Effectiveness of intervention programs in primary care for the robust elderly.

OBJECTIVE: This study aimed to search the literature for intervention programs in primary care with a multiprofes-sional character, specifically directed at the robust elderly, and with viable and cost-effective interventions. MATERIALS AND METHODS: The search strategies were applied in Cochrane, Lilacs, Pubmed, Scopus, WHOLIS, Embase, Medcarib, SciELO, Web of Science, and PAHO databases. RESULTS: 3 665 articles were found and 32 remained for analysis, grouped into four categories: care management; multidisciplinary intervention; interventions on the basis of risk; and educational interventions with health professionals. CONCLUSION: Strategies such as domestic interventions can promote health and functionality of elderlies, as well as reduce mortality, use of the health system and costs. Besides that, the use of hard and light-hard technologies are important for risk prevention and care management for the elderly.There is a need to create programs for risk prevention and effective management of elderly care at the primary level.

Half dose ChAdOx1 nCoV-19 vaccine was equivalent to full doses to reduce moderate and severe COVID-19 cases.

Objectives: Previously, we presented the effectiveness of ChAdOx1 nCoV-19 half-dose (HD) immunization for preventing new COVID-19 cases. Here, we evaluated the administration of an HD of ChAdOx1 nCoV-19 in the primary immunization protocol (up to two doses) in reducing moderate and severe cases, hospitalizations, and deaths when compared to the administration of full doses (FD) after a long-term follow-up. Methods: We evaluated data from 29,469 participants between January 2021 and November 2022 who received an HD or FD vaccine and crossed this information with their medical records to identify those who developed moderate or severe cases. All participants were classified into four groups according to their immunization status and followed 500 days after the last vaccine administration. Results: The propensity-score matching analysis indicates that the administration of the two HDs of ChAdOx1 nCoV-19 was equivalent to the use of two FDs to reduce moderate and severe COVID-19 cases. The relative risk of being infected and developing moderate or severe conditions after the administration of at least one HD or FD was similar 150 or 500 days after the administration of the immunizers. Conclusion: Administering two HDs can be used safely as a cost-effective alternative to the primary immunization protocol.

Space-time risk cluster and time trends of congenital syphilis in Brazil: an ecological study.

BACKGROUND: Congenital syphilis (CS) is a problem of great concern for public health, especially in Brazil. The aim of this study was to analyse the time trends and the space-time dynamics of morbidity and mortality from CS in Brazil. METHODS: An ecological and time series study, which included all cases and deaths from CS recorded in a national Brazilian database from 2013 to 2019 was performed. Time trends in CS incidence and mortality were assessed using segmented linear regression. Univariate global and local Moran indices and space-time scan statistics were used in the space and space-time analyses. RESULTS: A total of 183 171 cases and 2401 deaths from CS were recorded in Brazil, with the highest number of cases being observed in the Southeast Region (n=82 612 [45.1%]). Only 21.1% of pregnant mothers with syphilis received adequate treatment. There was an upward trend in CS rates among mothers ages 20-29 y (average annual percent change [AAPC] 1.4 [95% confidence interval {CI} 1.0 to 1.7]) and with <8 y of schooling (AAPC 6.6 [95% CI 5.3 to 7.9]). The primary space-time cluster involved 338 municipalities in the Southeast Region (relative risk 3.06, p<0.001) and occurred between 2017 and 2019. CONCLUSIONS: To reduce the trends in CS rates, it is necessary to develop actions to improve the quality of prenatal care and expand early diagnosis and adequate treatment of syphilis in pregnant women and their sexual partners, especially in groups with upward trends (mothers ages 20-29 y and <8 y of schooling) and living in higher-risk regions (Southeast, North and Northeast).

Use of Interrupted Time Series Analysis in Understanding the Course of the Congenital Syphilis Epidemic in Brazil.

Background: To fight against the rising incidence of syphilis, the Brazilian Ministry of Health (MoH) launched the "Syphilis No!" Project (SNP), with specific resources funded by a parliamentary amendment. Then, in 2018, a national rapid response started to be implemented on the Brazilian Unified Health System (SUS, Sistema Único de Saúde) in two strategic lines (1) to reinforce SUS's universal actions and (2) to implement specific ones to 100 municipalities chosen by the MoH as priorities for syphilis congenital response. In 2015, such localities represented 6895% of congenital syphilis cases in Brazil. In this context, SNP has implemented actions to strengthen epidemiological surveillance of acquired syphilis and congenital syphilis by instituting an integrated and collaborative response through health services networks and reinforcing interstate relations. Methods: A quasi-experimental study using time series analysis was conducted to assess immediate impacts and changes to the trend in national congenital syphilis before and after the project, from September 2016 to December 2019. Data were assessed considering rates of congenital syphilis per 1,000 live births in all priority municipalities (n=100) covered by the project and in non-priority municipalities (n=5,470) from all five macro-regions of Brazil. Findings: Priority municipalities showed a greater reduction (change in trend) in comparison to non-priority. The linear regression model revealed trend changes after the intervention, with both groups of municipalities showing a drop in the average monthly number of cases per 1,000 live births, with a reduction of -0·21 (CI 95% -0·33 to -0·09; p=0·0011) in priority municipalities and of -0·10 (CI 95% -0.19 to -0.02; p=0·0216) in non-priority municipalities. Interpretation: The study using ITS provides important evidence on the direction, timing, and magnitude of the effects of interventions introduced as part of the SNP on congenital syphilis in Brazil. Our results suggest that the Syphilis No! Project influenced the trends of congenital syphilis in Brazil from 2018, with higher reductions achieved in the priority municipalities. Funding: The research is funded by a grant to the Syphilis No! Project from Brazilian Ministry of Health (Project Number: 54/2017). The funders had no role in study design, analysis, decision to publish, or preparation of the manuscript.

Trends of syphilis in Brazil: A growth portrait of the treponemic epidemic.

Syphilis is a chronic infectious disease with its prevalence being described since the 15th century. Although its etiological agent and also the treatment measures are widely known, syphilis is still a great public health problem worldwide, mainly in countries with limited resources associated to low investments in health primary care. The aim of the present study was to analyze the trend and regional distribution of syphilis in Brazil between 2007 and 2017. This is an ecological study using secondary data from the Brazilian notification system. The Ministry of Health selected 100 municipalities which presented the worse outcomes related to syphilis from the 5,570 Brazilian municipalities as a target for a comprehensive project in order to tackle the prevalence of syphilis, called the "No Syphilis Project". These priority municipalities represent 57.7% of syphilis cases and about one third of the Brazilian population. They were compared with other 189 non-priority municipalities with more than 100 thousand inhabitants among the Brazilian regions (North, Northeast, Southeast, South and Center-West). Polynomial regression methods and Joinpoint analyses were used to analyze the trend, from which the Annual Average Percent Change (AACP) for each time period was calculated. There was a significant growth trend in all regions for the main three forms of syphilis (in pregnancy, congenital and acquired), especially in the South. The ratio between syphilis in pregnancy and congenital syphilis increased in both priority (AAPC: 8.54%; p<0.001) and non-priority municipalities (AAPC: 2.61%; p = 0.005), as well as in the regions, except the Center-West. High growth trends in syphilis prevalence were found in all municipalities, as well as all five regions between 2007 and 2017, showing that the challenge to reduce or even eliminate syphilis in Brazil is still difficult.