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A multicenter evaluation of leprosy rapid test fast ML Flow hanseníase in Brazil
(2025) Saavedra, Djairo Pastor; Nobre, Mauricio Lisboa; Guimarães, Rafael Alves; Fogaça, Matheus Bernardes Torres; Goulart, Isabela Maria Bernardes; Barreto, Jaison Antônio; Souza, Vânia Nieto Brito de; Jeronimo, Selma Maria Bezerra; Amorim, Francianne Medeiros; Silva, Tatiana Pereira da
Purpose Leprosy represents a public health concern; its diagnosis remains clinical. Recently, the Brazilian public health system/SUS incorporated the leprosy-specific IgM anti-PGL-I rapid test Fast ML Flow Hanseníase (MLFH/Bioclin, Brazil; originally ML Flow) to aid leprosy contacts surveillance and diagnosis. Anti-PGL-I antibody levels correlate with bacterial load. This multicenter study evaluated MLFH performance in confirmed leprosy cases from four Brazilian reference centers. Methods MLFH results were compared to anti-PGL-I ELISA, bacilloscopy/BI and analyzed in indeterminate/I, pure neuritic/PN and in Ridley Jopling/RJ categories (tuberculoid/TT, borderline-tuberculoid/BT, borderline/BB, borderline-lepromatous/BL, lepromatous/LL). Leprosy patients’ serum samples (N = 158; 95 multibacillary/MB, 63 paucibacillary/PB) were evaluated. Additionally, 20 previously tested leprosy samples were distributed to each center to assess MLFH repeatability, inter-center and inter-operator reproducibility. Results Higher MLFH seropositivity (84.8%) compared to ELISA (60.8%; p < 0.001) and bacilloscopy (50.6%; p < 0.001), indicated moderate and fair agreement, respectively. Visual intensity readings (0 to 4 + range) from 20 samples showed excellent agreement (ICC: 0.954); test repeatability was 95.57%. Compared to ELISA and bacilloscopy, positivity difference was statistically significant (p < 0.05) in TT, BT, and I forms. Lower MLFH positivity was observed in indeterminate, BT and PN forms. Conclusion The change in MLFH result criteria adopted by Bioclin/SUS considering faint test line (0.5) as positive (originally negative in ML Flow), increased MLFH sensitivity leading to higher seropositivity in MB and especially in PB, known as weak antibody producers. However, when screening asymptomatic leprosy contacts, this modified criterion may lead to reduced specificity since in endemic areas, anti-PGL-I positivity alone does not necessarily indicate active disease.
Characterising acute and chronic care needs: insights from the Global Burden of Disease Study 2019
(2025) Anza-Ramirez, Cecilia; Miranda, J. Jaime; Armocida, Benedetta; Correia, Jorge César; Spal , Harriette Gillian Christine Van; Beran, David; Aali, Amirali; Abate, Kalkidan Hassen; Abate, Semagn Mekonnen; Abbafati, Cristiana; Guimarães, Rafael Alves
Chronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global Burden of Diseases Study 2019 were classified into acute or chronic care categories. Data were analysed by age, sex, and socio-demographic index, presenting total numbers and contributions to burden metrics such as Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLD), and Years of Life Lost (YLL). Approximately 68% of DALYs were attributed to chronic care, while 27% were due to acute care. Chronic care needs increased with age, representing 86% of YLDs and 71% of YLLs, and accounting for 93% of YLDs from sequelae. These findings highlight that chronic care needs far exceed acute care needs globally, necessitating health systems to adapt accordingly.
Acidentes com material biológico durante limpeza de produtos para saúde na Enfermagem
(2025) Trindade, Júnnia Pires de Amorim; Guimarães, Rafael Alves; Tipple, Anaclara Ferreira Veiga
Objective: To assess incidence and factors associated with occupational accidents involving biological material that occur during the cleaning of reusable medical devices among nursing staff in Brazil. Methods: This is a retrospective cohort study conducted between 2015 and 2019. The population was divided into two groups for comparison purposes, one composed of professionals who suffered accidents while cleaning reusable medical devices and the other composed of professionals who suffered accidents under other circumstances. The study data were extracted from the Notifiable Diseases Information System (number of accidents) and the Brazilian National Registry of Health Establishments (number of professionals). The factors associated with the incidence of occupational accidents involving biological material (dependent variable) during the cleaning of reusable medical devices were analyzed using multiple Poisson regression. Results: The mean incidence rate of occupational accidents involving biological material was 115.0 cases per 100,000 nursing professionals between 2015 and 2020, and, among nursing technicians, the incidence was 151.6 cases per 100,000 professionals. For nursing professionals, it was found that the risk of accidents was 2.49 times higher in percutaneous exposure. The risk of accidents was 1.87 times higher when the material involved was blood. The risk increased even more when the device involved was a blade/blood lancet and others. Conclusion: The incidence rate was high and was associated with demographic, work-related and accident-related factors. Resumen Objetivo: Evaluar la incidencia y los factores asociados a los accidentes de trabajo con material biológico ocurridos durante la limpieza de productos para la salud por profesionales de equipos de enfermería en Brasil. Métodos: Estudio de cohorte retrospectivo realizado entre 2015 y 2019. La población fue dividida en dos grupos para fines comparativos, uno con profesionales que sufrieron accidentes durante la limpieza de productos para la salud y el otro grupo con profesionales que se accidentaron en otras circunstancias. Los datos del estudio se extrajeron del Sistema de Información de Agravios de Notificación (número de accidentes) y del Registro Nacional de Establecimientos de Salud (número de profesionales). Se analizaron los factores asociados a la incidencia de accidentes de trabajo con material biológico (variable dependiente) durante la limpieza de productos para la salud mediante la regresión de Poisson múltiple. Resultados: El índice promedio de incidencia de accidentes de trabajo con material biológico fue de 115,0 casos cada 100.000 profesionales de enfermería entre 2015 y 2020; y entre los técnicos de enfermería, la incidencia fue de 151,6 casos cada 100.000 profesionales. Se verificó que el riesgo de accidentes fue 2,49 veces más grande en exposiciones precutáneas entre los profesionales de enfermería. El riesgo de accidentes fue 1,87 veces más grande cuando el material era sangre. El riesgo aumentó más cuando el agente eran hojas/lancetas y otros agentes. Conclusión: El índice de incidencia fue alto y se asoció a los factores demográficos, laborales y relacionados con el accidente.
Retrospective study of immunization errors reported in an online Information System
(2020) Barboza, Tânia Cristina; Guimarães, Rafael Alves; Gimenes, Fernanda Raphael Escobar; Silva, Ana Elisa Bauer de Camargo
to analyze the immunization errors reported in an online Information System. Method: retrospective study conducted with data from the Adverse Event Following Immunization Surveillance Information System. Immunization errors were analyzed with respect to demographic characteristics and the vaccination process. Frequencies and error incidence rates have been calculated. Binomial and chi square tests were used to verify differences in the proportions of the variables. Results: 501 errors were analyzed, the majority involving routine doses (92.6%), without Adverse Event Following Immunization (90.6%) and in children under five years old (55.7%). The most frequent types of errors were inadequacy in the indication of the immunobiological (26.9%), inadequate interval between doses (18.2%) and error in the administration technique (14.2%). The overall error incidence rate was 4.05/100,000 doses applied; the highest incidences of routine vaccines were for human rabies vaccine, human papillomavirus and triple viral; the incidence rate of errors with Adverse Events Following Immunization was 0.45/100,000 doses applied. Conclusion: it was found that immunization errors are a reality to be faced by the health systems, but they are amenable to prevention through interventions such as the adoption of protocols, checklists and permanent education in health.
Institutional strategies as a mechanism to rationalize the negative effects of the judicialization of access to medicine in Brazil
(2020) Guimarães, Virginia Oliveira Chagas; Provin, Mercia Pandolfo; Mota, Pedro Augusto Prado; Guimarães, Rafael Alves; Amaral, Rita Goreti
Background: Recently, the Executive Branch and Judiciary in Brazil increased spending due to larger numbers of lawsuits that forced the State to provide health goods and services. This phenomenon, known as health judicialization, has created challenges and required the Executive Branch and Judiciary to create institutional strategies such as technical chambers and departments to reduce the social, economic and political distortions caused by this phenomenon. This study aims to evaluate the effects of two institutional strategies deployed by a Brazilian municipality in order to cope with the economic, social and political distortions caused by the phenomenon of health judicialization regarding access to medicines. Methods: A longitudinal study was carried out in a capital in the Central-West Region of Brazil. A sample of 511 lawsuits was analyzed. The variables were placed into three groups: the sociodemographic characteristics and the plaintiffs’ disease, the characteristics of the claimed medical products and the institutional strategies. To analyze the effect of the interventions on the total cost of the medicines in the lawsuits, bivariate and multivariate linear regressions with variance were performed. For the categorical outcomes, Poisson regressions were performed with robust variance, using a significance level of 5%. Results: A reduction in the costs of medicines in the lawsuits and of the requests for medicines within the SUS formulary was verified after the deployment of the Department of Assessment of Nonstandardized Medicines (DAMNP) and the Technical Chamber of Health Assessment (CATS); an increase in processed prescriptions from the Brazilian Universal Health System was observed after the deployment of the CATS; and an increase in medicines outside the SUS formulary without a therapeutic alternative was verified after the CATS. Conclusion: The institutional strategies deployed were important tools to reduce the high costs of the medicines in the lawsuits. In addition, they represented a step forward for the State, provided a benefit to society and indicated a potential path for the health and justice systems of other countries that also face problems caused by the judicialization of health.
Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems
(2021) Cork, Michael A.; Henry, Nathaniel J.; Watson, Stefanie; Croneberger, Andrew J.; Baumann, Mathew; Letourneau, Ian D.; Yang, Mingyou; Serfes, Audrey L.; Abbas, Jaffar; Abbasi, Nooshin; Abbastabar, Hedayat; Guimarães, Rafael Alves
Background: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.
Mapping routine measles vaccination in low- and middle-income countries
(2021) Sbarra, Alyssa N.; Rolfe, Sam; Nguyen, Jason Q.; Earl, Lucas; Galles, Natalie C.; Marks, Ashley; Abbas, Kaja M.; Abbasi-Kangevari, Mohsen; Abbastabar, Hedayat; Abd-Allah, Foad; Abdelalim, Ahmed; Guimarães, Rafael Alves
The safe, highly efective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs)1–4 . Globally comparable, annual, local estimates of routine frst-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19)5–8 . Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantifed geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children.
Global, regional, and national mortality among young people aged 10–24 years, 1950–2019: a systematic analysis for the Global Burden of Disease study 2019
(2021) Ward, Joseph L.; Azzopardi, Peter S.; Francis, Kate Louise; Santelli, John S.; Skirbekk, Vegard; Sawyer, Susan M.; Nicholas J. Kassebaum; Mokdad, Ali H.; Hay, Simon I.; Abd-Allah, Foad; Abdoli, Amir; Abdollahi, Mohammad; Abedi, Aidin; Guimarães, Rafael Alves
Background Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10–24 years by age group (10–14 years, 15–19 years, and 20–24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10–24 years with that in children aged 0–9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10–24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). Findings In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39–1·59) worldwide in people aged 10–24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10–14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15–19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1–4 years (2·4%), and around a third less than in females aged 1–4 years (2·5%). The proportion of global deaths in people aged 0–24 years that occurred in people aged 10–24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%. Interpretation Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10–24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group.
Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease study 2019
(2021) Paulson, Katherine R.; Kamath, Aruna Maria; Alam, Tahiya; Bienhoff, Kelly; Abady, Gdiom Gebreheat; Abbas, Jaffar; Abbasi-Kangevari, Mohsen; Abbastabar, Hedayat; Abd-Allah, Foad; Abd-Elsalam, Sherief M.; Abdoli, Amir; Guimarães, Rafael Alves
Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in 2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05–10·30) in 2000 and 5·05 million (4·27–6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53–4·02]) in 2000 to 48% (2·42 million; 2·06–2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71–0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27–1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35–2·58; 37% [95% UI 32–43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress.
Epidemiology of tobacco use and nicotine dependence in truck drivers
(2022) Fernandes, Inaina Lara; Guimarães, Rafael Alves; Lucchese, Roselma; Vera, Ivânia; Brito, Rodolfo Pereira de; Ramos, Camila Borges; Marinho, Tamíris Augusto; Nunes, Patrícia Silva; Pinto, Henrique Senna Diniz; Amorim, Thiago Aquino
OBJECTIVE To investigate the epidemiology of tobacco use and nicotine dependence in a sample of truck drivers in Brazil. METHODS Between 2015 and 2016, a cross-sectional study was conducted on 624 truck drivers who operate on the BR-050 highway in Brazil. Participants were interviewed about sociodemographic data, occupational characteristics, mental health, behavioral data, and tobacco use. Then, the Fagerstrom test for nicotine dependence (FTND) was used to verify nicotine dependence in smoking truck drivers. Logistic regression and linear regression were also used to verify factors associated with tobacco use in the previous 30 days and nicotine dependence scores, respectively. RESULTS The prevalence of tobacco use among truck drivers was 21.1% (n = 132;95%CI: 18.1–24.5). Of the total number of smokers who responded to the FTND (n = 118; 89.4%), most had high/very high nicotinic dependence (68.6%; 95%CI: 59.8–76.3). Tobacco use was associated with absence of religion (adjusted odds ratio [AOR]: 2.60; 95%CI: 1.35–5.01), employment relationship of the contract (AOR = 1.98; 95%CI: 1.26–3.13); > 12 hours daily working time (AOR = 1.80; 95%CI: 1.09–2.98) and alcohol use in the previous 30 days (AOR = 2.92; 95%CI: 1.86–4.57). Irregular physical activity was associated with higher scores of nicotine dependence (β = 1.87; 95%CI: 0.55–3.19). CONCLUSION The results showed a high prevalence of tobacco use and high/very high nicotine dependence among the truck drivers.
A qualidade de serviços de atenção primária, a formação profissional e o Programa Mais Médicos em uma região de saúde do sudoeste goiano
(2020) Maia, Ludmila Grego; Silva, Luiz Almeida da; Guimarães, Rafael Alves; Pelazza, Bruno Bordin; Leite, Giulena Rosa; Barbosa, Maria Alves
Introduction: Primary health care must assume the centrality of care so that health systems address and solve the health needs of the population. Objective: To evaluate the quality of primary health care from the perspective of health professionals, including those associated with the Mais Médicos Brasil Program, verifying associations between quality of services and professional qualification. Methodology: A cross-sectional study where interviews with health professionals were carried out. The quality of care was measured by means of interviews about the experience of doctors and nurses with the services, using the Primary Care Assessment Tool (PCATool Brasil). The presence and the extension of the primary health care attributes of the Southwest II region of Goiás state, constituted by 10 municipalities, were investigated. Results: The lowest APS Overall Score was for the first contact access attribute (3.71). The bivariate analysis showed statistical difference between the variables profession and the essential, derived and general scores. Doctors of the More Doctors Program had higher average scores (7,68 essential; 9,11 derivative; 8,04 general) when compared to other medical professionals and nurses. Conclusions: The findings highlight the importance of permanent evaluation of health services, especially primary care, due to its importance and centrality to the organization of other levels of care. Only from this monitoring is possible a better management orientation for strategic and resolutive investments.
Bacterial vaginosis and cervical human papillomavirus infection in young and adult women: a systematic review and meta-analysis
(2022) Martins, Bruno César Teodoro; Guimarães, Rafael Alves; Alves, Rosane Ribeiro Figueiredo; Saddi, Vera Aparecida
OBJECTIVE: To investigate the association between bacterial vaginosis and cervical human papillomavirus (HPV) infection in young and adult women. METHODS: This systematic review and meta-analysis was based on the Prisma methodological guidelines. PubMed and Web of Science were searched using the following descriptors: “bacterial vaginosis and HPV”, in June 2019. Articles published from 2012 to 2019 were included. Inclusion criteria were original studies that investigated the association between bacterial vaginosis and cervical HPV infection; articles published in English, Spanish or Portuguese; studies conducted in young and adult, non-pregnant, non-HIV-infected women; studies that used the Nugent criteria for the diagnosis of bacterial vaginosis and studies in which the detection of HPV used the polymerase chain reaction technique. Assembled data, odds ratio (OR) and respective 95% confidence intervals (95%CI) were estimated for the association between bacterial vaginosis and cervical HPV infection using random-effects models. A bilateral value of p < 0.05 was considered statistically significant. RESULT: Six studies were selected for analysis and demonstrated association between bacterial vaginosis and cervical HPV infection (OR = 2.68; 95%CI: 1.64–4.40; p < 0.001). CONCLUSION: Bacterial vaginosis was considered a risk factor for cervical HPV infection, since women with bacterial vaginosis were more likely to be infected with HPV.
Access and use of health services by people with diabetes from the item response theory
(2022) Siqueira, Isabela Silva Levindo de; Guimarães, Rafael Alves; Pagotto, Valéria; Rosso, Claci Fátima Weirich; Batista, Sandro Rogerio Rodrigues; Barbosa, Maria Alves
The objective of this study was to analyze the indicators of access and use of health services in people with diabetes mellitus. This study used data from the National Health Survey, conducted in Brazil in 2013. The National Health Survey was carried out with adults aged 18 years or older residing in permanent private households in Brazil. Indicators from 492 individuals with self-reported diabetes mellitus living in the Central–West region of the country were analyzed. Item response theory was used to estimate the score for access to and use of health services. Multiple linear regression was used to analyze factors associated with scores of access and use of health services by people with diabetes mellitus. The mean score of access estimated by the item response theory and use estimated was 51.4, with the lowest score of zero (lowest access and use) and the highest 100 (highest access and use). Among the indicators analyzed, 74.6% reported having received medical care in the last 12 months and 46.4% reported that the last visit occurred in primary care. Only 18.9% had their feet examined and 29.3% underwent eye examinations. Individuals of mixed-race/skin color and those residing outside capital and metropolitan regions had lower access and use scores when compared to white individuals and residents of state capitals, respectively. The study shows several gaps in the indicators of access and use of health services by people with diabetes. People of mixed race/skin color and residents outside the capitals and metropolitan regions had lower scores for access and use, suggesting the need to increase health care in these groups.
Mortality risk factors for coronavirus infection in hospitalized adults in Brazil: a retrospective cohort study
(2022) Guimarães, Rafael Alves; Pinheiro, Raquel Silva; Paula, Hellen da Silva Cintra de; Araújo, Lyriane Apolinário de; Gonçalves, Ingrid Aline de Jesus; Pedroso, Charlise Fortunato; Guilarde, Adriana Oliveira; Oliveira, Geraldo Andrade de; Batista, Karla de Aleluia
Background: The COVID-19 pandemic has presented high morbidity and mortality, with associated high socioeconomic costs. Brazil ranks third in the number of COVID-19 cases, behind only India and the United States. Objective: To analyze risk factors for mortality in adults hospitalized with COVID-19 in Brazil. Methods: Observational retrospective cohort study including data from all Brazilian states and regions. The study included information from 468,226 in-hospital patients from all regions of Brazil from 1 January 2021 to 31 July 2021. Data from the influenza epidemiological surveillance system were used. The participants were adults hospitalized with COVID-19. A Cox regression model was used to analyze factors associated with mortality in adults with COVID-19. Results: The in-hospital mortality lethality was 37.5%. The risk factors associated with COVID-19 mortality were older age, with a linear increase with increments in age, male sex, black or mixed race, low education level, comorbidities, use of ventilatory support, and living in the southeast, north, or northeast regions of the country. Conclusions: Our results illustrate the severity of the COVID-19 pandemic in Brazil and reinforce that policies and practices to deal with this disease should focus on groups and regions with higher risk, whereas public policies should promote nonpharmacological measures and vaccination in the Brazilian population.
Reproductive desire in women living with HIV/AIDS with serodiscordant partners
(2022) Souza, Marise Ramos de; Guimarães, Rafael Alves; Amaral, Waldemar Naves do; Cunha, Vanessa Elias da; Moura, Brenner Dolis Marretto de; Brunini, Maria Alves Barbosa Sandra Maria
Objective: To estimate the prevalence and factors associated with reproductive desire in a sample of women living with HIV/AIDS (WLHA) with serodiscordant partners. Study design: Between September 2015 and August 2016, a cross-sectional study was conducted among 110 WLHA from HIV/AIDS treatment services and non-governmental organizations. An interview was con ducted using a structured questionnaire to collect sociodemographic data, reproductive desire, and potential predictor variables. Poisson regression was used to analyze the factors associated with reproductive desire in the sample. Results: The prevalence of reproductive desire was 32.7% (95% Confidence Interval: % CI: 24.7–42.0%). In regression analysis, we observed an association between reproductive desire and the following variables: age < 30 years; relationship time < 2 years; repro ductive desire for the partner; and absence of children. Conclusions: The prevalence of reproductive desire in the investigated sample was relatively high. Young age and reproductive desire for the partner were the main associated factors.
Burden of diabetes and hyperglycaemia in adults in the Americas, 1990–2019: a systematic analysis for the Global Burden of Disease study 2019
(2022) Cousin Sobrinho, Ewerton Luiz Porto; Schmidt, Maria Inês; Ong, Kanyin Liane; Lozano, Rafael; Afshin, Ashkan; Abushouk, Abdelrahman I.; Agarwal, Gina; Agudelo-Botero, Marcela; Al-Aly, Ziyad; Alcalde Rabanal, Jacqueline Elizabeth; Guimarães, Rafael Alves
Background High prevalence of diabetes has been reported in the Americas, but no comprehensive analysis of diabetes burden and related factors for the region is available. We aimed to describe the burden of type 1 and type 2 diabetes and that of hyperglycaemia in the Americas from 1990 to 2019. Methods We used estimates from GBD 2019 to evaluate the burden of diabetes in adults aged 20 years or older and high fasting plasma glucose in adults aged 25 years or older in the 39 countries and territories of the six regions in the Americas from 1990 to 2019. The main source to estimate the mortality attributable to diabetes and to chronic kidney disease due to diabetes was vital registration. Mortality due to overall diabetes (ie, diabetes and diabetes due to chronic kidney disease) was estimated using the Cause of Death Ensemble model. Years of life lost (YLLs) were calculated as the number of deaths multiplied by standard life expectancy at the age that the death occurred, years lived with disability (YLDs) were estimated based on the prevalence and severity of complications of diabetes. Disability-adjusted life-years (DALYs) were estimated as a sum of YLDs and YLLs. We assessed the association of diabetes burden with the level of development of a country (according to the Socio-demographic Index), health-care access and quality (estimated with the Healthcare Access and Quality Index), and diabetes prevalence. We also calculated the population attributable fraction (PAF) of diabetes burden due to each of its risk factors. We report the 95% uncertainty intervals for all estimates. Findings In 2019, an estimated total of 409 000 (95% uncertainty interval 373 000–443 000) adults aged 20 years or older in the Americas died from diabetes, which represented 5·9% of all deaths. Diabetes was responsible for 2266 (1930–2649) crude DALYs per 100 000 adults in the Americas, and high fasting plasma glucose for 4401 DALYs (3685–5265) per 100000 adults, with large variation across regions. DALYs were mostly due to type 2 diabetes and distribution was heterogeneous, being highest in central Latin America and the Caribbean and lowest in high-income North America and southern Latin America. Between 1990 and 2019, age-standardised DALYs due to type 2 diabetes increased 27·4% (22·0–32·5). This increase was particularly high in Andean Latin America and high-income North America. Burden for both type 1 and type 2 diabetes across countries increased with higher diabetes prevalence and decreased with greater Socio-demographic and Healthcare Access and Quality Indices. Main risk factors for the burden were high BMI, with a PAF of 63·2% and dietary risks, with a PAF of 27·5%. The fraction of burden due to disability has increased since 1990 and now represents nearly half of the overall burden in 2019. Interpretation The burden of diabetes in the Americas is large, increasing, heterogeneous, and expanding. To confront the rising burden, population-based interventions aimed to reduce type 2 diabetes risk and strengthening health systems to provide effective and cost-efficient care for those affected are mandatory.
Prevalência de diabetes mellitus autorreferido e fatores associados em população rural e tradicional de Goiás: estudo transversal
(2022) Mota, Brenda Godoi; Barp, Milara; Guimarães, Rafael Alves; Rosso, Claci Fátima Weirich; Rocha, Bárbara Souza; Nunes, Cynthia Assis de Barros; Pagotto, Valéria
Objective: To identify the prevalence of and factors associated with diabetes mellitus in rural traditional communities. Methods: Cross-sectional study carried out in 115 rural communities distributed in 45 municipalities in the state of Goiás, including: 13 river communities, 51 quilombolas and 63 agrarian reform settlements. Probabilistic sampling was performed, and participants were selected at random. The outcome variable was self reported diabetes mellitus, while exposure variables were sociodemographic, lifestyle, health conditions and access to health services. Multiple regression was used to determine the association between study variables. Results: Among the 2,537 participants, the overall prevalence of diabetes was 9.8%, with 13.5% in river dwellers, 10.0% in quilombolas and 9.3% in settlers. Factors associated with diabetes were negative self-perception of health, being a former smoker, high blood pressure, hypercholesterolemia, and living in a river community. Conclusion: The results reinforce the need to strengthen strategies for the prevention and control of diabetes and its complications in rural populations, especially among river dwellers.
Analysis of the impact of coronavirus disease 19 on hospitalization rates for chronic non communicable diseases in Brazil
(2022) Guimarães, Rafael Alves; Policena, Gabriela Moreira; Paula, Hellen da Silva Cintra de; Pedroso, Charlise Fortunato; Pinheiro, Raquel Silva; Itria, Alexander; Braga Neto, Olavo de Oliveira; Teixeira, Adriana Melo; Silva, Irisléia Aires; Oliveira, Geraldo Andrade de; Batista, Karla de Aleluia
Background The coronavirus disease (COVID-19) pandemic has impacted health services and health care systems worldwide. Studies have shown that hospital admissions for causes related to chronic non-communicable diseases (NCDs) have decreased significantly during peak pan demic periods. An analysis of the impact of the COVID-19 pandemic on hospital admissions for NCDs is essential to implement disability and mortality mitigation strategies for these groups. Therefore, this study aimed to analyze the impact of the COVID-19 pandemic on hospital admissions for NCDs in Brazil according to the type of NCD, sex, age group, and region of Brazil. Methods This is an ecological study conducted in Brazil. Data on hospital admissions from January 1, 2017 to May 31, 2021 were extracted from the Unified Health System’s Hospital Admissions Information System. The hospital admission rates per 100,000 thousand inhabitants were calculated monthly according to the type of NCD, sex, age group, and region of Brazil. Pois son regression models were used to analyze the impact of the COVID-19 pandemic on the number of hospital admissions. In this study, the pre-pandemic period was set from January 1, 2017 to February 29, 2020 and the during-pandemic from March 1, 2020 to May 31, 2021. Results There was a 27.0% (95.0%CI: -29.0; -25.0%) decrease in hospital admissions for NCDs after the onset of the pandemic compared to that during the pre-pandemic period. Decreases were found for all types of NCDs—cancer (-23.0%; 95.0%CI: -26.0; -21.0%), dia betes mellitus (-24.0%; 95.0%CI: -25.0%; -22.0%), cardiovascular diseases (-30.0%; 95.0% CI: -31.0%; -28.0%), and chronic respiratory diseases (-29.0%; 95.0%CI: -30.0%; -27.0%). In addition, there was a decrease in the number of admissions, regardless of the age group, sex, and region of Brazil. The Northern and Southern regions demonstrated the largest decrease in the percentage of hospital admissions during the pandemic period. Conclusions There was a decrease in the hospitalization rate for NCDs in Brazil during the COVID-19 pandemic in a scenario of social distancing measures and overload of health services.
Global, regional, and national burden of diseases and injuries for adults 70 years and older: systematic analysis for the Global Burden of Disease 2019 study
(2022) Tyrovolas, Stefano; Stergachis, Andy; Krish, Varsha Sarah; Chang, Angela Y.; Skirbekk, Vegard; Dieleman, Joseph L.; Chatterji, Somnath; Abd-Allah, Foad; Abdollahi, Mohammad; Abedi, Aidin; Abolhassani, Hassan; Guimarães, Rafael Alves
Objectives To use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) to estimate mortality and disability trends for the population aged ≥70 and evaluate patterns in causes of death, disability, and risk factors. Design Systematic analysis. Setting Participants were aged ≥70 from 204 countries and territories, 1990-2019. Main outcomes measures Years of life lost, years lived with disability, disability adjusted life years, life expectancy at age 70 (LE- 70), healthy life expectancy at age 70 (HALE-70), proportion of years in ill health at age 70 (PYIH-70), risk factors, and data coverage index were estimated based on standardised GBD methods. Results Globally the population of older adults has increased since 1990 and all cause death rates have decreased for men and women. However, mortality rates due to falls increased between 1990 and 2019. The probability of death among people aged 70-90 decreased, mainly because of reductions in non communicable diseases. Globally disability burden was largely driven by functional decline, vision and hearing loss, and symptoms of pain. LE-70 and HALE- 70 showed continuous increases since 1990 globally, with certain regional disparities. Globally higher LE-70 resulted in higher HALE-70 and slightly increased PYIH-70. Sociodemographic and healthcare access and quality indices were positively correlated with HALE-70 and LE-70. For high exposure risk factors, data coverage was moderate, while limited data were available for various dietary, environmental or occupational, and metabolic risks. Co nclusions Life expectancy at age 70 has continued to rise globally, mostly because of decreases in chronic diseases. Adults aged ≥70 living in high income countries and regions with better healthcare access and quality were found to experience the highest life expectancy and healthy life expectancy. Disability burden, however, remained constant, suggesting the need to enhance public health and intervention programmes to improve wellbeing among older adults.
Negative self-assessment of health in women: association with sociodemographic characteristics, physical inactivity and multimorbidity
(2022) Santos, Thays Angélica de Pinho; Guimarães, Rafael Alves; Pagotto, Valéria; Aredes, Natália Del' Angelo; Siqueira, Isabela Silva Levindo de; Rocha, Suiany Dias; Carrijo, Clarissa Irineu de Sousa; Rosso, Claci Fátima Weirich
Introduction: Women present a higher prevalence of negative self-assessment of health (NSAH) when compared to men. However, there is a gap in the literature of factors associated with NSAH in women from developing countries such as Brazil. In addition, few studies have assessed the magnitude of the association between multimorbidity and NSAH in this population. Thus, the aim of this study was to evaluate the association between NSAH and sociodemographic characteristics, lifestyle and multimorbidity in women from the Midwest region of Brazil. Methods: A study based on data from the National Health Survey, a household survey that investigated health situation, lifestyle and risk factors for chronic diseases in the adult population of Brazil, was held. Sampling was performed in multiple stages. The selected women answered a standardized questionnaire on sociodemographic data, self-assessment of health and potential determinants. Poisson regression was used to analyze the association between NSAH and sociodemographic characteristics, lifestyle and multimorbidity. A significance level of 0.05% was established. Results: The study included 4233 women. The prevalence of NSAH found was 6.0% (95% Confidence Interval [95% CI]: 5.1–7.0%). There was an association between NSAH and advancing age, low schooling, physical inactivity and multimorbidity. Furthermore, there was an association between NSAH and diseases/disorders such as chronic back pain, systemic arterial hypertension, mental disorders, depression, cardiovascular diseases, stroke, cancer, hypercholesterolemia and diabetes mellitus. Conclusion: The prevalence of NSAH was low. A strong association was found between this variable and multimorbidity. In addition, increased age, low schooling and physical inactivity were predictors of NSAH in women.

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