Municipal Health Department Research Articles

Mycobacterium tuberculosis and human immunodeficiency virus coinfection in Alagoas, Brazil: a picture from 2009 to 2019

Objective: The present study surveyed the sociodemographic characteristics of individuals affected by co-infection with Human immunodeficiency virus (HIV) and tuberculosis (TB) in Alagoas-Brazil. Methods: The study was conducted with two different databases of Sistema de Informação de Agravos e Notificação (SINAN) with cases notified between 2009 and 2019. An additional cohort of HIV infected patients from PAM Salgadinho Specialized Health Unit, Municipal Health Department of Maceió-Alagoas, Brazil was also evaluated. The data was analyzed descriptively and by statistical tests to evaluate the population profile and potential associations. Results: During the period evaluated, 14,318 cases of tuberculosis and 1,438 human immunodeficiency virus and tuberculosis co-infections were notified. Most co-infected cases were identified in men (63.13%), between 30 and 59 years old (72.53%), with incomplete primary education (27.88%), alcoholics (61.02%), and homeless (48.09%). Significant correlations suggest that death by co-infection was more common among men, population between 30 and 59 years old and with complete superior education. Also, the HIV viral load was significantly higher in the co-infected group. Conclusion: The results show the recent scenario of HIV/TB co-infection in Alagoas-Brazil, revealing a profile of social vulnerability situation and increased risk of death. These observations suggest that public health policies should be developed looking carefully at this portion of the population, to provide quality of life, less death and more adherence to TB treatment.

CHALLENGES TO THE BRAZILIAN NETWORK OF HUMAN MILK BANKS: INTERFACE BETWEEN PRIMARY AND TERTIARY CARE

This study analyzed the interface between a family health unit and the human milk bank of a maternity hospital in Rio de Janeiro. Through interviews, key actors pointed out problems related to the Health Care Network and strategies for overcoming them. Matus's categories supported the analysis of the interviews. The link between primary and tertiary care, between health teams and the community, and the involvement of the actors in this process configured a network work recognized and multiplied by the Municipal Health Department, which articulated a network of Human Milk Receiving Stations. The experience contributed to increasing the collection of breast milk by milk banks. The study showed that local actions contribute to a more effective capillarization of human milk donation with the effective participation of the units that operate in the Family Health Strategy. The institutionalization of actions at the local level is an important strategy to reinforce national breastfeeding policies, in a network logic that goes beyond the traditional reference and counter-reference models.

PREVALÊNCIA DOS SINTOMAS DO TDAH EM CRIANÇAS COM BAIXO RENDIMENTO ESCOLAR SUBMETIDAS AO P.A.P.E. NO ANO 2022 EM PRESIDENTE PRUDENTE

Specific learning disorder impairs the brain's ability to process information, affecting around 30-40% of students. These disorders represent 35-45% of mental health visits and 35% of visits to pediatricians. In 2018, Presidente Prudente/SP launched the Specialized Pedagogical Support Program (PAPE) to offer support to students with learning difficulties in the Municipal Network. The study, including 136 students evaluated by MTA-SNAP IV, revealed that ADHD and ODD are common in the school age group, especially in elementary school and more frequent among boys, with inattention being the main characteristic. The research highlighted the effectiveness of the questionnaire in improving intervention and support methods, improving students' quality of life and academic performance. Greater involvement of the Municipal Health Department is recommended to enhance children's care and learning, preventing future problems such as school dropout and difficulties in adult life.

The High Cost of the Legal Route in Public Health: The Impact of the Judicialization of Medicines in the Municipal Unified Health System in Campinas

ObjectiveThis study aimed to assess the costs and factors associated with the judicialization of medicines for the municipal Unified Health System in Campinas, São Paulo, Brazil, from 2017 to 2021. MethodsThis cross-sectional study used data provided by the Municipal Health Department of Campinas and the Court of Justice of the State of São Paulo. ResultsThe sample comprised 506 medicines (322 active substances) and 493 legal cases. Of the US$9.270 million disbursed, 67.3% were allocated to purchase medicines. On average, 28.8% of the pharmaceuticals were listed on the National List of Essential Medicines (Rename), of which 52.3% were listed in the specialized component. Expenditures on nonincorporated and oncological medicines accounted for 76% of the total value. Acquisition of brand-specific medicines was predominant (53.7%), of which 75.5% had therapeutic equivalents. ABC curve shows that only 28 active substances corresponded to 79.8% of the expenses incurred to serve 573 plaintiffs. Four factors, when present in legal actions, prevented the rational use of public resources: assumption of responsibilities of other federative entities, acquisition of medicines not incorporated in Rename and oncological drugs, trademark determination, and the requirement to supply the medicine for an indefinite period. Costs associated with these factors caused an increase in expenditure, even with a decrease in legal demands filed against the municipality. ConclusionsJudicialization of medicines in Campinas from 2017 to 2021 required an allocation of US$6.2 million, aimed at treating only 0.068% of the population. Associated factors include legal requirements and internal management challenges that have increased costs.

Ecology and molecular analysis of sand flies in Bambuí, Minas Gerais, Brazil: Implications for leishmaniasis surveillance.

Leishmaniasis stands out as a public health problem in the state of Minas Gerais, Brazil, especially in the Midwest region. However, the entomological aspects in several municipalities remain unknown. Therefore, this study aimed to investigate the sand fly fauna in Bambuí, encompassing ecological dynamics and molecular detection of Leishmania. Monthly collections were conducted using CDC light traps from September 2018 to August 2020 across 16 selected points with urban and rural characteristics, chosen based on the coverage area of the Municipal Health Department and the occurrence of canine and human visceral leishmaniasis (VL) cases. Ecological indices of the sand fly population (Chao1, Shannon, Simpson and Pielou) were assessed, and sand fly abundance was correlated to climatic variables (humidity, temperature and rainfall). A total of 8838 specimens representing 17 species within nine genera were collected (estimated species richness by Chao 1 estimator = 17; SE ± 1.8). Predominantly, Lutzomyia longipalpis, Nyssomyia whitmani and Evandromyia cortelezzii constituted approximately 98% of all captured sand flies. While species richness and diversity displayed variations throughout the study, a positive correlation emerged between temperature (p < 0.0001; r = 0.7767), monthly rainfall (p < 0.0001; r = 0.7810) and sand fly abundance. Molecular analysis revealed Leishmania DNA in 2.05% of female sand flies, with the presence of Leishmania infantum in Lu. longipalpis and both Le. infantum and Leishmania braziliensis in Ev. cortelezzii. The entomological data, coupled with the occurrence of autochthonous cases of canine visceral leishmaniasis, offer valuable insights for evidence-based strategies to prevent leishmaniasis in Bambuí.

Analysis of the fight against the COVID-19 pandemic in long-term care facilities in the pre-vaccination period

IntroductionThe COVID-19 pandemic has disproportionately affected individuals residing in Long-Term Care Facilities (LTCFs), necessitating tailored strategies to manage outbreaks. This study examines the outcomes of the ILPI BH project, a collaborative effort between the Municipal Health Department and the Hospital das Clínicas of the Federal University of Minas Gerais, designed to mitigate COVID-19 spread within LTCFs. MethodsProspective cohort of secondary data: 1,794 old residents in 99 long-term care facilities of Belo Horizonte, Brazil, were followed from May 2020 to January 2021. The study analyzed the prevention strategies, residents’ clinical data, and the characteristics of the long-term care facilities, correlating these variables with the number of infections, hospitalizations, and deaths from COVID-19. It checked absolute numbers and rates of incidence, hospitalization, mortality, and lethality. ResultsThere have been 58 COVID-19 outbreaks in long-term care facilities. There were 399 cases among residents, 96 hospitalizations for COVID-19 and 48 deaths from COVID-19 (2.7 % of the cohort), with a case fatality rate of 12 %. After multivariate analysis, the intrinsic variables to residents associated with higher mortality risk were higher degree of frailty (OR=1.08; p = 0.004) and the fact of living in a long-term care facility with a considerable proportion of residents’ coverage by health plans (OR = 1.01; p = 0.028). Early geriatric follow-up showed an association with a reduction in the number of hospitalizations due to COVID-19. ConclusionThe correct classification of the degree of frailty of institutionalized older people seems to have been relevant for predicting mortality from COVID-19. The extensive assistance by private health plans, contrary to what is supposed, did not result in better health protection. Early geriatric follow-up was beneficial and may be an attractive strategy in the face of health emergencies that affect long-term care facilities to reduce hospital admissions.

Application of Business Intelligence for the automation in the Epidemiological Surveillance: XBI a successful case study from Municipal Health Department of Ribeirão Preto, Brazil (2020-2024)

Application of Business Intelligence for the automation in the Epidemiological Surveillance: XBI a successful case study from Municipal Health Department of Ribeirão Preto, Brazil (2020-2024)

A large multicenter Ralstonia pickettii outbreak in critically ill patients during the COVID-19 pandemic: Epidemiological and clinical characteristics of 66 cases.

To describe a multicenter outbreak of R. pickettii that occurred in a large number of critically ill patients in a city in Colombia, during the COVID-19 pandemic. In April 2021, the National Institute for Food and Drug Surveillance (INVIMA) reported an outbreak of R. pickettii infection associated with contaminated intravenous medications. The Municipal Health Department began collecting data for all cases identified by the hospitals and the results of microbiological studies. Medical records and death certificates of included cases were reviewed. Between March and May 2021, 66 cases of R. pickettii bloodstream infections from nine hospitals were documented. The median age of the patients was 60years (IQR 51-72), and most of them had comorbidities (78.8%), mainly arterial hypertension and diabetes mellitus. At the time of the R. pickettii bloodstream infection, 89.4% had COVID-19, 86.4% were on mechanical ventilation, and 98.5% were receiving corticosteroids. The overall mortality was 81.8%. Nearly 60% of the deaths were related to R. pickettii bloodstream infections. R. pickettii was identified in the cultures from intravenous medications. This large multicenter outbreak caused by intravenous medications contaminated with R. pickettii mainly affected critically ill COVID-19 patients. Mortality was high and largely related to R. pickettii bloodstream infection.

Preceptorship and education in Family Health Nursing residency

The objective of this study was to analyze the main duties of the nurse preceptor of the Family Health Nursing Residency Course linked to the Municipal Health Department of Rio de Janeiro, understanding their perceptions about preceptorship and identifying their skills and competencies. This was a qualitative study, of the field research type. Data collection was carried out at the Family Clinics that offered the course in Program Area 3.1, in the city of Rio de Janeiro, through semi-structured interviews with nine participants. It was identified that the professional who occupies this role builds his work process based on his previous knowledge and experiences. From there, the preceptor develops skills and competencies in the relationship with the resident in the field that transform him into an educator. We can understand this actor, still in definition, as an academic manager and care manager. We conclude that it is necessary to invest more in training preceptors to work within this role, producing more qualified health professionals to work in and for the SUS.

Modeling of Human Rabies Cases in Brazil in Different Future Global Warming Scenarios.

Bat species have been observed to have the potential to expand their distribution in response to climate change, thereby influencing shifts in the spatial distribution and population dynamics of human rabies cases. In this study, we applied an ensemble niche modeling approach to project climatic suitability under different future global warming scenarios for human rabies cases in Brazil, and assessed the impact on the probability of emergence of new cases. We obtained notification records of human rabies cases in all Brazilian cities from January 2001 to August 2023, as reported by the State and Municipal Health Departments. The current and future climate data were sourced from a digital repository on the WorldClim website. The future bioclimatic variables provided were downscaled climate projections from CMIP6 (a global model ensemble) and extracted from the regionalized climate model HadGEM3-GC31-LL for three future socioeconomic scenarios over four periods (2021-2100). Seven statistical algorithms (MAXENT, MARS, RF, FDA, CTA, GAM, and GLM) were selected for modeling human rabies. Temperature seasonality was the bioclimatic variable with the highest relative contribution to both current and future consensus models. Future scenario modeling for human rabies indicated a trend of changes in the areas of occurrence, maintaining the current pace of global warming, population growth, socioeconomic instability, and the loss of natural areas. In Brazil, there are areas with a higher likelihood of climatic factors contributing to the emergence of cases. When assessing future scenarios, a change in the local climatic suitability is observed that may lead to a reduction or increase in cases, depending on the region.

Changes in urgent and emergency care activity associated with COVID-19 lockdowns in a sub-region in the East of England: Interrupted times series analyses.

Access to and use of urgent and emergency care in the United Kingdom's National Health Service reduced during COVID-19 related lockdowns but demand reportedly increased since then. We investigated the impact of COVID-19 on urgent and emergency health care services activity in an eastern England population of 1.1 million. We used health care activity data from a municipal health department, recorded at the level of discrete events (such as visits to hospital or ambulance calls) to compare system activity between 2018-2020 (pre-COVID), 2020-2021 (lockdown) and 2021-2023 (post-lockdown), carrying out interrupted time series analyses to describe changes in activity. Daily emergency department (ED) attendances were 10% (95% confidence interval 9-12%) lower during the lockdown period, and 7% (6-8%) higher in the post-lockdown period than pre-COVID. Attendances arriving by ambulance were 13% (12-14%) lower post-lockdown than pre-COVID, while attendances of arrivals by other means were 17% (16-19%) higher. Post-lockdown, overall attendances were continually reducing. ED waiting times were 45% (44-47%) longer in the post-lockdown period compared to the pre-COVID period and continued to increase post-lockdown. There was a 15% (14-16%) reduction in daily ambulance dispatches post-lockdown versus pre-COVID. Ambulance arrivals with delayed handover to hospital care exceeding 60 minutes increased by 17% (16-18%) post-lockdown versus pre-COVID, and probability of delay showed a continuously upward trend post-lockdown of 20% (19-21%) per year. Patients are facing long waits in EDs to be admitted to hospital, discharged or transferred. This results in delays in ambulances handing over patients and attending to other calls, which may explain decreasing rates of ambulance dispatches. Potential solutions are likely to involve enhancing the flow through and discharge of patients from hospital, and a whole systems approach which considers the capacity of the local health and care infrastructure, including intermediate care and social care.

Protocolo assistencial de acolhimento em unidade de pronto atendimento no contexto da Covid-19 (2020-2021)

Abstract Qualitative action-research research aimed to describe the process of reorganizing the care flow of a UPA to face the COVID-19 pandemic, based on the implementation of care protocols. The collective problem was the organization of the care flow for people with the flu syndrome (FS). The study considered the action-research cycles proposed by Tripp (2005). In the planning phase, the flow of care for patients with FS was developed through the analysis of regulations, physical structure, and available resources. During implementation, intersectoral partnerships were established for physical adaptation, training of professionals, and resizing of the team. The planning and implementation process was described based on reports and data were collected from the unit's management equipment and the Municipal Health Department. The evaluation was carried out continuously, based on feedback from the literature and reflected practice. The reorganization of the unit with the implementation of protocols and division of flows showed positive points, such as participation and involvement of the team, review of processes, search for evidence, and intersectoral partnerships; and negative, such as the difficulty in separating FS patients within the physical structure of the UPA.

ELEMENTOS CONSTITUINTES DO CUIDADO: (DES)CONEXÕES QUE DESAFIAM A INTEGRALIDADE DO CUIDADO ÀS PESSOAS INDÍGENAS COM TUBERCULOSE

ABSTRACT Objective: To analyze the production of care, regarding reception, bonding, resolvability, and accountability, for indigenous people with tuberculosis. Method: Qualitative study, with systematic observation, document analysis, and semi-structured interviews with health workers and indigenous health management and the municipal health department of Banzaê/Bahia - Brazil. Data triangulation was carried out from interviews, documentary records, and field observation. Results: The reception is given when the need for understanding and respect for cultural specificities is recognized, the bond is related to the health worker’s culture, the resolvability is hindered due to municipal management, and there are divergences among those responsible for indigenous health in taking responsibility for care. Conclusion: Collective actions are necessary between the municipal, state instances and the Special Indigenous Sanitary Districts, regarding the path of the health services network.

Implementation of the Family and Community Medicine and Multidisciplinary Family Health Residency programs of the Municipal Health Department of Campo Grande-MS, Brazil

Resumo Embora haja aumento do número de vagas de residência médica em medicina de família e comunidade, ainda há má distribuição. Esses programas de residência apresentam uma cooperação com a Fundação Oswaldo Cruz através de ações embasadas e aplicáveis na prática, com a inovação de tecnologias assistenciais. Resultados mostram crescimento na evolução dos atendimentos médicos, de enfermagem e odontológicos, com percentuais de 86,94%, 81,97%, 81,80% e 66,00%, respectivamente. A melhoria da qualidade do registro, a mudança do processo de trabalho na odontologia e o empoderamento da enfermagem, com protocolos assistenciais são os principais resultados.

Implementation of the Family and Community Medicine and Multidisciplinary Family Health Residency programs of the Municipal Health Department of Campo Grande-MS, Brazil

Resumen Aunque hay un aumento en el número de vacantes de residencias médicas en medicina familiar y comunitaria, todavía hay una mala distribución. Estos programas de residencia presentan cooperación con la Fundación Oswaldo Cruz a través de acciones basadas y aplicables en la práctica, con la innovación de tecnologías asistenciales. Los resultados muestran un crecimiento en la evolución de la atención médica, de enfermería y odontológica, con porcentajes del 86,94%, 81,97%, 81,80% y 66,00%, respectivamente. Mejorar la calidad de los registros, cambiar el proceso de trabajo en odontología y empoderar a la enfermería, con protocolos de atención, son los principales resultados.

INFLUENCE OF PHYSICAL THERAPY REHABILITATION ON FUNCTIONAL RECOVERY OF OLDER PEOPLE AFTER COVID-19

Abstract Retrospective cohort conducted through an online survey sent to older people (≥60 years) of both sexes, with confirmed diagnosis of Covid-19 registered in the Municipal Health Department of Sao Paulo, Brazil. Individuals with cognitive limitations and those who refused to participate were excluded. Functional capacity was assessed using Katz and Lawton Indices for pre-Covid, immediate post-Covid, and current time points, and characteristics of post-Covid physiotherapeutic rehabilitation were collected. Statistical analysis was performed using JASP-0.17.3 software, and group comparisons were made using repeated measures ANOVA, considering alpha=0.05. From March to August 2023, 86 individuals participated, with median age of 66.5 [62.3-71.0] and 57.0% (n=49) male. Among them, 39.5% (n=34) received recommendations for physiotherapeutic rehabilitation and 88.2% (n=30) of them were rehabilitated, while 11.8% (n=4) did not receive treatment. Older people with recommendation for physiotherapy post-Covid-19 demonstrated worse functional status (p&amp;lt; 0.001). Older people who received treatment were functionally equivalent to those who did not attend physiotherapy rehabilitation (p=1.000 for Katz Index and p=0.812 for Lawton Index). The primary indication for post-Covid-19 physiotherapy was muscular fatigue (70.0%, n=21), and domiciliary care was the predominant modality received (46.7%, n=14). Older people who were recommended for physiotherapy showed worse functional status after Covid-19, but there was no difference in long-term functional capacity. This suggests the potential importance of physiotherapeutic rehabilitation for functional recovery after Covid-19.

Frailty and spatialization of older adults in the city of Uberlândia with IVCF-20.

To describe the functional clinical profile of elderly people linked to primary health care, using the Functional Clinical Vulnerability Index (IVCF-20) and to spatialize those with the greatest functional decline by primary health care units in the municipality of Uberlândia, in the state of Minas Gerais (MG), in the year 2022. A cross-sectional study with secondary data from the Municipal Health Department of Uberlândia-MG. The variables were compared using Student's t-test, Mann Whitney test, Pearson's chi-square, and multinomial logistic regression to obtain the independent effect of each variable. The significance level adopted was 5% (p < 0.05). The georeferenced database in ArcGIS® was used. 47,182 older adults were evaluated with a mean age of 70.3 years (60 to 113 years), 27,138 of whom were women (57.52%), with a clear predominance of low-risk or robust older adults (69.40%). However, 11.09% are high-risk older adults and 19.52% are at risk of frailty. Older men had independently lower odds of moderate and high risk compared to older women (OR = 0.53; p < 0.001). A high prevalence of polypharmacy was observed, 21.40% of the older adult population, particularly in frail older adults, with a prevalence of 63.08%. There was a greater distribution of frail older adults around the central region of the municipality and in health units with a larger coverage area. The IVCF-20 made it possible to screen frailty in primary health care. The instrument is capable of stratifying the risk of older adults in health care networks through primary health care, enabling the application of individualized preventive, promotional, palliative, or rehabilitative interventions, according to the clinical functional stratum of the older adult and the compromised functional domains. Risk stratification and spatial distribution of the frailest older adults can be a good strategy for qualifying health professionals with the aim of maximizing the autonomy and independence of the older adults.

Availability of emergency contraception in large Brazilian municipalities: a guaranteed right?

Introduction: Emergency Contraception (EC) is available in Brazil since 1996, when it was adopted as one if the family planning strategies and, in 1998, for use in services assisting victims of sexual violence. In the country, its use is regulated by guidelines. Its access through SUS (Unified Health System), however, does not seem to occur in a standardized manner.Methods: The aim of the study was to analyze the availability and barriers to accessing emergency contraception (levonorgestrel) in Brazilian municipalities with more than 500 thousand inhabitants. The survey was carried out by a form sent to the Municipal Health Departments (SMS) managers and a search on the list of standardized medicines by the hospitals in the same municipalities.Results: The Basic Health Units were identified as the standard access places to EC. However, one of the obstacles mentioned is the need for a prescription for dispensing in almost 80% of the analyzed cities. Access in emergency situations at night and on weekends is also uncertain, since although 67% of the places stated that they dispense at the hospital level, the item was only standardized in 21% of the hospital lists.Discussion: The difficult access this drug in the public system essentially tends to harm the poorest women, who are the ones who suffer most from the consequences of an unwanted pregnancy.

“VIII rural veterinary, global health”: the extension as a dialogical apparatus between community and university

"Veterinary Rural, Global Health" is an extracurricular extension project that aims to provide health education through disease prevention and health promotion actions. It is a collective, transdisciplinary, and multiprofessional approach that involves professors, students, and veterinarians, among other professionals and members of the Tutorial Education Programs (PET) of the Federal Rural University of Rio de Janeiro (UFRRJ). Our goal is to disseminate scientific knowledge to the residents of Seropédica, Rio de Janeiro, Brazil. In addition, the project aims to strengthen partnerships between the academic community and the Municipal Health Department to support rabies vaccination for dogs and cats in the municipality. For eight editions, the project seeks to address issues related to animal, human, and environmental health through extensionism to encourage the debate of ideas about One Health with the population. In 2022, two stages of activities were conducted. The first stage focused on supporting the vaccination of dogs and cats against rabies in various parts of the city. The second stage took place in the main square of the municipality, where health education activities were organized for children, adults, and seniors. These activities included lectures, playful interactions, drawing and painting workshops, distribution of gifts, and exhibition of anatomical and vertebrate pieces of importance in public health, among others. All practices addressed issues related to One Health and provided integration between the academic community and its surroundings, highlighting the importance of the inseparability of animal, human, and environmental health to reduce diseases with zoonotic potential.

Cities as Platforms for Population Health: Past, Present, and Future.

Policy Points Cities have long driven innovation in public health in response to shifting trends in the burden of disease for populations. Today, the challenges facing municipal health departments include the persistent prevalence of chronic disease and deeply entrenched health inequities, as well as the evolving threats posed by climate change, political gridlock, and surging behavioral health needs. Surmounting these challenges will require generational investment in local public health infrastructure, drawn both from new governmental allocation and from innovative financing mechanisms that allow public health agencies to capture more of the value they create for society. Additional funding must be paired with the local development of public health data systems and the implementation of evidence‐based strategies, including community health workers and the co‐localization of clinical services and social resources as part of broader efforts to bridge the gap between public health and health care. Above all, advancing urban health demands transformational public policy to tackle inequality and reduce poverty, to address racism as a public health crisis, and to decarbonize infrastructure. One strategy to help achieve these ambitious goals is for cities to organize into coalitions that harness their collective power as a force to improve population health globally.