Luciana Cavalcante Costa

Objective: to analyze the temporal trend of suicide mortality among elderly people in Brazil. Method: An ecological time series study was carried out using the country and its regions as the unit of analysis, from 2013 to 2020. Secondary data were collected from the Department of Informatics of the Unified Health System (DATASUS), using the Tabnet tool and the resident population from the 2010 Census provided by the Brazilian Institute of Geography and Statistics (IBGE). In the trend, the Prais-Winsten generalized linear regression model was used, considering p<0.05. Results: There was evidence of an increase in mortality from suicide in the elderly for almost all regions of the country, except for Amazonas, Roraima, Amapá, Rio Grande do Norte and Alagoas, which showed a stable trend. Rio Grande do Sul was the state with the highest mortality rate. Conclusion: There was an increase in the rate of deaths by suicide in the elderly in almost all regions of the country, with heterogeneous trends, with a higher concentration in Rio Grande do Sul. The results reinforce the need to build more actions and health programs focused on preventing suicide in the elderly.

Objetivo: Analizar la tendencia temporal y la espacialización de indicadores operativos de leishmaniasis visceral (LV) en Brasil, de 2010 a 2019. Métodos: Estudio ecológico mixto, con datos del Sistema de Información de Enfermedades de Declaración Obligatoria. Se utilizó la regresión de Prais-Winsten para analizar la tendencia temporal. Se calculó el índice global de Moran para verificar la existencia de autocorrelación espacial de los indicadores: criterios de laboratorio, coinfección leishmaniasis y VIH, curación clínica y evolución ignorada o en blanco, para la creación de los mapas se utilizó el software ArcGis Pro. Resultados: Se confirmaron 33.195 nuevos casos de LV en Brasil. En Brasil se observó una tendencia creciente (Coef = 0,020; valor p = 0,01) para la coinfección con VL-VIH. La región Norte tuvo tendencia a reducir la confirmación de laboratorio (Coef = -0,003; valor de p < 0,001). La región Centro-Oeste mostró una tendencia decreciente en la curación clínica (coeficiente = -0,005; valor p = 0,012) inversamente a la evolución ignorada (coeficiente = 0,028; valor p = 0,008). Se identificaron grupos "altos-altos" para la curación (Moran global = 0,309) y los criterios de laboratorio (Moran global = 0,302). Conclusión: El indicador VI-VIH fue el único con tendencia creciente. Sólo hubo una correlación positiva para los indicadores “confirmación de laboratorio” y “curación clínica”.

Introduction: Visceral leishmaniasis (VL) is a serious parasitic disease with potential evolutionto death. Objective: analyze the trend of hospitalizations for VL in Brazil from 2010 to 2019. Methodology: this is an ecological study of time series, using data from the SUS Hospital Information System (SIH/SUS). The hospitalization rate per Brazilian state was calculated for each year in the selected period. The hospitalization rate trend was analyzed by Prais-Winsten regression using Stata 14.0. Results: In Brazil, 24,259 hospitalizations due to VL were registered between 2010 and 2019. The lowest number of cases occurred in the state of Amapá (4 cases), while the highest number occurred in the state of Maranhão (3,601 cases). Analyzing the hospitalization rates for VL, the highest rates were observed in the state of Tocantins and the lowest rates in Paraná (Table 2). There was an increasing trend of hospitalization for VL in the states of Paraíba, Pernambuco, Alagoas, Rio Grande do Sul and Goiás, and decreasing in the states of São Paulo, Mato Grosso, Mato Grosso do Sul and the Federal District. Conclusion: The trend of hospitalizations was increasing in five states of Brazil and decreasing in four of them. The other Brazilian states showed a stable trend.

O objetivo do estudo foi verificar as características antropométricas e os fatores associados ao parto cesáreo em mulheres acompanhadas na atenção primária em São Luís – MA. Trata-se de estudo de coorte, realizado com gestantes que realizaram o pré-natal em Unidades Básicas de Saúde (UBS) em São Luís – MA e acompanhadas até 42 dias após o parto. A análise estatística foi realizada no Stata® versão 16.0 no qual foi realizado a Regressão de Poisson, e para aceitação das associações investigadas no modelo final, foi adotado o valor de p < 0,05. Das 80 mulheres acompanhadas, 49,37% tiveram parto cesáreo, 5,33% iniciaram a gravidez desnutridas e 41,33% com excesso de peso no final da gestação, 14,47% estavam desnutridas e 46,5% estavam com excesso de peso. Os fatores associados ao parto cesáreo foram gravidez na adolescência (IRR: 2,26; IC: 1,20 - 4,25), nível de escolaridade baixo, sendo este, classificado em analfabetismo / fundamental I incompleto (IRR: 3,57; IC: 2,61- 4,88), já ter tido ≥ 1 gestações (IRR: 0,53; IC: 0,16-1,72), ter sintomas de ansiedade (IRR: 2,24; IC: 1,20 - 4,19) e hipertensão arterial (IRR: 5,75; IC: 1,18 – 2,81) durante a gravidez, ter iniciado a gravidez com desnutrição (IRR:6,79; IC:1,43-3,22) e ter obesidade no final da gestação (IRR: 2,64; IC: 1,11 - 6,26). É necessário o aprimoramento da assistência nutricional durante as consultas do pré-natal, com o objetivo de prevenir a desnutrição e excesso de peso, minimizando assim as complicações oriundas do estado nutricional.

Resumo: O objetivo deste estudo foi analisar se existe associação entre violência por parceiro íntimo na gestação e o tempo de retorno das atividades sexuais após o parto na coorte BRISA, em São Luís, Maranhão, Brasil, entre os anos de 2010 e 2013. Trata-se de estudo longitudinal conduzido com 665 mulheres. A violência por parceiro íntimo na gestação foi medida por meio de instrumento criado e validado pela Organização Mundial da Saúde para medir violência contra a mulher. O tempo de retorno das atividades sexuais após o parto foi investigado por meio de questionário estruturado. Modelos de regressão logística foram utilizados para verificar se existe associação entre violência por parceiro íntimo na gestação e tempo de retorno das atividades sexuais após o parto. A prevalência de violência perpetrada pelo parceiro íntimo na gestação foi de 24,06%. A prevalência de mulheres que retornaram às atividades sexuais em até três meses após o parto foi de 67,96%. Ao analisar a associação entre exposição e desfecho, observou-se que não houve associação no modelo bruto (OR = 0,88; IC95%: 0,60-1,30), nem no modelo ajustado (OR = 1,00; IC95%: 0,61-1,63). Os resultados do estudo evidenciam a importância de prestar assistência integral à saúde da mulher, considerando tanto aspectos físicos quanto psicológicos, uma vez que a violência tem impacto significativo em diversas áreas da vida feminina.

This study aimed to analyze whether there is an association between intimate partner violence during pregnancy and time to return to sexual activity after childbirth in the BRISA cohort in São Luís, Maranhão State, Brazil, between 2010 and 2013. This is a longitudinal study conducted with 665 women. Intimate partner violence during pregnancy was measured using an instrument created and validated by the World Health Organization to measure violence against women. Time to return to sexual activity after childbirth was investigated using a structured questionnaire. Logistic regression models were used to analyze whether there is an association between intimate partner violence during pregnancy and time to return to sexual activity after childbirth. The prevalence of violence by an intimate partner during pregnancy was 24.06%. The prevalence of women who returned to sexual activity within 3 months after childbirth was 67.96%. When analyzing the association between exposure and outcome, no association was found in the crude model (OR = 0.88; 95%CI: 0.60-1.30), nor in the adjusted model (OR = 1.00; 95%CI: 0.61-1.63). The study results highlight the importance of providing comprehensive care to women, considering both physical and psychological aspects, since violence has a significant impact on several aspects of women’s lives.

Objective: To analyze cesarean delivery according to Robson's criteria in the birth cohorts of São Luís – MA and Ribeirão Preto – SP. Methods: Cross-sectional study conducted with mothers and newborns participating in the BRISA Cohort. Descriptive analyzes were performed using the STATA/SE 14.0 program. Results: In São Luís, 47.52% of births were cesarean sections, and in Ribeirão Preto, 59.82%. When distributing puerperal women within the 10 groups of the Robson Classification, a greater relative contribution to the cesarean section rate is observed in group 4 (multiparous women, without previous cesarean section, with a single fetus, cephalic, ≥ 37 weeks, whose delivery is induced or who undergo a cesarean section before the onset of labor) and 5 (multiparous women with at least one previous cesarean section, with a single fetus, cephalic, ≥ 37 weeks). Conclusions: Groups 4 and 5 showed greater relative contributions to cesarean rates, requiring the implementation of strategies to reduce cesarean sections in these groups. DOI:https://doi.org/10.56238/alookdevelopv1-122

Brazil is one of the countries that experienced an epidemic of microcephaly and other congenital manifestations related to maternal Zika virus infection which can result in Congenital Zika Syndrome (CZS). Since the Zika virus can modulate the immune system, studying mothers’ and children’s immune profiles become essential to better understanding CZS development. Therefore, we investigated the lymphocyte population profile of children who developed CZS and their mothers’ immune response in this study. The study groups were formed from the Plaque Reduction Neutralization Test (PRNT) (CZS+ group) result. To evaluate the lymphocyte population profile, we performed phenotyping of peripheral lymphocytes and quantification of serum cytokine levels. The immunophenotyping and cytokine profile was correlated between CSZ+ children and their mothers. Both groups exhibited increased interleukin-17 levels and a reduction in the subpopulation of CD4+ T lymphocytes. In contrast, the maternal group showed a reduction in the population of B lymphocytes. Thus, the development of CZS is related to the presence of an inflammatory immune profile in children and their mothers characterized by Th17 activation.

The immunological mechanisms involved in the development of congenital Zika syndrome (CZS) have yet to be fully clarified. This study aims to assess the immuno-inflammatory profile of mothers and their children who have been diagnosed with CZS. Blood samples, which were confirmed clinically using the plaque reduction neutralization test (PRNT), were collected from children with CZS and their mothers (CZS+ group). Samples were also collected from children who did not develop CZS and had a negative PRNT result and from their mothers (CZS- group). The data demonstrated a correlation between the leukocyte profile of CZS+ children and their mothers, more evident in monocytes. Monocytes from mothers of CZS+ children showed low expression of HLA and elevated hydrogen peroxide production. CZS+ children presented standard HLA expression and a higher hydrogen peroxide concentration than CZS- children. Monocyte superoxide dismutase activity remained functional. Moreover, when assessing the monocyte polarization, it was observed that there was no difference in nitrite concentrations; however, there was a decrease in arginase activity in CZS+ children. These data suggest that ZIKV infection induces a maternal immuno-inflammatory background related to the child’s inflammatory response after birth, possibly affecting the development and progression of congenital Zika syndrome.

Resumo Introdução Internações por transtornos mentais e comportamentais não são ocorrências raras em adolescentes. Estima-se que aproximadamente 30% dos adolescentes brasileiros sejam acometidos por transtornos mentais. Objetivo Analisar a evolução das internações por transtornos mentais e comportamentais em adolescentes brasileiros de 2008 a 2017. Método Estudo ecológico de séries temporais utilizando dados do Sistema de Informações Hospitalares do Sistema Único de Saúde e do IBGE. As variáveis utilizadas foram regiões de residência, sexo, faixa etária e grupos de diagnósticos. A tendência do coeficiente de internação foi analisada através da regressão de Prais-Winsten utilizando o Stata 14.0. Resultados Houve 152.465 internações no período; o coeficiente de internação hospitalar reduziu na região Nordeste de 27,75 a 23,16 por 100 mil habitantes (Coef = -0,0070; -1,6%), aumentou de 13,70 a 21,61 por 100 mil habitantes no Norte (Coef = 0,0192; 4,5%) e nas regiões Sul, Sudeste e Centro-oeste houve tendência estável. Verificou-se tendência crescente de internações entre as mulheres (Coef = 0,0136; 3,2%), e por transtornos do humor [afetivos] (0,0266; 6,33%) e outros transtornos mentais e comportamentais (0,0295; 7,03%). Conclusão Estudos epidemiológicos como este ajudam a fornecer informações úteis para o planejamento de serviços de prevenção e tratamento primário, secundário e terciário voltados à saúde mental, especialmente entre crianças e adolescentes.