Temporal trend in the incidence of human visceral leishmaniasis in Brazil

It is an ecological study that analyzed the time trend of visceral leishmaniasis incidence rates in Brazil using segmented time regression by joinpoints. There was a decreasing incidence rate of this disease in the country with an average annual percent change (AAPC) of -5 (CI95%: -9.1; -0.6) and a reduction of 1.69 cases/100 thousand inhabitants in 2007, and 0.91/100 thousand inhabitants in 2020. The Central-West region showed the highest reduction percent (AAPC: -9.1; CI95%: -13.8; -4.3), followed by the Southeast region (AAPC: -8.7; -14.6; -2.5). The North and South regions showed the largest number of joinpoints in the time series. The highest incidences were recorded in the male population, however, stable (AAPC: 2.14; CI95%: -8.3; 0). In the age group analysis, the trend was decreasing for the groups from 0 to 4 years old (AAPC: -7.7; CI95%: -12.6; -2.4), 5 to 9 years old (AAPC: -7.3; CI95%: -13.6; -0,4) and 10 to 14 years old (AAPC: -5.5; CI95%: -10.3; -0.3). It was found that although Visceral Leishmaniasis is an endemic disease in Brazil, there was a decrease in its incidence rate from 2007 to 2020.

Analyzing a national health surveillance strategy to reduce mother-to-child transmission of syphilis: The case of Brazilian investigation committees

Objectives

This study aimed to analyze the relevance of investigation committees in eliminating mother-to-child transmission of syphilis in Brazil.

Methods

Questionnaires and interviews were conducted with health managers of 25 Brazilian Federative Units and Brazil's Federal District. Data were analyzed using Bardin's content analysis technique and subsequently compared with the global prescriptions for syphilis response of the Pan American Health Organization, World Health Organization, and recent research publications examining the course of syphilis in Brazil, in Brazilian regions, and globally.

Results

While the investigation committees drew on the successful experience of those in reducing maternal mortality, which helped the country achieve the Millennium Development Goals, they are not demonstrated to be sufficient for preventing mother-to-child transmission of syphilis. The committees' systematic and bureaucratic agenda has not been efficient in managing avoidable factors for syphilis, nor do they operate in the scope of the integration of surveillance and care actions, as recommended by the health policy.

Conclusion

The committees' model needs to be reviewed in the context of Brazil's National Health System. The research process should be rescaled in order to remain a cornerstone for the induction of health policy that integrates surveillance and healthcare across Brazilian Federative Units. The advancement toward an automated case management model becomes relevant for the country to meet global commitments to eliminate congenital syphilis transmission and achieve the goals outlined in the 2030 Agenda.

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

Background

To fight against the rising incidence of syphilis, the Brazilian Ministry of Health (MoH) launched the "Syphilis No!" Project (SNP), with specific resources funded by a parliamentary amendment. Then, in 2018, a national rapid response started to be implemented on the Brazilian Unified Health System (SUS, Sistema Único de Saúde) in two strategic lines (1) to reinforce SUS's universal actions and (2) to implement specific ones to 100 municipalities chosen by the MoH as priorities for syphilis congenital response. In 2015, such localities represented 6895% of congenital syphilis cases in Brazil. In this context, SNP has implemented actions to strengthen epidemiological surveillance of acquired syphilis and congenital syphilis by instituting an integrated and collaborative response through health services networks and reinforcing interstate relations.

Methods

A quasi-experimental study using time series analysis was conducted to assess immediate impacts and changes to the trend in national congenital syphilis before and after the project, from September 2016 to December 2019. Data were assessed considering rates of congenital syphilis per 1,000 live births in all priority municipalities (n=100) covered by the project and in non-priority municipalities (n=5,470) from all five macro-regions of Brazil.

Findings

Priority municipalities showed a greater reduction (change in trend) in comparison to non-priority. The linear regression model revealed trend changes after the intervention, with both groups of municipalities showing a drop in the average monthly number of cases per 1,000 live births, with a reduction of -0·21 (CI 95% -0·33 to -0·09; p=0·0011) in priority municipalities and of -0·10 (CI 95% -0.19 to -0.02; p=0·0216) in non-priority municipalities.

Interpretation

The study using ITS provides important evidence on the direction, timing, and magnitude of the effects of interventions introduced as part of the SNP on congenital syphilis in Brazil. Our results suggest that the Syphilis No! Project influenced the trends of congenital syphilis in Brazil from 2018, with higher reductions achieved in the priority municipalities.

Funding

The research is funded by a grant to the Syphilis No! Project from Brazilian Ministry of Health (Project Number: 54/2017). The funders had no role in study design, analysis, decision to publish, or preparation of the manuscript.

Effect of the coverage of rapid tests for syphilis in primary care on the syphilis in pregnancy in Brazil

OBJECTIVE:

To analyze the effect of rapid tests coverage in Primary Care on syphilis detection rate in pregnant women in Brazil, in municipalities with more than 100,000 inhabitants.

METHODS:

The dependent variable was the syphilis detection rate in pregnant women between 2012 and 2018. As the main independent variables, the methods for measuring the coverage of rapid tests for syphilis in Primary Care were used and, as adjustment variables, some indicators of health services and socioeconomic. We opted for a linear regression model for panel data (panel data analysis), considering the municipality as the unit of analysis and the year as the time variable.

RESULTS:

From the results of the final model, we can infer that, for a given municipality, as the rate of rapid tests increases by one point for every thousand live births, the detection rate of syphilis in pregnant women increases by an average of 0.02 cases per thousand live births (p < 0.001). This value is adjusted for Family Health coverage, proportion of health facilities per inhabitant, per capita expenditure on health and the Human Development Index.

CONCLUSIONS:

There was a substantial improvement in the amount of rapid tests available, as well as a significant increase in the number of tests performed in pregnant women, which predicts an increase in syphilis rates in pregnant women. However, a worrying hypothesis is that the number of tests performed on pregnant women during the analyzed period may have been insufficient to detect the progress of the epidemic in this population.

Trends in the access and use of health services in PHC among Brazilian older adults in the years 2008, 2013 and 2019

This paper aims to identify the conditions and trends in access and use of primary health care (PHC) services by Brazilian older adults in 2008, 2013, and 2019. We performed a cross-sectional panel study with a descriptive analysis of the percentages and confidence intervals of the variables listed, in which data on the elderly population investigated in the Health Supplement of the 2008 National Household Sample Survey (PNAD) and the 2013 and 2019 National Health Surveys (PNS) were obtained. We initially identified that, while PHC was the primary service sought for care needs, this demand tended to decline in all Brazilian regions, among older women, the 60-69 years age group, and whites. The number of households registered with the USF increased 15.2%; the search for a place, service, or health professional by 4.5%; and the population served by 31.4%. The main factors of non-attendance were not being able to get a vacancy/service ticket and doctor unavailability. A growing trend was observed among those diagnosed with Systemic Arterial Hypertension, Diabetes Mellitus, and multimorbidities among those investigated.

Notifiable Diseases Information System and human poisoning by pesticides in Brazil

OBJECTIVE

To analyze trends in pesticide poisoning incidence rates in Brazilian regions, according to sex and circumstances of poisoning, between 2001 and 2014.

METHOD

Ecological time-series study, with data from the national Notifiable Diseases Information System (SINAN). The incidence rates were calculated by dividing the number of confirmed new cases of pesticide poisoning by the total resident population in the same period and location. Both Polynomial regression analysis and Mann-Whitney and Kruskal-Wallis tests were performed. When significant differences were found, these tests were followed by the Bonferroni penalty, in order to identify the difference more precisely.

RESULTS

In Brazil, 80,069 notified poisoning cases were recorded from 2001 to 2014. There was a steadily increasing growth of pesticide poisoning in this population, whose growth trend was 0,377 for 100,000 inhabitants per year. The highest incidence of poisoning occurred in the South and Midest Regions. Regarding sex, no significant differences were found (p < 0,347), and attempted suicide was the most significant circumstance of poisoning (p < 0,001).

CONCLUSION

The incidence of pesticide poisoning in Brazil has been continuously increasing in the twenty-first century.

Body mass index and acoustic voice parameters: is there a relationship?

Introduction

Specific elements such as weight and body volume can interfere in voice production and consequently in its acoustic parameters, which is why it is important for the clinician to be aware of these relationships.

Objective

To investigate the relationship between body mass index and the average acoustic voice parameters.

Methods

Observational, cross-sectional descriptive study. The sample consisted of 84 women, aged between 18 and 40 years, an average of 26.83 (±6.88). The subjects were grouped according to body mass index: 19 underweight; 23 normal ranges, 20 overweight and 22 obese and evaluated the fundamental frequency of the sustained vowel [a] and the maximum phonation time of the vowels [a], [i], [u], using PRAAT software. The data were submitted to the Kruskal–Wallis test to verify if there were differences between the groups regarding the study variables. All variables showed statistically significant results and were subjected to non-parametric test Mann–Whitney.

Results

Regarding to the average of the fundamental frequency, there was statistically significant difference between groups with underweight and overweight and obese; normal range and overweight and obese. The average maximum phonation time revealed statistically significant difference between underweight and obese individuals; normal range and obese; overweight and obese.

Conclusion

Body mass index influenced the average fundamental frequency of overweight and obese individuals evaluated in this study. Obesity influenced in reducing maximum phonation time average.