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.

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.

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.

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.

Human visceral leishmaniasis (HVL) cases are important public health problems due to their zoonotic aspect, with high rates of morbidity and mortality in Brazil. The aim of this this study was to identify spatial patterns in both rates of HVL cases in Brazilian states during the period from 2006 to 2015. This is an ecological study, using geoprocessing tools to create choropleth maps, based on secondary data from open access platforms, to identify priority areas for control actions of the disease. Data were collected in 2017 and analysed according to the global and local Moran's I, using TerraView 4.2.2 software. Similar clusters were observed in neighbouring municipalities in thematic maps of HVL, suggesting spatial similarity in the distribution of the disease in humans mainly in the North and Northeast Regions, which concentrate the states with the highest rates of HVL. Heterogeneous spatial patterns were observed in the distribution of HVL, which show municipalities that need higher priority in the intensification of disease surveillance and control strategies.

Introdução: A alimentação é um fator de importância para assegurar a existência, o crescimento e o desenvolvimento adequados de uma criança. Objetivos: identificar o perfil socioeconômico das crianças menores de um ano internadas em hospital público no interior do Maranhão e de suas mães; conhecer a alimentação complementar praticada por elas e o histórico de aleitamento materno das mesmas. Método: Pesquisa descritiva, transversal, quantitativa, realizada entre fevereiro e setembro de 2015. Dados coletados através de formulários aplicados às mães, sendo que a amostra compreendeu 174 sujeitos. Resultados: Eram do sexo masculino 62,7% das crianças, 42,5% tinham de 1 a 4 meses, 55,7% foram internadas com problemas respiratórios, suas mães eram donas de casa com idade entre 15 e 35 anos. Os dados mostram que as crianças receberam líquidos, leite artificial e alimentos precocemente, e apenas 20,1% praticaram ao aleitamento materno exclusivo até o sexto mês. Conclusão: As crianças menores de um ano internadas apresentam padrão alimentar inadequado. Portanto, são necessárias ações que promovam a prática da alimentação saudável. Introducción: La fuente de alimentación es un factor importante para asegurar el correcto crecimiento y desarrollo de un niño. Objetivo: Identificar el perfil socioeconómico de los niños menores de un año ingresados en hospital público en interior de Maranhão y de sus madres; conocer la alimentación complementaria practicada por ellas y el histórico de amamantamiento materno. Método: Investigación descriptiva, transversal de naturaleza cuantitativa, realizada entre febrero y septiembre de 2015. Datos recolectados en formularios aplicados a las madres de los niños, siendo la muestra de 174 sujetos. Resultados: Eran del sexo masculino 62,7% de los niños, 42,5% tenían de 1 a 4 meses, 55,7% fueron ingresados con problemas respiratorios, sus madres eran amas de casa con edad entre 15 y 35 años. Los datos muestran que los niños recibieron líquidos, leche artificial y alimentos precozmente, y sólo 20,1% practicaron al amamantamiento materno exclusivo hasta el sexto mes. Conclusión: Los niños menores de un año ingresados presentaron tipo alimentación inadecuado. Por lo tanto, son necesarias acciones que promuevan la práctica de la alimentación saludable. Introduction: Food is an important factor to ensuring the existence, growth and development of a child. Objectives: to identify the socioeconomic profile of children under one year of age hospitalized in a public hospital in the country side of Maranhão and of their mothers; to know the complementary feeding given tby mothers and their history of breastfeeding. Method: Descriptive, cross-sectional, quantitative research conducted between February and September 2015. Data were collected through forms applied to mothers, and the sample comprised 174 individuals. Results: 62.7% of the children were male, 42.5% were 1 to 4 months old, 55.7% were hospitalized with respiratory problems, their mothers were housewives aged between 15 and 35 years. The data showed that children received liquids, artificial milk and food precociously, and only 20.1% had practiced exclusive breastfeeding until the sixth month. Conclusion: The children under one year of age have an inadequate eating pattern. Therefore, actions that promote the practice of healthy feeding are necessary.