Resumo Esse estudo tem como objetivo refletir sobre os Determinantes Sociais da Saúde na cidade de Belém (PA) e a atuação da Atenção Primária à Saúde no enfrentamento à pandemia de COVID-19. A partir da utilização de dados secundários e da caracterização do município, foi possível refletir sobre os aspectos de habitação, saneamento básico e renda da população na distribuição dos casos de COVID-19 na cidade. Evidenciou-se que as desigualdades sociais entre os Distritos Administrativos são preponderantes, todavia não houve a elaboração de um plano de ação que considerasse os impactos de COVID-19 nas populações em vulnerabilidade social. Ao investigar o papel da Atenção Primária à Saúde no controle da pandemia, percebe-se que a baixa cobertura da Estratégia Saúde da Família aliada às ações desarticuladas entre município e estado podem ter contribuído para o agravamento epidemiológico da COVID-19 em Belém. O plano de contingência não conseguiu implementar políticas contundentes para o controle da doença, focando na medicalização e nas ações hospitalocêntricas para os casos graves, enquanto as unidades de saúde foram subutilizadas, faltando estabelecer um fluxo coordenado de cuidados para os pacientes com a COVID-19, uma doença fortemente atrelada às iniquidades sociais.

Background The 5-minute APGAR score is clinically used as a screening tool to assess how the newborn has reacted to previous care, remaining relevant for predicting neonatal survival. This study aimed to analyze the determinants of the 5th minute APGAR score, and the factors associated with the death and survival of newborns with low APGAR scores hospitalized in the neonatal intensive care unit (NICU) at a referral public hospital in North Brazil. Methods This was a hospital-based retrospective case-control study with 277 medical records. Newborns who presented with a 1-minute APGAR score < 7 followed by a 5-minute APGAR score < 7 were considered cases, while a score ≥ 7 was categorized as controls. Univariate and multivariable logistic regression analyses were used to establish the determinant factors of the low APGAR score and death outcome in this group. Survival curves were obtained using the Kaplan-Meier estimator, and then univariate and multivariate Cox regression was performed. Results After adjusted analysis, the factor associated with low APGAR scores was vaginal delivery (OR = 3.25, 95%CI = 1.60–6.62, p = 0.001). Birth injury (OR = 0.39, 95%CI = 0.19–0.83, p = 0.014) was associated with upper APGAR scores. No significant independent associations were observed between the variables analyzed and death in the low APGAR score group. The Kaplan-Meier curve showed that individuals who presented Cesarean delivery had a shorter survival time in the ICU. Conclusion In this setting, a 5-minute Apgar score < 7 was associated with the occurrence of vaginal delivery and birth injury with a 5-minute Apgar score ≥ 7. Survival in ICU was lower in newborns that were delivered via cesarean section.

To investigate the association between sociodemographic factors and variables related to oral health services in oral and oropharyngeal cancer mortality in Brazil, between 2000 and 2019. This study had an ecological design. Standardized mortality rates were compared between age group, sex, and regions. Age–Period–Cohort analysis was applied. Oral health services variables were analyzed in correlation tests. Survival analysis included Kaplan–Meier estimators, log-rank tests, and Cox regression. The mortality rate increased with age and was higher in men. Southeast and south regions had the highest rates for men, and the northeast and southeast had it for women. Age–Period–Cohort analysis showed a slight increase in female deaths and an increasing trend in the annual percent change in mortality for men over age 55. In survival analysis, males, Black individuals and southern residents were more strongly associated with death. The correlation between oral health teams’ coverage was high and negative, while the number of dental specialty centers and soft tissue biopsies had a high and positive correlation. Mortality and survival patterns were dependent on sex, age, geographic region and race/ethnicity. It was observed that preventive and diagnostic procedures were not being performed, which may be related to the increase in mortality.

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Objectives: This study aimed to verify possible associations between sociodemographic and clinical factors in live births with spinal dysraphism .Methods: An analytical (descriptive and inferential), ecological study was carried out based on secondary data of 11,308 live births with spinal dysraphism registered in the Live Birth Information System (SINASC) in Brazil from 1999 to 2019. Demographic factors analyzed were age, education, mothers' marital status and geographic region. The clinical factors analyzed were duration, gestation period, birthweight and number of prenatal visits performed by women who underwent medical follow-up.Results: There was an increase in the number of cases of spinal dysraphism in recent years in Brazil with an annual percentage variation of 3.52%. However, the period from 2005 to 2009 showed a reduction in live births with spinal dysraphism . The regions with the highest incidence were the South and Southeast. The risk increased in mothers born after 1980, older than 30 years and with a high level of education. The risk was increased in live births of whites and blacks, born from double pregnancy and with body weight less than 3,000 g. The absence of prenatal care was associated with a higher incidence.Conclusion: Sociodemographic and clinical factors have speci c characteristics that can predict spinal dysraphism in newborns in Brazil.

Background: To investigate the influence of sociodemographic factors and variables related to oral health services in oral and oropharyngeal cancer mortality in Brazil. Results: The mortality rate was higher in men than in women; the Southeast and South regions had the highest rates, which increased with age. Regarding APC analysis, men aged 57 years or more and those born from the 1920s to 1955, presented the highest mortality rate, while women born between the 1920s and the 1930s had a higher rate ratio. Kaplan-Meier survival curves and Cox regression showed that black men living in the Midwest region had the lowest survival rate. Considering the correlations, the North and Northeast regions presented mortality rates inversely proportional to FPDC and NSTB, while the Southeast presented it only to FPDC. Conclusions: The sociodemographic variables analyzed exhibited an influence on mortality and survival rates in relation to oral and oropharyngeal cancer. Regarding the oral health services, it was observed that preventive and diagnostic procedures are not being performed, which may be exacerbating the increase in the mortality rates observed.

Objetivo: Avaliar o índice de Anos Potenciais Perdidos por pessoas diagnosticadas com Carcinoma oral de células escamosas no Estado do Pará. Métodos: Estudo observacional e ecológico. Realizou-se uma análise da distribuição do Carcinoma oral de células escamosas no Estado do Pará com dados obtidos de 318 pacientes acometidos por este carcinoma e atendidos em um hospital de referência, no período de janeiro de 2007 a agosto de 2016. Calculou-se o índice de anos potenciais de vida perdidos pela fórmula adaptada de Romeder e McWhinie. Realizou-se consulta por meio do Termo de cessão de dados (TCD). Resultados: A idade de maior acometimento é na sexta década de vida, onde os homens se sobressaem em ralação às mulheres. Cerca de 61% dos pacientes eram tabagistas ao diagnóstico e aproximadamente 44,65% não faziam uso de bebidas alcoólicas. A língua se mostrou como sítio de maior acometimento das lesões. Foi calculado 921,5 anos de vidas perdidas para os pacientes estudados. Conclusão: Estes estudos servem como base para verificar impactos econômicos e sociais que o carcinoma carrega, ajudando a direcionar políticas públicas para o diagnóstico precoce e uma melhor capacitação dos profissionais que trabalham nesta área, podendo evitar gastos dispendiosos para a saúde no futuro.

Objectives: This study aimed to verify possible associations between sociodemographic and clinical factors in live births with spinal dysraphism .Methods: An analytical (descriptive and inferential), ecological study was carried out based on secondary data of 11,308 live births with spinal dysraphism registered in the Live Birth Information System (SINASC) in Brazil from 1999 to 2019. Demographic factors analyzed were age, education, mothers' marital status and geographic region. The clinical factors analyzed were duration, gestation period, birthweight and number of prenatal visits performed by women who underwent medical follow-up.Results: There was an increase in the number of cases of spinal dysraphism in recent years in Brazil with an annual percentage variation of 3.52%. However, the period from 2005 to 2009 showed a reduction in live births with spinal dysraphism . The regions with the highest incidence were the South and Southeast. The risk increased in mothers born after 1980, older than 30 years and with a high level of education. The risk was increased in live births of whites and blacks, born from double pregnancy and with body weight less than 3,000 g. The absence of prenatal care was associated with a higher incidence.Conclusion: Sociodemographic and clinical factors have specific characteristics that can predict spinal dysraphism in newborns in Brazil.