The Large-Scale Implementation of a Health Information System in Brazilian University Hospitals: Process and Outcomes.

Governments around the globe are paving the way for healthcare services that can have a profound impact on the overall well-being and development of their nations. However, government programs to implement health information technologies on a large-scale are challenging, especially in developing countries. In this article, the process and outcomes of the large-scale implementation of a hospital information system for the management of Brazilian university hospitals are analyzed. Based on a qualitative approach, this research involved 21 hospitals and comprised a documentary search, interviews with 24 hospital managers and two system user focus groups, and a questionnaire of 736 respondents. Generally, we observed that aspects relating to the wider context of system implementation (macro level), the managerial structure, cultural nuances, and political dynamics within each hospital (meso level), as well as the technology, work activities, and individuals themselves (micro level) acted as facilitators and/or obstacles to the implementation process. The dynamics and complex interactions established between these aspects had repercussions on the process, including the extended time necessary to implement the national program and the somewhat mixed outcomes obtained by hospitals in the national network. Mostly positive, these outcomes were linked to the eight emerging dimensions of practices and work processes; planning, control, and decision making; transparency and accountability; optimization in the use of resources; productivity of professionals; patient information security; safety and quality of care; and improvement in teaching and research. We argued here that to maximize the potential of information technology in healthcare on a large-scale, an integrative and cooperative vision is required, along with a high capacity for change management, considering the different regional, local, and institutional contexts.

Cross-cultural adaptation and validation of the Iowa Satisfaction with Anesthesia Scale for use in Brazil: a cross-sectional study.

BACKGROUND: The Iowa Satisfaction with Anesthesia Scale (ISAS) was developed to assess the satisfaction of patients undergoing sedation with monitored anesthesia care. This study aimed to cross-culturally adapt the ISAS instrument and evaluate the acceptability, validity, and reliability of the proposed Brazilian version (ISAS-Br). METHODS: The cross-cultural adaptation process involved translation, synthesis, back-translation, expert committee review, pre-testing, and final review of the ISAS-Br. A cross-sectional study was conducted, involving 127 adult individuals undergoing ambulatory surgeries with moderate/deep sedation. The acceptability, reliability, and construct validity of the scale were assessed. RESULTS: The cross-cultural adaptation process did not require significant changes to the final version of the scale. The ISAS-Br demonstrated excellent acceptability, with a completion rate of 99% and an average completion time of 4.6 minutes. Exploratory factor analysis revealed three factors: emotional well-being, physical comfort, and anxiety relief, with respective composite reliability coefficient values of 0.874, 0.580, and 0.428. The test-retest reliability of the ISAS-Br, measured by the intraclass correlation coefficient, was 0.67 (95% confidence interval [95% CI] 0.42 to 0.83), and the Bland-Altman plot showed satisfactory agreement between the measurements. CONCLUSION: The proposed Brazilian version of the ISAS underwent successful cross-cultural adaptation according to international standards. It demonstrated good acceptability and reliability, regarding the assessment of temporal stability. However, the ISAS-Br exhibited low internal consistency for some factors, indicating that this instrument lacks sensitivity to assess the satisfaction of deeply sedated patients. Further studies are necessary to explore the hypotheses raised based on the knowledge of its psychometric properties.

Incidence of infections associated with the use of invasive devices in an ICU after application of the Improvement Science Method

Objective: To reduce the incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) in the intensive care unit (ICU) using the Improvement Science method. Methods: This was a single-center retrospective cohort study. A collaborative quality improvement team developed and implemented local changes to HAI-related processes and protocols. Pre-intervention, intervention, and post-intervention periods were compared. The study was conducted at the Adult ICU of a hospital in southern Brazil. Variables were analyzed using interrupted time series analysis with segmented linear regression, simple correlation, and hypothesis testing. Results: There was a reduction in the incidence density of all infections. VAP was reduced from 27.2% to 7.2% (p < 0.001), CLABSI from 3.0% to 0.9% (p = 0.017), and CAUTI from 8.3% to 1.8% (p < 0.001). The ICU stay was also reduced from 6.7 to 6 days (p = 0.018). Conclusion: There was an improvement in all the evaluated parameters. Ongoing monitoring of related indicators and adherence to implemented measures are essential to sustain improvements. Applying the Improvement Science methodology can reduce the incidence of HAIs in the ICU.

Analysis of notified drug poisoning among children in Santa Catarina state, 2016-2020.

OBJECTIVE: The aim of this study was to analyze the incidence of drug poisoning in children registered in the Santa Catarina Information and Toxicological Assistance Center between 2016 and 2020. METHODS: This observational epidemiological study, with a historical cohort design, was carried out from reported cases of drug poisoning in children aged 0-12 years. Census sampling was used to collect data. RESULTS: There were 4839 reported cases of drug poisoning among children in the State of Santa Catarina in the surveyed period, with an average annual incidence rate of 6 cases/1000 live births. The median age was 3 years. Most cases of poisoning occurred among girls aged 0-3 years by accidental ingestion of drugs at home. There was a predominance of signs and symptoms affecting the nervous system; only a small portion required hospitalization. Most cases were considered mild poisoning with a favorable outcome. No deaths were recorded. There was a tendency of increasing cases over time, however not significant. There is a predominance of incident cases in the Great West of the state, followed by the Midwest and Serra Catarinense regions. CONCLUSIONS: Drug poisoning in children is predominant in early childhood, mainly caused by accidental ingestion of drugs at home. These findings highlight the importance of preventive and educational measures among family members and caregivers.

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Associated with Right Coronary Giant Aneurysm.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation, usually diagnosed in the infant period due to myocardial ischemia and heart failure, with the need for emergency surgery. Less commonly, it can be asymptomatic until adulthood. Coronary artery aneurysms are also rare anatomical anomalies with symptoms of acute or chronic angina or even remain completely asymptomatic. We present an unusual case of ALCAPA, associated with a giant aneurysm of the right coronary artery. Meeting presentation: American Association for Thoracic Surgery 102nd annual meeting, Boston MA, USA, May 16, 2022.

Temporary trend of breast cancer mortality in the state of Santa Catarina in the period from 1996 to 2019

Introduction: Breast cancer is the most common female cancer and the leading cause of cancer death in women around the world. It has repercussions not only on human health, but also on health services due to the high incidence resulting in a large number of consultations and treatments. The disease is responsible for a large demand for hospitalizations throughout Brazil, where an increase in mortality rates is observed and Santa Catarina does not differ from the national scenario. The study aimed to analyze the temporal trend of the breast cancer mortality rate in the state of Santa Catarina from 1996 to 2019 Methods: This is an ecological epidemiological study of time series of breast cancer mortality in the population residing in the state according to age groups and health macro-regions. Data were obtained from the Mortality Information System and the Brazilian Institute of Geography and Statistics. Simple linear regression of standardized mortality rates according to the world standard population was performed. p<0.05 was considered significant. Results: Data showed 9,637 deaths in the period. There was a significant upward trend in mortality in the state (from 6.50 to 7.92/100,000 women). An upward trend was observed in the age groups of 30­39 years, 60­69 years, and over 80 years. All seven health macro-regions showed an upward trend in mortality. Conclusion:The overall mortality rate from breast cancer in Santa Catarina showed a significant upward trend. A significant increase was also observed in the age groups of 30­39 years, 60­69 years, and 80 years old or older and in all health macro-regions. Problems in public health infrastructure, lack of control of risk factors and deficiency in mammographic screening are revealed. The elaboration and strengthening of public policies to control the disease are fundamental.

Analysis of notified drug poisoning among children in Santa Catarina state, 2016-2020 / Análise das intoxicações medicamentosas notificadas em crianças no estado de Santa Catarina, 2016-2020

ABSTRACT Objective: The aim of this study was to analyze the incidence of drug poisoning in children registered in the Santa Catarina Information and Toxicological Assistance Center between 2016 and 2020. Methods: This observational epidemiological study, with a historical cohort design, was carried out from reported cases of drug poisoning in children aged 0-12 years. Census sampling was used to collect data. Results: There were 4839 reported cases of drug poisoning among children in the State of Santa Catarina in the surveyed period, with an average annual incidence rate of 6 cases/1000 live births. The median age was 3 years. Most cases of poisoning occurred among girls aged 0-3 years by accidental ingestion of drugs at home. There was a predominance of signs and symptoms affecting the nervous system; only a small portion required hospitalization. Most cases were considered mild poisoning with a favorable outcome. No deaths were recorded. There was a tendency of increasing cases over time, however not significant. There is a predominance of incident cases in the Great West of the state, followed by the Midwest and Serra Catarinense regions. Conclusions: Drug poisoning in children is predominant in early childhood, mainly caused by accidental ingestion of drugs at home. These findings highlight the importance of preventive and educational measures among family members and caregivers.

RESUMO Objetivo: Analisar a incidência das intoxicações medicamentosas em crianças registradas no Centro de Informação e Assistência Toxicológica de Santa Catarina entre os anos de 2016 e 2020. Métodos: Estudo epidemiológico observacional, com delineamento de coorte histórica. Foi realizado com base nos casos notificados de intoxicação por medicamentos em crianças de zero a 12 anos. A amostra foi do tipo censo. Resultados: Foram notificadas 4.839 intoxicações medicamentosas em crianças no Estado de Santa Catarina no período, com taxa de incidência média anual de 6 casos/mil nascidos vivos. A idade apresentou mediana de três anos. A maioria (51,5%) dos casos de intoxicação ocorreu entre meninas, até os três anos de idade, de causa acidental, por exposição oral e no domicílio. Houve predomínio de sinais e sintomas que afetaram o sistema nervoso e apenas uma pequena parcela (6,2%) necessitou de hospitalização. A maioria dos casos (65,6%) foi considerada intoxicação leve com evolução favorável. Nenhum óbito foi registrado. Houve tendência de aumento dos casos ao longo do tempo, porém não significativo. Observa-se predomínio de casos incidentes no Grande Oeste, seguido do Meio-Oeste e Serra Catarinense. Conclusões: As intoxicações medicamentosas em crianças predominam na primeira infância, de forma acidental, sendo o ambiente doméstico o principal local. Esses achados destacam a importância de intensificar medidas preventivas e educativas entre familiares e cuidadores de crianças.

Early anticoagulation after aortic valve replacement with porcine bioprosthesis randomized control trial (ANTIPRO).

OBJECTIVES: Most evidence for anticoagulation (AC) in aortic bioprosthesis is centred on embolic events, bleeding and reintervention risk. The effect of AC on haemodynamics has not been previously assessed. Our hypothesis was that patients with early AC after aortic valve replacement (AVR) with porcine bioprosthesis have better haemodynamics at 1 year of follow-up. METHODS: Prospective, randomized, open-label trial conducted at 2 cardiac surgery centres. All patients undergoing AVR with porcine bioprosthesis were consecutively recruited. The anticoagulated group received warfarin + aspirin and the non-anticoagulated (control) only aspirin. The primary outcome was mean gradient after 1 year of AVR and change in New York Heart Association class. Secondary outcomes were major and minor bleeding, embolic events and prosthetic leak. RESULTS: Of 140 participants in the study, 71 were assigned to the anticoagulated group and 69 to the control group. The mean age of the overall population was 72.4 (SD: 7.1) years. Global EuroSCORE was 7.65 (SD: 5.73). At 1 year, the mean gradient was similar between both groups [18.6 (SD: 1.1 mmHg) and 18.1 (SD: 1.0 mmHg) in the control and anticoagulated groups, respectively, P = 0.701]. No differences in functional class at 3 months or 1 year were found among groups. No differences were found among groups in the secondary outcomes. CONCLUSIONS: The addition of 3 months of oral AC to anti-aggregation treatment was not detected to affect bioprosthetic haemodynamics nor functional class at 1 year after AVR. Likewise, AC does not lead to the higher incidence of complications.

Trastuzumab-induced cardiotoxicity in early breast cancer over a 10-year period in Uruguay.

This srudy aimed to estimate the prevalence of trastuzumab-induced cardiotoxicity in Uruguayan women diagnosed with human epidermal growth factor receptor 2 (HER2)-positive breast cancer over a 10-year period, who were treated under the financial coverage of the National Resources Fund (Fondo Nacional de Recursos). This was an observational, descriptive study based on the analysis of an anonymized database of Uruguayan women diagnosed with HER2-positive breast cancer who received adjuvant trastuzumab treatment from to 2006 to 2016, provided by the Fondo Nacional de Recursos. Statistical analysis was performed using SPSS Statistics version 25, and variables were assessed using measures of central tendency, dispersion, contingency tables, and proportions. The chi-square test was used to analyze the association between the different variables. The study included 1401 patients diagnosed with stage I to III HER2-positive breast cancer. The mean age at diagnosis was 52 years. The prevalence of cardiotoxicity was 20.3%. Most patients who discontinued treatment owing to cardiotoxicity eventually resumed treatment (92.6%). Moreover, the prevalence of cardiotoxicity was similar among patients who received regimens with and without anthracyclines. No association was observed between prior cardiovascular events or trastuzumab administration (concurrent vs sequential) and the development of cardiotoxicity. In the present study, the prevalence of cardiotoxicity was similar to that reported nationally and internationally. Most patients did not develop cardiotoxicity, while the ones who developed it remained asymptomatic and cardiotoxicity was reversible.

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

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

Transcultural adaptation of Patient-Reported Outcomes in Obesity (PROS) questionnaire for Brazil. / Adaptação transcultural do questionário Patient-Reported Outcomes in Obesity (PROS) para utilização no Brasil.

OBJECTIVE: To perform a cross-cultural adaptation and validation in the Brazilian cultural context of questionnaire Patient-Reported Outcomes in Obesity (PROS). METHODS: The cross-cultural adaptation process involved the translation from original English language into Brazilian Portuguese by two qualified and independent translators. The back-translation was performed by two English language teachers who were native speakers, without any medical knowledge of the original scale. An expert committee was created with researchers to assess semantic, idiomatic, experiential and conceptual equivalence. The pre-test of the Brazilian version, named PROS-Br, was carried out with ten adults with obesity. To assess the psychometric properties of the instrument, a cross-sectional epidemiological study was carried out. The population consisted of 120 Brazilian adults with obesity who went to the appointment at a school-clinic. The Item Response Theory and Factor Analysis with Principal Component Extraction was used for the psychometrics analysis. To measure reliability, the α-Cronbach indicator was used. RESULTS: In the reliability analysis, α-Cronbach was 0.82. Two factors explained 58.3% of the total variance in the principal component analysis, involving behavioral and physical aspects. Item Response Theory curves showed that all questions have discriminatory characteristics, pointing to the adequacy of the proposed version. CONCLUSION: The Brazilian version was proven valid and reliable to measure the quality of life of individuals with obesity, allowing one to develop intervention strategies, plan and execute actions at services and for public health policies.

OBJETIVO: Realizar a adaptação transcultural e a validação, no contexto cultural brasileiro, do instrumento de impacto da obesidade Patient-Reported Outcomes in Obesity (PROS). MÉTODOS: O processo de adaptação transcultural contou com a tradução do idioma original, inglês, para o português, executada por dois tradutores qualificados e independentes. A retrotradução foi realizada por dois professores de inglês, nativos, sem qualquer conhecimento médico nem da escala original. Um comitê de especialistas foi composto de pesquisadores para avaliar as equivalências semântica, idiomática, experiencial e conceitual. O pré-teste da versão brasileira, denominada PROS-Br, foi realizado com dez indivíduos adultos com obesidade. Para a avaliação das propriedades psicométricas, foi realizado um estudo epidemiológico de delineamento transversal. A população foi composta de 120 indivíduos adultos com obesidade, brasileiros, presentes para consulta médica em ambulatório-escola. Para análises psicométricas, foram utilizadas a Teoria de Resposta ao Item e análise fatorial com extração de componentes principais. Para aferição da confiabilidade foi utilizado o indicador α-Cronbach. RESULTADOS: Na análise de confiabilidade, o PROS-Br apresentou α-Cronbach de 0,82. Dois fatores explicaram 58,3% da variância total na análise de componentes principais, envolvendo aspectos comportamentais e físicos. As curvas da Teoria de Resposta ao Item mostraram que todas as perguntas apresentam características discriminatórias, apontando para a adequação da versão brasileira proposta. CONCLUSÃO: A versão brasileira mostrou-se válida e confiável para aferir a qualidade de vida de indivíduos com obesidade, possibilitando desenvolver estratégias de intervenção, planejamento e execução de ações nos serviços e na política pública de saúde.

Temporal trend and spatial distribution of cases of mother-to-child transmission of HIV in the state of Santa Catarina, Brazil, from 2007- 2017: an ecological study / Tendencia temporal y distribución espacial de los casos de transmisión vertical del VIH en el estado de Santa Catarina, Brasil, entre 2007 y 2017: un estudio ecológico / Tendência temporal e distribuição espacial dos casos de transmissão vertical do HIV em Santa Catarina entre 2007 e 2017: um estudo ecológico

Objective: To analyze the temporal trend and spatial distribution of HIV mother-to-children transmission in Santa Catarina, 2007-2017. Methods: Mixed ecological study with data from the Notifiable Diseases Information System. Linear regression was performed for time series analysis and the mean rates in the period and annual mean percentage changes in the rates of HIV-infected pregnant women were calculated; of children exposed to HIV during pregnancy; and seroconversion of children exposed to HIV/AIDS during pregnancy, in addition to data geoprocessing. Results: There were 5,554 pregnant women living with HIV, with a rate of 5.6 pregnant infected. The mean seroconversion rate was 13.5/100,000 live births (95%CI 6.8;20.1) and showed a decreasing trend (APC=-99.4%; 95%CI-99.9;-93.1). The seroconversion rate was more expressive in small towns. Conclusion: The rate of HIV-infected pregnant women was stable in the period, whereas the number of children infected with HIV by vertical transmission decreased.

Objetivo: Estimar la tendencia temporal y distribución de casos de VIH por transmisión vertical en Santa Catarina, 2007-2017. Métodos: Estudio ecológico mixto con datos del Sistema de Información de Enfermedades de Declaración Obligatoria. Se utilizó regresión lineal para análisis de series de tiempo y se calcularon las tasas medias en período y los cambios porcentuales medios anuales en las tasas de mujeres embarazadas infectadas por el VIH; de niños expuestos al VIH; y seroconversión de niños expuestos al VIH/SIDA durante el embarazo, además geoprocesamiento de datos. Resultados: Había 5.554 gestantes infectadas por el VIH, con tasa de 5,6 gestantes/1.000 nacidos vivos. La tasa media de seroconversión fue 13,5/100.000 nacidos vivos (IC95% 6,8;20,1) y mostró tendencia decreciente (APC=-99,4%; IC95%-99,9;-93,1). La tasa de seroconversión fue más expresiva en los municipios pequeños. Conclusión: Hubo una estable tasa de mujeres embarazadas infectadas por el VIH, mientras que el número de niños infectados por el VIH disminuyó.

Objetivo: Analisar a tendência temporal e distribuição espacial dos casos de transmissão vertical do HIV em Santa Catarina, de 2007-2017. Métodos: Estudo ecológico misto com dados do Sistema de Informação de Agravos de Notificação. Realizou-se regressão linear para análise de série temporal e calcularam-se as taxas médias no período e variações percentuais médias anuais das taxas de gestantes infectadas pelo HIV; de crianças expostas ao HIV na gestação; e de soroconversão das crianças expostas ao HIV/aids na gestação, além do geoprocessamento dos dados. Resultados: Foram registradas 5.554 gestantes infectadas com HIV, com taxa de 5,6 gestantes/1.000 nascidos vivos. A taxa média de soroconversão foi de 13,5/100.000 nascidos vivos (IC95% 6,8;20,1) e apresentou tendência decrescente (APC=-99,4%; IC95% -99,9;-93,1). A taxa de soroconversão foi mais elevada em municípios de pequeno porte. Conclusão: A taxa de gestantes infectadas pelo HIV foi estável e houve diminuição de crianças infectadas pelo HIV por via vertical.

Contribution of plasma, placental, inflammatory and pro-resolving mediators in labor induction.

INTRODUCTION: The onset of labor is regulated by endocrine, nervous and immunological factors. This study was designed to determine the inflammatory and pro-resolving mediator levels in plasma and placenta of women undergoing labor induction in late-term pregnancy. METHOD: Healthy pregnant women admitted for delivery or labor induction were included. TNF, IL-1ß, IL-6, IL-8, and IL-10 were quantified by ELISA in plasmatic and placental samples and Annexin A1 (ANXA1) in the placenta by Western Blotting, and immunofluorescence to CD15+ antibody. The data were analyzed using the Wilcoxon test and Spearman correlation. The p-value was significant when <0.05. RESULTS: There was a higher concentration of IL-8 was found in the amniotic plaque (p = 0.042) and IL-10 (p < 0.001) in the trophoblast of patients with spontaneous labor. Greater ANXA1 density in the trophoblast was also observed in those with induction failure. There was a positive correlation of ANXA1 density in trophoblast induction duration with (r = 0.580) and with the IL-6 level in amniotic plaque (r = 0.517), and a positive correlation between labor duration and density of ANXA1 was identified in the trophoblast (r = 0.419). An increase was identified in CD15+ cell immunocapturing among the groups with spontaneous labor compared to the group with induction failure (p < 0.001). DISCUSSION: The inflammatory process in labor involves both maternal and fetal participation. Induction failure is associated with higher levels of ANXA1 in the trophoblast.

Time trend and causes of HIV/AIDS mortality in the state of Santa Catarina, 2010­2019 / Tendência temporal e causas de mortalidade por HIV/AIDS no estado de Santa Catarina, 2010­2019

Introduction: Although the acquired immunodeficiency syndrome (AIDS) has no cure, antiretroviral treatment has considerably increased the survival of people living with the disease or with the human immunodeficiency virus (HIV), reducing the incidence of opportunistic infections in these patients. Thus, this treatment changed mortality rates and diversified the causes of death, including reasons related to increased longevity, such as chronic noncommunicable diseases, common in the uninfected population. Therefore, the current epidemiological transition motivated us to study the death profile of people with HIV/AIDS in the state of Santa Catarina. Objective: To investigate case characteristics, as well as the time trend and distribution of deaths, among people with HIV/AIDS in Santa Catarina between 2010 and 2019. Methods: In this ecological, epidemiological study, we consulted all death records from the Santa Catarina Mortality Information System that had HIV/AIDS among the causes and occurred between 2010 and 2019. Results: A total of 5,174 death records were analyzed. In the period, the mean mortality rate among people with HIV/AIDS was 7.64 deaths per 100 thousand inhabitants (95% confidence interval ­ 95%CI 6.61­8.67) ­ 8.99 in 2010 and 6.06 in 2019 ­, showing a downward trend of 0.38% per year. Conclusion: We identified a downward trend in mortality. Deaths were concentrated on the coast, in more populous cities. Furthermore, the finding of improper completion of the death certificate points to the need to invest in improving the training of professionals responsible for this document.

Introdução: Embora a síndrome da imunodeficiência adquirida (AIDS) não tenha cura, o tratamento antirretroviral aumentou consideravelmente a sobrevida das pessoas que vivem com a doença ou com o vírus da imunodeficiência humana (HIV), diminuindo a ocorrência de infecções oportunistas nesses pacientes. Assim, esse tratamento mudou as taxas de mortalidade e diversificou as causas de óbito, incluindo motivos relacionados ao aumento da longevidade, como doenças crônicas não transmissíveis comuns à população não infectada. Dessa forma, a atual transição epidemiológica motiva o estudo do perfil dos óbitos em pessoas com HIV/AIDS no estado de Santa Catarina. Objetivo: Investigar as características dos casos, a tendência temporal e a distribuição dos óbitos em pessoas com HIV/AIDS no estado de Santa Catarina entre os anos de 2010 e 2019. Métodos: Neste estudo epidemiológico com delineamento ecológico, foram consultados todos os registros de óbitos do Sistema de Informação sobre Mortalidade de Santa Catarina ocorridos entre os anos de 2010 e 2019 que apresentassem entre as causas o HIV/AIDS. Resultados: Foram analisados 5.174 registros de óbitos. A taxa de mortalidade média entre pessoas com HIV/AIDS do período foi de 7,64 óbitos a cada 100 mil habitantes (95% intervalo de confiança ­ IC95% 6,61­8,67), sendo de 8,99 em 2010 e 6,06 em 2019, mostrando tendência de queda de 0,38 pontos percentuais ao ano. Conclusão: Observou-se tendência de queda na mortalidade. A concentração dos óbitos foi na faixa litorânea, em cidades mais populosas. Ademais, a constatação do falho preenchimento da declaração de óbito aponta para a necessidade de investir no aprimoramento do treinamento dos profissionais responsáveis por esse documento.

Bio-packaging based on cellulose acetate from banana pseudostem and containing Butia catarinensis extracts.

Banana (Musa acuminata) pseudostem cellulose was extracted and acetylated (CA) to prepare membranes with potential use as bio-packages. The CA membrane was embedded by Butia seed (CA-BS) or Butia pulp (CA-BP) extracts obtained from Butia catarinenses (Butia). The produced CA, CA-BS, and CA-BP membranes were evaluated for their physical-chemical, mechanical, thermal, and antibacterial properties. The process for obtaining the cellulose yielded a material with about 92.17% cellulose (DS = 2.85). The purity, cellulose degree acetylation, and the incorporation of Butia extracts into the membranes were confirmed by FTIR. The CA-BS and CA-BP membranes showed a smaller contact angle and higher swelling ratio than the CA membrane. Furthermore, Butia seed or pulp extracts reduced the elastic modulus and deformation at break compared to the CA membrane. The DSC analysis suggested the compatibility between sections and the CA matrix, whereas the TGA analysis confirmed the thermal stability of the membranes. Moreover, less than 1% of the Butia seed and pulp extracts were put into a food simulant media from the membrane. Finally, the CA-BS and CA-BP membranes could inhibit the growth of Staphylococcus aureus and Escherichia coli on their surface, confirming the potential use of these membranes as bio-packaging for food preservation.

Epidemiology of COVID-19 Among Indigenous Populations in Brazil.

BACKGROUND: Due to social and geographical isolation, indigenous people are more vulnerable to adverse conditions; however, there is a lack of data on the epidemics' impact on these populations. Thus, this article's objective was to describe the epidemiological situation of COVID-19 in indigenous communities in Brazil. METHODS: This descriptive observational study was carried out in indigenous communities in the municipality of Amaturá (Amazonas, Brazil). Individuals from the Alto Rio Solimões Special Indigenous Sanitary District (DSEI) who met the Sars-Cov-2 infection case definitions during the period between January and August 2020 were included. For case notification, the definitions adopted by the Ministry of Health of Brazil and by the Special Secretariat for Indigenous Health were considered. RESULTS: Out of the entire population served by the Alto Rio Solimões DSEI (n = 2890), 109 indigenous people were suspected of having been infected with Sars-Cov-R during the study period; a total of 89 cases were actually confirmed (rate: 3.08 cases/100,000 inhabitants). Most patients diagnosed with COVID-19 were female (56.2%), with a mean age of 32.4 (± 23.6) years. Predominant symptoms were fever (76.4%), dry cough (64%), and headache (60.7%). Complications occurred in 7.9% of the patients; no deaths were reported. CONCLUSION: These results enhance the observation that indigenous populations, even if relatively isolated, are exposed to COVID-19. The disease cases assessed showed a favorable evolution, which does not mean reducing the need for caring of this population.

Tendência temporal e distribuição espacial dos casos de transmissão vertical do HIV em Santa Catarina, 2007-2017: um estudo ecológico / Tendencia temporal y distribución espacial de los casos de transmisión vertical del VIH en el estado de Santa Catarina, Brasil, 2007-2017: un estudio ecológico / Temporal trend and spatial distribution of cases of mother-to-child transmission of HIV in the state of Santa Catarina, Brazil, 2007-2017: an ecological study

Objetivo: Analisar a tendência temporal e a distribuição espacial dos casos de transmissão vertical do HIV, Santa Catarina, 2007-2017. Métodos: Estudo ecológico misto, com dados do Sistema de Informação de Agravos de Notificação. Realizou-se regressão linear para análise de série temporal; calcularam-se as taxas médias no período e variações percentuais médias anuais das taxas de gestantes infectadas pelo HIV, de crianças expostas ao HIV na gestação e de soroconversão das crianças expostas ao HIV/aids na gestação, além do geoprocessamento dos dados. Resultados: Foram registradas 5.554 gestantes infectadas pelo HIV, com taxa de 5,6 gestantes/1 mil nascidos vivos. A taxa média de soroconversão foi de 13,5/100 mil nascidos vivos (IC95% 6,8;20,1) e apresentou tendência decrescente (APC = -99,4%; IC95% -99,9;-93,1). A taxa de soroconversão foi mais elevada em municípios de pequeno porte. Conclusão: A taxa de gestantes infectadas pelo HIV foi estável; houve diminuição de crianças infectadas com HIV por via vertical.

Objetivo: Estimar la tendencia temporal y la distribución de casos de VIH por transmisión vertical en Santa Catarina, 2007-2017. Métodos: Estudio ecológico mixto con datos del Sistema de Información de Enfermedades de Declaración Obligatoria. Se utilizó la regresión lineal para análisis de series temporales y se calcularon las tasas medias en el período y los cambios porcentuales medios anuales en las tasas de mujeres embarazadas infectadas por el VIH; de niños expuestos al VIH; y seroconversión de niños expuestos al VIH/SIDA durante el embarazo, además del geoprocesamiento de datos Resultados: Había 5.554 gestantes infectadas por el VIH, con tasa de 5,6 gestantes/1.000 nacidos vivos. La tasa media de seroconversión fue 13,5/100.000 de nacidos vivos (IC95% 6,8;20,1) y mostró tendencia decreciente (APC = -99,4%; IC95%-99,9;-93,1). La tasa de seroconversión fue más expresiva en los municipios pequeños. Conclusão: Hubo una tasa estable de mujeres embarazadas infectadas por el VIH, mientras que el número de niños infectados por el VIH disminuyó.

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

Adaptação transcultural do questionário Patient-Reported Outcomes in Obesity (PROS) para utilização no Brasil / Transcultural adaptation of Patient-Reported Outcomes in Obesity (PROS) questionnaire for Brazil

RESUMO: Objetivo: Realizar a adaptação transcultural e a validação, no contexto cultural brasileiro, do instrumento de impacto da obesidade Patient-Reported Outcomes in Obesity (PROS). Métodos: O processo de adaptação transcultural contou com a tradução do idioma original, inglês, para o português, executada por dois tradutores qualificados e independentes. A retrotradução foi realizada por dois professores de inglês, nativos, sem qualquer conhecimento médico nem da escala original. Um comitê de especialistas foi composto de pesquisadores para avaliar as equivalências semântica, idiomática, experiencial e conceitual. O pré-teste da versão brasileira, denominada PROS-Br, foi realizado com dez indivíduos adultos com obesidade. Para a avaliação das propriedades psicométricas, foi realizado um estudo epidemiológico de delineamento transversal. A população foi composta de 120 indivíduos adultos com obesidade, brasileiros, presentes para consulta médica em ambulatório-escola. Para análises psicométricas, foram utilizadas a Teoria de Resposta ao Item e análise fatorial com extração de componentes principais. Para aferição da confiabilidade foi utilizado o indicador α-Cronbach. Resultados: Na análise de confiabilidade, o PROS-Br apresentou α-Cronbach de 0,82. Dois fatores explicaram 58,3% da variância total na análise de componentes principais, envolvendo aspectos comportamentais e físicos. As curvas da Teoria de Resposta ao Item mostraram que todas as perguntas apresentam características discriminatórias, apontando para a adequação da versão brasileira proposta. Conclusão: A versão brasileira mostrou-se válida e confiável para aferir a qualidade de vida de indivíduos com obesidade, possibilitando desenvolver estratégias de intervenção, planejamento e execução de ações nos serviços e na política pública de saúde.

ABSTRACT: Objective: To perform a cross-cultural adaptation and validation in the Brazilian cultural context of questionnaire Patient-Reported Outcomes in Obesity (PROS). Methods: The cross-cultural adaptation process involved the translation from original English language into Brazilian Portuguese by two qualified and independent translators. The back-translation was performed by two English language teachers who were native speakers, without any medical knowledge of the original scale. An expert committee was created with researchers to assess semantic, idiomatic, experiential and conceptual equivalence. The pre-test of the Brazilian version, named PROS-Br, was carried out with ten adults with obesity. To assess the psychometric properties of the instrument, a cross-sectional epidemiological study was carried out. The population consisted of 120 Brazilian adults with obesity who went to the appointment at a school-clinic. The Item Response Theory and Factor Analysis with Principal Component Extraction was used for the psychometrics analysis. To measure reliability, the α-Cronbach indicator was used. Results: In the reliability analysis, α-Cronbach was 0.82. Two factors explained 58.3% of the total variance in the principal component analysis, involving behavioral and physical aspects. Item Response Theory curves showed that all questions have discriminatory characteristics, pointing to the adequacy of the proposed version. Conclusion: The Brazilian version was proven valid and reliable to measure the quality of life of individuals with obesity, allowing one to develop intervention strategies, plan and execute actions at services and for public health policies.

Congenital anomalies in Santa Catarina: case distribution and trends in 2010-2018 / Anomalias congênitas em Santa Catarina: distribuição e tendências no período de 2010-2018

Abstract Objective: To evaluate the distribution of cases of congenital anomalies in the state of Santa Catarina by health macro-region, to determine the frequency according to maternal and neonatal variables, to estimate the related mortality, and the trends in the period 2010-2018. Methods: An ecological time-series study with secondary data on congenital anomalies and the sociodemographic and health variables of mothers and newborns living in Santa Catarina, from 2010 to 2018. For temporal trend analysis, generalized linear regression was performed using the Prais-Winsten method with robust variance. Results: The average prevalence of congenital anomalies in the period was 8.9 cases per 1,000 live births, being 9.4 cases by 1,000 live births in 2010 and, in 2018, 8.2/1,000. The trend remained stable in the analyzed period. The major malformations were musculoskeletal, hip, and foot malformations, with a proportion ≥30%. There was a higher prevalence of congenital anomalies in low birthweight, preterm, male livebirths with Apgar≤7, born by cesarean section, mothers of older age (≥40 years), and less educated (less than eight years of study). Infant mortality due to congenital malformations was 2.6 deaths/1,000 live births, representing about 25.8% of the total infant deaths in the period. Conclusions: The frequency of congenital anomalies and the mortality with anomalies was stable in the studied period in Santa Catarina. The presence of anomalies was associated with low birth weight, prematurity, and low Apgar score. The highest proportion of congenital anomalies was in the musculoskeletal system.

Resumo Objetivo: Avaliar a distribuição dos casos de anomalias congênitas no estado de Santa Catarina por macrorregião de saúde, determinar a frequência segundo fatores da mãe e do produto da gestação e estimar a mortalidade relacionada e a tendência no período de 2010-2018. Métodos: Estudo ecológico de série temporal, com dados secundários sobre anomalias congênitas e variáveis sociodemográficas e de saúde de mães e recém-nascidos residentes em Santa Catarina, no período de 2010 a 2018. Para análise de tendência temporal, foi utilizada a regressão linear generalizada pelo método de Prais-Winsten com variância robusta. Resultados: A prevalência média de anomalias congênitas no período foi de 8,9 casos a cada 1.000 nascidos vivos, sendo 9,4 casos a cada 1.000 em 2010 e 8,2 a cada 1.000 em 2018. A tendência manteve-se estável no período analisado. As principais malformações foram as osteomusculares, de quadril e de pés, com proporção ≥30%. Verificou-se prevalência maior de anomalias congênitas nas crianças de baixo peso, prematuras, de sexo masculino e Apgar≤7 e nos nascidos de cesariana, de mães de maior idade (≥40 anos) e menor escolaridade (menos de oito anos de estudo). A mortalidade infantil por malformações congênitas foi de 2,6 óbitos/1.000 nascidos vivos, representando 25,8% do total de óbitos infantis no período. Conclusões: Houve estabilidade na frequência e na mortalidade associada às anomalias congênitas em Santa Catarina de 2010 a 2018. A ocorrência dessas condições foi associada aos nascidos de baixo peso, pré-termo e baixo escore de Apgar. A maior proporção de anomalias congênitas foi do sistema osteomuscular.

Congenital anomalies in Santa Catarina: case distribution and trends in 2010-2018.

OBJECTIVE: To evaluate the distribution of cases of congenital anomalies in the state of Santa Catarina by health macro-region, to determine the frequency according to maternal and neonatal variables, to estimate the related mortality, and the trends in the period 2010-2018. METHODS: An ecological time-series study with secondary data on congenital anomalies and the sociodemographic and health variables of mothers and newborns living in Santa Catarina, from 2010 to 2018. For temporal trend analysis, generalized linear regression was performed using the Prais-Winsten method with robust variance. RESULTS: The average prevalence of congenital anomalies in the period was 8.9 cases per 1,000 live births, being 9.4 cases by 1,000 live births in 2010 and, in 2018, 8.2/1,000. The trend remained stable in the analyzed period. The major malformations were musculoskeletal, hip, and foot malformations, with a proportion ≥30%. There was a higher prevalence of congenital anomalies in low birthweight, preterm, male livebirths with Apgar≤7, born by cesarean section, mothers of older age (≥40 years), and less educated (less than eight years of study). Infant mortality due to congenital malformations was 2.6 deaths/1,000 live births, representing about 25.8% of the total infant deaths in the period. CONCLUSIONS: The frequency of congenital anomalies and the mortality with anomalies was stable in the studied period in Santa Catarina. The presence of anomalies was associated with low birth weight, prematurity, and low Apgar score. The highest proportion of congenital anomalies was in the musculoskeletal system.