ObjectiveTo analysis the epidemiological scenery of the congenital syphilis (CS) in Brazil employing spatial analysis techniques.DesignEcological study.SettingsThis study was conducted in BrazilSampleA total of 151 601 CS cases notified to the Diseases and Notification Information System from 2007 to 2018 from children aged 0–23 months and born from mothers living in Brazil were included in this study.Primary outcome measuresThe CS incidence rates were calculated by triad (2007–2010, 2011–2014 and 2015–2018) for all Brazilian municipalities following the Boxcox transformation to remove the discrepant values. The transformed rates were analysed through the spatial autocorrelation of Moran, Kernel density estimative and spatial scan.ResultsFrom 2007 to 2018, the CS incidence rates increased in all Brazilian regions. The CS spread towards the interior of Brazil, and a higher expansion was noticed between 2015 and 2018. The municipalities that were greatly affected by the CS were those having a high migration of people, such as the ones bordering other countries and the touristic cities. Recife, Campo Grande, Rio de Janeiro, Porto Alegre and Manaus were the capitals with the greatest spatial and spatiotemporal risk.ConclusionThis study provides assistance to health authorities to fight CS in Brazil. More investment is necessary in prenatal care quality focusing on pregnant women and their partners to guarantee their full access to preventive resources against sexually transmitted infections.
Background After 40 years of its starting, the HIV epidemic in Brazilian Amazon region remains on an increasing trend. The young men who have sex with men (MSM) have been the most impacted by the HIV in the last decade. However, much more than attributing the risk behavior to HIV uniquely to the individual, behaviors are shaped by social determinants of health (SDH). Despite the problem, there is a scarcity of studies evaluating the impact of SDH on HIV among young MSM and none of them were done in the Northern of Brazil. Therefore, the main goal of this study was to analyse the HIV epidemic among Brazilian Amazonian young MSM using temporal trends and spatial analysis. Methods We conducted an ecological study using reported cases of HIV/AIDS in young MSM living in Pará, the second larger Brazilian Amazonian province, between 2007 and 2018. Data were obtained from the Information System for Notifiable Diseases. For the temporal analysis, we employed a Seasonal and Trend decomposition using Loess Forecasting model (STLF), which is a hybrid time-series forecast model, that combines the Autoregressive-Integrated Moving Average (ARIMA) forecasting model with the Seasonal-Trend by Loess (STL) decomposition method. For the spatial analysis, Moran’s spatial autocorrelation, spatial scan, and spatial regression techniques were used. Results A total of 2192 notifications were included in the study. Greater variabilities in HIV/AIDS population-level diagnosis rates were found in the festive months. The HIV/AIDS population-level diagnosis rates exhibited an upward trend from 2013 and this trend is forecasted to continue until 2022. Belém, the capital of Pará, presented the highest spatial risk for HIV/AIDS and was the only city to present spatiotemporal risk from 2014 to 2018. The geographic variation of the HIV epidemic was associated with the number of men with formal jobs, the average salary of men, and the percentage of people over 18 years old with elementary education. Conclusion The upward trend of HIV/AIDS population-level diagnosis rate forecasted until 2022 and the variability of the epidemic promoted by the SDH brings an alert and subsidies to health authorities to implement more efficient and focalized public policies against HIV among young MSM in Pará.
Objetivo: Avaliar as características empregatícias dos enfermeiros atuantes na Atenção Básica no estado do Pará. Métodos: Trata-se de um estudo transversal de abordagem quantitativa e descritiva, utilizando dados do 3º Ciclo do Programa de Melhoria e Acesso à Qualidade da Atenção Básica coordenado pelo Ministério da Saúde. Foram incluídas na análise apenas as respostas fornecidas por enfermeiros. Resultados: Foram avaliadas as respostas fornecidas por 1.091 enfermeiros de equipes de atenção básica do estado do Pará. Os resultados revelaram fragilização e precarização do trabalho do enfermeiro, com incipiente realização de concursos ou seleção pública como via de mecanismo de ingresso, predomínio de contratos temporários pela administração pública direta, e sem implementação de Plano de Cargos, Carreiras e Salários e bonificações. Conclusão: Conclui-se que os enfermeiros atuantes na atenção básica paraense estão submetidos a vínculos precários de trabalhos, o que favorece a alta rotatividade de profissionais e consequente descontinuidade do cuidado aos usuários.
Worldwide, policies to combat human immunodeficiency virus (HIV) have led to a small decrease in the acquired immunodeficiency syndrome (AIDS) mortality rate among young people. For greater policy efficacy, it is necessary to determine the influence of social determinants of health (SDHs) in each territory. The objective of this study was to spatially analyse the AIDS mortality rate among young people in a province of the Brazilian Amazon and the spatial variability of the rate promoted by SDHs. All reports of AIDS deaths between 2007 and 2018 among young people living in the state of Pará were included in the study. The mortality rate was analysed using spatial distribution and autocorrelation, spatial scanning, and geographically weighted regression (GWR). During the study period, there were 1,372 deaths from AIDS among young people with a territorial expansion. The spatial autocorrelation showed two high-high clusters in the period from 2007 to 2010, one formed by municipalities in south-eastern Pará and one in the metropolitan region of Belém, with only the latter remaining between 2011 and 2018. This region showed a higher spatial risk for AIDS mortality and was the only cluster with spatiotemporal risk in the 2013-2018 period. Spatial variability was promoted by the i) the youth homicide rate, ii) the elementary school dropout rate and iii) the number of families registered in the Unified Registry for Social Programs (CadÚnico). This study provides support for the implementation of effective focal policies to combat HIV and reduce the mortality rate among young people in Pará.
Background: In the last decade, young men who have sex with men (MSM) have been highly affectedimpacted by the HIV. Much more than attributing the risk behavior to HIV uniquely to the individual, behaviors are shaped by social determinants of health (SDHs). Despite of the problem, there is a scarcity of studies evaluating the SHDs impact on HIV among young MSN. Therefore, . Iin this study,paper we analyzed the HIV epidemic among Amazonian young MSM byin employing temporal trendstrend and spatial analysis. The Brazilian Amazon region has the highest HIV/AIDS detection rate among all the other Brazilian regions. Methods: We conducted an ecologicalEcological study using reported cases of HIV/AIDS in young MSM living in Pará, the second largestlarger Brazilian Amazonian province, between 2007 and 2018. Data were obtained from the Information System for Notifiable Diseases. ForTo the temporal analysis, we employed autoregressive integrated moving average models, and seasonality and trend decomposition using locally weighted polynomial regression. To the spatial analysis, Moran’s spatial autocorrelation, spatial scan, and spatial regression techniques were used for spatial analysis.. Results: A total of 2,192 notifications were included in the study. Greater variabilityvariabilities in HIV/AIDS incidence rates waswere found in the festive months. The HIV/AIDS incidence rates exhibitedpresented an upward trend from 2013. This, and this trend is forecasted to continue until 2022. Belém, the capital of Pará, presented the highest spatial risk for HIV/AIDS and was the only city to present spatiotemporal risk from, 2014 to 2018. The geographic variation of the epidemic was associated with the number of men with formal jobs, the average salary of men, and the percentage of people over 18 years old with elementary education. Conclusion: The upward trend of HIV/AIDS incidence forecasted until 2022 and the variability of the epidemic promoted by the social determinants of health signalsbrings an alert and subsidies to health authorities. Policies Subsidies to reinforce the policies to controlagainst HIV among young MSM are urgently required.
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