Machine learning for predicting Chagas disease infection in rural areas of Brazil.

INTRODUCTION: Chagas disease is a severe parasitic illness that is prevalent in Latin America and often goes unaddressed. Early detection and treatment are critical in preventing the progression of the illness and its associated life-threatening complications. In recent years, machine learning algorithms have emerged as powerful tools for disease prediction and diagnosis. METHODS: In this study, we developed machine learning algorithms to predict the risk of Chagas disease based on five general factors: age, gender, history of living in a mud or wooden house, history of being bitten by a triatomine bug, and family history of Chagas disease. We analyzed data from the Retrovirus Epidemiology Donor Study (REDS) to train five popular machine learning algorithms. The sample comprised 2,006 patients, divided into 75% for training and 25% for testing algorithm performance. We evaluated the model performance using precision, recall, and AUC-ROC metrics. RESULTS: The Adaboost algorithm yielded an AUC-ROC of 0.772, a precision of 0.199, and a recall of 0.612. We simulated the decision boundary using various thresholds and observed that in this dataset a threshold of 0.45 resulted in a 100% recall. This finding suggests that employing such a threshold could potentially save 22.5% of the cost associated with mass testing of Chagas disease. CONCLUSION: Our findings highlight the potential of applying machine learning to improve the sensitivity and effectiveness of Chagas disease diagnosis and prevention. Furthermore, we emphasize the importance of integrating socio-demographic and environmental factors into neglected disease prediction models to enhance their performance.

Prevalence analysis of Chagas disease by age group in an endemic region of Brazil: possible scenario of active vectorial transmission.

Objectives: Chagas disease (CD) is an infectious disease that predominantly affects poor and vulnerable populations. The last estimate conducted by the World Health Organization in Latin America regarding the prevalence of CD occurred more than 10 years ago. However, there is a scarcity of data assessing the magnitude of CD in populations residing in considered high-risk regions. Therefore, this study aimed to assess the seroprevalence of CD in an endemic region in Northern Minas Gerais through serologic screening. Methods: This is a prevalence study conducted in the municipalities of Catuti, Mato Verde, Mirabela, Montes Azul, and São Francisco, Minas Gerais, Brazil. Data collection occurred between December 2021 and December 2022, involving a questionnaire with closed-ended questions. The variables analyzed included serologic test results, stratified age groups, health indicators, and housing conditions. Results: Of the 2978 participants, 272 individuals (9.1%) tested positive for CD serology. In the age group of 4 to 14 years, 15 to 49 years, and 50 years or older, the prevalence of positive serology was 0.8% (95% confidence interval [CI] 0.16-1.43), 5.5% (95% CI 4.20-6.83), and 18.8% (95% CI 16.48-21.11), respectively. Among the participating municipalities, Mato Verde had the highest prevalence of positive serology for CD (17%). For participants aged 4 to 14 years with positive serology for CD, first-degree relatives were invited to undergo serologic testing. It was possible to collect samples from relatives of all participants in this age group. However, none of the relatives tested positive. Conclusion: This study identified a 9.1% prevalence of individuals affected by CD who were unaware of their condition. In addition, having infected children in the 4 to 14 age group with mothers with negative serology would rule out congenital transmission of the disease.

Association between positive serology for COVID-19 and chagas cardiomyopathy progression: The SaMi-Trop project.

BACKGROUND: Chagas Disease (CD) can cause Chagas cardiomyopathy. The new coronavirus disease (COVID-19) also affects the cardiovascular system and may worsen Chagas cardiomyopathy. However, the cardiac evolution of patients with CD infected by COVID-19 is not known. Thus, the objective of this study is to assess, within one year, whether there was cardiac progression after COVID-19 in CD. METHODS: Longitudinal study with CD patients. The outcome was cardiac progression, defined as the appearance of new major changes in the current ECG compared to the previous ECG considered from the comparison of electrocardiograms (ECGs) performed with an interval of one year. Positive Anti-SARS-CoV2 Serology was the independent variable of interest. For each analysis, a final multiple model was constructed, adjusted for sociodemographic, clinical, and pandemic-related characteristics. RESULTS: Of the 404 individuals included, 22.8 % had positive serology for COVID-19 and 10.9 % had cardiac progression. In the final model, positive serology for COVID-19 was the only factor associated with cardiac progression in the group as a whole (OR = 2.65; 95 % CI = 1.27-5.53) and for new-onset cardiomyopathy in the group with normal previous ECG (OR = 3.50; 95 % CI = 1.21-10.13). CONCLUSION: Our study shows an association between COVID-19 and progression of Chagas cardiomyopathy, evaluated by repeated ECGs, suggesting that COVID-19 accelerated the natural history of CD.

Overview of Chagas disease surveillance in an endemic region in Southeastern Brazil.

Chagas disease (CD) is a neglected disease caused by the protozoan Trypanosoma cruzi. It has high morbidity and mortality rates and mainly affects socially vulnerable populations. This is a cross-sectional study, with retrospective and prospective data collection. Using questionnaires applied to environmental surveillance coordinators, we characterized the status of CD surveillance activities in municipalities endemic for the disease in Northern Minas Gerais State (MG) and Jequitinhonha Valley (Vale do Jequitinhonha). Moreover, we spatialized the vulnerability index for chronic CD in the study area. The population consisted of 22 environmental surveillance coordinators, active in 2020, from Northern MG and Jequitinhonha Valley, 21 municipalities included in the SaMi-Trop research project, and Montes Claros municipality. After applying the questionnaires to the coordinators, a descriptive analysis of the variables was performed. To characterize the active municipalities, the explanatory variables collected in the questionnaire were compared with the dichotomous variable. Bivariate descriptive analysis was performed. Finally, geoprocessing techniques were used to spatialize the data and prepare maps. Regarding the team of endemic combat agents (ECA), 90.9% reported the lack of a specific team for CD vector control actions. Of the 22 municipalities participating in this study, nine were active (41.1%). Only 25% (n=2) of active municipalities (9% of the municipalities studied) met the target of visiting 50% of households per year. Finally, 81.1% of the coordinators stated that in their municipality, they developed actions linked to primary health care (PHC). The implementation of CD surveillance activities weakened in the endemic region. Few municipalities have a surveillance team, with low regularity of active surveillance and noncompliance with the program's goal. The results suggest insufficient recording of activities in the information system, considering that there are municipalities that report performing the activities, but no production record was observed in the system.

Failure to use health services by people with Chagas disease: Multilevel analysis of endemic area in Brazil.

This study aimed to assess the prevalence of non-use of health services in the last year by people with Chagas disease (CD) in an endemic area in Brazil and the contextual and individual factors associated with this non-use. This is a multilevel study that considered contextual and individual data. Contextual data were collected from official publicly accessible databases of the Brazilian government, at the municipal level. The individual data came from the first follow-up of a Brazilian cohort that assessed patients with CD in 21 municipalities in endemic area for the disease. The sample consisted of 1,160 individuals with CD. The dependent variable "use of health services in the last year" was categorized as yes vs. no. The analysis was performed using Poisson regression with robust variance. The prevalence of non-use of health services in the last year was 23.5% (IC95%: 21.1-25.9). The contextual factor "larger population" (PR: 1.6; 95% CI = 1.2-2.0) and individual factors related to the lower severity of the disease as a functional class without limitations (PR: 1.6; 95% CI = 1.2-2.1) and unaltered N-terminal pro b-type natriuretic peptide levels (PR: 2.2; 95% CI = 1.3-3.6) increased the prevalence of non-use of the health service in the last year by people with CD. The results of this study showed that individual determinants are not isolated protagonists of the non-use of health services in the last year by people with CD, which reinforces the need for public policies that consider the contextual determinants of the use of health services by populations affected by the disease.

Two-year death prediction models among patients with Chagas Disease using machine learning-based methods.

Chagas disease (CD) is recognized by the World Health Organization as one of the thirteen most neglected tropical diseases. More than 80% of people affected by CD will not have access to diagnosis and continued treatment, which partly supports the high morbidity and mortality rate. Machine Learning (ML) can identify patterns in data that can be used to increase our understanding of a specific problem or make predictions about the future. Thus, the aim of this study was to evaluate different models of ML to predict death in two years of patients with CD. ML models were developed using different techniques and configurations. The techniques used were: Random Forests, Adaptive Boosting, Decision Tree, Support Vector Machine, and Artificial Neural Networks. The adopted settings considered only interview variables, only complementary exam variables, and finally, both mixed. Data from a cohort study with CD patients called SaMi-Trop were analyzed. The predictor variables came from the baseline; and the outcome, which was death, came from the first follow-up. All models were evaluated in terms of Sensitivity, Specificity and G-mean. Among the 1694 individuals with CD considered, 134 (7.9%) died within two years of follow-up. Using only the predictor variables from the interview, the different techniques achieved a maximum G-mean of 0.64 in predicting death. Using only the variables from complementary exams, the G-mean was up to 0.77. In this configuration, the protagonism of NT-proBNP was evident, where it was possible to observe that an ML model using only this single variable reached G-mean of 0.76. The configuration that mixed interview variables and complementary exams achieved G-mean of 0.75. ML can be used as a useful tool with the potential to contribute to the management of patients with CD, by identifying patients with the highest probability of death. Trial Registration: This trial is registered with ClinicalTrials.gov, Trial ID: NCT02646943.

Contextual influence on poor self-rated health in patients with Chagas disease: multilevel study.

Chagas disease (CD) is recognized by the World Health Organization as one of the thirteen most neglected tropical diseases in the world. Self-perceived health is considered a better predictor of mortality than objective measures of health status, and the context in which one lives influences this predictor. This study aimed to evaluate the prevalence and individual and contextual factors associated with poor self-rated health among CD patients from an endemic region in Brazil. It is a multilevel cross-sectional study. The individual data come from a cross-section of a cohort study named SaMi-Trop. Contextual data was collected from publicly accessible institutional information systems and platforms. The dependent variable was self-perceived health. The analysis was performed using multilevel binary logistic regression. The study included 1,513 patients with CD, where 335 (22.1%) had Poor self-rated health. This study revealed the influence of the organization/offer of the Brazilian public health service and of individual characteristics on the self-perceived health of patients with CD.

Occurrence and spatial distribution of triatomines (Hemiptera: Reduviidae) in the urban area of the municipality of Montes Claros, Northern Minas Gerais, Brazil.

The north of the Brazilian state of Minas Gerais is classified as an area of high risk of vectorial transmission of Chagas disease (CD) or of reestablishing transmission in the home, but the Chagas disease control programme is disjointed. The study evaluated the occurrence, natural infection and the spatial distribution of species of triatomines associated with climatic variations in the urban area of Montes Claros, a municipality endemic to CD in the north of Minas Gerais, Brazil. Triatomine data were obtained from passive entomological surveillance actions of the Chagas Disease Control Program (Programa de Controle de Doença de Chagas-PCDCh), registered by the Zoonosis Control Center (Centro de Controle de Zoonoses-CCZ) from 2009 to 2019. A total of 277 triatomines belonging to eight species were collected, and of these, 203 insects were examined. It was found that 46.2% of triatomines were captured inside the home and 8.3% around the home. The natural infection rate was 6.9%; 14 specimens showed natural infection by Trypanosoma cruzi (12 females and 2 males), and of these, 13 were found in the home and one in an uninformed location. The number of triatomine records collected was significantly higher in the month of September (p = .01), and there was an inverse correlation between the number of triatomines and the relative humidity of the air (p < .001). It was verified that the highest triatomine densities are located in transition areas between urban infrastructure (32.12%) and pasture (25.72%). The diversity of species of triatomines infected with T. cruzi in residential units in urban areas in the municipality of Montes Claros is worrying, as it suggests a potential risk of transmission of the parasite to domestic animals and humans.

Hospitalizations due to gastrointestinal Chagas disease: National registry.

OBJECTIVES: Analyze the hospitalizations of patients admitted for Chagas disease with gastro-intestinal involvement (CD-GI) in the Brazilian Unified Health System, describe the epidemiological profile, mortality and costs. METHODS: This is an observational study that uses secondary data from the National Hospital Information System (SIH-SUS) for the years 2017-2019. CD-GI admissions were defined by specific ICD-10 codes that identify the main diagnosis. RESULTS: From 2017 to 2019, there were 4,407 hospitalizations for CD-GI in Brazil, considering only public hospitals and those associated with the SUS. This corresponds to an average of 1,470 hospitalizations per year, or 0.6 per 100,000 inhabitants, with significant regional variation. Hospitalizations increased with age and were slightly higher in men. More than 60% were emergencies and in 50% the procedure performed was surgical. The most used code was the one for megaesophagus followed by megacolon. In-hospital mortality was 5.8% and 17.2% went to intensive care units. The median cost was USD$ 553.15 per hospitalization, and an overall cost of USD$ 812,579.98 per year to the SUS budget. CONCLUSION: The numbers, rates and costs presented here are possibly underestimated but they give us an idea of the overall profile of hospitalizations due to CD-GI, which are not rare and are related to significant in-hospital mortality. CD-GI is a neglected manifestation of a neglected disease.

Serological screening for Chagas disease in an endemic region of Northern Minas Gerais, Brazil: the SaMi-Trop project.

Chagas disease (CD) is still a neglected disease. Infected individuals are diagnosed late, being treated in worse clinical conditions. Thus, this study aimed to analyze the prevalence and the factors associated with new confirmed cases of CD identified by serological screening in an endemic region of Minas Gerais State, Brazil. This is an analytical cross-sectional study with data from a project of the Research Center in Tropical Medicine of Sao Paulo- Minas Gerais (SaMi-Trop) conducted in two municipalities. Data collection included a questionnaire with closed questions, a venous blood collection and an ELISA serological test for CD. A total of 2,038 individuals with no previous diagnosis of CD participated in the study. The result of the serological test for CD was adopted as the dependent variable. The independent variables addressed personal issues, health conditions and lifetime housing. A descriptive analysis of individual variables was performed. Subsequently, a bivariate analysis was performed using the Pearson's chi-square test. Households sheltering individuals positive for CD were georeferenced, and the analysis of spatial distribution was performed using the quartic function to estimate the density of the nucleus. Among the participants, 188 (9.2 %) were positive for CD. The profile of participants with CD was associated with place of residence, age, relative/family member with CD and living conditions. It is noteworthy that there are still patients with CD who are unaware of their diagnosis in both, rural and urban areas.

Impact of the social context on the prognosis of Chagas disease patients: Multilevel analysis of a Brazilian cohort.

The present study aims to investigate how the social context contributes to the prognosis of Chagas disease (CD). This is a multilevel study that considered individual and contextual data. Individual data came from a Brazilian cohort study that followed 1,637 patients who lived in 21 municipalities to which CD is endemic, over two years. Contextual data were collected from official Brazilian government databases. The dependent variable was the occurrence of cardiovascular events in CD during the two-year follow-up, defined from the grouping of three possible combined events: death, development of atrial fibrillation, or pacemaker implantation. Analysis was performed using multilevel binary logistic regression. Among the individuals evaluated, 205 (12.5%) manifested cardiovascular events in CD during two years of follow-up. Individuals living in municipalities with a larger rural population had protection for these events (OR = 0.5; 95% CI = 0.4-0.7), while those residing in municipalities with fewer physicians per thousand inhabitants (OR = 1.6; 95% CI = 1.2-2.5) and those living in municipalities with lower Primary Health Care (PHC) coverage (OR = 1.4; 95% CI = 1.1-2.1) had higher chances of experiencing cardiovascular events. Among the individual variables, the probability of experiencing cardiovascular events was higher for individuals aged over 60 years (OR = 1.4; 95% CI = 1.01-2.2), with no stable relationship (OR = 1.4; 95% CI = 0.98-2.1), without previous treatment with Benznidazole (OR = 1.5; 95% CI = 0.98-2.9), with functional class limitation (OR = 2.0; 95% CI = 1.4-2.9), with a QRS complex duration longer than 120 ms (OR = 1.5; 95% CI = 1.1-2.3), and in individuals with high NT-proBNP levels (OR = 6.4; 95% CI = 4.3-9.6). CONCLUSION: The present study showed that the occurrence of cardiovascular events in individuals with CD is determined by individual conditions that express the severity of cardiovascular involvement. However, these individual characteristics are not isolated protagonists of this outcome, and the context in which individuals live, are also determining factors for a worse clinical prognosis.

Challenges in the care of patients with Chagas disease in the Brazilian public health system: A qualitative study with primary health care doctors.

BACKGROUND: Care to patients with Chagas disease (CD) is still a challenge for health systems in endemic and non-endemic countries. In the Brazilian public health system, the expansion of Primary Health Care (PHC) services to remote and disadvantaged areas has facilitated the access of patients with CD to medical care, however this is in a context where care gaps remain, with insufficient public funding and inadequate distribution of services. Considering the need for studies on care to patients with CD in different settings, this study explored the challenges of family doctors to provide care to patients with CD in an endemic region in Brazil with high coverage of public PHC services. METHODS AND FINDINGS: This is a qualitative study. A focus group with 15 family doctors was conducted in a municipality participating in a multicenter cohort that monitors almost two thousand patients with CD in an endemic region in Brazil. The data were analyzed using a thematic content analysis technique. The family doctors pointed out the following challenges for care to patients with CD: unsatisfactory medical training (academic education not suitable for the clinical management of the disease, and lack of training on CD in PHC); uncertainties regarding antiparasitic treatment in the chronic phase of the disease; difficulty in patients' access to specialized care when necessary, especially to the cardiologist; and trivialization of the disease by patients as a barrier to seeking care. CONCLUSION: The access of CD patients to adequate medical care, even in regions with high coverage of public PHC services, still represents an important challenge for health systems. The results of this study may contribute to the development of strategies to improve the clinical management of CD in PHC.

[Factors associated with the non-use of telehealth consultancy by physicians of the Family Health Strategy]. / Fatores associados à não utilização da teleconsultoria por médicos da Estratégia Saúde da Família.

This study sought to evaluate the frequency and factors associated with non-use of telehealth consultancy by physicians who work in the Family Health Strategy (FHS) in the North of the State of Minas Gerais. It is a cross-sectional study that used a previously-tested self-administered questionnaire. Poisson regression analysis with robust variance was used after bivariate analysis to identify the factors associated with non-use of telehealth consultancy. A total of 385 physicians from 73 municipalities participated in the study. The frequency of non-use of telehealth consultancy by physicians in the FHS was 55.8%. After multiple analysis, the following variables were identified: the lack of availability of computers and Internet access in the Basic Health Units (BHU) for medical professionals (p = 0.001; PR = 1.10; 95% CI: 1.04-1.17), the lack of information about telehealth consultancy (p< 0.001; PR = 1.47; 95% CI: 1.38-1.56) and lack of training in telehealth consultancy (p < 0.001; PR = 1.15; 95% CI: 1.08-1.24). The results support that the informatics infrastructure of the BHU, the dissemination of the service and the training should orient the strategies for implementation, diffusion and improvement of the quality of telehealth consultancy services in primary health care.

Este estudo objetivou avaliar a frequência e os fatores associados à não utilização do serviço de teleconsultoria por médicos que atuam na Estratégia Saúde da Família (ESF) no Norte de Minas Gerais. Trata-se de um estudo transversal que utilizou questionário autoaplicado, previamente testado. A análise de regressão de Poisson com variância robusta foi empregada após análises bivariadas para identificação dos fatores associados à não utilização do serviço de teleconsultoria. Participaram do estudo 385 médicos de 73 municípios. A frequência de não utilização do serviço de teleconsultoria pelos médicos da ESF foi de 55,8%. Foram identificadas como variáveis associadas após análise múltipla a indisponibilidade de computador com internet na Unidade Básica de Saúde (UBS) para uso do profissional médico (p = 0,001; RP = 1,10; IC95%: 1,04-1,17), a falta de informação sobre o serviço (p < 0,001; RP = 1,47; IC95%: 1,38-1,56) e a falta de treinamento para uso da teleconsultoria (p < 0,001; RP = 1,15; IC95%: 1,08-1,24). Os resultados reforçam que a infraestrutura de informática das UBS, a divulgação do serviço e a oferta de treinamento devem direcionar as estratégias para implementação, difusão e melhoria da qualidade do serviço de teleconsultoria na atenção primária.

Avaliação de indicadores sociais e de saúde em municípios de Minas Gerais conforme tipologia rural-urbano / Assessment of social and health indicators in municipalities of Minas Gerais according to the rural-urban typology

RESUMO O presente artigo tem o objetivo de avaliar indicadores sociais e de saúde de municípios conforme a tipologia rural-urbano. Trata-se de estudo ecológico que utilizou dados oficiais de acesso público dos 853 municípios do estado de Minas Gerais, Brasil. Foram conduzidas análises descritivas e bivariadas através da Regressão de Poisson e Teste de Kruskal-Wallis. Do total de municípios, 547 (64,12%) são rurais. A maior média do Índice de Desenvolvimento Humano Municipal (IDH-M) foi observada entre os municípios urbanos. A maior média de cobertura da Estratégia Saúde da Família (ESF) foi verificada entre os municípios rurais, nos quais também foram demonstrados os melhores resultados para os indicadores de mortalidades infantil, prematura e por causas evitáveis, homogeneidade vacinal e prevalência de desnutrição. Os achados deste estudo evidenciam que uma maior cobertura da ESF está associada à ocorrência de melhores condições gerais de vida e de saúde das populações atendidas em municípios de tipologia rural. Recomenda-se aos gestores de saúde o fomento à consolidação da ESF em comunidades com contextos socioeconômicos e culturais desfavoráveis, como localidades rurais remotas e aglomerados urbanos, e o estabelecimento de ações intersetoriais com impacto positivo na saúde.

ABSTRACT This article aims to evaluate social and health indicators of municipalities according to the rural-urban typology. This is an ecological study that used official publicly accessible data from the 853 municipalities in the state of Minas Gerais, Brazil. Descriptive and bivariate analysis were carried out using Poisson Regression and Kruskal-Wallis Test. 547 (64.12%) are rural municipalities. The highest average of the Municipal Human Development Index (MHDI) was observed among urban municipalities. The highest average coverage of the Family Health Strategy (FHS) was found among rural municipalities. In these municipalities, the best results were shown for the indicators of infant mortality, premature mortality and mortality from preventable causes, vaccine homogeneity and prevalence of malnutrition. The findings of this study show that greater FHS coverage is associated with the occurrence of better general living and health conditions in the populations served in rural municipalities. It is recommended that health managers encourage the consolidation of the FHS in communities with unfavorable socioeconomic and cultural contexts, such as remote rural locations and urban agglomerations, and the establishment of intersectoral actions with a positive impact on health.

Manejo clínico da doença de Chagas na atenção primária à saúde em área endêmica do estado de Minas Gerais, Brasil / Clinical management of Chagas disease in primary health care in an endemic area in the state of Minas Gerais, Brazil

Objetivo: Descrever o manejo clínico da Doença de Chagas (DC) por profissionais médicos da Atenção Primária à Saúde (APS) de região endêmica. Metodologia: Estudo transversal entre médicos da APS de 23 municípios. A coleta contemplou questões Demográficas, Formação Acadêmica, Características da APS de Atuação, Práticas e Conhecimento Relativos à DC. Conduziram-se análises descritivas de todas as variáveis e bivariadas para os blocos de práticas e conhecimento relativos à DC considerando o tempo de conclusão da graduação. Resultados: Foram incluídos 136 médicos. A maioria mencionou conhecer o Protocolo Clínico e Diretriz Terapêutica da DC, mas não prescreveu o benzonidazol e se sente insegura no manejo do paciente. Na análise bivariada, a variável conhecimento sobre a DC adquirido na graduação mostrou-se associada estatisticamente ao tempo de graduação. Conclusão: Importantes obstáculos ainda persistem no manejo médico ao paciente com DC na APS. A partir desse achado espera-se incentivar a qualificação.

Objective: To describe the clinical management of Chagas Disease (CD) by Primary Health Care (PHC) physicians in an endemic region. Methodology: Cross-sectional study with PHC physicians from 23 municipalities. The collection included questions on Demographics, Academic Background, Characteristics of the APS in Action, Practices and Knowledge Relating to CD. Descriptive analyzes of all variables and bivariates were carried out for the blocks of practices and knowledge related to CD, considering the time of completion of graduation. Results: 136 physicians were included. Most mentioned knowing the CD Clinical Protocol and Therapeutic Guideline, but did not prescribe benznidazole and feel insecure in-patient management. In the bivariate analysis, the variable knowledge about CD acquired during graduation was statistically associated with graduation time. Conclusion: Important obstacles still persist in the medical management of patients with CD in PHC. Based on this finding, it is expected to encourage qualification.

Overview of Chagas disease surveillance in an endemic region in Southeastern Brazil

ABSTRACT Chagas disease (CD) is a neglected disease caused by the protozoan Trypanosoma cruzi. It has high morbidity and mortality rates and mainly affects socially vulnerable populations. This is a cross-sectional study, with retrospective and prospective data collection. Using questionnaires applied to environmental surveillance coordinators, we characterized the status of CD surveillance activities in municipalities endemic for the disease in Northern Minas Gerais State (MG) and Jequitinhonha Valley (Vale do Jequitinhonha). Moreover, we spatialized the vulnerability index for chronic CD in the study area. The population consisted of 22 environmental surveillance coordinators, active in 2020, from Northern MG and Jequitinhonha Valley, 21 municipalities included in the SaMi-Trop research project, and Montes Claros municipality. After applying the questionnaires to the coordinators, a descriptive analysis of the variables was performed. To characterize the active municipalities, the explanatory variables collected in the questionnaire were compared with the dichotomous variable. Bivariate descriptive analysis was performed. Finally, geoprocessing techniques were used to spatialize the data and prepare maps. Regarding the team of endemic combat agents (ECA), 90.9% reported the lack of a specific team for CD vector control actions. Of the 22 municipalities participating in this study, nine were active (41.1%). Only 25% (n=2) of active municipalities (9% of the municipalities studied) met the target of visiting 50% of households per year. Finally, 81.1% of the coordinators stated that in their municipality, they developed actions linked to primary health care (PHC). The implementation of CD surveillance activities weakened in the endemic region. Few municipalities have a surveillance team, with low regularity of active surveillance and noncompliance with the program's goal. The results suggest insufficient recording of activities in the information system, considering that there are municipalities that report performing the activities, but no production record was observed in the system.

Contextual influence on poor self-rated health in patients with Chagas disease: multilevel study / Influência contextual na pior autopercepção em saúde de portadores de Doença de Chagas: estudo multinível

Abstract Chagas disease (CD) is recognized by the World Health Organization as one of the thirteen most neglected tropical diseases in the world. Self-perceived health is considered a better predictor of mortality than objective measures of health status, and the context in which one lives influences this predictor. This study aimed to evaluate the prevalence and individual and contextual factors associated with poor self-rated health among CD patients from an endemic region in Brazil. It is a multilevel cross-sectional study. The individual data come from a cross-section of a cohort study named SaMi-Trop. Contextual data was collected from publicly accessible institutional information systems and platforms. The dependent variable was self-perceived health. The analysis was performed using multilevel binary logistic regression. The study included 1,513 patients with CD, where 335 (22.1%) had Poor self-rated health. This study revealed the influence of the organization/offer of the Brazilian public health service and of individual characteristics on the self-perceived health of patients with CD.

Resumo A Doença de Chagas (DC) é reconhecida pela Organização Mundial da Saúde como uma das treze doenças tropicais mais negligenciadas do mundo. A autopercepção de saúde é considerada um melhor preditor de mortalidade do que medidas objetivas do estado de saúde, e o contexto em que se vive influencia esse preditor. O objetivo deste estudo foi avaliar a prevalência e os fatores individuais e contextuais associados à pior autopercepção em saúde de pacientes com DC de uma região endêmica do Brasil. É um estudo transversal multinível. Os dados individuais vêm de um corte transversal de um estudo de coorte denominado SaMi-Trop. Os dados contextuais foram coletados a partir de plataformas e sistemas de informações institucionais acessíveis ao público. A variável dependente foi a autopercepção de saúde. A análise foi realizada por meio de regressão logística binária multinível. Participaram do estudo 1.513 pacientes com DC, sendo 335 (22,1%) com pior autopercepção de saúde. Este estudo revelou a influência da organização/oferta do serviço público de saúde brasileiro e de características individuais na autopercepção de saúde de pacientes com DC.

Salário de médicos contratados da Estratégia Saúde da Família e contexto municipal: estudo ecológico / Salary of physicians hired by the Family Health Strategy Program and the municipalities context: an ecological study

RESUMO O salário é um importante fator de atração, fixação e satisfação de profissionais médicos na Atenção Primária à Saúde (APS), sobretudo nas regiões mais remotas ou carentes. Este estudo tem o objetivo de identificar características contextuais municipais que estejam associadas ao valor do salário pago a médicos contratados da Estratégia Saúde da Família (ESF). Realizou-se um estudo ecológico e transversal com 78 municípios da Macrorregião de Saúde Norte, Minas Gerais, Brasil. A variável dependente referiu-se ao valor pago aos médicos contratados da ESF. Foram consideradas 22 variáveis independentes contextuais incluindo características sociodemográficas, de localização e indicadores assistenciais e de saúde de cada município, coletados de bases de dados oficiais. Conduziu-se Regressão Linear Múltipla. A média salarial encontrada foi de R$11.188,61 (±R$2.093,71), variando de R$6.388,20 até R$17.000,00. Após ajuste do modelo, somente a Distância ao Centro Regional manteve-se positivamente associada ao desfecho (R2=6,4%). O salário dos médicos não foi determinado por características municipais contextuais mensuráveis. Outros fatores mais subjetivos, de difícil mensuração, podem estar envolvidos na questão. Observa-se a necessidade do estabelecimento de parâmetros claros para definição do valor do salário de médicos contratados para atuação na ESF.

ABSTRACT Salary is an important factor of attraction, fixation and satisfaction of physicians in Primary Health Care (PHC), mainly in the most remote or poor regions. This study aims to identify characteristics related to municipalities that are associated to salaries paid to physicians hired from the Family Health Strategy (FHS) Program. An ecological and cross-sectional study was conducted with 78 municipalities of the Northern Health Macro-region of Minas Gerais State, Brazil. The dependent variable referred to the amount paid to the physicians hired from FHS. Twenty-two contextual independent variables were applied, including sociodemographic characteristics, location and health and care indicators of each municipality, all collected from public databases. Multiple Linear Regression was conducted. The outcome average salary was R$11,188.61 (±R$2,093.71), ranging from R$6,388.20 to R$17,000.00. After adjusting the model, only the variable 'Distance from Regional Center' remained positively associated to the outcome (R2=6.4%). The conclusion is that the salaries of physicians were not determined by measurable contextual municipal characteristics. Other more subjective and difficult to measure factors may be involved in the issue. Therefore, there is need to establish clear parameters so to define the salaries of physicians hired to work for FHS.

Fatores associados à não utilização da teleconsultoria por médicos da Estratégia Saúde da Família / Factors associated with the non-use of telehealth consultancy by physicians of the Family Health Strategy

Resumo Este estudo objetivou avaliar a frequência e os fatores associados à não utilização do serviço de teleconsultoria por médicos que atuam na Estratégia Saúde da Família (ESF) no Norte de Minas Gerais. Trata-se de um estudo transversal que utilizou questionário autoaplicado, previamente testado. A análise de regressão de Poisson com variância robusta foi empregada após análises bivariadas para identificação dos fatores associados à não utilização do serviço de teleconsultoria. Participaram do estudo 385 médicos de 73 municípios. A frequência de não utilização do serviço de teleconsultoria pelos médicos da ESF foi de 55,8%. Foram identificadas como variáveis associadas após análise múltipla a indisponibilidade de computador com internet na Unidade Básica de Saúde (UBS) para uso do profissional médico (p = 0,001; RP = 1,10; IC95%: 1,04-1,17), a falta de informação sobre o serviço (p < 0,001; RP = 1,47; IC95%: 1,38-1,56) e a falta de treinamento para uso da teleconsultoria (p < 0,001; RP = 1,15; IC95%: 1,08-1,24). Os resultados reforçam que a infraestrutura de informática das UBS, a divulgação do serviço e a oferta de treinamento devem direcionar as estratégias para implementação, difusão e melhoria da qualidade do serviço de teleconsultoria na atenção primária.

Abstract This study sought to evaluate the frequency and factors associated with non-use of telehealth consultancy by physicians who work in the Family Health Strategy (FHS) in the North of the State of Minas Gerais. It is a cross-sectional study that used a previously-tested self-administered questionnaire. Poisson regression analysis with robust variance was used after bivariate analysis to identify the factors associated with non-use of telehealth consultancy. A total of 385 physicians from 73 municipalities participated in the study. The frequency of non-use of telehealth consultancy by physicians in the FHS was 55.8%. After multiple analysis, the following variables were identified: the lack of availability of computers and Internet access in the Basic Health Units (BHU) for medical professionals (p = 0.001; PR = 1.10; 95% CI: 1.04-1.17), the lack of information about telehealth consultancy (p< 0.001; PR = 1.47; 95% CI: 1.38-1.56) and lack of training in telehealth consultancy (p < 0.001; PR = 1.15; 95% CI: 1.08-1.24). The results support that the informatics infrastructure of the BHU, the dissemination of the service and the training should orient the strategies for implementation, diffusion and improvement of the quality of telehealth consultancy services in primary health care.

Recursos Humanos e Estratégia Saúde da Família no norte de Minas Gerais: avanços e desafios / Human Resources and Family Health Strategy in the North of Minas Gerais: advances and challenges

Resumo Introdução O sistema público de saúde apresenta desafios à área de recursos humanos. Objetivo Avaliar os avanços e desafios na gestão dos recursos humanos inseridos na Estratégia Saúde da Família (ESF) no norte de Minas Gerais, Brasil. Método Estudo transversal com 317 profissionais vinculados à ESF: cirurgiões-dentistas, enfermeiros e médicos. Para a coleta de dados, utilizou-se questionário com variáveis sociodemográficas, econômicas, vínculo empregatício, plano de carreira, educação permanente e continuada e incentivo financeiro. Avaliou-se a remuneração conforme o sexo, o plano de carreira e a categoria profissional; a categoria profissional conforme o sexo, o plano de carreira e a educação permanente; nível de significância: p < 0,05. Resultados A maioria era mulheres (65,2%), enfermeiros (46,3%), pós-graduados (51,1%), com vínculo por contrato administrativo (67,4%), sem plano de carreira (90,8%) e incentivos financeiros (61,1%) e participava de educação permanente (57,8%). Mais de 40% trabalharam na ESF de outro município e 117 concluíram especialização em ESF/saúde pública/coletiva. Maior remuneração encontrou-se na medicina (p < 0,05) e com homens (p < 0,05). Enfermagem apresentou maior percentual de mulheres, de profissionais com plano de carreira e educação permanente (p < 0,05). Conclusão Avanços se destacam na qualificação profissional, especialistas na área e/ou capacitação em serviço. Há desafios quanto à precarização do trabalho, o que contribui para a rotatividade dos profissionais.

Abstract Background The public health system presents challenges for human resources. Objective To evaluate the advances and challenges in the management of human resources included in the Family Health Strategy - FHS in northern Minas Gerais, Brazil. Method A cross-sectional study with 317 professionals linked to the FHS: dentists, nurses and doctors was carried out. For data collection, it was used a questionnaire with variables: sociodemographic and economic characteristics, employment relationship, career path, permanent and continuing education, and financial incentive. It was also evaluated the remuneration according to gender, career plan and professional category; and professional category according to gender, career plan and permanent education; significance level p <0.05. Results The most were women (65.2%), nurses (46.3%), postgraduates (51.1%), bond by administrative contract (67.4%), no career plan (90.8%) and financial incentives (61.1%) and participated in permanent education (57.8%). More than 40% worked in the FHS of another municipality and 117 completed specialization in FHS / public / collective health. The higher remuneration was for medicine (p <0.05) and for men (p <0.05). Nursing presented higher percentage of women, of professionals with career plan and permanent education (p <0.05). Conclusion Advances stand out in professional qualification, specialists and / or capacitation in service. There are challenges concerning to the precariousness conditions of work, which contributes to the turnover of professionals.