 horas de vida.

Objective: to analyze the temporal pattern and estimate mortality rates in the first 24 hours of life and from preventable causes in the state of Pernambuco from 2000 to 2021. Method: an ecological study, using the quarter as the unit of analysis. The data source was made up of the Mortality Information System and the Live Birth Information System. The time series modeling was conducted according to the Autoregressive Integrated Moving Average Model. Results: 14,462 deaths were recorded in the first 24 hours of life, 11,110 (76.8%) of which being preventable. It is observed from the forecasts that the mortality rate in the first 24 hours of life ranged from 3.3 to 2.4 per 1,000 live births, and the mortality rate from preventable causes ranged from 2.3 to 1.8 per 1,000 live births. Conclusion: the prediction suggested progress in reducing mortality in the first 24 hours of life in the state and from preventable causes. The ARIMA models presented satisfactory estimates for mortality rates and preventable causes in the first 24 hours of life.

Objetivo: analisar o padrão temporal e estimar as taxas de mortalidade nas primeiras 24 horas de vida e por causas evitáveis no estado de Pernambuco no período de 2000 a 2021. Método: estudo ecológico, tendo como unidade de análise o trimestre. A fonte de dados foi constituída pelo Sistema de Informações sobre Mortalidade e pelo Sistema de Informações sobre Nascidos Vivos. A modelagem da série temporal foi conduzida segundo o Modelo Autorregressivo Integrado de Médias Móveis. Resultados: foram registrados 14.462 óbitos nas primeiras 24 horas de vida, sendo 11.110 (76,8%) evitáveis. Observa-se para os forecasts que a taxa de mortalidade nas primeiras 24 horas de vida variou de 3,3 a 2,4 por 1.000 nascidos vivos, e a taxa de mortalidade por causas evitáveis variou de 2,3 a 1,8 por 1.000 nascidos vivos. Conclusão: a previsão sugeriu avanços na redução da mortalidade nas primeiras 24 horas de vida no estado e por causas evitáveis. Os modelos ARIMA apresentaram estimativas satisfatórias para as taxas de mortalidade e por causas evitáveis nas primeiras 24 horas de vida.

Análise espaçotemporal da mortalidade nas primeiras 24 horas de vida e sua evitabilidade no estado de Pernambuco, 2000-2019 / Spatio-temporal analysis of mortality in the first 24 hours of life and its preventability in the state of Pernambuco, 2000-2019 / Análisis espaciotemporal sobre la mortalidad en las primeras 24 horas de vida y su prevención en el estado de Pernambuco entre 2000 y 2019

O objetivo deste estudo é analisar os padrões espaçotemporais da mortalidade nas primeiras 24 horas de vida e sua evitabilidade no estado de Pernambuco no período de 2000 a 2019. Trata-se de estudo ecológico misto, tendo os trimestres e os municípios como unidades de análise. Constituíram-se como fontes de dados os sistemas de Informações sobre Mortalidade e Nascidos Vivos. Foram incluídos todos os óbitos no estado nas primeiras 24 horas de vida e por causas evitáveis, caracterizados conforme fatores de riscos proximais, intermediários e distais. A análise de evitabilidade dos óbitos utilizou a Lista Brasileira de Causas de Mortes Evitáveis por Intervenções do Sistema Único de Saúde. Foram calculadas as taxas de mortalidade e de evitabilidade nas primeiras 24 horas de vida. A análise espacial foi conduzida por meio da estatística scan, e a temporal, segundo o Modelo Autorregressivo Integrado de Médias Móveis. No período de 2000 a 2019, foram registrados 13.601 óbitos nas primeiras 24 horas de vida, sendo 10.497 (77,19%) por causas evitáveis. Destes, 5.513 (40,53%) foram classificados como reduzíveis por adequada atenção à mulher na gestação. As variáveis do nível proximal idade gestacional < 22 semanas (RA = 855,01) e peso ao nascer < 1.500 gramas (RA = 204,03) representam uma parcela importante dos óbitos ocorridos nas primeiras 24 horas de vida. As variáveis idade gestacional, sexo, peso ao nascer, tipo de gravidez, tipo de parto, idade da mãe e escolaridade materna foram estatisticamente significantes (p < 0,01). A varredura espacial identificou o aumento de clusters para ambas as taxas. A análise temporal evidenciou que a taxa de mortalidade e a taxa de mortalidade por causas evitáveis apresentaram padrão estacionário no período e a previsão revelou tendência crescente. Os resultados mostraram que a mortalidade nas primeiras 24 horas de vida e por causas evitáveis se configura como um problema de saúde pública no estado. Áreas de maior risco de óbito foram apontadas e a previsão revelou um aumento nas taxas.

This study aims to analyze the spatio-temporal patterns of mortality in the first 24 hours of life and its preventability in the state of Pernambuco from 2000 to 2019. This is a mixed ecological study with the quarters and the municipalities as units of analysis. The information systems on Mortality and Live Births constituted the data sources. All deaths in the state in the first 24 hours of life and from preventable causes were included, characterized according to proximal, intermediate, and distal risk factors. The analysis of preventability of deaths used the Brazilian List of Preventable Causes of Death by Interventions of the Brazilian National Health System. Mortality and preventability rates in the first 24 hours of life were calculated. Spatial analysis was conducted using scan and temporal statistics according to the Autoregressive Integrated Moving Averages Model. In the period from 2000 to 2019, 13,601 deaths were recorded in the first 24 of life, of which 10,497 (77.19%) were due to preventable causes. Of these, 5,513 (40.53%) were classified as reducible due to adequate care for women during pregnancy. The variables at the proximal level: gestational age < 22 weeks (AR = 855.01) and birth weight < 1,500 grams (AR = 204.03) represent an important part of the deaths that occurred in the first 24 hours of life. The variables gestational age, sex, birth weight, type of pregnancy, type of delivery, mother's age and maternal education were statistically significant (p < 0.01). Spatial scanning identified the increase in clusters for both rates. The temporal analysis showed that the mortality rate and the mortality rate from preventable causes presented a stationary pattern in the period and the forecast reveals a growing trend. The results show that mortality in the first 24 hours of life and from preventable causes is configured as a public health problem in the state. Areas of greater risk of death were identified and the forecast reveals an increase in the rates.

El objetivo de este estudio es analizar los patrones espaciotemporales de mortalidad en las primeras 24 horas de vida y su prevención en el estado de Pernambuco (Brasil) en el periodo de 2000 a 2019. Se trata de un estudio ecológico mixto, con los trimestres y los municipios como unidades de análisis. Los sistemas de información sobre Mortalidad y Nacidos Vivos fueron las fuentes de datos. Se incluyeron todas las muertes en las primeras 24 horas de vida y por causas prevenibles en el estado y se caracterizaron según factores de riesgo proximal, intermedio y distal. El análisis de la prevención de las muertes utilizó la Lista Brasileña de Causas de Muerte Prevenibles por Intervenciones del Sistema Único de Salud. Se calcularon las tasas de mortalidad y de prevención en las primeras 24 horas de vida. El análisis espacial se llevó a cabo usando estadísticas de escaneo y análisis temporal de acuerdo con el modelo de promedios móviles integrados autorregresivos. En el período de 2000 a 2019 se registraron 13.601 muertes en las primeras 24 de vida, de las cuales 10.497 (77,19%) se debieron a causas evitables. De estas, 5.513 (40,53%) fueron clasificadas como reducibles por atención adecuada a la mujer durante el embarazo. Las variables a nivel proximal edad gestacional < 22 semanas (RA = 855,01) y peso al nacer < 1.500 gramos (RA = 204,03) representan parte importante de las muertes ocurridas en las primeras 24 horas de vida. Las variables edad gestacional, sexo, peso al nacer, tipo de embarazo, tipo de parto, edad de la madre y escolaridad materna fueron estadísticamente significativas (p < 0,01). El escaneo espacial identificó un aumento de conglomerados para ambas tasas. El análisis temporal mostró que la tasa de mortalidad y la tasa de mortalidad por causas evitables presentaron un patrón estacionario en el periodo, y el pronóstico revela una tendencia creciente. Los resultados muestran que la mortalidad en las primeras 24 horas de vida y por causas prevenibles se configura como un problema de salud pública en el estado. Se identificaron áreas de mayor riesgo de muerte, y el pronóstico revela un aumento en las tasas.

Avoidable deaths in the first 24 hours of life: health care reflexes / Muertes evitables en las primeras 24 horas de vida: reflejos asistenciales / Mortes evitáveis nas primeiras 24 horas de vida: reflexos da assistência à saúde

ABSTRACT Objectives: to analyze the risks of deaths in the first 24 hours of life and their preventable causes. Methods: cross-sectional study carried out in Pernambuco, Northeast of Brazil, between 2000-2019, with mortality and live birth data. The avoidability was analyzed through the Brazilian List of Avoidable Causes of Deaths due to Interventions of the Unified Health System. For the statistical analyses, Pearson's chi-squared test and relative and attributable risks were used. Results: 13,601 deaths were registered, of which 10,497 (77.19%) were from preventable causes. Of the total, 5,513 (40.53%) were reducible through adequate care for women during pregnancy. The lower the gestational age, birth weight and education level, the higher the relative and attributable risk of death in the first 24 hours of life. Conclusions: most of the deaths were considered avoidable and with high relative and attributable risks. These early deaths suggest care failures and the need to reinforce prevention and treatment measures.

RESUMEN Objetivos: analizar los riesgos de muerte en las primeras 24 horas de vida y sus causas prevenibles. Métodos: estudio transversal realizado en Pernambuco, Nordeste de Brasil, entre 2000-2019, con datos de mortalidad y nacidos vivos. La evitabilidad fue analizada por la Lista Brasileña de Causas de Muerte Evitables por Intervenciones del Sistema Único de Salud. Para los análisis estadísticos se utilizó la prueba de chi-cuadrado de Pearson y los riesgos relativos y atribuibles. Resultados: fueron registradas 13.601 muertes, de las cuales 10.497 (77,19%) se debieron a causas evitables. Del total, 5.513 (40,53%) fueron reducibles mediante una atención adecuada a la mujer durante el embarazo. Cuanto menor es la edad gestacional, el peso al nacer y el nivel educativo, mayor es el riesgo relativo y atribuible de muerte en las primeras 24 horas de vida. Conclusiones: la mayoría de las muertes se consideraron evitables y de alto riesgo relativo y atribuible. Estas muertes precoces sugieren fallas en la atención y la necesidad de reforzar las medidas de prevención y tratamiento.

RESUMO Objetivos: analisar os riscos de mortes nas primeiras 24 horas de vida e suas causas evitáveis. Métodos: estudo transversal realizado em Pernambuco, Nordeste do Brasil, entre 2000-2019, com dados de mortalidade e nascidos vivos. Analisou-se a evitabilidade pela Lista Brasileira de Causas de Mortes Evitáveis por Intervenções do Sistema Único de Saúde. Para as análises estatísticas, utilizou-se o teste de Qui-quadrado de Pearson e os riscos relativo e atribuível. Resultados: registraram-se 13.601 óbitos, sendo 10.497 (77,19%) por causas evitáveis. Do total, 5.513 (40,53%) eram reduzíveis por adequada atenção à mulher na gestação. Quanto menor a idade gestacional, o peso ao nascer e a escolaridade, maior o risco relativo e atribuível ao óbito nas primeiras 24 horas de vida. Conclusões: a maior parte dos óbitos foram considerados evitáveis e com elevados riscos relativo e atribuível. Esses óbitos precoces sugerem falhas assistenciais e a necessidade de reforçar as medidas de prevenção e tratamento.

Auto-Regressive Integrated Moving Average Model (ARIMA): conceptual and methodological aspects and applicability in infant mortality / Modelo Autorregressivo Integrado de Médias Móveis (ARIMA): aspectos conceituais e metodológicos e sua aplicabilidade na mortalidade infantil

Abstract This reflective theoretical article, aims to discuss conceptual and methodological aspects about the applications of time series modeling, in particular, the Integrated Auto-regressive Moving Average model and its applicability in infant mortality. This modeling makes it possible to predict future values using past data, outlining and estimating possible scenarios of the health event, highlighting its magnitude. Due to the persistence of infant mortality as a public health problem, the applicability of this method is useful in the timely and systematic management of child health indicators, in addition to being a method with low operating cost, which in contexts of cost reduction in public healthcare services, becomes a potential management tool. However, there are still gaps in the use of statistical methods in the decision-making and policy-making process in public healthcare, such as the modeling in question. These are methodological (robust statistics), institutional (outdated information systems) and cultural obstacles (devaluation of the data produced, mainly at the local level).

Resumo Este artigo, de cunho teórico-reflexivo, objetiva discutir os aspectos conceituais e metodológicos sobre as aplicações da modelagem de série temporal, em especial, o Modelo Autorregressivo Integrado de Médias Móveis e sua aplicabilidade na mortalidade infantil. Essa modelagem possibilita prever os valores futuros utilizando os dados passados, delineando e estimando os cenários possíveis do evento em saúde, evidenciando a sua magnitude. Devido à persistência da mortalidade infantil como um problema de saúde pública, a aplicabilidade desse método é útil no gerenciamento oportuno e sistemático dos indicadores da saúde infantil, além de ser um método que apresenta baixo custo operacional, que, em contextos de redução de gastos em saúde, se torna uma ferramenta de gestão em potencial. No entanto, ainda há lacunas na utilização de métodos estatísticos no processo decisório e formulador de políticas em saúde, a exemplo da modelagem em questão. São obstáculos de natureza metodológica (estatística robusta), institucional (sistemas de informações defasados) e cultural (desvalorização dos dados produzidos, principalmente em nível local).

Indicadores de cobertura vacinal para classificação de risco de doenças imunopreveníveis / Vacinnation coverage indicators for risk classification of vaccine-preventable diseases / Indicadores de cobertura de vacunación para la clasificación de riesgo de enfermedades inmunoprevenibles

Objetivo: Descrever os indicadores de cobertura vacinal e o risco de transmissão de doenças imunopreveníveis. Métodos: Estudo ecológico descritivo, tendo como unidade de análise os municípios da 1ª Região de Saúde do estado de Pernambuco. Utilizou-se a metodologia proposta pelo Ministério da Saúde, elaborada no ano de 2016, para classificação de risco de doenças imunopreveníveis, e coletaram-se os dados no Sistema de Informações do Programa Nacional de Imunizações do estado. Descreveram-se as variáveis referentes à situação vacinal das vacinas básicas para os menores de dois anos de idade (cobertura vacinal, taxa de abandono e homogeneidade da cobertura vacinal) e o risco de transmissão de doenças imunopreveníveis a partir da distribuição de frequências absolutas, relativas e médias. Resultados: Dos vinte municípios analisados, 20% (n=4) apresentaram a classificação de risco muito alto, 55% (n=11) tiveram risco alto, 15% (n=3) apresentaram risco médio e 10% (n=2) classificaram-se com risco muito baixo. As vacinas tetra viral, rotavírus e meningocócica C apresentaram os menores valores de cobertura na região: 25% (n=5) dos municípios alcançaram a meta da homogeneidade da cobertura vacinal entre vacinas e 20% (n=4) dos municípios estão com esse indicador zerado. As vacinas rotavírus, pentavalente e poliomielite apresentaram as maiores taxas de abandono. Conclusão: Nos municípios analisados há um enquadramento nas categorias de risco muito alto e alto, além de baixos indicadores de cobertura vacinal, evidenciando que há uma relação inversamente proporcional entre o risco e os indicadores. (AU)

Chemo-enzymatic assembly of clickable cellulose surfaces via multivalent polysaccharides.

The chemist's guide to the galactosyl unit: A chemo-enzymatic process is developed for the multivalent functionalization of cellulose surfaces via regioselective oxidation of heteropolysaccharides with galactose 6-oxidase. Reductive amination, surface sorption, and click chemistry enable the assembly of (bio)chemically active cellulose surfaces for applications ranging from functional biocomposites to in vitro diagnostics.

A general route to xyloglucan-peptide conjugates for the activation of cellulose surfaces.

Cellulose is an attractive supporting matrix for diverse biotechnological applications, including chromatography, diagnostics, and tissue replacement/scaffolding, due to its renewable resource status, low cost, and low non-specific interaction with biomolecules. In an effort to expand the biofunctionality of cellulose materials, we present here a versatile method for the synthesis of xyloglucan-peptide conjugates that harness the strong xyloglucan-cellulose binding interaction for gentle surface modification. Xylogluco-oligosaccharide aminoalditols (XGO-NH(2)) were coupled to both linear and cyclic peptides, which contained the endothelial cell epitope Arg-Gly-Asp, in a facile two-step approach employing diethyl squarate cross-linking. Subsequent xyloglucan endo-transglycosylase-mediated coupling of the resulting XGO-GRGDS (Gly-Arg-Gly-Asp-Ser) and XGO-c[RGDfK]-PEG-PEG (cyclo[Arg-Gly-Asp-(D-Phe)-Lys]-PEG-PEG; where PEG is 8-amino-3,6-dioxaoctanoic acid) conjugates into high molecular mass xyloglucan yielded xyloglucan-RGD peptide conjugates suitable for cellulose surface activation. Notably, use of XGO-squaramate as a readily accessible, versatile intermediate overcomes previous limitations of solid-phase synthetic approaches to XGO-peptide conjugates, and furthermore allows the method to be generalized to a wide variety of polypeptides and proteins, as well as diverse primary amino compounds.