HIV testing inside Brazilian female prisons: results of a national survey.

This study aimed to identify the prevalence of women in prisons who have already had an HIV test inside prison and the factors associated with this test. A cross-sectional study was carried out with 1327 women in 15 prisons in 9 states in Brazil. Almost 60% (95% CI: 57.8-63.7) of women have already been tested for HIV in prison. The factors associated with this HIV test were age ≥41 years (OR = 1.9; 95% CI = 1.2-2.9), highest level of education (OR = 1.9; 95% CI = 1.3-2.8), having been arrested 3 or more times (OR = 1.9; 95% CI = 1.3-2.8), having received information about HIV/STI in the lifetime (OR = 1.4; 95% CI = 1.1-1.9) and perceived themselves to be at no risk for HIV infection (OR = 1.7; 95% CI = 1.2-2.5), black or mixed race (OR = 0.7; 95% CI = 0.5-0.9) and having a male sexual partner (OR = 0.6; 95% CI = 0.5-0.9). The routine HIV testing in prisons needs to be expanded to promote HIV prevention for a population with limited access to these services outside of prison.

Natural environmental water sources in endemic regions of northeastern Brazil are potential reservoirs of viable Mycobacterium leprae.

BACKGROUND: The detection of live Mycobacterium leprae in soil and animals other than humans suggests that the environment plays a role in the transmission of leprosy. OBJECTIVE: The objective of this study was to investigate the presence of viable M. leprae in natural water sources used by the local population in five municipalities in the state of Ceará, northeastern Brazil. METHODS: Samples were collected from 30 different sources. Viable bacilli were identified by reverse transcriptase polymerase chain reaction (PCR) of the M. leprae gyrA gene and sequencing of the PCR products. Physicochemical properties of each water source were also assessed. FINDINGS: M. leprae gyrA mRNA was found in 23 (76.7%) of the water sources. No association was found between depth of the water and sample positivity, nor was there any association between the type of water used by the population and sample positivity. An association between viable M. leprae and temperature and pH was found. Georeferencing showed a relation between the residences of leprosy cases and water source containing the bacterium. MAIN CONCLUSIONS: The finding of viable M. leprae in natural water sources associated with human contact suggests that the environment plays an important role in maintaining endemic leprosy in the study region.

Correlation between clinical tests and electroneuromyography for the diagnosis of leprosy neuropathy.

BACKGROUND: In leprosy, sensory function of nerves is evaluated with monofilaments test and the motor function with voluntary muscle test, however electroneuromyography is considered as the gold-standard tool. OBJECTIVES: This study aimed: i) to evaluate the correlation between clinical tests and electroneuromyography for the diagnosis of leprosy neuropathy; and ii) to identify the prevalence of leprosy neuropathy and the most compromised peripheral nerves in leprosy. METHODS: We analysed the data from a nested case-control study that identified 166 patients diagnosed with leprosy neuropathy confirmed by electromyography. This study was designed for an analysis of correlation between the diagnostic tests. RESULTS: The most prevalent type of the neural damage was the sensory and motor multiple mononeuropathy, observed in 62 (37.3%) cases. The highest prevalence was the ulnar nerve in 67 (40.3%) cases. Agreement specified by nerves was moderate, ranging from k = 0.58 in the deep peroneal nerve to k = 0.41 in the posterior tibial nerve). Overall agreement between the clinical tests and electroneuromyography was very poor. Monofilaments test with k = 0.02 (95% CI 0.00-0.12) and voluntary muscle test with 0.16 (95% CI 0.04 to 0.28, P = 0.01). CONCLUSIONS: There is a low to moderate correlation between clinical tests (monofilaments and voluntary muscle tests) and the electroneuromyography examination. The most prevalent type of neural impairment was the sensory and motor multiple mononeuropathy, and the most affected nerve was the ulnar.

Widespread nasal carriage of Mycobacterium lepraeamong a healthy population in a hyperendemic region of northeastern Brazil.

A case-control study was conducted to determine the presence ofMycobacterium lepraeDNA in nasal secretions of leprosy cases and nonleprosy individuals in Fortaleza, Brazil. It included 185 cases identified by physicians at the Dona Libânia National Reference Centre for Sanitary Dermatology (CDERM). A control group (Co) (n = 136) was identified among individuals from CDERM not diagnosed as leprosy cases. To augment the spatial analysis of M. leprae specific repetitive element (RLEP) positive prevalence, an external group (EG) (n = 121), a convenience sample of healthy students, were included. Polymerase chain reaction for the RLEP sequence was conducted for all participants. Prevalence of RLEP positivity for cases and Co were 69.2% and 66.9%, respectively, significantly higher than for EG (28.1%), and reported elsewhere. Male sex, belonging to a lower socioeconomic status (D/E), history of a previous contact with a case and being older, were associated with being a leprosy case. Our geographical analysis demonstrated that the bacillus is widespread among the healthy population, with clusters of RLEP positive multibacillary cases concentrated in distinct areas of the city. Our results suggest that in endemic areas, as in Fortaleza, surveillance for both nonhousehold leprosy contacts and members of the general population living in cluster areas should be implemented.

Predictors of Appropriate Therapies and Death in Patients with Implantable Cardioverter-Defibrillator and Chronic Chagas Heart Disease. / Preditores de Terapias Apropriadas e Óbito em Pacientes com Cardiodesfibrilador Implantável e Cardiopatia Chagásica Crônica.

BACKGROUND: There are few retrospective and prospective studies on implantable cardioverter-defibrillators (ICD) in primary and secondary prevention of sudden death in chronic Chagas heart disease (CCHD). OBJECTIVES: To describe the long-term evolution of patients with CCHD and ICD and to identify and analyze predictors of mortality and appropriate device therapy in this population. METHODS: This was a historical prospective study with 117 patients with ICD and CCHD. Devices were implanted from January 2003 to December 2021. Predictors of appropriate therapies and long-term mortality were identified and analyzed. The level of statistical significance was p < 0.05. RESULTS: Patients (n = 117) had a median follow-up of 61 months (25 to 121 months); they were predominantly male (74%), with a median age of 55 years (48 to 64 years). There were 43.6% appropriate shocks, 26.5% antitachycardia pacing (ATP), and 51% appropriate therapies. During follow-up, 46 patients (39.7%) died. Mortality was 6.2% person-years (95% confidence interval [CI]: 4.6 to 8.3), with 2 sudden deaths during follow-up. Secondary prevention (hazard ratio [HR] 2.1; 95% CI: 1.1 to 4.3; p = 0.029) and ejection fraction less than 30% (HR 1.8; 95% CI: 1.1 to 3.1; p < 0.05) were predictors of appropriate therapies. Intermediate Rassi score showed a strong association with the occurrence of ATP alone (p = 0.015). Functional class IV (p = 0.007), left ventricular ejection fraction < 30 (p = 0.010), and age above 75 years (p = 0.042) were predictors of total mortality. CONCLUSION: ICDs in CCHD showed a high incidence of appropriate activation, especially in patients with secondary prevention, low left ventricular ejection fraction, and intermediate Rassi score. Patients with congestive heart failure, elevated functional class, and age over 75 years showed elevated mortality. Survival function of patients with implantable cardioverter-defibrillators and chronic Chagas heart disease. A - According to New York Heart Association functional class; B - According to left ventricular ejection fraction; C - According to Rassi score. D - According to age. CCHD: chronic Chagas heart disease; HR: hazard ratio; ICD: implantable cardioverter-defibrillator.

Use of insect repellent as personal protection among women of childbearing age in an arbovirus endemic area in Northeastern Brazil.

OBJECTIVE: To analyze the factors associated with the individual use of insect repellent by women of childbearing age living in area endemic for arboviruses in Fortaleza, Brazil. METHODS: This is a cohort study carried out between 2018 and 2019 with women aged between 15 and 39 years in Fortaleza, state of Ceará, Brazil. A total of 1,173 women users of one of the four selected primary health care units participated in the study. The outcome was divided into: continued use, discontinued use, and nonuse of insect repellent. Crude and adjusted multinominal logistic regression analysis was carried out guided by a hierarchical model, with presentation of the respective odds ratio (OR) and 95% confidence intervals (95%CI). The independent variables include: socioeconomic and demographic data, environmental and sanitary characteristics, knowledge of the insect repellent, and behavioral and pregnancy-related aspects. RESULTS: Only 28% of the participants reported using insect repellent during the two waves of the cohort. Women with higher education (OR=2.55; 95%CI 1.44-4.51); who are employed (OR=1.51; 95%CI 1.12-2.03); who received guidance from healthcare professionals (OR=1.74; 95%CI 1.28-2.36) and the media (OR=1.43; 95%CI 1.01-2.02); who intensified precautions against mosquitoes during the epidemic (OR=3.64; 95%CI 2.29-5.78); and who were pregnant between 2016 and 2019 (OR=2.80; 95%CI 1.83-4.30) had increased odds for continued use of insect repellent. CONCLUSION: The use of insect repellent among women of childbearing age was associated with a higher level of education, employment, guidance on insect repellent provided by healthcare professionals and the media, behavioral changes to protect against mosquitoes during the Zika virus epidemic, and pregnancy when occurring as of the beginning of the epidemic period.

Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead. / Vacinação contra poliomielite no Brasil de 2011 a 2021: sucessos, reveses e desafios futuros.

The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).

A queda de coberturas vacinais (CV) na infância, entre elas a da poliomielite, vem se tornando uma preocupação sanitária. O objetivo foi analisar a tendência temporal das coberturas das três doses da vacina contra a poliomielite nos primeiros 12 meses de vida entre 2011 e 2021, com destaque na pandemia de COVID-19, além de mapear as CV no Brasil. Foi realizado um estudo ecológico com técnicas de série temporal interrompida (STI) e análise espacial, a partir dos dados do Sistema de Informação do Programa Nacional de Imunização. A tendência da CV foi ajustada pelo estimador de variância de Newey-West, segundo as unidades federadas e o Índice de Privação Brasileiro. A distribuição da CV foi estimada por modelos bayesianos e os aglomerados espaciais pelos índices de Moran global e local, identificando áreas de menor cobertura nas Regiões de Saúde. Observa-se perda da CV ao longo do período em todas as regiões do país, sendo maiores no Norte e no Nordeste e se acentuando durante a pandemia. As maiores quedas foram identificadas em estados e regiões de saúde com maior vulnerabilidade social. A queda na CV mostra que o risco de reintrodução do vírus selvagem é iminente e os desafios precisam ser enfrentados com o fortalecimento do Sistema Único de Saúde.

Measles vaccination in Brazil: where have we been and where are we headed? / Vacinação do sarampo no Brasil: onde estivemos e para onde vamos?

The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted.

A reemergência de doenças imunopreveníveis devido à queda das coberturas vacinais (CV) tem sido documentada em vários países. O objetivo foi analisar a CV, a homogeneidade das CV e os casos de sarampo no Brasil de 2011 a 2021, com enfoque no período da pandemia de COVID-19, sua tendência temporal, distribuição espaço-temporal e fatores associados aos aglomerados de menor CV. Trata-se de um estudo ecológico sobre a CV de sarampo (dose 1), com métodos de série temporal interrompida e de avaliação da disposição espaço-temporal, por meio do teste de varredura na identificação de aglomerados de CV. A partir de 2015, observa-se queda progressiva das CV e da homogeneidade, acentuando-se após 2020 em todas as regiões, particularmente Norte e Nordeste. Aglomerados de baixa CV foram associados a piores indicadores de desenvolvimento humano, desigualdade social e menor acesso à Estratégia de Saúde da Família. No Brasil, a pandemia intensificou as iniquidades em saúde, com baixas CV de sarampo em municípios socialmente mais vulneráveis e desiguais. Há risco de circulação do vírus, reafirmando o desafio de fortalecer a atenção básica, aprimorar a comunicação em saúde e garantir acesso à vacina, diminuindo oportunidades perdidas de vacinação e a hesitação vacinal.

Screening for coronavirus disease 2019 in pregnant women admitted for delivery: an observational study.

OBJECTIVE: The aim of this study was to examine the impact of symptom-based screening on the prevalence and outcomes of neonatal coronavirus disease 2019 in pregnant women admitted for delivery. METHODS: A retrospective observational study was conducted from June to August 2020 at Gonzaga Mota of Messejana Hospital, Fortaleza, CE, Brazil. All pregnant women were screened for coronavirus disease 2019 based on symptoms. Reverse transcription-polymerase chain reaction or immunology assays for severe acute respiratory syndrome coronavirus 2 were performed when a patient reported a symptom. All newborns of symptomatic patients were submitted for Reverse transcription-polymerase chain reaction. Newborns were divided into groups according to the Reverse transcription-polymerase chain reaction results to identify the relationship between maternal symptoms and neonatal coronavirus disease 2019. RESULTS: A total of 55 (55/1,026, 5.4%) and 50 (50/1,026, 4.8%) pregnant women reported symptoms and had a positive confirmatory test, respectively. The most common symptom of coronavirus disease 2019 among the pregnant women with positive confirmatory test was cough (n=23, 46%). Seven newborns (7/50, 14%) of symptomatic mothers had positive Reverse transcription-polymerase chain reaction. Upon birth, no newborn had serious complications. CONCLUSION: Universal screening of pregnant women admitted for delivery can reduce the perinatal transmission of coronavirus disease 2019. Symptom-based screening can be an alternative for regions with a low prevalence of the disease where a better allocation of financial resources is necessary.

Positivity of dengue, chikungunya, and Zika infections in women in Northeast Brazil post-Zika epidemic.

The state of Ceará, in the Northeast Region of Brazil, presents the simultaneous circulation of Zika (ZIKV), dengue (DENV) and chikungunya (CHIKV) viruses. In 2017 there were a high number of cases of these three arboviruses, especially CHIKV. Here, we detected the presence of arboviruses ZIKV, DENV and CHIKV and their coinfections in women in endemic regions of the city of Fortaleza, Ceará in a post-Zika epidemic year. Sociodemographic and environmental characteristics associated with arbovirus positivity were also analyzed. Women (n = 1289) between 15 and 39 years old were included. RT-qPCR was performed for virus detection and IgM antibody positivity was also analyzed. One hundred and six (8.3%) participants were positive for one or more arboviruses. Monoinfections (76; 5.9%) were distributed between 22 (1.7%) for ZIKV, 39 (3.1%) for DENV and 15 (1.2%) for CHIKV. Co-infections were detected in 30 (2.3%) of the positive participants and one case with triple infection was found. IgM positivity was found in 2.4% of ZIKV RT-qPCR, 9.6% of DENV and 16.3% of CHIKV. RT-qPCR positivity for arboviruses was associated with low socioeconomic class and presence of a water box sealing in the household. A higher positivity to the three viruses occurred in the month with the lowest wind velocity, which was also preceded by the highest peak of rain and humidity. We identified the simultaneous circulation and co-infection of ZIKV, DENV and CHIKV in Fortaleza in a post-Zika epidemic year. We also highlight the need for continuous epidemiological surveillance combined with molecular diagnostic tools.

Spatial distribution pattern of new leprosy cases under 15 years of age and their contacts in Sobral, Ceará, Brazil.

This study's objective was to analyze the spatial distribution pattern of new leprosy cases under 15 years and their contacts. A cross-sectional descriptive study covering sociodemographic characteristics and spatial analysis was carried out. The participants were from the city of Sobral, Ceará and the study was conducted between August 2014 and September 2015. Contacts were identified by the persons responsible for the children. Seropositivity was determined with the NDO-LID antigen, and positive cases were plotted on Voronoi polygons. Nine new cases of leprosy under 15 years of age have been found. The average number of people living with the cases was higher than the number of people living with non-household contacts. All household contacts were aware of other leprosy cases and had a higher rate of seropositive tests than non-household contacts. The index cases lived in the poorest regions of the municipality and hyper-endemic areas. Spatial analysis revealed a cluster of subclinical infection within a radius of 102 meters, suggesting that non-household transmission is related to proximity with seropositive individuals. In conclusion, the search for new leprosy cases cannot be restricted to household contacts.

Social inequalities associated with COVID-19 case fatality rate in Fortaleza, Ceará state, Brazil, 2020. / Desigualdades sociais associadas com a letalidade por COVID-19 na cidade de Fortaleza, Ceará, 2020.

OBJECTIVE: To analyze the association among social and health inequalities, socioeconomic status, spatial segregation and Case Fatality Rate (CFR) due to COVID-19 in Fortaleza, the state capital of Ceará, Brazil. METHODS: This was an ecological study of confirmed cases and deaths due to COVID-19. The 119 neighborhoods of Fortaleza were used as units of analysis. Incidence, mortality and apparent CFR indicators due to COVID-19 were calculated between January 1 and June 8, 2020. Socioeconomic indicators were obtained from the 2010 Brazilian Demographic Census. Spatial analysis was performed and local and global Moran's indexes were calculated. RESULTS: There were 22,830 confirmed cases, 2,333 deaths and the apparent CFR was 12.7% (95% CI 11.6;13.9). Significant spatial autocorrelations between apparent CFR (I=0.35) and extreme poverty (I=0.51), overlapping in several neighborhoods of the city, were found. CONCLUSION: The apparent CFR due to COVID-19 is associated with the worst socioeconomic and health status, which shows the relationship between social inequalities and health outcomes in times of pandemic.

COVID-19 in northeast Brazil: first year of the pandemic and uncertainties to come.

OBJECTIVE: To analyze the epidemic of COVID-19 in northeastern Brazil, one of the regions most affected by the virus. METHODS: The official data for COVID-19, from March 2020 to March 2021 in the states of the Northeast Region (NE), were used. The analysis of capital cities and states for accumulated weekly cases and confirmed deaths was made using the JoinPoint Trend Analysis application. RESULTS: In one year, the Northeast region reported 22.9% of the cases and 21.5% of the deaths in the country due to COVID-19. At the beginning of the pandemic, all states showed a growing number of cases, first in the capitals and then in the interior. Following this wave, decreases are observed in all states and their capitals, but with many still reporting a large number of cases. In the middle of the 2nd semester of 2020 the number of cases begins to increase again simultaneously in states and their capitals-some at explosive speed-especially in late 2020 and early 2021. A similar pattern is observed in deaths, which exceed or approach the peak seen in the first wave. In the first wave, all capitals and northeastern states adopted intense isolation measures. Fortaleza, Recife and Teresina reached the highest isolation index of all capitals, close to 0.60. This index decreases, with a slight growth trend until the end of December. With the exception of Fortaleza and Salvador, the other capitals fell to less than 0.40. CONCLUSION: The Brazilian NE and the country are in increasingly complicated health, social and economic situations. It is necessary to speed up vaccinations and maintain non-pharmacological measures: face masks, social distancing measures and hygiene care, in addition to policies to protect workers who have lost their incomes and to subsidize small business owners.

[Covid-19 in the Northeast of Brazil: from lockdown to the relaxation of social distancing measures]. / Covid-19 no nordeste do Brasil: entre o lockdown e o relaxamento das medidas de distanciamento social.

Even in the period when the Covid-19 pandemic was on the rise in the Northeast of Brazil, the relaxation of social distancing measures was introduced. The scope of the study is to assess, in the light of the epidemiological-sanitary situation in the region, the suitability of relaxation of social distancing measures. Based on the WHO guidelines for relaxation of social distancing, operational indicators were created and analyzed for each guideline in the context of the Northeast. To analyze the behavior of the epidemic, according to selected indicators, Joinpoint trend analysis techniques, heat maps, rate ratios and time trends between capitals and the state interior were compared. The weekly growth peak of the epidemic occurred in May-July 2020 (epidemiological weeks 19 to 31). In most capitals, there was no simultaneous downward trend in the number of cases and deaths in the 14 days prior to flexibilization. In all states the number of tests performed was insufficient. In epidemiological week 24, the state percentages of ICU/Covid-19 bed occupancy were close to or above 70%. The epidemiological situation of the nine Northeastern state capitals analyzed here did not meet criteria and parameters recommended by the World Health Organization for the relaxation of social distancing measures.

Mesmo no período em que a pandemia de Covid-19 encontrava-se em crescimento no Nordeste do Brasil, iniciou-se a adoção de medidas de flexibilização do distanciamento social. O objetivo do estudo é o de avaliar a pertinência das propostas de flexibilização, tomando-se em conta a situação da pandemia em cada local e o momento em que foram adotadas. Tendo como referência as diretrizes da OMS, foram construídos e analisados indicadores operacionais para cada diretriz, no contexto da região Nordeste. Para análise do comportamento da epidemia, conforme indicadores selecionados, foram usadas técnicas de Joinpoint Trend Analysis, mapas de calor, razão de taxas e comparação da tendência temporal entre capitais e interior dos estados. O pico do crescimento semanal ocorreu em maio-julho/2020 (semanas epidemiológicas 19 a 31). Na maioria das capitais não se observou tendência decrescente simultânea do número de casos e óbitos nos 14 dias prévios à flexibilização. Em todos os estados o quantitativo de testes realizados foi insuficiente. Na semana epidemiológica 24 os percentuais estaduais de ocupação de leitos de UTI/Covid-19 foram próximos ou superiores 70%. A situação epidemiológica das nove capitais dos estados do Nordeste, no momento em que a decisão de flexibilização foi tomada, mostra que nenhuma delas atendia aos critérios e parâmetros recomendados pela OMS.

COVID-19 in Northeast Brazil: achievements and limitations in the responses of the state governments. / COVID-19 no Nordeste brasileiro: sucessos e limitações nas respostas dos governos dos estados.

The COVID-19 pandemic has been most severe in the poorest regions of Brazil, such as the states of the Northeast Region. The lack of national policies for pandemic control forced state and municipal authorities to implement public health measures. The aim of this study is to show the effect of these measures on the epidemic. The highest incidence of COVID-19 among the nine states in the Northeast was recorded in Sergipe, Paraíba and Ceará. Piauí, Paraíba and Ceará were the states that most tested. Factors associated with transmission included the high proportion of people in informal work. States with international airports played an important role in the entry of the virus and the initial spread, especially Ceará. All states applied social distancing measures, banned public events and closed schools. The response was a significant increase in social distancing, especially in Ceará and Pernambuco, a decline in the reproduction rate (Rt), and a separation of the curve of observed cases versus expected cases if the non-pharmacological interventions had not been implemented in all states. Poverty, inequality, and the high rates of informal work provide clues to the intensity of COVID-19 in the region. On the other hand, the measures taken early by the governments mitigated the effects of the pandemic.

No Brasil, a pandemia da COVID-19 tem sido severa nos estados das regiões mais pobres, como o Nordeste. A falta de políticas nacionais para controle da pandemia levou as autoridades estaduais e municipais a implementarem medidas de saúde pública. O objetivo deste estudo é mostrar o efeito dessas medidas na epidemia. A maior incidência da COVID-19 entre os nove estados do Nordeste foi registrada em Sergipe, Paraíba e Ceará. O Piauí, a Paraíba e Ceará foram os que mais testaram. Muitos estados apresentavam alta proporção de pessoas em trabalho informal. Estados com aeroportos internacionais tiveram importante papel na entrada e disseminação inicial do vírus, em especial o Ceará. Todos os estados aplicaram medidas de distanciamento social, proibição de eventos públicos e fechamento de unidades de ensino. As respostas foram o aumento significativo de distanciamento social, em especial Ceará e Pernambuco, a queda do número de reprodução (Rt) e a separação da curva dos casos observados da curva dos casos esperados sem as intervenções não medicamentosas em todos os estados. A pobreza, a desigualdade e as altas taxas de trabalho informal fornecem pistas do porquê da intensidade da COVID-19 na região. Por outro lado, as medidas de mitigação tomadas precocemente pelos governantes amenizaram os efeitos da pandemia.

Factors associated with inadequate follow-up of children with congenital syphilis.

OBJECTIVE: To analyze factors associated with outpatient follow-up of children with congenital syphilis. METHODS: A non-concurrent cohort study performed in primary care units and three reference maternity hospitals in Fortaleza (Ceará State). Data were collected from September 2013 to September 2016 in the notification forms and in the medical records of hospitalization and outpatient follow-up, and they were presented considering an adequate and inadequate follow-up. Children who attended the primary care unit or referral outpatient clinic during the period recommended by the Ministry of Health were considered adequately followed up and performed the recommended examinations. Pearson's chi-square and Fisher's exact tests were used in the comparative analysis. The estimated risk of adequate non-follow-up was verified by simple and multiple logistic regression. RESULTS: The total of 460 children with congenital syphilis were notified, of which 332 (72.2%) returned for at least one appointment and were part of the study. Exactly 287 (86.4%) children attended the primary health unit; however, there was no reference to congenital syphilis in 236 (71.1%) medical records and no information on the venereal disease research laboratory (VDRL) test was found in 264 (79.5%) children. There was nonadherence to subsequent appointments by 272 (81.9%) individuals. The following variables had a statistically significant association with the non-adequate follow-up of the children: marital status of the mothers, number of prenatal appointments, number of pregnancies, blood count, and radiography of long bones. CONCLUSIONS: Most children with congenital syphilis attended primary care for follow-up, but the services do not meet the recommendations of the Brazilian Ministry of Health for adequate follow-up.

Fetal and infant mortality of congenital syphilis reported to the Health Information System.

BACKGROUND: Congenital syphilis (CS) is a major cause of mortality in several countries, especially in Latin America and the Caribbean. This study aimed to analyze fetal and infant mortality of CS reported to the Health Information System in a State in Northeastern Brazil. METHODS AND RESULTS: This was a cross-sectional study that analyzed the deaths of CS from 2010 to 2014 through the linkage of the Mortality Information System (SIM) and the Notifiable Diseases Information System (Sinan). The Statistical Package for the Social Sciences (SPSS) version 23.0 was used to calculate the rates of Fetal, Perinatal, Neonatal (early and late), and Postneonatal Mortality. Simple linear regression was performed. Fisher's exact test or Pearson's chi-square test were used for comparison of proportions and Student's t-test was used for comparison of means. Of the 414 cases reported to the SIM as deaths possibly caused by CS, 44 (10.6%) presented CS as the underlying cause. From 2010 to 2014 the Infant Mortality Rate of CS was 16.3 per 100,000 live births (y = 0.65x + 14.33, R2 = 0.2338, p = 0.003). There was an 89.4% underreporting of deaths. Perinatal deaths and fetal deaths of CS accounted for 87.7% and 73.9% of total deaths, respectively. CONCLUSIONS: The results of the study revealed a significant Fetal and Infant Mortality rate of CS and demonstrated the importance of using the linkage method in studies that involve the analysis of secondary data obtained from mortality and disease reporting systems. The underreporting of CS as a cause of fetal and infant mortality leads to unawareness of the reality of deaths from this disease, hindering the development of public policies aimed at its prevention.

Preditores de Terapias Apropriadas e Óbito em Pacientes com Cardiodesfibrilador Implantável e Cardiopatia Chagásica Crônica / Predictors of Appropriate Therapies and Death in Patients with Implantable Cardioverter-Defibrillator and Chronic Chagas Heart Disease

Resumo Fundamento: Existem poucos estudos retrospectivos e prospectivos sobre cardiodesfibrilador implantável (CDI) na prevenção primária e secundária de morte súbita na cardiopatia chagásica crônica (CCC). Objetivos: Descrever a evolução a longo prazo dos portadores de CCC com CDI e identificar e analisar os preditores de mortalidade e de terapia apropriada do dispositivo nessa população. Métodos: Trata-se de um estudo prospectivo histórico com 117 pacientes portadores de CDI e CCC. Dispositivos foram implantados de janeiro de 2003 a dezembro de 2021. Fatores preditores de terapias apropriadas e mortalidade a longo prazo foram identificados e analisados. O nível de significância estatística é de p < 0,05. Resultados: Pacientes (n = 117) tiveram mediana de seguimento de 61 meses (25 a 121 meses), sendo o gênero masculino (74%) predominante e a mediana de idade de 55 anos (48 a 64 anos). Houve 43,6% de choques apropriados, 26,5% de estimulação cardíaca antitaquicardia (ATP) e 51% de terapias apropriadas. Durante o seguimento, 46 pacientes (39,7%) foram a óbito. A mortalidade foi de 6,2% pessoas-ano (intervalo de confiança [IC] 95%: 4,6 a 8,3), com 2 mortes súbitas durante o seguimento. A prevenção secundária (hazard ratio [HR] 2.1; IC 95%: 1,1 a 4,3; p = 0,029) e a fração de ejeção menor que 30% (HR 1.8; IC 95%: 1,1 a 3,1; p < 0,05) foram preditores de terapias apropriadas. Escore de Rassi intermediário apresentou uma forte associação com ocorrência de ATP isoladamente (p = 0,015). A classe funcional IV (p = 0,007), fração de ejeção do ventrículo esquerdo < 30 (p = 0,010) e a idade maior que 75 anos (p = 0,042) foram preditores de mortalidade total. Conclusão: Os desfibriladores na CCC apresentaram elevada incidência de acionamento apropriado especialmente naqueles pacientes de prevenção secundária, fração de ejeção do ventrículo esquerdo baixa e escore de Rassi intermediário. Os pacientes com insuficiência cardíaca congestiva, classe funcional avançada e idade maior que 75 anos apresentaram elevada mortalidade.

Abstract Background: There are few retrospective and prospective studies on implantable cardioverter-defibrillators (ICD) in primary and secondary prevention of sudden death in chronic Chagas heart disease (CCHD). Objectives: To describe the long-term evolution of patients with CCHD and ICD and to identify and analyze predictors of mortality and appropriate device therapy in this population. Methods: This was a historical prospective study with 117 patients with ICD and CCHD. Devices were implanted from January 2003 to December 2021. Predictors of appropriate therapies and long-term mortality were identified and analyzed. The level of statistical significance was p < 0.05. Results: Patients (n = 117) had a median follow-up of 61 months (25 to 121 months); they were predominantly male (74%), with a median age of 55 years (48 to 64 years). There were 43.6% appropriate shocks, 26.5% antitachycardia pacing (ATP), and 51% appropriate therapies. During follow-up, 46 patients (39.7%) died. Mortality was 6.2% person-years (95% confidence interval [CI]: 4.6 to 8.3), with 2 sudden deaths during follow-up. Secondary prevention (hazard ratio [HR] 2.1; 95% CI: 1.1 to 4.3; p = 0.029) and ejection fraction less than 30% (HR 1.8; 95% CI: 1.1 to 3.1; p < 0.05) were predictors of appropriate therapies. Intermediate Rassi score showed a strong association with the occurrence of ATP alone (p = 0.015). Functional class IV (p = 0.007), left ventricular ejection fraction < 30 (p = 0.010), and age above 75 years (p = 0.042) were predictors of total mortality. Conclusion: ICDs in CCHD showed a high incidence of appropriate activation, especially in patients with secondary prevention, low left ventricular ejection fraction, and intermediate Rassi score. Patients with congestive heart failure, elevated functional class, and age over 75 years showed elevated mortality.

Use of insect repellent as personal protection among women of childbearing age in an arbovirus endemic area in Northeastern Brazil / Uso de repelente como medida de proteção pessoal por mulheres em idade fértil residentes em áreas endêmicas para arboviroses no Nordeste do Brasil

ABSTRACT Objective: To analyze the factors associated with the individual use of insect repellent by women of childbearing age living in area endemic for arboviruses in Fortaleza, Brazil. Methods: This is a cohort study carried out between 2018 and 2019 with women aged between 15 and 39 years in Fortaleza, state of Ceará, Brazil. A total of 1,173 women users of one of the four selected primary health care units participated in the study. The outcome was divided into: continued use, discontinued use, and nonuse of insect repellent. Crude and adjusted multinominal logistic regression analysis was carried out guided by a hierarchical model, with presentation of the respective odds ratio (OR) and 95% confidence intervals (95%CI). The independent variables include: socioeconomic and demographic data, environmental and sanitary characteristics, knowledge of the insect repellent, and behavioral and pregnancy-related aspects. Results: Only 28% of the participants reported using insect repellent during the two waves of the cohort. Women with higher education (OR=2.55; 95%CI 1.44-4.51); who are employed (OR=1.51; 95%CI 1.12-2.03); who received guidance from healthcare professionals (OR=1.74; 95%CI 1.28-2.36) and the media (OR=1.43; 95%CI 1.01-2.02); who intensified precautions against mosquitoes during the epidemic (OR=3.64; 95%CI 2.29-5.78); and who were pregnant between 2016 and 2019 (OR=2.80; 95%CI 1.83-4.30) had increased odds for continued use of insect repellent. Conclusion: The use of insect repellent among women of childbearing age was associated with a higher level of education, employment, guidance on insect repellent provided by healthcare professionals and the media, behavioral changes to protect against mosquitoes during the Zika virus epidemic, and pregnancy when occurring as of the beginning of the epidemic period.

RESUMO Objetivo: Analisar os fatores associados ao uso de repelente individual por mulheres em idade fértil residentes em área endêmicas para arboviroses em Fortaleza, Brasil. Métodos: Coorte realizada entre 2018 e 2019, com mulheres entre 15 e 39 anos, moradoras em Fortaleza, Ceará, Brasil. Participaram 1.173 mulheres, usuárias de quatro unidades primárias de saúde do município. O desfecho foi categorizado em: uso continuado, uso descontinuado e não uso de repelente. Realizada análise de regressão logística multinominal norteada por modelo hierárquico, com apresentação dos respectivos odds ratio (OR) e intervalos de confiança de 95% (IC95%). As variáveis independentes incluem: dados socioeconômicos e demográficos, características ambientais e sanitárias, conhecimento sobre o repelente e aspectos comportamentais e relacionados à gravidez. Resultados: Somente 28% das participantes referiram o uso de repelente durante as duas ondas da coorte. Mulheres com escolaridade superior (OR=2,55; IC95% 1,44-4,51); com emprego (OR=1,51; IC95% 1,12-2,03); que receberam orientações por profissionais da saúde (OR=1,74; IC95% 1,28-2,36) e pela mídia (OR=1,43; IC95% 1,01-2,02); que intensificaram os cuidados contra o mosquito na epidemia (OR=3,64; IC95% 2,29-5,78); estavam grávidas entre 2016 e 2019 (OR=2,80; IC95% 1,83-4,30) tiveram as chances aumentadas para uso continuado de repelente. Conclusões: O uso de repelente entre mulheres em idade fértil mostrou-se associado a um maior nível de escolaridade, ao emprego, às orientações sobre repelente fornecidas por profissionais de saúde e pela mídia, às mudanças comportamentais de cuidado contra o mosquito durante a epidemia da Zika e à gravidez quando ocorrida a partir do início do período epidêmico.

Análise da tendência nas taxas de detecção de sífilis em gestantes e de incidência de sífilis congênita no Ceará no período de 2015 a 2021 / Trend analysis in syphilis detection rates in pregnant women and in the incidence rate of congenital syphilis in the state of Ceará from 2015 to 2021

RESUMO Objetivo: Analisar a tendência na taxa de detecção de sífilis em gestantes (SG) e na taxa de incidência de sífilis congênita (SC) no estado do Ceará. Métodos: Estudo ecológico que utilizou a técnica da série temporal interrompida para analisar os dados mensais de casos de SG e SC obtidos no Departamento de Informática do Sistema Único de Saúde (DATASUS) no período de janeiro de 2015 a julho de 2021. Utilizaram-se o teste de Kernel e a estimativa de Lincoln-Petersen para analisar a significância estatística. Resultados: Em 2015, estimou-se uma taxa de detecção mensal de SG de 5,4 e de incidência de SC de 8,2 por 1 mil nascidos vivos (NV). A implantação da portaria que alterou os critérios de definição de caso de SG e de SC implicou no aumento de 4,9 na taxa de detecção de SG (p<0,0001; IC95% 3,33; 6,61) e na queda de 0,1 na taxa de incidência de SC (p<0,001; IC95% -0,2; -0,1). A pandemia de COVID-19 não impactou na taxa de detecção mensal de SG (p=0,558; IC95% 5,92; 3,22), nem na sua tendência (p=0,7397; IC95% 0,28; 0,3), mas houve aumento de 0,19 na de SC (p<0,001; IC95% 0,1; -0,31). Conclusões: Entre os anos de 2015 e junho de 2021, a tendência na taxa de detecção de SG e na taxa de incidência da SC sofreu impacto das mudanças nos critérios de definição de caso desses agravos propostas pelo Ministério da Saúde e da pandemia de COVID-19.

ABSTRACT Objective: To analyze the trend in the detection rate of Syphilis in Pregnant Women (SP) and in the incidence rate of Congenital Syphilis (CS) in the state of Ceará. Methods: This is an ecological study that used the technique of interrupted time series to analyze monthly data on cases of SP and CS obtained from the Department of Informatics of the Brazilian Unified Health System (DATASUS) from January 2015 to July 2021. The Kernel test and the Lincoln-Petersen estimate were used to analyze the statistical significance. Results: In 2015, a monthly detection rate of SP was estimated at 5.4 and a CS incidence rate of 8.2 per one thousand live births (LB). The implementation of the ordinance that changed the criteria for defining cases of SP and CS resulted in an increase of 4.9 (p<0.0001; 95%CI; 3.33; 6.61) in the detection rate of SP and a decrease of 0.1 on the incidence of CS (p<0.001; 95%CI -0.2; -0.1). The COVID-19 pandemic did not impact the monthly detection rate of SP (p=0.558; 95%CI 5.92; 3.22), nor its trend (p=0.7397; 95%CI 0.28; 0.3), but there was an increase of 0.19 in CS (p<0.001; 95%CI 0.1; -0.31). Conclusion: Between 2015 and June 2021, the trend in the detection rate of SP and in the incidence rate of CS was impacted by changes in the criteria for defining cases of these diseases proposed by the Brazilian Ministry of Health and the COVID-19 pandemic.