BackgroundSexually transmitted infections (STIs) are associated with substantial adverse outcomes, including genital symptoms, pregnancy complications, infertility, increased risk of HIV transmission, and significant psychosocial impacts. Identifying priority areas for action and key elements to inform discussions on expanding access to STI prevention measures, including HIV pre-exposure prophylaxis (PrEP), is essential for planning effective control strategies.MethodsThis ecological study aimed to analyze the occurrence of notifiable STIs using data from a medium-sized state capital during the five years preceding the introduction of PrEP. Data on confirmed cases of notifiable STIs (HIV/AIDS, syphilis, and viral hepatitis) reported to the Brazilian Notifiable Diseases Information System (SINAN) in Campo Grande from 2014 to 2018, along with socioeconomic and demographic data, were assessed. Spatial analysis methods were used to identify clusters and areas with increased risk of STI occurrence.ResultsA total of 10,074 STI cases were reported to SINAN. Syphilis was the most frequently reported infection, accounting for 78.6% of cases, followed by HIV/AIDS (19.5%) and hepatitis B (1.9%). Higher risk for all three STIs was observed among non-white men over the age of 20 low educational attainment. Among HIV cases specifically, heterosexual individuals were the most affected, based on available data regarding sexual orientation. Spatial analysis revealed clusters of high incidence in peripheral neighborhoods of the city. Additionally, correlation analysis indicated an association between STI occurrence and lower socioeconomic conditions.ConclusionsThese findings suggest that STI control strategies should be re-evaluated to enhance coverage among individuals with the sociodemographic profile identified in this study, underscoring the need to broaden prevention strategies beyond traditionally defined key populations.

Background and Objectives: Tuberculosis is an infectious disease and presents risk factors linked to social and behavioral issues, as well as comorbidities. This study aimed to evaluate tuberculosis cases reported in Uberaba/MG between 2013 and 2023. Methods: A cross-sectional study was conducted using data from the Notifiable Diseases Information System regarding the notified cases of tuberculosis in the city of Uberaba, over a 10-year period (2013-2023). Results: During the evaluation period, 931 cases of tuberculosis were notified in Uberaba, with an average incidence of 25.6 cases/100,00 inhabitants. The majority of the cases were recorded in men (74.2%), aged between 25 and 44 years (48.3%), with elementary or high school education (complete or incomplete) (61.6%). In terms of social factors, 9.8% of tuberculosis cases were associated with individuals deprived of liberty and 5.4% of the patients were homeless. Regarding comorbidities, 20.1% of the patients with tuberculosis were co-infected with HIV, 32.1% were alcoholics, 7.5% were diabetic and 27.5% used illicit drugs. Laboratory confirmation of the disease occurred in 60.9% of the cases. The most common form of tuberculosis diagnosed was pulmonary (77.1%); pleural tuberculosis was the most common extrapulmonary form of the disease (36.6%). The majority of cases were classified as new cases (81.8%) with the most common outcomes being cure (55.4%), loss to follow-up (14.9%), and death from tuberculosis (10.6%). Conclusion: The results highlight well-defined sociodemographic characteristics among tuberculosis patients, such as adult males with low education level, comorbidities, and engaging in risky behaviors.

Background and Objectives: childhood tuberculosis is a neglected disease at a global level, and it remains invisible in the scientific literature. This study aims to analyze the temporal trend of tuberculosis in individuals under 15 years of age in the state of Paraná, Brazil. Methods: An ecological time‑series study conducted across the 399 municipalities of Paraná state. The population consisted of all reported cases of childhood tuberculosis (children under 15 years of age) registered in the Notifiable Diseases Information System from January 1, 2013, to December 31, 2022. The variables analyzed included age, sex, race/ethnicity, area of residence, type of case entry, clinical form, laboratory confirmation, sputum bacilloscopy, and case outcome. Descriptive statistical analysis was performed, including absolute and relative frequency calculations, along with time series analysis using the Prais-Winsten generalized linear regression method. Results: a total of 592 cases of childhood tuberculosis were reported. Among these, 194 (32.8%) were aged 10 to 14 years, 144 (24.3%) were under one year of age, 142 (24.0%) were aged one to four years, and 112 (18.9%) were aged five to nine years. The Prais-Winsten analysis indicated that the temporal trend remained stationary for all variables analyzed. Conclusion: the trend of childhood tuberculosis in Paraná is stationary, highlighting the need to strengthen TB control strategies within health services to improve case detection, diagnosis, and treatment.

IntroductionTuberculosis care has been seriously affected by the COVID-19 pandemic. Few studies have assessed the impact of the pandemic on tuberculosis outcomes in vulnerable populations. We aimed to evaluate tuberculosis outcomes before and during the pandemic in general and in unhoused populations in São Paulo, Brazil.MethodsWe performed a retrospective cohort study that compared tuberculosis outcomes between the unhoused and general populations using data from 2017 to 2019 and 2020 to 2022. Unfavorable outcomes were defined as loss to follow-up, treatment failure, death, toxicity, and resistance to drugs. Cox regression models and Kaplan‒Meier curves were used to evaluate the data.ResultsAmong 47,293 patients diagnosed with tuberculosis using the National Notifiable Diseases Information System (SINAN) between January 1, 2017, and December 31, 2021, 29,247 patients were included in our study. Patients diagnosed with TB during the pandemic were more likely to have unfavorable outcomes in the general population (hazard ratio [HR], 1.45, [95% confidence interval (CI), 1.37 to 1.55], p < 0.001), but not in the unhoused population. Patients with lost to follow-up (HR, 1.42, 95% CI 1.21–1.66, p < 0.001) or hospitalized (HR, 1.50, 95%CI 1.29–1.74, p < 0.001) were more likely to experience unfavorable outcomes in the unhoused population.ConclusionsIn conclusion, during the pandemic of COVID-19 period the tuberculosis care was not affected in the specific unhoused population but rather affected the general population in the largest city of São Paulo, Brazil.

Exploring subtypes of child maltreatment in a large Brazilian sample: Co-occurrence patterns and associated characteristics.

This study aimed to analyze the sociodemographic characteristics of tuberculosis (TB) in the state of Pará between 2019 and 2023. The clinical forms, diagnostic methods, associated comorbidities, gender, ethnicity, age group, and education level of reported cases were investigated. Secondary data from the Notifiable Diseases Information System (Sinan) of the Ministry of Health were used. During the analyzed period, 27,728 TB cases were recorded, with an incidence of 34.1 per 10,000 inhabitants. There was a predominance of cases in males (67.9%), in the age group 20 to 39 years (47.4%), and in individuals of mixed race (75.2%). The most common clinical form was pulmonary, representing 89.4% of cases. Most patients were cured (59.5%); however, 26.3% abandoned treatment. Laboratory confirmation occurred in 66.2% of cases, although many did not undergo specific tests. Comorbidities such as alcoholism, diabetes mellitus, and HIV were identified as significant risk factors. It was concluded that tuberculosis continues to disproportionately affect vulnerable populations, especially young men, individuals with low education, and mixed race. The findings highlight the need for an integrated and multifaceted approach to combat TB in Pará, considering sociodemographic factors and associated comorbidities.

Aims: The present study aims to observe the epidemiological factors that lead to the high occurrence of Leishmaniasis cases in Brazil, highlighting the endemic area of Maranhão, the main factors involved in its transmission, the challenges for controlling the disease and the prospects for controlling this disease in the state. Study Design: This is an analytical-descriptive epidemiological study of an ecological nature. Place and Duration of Study: Data were collected from the SINAN/DATASUS database related to the Maranhão state health network, covering the period from 2020 to 2024. Methodology: The study analyzed data obtained from the Notifiable Diseases Information System (SINAN/SUS) through TABNET/DATASUS. Variables such as sex, age group, and education level were assessed to determine their correlation with the prevalence of cutaneous leishmaniasis in Maranhão. Ethical approval was not required due to the use of publicly available data. Results: A total of 6,406 cases were recorded during the study period, with the highest prevalence among adults aged 20 to 59 years, predominantly male, and individuals with incomplete elementary education. The year 2024 showed a significant reduction in reported cases compared to previous years. Conclusion: The epidemiological profile of American Cutaneous Leishmaniasis in Maranhão is influenced by sociodemographic factors, with higher prevalence among men and individuals with incomplete elementary education. The study reinforces the importance of preventive health education policies to curb the spread of the disease.

Introduction: Suicide, a leading cause of death among young people and adults, has been increasing worldwide and is closely associated with substance use. Objective: To identify the factors associated with cocaine use in individuals who died by suicide between 2009 and 2019 in the Federal District, Brazil. Methods: This was a cross-sectional study of 1,161 individuals who died by suicide, with data sourced from the Mortality Information System, the Notifiable Diseases Information System (SINAN), and Civil Police records. We estimated crude and age- and sex-adjusted prevalence ratios (PR). Results: The 19–39 age group (PR: 5.2; 95% CI 2.0–13.6), Black or Brown race/skin color (PR: 1.8; 95% CI 1.3–2.5), male sex (PR: 2.9; 95% CI 1.8–4.8), fewer than 8 years of education (PR: 1.5; 95% CI 1.1–1.9), a criminal record (PR: 2.6; 95% CI 1.9–3.5), a history of being a victim of crime (PR: 1.3; 95% CI 1.0–1.8), and a positive toxicology screen for ethanol (PR: 2.9; 95% CI 2.2–3.7) and cannabis (PR: 3.0; 95% CI 2.2–4.0) were among the factors associated with cocaine use. In the adjusted analysis, race/skin color, educational level, criminal record, positive toxicology screens for ethanol and cannabis, and causes of suicide remained associated with the outcome. Conclusion: Social vulnerabilities, a criminal record, and polysubstance use increase the likelihood of cocaine use among individuals who died by suicide. Recognizing these factors can guide targeted interventions and prevention policies aimed at reducing these preventable deaths.

Introduction and Objective: Chikungunya virus (CV) is a tropical arbovirus with high incidence in Brazil, transmitted by Aedes aegypti, and is associated with significant morbidity and mortality. This study aimed to evaluate the impact of diabetes mellitus (DM) on the clinical presentation and outcomes of CV infection. Methods: This cohort study utilized data from Brazil’s public health database (Notifiable Diseases Information System) on confirmed CV cases reported in 2024. Cases with missing or incomplete data were excluded, as well as individuals with conditions other than DM, patients under 18 years, and those who died from causes unrelated to CV. Among 149,407 notifications, 74,405 were selected. Data analysis was performed using Jamovi® and Microsoft Excel®, with significance set at P&amp;lt;0.05 and a 95% confidence interval. Results: Among 74,405 confirmed CV cases (58.5% women, mean age 42), 1,937 (2.6%) had DM (63.4% women, mean age 53), while 72,468 did not (58.3% women, mean age 40). Clinical manifestations more common in DM patients included nausea (RR: 1.11; P&amp;lt;0.001), back pain (RR: 1.10; P&amp;lt;0.001), arthritis (RR: 1.07; P&amp;lt;0.001), rash (RR: 1.04; P&amp;lt;0.001), and fever (RR: 1.02; P=0.045). Otherwise, myalgia (RR: 0.964; P&amp;lt;0.001), arthralgia (RR: 0.954; P=0.001), and vomiting (RR: 0.856; P&amp;lt;0.001) were more frequent in the non-DM group. No significant differences were observed for headache (RR: 1.02; P=0.163), conjunctivitis (RR: 1.01; P=0.108), leucopenia (RR: 1.00; P=0.497), petechiae (RR: 1.00; P=0.841), or retroorbital pain (RR: 0.942; P=0.106). Regarding clinical outcomes, both groups had similar hospitalization rates (RR: 1.01; P&amp;lt;0.001) and recovery rates (RR: 1.00; P&amp;lt;0.001). Conclusion: DM patients exhibited more nausea, back pain, arthritis, rash, and fever, while myalgia, arthralgia, and vomiting were more common in the non-DM group. Despite these differences in clinical presentation, disease outcomes were similar between the two groups. Disclosure M.R. Hasbun: None. L.S. Facanha: None. A.C. Ortelan: None. A. Andrade: None. L. Moisés: None. T. Pinho: None. M.O. Marques: None. C.M. Teles: None. S.L. Silva: None. E.D. Daher: None.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which, despite being treatable, still represents a serious public health problem in Brazil, especially in regions marked by social inequalities and poor access to healthcare. This study aimed to analyze the epidemiological profile of leprosy cases reported in the state of Piauí between 2020 and 2024, based on variables such as sex, race/color, and education. This is a quantitative, descriptive study based on secondary data extracted from the Notifiable Diseases Information System (Sinan Net), accessed through the DATASUS platform. The results revealed a total of 6,141 cases reported in the period, with a higher prevalence in males (71.94%), which reinforces the need for specific strategies aimed at men's health. In terms of race/color, the most affected groups were mixed race and black people, highlighting the persistence of racial inequalities in access to prevention, diagnosis, and treatment. Education proved to be an important social determinant of the disease: more than half of the cases occurred among illiterate individuals or those who had completed only the 4th grade of elementary school (1,618 cases). Among women, the highest number of notifications was among mixed race individuals who had completed high school (197 cases), while among men, mixed race individuals with high school education also led the statistics (176 cases). There was an absence of records among indigenous women and an absence of cases among illiterate Asian people or those with higher education, indicating possible gaps in coverage and underreporting in specific populations. The analysis indicates that leprosy remains a neglected disease, the determinants of which go beyond the biomedical field, involving social, racial, economic, and cultural factors. It is concluded that effective combating leprosy requires not only expanding diagnosis and treatment, but also intersectoral public policies that combat stigma, promote equity and guarantee full access to health for the most vulnerable populations.

IntroductionTuberculous meningitis (TBM) is a severe form of central nervous system infection caused by Mycobacterium tuberculosis (Mtb) that is often associated with significant morbidity and mortality, particularly in people living with HIV (PLWH). This study investigated differences in clinical and laboratory profiles of TBM cases in Brazil associated with HIV status, and identified factors associated with in-hospital mortality.MethodsWe conducted a retrospective analysis of 1,819 hospitalized adult TBM patients reported in the Brazilian Notifiable Diseases Information System (SINAN) meningitis database from 2007 to 2021. Confirmed cases in hospitalized individuals aged >18 years with known HIV status were included; pregnant patients were excluded. Clinical and laboratory features were compared by HIV status and clinical outcomes. Classification and regression tree analysis was used to identify outcome-based cut-off values for selected continuous variables. Associations with in-hospital mortality were assessed using backward stepwise binomial logistic regressions.ResultsThe majority (57%) of TBM cases comprised of PLWH, who exhibited lower frequencies of vomiting, nuchal rigidity, signs of meningeal inflammation, and coma, along with lower leukocyte counts in cerebrospinal fluid (CSF) compared to HIV-negative patients. PLWH also displayed lower mortality rates (17.3% vs. 23.2%, p = 0.002). Features independently associated with mortality included seizures (aOR: 2.15, 95%CI: 1.39–3.33, p < 0.001), nuchal rigidity (aOR: 1.57, 95%CI: 1.1–2.23, p = 0.014), age > 64 years old (aOR: 2.11, 95%CI: 1.08–4.13, p = 0.03), CSF protein concentration ≥441 mg/dL (aOR: 2:08, 95%CI: 1.39–3.09, p < 0.001) and CSF glucose concentration ≥ 22 mg/dL (aOR: 0.54, 95%CI: 0.38–0.76, p < 0.001), but not HIV (OR: 0.73, [95%IC: 0.52–1.01], p = 0.06).ConclusionOur findings suggest that despite greater prevalence in PLWH, these patients present fewer clinical signs and symptoms and lower mortality rates. Additionally, HIV was not an independent predictor of mortality in this study population.

The objective of this study was to analyze the social characteristics associated with the psychiatric morbidity and mortality profile of 126 Brazilian municipalities with indigenous and quilombola communities between 2010 and 2021. Method: a descriptive study with a quantitative approach, based on data from the 2010 Census of the Brazilian Institute of Geography and Statistics/IBGE, the Hospital Information System of the Unified Health System, the Mortality Information System and the Violence and Accident Surveillance of the Notifiable Diseases Information System. The data was processed according to region, size and Regional Interagency Commission to which the municipality belongs and distributed among the self-declared black, brown and indigenous population. Results: the 126 municipalities presented a more unfavorable picture than the national one, with an increase in the average time/days of hospitalization for mental and behavioral disorders, the rate of deaths due to the use of alcohol and other psychoactive substances, suicide attempts due to exogenous intoxication and interpersonal and self-inflicted violence. Small hospitals with poor health care services stood out. The black and indigenous population stood out in several indicators. Conclusions: the psychiatric morbidity and mortality profile is associated with class, race and gender markers, social vulnerabilities and racism faced by the populations living in these municipalities.

Dengue remains one of the main arboviral diseases circulating in Brazil, posing a public health challenge due to persistent social inequalities, failures in epidemiological surveillance, and the spread of the vector in urbanized areas. This study aimed to analyze the epidemiological profile of dengue in the country between 2014 and 2024, identifying sociodemographic patterns, geographic distribution, clinical outcomes, and informational limitations in official notification systems. This is a retrospective descriptive study based on secondary data extracted from the Notifiable Diseases Information System (SINAN), involving 5,346,568 probable cases. Variables were organized in spreadsheets and processed using statistical and geospatial analyses, with the production of graphs and thematic maps. Results showed a high concentration of cases in São Paulo (53.1%) and Minas Gerais (15.5%), predominance in women, individuals of brown or white race/color, and those with low educational levels. A significant volume of missing data was observed, especially regarding viral serotypes and hospitalizations. Although most cases progressed to clinical cure, more than 1,900 deaths directly attributed to dengue were reported. The study concludes that dengue remains a neglected disease, requiring improved surveillance, investment in health education, and public policies that address the social determinants of infection.

Objective: To evaluate the effectiveness of Community Health Workers (CHWs) in identifying suspected cases of leprosy in risk areas, using spatial analysis as a support tool in the municipality of Santarém, Pará. Methods: A cross-sectional, descriptive, and quantitative study was conducted between June and October 2019. Twenty-four CHWs from Basic Health Units (BHUs) located in low-, medium-, and high-risk areas for leprosy were included, identified through spatial analysis of data from the Notifiable Diseases Information System (SINAN, 2006-2014). The CHWs received training on leprosy and administered suspicion questionnaires during home visits (HV). Data were statistically analyzed and georeferenced in QGIS. Results: 83% of CHWs recognized leprosy as an infectious disease, but only 50% demonstrated knowledge about transmission and contact surveillance. During the HD, 19 suspected cases were identified, 17 with skin lesions and 13 with neurological changes (pain, numbness, tingling). Spatial analysis revealed a heterogeneous distribution of leprosy, with detection rates varying between census sectors, and highlighted the non-strategic location of some CHUs, limiting access for the population. Conclusion: Despite gaps in knowledge about transmission and surveillance, CHWs were effective in detecting suspected cases, reinforcing their role in expanding the capillarity of the health system. Spatial analysis proved essential for identifying priority areas and optimizing resource allocation. Continuous training of CHWs and integration of geospatial techniques into health surveillance strategies for leprosy control in endemic regions are recommended.

The temporal trend of the incidence, detection, and mortality coefficients related to the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in Minas Gerais, Southeast Brazil, between 2007 and 2020, was analyzed. This study employed an ecological time series design using data from the Information System for Notifiable Diseases (SINAN). Prais-Winsten regression was utilized for trend analysis with 95% confidence intervals. Throughout the studied period, 55,376 cases of HIV/AIDS were reported, predominantly among males (71.8%), with sexual transmission being the primary mode (81.42%), of which 48.87% were among homosexual individuals and 41.33% among heterosexual and bisexual individuals (9.78%). There was a decrease of 2.87% (per 100,000 population) in the AIDS incidence rate (annual variation of -2.8%; 95% CI: 0.090; 0.038) and an increase of 18.96% in HIV detection (annual variation 43.0%; 95% CI: 0.194; 0.713). The mortality rate decreased by 1.75% (95% CI: -0.116; -0.020). The percentage of notifications based on the HIV+ criterion increased from 3.22% in 2007 to 77.29% in 2020. The trend of increasing HIV detection aligns with the strategy for case identification through compulsory notification in 2014.

Dengue is the most widespread arboviral disease globally, affecting over 100 countries; Brazil accounts for 83% of cases in the Americas. This is an observational, cross-sectional ecological study encompassed all 27 Brazilian federative units, drawing on data from the Notifiable Diseases Information System (SINAN) and the Department of Informatics of the Unified Health System (DATASUS) from January 1, 2019, to June 30, 2024. Between January 2019 and June 2024, Brazil recorded 12.564.395 dengue cases and 316.519 hospitalizations (2.52% of cases). In the first half of 2024 alone, case counts surged to 6.393.080 with 129.127 hospitalizations, representing 70% of all admissions over the previous five years, and 1.593 dengue-related deaths, the highest six-month toll since 2019. Regional stratification revealed a disproportionately high burden in the Midwest: The Federal District exhibited the highest incidence and hospitalization rates per 100.000 inhabitants, while Goiás and Mato Grosso do Sul recorded mortality rates above the national average. Highest dengue incidence and hospitalization rates were observed in the Center-West and North regions, while mortality peaked in the Southeast, guiding targeted allocation of prevention and control efforts. These cumulative and half-year patterns reveal critical gaps in vector control, disease surveillance, and healthcare preparedness. Integrated public health strategies—including sustained mosquito control efforts, enhanced entomological and clinical monitoring, and bolstered hospital readiness—are essential to mitigate dengue’s impact. Policymakers should prioritize resource allocation and tailored interventions in high-burden regions to reduce transmission, morbidity, and mortality.

Epidemiology of American tegumentary leishmaniasis in Bahia, Brazil (2007-2023).

The aim of the study was to apply interpretable machine learning to identify key factors influencing work-related mental health cases to support early intervention. Using 1117 records from Brazil's Notifiable Diseases Information System for the period from 2007 to 2022, five machine learning models were developed to classify mental health cases as mild or severe. SHAP analysis was employed to rank and interpret the most influential predictors. The decision tree model achieved 82.9% accuracy (92 of 111 cases classified, including 83 of 85 severe cases), while the support vector machine reached 82.0% accuracy (91 of 111 correct, including 84 of 85 severe). Key determinants included work removal, protective measures, and regional factors. High-risk occupations comprised energy/water operators, legal professionals, and engineers. Interpretable machine learning models effectively predict mental health outcomes, revealing actionable sociodemographic and occupational risk factors for targeted interventions.

The increase in suicide attempts among children and adolescents is a growing concern in Brazil, recognized as a serious public health issue. This study analyzed cases of suicide attempts by intentional medication ingestion, recorded in the Notifiable Diseases Information System (SINAN) between 2015 and 2019. Secondary data were analyzed, focusing on age group, sex, region, and state of residence. Associations between variables were assessed using ANOVA for quantitative variables and Pearson’s Chi-square for categorical variables. Results showed a predominance of cases among females (72%), mainly in adolescents aged 15 to 19, although boys had higher completion rates. The Southeast and South regions had the highest number of records, while Tocantins and Paraná showed the highest coefficients per 100,000 inhabitants. Factors such as psychiatric disorders, early use of alcohol and drugs, and feelings of loneliness were identified as significant risks, whereas socioeconomic conditions showed no significant correlation. The findings highlight the need for public policies focused on mental health prevention and care, prioritizing early interventions, specific territorial planning, and training of primary care professionals to identify risk and protective factors. Raising awareness among policymakers, health professionals, and society about proper case reporting is essential to mitigate the impact of this issue.

The severity of physical disability at leprosy diagnosis reflects the timeliness of case detection and the effectiveness of disease surveillance. This study evaluates machine learning models to predict factors associated with late leprosy diagnosis-defined as grade 2 physical disability (G2D)-in Brazil from 2018 to 2022. Using an observational cross-sectional design, we analyzed data from the Notifiable Diseases Information System and trained four machine learning models: Random Forest, LightGBM, CatBoost, XGBoost, and an Ensemble model. Model performance was assessed through accuracy, area under the receiver operating characteristic curve (AUC-ROC), recall, precision, F1 score, specificity, and Matthew's correlation coefficient (MCC). An increasing trend in G2D prevalence was observed, averaging 11.6% over the study period and rising to 13.1% in 2022. The Ensemble model and LightGBM demonstrated the highest predictive performance, particularly in the north and northeast regions (accuracy: 0.85, AUC-ROC: 0.93, recall: 0.90, F1 score: 0.83, MCC: 0.70), with similar results in other regions. Key predictors of G2D included the number of nerves affected, clinical form, education level, and case detection mode. These findings underscore the potential of machine learning to enhance early detection strategies and reduce the burden of disability in leprosy, particularly in regions with persistent health disparities.