BackgroundDiarrhea is a waterborne disease that affects children, especially those under 5 years of age. The objective of this study was to identify the spatial patterns of distribution of diarrheal disease in under 5-year-old children in the State of Tocantins, Brazil, from 2008 to 2013.MethodsGeoprocessing tools were used to carry out an epidemiological study, to prepare thematic maps in the TerraView 4.2.2 software based on secondary data. General indicators of the disease, presence of spatial dependence through the Global Moran’s Index (I) and the Spatial Association Index (LISA) were described.ResultsThere were 3,015 cases of under 5-year-old children hospitalized for diarrhea, with an average annual rate (AAR) of 4.10/1,000 inhabitants (inhab.). Among the main characteristics were: increasing rates in under 1-year-old children (6.16 to 9.66/1,000 inhabitants); children aged 1 to 4 full years (63%); males (55%); 8 deaths of under one-year-old children (75%); county of Araguaína (67%); incidence in the county of Nazaré (63.97/1,000 inhab.); prevalence and incidence in the Araguaína microregion (45%, AAR 9.38/1,000 inhab.). The presence of a cluster with spatial autocorrelation was found in the Araguaína microregion, which was statistically significant (I = 0.11, p-value < 0.03), with priority of intervention (Moran Map).ConclusionsThere was an increase in the number of hospitalizations for diarrhea in under 5–year-old children in the state of Tocantins. The spatial analysis identified clusters of priority areas for measures of maintenance and control of diarrheal diseases.

O Brasil e outros quatro países detêm 90% dos casos de leishmaniose visceral, que é uma doença grave que acarreta óbito, se não tratada. Este estudo teve por objetivo identificar padrões espaciais de distribuição da leishmaniose visceral no estado do Tocantins, Brasil, de 2008 a 2011. Trata-se de estudo ecológico e exploratório com dados obtidos do Datasus e realizada análise por município. Foram estimados os índices de Moran global e construídos mapas temáticos das taxas por 100 mil habitantes, mapa de Moran e de Kernel. Foram georreferenciados 1778 casos de leishmaniose visceral representando uma taxa de 31,75 casos/100 mil habitantes sendo a taxa variou entre 0,00 e 343,16 por 100.000 habitantes com a microrregião de Araguaína, no norte do estado, a mais atingida. O índice de Moran foi Im = 0,20 (p-valor < 0,01). Constatou-se que as microrregiões com maior necessidade de intervenção são as de Araguaína e do Bico do Papagaio, onde foi identificada maior densidade de casos notificados por local de residência, assim como os municípios vizinhos a Juarina, pertencentes à microrregião de Miracema do Tocantins.

The remnants of quilombos, individuals of African descent, have faced several barriers throughout its history, either due to prejudice imposed by society, or the non-fulfillment of their rights guaranteed in the 1988 Constitution, such as access to health services. Thus, this study aims to evaluate the health care offered to quilombo communities in the northern region of Tocantins. This is an exploratory, descriptive study with a qualitative approach, including field research and focus group, carried out with 58 quilombo remnants people from communities in the northern region of Tocantins. Data collection was carried out between from October 2017 to July 2018, through semi-structured interviews. We found that these communities have limited access to health services, in addition to a negative perception of the assistance offered to the health of their population and the commitment of managers. Therefore, access to health and assistance received by the studied communities required to be prioritized since the care provided is not unique and has not met the health demands and needs of the remaining quilombos in northern Tocantins, Brazil.

Coinfection with human visceral leishmaniasis (HVL) and human immunodeficiency virus (HIV) has become an emerging public health problem in several parts of the world, with high morbidity and mortality rates. A systematic review was carried out in the literature available in PubMed, Scielo and Lilacs related to HVL associated with HIV coinfection, seeking to analyze epidemiological, clinical and laboratory aspects. Of the 265 articles found, 15 articles were included in the qualitative analysis, which referred to the results of HVL treatment in patients coinfected with HIV. In the published articles between 2007 and 2015, 1171 cases of HVL/HIV coinfection were identified, 86% males, average age 34 years, liposomal amphotericin B was the most commonly used drug, cure rates 68 and 20% relapses and 19% deaths, five different countries, bone marrow was used in 10/15 manuscripts. HVL/HIV coinfection is a major challenge for public health, mainly due to the difficulty in establishing an accurate diagnosis, low response to treatment with high relapse rates and evolution to death. In addition, these two pathogens act concomitantly for the depletion of the immune system, contributing to worsening the clinical picture of these diseases, which requires effective surveillance and epidemiological control measures.

Epidemiological, clinical and laboratory aspects of human visceral leishmaniasis (HVL) associated with human immunodeficiency virus (HIV) coinfection: a systematic review-CORRIGENDUM.

Os métodos alternativos para o alívio da dor têm a finalidade de tornar o parto o mais natural possível, reduzindo as intervenções desnecessárias e prejudiciais, segundo a Organização Mundial da Saúde, e resgatando a autonomia da parturiente. O objetivo deste estudo foi investigar as terapias alternativas para o alívio da dor do parto normal na literatura disponível em diferentes partes do mundo. Foi feita uma revisão sistemática de literatura nas bases de dados PubMed®, Scientific Electronic Library Online (SciELO), Biblioteca Virtual em Saúde (BVS) e ScienceDirect de estudos publicados entre os anos de 2002 e 2019. A pesquisa ocorreu entre os meses de fevereiro a abril de 2020, conforme os descritores “parturição”, “terapias complementares”, “dor” e “parto normal”. Utilizaram-se as recomendações PRISMA e registradas no PROSPERO (CRD42020186056). Foram analisados 6.758 artigos. Foram incluídos 16 artigos para síntese qualitativa, envolvendo cinco países diferentes. Os estudos tiveram, em sua maioria, participantes primíparas, e, por critérios das inclusões, mulheres saudáveis e com risco habitual de pré-natal. Os 16 estudos envolveram dez técnicas não farmacológicas diferentes, sendo a acupuntura e o banho de aspersão com termoterapia quente as mais utilizadas. A maioria das terapias alternativas respondeu satisfatoriamente ao auxílio da dor do parto, além de não se apresentarem prejudiciais aos recém-nascidos. Os métodos alternativos no parto são abrangentes e colaborativos durante todo o processo gestacional e parturitivo, sendo estaticamente significativos em relação à dor e oportunizando uma gama de modelos que podem ser planejados e empregados pelas maternidades de modo fácil e econômico.

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Background Geographical overlap of human visceral leishmaniasis (HVL) and HIV infection favors occurrences of HVL/HIV coinfection. The increasing numbers of cases of HVL/HIV coinfection are a worldwide concern and knowledge of the factors involved can help in developing preventive measures. Methods We aimed to identify spatial patterns and describe the epidemiological profile of HVL/HIV coinfection in Brazil from 2007 to 2015. This was an ecological study, in which thematic maps were created through geoprocessing tools, based on secondary data obtained from open-access platforms, to identify priority areas for interventions for controlling HLV/HIV coinfection, using the TerraView 4.2.2 software. Results We found spatial autocorrelations between the HVL/HIV rates of neighboring municipalities according to the global Moran index (0.10; p&lt;0.01). The highest HVL/HIV rate was in the central-western region. Among the epidemiological characteristics according to the regions, an increasing trend in the annual variation rate was observed, with positive values over the years and statistical significance (p&lt;0.05) in the North with 1.62 (95% CI 0.57 to 2.69; p=0.02) and Northeast with 6.41 (95% CI 2.60 to 10.37; p=0.006). Similarly, increasing trends were observed in the states of Maranhão with 21.34 (95% CI 13.99 to 9.16; p&lt;0.001) and Sergipe with 5.44 (95% CI 0.61 to 10.50; p=0.04). Conclusions Our results showed spatial overlap between occurrences of HVL and HIV with spatial patterns of HVL/HIV coinfection, thus revealing that the numbers of cases reported are increasing. Identifying areas with higher coinfection indices contributes to applying interventions and control measures among targeted populations, to prevent new cases.