Geographic Regions Of Brazil Research Articles

Changes in dietary markers during the covid-19 pandemic in Brazil.

Evaluate changes in the Brazilian population's diet and its determinants during the covid-19 pandemic. We used diet data collected by the Datafolha Institute in 2019 (n = 1,384), 2020 (n =1,214), and 2021 (n = 1,459) from independent and representative samples of the adult population (aged 18 to 55 years) from all socioeconomic classes and geographic regions of Brazil. Food consumption was measured by checking the consumption of 22 sets of food on the day before the survey. The third cycle also included questions about changes in eating habits during the pandemic. We estimated the prevalence of consumption of the food sets in each cycle of the survey and used statistical tests for comparisons of proportions between the three cycles. Between 2019 and 2020, we observed a significant increase in the consumption of cereals, milk, packaged snacks or salty cookies, and industrialized sauces, as opposed to a decrease in the consumption of eggs. Between 2019 and 2021 and between 2020 and 2021, on the other hand, there was a significant decrease in the consumption of cereals, vegetables, fruits, and industrialized fruit juices and an increase in the consumption of soda, sweets, cookies, sausages, industrialized sauces, and ready meals. When asked about the main changes in the purchase and preparation of meals, 46.3% of the respondents reported consuming more food prepared at home during the pandemic. Regarding changes in eating habits, 48.6% of the respondents reported a change in their eating habits during the pandemic. The main reasons for such changes were greater concern with health (39.1%) and self-reported decreased family income (30.2%). The covid-19 pandemic had a negative impact on the diet of the population, and increased consumption of ultra-processed foods was reported for that period.

Molecular detection and characterization of SARS-CoV-2 in cats and dogs of positive owners during the first COVID-19 wave in Brazil

Despite previous reports of SARS-CoV-2 infection in dogs and cats worldwide, the type of swab sample used for its detection through RT-qPCR needs to be better compared and described. Accordingly, as part of a multicenter study in Brazil, the aim of the present study was to assess which rectal or oropharyngeal swabs would be more appropriate for detecting SARS-CoV-2 in cats and dogs, through viral load comparison. Pets of owners diagnosed with COVID-19 in the last 7 days were eligible. A total of 148 animals from four of the five Brazilian geographical regions were analyzed, among which 10/48 cats (20.83%) and 11/100 dogs (11.00%) were positive. The results suggested that oropharyngeal swabs should be considered for SARS-CoV-2 detection, particularly in cats, due to the higher cDNA viral load. Also, the genomic results showed similarities between SARS-CoV-2 animal variants and human variants that were circulating at the time of sampling, thus corroborating the existence of zooanthroponotic transmission. In conclusion, the present study highlighted the importance of SARS-CoV-2 monitoring among cats and dogs, as virus modification may indicate the possibility of mutations in animals and spillover back to owners. Thus, positive individuals should always self-isolate from their pets during COVID-19, to prevent trans-species transmission and mutation.

Associations between anxiety disorders and depression symptoms are related to 24-hour movement behaviors among Brazilian adolescents

BackgroundWe tested whether 24-hour movement behaviors modified the effect of the association between anxiety and depression symptoms among adolescents. MethodsThis cross-sectional study included 4141 adolescents aged 15 to 19 years (50.0 % females) across all Brazilian geographic regions. Using self-reported data, 4.4 % (n = 180) reported having been diagnosed with anxiety disorders. We used the Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. Accruing moderate-vigorous physical activity during leisure time, <3 h/day of recreational screen, and good sleep quality were the exposures investigated. We evaluated interactions between anxiety and movement behaviors in the association with depression symptoms adjusted by covariates. ResultsAdolescents diagnosed with anxiety who met two (B: –4.93; 95%CI: −6.43; −3.44) or three (B: –5.71; 95%CI: −7.85; −3.57) movement behavior targets, and adolescents without diagnosis of anxiety who met one (B: –6.97; 95%CI: −8.15; −5.79), two (B: –8.21; 95%CI: −9.38; −7.03), or three (B: –8.46; 95%CI: −9.66; −7.27) of the movement behavior targets had lower PHQ-9 scores for depression symptoms than adolescents with anxiety who did not meet any of the movement behaviors. There was a significant interaction (B: –1.89; 95%CI: −3.24; −0.55) between anxiety disorders status and meeting the movement behavior targets. LimitationsThe cross-sectional design is a limitation. ConclusionsVariations in meeting movement behaviors modified the effect of the association between anxiety disorders status and depressive symptoms, with favourable modifications seen in adolescents without anxiety who met one, two or three of the movement behavior targets and in adolescents with anxiety who met two or three of the behaviors.

Brazilian teachers’ views and experiences regarding teaching biodiversity in an evolutionary and phylogenetic approach

BackgroundThe centrality of evolution to the biological sciences is recognized by many authors. Given the importance of evolution to biology, we intend to understand if, and how, science and biology teachers teach about biodiversity from an evolutionary perspective. In the first part of the research (Study 1), teachers from all geographic regions of Brazil (n = 147) answered a questionnaire containing both open-ended and Likert scale items in order to compare biodiversity-related contents to evolution. Considering the results obtained, a second study sought to analyze what challenges and possibilities Brazilian teachers who were enrolled in a continuing professional development course find in their classroom practices and the teaching materials they use when approaching cladograms while teaching about the diversity of organisms, as well as the experiences they had with cladograms during their education. These teachers responded to open-ended questionnaires concerning their experiences when learning and teaching about cladograms.ResultsFindings in Study 1 revealed that the concepts with the least emphasis among teachers were those related to macroevolution and phylogenetics. We found in Study 2 that teachers recognize cladograms as an important biological representation. In general, they approach it in biology and science classes, but often not relating it to topics concerning biodiversity. Teachers reported using multiple resources for teaching about cladograms, but textbooks were the most used teaching material. However, teachers reported that textbooks do not approach the theme sufficiently enough and mentioned it as a challenge. They also reported learning about phylogenetic content during teacher education but did not discuss aspects regarding teaching about cladograms.ConclusionsThese findings suggest that it is important that teacher education courses and new teaching materials consider the importance of cladograms and the specificities of phylogenetics within the teaching context.

THE ROLE OF ORAL AND MAXILLOFACIAL PATHOLOGY LABORATORIES IN THE ORAL CANCER DIAGNOSIS: A BRAZILIAN MULTICENTER STUDY

Objective To show the essential role of public oral and maxillofacial pathology laboratories (OMPLs) in the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC) in Brazil. Study Design This retrospective observational study was approved by the local research Ethics Committee. Cases diagnosed as lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were retrieved from the archives of fifteen OMPLs of all five Brazilian geographic regions. Patients´ clinical data were collected from their pathology forms. Results A total of 7,561 cases were received at each center with a mean of 756 ± 58.6 cases per year (2010-2019); among these, 11.9% (n=900) were lip SCC, 71% (n=5,369) were oral cavity SCC, and 17.1% (n=1,292) were oropharyngeal SCC. Most cases were incisional biopsies (89.6%; n=6,263). The average age of patients upon diagnosis was higher for lip cases (63.6 ± 13.7 years) compared to other sites. The schooling level was low for most patients, especially in lip SCC (61%). Conclusions The Brazilian OMPLs analyzed herein played an important role in the diagnosis of a large number of oral cancer cases in the last decade. To show the essential role of public oral and maxillofacial pathology laboratories (OMPLs) in the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC) in Brazil. This retrospective observational study was approved by the local research Ethics Committee. Cases diagnosed as lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were retrieved from the archives of fifteen OMPLs of all five Brazilian geographic regions. Patients´ clinical data were collected from their pathology forms. A total of 7,561 cases were received at each center with a mean of 756 ± 58.6 cases per year (2010-2019); among these, 11.9% (n=900) were lip SCC, 71% (n=5,369) were oral cavity SCC, and 17.1% (n=1,292) were oropharyngeal SCC. Most cases were incisional biopsies (89.6%; n=6,263). The average age of patients upon diagnosis was higher for lip cases (63.6 ± 13.7 years) compared to other sites. The schooling level was low for most patients, especially in lip SCC (61%). The Brazilian OMPLs analyzed herein played an important role in the diagnosis of a large number of oral cancer cases in the last decade.

IMPACT IN NOTIFIED SYPHILIS DIAGNOSIS DURING THE COVID-19 PANDEMIC IN BRAZIL

Objective This study aimed to compare the average number of syphilis cases reported in the five Brazilian geographic regions, from March to December from 2017 to 2019, and in the same period in 2020, the latter representing the period of the pandemic. Study Design In this descriptive study, data were extracted from a SUS public disease notification database. Results There was a significant increase in syphilis incidence rates per million inhabitants in all Brazilian macro-regions during the COVID-19 pandemic, reaching +157% in the Southeast. The average increase was +78% overall, representing an additional 161 incident cases per million inhabitants. In all stages of syphilis, oral changes are observed. In congenital syphilis, pathognomonic signs and the Hutchinson triad (interstitial keratitis, Hutchinson teeth, hearing loss) can appear. The data suggest that distancing measures in the pandemic period were not able to interfere with sexual behavior in Brazil. Conclusion The epidemiology of syphilis in Brazil, in the 2019 coronavirus pandemic (COVID-19), presents interferences. Studies are needed to plan health measures. FAPEMIG, CNPq, CAPES. This study aimed to compare the average number of syphilis cases reported in the five Brazilian geographic regions, from March to December from 2017 to 2019, and in the same period in 2020, the latter representing the period of the pandemic. In this descriptive study, data were extracted from a SUS public disease notification database. There was a significant increase in syphilis incidence rates per million inhabitants in all Brazilian macro-regions during the COVID-19 pandemic, reaching +157% in the Southeast. The average increase was +78% overall, representing an additional 161 incident cases per million inhabitants. In all stages of syphilis, oral changes are observed. In congenital syphilis, pathognomonic signs and the Hutchinson triad (interstitial keratitis, Hutchinson teeth, hearing loss) can appear. The data suggest that distancing measures in the pandemic period were not able to interfere with sexual behavior in Brazil. The epidemiology of syphilis in Brazil, in the 2019 coronavirus pandemic (COVID-19), presents interferences. Studies are needed to plan health measures.

WHODAS measurement properties for women with dysmenorrhea

BackgroundThere is an association of dysmenorrhea with human functioning and disability. However, no patient-reported outcome measure has been developed to assess this construct in women with dysmenorrhea. WHODAS 2.0 has been recognized as an important generic patient-reported outcome information of physical function and disability. Thus, the aim of this study was to assess the measurement properties of the WHODAS 2.0 in women with dysmenorrhea.MethodsThis is an online and cross-sectional study conducted with Brazilian women aged 14 to 42 years with self-report of dysmenorrhea in the last three months. According to COSMIN, structural validity was evaluated by exploratory and confirmatory factor analysis; internal consistency by Cronbach’s Alpha; measurement invariance by multigroup confirmatory factor analysis between geographic regions of Brazil; and construct validity by correlating WHODAS 2.0 to the Numerical Rating Scale for pain severity.ResultsOne thousand three hundred and eighty-seven women (24.7 ± 6.5 years) with dysmenorrhea participated in the study. WHODAS 2.0 presented a single factor by exploratory factor analysis and adequate model by confirmatory factor analysis (CFI = 0.924, TLI = 0.900, RMSEA = 0.038), excellent internal consistence (α = 0.892) for all items and an invariancy across geographic regions (ΔCFI ≤ 0.01 and ΔRMSEA < 0.015). Correlation between WHODAS 2.0 and numerical rating scale was positive and moderate (r = 0.337).ConclusionWHODAS 2.0 has a valid structure to assess functioning and disability related to dysmenorrhea in women.

Epidemiological Surveillance Reveals the Rise and Establishment of the Omicron SARS-CoV-2 Variant in Brazil.

The introduction of SARS-CoV-2 variants of concern (VOCs) in Brazil has been associated with major impacts on the epidemiological and public health scenario. In this study, 291,571 samples were investigated for SARS-CoV-2 variants from August 2021 to March 2022 (the highest peak of positive cases) in four geographical regions of Brazil. To identify the frequency, introduction, and dispersion of SARS-CoV-2 variants in 12 Brazilian capitals, VOCs defining spike mutations were identified in 35,735 samples through genotyping and viral genome sequencing. Omicron VOC was detected in late November 2021 and replaced the Delta VOC in approximately 3.5 weeks. We estimated viral load differences between SARS-CoV-2 Delta and Omicron through the evaluation of the RT-qPCR cycle threshold (Ct) score in 77,262 samples. The analysis demonstrated that the Omicron VOC has a lower viral load in infected patients than the Delta VOC. Analyses of clinical outcomes in 17,586 patients across the country indicated that individuals infected with Omicron were less likely to need ventilatory support. The results of our study reinforce the importance of surveillance programs at the national level and showed the introduction and faster dispersion of Omicron over Delta VOC in Brazil without increasing the numbers of severe cases of COVID-19.

Molecular detection of Burkholderia mallei in different geographic regions of Brazil.

Glanders is a contagious disease of equids caused by the Gram-negative bacterium Burkholderia mallei. In Brazil, the disease is considered to be reemerging and has been expanding, with records of equids with positive serology in most of the federative units. However, there are few reports describing the genotypic detection of the agent. This study demonstrated the detection of B. mallei by species-specific PCR directly from tissues or from bacterial cultures, followed by amplicon sequencing in equids (equines, mules, and asinines) with positive serology for glanders in all five geographic regions of Brazil. The molecular evidence of B. mallei infection in serologically positive equids in this study expands the possibility of strain isolation and the conduction of epidemiological characterizations based on molecular information. The microbiological detection of B. mallei in cultures from nasal and palate swabs, even in equids without clinical manifestations, raises the possibility of environmental elimination of the agent.

Serological survey of leptospirosis in horses with historical displacement through different geographic regions in Brazil

Leptospirosis has worldwide occurrence and shows higher incidence in tropical areas. Equines can present several serovars according to geographic region and it is important analyze de possible contribution of animal displacement on the Leptospira spp. strains occurrence. This research aimed to conduct a serological investigation in an equine regiment belonging to the Brazilian Army Guard Cavalry, resident in an urban area of Rio de Janeiro municipality, but with history of displacement between different regions in Brazil. A microscopic agglutination test was performed in a serum bank of 197 horses using 29 Leptospira spp. strains. The test showed 94.92% positivity, with 90.36% of the animals presenting a positive result for two or more serovars. Higher titers (?1:400) could be detected in 54.31% of horses for at least one serovar, whereas seropositivity for more than one bacterial type occurred mostly at lower titers (&lt;1:400). All animals were clinically healthy. Occurrence of serogroup Icterohaemorraghiae in urban areas was confirmed; however, equine serovars Bratislava and Australis presented low frequencies. The serovars Hardjo, Wolffi, and Canicola were detected, and indicated the presence of ruminants and dogs as reservoirs in proximity in some of the places frequented by the animals. It is suggested that travel history has contributed to the high frequency found and a possible greater contact with different types of Leptospira spp. Therefore, veterinarians should consider the history of geographic displacement and other animal species coexistence with horses when conducting their clinical investigation.

Milk and Dairy Consumption and Its Relationship With Abundance of Lactobacillus crispatus in the Vaginal Microbiota: Milk Intake and Vaginal Lactobacillus.

Diet habits, such as low milk and dairy intake, have been associated with bacterial vaginosis. Thus, the authors compared vaginal Lactobacillus crispatus abundances in women with different molecularly defined community state types (CSTs) according to the consumption of milk and/or dairy products. A total of 516 women from the 5 geographic regions of Brazil were included. Participants were interviewed with a structured questionnaire for assessment of milk and/or dairy intake. Vaginal samples were used for sequencing of V3-V4 regions of the 16S ribosomal RNA gene for further determination of L. crispatus relative abundance (RA) and clustering into 1 of the 5 CSTs (CSTI-CSTV), as firstly described by Ravel et al. (2011). The nonparametric Mann-Whitney test was used to compare L. crispatus RA within the most representative CSTs ( L. crispatus -dominant CSTI, Lactobacillus iners -dominant CSTIII, and Lactobacillus -depleted CSTIV) in this population, according to the frequency of milk and/or dairy intake. The prevalence of CSTI was 33.3% ( n = 172), CSTIII was 39% ( n = 201), and CSTIV was 27.7% ( n = 143). Among the participants with CSTIII, higher L. crispatus RA was observed for those who reported milk/dairy intake (median = 0.02; interquartile range = 0.01-0.09) than those with no consumption (median = 0.01; interquartile range = 0-0.03) ( p = .03). Such difference was not observed for participants with CSTI and CSTIV. Women with vaginal microbiota dominated by L. iners who consume milk and/or dairy present increased abundances of L. crispatus . Therefore, they could benefit from L. crispatus protective properties conferring greater temporal microbiota stability and, consequently, increased protection against infections.

Selective whole-genome amplification reveals population genetics of Leishmania braziliensis directly from patient skin biopsies.

In Brazil, Leishmania braziliensis is the main causative agent of the neglected tropical disease, cutaneous leishmaniasis (CL). CL presents on a spectrum of disease severity with a high rate of treatment failure. Yet the parasite factors that contribute to disease presentation and treatment outcome are not well understood, in part because successfully isolating and culturing parasites from patient lesions remains a major technical challenge. Here we describe the development of selective whole genome amplification (SWGA) for Leishmania and show that this method enables culture-independent analysis of parasite genomes obtained directly from primary patient skin samples, allowing us to circumvent artifacts associated with adaptation to culture. We show that SWGA can be applied to multiple Leishmania species residing in different host species, suggesting that this method is broadly useful in both experimental infection models and clinical studies. SWGA carried out directly on skin biopsies collected from patients in Corte de Pedra, Bahia, Brazil, showed extensive genomic diversity. Finally, as a proof-of-concept, we demonstrated that SWGA data can be integrated with published whole genome data from cultured parasite isolates to identify variants unique to specific geographic regions in Brazil where treatment failure rates are known to be high. SWGA provides a relatively simple method to generate Leishmania genomes directly from patient samples, unlocking the potential to link parasite genetics with host clinical phenotypes.

Ancestry, diversity, and genetics of health-related traits in African-derived communities (quilombos) from Brazil.

Brazilian quilombos are communities formed by enslaved Africans and their descendants all over the country during slavery and shortly after its abolition. Quilombos harbor a great fraction of the largely unknown genetic diversity of the African diaspora in Brazil. Thus, genetic studies in quilombos have the potential to provide important insights not only into the African roots of the Brazilian population but also into the genetic bases of complex traits and human adaptation to diverse environments. This review summarizes the main results of genetic studies performed on quilombos so far. Here, we analyzed the patterns of African, Amerindian, European, and subcontinental ancestry (within Africa) of quilombos from the five different geographic regions of Brazil. In addition, uniparental markers (from the mtDNA and the Y chromosome) studies are analyzed together to reveal demographic processes and sex-biased admixture that occurred during the formation of these unique populations. Lastly, the prevalence of known malaria-adaptive African mutations and other African-specific variants discovered in quilombos, as well as the genetic bases of health-related traits, are discussed here, together with their implication for the health of populations of African descent.

Estimates of genetic and phenotypic parameters for feeding behaviour and feed efficiency-related traits in Nelore cattle.

The objective of this study was to obtain (co)variance components, heritability, and genetic and phenotypic correlation estimates for feed efficiency and feed behaviour-related indicator traits. Further, it aimed to predict the direct and correlated responses for feed efficiency traits when selection was applied for feeding behaviour-related traits in Nelore cattle. Phenotypic records (n=4840) from 125 feed efficiency tests (RFI: Residual feed intake and DMI: Dry matter intake) carried out between 2011 and 2018 were considered in this study. Animals belonged to five farms located in two Brazilian geographical regions (Midwest and Southeast). Animals under similar management and environmental conditions in the feedlot were evaluated when they attained an average of 13.5± 4.15 months of age. Feed behaviour-related traits were also obtained, including meal criteria (MC), meal frequency (MF), average meal duration (AMD), meal duration (MD), average consumption per meal (ACM), and consumption rate (CR) through the GrowSafe System® electronic bunk system. The contemporary groups for all traits were composed of farm, management group, feed efficiency test, sex, and birth year. The (co)variance components were estimated using the restricted maximum likelihood method considering a multi-trait (n=8) animal model. The heritability estimates for RFI (0.23± 0.02), DMI (0.31± 0.02), MF (0.65± 0.02), AMD (0.29± 0.02), ACM (0.24± 0.02), MD (0.41± 0.02), MC (0.48± 0.02), and CR (0.42± 0.02) were moderate to high. The highest genetic correlation was obtained between CR and MD (-0.91 ± 0.04), MD and AMD (0.73± 0.03), CR and AMD (-0.68± 0.04), and RFI and DMI (0.81± 0.02). The highest phenotypic correlation was between ACM and AMD (0.76 ± 0.02), DMI and MD (0.77± 0.02), and DMI and RFI (0.77± 0.02). Genetic improvement for feed efficiency and feeding behaviour-related traits is feasible and the results obtained herein provided valuable information regarding the genetic background of Nelore feeding behaviour-related traits. The genetic association between feeding behaviour and feed efficiency-related traits suggested that animals spending less time feeding at a low feeding rate also had lower DMI and higher feed efficiency (RFI), and likely had lower energy maintenance requirements. The relative efficiency of selection showed that feeding behaviour-related traits were not adequate indicator traits to improve RFI and DMI. The DMI might be an effective selection criterion to improve RFI and reduce the herd's maintenance requirements.

Tendência temporal de procedimentos audiológicos no Sistema Único de Saúde

ABSTRACT Purpose: to analyze the time trend of audiological procedures in the Brazilian Public Health System (SUS) between 2008 and 2019 in the geographical regions of Brazil. Methods: a time series ecological study with data on audiological procedures from the SUS Outpatient Information System. The study calculated annual indices of audiological procedures with joinpoint regression for the trend analysis. The progress in the provision of procedures between the initial and final years in the series and the distribution of identified records was calculated. Results: altogether, 38,500,404 records were found in the study period. The South (178.84/10,000 inhabitants) and North of Brazil (130.97/10,000 inhabitants), respectively, had the highest and lowest mean procedure indices. Both were the only regions with a trend towards a significant increase in procedures. In Brazil, they increased by 56.91%, with an emphasis on the increase in “otoacoustic evoked emissions in neonatal hearing screening” and a decrease in “visual reinforcement audiometry (air/bone conduction).” In the distribution, procedures concentrated on basic audiological assessments. Conclusion: audiological procedures have increased at SUS, but there are discrepancies between procedures and geographical regions of Brazil.

Moonlighting and physician residents' compensation: is it all about money? A cross-sectional Brazilian study.

Moonlighting is a largely discussed, however under-explored, subject among physician residents. To analyze the frequency of moonlighting and its related factors. This cross-sectional study enrolled medical residents from all geographical regions of Brazil. A web-based structured closed-ended survey was applied that explored the frequency and type of moonlighting, residency programs characteristics, and psychological distress. The questionnaire was published on social networks. The completion rate was 71.4% (n = 1,419) and 37.7% were males aged 28.8 ± 3.2 (mean ± standard deviation) years, and 571 (40.2%) were post-graduate year (PGY) 1. There were residents from 50 medical specialties (the most common training area was clinical, 51.9%). A total of 80.6% practiced moonlighting, with an average weekly workload of 14.1 ± 9.4 h, usually overnight or in weekend shifts. Factors related to it were being PGY-2 or higher (adjusted odds ratio = 3.90 [95% confidence interval = 2.93-5.18], logistic regression), lower weekly residency duty hours (0.98 [0.97-0.99]), and a higher salary (1.23 [1.08-1.40]). In contrast, perception of a "fair/adequate" compensation was influenced by age (1.02 [1.01-1.02]), not being single (1.05 [1.01-1.10]), and residency duty hours (1.51 [1.22-1.88]). Depression, anxiety, diurnal somnolence scores, and work-personal life conflicts were not correlated with moonlighting status. Moonlighting frequency is high, and it is related to higher PGY, briefer residency duty hours, and the perception that remuneration should be higher. This study provides insights into the motivations for moonlighting and effort-reward imbalance.

Analysis of spatial evolution and factors associated with Covid-19 morbidity and mortality in the geographic regions of Brazil: an ecological study

Resumo Objetivo Este estudo analisou a evolução do padrão de distribuição espacial dos coeficientes de morbimortalidade por Covid-19 e fatores associados nas Regiões Intermediárias de Articulação Urbana do Brasil. Métodos Estudo ecológico com variáveis de bancos secundários, com dados de incidência e mortalidade por Covid-19 acumulados no intervalo de três meses, o que corresponde ao aumento das medidas de flexibilização do isolamento social. As variáveis independentes representaram fatores socioeconômicos. Foram realizadas análise de dependência espacial, regressão clássica e espacial. Resultados Houve um aumento da morbimortalidade por Covid-19 entre os dois períodos analisados. Foi encontrada uma autocorrelação positiva com formação de cluster em áreas de maior incidência de Covid-19 e com maior significância em Regiões Intermediárias de Articulação Urbana na região Norte do Brasil, com agrupamentos maiores em relação à mortalidade após a flexibilização das medidas de isolamento. A ocorrência da morbimortalidade apresentou associação significativa com variáveis étnicas com maiores coeficientes de determinação na região Norte. Conclusão Determinantes sociais demonstraram um comportamento preditivo no aumento da autocorrelação positiva para a mortalidade por Covid-19 durante os períodos observados, com aumento da morbimortalidade na região Norte após a flexibilização do isolamento social.

Construction of a nutritional assessment tool for the pediatric cancer population (ANPEDCancer): content validation using the Delphi method.

ABSTRACTObjective:To develop and establish content validation of a nutritional assessment tool for pediatric cancer patients using the Delphi method.Methods:A literature review was performed and the nutritional assessment in pediatrics and cancer construct was discussed with experts. Forty-six nutrition experts from Brazil with experience in oncology participated in the panel. Rounds were held to discuss and judge the items that should be included in this tool. With the aid of an algorithm, it was possible to simultaneously consider the adequacy, relevance and measurement of the items. The consensus was reached with an agreement equal to or greater than 80% among the experts.Results:From the 7 domains suggested by the literature, the first round generated 81 items, which were assessed for adequacy, relevance and the possibility of being measured in the routine of nutritional assessment, by specialists in the following two rounds. The percentage of specialists who responded to each round was high (above 90%) and the dropout rate between the stages was relatively low. After applying the algorithm, the ANPEDCancer tool had 36 items considered appropriate by specialists from the five different geographical regions of Brazil.Conclusions:The Delphi method allowed the construction and content validation of the nutritional assessment tool for children and adolescents with cancer, providing the first stage for use in the Brazilian hospital setting.

The financial impact of neonatal sepsis on the Brazilian Unified Health System

ObjectiveTo evaluate the hospital cost of newborn infants diagnosed with sepsis from the perspective of the Brazilian Public Health System over 11 years. MethodCross-sectional study that analyzed secondary data from the databases of the Hospital Information System of the Brazilian Public Health System. Infants hospitalized between 0‒29 days after birth with a diagnosis of sepsis from 2008 to 2018 were included. The diagnosis used in the study was the one that the hospital considered the main diagnosis at admission. Costs were analyzed in US dollars and reflected the amount paid by the Brazilian Public Health System to the hospitals for the informed diagnosis upon admission. The costs were evaluated as the total per admission, and they were compared among Brazilian geographic regions, among etiologic agents, and between neonates with the diagnosis of sepsis that survived or died. ResultsFrom 2008 to 2018, 47,554 newborns were hospitalized with sepsis (148.04 cases per 100,000 live births), with an average cost of US$ 3345.59 per hospitalization, ranging from US$ 2970.60 in the North region to US$ 4305.03 in the Midwest. Among sepsis with identified agents, the highest mean cost was related to Gram-negative agents, and the lowest to Streptococcus agalactiae sepsis. Patients with sepsis who died had a higher cost than the survivors (t-test; p = 0.046). ConclusionsThe evaluation of costs related to neonatal sepsis in the country during an 11-year period shows the economic impact of morbidity that may be avoided by improving the quality of neonatal care.

Correlation of TcII discrete typing units with severe chronic Chagas cardiomyopathy in patients from various Brazilian geographic regions.

Chagas disease (ChD) is caused by Trypanosoma cruzi. The genetic structure of the species is divided into seven distinct genetic groups, TcI to TcVI, and Tcbat, which have shown differences in terms of geographic distribution, biological properties, and susceptibility to drugs. However, the association between genetic variability and clinical forms of ChD has not yet been fully elucidated. The predominance of TcII and TcVI discrete typing units (DTUs) (genetic groups) is known to occur in several Brazilian regions and is associated with both the domestic and the wild cycles of ChD. Thus, this study aimed to verify the genotypes of the parasites present in 330 patients with chronic Chagas cardiomyopathy (CCC) from different Brazilian states attended at the Clinical Hospital of the Ribeirão Preto Medical School and to assess the existence of a correlation between the clinical forms with the main cardiovascular risk factors and the genetics of the parasite. All patients with CCC were clinically evaluated through anamnesis, physical examination, biochemical tests, 12-lead electrocardiogram, echocardiogram and chest X-ray. Peripheral blood (5 mL) was collected in guanidine/ethylenediaminetetraacetic acid from each patient for DNA extraction and real-time polymerase chain reaction (PCR) for Chagas disease and genotyping of the parasite in the 7 DTUs. Parasite genotyping was performed using conventional multilocus PCR. Samples of only 175 patients were positive after amplification of the specific genes contained in the T. cruzi genotyping criteria. TcII (64/175), TcVI (9/175), and TcI (3/175) DTUs were predominant, followed by TcII/TcV/TcVI (74/175), and TcII/TcVI (23/175). The TcIII and TcIV DTU´s was detected in only one sample of CCC patients. Our data corroborate previous findings, indicating the predominance of the TcII genotype in patients with CCC of Brazilian origin. Moreover, this study pioneered disclosing a direct correlation between the TcII DTU and severe CCC.