Chemsex among men who have sex with men during the Mpox health crisis in Brazil: A nationwide web survey.

OBJECTIVE: To understand the factors associated with the practice of chemsex among MSM in Brazil, especially during the Mpox health crisis, and to design effective prevention and intervention strategies specifically for this population. DESIGN: A cross-sectional and analytical study using an electronic survey, conducted from September to December 2022, during the peak of the Mpox outbreak in Brazil. SAMPLE: A total of 1452 MSM aged 18 and older. MEASUREMENTS: Data were collected via the REDCap platform through a survey with 46 questions. These addressed demographic data, sexual affiliations, practices, experiences with Mpox, healthcare service usage, and stigma or fear related to Mpox. RESULTS: The prevalence of chemsex was 19.42% (n = 282). Multivariate Poisson modeling indicated a high incidence of chemsex among those diagnosed with Mpox and those involved in high-risk behaviors. The practice of chemsex was six times higher among those diagnosed with Mpox (95% CI: 4.73-9.10). MSM who engage in bugchasing had a prevalence twice that of the main outcome (95% CI: 1.31-3.16). CONCLUSION: There is a significant need for targeted interventions for MSM in Brazil, especially given the Mpox outbreak. This study highlights the strong relationships between chemsex, experiences with Mpox, and various sexual behaviors, underscoring the importance of effective public health initiatives.

Magnitude of visceral leishmaniasis and HIV coinfection and association with social determinants of health in the Northeast region of Brazil: a retrospective, spatiotemporal model (2010-2018).

The Northeast region of Brazil (NRB) includes the states with the highest prevalence of visceral leishmaniasis (VL), as well as those with significant increases in HIV cases. This study aims to analyze the spatiotemporal patterns of VL-HIV coinfection and its association with the social determinants of health (SDH) in the NRB. Time trend analysis and Bayesian spatial statistical inferences, Moran's autocorrelation, and retrospective space-time scanning were performed. Spatial regression modelling was used to build an explanatory model for the occurrence of VL-HIV coinfection within NRB. A total of 1550 cases of VL-HIV coinfection were confirmed. We observed a higher prevalence among males (1232; 83%), individuals aged from 20 to 59 years (850; 54.8%), non-white skin color (1,422; 91.7%), and with low education (550; 35.48%). NRB showed an increasing and significant trend in the detection rate of coinfection (APC, 5.3; 95% CI, 1.4 to 9.4). The states of Maranhão and Piauí comprised the high-risk cluster. The SDH that most correlated with the occurrence of coinfection were poor housing, low income, and low education. VL-HIV is dispersed in the NRB but chiefly affects states with greater social vulnerability. Taken together, these findings reinforce the necessity to implement surveillance strategies that will contribute to the reduction of cases in these populations.

Spatial and temporal analysis of tuberculosis in an area of social inequality in Northeast Brazil.

BACKGROUND: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It is a disease known worldwide for its vulnerability factors, magnitude and mortality. The objective of the study was to analyze the spatial and temporal dynamics of TB in the area of social inequality in northeast Brazil between the years 2001 and 2016. METHODS: An ecological time series study with the use of spatial analysis techniques was carried out from 2001 to 2016. The units of analysis were the 75 municipalities in the state of Sergipe. Data from the Notification of Injury Information System were used. For the construction of the maps, the cartographic base of the state of Sergipe, obtained at the Instituto Brasileiro de Geografia e Estatística, was used. Georeferenced data were analysed using TerraView 4.2.2 software (Instituto Nacional de Pesquisas Espaciais) and QGis 2.18.2 (Open Source Geospatial Foundation). Spatial analyses included the empirical Bayesian model and the global and local Moran indices. The time trend analyses were performed by the software Joinpoint Regression, Version 4.5.0.1, with the variables of sex, age, cure and abandonment. RESULTS: There was an increasing trend of tuberculosis cases in patients under 20 years old and 20-39 years old, especially in males. Cured cases showed a decreasing trend, and cases of treatment withdrawal were stationary. A spatial dependence was observed in almost all analysed territories but with different concentrations. Significant spatial correlations with the formation of clusters in the southeast and northeast of the state were observed. The probability of illness among municipalities was determined not to occur in a random way. CONCLUSION: The identification of risk areas and priority groups can help health planning by refining the focus of attention to tuberculosis control. Understanding the epidemiological, spatial and temporal dynamics of tuberculosis can allow for improved targeting of strategies for disease prevention and control.

Impact of the COVID-19 Pandemic Surveillance of Visceral Leishmaniasis in Brazil: An Ecological Study.

The aim of the study was to assess the impact of the COVID-19 pandemic on the notification of new VL cases in Brazil in 2020. It is an ecological and time-series study (2015-2020) with spatial analysis techniques, whose units of analysis were the 5570 Brazilian municipalities. The study population consisted of all new cases of VL recorded between 2015 and 2020. The P-score was calculated to estimate the percentage variation in new VL cases. Global and local univariate Moran's Indices and retrospective space-time scan statistics were used in spatial and space-time analyses, respectively. It was expected that there would be 3627 new cases of VL in Brazil in 2020, but 1932 cases were reported (-46.73%). All Brazilian regions presented a negative percentage variation in the registration of new VL cases, with the Southeast (-54.70%), North (-49.97%), and Northeast (-44.22%) standing out. There was spatial dependence of the disease nationwide in both periods, before and during the first year of the COVID-19 pandemic. There was a significant reduction in the incidence of new VL cases in Brazil during the first year of the COVID-19 pandemic. These findings reinforce the need for better preparedness of the health system, especially in situations of new epidemics.

Surveillance of TB-HIV coinfection in Brazil: a space-time approach.

OBJECTIVE: To identify the epidemiological, spatial, and temporal pattern of TB-HIV coinfection in Brazil during the period from 2001 to 2020. METHODS: Ecological study using space-time analysis techniques. It included cases of TB-HIV coinfection registered in Brazil from 2001 to 2020. The temporal trend analysis was performed using segmented regression by Joinpoint regression. For spatial analysis, Moran indices were calculated and choropleth maps were produced using TerraView and QGIS software. RESULTS: A stable temporal trend was observed in the incidence rates of TB-HIV coinfection in Brazil during the analyzed period. In addition, high-risk areas for coinfection located in states in the North, Southeast, South, and Midwest regions were identified. CONCLUSION: There was stability in the incidence of TB-HIV coinfection in Brazil over the last 20 years and heterogeneous geographic distribution of risk areas for the condition.

Space-time analysis of work-related musculoskeletal disorders in Brazil: an ecological study.

This study aimed to analyze the incidence of work-related musculoskeletal disorders (WMSD) in Brazil from 2007 to 2019, examining the spatial, temporal, and spatiotemporal patterns of their occurrence. An ecological time series study was conducted using spatial analysis techniques. WMSD morbidity data from 2007 to 2019 were collected from the Brazilian Information System for Notificable Diseases of the Brazilian Health Informatics Department. Incidence rates were standardized and smoothed using the local empirical Bayes' theorem. Time trends were analyzed by segmented linear regression. Spatial analysis was performed using Moran's univariate global (I) and local (LISA) indexes. The spatiotemporal scan statistic was used to identify high-risk spatiotemporal clusters for WMSD. A total of 93,387 cases of WMSD were recorded in Brazil. Temporal trends showed an increase in all regions except the Northeast, which remained stable. The incidence of WMSD showed a spatial dependence, with spatial and space-time clusters identified, especially in the Southeast region, overlapping the largest economic-industrial center of the country. The spatiotemporal clustering observed in one region suggests the highest level of industrial and economic development. Our findings highlight the need to implement intersectoral surveillance policies, inspect working conditions, and invest in the prevention and promotion of workers' health.

Spatial and Temporal Dynamics of Chikungunya Incidence in Brazil and the Impact of Social Vulnerability: A Population-Based and Ecological Study.

To assess the temporal and spatial dynamics of chikungunya incidence and its association with social vulnerability indicators in Brazil, an ecological and population-based study was conducted herein, with confirmed cases of chikungunya and based on clinical and clinical-epidemiological criteria from 2017 to 2023. Data were obtained from the Notifiable Diseases Information System and social vulnerability indicators were extracted from the official platform of the United Nations Development Program and the Social Vulnerability Atlas. Temporal, spatial, and global spatial regression models were employed. The temporal trend showed that in 2017, the incidence increased by 1.9%, and this trend decreased from 2020 to 2021 (-0.93%). The spatial distribution showed heterogeneity and positive spatial autocorrelation (I: 0.71; p < 0.001) in chikungunya cases in Brazil. Also, the high-risk areas for the disease were concentrated in the northeast and north regions. The social vulnerability indicators associated with the outcome were those related to income, education, and housing conditions. Our analyses demonstrate that chikungunya continues to be a serious health concern in Brazil, but specially in the northeast and north regions. Lastly, mapping risk areas can provide evidence for the development of public health strategies and disease control in endemic regions.

A space-time analysis of mortality in older people living with HIV/AIDS in the state of São Paulo, Brazil.

OBJECTIVE: To analyze the spatiotemporal distribution of mortality in older people living with the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the state of São Paulo, Brazil. METHODS: This is an ecological study with temporal and spatial approaches to analyze mortality from HIV/AIDS in the older adult population in the 2010-2020 period in the state of São Paulo, Brazil. Analysis of temporal trends was performed using the joinpoint regression, and spatial analysis was carried out using the Moran's index and the local empirical Bayesian model. RESULTS: We identified a total of 3,070 deaths from HIV/AIDS among older adults and a mortality rate of 51.71 per 100 thousand inhabitants during the study period. The joinpoint method showed a growing trend for the age groups from 70 to 79 years (annual percent change [APC]=3.45; p=0.01) and ≥80 years (APC=6.60; p=0.006) and stability for the general older adult population (APC=0.99; p=0.226). The spatial distribution of the crude mortality rate was diffuse throughout the state. After smoothing by the Bayesian estimator, we observed greater concentration in the eastern mesoregions. In Moran's analysis, we observed clusters of lower mortality rates in more central regions; and of higher rates in the southern and northern regions of the state. CONCLUSIONS: We found a major growing trend in mortality from HIV/AIDS in the age group of older adults over 69 years during the 2010-2020 period. Clusters of high mortality rates were located in regions further to the south and north of the state, where places of greater social inequalities are concentrated.

Pre-exposure prophylaxis among Brazilian men who have sex with men: a comparative study between migrants and non-migrants.

Introduction: Investigating the use and adherence to pre-exposure prophylaxis (PrEP) in MSM is a global health priority in the fight against HIV. Strategies must be capable of increasing usage and reaching not only the population living in the country but also those who immigrate, who face additional vulnerabilities. Based on this, in this observational, cross-sectional, and analytical study, our aim is to analyze the use of PrEP among Brazilian men who have sex with men, whether they are migrants or not. We aim to highlight preventive opportunities and strategies for the global health scenario. Methods: We utilized a sample of Brazilians living in the country and Brazilian immigrants residing in Portugal, one of the main destinations for Brazilians in recent years. To estimate the prevalence ratio (PR) of PrEP use, we employed the Poisson regression model with robust variance estimation using a covariance matrix. Results: A total of 1,117 Brazilian MSM PrEP users participated in this study, with 788 residing in Brazil and 328 in Portugal. Multivariate analysis was conducted in three stages: overall, and for subgroups of residents in Brazil and immigrants in Portugal. We identified four convergent factors that increased the prevalence of PrEP use in Brazilians regardless of migration status: having two or more casual sexual partners per month, engaging in challenging sexual practices as the receptive partner, disclosing serological status on apps, and being single. Among native Brazilians, four unique factors stood out: being in a polyamorous relationship, having sexual relations with unknown casual partners, and having higher levels of education. Discussion: This study highlights the need to implement strategies to strengthen PrEP adherence in Brazil and create international programs that facilitate its usage among populations migrating between these two countries.

Adherence to Pre-Exposure Prophylaxis (PrEP) among Men Who Have Sex with Men (MSM) in Portuguese-Speaking Countries.

Strengthening strategies to improve adherence to the use of pre-exposure prophylaxis (PrEP) in key populations constitutes a global health priority to be achieved across countries, especially in countries that share a high flow of people such as Brazil and Portugal. This study aimed to analyze the factors associated with adherence to PrEP among MSM from two Portuguese-speaking countries, highlighting the opportunities and preventive strategies for the global health scenario. This was a cross-sectional analytical online survey conducted from January 2020 to May 2021 with MSM in Brazil and Portugal. For analysis of the data, the Poisson regression model was used to estimate the prevalence ratio (PR) for developing a model to evaluate the associated factors in both countries in a comparative and isolated way. Adherence to PrEP use corresponded to 19.5% (n = 1682) of the overall sample: 18.3% (n = 970) for Brazil and 21.5% (n = 712) for Portugal. Having more than two sex partners in the last 30 days (aPR: 30.87) and routinely undergoing HIV tests (aPR: 26.21) increased the use of this medication. Being an immigrant (PR: 1.36) and knowing the partner's serological status (PR: 1.28) increased adherence to PrEP in Portugal, whereas, in Brazil, it was being an immigrant (PR: 0.83) and not knowing the serological status (PR: 2.24) that promoted the use of this medication. Our findings reinforce the need to invest in programs and strategies to improve access and adherence to PrEP, especially in key populations.

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).

Quality of basic health care and social vulnerability: a spatial analysis.

OBJECTIVE: To analyze the association between quality of basic health care and social vulnerability in municipalities of the Brazilian northeast. METHOD: Ecological study with spatial analysis using univariate global and local Moran's indexes. Bivariate analyses were employed to examine the relationship between the quality of basic health care and the Social Vulnerability Index in the Northeast. The dependent variable corresponded to the final scores of certifications of teams of basic health care in the Northeast that had participated in the third cycle of the Brazilian Program for the Improvement of Access and Quality of Basic Health Care. The independent variable was the Social Vulnerability Index of the municipality. RESULTS: The bivariate analysis has pointed out the presence of areas of low vulnerability with high quality basic health care in the municipalities in the states of Piauí, Ceará, Rio Grande do Norte, Pernambuco, and Bahia. The state of Maranhão is emphasized for its low performance in basic health care in a large number of municipalities with high vulnerability. CONCLUSION: The study has revealed a spatial relation between the indicators of social vulnerability and quality of basic health care in the Northeast, suggesting that limitations in access to health resources and services may be related to social and health determinants.

Spatial and spatiotemporal dynamics of visceral leishmaniasis in an endemic North-eastern region of Brazil.

Visceral Leishmaniasis (VL) is a neglected disease with increasing incidence in Brazil, particularly in the North-eastern. The aim of this study was to analyze the spatial and spatiotemporal dynamics of VL in an endemic region of North-eastern Brazil, between 2009 and 2017. Using spatial analysis techniques, an ecological and time series study was made regarding VL cases in Sergipe filed as notifiable disease events. With data from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE), a digital population and cartographic baseline was established. Segmented linear regression was used to examine the temporal trends. The statistical analysis methods of Global and Local Moran' I, local Bayesian empirical methodology and spatial-temporal scanning were used to produce thematic maps. High instances were found among adults, males, urban residents, non-Whites and persons with low levels of education. A decrease in the recovery rate and an increase in the proportion of urban cases and lethality was found. A heterogeneous VL distribution with spatiotemporal agglomeration on the seaside of the state was seen in Sergipe. To better manage the disease, new research is encouraged together with development of public health strategies. Further, improving health care networks, especially primary care, is suggested as this approach has a key role in health promotion, prevention and monitoring of the most prevalent diseases.

Analgesic efficacy of 10% lidocaine spray during nasoenteral catheterization: Randomized triple-blind trial.

BACKGROUND: Pain is a common experience during nasoenteral catheterization. Although the procedure causes discomfort and distress to patients, procedural pain remains neglected and undertreated. OBJECTIVE: To evaluate the analgesic efficacy of the use of 10% lidocaine spray during nasoenteral catheterization. METHOD: A randomized, triple-blind trial of 50 patients was performed. The patients were randomly assigned to two groups: an intervention group (IG), in which 10% lidocaine spray combined with 2% lidocaine gel was used, and a control group (CG), in which a saline solution spray combined with 2% lidocaine gel was used. Pain and discomfort were assessed during and after nasoenteral catheterization using numerical rating scale (NRS) and the visual analogue scale (VAS), respectively. RESULTS: Intervention group participants reported lower pain scores during (0.20 ± 0.71 vs. 5.00 ± 2.84, p < .001; |d| = -0.677) and after (0.00 ± 0.00 vs. 2.80 ± 2.83, p < .001; |d| = -0.718) nasoenteral catheterization compared to the CG. CONCLUSION: Spraying 10% lidocaine spray before nasoenteral catheterization was most effective for relieving discomfort and pain, with lower pain and discomfort recorded in NRS and VAS. Topical administration of 10% lidocaine spray is therefore a suggested measure for procedural pain relief related to nasoenteral catheterization. SIGNIFICANCE: The use of 10% lidocaine spray was more effective in relieving procedural pain and discomfort during nasoenteral catheterization. Patients who received 10% lidocaine spray registered lower discomfort and pain scores than those from 2% lidocaine gel group; there were less complications among patients in the IG.

Surveillance of the first cases of COVID-19 in Sergipe using a prospective spatiotemporal analysis: the spatial dispersion and its public health implications.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has become a global public health emergency with lethality ranging from 1% to 5%. This study aimed to identify active high-risk transmission clusters of COVID-19 in Sergipe. METHODS: We performed a prospective space-time analysis using confirmed cases of COVID-19 during the first 7 weeks of the outbreak in Sergipe. RESULTS: The prospective space-time statistic detected "active" and emerging spatio-temporal clusters comprising six municipalities in the south-central region of the state. CONCLUSIONS: The Geographic Information System (GIS) associated with spatio-temporal scan statistics can provide timely support for surveillance and assist in decision-making.

Space-time analysis of work-related musculoskeletal disorders in Brazil: an ecological study / Análise espaço-temporal dos distúrbios osteomusculares relacionados ao trabalho no Brasil: um estudo ecológico / Análisis espacio-temporal de los trastornos musculoesqueléticos relacionados con el trabajo en Brasil: un estudio ecológico

Abstract: This study aimed to analyze the incidence of work-related musculoskeletal disorders (WMSD) in Brazil from 2007 to 2019, examining the spatial, temporal, and spatiotemporal patterns of their occurrence. An ecological time series study was conducted using spatial analysis techniques. WMSD morbidity data from 2007 to 2019 were collected from the Brazilian Information System for Notificable Diseases of the Brazilian Health Informatics Department. Incidence rates were standardized and smoothed using the local empirical Bayes' theorem. Time trends were analyzed by segmented linear regression. Spatial analysis was performed using Moran's univariate global (I) and local (LISA) indexes. The spatiotemporal scan statistic was used to identify high-risk spatiotemporal clusters for WMSD. A total of 93,387 cases of WMSD were recorded in Brazil. Temporal trends showed an increase in all regions except the Northeast, which remained stable. The incidence of WMSD showed a spatial dependence, with spatial and space-time clusters identified, especially in the Southeast region, overlapping the largest economic-industrial center of the country. The spatiotemporal clustering observed in one region suggests the highest level of industrial and economic development. Our findings highlight the need to implement intersectoral surveillance policies, inspect working conditions, and invest in the prevention and promotion of workers' health.

Resumo: O objetivo foi analisar a incidência de distúrbios osteomusculares relacionados ao trabalho (DORT) no Brasil de 2007 a 2019, examinando os padrões espaciais, temporais e espaço-temporais de sua ocorrência. Foi realizado um estudo ecológico de séries temporais utilizando técnicas de análise espacial. Os dados de morbidade por DORT de 2007 a 2019 foram coletados do Sistema de Informação de Agravos de Notificação do Departamento de Informática do SUS. As taxas de incidência foram padronizadas e suavizadas pelo método de Bayes empírico local. As tendências temporais foram examinadas por meio de regressão linear segmentada. A análise espacial foi realizada utilizando-se os índices univariados de Moran global (I) e índice de Moran local (LISA). A estatística de varredura espaço-temporal foi aplicada para identificar aglomerados espaço-temporais de DORT de alto risco. Foram registrados 93.387 casos de DORT no Brasil. A tendência temporal mostrou aumento em todas as regiões, exceto no Nordeste, que se manteve estável. A incidência de DORT apresentou dependência espacial e foram identificados aglomerados espaciais e espaço-temporais, particularmente na Região Sudeste, sobrepondo-se ao maior centro econômico-industrial do país. A aglomeração espaço-temporal observada em uma região sugere maior nível de desenvolvimento industrial e econômico. Os achados evidenciam a necessidade de implementação de políticas intersetoriais de vigilância, fiscalização das condições de trabalho e investimentos na prevenção e promoção da saúde do trabalhador.

Resumen: El objetivo fue analizar la incidencia de los trastornos musculoesqueléticos relacionados con el trabajo (TMERT) en Brasil del 2007 al 2019, examinando los patrones espaciales, temporales y espacio-temporales de su incidencia. Se realizó un estudio ecológico de series temporales usando técnicas de análisis espacial. Los datos de morbilidad por TMERT del 2007 al 2019 se recolectaron del Sistema de Información de Enfermedades de Notificación Obligatoria del Departamento de Informática del Sistema Único de Salud. Las tasas de incidencia se estandarizaron y se suavizaron usando el método de Bayes empírico local. Las tendencias temporales se examinaron mediante regresión lineal segmentada. El análisis espacial se realizó utilizando los índices univariados de Moran global (I) y el índice de Moran local (LISA). Se aplicó la estadística de análisis espacio-temporal para identificar aglomerados espacio-temporales de TMERT de alto riesgo. En Brasil se registraron 93.387 casos de TMERT. La tendencia temporal mostró aumento en todas las regiones, salvo en el Nordeste, que se mantuvo estable. La incidencia de TMERT presentó dependencia espacial y se identificaron aglomerados espaciales y espacio-temporales, particularmente en la región Sudeste, superponiéndose al centro económico-industrial más grande del país. La aglomeración espacio-temporal observada en una región sugiere un mayor nivel de desarrollo industrial y económico. Los hallazgos resaltan la necesidad de implementar políticas intersectoriales de vigilancia, inspección de las condiciones de trabajo e inversiones en la prevención y promoción de la salud del trabajador.

Surveillance of TB-HIV coinfection in Brazil: a space-time approach / Vigilância da coinfecção TB-HIV no Brasil: uma abordagem temporal e espacial

ABSTRACT Objective To identify the epidemiological, spatial, and temporal pattern of TB-HIV coinfection in Brazil during the period from 2001 to 2020. Methods: Ecological study using space-time analysis techniques. It included cases of TB-HIV coinfection registered in Brazil from 2001 to 2020. The temporal trend analysis was performed using segmented regression by Joinpoint regression. For spatial analysis, Moran indices were calculated and choropleth maps were produced using TerraView and QGIS software. Results: A stable temporal trend was observed in the incidence rates of TB-HIV coinfection in Brazil during the analyzed period. In addition, high-risk areas for coinfection located in states in the North, Southeast, South, and Midwest regions were identified. Conclusion: There was stability in the incidence of TB-HIV coinfection in Brazil over the last 20 years and heterogeneous geographic distribution of risk areas for the condition.

RESUMO Objective Identificar o padrão epidemiológico, espacial e temporal da coinfecção TB-HIV no Brasil durante o período de 2001 a 2020. Métodos: Estudo ecológico com técnicas de análise espacial e temporal. Incluiu os casos de coinfecção por TB-HIV registrados no Brasil entre 2001 e 2020. A análise de tendência temporal foi realizada por meio da regressão segmentada, através do Joinpoint regression. Para a análise espacial, foram calculados os índices de Moran e construídos mapas coropléticos através dos softwares TerraView e QGIS. Resultados: Observou-se tendência temporal estável das taxas de incidência da coinfecção por TB-HIV no Brasil durante o período analisado. Adicionalmente, foram identificadas áreas de alto risco para coinfecção localizadas em estados das regiões Norte, Sudeste, Sul e Centro-Peste. Conclusão: Houve estabilidade da incidência da coinfecção TB-HIV no Brasil nos últimos 20 anos e distribuição geográfica heterogênea das áreas de risco para o agravo.

Pain assessment of traumatic brain injury victims using the Brazilian version of the Behavioral Pain Scale. / Avaliação da dor de vítimas de traumatismo craniencefálico pela versão brasileira da Behavioral Pain Scale.

OBJECTIVE: To evaluate the validity and reliability of the Brazilian version of the Behavioral Pain Scale (BPS-Br) in victims of traumatic brain injury. METHODS: Observational prospective study with paired and repeated measures conducted at two intensive care units (clinical and surgical) of a large general hospital. The convenience sample consisted of adult victims of moderate or severe penetrating or blunt craniocerebral trauma who were sedated and mechanically ventilated. A total of 432 paired observations were performed by independent evaluators simultaneously, prior to eye cleaning, during eye cleaning, during tracheal aspiration and after tracheal aspiration. Sociodemographic, clinical, trauma-related, sedoanalgesia and physiological parameter data (heart rate, systolic and diastolic blood pressure) were collected. The discriminant validity was tested using the Friedman and Wilcoxon paired tests. The intraclass correlation coefficient and Cohen's Kappa coefficient were used to evaluate the reliability. The Spearman correlation test was used to test the association between clinical variables and BPS-Br scores during tracheal aspiration. RESULTS: There was a significant increase in the physiological parameters during tracheal aspiration, but without correlation with the BPS-Br scores. Pain was significantly more intense during tracheal aspiration (p < 0.005). Satisfactory interobserver agreement was found, with an intraclass correlation coefficient of 0.95 (0.90 - 0.98) and Kappa coefficient of 0.70. CONCLUSION: Brazilian version of the Behavioral Pain Scale scores increased during tracheal aspiration. The Brazilian version of the scale was valid and reliable for pain assessment of traumatic brain injury victims undergoing tracheal aspiration.

A space-time analysis of mortality in older people living with HIV/AIDS in the state of São Paulo, Brazil / Uma análise espaço temporal da mortalidade em pessoas idosas que vivem com HIV/AIDS no estado de São Paulo, Brasil

ABSTRACT Objective: To analyze the spatiotemporal distribution of mortality in older people living with the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the state of São Paulo, Brazil. Methods: This is an ecological study with temporal and spatial approaches to analyze mortality from HIV/AIDS in the older adult population in the 2010-2020 period in the state of São Paulo, Brazil. Analysis of temporal trends was performed using the joinpoint regression, and spatial analysis was carried out using the Moran's index and the local empirical Bayesian model. Results: We identified a total of 3,070 deaths from HIV/AIDS among older adults and a mortality rate of 51.71 per 100 thousand inhabitants during the study period. The joinpoint method showed a growing trend for the age groups from 70 to 79 years (annual percent change [APC]=3.45; p=0.01) and ≥80 years (APC=6.60; p=0.006) and stability for the general older adult population (APC=0.99; p=0.226). The spatial distribution of the crude mortality rate was diffuse throughout the state. After smoothing by the Bayesian estimator, we observed greater concentration in the eastern mesoregions. In Moran's analysis, we observed clusters of lower mortality rates in more central regions; and of higher rates in the southern and northern regions of the state. Conclusions: We found a major growing trend in mortality from HIV/AIDS in the age group of older adults over 69 years during the 2010-2020 period. Clusters of high mortality rates were located in regions further to the south and north of the state, where places of greater social inequalities are concentrated.

RESUMO Objetivo: O estudo tem como objetivo analisar a distribuição espaço-temporal da mortalidade em idosos que vivem com HIV/AIDS no estado de São Paulo, Brasil. Métodos: Estudo ecológico com abordagens temporal e espacial para análise da mortalidade por HIV/AIDS em pessoas idosas no período de 2010-2020 no estado de São Paulo, Brasil. A análise das tendências temporais foi realizada por meio da regressão joinpoint e as análises espaciais foram realizadas usando o índice de Moran e o modelo bayesiano empírico local. Resultados: Foram identificados 3.070 óbitos por HIV/AIDS entre pessoas idosas e taxa de mortalidade de 51,71 por 100 mil habitantes no período de estudo. O método joinpoint revelou tendência crescente para as faixas etárias de 70 a 79 anos (variação percentual anual — APC=3,45 p=0,01) e 80 anos ou mais (APC=6,60, p=0,006) e de estabilidade para a população idosa geral (APC=0,99, p=0,226). A distribuição espacial da taxa bruta de mortalidade demonstrou-se difusa em todo o estado. Após suavização pelo estimador bayesiano, observou-se maior concentração nas mesorregiões ao leste. Na análise de Moran, foram observados aglomerados das menores taxas de mortalidade em regiões mais centrais e das altas taxas em regiões mais ao sul e norte do estado. Conclusão: O grupo etário em que ocorreu maior tendência de crescimento da mortalidade por HIV/AIDS durante o período de 2010-2020 foi o de pessoas idosas com mais de 69 anos. Os aglomerados das altas taxas de mortalidade foram localizados em regiões mais ao sul e norte do estado, onde se concentram locais de maiores desigualdades sociais.