Maternal mortality in South region of Brazil: an analysis from 2000 to 2018.

This study characterises maternal mortality in southern Brazil and verifies its trends between 2000 and 2018. It is an ecological time-series study, analysing secondary data from the Department of Informatics of the Unified Health System. The trend of the maternal mortality ratio (MMR) was calculated using generalised linear regression, and the ratios of the rates according to women's characteristics, with a confidence interval (CI) of 95%. The MMR in the South region went from 53.4 to 36.8 deaths per 100,000 live births from 2000 to 2018, a reduction trend of 1.2 percentage points per year. Mortality was directly related to increasing age (p < .001) and inversely related to schooling (p < .001) and predominated in non-white women (p < .001). The main cause of death was direct causes, including hypertensive disorders. Despite the reduction trend in maternal mortality in southern Brazil, the MMR observed is constantly above the recommended by the World Health Organisation.Impact StatementWhat is already known on this subject? The Maternal Mortality Ratio (MMR) is an indicator that allows an analysis of women's health in relation to the socio-economic and care characteristics of the region where they live. Between 2000 and 2015, Brazil had presented a high MMR, with around 50 deaths per 100,000 live births, while WHO considers a reasonably adequate MMR of fewer than 20 deaths per 100,000 live births.What do the results of this study add? This study updates data about MMR in the Southern Region of Brazil, the one which has the lowest rates in the country, but with variable values between the states. There was a reduction in MMR in southern Brazil between 2000 and 2018 but higher rates for women over 30 years old and in a situation of social vulnerability, as low-income and non-white women. Santa Catarina State presented stable values in the period and remained below the RMM averages of the other states during all years.What are the implications of these findings for clinical practice and/or further research? Comparing previous and current Maternal Mortality Rates in the regional context is important to adapt public health policies for the most affected population. Maternal death is still a reality for single and low-income women, who have greater difficulty in access to health care. Strategies in the Unified Health System are needed to tackle this problem.

Time trend and costs of hospitalizations with diabetes mellitus as main diagnosis in the Brazilian National Health System, 2011 to 2019.

OBJECTIVE: To analyze the diabetes mellitus (DM) temporal trend and hospitalization costs in Brazil, by region, Federative Units (FUs) and population characteristics, from 2011 to 2019. METHODS: This was an ecological study with data from the Hospital Information System, analyzing the annual trend in hospitalization rates for DM according to sex, age, race/skin color and region/FU by Prais-Winsten generalized linear regression. RESULTS: A total of 1,239,574 DM hospitalizations were recorded in the country and the hospitalization rates was 6.77/10,000 inhabitants in the period. The DM hospitalization rates trend was falling for both sexes and in most regions, while it was rising in the younger population and for length of stay (average 6.17 days). Total expenditure was US$ 420,692.23 and it showed a rising trend. CONCLUSION: The temporal trend of hospitalization rates due to DM was falling, with differences according to region/FU and age group. Average length of stay and expenditure showed a rising trend. MAIN RESULTS: From 2011 to 2019, the diabetes mellitus hospitalization rate was 6.77 per 10,000 inhabitants, with a falling trend. Total expenditure was US$420,692.23 and it showed a rising trend. IMPLICATIONS FOR SERVICES: The study warns of the increase in child and adolescent hospitalizations, which indicates the need to invest in preventive actions and early diagnosis. PERSPECTIVES: The increase in length of hospital stay and related costs indicates a worrying scenario for the Brazilian National Health System and emphasizes the need to improve access to and quality of care, with a focus on diabetes education, so as to avoid complications and hospitalizations.

Prevalence and temporal trend of prematurity in Brazil before and during the COVID-19 pandemic: a historical time series analysis, 2011-2021.

OBJECTIVE: to measure the prevalence of prematurity according to the Brazilian macro-regions and maternal characteristics over the past 11 years; to compare the proportions during the COVID-19 pandemic (2020-2021) with those of the historical series (2011-2019). METHODS: this was an ecological study, with data from the Live Birth Information System; the prevalence was calculated according to year, macro-region and maternal characteristics; time series analysis was performed using Prais-Winsten regression model. RESULTS: the prevalence of preterm birth in 2011-2021 was 11.1%, stable; the average in the pandemic period 11.3% (95%CI 11.2;11.4%) was similar to that of the base period 11.0% (95%CI 10.6;11.5%); the North region (11.6%) showed the highest proportion between 2011 and 2021; twin pregnancy (56.3%) and pregnant women who had 4-6 prenatal care visits (16.7%) showed an increasing trend (p-value < 0.001); the highest prevalence was observed for extremes of maternal age, pregnant women of Black race/skin color, indigenous women and those with lower level of education. CONCLUSION: preterm birth rates were highest for socially vulnerable pregnant women, twin pregnancies and in the North; stable prevalence, with no difference between periods.

A portrait of gestational diabetes mellitus in Brazil: A systematic review and meta-analysis.

The diagnostic criteria for gestational diabetes mellitus (GDM), a transient hyperglycemic state during pregnancy, has varied remarkably over time, resulting in a diversity of prevalence rates. The aim of this systematic literature review was to provide estimates of prevalence rates of GDM in Brazil according to different diagnostic criteria. We identified, reviewed, and extracted data from the scientific literature on studies estimating the prevalence of diabetes in pregnant women living in Brazil. The databases searched were PubMed, LILACS, SciELO, Embase, Web of Science, and Cochrane Library. We grouped studies by the source of information assessing GDM, patients' age, and criteria used to diagnose GDM. When three or more studies were available in a group, we calculated the pooled prevalence. The Joanna Briggs Institute (JBI) appraisal tool was used to assess the risk of bias. The data were reported according to the 2020 PRISMA recommendations. The study protocol was registered in PROSPERO. We identified 1,328 records and selected 21 studies involving 122,635 pregnant women. Studies in adults only, with primary data and laboratory measurements, and using the IADPSG criteria (n = 3) had a GDM prevalence of 18.0% (95% confidence interval [CI]: 16.0-20.1%) and included 6,243 participants. Estimates of self-reported GDM (n = 3; 10,136 participants of all ages) had a pooled GDM prevalence of 2.1% (95% CI: 1.5-5.2%), with high heterogeneity (I2 = 85.0%, p < 0.01). Studies including adolescents had consistently low prevalences. The prevalence of GDM in Brazil varied, was greater when the IADPSG criteria were applied, and depended on the methods used to obtain the GDM information and the age structure of the sample.

Dental visits and depression mediating the association of socioeconomic status with oral health behaviors.

Determinants of oral diseases include behaviors, which in turn are influenced by a series of social determinants such as psychosocial aspects and dental care services. Therefore, the aim of this study was to investigate whether depressive symptoms and use of dental care services mediate the relationship between socioeconomic status (SES) and oral health behaviors. This was a cross-sectional study that analyzed data from participants in the 2019 National Health Survey (PNS) (n = 88,531). The eligibility criteria were individuals who were 18 years and older and exclusion criterion was living in households located in special or sparsely populated census tracts. Structural equation modeling (SEM) was used to test direct and indirect pathways from a latent variable for SES to oral health through depressive symptoms (assessed through the "Patient Health Questionnaire-9") and use of dental care services. The maximum likelihood estimator for complex samples with the robust standard error was used. The final model presented an adequate fit: RMESA of 0.008, CFI of 0.998, and SMRM of 0.005. The results showed that higher SES was directly associated with better oral health-related behaviors [standardized coefficient (SC): 0.428; p < 0.01] and indirectly through depressive symptoms [(SC): 0.002; p < 0.01] and dental care services [(SC): 0.089; p < 0.01]. The total effect of SES on oral health-related behaviors was equal to [(SC: 0.519 (p < 0.01)]. In conclusion, the findings suggest that high socioeconomic status, mediated by depressive symptoms and dental care services, has a positive effect on oral health.

Aedes aegypti in Southern Brazil: Spatiotemporal Distribution Dynamics and Association with Climate and Environmental Factors.

In Brazil, the mosquito Aedes (Stegomyia) aegypti is considered the main vector of the dengue, chikungunya, and Zika arbovirus transmission. Recent epidemiological studies in southern Brazil have shown an increase in the incidence of dengue, raising concerns over epidemiological control, monitoring, and surveys. Therefore, this study aimed at performing a historical spatiotemporal analysis of the Ae. aegypti house indices (HI) in southern Brazil over the last 19 years. As vector infestation was associated with climatic and environmental variables, HI data from the Brazilian Ministry of Health, climate data from the Giovanni web-based application, and environmental data from the Mapbiomas project were used in this study. Our results showed an expressive increase in the number of HI surveys in the municipalities confirming the vector presence, as compared to those in 2017. Environmental variables, such as urban infrastructure, precipitation, temperature, and humidity, were positively correlated with the Ae. aegypti HI. This was the first study to analyze Ae. aegypti HI surveys in municipalities of southern Brazil, and our findings could help in developing and planning disease control strategies to improve public health.

Epidemiologic investigation of an occupational illness of tobacco harvesters in southern Brazil, a worldwide leader in tobacco production.

OBJECTIVES: As part of smoking surveillance, the authors conducted an epidemiologic investigation in southern Brazil to identify the occurrence of Green Tobacco Sickness and risk factors for illness and to recommend control and prevention measures. METHODS: A 1:2 case-control study matched by subjects' smoking habits. The study population was residents of Candelária, Rio Grande do Sul state, who farm tobacco and provided a urine sample for cotinine measurement by high-performance liquid chromatography. Confirmed cases were persons with compatible clinical presentation (headache, nausea, vomit, dizziness or weakness) and cotinine level >10 ng/ml. Controls were persons without compatible signs or symptoms. The association measure was the matched OR with 95% CIs and p<0.05. RESULTS: Of 33 confirmed cases, 64% were men, average age was 33 years (SD ± 11.8 years) and 57% were landowners. Cases have had similar illness in the past and were likelier to be workers hired by farmers-landowners than controls. Multivariate analysis yielded independent association between these variables and illness, controlled for age and sex. Contact with pesticides and working with wet tobacco leaves were not associated with illness. CONCLUSIONS: The authors confirmed Green Tobacco Sickness in southern Brazil; the authors recommend investigation of its prevalence in tobacco-growing regions and monitoring of and education about the disease and its prevention by occupational health authorities.

Gestational diabetes mellitus according to different diagnostic criteria: Prevalence and related factors.

OBJECTIVE: Gestational diabetes mellitus (GDM) has an impact on maternal health; however, there is no consensus about the diagnostic criterion and frequency of disease. The objective of this study was to estimate the prevalence of GDM and to evaluate the clinical characteristics of normoglycemic pregnant women and of those diagnosed with gestational diabetes mellitus, based on each criterion. METHODS: Prospective cohort study. Third-trimester pregnant women participated, with the occurrence of GDM being verified, according to two different diagnostic criteria. Prevalence was estimated in each category, and the prevalence ratios (PR) and 95% confidence intervals were adjusted using Poisson Regression. RESULTS: A total of 8.7% of women were diagnosed with GDM (glycemia ≥95) and 8% had glycemic levels ≥92mg/dL according to IADPSG diagnosis. Factors related to the disease were the same, although the magnitude of the associations differed according to the diagnosis criteria. Pre-gestational obesity (PR 3.59 CI 1.28-10,07), previous diseases (PR 3.03 CI 1.15-7.94), and excessive weight gain (PR 4.71 CI 1.80-12.33) were factors related to total GDM, plus low nutritional knowledge (PR 3.17 CI 1.10-9.11). Regardless of the diagnostic criterion, women with GDM were at higher risk of intercurrences during pregnancy. CONCLUSION: Nutritional knowledge and status were associated with GDM occurrence, independently of the diagnosis criteria. The adoption of the glycemic cutoff point of ≥ 92mg/dL indicated an important portion of the population without a diagnosis, suggesting that this cutoff point, more sensitive, should be used in order to guide women and minimize untoward outcomes.

Time series analysis of in-hospital maternal case fatality ratio in the postpartum period according to pregnancy risks and route of delivery in the regions of Brazil, 2010-2019. / Análise temporal da letalidade materna hospitalar no pós-parto segundo risco gestacional e via de parto, nas regiões do Brasil, 2010-2019.

OBJECTIVE: to analyze in-hospital maternal case fatality ratio in the postpartum period according to pregnancy risks and route of delivery, within the Brazilian National Health System, Brazil and macro-regions, 2010-2019. METHODS: this was an ecological time-series study, using data from the Hospital Information System; in-hospital maternal case fatality ratio in the postpartum period took into consideration maternal hospitalizations with outcome 'death' over the total number of hospitalizations per year, according to pregnancy risks and route of delivery, in the regions. RESULTS: there were 19,158,167 hospitalizations for childbirth and 5,110 deaths in the period analyzed; maternal case fatality ratio increased from 1.1 (2010) to 1.9 death/10,000 hospitalizations (2019), in usual-risk pregnancies after vaginal deliveries, and decreased from 10.5 (2010) to 7.0 deaths/10,000 hospitalizations (2019) in high-risk pregnancies after cesarean sections; the Midwest region presented the highest and the South region the lowest case fatality ratio for high-risk pregnancies. CONCLUSION: in-hospital case fatality ratio was higher for high-risk pregnancies, showing differences according to route of delivery and regions.

Increment of Maternal Mortality Among Admissions for Childbirth in Low-risk Pregnant Women in Brazil: Effect of COVID-19 Pandemic?

OBJECTIVE: To assess the possible impact of the COVID-19 pandemic on maternal mortality among admissions for childbirth in 2020 in relation of the last 10 years. METHODS: An ecological study with pregnant women who underwent hospital births at the Brazilian unified public health service (SUS, in the Portuguese acronym) in Brazil from 2010 to 2020. The mortality among admissions for childbirth was obtained based on the number of admissions for childbirth with reported death as outcome divided by the total number of admissions. The underlying gestational risk and route of delivery were considered based on the national surveillance system. The average mortality for the period between 2010 and 2019 (baseline) was compared with the rate of deaths in 2020 (1st pandemic year); the rate ratio was interpreted as the risk of death in 2020 in relation to the average of the previous period (RR), with 95% confidence intervals (CIs). RESULTS: In 2020, the 1st year of the COVID-19 pandemic, 1,821,775 pregnant women were hospitalized for childbirth and 651 deaths were reported, which represents 8.7% of the total hospitalizations and 11.3% of maternal deaths between 2010 and 2020. There was an increase in maternal mortality after births in 2020 compared with the average for the period between 2010 and 2019, specially in low-risk pregnancies, both in vaginal (RR = 1.60; 95%CI:1.39-1.85) and cesarean births (RR = 1.18; 95%CI:1.04-1.34). CONCLUSION: Maternal mortality among admissions for childbirth according to SUS data increased in 2020 compared with the average between 2010 and 2019, with an increment of 40% in low-risk pregnancies. The increase was of 18% after cesarean section and of 60% after vaginal delivery.

OBJETIVO: Avaliar os possíveis impactos da pandemia de COVID-19 na mortalidade materna nas admissões para o parto em 2020 em relação ao histórico dos últimos 10 anos. MéTODOS: Estudo ecológico com gestantes que realizaram parto hospitalar pelo Sistema Unificado de Saúde do Brasil (SUS) de 2010 a 2020. Para obter-se a taxa de mortalidade entre as admissões para o parto, foi utilizado o número de internações para parto que tiveram óbito como desfecho dividido pelo total de internações. O risco gestacional e o tipo de parto foram considerados a partir do sistema de vigilância nacional. A média de mortalidade no período de 2010 a 2019 (linha de base) foi comparada com a taxa de mortalidade pós-parto de 2020 (1° ano pandêmico); a razão das taxas foi interpretada como risco de óbito em 2020 em relação à média no período anterior (RR), com intervalo de confiança (IC) de 95%. RESULTADOS: Em 2020, 1° ano da pandemia de COVID-19, 1.821.775 gestantes foram internadas para o parto e 651 óbitos foram registrados, o que representa 8,7% do total de internações e 11,3% das mortes maternas entre 2010 e 2020. Houve aumento na mortalidade materna após partos em 2020 em relação à média do período entre 2010 e 2019, especialmente em gestações de baixo risco, tanto em partos normais (RR = 1.60; IC95%: 1.39­185) quanto em cesáreas (RR = 1.18; IC95%: 1.04­1.34). CONCLUSãO: A mortalidade entre as admissões para o parto pelo SUS aumentou em 2020 em relação à média de óbitos entre 2010 e 2019, com um incremento de 40% em mulheres de baixo risco gestacional. O aumento verificado foi de 18% após cesárea e de 60% após parto vaginal.

Prostate cancer mortality in Brazil 1990-2019: geographical distribution and trends.

INTRODUCTION: To analyze the trend of prostate cancer mortality in the Brazilian population of 40 years of age and above. METHODS: Time series ecological study of the mortality rates due to prostate cancer in men of 40 years of age and above, using data from the Global Burden of Disease 2019 (GBD). Age-standardized mortality rates were calculated, as well as the age-standardized rates by the GBD for the global population, per 100,000 inhabitants, for Brazil and its States, from 1990 to 2019. The annual average percent change (AAPC) was calculated to identify the mortality trends in Brazil, through linear regression using the Joinpoint Regression Program. RESULTS: The standardized rates of prostate cancer mortality in Brazil were 76.89 in 1990 and 74.96 deaths for every 100 thousand men ≥ 40 years of age in 2019, with a stability trend. By age group, it was observed a decreasing trend up to 79 years of age, and an increasing trend as of 80 years of age. The state of Bahia showed the highest increase in mortality in the period (1.2%/year), followed by Maranhão and Pernambuco (1.0 and 0.9%/year). A decrease of prostate cancer mortality was found in the Federal District, Goiás, Minas Gerais, Rio de Janeiro, Rio Grande do Sul, Roraima, Santa Catarina, São Paulo, and Sergipe. CONCLUSIONS: In Brazil, the standardized mortality rates show a trend toward stability from 1990 to 2019 and no pattern was observed for the trends according to the Brazilian States.

Toothache and tooth extraction as reasons for dental visits: an analysis of the 2019 National Health Survey.

The aim of this study was to analyze the prevalence of dental visits due to toothache and tooth extraction in Brazil and its association with individual and contextual variables. This two-step cross-sectional study included persons aged 18 years and older in the 2019 National Health Survey who had visited a dentist in the 12 months prior to the interview (n = 40,369). The individual-level outcome was having a dental visit due to toothache or tooth extraction. The ecological-level outcome was the proportion of dental visits for these reasons relative to all dental visits by Brazilian state. Associations with individual - sociodemographic characteristics, number of teeth, and type of health service used - and ecological variables - HDI and dental service coverage - were assessed using Poisson regressions. The prevalence of dental visits due to toothache or extraction was higher among individuals with no formal education, household income < 25% of the minimum wage, of black and brown skin color, living in rural areas, who consulted in the public health system, with 10-19 and 1-9 teeth, and men. The proportion of dental visits due to toothache/extraction in Brazilian states was negatively associated with the HDI and the rate of dental emergency team/100,000 inhabitants and positively associated with primary dental care coverage. The prevalence of dental visits due to toothache/extraction was associated with individual and ecological characteristics, indicating inequities in reasons for dental visits in Brazil. The potential of a well-structured oral health care network to overcome these inequities is suggested and needs to be better explored.

Temporal trend and spatial distribution of cases of mother-to-child transmission of HIV in the state of Santa Catarina, Brazil, 2007-2017: an ecological study. / Tendência temporal e distribuição espacial dos casos de transmissão vertical do HIV em Santa Catarina, 2007-2017: um estudo ecológico.

OBJECTIVE: To analyze the temporal trend and spatial distribution of mother-to-child HIV transmission in Santa Catarina between 2007 and 2017. METHODS: This was a mixed ecological study with data from the Notifiable Health Conditions Information System. Linear regression was performed for time series analysis and the mean rates in the period and mean annual percentage changes in the rates of HIV-infected pregnant women were calculated, children exposed to HIV during pregnancy, and seroconversion of children exposed to HIV/AIDS during pregnancy, in addition to data geoprocessing. RESULTS: There were 5,554 records of HIV-infected pregnant women, with a rate of 5.6 pregnant women per 1,000 live births. The mean seroconversion rate was 13.5/100,000 live births (95%CI 6.8;20.1) and it showed a falling trend (APC = -99.4%; 95%CI -99.9;-93.1). The seroconversion rate was more expressive in small towns. CONCLUSION: The rate of HIV-infected pregnant women was stable in the period, whereas the number of children infected with HIV through mother-to-child transmission decreased.

Evolution of diabetes in Brazil: prevalence data from the 2013 and 2019 Brazilian National Health Survey.

The prevalence of diabetes has been growing worldwide. This study aimed to estimate the prevalence of self-reported diabetes in Brazil in 2019, to describe its evolution from 2013, and to evaluate the role of population growth, aging, and other factors in the changes found. The 2019 Brazilian National Health Survey, a nationally representative cross-sectional survey, queried a physician diagnosis of diabetes in a probabilistic multistage cluster sample. The crude prevalence of known diabetes in 2019 was 7.7% (7.4%-8.0%), a 24% relative increase to the prevalence of 2013. Though this increase was greater in men (30%) than women (20%), 2019 prevalence remained higher in women (8.4%) than in men (6.9%). Age-adjusted prevalence was uniformly lower in the North region, and uniformly higher in the Southeast and Central-West regions. In 2019, 12.3 million cases of diabetes were found, a 36.4% increase from the 9.0 million in 2013. Drivers of this rise include increase in size (9.9%) and aging (1.8%) of the Brazilian population, and to all other factors, including increased case-detection and incidence, as well as decreased diabetes mortality (24.7%). Main correlates of greater prevalence - adjusted by the Poisson regression with robust variance - were older age (PR = 27.2, 95%CI: 1.2-42.9 for ≥ 65 years vs. 18-24 years), hypertension (PR = 2.6, 95%CI: 2.4-2.8 vs. normotension), and obesity (PR = 2.3, 95%CI: 2.1-2.5 vs. BMI < 25kg/m2). Those with a complete higher education had a 40% lower prevalence (PR = 0.6; 95%CI: 0.54-0.70 vs. incomplete elementary education). In conclusion, accompanying a worldwide trend, Brazil presents an increasing prevalence of diabetes throughout its regions, posing a huge burden to its population and health systems.

Hospitalization due to abortion in Brazil, 2008-2018: an ecological time-series study. / Internações por aborto no Brasil, 2008-2018: estudo ecológico de série temporal.

OBJECTIVE: To analyze the temporal trend of hospitalizations caused by abortion in Brazil between 2008-2018, according to region and federal units (FU). METHODS: Ecological study concerning hospitalizations due to abortion of women of childbearing age, from Hospital Information System data. The rates were calculated according the characteristics of women. The trend was assessed by Prais-Winsten generalized linear regression. RESULTS: The 2,258,104 hospitalizations due to abortion represent 5% of all hospitalizations in women of childbearing age. Hospitalizations for abortions in Brazil reduced 0.76 in the period; this trend occurred in 19 Brazilian FUs and all regions, except the South (stable). There was a significant reduction (p<0.001) in hospitalizations for spontaneous abortion and in admissions for abortion in women aged 20 to 39 years. CONCLUSION: A temporal trend of reduction in the hospitalizations due to abortion in Brazil was found, variating according to characteristics of the woman, FU and region of residence.

Prevalence, incidence, and years-lived with disability due to oral disorders in Brazil: an analysis of the Global Burden of Disease Study 2019.

INTRODUCTION: Epidemiological surveys revealed that Brazil has a high burden of oral diseases. However, no prior study has reported estimates of untreated dental caries, periodontitis, and edentulism over a three-decade period. The objective of this study is to report the trends of prevalence, incidence, and years-lived with disability (YLDs) due to untreated dental caries in primary and permanent teeth, periodontitis, and edentulism in Brazil between 1990 and 2019. METHODS: Estimates of prevalence, incidence, and YLDs due to dental caries in primary and permanent teeth, periodontitis, and edentulism were produced for Brazil, by sex and age, between 1990 and 2019, using Dismod-MR 2.1, as part of the Global Burden of Disease Study 2019 (GBD 2019). Trends of oral disorders were analyzed using generalized linear regression models applying the Prais-Winsten method. RESULTS: Almost 100 million Brazilians presented at least one oral disorder in 2019, which was equivalent to a prevalence of 45.3%. All oral diseases combined ranked eighth among all causes of disability, causing more than 970,000 YLDs. Untreated dental caries in primary teeth were estimated to affect 13.5 million children, and untreated dental caries in permanent teeth affected more than 52 million people. Periodontitis affected 29.5 million people, and edentulism affected almost 22 million. The generalized linear regression models revealed a trend of stability of oral disorders between 1990 and 2019. CONCLUSIONS: The burden of oral diseases in Brazil is extremely high. Oral disorders, edentulism in particular, caused disability at levels that are comparable to other important chronic diseases.

Incidence and mortality rates of lip, oral cavity, and pharynx cancers in Brazil: time-trend and age-period-cohort analysis from the last 30 years, Global Burden of Disease Study.

INTRODUCTION: Cancers are the second main cause of morbidity worldwide, but robust information on lip, oral cavity, and pharynx cancers in Brazil is lacking. This study aimed to analyze the trends of incidence and mortality caused by lip, oral cavity, and pharynx cancers and age-period-cohort effects in the Brazilian population of 30 years of age and over, in the period of 1990 to 2019. METHODS: A time series study of the incidence and mortality rates for oral cavity and pharynx cancer ("Lip and oral cavity cancer", "Nasopharynx cancer", and "Other pharynx cancer") was conducted, with corrected data from the Global Burden of Disease Study (GBD) 2019. Age-standardized rates per 100,000 inhabitants, for the global population, were gathered according to the individuals' sex. The annual average percentage change (AAPC) was estimated, as was the age-period-cohort effects. RESULTS: The incidence and mortality rates were higher for men in the studied anatomical regions. The cancers tended to decrease for men, except for nasopharynx cancer, which increased in individuals of both sexes. Mortality tended to present a decline in most of the groups studied. For men and women, the age-period-cohort model presented a better adjustment for both incidence and mortality. CONCLUSIONS: Incidence and mortality caused by the main head and neck cancers showed a tendency to decline over the past 30 years in Brazil, except for nasopharynx cancer, which showed an increase in incidence and mortality in some segments of the population. Higher rates were found for lip and oral cavity cancers in men.

Analysis of the first test event in Santa Catarina, Brazil, in the context of the COVID-19 pandemic in July 2021: an experience report. / Análise do primeiro evento-teste de Santa Catarina no contexto da pandemia da COVID-19, em julho de 2021: um relato de experiência.

This study aimed to describe the management and results of the test event for evaluating relaxation of social distancing measures in Santa Catarina, Brazil. This is an experience report that described results of the test event carried out in July 2021 and for which the participants underwent real-time polymerase chain reaction diagnostic testing 72-48 hours before the event and had follow-up for 15 days afterwards. The outcomes analyzed were SARS-CoV-2 infection up to 14 days after the event and presence of symptoms. Among 313 participants, the mean age was 45.1 years and 54.3% were female. During follow-up, 7.7% (24) of the contacted participants reported symptoms compatible with infection, but of the 240 who attended post-event testing, none of the results detected the presence of the virus. No post-event COVID-19 cases were reported. We suggest that other test events be carried out to evaluate the recommendations indicated.

Este estudo visou descrever a gestão e os resultados do evento-teste para flexibilização das medidas de distanciamento em Santa Catarina, Brasil. Trata-se de relato de experiência que descreveu os resultados do evento-teste, realizado em julho de 2021, quando os participantes foram submetidos ao teste diagnóstico de reação em cadeia da polimerase em tempo real 72-48 horas antes, sendo monitorados por 15 dias. Os desfechos analisados foram a infecção pelo SARS-CoV-2 até 14 dias após o evento e a presença de sintomas. Entre 313 participantes, a média de idade foi de 45,1 anos e 54,3% eram do sexo feminino. No monitoramento, 7,7% (24) dos participantes contactados relataram sintomas compatíveis com infecção, embora, dos 240 que compareceram para testagem pós-evento, nenhum resultado tenha acusado presença do vírus. Não houve registro de casos de COVID-19 pós-evento. Sugere-se realização de outros eventos-teste para avaliar as recomendações indicadas.

Este estudio tuvo como objetivo describir la gestión y los resultados del evento test para flexibilizar las medidas de distanciamiento en Santa Catarina, Brasil. Este es un relato de experiencia que describe los resultados del evento, realizado en julio de 2021 y para el cual, los participantes se sometieron a la prueba diagnóstica de reacción en cadena de la polimerasa en tiempo real, 72-48 horas antes, monitoreados durante 15 días. Los desenlaces analizados fueron la infección por SARS-CoV-2 hasta 14 días después del evento y presencia de síntomas. Entre 313 participantes, la edad promedio fue de 45,1 años y 54,3% fueran del sexo femenino. En el seguimiento, 7,7% (24) reportaron síntomas compatibles con infección, pero de los 240 que acudieron a los exámenes posteriores al evento, ninguno de los resultados detectó virus. No se informaron casos de COVID-19 posteriores al evento. Se sugiere realizar otros eventos de prueba para evaluar las recomendaciones indicadas.

Self-reported diabetes and factors associated with it in the Brazilian adult population: National Health Survey, 2019. / Diabetes autorreferido e fatores associados na população adulta brasileira: Pesquisa Nacional de Saúde, 2019.

This study aims to analyze the prevalence of self-reported diabetes and its associated factors in the Brazilian adult population. It is a cross-sectional study using the 2019 National Health Survey. Prevalence and crude prevalence ratios (PRc) and adjusted prevalence ratios (PRa) of self-reported diabetes were estimated, with confidence intervals (95% CI), using Poisson regression. In the 82,349 adults, the prevalence of self-reported diabetes was 7.7%. Positively associated factors were: advanced age with greater association after 60 years (PRa 24.87; 95%CI 15.78-39.18); living in the Northeast (PRa 1.16; 95%CI 1.04-1.29), Southeast (PRa 1.27; 95% CI 1.14-1.43), South (PRa 1.18; 95%CI 1, 05-1.34), and Midwest (PRa 1.21; 95%CI 1.06-1.38); being a former smoker (PRa 1.17; 95%CI 1.09-1.27); self-assessment of regular health (PRa 2.41; 95%CI 2.21-2.64), bad/very bad (PRa 3.45; 95%CI 3.06-3.88); having heart disease (PRa 1.81; 95%CI 1.64-2.00), hypertension (PRa 2.84; 95%CI 2.60-3.69), high cholesterol (PRa 2.22; 95%CI 2.05-2.41), overweight (PRa 1.49; 95%CI 1.36-1.64), and obesity (PRa 2.25; 95%CI 2.05-2.47). It could be concluded that diabetes in Brazilian adults is associated with sociodemographic factors, aging, lifestyle, and morbidities. These results can guide public policies for the prevention and control of disease in Brazil.

O estudo analisa a prevalência de diabetes autorreferido e fatores associados na população adulta brasileira. Estudo transversal usando a Pesquisa Nacional de Saúde 2019. Estimaram-se as prevalências e razões de prevalência brutas (RPb) e ajustadas (RPa) de diabetes autorreferido, com intervalos de confiança (IC95%), empregando-se regressão de Poisson. Nos 82.349 adultos, a prevalência de diabetes autorreferido foi de 7,7%. Associaram-se positivamente: idade avançada, sendo maior após 60 anos (RPa 24,87; IC95%: 15,78-39,18); residir nas regiões Nordeste (RPa 1,16; IC95%: 1,04-1,29), Sudeste (RPa 1,27; IC95%: 1,14-1,43), Sul (RPa 1,18; IC95%: 1,05-1,34) e Centro-Oeste (RPa 1,21; IC95%: 1,06-1,38), ser ex-fumante (RPa 1,17; IC95%: 1,09-1,27), autoavaliação de saúde regular (RPa 2,41; IC95%: 2,21-2,64), ruim/muito ruim (RPa 3,45; IC95%: 3,06-3,88), ter doença cardíaca (RPa 1,81; IC95%: 1,64-2,00), hipertensão (RPa 2,84; IC95%: 2,60-3,69), colesterol elevado (RPa 2,22; IC95%: 2,05-2,41), sobrepeso (RPa 1,49; IC95%: 1,36-1,64) e obesidade (RPa 2,25; IC95%: 2,05- 2,47). Conclui-se que o diabetes nos adultos brasileiros se associa a fatores sociodemográficos, envelhecimento, estilos de vida e morbidades. Esses resultados podem orientar políticas públicas para prevenção e controle da doença no Brasil.