Pneumonia in Children under 5 Years: Temporal Trends and Spatial Patterns of Hospitalizations in Brazil.

This study aimed to identify temporal and spatial patterns in the distribution of hospitalization rates for pneumonia in children under 5 years in Brazil. An ecological study was developed using data from the Unified Health System of hospitalizations for pneumonia in children under 5 years in Brazil from 2000 to 2019. Hospitalization rates per 1,000 children were calculated and Joinpoint Regression analyzed the temporal trends. Different spatial analysis techniques were performed. Annual rates of 25 hospitalizations per 1,000 children were observed in 2000 and of 13.83 per 1,000 children in 2019, with a significant downward trend for the country (annual percentage change = -3.4%; 95% confidence interval: -3.8 to -3.0) and for the regions. There was weak spatial autocorrelation; however, there were regions with high rates of hospitalization in the south region and clusters of low rates in the northeast and southeast. Clusters of areas with high hospitalization rates were observed in areas of favorable socioeconomic conditions and provision of health services in the interior of southern Brazil. There is a decreasing trend in hospitalizations for pneumonia in general; however, there are clusters of high rates in the south of Brazil.

Prevalence of Access to Prenatal Care in the First Trimester of Pregnancy Among Black Women Compared to Other Races/Ethnicities: A Systematic Review and Meta-Analysis.

Objective: To analyze the prevalence of access to prenatal care in the first trimester of pregnancy among black women compared to other races/ethnicities through a systematic review and meta-analysis. Methods: Searches were carried out at PUBMED, LILACS, Web of Science, Scopus, CINAHL, and in the grey literature. The quality of the studies and the risk of bias were analyzed using the Joanna Briggs Critical Appraisal Checklist for Analytical Cross-Sectional Studies instrument. The extracted data were tabulatesd and analyzed qualitatively and quantitatively through meta-analysis. Results: Black women had the lowest prevalence of access to prenatal services in the first trimester, with prevalence ranging from 8.1% to 74.81%, while among white women it varied from 44.9 to 94.0%; 60.7% of black women started prenatal care in the first trimester, while 72.9% of white women did so. Conclusion: Black women compared to other racial groups had lower prevalence of access to prenatal care, with less chance of access in the first trimester, and it can be inferred that the issue of race/skin color is an important determinant in obtaining obstetric care. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020159968_, PROSPERO CRD42020159968.

Alcoholic beverage purchase by Brazilian adolescents: individual and contextual factors associated in a multilevel analysis.

OBJECTIVE: To analyze the individual and contextual factors associated with the purchase of alcoholic beverages by adolescents in Brazil. METHODOLOGY: A cross-sectional study with data from the National Adolescent Health Survey (2015). The study sample consisted of 21,125 adolescents who reported having consumed alcohol in the 30 days before the survey. Bivariate and multivariate analysis was performed by calculating the Prevalence Ratios in a multilevel Poisson Regression (95%CI) to verify the effect of individual variables, school context, and Brazilian federation units on the outcome. RESULTS: 17.54% (95%CI 17.03-18.06) bought the alcoholic beverage for their consumption. The outcome was associated with male gender (PR 1.69; 95%CI 1.56-1.83), the age group from 15 to 17 years old (PR 1.52 95%CI 1.41-1.65), who ingested alcohol more than six times in 30 days (PR 1.47; 95%CI 1.37-1.61), who work (PR 1.26 95%CI 1.16-1.37), who are children of women with low education, who study in public schools (RP 1.16 95%CI 1.04-1.30), who missed classes (RP 1.14 95%CI 1.05-1.23) and who do not have a follow-up responsible in their free time (PR 1.13 95%CI 1.04-1.21) and who live in states with higher illiteracy rates of people aged 25 years old and over (PR=1.19; 95%CI 1, 02-1.39). CONCLUSION: The adolescents' access to alcohol purchase was associated with individual factors, the school context, and the federation unit. These findings indicate the importance of strengthening health promotion aimed at vulnerable youth people.

Vitamin C and D supplementation and the severity of COVID-19: A protocol for systematic review and meta-analysis.

BACKGROUND: The COVID-19 pandemic has rapidly spread to other countries, causing numerous deaths and challenges for organizations and health professionals. Diet and nutrition invariably influence the competence of the immune system and determine the risk and severity of infections. Studies have already been published on the relationships through which vitamins C and D can mitigate the severity of infections such as COVID-19. In this context, this protocol describes a systematic review intended to analyze if vitamin C and D supplementation can reduce the severity of Covid-19. METHODS: This protocol was developed based on the recommendations of PRISMA-P. In order to accomplish the systematic review, we will carry out searches in the PubMed, Web of Science, Scopus, Cochrane, and ScienceDirect databases in the quest for control case studies that analyze the supplementation and evolution of patients with COVID-19. There will be no limitations related to language or publication time. The searches will be carried out by 2 independent researchers who will select the articles, and then the duplicate studies will be removed, while the suitable ones will be selected using the Rayyan QCRI application. In order to assess the risk of bias, we will use the instrument proposed by the National Heart, Lung and Blood Institute. Moreover, we will carry out metaanalyses and subgroup analyses according to the conditions of the included data. RESULTS: This review will assess the association between vitamin C and D supplementation and the reduction in the severity of COVID-19. CONCLUSION: The findings of this systematic review will summarize the latest evidence for the association between vitamin C and D supplementation and COVID-19 through a systematic review and meta-analysis. RECORD OF SYSTEMATIC REVIEW: CRD42021255763.

Factors Associated With Mental Suffering in the Brazilian Population: A Multilevel Analysis.

Purpose: To analyze how individual characteristics and the social context are associated with mental distress symptoms in the Brazilian population. Method: A multilevel cross-sectional study with data from the 2013 National Health Survey. There were two dependent variables: (a) decreased vital energy and somatic symptoms, (b) the presence of depressive thoughts. The independent variables were biological characteristics, education and income, habits and lifestyle, and context variables. Bivariate analysis was performed, and Prevalence Ratios calculated in a Poisson Regression (95% CI). A multilevel Poisson Regression was performed to verify the effect of individual and contextual variables. Results: Regarding depressive thoughts, young and middle-aged individuals, low education, women, absence of partner, smokers or former smokers, and absence of health insurance were the categories at highest risk; belonging to classes D-E and living in states with lower expected years of schooling proved to be protective factors. Similar results were found for the second outcome. Conclusions: Symptoms of mental distress were associated with the individual characteristics and contextual aspects of the federation unit. These findings indicate the importance of strengthening psychosocial care aimed at vulnerable groups.

Incidence and mortality from thyroid cancer in Latin America.

OBJECTIVE: To describe trends in thyroid cancer incidence and mortality in Latin America. METHODS: Ecological study of time series, with incidence data from the International Agency for Research on Cancer for the 1990-2012 period and mortality data of 16 countries obtained from WHO for the 1995-2013 period. The trends of incidence rates were analysed by the Joinpoint regression. Average annual percentage change and 95% confidence intervals were calculated for incidence and mortality. RESULTS: Incidence and mortality from thyroid cancer in Latin America were higher in women, with the highest incidence rate in women in Quito (Ecuador) aged 40-59 years: 42.2 new cases per 100 000 inhabitants, and mortality of 4.8/100 000 in women over 60. Thyroid cancer incidence increased in women of all age groups in Cali (Colombia), Costa Rica and Quito (Ecuador); and in men in Costa Rica. Incidence rates were stable above the age of 60 years in Cali, in Goiania (Brazil), Quito (Ecuador) and Valdivia (Chile) in men, and in women in Goiania (Brazil) and Valdivia (Chile). Mortality among women increased in Ecuador (AAPC = 3.28 CI 95% 1.36; 5.24), Guatemala (AAPC = 6.14 CI 95% 2.81; 9.58) and Mexico (AAPC = 0.67 CI 95% 0.16; 1.18). CONCLUSIONS: Thyroid cancer incidence in Latin America is high and rising in women. Mortality remains stable in most countries of Latin America.

Prevalence of COVID-19 infection in black people in primary health care, hospital units and intensive care units: a protocol for a systematic review and meta-analysis.

INTRODUCTION: COVID-19 pandemic has affected people all over the world. In this context, health disparities are already evident in becoming ill and dying from this condition, further accentuating historical racial inequalities. METHODS AND ANALYSIS: This protocol will be developed based on the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. For this, searches will be carried out in PubMed, Web of Science, Scopus, Lilacs and ScienceDirect databases searching for cross-sectional studies that assessed the prevalence of black people with COVID-19 at different levels of complexity. All cross-sectional studies that analysed the prevalence of COVID-19 in black people assisted in primary care, hospital wards and intensive care units will be included. The research will be carried out by two independent researchers who will identify the articles; they will exclude duplicate studies. Through blind evaluation, they will select the articles using the Rayyan QCRI application. The instrument proposed by Downs and Black will be used to assess the risk of bias. The meta-analyses will be performed according to the data conditions included. ETHICS AND DISSEMINATION: For this study's development, there is no need for an ethical appraisal considering that it is a systematic review that will use secondary studies. This study's findings will be disseminated through peer-reviewed publications, conference presentations and condensed summaries for main stakeholders and partners in the field. The database search is expected to begin on 1 February 2021. It is expected to complete the entire review process by 30 October 2021 TRIAL REGISTRATION NUMBER: CRD42020209079.

Intra-urban differentials of congenital and acquired syphilis and syphilis in pregnant women in an urban area in northeastern Brazil.

BACKGROUND: Currently syphilis is considered an epidemic disease worldwide. The objective of this study was to identify intra-urban differentials in the occurrence of congenital and acquired syphilis and syphilis in pregnant women in the city of Natal, in northeast Brazil. METHODS: Cases of syphilis recorded by the municipal surveillance system from 1 January 2011 to 30 December 2018 were analysed. Spatial statistical analyses were performed using the kernel density estimator of the quadratic smoothing function (weighted). SaTScan software was applied for the calculation of risk based on a discrete Poisson model. RESULTS: There were 2163 cases of acquired syphilis, 738 cases of syphilis in pregnant women and 1279 cases of congenital syphilis. Kernel density maps showed that the occurrence of cases is more prevalent in peripheral areas and in areas with more precarious urban infrastructure. In 2011-2014 and 2015-2018, seven statistically significant clusters of acquired syphilis were identified. From 2011 to 2014, the most likely cluster had a relative risk of 3.54 (log likelihood ratio [LLR] 38 895; p<0.001) and from 2015 to 2018 the relative risk was 0.54 (LLR 69 955; p<0.001). CONCLUSIONS: In the municipality of Natal, there was a clustered pattern of spatial distribution of syphilis, with some areas presenting greater risk for the occurrence of new cases.

Digital technologies for monitoring infected people, identifying contacts and tracking transmission chains in the corona virus disease 2019 pandemic: A protocol for a systematic review.

BACKGROUND: In times of the corona virus disease 2019 (COVID-19) pandemic, due to the urgent need to respond quickly to the challenges posed by the introduction of a new etiological agent and the peculiarity of the disease, which poses risks to people's lives and health, the use of digital technologies for monitoring and surveillance have been used as a means of fighting coronavirus. Thus, this study will identify the use of digital technologies to monitor, identify contacts and track transmission chains of COVID-19 worldwide. METHODS: The systematic review of this protocol will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes Protocols. We will include studies that present digital technologies used in the monitoring of infected people, contact identification and the transmission chain of COVID-19 developed worldwide. For the selection of articles, the following databases will be consulted: PubMed, EMBASE, LILACS, Web of Science, Science Direct, Scopus, Livivo and CINAHL. In addition, we will conduct extensive research on selected sources of gray literature, including bibliographic databases, web-based search engines, practice-oriented magazines and government websites. Data extraction will take place in 2 stages (1- title and abstract screening and 2- full-text screening) and will be carried out independently by 2 reviewers, using the Mendeley software and the Rayyan QCRI application. The studies will be characterized as to the type and design of the study in relation to the ease in demonstrating the technologies used and the type of information produced. If it is necessary to synthesize quantitative data, the heterogeneity assessment will be performed using I2 statistics, and the meta-analysis will be processed using Review Manager 5.3. RESULTS: The development of this research will allow the knowledge of how these technologies were applied according to each territory and their effectiveness in reducing cases of COVID-19. CONCLUSION: The results of this review can reveal the importance of modern technologies for reducing cases of COVID-19 and that these measures can be adopted by governments, organizations and for everyone. RECORD OF SYSTEMATIC REVIEW: CRD42020211744.

The association between race and risk of illness and death due to COVID-19: A protocol for systematic review and meta-analysis.

BACKGROUND: The Corona Virus Disease, 2019 (COVID-19) pandemic revealed many social disparities that already exist in countries that have social inequalities in their historical context. Studies have already been published on the epidemiological and clinical characteristics of population groups considered to be at risk where they reveal that Black people are at greater risk of becoming ill and dying from this cause. In this context, this protocol describes a systematic review that aims to analyze the association of race as the higher risk for illness and death due to COVID-19. METHODS: This protocol will be developed based on the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P). For this, we will conduct searches in the PubMed, Web of Science, Scopus, Lilacs, and ScienceDirect databases in the search for cross-sectional studies. All cross-sectional studies that analyzed hospitalization and death by COVID-19 as race in its determinant will be included. The search will be carried out by 2 independent researchers who will carry out the selection of articles, then the duplicate studies will be removed and screened using the Rayyan QCRI application. To assess the risk of bias, the instrument proposed by Downs and Black will be used. Meta-analyzes and subgroup analyzes will be carried out according to included data conditions. RESULTS: Based on this review, it will be possible to carry out a high-quality synthesis of available evidence that brings race as a factor for illness and death by COVID-19 and to verify which race is most affected by this disease. CONCLUSION: The relevance of this systematic review to the current context is considered, as it has a high potential to assist in the development of public health strategies and policies that address existing racial differences.Record of systematic review: CRD42020208767.

Spatio-temporal dynamics of Aedes aegypti and Aedes albopictus oviposition in an urban area of northeastern Brazil.

OBJECTIVE: The objective of this study was to analyse abundance and spatial distribution of Aedes aegypti and Aedes albopictus oviposition in the city of Natal-RN, 2016 to 2018. METHODS: Three hundred and seven oviposition traps were installed covered the whole city and were monitored weekly from January 2016 to December 2018. To verify the abundance of the vector based on its location, the formation of oviposition clusters was studied using the Kernel statistics. Egg Density Index (EDI) and Oviposition Positivity Index (OPI) values were calculated. RESULTS: Temperature and humidity presented weak and very weak correlation, respectively, with the oviposition indicators. The median of oviposition positivity index (OPI) was 60.5%, and the egg density index (EDI) was 45.4 eggs/trap. The OPI (71.1%) was higher in the second quarter of the year. The areas with the most persistent oviposition are located in a continuous strip that extends from the extreme of the northern district and extends along the western district of the city. Also noteworthy is the proximity to the strategic points. CONCLUSION: The spatio-temporal distribution of oviposition revealed that there is spatial segregation and marked seasonality. Therefore, this study highlights the importance of maintaining surveillance targeting and control strategies focused on these areas, especially during the most important period of the year.

OBJECTIF: L'objectif de cette étude était d'analyser l'abondance et la distribution spatiale de la ponte d'Aedes aegypti et d'Aedes albopictus dans la ville de Natal-RN, de 2016 à 2018. MÉTHODES: 307 pièges de ponte ont été installés dans toute la ville et surveillés chaque semaine de janvier 2016 à décembre 2018. Pour vérifier l'abondance du vecteur en fonction de sa localisation, la formation de grappes de ponte a été étudiée à l'aide des statistiques de Kernel. Les valeurs de l'indice de densité des œufs (IDO) et de l'indice de positivité de la ponte(IPP) ont été calculées. RÉSULTATS: La température et l'humidité ont présenté une corrélation faible et très faible, respectivement, avec les indicateurs de ponte. L'indice médian de positivité de ponte (IPP) était de 60,5% et l'indice de densité des œufs (IDO) était de 45,4 œufs/piège. L'IPP (71,1%) était plus élevé au deuxième trimestre de l'année. Les zones avec la ponte la plus persistante sont situées dans une bande continue qui s'étend de l'extrémité du district nord et s'étend le long du district ouest de la ville. A noter également la proximité des points stratégiques. CONCLUSIONS: La distribution spatiotemporelle de la ponte a révélé une ségrégation spatiale et une saisonnalité marquée. Par conséquent, cette étude met en évidence l'importance de maintenir des stratégies de surveillance ciblée et de contrôle axés sur ces zones, en particulier pendant la période la plus importante de l'année.