We report the early growth and neurologic findings of 48 infants in Brazil diagnosed with probable congenital Zika virus syndrome and followed to age 1–8 months. Most of these infants had microcephaly (86.7%) and craniofacial disproportion (95.8%). The clinical pattern included poor head growth with increasingly negative z-scores, pyramidal/extrapyramidal symptoms, and epilepsy.

BackgroundPreterm birth is the main cause of morbidity and mortality during the perinatal period. Classical risk factors are held responsible for only 1/3 of preterm births and no current intervention has produced an appreciable reduction of this event. It is necessary to explore new hypotheses and mechanisms of causality by using an integrated approach, collaboration among research groups and less fragmented theoretical-methodological approaches in order to detect new risk factors and to formulate more effective intervention strategies.MethodsThe study will be conducted on a convenience cohort of Brazilian pregnant women recruited at public and private prenatal health services. A total of 1500 pregnant women in São Luís, and 1500 in Ribeirão Preto, will be invited for an interview and for the collection of biological specimens from the 22nd to the 25th week of gestational age (GA). At the time of delivery they will be reinterviewed. GA will be determined using an algorithm based on two criteria: date of last menstruation (DLM) and obstetric ultrasound (OUS) performed at less than 20 weeks of GA. Illicit drug consumption during pregnancy will be determined using a self-applied questionnaire and the following instruments will be used: perceived stress scale, Beck anxiety scale, screening for depression of the Center of Epidemiological Studies (CES-D), experiences of racial discrimination, social network and social support scale of the Medical Outcomes Study and violence (Abuse Assessment Screening and violence questionnaire of the WHO). Bacterial vaginosis, urinary tract infection and periodontal disease will also be identified. Neuroendocrine, immunoinflammatory and medical intervention hypotheses will be tested. The occurrence of elective cesarean section in the absence of labor will be used as a marker of medical intervention.ConclusionPsychosocial, genetic and infectious mechanisms will be selected, since there are indications that they influence preterm birth (PTB). The studies will be conducted in two Brazilian cities with discrepant socioeconomic conditions. The expectation is to identify risk factors for PTB having a greater predictive power than classically studied factors. The final objective is to propose more effective interventions for the reduction of PTB, which, after being tested, might subsidize health policies.Electronic supplementary materialThe online version of this article (doi:10.1186/1742-4755-11-79) contains supplementary material, which is available to authorized users.

BackgroundOver the last decades there has been a reduction of social inequalities in Brazil, as well as a strong expansion of health services, including prenatal care. The objective of the present study was to estimate the rate of inadequate prenatal care utilization and its associated factors in São Luís, Brazil, in 2010 and to determine whether there was a reduction of inequity in prenatal care use by comparing the present data to those obtained from a previous cohort started in 1997/98.MethodsData from the BRISA (Brazilian birth cohort studies of Ribeirão Preto and São Luís) population-based cohort, which started in 2010 (5067 women), were used. The outcome variable was the inadequate utilization of prenatal care, classified according to the recommendations of the Brazilian Ministry of Health. The explanatory variables were organized into three hierarchical levels based on the Andersen’s behavioral model of the use of health services: predisposing, enabling and need factors.ResultsOnly 2.0% of the women did not attend at least one prenatal care visit. The rate of inadequate prenatal care utilization was 36.7%. Despite an improved adequacy of prenatal care use from 47.3% in 1997/98 to 58.2% in 2010, social inequality persisted: both low maternal schooling (prevalence ratio (PR) = 2.78; 95% confidence interval (95% CI) 2.23-3.47 for 0 to 4 years of study) and low family income, less than 0.5 monthly minimum wage per capita (PR = 1.37; 95% CI 1.22-1. 54), continued to be associated with higher rates of inadequate prenatal care utilization. Racial disparity regarding adequate utilization of prenatal services was detected, with black (PR = 1.19; 95% CI 1.04-1.36) and mulatto (PR = 1.14; 95% CI 1.02-1.26) women showing higher rates of inadequate use. On the other hand, women covered by the FHP - Family Health Program (PR = 0.92; 95% CI 0.85-0.98) showed a lower rate of inadequate prenatal care utilization.ConclusionsDespite strong expansion of health services and expressive improvements in adequate prenatal care use and social indicators, inequalities in prenatal care use still persist. The FHP seems to be effective in reducing inadequate prenatal care utilization.

BackgroundOral cancer is a potentially fatal disease, especially when diagnosed in advanced stages. In Brazil, the primary health care (PHC) system is responsible for promoting oral health in order to prevent oral diseases. However, there is insufficient evidence to assess whether actions of the PHC system have some effect on the morbidity and mortality from oral cancer. The purpose of this study was to analyze the effect of PHC structure and work processes on the incidence and mortality rates of oral cancer after adjusting for contextual variables.MethodsAn ecological, longitudinal and analytical study was carried out. Data were obtained from different secondary data sources, including three surveys that were nationally representative of Brazilian PHC and carried out over the course of 10 years (2002–2012). Data were aggregated at the state level at different times. Oral cancer incidence and mortality rates, standardized by age and gender, served as the dependent variables. Covariables (sociodemographic, structure of basic health units, and work process in oral health) were entered in the regression models using a hierarchical approach based on a theoretical model. Analysis of mixed effects with random intercept model was also conducted (alpha = 5%).ResultsThe oral cancer incidence rate was positively association with the proportion of of adults over 60 years (β = 0.59; p = 0.010) and adult smokers (β = 0.29; p = 0.010). The oral cancer related mortality rate was positively associated with the proportion of of adults over 60 years (β = 0.24; p < 0.001) and the performance of preventative and diagnostic actions for oral cancer (β = 0.02; p = 0.002). Mortality was inversely associated with the coverage of primary care teams (β = −0.01; p < 0.006) and PHC financing (β = −0.52−9; p = 0.014).ConclusionsIn Brazil, the PHC structure and work processes have been shown to help reduce the mortality rate of oral cancer, but not the incidence rate of the disease. We recommend expanding investments in PHC in order to prevent oral cancer related deaths.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3700-z) contains supplementary material, which is available to authorized users.

Resumo O objetivo desta pesquisa foi analisar o conteúdo da assistência pré-natal em São Luís e os fatores associados com sua inadequação. Realizou-se estudo transversal baseado em dados da coorte de nascimento de São Luís em 2010. O conteúdo da assistência pré-natal foi classificado como inadequado quando não atendeu aos critérios do Programa de Humanização no Pré-Natal e Nascimento (PHPN) que estabelece o início precoce, o número mínimo de consultas, os exames laboratoriais básicos, a vacinação antitetânica e os procedimentos obstétricos. Regressão de Poisson foi utilizada para observar associações das variáveis com o desfecho. A taxa de inadequação foi de 60,2%. O pré-natal inadequado foi associado à classe econômica C (RP = 1,39; IC = 1,26-1,55), à D/E (RP = 1,60; IC = 1,43-1,79), à ocupação da mãe não qualificada/desempregada (RP = 1,24; IC = 1,11-1,37), à escolaridade de 5-8 anos (RP = 1,12; IC = 1,06-1,19) e de 0-4 anos (RP = 1,13; IC = 1,01-1,26), a não ter religião (RP = 1,10; IC = 1,04-1,17), ao uso de álcool durante a gestação (RP = 1,13; IC = 1,06-1,20) e ao atendimento no serviço público (RP = 1,75; IC = 1,54-2,00). Os resultados demonstraram inadequação e iniquidade da assistência pré-natal, evidenciando que mulheres de pior condição socioeconômica foram as que receberam assistência de menor qualidade.

Avaliação do enfoque familiar e orientação para a comunidade na Estratégia Saúde da FamíliaEvaluation of the family focus and community orientation in the Family Health Strategy

OBJECTIVE To estimate the 2020 all-cause and COVID-19 excess mortality according to sex, age, race/color, and state, and to compare mortality rates by selected causes with that of the five previous years in Brazil. METHODS Data from the Mortality Information System were used. Expected deaths for 2020 were estimated from 2015 to 2019 data using a negative binomial log-linear model. RESULTS Excess deaths in Brazil in 2020 amounted to 13.7%, and the ratio of excess deaths to COVID-19 deaths was 0.90. Reductions in deaths from cardiovascular diseases (CVD), respiratory diseases, and external causes, and an increase in ill-defined causes were all noted. Excess deaths were also found to be heterogeneous, being higher in the Northern, Center-Western, and Northeastern states. In some states, the number of COVID-19 deaths was lower than that of excess deaths, whereas the opposite occurred in others. Moreover, excess deaths were higher in men aged 20 to 59, and in black, yellow, or indigenous individuals. Meanwhile, excess mortality was lower in women, in individuals aged 80 years or older, and in whites. Additionally, deaths among those aged 0 to 19 were 7.2% lower than expected, with reduction in mortality from respiratory diseases and external causes. There was also a drop in mortality due to external causes in men and in those aged 20 to 39 years. Moreover, reductions in deaths from CVD and neoplasms were noted in some states and groups. CONCLUSION There is evidence of underreporting of COVID-19 deaths and of the possible impact of restrictive measures in the reduction of deaths from external causes and respiratory diseases. The impacts of COVID-19 on mortality were heterogeneous among the states and groups, revealing that regional, demographic, socioeconomic, and racial differences expose individuals in distinct ways to the risk of death from both COVID-19 and other causes.

The Brazilian Oral Health Survey (SB Brazil 2003) IntroduçãoO processo de inserção da área de saúde bucal na agenda da saúde pública brasileira trouxe a necessidade de ampliar o conhecimento das condições de saúde bucal da população brasileira e de quantificar os eventos de interesse para apoiar o planejamento de ações na área. A partir da década de 80 do século passado, a área começou a acumular experiência em grandes inquéritos epidemiológicos que incluíam exames clínicos bucais dos entrevistados, especialmente escolares.O primeiro inquérito sobre a saúde bucal no Brasil foi realizado em 1986 1 pela Divisão Nacional de Saúde Bucal (DNSB) do Ministério da Saúde, com o apoio do Instituto de Planejamento Econômico e Social da Secretaria de Planejamento da Presidência da República. As limitações orçamentárias foram determinantes para definir a abrangência geográfica, a população alvo e a abrangência do exame bucal. Realizou-se um inquérito na área urbana de 16 capitais, distribuídas entre as cinco macrorregiões do país, incluindo crianças (6 a 12 anos), adolescentes (15 a 19 anos) e adultos (35 a 44 anos e 50 a 59 anos). A justificativa para não considerar idosos entre 65 e 74, como proposto pela Organização Mundial da Saúde (OMS) e adotado em países desenvolvidos (65 a 74 anos), foi baseada no fato de a esperança de vida ao nascer ser, à época, de 65,5 anos no Brasil 2 . Ocorrência de cárie e doença periodon-ARTIGO ARTICLE Queiroz RCS et al. 48