Notifiable Diseases Information System Research Articles

Syphilis in pregnancy and adverse birth outcomes: Anationwide longitudinal study in Brazil.

The present study aimed to evaluate the association between syphilis in pregnancy and low birth weight, small for gestational age, and preterm birth. This longitudinal study used Brazilian National Information System for livebirths (SINASC) linked to the gestational syphilis cases from Notifiable Diseases Information System (SINAN) from 2011 to 2017. Descriptive statistics and logistic regression were used to compare the birth outcomes of pregnant women with and without syphilis. The study protocol was approved by the Research Ethics Committee of the Institute of Collective Health of the Federal University of Bahia (CAAE: registration no. 18022319.4.0000.5030). A total of 17 930 817 live births were included in the study. Of these, 155 214 (8.7/1000) were exposed to syphilis during pregnancy. Maternal syphilis increased the odds of low birth weight (aOR 1.88, 95% CI: 1.85-1.91), small for gestational age (aOR 1.53, 95% CI: 1.51-1.56), and preterm birth (aOR 1.35, 95% CI: 1.33-1.37). Higher odds were observed for pregnant women with VDRL titer ≥64 and untreated maternal syphilis when compared to mothers without syphilis. Analysis stratified by prenatal care showed higher odds for all adverse birth outcomes for mothers attending ≤6 prenatal appointments. Our findings showed a strong association between gestational syphilis and adverse birth outcomes with increased odds observed among women with higher VDRL titers, lack of treatment, and fewer prenatal appointments. These results highlight the need for adequate screening and treatment for gestational syphilis during pregnancy to mitigate the risk of adverse birth outcomes.

Temporal trends and space-time distribution of leprosy relapse in Brazil from 2001 to 2021.

To analyse the temporal trends and spatiotemporal distribution of leprosy relapse in Brazil from 2001 to 2021. An ecological study with a temporal trend approach and space-time analysis of leprosy relapse in Brazil was carried out with data from the Notifiable Diseases Information System. A total of 31334 patients who experienced leprosy relapse were identified. The number of recurrent cases tended to increase throughout the study period, and this increase was significant among females and in almost all age groups, except for those <15, 50-59 and ≥70y. Several clusters of high- and low-risk patients were identified across all regions with a heterogeneous distribution. The burden of relapse showed an increasing trend in some groups and was distributed in all regions.

Sexual violence against children and adolescents in Paraná State: geospatial analysis and main socioeconomic indicators

ObjectiveChild sexual violence is a multidimensional problem of many contemporary societies, affecting people of all sexes, social stratum and age groups. Offenses involving children and adolescents are more serious, given their total or partial dependence on parents and caregivers. Information on child sexual violence in Brazil is found in raw form and without detail. The objective was to compare the information with social and economic data in the state of Paraná. MethodsThe authors conducted a retrospective study of secondary data from the Notifiable Diseases Information System (SINAN) on cases of sexual violence involving victims aged 0 to 19 years. Results are presented according to notification characteristics. The authors applied exploratory spatial data analysis to assess spatial autocorrelations and investigated relationships by the ordinary least squares regression model. ResultsBetween 2017 and 2021, there were 13,403 reports of child sexual violence in Paraná State, Brazil. Most victims (82.8%) were female and aged between 10 and 14 years. The majority of sexual violence cases (67.8%) occurred in the home environment. The highest rates on a population basis were observed in the North Central and Greater Curitiba regions, mainly in cities with higher population density and with higher rates of other types of violence. ConclusionThe results provide data that can promote a broader understanding of the distribution of sexual violence and the state and associated variations. It is expected to improve the provision of care for victims of child sexual violence and assist in strategic planning to prevent future offenses.

Spatiality of Human Visceral Leishmaniasis in Maranhão, Brazil

Objective: the study analyzed the spatio-temporal and epidemiological behavior of HVL in the state of Maranhão, between 2010 and 2020.&#x0D;  &#x0D; Theoretical framework: In Brasil, HVL is one of several diseases with compulsory notification, and is registered in 21 Federation Units, establishing itself in the five Brasilian regions. The Northeast region has the highest number of recorded cases, considered a focus of transmission of the disease, with Maranhão being one of the states with the highest occurrence.&#x0D;  &#x0D; Method: the study used secondary data from the Notifiable Diseases Information System. The incidence rate, lethality rate, mortality rate, Odds Ratio and Annual Increment Rate were calculated.&#x0D;  &#x0D; Results and conclusions: pointed to an endemic scenario of the disease. The predominant profile was male, aged between 1 and 9 years old, brown color/race, primary education and urban residence area. It is necessary to monitor the environment where vectors are present to control them and reduce the possibility of illness.&#x0D;  &#x0D; Implications: the study is relevant as it contributes with epidemiological data and health indicators from an endemic region, so that health authorities can implement surveillance actions, health education and carry out public health interventions respecting socioeconomic differences and local environmental.&#x0D;  &#x0D; Novelty: the identification of areas at risk for the disease in a given region allows us to know their spatiality, the population's chances of becoming ill and the rate of increase in the disease.

Analysis of signs and symptoms in confirmed cases of severe dengue among children aged 0 to 10 years old.

The prevalent symptoms of severe dengue in pediatric patients are divided into three subgroups: severe plasma leakage, severe bleeding, and severe organ damage. In addition, the seasonal patterns of the disease and the outcomes of cure or death from dengue were evaluated. An epidemiological, observational, analytical, cross-sectional study was conducted with data from the Notifiable Disease Information System (SINAN - Sistema de Informação de Agravos de Notificação and DATASUS - Departamento de Informática do Sistema Único de Saúde) of the Ministry of Health from 2019 to 2020. During the study period, 1,857 cases of severe dengue were observed in the pediatric age group, with the most common symptoms being respiratory failure, melena, hematemesis, and altered level of consciousness. The total proportion of patients hospitalized for severe dengue was 89.6%, and 51.2% of these patients died, corroborating the importance of early detection of the disease. Severe dengue is more prevalent during the seasonal period, with hot and humid characteristics owing to the mechanism involved in the viral cycle. The most prevalent symptoms of severe dengue in pediatric patients were respiratory failure alone, gastrointestinal bleeding, and altered level of consciousness. It is important to identify signs of severity for early intervention and a better prognosis, considering that death is closely related to a delayed diagnosis.

Spatio-Temporal Analysis and Clinical-Epidemiological Characterization of Visceral Leishmaniasis in Maranhão, Brazil, from 2009 to 2020.

This study was carried out to identify the spatial distribution and characterize the clinical-epidemiological profile of Visceral Leishmaniasis (VL) in Maranhão state, Brazil, from 2009 to 2020. This descriptive ecological study collected sociodemographic and clinical data of VL cases from the Brazilian Notifiable Diseases Information System database. A spatial autocorrelation analysis (Moran statistics) was performed. From 2009 to 2020, 5699 cases of VL were reported, with incidence of 6.5 cases/100,000 and prevalence of 7.1 cases/100,000. The temporal analysis showed a significant growth in incidence from 2009 to 2018, followed by a significant decrease between 2019 and 2020. The Moran map shows hotspots of high values in the central-west and central-east regions, and hotspots of low values in the northern region of Maranhão. The profile of patients affected by VL comprises males (OR = 1.8; IC95% = 1.72-1.92), aged under 14 years, brown, and with incomplete elementary schooling. The main symptoms reported were fever, fatigue, and edema. The main diagnostic method was laboratory. The mortality rate was 6.8%, and co-infection with HIV was reported by 8.5% of patients. The results of this study indicated the increase in incidence and lethality, as well as the expansion, of leishmaniasis in the state of Maranhão.

Male rape in Brazil: A descriptive analysis from 2010 to 2022

Male rape is a relatively under-discussed topic in scientific literature, despite its significant relevance and prevalence worldwide, including in Brazil. To inform public health and safety policies, this study aimed to analyze cases of male rape using data from SINAN, the Information System for Notifiable Diseases, a division of the Brazilian Ministry of Health, for the years 2010–2022. Our findings reveal a 469 % increase in male rape cases in the country over the study period, with a predominance of cases in the state of São Paulo. Also, a higher prevalence of cases was observed among individuals aged 5–9 years. Furthermore, we identified a correlation between the occurrence of rape and certain factors, including individuals with less than 4 years of formal education if they were over the age of 50, and those who had a history of being sexually abused between the ages of 5 and 14. Additionally, this study reinforces the prevalence of rape cases occurring within domestic environments and perpetrated by individuals closely related to the victims. This study contributes to filling the gap in research on male rape in Brazil, laying the foundation for the development of strategies to prevent and combat rape in the country.

Efficacy of prenatal care in preventing congenital syphilis: a retrospective longitudinal analysis in Araçatuba, São Paulo

Introduction: Congenital syphilis stands as one of the primary causes of abortion worldwide, presenting a public health challenge in Brazil, where its incidence has been on the rise for the past 10 years, despite its preventable nature. Aim: To assess the effectiveness of prenatal care in averting congenital syphilis and mitigating adverse complications for newborns. Design: An observational, longitudinal, retrospective study was conducted, involving 65 newborns with congenital syphilis and their respective mothers. Data were gathered from the Notifiable Diseases Information System of Araçatuba-SP, spanning from 2018 to 2021. Results: A significant correlation was observed between attendance of prenatal care and neonatal outcomes. It was discovered that delayed diagnosis of infection in pregnant women was linked to more severe clinical manifestations in newborns. While only 13.7% of infants born to mothers diagnosed during prenatal care exhibited early symptoms, this figure rose to 57.1% in cases where diagnosis occurred during delivery. Implications: Despite endeavors to eradicate congenital syphilis, the persistent uptick in its incidence indicates deficiencies in prenatal care, underscoring the urgent necessity for interventions in primary healthcare.

Quantifying gaps in the tuberculosis care cascade in Brazil: A mathematical model study using national program data.

In Brazil, many individuals with tuberculosis (TB) do not receive appropriate care due to delayed or missed diagnosis, ineffective treatment regimens, or loss-to-follow-up. This study aimed to estimate the health losses and TB program costs attributable to each gap in the care cascade for TB disease in Brazil. We constructed a Markov model simulating the TB care cascade and lifetime health outcomes (e.g., death, cure, postinfectious sequelae) for individuals developing TB disease in Brazil. We stratified the model by age, human immunodeficiency virus (HIV) status, drug resistance, state of residence, and disease severity, and developed a parallel model for individuals without TB that receive a false-positive TB diagnosis. Models were fit to data (adult and pediatric) from Brazil's Notifiable Diseases Information System (SINAN) and Mortality Information System (SIM) for 2018. Using these models, we assessed current program performance and simulated hypothetical scenarios that eliminated specific gaps in the care cascade, in order to quantify incremental health losses and TB diagnosis and treatment costs along the care cascade. TB-attributable disability-adjusted life years (DALYs) were calculated by comparing changes in survival and nonfatal disability to a no-TB counterfactual scenario. We estimated that 90.0% (95% uncertainty interval [UI]: 85.2 to 93.4) of individuals with TB disease initiated treatment and 10.0% (95% UI: 7.6 to 12.5) died with TB. The average number of TB-attributable DALYs per incident TB case varied across Brazil, ranging from 2.9 (95% UI: 2.3 to 3.6) DALYs in Acre to 4.0 (95% UI: 3.3 to 4.7) DALYs in Rio Grande do Sul (national average 3.5 [95% UI: 2.8 to 4.1]). Delayed diagnosis contributed the largest health losses along the care cascade, followed by post-TB sequelae and loss to follow up from TB treatment, with TB DALYs reduced by 71% (95% UI: 65 to 76), 41% (95% UI: 36 to 49), and 10% (95% UI: 7 to 16), respectively, when these factors were eliminated. Total health system costs were largely unaffected by improvements in the care cascade, with elimination of treatment failure reducing attributable costs by 3.1% (95% UI: 1.5 to 5.4). TB diagnosis and treatment of false-positive individuals accounted for 10.2% (95% UI: 3.9 to 21.7) of total programmatic costs but contributed minimally to health losses. Several assumptions were required to interpret programmatic data for the analysis, and we were unable to estimate the contribution of social factors to care cascade outcomes. In this study, we observed that delays to diagnosis, post-disease sequelae and treatment loss to follow-up were primary contributors to the TB burden of disease in Brazil. Reducing delays to diagnosis, improving healthcare after TB cure, and reducing treatment loss to follow-up should be prioritized to improve the burden of TB disease in Brazil.

Clinical and epidemiological aspects of patients injured by stingrays in the state of Pará, Brazil

The objective of this study was to outline the clinical-epidemiological profile of patients injured by stingrays from 2007 to 2021. A descriptive study was carried out through an epidemiological retrospective of ichthyism in 20 municipalities in Pará belonging to the Amazon Basin. Notified cases were obtained from the Notifiable Diseases Information System, where the following variables were investigated: socioeconomic profile, affected anatomical region, local and systemic clinical symptomatology. Treatment evolution regarding death and cure was also evaluated. Data were statistically evaluated using the chi-square test, at 5% significance level. A total of 737 cases of accidents caused by stingrays were reported during the period. Of these, 438 forms were not completed with the education data of the patients treated, followed by 158 forms not completed for the race item. Accidents caused by stingrays tend to happen to brown men, aged over 20 years, with incomplete secondary education, living in urban areas, with accidents occurring mainly on the region's beaches. The foot and leg were the most affected regions (p&lt;0.05). Patients sought care in the first hours after the accident or only 24 hours (p&lt;0.05) later. They presented local symptoms, such as pain and swelling. Some cases had systemic complications, mainly myolytic and neurological. This study reinforces the need to adopt strategies related to health and environmental education for people who visit risky areas to mitigate the occurrence of accidents caused by stingrays.

LEISHMANIOSE TEGUMENTAR AMERICANA EM UMA MICRORREGIÃO DA AMAZÔNIA BRASILEIRA ENTRE 2010-2019

Objective: The study sought to analyze the epidemiological profile of people with American Tegumentary Leishmaniasis (ATL) in the Lake Tucuruí Integration Region, between 2010 and 2019. Methods: Descriptive study, with data obtained from the Health System Notifiable Disease Information System. Results: There were 3,305 patients with ATL distributed in seven cities. Males, aged 15-39 and 40-59 years were the most affected. New cases are the main route of transmission and the most prevalent clinical form is cutaneous leishmaniasis. The cure was shown in four of the seven cities studied. The cities of Itupiranga and Novo Repartimento showed that the rural area is the main area of ​​infection. The urban area was the area of ​​greatest contagion for the cities of Jacundá and Tucuruí. Conclusion: The study for ATL showed that this zoonosis is endemic in this Amazon microregion and it mainly affects male individuals, with low education and aged between 15-39 and 40-59 years.

Spatial distribution of visceral leishmaniasis in the state of Paraíba, Brazil between 2007 and 2017

Leishmaniasis is currently a complex and neglected disease, making it a public health problem. Visceral leishmaniasis is the most serious systemic form and can be fatal if left untreated. Thus, knowing the epidemiological profile of visceral leishmaniasis can support the actions of health professionals and managers. To investigation was to describe the spatial distribution of visceral leishmaniasis in the State of Paraíba, Brazil, between 2007 and 2017. An ecological, observational and descriptive study, with a quantitative approach using data from the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação, Sinan), recorded between 2007 and 2017. Statistical analysis was performed with the calculation of the Relative Risk, the Spatial Scan Method and the Local Empirical Bayesian Method, with use of R-Project, version 3.5.1. In Paraíba 431 cases of visceral leishmaniasis were recorded, 227 (52.7%) of which were in male individuals and with a higher incidence in the years 2012 and 2014, in the age group of 20 to 40, with a predominance of new cases (first time that the case was recorded in the information system, which differs from recurrence), as regards entry method in the Sinan. Most of the cases occurred in the white race and with laboratory criterion for diagnostic confirmation. Spatial clusters of visceral leishmaniasis are evidenced in the State, described in the micro region of the South Coast, of Cajazeiras, Sousa and Catolé do Rocha, in addition to the municipality of Campina Grande. It is urgent to carry out actions that can implement comprehensive assistance to people exposed to the risk of infection of this disease, in order to prevent the disease or to minimize its impacts when installed.

Prevalence and Spatial Autocorrelation of Tuberculosis in Indigenous People in Brazil, 2002-2022.

Tuberculosis (TB) among indigenous populations in Brazil poses a multifaceted public health challenge influenced by geographical, social, institutional, economic, and cultural factors. This study scrutinized the prevalence and spatial distribution of TB among Brazilian indigenous communities from 2002 to 2022. Employing a cross-sectional and descriptive approach, we analyzed data from the Notifiable Diseases Information System (SINAN) and conducted spatial autocorrelation tests to identify clusters and outliers. The findings uncovered substantial disparities in TB prevalence between the North and Central-West regions, in contrast to the South and Southeast, mirroring social, economic, and cultural inequalities in Brazil. It is concluded that public health strategies should not only consider the epidemiological aspects of TB but also encompass social and environmental determinants, notably the impact of climate change. Holistic and context-sensitive approaches are imperative for addressing TB within indigenous communities, underscoring the need for adaptive and culturally sensitive interventions in the public health landscape.

Effect of environmental variables on the incidence of Visceral Leishmaniasis in Brazil and Colombia

Visceral Leishmaniasis (VL) is the most severe of the three forms of Leishmaniasis. In the Americas, Brazil and Colombia present more than 90 % of the cases in the region. Our aim in this research was to estimate the association of the incidence rate of Visceral Leishmaniasis with the following environmental variables: the percentage of area suitable for the vector Lutzomyia longipalpis, the episodes of La Niña and El Niño, the Brazilian and Colombian biomes. Epidemiological data were obtained from the Brazilian Notifiable Diseases Information System and the Colombian National Public Health Surveillance System. Environmental data were downloaded from the NASA Giovanni web app, the Modis Sensor database, and the meteorological agencies of Australia, Japan, and the United States of America. Records of the presence of Lu. longipalpis were obtained from public databases and previous studies. As a result, the incidence per 10,000 inhabitants with LEBS for each El Niño-Southern Oscillation (ENSO) episode showed the largest values during El Niño 2015–2016, mainly in Brazil's Northeast and Central regions and the Northeast region of Colombia. Compared with the Neutral 2012–2014 episode, the episodes of El Niño 2015–2016 and La Niña 2010–2011 showed an average increase in the monthly incidence rate of VL, and the average increase was higher during El Niño 2015–2016 (aIRR = 2.304 vs.1.453) We found a positive association between the incidence rate of VL and the El Niño 2015–2016 episode and an impressive% of area suitable for the vector Lu. longipalpis in the Amazon region.An increase of 1 % in the area suitable for the vector Lu. longipalpis leads to an average rise of 0.8 % in the monthly incidence rate of VL. Our study shows a possible association between VL incidence and ENSO, with the most considerable incidence rates observed during El Niño 2015–2016 in Brazil's Northeast and Central regions and the Northeast region of Colombia. The present study is very important to better understand the Visceral Leishmaniasis transmission dynamics.

Spatial analysis of HIV detection rates among Brazilian young men, 2007–2021

ABSTRACT The main goal of this study was to spatially analyze the HIV epidemic scenario in young men in Brazil, 2007–2021. We used secondary data obtained from the Brazilian Information System for Notifiable Diseases. Individuals aged 15–29 years with permanent residence in Brazil who were diagnosed with HIV during the study period were included in the analysis. Municipality HIV age-adjusted detection rates were analyzed through spatial distribution, autocorrelation, and spatiotemporal risk analyses. During the study period, 108,392 HIV cases were reported in young Brazilian men. The HIV epidemic increased territorially in the northern, northeastern, midwestern, and southeastern regions but decreased in the southern region. Although the number of clusters comprising municipalities with high HIV detection rates (hotspots) decreased, new ones appeared, expanded, or stopped changing size. Hotspots and spatio-temporal risk zones (spatial areas with increased HIV detection in a specific period) comprised economically developed municipalities with high demographic density surrounded by less developed municipalities. The period of the spatiotemporal risk zones was between 2008 and 2021. Our study showed that HIV detection rates continue to increase among young Brazilian men, and health authorities should reinforce efforts mainly in capitals and surrounded municipalities in the north, northeast, southeast, and midwest regions.

Isoniazid Monoresistance and Antituberculosis Treatment Outcome in Persons With Pulmonary Tuberculosis in Brazil.

The high burden of drug-resistant tuberculosis (TB) is a problem to achieve the goals of the End TB Strategy by 2035. Whether isoniazid monoresistance (Hr) affects anti-TB treatment (ATT) outcomes remains unknown in high-burden countries. We evaluated determinants of ATT outcome among pulmonary TB cases reported to the National Notifiable Disease Information System (SINAN) between June 2015 and June 2019, according to drug sensitivity testing (DST) results. Binomial logistic regression models were employed to evaluate whether Hr was associated with an unfavorable ATT outcome: death or failure, compared to cure or treatment completion. Among 60 804 TB cases reported in SINAN, 21 197 (34.9%) were included in the study. In this database, the frequency of unfavorable outcomes was significantly higher in those with Hr in contrast to isoniazid-sensitive persons with pulmonary TB (9.1% vs 3.05%; P < .001). Using a binomial logistic regression model, Hr was independently associated with unfavorable outcomes (odds ratio, 3.34 [95% confidence interval, 2.06-5.40]; P < .001). Hr detected prior to ATT was predictive of unfavorable outcomes at the national level in Brazil. Our data reinforce the need for high-TB-burden countries to prioritize DST to detect Hr. Effective treatment regimens for Hr-TB are needed to improve outcomes.

Epidemiology of visceral leishmaniasis in municipalities of Mato Grosso and the performance of surveillance activities: an updated investigation.

Visceral leishmaniasis (VL) is considered a globally neglected disease. To address the problem of VL endemic to Brazil, the Visceral Leishmaniasis Control Program (VLCP) was created, which recommends the development of health surveillance actions such as the identification of human and canine cases, vector control and prevention of disease. We aimed to investigate the epidemiological situation of VL in municipalities of the State of Mato Grosso (MT) and assess the execution of VLCP activities. Data on human cases were obtained from the Information System for Notifiable Diseases (SINAN), and data from entomological and canine inquiry were provided by the State's Health Department. Analyzes from the period 2019 - 2021 recorded 30 cases of human VL, distributed among 16 municipalities. Vectors were identified in 50% of the municipalities where entomological investigations were carried out, and the predominant specie was Lutzomyia longipalpis. A total of 15,585 dogs were subjected to serological examination, of which 18.91% tested seropositive for Leishmania infantum. However, it must be emphasized that only three municipalities conducted consecutive inquiries involving canine VL. Although VL is distributed widely throughout the State, only a few municipalities have undertaken the actions of the VLCP, thus highlighting the neglected status of the disease.

Tendência e distribuição espacial da hepatite B em gestantes no Brasil

Abstract Objectives: to analyze the trend and spatial distribution of hepatitis B in pregnant women in Brazil. Methods: ecological study based on all notified cases of hepatitis B in pregnant women through the Information System for Notifiable Diseases – Sinan between 2009 and 2018. Hepatitis B virus (HBV) detection rates were calculated in all municipalities. Spatial analysis was performed using the Global Moran Index for global data and local indicators of spatial association (Lisa) for the 5,570 municipalities. For trend analysis by State, the Prais-Winsten generalized linear regression model was used. Results: 15,253 pregnant women with HBV were reported. High detection rates were observed in the municipalities of São Miguel da Boa Vista-SC (68.96/1000 live births (LB)), Araguaiana-MT (68.18/1000 LB), Reserva do Cabaçal-MT (80, 00/1,000 LB), São Geraldo da Piedade-MG (75/1000 LB), Porto Mauá-RS (111, 11/1000 LB), in the respective bienniums. Moran (I) (I=0.056) showed a positive spatial association. In Lisa, 78 municipalities were included in the high-high cluster, 51.28% in the South region and 48 in the low-low cluster with 72.91% in the Southeast. There was an increasing trend in Maranhão (p=0.004) and Pernambuco (p=0.007) and a decrease in Mato Grosso (p=0.012), Paraná (p=0.031) and Santa Catarina (p=0.008). Conclusion: the detection of hepatitis B in pregnant women was observed in most Brazilian municipalities, with an increasing trend in two states and a decrease in three others.

PREVALÊNCIA E FATORES PESSOAIS ASSOCIADOS À VIOLÊNCIA AUTOPROVOCADA EM ADOLESCENTES

ABSTRACT Objective: To identify the prevalence and personal factors associated with self-harm in adolescents. Method: A cross-sectional analytical observational study. The population consisted of notifications of interpersonal or self-harm violence in adolescents in Brazil from the Notifiable Diseases Information System. Notifications between 2009 and 2021 in Brazil were included in adolescents aged 10 to 19. The data was analyzed using descriptive and inferential statistics. Results: The prevalence of self-harm was 27.39% in Brazil. Black adolescents increase the prevalence of self-harm violence by 3% and brown and indigenous adolescents by 2%; more than eight years of schooling is a protective factor in relation to self-harm violence, reducing the prevalence of self-inflicted violence by 12%. Conclusion: The results indicate the need for effective policies and strategies to help care for this public.

HIV and AIDS in the state of Paraná, Brazil, 2007-2022: trends and spatiotemporal distribution.

The aim of this study was to analyze the spatiotemporal evolution of the incidence rates of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the state of Paraná, Brazil. An ecological study with an analytical component of time series analysis was conducted in the state of Paraná from 2007 to 2022. The data source was the Notifiable Diseases Information System. To study the trend, the Prais-Winsten generalized linear regression model was used by decomposing the time series, and for spatial analysis, the Moran's index was applied. The total sample consisted of 50,676 HIV/AIDS records. The incidence rate showed an increasing trend, with an average growth of 2.14% [95% confidence interval - 95%CI 1.16-3.13] per month. From 2007 to 2014 and from 2015 to 2022, the average number of cases in the state was 105.64 and 159.20 per 100,000 inhabitants, respectively, with significant variation among municipalities. Spatial clusters of high risk persisted in the metropolitan region, the capital, and coastal areas, and a new cluster was observed in the northern region of the state. The incidence rates of HIV/AIDS showed an upward trend over time. The number of cases varied considerably in some municipalities, especially in the coastal region. Spatial analysis revealed geospatial patterns of high risk in the main metropolitan areas of Paraná: Curitiba (including the coastal area), Londrina, and Maringá, which share characteristics such as a high degree of urbanization and ongoing economic development.