Describing Trends in Maternal Mortality in the State of São Paulo, Brazil, from 2009 to 2019.

BACKGROUND: Maternal mortality is a significant public health concern, with varying impacts across different regions in Brazil, particularly affecting women from lower-income social classes with limited access to social resources. The aim of this study is to describe the trends in maternal mortality in São Paulo, Brazil, from 2009 to 2019. MATERIALS AND METHODS: This study employed an ecological approach utilizing a time-series design to examine maternal deaths. Secondary data from the Mortality Information System (SIM) and the Live Births Information System (SINASC) from 2009 to 2019 were utilized. The analysis included all maternal deaths among women aged 10 to 49 years residing in the state of São Paulo. Time-series data for maternal mortality ratios were constructed for the seven regions within São Paulo State. Joinpoint regression analysis was applied to characterize the maternal mortality ratio. The study estimated the annual percentage variation, the average annual percentage variation, and their respective 95% confidence intervals. RESULTS: In São Paulo, a total of 3075 maternal deaths were reported, resulting in a mortality ratio of 45.9 deaths per 100,000 live births. The leading causes of maternal death were eclampsia (7.13%), gestational hypertension (6.09%), and postpartum hemorrhage (5.89%). The analysis of the annual percentage change in the maternal mortality ratio for São Paulo State and its six clusters showed stationarity. CONCLUSIONS: The assessment of the maternal mortality ratio in the state of São Paulo, Greater São Paulo, and Baixada Santista revealed an increase in the maternal death ratio over the studied period.

Trends in mortality from Alzheimer's disease in Brazil, 2000-2019.

OBJECTIVE: to analyze trends in mortality rates due to Alzheimer's disease in Brazil and its macro-regions by age and sex, from 2000 to 2019. METHODS: this was a time-series study on mortality from Alzheimer's disease in Brazil and its macro-regions by age and sex; data were obtained from the Mortality Information System; a Prais-Winsten model was used to analyze trends. RESULTS: there were 211,658 deaths in the period analyzed, with an increasing trend in Alzheimer's disease mortality in Brazil in elderly people aged 60-69 years (APC = 4.3; 95%CI 2.9;5.9), 70-79 years (APC = 8.1; 95%CI 4.8;11.5) and ≥ 80 years (APC = 11.3; 95%CI 8.1;14.6) and in all macro-regions, age groups and sexes. CONCLUSION: Brazil and all its macro-regions showed a rising trend in Alzheimer's disease mortality rates, following the global trend.

Tendência de mortalidade por doença de Alzheimer no Brasil, 2000 a 2019 / Tendencias de mortalidad por enfermedad de Alzheimer en Brasil, 2000 a 2019 / Trends in mortality from Alzheimer's disease in Brazil, 2000-2019

Objetivo: analisar as tendências das taxas de mortalidade por doença de Alzheimer no Brasil e nas suas macrorregiões, por faixa etária e sexo, no período de 2000 a 2019. Métodos: estudo de séries temporais sobre mortalidade por doença de Alzheimer no Brasil e suas macrorregiões por faixa etária e sexo; os dados foram extraídos do Sistema de Informação sobre Mortalidade (SIM); o modelo de Prais-Winsten foi utilizado para análise das tendências. Resultados: houve 211.658 óbitos no período analisado, com tendência crescente na mortalidade por doença de Alzheimer no país em idosos de 60-69 anos (VPA = 4,3; IC95% 2,9;5,9), 70-79 anos (VPA = 8,1; IC95% 4,8;11,5) e ≥ 80 anos (VPA = 11,3; IC95% 8,1;14,6), e em todas as macrorregiões, faixas etárias e sexo. Conclusão: o Brasil e todas as suas macrorregiões apresentaram tendência crescente nas taxas de mortalidade por doença de Alzheimer, seguindo a tendência mundial.

Objective: to analyze trends in mortality rates due to Alzheimer's disease in Brazil and its macro-regions by age and sex, from 2000 to 2019. Methods: this was a time-series study on mortality from Alzheimer's disease in Brazil and its macro-regions by age and sex; data were obtained from the Mortality Information System; a Prais-Winsten model was used to analyze trends. Results: there were 211,658 deaths in the period analyzed, with an increasing trend in Alzheimer's disease mortality in Brazil in elderly people aged 60-69 years (APC = 4.3; 95%CI 2.9;5.9), 70-79 years (APC = 8.1; 95%CI 4.8;11.5) and ≥ 80 years (APC = 11.3; 95%CI 8.1;14.6) and in all macro-regions, age groups and sexes. Conclusion: Brazil and all its macro-regions showed a rising trend in Alzheimer's disease mortality rates, following the global trend.

Objetivo: analizar las tendencias en las tasas de mortalidad por enfermedad de Alzheimer en Brasil y sus macrorregiones por grupo de edad y sexo, de 2000 a 2019. Métodos: estudio de series temporales de mortalidad por enfermedad de Alzheimer en Brasil y sus macrorregiones por grupo de edad y sexo; los datos se obtuvieron del Sistema de Información sobre Mortalidad del Ministerio de Salud de Brasil; se utilizó el modelo Prais-Winsten para analizar tendencias. Resultados: hubo 211.658 óbitos, con tendencia creciente en la mortalidad por enfermedad de Alzheimer en el país, en adultos mayores de 60-69 años (VPA = 4,3; IC95% 2,9;5,9), 70-79 años (VPA = 8,1; IC95%: 4,8;11,5) y ≥ 80 años (VPA = 11,3; IC95% 8,1;14,6) y en todas las macrorregiones, grupos de edad y sexo. Conclusión: Brasil y todas sus macrorregiones mostraron una tendencia creciente en las tasas de mortalidad por enfermedad de Alzheimer siguiendo la tendencia mundial.

Trend in the incidence rates of accidents with venomous animals in children and adolescents in Brazil (2007-2019) / Tendência das taxas de incidência de acidentes com animais peçonhentos em crianças e adolescentes no Brasil (2007-2019)

ABSTRACT Objective: To estimate the temporal trend of the incidence rates of accidents with venomous animals in children and adolescents in Brazil. Methods: An ecological time-series study was carried out between 2007 and 2019. Data were obtained from the Brazilian Information System on Diseases of Compulsory Declaration (Sistema de Informação de Agravos de Notificação - SINAN). The time series of incidence rates of accidents with venomous animals were stratified by age group (children aged 0 to 9 years and adolescents aged 10 to 19 years), Brazilian macro-regions (North, Northeast, Midwest, Southeast, and South), and type of accident (snake, scorpion, spider, and caterpillar). For trend analysis, the Prais-Winsten model and the Annual Percent Change (APC) were used. Results: The time series of the incidence rate of accidents with venomous animals in children and adolescents from the North, Northeast, Midwest, and Southeast macro-regions and in children from the South region showed an upward trend. The average annual incidence rates were higher in the age group of 10 to 19 years, except for the South macro-region. Accidents with scorpions, snakes, and spiders, in this order, were the most frequent; the trends in the time series stratified by type of animal varied according to the geographic macro-region. Conclusions: There was an upward trend in the incidence rate of accidents with venomous animals in children and adolescents in Brazil, except for adolescents in the South macro-region of the country.

RESUMO Objetivo: Estimar a tendência temporal das taxas de incidência de acidentes com animais peçonhentos em crianças e adolescentes no Brasil. Métodos: Foi realizado um estudo ecológico de séries temporais, entre 2007 e 2019. Os dados foram obtidos do Sistema de Informação de Agravos de Notificação (SINAN). As séries temporais das taxas de incidência com animais peçonhentos foram estratificadas por faixa etária (crianças de 0 a 9 anos e adolescentes de 10 a 19 anos), macrorregiões brasileiras (Norte, Nordeste, Centro-Oeste, Sudeste e Sul) e tipo de acidente (serpente, escorpião, aranha e lagarta). Para análise de tendência, foi utilizado o modelo de Prais-Winsten e calculada a variação percentual anual das taxas (Annual Percentage Change — APC). Resultados: As séries históricas da taxa de incidência de acidentes com animais peçonhentos em crianças e adolescentes das macrorregiões Norte, Nordeste, Centro-Oeste e Sudeste e em crianças da macrorregião Sul apresentaram tendência ascendente. As taxas de incidências anuais médias foram maiores na faixa etária de 10 a 19 anos, exceto na macrorregião Sul. Os acidentes com escorpiões, serpentes e aranhas, nesta ordem, foram os mais frequentes; as tendências das séries históricas estratificadas por tipo de animal variaram conforme a macrorregião. Conclusões: Houve tendência ascendente na taxa de incidência de acidentes com animais peçonhentos em crianças e adolescentes no Brasil, exceto nos adolescentes da macrorregião Sul do país.

The Relationship Between Different Bench Test Methodologies and Accuracy of Insulin Infusion Pumps: A Systematic Literature Review.

Diabetes technology has rapidly evolved, and insulin infusion pumps (IIPs) have gained worldwide acceptance in diabetes care. The safety of medical equipment is highly discussed, imposing complex challenges in its use. The accuracy of IIPs can be determined through laboratory tests, generally following the IEC 60601-2-24 protocol. Studies have evaluated the accuracy and precision of IIPs, and there are discrepant results. So, we conducted a Systematic Literature Review to assess the methodologies used to evaluate the accuracy of IIPs, organizing the findings in a compiled perspective. The methodology was based on Kitchenham and Biolchini guidelines, and when possible it was carried out the Bayesian meta-analyses to compare the accuracy of IIPs. Most studies used the microgravimetric technique to evaluate the device accuracy, and some proposed adaptations for the standard protocol. The variation of results was recurrent, and the establishment of a protocol, especially to evaluate patch pumps, is necessary. The present study gives enough data to understand the scenario of the IIPs evaluation, as well as the different protocols that can be explored for its evaluation. This highlights the need for a reliable, practical, and low-cost methodology to assist the evaluation of IIPs.

Trend in the incidence rates of accidents with venomous animals in children and adolescents in Brazil (2007-2019).

OBJECTIVE: To estimate the temporal trend of the incidence rates of accidents with venomous animals in children and adolescents in Brazil. METHODS: An ecological time-series study was carried out between 2007 and 2019. Data were obtained from the Brazilian Information System on Diseases of Compulsory Declaration (Sistema de Informação de Agravos de Notificação - SINAN). The time series of incidence rates of accidents with venomous animals were stratified by age group (children aged 0 to 9 years and adolescents aged 10 to 19 years), Brazilian macro-regions (North, Northeast, Midwest, Southeast, and South), and type of accident (snake, scorpion, spider, and caterpillar). For trend analysis, the Prais-Winsten model and the Annual Percent Change (APC) were used. RESULTS: The time series of the incidence rate of accidents with venomous animals in children and adolescents from the North, Northeast, Midwest, and Southeast macro-regions and in children from the South region showed an upward trend. The average annual incidence rates were higher in the age group of 10 to 19 years, except for the South macro-region. Accidents with scorpions, snakes, and spiders, in this order, were the most frequent; the trends in the time series stratified by type of animal varied according to the geographic macro-region. CONCLUSIONS: There was an upward trend in the incidence rate of accidents with venomous animals in children and adolescents in Brazil, except for adolescents in the South macro-region of the country.

Hypofractionated radiotherapy for newly diagnosed elderly glioblastoma patients: A systematic review and network meta-analysis.

OBJECTIVE: To evaluate different hypofractionated radiotherapy (HRT) regimens for newly diagnosed elderly glioblastoma (GBM) patients. METHODS: We performed a systematic review with network meta-analysis (NMA), including searches on CENTRAL, Medline, EMBASE, CINAHL, clinical trial databases and manual search. Only randomized clinical trials (RCTs) were included. Primary outcomes: overall survival (OS) and adverse events (AE). Secondary outcomes: progression-free-survival (PFS) and quality of life (QoL). We used the Cochrane Risk of Bias (RoB) table for assessing individual studies and CINeMA for evaluating the certainty of the final body of evidence. RESULTS: Four RCTs (499 patients) were included. For OS, the estimates from NMA did not provide strong evidence of a difference between the HRTs: 40 Gray (Gy) versus 45 Gy (HR: 0.89; CI 95%: 0.42, 1.91); 34 Gy versus 45 Gy (HR: 0.85; CI 95% 0.43, 1.70); 25 Gy versus 45 Gy (HR: 0.81; CI 95% 0.32, 2.02); 34 Gy versus 40 Gy (HR: 0.95; CI 95% 0.57, 1.61); and 25 Gy versus 34 Gy (HR: 0.95; CI 95% 0.46, 1.97). We performed qualitative synthesis for AE and QoL due to data scarcity and clinical heterogeneity among studies. The four studies reported a similar QoL (assessed by different methods) between arms. One RCT reported grade ≥ 3 AE, with no evidence of a difference between arms. PFS was reported in one study (25 Gy versus 40 Gy), with no evidence of a difference between arms. CONCLUSION: This review found no evidence of a difference between the evaluated HRTs for efficacy and safety.

Development of an Instrument to Assess Spirituality: Reliability and Validation of the Attitudes Related to Spirituality Scale (ARES).

Background: Several instruments that measure spirituality present overlaps with positive emotions, impacting the interpretation of their findings. In order to minimize these problems, we aimed to develop, assess the reliability and validate a new scale to evaluate spirituality. Methods: The instrument was designed using a theoretical framework minimizing tautological issues (i.e., Koenig's framework), a qualitative study investigating the definitions of spirituality, the development of the first version of instrument by experts' meetings and a qualitative cognitive debriefing. Then, the instrument was examined for its content validity by a multidisciplinary group of judges and was pilot-tested in two different groups - less religious (medical students - n = 85) and more religious (practicing religious members - n = 85). Finally, psychometric properties and validity were assessed. Results: The developed Attitudes Related to Spirituality Scale (ARES) is a self-report 11-item instrument using five-level Likert items. ARES presented appropriate psychometric properties revealing excellent internal consistency (alpha = 0.98) and temporal stability (ICC = 0.98). Likewise, ARES was strongly correlated with other validated R/S instruments (i.e., Duke Religion Index and Brief Multidimensional Measure of Religiousness/Spirituality) and was able to discriminate higher and lower religious groups. In the exploratory factor analysis, a unidimensional structure of the scale was described. Fit indices for the scale demonstrated good fit in the unidimensional model. Conclusion: The ARES is a reliable, valid and stable one-dimension instrument that is appropriate for use in the Portuguese-speaking population. Descriptors: Spirituality; Scale; Factorial Analysis; Instrument; Measure; Psychometrics.

Baseline factors associated with death in a COVID-19 hospital cohort, Sao Paulo, 2020.

This study aimed to verify socio-demographic and baseline clinical factors associated with death in a hospital cohort of patients with COVID-19. A retrospective cohort study was conducted between February and December 2020 in a university hospital in the city of São Paulo, using Hospital Epidemiology Center data. RT-PCR-positive patients were selected to compose the sample (n = 1,034). At the end of the study, 362 (32%) patients died. In this cohort, age equal to or greater than sixty years (HR = 1.49) and liver disease (HR = 1.81) were independent risk factors for death from COVID-19 associated with higher in-hospital mortality.

Muscle-strengthening activities and cancer incidence and mortality: a systematic review and meta-analysis of observational studies.

BACKGROUND: Physical activity has been associated with reduced risk of seven types of cancer. It remains unclear, however, whether muscle-strengthening activities also reduce cancer incidence and mortality. METHODS: PubMed, Embase, Web of Science and Scopus were searched from inception to March 2020. Summary hazard ratio (HR) and 95% confidence intervals (CI) were estimated using random-effects models. RESULTS: Twelve studies (11 cohorts; 1 case-control), 6 to 25 years of follow-up, including 1,297,620 participants, 32,196 cases and 31,939 deaths, met inclusion criteria. Muscle-strengthening activities were associated with a 26% lower incidence of kidney cancer (HR for high vs low levels of muscle-strengthening activities: 0.74; 95% CI 0.56 to 0.98; I2 0%; 2 studies), but not with incidence of other 12 types of cancer. Muscle-strengthening activities were associated with lower total cancer mortality: HRs for high vs low levels of muscle-strengthening activities was 0.87 (95% CI 0.73 to 1.02; I2 58%; 6 studies); and HR for ≥2 times/week vs < 2 times/week of muscle-strengthening activities was 0.81 (95% CI 0.74 to 0.87; I2 0%; 4 studies). Regarding the weekly duration of muscle-strengthening activities, HR for total cancer mortality were 0.91 (95% CI 0.82 to 1.01; I2 0%; 2 studies) for 1-59 min/week and 0.98 (95% CI 0.89 to 1.07; I2 0%) for ≥60 min/week vs none. Combined muscle-strengthening and aerobic activities (vs none) were associated with a 28% lower total cancer mortality (HR 0.72; 95% CI 0.53 to 0.98; I2 85%; 3 studies). CONCLUSIONS: Muscle-strengthening activities were associated with reduced incidence of kidney cancer and total cancer mortality. Combined muscle-strengthening and aerobic activities may provide a greater reduction in total cancer mortality.

Rtabnetsp: an R package for retrieving São Paulo State health status indicators, Brazil. / Rtabnetsp: pacote R para extração de indicadores de saúde do estado de São Paulo.

Health status indicators are an important tool for monitoring the performance of public health actions, identifying trends and priority regions for resource allocation. An R package was developed in order to increase the feasibility of handling and analyzing health status indicator data. The rtabnetsp package requests data from TabNet servers on the São Paulo State Department of Health website, retrieving and preprocessing the data for user manipulation. This article presents the rtabnetsp package and its functions, installation and use; as well as providing examples of its functionalities, which involve listing and searching among available indicators, selecting desired content and obtaining data aggregated according to regionalization level held on the data matrix, enabling greater agility in tasks regarding public health management in the state of São Paulo.

Indicadores de saúde representam uma importante ferramenta de acompanhamento de desempenho de ações em Saúde Pública, permitindo a avaliação de intervenções realizadas, bem como a identificação de tendências e regiões prioritárias para alocação de recursos. Com o objetivo de aumentar a praticidade nas tarefas de análise e manipulação de dados desses indicadores, foi criado um pacote R. O pacote rtabnetsp realiza requisições aos servidores TabNet da página eletrônica da Secretaria de Estado da Saúde de São Paulo, recuperando e tratando tais dados para utilização do usuário. Este artigo apresenta o pacote rtabnetsp e suas funções, modo de instalação e uso; traz também exemplos de suas funcionalidades, que permitem a visualização, busca e seleção, entre uma lista de indicadores, do conteúdo desejado, além da obtenção dos dados agregados pelo nível de regionalização disponível na matriz de dados, conferindo maior agilidade a tarefas de gestão em saúde do estado de São Paulo.

Indicadores de salud son una herramienta importante para monitorear el desempeño de las acciones de salud pública, permitiendo la evaluación de las intervenciones hechas, así como la identificación de tendencias y regiones prioritarias para la asignación de recursos. En la búsqueda de aumentar la practicidad en las tareas de análisis y manipulación de datos de estos indicadores, se creó un paquete R. El paquete rtabnetsp realiza solicitudes a los servidores TabNet del Departamento de Salud del Estado de São Paulo, recogiendo y procesando dichos datos para el usuario. Este artículo presenta el paquete, sus funciones, instalación y uso, así como ejemplos de sus funcionalidades, que permiten visualizar y buscar desde un listado de indicadores, seleccionar el contenido deseado y obtener los datos agregados por el nivel de regionalización disponible en la matriz de datos, alcanzando más agilidad en las tareas de gestión de la salud en el estado de São Paulo.

Baseline factors associated with death in a COVID-19 hospital cohort, Sao Paulo, 2020

ABSTRACT This study aimed to verify socio-demographic and baseline clinical factors associated with death in a hospital cohort of patients with COVID-19. A retrospective cohort study was conducted between February and December 2020 in a university hospital in the city of São Paulo, using Hospital Epidemiology Center data. RT-PCR-positive patients were selected to compose the sample (n = 1,034). At the end of the study, 362 (32%) patients died. In this cohort, age equal to or greater than sixty years (HR = 1.49) and liver disease (HR = 1.81) were independent risk factors for death from COVID-19 associated with higher in-hospital mortality.

Rtabnetsp: pacote R para extração de indicadores de saúde do estado de São Paulo / Rtabnetsp: paquete R para extracción de indicadores de salud del estado de São Paulo, Brasil / Rtabnetsp: an R package for retrieving São Paulo State health status indicators, Brazil

Indicadores de saúde representam uma importante ferramenta de acompanhamento de desempenho de ações em Saúde Pública, permitindo a avaliação de intervenções realizadas, bem como a identificação de tendências e regiões prioritárias para alocação de recursos. Com o objetivo de aumentar a praticidade nas tarefas de análise e manipulação de dados desses indicadores, foi criado um pacote R. O pacote rtabnetsp realiza requisições aos servidores TabNet da página eletrônica da Secretaria de Estado da Saúde de São Paulo, recuperando e tratando tais dados para utilização do usuário. Este artigo apresenta o pacote rtabnetsp e suas funções, modo de instalação e uso; traz também exemplos de suas funcionalidades, que permitem a visualização, busca e seleção, entre uma lista de indicadores, do conteúdo desejado, além da obtenção dos dados agregados pelo nível de regionalização disponível na matriz de dados, conferindo maior agilidade a tarefas de gestão em saúde do estado de São Paulo.

Indicadores de salud son una herramienta importante para monitorear el desempeño de las acciones de salud pública, permitiendo la evaluación de las intervenciones hechas, así como la identificación de tendencias y regiones prioritarias para la asignación de recursos. En la búsqueda de aumentar la practicidad en las tareas de análisis y manipulación de datos de estos indicadores, se creó un paquete R. El paquete rtabnetsp realiza solicitudes a los servidores TabNet del Departamento de Salud del Estado de São Paulo, recogiendo y procesando dichos datos para el usuario. Este artículo presenta el paquete, sus funciones, instalación y uso, así como ejemplos de sus funcionalidades, que permiten visualizar y buscar desde un listado de indicadores, seleccionar el contenido deseado y obtener los datos agregados por el nivel de regionalización disponible en la matriz de datos, alcanzando más agilidad en las tareas de gestión de la salud en el estado de São Paulo.

Health status indicators are an important tool for monitoring the performance of public health actions, identifying trends and priority regions for resource allocation. An R package was developed in order to increase the feasibility of handling and analyzing health status indicator data. The rtabnetsp package requests data from TabNet servers on the São Paulo State Department of Health website, retrieving and preprocessing the data for user manipulation. This article presents the rtabnetsp package and its functions, installation and use; as well as providing examples of its functionalities, which involve listing and searching among available indicators, selecting desired content and obtaining data aggregated according to regionalization level held on the data matrix, enabling greater agility in tasks regarding public health management in the state of São Paulo.

Safety and immunogenicity of the quadrivalent human papillomavirus vaccine in patients with juvenile dermatomyositis: a real-world multicentre study.

BACKGROUND: Concerns about the safety and efficacy of vaccines in patients with autoimmune diseases (AID) have led to contradictions and low vaccination coverage in this population, who are at a higher risk of infections, including by human papillomavirus (HPV). Although HPV vaccines have been recommended for immunocompromised patients, there is still a lack of data to support its use for AID patients, such as juvenile dermatomyositis (JDM) patients. The aim of this study was to assess the safety and immunogenicity of the quadrivalent HPV (qHPV) vaccine in a cohort of JDM patients. METHODS: JDM patients aged from 9 to 20 years and healthy controls (HC) were enrolled to receive a 3-dose schedule of qHPV vaccine from March/2014 to March/2016. Study visits were performed before the first dose, 1 month after the second and third doses, and 6 months after the third dose. Participants completed a diary of possible adverse events for 14 days following each dose of vaccination (AEFV). Disease activity and current therapy were analyzed at each visit for JDM patients. In addition, serum samples from all participants were collected to test antibody concentrations against HPV16 and 18 at each visit. Participant recruitment was conducted in ten Brazilian centres. From 47 eligible JDM patients and 41 HC, 42 and 35, respectively, completed the 3-dose schedule of the vaccine, given that five JDM patients and two HC had received doses prior to their inclusion in the study. RESULTS: The AEFVs presented by the participants were mild and in general did not differ between JDM and HC groups. No severe AEFVs were related to the vaccination. Disease activity was stable, or even improved during the follow-up. One month after the third dose of the vaccine the JDM group presented seropositivity of 100% for HPV16 and 97% for HPV18, similarly to the HC group, who presented 100% for both serotypes (p = 1.000). Six months after the third dose the seropositivity for the patient group was 94% for both HPV types. CONCLUSIONS: The HPV vaccination in this cohort of JDM patients was safe and immunogenic. Since the seropositivity against HPV16 and 18 was very high after the 3-dose schedule, this regimen should be recommended for JDM patients. TRIAL REGISTRATION: Brazilian Clinical Trials Registry, number: RBR-9ypbtf . Registered 20 March 2018 - Retrospectively registered.

Heavy episodic drinking trends in the Brazilian state capitals and Federal District, 2006-2018: an ecological time series analysis. / Tendência do beber episódico excessivo nas capitais brasileiras e no Distrito Federal, 2006-2018: um estudo ecológico de séries temporais.

OBJECTIVE: To assess heavy episodic drinking trends in the 26 Brazilian state capitals and Federal District, overall and according to sex. METHODS: This was an ecological time series study of heavy episodic drinking patterns among adults, from 2006 to 2018. The data were obtained from VIGITEL Survey time series. Prais-Winsten regression was used. RESULTS: In the period studied a stationary heavy episodic drinking trend was found in 23 out of the 27 state capitals, with the exception of Macapá, where there was a decrease in this practice, and in São Paulo, Florianópolis and the Federal District, where an increase was found. There were important differences by sex in relation to heavy episodic drinking, with a tendency to increased consumption among women in seven state capitals. CONCLUSION: There was no reduction in heavy episodic drinking in most capitals, showing the urgency of implementing interventions to reduce alcohol consumption among the Brazilian population.

Forecast UTI: application for predicting intensive care unit beds in the context of the COVID-19 pandemic. / Forecast UTI: aplicativo para previsão de leitos de unidades de terapia intensiva no contexto da pandemia de COVID-19.

In view of the need to manage and forecast the number of Intensive Care Unit (ICU) beds for critically ill COVID-19 patients, the Forecast UTI open access application was developed to enable hospital indicator monitoring based on past health data and the temporal dynamics of the Coronavirus epidemic. Forecast UTI also enables short-term forecasts of the number of beds occupied daily by COVID-19 patients and possible care scenarios to be established. This article presents the functions, mode of access and examples of uses of Forecast UTI, a computational tool intended to assist managers of public and private hospitals within the Brazilian National Health System by supporting quick, strategic and efficient decision-making.

Frente à necessidade de gerenciamento e previsão do número de leitos de unidades de terapia intensiva (UTIs) para pacientes graves de COVID-19, foi desenvolvido o Forecast UTI, um aplicativo de livre acesso, que permite o monitoramento de indicadores hospitalares com base em dados históricos do serviço de saúde e na dinâmica temporal da epidemia por coronavírus. O Forecast UTI também possibilita realizar previsões de curto prazo do número de leitos ocupados pela doença diariamente, e estabelecer possíveis cenários de atendimento. Este artigo apresenta as funções, modo de acesso e exemplos de uso do Forecast UTI, uma ferramenta computacional destinada a auxiliar gestores de hospitais da rede pública e privada do Sistema Único de Saúde (SUS) no subsídio à tomada de decisão, de forma rápida, estratégica e eficiente.

En vista de la necesidad de administrar y prever el número de camas en la Unidad de Cuidados Intensivos para pacientes graves de COVID-19, se desarrolló Forecast UTI: una aplicación de acceso abierto que permite el monitoreo de indicadores hospitalarios basados en datos históricos del servicio salud y la dinámica temporal de esta epidemia por coronavirus También es posible hacer pronósticos a corto plazo del número de camas ocupadas diariamente por la enfermedad y establecer posibles escenarios de atención. Este artículo presenta las funciones, el modo de acceso y ejemplos de uso de Forecast UTI, una herramienta computacional capaz de ayudar a los gestores de hospitales públicos y privados en el Sistema Único de Salud, ya que apoyan la toma de decisiones de manera rápida, estratégica y eficiente.

Binge drinking and frequent or heavy drinking among adolescents: prevalence and associated factors / Binge drinking e beber frequente ou pesado entre os adolescentes: prevalência e fatores associados

Abstract Objective: To analyze the sociodemographic, school, and family factors associated with the patterns of binge drinking and frequent or heavy drinking among adolescents. Methods: This was a cross-sectional study, nested in a randomized controlled trial, of 6285 seventh and eighth grade adolescent students from Brazilian public schools. The associations between binge drinking (consumption of five or more doses of alcohol on a single occasion) in the last 12 months and frequent or heavy drinking (alcohol consumption on six or more days) in the last month and the several factors were analyzed through weighted logistic regression. Results: 16.5% of the students reported binge drinking in the year before the interview and 2.2% reported frequent/heavy drinking in the previous month. The factors associated with binge drinking were cigarette smoking (OR = 6.7, 95% CI = 3.96; 11.23), use of marijuana (OR = 2.2, 95% CI = 1.17; 4.31), use of inhalant drugs (OR = 3.0, 95% CI = 1.98; 4.43), exposure to a drunk relative (OR = 2.1, 95% C = 1.67; 2.53), practice of bullying (OR = 1.8, 95% CI = 1.47; 2.17), verbal aggression (OR = 1.7, 95%CI = 1.40; 2.14), and intermediate/low school grades (OR = 1.7, 95% CI = 1.35; 2.20). The factors associated with frequent/heavy drinking were cigarette smoking (OR = 2.5, 95% CI = 1.16; 5.22), use of marijuana (OR = 3.2, 95% CI = 1.32; 7.72), and physical aggression (OR = 2.2, 95% CI = 1.36; 3.50). Conclusions: The analyzed outcomes showed an association between the risk consumption of alcohol in early adolescence and low academic performance, involvement with other drugs, aggressiveness, and witnessing episodes of a family member's drunkenness. Considering the impact on public health of the damages caused by alcohol consumption during adolescence, these factors that showed such association should be considered in the development of preventive interventions.

Resumo Objetivo Analisar os fatores sociodemográficos, escolares e familiares associados aos padrões binge drinking, beber frequente ou beber pesado em adolescentes. Métodos Estudo transversal aninhado em ensaio controlado randomizado entre 6.387 estudantes do 7° e 8° anos de escolas públicas brasileiras. Associações entre o binge drinking (consumo de cinco ou mais doses de álcool em uma única ocasião) nos últimos 12 meses e o beber frequente/beber pesado (consumo de álcool em seis ou mais dias) no último mês e os diversos fatores foram analisados por meio de regressão logística ponderada. Resultados Dos estudantes, 16,5% reportaram ter praticado binge drinking no ano anterior à entrevista e 2,2% praticaram beber frequente/beber pesado no último mês. Os fatores associados ao binge drinking foram consumo de cigarro (OR = 6,7, IC95% = 3,96; 11,23), maconha (OR = 2,2, IC95% = 1,17; 4,31), uso de inalantes (OR = 3,0, IC95% = 1,98; 4,43), exposição a algum familiar embriagado (OR = 2,1, IC95% = 1,67; 2,53), prática de bullying (OR = 1,8, IC95% = 1,47; 2,17), agressão verbal (OR = 1,7, IC95% = 1,40; 2,14), notas médias e baixas (OR = 1,7, IC95% = 1,35; 2,20). Os fatores associados ao beber frequente/beber pesado foram o consumo de cigarro (OR = 2,5, IC95% = 1,16; 5,22), maconha (OR = 3,2, IC95% = 1,32; 7,72), agressão física (OR = 2,2, IC95% = 1,36; 3,50). Conclusões Os desfechos analisados evidenciaram associação do consumo de risco de álcool no início da adolescência com o baixo desempenho escolar, envolvimento com outras drogas, agressividade e vivência de episódios de embriaguez dos familiares. Considerando o impacto na saúde pública dos prejuízos decorrentes do consumo de risco de álcool na adolescência, estes fatores que evidenciaram associação devem ser considerados na construção de intervenções preventivas.

Binge drinking and frequent or heavy drinking among adolescents: prevalence and associated factors.

OBJECTIVE: To analyze the sociodemographic, school, and family factors associated with the patterns of binge drinking and frequent or heavy drinking among adolescents. METHODS: This was a cross-sectional study, nested in a randomized controlled trial, of 6285 seventh and eighth grade adolescent students from Brazilian public schools. The associations between binge drinking (consumption of five or more doses of alcohol on a single occasion) in the last 12 months and frequent or heavy drinking (alcohol consumption on six or more days) in the last month and the several factors were analyzed through weighted logistic regression. RESULTS: 16.5% of the students reported binge drinking in the year before the interview and 2.2% reported frequent/heavy drinking in the previous month. The factors associated with binge drinking were cigarette smoking (OR=6.7, 95% CI=3.96; 11.23), use of marijuana (OR=2.2, 95% CI=1.17; 4.31), use of inhalant drugs (OR=3.0, 95% CI=1.98; 4.43), exposure to a drunk relative (OR=2.1, 95% C=1.67; 2.53), practice of bullying (OR=1.8, 95% CI=1.47; 2.17), verbal aggression (OR=1.7, 95%CI=1.40; 2.14), and intermediate/low school grades (OR=1.7, 95% CI=1.35; 2.20). The factors associated with frequent/heavy drinking were cigarette smoking (OR=2.5, 95% CI=1.16; 5.22), use of marijuana (OR=3.2, 95% CI=1.32; 7.72), and physical aggression (OR=2.2, 95% CI=1.36; 3.50). CONCLUSIONS: The analyzed outcomes showed an association between the risk consumption of alcohol in early adolescence and low academic performance, involvement with other drugs, aggressiveness, and witnessing episodes of a family member's drunkenness. Considering the impact on public health of the damages caused by alcohol consumption during adolescence, these factors that showed such association should be considered in the development of preventive interventions.

Transition from nonuse to use of alcohol or binge drinking among adolescents: Secondary analysis of a randomized controlled trial.

OBJECTIVE: The objective of this study was to evaluate the predictors of the transition from nonuse of alcohol to the first use of alcohol and the first episode of binge drinking. METHODS: Data were drawn from a randomized controlled trial conducted with seventh- and eighth-grade students from 72 public schools over a 21-month period in six cities in Brazil. A total of 3298 students who reported that they had never consumed alcoholic beverages and had never engaged in binge drinking at baseline were included in this study. The two binary outcomes were tested concomitantly via structural equation modeling. Maximum likelihood estimates for logistic regression models were performed to evaluate how baseline data regarding risk factors, such as sociodemographic characteristics (socioeconomic status, gender, and age), school experiences (violence and perception of academic performance), and social variables (family and friends), affected the initiation of alcohol use and binge drinking at 9- and 21-month follow-up assessments. RESULTS: Older age, the perpetration of violent behaviors at baseline and the absence of the father living with the adolescent were predictors of both alcohol use initiation and binge drinking initiation. The #Tamojunto program showed iatrogenic effect for first alcohol use. CONCLUSIONS: The results indicate the need to develop and implement effective alcohol prevention programs that consider the main characteristics in the prediction model for alcohol consumption and binge drinking, including early intervention for aggressive behaviors at school and parental alcohol use.

Tendência do beber episódico excessivo nas capitais brasileiras e no Distrito Federal, 2006-2018: um estudo ecológico de séries temporais / Tendencia del consumo episódico excesivo de alcohol en las capitales brasileñas y el Distrito Federal, 2006-2018: un estudio ecológico de series temporales / Heavy episodic drinking trends in the Brazilian state capitals and Federal District, 2006-2018: an ecological time series analysis*

Objetivo: Avaliar as tendências do beber episódico excessivo nas 26 capitais brasileiras e no Distrito Federal, geral e por sexo. Métodos:Estudo ecológico de séries temporais do padrão de beber episódico excessivo entre adultos, entre os anos de 2006 a 2018. Os dados foram obtidos da série histórica do Vigitel. Empregou-se regressão de Prais-Winsten. Resultados: No período estudado, observou-se tendência estacionária de beber episódico excessivo em 23 das 27 capitais brasileiras; na capital Macapá, observou-se diminuição dessa prática; e nas capitais São Paulo e Florianópolis, assim como no Distrito Federal, tendência crescente nesse consumo. Há importantes diferenças no beber episódico excessivo por sexo, com tendência de aumento entre mulheres em sete capitais. Conclusão: Não houve redução do beber episódico excessivo na maioria das capitais, evidenciando a urgência da implantação de intervenções visando reduzir o consumo de álcool na população brasileira.

Objetivo: Evaluar las tendencias del consumo episódico excesivo de alcohol en las 26 capitales brasileñas y el Distrito Federal, total y según el sexo. Métodos: Estudio ecológico de series temporales del patrón de consumo excesivo de alcohol episódico entre adultos, de 2006 a 2018. Los datos se obtuvieron de la serie histórica de Vigitel. Se utilizó la regresión de Prais-Winsten. Resultados: Se observó una tendencia estacionaria al consumo episódico excesivo de alcohol entre 2006 y 2018 en 23 de 27 de las capitales brasileñas; con excepción de Macapá donde hubo una disminución en esta práctica, y en las capitales São Paulo, Florianópolis y Distrito Federal, donde se encontró una tendencia creciente. Existen diferencias importantes por sexo, con aumento del consumo entre las mujeres en siete capitales. Conclusión: No hubo reducción en el consumo episódico excesivo de alcohol en la mayoría de las capitales, lo que demuestra la urgencia de implementar intervenciones para reducir el consumo de alcohol en la población brasileña.

Objective: To assess heavy episodic drinking trends in the 26 Brazilian state capitals and Federal District, overall and according to sex. Methods: This was an ecological time series study of heavy episodic drinking patterns among adults, from 2006 to 2018. The data were obtained from VIGITEL Survey time series. Prais-Winsten regression was used. Results: In the period studied a stationary heavy episodic drinking trend was found in 23 out of the 27 state capitals, with the exception of Macapá, where there was a decrease in this practice, and in São Paulo, Florianópolis and the Federal District, where an increase was found. There were important differences by sex in relation to heavy episodic drinking, with a tendency to increased consumption among women in seven state capitals. Conclusion: There was no reduction in heavy episodic drinking in most capitals, showing the urgency of implementing interventions to reduce alcohol consumption among the Brazilian population.