The COVID-19 pandemic in Brazil: space-time approach of cases, deaths, and vaccination coverage (February 2020 - April 2024).

OBJECTIVE: To assess the evolution of the COVID-19 pandemic in Brazil and its macro-regions, considering disease incidence and mortality rates, as well as identifying territories with still rising disease indices and evaluating vaccine coverage and population adherence to COVID-19 immunization. METHODS: An ecological study conducted in Brazil with COVID-19 cases and deaths reported between February 2020 and April 2024, obtained through the Coronavirus Panel. Historical series were constructed from incidence and mortality rates to assess the pandemic's evolution, and temporal trends were estimated using the Seasonal Trend Decomposition using Loess (STL) method. The Spatial Variation in Temporal Trends (SVTT) technique was employed to identify clusters with significant variations in temporal trends. Vaccination was analyzed considering the percentage of vaccinated and unvaccinated population in each municipality of the country. RESULTS: Brazil recorded a total of 38,795,966 cases and 712,038 deaths from COVID-19 during the study period. Incidence and mortality rates showed three waves of the disease, with a fourth wave of smaller amplitude. Four clusters with significant case growth and two with increased deaths were identified. Vaccine coverage varied among municipalities, with some regions showing low vaccination rates and others with high immunization adherence. CONCLUSION: The study provided a comprehensive overview of coronavirus behavior in Brazil, and its results highlight the ongoing importance of vaccination and the need to direct efforts and resources to areas of higher risk.

Does machine learning have a high performance to predict obesity among adults and older adults? A systematic review and meta-analysis.

AIM: Machine learning may be a tool with the potential for obesity prediction. This study aims to review the literature on the performance of machine learning models in predicting obesity and to quantify the pooled results through a meta-analysis. DATA SYNTHESIS: A systematic review and meta-analysis were conducted, including studies that used machine learning to predict obesity. Searches were conducted in October 2023 across databases including LILACS, Web of Science, Scopus, Embase, and CINAHL. We included studies that utilized classification models and reported results in the Area Under the ROC Curve (AUC) (PROSPERO registration: CRD42022306940), without imposing restrictions on the year of publication. The risk of bias was assessed using an adapted version of the Transparent Reporting of a multivariable prediction model for individual Prognosis or Diagnosis (TRIPOD). Meta-analysis was conducted using MedCalc software. A total of 14 studies were included, with the majority demonstrating satisfactory performance for obesity prediction, with AUCs exceeding 0.70. The random forest algorithm emerged as the top performer in obesity prediction, achieving an AUC of 0.86 (95%CI: 0.76-0.96; I2: 99.8%), closely followed by logistic regression with an AUC of 0.85 (95%CI: 0.75-0.95; I2: 99.6%). The least effective model was gradient boosting, with an AUC of 0.77 (95%CI: 0.71-0.82; I2: 98.1%). CONCLUSION: Machine learning models demonstrated satisfactory predictive performance for obesity. However, future research should utilize more comparable data, larger databases, and a broader range of machine learning models.

Advances in the development of new vaccines for tuberculosis and Brazil's role in the effort forward the end TB strategy.

Tuberculosis (TB) continues to be the world's leading killer of infectious diseases. Despite global efforts to gradually reduce the number of annual deaths and the incidence of this disease, the coronavirus disease 19 (COVID-19) pandemic caused decreased in TB detection and affected the prompt treatment TB which led to a setback to the 2019 rates. However, the development and testing of new TB vaccines has not stopped and now presents the possibility of implanting in the next five years a new vaccine that is affordable and might be used in the various key vulnerable populations affected by TB. Then, this assay aimed to discuss the main vaccines developed against TB that shortly could be selected and used worldwide, and additionally, evidence the Brazilian potential candidates' vaccines in developing in Brazil that could be considered among those in level advanced to TB end.

Epidemiology of TB in prisoners: a metanalysis of the prevalence of active and latent TB.

BACKGROUND: Tuberculosis (TB) in prisons usually occurs at higher rates than in the general population, especially in developing countries. TB has been reported as the most common cause of death among prisoners. Studies have shown limitations for early detection of TB in prisons that seem to result from mistaken concepts about TB, delayed diagnosis mainly due to the naturalization of lack of healthcare for this population METHODS: A scoping review was performed using the methodology of the Joanna Briggs Institute to assess "What are the scientific evidences on the epidemiology of TB in the prison system?". Then, a meta-analysis was performed to assess the prevalence of TB (active and latent) TB in prisoners. The results are presented as prevalence, in percentage, through random effects models, with a confidence interval of 95%. RESULTS: Regarding active TB, the results of the metanalysis showed that countries with a high burden of TB had a prevalence of 3.54% [2.71; 4.63], countries not considered to be high burden TB countries had a prevalence of 1.43% [0.86; 2.37]. Latent TB had a prevalence of 51.61% [39.46; 63.58] in high TB burden countries and a prevalence of 40.24% [23.51; 59.61] in countries with low TB burden. In terms of development, in low- and lower-middle-income countries, the prevalence of active TB was 3.13% [1.84; 5.29] and in high- and upper-middle income countries the prevalence was 2.25% [1.70; 2.99]. The prevalence of latent TB in high- and middle-income countries was 43.77% [28.61; 60.18] and of 49.42% [45.91; 52.94] in low and lower middle-income countries. CONCLUSION: Our analysis suggests that TB, and probably other infectious diseases, find fertile ground in prisons where previous acquire social disadvantages seem to thrive-therefore, TB in prisons is a global public health problem and effective strategies are needed to control the disease are needed targeting the prison environment, including rapid health assessments to understand each context and to implement tailored and precision interventions.

Geo-spatial high-risk clusters of Tuberculosis in the global general population: a systematic review.

INTRODUCTION: The objective of this systematic review is to identify tuberculosis (TB) high-risk among the general population globally. The review was conducted using the following steps: elaboration of the research question, search for relevant publications, selection of studies found, data extraction, analysis, and evidence synthesis. METHODS: The studies included were those published in English, from original research, presented findings relevant to tuberculosis high-risk across the globe, published between 2017 and 2023, and were based on geospatial analysis of TB. Two reviewers independently selected the articles and were blinded to each other`s comments. The resultant disagreement was resolved by a third blinded reviewer. For bibliographic search, controlled and free vocabularies that address the question to be investigated were used. The searches were carried out on PubMed, LILACS, EMBASE, Scopus, and Web of Science. and Google Scholar. RESULTS: A total of 79 published articles with a 40-year study period between 1982 and 2022 were evaluated. Based on the 79 studies, more than 40% of all countries that have carried out geospatial analysis of TB were from Asia, followed by South America with 23%, Africa had about 15%, and others with 2% and 1%. Various maps were used in the various studies and the most used is the thematic map (32%), rate map (26%), map of temporal tendency (20%), and others like the kernel density map (6%). The characteristics of the high-risk and the factors that affect the hotspot's location are evident through studies related to poor socioeconomic conditions constituting (39%), followed by high population density (17%), climate-related clustering (15%), high-risk spread to neighbouring cities (13%), unstable and non-random cluster (11%). CONCLUSION: There exist specific high-risk for TB which are areas that are related to low socioeconomic conditions and spectacular weather conditions, these areas when well-known will be easy targets for intervention by policymakers. We recommend that more studies making use of spatial, temporal, and spatiotemporal analysis be carried out to point out territories and populations that are vulnerable to TB.

Health condition, income loss, food insecurity and other social inequities among migrants and refugees during the COVID-19 pandemic in Brazil.

BACKGROUND: Brazil is the destination of many international migrants and refugees and, given the circumstances of their entry into the country, many face difficulties due to the absence of targeted policies. Thus, the objective of this study was to survey the social impact of COVID-19 on international migrants and refugees regarding income loss, food insecurity and other social inequities, and to identify explanatory factors on these aspects. METHODS: This is a cross-sectional, analytical study. We used a validated instrument applied by trained interviewers. Descriptive analysis and binary logistic regression were performed to identify factors associated with income loss and food insecurity. RESULTS: A total of 360 individuals from sub-Saharan African and South American countries participated in the study. Individuals who were white, black/brown, yellow, had an occupation/employment, and earned less than one minimum wage were more likely to lose income. Those who reported no income, received less than one minimum wage, and were diagnosed with COVID-19 were more likely to be food insecure. CONCLUSIONS: The study advances knowledge by identifying factors associated with income loss, food insecurity, and individuals' difficulty in accessing health services and social support measures in Brazil.

[Addressing HIV/AIDS and syphilis in Venezuelan migrant women from the perspective of health managers in the North of BrazilManejo de la infección por el VIH/sida y la sífilis en mujeres migrantes venezolanas desde la perspectiva de los gestores de salud en el norte de Brasil]. / Enfrentamento de HIV/aids e sífilis em mulheres venezuelanas migrantes na perspectiva de gestores de saúde no Norte do Brasil.

Objective: To identify the perception of health managers regarding the actions taken and the challenges encountered in addressing HIV and syphilis in Venezuelan migrant women in Brazil. Method: This descriptive-exploratory study using a qualitative approach was conducted from January to March 2021 in the municipalities of Boa Vista (state of Roraima) and Manaus (state of Amazonas). Audio interviews with the participants were transcribed in full and examined using thematic content analysis. Results: Ten managers were interviewed (five in Boa Vista and five in Manaus). Content analysis identified the following domains and themes: available infrastructure for diagnosis and treatment of AIDS and syphilis - access, availability of medical appointments /waiting list, training of health teams, and psychosocial support; challenges faced by Venezuelan women - language, documentation issues, and frequent address changes; and strategies and actions adopted and expectations for addressing HIV/AIDS and syphilis in the context of migration. Conclusions: Despite the care provided to Venezuelan women in Brazil - guaranteed by the universal nature of the Brazilian health system - language and lack of documentation remain as barriers. Given the absence of action plans and future planning for the care of migrant women with HIV or syphilis in municipalities, it is important to develop public policies aimed at minimizing the difficulties faced by this population.

Objetivo: Determinar la percepción de los gestores de salud sobre las medidas adoptadas y los desafíos encontrados para manejar la infección por el VIH y la sífilis en mujeres migrantes venezolanas en Brasil. Métodos: Este estudio descriptivo y exploratorio, con enfoque cualitativo, se realizó de enero a marzo del 2021 en los municipios de Boa Vista (estado de Roraima) y Manaos (estado de Amazonas). La grabación de las entrevistas de los participantes se transcribió en su totalidad. El análisis se basó en la técnica de evaluación temática del contenido. Resultados: Se hicieron entrevistas a diez gestores (cinco en Boa Vista y cinco en Manaos). En el análisis del contenido se observaron los siguientes ejes y temas: la estructura disponible para el diagnóstico y tratamiento del sida y de la sífilis, con inclusión de acceso, cupos de atención, filas de espera y formación de equipos de salud y apoyo psicosocial; los desafíos enfrentados por las mujeres venezolanas, como idioma, problemas de documentación y frecuencia de cambio de domicilio; las estrategias y medidas adoptadas y las expectativas para enfrentar la infección por el VIH/sida y la sífilis en el marco de la migración. Conclusiones: A pesar de las medidas de acogida a las mujeres migrantes venezolanas, garantizadas por la universalidad del sistema de salud brasileño, todavía existen algunas barreras como el idioma y la falta de documentación. Ante la falta de planes de acción y planificación futura de la atención a las mujeres migrantes portadoras del VIH o con sífilis en los municipios, es importante formular políticas públicas con el fin de reducir las dificultades enfrentadas por este grupo de la población.

Temporal trend and spatial analysis of the HIV epidemic in young men who have sex with men in the second largest Brazilian Amazonian province.

BACKGROUND: After 40 years of its starting, the HIV epidemic in Brazilian Amazon region remains on an increasing trend. The young men who have sex with men (MSM) have been the most impacted by the HIV in the last decade. However, much more than attributing the risk behavior to HIV uniquely to the individual, behaviors are shaped by social determinants of health (SDH). Despite the problem, there is a scarcity of studies evaluating the impact of SDH on HIV among young MSM and none of them were done in the Northern of Brazil. Therefore, the main goal of this study was to analyse the HIV epidemic among Brazilian Amazonian young MSM using temporal trends and spatial analysis. METHODS: We conducted an ecological study using reported cases of HIV/AIDS in young MSM living in Pará, the second larger Brazilian Amazonian province, between 2007 and 2018. Data were obtained from the Information System for Notifiable Diseases. For the temporal analysis, we employed a Seasonal and Trend decomposition using Loess Forecasting model (STLF), which is a hybrid time-series forecast model, that combines the Autoregressive-Integrated Moving Average (ARIMA) forecasting model with the Seasonal-Trend by Loess (STL) decomposition method. For the spatial analysis, Moran's spatial autocorrelation, spatial scan, and spatial regression techniques were used. RESULTS: A total of 2192 notifications were included in the study. Greater variabilities in HIV/AIDS population-level diagnosis rates were found in the festive months. The HIV/AIDS population-level diagnosis rates exhibited an upward trend from 2013 and this trend is forecasted to continue until 2022. Belém, the capital of Pará, presented the highest spatial risk for HIV/AIDS and was the only city to present spatiotemporal risk from 2014 to 2018. The geographic variation of the HIV epidemic was associated with the number of men with formal jobs, the average salary of men, and the percentage of people over 18 years old with elementary education. CONCLUSION: The upward trend of HIV/AIDS population-level diagnosis rate forecasted until 2022 and the variability of the epidemic promoted by the SDH brings an alert and subsidies to health authorities to implement more efficient and focalized public policies against HIV among young MSM in Pará.

Risk-prone territories for spreading tuberculosis, temporal trends and their determinants in a high burden city from São Paulo State, Brazil.

OBJECTIVES: To identify risk-prone areas for the spread of tuberculosis, analyze spatial variation and temporal trends of the disease in these areas and identify their determinants in a high burden city. METHODS: An ecological study was carried out in Ribeirão Preto, São Paulo, Brazil. The population was composed of pulmonary tuberculosis cases reported in the Tuberculosis Patient Control System between 2006 and 2017. Seasonal Trend Decomposition using the Loess decomposition method was used. Spatial and spatiotemporal scanning statistics were applied to identify risk areas. Spatial Variation in Temporal Trends (SVTT) was used to detect risk-prone territories with changes in the temporal trend. Finally, Pearson's Chi-square test was performed to identify factors associated with the epidemiological situation in the municipality. RESULTS: Between 2006 and 2017, 1760 cases of pulmonary tuberculosis were reported in the municipality. With spatial scanning, four groups of clusters were identified with relative risks (RR) from 0.19 to 0.52, 1.73, 2.07, and 2.68 to 2.72. With the space-time scan, four clusters were also identified with RR of 0.13 (2008-2013), 1.94 (2010-2015), 2.34 (2006 to 2011), and 2.84 (2014-2017). With the SVTT, a cluster was identified with RR 0.11, an internal time trend of growth (+ 0.09%/year), and an external time trend of decrease (- 0.06%/year). Finally, three risk factors and three protective factors that are associated with the epidemiological situation in the municipality were identified, being: race/brown color (OR: 1.26), without education (OR: 1.71), retired (OR: 1.35), 15 years or more of study (OR: 0.73), not having HIV (OR: 0.55) and not having diabetes (OR: 0.35). CONCLUSION: The importance of using spatial analysis tools in identifying areas that should be prioritized for TB control is highlighted, and greater attention is necessary for individuals who fit the profile indicated as "at risk" for the disease.

[Quality of life of health personnel during the COVID-19 pandemic: exploratory reviewQualidade de vida do pessoal de saúde durante a pandemia de COVID-19: revisão exploratória]. / Calidad de vida del personal de salud durante la pandemia de COVID-19: revisión exploratoria.

Objective: Describe the quality of life of health personnel, the work environment, and interactions between employees and their work environment during the pandemic. Methods: A scoping review was conducted. The electronic databases PubMed, Cumulative Index of Nursing and Allied Literature Complete, and Google Scholar were used, as well as the repositories of the World Health Organization and the Centers for Disease Control and Prevention. Primary, secondary, and grey literature studies published between December 2019 and March 2021 in Spanish, English, and Portuguese were included. Methodological quality was assessed using the Authority, Accuracy, Coverage, Objectivity, Date and Importance (AACODS) checklist; a tool for the measurement of multiple systematic reviews (AMSTAR); and the Critical Appraisal Checklist for Text and Opinion Papers. A thematic analysis was carried out based on the quality-of-life and well-being model. Results: Of a total of 208 articles, 11 were included. The quality of life of health personnel during the COVID-19 pandemic was affected by the characteristics of health personnel, the work environment, and interactions between employees and their work environment. Problems related to psychosocial and occupational factors were observed. Discussion: The quality of life of health personnel was characterized by stigmatization, stress, anxiety, and fatigue. Organizational management and the implementation of psychological interventions appear to affect interactions between employees and their work environment, and improve their quality of life.

Objetivo: Descrever a qualidade de vida do pessoal de saúde, o ambiente de trabalho e a interação entre o funcionário e o ambiente de trabalho durante a pandemia. Métodos: Foi realizada uma revisão exploratória. Foram utilizadas as bases de dados eletrônicas PubMed, Cumulative Index of Nursing and Allied Literature Complete, Google Scholar e os repositórios da Organização Mundial da Saúde e dos Centros de Controle e Prevenção de Doenças. Foram incluídos estudos primários, secundários e da literatura cinzenta, publicados entre dezembro de 2019 e março de 2021, em espanhol, inglês e português. A qualidade metodológica foi avaliada pelas checklists AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance), AMSTAR (A measurement tool to assess systematic reviews) e Critical Appraisal Checklist for Text and Opinion Papers. Foi realizada uma análise temática com base no modelo de qualidade de vida e bem-estar. Resultados: De um total de 208 artigos, 11 foram incluídos. A qualidade de vida do pessoal de saúde durante a pandemia de COVID-19 foi influenciada pelas características do pessoal de saúde, do ambiente de trabalho e da interação entre o funcionário e o ambiente de trabalho. Constataram-se deficiências relacionadas a fatores psicossociais e ocupacionais. Discussão: A qualidade do pessoal de saúde foi caracterizada por estigma, estresse, ansiedade e fadiga. A gestão organizacional e a aplicação de intervenções psicológicas evidenciam um efeito na interação entre o funcionário e o ambiente de trabalho, e influenciam sua qualidade de vida.

[COVID-19 morbidity and mortality associated with chronic disorders, healthcare services, and inequity: evidence for a syndemicMorbimortalidad por COVID-19 asociada a los problemas crónicos de salud, los servicios de salud y las inequidades: evidencia de sindemia]. / Morbimortalidade por COVID-19 associada a condições crônicas, serviços de saúde e iniquidades: evidências de sindemia.

Objective: To identify factors correlated with the incidence and mortality from COVID-19 and investigate syndemic situations at the global level. Method: An ecologic study of confirmed COVID-19 cases and deaths was performed using information collected from the European Center for Disease Prevention and Control in 2019 and 2020. World Bank indicators and information obtained from Worldometer Coronavirus were used to characterize the countries. Descriptive analyses and correlations between independent variables were performed, followed by multiple linear regression analysis to identify factors correlated with COVID-19 incidence and mortality. Results: Data were obtained for 185 countries. Mean case incidence was 16 482/1,000 population, whereas mean COVID-19 mortality was 291/1,000 population, with the highest and lowest rates recorded in North America and East Asia and Pacific respectively. A positive correlation was identified between incidence rate and percent population aged 15 to 64 years, urban population, inequality measured by the Gini coefficient, and six out of the seven regions analyzed (except East Asia and Pacific). Mortality rate was negatively correlated with population aged 0 to 14 years and positively correlated with urban population, inequality measured by the Gini coefficient, and all regions analyzed except East Asia and Pacific. Conclusions: COVID-19 morbidity and mortality were correlated with the burden of chronic diseases, aging population, and low capacity of healthcare services for testing and providing hospital beds, a scenario complicated by social inequality in countries and regions, indicating a syndemic effect.

Objetivo: Identificar los factores correlacionados con la incidencia de COVID-19 y la mortalidad por esa causa y verificar las situaciones de sindemia a escala mundial. Métodos: Se realizó un estudio ecológico de casos de COVID-19 y de defunciones confirmadas por esa causa a partir de la información obtenida del Centro Europeo para la Prevención y el Control de las Enfermedades en el 2019 y el 2020. Para caracterizar a los países, se utilizaron indicadores del Banco Mundial y del sitio web de referencia Worldometer Coronavirus. Se hicieron análisis descriptivos y de correlación entre las variables independientes para crear posteriormente un modelo de regresión lineal múltiple con el fin de identificar los factores correlacionados con la incidencia de COVID-19 y la mortalidad por esa causa. Resultados: Se obtuvieron datos de 185 países. La tasa media de incidencia de casos de COVID-19 fue de 16 482 por mil habitantes y la tasa media de mortalidad por esa causa fue de 291 por mil habitantes. Las regiones de América del Norte y de Asia oriental y el Pacífico presentaron los mayores y menores índices, respectivamente. Se observó una correlación positiva de la tasa de incidencia con la proporción del grupo de 15 a 64 años de edad, la población urbana, la desigualdad medida por el coeficiente de Gini y seis de las siete regiones analizadas (excepto Asia oriental y el Pacífico). La tasa de mortalidad presentó una correlación negativa con el grupo de 0 a 14 años de edad y positiva con la población urbana, la desigualdad medida por el coeficiente de Gini y todas las regiones analizadas, excepto Asia oriental y el Pacífico. Conclusiones: La morbimortalidad por COVID-19 guardó una correlación con la carga de problemas crónicos de salud, el envejecimiento de la población y la poca capacidad de realizar pruebas en los servicios de salud y de ofrecer camas de hospital, cuadro agravado en los países o regiones con una elevada tasa de desigualdad social y característico de una situación de sindemia.

Factors associated with latent tuberculosis among international migrants in Brazil: a cross-sectional study (2020).

BACKGROUND: Migrants are a high priority group for TB control measures due to their high exposure to risk factors such as poverty and social vulnerability. The study aimed to identify factors associated with latent TB among international migrants living in four Brazilian state capitals. This was a cross-sectional study conducted in September and October 2020 in a sample of 903 international migrants living in four Brazilian state capitals: Boa Vista/RR (458), Manaus/AM (136), São Paulo/SP (257), and Curitiba/PR (52). Data were collected with a questionnaire consisting of open and closed questions on personal characteristics, information on TB, and use of preventive measures. Tuberculin skin test (TST) was performed, with reading after 72 h by trained nurses and using 5 mm induration as the positive cutoff. Chi-square test (X2) and Fisher's exact test, both two-tailed, were used to compare statistically significant levels of association between the migrants´ sociodemographic characteristics, vulnerability, and latent TB infection (LTBI). Binary logistic regression was applied to calculate odds ratios and respective 95% confidence intervals. For all the tests, type I error of 5% was defined as statistically significant (p < 0.05). RESULTS: Prevalence of LTBI among migrants was 46.1% in Manaus/AM, 33.3% in São Paulo/SP, 28.1% in Curitiba/PR, and 23.5% in Boa Vista/RR. Factors associated with latent infection were age, male gender, and brown or indigenous race. CONCLUSIONS: The study showed high prevalence of latent TB among international migrants.

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

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

Causes of multidrug-resistant tuberculosis from the perspectives of health providers: challenges and strategies for adherence to treatment during the COVID-19 pandemic in Brazil.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is a serious phenomenon on a global scale that can worsen with the COVID-19 pandemic. The study aimed to understand the perceptions of health professionals about MDR-TB, their strategies to ensure adherence to treatment and their challenges in the context of the COVID-19 pandemic in a priority municipality for disease control. METHODS: We conducted a qualitative study and recruited 14 health providers (four doctors, three nurses, three nursing technicians, three nursing assistants and a social worker) working in a city in the state of São Paulo, Brazil. Remote semi-structured interviews were conducted with the participants. For data analysis, the thematic content analysis technique was applied according to the study's theoretical framework. RESULTS: The study revealed the causes of MDR-TB are associated with poverty, vulnerability, and social risk. A pre-judgement from the providers was observed, namely, all patients do not adhere due their resistance and association with drug abuse or alcoholism. The study also observed difficulty among health providers in helping patients reconstruct and reframe their life projects under a care perspective, which would strengthen adherence. Other issues that weakened adherence were the cuts in social protection and the benefits really necessary to the patients and a challenge for the providers manage that. The participants revealed that their actions were impacted by the pandemic and insecurity and fear manifested by patients after acquiring COVID-19. For alleviating this, medical appointments by telephone, delivery of medicine in the homes of patients and visits by health professionals once per week were provided. CONCLUSION: The study advances knowledge by highlighting the challenges faced by the health system with the adherence of patients with MDR-TB in a context aggravated by the pandemic. An improvement in DOT is really necessary to help the patients reframe their lives without prejudices, face their fears and insecurity, recover their self-esteem and motivate in concluding their treatment.

Determinants of multidrug-resistant tuberculosis in São Paulo-Brazil: a multilevel Bayesian analysis of factors associated with individual, community and access to health services.

OBJECTIVE: Multidrug-resistant tuberculosis (MDR-TB) remains a serious public health problem worldwide. Accordingly, this study sought to identify individual, community and access to health services risk factors for MDR-TB. METHODS: Retrospective cohort of all TB cases diagnosed between 2006 and 2016 in the state of São Paulo. A Bayesian spatial hierarchical analysis with a multilevel design was carried out. RESULTS: It was identified that the history of previous TB treatment (Odds Ratios [OR]:13.86, 95% credibility interval [95% CI]:12.06-15.93), positive sputum culture test (OR: 5.26, 95% CI: 4.44-6.23), diabetes mellitus (OR: 2.34, 95% CI: 1.87-2.91), residing at a standard address (OR: 2.62, 95% CI: 1.91-3.60), positive sputum smear microscopy (OR: 1.74, 95% CI: 1.44-2.12), cavitary pulmonary TB (OR: 1.35, 95% CI: 1.14-1.60) and diagnosis performed due to spontaneous request (OR: 1.26; 95% CI: 1.10-1.46) were associated with MDR-TB. Furthermore, municipalities that performed HIV tests in less than 42.65% of patients with TB (OR: 1.50, 95% CI: 1.25-1.79), that diagnosed TB cases only after death (OR: 1.50, 95% CI: 1.17-1.93) and that had more than 20.16% of their population with income between » and ½ of one minimum wage (OR: 1.56, 95% CI: 1.30-1.87) were also related to the MDR-TB. CONCLUSIONS: Knowledge of these predictive factors may help to develop more comprehensive disease prevention strategies for MDR-TB, avoiding the risks expressed regarding drug resistance expansion.

OBJECTIF: La tuberculose multirésistante (TB-MDR) reste un grave problème de santé publique dans le monde. Cette étude visait à identifier les facteurs de risque individuels, communautaires et d'accès aux services de santé pour la TB-MDR. MÉTHODES: Analyse de cohorte rétrospective de tous les cas de TB diagnostiqués entre 2006 et 2016 dans l'Etat de São Paulo par analyse bayésienne spatiale à plusieurs niveaux. RÉSULTATS: Les antécédents de traitements antituberculeux (Rapports de cotes [OR]: 13,86, Intervalle de confiance à 95% [IC95%]: 12.06-15.93), un test de culture d'expectorations positif (OR: 5,26, IC95%: 4,44-6,23), le diabète sucré (OR: 2,34, IC95%: 1,87-2,91), la résidence à une adresse standard (OR: 2,62, IC95%: 1,91-3,60), la microscopie à frottis positif (OR: 1,74, IC95%: 1,44-2,12), la TB pulmonaire (OR: 1,35, IC95%: 1,14-1,60) et le diagnostic réalisé en raison d'une demande spontanée (OR: 1,26; IC95%: 1,10-1,46) étaient associés à la TB-MDR. Les municipalités qui ont effectué des tests de dépistage du VIH chez moins de 42,65% des patients atteints de TB (OR: 1,50, IC95%: 1,25-1,79), qui ont diagnostiqué des cas de TB uniquement après le décès (OR: 1,50, IC95%: 1,17-1,93) et qui avaient plus de 20,16% de leur population avec un revenu entre » et ½ d'un salaire minimum (OR: 1,56, IC95%: 1,30-1,87) étaient également associées à la TB-MDR. CONCLUSIONS: La connaissance de ces facteurs prédictifs peut aider à développer des stratégies plus complètes de prévention des maladies pour la TB-MDR, en évitant les risques d'extension de la résistance aux médicaments.

Leprosy in urban space, areas of risk for disability and worsening of this health condition in Foz Do Iguaçu, the border region between Brazil, Paraguay and Argentina.

BACKGROUND: Leprosy is a public health problem and a challenge for endemic countries, especially in their border regions where there are intense migration flows. The study aimed to analyse the dynamics of leprosy, in order to identify areas of risk for the occurrence of the disease and disability and places where this health condition is worsening. METHOD: This ecological study considered the new cases of leprosy reported in the municipality of Foz do Iguaçu from 2003 to 2015. Spatial and spatial-temporal scan statistics were used to identify the risk areas for the occurrence of leprosy, as well as the Getis-Ord Gi and Getis-Ord Gi* methods. Areas of risk for disabilities were identified by the scan statistic and kernel density estimation. RESULTS: A total of 840 cases were reported, of which 179 (21.3%) presented Grade 1 or 2 disabilities at the time of diagnosis. Leprosy risk areas were concentrated in the Southern, Eastern and Northeastern Health Districts of the municipality. The cases of Grade 2 disability were observed with higher intensity in regions characterized by high population density and poverty. CONCLUSION: The results of the study have revealed changes in the pattern of areas at risk of leprosy according to the investigated periods. In addition, it was possible to verify disabilities as a condition present in the investigated cases, or that may be related to the late diagnosis of the disease. In the areas of risk identified, patients have reported worse physical disability after diagnostic confirmation, or indicate inadequate clinical examination, reinforcing the need for structuring leprosy control services in a qualified manner.

Using geo-spatial analysis for assessing the risk of hospital admissions due to community-acquired pneumonia in under-5 children and its association with socially vulnerable areas (Brazil).

BACKGROUND: The concentration of under-5 child morbidity and mortality due to pneumonia in developing countries reflects the social inequities. This study aimed to map and assess the spatial risk for hospitalization due to Community-Acquired Pneumonia in children under 5 years of age and its association with vulnerable areas. METHODS: Ecological study in the city of Ribeirão Preto, state of São Paulo, Brazil. The study population consisted of hospitalized under-5 children, diagnosed with community-acquired pneumonia, in Ribeirão Preto-São Paulo-Brazil, from 2012 to 2013. Data were collected in different databases, by a trained team, between March 2012 and August 2013 and from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics. The 956 urban census tracts were considered as the units of analysis. The incidence of cases per 10,000 inhabitants was calculated by census tracts during the study period. For the identification of the spatial risk clusters, the Kernel density estimator and the Getis-Ord Gi* technique were performed. Generalized additive models were used to verify the association between areas with social vulnerability and the occurrence of childhood pneumonia. RESULTS: The study included 265 children under the age of five, hospitalized due to community-acquired pneumonia. A concentration of cases was identified in the regions with greater social vulnerability (low income, poor housing conditions and homelessness), as well as a lower occurrence of cases in the most developed and economically privileged area of the city. The majority of the children lived in territories served by traditional primary healthcare units, in which the health surveillance and family and community focus are limited. It is important to highlight that the tracts with the highest degrees of vulnerability, such as those identified as high vulnerability (urban) and very high vulnerability (subnormal urban clusters). CONCLUSIONS: The results contribute to the comprehension of the social factors involved in child hospitalization due to pneumonia, based on the analysis of the spatial distribution. This approach revealed a strategic tool for diagnosing the disparities as well presenting evidences for the planning in health and strength health care system in achieving equity, welfare and social protection of children.

Risk areas for tuberculosis among children and their inequalities in a city from Southeast Brazil.

BACKGROUND: The objective of the study was to identify areas of risk for the appearance of tuberculosis in children and their association with social inequalities in a municipality in southeastern Brazil. METHODS: Ecological study conducted in Ribeirão Preto, Brazil. To identify areas of spatial risk for tuberculosis in children, we used spatial scanning statistics. To analyze the association of cases of childhood tuberculosis with social vulnerability, we used the Social Vulnerability Index of São Paulo, and four explanatory statistical models were listed. RESULTS: There were 96 cases of childhood tuberculosis, of which 90 were geocoded through a process of converting addresses to geographic coordinates. A risk area was identified in the municipality, where children under 15 years old have 3.14 times greater risk of contracting tuberculosis than those living outside this area. The variables identified as risk factors were: number of private and collective households, proportion of children aged 0 to 5 years in the population, proportion of households without per capita income, and the proportion of private households with monthly nominal incomes of up to one quarter of wage minimums. The variables identified as protection factors were the proportion of women under the age of 30 years responsible for the household under and women responsible for the household with an average income over BRL 2344. CONCLUSION: The study showed areas of risk for the occurrence of tuberculosis in children. The study is in line with the End TB Strategy and the 2030 Agenda, which aim to support strategic actions and, therefore, save the lives of children through the systematic, intensified, and comprehensive identification of children with tuberculosis respiratory symptoms in the community.

Detection of risk clusters for deaths due to tuberculosis specifically in areas of southern Brazil where the disease was supposedly a non-problem.

BACKGROUND: Tuberculosis (TB) is the infectious disease that kills the most people worldwide. The use of geoepidemiological techniques to demonstrate the dynamics of the disease in vulnerable communities is essential for its control. Thus, this study aimed to identify risk clusters for TB deaths and their variation over time. METHODS: This ecological study considered cases of TB deaths in residents of Londrina, Brazil between 2008 and 2015. We used standard, isotonic scan statistics for the detection of spatial risk clusters. The Poisson discrete model was adopted with the high and low rates option used for 10, 30 and 50% of the population at risk, with circular format windows and 999 replications considered the maximum cluster size. Getis-Ord Gi* (Gi*) statistics were used to diagnose hotspot areas for TB mortality. Kernel density was used to identify whether the clusters changed over time. RESULTS: For the standard version, spatial risk clusters for 10, 30 and 50% of the exposed population were 4.9 (95% CI 2.6-9.4), 3.2 (95% CI: 2.1-5.7) and 3.2 (95% CI: 2.1-5.7), respectively. For the isotonic spatial statistics, the risk clusters for 10, 30 and 50% of the exposed population were 2.8 (95% CI: 1.5-5.1), 2.7 (95% CI: 1.6-4.4), 2.2 (95% CI: 1.4-3.9), respectively. All risk clusters were located in the eastern and northern regions of the municipality. Additionally, through Gi*, hotspot areas were identified in the eastern and western regions. CONCLUSIONS: There were important risk areas for tuberculosis mortality in the eastern and northern regions of the municipality. Risk clusters for tuberculosis deaths were observed in areas where TB mortality was supposedly a non-problem. The isotonic and Gi* statistics were more sensitive for the detection of clusters in areas with a low number of cases; however, their applicability in public health is still restricted.

Systematic review of the psychometric properties of instruments to measure sexual desire.

BACKGROUND: Sexual desire is one of the domains of sexual function with multiple dimensions, which commonly affects men and women around the world. Classically, its assessment has been applied through self-report tools; however, an issue is related to the evidence level of these questionnaires and their validity. Therefore, a systematic review addressing the available questionnaires is really relevant, since it will be able to show their psychometric properties and evidence levels. METHOD: A systematic review was carried out in the PubMed, EMBASE, PsycINFO, Science Direct, and Web of Science databases. The search strategy was developed according to the following research question and combination of descriptors and keywords, including original studies with no limit of publication date and in Portuguese, English, and Spanish. Two reviewers carried out the selection of articles by abstracts and full texts as well as the analysis of the studies independently. The methodological quality of the instruments was evaluated by the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. RESULTS: The search resulted in 1203 articles, of which 15 were included in the review. It identified 10 instruments originally developed in the English language. Unsatisfactory results on methodological quality were evidenced in cultural adaptation studies with no description of the steps of the processes and inadequacy of techniques and parameters of adequacy for models. The Principal Component Analysis with Varimax rotation predominated in the studies. CONCLUSIONS: The limitation of the techniques applied in the validation process of the reviewed instruments was evident. A limitation was observed in the number of adaptations conducted and contexts to which the instruments were applied, making it impossible to reach a better understanding of the functioning of instruments. In future studies, the use of robust techniques can ensure the quality of the psychometric properties and the accuracy and stability of instruments. A detailed description of procedures and results in validation studies may facilitate the selection and use of instruments in the academic and/or clinical settings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018085706.