BackgroundThe World Health Organization (WHO) launched the “End TB Strategy”, which aims to reduce tuberculosis (TB) mortality by 95% by 2035, Brazil has made a commitment to this, however, one challenge is achieving the goal in the border region, where the TB situation is more critical. The proposal was to analyse the spatial mortality due to TB and its socio-economic determinants in the general population, around the border areas of Brazil, Paraguay and Argentina, as well as the temporal trend in this region.MethodThis ecological study considered the cases of TB deaths of residents of Foz do Iguaçu (BR), with its units of analysis being the census sectors. The standardized mortality rate was calculated for each area. Socioeconomic variables data were obtained from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE). The scan statistic was applied to calculate the spatial relative risk (RR), considering a 95% confidence interval (CI). Spatial dependence was analysed using the Global Bivariate Moran I and Local Bivariate Moran I (LISA) to test the relationship between the socioeconomic conditions of the urban areas and mortality from TB. Analysis of the temporal trend was also performed using the Prais-Winsten test.ResultsA total of 74 cases of TB death were identified, of which 53 (71.6%) were male and 51 (68.9%) people of white skin colour. The mortality rate ranged from 0.28 to 22.75 cases per 100,000 inhabitants. A spatial relative risk area was identified, RR = 5.07 (95% CI 1.79–14.30). Mortality was associated with: proportion of people of brown skin colour (I: 0.0440, p = 0.033), income (low income I: − 0.0611, p = 0.002; high income I: − 0.0449, p = 0.026) and density of residents (3 and 4 residents, I: 0.0537, p = 0.007; 10 or more residents, I: − 0.0390, p = 0.035). There was an increase in the mortality rate in people of brown skin colour (6.1%; 95% CI = 0.029, 0.093).ConclusionDeath due to TB was associated with income, race resident density and social conditions. Although the TB mortality rate is stationary in the general population, it is increasing among people of brown skin colour.

BackgroundBrazil is the only country in Latin America that has adopted a national health system. This causes differences in access to health among Latin American countries and induces noticeable migration to Brazilian regions to seek healthcare. This phenomenon has led to difficulties in the control and elimination of diseases related to poverty, such as leprosy. The aim of this study was to evaluate social determinants and their relationship with the risk of leprosy, as well as to examine the temporal trend of its occurrence in a Brazilian municipality located on the tri-border area between Brazil, Paraguay and Argentina.MethodsThis ecological study investigated newly-diagnosed cases of leprosy between 2003 and 2015. Exploratory analysis of the data was performed through descriptive statistics. For spatial analysis, geocoding of the data was performed using spatial scan statistic techniques to obtain the Relative Risk (RR) for each census tract, with their respective 95% confidence intervals calculated. The Bivariate Moran I test, Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) models were applied to analyze the spatial relationships of social determinants and leprosy risk. The temporal trend of the annual coefficient of new cases was obtained through the Prais-Winsten regression. A standard error of 5% was considered statistically significant (p < 0.05).ResultsOf the 840 new cases identified in the study, there was a predominance of females (n = 427, 50.8%), of white race/color (n = 685, 81.6%), age range 15 to 59 years (n = 624, 74.3%), and incomplete elementary education (n = 504, 60.0%). The results obtained from multivariate analysis revealed that the proportion of households with monthly nominal household income per capita greater than 1 minimum wage (β = 0.025, p = 0.036) and people of brown race (β = -0.101, p = 0.024) were statistically-significantly associated with risk of illness due to leprosy. These results also confirmed that social determinants and risk of leprosy were significantly spatially non-stationary. Regarding the temporal trend, a decrease of 4% (95% CI [-0.053, -0.033], p = 0.000) per year was observed in the rate of detection of new cases of leprosy.ConclusionThe social determinants income and race/color were associated with the risk of leprosy. The study’s highlighting of these social determinants can contribute to the development of public policies directed toward the elimination of leprosy in the border region.

OBJECTIVE: to analyze the temporal trend, identify the factors related and elaborate a predictive model for unfavorable treatment outcomes for multidrug-resistant tuberculosis (MDR-TB). METHODS: Retrospective cohort study with all cases diagnosed with MDR-TB between the years 2006 and 2015 in the state of São Paulo. The data were collected from the state system of TB cases notifications (TB-WEB). The temporal trend analyzes of treatment outcomes was performed through the Prais-Winsten analysis. In order to verify the factors related to the unfavorable outcomes, abandonment, death with basic cause TB and treatment failure, the binary logistic regression was used. Pictorial representations of the factors related to treatment outcome and their prognostic capacity through the nomogram were elaborated. RESULTS: Both abandonment and death have a constant temporal tendency, whereas the failure showed it as decreasing. Regarding the risk factors for such outcomes, using illicit drugs doubled the odds for abandonment and death. Besides that, being diagnosed in emergency units or during hospitalizations was a risk factor for death. On the contrary, having previous multidrug-resistant treatments reduced the odds for the analyzed outcomes by 33%. The nomogram presented a predictive model with 65% accuracy for dropouts, 70% for deaths and 80% for failure. CONCLUSIONS: The modification of the current model of care is an essential factor for the prevention of unfavorable outcomes. Through predictive models, as presented in this study, it is possible to develop patient-centered actions, considering their risk factors and increasing the chances for cure.

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Background: Leprosy is a public health problem and a challenge for endemic countries, especially in their border regions where there are intense migration flows. The study aimed to analyse the dynamics of leprosy, in order to identify areas of risk for the occurrence of the disease and disability and places where this health condition is worsening. Method: This ecological study considered the new cases of leprosy reported in the municipality of Foz do Iguaçu from 2003 to 2015. Spatial and spatial-temporal scan statistics were used to identify the risk areas for the occurrence of leprosy, as well as the Getis-Ord Gi and Getis-Ord Gi* methods. Areas of risk for disabilities were identified by the scan statistic and kernel density estimation. Results: A total of 840 cases were reported, of which 179 (21.3%) presented Grade 1 or 2 disabilities at the time of diagnosis. Leprosy risk areas were concentrated in the Southern, Eastern and Northeastern Health Districts of the municipality. The cases of Grade 2 disability were observed with higher intensity in regions characterized by high population density and poverty. Conclusion: The results of the study have revealed changes in the pattern of areas at risk of leprosy according to the investigated periods. In addition, it was possible to verify disabilities as a condition present in the investigated cases, or that may be related to the late diagnosis of the disease. In the areas of risk identified, patients have reported worse physical disability after diagnostic confirmation, or indicate inadequate clinical examination, reinforcing the need for structuring leprosy control services in a qualified manner.

Objective: to analyze the spatial distribution and temporal trend of human resources for the Brazilian National Health System (SUS) and the Supplemental Health sector. Methods: an ecological study was conducted in the country's 27 Federative Units (FUs); SUS Information Technology Department (DATASUS) data were used relating to the doctor, dental surgeon, nurse and nursing technician personnel categories for the period 2005-2016; Prais-Winsten regression was used to assess the time trend. Results: there was an rising trend of Supplemental Health Sector human resources in all personnel categories, with an mean annual increase of 0.054 (95%CI: 0.031;0.076); with regard to SUS, there was an increase in dental surgeons and nursing technicians, with annual increases of 0.008 (95%CI: 0.003;0.011), and 0.066 (95%CI 0.022; 0.087), respectively, while in most FU, nurses showed a stationary trend and doctors showed a stationary or falling trend. Conclusion: inequalities were found in human resource distribution, reflecting the health system crisis.

RESUMO Objetivo Avaliar a associação entre o acesso à mamografia no Brasil e a cobertura pela Estratégia Saúde da Família (ESF) e pela saúde suplementar. Métodos Realizou-se um estudo ecológico com dados obtidos do Departamento de Informática do Sistema Único de Saúde (DATASUS). A tendência da série temporal foi analisada pelo método de Prais-Winsten utilizando-se como unidades de análise as unidades federativas brasileiras. Para investigar a relação entre a variável dependente – mulheres de 50 a 69 anos que nunca realizaram exame de mamografia – e as independentes, de cobertura de ESF ou saúde suplementar e socioeconômicas, realizou-se análise de regressão linear múltipla. Resultados O Acre foi o único estado que não apresentou tendência crescente da cobertura da saúde suplementar. Roraima, Tocantins, Maranhão, Piauí, Rio Grande do Norte e Paraíba apresentaram tendência estacionária para a cobertura pela ESF, enquanto as demais unidades federativas apresentaram cobertura crescente. Observou-se associação significativa entre nunca ter realizado mamografia na idade de 50 a 69 anos e as variáveis renda média per capita e cobertura pela ESF e saúde suplementar (R 2 = 0,77; P < 0,001). Conclusão A desigualdade no acesso a mamografia é uma realidade no Brasil. Tanto a saúde suplementar quanto a Estratégia Saúde da Família têm contribuído para melhoria do acesso dessas mulheres.

Atualmente a AIDS encontra-se como uma doença crônica que avança drasticamente pela população feminina, especialmente em mulheres em idade reprodutiva, o que contribui para a ocorrência da transmissão vertical. O objetivo desta pesquisa foi compreender os sentimentos e expectativas de gestantes com HIV sobre a doença e a gestação, a partir de um olhar fenomenológico. Foram sujeitos do estudo cinco gestantes em acompanhamento no Serviço de Atendimento Especializado em HIV/AIDS, residentes em Foz do Iguaçu, Brasil. A coleta dos discursos ocorreu mediante entrevistas semiestruturadas, as quais foram gravadas por meio digital. Após a transcrição e análise foi possível encontrar duas unidades temáticas, a saber, "preconceito, discriminação e estigmatização como realidade de gestantes vivendo com HIV" e "esperanças e expectativas emergentes da gestação com HIV". Apesar do contexto de preconceito, as gestantes não perderam esperança em relação ao tratamento e futuro com o HIV. Observaram-se diversas formas de expressão sobre os problemas enfrentados pelas gestantes, sendo que a aceitação da gravidez evidenciou o motivo existente de superação sobre o diagnóstico da doença. Palavras-chave: Gestantes; Infecções por HIV; Existencialismo. ABSTR ACT AIDS is a chronic disease increasing dramatically among the female population, especially amongst those women in their reproductive years, which can be seen in the increase of mother-to-child transmission of HIV cases. The objective of this research was to identify the feelings and expectations of such pregnant women about the disease and pregnancy from a phenomenological perspective. Five pregnant women living in Foz do Iguaçu, Brazil and being monitored at the HIV/AIDS Specialized Service were selected as study subjects. Their accounts were collected through semi-structured interviews, which were recorded by digital media. Two Thematic Units were identified after the transcription and analysis of the discourses, namely, "The reality of prejudice, discrimination and stigmatization against pregnant women living with HIV" and "Emergent hope and expectations in a HIV pregnancy". Despite prejudice, the pregnant women participating in the study had not lost hope neither in the treatment nor in the future. Several forms of expressing their problems were observed and the acceptance of being pregnant made them feel strong enough to face the situation.