ABSTRACT BACKGROUND: There is a lack of studies evaluating the oral health of traditional indigenous communities in Brazil. OBJECTIVES: Thus, the objective of this study was to describe the oral health characteristics of the indigenous Fulni-ô ethnic group in Northeast Brazil. DESIGN AND SETTING: A cross-sectional observational investigation was conducted within the Project on Atherosclerosis among Indigenous Populations. METHODS: This study included participants of both sexes from the Fulni-ô ethnic group. The participants included in this investigation underwent a comprehensive oral health evaluation by a registered and experienced dentist to assess oral health and identify potentially malignant oral lesions. Participants with suspicious lesions were referred for biopsy. Shapiro-Wilk, Mann-Whitney, and Student’s t-tests were used, and measures of central tendency and dispersion were described. Statistical significance was 5%. RESULTS: A total of 104 individuals were included in this study. The prevalence of the use of tobacco derivatives was 94.0%, with similarities between sexes. The prevalence of oral changes in this study population was 84.4%. Fifty-one individuals who underwent oral reassessment were referred for oral lesion biopsy. CONCLUSIONS: This study demonstrated a high prevalence of oral alterations in the Fulni-ô population. Histopathological analyses indicated the presence of mild oral epithelial dysplasia in five cases.

SUMMARY OBJECTIVE: The aim of this study was to investigate whether the degree of urbanization influences the prevalence of chronic kidney disease in Brazilian indigenous people. METHODS: This is a cross-sectional study conducted between 2016 and 2017 in northeastern Brazil and includes individuals aged between 30 and 70 years from two specific indigenous groups who volunteered to participate in the study: the Fulni-ô people (lowest degree of urbanization) and the Truká group (greater degree of urbanization). Cultural and geographical parameters were used to characterize and measure the magnitude of urbanization. We excluded individuals with known cardiovascular disease or renal failure who required hemodialysis. Chronic kidney disease was defined as a single measurement of an estimated glomerular filtration rate <60 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. RESULTS: A total of 184 indigenous people from the Fulni-ô group and 96 from the Truká group with a median age of 46 years (interquartile range: 15.2) were included. We found a chronic kidney disease rate of 4.3% in the total indigenous population, generally affecting an older population: 41.7% over 60 years old (p<0.001). The Truká people had a chronic kidney disease prevalence of 6.2%, with no differences in kidney dysfunction across age groups. The Fulni-ô participants had a chronic kidney disease prevalence of 3.3%, with a higher proportion of kidney dysfunction in older participants (of the six Fulni-ô indigenous people with chronic kidney disease, five were older). CONCLUSION: Our results suggest that a higher degree of urbanization seems to negatively influence the prevalence of chronic kidney disease in Brazilian indigenous people.

Abstract: Introduction: Although the internet provides various facilities, its inadequate and excessive use can cause Internet Addiction Disorder, especially among university students, who browse the web for entertainment, communication and academic activities, and even more so during the COVID-19 pandemic, when education switched to online. This disorder results in several detrimental consequences such as diminished student performance and aggravation or triggering of other psychiatric conditions. Objective: To evaluate the presence of Internet Addiction Disorder in medical students at the state of Alagoas, Brazil. Methods: Quantitative, cross-sectional and analytic study conducted among medical students from two universities in the state of Alagoas during the first year of the COVID-19 pandemic. The data was gathered through an online form with a social-demographic questionnaire, the Internet Addiction Test, and variables (sex, age, semester of study, city of birth, grade point average). The data was analysed in the SPSS 24 and JASP 0.14 programs. Results: The survey was applied to 325 students, 97.2% of whom affirmed to have increased their internet usage during the pandemic. The average score in the Internet Addiction Test was 32.5, with 80.6% displaying some degree of disorder, 66.8% a mild dependence, and 13.8% moderate dependence. A higher prevalence of the disorder was found among males, who were also shown to be more used to making new friendships through the internet, to hide what they are doing online, and to spend more time logged in than planned. The compulsion was more severe in lower social classes, initial semester and those who came from public university, cities with a population of less than 50.000, and immigrants. There was a negative correlation between lower final semester grades and higher grades in the Internet Addiction Test (Pearson -0,121, p-value: 0,045). Conclusions: The data of this study point to a major possibility of medical students developing Internet Addiction Disorder, with more severe dependence among those who are males, from lower social classes, in earlier periods of study, students from public universities, from cities with a population of less than 50.000 inhabitants and immigrants. The presence of Internet Addiction Disorder was inversely proportional to academic performance.

Resumo: Introdução: Apesar das facilidades proporcionadas pela internet, seu uso inadequado e excessivo pode gerar Transtorno de Uso de Internet, principalmente entre os universitários que a utilizam para entretenimento, comunicação e atividades acadêmicas, como ocorreu durante a pandemia de Covid-19, quando o ensino ficou on-line. Esse transtorno culmina em prejuízos, como a redução no desempenho estudantil e a exacerbação ou o aparecimento de doenças psiquiátricas. Objetivo: Este estudo teve como objetivo avaliar a presença do transtorno de uso de internet entre estudantes de Medicina em universidades do estado de Alagoas, Brasil. Método: Trata-se de um estudo quantitativo, transversal e analítico realizado com estudantes de Medicina de duas instituições de ensino superior do estado de Alagoas durante o primeiro ano de pandemia de Covid-19. A coleta foi feita por um instrumento on-line com uma avaliação sociodemográfica, o Teste de Dependência de Internet e as variáveis sexo, idade, período, cidade de origem e coeficiente acadêmico de rendimento. Os dados foram analisados nos programas SPSS 24 e JASP 0.14. Resultado: Participaram da pesquisa 325 estudantes, dos quais 97,2% afirmaram ter aumentado o consumo da internet durante o período da pandemia. A média de pontuação no teste foi de 32,5, no qual 80,6% apresentaram algum grau de transtorno de uso de internet, sendo 66,8% leve e 13,8% moderado. Constatou-se maior prevalência da dependência no sexo masculino, com achado entre eles de criar novas amizades pela internet, de ocultar revelar o que faz on-line e gastar mais tempo que o planejado navegando. Houve maior gravidade de compulsão nos estudantes de classes sociais mais baixas, em períodos iniciais do curso, provenientes de instituição pública, oriundos de cidades com até 50 mil habitantes e nos imigrantes. Houve uma relação negativa significativa entre menor coeficiente do último período cursado e maior nota no teste (Pearson -0,121, valor de p: 0,045). Conclusão: Os dados apontaram que os estudantes de Medicina estão propensos a desenvolver transtorno de uso de internet e que houve maior gravidade entre o sexo masculino, em classes sociais mais baixas, nos períodos iniciais do curso, nos procedentes de instituição pública, de cidades com até 50 mil habitantes e nos imigrantes. A presença do transtorno foi inversamente proporcional à performance acadêmica.

Abstract: Introduction: Traditional communities are groups of socially organized individuals with common economic, socio-environmental, and cultural behaviors. Brazil’s indigenous communities are a prime example of these groups, suffering the impact of urbanization, the growth of chronic diseases, epidemics, and increased food insecurity. Experience report: To describe the health team’s experiences in the use of a data management tool for care in an indigenous community in northeastern Brazil. Methodology: This is an experience report on the use of a digital tool to assist actions in a traditional community. The health team was divided into community health agents and medical students. Discussion: The description of the experiences and analysis of the narratives resulted in identifying 258 citations, classified into 12 categories related to the study scope. Of these, issues related to benefits of the tool were the most commonly mentioned (43.41%), where the subgroups addressed different reflections. The second most cited category referred to the tool’s limitations (15.11%), with the need for an internet connection being the critical point. This research, therefore, shows the tool’s advantages in health care but also explains weaknesses inherent to its use, raising important issues of this experience and stimulating similar practices. Conclusion: This experience report, as a scientific method, addresses essential experienced issues related to the practical applicability of a digital tool in an indigenous community. Although it is undeniable that there are obvious points of weakness, these did not compromise the positive result of the experience, and care was improved.

Resumo: Introdução: As comunidades tradicionais são grupos de indivíduos socialmente organizados que partilham comportamentos econômicos, socioambientais e culturais comuns. Entre elas, destacam-se as comunidades indígenas no Brasil, que vêm sofrendo o impacto da urbanização, do crescimento de doenças crônicas e epidemias e do aumento da insegurança alimentar. Relato de experiência: Este estudo teve como objetivo descrever as experiências da equipe de saúde, quanto ao uso de uma ferramenta de gestão de dados na assistência, em uma comunidade indígena no Nordeste brasileiro. Trata-se de um relato de experiência do uso de uma ferramenta digital nas ações assistenciais em uma comunidade tradicional. A equipe de saúde foi dividida em dois grupos: agentes comunitários de saúde e estudantes de Medicina. Discussão: A descrição das experiências e a análise das narrativas resultaram na identificação de 258 citações, que foram classificadas em 12 categorias, relacionadas ao objeto de estudo. Dentre estas, as questões ligadas aos benefícios da ferramenta foram as mais mencionadas (43,41%), em que os subgrupos abordaram diferentes reflexões. A segunda categoria mais citada se referia às limitações da ferramenta (15,11%), sendo a necessidade do sinal de internet o ponto crítico. Ou seja, esta pesquisa mostra vantagens da ferramenta na atenção à saúde, mas também explicita fragilidades inerentes ao seu uso, de modo a trazer questões importantes dessa vivência e estimular práticas semelhantes. Conclusão: Esse relato de experiência, como método científico, traz importantes questões vivenciadas, relacionadas à aplicabilidade prática de uma ferramenta digital em uma comunidade indígena. Apesar de ser inegável que há pontos de fragilidade evidentes, eles não comprometeram o resultado afirmativo da vivência, melhorando a assistência.

ABSTRACT Job satisfaction is multifactorial and is directly related to the quality of health services. The main objective of this study was to characterize the level of job satisfaction and the work context of the multidisciplinary teams in specialized rehabilitation services in the state of Alagoas, Brazil. We evaluated the professional profile of participants and sociodemographic information. The Work Context Assessment Scale (WCAS) which is divided into three dimensions and questions adapted from the satisfaction and remuneration dimensions of the Great Place to Work methodology for the Organizational Climate Survey, was used. We included 190 professionals, the mean age was 35.47±9.25 and 86.3% were women. Most participants worked in the capital (60%) and 84.7% had a monthly wage ranging from R$1,000 to R$3,000. The dimension of “work organization” was crucial. The items “pace of work,” “strong demand,” “performance monitoring,” and “repetitive tasks” presented the worst results, but 92.7% are satisfied with their professional activities. The logistic regression analysis showed that more years since graduation and lower scores of Work conditions and Socio-professional relationships were associated with higher job satisfaction. Job satisfaction was found to be high, the dimension of work organization was crucial, and almost half of the participants have already thought about leaving their careers.

RESUMEN La satisfacción laboral es multifactorial y está directamente relacionada con la calidad de los servicios de salud. El objetivo principal de este estudio fue identificar el nivel de satisfacción y el contexto de trabajo de equipos multidisciplinarios en servicios especializados de rehabilitación en el estado de Alagoas, Brasil. Se evaluó el perfil profesional y el perfil sociodemográfico, y se aplicaron la Escala de Evaluación del Contexto de Trabajo (EACT), dividida en tres dimensiones, y preguntas adaptadas de las dimensiones de satisfacción y remuneración de la metodología de encuesta de clima organizacional, Great Place to Work. Se incluyeron a 190 profesionales, de los cuales el 86,3% eran mujeres, y la edad media fue de 35,47±9,25 años. La mayoría trabajaba en la capital (60%) y el 84,7% ganaba entre R$1.000 y R$3.000. La dimensión “organización del trabajo” fue crítica. Los ítems “ritmo de trabajo”, “exigencia de resultados”, “control del rendimiento” y “tareas repetitivas” obtuvieron los peores resultados, pero el 92,7% de los participantes estaban satisfechos con su actividad profesional. La regresión logística mostró que a más años de formación y puntuaciones más bajas en las dimensiones “condiciones de trabajo” y “relación socioprofesional” se asociaban a una mayor satisfacción laboral. La satisfacción laboral fue alta, la dimensión “organización del trabajo” crítica, y casi la mitad de los participantes había pensado en dejar su carrera.

RESUMO A satisfação no trabalho é multifatorial e está diretamente relacionada com a qualidade dos serviços de saúde. O objetivo principal deste estudo foi caracterizar o nível de satisfação e o contexto de trabalho de equipes multidisciplinares de serviços especializados em reabilitação no estado de Alagoas, Brasil. Foi avaliado o perfil profissional e sociodemográfico e foram aplicadas a escala de avaliação do contexto de trabalho (EACT), que é dividida em três dimensões, e questões adaptadas das dimensões de satisfação e remuneração da metodologia Great Place to Work da pesquisa de clima organizacional. Incluímos 190 profissionais, sendo 86,3% do sexo feminino, e a idade média foi de 35,47±9,25 anos. A maioria trabalhava na capital (60%) e 84,7% recebiam mensalmente de R$ 1.000,00 a R$ 3.000,00. A dimensão organização do trabalho foi considerada crítica. Os itens ritmo de trabalho, cobrança por resultados, fiscalização do desempenho e tarefas repetitivas tiveram os piores resultados, mas 92,7% dos participantes estavam satisfeitos com suas atividades profissionais. A regressão logística mostrou que mais anos de formado e menores pontuações nas dimensões condições de trabalho e relações socioprofissionais estão associados com maior satisfação no trabalho. A satisfação no trabalho foi alta, a dimensão organização do trabalho crítica, e quase metade dos participantes já pensaram em deixar sua carreira.

Abstract Objectives: to analyze the temporal trend and spatial distribution of infant mortality in Pernambuco from 2001 to 2019. Methods: an ecological study involving all deaths in children under one year of age living in the state. Data were collected from the Mortality Information System and the Live Birth Information System. Four mortality rates were calculated and the temporal analysis was performed by applying the regression model by inflection points of the rates at different spatial levels. Results: 47,949 deaths were recorded, of which 51.0% (n=24,447) occurred in the first six days of life. A statistically significant downward trend was observed in all the rates analyzed (-4.5%/year in overall mortality, -3.6%/year in early neonatal mortality, -1.9%/year in the late neonatal component, and -6.3%/year in the post-neonatal component). Additionally, 64.3% of the municipalities (n=119) showed a declining trend in the overall infant mortality rate. Less than 50% of the municipalities showed a downward trend in early neonatal and late neonatal mortality (41.08%; n=76 and 43.2%; n=80, respectively). In post-neonatal mortality, 57.3% (n=106) showed decreasing trends. Conclusions: there was a temporal trend of decline in overall infant mortality, although there is an important portion of municipalities with a stationary trend, justifying the need to reduce social inequalities and geographical asymmetries.

Resumo Objetivos: analisar a tendência temporal e a distribuição espacial da mortalidade infantil em Pernambuco no período de 2001 a 2019. Métodos: estudo ecológico envolvendo todos os óbitos em crianças menores de um ano residentes no estado. Os dados foram coletados no Sistema de Informações sobre Mortalidade e no Sistema de Informação sobre Nascidos Vivos. Foram calculados quatro coeficientes de mortalidade e a análise temporal foi realizada aplicando o modelo de regressão por pontos de inflexão dos coeficientes em diferentes níveis espaciais. Resultados: foram registrados 47.949 óbitos, dos quais 51,0% (n=24.447) ocorreram nos seis primeiros dias de vida. Foi observada tendência de declínio estatisticamente significativo em todos os coeficientes analisados (-4,5%/ano na mortalidade geral, -3,6%/ano na neonatal precoce, -1,9%/ano no componente neonatal tardio e de -6,3%/ano no componente pós-neonatal). Adicionalmente, 64,3% dos municípios (n=119) apresentaram tendência de declínio no coeficiente de mortalidade infantil geral. Menos de 50% dos municípios apresentaram tendência de redução na mortalidade neonatal precoce e neonatal tardia (41,08%; n=76 e 43,2%; n=80, respectivamente). Na mortalidade pós-neonatal, 57,3% (n=106) apresentaram tendências decrescentes. Conclusões: houve tendência temporal de declínio da mortalidade infantil geral, embora haja importante parcela de municípios com tendência estacionária, justificando a necessidade de reduzir desigualdades sociais e assimetrias geográficas.

ABSTRACT BACKGROUND: Breast cancer is a common neoplasm in women worldwide. Its varying patterns of incidence and clinical prognosis in Brazil make it an important and complex public health problem that needs to be solved. OBJECTIVES: To analyze the temporal dynamics of hospital admissions and deaths due to female breast cancer in the state of Alagoas, Brazil, from 2009 to 2019. DESIGN AND SETTING: Cross-sectional study including secondary data from hospital admissions and deaths due to female breast cancer in Alagoas. METHODS: A joinpoint regression model was constructed for temporal analysis of hospital admissions and deaths due to female breast cancer in Alagoas, over this period. The hospital information system of the Department of Informatics of the National Health System was used. RESULTS: There were 5,801 hospitalizations and 633 hospital deaths due to neoplasm in Alagoas over the period. The age group from 50 to 59 years old stood out, corresponding to 28.1% of hospitalizations and 31.1% of registered deaths. An increasing trend in the rate of hospital admissions was observed (average annual percentage change, AAPC = 14.0; P-value < 0.001), from 14.9/100,000 inhabitants in 2009 to 53.6 in 2019. There was a growth trend in the in-hospital mortality rate (AAPC = 19.8; P-value < 0.001), from 6.3% in 2009 to 11.0% in 2019. CONCLUSION: The results indicated an increasing trend of hospital admissions and mortality rates in the state of Alagoas, with a higher percentage of hospitalizations and deaths in the 50-59 age group.

Abstract BACKGROUND: Meningitis is listed as one of the diseases requiring compulsory notification in Brazil. It can affect all age groups and also has no seasonality. Cases can be recorded in all months of the year and in all states of Brazil. Despite its importance, the obligation of immediate notification may have been compromised by the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: To analyze the immediate impact of the COVID-19 pandemic on compulsory notifications of meningitis in Brazil and its states during the first wave of the pandemic. DESIGN AND SETTING: This was an ecological study involving all confirmed cases of meningitis in Brazil, in its regions and in its states. METHODS: Data for the months from 2015 to 2020 were obtained from the database of the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação, SINAN), in the Department of Informatics of the National Health System (Departamento de Informática do Sistema Único de Saúde, DATASUS). The P-score was used to obtain the percentage change in the numbers of cases reported in 2020. RESULTS: A 45.7% reduction in notifications of meningitis in Brazil was observed. Regarding the regions and the states, with the exception of Roraima, all of them showed a negative P-score, with decreasing curves each month. CONCLUSION: The pandemic caused a negative impact on meningitis notifications in Brazil.

RESUMO Objetivo Avaliar as tendências temporais das hospitalizações por Embolia Pulmonar (EP) no Brasil, assim como suas regiões e estados no período entre 2008 e 2019. Métodos Foi realizado um estudo ecológico e de série temporal. Os dados foram obtidos do Sistema de Informação Hospitalar (SIH) do Ministério da Saúde (MS) do Brasil. O modelo de regressão de pontos de inflexão foi aplicado para análises de tendências temporais. As tendências foram classificadas como crescentes, decrescentes ou estacionárias de acordo com a inclinação da linha de regressão. O percentual de variação anual (APC) e Percentual de Variação Médio do Período (AAPC) foram calculados considerando Intervalo de Confiança de 95% (IC 95%) e significância de 5%. Além disso, foram elaborados mapas de distribuição espacial dos indicadores epidemiológicos relacionados à EP no Brasil. Resultados Houve uma tendência crescente na taxa de hospitalização de EP no Brasil, variando de 2,57 em 2008 a 4,44/100.000 em 2019 (AAPC=5,6%; p<0,001). Os custos totais e médios de hospitalização também mostraram uma tendência crescente no país (AAPC=9,2% e 3,0%, respectivamente). Ainda assim, houve uma diminuição na taxa de mortalidade hospitalar (de 21,21% para 17,11%; AAPC=-1,9%; p<0,001). Tendências similares foram observadas na maioria das regiões. O tempo médio de hospitalização no Brasil mostrou uma tendência estacionária. A taxa de hospitalização também aumentou em 18 estados (66,67%). Sete estados mostraram uma diminuição na taxa de mortalidade (25,93%), exceto Roraima, que mostrou uma tendência crescente. Conclusão As hospitalizações de EP representam um grave problema de saúde pública no Brasil, e os padrões temporais aqui observados demonstraram uma tendência crescente em todas as regiões e estados do país.

ABSTRACT Objective To assess the temporal trends of hospitalizations for pulmonary embolism (PE) in Brazil, its regions, and states between 2008 and 2019. Methods An ecological and time series study was conducted. Data were obtained from the Hospital Information System (SIH) of the Brazilian Ministry of Health. The inflection point regression model was applied for temporal trend analyses. Trends were classified as increasing, decreasing, or stationary according to the slope of the regression line. The Annual Percent Charge (APC) and the Average Annual Percent Change (AAPC) were calculated considering a confidence interval of 95% and p-value <0.05. Furthermore, spatial distribution maps of epidemiological indicators related to PE in Brazil were elaborated. Results There was an increasing trend in the hospitalization rate for PE in Brazil, ranging from 2.57 in 2008 to 4.44/100,000 in 2019 (AAPC=5.6%; p<0.001). Total and average hospitalizations costs also showed increasing trend in the country (AAPC=9.2% and 3.0%, respectively). Still, there was a decrease in the in-hospital mortality rate (from 21.21% to 17.11%; AAPC=-1.9%; p<0.001). Similar trends were observed in most regions. The average hospitalization time in Brazil showed a stationary trend. The hospitalization rate has also increased in 18 states (66.67%). Seven states showed a decrease in the mortality rate (25.93%), except for Roraima, which showed an increasing trend. Conclusion Hospitalizations for PE represent a serious public health problem in Brazil and the temporal patterns observed herein demonstrate an increasing trend in all regions and states of the country.

Resumo Fundamento: A pandemia da COVID-19 tem causado um impacto sobre a mortalidade por várias doenças em todo o mundo, especialmente por doenças cardiovasculares (DCVs). O Brasil é um país de dimensões continentais com diferenças significativas na estrutura de saúde entre seus estados. Objetivo: Analisar a mortalidade hospitalar por DCV no sistema público de saúde durante o primeiro ano da pandemia por COVID-19 (2020) no Brasil. Métodos: Este é um estudo ecológico analisando o número absoluto de mortes hospitalares e a taxa de mortalidade hospitalar no Brasil, suas macrorregiões, e unidades federativas. Os dados foram obtidos do Sistema de Informações Hospitalares (SIH) do Ministério da Saúde. O P-escore foi usado para analisar o excesso de mortalidade. O escore compara os eventos observados com os eventos esperados para um dado local e período. O escore-P foi corrigido por um modelo de regressão joinpoint, com um intervalo de confiança de 95% e nível de significância de 5%. Resultados: Houve 93.104 óbitos hospitalares por DCV no Brasil em 2020, o que representa 1495 menos óbitos (escore-P: -1,58) que o esperado. A região centro-oeste apresentou um escore-P positivo, com um aumento de 15,1% no número de mortes. Dez estados apresentaram um maior número de óbitos em 2020. Ainda, observou-se um excesso de 13,3% de mortalidade hospitalar no país como um todo, e um excesso de mortalidade hospitalar em todas as macrorregiões. Conclusões: Houve uma diminuição no número absoluto de óbitos hospitalares, bem como um aumento na taxa de mortalidade por DCV no Brasil em 2020, após o início da pandemia por COVID-19.

Abstract Background: The COVID-19 pandemic has had an impact on mortality from several diseases worldwide, especially cardiovascular diseases (CVD). Brazil is a continent-sized country with significant differences in the health care structure between its federative units. Objective: Analyze in-hospital mortality from CVDs in the Brazilian public health system during the first year of the COVID-19 pandemic (2020). Methods: This is an ecological study analyzing the absolute number of in-hospital deaths and the rate of in-hospital mortality in Brazil, its macro-regions, and federative units. Data were obtained from the Hospital Information System of the Brazilian Ministry of Health. To analyze excess mortality, the P-score was used. It compares the events observed with those expected for a given place and period. The P-score was corrected by the joinpoint regression model, with a 95% confidence interval and 5% significance level. Results: There were 93,104 in-hospital deaths due to CVD in Brazil in 2020, representing 1,495 fewer deaths (P score: −1.58) than expected. The central-west region had a positive P-score, with a 15.1% increase in the number of deaths. Ten federative units showed a greater number of deaths in 2020. There was also a 13.3% excess in-hospital mortality at the country level, and an excess in-hospital mortality in all macro-regions. Conclusions: There was a decrease in the absolute number of in-hospital deaths, as well as an increase in in-hospital mortality from CVD in Brazil, in 2020, after the COVID-19 pandemic onset.

ABSTRACT Background: Although most coronavirus disease 2019 (COVID-19) infections are mild, some patients have severe clinical conditions requiring hospitalization. Data on the severity of COVID-19 in Brazil are scarce and are limited to public databases. This study aimed to investigate the clinical and laboratory factors associated with the severity of COVID-19 in a cohort of hospitalized adults from two hospitals in Northeast Brazil. Methods: Patients over 18 years of age who were hospitalized between August 2020 and July 2021 with a confirmed diagnosis of COVID-19 were included. The patients were classified into two groups: moderate and severe. Clinical, laboratory and imaging parameters were collected and compared between the groups. A multivariate logistic regression model was used to determine the predictors of COVID-19 severity. Results: This study included 495 patients (253 moderate and 242 severe). A total of 372 patients (75.2%) were between 18 and 65 years of age, and the majority were male (60.6%; n = 300). Patients with severe disease had higher levels of leukocytes, neutrophils, platelets, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, blood glucose, C-reactive protein, ferritin, D-dimer, aspartate aminotransferase, creatinine, and urea (p < 0.05). In multivariate logistic regression, the following variables were significant predictors of COVID-19 severity: leukocytes (odds ratio [OR] 3.27; 95% confidence interval [CI] 2.12-5.06), international normalized ratio (INR) (OR 0.22, 95% CI 0.14-0.33), and urea (OR 4.03; 95% CI 2.21-7.35). Conclusions: The present study identified the clinical and laboratory factors associated with the severity of COVID-19 in hospitalized Brazilian individuals.

Abstract Objective: To describe the epidemiological profile and to analyze the trend in the incidence rate of exogenous poisoning concerning children and adolescents (0–19 years old) in the city of Arapiraca, Alagoas, Brazil, in the period from 2007 to 2015. Methods: Observational study with data extracted from the Notifiable Diseases Information System. The variables sex, age group, toxic agent, and circumstance were analyzed using descriptive statistics. For temporal analysis, cut-off rates of incidence/10,000 inhabitants were calculated and the inflection point regression model was used for analysis. Results: There were 5,539 cases of exogenous intoxication in individuals aged 0–19 years in the city, of which 53.1% (n=2,944) occurred in girls and 61.5% (n=3,405) in children aged 0–9 years. Medicines consisted in the main agent responsible for intoxications (28.5%; n=1,580), mainly by accidental use (18.2%; n=1,010). There was a significant increase in the events during the study period (Average Annual Percent Change: 12.7; 95%CI 1.1–25.6; p<0.001), with rates increasing from 56.52/10,000 inhabitants in 2007 to 56.64/10,000 inhabitants in 2015. The incidence of cases in girls increased from 57.34/10,000 inhabitants in 2007 to 62.27/10,000 inhabitants in 2015. In boys, the incidence of cases was stationary: 55.69/10,000 inhabitants to 50.9 /10,000 inhabitants in the same period. Conclusions: The study showed a higher frequency of cases in girls aged 0 to 4 years and an increasing trend in the incidence rate during the study period. Implementation of actions and strategies, with emphasis on health education, is needed in order to prevent cases of exogenous intoxication.

Resumo Objetivo: Descrever o perfil epidemiológico e analisar a tendência da taxa de incidência por intoxicações exógenas ocorridas em crianças e adolescentes (0–19 anos) em Arapiraca, Alagoas, Brasil, no período de 2007 a 2015. Métodos: Realizou-se um estudo observacional com dados extraídos do Sistema de Informações de Agravos de Notificação. No componente descritivo, foram analisadas as variáveis sexo, faixa etária, agente tóxico e circunstância mediante estatística descritiva (frequência). Para a análise temporal, foram calculadas as taxas de incidência/10 mil habitantes e foi utilizado o modelo de regressão por pontos de inflexão para a análise. Resultados: Ocorreram 5.539 casos de intoxicações exógenas em indivíduos de 0 a 19 anos em Arapiraca (AL), dos quais 53,1% (n=2.944) eram do sexo feminino e 61,5% (n=3.405) eram crianças de 0 a 9 anos. Os principais agentes responsáveis pelas intoxicações foram medicamentos (28,5%; n=1.580) e a circunstância frequente foi uso acidental (18,2%; n=1.010). Houve variação do coeficiente de incidência geral, o qual apresentou comportamento temporal crescente (average annual percent change: 12,7; intervalo de confiança — IC95% 1,1–25,6; p<0,001) e cuja taxa passou de 56,52/10.000 habitantes para 56,64/10.000 habitantes. A incidência de casos, no sexo feminino, passou de 57,34/10.000 habitantes para 62,27/10.000 habitantes e apresentou tendência crescente. Já no sexo masculino, a incidência de casos passou de 55,69/10.000 habitantes para 50,99/10.000 habitantes e apresentou comportamento temporal estacionário. Conclusões: O estudo demonstrou maior frequência de casos no sexo feminino, na faixa de 0 a 4 anos, e tendência crescente da taxa de incidência. Recomenda-se a implementação de ações e estratégias, com destaque para a educação em saúde, a fim de prevenir casos de intoxicação exógena.

RESUMO Objetivo Descrever o perfil epidemiológico e analisar a tendência temporal da mortalidade por suicídio entre adolescentes (10-19 anos) do Nordeste brasileiro, no período de 2001 a 2015. Métodos Trata-se de estudo observacional, que teve como cenário a região Nordeste do Brasil. O período de estudo foi de 2001 a 2015. Consideraram-se as mortes por lesão autoprovocada intencionalmente (X60 a X84), intoxicação exógena de intenção indeterminada (Y10 a Y19) e sequela de lesões autoprovocadas intencionalmente (Y87.0), de acordo com a 10ª Revisão da Classificação Internacional de Doenças (CID-10), de adolescentes de 10 a 19 anos. As variáveis analisadas foram: sexo, faixa etária, raça/cor, CID específico, estado de residência e taxa de mortalidade por suicídio/100.000 habitantes. Resultados Foram registrados 3.194 óbitos em decorrência de suicídio na faixa etária estudada, com predomínio do sexo masculino (62,1%; n = 1.984), faixa etária de 15 a 19 anos (84,8%; n = 2.707), raça/cor parda (65,4%; n = 2.090); entre quatro e sete anos de escolaridade (31,7%; n = 1.011) e no CID X70 (47,8%; n = 1.528). A tendência temporal de mortalidade foi crescente de 2001 a 2015 (APC: 2,4%; p < 0,01), com maiores taxas no sexo masculino. Observou-se tendência crescente da taxa de suicídios, no sexo masculino, em todo o período (AAPC: 2,9%; p < 0,01). No sexo feminino, identificou-se tendência decrescente a partir de 2004 (APC: -2,2%; p < 0,01). Conclusão O perfil epidemiológico foi caracterizado pelo sexo masculino, faixa etária de 15-19 anos, cor/raça parda e escolaridade média. A tendência apresentou padrão de crescimento no sexo masculino e declínio no feminino. Recomenda-se que políticas públicas sejam voltadas para a população adolescente.

ABSTRACT Objective To describe the epidemiological profile and analyze the time trend of suicide mortality among adolescents (10-19 years old) from the Brazilian Northeast, from 2001 to 2015. Methods This is an observational study, which took place in the Northeast region, Brazil. The study period was from 2001 to 2015. Deaths from intentional self-harm (X60 to X84). exogenous poisoning of undetermined intent (Y10 to Y19) and intentional self-harm (Y87.0) were considered, according to the 10th Review of the International Classification of Diseases (ICD-10), for adolescents aged 10 to 19 years. The variables analyzed were: sex, age group, race / color, specific ICD, state of residence and suicide mortality rate/100,000 inhabitants. Results There were 3,194 deaths due to suicide in the age group studied, with a male predominance (62.1%; n = 1,984), age group 15 to 19 years (84.8%; n = 2,707), race/brown color (65.4%; n = 2,090); between 4 and 7 years of schooling (31.7%; n = 1,011) and at CID X70 (47.8%; n = 1,528). The time trend of mortality was increasing from 2001 to 2015 (APC: 2.4%; p < 0.01), with higher rates in males. There was an increasing trend in the suicide rate, among men, throughout the period (AAPC: 2.9%; p < 0.01). In women, a decreasing trend was identified as of 2004 (APC: -2.2%; p < 0.01). Conclusion The epidemiological profile was characterized by male gender, age group 15-19 years, color/brown race and average schooling. The trend showed a growth pattern in males and a decline in females. It is recommended that public policies are aimed at the adolescent population.