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BACKGROUND: To analyse the temporal trends and spatiotemporal distribution of leprosy relapse in Brazil from 2001 to 2021. METHODS: An ecological study with a temporal trend approach and space-time analysis of leprosy relapse in Brazil was carried out with data from the Notifiable Diseases Information System. RESULTS: A total of 31 334 patients who experienced leprosy relapse were identified. The number of recurrent cases tended to increase throughout the study period, and this increase was significant among females and in almost all age groups, except for those <15, 50-59 and ≥70 y. Several clusters of high- and low-risk patients were identified across all regions with a heterogeneous distribution. CONCLUSIONS: The burden of relapse showed an increasing trend in some groups and was distributed in all regions.
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Lepra , Recurrencia , Análisis Espacio-Temporal , Humanos , Brasil/epidemiología , Femenino , Lepra/epidemiología , Masculino , Adulto , Persona de Mediana Edad , Adolescente , Adulto Joven , Anciano , Niño , Preescolar , LactanteRESUMEN
Objective: the aim of this study was to relate sociodemographic, epidemiological and clinical conditions to the occurrence of severe cases of HZ in reference hospital of Fortaleza. Methods: this is a cross-sectional analytical study, based on medical records of patients admitted from 2009 to 2018. Pearson's x2 test or Fisher's exact test were used when appropriate. Results: we analyzed 196 medical records. The presence of complications occurred in 69.9%, the most affected region was the cranial (68.9%), and 1.5% died. The presence of vesicles (PR=1.37; 95%CI: 1.03-1.82; p=0.01) and the choice of antibiotic associated antiviral therapy (PR=0.58; 95%CI: 0.46-0.73; p=0.00) were significantly associated with the severity. Conclusions: the disease may be more severe at ages over 50. The presence of lesions in vesicles was associated with a higher prevalence of complications and the use of antibiotics and antivirals as a protective factor.
Objetivo: relacionar condições sociodemográficas, epidemiológicas e clínicas à ocorrência de casos graves de HZ em hospital de referência de Fortaleza. Métodos: trata-se de um estudo analítico transversal, baseado em prontuários de pacientes internados de 2009 a 2018. Foram utilizados o teste x2 de Pearson ou o teste exato de Fisher, quando apropriado. Resultados: foram analisados 196 prontuários. A presença de complicações ocorreu em 69,9%, a região mais acometida foi a craniana (68,9%), e 1,5% foi a óbito. A presença de vesículas (RP=1,37; IC95%: 1,03-1,82; p=0,01) e a escolha da terapia antiviral associada a antibióticos (RP=0,58; IC95%: 0,46-0,73; p=0,00) foram significativamente associadas com a gravidade. Conclusões: a doença pode ser mais grave a partir dos 50 anos. A presença de lesões em vesículas foi associada à maior prevalência de complicações e o uso de antibióticos e antivirais como fator de proteção.
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Herpes Zóster , Registros Médicos , Enfermedad , Epidemiología , Herpesvirus Humano 3 , Hospitalización , Pacientes Internos , MétodosRESUMEN
Human Visceral Leishmaniasis (HVL) presents a subacute clinical evolution with systemic involvement, which can result in high case fatality, especially among untreated individuals or those with low socioeconomic status. This study aimed to identify epidemiological and clinical factors associated with HVL case fatality in the Ceara State, from 2007 to 2018. This is an analytical cross-sectional study. The bivariate analysis was performed by Stata 15.1 using Pearson's Chi-square or Fisher's exact test; and Poisson regression for age-controlled multivariate analysis. From 2007 to 2018, there were 4,863 new confirmed cases and 343 deaths from HVL (case fatality rate=7.05%). The risk factors associated with case fatalities were: age group (RR=8.69; 95%CI:3.56-21.20); black population (RR=2.21; 95%CI:1.45-3.35); jaundice symptoms (RR=1.72; 95%CI:1.38-2.14); edema (RR=2.62; 95%CI:2.10-3.26) and hemorrhagic phenomena (RR=1.63; 95%CI:1.26-2.10); and no prescription drug intake (RR=4.03; 95%CI:2.98-5.46). Treatment with pentavalent antimonial was a protective factor (RR=0.35; 95%CI:0.27-0.45). The number of deaths increased among the elderly, illiterate, urban residents, and black skin color individuals. The drugs pentavalent antimonial and amphotericin B showed an association with death, but were not considered causal factors. Treatment failure led to a high risk of death. In multivariate analysis, the risk factors for fatal cases were age group, black skin, symptoms of jaundice, edema and hemorrhagic phenomena; and failure to take the prescription drugs. Treatment with pentavalent antimonial was shown to be a protective factor. Knowing the factors associated with the fatality of VL-HIV cases may help to improve public policies, in order to refine the epidemiological surveillance program and, consequently, prevent deaths related to the disease in Ceara.
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Ictericia , Leishmaniasis Visceral , Anciano , Brasil/epidemiología , Estudios Transversales , Edema , Humanos , Leishmaniasis Visceral/diagnóstico , Leishmaniasis Visceral/tratamiento farmacológico , Leishmaniasis Visceral/epidemiologíaRESUMEN
BACKGROUND: Human visceral leishmaniasis HVL is endemic to 75 countries. The state of Ceará, the Northeast region of Brazil, is of great sanitary importance for the transmission of HVL, and it stands out as an area of interest for epidemiological aspects and control strategies. This study aimed to characterize HVL in relation to epidemiological aspects, composite incidence, and mortality rates in the state of Ceará, Brazil, from 2007 to 2021. METHODS: This ecological study used temporal and spatial cuts of HVL data from the notifiable diseases information system. Epidemiological indicators such as incidence, mortality, and composite indices of incidence and mortality were calculated according to the Ministry of Health standardization. RESULTS: There were 6,775 confirmed cases, with high incidence coefficients in 2009 6.96 cases/100,000 inhabitants and 2011 9.83 cases/100,000 inhabitants, and the highest mortality rate in 2011 6.96 deaths/100,000 inhabitants. The composite index of incidence and mortality identified municipalities in the Northern, Northwestern, and Southern regions of Ceará as having the highest risk of HVL. CONCLUSIONS: HVL remained endemic throughout the study period, with epidemiological indicators and risk of transmission expressing high magnitude, mainly in the Northeast, Northwest, and South regions of Ceará.
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Leishmaniasis Visceral , Brasil/epidemiología , Ciudades , Humanos , IncidenciaRESUMEN
ABSTRACT Background: Human visceral leishmaniasis HVL is endemic to 75 countries. The state of Ceará, the Northeast region of Brazil, is of great sanitary importance for the transmission of HVL, and it stands out as an area of interest for epidemiological aspects and control strategies. This study aimed to characterize HVL in relation to epidemiological aspects, composite incidence, and mortality rates in the state of Ceará, Brazil, from 2007 to 2021. Methods: This ecological study used temporal and spatial cuts of HVL data from the notifiable diseases information system. Epidemiological indicators such as incidence, mortality, and composite indices of incidence and mortality were calculated according to the Ministry of Health standardization. Results: There were 6,775 confirmed cases, with high incidence coefficients in 2009 6.96 cases/100,000 inhabitants and 2011 9.83 cases/100,000 inhabitants, and the highest mortality rate in 2011 6.96 deaths/100,000 inhabitants. The composite index of incidence and mortality identified municipalities in the Northern, Northwestern, and Southern regions of Ceará as having the highest risk of HVL. Conclusions: HVL remained endemic throughout the study period, with epidemiological indicators and risk of transmission expressing high magnitude, mainly in the Northeast, Northwest, and South regions of Ceará.
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ABSTRACT Human Visceral Leishmaniasis (HVL) presents a subacute clinical evolution with systemic involvement, which can result in high case fatality, especially among untreated individuals or those with low socioeconomic status. This study aimed to identify epidemiological and clinical factors associated with HVL case fatality in the Ceara State, from 2007 to 2018. This is an analytical cross-sectional study. The bivariate analysis was performed by Stata 15.1 using Pearson's Chi-square or Fisher's exact test; and Poisson regression for age-controlled multivariate analysis. From 2007 to 2018, there were 4,863 new confirmed cases and 343 deaths from HVL (case fatality rate=7.05%). The risk factors associated with case fatalities were: age group (RR=8.69; 95%CI:3.56-21.20); black population (RR=2.21; 95%CI:1.45-3.35); jaundice symptoms (RR=1.72; 95%CI:1.38-2.14); edema (RR=2.62; 95%CI:2.10-3.26) and hemorrhagic phenomena (RR=1.63; 95%CI:1.26-2.10); and no prescription drug intake (RR=4.03; 95%CI:2.98-5.46). Treatment with pentavalent antimonial was a protective factor (RR=0.35; 95%CI:0.27-0.45). The number of deaths increased among the elderly, illiterate, urban residents, and black skin color individuals. The drugs pentavalent antimonial and amphotericin B showed an association with death, but were not considered causal factors. Treatment failure led to a high risk of death. In multivariate analysis, the risk factors for fatal cases were age group, black skin, symptoms of jaundice, edema and hemorrhagic phenomena; and failure to take the prescription drugs. Treatment with pentavalent antimonial was shown to be a protective factor. Knowing the factors associated with the fatality of VL-HIV cases may help to improve public policies, in order to refine the epidemiological surveillance program and, consequently, prevent deaths related to the disease in Ceara.
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Visceral leishmaniasis (VL) is considered as an important tropical disease because it rapidly spreads across a wide geographical area. This study aimed to analyse the temporal and spatial patterns of incidence, mortality and case fatality rates due to human VL in Ceará, Brazil, from 2007 to 2018. This is an ecological study involving time series and spatial analyses, and data were obtained from human VL notifications. Temporal trend analysis was carried out using the Joinpoint Regression Program. SaTScan 9.6 was used for conducting spatial analyses, and ArcMap 9.2 was used for building maps. There were 6,066 incident cases and 516 deaths due to human VL. There was an increasing trend in the incidence rate from 2007 to 2014 (annual per cent change [APC] = 3.8; 95% confidence interval [CI]:0.5 to 7.3; p = .031). Mortality (APC = -0.3; 95%CI: -2.5 to 1.9; p = .765) and VL case fatality rates (APC = -3.0; 95%CI: -4.3 to -1,7; p = .188) showed non-significant decline. The incidence rates were higher in the northwest and south regions of the state, with 11 high incidence rate clusters from 2007 to 2010, seven clusters in 44 municipalities from 2011 to 2014, and six clusters in 49 municipalities from 2015 to 2018. During 2007-2010, only one significant mortality rate cluster was identified in the southern region (relative risk [RR] = 7.6); during 2011-2014, two clusters in the northwest region were identified (RR=3.9 and RR=4.6). In the last period, a cluster of 11 municipalities in the southern region was identified (RR = 4.2). Mortality rate clusters were identified in the centre-south (2007-2010), northwest and south (both from 2011 to 2018). VL has a heterogeneous distribution, with maintenance of clusters with high incidence and mortality rates, as well as case fatality rates in municipalities in the northwest and south regions. These clusters present areas with the greatest risk of transmission of human VL.
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Leishmaniasis Visceral , Animales , Brasil/epidemiología , Ciudades , Humanos , Incidencia , Leishmaniasis Visceral/epidemiología , Leishmaniasis Visceral/veterinaria , Análisis EspacialRESUMEN
INTRODUCTION: This study analyzed the magnitude and temporal trends of leprosy relapse in Ceará in 2001-2018. METHODS: Descriptive cross-sectional and ecological-time trend studies were performed. RESULTS: We diagnosed 1,777 leprosy relapse cases. Higher prevalence of relapse was observed in men, illiterates, mixed race, multibacillary leprosy, lepromatous leprosy, and persons with visible disabilities. The proportion of relapse increased throughout the study period. CONCLUSIONS: Leprosy relapse is prevalent in certain groups.
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Lepra Multibacilar , Lepra , Brasil/epidemiología , Estudios Transversales , Humanos , Lepra/epidemiología , Masculino , RecurrenciaRESUMEN
Resumo O artigo apresenta um estudo exploratório descritivo sobre habilidades de Comunicação de Más Notícias (CMN) de internos de Medicina. Investigou-se a percepção discente sobre aprendizagem para CMN com delineamento transversal e abordagem mista. Houve aplicação de questionário, obtendo 176 participantes, e grupo focal com 12 estudantes. Os dados foram analisados pelo cálculo das médias e desvios-padrão para variáveis quantitativas e as falas do grupo focal foram submetidas à Análise de Conteúdo. Observou-se o dobro da frequência com mais habilidade para CMN no grupo que teve treinamento em comparação ao que não teve. No manejo da CMN, considerou-se mais difícil "ser honesto, sem tirar a esperança" (69%) e "lidar com a emoção do paciente" (59%). 99,4% conheciam o protocolo SPIKES, destes 41,5% consideraram a expressão de emoções sua etapa mais difícil. A comunicação e o manejo das emoções foram apontados como desafios na relação médico-paciente, com déficits no ensino de CMN. Obteve-se que a CMN não se limita à técnica, mas envolve atitudes que precisam ser abordadas com metodologias diversas, assim como requerem a implementação de políticas de educação na área médica, sobretudo diante das demandas emergentes da pandemia de Covid-19.
Abstract The article presents an exploratory, descriptive study on Bad News Communication skills (CMN) of medical interns. The student's perception was on learning for the CMN was investigated with a cross-sectional design and a mixed approach. A questionnaire was applied, 176 participants were obtained, and a focus group was held with 12 students. The data were analyzed through the calculation of means and standard deviations for quantitative variables and the focus group reports were subjected to Content Analysis. It was observed that in the group that had training, compared to the one who did not, ocurred twice frequency with more skill for CMN. In the CMN's management, it was considered harder to be "honest without taking away hope" (69%) and "to deal with the patient's emotion" (59%). 99.4% knew the SPIKES protocol, of which 41.5% considered the expression of emotions as its most difficult stage. Communication and handling of emotions were pointed out as the main difficulties in the doctor-patient relationship, with deficits in the teaching of CMN. It was found that CMN is not limited to the technical issue, but it involves attitudes that need to be addressed with different methodologies, as well as the implementation of educational policies in the medical field, especially given the demands that emerges with the covid-19 pandemic.
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Humanos , Masculino , Femenino , Relaciones Médico-Paciente , Estudios Transversales , Comunicación , Educación Médica , Educación de Pregrado en Medicina , COVID-19RESUMEN
Objetivo: Relacionar as condições sociodemográficas, epidemiológicas e clínicas à ocorrência de casos graves de varicela. Métodos: Trata-se de um estudo transversal e analítico, tendo como fonte de dados prontuários de pacientes internados entre os anos de 2009 a 2018 no Hospital São José de doenças infecciosas (HSJ). Todas as variáveis selecionadas foram analisadas pelo programa Stata versão 15.1 e relacionadas com a presença de complicação, de forma a descobrir os fatores associados. Resultado: De um total de 302 prontuários, 54,3% eram do sexo masculino com idade mediana de 8 anos. A presença de complicação ocorreu em 82,4%, sendo complicações cutâneas as mais relatadas (65,4%). Das internações, 2,3% foram a óbito. A escolha da terapêutica com uso de antivirais associados a antibióticos (RP: 0,44; IC95%: 0,33 0,59 p=0,00) e alterações no exame de raios x de tórax (RP: 1,37; IC95%: 1,13 1,66; p=0,01) foram significativamente associados à gravidade do quadro de infecção por varicela. Conclusão: A varicela não deve ser considera uma doença inofensiva devido aos inúmeros tipos de complicações que podem associar-se à doença, causando internamento hospitalar e, em alguns casos, necessidade de tratamento intensivo. Os fatores associados foram a terapêutica utilizada, reduzindo a gravidade, e alteracoes no raio-x, aumentando a gravidade do caso.
Objective: The aim of this study is to relate sociodemographic, epidemiological and clinical conditions to the occurrence of severe cases of varicella. Methods: This is a cross-sectional and analytical study, using as a source of data medical records of patients hospitalized between the years 2009 to 2018 at the São José Hospital for infectious diseases (HSJ). All selected variables were analyzed by Stata program version 15.1 and related to the presence of complication in order to discover the associated factors. Result: From a total of 302 records, 54.3% were male, with a median age of 8 years. The presence of complications occurred in 82.4%, with cutaneous complications being the most reported (65.4%). Of the hospitalizations, 2.3% died. Choice of therapy with use of antivirals associated with antibiotics (PR: 0.44; 95% CI: 0.33 - 0.59; p = 0.00) and changes in chest x-ray exams (PR: 1.37; 95% CI: 1.13 - 1.66; p = 0.01) were significantly associated with the severity of varicella infection. Conclusion: Varicella should not be considered a harmless disease due to the numerous types of complications that can be associated with the disease, causing hospitalization and, in some cases, the need for intensive treatment. The associated factors were the therapy used, reducing the severity, and changes on x-ray that increased the severity of the case.
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Varicela , Pacientes , Sexo , Terapéutica , Registros Médicos , Epidemiología , Enfermedades Transmisibles , Factores de Riesgo , InfeccionesRESUMEN
Abstract INTRODUCTION: This study analyzed the magnitude and temporal trends of leprosy relapse in Ceará in 2001-2018. METHODS: Descriptive cross-sectional and ecological-time trend studies were performed. RESULTS: We diagnosed 1,777 leprosy relapse cases. Higher prevalence of relapse was observed in men, illiterates, mixed race, multibacillary leprosy, lepromatous leprosy, and persons with visible disabilities. The proportion of relapse increased throughout the study period. CONCLUSIONS: Leprosy relapse is prevalent in certain groups.
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Humanos , Masculino , Lepra Multibacilar , Lepra/epidemiología , Recurrencia , Brasil/epidemiología , Estudios TransversalesRESUMEN
OBJECTIVE: To analyze the temporal trend and describe the spatial distribution of Visceral Leishmaniasis (VL) in Fortaleza from 2007 to 2017. METHODS: This was an ecological study using segmented temporal regression and thematic mapping. RESULTS: Between 2007-2017, 1,660 new cases and 97 deaths were confirmed. The overall incidence rate showed a rising trend (Annual Percent Change - APC=8.7% - 95%CI -3.3;34.1), while the mortality rate (APC=-25.9 - 95%CI -48.5;-10.6) and lethality (APC=-33.0 - 95%CI -53.7;-17.6) showed a falling trend. From 2010-2015 the incidence rate fell (APC=-15.8 - 95%CI -25.1;-4.0), but mortality (APC=18.7 - 95%CI 9.4;50.6) and lethality (APC=40.1 - 95%CI 22.5;72.0) had an upward trend. In 2015-2017, incidence (APC=-24.6 - 95%CI -36.2;-10.3), and mortality (APC=-44.6 - 95%CI -58.8;-17,6) fell, while lethality remained stable (APC=-13.5 - 95%CI -38.7;3.8). High incidence neighborhoods were clustered in the western region of the city, however, mortality and lethality did not present defined spatial patterns. CONCLUSION: VL is endemic in Fortaleza, although there was a reduction in the last three years studied.
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Leishmaniasis Visceral , Brasil/epidemiología , Humanos , Incidencia , Leishmaniasis Visceral/epidemiología , Análisis Espacio-TemporalRESUMEN
RESUMO: Objetivo: Descrever a tendência temporal da hanseníase e seus indicadores epidemiológicos em uma região de saúde do estado do Ceará, no período de 2001 a 2015. Métodos: Estudo ecológico de base temporal, realizado a partir de dados obtidos pelo Sistema Nacional de Agravos de Notificação (SINAN), referentes aos casos novos de hanseníase registrados durante o período de 2001 a 2015. Os dados foram analisados a partir do modelo de regressão por pontos de inflexão (Joinpoint). Resultados: Dos 1.151 casos notificados no período, verificou-se redução do coeficiente de detecção geral e em menores de 15 anos. Em relação à proporção de casos com grau 2 de incapacidade física, identi-ficou-se uma tendência de aumento significativo (APC = 9,04; IC95% 1,017,8), assim como nos casos multibacilares (APC = 2,89; IC95% 0,3-5,5). Conclusão: Concluiu-se que há aumento no número de casos multibacilares e com grau 2 de incapacidade física, tornando-se necessário o fortalecimento das medidas de vigilância e controle da doença na região. (AU)
ABSTRACT: Objective: Describing the temporal trend of leprosy and its epidemiological indicators in a health region in the state of Ceará, from 2001 to 2015. Methods: Ecological study based on the indicators monitored using the Information System of Notifiable Diseases . Data were analyzed using the inflection point regression model (Joinpoint). Results: Of the 1,151 cases reported in the period, there was a reduction in the general detection coefficient and children under 15 years old. For proportions of cases with grade 2 physical disability, a significant increase (APC = 9.04; 95% CI 1.017.8) was observed, as well as in multibacillary cases (APC = 2.89; 95% CI 0.3-5.5). Conclusion: There is an increase in the number of multibacillary cases and with grade 2 of physical disability, making it neces-sary to strengthen the measures of surveillance and disease control in the region. (AU)
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Estudios de Series Temporales , Notificación de Enfermedades , Enfermedades Endémicas , Enfermedades Desatendidas , Sistemas de Información en Salud , Lepra/epidemiologíaRESUMEN
Objective. To analyze the temporal trend and describe the spatial distribution of Visceral Leishmaniasis (VL) in Fortaleza from 2007 to 2017. Methods. Ecological study using segmented temporal regression and spatial distribution. Results. Between 2007-2017, 1,660 new cases and 97 deaths were confirmed. The incidence was ascending (Annual Percent Change (APC)=8.7% 95%CI -3.3;34.1), but descending mortality and lethality: APC=-25.9 (95%CI -48.5;-10.6) and APC=-33.0 (95%CI -53.7;-17.6), respectively. From 2010-2015 the incidence decreased (APC=-15.8 95%CI -25.1;-4.0), but mortality (APC=18.7 95%CI 9.4;50.6) and lethality (APC=40.1 95%CI 22.5;72.0) had an upward trend. In 2015-2017, decreased incidence (APC=-24.6 95%CI -36.2;-10.3), and mortality (APC=-44.6 95%CI -58.8;-17,6) lethality remained stable (APC=-13.5 95%CI -38.7;3.8). High incidence neighborhoods were clustered in the western region, however, mortality and lethality did not present defined spatial patterns. Conclusion. VL is endemic in Fortaleza, although there has been a decline in the last three years studied.
Objetivo. Analisar a tendência temporal e descrever a distribuição espacial da leishmaniose visceral (LV) em Fortaleza, 2007-2017. Métodos. Estudo ecológico, mediante regressão temporal segmentada e mapeamento temático. Resultados. No período 2007-2017, foram confirmados 1.660 casos novos e 97 óbitos. No período 2007-2010, a incidência foi ascendente (variação percentual anual [Annual Percent Change], APC=8,7% IC95% -3,3;34,1), enquanto a mortalidade (APC=-25,9 IC95% -48,5;-10,6) e a letalidade (APC=-33,0 IC95% -53,7;-17,6), descendentes. No período 2010-2015, a incidência reduziu-se (APC=-15,8 IC95% -25,1;-4,0) mas a mortalidade (APC=18,7 IC95% 9,4;50,6) e a letalidade (APC=40,1 IC95% 22,5;72,0) apresentaram tendência de crescimento. Em 2015-2017, decresceram a incidência (APC=-24,6 IC95% -36,2;-10,3), e a mortalidade (APC=-44,6 IC95% -58,8;-17,6), a letalidade se manteve estável (APC=-13,5 IC95% -38,7;3,8). Houve concentração de bairros com incidência elevada na região oeste da cidade; porém, a mortalidade e a letalidade não apresentaram padrões espaciais definidos. Conclusão. A LV é endêmica em Fortaleza, embora tenha havido declínio no último triênio estudado.
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Visceral leishmaniasis is a highly lethal zoonosis transmitted by a sandfly. It is caused by a Leishmania protozoan parasite and dogs are the main reservoir. Ceara State is endemic to visceral leishmaniasis and it is considered a high risk transmission area. Temporal and spatial epidemiological studies have been used as tools to analyze the distribution and frequency of human visceral leishmaniasis (HVL). This study aimed to characterize HVL in its epidemiological andtemporal aspects in Ceara State, from 2003 to 2017, as this is a neglected disease and a public health problem. This is an ecological study carried out with HVL confirmed cases in Ceara, using three blocks of years (2003 to 2007, 2008 to 2012 and 2013 to 2017). The disease presented an endemic behavior, affecting mainly male residents in the urban area, especially children under five and young adults between 30 and 49 years old. HVL is recorded in all the municipalities, for more than 10 years, with a growing trend and territorial expansion to the Central and Eastern regions of the State. The results of this study indicated the increase in the incidence and lethality, as well as the expansion of leishmaniasis in Ceara State.
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Enfermedades Endémicas , Leishmaniasis Visceral/epidemiología , Adulto , Animales , Brasil/epidemiología , Preescolar , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Análisis Espacio-TemporalRESUMEN
Objetivo: Analisar a tendência temporal e descrever a distribuição espacial da leishmaniose visceral (LV) em Fortaleza, 2007-2017. Métodos: Estudo ecológico, mediante regressão temporal segmentada e mapeamento temático. Resultados: No período 2007-2017, foram confirmados 1.660 casos novos e 97 óbitos. No período 2007-2010, a incidência foi ascendente (variação percentual anual [Annual Percent Change], APC=8,7% - IC95% -3,3;34,1), enquanto a mortalidade (APC=-25,9 - IC95% -48,5; -10,6) e a letalidade (APC=-33,0 - IC95% -53,7;-17,6), descendentes. No período 2010-2015, a incidência reduziu (APC=-15,8 - IC95% -25,1;-4,0), mas a mortalidade (APC=18,7 - IC95% 9,4;50,6) e a letalidade (APC=40,1 - IC95% 22,5;72,0) apresentaram tendência de crescimento. Em 2015-2017, decresceram a incidência (APC=-24,6 - IC95% -36,2;-10,3) e a mortalidade (APC= -44,6 - IC95% -58,8;-17,6); a letalidade se manteve estável (APC=-13,5 - IC95% -38,7;3,8). Houve concentração de bairros com incidência elevada na região oeste da cidade; porém, a mortalidade e a letalidade não apresentaram padrões espaciais definidos. Conclusão: A LV é endêmica em Fortaleza, embora tenha havido declínio no último triênio estudado.
Objetivo: Analizar la tendencia temporal y describir la distribución espacial de la leishmaniasis visceral (LV) en Fortaleza de 2007 a 2017. Métodos: Estudio ecológico utilizando regresión temporal segmentada y mapas temáticos. Resultados: Entre 2007-2017, se confirmaron 1,660 casos nuevos y 97 muertes. La incidencia fue ascendente (cambio porcentual anual [Annual Percent Change], APC=8,7% - IC95% -3,3;34,1), y mortalidad y letalidad descendentes: APC=-25,9 (IC95% -48,5;-10,6) y APC=-33,0 (IC95% -53,7;-17,6), respectivamente. Desde 2010-2015, la incidencia disminuyó (APC=-15,8 - IC95% -25,1;-4,0), pero la mortalidad (APC=18,7 - IC95% 9,4; 50,6) y la letalidad (APC=40,1 - IC95% 22,5; 72,0) tuvieron una tendencia al alza. En 2015-2017, disminuyeron incidencia (APC=-24,6 - IC95% -36,2;-10,3), y mortalidad (APC=-44,6 - IC95% -58,8;-17,6) la letalidad se mantuvo estable (APC=-13,5 - IC95% -38,7; 3,8). Los barrios con alta incidencia se agruparon en la región oeste de la ciudad, pero, la mortalidad y la letalidad no fueron definidos espacialmente. Conclusión: La LV es endémica en Fortaleza, aunque ha habido una disminución en el último trienio estudiado.
Objective: To analyze the temporal trend and describe the spatial distribution of Visceral Leishmaniasis (VL) in Fortaleza from 2007 to 2017. Methods: This was an ecological study using segmented temporal regression and thematic mapping. Results: Between 2007-2017, 1,660 new cases and 97 deaths were confirmed. The overall incidence rate showed a rising trend (Annual Percent Change - APC=8.7% - 95%CI -3.3;34.1), while the mortality rate (APC=-25.9 - 95%CI -48.5;-10.6) and lethality (APC=-33.0 - 95%CI -53.7;-17.6) showed a falling trend. From 2010-2015 the incidence rate fell (APC=-15.8 - 95%CI -25.1;-4.0), but mortality (APC=18.7 - 95%CI 9.4;50.6) and lethality (APC=40.1 - 95%CI 22.5;72.0) had an upward trend. In 2015-2017, incidence (APC=-24.6 - 95%CI -36.2;-10.3), and mortality (APC=-44.6 - 95%CI -58.8;-17,6) fell, while lethality remained stable (APC=-13.5 - 95%CI -38.7;3.8). High incidence neighborhoods were clustered in the western region of the city, however, mortality and lethality did not present defined spatial patterns. Conclusion: VL is endemic in Fortaleza, although there was a reduction in the last three years studied.
Asunto(s)
Humanos , Enfermedades Desatendidas , Análisis Espacio-Temporal , Leishmaniasis Visceral/epidemiología , Factores Socioeconómicos , Brasil/epidemiología , Incidencia , Estudios EcológicosRESUMEN
Abstract INTRODUCTION: This study investigated the spatial distribution of inappropriate post-exposure human rabies procedures in Ceará, Brazil, between 2007 and 2015. METHODS: The ecological study population was based on the records of post-exposure human rabies procedures from the Notification Disease Information System. We analyzed the data using the Moran Index (I) and the Moran Local Index. RESULTS: There were 222,036 (95.8%) records with inappropriate post-exposure human rabies procedures. There was heterogeneity in their spatial distribution, with two significant clusters in the northeast and northwest regions. CONCLUSIONS: These findings help elaborate differentiated strategies to reduce unnecessary post-exposure human rabies procedures.
Asunto(s)
Humanos , Rabia/prevención & control , Vacunas Antirrábicas/administración & dosificación , Profilaxis Posexposición/estadística & datos numéricos , Notificación de Enfermedades , Profilaxis Posexposición/métodos , Análisis EspacialRESUMEN
RESUMO Objetivo Analisar a aplicabilidade da Screening of Activity Limitation and Safety Awareness (SALSA) para a avaliação da capacidade funcional de idosos com hanseníase. Método Pesquisa descritiva, transversal, desenvolvida com 77 idosos com hanseníase acompanhados no Centro de Referência em Dermatologia, em Fortaleza, Ceará, de junho a agosto de 2015, por meio da aplicação da SALSA e de outras duas escalas já validadas para uso em idosos. Para a análise, utilizou-se estatística descritiva e inferencial. Resultados Houve convergência entre as escalas (p=0,0000) na avaliação da capacidade funcional. As variáveis idade e sexo apresentaram maior número de associações com as atividades avaliadas, ao passo que, nas variáveis clínicas relacionadas à hanseníase, apenas o grau de incapacidade física apresentou relação com mais de duas atividades. Conclusão A SALSA contribuiu para a avaliação eficaz da capacidade funcional na população estudada, sendo mais influenciada pela idade do que pela hanseníase. Implicações para a prática: Assim, recomenda-se a sua aplicação nas consultas iniciais como instrumento de rastreio da capacidade funcional de idosos com hanseníase.
RESUMEN Objetivo Analizar la aplicabilidad del Screening of Activity Limitation and Safety Awareness (SALSA) para evaluación de la capacidad funcional de personas mayores con lepra. Método Investigación descriptiva, transversal, desarrollada con 77 personas mayores con enfermedad de Hansen acompañadas por el Centro de Referencia en Dermatología, en Fortaleza, Ceará, desde junio hasta agosto de 2015, mediante la aplicación de la SALSA y otras dos escalas ya validadas para uso en personas de edad avanzada. Para el análisis, se utilizó estadística descriptiva e inferencial. Resultados Hubo convergencia entre las escalas (p=0,0000) en la evaluación de la capacidad funcional. Los variables edad y sexo mostraron mayor número de asociaciones con las actividades evaluadas, mientras que en las variables clínicas relacionadas con la lepra, apenas el grado de incapacidad física presentó relación con más de dos actividades. Conclusiones La SALSA ha contribuido a la efectiva evaluación de la capacidad funcional en la población estudiada, siendo influenciada más por edad que por la enfermedad de Hansen. Implicaciones para la práctica: Su aplicación se recomienda en las consultas iniciales como una herramienta para la detección de la capacidad funcional de personas mayores con lepra.
ABSTRACT Objective To analyze the applicability of Screening of Activity Limitation and Safety Awareness (SALSA) for the evaluation of the functional capacity of the elderly with leprosy. Method Descriptive and transversal research, developed with 77 elderly people with Hansen's disease accompanied at the Reference Center in Dermatology, in Fortaleza, Ceará, from June to August 2015, through the application of SALSA and two other scales already validated for use in elderly. For the analysis, descriptive and inferential statistics were used. Results There was convergence between the scales (p=0.0000) on the evaluation of functional capacity. The variables age and gender showed a larger number of associations with the activities evaluated, whereas, in the clinical variables related to leprosy, just the grade of disability presented a relationship with more than two activities. Conclusion and Implications for practice The SALSA has contributed to the effective evaluation of functional capacity in the population studied, being more influenced by age than by leprosy. SALSA's application is recommended in the initial consultations as a tool for screening of the functional capacity of older people with leprosy.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Evaluación Geriátrica , Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud/estadística & datos numéricos , Lepra , Factores Socioeconómicos , Actividades Cotidianas , Estudios TransversalesRESUMEN
INTRODUCTION: This study investigated the spatial distribution of inappropriate post-exposure human rabies procedures in Ceará, Brazil, between 2007 and 2015. METHODS: The ecological study population was based on the records of post-exposure human rabies procedures from the Notification Disease Information System. We analyzed the data using the Moran Index (I) and the Moran Local Index. RESULTS: There were 222,036 (95.8%) records with inappropriate post-exposure human rabies procedures. There was heterogeneity in their spatial distribution, with two significant clusters in the northeast and northwest regions. CONCLUSIONS: These findings help elaborate differentiated strategies to reduce unnecessary post-exposure human rabies procedures.
Asunto(s)
Profilaxis Posexposición/estadística & datos numéricos , Vacunas Antirrábicas/administración & dosificación , Rabia/prevención & control , Notificación de Enfermedades , Humanos , Profilaxis Posexposición/métodos , Análisis EspacialRESUMEN
Resumo Introdução A principal recomendação para o controle da raiva em humanos é a vacinação profilática. Objetivo Considerando-se a endemicidade da raiva no Brasil e o direcionamento das ações de controle, buscou-se caracterizar a tendência temporal dos atendimentos antirrábicos humanos pós-exposição no Ceará, de 2007 a 2015. Método O estudo é ecológico de tendência temporal e analítico. Os dados das fichas de atendimento antirrábico foram organizados em planilhas e calculados os coeficientes anuais de prevalência. Resultados Houve 231.694 atendimentos antirrábicos, com coeficientes de prevalência crescentes de 2007 a 2011 (35,09 por 10.000 habitantes; APC=13,5; p<0,001) e ápice em 2015 (40,35 por 10.000 habitantes; APC=5,5; p=0,005). Houve um aumento na faixa etária de 20 a 59 anos (APC=14,0; p<0,001), e residentes da zona urbana (APC=7,0; p<0,001). A espécie canina teve tendência crescente de 2007 a 2011 (APC=14,3; p<0,001). Das notificações, 95,8% apresentaram condutas inadequadas, com crescimento nos coeficientes de prevalência de 2007 a 2011 (APC=13,6; p<0,001). Conclusão As condutas profiláticas inadequadas aconteceram mais de 2007 a 2011. A análise temporal, com tendência crescente no período analisado, deve ser utilizada como componente contínuo das ações de vigilância da raiva no Ceará, para assistência adequada e segura aos pacientes vítimas de agressão animal.
Abstract Background The main recommendation for the control of rabies in humans is the prophylactic vaccination. Objective Considering the endemicity of rabies in Brazil and the direction of control actions, it was aimed to characterize the temporal trend of post-exposure human anti-rabies in Ceará from 2007 to 2015. Method The study is ecological with a temporal trend and analytical. The data of the anti-rabies data sheets were organized into spreadsheets and the annual prevalence coefficients were calculated. Results There were 231,694 rabies treatments, with prevalence coefficients increasing from 2007 to 2011 (35.09 per 10,000 inhabitants, APC = 13.5, p <0.001) and apex in 2015 (40.35 per 10,000 inhabitants, APC = 5, 5, p = 0.005). There was an increase in the age group of 20 to 59 years old (APC = 14.0, p <0.001), and urban residents (APC = 7.0, p <0.001). The canine species showed an increasing trend from 2007 to 2011 (APC = 14.3, p <0.001). Of the notifications, 95.8% presented inadequate behaviors, with an increase in the prevalence coefficients from 2007 to 2011 (APC = 13.6, p <0.001). Conclusion Inadequate prophylactic behaviors occurred more than 2007 to 2011. The temporal analysis, with an increasing trend in the analyzed period, should be used as a continuous component of the rabies surveillance actions in Ceará, for adequate and safe assistance to the patients who are victims of animal aggression.