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Objectives: The control chart is a classic statistical technique in epidemiology for identifying trends, patterns, or alerts. One meaningful use is monitoring and tracking Infant Mortality Rates, which is a priority both domestically and for the World Health Organization, as it reflects the effectiveness of public policies and the progress of nations. This study aims to evaluate the applicability and performance of this technique in Brazilian cities with different population sizes using infant mortality data. Results: In this article, we evaluate the effectiveness of the statistical process control chart in the context of Brazilian cities. We present three categories of city groups, divided based on population size and classified according to the quality of the analyses when subjected to the control method: consistent, interpretable, and inconsistent. In cities with a large population, the data in these contexts show a lower noise level and reliable results. However, in intermediate and small-sized cities, the technique becomes limited in detecting deviations from expected behaviors, resulting in reduced reliability of the generated patterns and alerts. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The study aimed to detect high-risk areas for deaths of children and adolescents 5 to 14 years of age in the state of Mato Grosso, Brazil, from 2009 to 2020. This was an exploratory ecological study with municipalities as the units of analysis. Considering mortality data from the Mortality Information System (SIM) and demographic data from the Brazilian Institute of Geography and Statistics (IBGE), the study used multivariate statistics to identify space-time clusters of excess mortality risk in this age group. From 5 to 9 years of age, two clusters with high mortality risk were detected; the most likely located in the state's southern mesoregion (RR: 1.6; LRT: 8,53). Among the 5 clusters detected in the 10-14- year age group, the main cluster was in the state's northern mesoregion (RR: 2,26; LRT: 7,84). A reduction in mortality rates was observed in the younger age group and an increase in these rates in the older group. The identification of these clusters, whose analysis merits replication in other parts of Brazil, is the initial stage in the investigation of possible factors associated with morbidity and mortality in this group, still insufficiently explored, and for planning adequate interventions. [ABSTRACT FROM AUTHOR]

Background: Accurate estimates of the COVID-19 pandemic's indirect impacts are crucial, especially in low- and middle-income countries. This study aims to update estimates of excess maternal deaths in Brazil during the first two years of the COVID-19 pandemic. Methods: This was an exploratory mixed ecological study using the counterfactual approach. The observed maternal deaths were gathered from the Mortality Information System (SIM) for the period between March 2015 and February 2022. Expected deaths from March 2020 to February 2022 were estimated using quasipoisson generalized additive models, considering quadrimester, age group, and their interaction as predictor variables. Analyses were performed in R version 4.1.2, RStudio, version 2023.03.1+446 and carried out with support from the "mgcv" and "plot_model" libraries. Results: A total of 5,040 maternal deaths were reported, with varying excess mortality across regions and age groups, resulting in 69% excess maternal mortality throughout Brazil during the first two years of the pandemic. The Southeast region had 50% excess mortality throughout the first two years and 76% excess in the second year. The North region had 69% excess mortality, increasing in the second year, particularly among women aged 20–34. The Northeast region showed 80% excess mortality, with a significant increase in the second year, especially among women aged 35–49. The Central-West region had 75% excess mortality, higher in the second year and statistically significant among women aged 35–49. The South region showed 117% excess mortality, reaching 203% in the second year among women aged 20–34, but no excess mortality in the 10–19 age category. Conclusions: Over two years, Brazil saw a significant impact on maternal excess deaths, regardless of region and pandemic year. The highest peak occurred between March and June 2021, emphasizing the importance of timely and effective epidemic responses to prevent avoidable deaths and prepare for new crises. [ABSTRACT FROM AUTHOR]

[Display omitted] • Vector species richness is a strong predictor of Chagas disease mortality rates. • The findings give support for the Amplification Effect Hypothesis. • It is important to consider vector diversity when studying vector-borne diseases. Vector species richness may drive the prevalence of vector-borne diseases by influencing pathogen transmission rates. The dilution effect hypothesis predicts that higher biodiversity reduces disease prevalence, but with inconclusive evidence. In contrast, the amplification effect hypothesis suggests that higher vector diversity may result in greater disease transmission by increasing and diversifying the transmission pathways. The relationship between vector diversity and pathogen transmission remains unclear and requires further study. Chagas disease is a vector-borne disease most prevalent in Brazil and transmitted by multiple species of insect vectors of the subfamily Triatominae, yet the drivers of spatial variation in its impact on human populations remain unresolved. We tested whether triatomine species richness, latitude, bioclimatic variables, human host population density, and socioeconomic variables predict Chagas disease mortality rates across over 5000 spatial grid cells covering all of Brazil. Results show that species richness of triatomine vectors is a good predictor of mortality rates caused by Chagas disease, which supports the amplification effect hypothesis. Vector richness and the impact of Chagas disease may also be driven by latitudinal components of climate and human socioeconomic factors. We provide evidence that vector diversity is a strong predictor of disease prevalence and give support to the amplification effect hypothesis. [ABSTRACT FROM AUTHOR]

This essay seeks to understand the sensitive responses of contemporary perspectives and experiences in dealing with whales washed up on beaches killed largely by plastic pollution in our seas and oceans. Identified in Brazilian online mass-circulation periodicals and denounced by environmentally engaged art, the interactions between the bodies of whales and culture are interpreted in the light of studies of the history of human–non-human–animal relationships, human sensibilities triggered by this contact, and media reports denouncing the current environmental crisis and raising awareness of the importance of protecting species, in this case cetaceans. Through the Brazilian periodical press, one can see, in the record of whale deaths, the sensitivity toward non-human animals and the concern with the explanations of this phenomenon. [ABSTRACT FROM AUTHOR]

Aims: This study describes the spatio‐temporal dynamics of new visceral leishmaniasis (VL) cases notified in Brazil between 2001 and 2020. Methods and Results: Data on the occurrence of the disease were obtained by means of the Notifiable Diseases Information System of the Brazilian Ministry of Health. Joinpoint, temporal generalized additive models and conditional autoregressive (CAR) models were used to analyse the temporal evolution of the rates in Brazil, states and regions. Spatio‐temporal generalized additive and CAR models were used to identify the distribution of annual risks of VL occurrence in the Brazilian territory in relation to variation in the spatial average. There were 63,966 VL cases in the target period (3.198 cases/year), corresponding to a mean incidence rate of 1.68 cases/100,000 inhabitants. Of these, 4451 resulted in deaths, which gives a mean mortality rate of 0.12 deaths/100,000 inhabitants and a case fatality of 6.96%. The highest incidence rate was found in the North region, followed closely by the Northeast region, which presented the second and first highest mortality rates, respectively. For all of Brazil, and in the Northeast region, there were stability in the incidence rates, while the other regions showed an increasing trend in different time segments in the period: Central‐West up to 2011, North up to 2008, Southeast up to 2004, and South up to 2010. On the other hand, all regions experienced a reduction in incidence rate during the last years of the series. The Northeast region had the highest number of municipalities with statistically significant elevated relative risks. The spatio‐temporal analysis showed the highest risk area predominantly in the Northeast region in the beginning of the time series. From 2002 to 2018, this area expanded to the interior of the country. Conclusions: The present study has shown that VL has expanded in Brazil. However, the North and Northeast regions continue to have the highest incidence, and the risk of infection has decreased in recent years. [ABSTRACT FROM AUTHOR]

Living with extremely low-income is an important risk factor for HIV/AIDS and can be mitigated by conditional cash transfers. Using a cohort of 22.7 million low-income individuals during 9 years, we evaluated the effects of the world's largest conditional cash transfer, the Programa Bolsa Família, on HIV/AIDS-related outcomes. Exposure to Programa Bolsa Família was associated with reduced AIDS incidence by 41% (RR:0.59; 95%CI:0.57-0.61), mortality by 39% (RR:0.61; 95%CI:0.57-0.64), and case fatality rates by 25% (RR:0.75; 95%CI:0.66-0.85) in the cohort, and Programa Bolsa Família effects were considerably stronger among individuals of extremely low-income [reduction of 55% for incidence (RR:0.45, 95% CI:0.42-0.47), 54% mortality (RR:0.46, 95% CI:0.42-0.49), and 37% case-fatality (RR:0.63, 95% CI:0.51 −0.76)], decreasing gradually until having no effect in individuals with higher incomes. Similar effects were observed on HIV notification. Programa Bolsa Família impact was also stronger among women and adolescents. Several sensitivity and triangulation analyses demonstrated the robustness of the results. Conditional cash transfers can significantly reduce AIDS morbidity and mortality in extremely vulnerable populations and should be considered an essential intervention to achieve AIDS-related sustainable development goals by 2030. Brazil has operated a conditional cash transfer program to support families living in precarious conditions since 2004. Here, the authors use linked administrative and health data to investigate the impacts of the program on HIV/AIDS-related outcomes, demonstrating strong positive associations. [ABSTRACT FROM AUTHOR]

Introduction: The novel Coronavirus disease (COVID-19) is caused by SARS-CoV-2 and represents the agent responsible for a respiratory and metabolic disease with a high fatality rate, remaining a public health problem to this day. There has been an exacerbation of social inequalities experienced in Brazil and worldwide. Notably, the absence of a consolidated and universal healthcare system has contributed to the increased inequalities and survival opportunities for those affected by SARS-CoV-2 infection and manifestation of COVID-19. The southern region has become the second region with the highest number of cases in Brazil. Objective: To avaluate the epidemiological outcomes of incidence, lethality, and mortality among the states of Rio Grande do Sul and Paraná in the southern region of Brazil. Methods: An ecological time-series study was conducted using official secondary data on COVID-19 cases and deaths publicly disclosed by the health departments of the states of Rio Grande do Sul and Paraná. Time series were constructed applying the Prais-Winsten regression model. Statistical analyses were performed using STATA 14.0 software. Results: It was observed that for the state of Rio Grande do Sul, the trends regarding incidence were increasing in 2020 and decreasing in 2021 (p<0.05). Regarding mortality, it increased in 2020 and decreased in 2021 and 2022 (p<0.05). When assessing lethality, a decreasing trend was observed for the entire period (p<0.05). In relation to Paraná, incidence increased in 2020 and over the entire period, while it decreased in 2021 and 2022 (p<0.05). Mortality was stationary in 2020 and decreased in 2021 and 2022 (p<0.05). Conclusion: The COVID-19 pandemic is a serious public health problem in the states of Paraná and Rio Grande do Sul. Paraná presented a more severe epidemiological outcome compared to Rio Grande do Sul. [ABSTRACT FROM AUTHOR]

The present study aimed to verify the time series (2000–2017) of death rates by suicide and its associated factors in 4 municipalities in the extreme south of Brazil. Data were obtained through the analysis of medical reports and police report bulletins at the Instituto Médico Legal, in the city of Rio Grande. The suicide rate in the Rio Grande region varied from 4 to 11 suicides per 100,000 inhabitants and it is estimated that by 2030 this rate could reach 16.5 suicides per 100,000 inhabitants. The rural cities of Santa Vitória do Palmar and Chuí present even higher suicide averages when compared to Rio Grande, the most populous city of the four. The death rate from suicide increased gradually in the period analyzed, with the prevalence rising among the youngest and the elderly population. A more comprehensive understanding of the influences of environmental issues on suicidal decisions constitutes an important action that needs to be taken, both because of regional vulnerabilities and the target population identified. Evidence indicates that knowledge of factors affecting individuals residing in this Brazilian region where increased suicide rates are recorded needs to be recognized as a priority. [ABSTRACT FROM AUTHOR]

Background: A cohort study for 2 years period analysed the prevalence, incidence and clinical–immunological features of canine Leishmania (L.) chagasi‐infection in 316 mongrel dogs in a visceral leishmaniasis‐endemic area in Pará State, Brazil. Objective/Methods: Diagnosis of infection was performed by the indirect fluorescent antibody test (IFAT‐IgG), the leishmanin skin test (LST) and a parasite search (from the popliteal lymph node aspiration) at the beginning of the study and at 6, 12 and 24 months intervals. Results: IFAT/LST revealed three immune profiles of infection: (I) IFAT(+)/LST(−) (81), (II) IFAT(−)/LST(+) (17) and (III) IFAT(+)/LST(+) (13). Prevalence of profiles I, II and III were 25.6, 5.4 and 4.1%, and an overall prevalence 35.1%. Incidence of profiles I, II and III were 5.4, 0.3 and 0.0%, and an overall incidence 5.7% dogs per month. Incidence at the age ranges <1 year, ≥1 year, <7 years and ≥7 years evidenced a highest rate in the age range <1 year (6.6% dogs per month). Parasitological diagnosis was positive in 19% dogs at the prevalence (85.7% profile I), and in 11% at the incidence (100% profile I). The clinical picture of 179 infected dogs showed 145 (81%) of profile I (82% subclinical); 21 (11.7%) of profile II (100% subclinical); and 13 (7.3%) of profile III (84.6% subclinical). Conversion from subclinical to sick dogs was higher (p < 0.05) in profile I (40.2%) than in profiles II (5.8%) and III (9%). Immunological conversion showed that only 3.2% of profile I dogs (prevalence) converted to LST(+) (two at the end of the first 6 months and 1 after 24 months), while 82.3% of profile II dogs converted to IFAT(+) (11 in the first 6 months, whereas three after 12 months). A 100% death rate was observed in dogs from profile I alone. Conclusion: These results reinforce the need of adopting preventive strategies against CVL as early as in the first semester of the dog's life. [ABSTRACT FROM AUTHOR]

Snakebite envenoming represents an important Neglected Tropical Disease (NTD) that mainly affects tropical and subtropical developing countries according to the World Health Organization (WHO). As a priority issue in the tropics, it is estimated that accidental encounter between snakes and humans is the leading cause of morbidity and mortality among all NTDs in the world. In Brazil, an extremely diverse country with continental dimensions, snakebite envenoming is the second leading cause of reported human envenoming. Treating the disease has been an unprecedented challenge for Brazilian Health Systems for decades. Despite access to Antivenom therapy and distributing it free of charge across the country, Brazil faces numerous issues regarding the notification process and accurate treatment targeting for at-risk populations. Thus, this study aimed to identify the temporal epidemiological dynamics of accidents caused by Bothrops snakes in Brazil, the country's major group of venomous snakes, based on secondary information from the online database provided by The Brazilian Notifiable Diseases Information System (SINAN). For this purpose, reported Bothrops snakebites between 2012 and 2021 were counted, then the data were analyzed. We looked at the frequency, occurrence, mortality rates, case fatality rate (CFR), age and gender distribution, and the time lapse between the incident and the initiation of Antivenom therapy. The data were also organized considering regional variations of the country. Throughout the studied period, a total of 202,604 cases of envenoming caused by Bothrops spp. were notified, resulting in 766 fatalities. These accidents were found to occur in variable proportions across different regions in Brazil, with notable concentrations observed in the North, Northeast, and Southeast regions. The epidemiological profile of patients varied greatly between the regions, revealing that snake envenoming is much more a social, economic, and ecological problem than a medical one. In conclusion, our study provides an overview of the clinical and epidemiological profile of envenoming by Bothrops snakes in Brazil. Notably, this is the first study to present such information in a country as vast and diverse as Brazil, encompassing a comparative analysis of its regions using SINAN data, that proves to be a very useful national tool to improve the control and management of envenoming. Author summary: Snakebite envenoming it is a health challenge worldwide. In Brazil, the largest country in Latin America, Bothrops snakebites represents the main cause of envenoming by venomous snakes. Every year, at least 20,000 accidents with Bothrops snakes are notified by The Brazilian Information System for Notifiable Diseases (SINAN). However, it is well known that these numbers do not represent reality in many cases, since a significant portion of envenoming patients continue to dispense specialized medical care or are unable to arrive in time at the reference medical centers. Therefore, in our comprehensive study with secondary data made available online by SINAN, we decided to understand the temporal dynamics of Bothrops snakebites over a ten-year period across the five regions of Brazil. According to our results, which evaluated variables such as occurrence, incidence, mortality and lethality, envenoming by Bothrops snakes remains an important neglected public health problem in our country. Currently, the high rates of occurrence and incidence in certain regions are due to socioeconomic problems found in a vast and developing country such as Brazil. Despite this, lethality and mortality rates remain low at all regions of the country, a fact that can be associated with the effectiveness of the Antivenom therapy treatment provided free of charge by The Brazilian National Health System (SUS). [ABSTRACT FROM AUTHOR]

Copepod carcasses and non‐predatory mortality can occur due to natural senescence, disease, pollution, and physicochemical stress. Our objective is to evaluate and characterize the rates of non‐predatory mortality and the contribution of zooplankton community carcasses, represented by the copepods, in tropical estuarine ecosystems with different degrees of urbanization. During the study, there was a significant difference between environments and copepod carcasses, with Suape Bay (moderately urbanized) being the environment with the highest abundance of adult copepod carcasses (93.3%). The average non‐predatory mortality rate of adult copepods was 0.15 day−1: Santa Cruz Channel (sparsely urbanized) contributed the lowest values, with a mortality rate of 0.01 day−1, and Suape (moderately urbanized) had the highest rate (2.80 day−1). The families Paracalanidae (0.554 day−1) and Oithonidae (0.122 day−1) had the highest values, with an average carcass decomposition of 4.7 days. Among the environments studied, there was little differentiation between carcass percentages and mortality rate, not supporting the hypothesis that the higher rates of mortality among non‐predatory copepods were related to large urban centers. However, there was an almost proportional contribution of carcasses and non‐predatory mortality in all but a few areas, agreeing with the hypothesis that there is spatial variation with respect to carcasses in tropical estuaries. With our work, we show that estuaries can provide the estuarine food web with a significant portion of copepod carcasses, which may vary by family, and that it is not necessarily environments with a higher degree of urbanization that will have higher mortality rates. [ABSTRACT FROM AUTHOR]

Summer mortality of Crassostrea gigas occurs in Brazilian crops, with predominance in the final phase of cultivation, when they reach the commercial size, generating significant losses for local producers. In order to mitigate this problem, a technical solution, whose principle is based on long-term confinement at low temperatures (10 −12°C) for inducing a similar basal metabolism regime, has been developed. According to the current literature, if the spawning process is not triggered, a substantial reduction in the mortality rate can be achieved. This work evaluates not only the effectiveness of this technological solution to reduce summer mortality but also the quality associated to commercial attributes of the oysters as a final product. A ninety-one day experiment has been carried out and has shown that the proposed solution is able to maintain Crassostrea gigas diploid oysters alive and healthy. [ABSTRACT FROM AUTHOR]

This article discusses the temporal trends and spatial distribution of Brazilian spotted fever (BSF) in Brazil. BSF is an acute febrile infectious disease caused by the bacterium Rickettsia rickettsii and primarily transmitted through tick bites. The study analyzed data from 2012 to 2020 and found that the incidence and mortality rates of BSF remained stable over the study period, while the fatality rate showed a decreasing trend in the last five years. The disease had a heterogeneous geographical distribution, with well-defined spatial clusters. The findings highlight the need for improved surveillance, preventive measures, and targeted interventions in high-risk areas to reduce the impact of BSF on public health. [Extracted from the article]

Introduction: the first COVID-19 case in Brazil was confirmed on February 26, 2020. As of March 17, 2023, the Ministry of Health reported 699,634 deaths from COVID-19, with a case fatality rate of 1.9%. The impact of the COVID-19 pandemic in Brazil extends to socioeconomic and healthcare systems, reflecting significant regional disparities. Objective: To analyze mortality, incidence, and case fatality rates for COVID-19 in the states of Paraná and Santa Catarina, in the southern region of Brazil. Methods: This is an ecological time-series study using official Brazilian secondary data for COVID-19 cases and deaths. Data were extracted from the dashboard of the State Health Department of Santa Catarina and Paraná. Temporal series were developed for trend analysis using the Prais-Winsten regression model. Statistical analyses were performed using STATA 14.0 software (College Station, TX, USA, 2013). Results: In the analysis of rates over the entire period, trends for mortality, case fatality, and incidence in the state of Santa Catarina are decreasing, decreasing, and stationary, respectively. In Paraná, rates over the entire period showed a stationary trend for mortality, decreasing for case fatality, and increasing for incidence. Conclusion: COVID-19 had a devastating effect on the states of Santa Catarina and Paraná. Both states experienced the progression of the COVID-19 pandemic, with higher case fatality and mortality rates observed in Paraná, while Santa Catarina had a higher incidence rate over the three years of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between the risk of death from COPD and air temperature events in ten major Brazilian microregions. Methods: This was a time series analysis of daily COPD deaths and daily mean air temperatures between 1996 and 2017. Using distributed nonlinear lag models, we estimated the cumulative relative risks of COPD mortality for four temperature percentiles (representing moderate and extreme cold and heat events) in relation to a minimum mortality temperature, with a lag of 21 days, in each microregion. Results: Significant associations were found between extreme air temperature events and the risk of death from COPD in the southern and southeastern microregions in Brazil. There was an association of extreme cold and an increased mortality risk in the following microregions: 36% (95% CI, 1.12-1.65), in Porto Alegre; 27% (95% CI, 1.03-1.58), in Curitiba; and 34% (95% CI, 1.19-1.52), in São Paulo; whereas moderate cold was associated with an increased risk of 20% (95% CI, 1.01-1.41), 33% (95% CI, 1.09-1.62), and 24% (95% CI, 1.12-1.38) in the same microregions, respectively. There was an increased COPD mortality risk in the São Paulo and Rio de Janeiro microregions: 17% (95% CI, 1.05-1.31) and 12% (95% CI, 1,02-1,23), respectively, due to moderate heat, and 23% (95% CI, 1,09-1,38) and 32% (95% CI, 1,15-1,50) due to extreme heat. Conclusions: Non-optimal air temperature events were associated with an increased risk of death from COPD in tropical and subtropical areas of Brazil. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Studies evaluating the local quality of death certification in Brazil focused on completeness of death reporting or inappropriate coding of causes of death, with few investigating missing data. We aimed to use missing and unexpected values in core topics to assess the quality of death certification in Brazilian municipalities, to evaluate its correlation with the percentage of garbage codes, and to employ a data-driven approach with non-linear models to investigate the association of the socioeconomic and health infrastructure context with quality of death statistics among municipalities. This retrospective study used data from the Mortality Information System (2010–2017), and municipal data regarding healthcare infrastructure, socioeconomic characteristics, and death rates. Quality of death certification was assessed by missing or unexpected values in the following core topics: dates of occurrence, registration, and birth, place of occurrence, certifier, sex, and marital status. Models were fit to classify municipalities according to the quality of death certification (poor quality defined as death records with missing or unexpected values in core topics ≥ 80%). Municipalities with poor quality of death certification (43.9%) presented larger populations, lower death rates, lower socioeconomic index, healthcare infrastructure with fewer beds and physicians, and higher proportion of public healthcare facilities. The correlation coefficients between quality of death certification assessed by missing or unexpected values and the proportion of garbage codes were weak (0.11–0.49), but stronger for municipalities with lower socioeconomic scores. The model that best fitted the data was the random forest classifier (ROC AUC = 0.76; precision-recall AUC = 0.78). This innovative way of assessing the quality of death certification could help quality improvement initiatives to include the correctness of essential fields, in addition to garbage coding or completeness of records, especially in municipalities with lower socioeconomic status where garbage coding and the correctness of core topics appear to be related issues. [ABSTRACT FROM AUTHOR]

Vaccines are an essential public health resource for disease containment and reduction of associated mortality rates. With the emergence of COVID-19, public debates on the themes of vaccines and vaccination processes became important topics on diverse media and social networking platforms. In this article, our objective was to identify and reflect on the emotions evoked in the Brazilian public with respect to the COVID-19 vaccine during 2020 and 2021 on Facebook. To achieve this, we used the Crowdtangle graphical interface to extract complete copies of posts made by public Facebook profiles during this timeframe, from which a random sample of 1,067 posts was selected for analysis. Identification of emotions was performed using the Human-Machine Interaction Network on Emotion (HUMAINE) descriptors as a baseline reference. Emotions were then grouped into categories following Core Affect Model guidelines. Data analysis and interpretation indicated a prevalence of positive emotions such as trust, interest, and hope directed toward vaccines in the Brazilian domestic scenario. Negative emotions such as worry and disapproval were also expressed, albeit in reference to contextual issues (for example, the spread of COVID-19, delays in vaccine access, and the emergence of new variants) and public figures, such as the President of Brazil. [ABSTRACT FROM AUTHOR]

Background: Most cases of malaria in Brazil are concentrated in the Amazon region. One of the vector control alternatives recommended by the WHO is the long-lasting insecticidal net (LLIN). This tool is used in the nine federal states of the Brazilian Legal Amazon, where LLINs are essential for reducing vector density and disease transmission as they prevent contact between the mosquito and the individual. The objective of this study was to evaluate the residuality and use of LLIN insecticides in different health regions in a city located in the Brazilian Amazon. Methods: A total of 17,027 LLINs were installed in the third, fifth and ninth health regions of the municipality of Porto Velho, Rondonia State, Brazil. The LLINs were of two types: Olyset (permethrin), for around the bed, and Interceptor (alphacypermethrin), for around hammocks. The residuality of 172 LLINs was evaluated using cone bioassays to verify the mortality rate of the mosquito Nyssorhynchus darlingi, over a period of 2 years. Structured questionnaires on the acceptance and use of LLINs were distributed to the participating population (n = 391), covering a total sample of 1147 mosquito nets. The mortality rate was evaluated both in terms of days after LLIN installation and the type of insecticide used. Statistical analyses were based on analysis of variance (ANOVA) and Chi-square and were performed using the SPSS statistical program. Results: For the Ny. darlingi mosquito, Interceptor-type LLINs showed residual efficacy, with mortality rates ≥ 80% during the 2-year study period, as determined by the WHO. In contrast, Olyset-type LLINs were associated with a reduction in mortality rates, with 76% and 45% mortality rates in the last two assessments, which occurred during the last 6 months of the study period. Based on the structured questionnaires, the acceptance rate, i.e. percentage of individuals accepting the permanence of the 1147 LLINs sampled, in the three health regions of Porto Velho was 93.8% (of 1076 LLINs). Conclusion: The alphacypermethrin-impregnated LLIN was more effective than the LLIN impregnated with permethrin. The results indicate that the correct use of mosquito nets—and consequently the protection of the population—needs to be supported by health promotion actions. These initiatives are considered to be essential for the success of this vector control strategy. New studies that consider the monitoring of the placement of mosquito nets are necessary to provide effective support in the correct use of this methodology. [ABSTRACT FROM AUTHOR]

Background We analysed the spatial and spatiotemporal patterns of visceral leishmaniasis (VL) mortality at the municipality level in an endemic state in the southern Amazon region of Brazil. Individual-level factors associated with death due to VL were also investigated. Methods All VL cases and deaths reported between 2007 and 2018 were included. The global and local bivariate Moran's index assessed the space–time autocorrelation of smoothed triennial VL mortality. Kulldorff's scan statistics investigated spatial and spatiotemporal clusters. A multivariable logistic regression explored sociodemographic, diagnostic and clinical variables associated with death due to VL. Results We observed an overall VL mortality and lethality of 0.14 cases/100 000 inhabitants and 11.2%, respectively. A total of 14% of the municipalities registered at least one VL-related death. In the southeastern mesoregion of the state, we detected high-risk spatial (relative risk [RR] 14.14; p<0.001) and spatiotemporal (RR 15.91; p<0.001) clusters for VL mortality. Bivariate Moran's analysis suggested a high space–time autocorrelation of VL mortality. Death by VL was associated with age ≥48 y (odds ratio [OR] 7.2 [95% confidence interval {CI} 3.4 to 15.3]), displacement for notification (OR 3.3 [95% CI 1.5 to 7.2]) and occurrence of oedema (OR 2.8 [95% CI 1.3 to 6.1]) and bleeding (OR 5.8 [95% CI 2.6 to 12.8]). Conclusions VL mortality has a heterogeneous spatiotemporal distribution. The death-related factors suggest late diagnosis as an underlying cause of mortality. [ABSTRACT FROM AUTHOR]

Suicide is a complex and multi-determined phenomenon. Higher rates are observed in men and are related to multiple risk factors, including mental disorders, financial crises, unemployment, and easy access to highly lethal means of perpetration, such as firearms. We studied the effects of age, period, and cohort (APC) on total and firearm-related suicides in men in Brazil and its major regions from 1980 to 2019. Death records were extracted from the Brazilian Ministry of Health's Mortality Information System. Estimable functions were used to estimate APC models, through the Epi library of the R statistical program, version 4.2.1. During the study period, Brazil had an average rate of 10.22 deaths per 100,000 men. Among regions, rates ranged from 8.62 (Northeast) to 16.93 (South). The same profile was observed in suicides by firearms. After estimating the APC models, we observed a temporal trend of increasing total suicides for Brazil and regions, except for the South region, where the trend was stationary. The trend was downward for firearm suicides for all locations. A positive gradient was observed in the mortality rate with advancing age for total suicides; and peak incidence between 20–29 years, with subsequent stabilization, for suicides perpetrated by firearms. There was a reduction in the risk of death for suicides perpetrated by firearms in relation to the reference period (1995–1999) for all locations, except in the North region, where the effect was not significant. The younger generations from the 1960s onwards had a higher risk of death from total suicide and a lower risk for those perpetrated by firearms in relation to the reference cohort (1950–1954). We observed a reduction in the mortality trend for suicides perpetrated by firearms, a reduction in the risk of death in the 2000s and for men born after 1960. Our results suggest reducing the risk of death from suicide by firearms in Brazil and regions. However, there is an upward trend in mortality from total suicides in the study period (1980–2019) and for younger cohorts. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 genome surveillance is important for monitoring risk groups and health workers as well as data on new cases and mortality rate due to COVID-19. We characterized the circulation of SARS-CoV-2 variants from May 2021 to April 2022 in the state of Santa Catarina, southern Brazil, and evaluated the similarity between variants present in the population and healthcare workers (HCW). A total of 5291 sequenced genomes demonstrated the circulation of 55 strains and four variants of concern (Alpha, Delta, Gamma and Omicron—sublineages BA.1 and BA.2). The number of cases was relatively low in May 2021, but the number of deaths was higher with the Gamma variant. There was a significant increase in both numbers between December 2021 and February 2022, peaking in mid-January 2022, when the Omicron variant dominated. After May 2021, two distinct variant groups (Delta and Omicron) were observed, equally distributed among the five Santa Catarina mesoregions. Moreover, from November 2021 to February 2022, similar variant profiles between HCW and the general population were observed, and a quicker shift from Delta to Omicron in HCW than in the general population. This demonstrates the importance of HCW as a sentinel group for monitoring disease trends in the general population. [ABSTRACT FROM AUTHOR]

Candidemia remains a major public health challenge due to its high mortality rates, especially in developing countries. Monitoring epidemiological trends may provide insights for better clinical outcomes. This study aimed to describe trends in the epidemiology, therapeutic practices, and mortality in candidemia through a retrospective comparative analysis between two surveillance cohorts of all candidemic adults at eleven tertiary hospitals in Brazil, from 2010–2011 (Period I) versus 2017–2018 (Period II). A total of 616 cases were diagnosed, with 247 being from Period II. These patients were more likely to have three or more coexisting comorbidities [72 (29.1%) vs. 60 (16.3%), p < 0.001], had a prior history of in-hospital admissions more often [102 (40.3%) vs. 79 (21.4%), p = 0.001], and presented with candidemia earlier after admission, within 15 days (0–328) vs. 19 (0–188), p = 0.01. Echinocandins were more frequently prescribed [102 (41.3%) vs. 50 (13.6%), p = 0.001], but time to antifungal initiation [2 days (0–14) vs. 2 (0–13), p = 0.369] and CVC removal within 48 h [90/185 (48.6%) vs. 148/319 (46.4%), p = 0.644] remained unchanged. Additionally, many patients went untreated in both periods I and II [87 (23.6%) vs. 43 (17.4%), p = 0.07], respectively. Unfortunately, no improvements in mortality rates at 14 days [123 (33.6%) vs. 93 (37.7%), p = 0.343] or at 30 days [188 (51.4%) vs. 120 (48.6%), p = 0.511] were observed. In conclusion, mortality rates remain exceedingly high despite therapeutic advances, probably associated with an increase in patients' complexity and suboptimal therapeutic interventions. Management strategies should be tailored to suit epidemiological changes, expedite diagnosis to reduce the number of untreated eligible patients and guarantee early antifungal initiation and source control. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic caused impact on public health worldwide. Brazil gained prominence during the pandemic due to the magnitude of disease. This study aimed to evaluate the spatial–temporal dynamics of incidence, mortality, and case fatality of COVID-19 and its associations with social determinants in Brazilian municipalities and epidemiological week. We modeled incidence, mortality, and case fatality rates using spatial–temporal Bayesian model. "Bolsa Família Programme" (BOLSAFAM) and "proportional mortality ratio" (PMR) were inversely associated with the standardized incidence ratio (SIR), while "health insurance coverage" (HEALTHINSUR) and "Gini index" were directly associated with the SIR. BOLSAFAM and PMR were inversely associated with the standardized mortality ratio (SMR) and standardized case fatality ratio (SCFR). The highest proportion of excess risk for SIR and the SMR started in the North, expanding to the Midwest, Southeast, and South regions. The highest proportion of excess risk for the SCFR outcome was observed in some municipalities in the North region and in the other Brazilian regions. The COVID-19 incidence and mortality in municipalities that most benefited from the cash transfer programme and with better social development decreased. The municipalities with a higher proportion of non-whites had a higher risk of becoming ill and dying from the disease. [ABSTRACT FROM AUTHOR]

This study aims at providing an overview of the socioeconomic consequences that debris-flow events have caused in Brazil, positioning the country in the international scenario and identifying areas where targeted actions are necessary. The analysis is conducted by calculating the debris-flow mortality rate (MR) and by using the so-called F-N plots (frequency of events that have caused N or more fatalities vs. the number of fatalities), based on a compilation of debris-flow-related disasters from 1920 to 2021. In total, 45 debris-flow events were documented in the considered period, responsible for 5771 fatalities and more than 5.5 billion USD in economic losses. The Serra do Mar Mountain Range is the main site of reported debris-flow occurrences (64.5%), followed by Serra da Mantiqueira (13.3%), and Serra Geral (13.3%). Southeast Brazil (SEB) is the region most affected by debris-flow events, due to the highest population density and the development of several cities in hilly areas, such as Petrópolis (Rio de Janeiro state) and Cubatão (São Paulo state). The debris-flow MR of SEB is higher than any other region in Brazil, pushing the national debris-flow MR upwards, and the F-N curve of SEB consolidates the region as the one with the highest risk to the phenomenon, indicating a higher probability of fatal events. The F-N plots further show that debris-flow events in Brazil represent a higher societal risk than in countries such as China, Japan and Italy. While there are differences in country size and the scale effect should be considered, these results highlight the urgent need for investments in disaster prevention and preparedness programs. [ABSTRACT FROM AUTHOR]

Objective: To identify priority areas for schistosomiasis control, we analysed the epidemiological characteristics, temporal trends and spatial patterns of schistosomiasis‐related mortality in the state of Minas Gerais from 2000 to 2019. Methods: Ecological and time‐series study with spatial analysis techniques on deaths from Schistosomiasis mansoni. A log‐linear regression model was used to identify changes in mortality rates. Moran's global index, local indicators of spatial association and a retrospective spatio‐temporal permutation model were applied to identify the spatial and temporal distribution of mortality rates and assist in identifying priority areas for interventions. Results: A total of 1290 deaths from schistosomiasis were recorded between 2000 and 2019, with an average mortality rate of 0.33 deaths/100,000. Although the overall mortality rate in the state of Minas Gerais decreased significantly over time (average annual percentage change = −9.6; 95% confidence interval = −14.4 to −4.6; p < 0.001), it increased in the mesoregions of Jequitinhonha, Mucuri Valley, and Rio Doce Valley. Spatial analysis identified the displacement and emergence of high‐risk clusters from the central region of the state to the mesoregion of Rio Doce Valley. Conclusion: Temporal changes and shifting of high‐risk areas from the central region to the mesoregion of Rio Doce Valley may indicate possible failures in early diagnosis and treatment of the schistosomiasis control program in these areas. Our research contributes to a better understanding of the spatio‐temporal dynamics of death rates due to schistosomiasis infections and might help health authorities to direct resources most efficiently to avoid serious clinical outcomes in Minas Gerais. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic brought a new challenge to maternal mortality in Brazil. Throughout 2020, Brazil registered 549 maternal deaths, mainly in second and third-trimester pregnant women. The objective of this study was to estimate the excess maternal deaths in Brazil caused directly and indirectly by Covid-19 in the year 2020. In addition, we sought to identify clinical, social and health care factors associated with the direct maternal deaths caused by Covid-19. Methods: We performed nationwide analyses based on data from the Mortality Information System (SIM) for general and maternal deaths and the Influenza Epidemiological Surveillance System (SIVEP-Influenza) for estimates of female and maternal deaths due to COVID-19. Two distinct techniques were adopted. First, we describe maternal deaths directly caused by covid-19 and compare them with the historical series of deaths from covid-19 among women of childbearing age (15 to 49 years). Next, we estimated the total excess maternal mortality. Then, we calculated odds ratios for symptoms, comorbidities, social determination proxies and hospital care aspects between COVID-19 maternal deaths and deaths of women of childbearing age who were not pregnant or no maternal deaths. We chose women of childbearing age (15 to 49 years) as a reference because sex and age introduce differentials in the risk of COVID-19 death. Results: Most maternal deaths occurred during pregnancy compared to postpartum deaths month by month in 2020 (μ = 59.8%, SD = 14.3%). The excess maternal mortality in 2020 in Brazil was 1.40 (95% CI 1.35–1.46). Even considering excess mortality due to COVID-19 for the childbearing age female population (MMR 1.14; 95% CI 1.13–1.15), maternal mortality exceeded the expected number. The odds of being a black woman, living in a rural area and being hospitalized outside the residence municipality among maternal deaths were 44, 61 and 28% higher than the control group. Odds of hospitalization (OR 4.37; 95% CI 3.39–5.37), ICU admission (OR 1.73; 95% CI 1.50–1.98) and invasive ventilatory support use (OR 1.64; CI 95% 1.42–1.86) among maternal deaths were higher than in the control group. Conclusions: There was excess maternal mortality in 2020 in Brazil. Even with adjustment for the expected excess mortality from Covid-19 in women of childbearing age, the number of maternal deaths exceeds expectations, suggesting that there were deaths among pregnant and postpartum women indirectly caused by the pandemic, compromising access to prenatal care., adequate childbirth and puerperium. [ABSTRACT FROM AUTHOR]

Objective. To analyze the temporal trend of tuberculosis incidence and mortality rates in Brazil between 2011 and 2019. Methods. This was an ecological time series study of tuberculosis incidence and mortality rates in Brazil between 2011 and 2019. Data were extracted from the Notifiable Disease Information System and the Mortality Information System, and population estimates were from the Brazilian Institute of Geography and Statistics. Trends were analyzed by Joinpoint regression, which recognizes inflection points for temporal analysis. Results. The average incidence rate of tuberculosis in Brazil in the period was 35.8 cases per 100 000 population. From 2011 to 2015, this coefficient had an annual percentage change of --1.9% (95% CI [--3.4, --0.5]) followed by an increase of 2.4% (95% CI [0.9, 3.9]) until 2019. The average mortality rate between 2011 and 2019 was 2.2 deaths per 100 000 population, with an average annual percentage change of --0.4% (95% CI [--1.0, 0.2]). Amazonas was the only state with an increase in the annual average percentage variation for the incidence rate (3.2%; 95% CI [1.3, 5.1]) and mortality rate (2.7%; 95% CI [1.0, 4.4]) over the years, while Rio de Janeiro state had an increasing inflection for incidence from 2014 to 2019 (2.4%; 95% CI [1.4, 3.5]) and annual average of decreasing percentage variation (--3.5%; 95% CI [--5.0, --1.9]). Conclusions. During the period analyzed, a decreasing trend in incidence was observed between 2011 and 2015, and an increasing trend for the period from 2015 to 2019. On the other hand, no change in the trend for mortality was found in Brazil. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 caused 6.2 million deaths in the world. The present study aims to evaluate hospital mortality rates from 2015 to 2022, to compare the pre and during the pandemic period. Methods: The study was carried out in a private hospital in southern Brazil. 174,013 hospital discharges between January 2015 and March 2022 were analyzed. Pearson's chi-squared test was performed to evaluate the mortality rate by year. Differences between mortality rates before and during the pandemic was tested with Student's t-test. P-values < 0.05 for all tests were considered significant. Results: Mortality rates were 2.29% in 2015; 2.37% in 2016; 2.25% in 2017; 2.31% in 2018; 2.46% in 2019; 3.45% in 2020; 3.58% in 2021 and 2.77% in 2022 (p < 0.01). The mortality for 2020 and 2021 was higher than in the other years (3.50% ± 0.14 vs 2.34% ± 0.05; p < 0.01). Conclusion: The mortality rates were significantly higher in the years 2020 and 2021, demonstrating that COVID-19 is a critical health problem. [ABSTRACT FROM AUTHOR]

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Background: The COVID-19 pandemic brought countless challenges to public health and highlighted the Brazilian health system vulnerabilities in facing the emergency. In this article, we analyze data on COVID-19-related deaths in 2020-21 to show the epidemic consequences in Brazil. Methods: The Mortality Information System and the Live Birth Information System were the primary information sources. We used population estimates in 2020-21 to calculate COVID-19 specific mortality rates by age, sex, and educational level. Considering the total number of COVID-19 deaths in 2020-21, the COVID-19 proportional mortality (%) was estimated for each age group and sex. A graph of the daily number of deaths from January 2020 to December 2021 by sex was elaborated to show the temporal evolution of COVID-19 deaths in Brazil. In addition, four indicators related to COVID-19 mortality were estimated: infant mortality rate (IMR); maternal mortality ratio (MMR); number and rate of orphans due to mother's COVID-19 death; the average number of years lost. Results: The overall COVID-19 mortality rate was 14.8 (/10,000). The mortality rates increase with age and show a decreasing gradient with higher schooling. The rate among illiterate people was 38.8/10,000, three times higher than a college education. Male mortality was 31% higher than female mortality. COVID-19 deaths represented 19.1% of all deaths, with the highest proportions in the age group of 40-59 years. The average number of years lost due to COVID-19 was 19 years. The MMR due to COVID-19 was 35.7 per 100,000 live births (LB), representing 37.4% of the overall MMR. Regarding the number of orphans due to COVID-19, we estimated that 40,830 children under 18 lost their mothers during the epidemic, with an orphans' rate of 7.5/10,000 children aged 0-17 years. The IMR was 11.7 per 1000 LB, with 0.2 caused by COVID-19. The peak of COVID-19 deaths occurred in March 2021, reaching almost 4000 COVID-19 deaths per day, higher than the average number of deaths per day from all causes in 2019. Conclusions: The delay in adopting public health measures necessary to control the epidemic has exacerbated the spread of the disease, resulting in several avoidable deaths. [ABSTRACT FROM AUTHOR]

Objectives: Surveillance of infant and fetal deaths is of paramount importance in thinking about government strategies to reduce these rates, provide greater visibility of these mortality figures in the country, enable the adoption of prevention measures, as well as contribute to a better record of deaths. Data description: The dataset comprises fetal, neonatal, early neonatal, late neonatal, and perinatal Mortality Rates of Brazilian municipalities with their respective information, between 2010 to 2020, aggregated by epidemiological week. [ABSTRACT FROM AUTHOR]

Socioeconomic factors have exacerbated the impact of COVID–19 worldwide. Brazil, already marked by significant economic inequalities, is one of the most affected countries, with one of the highest mortality rates. Understanding how inequality and income segregation contribute to excess mortality by COVID–19 in Brazilian cities is essential for designing public health policies to mitigate the impact of the disease. This paper aims to fill in this gap by analyzing the effect of income inequality and income segregation on COVID–19 mortality in large urban centers in Brazil. We compiled weekly COVID–19 mortality rates from March 2020 to February 2021 in a longitudinal ecological design, aggregating data at the city level for 152 Brazilian cities. Mortality rates from COVID-19 were compared across weeks, cities and states using mixed linear models. We estimated the associations between COVID-19 mortality rates with income inequality and income segregation using mixed negative binomial models including city and week-level random intercepts. We measured income inequality using the Gini index and income segregation using the dissimilarity index using data from the 2010 Brazilian demographic census. We found that 88.2% of COVID–19 mortality rates variability was between weeks, 8.5% between cities, and 3.3% between states. Higher-income inequality and higher-income segregation values were associated with higher COVID–19 mortality rates before and after accounting for all adjustment factors. In our main adjusted model, rate ratios (RR) per 1 SD increases in income inequality and income segregation were associated with 17% (95% CI 9% to 26%) and 11% (95% CI 4% to 19%) higher mortality. Income inequality and income segregation are long-standing hallmarks of large Brazilian cities. Risk factors related to the socioeconomic context affected the course of the pandemic in the country and contributed to high mortality rates. Pre-existing social vulnerabilities were critical factors in the aggravation of COVID–19, as supported by the observed associations in this study. [ABSTRACT FROM AUTHOR]

This paper describes the structure and results of Primary Health Care (PHC) in Brazil between 2008 and 2019. The medians of the following variables were calculated: PHC spending per inhabitant covered, PHC coverage, and rates of mortality and hospitalizations due to primary care sensitive conditions (PCSC), in 5,565 Brazilian municipalities stratified according to population size and quintile of the Brazilian Deprivation Index (IBP), and the median trend in the period was analyzed. There was a 12% increase in median PHC spending. PHC coverage expanded, with 3,168 municipalities presenting 100% coverage in 2019, compared to 2,632 in 2008. The median rates of PCSC mortality and hospitalizations increased 0.2% and decreased 44.9%, respectively. PHC spending was lower in municipalities with greater socioeconomic deprivation. The bigger the population and the better the socioeconomic conditions were in the municipalities, the lower the PHC coverage. The greater the socioeconomic deprivation was in the municipalities, the higher the median PCSC mortality rates. This study showed that the evolution of PHC was heterogeneous and is associated both with the population size and with the socioeconomic conditions of the municipalities. [ABSTRACT FROM AUTHOR]

This study characterises maternal mortality in southern Brazil and verifies its trends between 2000 and 2018. It is an ecological time-series study, analysing secondary data from the Department of Informatics of the Unified Health System. The trend of the maternal mortality ratio (MMR) was calculated using generalised linear regression, and the ratios of the rates according to women's characteristics, with a confidence interval (CI) of 95%. The MMR in the South region went from 53.4 to 36.8 deaths per 100,000 live births from 2000 to 2018, a reduction trend of 1.2 percentage points per year. Mortality was directly related to increasing age (p <.001) and inversely related to schooling (p <.001) and predominated in non-white women (p <.001). The main cause of death was direct causes, including hypertensive disorders. Despite the reduction trend in maternal mortality in southern Brazil, the MMR observed is constantly above the recommended by the World Health Organisation. What is already known on this subject? The Maternal Mortality Ratio (MMR) is an indicator that allows an analysis of women's health in relation to the socio-economic and care characteristics of the region where they live. Between 2000 and 2015, Brazil had presented a high MMR, with around 50 deaths per 100,000 live births, while WHO considers a reasonably adequate MMR of fewer than 20 deaths per 100,000 live births. What do the results of this study add? This study updates data about MMR in the Southern Region of Brazil, the one which has the lowest rates in the country, but with variable values between the states. There was a reduction in MMR in southern Brazil between 2000 and 2018 but higher rates for women over 30 years old and in a situation of social vulnerability, as low-income and non-white women. Santa Catarina State presented stable values in the period and remained below the RMM averages of the other states during all years. What are the implications of these findings for clinical practice and/or further research? Comparing previous and current Maternal Mortality Rates in the regional context is important to adapt public health policies for the most affected population. Maternal death is still a reality for single and low-income women, who have greater difficulty in access to health care. Strategies in the Unified Health System are needed to tackle this problem. [ABSTRACT FROM AUTHOR]

The article presents an exploratory study of the evolution of demography and the already identified impacts of the COVID pandemic on demography in the world and in Brazil. The article aimed to identify the effects of the COVID pandemic on demographics, and the results indicate a drop in the birth rate, an acceleration of population aging, and an increase in excess deaths. It was not possible to identify an immediate drop in the total population or identify quantitative trends. The introduction takes up the importance of the topic for the development of public policies; then, aspects of demography as a social phenomenon are addressed, and an attempt is made to evaluate, at the global, national and regional levels, the evolution of the birth rate and life expectancy, associating, in the course of the document, the already mapped effects of COVID on the desire to have children, on the birth rate, and on the death rate. [ABSTRACT FROM AUTHOR]

Introduction: the initial spread of the pandemic in Brazil was mainly affected by patterns of socioeconomic vulnerability. It should be noted that the Central-West region of Brazil is one of the regions with the lowest number of cases, but the states of this region together have the highest mortality rate of COVID-19 in the country. Goiás was the most affected state of this region, with the highest number of deaths in the area. Objective: to assess the incidence of mortality and lethality caused by COVID-19 from March 2020 to June 2021 in the State of Goiás, Brazil. Methods: an ecological study, using a series of time series of public and official data of the Department of Health of the State of Goiás, Brazil. Information was collected on cases and deaths from COVID-19 from March 2020 to June 2021. Mortality, case fatality, and incidence rates were calculated. The Prais- Wisten regression model was used to build time series. The daily percent change (DPC) and the effective reproductive number (Rt) were estimated. Results: Goiás had a predominance of a greater viral spread during the first and the beginning of the second wave, with Rt higher than 1. The second wave from December 2020 to June 2021 was more lethal and had higher mortality rates than the first wave. It was observed, higher scores of case fatality and mortality belonged to males and the elderly. Conclusion: an analysis of mortality and case fatality rates helps understand the COVID-19 pandemic behavior in Goiás. It is essential to monitor epidemiological indicators and strengthen intervention strategies to contain the pandemic in this state. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus 2019 Disease (COVID-19) was quickly declared a pandemic, and Brazil is facing the most significant health and hospital crisis in its history. From March to June 2021 represented 50.8% of all deaths in the State of Espirito Santo. Objective: To analyze the lethality and mortality by COVID-19 in the State of Espirito Santo from March 2020 to June 2021. Methods: An ecological study was carried out, using a time series of public and official data available on the Health Department of the State of Espirito Santo, Brazil. Were considered information about cases and deaths (from March 2020 to June 2021) of COVID-19. Percentage case-fatality and mortality and incidence rates per 100,000 population were calculated. Timeseries analyses were performed using the Prais-Winsten regression model, estimating the Daily Percent Change (DPC), and the trends were classified as flat, increasing, or decreasing. Significant differences were considered when p<0.05. Results: 524,496 confirmed cases of COVID-19 as of June 30, 2021, and 11,516 progressed to death. The presence of cardiovascular diseases represents more than half of confirmed comorbidities (54.37%) in patients with COVID-19, followed by diabetes (19.95%) and obesity (9.34%). Men had higher mortality and lethality, especially in older age groups, but the incidence was higher among women. A characteristic profile of two waves was observed; the first wave was extended from March to October 2020 and the second complete wave from November 2020 to June 2021. During the second wave, high peaks of incidence, lethality, and mortality were recorded. At the end of the second wave, the incidence rate remained with increasing trends (p < 0.05), with a DPC of 2.06%. Conclusion: The peak concentration of cases, deaths, and indicators of lethality, mortality evidenced even after one year of pandemic, characterizes the severity of the COVID-19 pandemic, still in entire evolution in the State Espirito Santo and Brazil. [ABSTRACT FROM AUTHOR]

Introduction: the context of the Covid-19 pandemic in the Brazilian North region is worrying. There is a lack of resources for Public Health, a low human development index, and poverty indicators above the national average. Objective: to analyze mortality and lethality from COVID-19 in the State of Roraima, Brazil. Methods: this is an ecological time-series study of secondary data on COVID-19 in Roraima, Northern Brazil, from March 2020 to July 2021. The incidence, mortality, and lethality rates due to COVID-19 were calculated. The Prais-Winsten regression model was used to calculate the time series trends. Trends were classified as increasing, decreasing, or stationary. The trend was considered static when the p-value was not significant (p>0.05). Results: in the state of Roraima, from March 2020 to July 2021, there were 123,125 cases and 1,903 accumulated deaths due to COVID-19. The first wave (March 2020 to October 2021) of COVID-19 recorded the incidence rate (2,995.30 new cases per 100,000 inhabitants - July 2020) and mortality (56.32 deaths per 100,000 inhabitants - June 2020) higher lethality. However, in the second wave (November 2020 to July 2021), the highest lethality rate was observed (3.47% - February 2021). It was observed that during the first wave, the incidence rate of COVID-19 showed increasing trends. During this period, the mortality rate had a stationary tendency (p>0.05) and the percentage lethality with a decreasing trend (p<0.05). During the second wave, there was a more aggravating scenario for lethality, which changed from a daily reduction rate of 0.90% to stationary trends. Conclusion: the pandemic in the state of Roraima is not yet under control, so it is necessary to strengthen strategies to mitigate the spread of the pandemic in the region and prevent the formation of new waves. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 impacted health systems worldwide; the virus quickly spread in Brazil, reaching the 27 Federative units in Brazil peculiarly. The northern region of Brazil recorded the lowest number of cases and accumulated deaths from the disease. However, it is a region of sizeable territorial extension and low demographic density, marked by socioeconomic inequalities and vulnerable groups, such as indigenous tribes, riverine peoples, and quilombolas. Sociodemographic factors may contribute to the dissemination of the coronavirus in the region; thus, studies are needed to analyze the epidemiological indicators related to the pandemic. Objective: to evaluate incidence, mortality, and case fatality of COVID-19 trends in the state of Amapá, Brazil, from March 2020 to April 2021. Methods: an ecological time-series study was conducted with publicly accessible data from the Health Department of the State of Amapá. Incidence and mortality rates per 100,000 inhabitants and percentage case fatality were calculated. Crude rates were calculated by municipalities, age, and sex, per month. The Prais-Winsten regression test was performed, and the trends of monthly rates were classified as increasing, decreasing, or flat. Results: during the study period, there were 99.936 cases and 1,468 deaths accumulated by COVID-19 in the State of Amapá, Brazil. Macapá and Santana's cities, which have the highest demographic density and Human Development Index (HDI), had the highest number of cases and deaths. The most vulnerable population was elderly males aged 70 years or over; these individuals had the highest cumulative incidence, case fatality, and mortality rates. The second wave of the disease (October 2020 to April 2021) illustrated a more aggravating scenario, with increasing incidence and mortality rates. Conclusion: the COVID-19 pandemic in the state of Amapá, Brazil, is in increasing evolution, which illustrates that non-pharmacological prevention measures and acceleration of vaccination must be strengthened to avoid the development of future waves of the disease. [ABSTRACT FROM AUTHOR]

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Simple Summary: Echinococcosis is a zoonotic disease relevant to public health in many countries. The disease is present in Brazil; however, it is often underreported due to the lack of mandatory notification of cases across all Brazilian states. The records of two national databases were accessed during the period of 1995–2016 to describe the registered cases and deaths from echinococcosis in the country. Demographic, epidemiological, and health care data related to the occurrence of disease, and deaths attributed to echinococcosis are described. During the study period, 7955 hospitalizations were recorded due to echinococcosis, with 185 deaths. In a second database recording just mortality, a further 113 deaths were documented. Deaths were observed in every state of Brazil. When comparing between states, there was great variability in mortality rates, possibly indicating differences in the quality of health care received by patients and reinforcing the need to expand the compulsory notification of the disease across the country. Echinococcosis is a zoonotic disease relevant to public health in many countries, on all continents except Antarctica. The objective of the study is to describe the registered cases and mortality from echinococcosis in Brazil, from 1995 to 2016. The records of two national databases, the Hospital Information System (HIS) and the Mortality Information System (MIS), were accessed during the period of 1995–2016. Demographic, epidemiological, and health care data related to the occurrence of disease and deaths attributed to echinococcosis in Brazil are described. The results showed that 7955 records of hospitalizations were documented in the HIS, during the study period, with 185 deaths from echinococcosis, and 113 records of deaths were documented in the MIS Deaths in every state of Brazil in the period. When comparing between states, the HIS showed great variability in mortality rates, possibly indicating heterogeneity in diagnosis and in the quality of health care received by patients. Less severe cases that do not require specialized care are not recorded by the information systems, thus the true burden of the disease could be underrepresented in the country. A change in the coding of disease records in the HIS in the late 1990s, (the integration of echinococcosis cases with other pathologies), led to the loss of specificity of the records. The records showed a wide geographic distribution of deaths from echinococcosis, reinforcing the need to expand the notification of the disease in Brazil. Currently, notification of cases is compulsory in the state of Rio Grande do Sul. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic was severely aggravated in Brazil due to its politicization by the country's federal government. However, the impact of diffuse political forces on the fatality of an epidemic is notoriously difficult to quantify. Here we introduce a method to measure this effect in the Brazilian case, based on the inhomogeneous distribution throughout the national territory of political support for the federal government. This political support is quantified by the voting rates in the last general election in Brazil. This data is correlated with the fatality rates by COVID-19 in each Brazilian state as the number of deaths grows over time. We show that the correlation between fatality rate and political support grows as the government's misinformation campaign is developed. This led to the dominance of such political factor for the pandemic impact in Brazil in 2021. Once this dominance is established, this correlation allows for an estimation of the total number of deaths due to political influence as 350±70 thousand up to the end of 2021, corresponding to (57±11)% of the total number of deaths. [ABSTRACT FROM AUTHOR]

Objectives: to analyze a decade of spatio-temporal behavior of pertussis in Brazil and its epidemiological characteristics. Methods: ecological time series study of pertussis cases and deaths from the Notifiable Diseases Information System in Brazil (2010-2019). The method of generalized linear analysis of Prais-Winsten and the Kernel analysis were used. Results: 32,849 cases were reported, of which 466 (1.42%) evolved to death, with a prevalence of 1.63/100,000 inhabitants and a mortality rate of 0.023/100,000 inhabitants. In the temporal analysis, the cyclical behavior of pertussis was evidenced, with trend variations in the period in 2014. Most cases occurred in children under 1 year of age (60.16%, p<0.01), sex female (55.28%, p=0.066) and white (48.42%, p=0.14). The largest share of deaths was in children aged <1 year (98.07, p<0.01), females (56.01%, p=0.066) and whites (43.78%, p=0.14). In the Kernel of prevalence, the South, Southeast and Northeast regions stood out with high density; while for mortality, the Southeast and Northeast stood out. Conclusions: the cyclical behavior of pertussis was observed, with a decreasing trend in recent years and the concentration of cases in children. This reinforces the importance of strengthening the population's immunization process. [ABSTRACT FROM AUTHOR]

Background: In Brazil, some local city government's adopted several measures, which probably had a positive impact on COVID-19 control. Objective: To report the distribution of COVID-19 cases in Brazil, Rio de Janeiro state and Niterói city. In parallel, we aimed to demonstrate the preventive strategies adopted by Niterói city. Method: Data provided by the Brazilian Ministry of Health and Municipal Health Foundation of Niterói were used to report COVID-19 cases and deaths. For some analysis, data were grouped by week and normalized for 100,000 inhabitants. Results: By July 18th, 2020, Brazil reported 2,074,860 cases and 78,772 deaths and Rio de Janeiro state registered 135,230 cases and 11,919 deaths; both still presenting ascendant curves for COVID-19 deaths. In contrast, the rate of new deaths per 100,000 inhabitants is consistently lower in Niterói city. Importantly, we estimated that 712 deaths were prevented by the measures adopted by Niterói city, in comparison to which was observed in Rio de Janeiro. Conclusion: The early preventive measures adopted in Niterói city were effective in reducing both the viral spread and rate of deaths. In this regard, this discussion could be relevant for making future decisions during the COVID-19 outbreak in Brazil. [ABSTRACT FROM AUTHOR]

Suicide attempts are considered intentional acts of self-harm without culminating in the individual’s death and exceed the number of actual suicides by 10 to 20 times. This study aimed to investigate the epidemiological characteristics of suicide attempts in the state of Sergipe, Brazil, in the period between 2010 and 2019, registered in the Notifiable Diseases Information System (SINAN). This is a qualitative-quantitative study seeking to analyze the causes and consequences of the issue from the social context perspective and its absolute numbers. The victims of suicide attempts in Sergipe are mostly female, adolescents and young adults, had incomplete elementary to middle school education. Their residence was the main place where the suicide attempt occurred. Sharp objects and poisoning were the main means employed, and alcohol use was identified as an aggravating factor. [ABSTRACT FROM AUTHOR]