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Objective: To evaluate the distribution of the proportion of teenage mothers (PTM) in time and space and its relationship with socioeconomic indicators and social vulnerability., Methods: An ecological study was carried out with teenage mothers living in 322 census tracts in Foz do Iguaçu (state of Paraná, Brazil) between 2013 and 2019. Spatial clusters of teenage mothers were identified by spatial scanning and grouped into strata with different prevalence. The association between these strata and the individual social vulnerability of the mothers was evaluated using the Pearson's Chi-square test. Linear regression models were adjusted to evaluate the association between PTM and socioeconomic factors by census tract and temporal trend in PTM in different strata., Results: We identified five high prevalence clusters in peripheral regions and six with low prevalence in the central region of the municipality. Proportionally, there were more teenage mothers with a worse vulnerability index in the high prevalence stratum than in the low prevalence stratum. Places with worse socioeconomic conditions present higher PTM, a profile that did not change over time. For the increase of one unit in the Brazilian Deprivation Index and proportion of women responsible for the household, the PTM increased, respectively, by 3.8 (95%CI 3.1-4.4) and 0.086% (95%CI 0.03-0.14). There was a reduction in the global PTM in part of the period, which occurred later in the higher prevalence strata, but the proportions were stable again in the last years of study., Conclusion: Teenage pregnancy is concentrated in regions with worse socioeconomic conditions and greater maternal vulnerability and its behavior over time occurred differently in these areas.

Microbiological contamination may cause microbial proliferation and consequently additional problems for pharmaceutical companies through production stoppage, product contamination, investigations of process deviations, out-of-specification results and product disposal. This is one of the major concerns of the regulatory health agencies. Microbiological load (bioburden) may represent a potential risk for patients if the sterilization process is not effective and/or due to the production of toxins. Although bioburden can be eliminated by terminal sterilization or filtration processes, it is important to monitor the amount and determine the identity and characteristics of the microorganisms present prior to final processing. The application of microorganism identification systems is crucial for identifying the type of contamination, which can be extremely useful for investigating. The aim of this study was to evaluate the profiles of microorganisms identified in bioburden assays from solutions, culture medias, and products (SCP) from a pharmaceutical industry facility. From 2018-2020, a total of 1,078 samples from 857 different lots of SCP were analyzed and isolated microorganisms were identified. A prefiltering step was included after March 2020, in order to reduce the bioburden before sterilizing filtration. Criteria for the definition and management of microorganisms identified were evaluated after an integrative bibliographic review, and three groups were proposed (critical, objectionable, and nonobjectionable microorganisms). For the samples that did not include prefiltering (n=636), 227 (35.7%) presented microbial growth. For those that included prefiltering, before prefiltering (n=221), 60.6% presented microbial growth, and after prefiltering, this value was reduced to 4.1%, which can be attributed to a contamination during the sampling or a wrong filtering. From the samples that presented microbial growth, 678 microorganisms were identified as bacteria and 59 as molds and yeasts. A total of 120 microorganisms (56 and 27 Gram-positive and negative bacteria, respectively, 31 yeasts, and six filamentous molds) could not be identified, and the remaining microorganisms were classified as objectionable (n=507; 82.2%), nonobjectionable (n=103; 16.7%) and critical (n=7; 1.1%). Most of the bioburden species (>80.0%) were considered objectionable microorganisms. A process for classification and management of bioburden analysis results based on a literature review of pathogenic and physiological characteristics of the microorganisms was proposed., (Copyright © 2024, Parenteral Drug Association.)

The zoonotic visceral leishmaniasis is caused by the protozoan Leishmania infantum and dogs are reservoirs for this parasite. For the diagnosis of Leishmania at the species level in dogs in formalin-fixed, paraffin-embedded skin (FFPES) samples, colorimetric in situ hybridization (CISH) and quantitative real-time polymerase chain reaction (qPCR) are options, but their sensitivities are not well established. Therefore, the aim of this study was to determine the sensitivity of these two techniques in FFPES for the diagnosis of the L. infantum infection in dogs using culture as the reference standard. The FFPES of 48 dogs with cutaneous infection by L. infantum confirmed by culture and by multilocus enzyme electrophoresis were examined by CISH and qPCR using specific probes for L. infantum . The sensitivities of qPCR, CISH and their combination were, respectively, 77.0%, 58.0% and 83.3%. The sensitivities of qPCR in dogs with and without clinical signs were, respectively, 74.2% and 82.4%. The sensitivities of CISH in dogs with and without clinical signs were, respectively, 61.3% and 52.9%. The CISH and qPCR showed satisfactory sensitivities for the diagnosis of L. infantum in the FFPES of dogs, even in dogs without clinical signs, and their combination increases the sensitivity for this diagnosis.

Leptospirosis is a zoonosis with epidemic potential, especially after heavy rainfall causing river, urban and flash floods. Certain features of Santa Catarina's coastal region influence these processes. Using negative binomial regression, we investigated trends in the incidence of leptospirosis in the six municipalities with the highest epidemic peaks between 2000 and 2015 and the climatic and environmental variables associated with the occurrence of the disease. Incidence was highest in 2008 and 2011, and peaks occurred in the same month or month after disasters. Incidence showed a strong seasonal trend, being higher in summer months. There was a decrease trend in incidence across the six municipalities (3.21% per year). The climatic and environmental factors that showed the strongest associations were number of rainy days, maximum temperature, presence of flash floods, and river flooding. The impact of these variables varied across the municipalities. Significant interactions were found, indicating that the effect of river flooding on incidence is not the same across all municipalities and differences in incidence between municipalities depend on the occurrence of river flooding.

Although São Paulo is the most populous city in Brazil - one of the world's most violent countries - a significant reduction in its homicide mortality rate (HMR) has been detected. This study aims to estimate the effects of age, period, and birth cohort on the trend of homicide mortality according to sex in the city of São Paulo, from 1996 to 2015. An ecological study was undertaken with data on deaths by homicide for both sexes, in all age brackets, in the city of São Paulo. Poisson models were adjusted for each sex to estimate the age-period-cohort effects. In total, 61,833 deaths by homicide were recorded among males and 5,109 among females. Regardless of the period, the highest HMR occurred in the 20-24 age bracket. Higher HMRs were found in those born in the 1970s and 1980s. The complete model, with age-period-cohort effects, were the best fit to the data. The risk of death by homicide declined over the periods, with lower intensity in the final five years (2011-2015), for both males (RR = 0.48; 95%CI: 0.46; 0.49) and females (RR = 0.52; 95%CI: 0.47; 0.57). A reduction was found in the risk of homicide, regardless of the sex or age bracket, and also in recent cohorts. However, the intensity of such reductions has been decreasing over time, which suggests that the public policies adopted have limited potential to maintain these achievements.

This study assessed the hospitalization rates from motor vehicle accidents in the Brazilian Unified National Health System (SUS) in residents of the city of São Paulo, Brazil, from 2000 to 2019, according to sex, age bracket, and means of transportation (pedestrians, cyclists, motorcyclists, and motor vehicle occupants). A segmented regression model with negative binomial response was adjusted with inflection points to accommodate possible changes in trends. 189,765 hospitalizations were recorded during the study period, mostly males (80.5%) and from 20 to 49 years of age (71.2%). The most frequent type of accident involved motorcyclists (42.8%), followed by run-over pedestrians (33.7%). In general, the period from 2000 to 2007 was marked by increasing hospitalization rates from motor vehicle accidents involving all means of transportation, in both sexes, and in most age brackets. The year when the rates stopped increasing (or in some cases began to drop) differed according to the means of transportation. For vehicle occupants and cyclists, the trend in most age brackets turned downward in 2008, but the same did not happen with pedestrians and motorcyclists until 2012. Starting in 2015, the decline stopped in pedestrians, and the rates in cyclists turned upward again in most age brackets. For motorcyclists, the rates turned upward again in men 20 to 59 years of age (7.2% per year, exceeding 140 per 100,000 inhabitants in 2019) and in women 15 to 39 years of age (4.9% per year). The benefits of traffic safety measures implemented thus far in Brazil may have reached their limit, so that the current control and prevention measures need to be revised.

Background: Studies have shown that human mobility is an important factor in dengue epidemiology. Changes in mobility resulting from COVID-19 pandemic set up a real-life situation to test this hypothesis. Our objective was to evaluate the effect of reduced mobility due to this pandemic in the occurrence of dengue in the state of São Paulo, Brazil., Method: It is an ecological study of time series, developed between January and August 2020. We use the number of confirmed dengue cases and residential mobility, on a daily basis, from secondary information sources. Mobility was represented by the daily percentage variation of residential population isolation, obtained from the Google database. We modeled the relationship between dengue occurrence and social distancing by negative binomial regression, adjusted for seasonality. We represent the social distancing dichotomously (isolation versus no isolation) and consider lag for isolation from the dates of occurrence of dengue., Results: The risk of dengue decreased around 9.1% (95% CI: 14.2 to 3.7) in the presence of isolation, considering a delay of 20 days between the degree of isolation and the dengue first symptoms., Conclusions: We have shown that mobility can play an important role in the epidemiology of dengue and should be considered in surveillance and control activities., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to describe the incidence and proportional lethality of human leptospirosis in the municipality of São Paulo, between 2007 and 2016, according to sociodemographic factors and characteristics of the disease, and to assess the temporal trends of incidence, according to age group and region of residence., Methods: Proportional distributions of leptospirosis cases of residents in the municipality were built and regression models with a Binomial Negative response were adjusted., Results: 2,201 cases of leptospirosis were registered, most of them being males (82%), aged between 20 to 59 years (64.6%), white (39%) or brown (32.8%), residing in the South (27.8%), East (23.8%) and North (18.5%) regions. The overall lethality was 15.1%. The risk was higher in the 20 to 59 age group. There was a downward trend in incidence in all age groups and regions, estimated at 5.6% per year., Conclusions: Despite the downward trend in incidence, leptospirosis is a serious disease with high lethality, affecting mainly male individuals in the age groups considered economically active and living in the peripheral regions of the municipality.

Introduction: Leptospirosis is an endemic disease in Brazil that can become an epidemic during the rainy season resulting from floods in areas susceptible to natural disasters. These areas are widespread in Santa Catarina, particularly in the coastal region. Therefore, the objective of this study was to identify environmental, climatic, and demographic factors associated with the incidence of leptospirosis in the municipalities of Santa Catarina from 2001 to 2015, taking into account possible spatial dependence., Methods: This was an ecological study aggregated by municipality. To evaluate the association between the incidence of leptospirosis and the factors under study (temperature, altitude, occurrence of natural disasters, etc.) while taking into account spatial dependence, linear regression models and models with global spatial error were used., Results: Lower altitudes, higher temperatures, and areas of natural disaster risk in the municipality contributed the most to explaining the variability in the incidence rate. After taking spatial dependence into account, only the minimum altitude variable remained significant. The regions of lower altitude, where the highest rates of leptospirosis were recorded, corresponded to the eastern portion of the state near the coastal region, where floods, urban floods, and overflows are common occurrences. No associations were found concerning demographic factors., Conclusions: The incidence of leptospirosis in Santa Catarina was associated with environmental factors, particularly low altitude, even when considering the spatial dependence structure present in the data. The spatial error model allowed for adequate modeling of spatial autocorrelation.

Leptospirosis is a serious bacterial infection that occurs worldwide, with fatality rate of up to 40% in the most severe cases. The number of cases peaks during the rainy season and may reach epidemic proportions in the event of flooding. It is possible that people living in areas affected by natural disasters are at greater risk of contracting the disease. The aim of this study was to identify clusters of relatively higher risk for leptospirosis occurrence, both in space and time, in six municipalities of Santa Catarina, Brazil, which had the highest incidence of the disease between 2000 and 2016, and to evaluate if these clusters coincide with the occurrence of natural disasters. The cases were geocoded with the geographic coordinates of patients' home addresses, and the analysis was performed using SaTScan software. The areas mapped as being at risk for hydrological and mass movements were compared with the locations of detected leptospirosis clusters. The disease was more common in men and in the age group from 15 to 69 years. In the scan statistics performed, only space-time showed significant results. Clusters were detected in all municipalities in 2008, when natural disasters preceded by heavy rainfall occurred. One of the municipalities also had clusters in 2011. In these clusters, most of the cases lived in urban areas and areas at risk for experiencing natural disasters. The interaction between time (time of disaster occurrence) and space (areas at risk of experiencing natural disasters) were the determining factors affecting cluster formation.

Human papillomavirus (HPV) is responsible for the rise in the incidence of cancer in the oropharynx, tonsils, and base of the tongue (i.e., HPV-related subsites). HPV triggered the changes in the epidemiology of oropharyngeal and oral cavity cancer (OPC/OCC) in Asia, Europe, North America, and Oceania. Hence, the incidence of cancer in HPV-related subsites is augmenting, while that in other HPV-unrelated subsites is decreasing. In South America, although the incidence of HPV-positive tumors has gradually increased, there is an atypically low prevalence of HPV in people with OPC/OCC. To clarify whether this dramatic shift in incidence trends also occurred in this population, we estimated the burden of HPV on the incidence trends of OPCs/OCCs in São Paulo city in Brazil. In this population-based study, we categorized OPCs/OCCs by HPV-related and HPV-unrelated subsites. We used Poisson regression to assess the age-standardized incidence rates (ASRs) stratified by sex and age groups, as well as to examine the age-period-cohort effects. There were 15,391 cases of OPCs/OCCs diagnosed in HPV-related (n = 5,898; 38.3%) and HPV-unrelated (n = 9,493; 61.7%) subsites. Overall, the ASRs decreased for most subsites, for both sexes and for all age groups, except for HPV-related OPC/OCC in young males and females, which increased by 3.8% and 8.6% per year, respectively. In the birth-cohort-effect analysis, we identified an increasing risk for HPV-related OPC/OCC in both sexes in recent birth cohorts; however, this risk was sharply decreased in HPV-unrelated subsites. Our data demonstrate an emerging risk for HPV-related OPC/OCC in young people, which supports prophylactic HPV vaccination in this group., Competing Interests: The authors have declared that no competing interests exist.

There are scarce epidemiological studies on lung cancer mortality in areas exposed to asbestos in developing countries. We compared the rates and trends in mortality from lung cancer between 1980 and 2016 in a municipality that made extensive use of asbestos, Osasco, with rates from a referent municipality with lower asbestos exposure and with the rates for the State of São Paulo. We retrieved death records for cases of lung cancer (ICD-9 C162) (ICD-10 C33 C34) from 1980 to 2016 in adults aged 60 years and older. The join point regression and age-period-cohort models were fitted to the data. Among men, there was an increasing trend in lung cancer mortality in Osasco of 0.7% (CI: 0.1; 1.3) in contrast to a mean annual decrease for Sorocaba of -1.5% (CI: -2.4; -0.6) and a stable average trend for São Paulo of -0.1 (IC: -0.3; 0.1). Similar increasing trends were seen in women. The age-period-cohort model showed an increase in the risk of death from 1996 in Osasco and a reduction for Sorocaba and São Paulo State during the same period. Our results point to a need for a special monitoring regarding lung cancer incidence and mortality in areas with higher asbestos exposure.