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Alves YM, Berra TZ, Tavares RBV, Popolin MAP, da Costa FBP, de Jezus SV, Ferezin LP, Tártaro AF, Serrano-Gallardo MDP, Pinto IC, Maciel ELN, Arcêncio RA. International Migration, Refugees, and Spread of Tuberculosis in Brazil: Analysis of Clusters, Trends, and Associated Factors (2010-2021). Trop Med Infect Dis 2024; 9:82. [PMID: 38668543 PMCID: PMC11053982 DOI: 10.3390/tropicalmed9040082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND International migration is a global phenomenon with significant implications on the health-disease process due to exposures along transit routes and local/destination epidemiological indicators. We aimed to analyze the transmission and spread of tuberculosis among international migrants and refugees from a spatiotemporal perspective and the associated factors. METHOD This was an ecological study of cases of tuberculosis in international migrants in Brazil, between 2010 and 2021. Annual incidence rates were calculated and spatiotemporal scan techniques were used to identify municipalities at risk. Multiple logistic regression was used to identify factors associated with tuberculosis in international migrants. RESULTS A total of 4037 cases of tuberculosis were reported in Brazil in international migrants. Municipalities at risk for this event were identified using the spatiotemporal scan technique, and a cluster was identified with ITT: +52.01% and ETT: +25.60%. A higher probability of TB infection was identified in municipalities with a TB incidence rate >14.40 cases/100 inhabitants, population >11,042 inhabitants, Gini index >0.49, and illiteracy rate >13.12%. A lower probability was found in municipalities with average per capita household income >BRL 456.43. CONCLUSIONS It is recommended that health authorities implement monitoring and rigorous follow-up in affected areas to ensure proper diagnosis and treatment completion for international migrants, preventing disease spread to other communities.
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Affiliation(s)
- Yan Mathias Alves
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
| | - Thaís Zamboni Berra
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
| | - Reginaldo Bazon Vaz Tavares
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
| | - Marcela Antunes Paschoal Popolin
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
- Nursing Department, Federal University of Tocantins, Palmas 77001-090, Brazil
| | - Fernanda Bruzadelli Paulino da Costa
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
| | - Sonia Vivian de Jezus
- Instituto de Ciências da Saúde, Federal University of Mato Grosso, Sinop 78550-728, Brazil
| | - Letícia Perticarrara Ferezin
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
| | - Ariela Fehr Tártaro
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
| | | | - Ione Carvalho Pinto
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
| | - Ethel Leonor Noia Maciel
- Ministry of Health, Secretary of Health Surveillance and Environment, Brasília 70058-900, Brazil;
| | - Ricardo Alexandre Arcêncio
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
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Tavares RBV, Berra TZ, Alves YM, Popolin MAP, Ramos ACV, Tártaro AF, de Souza CF, Arcêncio RA. Unsuccessful tuberculosis treatment outcomes across Brazil's geographical landscape before and during the COVID-19 pandemic: are we truly advancing toward the sustainable development/end TB goal? Infect Dis Poverty 2024; 13:17. [PMID: 38369536 PMCID: PMC10874548 DOI: 10.1186/s40249-024-01184-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/31/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Tuberculosis is one of the most significant infectious diseases for global public health. The reallocation of healthcare resources and the restrictions imposed by the COVID-19 pandemic have hindered access to TB diagnosis and treatment. Increases in unfavorable outcomes of the disease have been observed in Brazil. The objective of this study was to analyze the spatial distribution of unfavorable TB treatment outcomes in Brazil before and during the pandemic. METHODS An ecological study with spatial analysis was conducted with all 5569 municipalities in Brazil. All reported cases of tuberculosis between January 2010 and December 2021, as well as reported cases of COVID-19 from February 2020 to December 2021, were included. The outcomes studied encompass loss to follow-up, drug-resistant tuberculosis, and death. The Getis Ord GI* technique was employed to assess spatial association, and the Kernel density estimator was used to identify areas with concentrated increases or decreases in outcomes. Bivariate Local Moran's I was used to examine the spatial association between outcomes and COVID-19 incidence. The study was approved by the Research Ethics Committee of Ribeirão Preto Nursing School, University of São Paulo. RESULTS There were 134,394 cases of loss to follow-up, 10,270 cases of drug resistance, and 37,863 deaths. Clusters of high and low values were identified for all three outcomes, indicating significant changes in the spatial distribution patterns. Increases in concentrations were observed for lost to follow-up cases in the Southeast, while reductions occurred in the Northeast, South, and Midwest. Drug-resistant tuberculosis experienced an increase in the Southern and Southeastern regions and a decrease in the Northeast and South. TB-related deaths showed notable concentrations in the Midwest, Northeast, South, and Southeast. There was an increase in high occurrence clusters for deaths after 2020 and 2021 in the Northeast. CONCLUSIONS The pandemic has brought additional challenges, emphasizing the importance of enhancing efforts and disease control strategies, prioritizing early identification, treatment adherence, and follow-up. This commitment is vital for achieving the goal of tuberculosis elimination.
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Affiliation(s)
- Reginaldo Bazon Vaz Tavares
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing (USP/RPCN), Avenida Dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil.
| | - Thaís Zamboni Berra
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing (USP/RPCN), Avenida Dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Yan Mathias Alves
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing (USP/RPCN), Avenida Dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Marcela Antunes Paschoal Popolin
- Federal University of Tocantins, Palmas Campus (FUT), Quadra 109 Norte, Avenida NS 15, Plano Diretor Norte, Palmas, Tocantins, Brazil
| | - Antônio Carlos Vieira Ramos
- State University of Minas Gerais, Passos Campus (SUMG), Avenida Juca Stockler, 1130, Bairro Belo Horizonte, Passos, Minas Gerais, Brazil
| | - Ariela Fehr Tártaro
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing (USP/RPCN), Avenida Dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Clara Ferreira de Souza
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing (USP/RPCN), Avenida Dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing (USP/RPCN), Avenida Dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
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Nanque AR, Ramos ACV, Moura HSD, Berra TZ, Tavares RBV, Monroe AA, Pinto IC, Arcêncio RA. Spatial and temporal analysis of tuberculosis incidence in Guinea-Bissau, 2018 to 2020. Rev Bras Enferm 2023; 76:e20220481. [PMID: 37820137 PMCID: PMC10561932 DOI: 10.1590/0034-7167-2022-0481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/10/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE to analyze the epidemiological profile, spatial and temporal distribution of tuberculosis in Guinea-Bissau from 2018 to 2020. METHODS an ecological study, carried out in Guinea-Bissau, considering new cases of tuberculosis. Spatial analysis of areas was used to verify tuberculosis distribution in the country, and time series were used to identify incidence evolution over the years of study. RESULTS a total of 6,840 new cases of tuberculosis were reported. Tuberculosis incidence rate in the country ranged from 36.8 to 267.7 cases/100,000 inhabitants, with emphasis on the regions of Bissau and Biombo (over 90 cases/100,000). By using time series, it was possible to observe an increase in case incidence over the years of study. CONCLUSIONS the study made it possible to identify the epidemiological profile of tuberculosis in Guinea-Bissau, spatial distribution heterogeneity, in addition to identifying the disease evolution over the years of investigation.
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Teibo TKA, Andrade RLDP, Rosa RJ, Tavares RBV, Berra TZ, Arcêncio RA. Geo-spatial high-risk clusters of Tuberculosis in the global general population: a systematic review. BMC Public Health 2023; 23:1586. [PMID: 37598144 PMCID: PMC10439548 DOI: 10.1186/s12889-023-16493-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023] Open
Abstract
INTRODUCTION The objective of this systematic review is to identify tuberculosis (TB) high-risk among the general population globally. The review was conducted using the following steps: elaboration of the research question, search for relevant publications, selection of studies found, data extraction, analysis, and evidence synthesis. METHODS The studies included were those published in English, from original research, presented findings relevant to tuberculosis high-risk across the globe, published between 2017 and 2023, and were based on geospatial analysis of TB. Two reviewers independently selected the articles and were blinded to each other`s comments. The resultant disagreement was resolved by a third blinded reviewer. For bibliographic search, controlled and free vocabularies that address the question to be investigated were used. The searches were carried out on PubMed, LILACS, EMBASE, Scopus, and Web of Science. and Google Scholar. RESULTS A total of 79 published articles with a 40-year study period between 1982 and 2022 were evaluated. Based on the 79 studies, more than 40% of all countries that have carried out geospatial analysis of TB were from Asia, followed by South America with 23%, Africa had about 15%, and others with 2% and 1%. Various maps were used in the various studies and the most used is the thematic map (32%), rate map (26%), map of temporal tendency (20%), and others like the kernel density map (6%). The characteristics of the high-risk and the factors that affect the hotspot's location are evident through studies related to poor socioeconomic conditions constituting (39%), followed by high population density (17%), climate-related clustering (15%), high-risk spread to neighbouring cities (13%), unstable and non-random cluster (11%). CONCLUSION There exist specific high-risk for TB which are areas that are related to low socioeconomic conditions and spectacular weather conditions, these areas when well-known will be easy targets for intervention by policymakers. We recommend that more studies making use of spatial, temporal, and spatiotemporal analysis be carried out to point out territories and populations that are vulnerable to TB.
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Affiliation(s)
- Titilade Kehinde Ayandeyi Teibo
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil.
| | - Rubia Laine de Paula Andrade
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Rander Junior Rosa
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Reginaldo Bazon Vaz Tavares
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Thais Zamboni Berra
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
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Martoreli JF, Ramos ACV, Berra TZ, do Nascimento MC, Tavares RBV, Moura HSD, de Mello DF, Alves JD, Arcêncio RA. Clusters of risk for the occurrence of leprosy and disabilities in children under 15 years of age in Cuiabá: a geospatial study. Rev Bras Epidemiol 2023; 26:e230006. [PMID: 36629618 PMCID: PMC9838240 DOI: 10.1590/1980-549720230006.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/13/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE This study aimed to analyze the spatial distribution of leprosy and disabilities in children under 15 years of age in Cuiabá. METHODS Ecological study carried out in the city of Cuiabá, Mato Grosso, Brazil. The study population consisted of leprosy cases in children under 15 years old notified in the Notifiable Diseases Information System, between 2008 and 2018. Based on residential addresses, cases were georeferenced. In the analysis of the spatial distribution of the cases, the estimation of the Kernel density was used and, later, the statistics of spatial, spatio-temporal and Spatial Variation in Temporal Trends were applied. RESULTS 514 cases of leprosy were reported in children under 15 years of age in Cuiabá, with a percentage of 10.1% of cases with degree of physical disability 1 and 2.3% with degree of physical disability 2 at the time of diagnosis. With the techniques of spatial and spatio-temporal scanning, clusters of risk for leprosy were identified in the North, West, East and South regions of Cuiabá, and with the technique of Spatial Variation in Temporal Trends, a cluster was identified in the West region of Cuiabá. CONCLUSION In Cuiabá, cases of leprosy in children under 15 years of age with disabilities were distributed throughout the urban area of the city, with the highest density of cases in the North and West regions, followed by the East region. The clusters with the highest Relative Risk were identified in the East and West regions, characterized by having low and medium income levels.
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Affiliation(s)
- José Francisco Martoreli
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Escola de Enfermagem – Ribeirão Preto (SP), Brasil
| | - Antônio Carlos Vieira Ramos
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Escola de Enfermagem – Ribeirão Preto (SP), Brasil
| | - Thaís Zamboni Berra
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Escola de Enfermagem – Ribeirão Preto (SP), Brasil
| | | | - Reginaldo Bazon Vaz Tavares
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Escola de Enfermagem – Ribeirão Preto (SP), Brasil
| | - Heriederson Sávio Dias Moura
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Escola de Enfermagem – Ribeirão Preto (SP), Brasil
| | - Débora Falleiros de Mello
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Escola de Enfermagem – Ribeirão Preto (SP), Brasil
| | | | - Ricardo Alexandre Arcêncio
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Escola de Enfermagem – Ribeirão Preto (SP), Brasil
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Martoreli Júnior JF, Ramos ACV, Berra TZ, Nascimento MCD, Tavares RBV, Moura HSD, Mello DFD, Alves JD, Arcêncio RA. Clusters of risk for the occurrence of leprosy and disabilities in children under 15 years of age in Cuiabá: a geospatial study. Rev bras epidemiol 2023. [DOI: 10.1590/1980-549720230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
ABSTRACT Objective This study aimed to analyze the spatial distribution of leprosy and disabilities in children under 15 years of age in Cuiabá. Methods Ecological study carried out in the city of Cuiabá, Mato Grosso, Brazil. The study population consisted of leprosy cases in children under 15 years old notified in the Notifiable Diseases Information System, between 2008 and 2018. Based on residential addresses, cases were georeferenced. In the analysis of the spatial distribution of the cases, the estimation of the Kernel density was used and, later, the statistics of spatial, spatio-temporal and Spatial Variation in Temporal Trends were applied. Results 514 cases of leprosy were reported in children under 15 years of age in Cuiabá, with a percentage of 10.1% of cases with degree of physical disability 1 and 2.3% with degree of physical disability 2 at the time of diagnosis. With the techniques of spatial and spatio-temporal scanning, clusters of risk for leprosy were identified in the North, West, East and South regions of Cuiabá, and with the technique of Spatial Variation in Temporal Trends, a cluster was identified in the West region of Cuiabá. Conclusion In Cuiabá, cases of leprosy in children under 15 years of age with disabilities were distributed throughout the urban area of the city, with the highest density of cases in the North and West regions, followed by the East region. The clusters with the highest Relative Risk were identified in the East and West regions, characterized by having low and medium income levels
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Berra TZ, Ramos ACV, Alves YM, Tavares RBV, Tartaro AF, do Nascimento MC, Moura HSD, Delpino FM, de Almeida Soares D, Silva RVDS, Gomes D, Monroe AA, Arcêncio RA. Impact of COVID-19 on Tuberculosis Indicators in Brazil: A Time Series and Spatial Analysis Study. Trop Med Infect Dis 2022; 7:tropicalmed7090247. [PMID: 36136658 PMCID: PMC9500936 DOI: 10.3390/tropicalmed7090247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background: We aimed to visualize and classify the time series of COVID-19, tuberculosis (TB) notification, and TB outcomes (cure, treatment abandonment, and death), verify the impact of the new coronavirus pandemic on these indices in Brazil, and verify the presence of spatial autocorrelation between COVID-19 and TB. Methods: This was an ecological time series study that considered TB and COVID-19 cases. Seasonal Trend Decomposition using Loess (STL) was used to trace the temporal trend, Prais–Winsten was used to classify the temporal trend, Interrupted Time Series (ITS) was used to verify the impact of COVID-19 on TB rates, and the Bivariate Moran Index (Global and Local) was used to verify the spatial autocorrelation of events. Results: Brazil and its macro-regions showed an increasing temporal trend for the notification of TB in the pre-pandemic period. Only the Northeast Region showed a decreasing temporal trend for cured cases. For treatment abandonment, all regions except for the Northeast showed an increasing temporal trend, and regarding death, Brazil and the Northeast Region showed an increasing temporal trend. With the ITS, COVID-19 caused a decline in TB notification rates and TB outcome rates. With the global spatial analysis, it was possible to identify the existence of spatial autocorrelation between the notification rate of COVID-19 and the TB notification rate and deaths. With the local analysis, it was possible to map the Brazilian municipalities and classify them according to the relationship between the rates of both diseases and space. Conclusions: COVID-19 influenced the follow-up of and adherence to TB treatment and intensified social vulnerability and, consequently, affected the notification of TB since the relationship between the disease and social determinants of health is already known. The restoration and strengthening of essential services for the prevention and detection of cases and treatment of TB in endemic environments such as Brazil have been oriented as a priority in the global health agenda.
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Affiliation(s)
- Thaís Zamboni Berra
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, SP, Brazil
- Correspondence: ; Tel.: +55-1633151408
| | - Antônio Carlos Vieira Ramos
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, SP, Brazil
| | - Yan Mathias Alves
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, SP, Brazil
| | - Reginaldo Bazon Vaz Tavares
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, SP, Brazil
| | - Ariela Fehr Tartaro
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, SP, Brazil
| | - Murilo César do Nascimento
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, SP, Brazil
| | - Heriederson Sávio Dias Moura
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, SP, Brazil
| | - Felipe Mendes Delpino
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, SP, Brazil
| | - Débora de Almeida Soares
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, SP, Brazil
| | - Ruan Víctor dos Santos Silva
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, SP, Brazil
| | - Dulce Gomes
- Mathematics Department, University of Évora, 7000-671 Évora, Portugal
| | - Aline Aparecida Monroe
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, SP, Brazil
| | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, SP, Brazil
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