Health Macro-Region Research Articles

Congenital anomalies in Santa Catarina, Southern Brazil: macroregional and temporal birth prevalence for the period 2011-2020.

Congenital anomalies (CAs) are an important cause of infant mortality and efficient surveillance is necessary for their prevention. Therefore, the objective of this study is to establish baselines of prevalence at birth of priority CAs for surveillance in the state of Santa Catarina, using data from the Live Birth Information System considering the period 2011-2019 (baseline) and 2020 (pandemic year). The analyses were carried out based on the mother's residence health macroregion. The CAs were selected following the ICD-10 coding for chapter XVII. Birth prevalence was calculated per 10,000 live births and the confidence interval was established at 95%. 2011-2019 recorded 88.8/10,000 births with CAs (total). For 2011-2019, limb defects (without polydactyly) were the most prevalent (14.1/10,000), followed by congenital heart defects (8.9), oral clefts (8.2), polydactyly (7.9), Down syndrome (5.6), hypospadias (5.4), neural tube defects (4.7), gastroschisis (3.3), undefined sex (1.2), microcephaly (0.8) and omphalocele (0.3). There were no significant differences in temporal and spatial distribution. However, unusual fluctuations were observed in 2020, which may reflect the pandemic in CAs notifications. In the base period, Santa Catarina recorded CAs below the expected level of being identified at birth. With this, we conclude that the training and awareness of teams are essential for the surveillance of CAs in Santa Catarina.

FLUORIDATION AND DISPOSAL OF PUBLIC WATER SUPPLY IN THE MARANHÃO AMAZON

Objective: to investigate access and fluoridation of public water supplies in the state of Maranhão. Method: descriptive, direct documentary research, carried out in governmental databases in 2022, also on-site surveys involving 23 municipalities in Maranhão Amazon belonging to the health macro-region IV. The investigated aspects were: population supplied by water; raw water sources; responsible body; water fluoridation and data availability. Only 38% of the population in the macro-region have access to piped water, of which only 44% is treated, the service performed by the state company and those managed by the municipal body were equivalent (48%). 484 sources of collection were identified, 99% underground supplying 92% of the population, this dependence on groundwater reaches 63% throughout the state, surface collection occurs only in the main municipality (5%). Despite the index that 91% of indicator 6.1.1 of the SDGs, the high rural population and the low demographic density constitute a challenge for the expansion of access. No municipality performs artificial fluoridation and there are no records of fluoride levels or previous analyses. There is a direct relationship between a lower HDI and access to potable water. Conclusion: a small part of the population has access to treated water, therefore fluoridation is not guaranteed and the surveillance system needs to be improved.

Generalized anxiety disorder and associated factors in primary health care workers in Minas Gerais, Brazil.

The COVID-19 pandemic had direct and indirect impacts on public health, also affecting the mental health of the population. To analyze symptoms of generalized anxiety disorder (GAD) and associated factors, in primary health care (PHC) professionals. Cross-sectional and analytical study conducted with professionals who work in the Primary Health Care (PHC) of the Northern health macro-region of the state of Minas Gerais, Brazil. Data collection was carried out through an online, self-administered questionnaire, made available from August 27, 2021, to October 30, 2021 using the Google Forms tool. The questionnaire included sociodemographic questions as well as questions related to the history of anxiety and work during the pandemic. To assess anxiety symptoms, the General Anxiety Disorder-7 (GAD-7) instrument was used. Data treatment consisted of descriptive analysis of the variables, bivariate analysis followed by multivariate Poisson Regression with robust variance. 702 health professionals participated in the study and the general prevalence of GAD was 32.2%. Current anxiety symptoms were self-reported by 37.6% of the participants. In the final model, the associated factors identified were: female sex (PR = 1.82; 95% CI = 1.17-2.84; p = 0.007), previous symptoms (PR = 1.58; 95% CI = 1.19-2.10; p = 0.002) and (PR = 2.68; 95% CI = 2.00-3.62; p < 0.001) current self-reported anxiety. The results show the need to implement actions in mental health promotion and anxiety prevention, through the dissemination of information about mental health care, health education activities, encouraging the adoption of healthy habits and professional monitoring when necessary.

Detection of gestational and congenital syphilis in Paraná state, Brazil, 2007-2021: a time series analysis.

To describe temporal trends in the detection rates of gestational and congenital syphilis, by maternal age and health macro-region of the state of Paraná, Brazil, 2007-2021. This was a time-series study using surveillance data; the trend analysis was performed by means of joinpoint regression, and average annual percent change (AAPC) and 95% confidence intervals (95%CI) were estimated. An increase in statewide detection of gestational syphilis (AAPC = 21.7; 95%CI 17.7; 32.8) and congenital syphilis (AAPC = 14.8; 95%CI 13.0; 19.7) was found; an increase was also found in the health macro-regions, with the Northwest (gestational, AAPC = 26.1; 95%CI 23.4; 31.6) and North (congenital, AAPC = 23.8; 95%CI 18.8; 48.9) macro-regions standing out; statewide rising trends were observed for young women [gestational, AAPC = 26.2 (95%CI 22.4; 40.6); congenital, AAPC = 19.4 (95%CI 17.6; 21.8)] and adult women [gestational, AAPC = 21.3 (95%CI 16.9; 31.9); congenital, AAPC = 13.7 (95%CI 11.9; 19.3)]. Maternal and child syphilis detection rates increased in the state, regardless of maternal age and health macro-region. Increasing trends were found for the detection rates of gestational and congenital syphilis in Paraná state and its health macro-regions, including in the analysis stratified by maternal age group; however, there was a decline during the COVID-19 period. There is a need for strategic and immediate action by the state health services, focusing on expanding access and linkage to care, in order to ensure maternal and child well-being and reverse the rising trends observed. Prevention and control actions towards the elimination of syphilis are needed to overcome these obstacles, directing efforts towards strengthening health education, early detection and appropriate treatment for pregnant women and their partners.

Temporal analysis and spatial distribution of acquired syphilis in the state of Mato Grosso, Brazil, 2010-2021: an ecological study.

To analyze the temporal trend and the spatial distribution of acquired syphilis in Mato Grosso, Brazil, between 2010 and 2021. This was an ecological study using notifications of acquired syphilis held on the Notifiable Health Conditions Information System. Detection rates were calculated by health macro-region and three-year periods (2010-2012, 2013-2015, 2016-2018, 2019-2021). The jointpoint method was used to calculate annual percentage change (APC). Thematic maps of Bayesian rates were built and distribution was analyzed using Local Moran. The detection rate increased from 16.2 per 100,000 inhabitants in the first three-year period (2010-2012) to 70.0 in the last three-year period (2019-2021). The Central-North macro-region had the highest rate in the last three years (94.3/100,000 inhab.), while the highest upward trend occurred in the Central-Northwest macro-region, from 2013 to 2018 (APC = 50.2; 95%CI 26.3;78.6). There was an increase in Bayesian rates in most municipalities. There was a trend towards an increase in acquired syphilis, especially in the last two three-year periods.

Analysis of the completeness and consistency of records of violence against indigenous women in the health macro-region of Dourados, Mato Grosso do Sul state, Brazil, 2009-2020.

To analyze the temporal trend of completeness and consistency of data on notifications of violence against indigenous women in the health macro-region of Dourados, state of Mato Grosso do Sul, Brazil, between 2009 and 2020. An ecological time series study was conducted using data from the Notifiable Health Conditions Information System; Prais-Winsten regression was used to analyze the trend of data completeness and consistency, as well as the proportion of completed and coherent fields. A total of 2,630 cases were reported; completeness was found to be very poor in the variable "occupation" (48.9%) and poor in the variables "schooling" (68.3%) and "time of occurrence" (67.9%); in the analysis of temporal trends, only the variable "occupation" showed a decreasing trend (p = 0.045). The data analyzed demonstrated the need for improvement in the completeness of the variables "schooling", "occupation" and "time of occurrence" of the violent act. There was a progressive increase in notifications over the years. Most of the variables showed regular or excellent completeness and consistency. In the analysis of temporal trend, only the "occupation" variable showed a decreasing trend. Care for victims of violence is part of the daily routine of health services, and it is essential for health professionals to provide adequate compulsory notification for a comprehensive understanding of the victims' profile, thus assisting in addressing this issue. Further studies are needed to understand the factors associated with violence against indigenous women, which could help the development of health promotion actions and violence prevention strategies targeting these women.

Overview of dentists' coverage in health teams in the Northern Macroregion of Minas Gerais: analysis of determinant aspects

Objective: To survey the incidence of family health teams, oral health teams, and dental surgeons in the Northern Macroregion of Minas Gerais from 2008 to 2023. Methods: a quantitative and descriptive study was conducted between March and April 2023. The data used in this work refer to healthcare teams and collaborating professionals and were obtained from the DATASUS platform. The only inclusion criterion considered was the municipality belonging to the Northern Health Macroregion of Minas Gerais, according to the state’s Master Plan. Results: Of the 86 municipalities in the North Macroregion of Minas Gerais evaluated, 63 (73.2%) showed an increase in the number of oral health teams and dental surgeons in 2023 compared with 2008. An exponential increase was observed in the municipalities of Várzea da Palma (733.2%), Fruta de Leite (729.4%), and Francisco Dumont (550.3%). Conclusions: There was an increase in the number of oral health teams and family health teams in all municipalities, demonstrating a satisfactory distribution of dental surgeons in the public sector and concern for the population’s oral health on the part of public authorities.

Morbidity trend and space-time clusters of COVID-19 occurrence in children and adolescents

ObjectiveTo analyze the morbidity trend and space-time distribution clusters of confirmed COVID-19 cases in children and adolescents. MethodAn ecological study of COVID-19 cases confirmed in the Information System from 2020 to 2022 in the age group from 0 to 19 years old, residents in Mato Grosso municipalities, Brazilian Midwest region. A trend analysis of the monthly morbidity rate of cases/100,000 inhabitants was used, following Prais-Winsten's regression. A space-time distribution of the Bayesian incidence rate per 100,000 inhabitants was performed, in addition to a space-time scan to identify high-risk clusters. ResultsOf all 79,592 COVID-19 cases studied, 51.6% were in females and 44.21% in people aged 15–19 years old. The mean monthly rate was 265.87 cases per 100,000 inhabitants, with a stationary trend in the period analyzed (Monthly Percentage Variation [MPV]) = 12.15; CI95%[MPV]: -0.73;26.70). The morbidity rate due to COVID-19 was higher in the female gender (283.14/100,000 inhabitants) and in the age group from 15 to 19 years old (485.90/100,000 inhabitants). An increasing trend was observed with a greater monthly time variation of 14.42% (CI95%[MPV]: 1.28;29.28)] among those aged from 10 to 14 years old. The primary cluster, which was also the one with the highest Relative Risk (RR = 5,16, p-value = 0.001), included 19 municipalities located in the North health macro-region. ConclusionThe findings indicated a monthly stationary trend in the study population, an increase in the age group from 10 to 14 years old, and areas at a higher risk for the disease in the North health macro-region of the state.

Dimensão técnico-pedagógica na atuação dos Núcleos Ampliados de Saúde da Família e da Atenção Básica

ABSTRACT This study aim to analyze the performance of the Amplified Family Health Nucleus and Primary Care (Nasf-AB) from the perspective of the technical-pedagogical dimension, based on the contextual levels defined by Hind, Chaves and Cypress (1992). Conducted from 2016 to 2017, this is a multiple case study, carried out in three municipalities belonging to the health macro-region of Sobral, Ceará, Brazil. Information sources were documentary data (activity planning reports and photographic records), observation of the Nasf work process, following a structured script, and six focus groups with the Family Health (eSF) and Nasf teams. There was the need to reorganize the work management of teams, in order to overcome challenges such as communication and recognition of their roles, in order to improve the operationalization of actions, with the aim of strengthening integration and making progress in the construction of resolutive and quality policies and services.

Effects of climate variability on respiratory diseases in the Western Region of Bahia, Brazil

ObjectivesThis study aimed to analyse hospitalisations for respiratory diseases in the Western Region of Bahia, Northeast Brazil, from 2010 to 2019, and to explore possible correlations with meteorological data. Study designThis descriptive, epidemiological, ecological study analysed data from 37 municipalities in the Western Bahia health macro-region, defined according to geographical, administrative, demographic, epidemiological, social and cultural criteria, and accounting for availability of health resources. MethodsHospitalisation data for respiratory diseases, including total admissions and disease frequency, mean and prevalence, were obtained from DATASUS (Ministry of Health). The data were evaluated by sex, age group and city. Statistical tests, such as the Chi-squared test and analysis of variance, were used for data analysis. Meteorological data were compared using the t-test and Mann–Whitney test. Correlations between health indicators and weather data were assessed using the Pearson and Spearman correlation coefficients. ResultsOver the investigated period, there were 536,195 hospitalisation records in the region, with respiratory diseases accounting for 17.1% of admissions. Notably, 40% of respiratory hospitalisations were among children aged 0–9 years. The most prevalent respiratory conditions were pneumonia and asthma, which together constituted 73% of all respiratory hospitalisations. A significant negative correlation was observed between respiratory diseases and rainfall (r = −0.70, P = 0.011). ConclusionsPneumonia and asthma remain important causes of hospitalisation among children in the Western Bahia Region. The study findings suggest that respiratory diseases are influenced by rainfall, possibly due to increased atmospheric pollutants during time of low rainfall. These findings emphasise the importance of environmental factors in the development and exacerbation of respiratory diseases.

Access to childbirth care services in the interior of Pernambuco, Northeast region of Brazil.

To analyze the access of women to the public health system network to childbirth care, highlighting the barriers related to the "availability and accommodation" dimension in a health macroregion of Pernambuco. Ecological study, conducted based on hospital birth records from the Hospital Information System of the Brazilian Unified Health System (SUS), and information from the state's Hospital Beds Regulation Center, about women residing in health macroregion II, in 2018. Displacements were reviewed considering the geographic distance between the municipality of residence and that of the childbirth; estimated time of displacement of pregnant women; ratio of shifts blocked for admission of pregnant women for delivery; and the reason for unavailability. In 2018, health macroregion II performed 84% of usual risk childbirths, and 46.9% of high-risk childbirths. The remaining high-risk childbirths (51.1%) occurred in macroregion I, especially in Recife. The reference maternity for high-risk childbirths in that macroregion had 30.4% of the days of day shifts and 38.9% of the night shifts blocked for admission of childbirths; the main reason was the difficulty in maintaining the full team in service. Women residing in the health macroregion II of Pernambuco face great barriers of access in search of hospital care for childbirth, traveling great distances even when pregnant women of usual risk, leading to pilgrimage in search of this care. There is difficulty regarding availability and accommodation in high-risk services and obstetric emergencies, with shortage of physical and human resources. The obstetric care network in macroregion II of Pernambuco is not structured to ensure equitable access to care for pregnant women at the time of childbirth. This highlights the need for restructuring this healthcare services pursuant to what is recommended by the Cegonha Network.

Common mental disorders in Primary Health Care professionals during the COVID-19 pandemic period: a cross-sectional study in the Northern health macro-region of Minas Gerais state, Brazil, 2021.

to analyze the prevalence of symptoms of common mental disorders (CMDs) in Primary Health Care professionals between August-October/2021. this was a cross-sectional study conducted with health professionals in the Northern health macro-region of Minas Gerais state; snowball sampling was used; the dependent variable, CMDs, was evaluated using the Self-Reporting Questionnaire (SRQ-20); Poisson regression was used to perform the statistical analysis. a total of 702 health professionals took part in the study; the prevalence of CDMs was 43.2%. It was higher in those with previous [prevalence ratios (PR) = 2.42; 95%CI 1.43;4.08] and current (PR = 1.54; 95%CI 1.25;1.89) symptoms of mental disorders, overwork during the pandemic (PR = 1.42; 95%CI 1.16;1.73), previous symptoms of anxiety (PR = 1.27; 95%CI 1.01;1.61), depression (PR = 1.27; 95%CI 1.06;1.52) and other mental disorders (PR = 1.20; 95%CI 1.01;1.43). there was an association between CDMs and presenting previous and current symptoms of mental disorders and work overload during the covid-19 pandemic.

Position of Medical Tourism in Service Integration and Destination Competitiveness: Evaluating the Barriers and Compiling the Strategies (A Case Study of Health Macro-region NO.10- Tehran)

Position of Medical Tourism in Service Integration and Destination Competitiveness: Evaluating the Barriers and Compiling the Strategies (A Case Study of Health Macro-region NO.10- Tehran)

Tuberculosis among People Living on the Street and Using Alcohol, Tobacco, and Illegal Drugs: Analysis of Territories in Extreme Vulnerability and Trends in Southern Brazil.

(1) Background: Tuberculosis presents an epidemiological trend toward inequality, especially among people in social exclusion and situations of vulnerability. This study aimed to analyze territories with a concentration of people diagnosed with tuberculosis in a street situation and who partake in chronic use of alcohol, tobacco, and illicit drugs. We also analyzed trends in this health condition in southern Brazil. (2) Methods: Ecological study, developed in the 399 municipalities of Paraná, southern Brazil, with all tuberculosis cases in the homeless population registered in the Information System of Notifiable Diseases between 2014 and 2018. For data analysis, we used descriptive statistics, the Prais–Winsten autoregression method for the time series, and the Getis-Ord Gi technique* for spatial analysis. (3) Results: in total, 560 cases were reported. We found a predominance of alcohol, smoking, and illicit drug users, with an increasing trend in the state and clusters of spatial risk in the East health macro-region. (4) Conclusions: We observed territories with critical levels of highly vulnerable people who use psychoactive substances and are in a street situation. The results highlight the importance of incorporating public policies of social protection for these individuals and resolutive health services that receive these cases and assist in eradicating TB.

Quality of prehospital fixed components of the Brazilian Emergency and Urgent Care Network: a study based on data from PMAQ-AB and PNASS

The organization and management of integrated health systems is complex and challenging. As a strategy to improve the quality and access to urgent services, the Brazilian Ministry of Health implemented the Emergency and Urgent Care Network (RUE), comprised of care facilities with different technological levels. Assess the quality of prehospital fixed components of the RUE in health macroregions. A cross-sectional study using data from the Brazilian National Health Services Evaluation Program (PNASS) and the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB) was carried out. A typology was built for the quality of the emergency care units (UPAs) and the first visit by health macroregion, correlating it with socioeconomic variables. A cluster analysis was performed. In total, 280 UPAs, 21,182 basic health units (UBSs), and 27,335 family health teams from 74 health macroregions were evaluated. The general indicator of the quality of the components presented an average of 0.687 (reference score: 1.00). UPA quality (0.61) was positively influenced by the indicators Pharmacy support and Immediate emergency and urgent care, with worse results in Contract management, Planning and organization, and Organizational model. In primary healthcare (PHC) quality (0.78), the dimensions with better evaluations were Articulation with the network, Reception and procedures, unlike Exams and medications. Health macroregions were allocated to three clusters. Cluster 3 obtained a much higher overall average score (0.81) than the others (0.64 and 0.63). A lower quality of PHC was observed in Cluster 1, which showed the highest level of social vulnerability.

Congenital anomalies in Santa Catarina: case distribution and trends in 2010-2018.

Objective:To evaluate the distribution of cases of congenital anomalies in the state of Santa Catarina by health macro-region, to determine the frequency according to maternal and neonatal variables, to estimate the related mortality, and the trends in the period 2010–2018.Methods:An ecological time-series study with secondary data on congenital anomalies and the sociodemographic and health variables of mothers and newborns living in Santa Catarina, from 2010 to 2018. For temporal trend analysis, generalized linear regression was performed using the Prais-Winsten method with robust variance.Results:The average prevalence of congenital anomalies in the period was 8.9 cases per 1,000 live births, being 9.4 cases by 1,000 live births in 2010 and, in 2018, 8.2/1,000. The trend remained stable in the analyzed period. The major malformations were musculoskeletal, hip, and foot malformations, with a proportion ≥30%. There was a higher prevalence of congenital anomalies in low birthweight, preterm, male livebirths with Apgar≤7, born by cesarean section, mothers of older age (≥40 years), and less educated (less than eight years of study). Infant mortality due to congenital malformations was 2.6 deaths/1,000 live births, representing about 25.8% of the total infant deaths in the period.Conclusions:The frequency of congenital anomalies and the mortality with anomalies was stable in the studied period in Santa Catarina. The presence of anomalies was associated with low birth weight, prematurity, and low Apgar score. The highest proportion of congenital anomalies was in the musculoskeletal system.

Síndrome de fragilidade entre pessoas idosas longevas de uma macrorregião de saúde em Minas Gerais

Abstract Objective to identify frailty conditions and their associated factors among oldest old individuals living in the urban area of a health macro-region of Minas Gerais state. Methods a cross-sectional study of 314 oldest old from a health macro-region in Minas Gerais state, Brazil, was conducted. Data were collected from households by applying instruments validated for use in Brazil. Descriptive and multinomial logistic regression analyses (p&lt;0.05) were carried out. Results In the sample assessed, 44.3% of the oldest old were frail, 44.3% pre-frail and 11.4% non-frail. The pre-frail condition was associated with living alone (p=0.047) and very poor/poor physical performance (p=0.026), while frailty was associated with very poor/poor physical performance (p&lt;0.001), the presence of depressive symptomatology (p=0.029) and of ≥5 morbidities (p=0.003). Conclusion pre-frail and frail conditions predominated among the oldest old assessed. Maintaining physical performance is an aspect that can be targeted by health professionals in oldest old to delay pre-frailty and frailty.

Frailty syndrome among oldest old individuals in a health macro-region of Minas Gerais

Resumo Objetivo identificar as condições de fragilidade e seus fatores associados entre pessoas idosas longevas residentes na área urbana de uma macrorregião de saúde de Minas Gerais, Brasil. Métodos estudo transversal, desenvolvido com 314 pessoas idosas longevas residentes em uma macrorregião de saúde de Minas Gerais. Os dados foram coletados nos domicílios mediante a aplicação de instrumentos validados no Brasil. Procederam-se as análises descritiva e regressão logística multinomial (p&lt;0,05). Resultados verificou-se que 44,3% do longevos eram frágeis, 44,3% pré-frágeis e 11,4% não frágeis. A condição de pré-fragilidade associou-se ao fato de morar só (p=0,047) e ao desempenho físico muito ruim/baixo (p=0,026), enquanto a fragilidade, ao desempenho físico muito ruim/baixo (p&lt;0,001); ao indicativo de sintomas depressivos (p=0,029) e à presença de 5 ou mais morbidades (p=0,003). Conclusão as condições de pré-fragilidade e fragilidade foram as mais frequentes entre os longevos. A manutenção do desempenho físico é um aspecto passível de atuação pelos profissionais de saúde, a ser trabalhado entre as pessoas idosas longevas visando postergar a pré-fragilidade e a fragilidade.

Vulnerability and resilience of the European health care systems in the face of the Covid-19 pandemic: a framework for the comparative analysis of problematic sentinel cases

The main results in terms of inter-regional and intra-regional variations of the application of the concept of "health macro-region" are presented in the first part of the article in order to show how the European health care systems have differently coped with the COVID-19 outbreak. Given the high levels of intra-regional variation found, it seemed appropriate to also add an analysis by country in order to identify those "sentinel cases", given their alert value, which recorded the worst ratio between the infection rates (cases/population) and the lethality rates (deaths/cases). In order to explore the possible reasons behind the problematic coping with the pandemic of these "sentinel cases", a conceptual framework for the analysis of vulnerability, resilience and their governance in terms of sustainability of health care systems is developed in the second part, hoping its application could represent a useful contribution for best-practice solutions that could guide the management of future pandemics.

Inland expansion of COVID-19 in Western Bahia: epidemiological profile and spatial analysis of deaths and confirmed cases.

This article aims to describe the epidemiological profile and the spatial distribution of deaths and confirmed cases of COVID-19 in the health macroregion of Western Bahia. An ecological study on the inland expansion of SARS-CoV-2 was performed from March 21, 2020 to March 31, 2021 considering incidence and mortality rate, case fatality rate, case density and moving average of cases and deaths. 37,036 cases and 536 confirmed deaths were registered. Of all cases, 94.5% recovered and 4.0% remained active. The incidence rate was 3884.1/100,000 inhabitants, the mortality rate 56.2/100,000 inhabitants and the fatality rate was 1.4% A predominance of very high and high intensity of the occurrence of COVID-19 in the macroregion was identified and moving average revealed an increasing trend. Findings show a high risk of infection and death in the macroregion, in addition to a growing trend in accumulated cases, confirming the inland expansion of the disease.