The Brazilian COVID-19 vaccination campaign: a modelling analysis of sociodemographic factors on uptake.

OBJECTIVE: Dose shortages delayed access to COVID-19 vaccination. We aim to characterise inequality in two-dose vaccination by sociodemographic group across Brazil. DESIGN: This is a cross-sectional study. SETTING: We used data retrieved from the Brazilian Ministry of Health databases published between 17 January 2021 and 6 September 2021. METHODS: We assessed geographical inequalities in full vaccination coverage and dose by age, sex, race and socioeconomic status. We developed a Campaign Optimality Index to characterise inequality in vaccination access due to premature vaccination towards younger populations before older and vulnerable populations were fully vaccinated. Generalised linear regression was used to investigate the risk of death and hospitalisation by age group, socioeconomic status and vaccination coverage. RESULTS: Vaccination coverage is higher in the wealthier South and Southeast. Men, people of colour and low-income groups were more likely to be only partially vaccinated due to missing or delaying a second dose. Vaccination started prematurely for age groups under 50 years which may have hindered uptake in older age groups. Vaccination coverage was associated with a lower risk of death, especially in older age groups (ORs 9.7 to 29.0, 95% CI 9. 4 to 29.9). Risk of hospitalisation was greater in areas with higher vaccination rates due to higher access to care and reporting. CONCLUSIONS: Vaccination inequality persists between states, age and demographic groups despite increasing uptake. The association between hospitalisation rates and vaccination is attributed to preferential delivery to areas of greater transmission and access to healthcare.

Cytogenotoxic potential and toxicity in adult Danio rerio (zebrafish) exposed to chloramine T.

Background: Chloramine-T (CL-T) is a synthetic sodium salt used as a disinfectant in fish farms to combat bacterial infections in fish gills and skin. While its efficacy in pathogen control is well-established, its reactivity with various functional groups has raised concerns. However, limited research exists on the toxicity of disinfection by-products to aquatic organisms. Therefore, this study aims to assess the sublethal effects of CL-T on adult zebrafish by examining biomarkers of nucleus cytotoxicity and genotoxicity, acetylcholinesterase (AChE) inhibition, and histopathological changes. Methods: Male and female adult zebrafish (wildtype AB lineage) specimens were exposed to 70, 140, and 200 mg/L of CL-T and evaluated after 96 h. Cytotoxic and genotoxic effects were evaluated by estimating the frequencies of nuclear abnormalities (NA), micronuclei (MN), and integrated optical density (IOD) of nuclear erythrocytes. Histopathological changes in the gills and liver were assessed using the degree of tissue changes (DTC). AChE activity was measured in brain samples. Results and conclusions: At a concentration of 200 mg/L, NA increased, indicating the cytogenotoxic potential of CL-T in adult zebrafish. Morphological alterations in the nuclei were observed at both 70 and 200 mg/L concentrations. Distinct IOD profiles were identified across the three concentrations. There were no changes in AChE activity in adult zebrafish. The DTC scores were high in all concentrations, and histological alterations suggested low to moderate toxicity of CL-T for adult zebrafish.

Kidney function decline associated with proton pump inhibitors: results from the ELSA-Brasil cohort.

OBJECTIVE: Investigate the longitudinal association of use and time of use of proton pump inhibitors (PPI) with incidence of chronic kidney disease (CKD) and kidney function change. METHODS: Prospective study with 13,909 participants from baseline (2008-2010) and second wave (2012-2014) of the ELSA-Brasil (mean interval between visits = 3.9 years (1.7-6.0)). Participants answered about use and time use of the PPI in the two weeks prior the interview. Renal function was assessed by glomerular filtration rate estimated by the Collaboration Equation for the Epidemiology of Chronic Kidney Disease. Values below 60ml/min/1.73 m² in wave 2 were considered incident CKD. Associations between PPI use and time of use at baseline and incident CKD and decline in renal function were estimated, respectively, by logistic regression and linear models with mixed effects, after adjusting for confounders. RESULTS: After adjustments, PPI users for more than six months had an increased risk of CKD compared to non-users. Compared to non-users, users PPIs for up to six months and above six months had greater decline in kidney function over time. CONCLUSION: This cohort of adults and elderly, after a mean interval of 3.9 years, PPI use and initial duration were associated with kidney function change between visits.

Effects of Chloramine T on zebrafish embryos malformations associated with cardiotoxicity and neurotoxicity.

Chloramine T, a sodium p-toluene sulfonchloramide, is known to possess a wide spectrum of biocidal activity and is employed as a disinfectant in fish farms to treat bacterial infections. Although Chloramine T may effectively combat pathogens, the sublethal and lethal effects and changes in acetylcholinesterase (AChE) activity remain poorly elucidated using Danio rerio (zebrafish) embryos. Zebrafish is considered a model organism for toxicant screening research and exhibits mammalian-like physiological responses when exposed to environmental pollutants. The aim of this study was to (1) determine LC50 of Chloramine T after 96 hr exposure, (2) verify disinfectant effects on developmental morphology, and (3) evaluate the disinfectant effects on AChE activity in zebrafish embryos. Chloramine T exposure was performed using 16, 32, 64, 128, or 256 mg/L concentrations. The mortality LC50 values were 143.05 ± 3.11 and 130.97 ± 7.4 mg/L at 24 and 96 hr, respectively. Data demonstrated delayed hatching, reduced heartbeats, cardiac edema, and equilibrium disruption of hatched larvae throughout embryonic development. In addition, Chloramine T inhibited AChE activity at 64 or 128 mg/L after 96 hr treatment, corroborating the sub-lethality results observed in zebrafish embryo development and demonstrating an equilibrium disruption in zebrafish larvae.

Parestesia do nervo alveolar inferior decorrente de procedimentos cirúrgicos e suas formas de tratamentos / Paresthesi of the lower alveolar nerve resulting from surgical procedures and its forms of treatment

Nas cirurgias odontológicas é possível que ocorra alguns acidentes ou complicações que podem interferir no dia a dia do paciente. A lesão do nervo alveolar inferior é uma complicação decorrente de cirurgias orais que podem causar um distúrbio de sensibilidade transitória ou persistente, na região do lábio inferior e na região delimitada do forame mentoniano e hemi-arco da mucosa. O diagnóstico da parestesia pode ser feito através de testes mecanoceptivos e nocioceptivos em que o profissional escolherá para qual melhor se adapte no paciente. O objetivo do presente trabalho foi abordar por meio de uma revisão de literatura as formas de diagnóstico e tratamento da parestesia do nervo alveolar inferior decorrentes de cirurgias orais. As bases de dados utilizadas para confecção desta revisão são encontradas nas bibliotecas virtuais eletrônicas: BVS (Biblioteca Virtual em Saúde), LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e Pubmed. Como critério de inclusão foram selecionados artigos publicados de 2012 a 2022 em língua inglesa, portuguesa e espanhola. Após a leitura do título e resumo dos resultados da pesquisa e aplicação dos critérios de inclusão e exclusão dentre eles foram excluídos 883, pois não se enquadravam no nosso critério de inclusão. No final, foram selecionados 13 estudos por meio de base de dados, que serviram de base para esta revisão. Concluímos que as formas de tratamento para a parestesia na literatura, são um pouco escassas e conflitantes, mas relata que o uso da laserterapia e acupuntura tem sido uma forma de tratamento com um bom índice de sucesso, e para os casos que não sejam suficientes tais tratamentos, pode-se optar por uma cirurgia(AU)

In dental surgeries it is possible to have some accidents or complications that can interfere with the patient's day. Injury to the inferior alveolar nerve is a complication resulting from oral surgeries that can cause a disturbance of sensitivity that can be transient or persistent in the region of the lower lip and in the delimited region of the mental foramen and hemiarch of the mucosa. The diagnosis of paresthesia can be made through mechanoceptive and nocioceptive tests that the professional will choose, which best suits the patient. The objective of the present work is to approach, through a literature review, the forms of diagnosis and treatment aimed at inferior alveolar nerve paresthesia resulting from oral surgeries. The databases used for this review are found in the virtual electronic libraries: VHL (Virtual Health Library), LILACS (Latin American and Caribbean Literature on Health Sciences) and Pubmed. As inclusion criteria, articles published from 2012 to 2022 in English, Portuguese and Spanish were selected. After reading the title and summary of the research results and applying the inclusion and exclusion criteria, 883 were excluded, as they did not meet our inclusion criteria. In the end, 13 studies were selected from the database, which served as the basis for this review. We conclude that the forms of treatment for paresthesia in the literature are a little scarce and conflicting, but it reports that the use of laser therapy and acupuncture has been a form of treatment with a good success rate, and for cases that are not enough, such treatments, one can opt for surgery(AU)

Um roteiro virtual sobre ativismo biossocial e biodeserção no Movimento dos Consumidores/ Ex-pacientes/Sobreviventes da Psiquiatria / A virtual script about biosocial and biodesertion activism in the User, Ex-patient, and Survivor of Psychiatry Movement / Un guion virtual sobre activismo biosocial y biodeserción en el Movimiento de los Consumidores/Ex-pacientes/Sobrevivientes de la Psiquiatría

A dificuldade em demarcar um termo que designe o movimento indicado no título deste artigo é uma demonstração da heterogeneidade que o caracteriza: consumidores, ex-pacientes, sobreviventes da Psiquiatria são algumas das denominações utilizadas pelos grupos que se organizam em torno da advocacy pelos direitos das pessoas que são submetidas a tratamentos psiquiátricos (incluindo o direito de recusa a esses tratamentos) e da construção de redes de autoajuda, pensadas como alternativas ao sistema de Saúde Mental, no contexto dos Estados Unidos. Convido o leitor a conhecer um pouco dessa história por meio do roteiro de um documentário, que não foi e não será gravado, mas que é virtualmente narrado neste texto com a intenção de situar a atuação desse movimento e propor uma discussão teórica que o articule com os conceitos de ativismo biossocial e biodeserção.(AU)

The difficulty defining a term to describe the movement indicated in the title of this article illustrates its heterogeneity: users, ex-patients, and survivors of Psychiatry are some of the names used by the groups who advocate for the rights of people undergoing psychiatric treatment (including the right to refuse treatment) and the creation of self-help networks, designed to be an alternative to the Mental Health system in the context of the United States. I invite the reader to understand a little about the history of this movement using the script of a documentary that has not and will never be recorded, but is narrated virtually in this text with the intention of situating the movement's role and proposing a theoretical discussion that articulates the concepts of biosocial and biodesertion activism.(AU)

La dificultad de demarcar un término que designe el movimiento indicado en el título de ese artículo es una demostración de la heterogeneidad que lo caracteriza: consumidores, expacientes, sobrevivientes de la Psiquiatría son algunas de las denominaciones utilizadas por los grupos que se organizan alrededor de la advocacy por los derechos de las personas sometidas a tratamientos psiquiátricos (incluyendo el derecho de rechazarlos) y de la construcción de redes de auto-ayuda pensadas como alternativas para el sistema de Salud Mental, en el contexto de Estados Unidos. Invito al lector a conocer un poco de esa historia por medio del guion de un documental que no fue ni será grabado, pero que se narra virtualmente en este texto con la intención de situar la actuación de ese movimiento y proponer una discusión teórica que lo articule con los conceptos de activismo biosocial y biodeserción.(AU)

Indicadores de acesso nos serviços de reabilitação física das desordens musculoesqueléticas em Belo Horizonte (MG) / Indicadores de acceso en servicios de rehabilitación física para trastornos musculoesqueléticas en Belo Horizonte (MG) / Access indicators in physical rehabilitation services for musculoskeletal disorders in Belo Horizonte (MG)

RESUMO A crescente demanda por atendimento nos serviços de reabilitação física do Sistema Único de Saúde (SUS) excede a oferta, o que resulta em longas filas de espera. Neste estudo, realizou-se uma pesquisa quantitativa de cunho exploratório que teve por objetivo a apresentação de indicadores para facilitar o acesso aos serviços de reabilitação física no que tange às desordens musculoesqueléticas. Os dados foram colhidos dos prontuários de usuários residentes nas regiões noroeste e oeste de Belo Horizonte (MG), com mais de 18 anos de idade, submetidos a acolhimento no Centro Especializado em Reabilitação IV no ano de 2019. Obtiveram-se os seguintes indicadores: absenteísmo no momento da avaliação; tempo médio para início do tratamento de acordo com a prioridade; tempo médio de tratamento; e média de usuários atendidos ao mês. A análise deste estudo foi pautada em 362 prontuários. O tempo médio para início de tratamento foi de aproximadamente 69 dias e o período médio de tratamento, de 94 dias. O serviço absorveu cerca de 30 novos usuários ao mês e apresentou índice de absenteísmo de 16,8%. Acredita-se que os indicadores apresentados possivelmente favorecerão a gestão e o controle das filas de espera dos serviços de reabilitação do SUS.

RESUMEN La creciente demanda de atención en los servicios de rehabilitación física del Sistema Único de Salud (SUS) supera la oferta, lo que se traduce en largas colas de espera. Este estudio es una investigación cuantitativa exploratoria, que tuvo como objetivo presentar indicadores para facilitar el acceso a los servicios de rehabilitación física con respecto a los trastornos musculoesqueléticos. Se recolectaron datos de las historias clínicas de los usuarios residentes en las regiones noroeste y oeste de Belo Horizonte (en Mina Gerais, Brasil), mayores de 18 años de edad y que ingresaron al Centro Especializado en Rehabilitación IV en 2019. Se obtuvieron los siguientes indicadores: Absentismo al momento de la evaluación; tiempo medio para iniciar el tratamiento según la prioridad; tiempo medio de tratamiento y número medio de usuarios atendidos por mes. El análisis de este estudio se basó en 362 historias clínicas. El tiempo medio para iniciar el tratamiento fue de aproximadamente 69 días y el período medio de tratamiento, 94 días. El servicio recibió cas 30 nuevos usuarios al mes y presentó una tasa de absentismo del 16,8%. Los indicadores presentados pueden favorecer la gestión y control de las listas de espera de los servicios de rehabilitación del SUS.

ABSTRACT The growing demand for care in the physical rehabilitation services of the Unified Health System (SUS) exceeds the supply, resulting in long waiting lines. This study is an exploratory quantitative research, which aims to present indicators to ease the access to physical rehabilitation services related to musculoskeletal disorders. Data were collected from the medical records of users residing in the northwest and west regions of Belo Horizonte (MG), who were over 18 years old and underwent treatment at the Specialized Rehabilitation Center IV (CER-IV) in 2019. The following indicators were obtained: absenteeism at the time of assessment; average time to start treatment according to priority; mean treatment time; and average number of users served per month. The analysis was based on 362 medical records. The mean time to start treatment was approximately 69 days and the mean treatment period was 94 days. The service absorbed around 30 new users per month and presented an absenteeism rate of 16.8%. It is believed that the indicators presented will possibly favor the management and control of the SUS rehabilitation services waiting lines.

Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Gamma variant of concern has spread rapidly across Brazil since late 2020, causing substantial infection and death waves. Here we used individual-level patient records after hospitalization with suspected or confirmed coronavirus disease 2019 (COVID-19) between 20 January 2020 and 26 July 2021 to document temporary, sweeping shocks in hospital fatality rates that followed the spread of Gamma across 14 state capitals, during which typically more than half of hospitalized patients aged 70 years and older died. We show that such extensive shocks in COVID-19 in-hospital fatality rates also existed before the detection of Gamma. Using a Bayesian fatality rate model, we found that the geographic and temporal fluctuations in Brazil's COVID-19 in-hospital fatality rates were primarily associated with geographic inequities and shortages in healthcare capacity. We estimate that approximately half of the COVID-19 deaths in hospitals in the 14 cities could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization and pandemic preparedness are critical to minimize population-wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries.

Adaptation and psychometric evaluation of a Brazilian version of the CYRM-28 / Adaptação e avaliação psicométrica de uma versão brasileira da CYRM-28 / Adaptación y evaluación psicométrica de una versión brasileña del CYRM-28

Using a sample of 832 young people, between 13 and 25 years old, the present research examined the psychometric properties of a Brazilian adaptation of the Child and Youth Resilience Measure-28 (CYRM-28), a scale empirically derived from a threefactor resilience model that has been promising for cross-cultural research. To establish validation, we use Confirmatory Factor Analysis to determine whether the traditional three-factor structure and the original items of CYRM-28 are compatible with a Brazilian sample. This was followed by tests of internal consistency by examining Cronbach's alpha and convergent validity by testing correlations with the CD-RISC-10. The results led to a reduced version of 19 items distributed in three resilience factors. The findings are consistent with those observed in samples from other cultures and suggest that CYRM-19-Br is promising for use in resilience research in Brazil.

Utilizando uma amostra de 832 jovens, entre 13 e 25 anos, a presente investigação examinou as propriedades psicométricas de uma adaptação brasileira da Child and Youth Resilience Measure-28 (CYRM-28), uma escala empiricamente derivada de um modelo de resiliência de três fatores que tem sido promissora para pesquisas interculturais. Para estabelecer a validação, usamos a Análise Fatorial Confirmatória para determinar se a estrutura tradicional de três fatores e os itens originais da CYRM-28 são compatíveis com uma amostra brasileira. Isso foi seguido por testes de consistência interna examinando o alfa de Cronbach e a validade convergente testando correlações com o CD-RISC-10. Os resultados levaram a uma versão reduzida de 19 itens distribuídos em três fatores de resiliência. Os achados são consistentes com aqueles observados em amostras de outras culturas e sugerem que a CYRM-19-Br é promissora para uso em pesquisas de resiliência no Brasil.

Utilizando una muestra de 832 jóvenes, entre 13 y 25 años, la presente investigación examinó las propiedades psicométricas de una adaptación brasileña de Child and Youth Resilience Measure-28 (CYRM-28), una escala derivada empíricamente de un modelo de escala de tres factores de resiliencia que ha sido prometedor para la investigación intercultural. Para establecer la validación, utilizamos el Análisis Factorial Confirmatorio para determinar si la estructura tradicional de tres factores y los ítems originales de CYRM-28 son compatibles con una muestra brasileña. A esto le siguieron pruebas de consistencia interna examinando el alfa de Cronbach y la validez convergente probando las correlaciones con el CD-RISC-10. Los resultados llevaron a una versión reducida de 19 ítems distribuidos en tres factores de resiliencia. Los hallazgos son consistentes con los observados en muestras de otras culturas y sugieren que el CYRM-19-Br es prometedor para su uso en la investigación de resiliencia en Brasil.

Tracking the emergence of disparities in the subnational spread of COVID-19 in Brazil using an online application for real-time data visualisation: A longitudinal analysis.

BACKGROUND: Brazil is one of the countries worst affected by the COVID-19 pandemic with over 20 million cases and 557,000 deaths reported by August 2021. Comparison of real-time local COVID-19 data between areas is essential for understanding transmission, measuring the effects of interventions, and predicting the course of the epidemic, but are often challenging due to different population sizes and structures. METHODS: We describe the development of a new app for the real-time visualisation of COVID-19 data in Brazil at the municipality level. In the CLIC-Brazil app, daily updates of case and death data are downloaded, age standardised and used to estimate the effective reproduction number (Rt ). We show how such platforms can perform real-time regression analyses to identify factors associated with the rate of initial spread and early reproduction number. We also use survival methods to predict the likelihood of occurrence of a new peak of COVID-19 incidence. FINDINGS: After an initial introduction in São Paulo and Rio de Janeiro states in early March 2020, the epidemic spread to northern states and then to highly populated coastal regions and the Central-West. Municipalities with higher metrics of social development experienced earlier arrival of COVID-19 (decrease of 11·1 days [95% CI:8.9,13.2] in the time to arrival for each 10% increase in the social development index). Differences in the initial epidemic intensity (mean Rt ) were largely driven by geographic location and the date of local onset. INTERPRETATION: This study demonstrates that platforms that monitor, standardise and analyse the epidemiological data at a local level can give useful real-time insights into outbreak dynamics that can be used to better adapt responses to the current and future pandemics. FUNDING: This project was supported by a Medical Research Council UK (MRC-UK) -São Paulo Research Foundation (FAPESP) CADDE partnership award (MR/S0195/1 and FAPESP 18/14389-0).

Anti-obesity properties and mechanism of action of flavonoids: A review.

Obesity is a major public health problem, and there is increasing scientific interest in its mechanisms, as well as a search for new compounds with antioxidant and anti-inflammatory properties that can minimize the metabolic complications associated with its pathology. One potential source of these compounds is natural products; Among these, flavonoids are a promising group of natural substances. Flavonoids are active constituents with diverse biological activities and are widely found in plants kingdom. Numerous studies have shown that flavonoids can effectively inhibit obesity and related metabolic disorders. The review synthesizes recent evidence in respect of progress in the understanding of the anti-obesity effects of flavonoids. Such effects which occurs through the modulation of proteins, genes and transcriptional factors involved in decreasing lipogenesis, increasing lipolysis, expenditure energy, stimulating fatty acids B-oxidation, digestion and metabolism of carbohydrates. In addition to mitigating inflammatory responses and suppress oxidative stress. A better understanding of the modulating effects and mechanisms of flavonoids in relation to obesity will allow us to better use these compounds to treat or even prevent obesity and its associated comorbidities.

Entre ações e reações: controvérsias em torno da recusa aos psicofármacos na atenção psicossocial / Between actions and reactions: controversies around the refusal psychotropic drugs in psychosocial care

A proposta desta dissertação é discutir sobre a recusa aos psicofármacos dentro do escopo da atenção psicossocial. Considerada por alguns como um dos direitos mais controversos no panorama ético do cuidado em Saúde Mental, a recusa ao tratamento medicamentoso costuma mobilizar variadas implicações dentro das cenas clínicas. Aqui ela é utilizada como um operador analítico voltado para os serviços e as práticas de saúde, partindo dos agenciamentos não só dos sujeitos, mas também dos próprios medicamentos, enquanto atores não-humanos. O texto consiste em um passeio bibliográfico sobre o tema e nos desdobramentos de um estudo de campo realizado em um Centro de Atenção Psicossocial - CAPS III do município do Rio de Janeiro, onde se procurou acessar o relato de profissionais acerca dos manejos da recusa aos psicofármacos no cotidiano assistencial. O material colhido a partir de entrevistas semiestruturadas realizadas remotamente com 10 (dez) profissionais desse serviço foi submetido a uma análise de cunho narrativo e utilizado como eixo norteador para a discussão. Um olhar mais demorado sobre esse fenômeno revelou o seu alcance ético e político, permitindo a elaboração de questões sobre o papel dos psicofármacos e da autonomia dentro da Reforma Psiquiátrica Brasileira e da cultura contemporânea. Por meio de uma torção dinâmica entre o direito de recusa e o direito de acesso, tornou-se possível explorar distintas reações mutuamente produzidas entre os atores do campo. Nesse contexto, em que algumas faltas e excessos se mostraram presentes, os limites no encontro com os diferentes cenários de crise destacaram certas interfaces sobre os usos medicamentosos e as implicações de suas recusas. O trabalho procura contribuir para o mapeamento dessa controvérsia dentro da conjuntura brasileira por intermédio de um contorno dos aspectos situados localmente em contraponto a outras realidades em que esse debate tem historicamente recebido mais atenção.

The purpose of this dissertation is to discuss the refusal of psychotropic drugs within the scope of psychosocial care. Considered by some to be one of the most controversial rights in the ethical panorama of mental health care, the refusal to take medication tends to mobilize various implications within clinical settings. Here it is used as an analytical operator focused on health services and practices, starting from the agencies not only of the subjects, but also of the medicines themselves, as non-human actors. The text is divided into a bibliographic tour on the subject and the consequences of a field study carried out in a Psychosocial Care Center - CAPS III in the city of Rio de Janeiro, where we sought to access the report of professionals about the management of the refusal to psychotropic drugs in everyday care. The material collected from semi-structured interviews carried out remotely with 10 (ten) professionals from this service was submitted to a narrative analysis and used as a guideline for the discussion. A longer look at this phenomenon revealed its ethical and political scope, allowing the elaboration of questions about the role of psychotropic drugs and autonomy within the Brazilian Psychiatric Reform and contemporary culture. Through a dynamic twist between the right of refusal and the right of access, it became possible to explore different reactions mutually produced among the actors in the field. In this context, in which some shortages and excesses were present, the limits in the encounter with the different crisis scenarios highlighted certain interfaces on drug uses and the implications of their refusal. The work seeks to contribute to the mapping of this controversy within the Brazilian conjuncture through an outline of locally situated aspects in contrast to other realities in which this debate has received more attention.

Report 46: Factors driving extensive spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals.

The SARS-CoV-2 Gamma variant spread rapidly across Brazil, causing substantial infection and death waves. We use individual-level patient records following hospitalisation with suspected or confirmed COVID-19 to document the extensive shocks in hospital fatality rates that followed Gamma's spread across 14 state capitals, and in which more than half of hospitalised patients died over sustained time periods. We show that extensive fluctuations in COVID-19 in-hospital fatality rates also existed prior to Gamma's detection, and were largely transient after Gamma's detection, subsiding with hospital demand. Using a Bayesian fatality rate model, we find that the geographic and temporal fluctuations in Brazil's COVID-19 in-hospital fatality rates are primarily associated with geographic inequities and shortages in healthcare capacity. We project that approximately half of Brazil's COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization, and pandemic preparedness are critical to minimize population wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries. NOTE: The following manuscript has appeared as 'Report 46 - Factors driving extensive spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals' at https://spiral.imperial.ac.uk:8443/handle/10044/1/91875 . ONE SENTENCE SUMMARY: COVID-19 in-hospital fatality rates fluctuate dramatically in Brazil, and these fluctuations are primarily associated with geographic inequities and shortages in healthcare capacity.

Lack of association between proton pump inhibitor use and decline in cognitive performance in the ELSA-Brasil cohort.

OBJECTIVE: The study aims to investigate the longitudinal association of use and time of use of proton pump inhibitors (PPIs) with decreased performance in three cognitive tests. METHODS: Prospective cohort study included 7115 participants with mean age of 58.9 years at baseline (2008-2010) who participated in the second wave (2012-2014) of ELSA-Brasil (average interval between visits = 3.9 years (range: 1.7 to 6.0 years)). Cognitive performance was assessed by tests of memory, phonemic and semantic verbal fluency, and the trail making test, applied to both waves. Associations with the use and time of use of PPIs at baseline were investigated using linear models with mixed effects after adjusting for confounding factors. RESULTS: At baseline, 7.4% (529) of the participants used PPIs on a regular basis. After all adjustments, the interaction term use of PPI × age was not statistically significant for the cognitive tests evaluated, indicating that the use of PPI at baseline was not associated with a more accelerated decline in cognitive performance between waves. The interaction term PPI use × age was not statistically significant, in any of the categories of medication use time, any of the cognitive function tests evaluated, indicating that PPI use time is not associated with decrease in cognitive scores as the time interval between visits increases. CONCLUSION: In this cohort middle-aged and elderly adults, after average interval of 3.9 years (relatively short time to detect cognitive decline in a young cohort), the use and time of use of PPIs at the beginning of the study were not associated with a decline in cognitive performance in these tests between visits.

Seasonal dynamics of Amblyomma sculptum in two areas of the Cerrado biome midwestern Brazil, where human cases of rickettsiosis have been reported.

Amblyomma sculptum is a common human-biting tick in Brazil, where it plays an important role as a vector of Rickettsia rickettsii, the agent of the Brazilian spotted fever. Herein, we studied the seasonal dynamics of A. sculptum in an urban area of the Cerrado biome in midwestern Brazil, where human rickettsiosis is endemic. Ticks were collected in two sites located within the campus of Federal University of Goiás. The collections were done by dragging, flagging and visual search. In total, 117,685 ticks were collected, including 100,627 Amblyomma spp. larvae, 10,055 nymphs and 6977 adults of A. sculptum, and one nymph and 25 adults of Amblyomma dubitatum. The highest peak of larvae occurred in June 2018 and in July 2019, whereas nymphs peaked in July 2018 and September 2019. Adults reached their highest numbers in March 2018 and November 2019. These data suggest that A. sculptum develops one generation per year in this urban area of the Cerrado biome in midwestern Brazil. Interestingly, the peak of nymphs occurred during the same period of all confirmed cases of rickettsiosis in Goiás, suggesting a possible relationship between the seasonal dynamics of this tick stage and rickettsiosis transmission in this state.

Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil.

INTRODUCTION: Little evidence exists on the differential health effects of COVID-19 on disadvantaged population groups. Here we characterise the differential risk of hospitalisation and death in São Paulo state, Brazil, and show how vulnerability to COVID-19 is shaped by socioeconomic inequalities. METHODS: We conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in the Sistema de Monitoramento Inteligente de São Paulo database. We examined the risk of hospitalisation and death by race and socioeconomic status using multiple data sets for individual-level and spatiotemporal analyses. We explained these inequalities according to differences in daily mobility from mobile phone data, teleworking behaviour and comorbidities. RESULTS: Throughout the study period, patients living in the 40% poorest areas were more likely to die when compared with patients living in the 5% wealthiest areas (OR: 1.60, 95% CI 1.48 to 1.74) and were more likely to be hospitalised between April and July 2020 (OR: 1.08, 95% CI 1.04 to 1.12). Black and Pardo individuals were more likely to be hospitalised when compared with White individuals (OR: 1.41, 95% CI 1.37 to 1.46; OR: 1.26, 95% CI 1.23 to 1.28, respectively), and were more likely to die (OR: 1.13, 95% CI 1.07 to 1.19; 1.07, 95% CI 1.04 to 1.10, respectively) between April and July 2020. Once hospitalised, patients treated in public hospitals were more likely to die than patients in private hospitals (OR: 1.40%, 95% CI 1.34% to 1.46%). Black individuals and those with low education attainment were more likely to have one or more comorbidities, respectively (OR: 1.29, 95% CI 1.19 to 1.39; 1.36, 95% CI 1.27 to 1.45). CONCLUSIONS: Low-income and Black and Pardo communities are more likely to die with COVID-19. This is associated with differential access to quality healthcare, ability to self-isolate and the higher prevalence of comorbidities.

Dataset on SARS-CoV-2 non-pharmaceutical interventions in Brazilian municipalities.

Brazil has one of the fastest-growing COVID-19 epidemics worldwide. Non-pharmaceutical interventions (NPIs) have been adopted at the municipal level with asynchronous actions taken across 5,568 municipalities and the Federal District. This paper systematises the fragmented information on NPIs reporting on a novel dataset with survey responses from 4,027 mayors, covering 72.3% of all municipalities in the country. This dataset responds to the urgency to track and share findings on fragmented policies during the COVID-19 pandemic. Quantifying NPIs can help to assess the role of interventions in reducing transmission. We offer spatial and temporal details for a range of measures aimed at implementing social distancing and the dates when these measures were relaxed by local governments.

Desempenho motor e índice de massa corporal em crianças de cinco anos / Motor performance and body mass index in children of five years

As crianças estão cada vez mais utilizando brincadeiras e jogos eletrônicos, passando muitas horas diante da televisão e isso pode atrapalhar o processo de desenvolvimento motor bem como o desenvolvimento do processo de sobrepeso e obesidade. A educação física escolar é um importante aliado na promoção de hábitos de vida mais ativos, sendo a educação infantil a primeira etapa de escolarização e prática de atividades motoras desta fase é fundamental. O objetivo desse estudo foi avaliar o índice de massa corporal (IMC) e o desempenho motor de escolares com idade de cinco anos dos Centros Municipais de Educação Infantil em Divinópolis/MG. O desempenho motor foi avaliado com o Teste de Coordenação Corporal para Crianças (Körperkoodinations test Für Kinder ­ KTK) composto por quatro testes: equilibrar-se andando de costas, saltos monopedais, saltos laterais e transposição lateral sobre plataforma. O IMC foi calculado a partir de medidas de peso e altura. Os resultados do presente estudo demonstram que 80,65% da amostra apresenta deficiência na coordenação motora, e quando comparado entre os sexos, os meninos apresentaram melhor coordenação motora que as meninas. Ao analisar o IMC e a coordenação motora não foi encontrada qualquer relação significativa entre eles. Pode-se concluir com o presente estudo que o IMC não influenciou no desempenho motor dos alunos, e que a maioria dos alunos está com a coordenação motora abaixo do esperado. A falta de aulas de educação física com o professor especialista e estímulos específicos para o desenvolvimento motor podem ter contribuído para os resultados encontrados neste estudo, reforçando a necessidade do professor de educação física n o ensino infantil.(AU)

: Children are increasingly using games and electronic games, spending many hours in front of the television and this can hinder the process of motor development as well as the development of overweight and obesity. School physical education is an important ally in the promotion of more active life habits, with early childhood education being the first stage of schooling and the practice of motor activities in this phase is fundamental. The objective of this study was to evaluate the body mass index (BMI) and the motor performance of schoolchildren aged five years old from the Municipal Centers of Early Childhood Education in Divinópolis / MG. Motor performance was assessed with the Body Coordination Test for Children (Körperkoordinations test Für Kinder - KTK) composed of four tests: balance on your back, single-legged jumps, lateral jumps and lateral transposition on a platform. BMI was calculated from weight and height measurements. The results of the present study showed that 80.65% of the sample has impaired motor coordination, and when compared between genders, boys showed better motor coordination than girls. When analyzing BMI and motor coordination, no significant relationship was found between them. It can be concluded with the present study that the BMI did not influence the motor performance of the students, and that the majority of the students have motor coordination below the expected. The lack of physical education classes with the specialist teacher and specific stimuli for motor development may have contributed to the results found in this study, reinforcing the need for physical education teachers in early childhood education.(AU)