Malaria time series in the extra-Amazon region of Brazil: epidemiological scenario and a two-year prediction model.

BACKGROUND: In Brazil, malaria is caused mainly by the Plasmodium vivax and Plasmodium falciparum species. Its transmission occurs in endemic and non-endemic areas. Malaria geography in Brazil has retracted and is now concentrated in the North region. The Brazilian Amazon region accounts for 99% of Brazil's cases. Brazil's extra-Amazon region has a high frequency of imported cases and in 2019 presented a mortality rate 123 times higher than the Amazon region. Extra-Amazon cases present risks of reintroduction. This study aims to characterize the epidemiological scenario for malaria in the extra-Amazon region of Brazil from 2011 to 2020 with a two-year forecast. METHODS: Time-series study with description of malaria cases and deaths registered in Brazilian extra-Amazon region from 2011 to 2020. Public data from the Notifiable Diseases Information System (Sinan) and the Mortality Information System (SIM) were used. Descriptive analysis, incidence, and notification rates were calculated. Flow charts analysed the flux between Places of Probable Infection (PI) and places of notification. The prediction model utilized a multiplicative Holt-winters model for trend and seasonality components. RESULTS: A total of 6849 cases were registered. Cases were predominantly white males with 9 to 11 years of education, mostly between 30 and 39 years old. Imported cases accounted for 78.9% of cases. Most frequent occupations for imported cases are related to travelling and tourism activities. Among autochthonous cases, there is a higher frequency of agriculture and domestic economic activities. In the period there were 118 deaths due to malaria, of which 34.7% were caused by P. falciparum infections and 48.3% were not specified. The most intense flows of imported cases are from Amazonas and Rondônia to São Paulo, Rio de Janeiro, and Paraná. The prediction estimates around 611 cases for each of the following two years. CONCLUSION: The time series allows a vast epidemiological visualization with a short-term prediction analysis that supports public health planning. Government actions need to be better directed in the extra-Amazon region so the objective of eliminating malaria in Brazil is achieved. Carrying out quality assessments for information systems and qualifying personnel is advisable. Malaria outside the Amazon region is mainly due to imported cases and delay in diagnosis is associated with a higher fatality rate. Better strategies to diagnose and treat suspected cases can lead to lower risk of deaths and local outbreaks that will be important for achieving malaria elimination in Brazil.

Characterization of Guillain-Barré Syndrome in the integrated development region of the Federal District and Surrounding Areas (RIDE), Brazil, between 2017 and 2019.

INTRODUCTION: Guillain-Barré Syndrome (GBS) is an acute immune-mediated polyneuropathy that primarily affects the peripheral nerves. Following the Zika virus outbreak in Latin America, all the Latin American and Brazilian studies conducted reported an increase in the incidence of GBS. The present study aims to characterize the clinical and demographic profile of patients with GBS, according to electrophysiological estudies. METHODS: This is a clinical cohort study based on data from medical charts and interviews conducted at the homes of GBS cases identified by three data sources, admitted to and treated at a tertiary referral hospital between March 2017 and May 2019. RESULTS: There was a high level of diagnostic certainty among the 51 GBS cases monitored, with most classified as exhibiting acute inflammatory demyelinating polyneuropathy (AIDP). The majority of the individuals were of working age, with an average schooling level. Diarrhea and upper respiratory tract infection were the previous events most reported. Most cases were admitted to the hospital unable to walk and the main complication identified was aspiration pneumonia. CONCLUSION: The findings indicate the need to rethink the care of patients with GBS in order to minimize the possibility of future complications during hospitalization that may lead to unfavorable outcomes.

Costs of Guillain-Barré Syndrome in the Brazilian Federal District: the patients' perspective.

BACKGROUND: Although rare, Guillain-Barré Syndrome (GBS) has a high economic burden, with consequences for families and society. This study aimed to estimate the total cost of GBS, per individual and per variant of the disease, as well as its effect on household income, from the perspective of patients. METHODS: This was a cost-of-illness study from the perspective of patients and their families, with a time horizon from disease onset to 6 mo after discharge. The total cost of GBS was estimated by bottom-up microcosting, considering direct and indirect costs. RESULTS: The median cost of GBS per individual was US$1635.5, with direct costs accounting for 64.3% of this amount. Among the variants analyzed, acute motor sensory axonal neuropathy (US$4660.1) and acute inflammatory demyelinating polyneuropathy (US$2017.0) exhibited the highest costs compared with acute motor axonal neuropathy (US$1635.5) and Miller Fisher Syndrome (US$1464.8). The costs involved compromise more than 20% of the household income of 22 (47.8%) patients. CONCLUSIONS: This study demonstrated how costly GBS can be. It is hoped that decision-makers will analyze these results with a view to improving the structure of healthcare services.

Assessment of the Perception of People Living With HIV Regarding the Quality of Outpatient Care at a Reference Facility in the Federal District, Brazil.

The effectiveness of antiretroviral treatment has transformed HIV infection into a chronic transmissible condition, requiring health systems to adapt in order to care for people living with HIV. The Chronic Care Model (CCM) is the gold standard for this type of care in many countries. Among its tools, the Patient Assessment of Chronic Illness Care (PACIC) questionnaire gives the patient's perspective of the care provided. The aim of the present study was to adapt and apply, for the first time, the questionnaire to people living with HIV to determine their perception of the quality of care provided at a reference hospital in the Federal District of Brazil. This is a case study conducted in 2019 at a teaching hospital, with a convenience sample of 30 individuals treated for at least 1 year at the facility. The median PACIC score (3.5 with a range of 1.0-5.0) seems to suggest that the users perceive the outpatient care provided by the hospital as being basic. The "delivery system design/decision support" component was deemed the best (5.0, with a range of 1.0-5.0) and "follow-up/coordination" the worst (1.0, with a range of 1.0-5.0). The results suggest the need to improve the organization of care and make adequate use of community resources, in line with the CCM. The questionnaire makes it possible to determine the strengths and weaknesses of the care provided to people living with HIV and can be used as a planning and monitoring tool to improve management of the condition, with the contribution of the patient, in particular, thereby strengthening self-care.

Ten Epidemiological Parameters of COVID-19: Use of Rapid Literature Review to Inform Predictive Models During the Pandemic.

Objective: To describe the methods used in a rapid review of the literature and to present the main epidemiological parameters that describe the transmission of SARS-Cov-2 and the illness caused by this virus, coronavirus disease 2019 (COVID-19). Methods: This is a methodological protocol that enabled a rapid review of COVID-19 epidemiological parameters. Findings: The protocol consisted of the following steps: definition of scope; eligibility criteria; information sources; search strategies; selection of studies; and data extraction. Four reviewers and three supervisors conducted this review in 40 days. Of the 1,266 studies found, 65 were included, mostly observational and descriptive in content, indicating relative homogeneity as to the quality of the evidence. The variation in the basic reproduction number, between 0.48 and 14.8; and the median of the hospitalization period, between 7.5 and 20.5 days stand out as key findings. Conclusion: We identified and synthesized 10 epidemiological parameters that may support predictive models and other rapid reviews to inform modeling of this and other future public health emergencies.

Tuberculosis cases with post-mortem notification in Brazil, 2014: a descriptive study based on surveillance data. / Casos de tuberculose com notificação após o óbito no Brasil, 2014: um estudo descritivo com base nos dados de vigilância.

OBJECTIVE: To characterize tuberculosis cases notified at post-mortem in Brazil in 2014. METHODS: This is a descriptive study of tuberculosis cases notified at post-mortem. Data resulted from linkage of the Notifiable Health Conditions Information System-TB (SINAN-TB) and the Mortality Information System (SIM), and were described according to underlying cause of death: tuberculosis, AIDS and other. RESULTS: In the 2,703 tuberculosis cases notified at post-mortem, a higher proportion was found of people of the male sex (73.5%), aged over 39 (80.8%), <8 years of schooling (66.5%), of Black and brown race/skin color (62.8%), with the pulmonary clinical form of tuberculosis (75.2%); there was also a higher proportion of cases notified by the public health service (57.6%) and in municipalities with HDI-M >0.7 (66.6%). CONCLUSION: The characteristics described of people with post-mortem notification and the magnitude of this outcome suggest weaknesses in tuberculosis care and surveillance services.

Tuberculosis cases with post mortem notification in Brazil, 2014: a descriptive study based on surveillance data / Casos de tuberculosis notificados después de la muerte en Brasil, 2014: un estudio descriptivo basado en datos de vigilancia / Casos de tuberculose com notificação após o óbito no Brasil, 2014: um estudo descritivo com base nos dados de vigilância

Objective. To characterize cases with post-mortem notification of Tuberculosis in Brazil, in 2014. Methods. This is a descriptive study of tuberculosis cases with post-mortem notification. Data were resulted from the linkage of the Notifiable Diseases Information System-TB (Sinan-TB) and the Mortality Information System (SIM); and were described according to the underlying cause of death: TB, AIDS and others. Results. 2,703 tuberculosis cases had post-mortem notification in Brazil in 2014. There were a high proportion of male (73.5%), age over 39(80.8%), <8 years of education (66.5%), black & brown ethnicity (62.8%), pulmonary clinic form (75.2%), notified by public health service (57.6%) and from municipalities with MHDI >0.7 (66.6%). Conclusion. The described characteristics of people with post-mortem notification and the magnitude of this outcome suggest weaknesses in tuberculosis care and surveillance services.

Objetivo. Caracterizar os casos com notificação pós-óbito da tuberculose no Brasil em 2014. Métodos. Estudo descritivo dos casos de tuberculose com notificação pós-óbito. Os dados são resultantes da vinculação do Sistema de Informação de Agravos de Notificação (Sinan-TB) com o Sistema de Informações sobre Mortalidade (SIM), e foram descritos segundo causa básica de óbito: tuberculose, aids e outras. Resultados. Nos 2.703 casos de tuberculose com notificação pós-óbito, observou-se maior proporção de pessoas do sexo masculino (73,5%), com mais de 39 anos de idade (80,8%), com escolaridade <8 anos de estudo (66,5%), de raça/cor da pele negra e parda (62,8%), que adoeceram de tuberculose na forma clínica pulmonar (75,2%); também prevaleceram notificações pelo serviço público (57,6%) e em municípios com índice de desenvolvimento humano >0,7 (66,6%). Conclusão. As características descritas das pessoas notificadas pós-óbito e a magnitude desse desfecho sugerem fragilidades dos serviços de atenção e vigilância da tuberculose

Casos de tuberculose com notificação após o óbito no Brasil, 2014: um estudo descritivo com base nos dados de vigilância / Casos de tuberculosis notificados después del óbito en Brasil, 2014: un estudio descriptivo basado en datos de vigilância / Tuberculosis cases with post-mortem notification in Brazil, 2014: a descriptive study based on surveillance data

Objetivo: Caracterizar os casos com notificação pós-óbito da tuberculose no Brasil em 2014. Métodos: Estudo descritivo dos casos de tuberculose com notificação pós-óbito. Os dados são resultantes da vinculação do Sistema de Informação de Agravos de Notificação (Sinan-TB) com o Sistema de Informações sobre Mortalidade (SIM), e foram descritos segundo causa básica de óbito: tuberculose, aids e outras. Resultados: Nos 2.703 casos de tuberculose com notificação pós-óbito, observou-se maior proporção de pessoas do sexo masculino (73,5%), com mais de 39 anos de idade (80,8%), com escolaridade <8 anos de estudo (66,5%), de raça/cor da pele negra e parda (62,8%), que adoeceram de tuberculose na forma clínica pulmonar (75,2%); também prevaleceram notificações pelo serviço público (57,6%) e em municípios com índice de desenvolvimento humano >0,7 (66,6%). Conclusão: As características descritas das pessoas notificadas pós-óbito e a magnitude desse desfecho sugerem fragilidades dos serviços de atenção e vigilância da tuberculose

Objetivo: Caracterizar los casos con notificación de tuberculosis post mortem en Brasil en 2014. Métodos: Estudio descriptivo de casos de tuberculosis con notificación post mortem. Los datos son resultantes de la vinculación del Sistema de Información de Enfermedades de Notificación (Sinan-TB) y Sistema de Información de Mortalidad (SIM); y fueron descritos de acuerdo con la causa básica de muerte: tuberculosis, sida y otros. Resultados: De los 2.703 casos de tuberculosis con notificación post mortem, hubo una mayor proporción de hombres (73,5%), >39 años de edad (80,8%), <8 años de escolaridad (66,5%), raza negra/parda (62,8%), que enfermaron con la forma clínica pulmonar (75,2%), notificados por el servicio público (57,6%) y de municipios con índice de desarrollo humano >0,7 (66,6%). Conclusión: Las características descritas de las personas notificadas post mortem y la magnitud de este resultado sugieren fragilidades en los servicios de atención y vigilancia de la tuberculosis.

Objective: To characterize tuberculosis cases notified at post-mortem in Brazil in 2014. Methods: This is a descriptive study of tuberculosis cases notified at post-mortem. Data resulted from linkage of the Notifiable Health Conditions Information System-TB (SINAN-TB) and the Mortality Information System (SIM), and were described according to underlying cause of death: tuberculosis, AIDS and other. Results: In the 2,703 tuberculosis cases notified at post-mortem, a higher proportion was found of people of the male sex (73.5%), aged over 39 (80.8%), <8 years of schooling (66.5%), of Black and brown race/skin color (62.8%), with the pulmonary clinical form of tuberculosis (75.2%); there was also a higher proportion of cases notified by the public health service (57.6%) and in municipalities with HDI-M >0.7 (66.6%). Conclusion: The characteristics described of people with post-mortem notification and the magnitude of this outcome suggest weaknesses in tuberculosis care and surveillance services.

Casos de tuberculose com notificação após o óbito no Brasil, 2014: um estudo descritivo com base nos dados de vigilância / Tuberculosis cases with post mortem notification in Brazil, 2014: a descriptive study based on surveillance data

Objetivo.Caracterizar os casos com notificação pós-óbito da tuberculose no Brasil em 2014. Métodos.Estudo descritivo dos casos de tuberculose com notificação pós-óbito. Os dados sãoresultantesda vinculação do Sistema de Informação de Agravos de Notificação (Sinan-TB) comoSistema de Informações sobre Mortalidade (SIM),eforam descritos segundo causa básica de óbito: tuberculose, aids e outras.Resultados.Nos 2.703 casos de tuberculosecomnotificaçãopós-óbito,observou-se maior proporção de pessoas do sexo masculino (73,5%), com mais de 39 anos de idade (80,8%),com escolaridade <8anosde estudo(66,5%), de raça/cor da pele negra eparda (62,8%),que adoeceram de tuberculose na forma clínica pulmonar (75,2%); também prevaleceram notificaçõespelo serviço público (57,6%) e emmunicípios com índice de desenvolvimento humano >0,7 (66,6%). Conclusão.As características descritas das pessoas notificadas pós-óbito e a magnitude desse desfecho sugerem fragilidades dos serviços de atenção e vigilância da tuberculose.