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Cerqueira-Silva T, Pescarini JM, Cardim LL, Leyrat C, Whitaker H, Antunes de Brito CA, Brickley EB, Barral-Netto M, Barreto ML, Teixeira MG, Boaventura VS, Paixão ES. Risk of death following chikungunya virus disease in the 100 Million Brazilian Cohort, 2015-18: a matched cohort study and self-controlled case series. Lancet Infect Dis 2024; 24:504-513. [PMID: 38342106 DOI: 10.1016/s1473-3099(23)00739-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND Chikungunya virus outbreaks have been associated with excess deaths at the ecological level. Previous studies have assessed the risk factors for severe versus mild chikungunya virus disease. However, the risk of death following chikungunya virus disease compared with the risk of death in individuals without the disease remains unexplored. We aimed to investigate the risk of death in the 2 years following chikungunya virus disease. METHODS We used a population-based cohort study and a self-controlled case series to estimate mortality risks associated with chikungunya virus disease between Jan 1, 2015, and Dec 31, 2018, in Brazil. The dataset was created by linking national databases for social programmes, notifiable diseases, and mortality. For the matched cohort design, individuals with chikungunya virus disease recorded between Jan 1, 2015, and Dec 31, 2018, were considered as exposed and those who were arbovirus disease-free and alive during the study period were considered as unexposed. For the self-controlled case series, we included all deaths from individuals with a chikungunya virus disease record, and each individual acted as their own control according to different study periods relative to the date of disease. The primary outcome was all-cause natural mortality up to 728 days after onset of chikungunya virus disease symptoms, and secondary outcomes were cause-specific deaths, including ischaemic heart diseases, diabetes, and cerebrovascular diseases. FINDINGS In the matched cohort study, we included 143 787 individuals with chikungunya virus disease who were matched, at the day of symptom onset, to unexposed individuals using sociodemographic factors. The incidence rate ratio (IRR) of death within 7 days of chikungunya symptom onset was 8·40 (95% CI 4·83-20·09) as compared with the unexposed group and decreased to 2·26 (1·50-3·77) at 57-84 days and 1·05 (0·82-1·35) at 85-168 days, with IRR close to 1 and wide CI in the subsequent periods. For the secondary outcomes, the IRR of deaths within 28 days after disease onset were: 1·80 (0·58-7·00) for cerebrovascular diseases, 3·75 (1·33-17·00) for diabetes, and 3·67 (1·25-14·00) for ischaemic heart disease, and there was no evidence of increased risk in the subsequent periods. For the self-controlled case series study, 1933 individuals died after having had chikungunya virus disease and were included in the analysis. The IRR of all-cause natural death within 7 days of symptom onset of chikungunya virus disease was 8·75 (7·18-10·66) and decreased to 1·59 (1·26-2·00) at 57-84 days and 1·09 (0·92-1·29) at 85-168 days. For the secondary outcomes, the IRRs of deaths within 28 days after disease onset were: 2·73 (1·50-4·96) for cerebrovascular diseases, 8·43 (5·00-14·21) for diabetes, and 2·38 (1·33-4·26) for ischaemic heart disease, and there was no evidence of increased risk at 85-168 days. INTERPRETATION Chikungunya virus disease is associated with an increased risk of death for up to 84 days after symptom onset, including deaths from cerebrovascular diseases, ischaemic heart diseases, and diabetes. This study highlights the need for equitable access to approved vaccines and effective anti-chikungunya virus therapeutics and reinforces the importance of robust vector-control efforts to reduce viral transmission. FUNDING Brazilian National Research Council (CNPq), Fundação de Amparo à Pesquisa do Estado da Bahia, Wellcome Trust, and UK Medical Research Council. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Thiago Cerqueira-Silva
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil; Laboratório de Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz, Salvador, Brazil.
| | - Julia M Pescarini
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Luciana L Cardim
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Clémence Leyrat
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Elizabeth B Brickley
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Manoel Barral-Netto
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil; Laboratório de Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Maurício L Barreto
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Maria G Teixeira
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Viviane S Boaventura
- Laboratório de Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Enny S Paixão
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
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Malta DC, Romero-Sandoval N, Cardoso LSDM, Arcos P, Gualán M, Pescarini JM, Brickley EB, Veloso GA, Bernal RTI, Gomes CS, Kerr LRFS, Naghavi M, Cooper PJ, Barreto ML, Leyland AH. Sustainable Development Goals' health-related indicators for Brazil and Ecuador: an analysis for the period of 1990-2019. Public Health 2024; 231:88-98. [PMID: 38653016 DOI: 10.1016/j.puhe.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE This article aims to analyse the evolution of 40 Sustainable Development Goals' (SDGs) health-related indicators in Brazil and Ecuador from 1990 to 2019. STUDY DESIGN Epidemiological study of long-term trends in 40 SDGs' health-related indicators for Brazil and Ecuador from 1990 to 2019, using estimates from the Global Burden of Disease Study. METHODS Forty SDGs' health-related indicators and an index from 1990 to 2017 for Brazil and Ecuador, and their projections up to 2030 were extracted from the Institute for Health Metrics and Evaluation's Global Burden of Disease website and analysed. The percent annual change (PC) between 1990 and 2019 was calculated for both countries. RESULTS Both countries have made progress on child stunting (Brazil: PC = -38%; Ecuador: PC = -43%) and child wasting prevalences (Brazil: PC = -42%; Ecuador: PC = -41%), percent of vaccine coverage (Brazil: PC = +215%; Ecuador: PC = +175%), under-5 (Brazil: PC = -75%; Ecuador: PC = -60%) and neonatal mortality rates (Brazil: PC = -69%; Ecuador: PC = -51%), health worker density per 1000 population (Brazil: PC = +153%; Ecuador: PC = +175%), reduction of neglected diseases prevalences (Brazil: PC = -40%; Ecuador: PC = -58%), tuberculosis (Brazil: PC = -27%; Ecuador: PC = -55%) and malaria incidences (Brazil: PC = -97%; Ecuador: PC = -100%), water, sanitation and hygiene mortality rates (Brazil and Ecuador: PC = -89%). However, both countries did not show sufficient improvement in maternal mortality ratio to meet SDGs targets (Brazil: PC = -37%; Ecuador: PC = -40%). Worsening of indicators were found for violence, such as non-intimate partner violence for both countries (Brazil: PC = +26%; Ecuador: PC = +18%) and suicide mortality rate for Ecuador (PC = +66%), child overweight indicator for Brazil (PC = -67%), disaster mortality rates (Brazil: PC = +100%; Ecuador: PC = +325%) and alcohol consumption (Brazil: PC = +46%; Ecuador: PC = +35%). CONCLUSIONS Significant improvements are necessary in both countries requiring the strengthening of health and other policies, particularly concerning the prevention and management of violence and alcohol consumption, and preparedness for dealing with environmental disasters.
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Affiliation(s)
- D C Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - N Romero-Sandoval
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador.
| | - L S de M Cardoso
- Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - P Arcos
- Universidad Internacional del Ecuador, Quito, Ecuador.
| | - M Gualán
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador.
| | - J M Pescarini
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Oswaldo Cruz Foundation, Salvador, Brazil.
| | - E B Brickley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - G A Veloso
- Departamento de Estatística, Instituto de Matemática e Estatística, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
| | - R T I Bernal
- Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - C S Gomes
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - L R F S Kerr
- Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
| | - M Naghavi
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA.
| | - P J Cooper
- Institute of Infection and Immunity St. George's University of London. School of Medicine, Universidad Internacional del Ecuador, Ecuador.
| | - M L Barreto
- Centre for Data and Knowledge Integration for Health, Fiocruz Bahia, Salvador, Brazil.
| | - A H Leyland
- Social and Public Health Sciences Unit, University of Glasgow, United Kingdom.
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Santiago-Vieira C, Velasquez-Melendez G, de Cássia Ribeiro-Silva R, de Jesus Pinto E, Barreto ML, Li L. Recent changes in growth trajectories: a population-based cohort study of over 5 million Brazilian children born between 2001 and 2014. Lancet Reg Health Am 2024; 32:100721. [PMID: 38629028 PMCID: PMC11019368 DOI: 10.1016/j.lana.2024.100721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/19/2024]
Abstract
Background There is limited evidence on recent trends in childhood growth trajectories in Low-/middle-income countries. We investigated how age-trajectories for height and Body Mass Index (BMI) have changed among Brazilian children born in two different time periods after 2000. Methods We used a population-based cohort (part of the "Cohort of 100-Million Brazilians") created by the linkage of three Brazilian administrative databases: the Cadastro Único of the Federal Government, the National System of Live Births and the National Nutritional and Food Surveillance System. We included longitudinal data on 5,750,214 children who were 3 to <10 years of age and born between 2001 and 2014 (20,209,133 observations). We applied fractional polynomial models with random-effects to estimate mean height and BMI trajectories for children. Findings Compared to children born in 2001-2007, the cohort born in 2008-2014 were on average taller, by a z-score of 0.15 in boys and 0.12 in girls. Their height trajectories shifted upwards, by approximately 1 cm in both sexes. Levels of BMI increased little, by a z-score of 0.06 (boys) and 0.04 (girls). Mean BMI trajectories also changed little. However, the prevalence of overweight/obesity increased between cohorts, e.g., from 26.8% to 30% in boys and 23.9%-26.6% in girls aged between 5 and <10 years. Interpretation An increase of 1 cm in mean height of Brazilian children during a short period indicates the improvement in maternal and child health, especially those from low-income families due to the new health and welfare policies in Brazil. Although mean BMI changed little, the prevalence of child overweight/obesity slightly increased and remained high. Funding This work was supported by National Council for Scientific and Technological Development - CNPq; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES; National Institute for Health Research (NIHR) Great Ormond Street Hospital Biomedical Research Centre; Society for the Study of Human Biology; Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG; Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, Inovação e Complexo da Saúde do Ministério da Saúde - Decit/SECTICS/MS. The study also used resources from the Centre for Data and Knowledge Integration for Health (CIDACS), which receives funding from the Bill & Melinda Gates Foundation, the Wellcome Trust, the Health Surveillance Secretariat of the Ministry of Health and the Secretariat of Science and Technology of the State of Bahia (SECTI-BA).
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Affiliation(s)
- Carolina Santiago-Vieira
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Salvador, Brazil
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Rita de Cássia Ribeiro-Silva
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Salvador, Brazil
| | - Elizabete de Jesus Pinto
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Salvador, Brazil
- Health Sciences Center, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Brazil
| | - Maurício L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Salvador, Brazil
| | - Leah Li
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
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Oliveira Alves FJ, Fialho E, Paiva de Araújo JA, Naslund JA, Barreto ML, Patel V, Machado DB. The rising trends of self-harm in Brazil: an ecological analysis of notifications, hospitalisations, and mortality between 2011 and 2022. Lancet Reg Health Am 2024; 31:100691. [PMID: 38500959 PMCID: PMC10945432 DOI: 10.1016/j.lana.2024.100691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 03/20/2024]
Abstract
Background Self-harm is considered an important public health issue and is comprised by a wide range of definitions and behaviours. It is estimated that suicide affects more than 700,000 individuals every year, although, globally, there is a lack of evidence on other self-harm behaviour, such as attempted suicide. The objective of this study is to report and examine temporal trends of notifications, hospitalisations related to self-harm and suicide rates in Brazil between 2011 and 2022, as well as investigating differences in sociodemographic characteristics, methods, and region. Methods This ecological study used secondary, Brazilian Health Information System data between 2011 and 2022. Self-harm notifications were collected from the Notifiable Diseases Information System (SINAN); self-harm hospitalisations from the Hospital Information System (SIH), and suicide data from the Mortality Information System (SIM). We calculated self-harm notifications, hospitalisations, and suicide rates by sex, age, race, region, and overall. We assessed time-related trends using Joinpoint regression analyses. Findings From 2011 to 2022, 720,480 self-harm notifications, 104,458 self-harm hospitalisations, and 147,698 suicides were recorded in Brazil. In this period, self-harm notifications (AAPC: 21.13 (CI: 17.50, 25.33)) and suicide (AAPC: 3.70 (CI: 3.05, 4.38)) have increased in the country. Male adults (25-59 years old) and the elderly (>60 years old) continue to be the groups most affected by suicide, with respective rates of 9.59 and 8.60/100,000 in 2022. However, the largest percentage increases have been seen in young people (AAPC: 6.14 (CI: 4.57, 7.88)). The Indigenous population had the highest self-harm notification (103.72, 10,000) and suicide (16.58/100,000) rates, but the lowest hospitalisation rates (1.14/100,000) in 2022), compared to the overall population (70.06, 7.27, and 4.69/100,000, respectively, in 2022). Interpretation The observed trend of increased self-harm notifications and suicide rates suggests the need for a greater allocation of resources to strategies to prevent self-harm and suicide. The Indigenous population seems to be the group with less access to healthcare. Funding Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award number R01MH128911-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Affiliation(s)
- Flávia Jôse Oliveira Alves
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Erika Fialho
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Jacyra Azevedo Paiva de Araújo
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Maurício L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Daiane Borges Machado
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
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de Mello E Silva JF, de Jesus Silva N, Carrilho TRB, Jesus Pinto ED, Rocha AS, Pedroso J, Silva SA, Spaniol AM, da Costa Santin de Andrade R, Bortolini GA, Paixão E, Kac G, de Cássia Ribeiro-Silva R, Barreto ML. Identifying biologically implausible values in big longitudinal data: an example applied to child growth data from the Brazilian food and nutrition surveillance system. BMC Med Res Methodol 2024; 24:38. [PMID: 38360575 PMCID: PMC10868032 DOI: 10.1186/s12874-024-02161-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Several strategies for identifying biologically implausible values in longitudinal anthropometric data have recently been proposed, but the suitability of these strategies for large population datasets needs to be better understood. This study evaluated the impact of removing population outliers and the additional value of identifying and removing longitudinal outliers on the trajectories of length/height and weight and on the prevalence of child growth indicators in a large longitudinal dataset of child growth data. METHODS Length/height and weight measurements of children aged 0 to 59 months from the Brazilian Food and Nutrition Surveillance System were analyzed. Population outliers were identified using z-scores from the World Health Organization (WHO) growth charts. After identifying and removing population outliers, residuals from linear mixed-effects models were used to flag longitudinal outliers. The following cutoffs for residuals were tested to flag those: -3/+3, -4/+4, -5/+5, -6/+6. The selected child growth indicators included length/height-for-age z-scores and weight-for-age z-scores, classified according to the WHO charts. RESULTS The dataset included 50,154,738 records from 10,775,496 children. Boys and girls had 5.74% and 5.31% of length/height and 5.19% and 4.74% of weight values flagged as population outliers, respectively. After removing those, the percentage of longitudinal outliers varied from 0.02% (<-6/>+6) to 1.47% (<-3/>+3) for length/height and from 0.07 to 1.44% for weight in boys. In girls, the percentage of longitudinal outliers varied from 0.01 to 1.50% for length/height and from 0.08 to 1.45% for weight. The initial removal of population outliers played the most substantial role in the growth trajectories as it was the first step in the cleaning process, while the additional removal of longitudinal outliers had lower influence on those, regardless of the cutoff adopted. The prevalence of the selected indicators were also affected by both population and longitudinal (to a lesser extent) outliers. CONCLUSIONS Although both population and longitudinal outliers can detect biologically implausible values in child growth data, removing population outliers seemed more relevant in this large administrative dataset, especially in calculating summary statistics. However, both types of outliers need to be identified and removed for the proper evaluation of trajectories.
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Affiliation(s)
| | - Natanael de Jesus Silva
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- ISGlobal, Hospital Clínic. Universitat de Barcelona, Barcelona, Spain
| | - Thaís Rangel Bousquet Carrilho
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Elizabete de Jesus Pinto
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, BA, Brazil
| | - Aline Santos Rocha
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- Food and Nutrition Coordinating Unit, Ministry of Health, Brasília, DF, Brazil
| | - Jéssica Pedroso
- Food and Nutrition Coordinating Unit, Ministry of Health, Brasília, DF, Brazil
| | - Sara Araújo Silva
- Food and Nutrition Coordinating Unit, Ministry of Health, Brasília, DF, Brazil
| | - Ana Maria Spaniol
- Food and Nutrition Coordinating Unit, Ministry of Health, Brasília, DF, Brazil
| | | | | | - Enny Paixão
- London School of Hygiene & Tropical Medicine, London, UK
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Rita de Cássia Ribeiro-Silva
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil.
- School of Nutrition, Federal University of Bahia, Av. Araújo Pinho, nº 32, Canela, Salvador, Bahia, CEP: 40.110-150, BA, Brazil.
| | - Maurício L Barreto
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, BA, Brazil
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Benes Matos da Silva H, Ribeiro-Silva RDC, Freitas de Mello E Silva J, Chis Ster I, Rebouças P, Goes E, Ichihara MY, Ferreira A, M Pescarini J, Leovigildo Fiaccone R, S Paixão E, L Barreto M. Ethnoracial disparities in childhood growth trajectories in Brazil: a longitudinal nationwide study of four million children. BMC Pediatr 2024; 24:103. [PMID: 38341551 PMCID: PMC10858530 DOI: 10.1186/s12887-024-04550-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/10/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The literature contains scarce data on inequalities in growth trajectories among children born to mothers of diverse ethnoracial background in the first 5 years of life. OBJECTIVE We aimed to investigate child growth according to maternal ethnoracial group using a nationwide Brazilian database. METHODS A population-based retrospective cohort study employed linked data from the CIDACS Birth Cohort and the Brazilian Food and Nutrition Surveillance System (SISVAN). Children born at term, aged 5 years or younger who presented two or more measurements of length/height (cm) and weight (kg) were followed up between 2008 and 2017. Prevalence of stunting, underweight, wasting, and thinness were estimated. Nonlinear mixed effect models were used to estimate childhood growth trajectories, among different maternal ethnoracial groups (White, Asian descent, Black, Pardo, and Indigenous), using the raw measures of weight (kg) and height (cm) and the length/height-for-age (L/HAZ) and weight-for-age z-scores (WAZ). The analyses were also adjusted for mother's age, educational level, and marital status. RESULTS A total of 4,090,271 children were included in the study. Children of Indigenous mothers exhibited higher rates of stunting (26.74%) and underweight (5.90%). Wasting and thinness were more prevalent among children of Pardo, Asian, Black, and Indigenous mothers than those of White mothers. Regarding children's weight (kg) and length/height (cm), those of Indigenous, Pardo, Black, and Asian descent mothers were on average shorter and weighted less than White ones. Regarding WAZ and L/HAZ growth trajectories, a sharp decline in average z-scores was evidenced in the first weeks of life, followed by a period of recovery. Over time, z-scores for most of the subgroups analyzed trended below zero. Children of mother in greater social vulnerability showed less favorable growth. CONCLUSION We observed racial disparities in nutritional status and childhood growth trajectories, with children of Indigenous mothers presenting less favorable outcomes compared to their White counterparts. The strengthening of policies aimed at protecting Indigenous children should be urgently undertaken to address systematic ethnoracial health inequalities.
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Affiliation(s)
- Helena Benes Matos da Silva
- School of Nutrition, Federal University of Bahia, Salvador, BA, Brazil.
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil.
| | - Rita de Cássia Ribeiro-Silva
- School of Nutrition, Federal University of Bahia, Salvador, BA, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil
| | - Juliana Freitas de Mello E Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil
| | - Irina Chis Ster
- Infection and Immunity Research Institute, St George's University of London, London, UK
| | - Poliana Rebouças
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil
| | - Emanuelle Goes
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil
| | - Andrêa Ferreira
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil
- The Ubuntu Center on Racism, Global Movements, and Population Health Equity, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Julia M Pescarini
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Enny S Paixão
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Maurício L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil
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Pinto PFPS, Teixeira CSS, Ichihara MY, Rasella D, Nery JS, Sena SOL, Brickley EB, Barreto ML, Sanchez MN, Pescarini JM. Incidence and risk factors of tuberculosis among 420 854 household contacts of patients with tuberculosis in the 100 Million Brazilian Cohort (2004-18): a cohort study. Lancet Infect Dis 2024; 24:46-56. [PMID: 37591301 PMCID: PMC10733584 DOI: 10.1016/s1473-3099(23)00371-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Although household contacts of patients with tuberculosis are known to be particularly vulnerable to tuberculosis, the published evidence focused on this group at high risk within the low-income and middle-income country context remains sparse. Using nationwide data from Brazil, we aimed to estimate the incidence and investigate the socioeconomic and clinical determinants of tuberculosis in a cohort of contacts of tuberculosis patients. METHODS In this cohort study, we linked individual socioeconomic and demographic data from the 100 Million Brazilian Cohort to mortality data and tuberculosis registries, identified contacts of tuberculosis index patients diagnosed from Jan 1, 2004 to Dec 31, 2018, and followed up the contacts until the contact's subsequent tuberculosis diagnosis, the contact's death, or Dec 31, 2018. We investigated factors associated with active tuberculosis using multilevel Poisson regressions, allowing for municipality-level and household-level random effects. FINDINGS We studied 420 854 household contacts of 137 131 tuberculosis index patients. During the 15 years of follow-up (median 4·4 years [IQR 1·9-7·6]), we detected 8953 contacts with tuberculosis. The tuberculosis incidence among contacts was 427·8 per 100 000 person-years at risk (95% CI 419·1-436·8), 16-times higher than the incidence in the general population (26·2 [26·1-26·3]) and the risk was prolonged. Tuberculosis incidence was associated with the index patient being preschool aged (<5 years; adjusted risk ratio 4·15 [95% CI 3·26-5·28]) or having pulmonary tuberculosis (2·84 [2·55-3·17]). INTERPRETATION The high and sustained risk of tuberculosis among contacts reinforces the need to systematically expand and strengthen contact tracing and preventive treatment policies in Brazil in order to achieve national and international targets for tuberculosis elimination. FUNDING Wellcome Trust and Brazilian Ministry of Health.
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Affiliation(s)
- Priscila F P S Pinto
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil.
| | - Camila S S Teixeira
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Davide Rasella
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil; Institute of Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Joilda S Nery
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Samila O L Sena
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Maurício L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Mauro N Sanchez
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil; Núcleo de Medicina Tropical, Universidade de Brasília (UnB), Brasília, Brazil
| | - Julia M Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Paiva ASS, Santos GF, Castro CP, Rodriguez DA, Bilal U, de Sousa Filho JF, Freitas A, Montes F, Dronova I, Barreto ML, Andrade RFS. A scaling investigation of urban form features in Latin America cities. PLoS One 2023; 18:e0293518. [PMID: 38109440 PMCID: PMC10727436 DOI: 10.1371/journal.pone.0293518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/15/2023] [Indexed: 12/20/2023] Open
Abstract
This paper examines scaling behaviors of urban landscape and street design metrics with respect to city population in Latin America. We used data from the SALURBAL project, which has compiled and harmonized data on health, social, and built environment for 371 Latin American cities above 100,000 inhabitants. These metrics included total urbanized area, effective mesh size, area in km2 and number of streets. We obtained scaling relations by regressing log(metric) on log (city population). The results show an overall sub-linear scaling behavior of most variables, indicating a relatively lower value of each variable in larger cities. We also explored the potential influence of colonization on the current built environment, by analyzing cities colonized by Portuguese (Brazilian cities) or Spaniards (Other cities in Latin America) separately. We found that the scaling behaviors are similar for both sets of cities.
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Affiliation(s)
- Aureliano S. S. Paiva
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Gervásio F. Santos
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Economics Faculty, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Caio P. Castro
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Institute of Physics, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Daniel A. Rodriguez
- Department of City and Regional Planning and Institute of Transportation Studies, University of California Berkeley, Berkeley, California, United States of America
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania, United States of America
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania, United States of America
| | - J. Firmino de Sousa Filho
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Economics Faculty, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Anderson Freitas
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Felipe Montes
- Department of Industrial Engineering, Universidad de los Andes, Social and Health Complexity Center, Bogotá, Colombia
| | - Iryna Dronova
- Department of Landscape Architecture & Environmental Planning, University of California Berkeley, Berkeley, California, United States of America
| | - Maurício L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Roberto F. S. Andrade
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Institute of Physics, Federal University of Bahia, Salvador, Bahia, Brazil
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Victor A, Gotine ARM, Falcão IR, Ferreira AJF, Flores-Ortiz R, Xavier SP, Vasco MD, de Jesus Silva N, Mahoche M, Rodrigues OAS, de Cássia Ribeiro R, Rondó PH, Barreto ML. Association between food environments and fetal growth in pregnant Brazilian women. BMC Pregnancy Childbirth 2023; 23:661. [DOI: https:/doi.org/10.1186/s12884-023-05947-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 08/22/2023] [Indexed: 09/14/2023] Open
Abstract
Abstract
Introduction
Birth weight is described as one of the main determinants of newborns’ chances of survival. Among the associated causes, or risk factors, the mother’s nutritional status strongly influences fetal growth and birth weight outcomes of the concept. This study evaluates the association between food deserts, small for gestational age (SGA), large for gestational age (LGA) and low birth weight (LBW) newborns.
Design
This is a cross-sectional population study, resulting from individual data from the Live Birth Information System (SINASC), and commune data from mapping food deserts (CAISAN) in Brazil. The newborn’s size was defined as follows: appropriate for gestational age (between 10 and 90th percentile), SGA (< 10th percentile), LGA (> 90th percentile), and low birth weight < 2,500 g. To characterize food environments, we used tertiles of the density of establishments which sell in natura and ultra-processed foods. Logistic regression modeling was conducted to investigate the associations of interest.
Results
We analyzed 2,632,314 live births in Brazil in 2016, after appropriate adjustments, women living in municipalities with limited availability of fresh foods had a higher chance of having newborns with SGA [OR2nd tertile: 1.06 (1.05–1.07)] and LBW [OR2nd tertile: 1.11 (1.09–1.12)]. Conversely, municipalities with greater availability of ultra-processed foods had a higher chance of having newborns with SGA [OR3rd tertile: 1.04 (1.02–1.06)] and LBW [OR2nd tertile: 1.13 (1.11–1.16)]. Stratification by race showed that Black and Mixed/Brown women had a higher chance of having newborns with SGA [OR3rd tertile: 1.09 (1.01–1.18)] and [OR3rd tertile: 1.06 (1.04–1.09)], respectively, while Mixed-race women also had a higher chance of having newborns with LBW [OR3rd tertile: 1.17 (1.14–1.20)]. Indigenous women were associated with LGA [OR3rd tertile: 1.20 (1.01–1.45)].
Conclusion
The study found that living in areas with limited access to healthy foods was associated with an increased risk of SGA and low birth weight among newborns, particularly among Black and Mixed/Brown women. Therefore, urgent initiatives aimed at reducing social inequalities and mitigating the impact of poor food environments are needed in Brazil.
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Victor A, Gotine ARM, Falcão IR, Ferreira AJF, Flores-Ortiz R, Xavier SP, Vasco MD, de Jesus Silva N, Mahoche M, Rodrigues OAS, de Cássia Ribeiro R, Rondó PH, Barreto ML. Association between food environments and fetal growth in pregnant Brazilian women. BMC Pregnancy Childbirth 2023; 23:661. [PMID: 37704954 PMCID: PMC10500732 DOI: 10.1186/s12884-023-05947-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Birth weight is described as one of the main determinants of newborns' chances of survival. Among the associated causes, or risk factors, the mother's nutritional status strongly influences fetal growth and birth weight outcomes of the concept. This study evaluates the association between food deserts, small for gestational age (SGA), large for gestational age (LGA) and low birth weight (LBW) newborns. DESIGN This is a cross-sectional population study, resulting from individual data from the Live Birth Information System (SINASC), and commune data from mapping food deserts (CAISAN) in Brazil. The newborn's size was defined as follows: appropriate for gestational age (between 10 and 90th percentile), SGA (< 10th percentile), LGA (> 90th percentile), and low birth weight < 2,500 g. To characterize food environments, we used tertiles of the density of establishments which sell in natura and ultra-processed foods. Logistic regression modeling was conducted to investigate the associations of interest. RESULTS We analyzed 2,632,314 live births in Brazil in 2016, after appropriate adjustments, women living in municipalities with limited availability of fresh foods had a higher chance of having newborns with SGA [OR2nd tertile: 1.06 (1.05-1.07)] and LBW [OR2nd tertile: 1.11 (1.09-1.12)]. Conversely, municipalities with greater availability of ultra-processed foods had a higher chance of having newborns with SGA [OR3rd tertile: 1.04 (1.02-1.06)] and LBW [OR2nd tertile: 1.13 (1.11-1.16)]. Stratification by race showed that Black and Mixed/Brown women had a higher chance of having newborns with SGA [OR3rd tertile: 1.09 (1.01-1.18)] and [OR3rd tertile: 1.06 (1.04-1.09)], respectively, while Mixed-race women also had a higher chance of having newborns with LBW [OR3rd tertile: 1.17 (1.14-1.20)]. Indigenous women were associated with LGA [OR3rd tertile: 1.20 (1.01-1.45)]. CONCLUSION The study found that living in areas with limited access to healthy foods was associated with an increased risk of SGA and low birth weight among newborns, particularly among Black and Mixed/Brown women. Therefore, urgent initiatives aimed at reducing social inequalities and mitigating the impact of poor food environments are needed in Brazil.
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Affiliation(s)
- Audêncio Victor
- Faculdade de Saúde Pública- USP, School of Public Health, University of São Paulo (USP), Avenida Doutor Arnaldo, 715, São Paulo, São Paulo, 01246904, Brazil.
- Department of Nutrition, Ministry of Health of Mozambique, Maputo, Mozambique.
- Iyaleta - Research, Science and Humanities, Salvador, Bahia, Brazil.
| | - Ana Raquel Manuel Gotine
- Faculdade de Saúde Pública- USP, School of Public Health, University of São Paulo (USP), Avenida Doutor Arnaldo, 715, São Paulo, São Paulo, 01246904, Brazil
- Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
| | - Ila R Falcão
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Sl 315. Rua Mundo, 121. Trobogy, Salvador, Bahia, 41745-715, Brazil
| | - Andrêa J F Ferreira
- Faculdade de Saúde Pública- USP, School of Public Health, University of São Paulo (USP), Avenida Doutor Arnaldo, 715, São Paulo, São Paulo, 01246904, Brazil
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Sl 315. Rua Mundo, 121. Trobogy, Salvador, Bahia, 41745-715, Brazil
- Center On Racism, Global Movements, and Population Health Equity Drexel University Dornsife School of Public Health, Philadelphia, USA
| | - Renzo Flores-Ortiz
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Sl 315. Rua Mundo, 121. Trobogy, Salvador, Bahia, 41745-715, Brazil
| | - Sancho Pedro Xavier
- Institute of Collective Health, Federal University of Mato Grosso (UFMT), Cuiabá, MT, Brasil
| | - Melsequisete Daniel Vasco
- Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Natanael de Jesus Silva
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Sl 315. Rua Mundo, 121. Trobogy, Salvador, Bahia, 41745-715, Brazil
- Barcelona Institute for Global Health, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Manuel Mahoche
- Faculdade de Saúde Pública- USP, School of Public Health, University of São Paulo (USP), Avenida Doutor Arnaldo, 715, São Paulo, São Paulo, 01246904, Brazil
| | | | - Rita de Cássia Ribeiro
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Sl 315. Rua Mundo, 121. Trobogy, Salvador, Bahia, 41745-715, Brazil
- School of Nutrition, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Patrícia H Rondó
- Faculdade de Saúde Pública- USP, School of Public Health, University of São Paulo (USP), Avenida Doutor Arnaldo, 715, São Paulo, São Paulo, 01246904, Brazil
| | - Maurício L Barreto
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Sl 315. Rua Mundo, 121. Trobogy, Salvador, Bahia, 41745-715, Brazil
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
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Lopes de Oliveira G, Ferreira AJ, Teles CADS, Paixao ES, Fiaccone R, Lana R, Aquino R, Cardoso AM, Soares MA, Oliveira dos Santos I, Pereira M, Barreto ML, Ichihara MY. Estimating the real burden of gestational syphilis in Brazil, 2007-2018: a Bayesian modeling study. Lancet Reg Health Am 2023; 25:100564. [PMID: 37575963 PMCID: PMC10415804 DOI: 10.1016/j.lana.2023.100564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023]
Abstract
Background Although several studies have estimated gestational syphilis (GS) incidence in several countries, underreporting correction is rarely considered. This study aimed to estimate the level of under-registration and correct the GS incidence rates in the 557 Brazilian microregions. Methods Brazilian GS notifications between 2007 and 2018 were obtained from the SINAN-Syphilis system. A cluster analysis was performed to group microregions according to the quality of GS notification. A Bayesian hierarchical Poisson regression model was applied to estimate the reporting probabilities among the clusters and to correct the associated incidence rates. Findings We estimate that 45,196 (90%-HPD: 13,299; 79,310) GS cases were underreported in Brazil from 2007 to 2018, representing a coverage of 87.12% (90%-HPD: 79.40%; 95.83%) of registered cases, where HPD stands for the Bayesian highest posterior density credible interval. Underreporting levels differ across the country, with microregions in North and Northeast regions presenting the highest percentage of missed cases. After underreporting correction, Brazil's estimated GS incidence rate increased from 8.74 to 10.02 per 1000 live births in the same period. Interpretation Our findings highlight disparities in the registration level and incidence rate of GS in Brazil, reflecting regional heterogeneity in the quality of syphilis surveillance, access to prenatal care, and childbirth assistance services. This study provides robust evidence to enhance national surveillance systems, guide specific policies for GS detection disease control, and potentially mitigate the harmful consequences of mother-to-child transmission. The methodology might be applied in other regions to correct disease underreporting. Funding National Council for Scientific and Technological Development; The Bill Melinda Gates Foundation and Wellcome Trust.
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Affiliation(s)
- Guilherme Lopes de Oliveira
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Department of Computing, Federal Centre of Technological Education of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Andrêa J.F. Ferreira
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- The Ubuntu Center on Racism, Global Movement, Population and Equity, School of Public Health, Drexel University, Pennsylvania, USA
| | - Carlos Antônio de S.S. Teles
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
| | - Enny S. Paixao
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- London School of Hygiene and Tropical Medicine, London, UK
| | - Rosemeire Fiaccone
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Statistics Department, Institute of Mathematics, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Raquel Lana
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Barcelona Supercomputing Center, Catalonia, Spain
| | - Rosana Aquino
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Maria Auxiliadora Soares
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Idália Oliveira dos Santos
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Marcos Pereira
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Maurício L. Barreto
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Maria Yury Ichihara
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
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de Oliveira GL, Ferreira AJF, Santana JG, Lana RM, Cardoso AM, Teles C, Fiaccone RL, Aquino R, Soares MAS, Paixao ES, Santos IO, Salvi L, Barreto ML, Ichihara MY. A completeness indicator of gestational and congenital syphilis information in Brazil. Rev Saude Publica 2023; 57:42. [PMID: 37556664 PMCID: PMC10355315 DOI: 10.11606/s1518-8787.2023057004789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/08/2022] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To evaluate the quality of information on gestational syphilis (GS) and congenital syphilis (CS) on the Sistema de Informação de Agravos de Notificação (SINAN-Syphilis Brazil - Notifiable Diseases Information System) by compiling and validating completeness indicators between 2007 and 2018. METHODS Overall, care, and socioeconomic completeness scores were compiled based on selected variables, by using ad hoc weights assigned by experts. The completeness scores were analysed, considering the region and area of residence, the pregnant woman's race/colour, and the year of case notification. Pearson's correlation coefficients were used to validate the scores obtained by the weighted average method, compared with the values obtained by principal component analysis (PCA). RESULTS Most selected variables presented a good or excellent degree of completeness for GS and CS, except for clinical classification, pregnant woman's level of education, partner's treatment, and child's race/colour, which were classified as poor or very poor. The overall (89.93% versus 89.69%) and socioeconomic (88.71% versus 88.24%) completeness scores for GS and CS, respectively, were classified as regular, whereas the care score (GS-90.88%, and CS-90.72%) was good, despite improvements over time. Differences in the overall, care and socioeconomic completeness scores according to region, area of residence, and ethnic-racial groups were reported for syphilis notifications. The completeness scores estimated by the weighted average method and PCA showed a strong linear correlation (> 0.90). CONCLUSION The completeness of GS and CS notifications has been improving in recent years, highlighting the variables that form the care score, compared with the socioeconomic scores, despite differences between regions, area of residence, and ethnic-racial groups. The weighted average was a viable methodological alternative easily operationalised to estimate data completeness scores, allowing routine monitoring of the completeness of gestational and congenital syphilis records.
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Affiliation(s)
- Guilherme Lopes de Oliveira
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Centro Federal de Educação Tecnológica de Minas GeraisDepartamento de ComputaçãoBelo HorizonteMGBrasilCentro Federal de Educação Tecnológica de Minas Gerais. Departamento de Computação. Belo Horizonte, MG, Brasil
| | - Andrêa JF Ferreira
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Drexel UniversityDornsife School of Public HealthThe Ubuntu Center on Racism, Global Movements & Population Health EquityPhiladelphiaUSADrexel University. Dornsife School of Public Health. The Ubuntu Center on Racism, Global Movements & Population Health Equity. Philadelphia, USA
| | - José Guilherme Santana
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Drexel UniversityDornsife School of Public HealthThe Ubuntu Center on Racism, Global Movements & Population Health EquityPhiladelphiaUSADrexel University. Dornsife School of Public Health. The Ubuntu Center on Racism, Global Movements & Population Health Equity. Philadelphia, USA
| | - Raquel Martins Lana
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Centro Nacional de SupercomputaciónBarcelonaEspañaCentro Nacional de Supercomputación. Barcelona, España
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sérgio AroucaDepartment of Endemic Diseases Samuel PessoaRio de JaneiroRJBrasilFundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca, Department of Endemic Diseases Samuel Pessoa. Rio de Janeiro, RJ, Brasil
| | - Andrey Moreira Cardoso
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sérgio AroucaDepartment of Endemic Diseases Samuel PessoaRio de JaneiroRJBrasilFundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca, Department of Endemic Diseases Samuel Pessoa. Rio de Janeiro, RJ, Brasil
| | - Carlos Teles
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Universidade Estadual de Feira de SantanaDepartamento de Ciências ExatasFeira de SantanaBABrasilUniversidade Estadual de Feira de Santana, Departamento de Ciências Exatas. Feira de Santana, BA, Brasil
| | - Rosemeire L. Fiaccone
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Matemática e EstatísticaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Matemática e Estatística, Salvador, BA, Brasil
| | - Rosana Aquino
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
| | - Maria Auxiliadora Santos Soares
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
| | - Enny S. Paixao
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- London School of Hygiene and Tropical MedicineLondonUnited KingdomLondon School of Hygiene and Tropical Medicine. London, United Kingdom
| | - Idália Oliveira Santos
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
| | - Leonardo Salvi
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
| | - Maurício L. Barreto
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
| | - Maria Yury Ichihara
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
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Junior EPP, Normando P, Flores-Ortiz R, Afzal MU, Jamil MA, Bertolin SF, Oliveira VDA, Martufi V, de Sousa F, Bashir A, Burn E, Ichihara MY, Barreto ML, Salles TD, Prieto-Alhambra D, Hafeez H, Khalid S. Integrating real-world data from Brazil and Pakistan into the OMOP common data model and standardized health analytics framework to characterize COVID-19 in the Global South. J Am Med Inform Assoc 2023; 30:643-655. [PMID: 36264262 PMCID: PMC9619798 DOI: 10.1093/jamia/ocac180] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/16/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this work is to demonstrate the use of a standardized health informatics framework to generate reliable and reproducible real-world evidence from Latin America and South Asia towards characterizing coronavirus disease 2019 (COVID-19) in the Global South. MATERIALS AND METHODS Patient-level COVID-19 records collected in a patient self-reported notification system, hospital in-patient and out-patient records, and community diagnostic labs were harmonized to the Observational Medical Outcomes Partnership common data model and analyzed using a federated network analytics framework. Clinical characteristics of individuals tested for, diagnosed with or tested positive for, hospitalized with, admitted to intensive care unit with, or dying with COVID-19 were estimated. RESULTS Two COVID-19 databases covering 8.3 million people from Pakistan and 2.6 million people from Bahia, Brazil were analyzed. 109 504 (Pakistan) and 921 (Brazil) medical concepts were harmonized to Observational Medical Outcomes Partnership common data model. In total, 341 505 (4.1%) people in the Pakistan dataset and 1 312 832 (49.2%) people in the Brazilian dataset were tested for COVID-19 between January 1, 2020 and April 20, 2022, with a median [IQR] age of 36 [25, 76] and 38 (27, 50); 40.3% and 56.5% were female in Pakistan and Brazil, respectively. 1.2% percent individuals in the Pakistan dataset had Afghan ethnicity. In Brazil, 52.3% had mixed ethnicity. In agreement with international findings, COVID-19 outcomes were more severe in men, elderly, and those with underlying health conditions. CONCLUSIONS COVID-19 data from 2 large countries in the Global South were harmonized and analyzed using a standardized health informatics framework developed by an international community of health informaticians. This proof-of-concept study demonstrates a potential open science framework for global knowledge mobilization and clinical translation for timely response to healthcare needs in pandemics and beyond.
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Affiliation(s)
- Elzo Pereira Pinto Junior
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Priscilla Normando
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Renzo Flores-Ortiz
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Muhammad Usman Afzal
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Johar Town, Lahore, 54840, Pakistan
| | - Muhammad Asaad Jamil
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Johar Town, Lahore, 54840, Pakistan
| | - Sergio Fernandez Bertolin
- Fundació Institut, Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, 587 08007, Spain
| | - Vinícius de Araújo Oliveira
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Valentina Martufi
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Fernanda de Sousa
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Amir Bashir
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Johar Town, Lahore, 54840, Pakistan
| | - Edward Burn
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Maria Yury Ichihara
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Maurício L Barreto
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Talita Duarte Salles
- Fundació Institut, Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, 587 08007, Spain
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Haroon Hafeez
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Johar Town, Lahore, 54840, Pakistan
| | - Sara Khalid
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom
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Santos ES, Miranda JG, Saba H, Skalinski LM, Araújo ML, Veiga RV, Costa MDCN, Cardim LL, Paixão ES, Teixeira MG, Andrade RF, Barreto ML. Complex network analysis of arboviruses in the same geographic domain: Differences and similarities. Chaos Solitons Fractals 2023; 168:None. [PMID: 36876054 PMCID: PMC9980430 DOI: 10.1016/j.chaos.2023.113134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/29/2022] [Accepted: 01/09/2023] [Indexed: 06/18/2023]
Abstract
Arbovirus can cause diseases with a broad spectrum from mild to severe and long-lasting symptoms, affecting humans worldwide and therefore considered a public health problem with global and diverse socio-economic impacts. Understanding how they spread within and across different regions is necessary to devise strategies to control and prevent new outbreaks. Complex network approaches have widespread use to get important insights on several phenomena, as the spread of these viruses within a given region. This work uses the motif-synchronization methodology to build time varying complex networks based on data of registered infections caused by Zika, chikungunya, and dengue virus from 2014 to 2020, in 417 cities of the state of Bahia, Brazil. The resulting network sets capture new information on the spread of the diseases that are related to the time delay in the synchronization of the time series among different municipalities. Thus the work adds new and important network-based insights to previous results based on dengue dataset in the period 2001-2016. The most frequent synchronization delay time between time series in different cities, which control the insertion of edges in the networks, ranges 7 to 14 days, a period that is compatible with the time of the individual-mosquito-individual transmission cycle of these diseases. As the used data covers the initial periods of the first Zika and chikungunya outbreaks, our analyses reveal an increasing monotonic dependence between distance among cities and the time delay for synchronization between the corresponding time series. The same behavior was not observed for dengue, first reported in the region back in 1986, either in the previously 2001-2016 based results or in the current work. These results show that, as the number of outbreaks accumulates, different strategies must be adopted to combat the dissemination of arbovirus infections.
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Affiliation(s)
- Eslaine S. Santos
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - José G.V. Miranda
- Physics Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Hugo Saba
- Centro Universitário SENAI CIMATEC, Av. Orlando Gomes, 1845—Piatã, Salvador 41650-010, Brazil
- Department of Exact and Earth Sciences, University of the State of Bahia, R. Silveira Martins, 2555—Cabula, Salvador 41180-045, Brazil
| | - Lacita M. Skalinski
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
- Santa Cruz State University, Ilhéus, Bahia, Brazil
| | - Marcio L.V. Araújo
- Instituto Federal de Ciência e Tecnologia da Bahia (IFBA), R. São Cristóvão, s/n - Novo Horizonte, Lauro de Freitas, 42700-000, Brazil
| | - Rafael V. Veiga
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- The Babraham Institute, Laboratory of Lymphocyte Signalling and Development, Cambridge, United Kingdom
| | | | - Luciana L. Cardim
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Enny S. Paixão
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Glória Teixeira
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Roberto F.S. Andrade
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Physics Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Maurício L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
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15
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Victor A, Silva RDCR, Silva NDJ, Ferreira A, Barreto ML, Campello T. Influence of Unhealthy Food Environment on Premature Cardiovascular Disease Mortality in Brazil: An Ecologic Approach. Am J Prev Med 2023; 64:285-292. [PMID: 36437143 DOI: 10.1016/j.amepre.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Cardiovascular disease is the main cause of general and premature death of adults aged 30-69 years in Brazil and around the world. Unhealthy food environments have been implicated as one of the factors associated with cardiovascular disease morbimortality because they affect people's health conditions and nutrition. This study aims to explore the association between unhealthy food environments (deserts/swamps) and premature cardiovascular disease mortality in the Brazilian population. METHODS This is an ecologic study using data from 5,558 Brazilian municipalities in 2016. The cardiovascular disease mortality data were obtained from the Mortality Information System of the Ministry of Health. The study on mapping food deserts in Brazil, developed by the Interministerial Chamber of Food and Nutrition Security, was used to evaluate the physical dimension of food access. The authors calculated the standardized rates of premature general and specific cardiovascular disease (stroke and ischemic heart disease) causes of death in the same period. To characterize food environments, the density of unprocessed and ultraprocessed foods per 10,000 population in tertiles was used. Crude and adjusted negative binomial regression models were used to study the associations of interest. RESULTS After the necessary adjustments (human development index, gross domestic product per capita, unemployment rate, Gini index and Family Health Strategy coverage), it was found that municipalities with low unprocessed food supply were at the highest risk of increased mortality among women with ischemic heart disease (rate ratio first tertile: 1.08 [95% CI=1.01, 1.15]). Conversely, the municipalities where there was a greater offer of ultraprocessed foods showed a higher risk of death from cardiovascular diseases (rate ratio second tertile: 1.17 [95% CI=1.12, 1.22]; rate ratio third tertile: 1.20 [95% CI=1.14, 1.26]), from strokes (rate ratio second tertile: 1.19 [95% CI=1.13, 1.25]; rate ratio third tertile: 1.22 [95% CI=1.15, 1.30]), and ischemic heart disease (rate ratio second tertile: 1.19 [95% CI=1.12, 1.25]; rate ratio third tertile: 1.22 [95% CI=1.13, 1.29]). CONCLUSIONS This study's findings show an increase in the risk of cardiovascular disease, stroke, and ischemic heart disease mortality, especially in the municipalities where there was a greater offer of ultraprocessed foods. Initiatives aiming to minimize the effects of these food environments are urgently needed in the Brazilian context.
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Affiliation(s)
- Audêncio Victor
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; School of Public Health, University of São Paulo, São Paulo, Brazil; Department of Nutrition, Ministry of Health of Mozambique, Zambezia, Mozambique.
| | - Rita de Cássia Ribeiro Silva
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil; School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | | | - Andrêa Ferreira
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil; The Ubuntu Center on Racism, Global Movements, and Population Health Equity, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Maurício L Barreto
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Tereza Campello
- School of Public Health, University of São Paulo, São Paulo, Brazil; Fiocruz School of Government, Oswaldo Cruz Foundation, Brasília, Brazil; University of Nottingham, Nottingham, United Kingdom
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Guimarães R, Andrade FCD, Costa GNO, Rocha ADS, Barreto ML, Salles C. Setting references for daily intake of micronutrients: A study on magnesium. Nutrition 2023; 106:111903. [PMID: 36436333 DOI: 10.1016/j.nut.2022.111903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 09/24/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The Institute of Medicine stratifies the references for daily nutrient intake into age and sex groups, considering that the basal metabolic rate varies according to these aspects, and in most cases, it extrapolates the values calculated for adults to children, because their body weights are different. In this context, this study aimed to evaluate the recommendation for magnesium in children according to energy expenditure. METHODS This was an observational study using the database of the Social Changes, Asthma and Allergy in Latin America (SCAALA) cohort, which randomly collected information from 1445 children ages 4 to 11 y. Of these, 480 (33%) were part of the present study (children between 7 and 11 y old with eutrophic body mass index and adequate growth). Information on food intake was obtained from the child's parents or legal guardians through a 24-h recall. The population was characterized using static analyses such as the Student t test, Pearson correlation coefficient, and linear regression. RESULTS The mean age of the sample was 8.5 ± 0.96 y, and 54% were males. The mean magnesium intake was 149 ± 70 mg, with a high correlation observed between energy expenditure and magnesium intake (boys: R, 0.716; P <0.001; girls: R, 0.641; P < 0.001). CONCLUSIONS The metabolic rate can be considered a reference variable for recommending the daily intake of the studied nutrient, aiming to avoid deficiencies and food poisoning because of poor intake.
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Affiliation(s)
- Rafael Guimarães
- International Center on Clinical Sleep Medicine and Research, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil; Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign.
| | | | - Gustavo N O Costa
- UNIFACS: Universidade Salvador, Laureate International Universities, Salvador, Bahia, Brazil; Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz - FIOCRUZ, Salvador, Bahia, Brazil
| | - Aline Dos Santos Rocha
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz - FIOCRUZ, Salvador, Bahia, Brazil
| | - Maurício L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz - FIOCRUZ, Salvador, Bahia, Brazil
| | - Cristina Salles
- International Center on Clinical Sleep Medicine and Research, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil; Professor Edgard Santos University Hospital Complex, Federal University of Bahia- Ebserh Network, Salvador, Bahia, Brazil
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Alves FJO, Ramos D, Paixão ES, Falcão IR, de Cássia Ribeiro-Silva R, Fiaccone R, Rasella D, Teixeira C, Machado DB, Rocha A, de Almeida MF, Goes EF, Rodrigues LC, Ichihara MY, Aquino EML, Barreto ML. Association of Conditional Cash Transfers With Maternal Mortality Using the 100 Million Brazilian Cohort. JAMA Netw Open 2023; 6:e230070. [PMID: 36821115 PMCID: PMC9951038 DOI: 10.1001/jamanetworkopen.2023.0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
IMPORTANCE Conditional cash transfers (CCTs) have been consistently associated with improvements to the determinants of maternal health, but there have been insufficient investigations regarding their effects on maternal mortality. OBJECTIVE To evaluate the association between being a Bolsa Família program (BFP) beneficiary and maternal mortality and to examine how this association differs by duration of BFP receipt, maternal race, living in rural or urban areas, the Municipal Human Development Index (MHDI), and municipal primary health care coverage. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis was nested within the 100 Million Brazilian Cohort. Girls and women aged 10 to 49 years (hereinafter referred to as women) who had at least 1 live birth were included, using data from Brazilian national health databases linked to the 100 Million Brazilian Cohort (January 1, 2004, to December 31, 2015). Propensity score kernel weighting was applied to control for sociodemographic and economic confounders in the association between BFP receipt and maternal mortality, overall and stratified by different subgroups (race, urban or rural area, and MHDI), and duration of BFP receipt. Data were analyzed from July 12, 2019, to December 31, 2022. MAIN OUTCOME(S) AND MEASURES Maternal death. RESULTS A total of 6 677 273 women aged 10 to 49 years were included in the analysis, 4056 of whom had died from pregnancy-related causes. The risk of maternal death was 18% lower in women who received BFP (weighted odds ratio [OR], 0.82 [95% CI, 0.71-0.93]). A longer duration receiving BFP was associated with an increased reduction in maternal mortality (OR for 1-4 years, 0.85 [95% CI, 0.75-0.97]; OR for 5-8 years, 0.70 [95% CI, 0.60-0.82]; OR for ≥9 years, 0.69 [95% CI, 0.53-0.88]). Receiving BFP was also associated with substantial increases in the number of prenatal appointments and interbirth intervals. The reduction was more pronounced in the most vulnerable groups. CONCLUSIONS AND RELEVANCE This cross-sectional analysis nested within the 100 Million Brazilian Cohort found an association between BFP receipt and maternal mortality. This association was of greater magnitude in women with longer exposure to BFP and in the most vulnerable groups. These findings reinforce evidence that programs such as BFP, which have already proven effective in poverty reduction, have great potential to improve maternal survival.
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Affiliation(s)
- Flávia Jôse O. Alves
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Dandara Ramos
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Iyaleta Research Association, Salvador, Brazil
| | - Enny S. Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ila R. Falcão
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rita de Cássia Ribeiro-Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | - Rosemeire Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Camila Teixeira
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Daiane Borges Machado
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Aline Rocha
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | | | - Emanuelle F. Goes
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Iyaleta Research Association, Salvador, Brazil
| | - Laura C. Rodrigues
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Yury Ichihara
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Estela M. L. Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Maurício L. Barreto
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
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Alcantara Galvão A, de Andrade Belitardo EMM, de Araújo Sena F, Santos JM, de Oliveira Costa GN, Feitosa CA, Fiaccone RL, Cruz ÁA, Barreto ML, Figueiredo CA, Alcantara-Neves NM. Serum 25-hydroxyvitamin D deficiency is associated with atopy, and sex may be an effect modifier of its association with asthma in teenagers from northeast Brazil. Pediatr Pulmonol 2023; 58:297-305. [PMID: 36263459 DOI: 10.1002/ppul.26200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 09/03/2022] [Accepted: 10/08/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Sufficient vitamin D (25-hydroxyvitamin D [25(OH)D]) serum levels are associated with decreased asthma symptoms. Our aim was to investigate associations between vitamin D and atopy, asthma, asthma severity, and asthma phenotypes in Brazilian teenagers. METHODS This cross-sectional study involved 942 individuals (11-19 years old) engaged in an asthma cohort. The ISAAC questionnaire was employed to diagnosis asthma and asthma severity. Serum allergen-specific immunoglobulin E (sIgE) was measured by ImmunoCap and serum 25(OH)D was measured by ELISA. We calculated the correlation between sIgE and 25(OH)D. We used multivariate logistic regression analysis to assess associations of interest. RESULTS We found that 25(OH)D deficiency was positively associated with atopy (OR 1.45, confidence interval [CI] 1.05-2.00) and high levels of this vitamin negatively correlated with sIgE to Dermatophagoides pteronyssinus (r = -0.11, p = 0.019). The average 25(OH)D serum level was 27.0 ± 9.5 ng/ml; 366 individuals (38.8%) had a sufficient level. There was no association between 25(OH)D and asthma, asthma severity or asthma phenotypes in the population. However, sex was a possible effect modifier of the association between vitamin D and asthma: insufficiency in asthmatic women (86%) was higher than in asthmatic men (42%), and there was an association between insufficient vitamin D levels and greater asthma risk only in women (OR = 3.06, 95% CI 1.16-8.07). CONCLUSION We have shown that vitamin D deficiency was associated with greater risk of atopy in both sexes and vitamin D insufficiency was associated with asthma only in women. There was no association between vitamin D levels and asthma phenotypes or asthma severity.
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Affiliation(s)
| | | | - Flávia de Araújo Sena
- Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Juliana M Santos
- Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | | | - Caroline A Feitosa
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Salvador, Brazil.,Escola Baiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Rosemeire L Fiaccone
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Brazil
| | - Álvaro A Cruz
- ProAR, Faculdade de Medicina, Universidade Federal da Bahia, (UFBA), Salvador, Brazil
| | - Maurício L Barreto
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Salvador, Brazil.,Centro de Integração de Dados e Conhecimentos Para a Saúde (CIDACS), Fiocruz, Brazil
| | - Camila A Figueiredo
- Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, Brazil
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de Sousa Filho JF, Silva UM, Lima LL, Paiva ASS, Santos GF, Andrade RFS, Gouveia N, Silveira IH, de Lima Friche AA, Barreto ML, Caiaffa WT. Association of urban inequality and income segregation with COVID-19 mortality in Brazil. PLoS One 2022; 17:e0277441. [PMID: 36378655 PMCID: PMC9665357 DOI: 10.1371/journal.pone.0277441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- J. Firmino de Sousa Filho
- Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil
- Faculty of Economics (PPGE)–Federal University of Bahia, Salvador, Brazil
- * E-mail:
| | - Uriel M. Silva
- Observatory for Urban Health in Belo Horizonte (OSUBH)–Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Larissa L. Lima
- Observatory for Urban Health in Belo Horizonte (OSUBH)–Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
- Postgraduate Program in Mathematical and Computational Modeling–Federal Center for Technological Education of Minas Gerais (CEFET-MG), Belo Horizonte, MG, Brazil
| | | | - Gervásio F. Santos
- Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil
- Faculty of Economics (PPGE)–Federal University of Bahia, Salvador, Brazil
| | - Roberto F. S. Andrade
- Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil
- Institute of Physics–Federal University of Bahia, Salvador, Brazil
| | - Nelson Gouveia
- University of São Paulo Medical School, São Paulo, Brazil
| | - Ismael H. Silveira
- Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil
- Institute of Public Health (ISC)–Federal University of Bahia, Salvador, Brazil
| | - Amélia A. de Lima Friche
- Observatory for Urban Health in Belo Horizonte (OSUBH)–Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maurício L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil
- Institute of Public Health (ISC)–Federal University of Bahia, Salvador, Brazil
| | - Waleska Teixeira Caiaffa
- Observatory for Urban Health in Belo Horizonte (OSUBH)–Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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20
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Pescarini JM, Goes E, Scaff P, Schindler B, Rodrigues LC, Brickley EB, Smeeth L, Barreto ML. Mortality among internal and international migrants in the 100 Million Brazilian Cohort. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is limited evidence on the health of migrant populations in low and middle-income countries (LMICs). Here, we investigated the patterns of mortality risk in migrants and non-migrants in women and men over the life course.
Methods
We linked socioeconomic and mortality data from 1st Jan 2011 to 31st Dec 2018 in the 100 Million Brazilian Cohort. We calculated all-cause and cause-specific age-standardised mortality rates according to individuals’ migration status. Using Cox regression models, we estimated the age- and sex-adjusted mortality hazard ratios (HR) for internal migrants (i.e., people born in Brazil but living in a different Brazilian state to their state of birth) compared to Brazilian-born non-migrants; and for international migrants (i.e., people born in another country) compared to Brazilian-born individuals.
Results
We followed 45,051,476 individuals, of whom 6,057,814 were internal migrants and 277,230 were international migrants. Internal migrants had a similar overall risk of all-cause mortality compared to Brazilian non-migrants (aHR=0.99, 95%CI=0.98-0.99), with lower mortality from some causes but higher mortality for some non-communicable diseases (NCDs). Compared to Brazilian-born individuals, international migrants had a lower risk of all-cause mortality (aHR=0.82, 95%CI=0.80-0.84), with up to 50% lower risk of death attributed to interpersonal violence among international migrant men (aHR=0.50, 95%CI=0.40-0.64), but a markedly higher risk of death by avoidable causes related to maternal health among young migrant women (aHR=2.17, 95%CI=1.17-4.05).
Conclusions
Overall, internal migration was not associated with excess all-cause mortality, while international migration into Brazil was associated with lower all-cause mortality. Mortality patterns among migrant populations in Brazil show marked variation for specific causes of death, and risks varied by age and sex.
Key messages
• Non-communicable diseases and maternal mortality are disproportionally higher among internal and international migrants, respectively.
• Further investigation of the underlying factors associated with higher maternal mortality among international migrant women is key to informing the targeting of social and health interventions.
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Affiliation(s)
- JM Pescarini
- Centre of Data and Knowledge Integration for Health, Oswaldo Cruz Foundation , Salvador, Brazil
- Faculty of Epidemiology and Population, LSHTM , London, Brazil
| | - E Goes
- Centre of Data and Knowledge Integration for Health, Oswaldo Cruz Foundation , Salvador, Brazil
| | - P Scaff
- Centre of Data and Knowledge Integration for Health, Oswaldo Cruz Foundation , Salvador, Brazil
| | - B Schindler
- Centre of Data and Knowledge Integration for Health, Oswaldo Cruz Foundation , Salvador, Brazil
| | - LC Rodrigues
- Faculty of Epidemiology and Population, LSHTM , London, Brazil
| | - EB Brickley
- Faculty of Epidemiology and Population, LSHTM , London, Brazil
| | - L Smeeth
- Faculty of Epidemiology and Population, LSHTM , London, Brazil
| | - ML Barreto
- Centre of Data and Knowledge Integration for Health, Oswaldo Cruz Foundation , Salvador, Brazil
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21
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Diógenes VHD, Pinto EP, Gonzaga MR, Queiroz BL, Lima EEC, da Costa LCC, Rocha AS, Ferreira AJF, Teixeira CSS, Alves FJO, Rameh L, Flores-Ortiz R, Leyland A, Dundas R, Barreto ML, Ichihara MYT. Differentials in death count records by databases in Brazil in 2010. Rev Saude Publica 2022; 56:92. [PMID: 36287489 PMCID: PMC9586519 DOI: 10.11606/s1518-8787.2022056004282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the death counts from three sources of information on mortality available in Brazil in 2010, the Mortality Information System (SIM - Sistema de Informações sobre Mortalidade ), Civil Registration Statistic System (RC - Sistema de Estatísticas de Resgistro Civil ), and the 2010 Demographic Census at various geographical levels, and to confirm the association between municipal socioeconomic characteristics and the source which showed the highest death count. METHODS This is a descriptive and comparative study of raw data on deaths in the SIM, RC and 2010 Census databases, the latter held in Brazilian states and municipalities between August 2009 and July 2010. The percentage of municipalities was confirmed by the database showing the highest death count. The association between the source of the highest death count and socioeconomic indicators - the Índice de Privação Brasileiro (IBP - Brazilian Deprivation Index) and Índice de Desenvolvimento Humano Municipal (IHDM - Municipal Human Development Index) - was performed by bivariate choropleth and Moran Local Index of Spatial Association (LISA) cluster maps. RESULTS Confirmed that the SIM is the database with the highest number of deaths counted for all Brazilian macroregions, except the North, in which the highest coverage was from the 2010 Census. Based on the indicators proposed, in general, the Census showed a higher coverage of deaths than the SIM and the RC in the most deprived (highest IBP values) and less developed municipalities (lowest IDHM values) in the country. CONCLUSION The results highlight regional inequalities in how the databases chosen for this study cover death records, and the importance of maintaining the issue of mortality on the basic census questionnaire.
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Affiliation(s)
- Victor Hugo Dias Diógenes
- Universidade Federal do Rio Grande do NorteCentro de Ciências Exatas e da TerraPrograma de Pós-Graduação em DemografiaNatalRNBrasil Universidade Federal do Rio Grande do Norte . Centro de Ciências Exatas e da Terra . Programa de Pós-Graduação em Demografia . Natal , RN , Brasil ,Universidade Federal da ParaíbaCentro de Ciências Sociais AplicadasDepartamento de Finanças e ContabilidadeJoão PessoaPBBrasil Universidade Federal da Paraíba . Centro de Ciências Sociais Aplicadas . Departamento de Finanças e Contabilidade . João Pessoa , PB , Brasil
| | - Elzo Pereira Pinto
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz . Centro de Integração de Dados e Conhecimentos para Saúde . Salvador , BA , Brasil
| | - Marcos Roberto Gonzaga
- Universidade Federal do Rio Grande do NorteCentro de Ciências Exatas e da TerraPrograma de Pós-Graduação em DemografiaNatalRNBrasil Universidade Federal do Rio Grande do Norte . Centro de Ciências Exatas e da Terra . Programa de Pós-Graduação em Demografia . Natal , RN , Brasil ,Universidade Federal do Rio Grande do NorteCentro de Ciências Exatas e da TerraDepartamento de Demografia e Ciências AtuariaisNatalRNBrasil Universidade Federal do Rio Grande do Norte . Centro de Ciências Exatas e da Terra . Departamento de Demografia e Ciências Atuariais . Natal , RN , Brasil
| | - Bernardo Lanza Queiroz
- Universidade Federal de Minas GeraisFaculdade de Ciências EconômicasCentro de Desenvolvimento e Planejamento RegionalBelo HorizonteMGBrasil Universidade Federal de Minas Gerais . Faculdade de Ciências Econômicas . Centro de Desenvolvimento e Planejamento Regional . Belo Horizonte , MG , Brasil
| | - Everton E. C. Lima
- Universidade Estadual de CampinasInstituto de Filosofia e Ciências HumanasNúcleo de Estudos de PopulaçãoCampinasSPBrasil Universidade Estadual de Campinas . Instituto de Filosofia e Ciências Humanas e Núcleo de Estudos de População . Campinas , SP , Brasil
| | - Lilia Carolina C. da Costa
- Universidade Federal da BahiaInstituto de Matemática e EstatísticaDepartamento de EstatísticaSalvadorBABrasil Universidade Federal da Bahia . Instituto de Matemática e Estatística . Departamento de Estatística . Salvador , BA , Brasil
| | - Aline S. Rocha
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz . Centro de Integração de Dados e Conhecimentos para Saúde . Salvador , BA , Brasil ,Universidade Federal da BahiaEscola de NutriçãoPrograma de Pós-Graduação em Alimento, Nutrição e SaúdeSalvadorBABrasil Universidade Federal da Bahia . Escola de Nutrição . Programa de Pós-Graduação em Alimento, Nutrição e Saúde . Salvador , BA , Brasil
| | - Andrêa J. F. Ferreira
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz . Centro de Integração de Dados e Conhecimentos para Saúde . Salvador , BA , Brasil ,Universidade Federal da BahiaInstituto de Saúde ColetivaPrograma de Pós-Graduação em Saúde ColetivaSalvadorBABrasil Universidade Federal da Bahia . Instituto de Saúde Coletiva . Programa de Pós-Graduação em Saúde Coletiva . Salvador , BA , Brasil
| | - Camila S. S. Teixeira
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz . Centro de Integração de Dados e Conhecimentos para Saúde . Salvador , BA , Brasil ,Universidade Federal da BahiaInstituto de Saúde ColetivaPrograma de Pós-Graduação em Saúde ColetivaSalvadorBABrasil Universidade Federal da Bahia . Instituto de Saúde Coletiva . Programa de Pós-Graduação em Saúde Coletiva . Salvador , BA , Brasil
| | - Flávia Jôse O Alves
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz . Centro de Integração de Dados e Conhecimentos para Saúde . Salvador , BA , Brasil ,Universidade Federal da BahiaInstituto de Saúde ColetivaPrograma de Pós-Graduação em Saúde ColetivaSalvadorBABrasil Universidade Federal da Bahia . Instituto de Saúde Coletiva . Programa de Pós-Graduação em Saúde Coletiva . Salvador , BA , Brasil
| | - Leila Rameh
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz . Centro de Integração de Dados e Conhecimentos para Saúde . Salvador , BA , Brasil
| | - Renzo Flores-Ortiz
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz . Centro de Integração de Dados e Conhecimentos para Saúde . Salvador , BA , Brasil
| | - Alastair Leyland
- University of GlasgowMedical Research CouncilGlasgowScotland University of Glasgow . Medical Research Council . Glasgow , Scotland
| | - Ruth Dundas
- University of GlasgowMedical Research CouncilGlasgowScotland University of Glasgow . Medical Research Council . Glasgow , Scotland
| | - Maurício L. Barreto
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz . Centro de Integração de Dados e Conhecimentos para Saúde . Salvador , BA , Brasil ,Universidade Federal da BahiaInstituto de Saúde ColetivaPrograma de Pós-Graduação em Saúde ColetivaSalvadorBABrasil Universidade Federal da Bahia . Instituto de Saúde Coletiva . Programa de Pós-Graduação em Saúde Coletiva . Salvador , BA , Brasil
| | - Maria Yury Travassos Ichihara
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz . Centro de Integração de Dados e Conhecimentos para Saúde . Salvador , BA , Brasil
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22
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Rebouças P, Goes E, Pescarini J, Ramos D, Ichihara MY, Sena S, Veiga R, Rodrigues LC, Barreto ML, Paixão ES. Ethnoracial inequalities and child mortality in Brazil: a nationwide longitudinal study of 19 million newborn babies. Lancet Glob Health 2022; 10:e1453-e1462. [PMID: 36113530 PMCID: PMC9638038 DOI: 10.1016/s2214-109x(22)00333-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Racism is a social determinant of health inequities. In Brazil, racial injustices lead to poor outcomes in maternal and child health for Black and Indigenous populations, including greater risks of pregnancy-related complications; decreased access to antenatal, delivery, and postnatal care; and higher childhood mortality rates. In this study, we aimed to estimate inequalities in childhood mortality rates by maternal race and skin colour in a cohort of more than 19 million newborns in Brazil. METHODS We did a nationwide population-based, retrospective cohort study using linked data on all births and deaths in Brazil between Jan 1, 2012, and Dec 31, 2018. The data consisted of livebirths followed up to age 5 years, death, or Dec 31, 2018. Data for livebirths were extracted from the National Information System for livebirths, SINASC, and for deaths from the Mortality Information System, SIM. The final sample consisted of complete data for all cases regarding maternal race and skin colour, and no inconsistencies were present between date of birth and death after linkage. We fitted Cox proportional hazard regression models to calculate the crude and adjusted hazard ratios (HRs) and 95% CIs for the association between maternal race and skin colour and all-cause and cause-specific younger than age 5 mortality rates, by age subgroups. We calculated the trend of HRs (and 95% CI) by time of observation (calendar year) to indicate trends in inequalities. FINDINGS From the 20 526 714 livebirths registered in SINASC between Jan 1, 2012, and Dec 31, 2018, 238 436 were linked to death records identified from SIM. After linkage, 1 010 871 records were excluded due to missing data on maternal race or skin colour or inconsistent date of death. 19 515 843 livebirths were classified by mother's race, of which 224 213 died. Compared with children of White mothers, mortality risk for children younger than age 5 years was higher among children of Indigenous (HR 1·98 [95% CI 1·92-2·06]), Black (HR 1·39 [1·36-1·41]), and Brown or Mixed race (HR 1·19 [1·18-1·20]) mothers. The highest hazard ratios were observed during the post-neonatal period (Indigenous, HR 2·78 [95% CI 2·64-2·95], Black, HR 1·54 [1·48-1·59]), and Brown or Mixed race, HR 1·25 [1·23-1·27]) and between the ages of 1 year and 4 years (Indigenous, HR 3·82 [95% CI 3·52-4·15]), Black, HR 1·51 [1·42-1·60], and Brown or Mixed race, HR 1·30 [1·26-1·35]). Children of Indigenous (HR 16·39 [95% CI 12·88-20·85]), Black (HR 2·34 [1·78-3·06]), and Brown or Mixed race mothers (HR 2·05 [1·71-2·45]) had a higher risk of death from malnutrition than did children of White mothers. Similar patterns were observed for death from diarrhoea (Indigenous, HR 14·28 [95% CI 12·25-16·65]; Black, HR 1·72 [1·44-2·05]; and Brown or Mixed race mothers, HR 1·78 [1·61-1·98]) and influenza and pneumonia (Indigenous, HR 6·49 [95% CI 5·78-7·27]; Black, HR 1·78 [1·62-1·96]; and Brown or Mixed race mothers, HR 1·60 [1·51-1·69]). INTERPRETATION Substantial ethnoracial inequalities were observed in child mortality in Brazil, especially among the Indigenous and Black populations. These findings demonstrate the importance of regular racial inequality assessments and monitoring. We suggest implementing policies to promote ethnoracial equity to reduce the impact of racism on child health. FUNDING MCTI/CNPq/MS/SCTIE/Decit/Bill & Melinda Gates Foundation's Grandes Desafios Brasil, Desenvolvimento Saudável para Todas as Crianças, and Wellcome Trust core support grant awarded to CIDACS-Center for Data and Knowledge Integration for Health.
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Affiliation(s)
- Poliana Rebouças
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil.
| | - Emanuelle Goes
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Iyaleta Research Association-Research, Science and Humanities, Salvador, Bahia, Brazil
| | - Julia Pescarini
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Dandara Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Instituto de Saude Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil; Iyaleta Research Association-Research, Science and Humanities, Salvador, Bahia, Brazil
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Samila Sena
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Rafael Veiga
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Laura C Rodrigues
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Maurício L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Instituto de Saude Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Enny S Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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23
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Ichihara MY, Ferreira AJ, Teixeira CSS, Alves FJO, Rocha AS, Diógenes VHD, Ramos DO, Pinto EP, Flores-Ortiz R, Rameh L, da Costa LCC, Gonzaga MR, Lima EEC, Dundas R, Leyland A, Barreto ML. Mortality inequalities measured by socioeconomic indicators in Brazil: a scoping review. Rev Saude Publica 2022; 56:85. [PMID: 36228230 PMCID: PMC9529207 DOI: 10.11606/s1518-8787.2022056004178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Summarize the literature on the relationship between composite socioeconomic indicators and mortality in different geographical areas of Brazil. METHODS This scoping review included articles published between January 1, 2000, and August 31, 2020, retrieved by means of a bibliographic search carried out in the Medline, Scopus, Web of Science, and Lilacs databases. Studies reporting on the association between composite socioeconomic indicators and all-cause, or specific cause of death in any age group in different geographical areas were selected. The review summarized the measures constructed, their associations with the outcomes, and potential study limitations. RESULTS Of the 77 full texts that met the inclusion criteria, the study reviewed 24. The area level of composite socioeconomic indicators analyzed comprised municipalities (n = 6), districts (n = 5), census tracts (n = 4), state (n = 2), country (n = 2), and other areas (n = 5). Six studies used composite socioeconomic indicators such as the Human Development Index, Gross Domestic Product, and the Gini Index; the remaining 18 papers created their own socioeconomic measures based on sociodemographic and health indicators. Socioeconomic status was inversely associated with higher rates of all-cause mortality, external cause mortality, suicide, homicide, fetal and infant mortality, respiratory and circulatory diseases, stroke, infectious and parasitic diseases, malnutrition, gastroenteritis, and oropharyngeal cancer. Higher mortality rates due to colorectal cancer, leukemia, a general group of neoplasms, traffic accident, and suicide, in turn, were observed in less deprived areas and/or those with more significant socioeconomic development. Underreporting of death and differences in mortality coverage in Brazilian areas were cited as the main limitation. CONCLUSIONS Studies analyzed mortality inequalities in different geographical areas by means of composite socioeconomic indicators, showing that the association directions vary according to the mortality outcome. But studies on all-cause mortality and at the census tract level remain scarce. The results may guide the development of new composite socioeconomic indicators for use in mortality inequality analysis.
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Affiliation(s)
- Maria Yury Ichihara
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil
| | - Andrêa J.F. Ferreira
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil,Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Camila S. S. Teixeira
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil,Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Flávia Jôse O. Alves
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil,Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Aline Santos Rocha
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil,Universidade Federal da BahiaEscola de NutriçãoSalvadorBABrasil Universidade Federal da Bahia. Escola de Nutrição. Salvador, BA, Brasil
| | - Victor Hugo Dias Diógenes
- Universidade Federal do Rio Grande do NortePrograma de Pós-Graduação em DemografiaNatalRNBrasil Universidade Federal do Rio Grande do Norte. Programa de Pós-Graduação em Demografia. Natal, RN, Brasil,Universidade Federal da ParaíbaDepartamento de Finanças e ContabilidadeJoão PessoaPBBrasilUniversidade Federal da Paraíba. Departamento de Finanças e Contabilidade. João Pessoa, PB, Brasil
| | - Dandara Oliveira Ramos
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil,Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Elzo Pereira Pinto
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil
| | - Renzo Flores-Ortiz
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil
| | - Leila Rameh
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil
| | - Lilia Carolina C. da Costa
- Universidade Federal da BahiaInstituto de Matemática e EstatísticaSalvadorBABrasil Universidade Federal da Bahia. Instituto de Matemática e Estatística. Salvador, BA, Brasil
| | - Marcos Roberto Gonzaga
- Universidade Federal do Rio Grande do NortePrograma de Pós-Graduação em DemografiaNatalRNBrasil Universidade Federal do Rio Grande do Norte. Programa de Pós-Graduação em Demografia. Natal, RN, Brasil
| | - Everton E. C. Lima
- Universidade Estadual de CampinasDepartamento de DemografiaCampinasSPBrasilUniversidade Estadual de Campinas, Departamento de Demografia. Campinas, SP, Brasil
| | - Ruth Dundas
- Medical Research CouncilUniversity of GlasgowGlasgowScotlandMedical Research Council. University of Glasgow, Glasgow, Scotland
| | - Alastair Leyland
- Medical Research CouncilUniversity of GlasgowGlasgowScotlandMedical Research Council. University of Glasgow, Glasgow, Scotland
| | - Maurício L. Barreto
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil,Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
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Cerqueira-Silva T, de Araujo Oliveira V, Paixão ES, Júnior JB, Penna GO, Werneck GL, Pearce N, Barreto ML, Boaventura VS, Barral-Netto M. Duration of protection of CoronaVac plus heterologous BNT162b2 booster in the Omicron period in Brazil. Nat Commun 2022; 13:4154. [PMID: 35851597 PMCID: PMC9289933 DOI: 10.1038/s41467-022-31839-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/04/2022] [Indexed: 01/07/2023] Open
Abstract
To date, no information has been published on the effectiveness of inactivated whole-virus COVID-19 vaccines plus heterologous booster against symptomatic infection and severe outcomes (hospitalization or death) during the dominance of the SARS-CoV-2 Omicron variant period. We evaluated the vaccine effectiveness (VE) of CoronaVac plus BNT162b2 booster during the period of dominance of the Omicron variant in Brazil (January to April 2022). Using a test-negative design, we analysed data for 2,471,576 individuals tested during the Omicron variant’s dominant period using a nationally linked database from Brazil. Compared to unvaccinated, vaccinees maintained protection against severe outcomes, with an estimated VE of 84.1% (95% CI:83.2–84.9) at more than 120 days after BNT162b2 booster. Furthermore, while we detected a high level of protection against severe outcomes for individuals up to 79 years old, waning was observed for individuals aged ≥80 years, with VE decreasing from 81.3% (95% CI:77.9–84.2) at 31–60 days to 72.9% (95% CI:70.6–75.1) at 120 days or more after the booster dose. However, no significant protection against symptomatic infection was observed at this time period. In conclusion, except for individuals aged ≥80 years, CoronaVac plus a BNT162b2 booster dose offered high and durable protection against severe outcomes due to Omicron. Primary CoronaVac vaccination followed by a BNT162b2 booster dose confers protection against some SARS-CoV-2 variants but its effectiveness against Omicron is unknown. Here, the authors show that this combination confers a high level of protection against severe outcomes for up to 120 days, with evidence of waning for those aged 80 or older.
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Affiliation(s)
- Thiago Cerqueira-Silva
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil.,Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Vinicius de Araujo Oliveira
- Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
| | - Enny S Paixão
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Juracy Bertoldo Júnior
- Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
| | - Gerson O Penna
- Núcleo de Medicina Tropical, Universidade de Brasília. Escola Fiocruz de Governo, Fiocruz, DF, Brazil
| | - Guilherme L Werneck
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.,Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Neil Pearce
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Maurício L Barreto
- Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
| | - Viviane S Boaventura
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil. .,Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Manoel Barral-Netto
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil.,Universidade Federal da Bahia, Salvador, Bahia, Brazil
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25
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Cerqueira-Silva T, de Araujo Oliveira V, Paixão ES, Florentino PTV, Penna GO, Pearce N, Werneck GL, Barreto ML, Boaventura VS, Barral-Netto M. Vaccination plus previous infection: protection during the omicron wave in Brazil. Lancet Infect Dis 2022; 22:945-946. [PMID: 35588753 PMCID: PMC9110013 DOI: 10.1016/s1473-3099(22)00288-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Thiago Cerqueira-Silva
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil; Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Vinicius de Araujo Oliveira
- Universidade Federal da Bahia, Salvador, Bahia, Brazil; Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia 40296-710, Brazil
| | - Enny S Paixão
- London School of Hygiene & Tropical Medicine, London, UK
| | - Pilar Tavares Veras Florentino
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia 40296-710, Brazil; Instituto de Ciências Biomédicas, University of Sao Paulo, Sao Paulo, Brazil
| | - Gerson O Penna
- Núcleo de Medicina Tropical, Universidade de Brasília. Escola Fiocruz de Governo, Fiocruz, DF, Brazil
| | - Neil Pearce
- London School of Hygiene & Tropical Medicine, London, UK
| | - Guilherme L Werneck
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maurício L Barreto
- Universidade Federal da Bahia, Salvador, Bahia, Brazil; Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia 40296-710, Brazil
| | - Viviane S Boaventura
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil; Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Manoel Barral-Netto
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil; Universidade Federal da Bahia, Salvador, Bahia, Brazil.
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26
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Araújo JAPD, Rodrigues EDS, Castro-de-Araujo LFS, Machado DB, Barreto ML. Use of routine health records to study mental health care of Brazilian children. J bras psiquiatr 2022. [DOI: 10.1590/0047-2085000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT Objective To investigate the clinical epidemiological characteristics of a large data set of visits to outpatient children mental health services in Brazil, as well as to identify relevant relationships between age, sex and three common mental disorders in childhood: pervasive developmental disorders, ADHD, and mild depressive disorders. Methods We extracted data from the Ambulatorial Information System (SIA) part of a public repository, Datasus, regarding child outpatient mental health services in Brazil, from 2008 to 2012. We performed an analysis of the number of visits per one hundred thousand inhabitants and further analyses with logistic regressions for ADHD (F90.0), Pervasive Developmental Disorders (F84.0-F84.9), and Mild Depressive Episode (F32.0) as outcomes, controlling for age, year of the visit, number of new CAPSI stratified by region. Results Attention-deficit hyperactivity disorder (ADHD) was the most common condition identified across the country. The analyses by region showed a high number of visits due to mental retardation in the Northeast and depressive episodes in the South. Regressions showed that older children are less likely to visit outpatient services with a diagnosis of ADHD (F90.0). Conclusions Our analysis shows the conditions which cause the most burden to the child psychiatry outpatient centers in Brazil and relevant differences between regions. This information has immediate use for the training of staff and allocation of resources in each region.
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Affiliation(s)
| | | | | | - Daiane Borges Machado
- Center of Data and Knowledge Integration for Health, Brazil; Harvard Medical School, EUA
| | - Maurício L. Barreto
- Center of Data and Knowledge Integration for Health, Brazil; Federal University of Bahia, Brazil
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Machado DB, Williamson E, Pescarini JM, Alves FJO, Castro-de-Araujo LFS, Ichihara MY, Rodrigues LC, Araya R, Patel V, Barreto ML. Relationship between the Bolsa Família national cash transfer programme and suicide incidence in Brazil: A quasi-experimental study. PLoS Med 2022; 19:e1004000. [PMID: 35584178 PMCID: PMC9162363 DOI: 10.1371/journal.pmed.1004000] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 06/02/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Socioeconomic factors have been consistently associated with suicide, and economic recessions are linked to rising suicide rates. However, evidence on the impact of socioeconomic interventions to reduce suicide rates is limited. This study investigates the association of the world's largest conditional cash transfer programme with suicide rates in a cohort of half of the Brazilian population. METHODS AND FINDINGS We used data from the 100 Million Brazilian Cohort, covering a 12-year period (2004 to 2015). It comprises socioeconomic and demographic information on 114,008,317 individuals, linked to the "Bolsa Família" programme (BFP) payroll database, and nationwide death registration data. BFP was implemented by the Brazilian government in 2004. We estimated the association of BFP using inverse probability of treatment weighting, estimating the weights for BFP beneficiaries (weight = 1) and nonbeneficiaries by the inverse probability of receiving treatment (weight = E(ps)/(1-E(ps))). We used an average treatment effect on the treated (ATT) estimator and fitted Poisson models to estimate the incidence rate ratios (IRRs) for suicide associated with BFP experience. At the cohort baseline, BFP beneficiaries were younger (median age 27.4 versus 35.4), had higher unemployment rates (56% versus 32%), a lower level of education, resided in rural areas, and experienced worse household conditions. There were 36,742 suicide cases among the 76,532,158 individuals aged 10 years, or older, followed for 489,500,000 person-years at risk. Suicide rates among beneficiaries and nonbeneficiaries were 5.4 (95% CI = 5.32, 5.47, p < 0.001) and 10.7 (95% CI = 10.51, 10.87, p < 0.001) per 100,000 individuals, respectively. BFP beneficiaries had a lower suicide rate than nonbeneficiaries (IRR = 0.44, 95% CI = 0.42, 0.45, p < 0.001). This association was stronger among women (IRR = 0.36, 95% CI = 0.33, 0.38, p < 0.001), and individuals aged between 25 and 59 (IRR = 0.41, 95% CI = 0.40, 0.43, p < 0.001). Study limitations include a lack of control for previous mental disorders and access to means of suicide, and the possible under-registration of suicide cases due to stigma. CONCLUSIONS We observed that BFP was associated with lower suicide rates, with similar results in all sensitivity analyses. These findings should help to inform policymakers and health authorities to better design suicide prevention strategies. Targeting social determinants using cash transfer programmes could be important in limiting suicide, which is predicted to rise with the economic recession, consequent to the Coronavirus Disease 2019 (COVID-19) pandemic.
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Affiliation(s)
- Daiane Borges Machado
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Elizabeth Williamson
- Department of Medical Statistics and Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Julia M. Pescarini
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
- Department of Medical Statistics and Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Flavia J. O. Alves
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Luís F. S. Castro-de-Araujo
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
- Department of Psychiatry, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Maria Yury Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Laura C. Rodrigues
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
- Department of Medical Statistics and Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Ricardo Araya
- Centre for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College, London, United Kingdom
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Chan School of Public Health, Harvard, United States of America
| | - Maurício L. Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
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Cerqueira-Silva T, Katikireddi SV, de Araujo Oliveira V, Flores-Ortiz R, Júnior JB, Paixão ES, Robertson C, Penna GO, Werneck GL, Barreto ML, Pearce N, Sheikh A, Barral-Netto M, Boaventura VS. Vaccine effectiveness of heterologous CoronaVac plus BNT162b2 in Brazil. Nat Med 2022; 28:838-843. [PMID: 35140406 PMCID: PMC9018414 DOI: 10.1038/s41591-022-01701-w] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/14/2022] [Indexed: 11/10/2022]
Abstract
There is considerable interest in the waning of effectiveness of coronavirus disease 2019 (COVID-19) vaccines and vaccine effectiveness (VE) of booster doses. Using linked national Brazilian databases, we undertook a test-negative design study involving almost 14 million people (~16 million tests) to estimate VE of CoronaVac over time and VE of BNT162b2 booster vaccination against RT-PCR-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe COVID-19 outcomes (hospitalization or death). Compared with unvaccinated individuals, CoronaVac VE at 14-30 d after the second dose was 55.0% (95% confidence interval (CI): 54.3-55.7) against confirmed infection and 82.1% (95% CI: 81.4-82.8) against severe outcomes. VE decreased to 34.7% (95% CI: 33.1-36.2) against infection and 72.5% (95% CI: 70.9-74.0) against severe outcomes over 180 d after the second dose. A BNT162b2 booster, 6 months after the second dose of CoronaVac, improved VE against infection to 92.7% (95% CI: 91.0-94.0) and VE against severe outcomes to 97.3% (95% CI: 96.1-98.1) 14-30 d after the booster. Compared with younger age groups, individuals 80 years of age or older had lower protection after the second dose but similar protection after the booster. Our findings support a BNT162b2 booster vaccine dose after two doses of CoronaVac, particularly for the elderly.
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Affiliation(s)
- Thiago Cerqueira-Silva
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Salvador, Brazil
- Universidade Federal de Bahia (UFBA), Salvador, Brazil
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Vinicius de Araujo Oliveira
- Universidade Federal de Bahia (UFBA), Salvador, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Salvador, Brazil
| | - Renzo Flores-Ortiz
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Salvador, Brazil
| | - Juracy Bertoldo Júnior
- Universidade Federal de Bahia (UFBA), Salvador, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Salvador, Brazil
| | - Enny S Paixão
- London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Robertson
- Public Health Scotland, Glasgow, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Gerson O Penna
- Núcleo de Medicina Tropical, Universidade de Brasília, Escola Fiocruz de Governo, Fiocruz, Brazil
| | | | - Maurício L Barreto
- Universidade Federal de Bahia (UFBA), Salvador, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Salvador, Brazil
| | - Neil Pearce
- London School of Hygiene and Tropical Medicine, London, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Manoel Barral-Netto
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Salvador, Brazil
- Universidade Federal de Bahia (UFBA), Salvador, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Salvador, Brazil
| | - Viviane S Boaventura
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Salvador, Brazil.
- Universidade Federal de Bahia (UFBA), Salvador, Brazil.
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Alves FJO, Castro-de-Araujo LF, Xavier EFM, Machado DB, Barreto ML. Factors associated with postpartum psychiatric disorders using routine administrative data. Int J Popul Data Sci 2022. [PMCID: PMC8902499 DOI: 10.23889/ijpds.v7i2.1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BackgroundAlmost twenty percent of women worldwide experience mental health disorders following childbirth. Despite their importance and consequences, postpartum psychiatric disorders are still under-investigated. In Brazil, studies are restricted to state capitals and are not representative of the country as a whole. Understanding the factors associated with postpartum psychiatric disorders can provide insights for adequate maternal mental health screening. This study was conducted with the objective of evaluating factors associated with postpartum psychiatric disorders in Brazil.
MethodsWe used Authorization of Outpatient Procedure data for women who used community mental health services in Brazil between 2008 and 2012. The dependent variable was the diagnosis of mental disorders and behavioural factors associated with the puerperium (ICD-10 code F53). Age categorized in quartiles and Psychosocial Care Centre (CAPS) coverage were covariates considered for the analysis. To partially neutralize the bias from repeated observations, we used the Proximity Index (PP), created through of geographic information for each visit to the level of the patient’s neighbourhood. We used Generalized Additive Models for Location, Scale, and Shape (GAMLSS) with double Poisson distribution.
FindingsWe identified 6,802 records of mental and behavioural disorders associated with the puerperium diagnoses. Among them, 47.6% of the outpatient records were for diagnosis of ICD F53.1, and 32.09% for ICD-10 F53.0, which correspond to severe and mild mental disorders associated with the puerperium, respectively. Diagnosis for ICD-10 F53.0 was higher between the ages of 26 and 30 (10%), while diagnosis for ICD F53.1 was higher between the ages of 31 and 35 (12.7%). For each increment in the maternal age unit and CAPS coverage percentage, there is an increase of 1.01 (p<0.001) in the occurrence of postpartum psychiatric disorders.
ConclusionsOur results showed that increases in maternal age and municipal CAPS coverage heightened the risk of postpartum psychiatric disorders. With regards to severity, we found that diagnosis for ICD F53.0 (mild mental and behavioural disorders associated with the puerperium) was higher among women aged between 26 and 30, while diagnosis for ICD F53.1(severe mental and behavioural disorders associated with the puerperium) was higher among women aged between 31 and 35. Our findings support the need to improve knowledge of maternal mental health and to integrate routine screening into postnatal care settings, for the early identification of women who are at risk, and to apply timely preventive and therapeutic approaches.
For collaborations please contact: Email: flaviajosy1@gmail.com
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Araujo J, Da Silva Rodrigues E, Castro-de-Araujo LFS, Machado DB, Barreto ML. Characteristics of mental health service use of Brazilian children using routine health records. Int J Popul Data Sci 2022. [PMCID: PMC8902507 DOI: 10.23889/ijpds.v7i2.1740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BackgroundTo investigate the clinical epidemiological characteristics of a large data set of visits to outpatient children mental health services in Brazil, as well as to identify relevant relationships between age, sex and three common mental disorders in childhood: pervasive developmental disorders, ADHD and mild depressive disorders.
MethodsWe extracted data from a public repository, DATASUS, regarding child outpatient mental health services in Brazil, from 2008 to 2012. We performed an analysis of the number of visits per inhabitant and inferential analyses with logistic regressions for ADHD (F90.0), Pervasive Developmental Disorders (F84.0-F84.9), and Mild Depressive Episode (F32.0) as outcomes, controlling for age, year of the visit, number of new CAPSI stratified by region.
FindingsAttention-deficit hyperactivity disorder (ADHD) was the most common condition identified across the country. The analyses by region showed a high number of visits due to mental retardation in the Northeast and depressive episodes in the South. Regressions showed that older children are less likely to visit outpatient services with a diagnosis of ADHD (F90.0).
ConclusionsOur analysis shows the conditions which cause the most burden to the child psychiatry outpatient centers in Brazil and relevant differences between regions. This information has immediate use for the training of staff and allocation of resources in each region.
For collaborations please contact: Email: jacyra.paiva@fiocruz.brFor collaborations please contact: Email: jacyra.paiva@fiocruz.br
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McDonald K, Machado DB, Castro-de-Araujo LFS, Kiss L, Palfreyman A, Barreto ML, Devakumar D, Lewis G. Trends in method-specific suicide in Brazil from 2000 to 2017. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1779-1790. [PMID: 33782727 PMCID: PMC8429168 DOI: 10.1007/s00127-021-02060-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Understanding long-term patterns of suicide methods can inform public health policy and prevention strategies. In Brazil, firearm-related policies may be one salient target for suicide prevention. This study describes trends in method-specific suicide at the national and state-levels in Brazil, with a particular focus on firearm-related suicides. METHODS Brazilian mortality data for suicide and undetermined intent among people aged 10 years and older between 2000 and 2017 were obtained from the National Mortality Information System. We examined national and state-level trends in age-standardised suicide rates for hanging, self-poisoning, firearms, jumping from a high place, other, and unspecified methods. We also compared total rates of mortality from suicide and undetermined intent over the period. Applying Joinpoint regression, we tested changes in trends of firearm-specific suicide rates. RESULTS The total suicide rate increased between 2000 and 2017. Rates of hanging, self-poisoning by drugs or alcohol and jumping from a high place showed the largest increases, while firearm-specific suicide rates decreased over the study period. Trends in methods of suicide varied by sex and state. CONCLUSION It is of public health concern that suicide rates in Brazil have risen this millennium. Restricting access to firearms might be an effective approach for reducing firearm-specific suicides, especially in states where firearm availability remains particularly high. Treatment and management of substance misuse may also be an important target for suicide prevention policies. More work is needed to understand the causes of rising suicide rates in Brazil and to improve the mental health of the population.
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Affiliation(s)
- Keltie McDonald
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Daiane Borges Machado
- Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Luís F S Castro-de-Araujo
- Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil
- The University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC, Australia
| | - Lígia Kiss
- Institute for Global Health, University College London, London, UK
| | | | - Maurício L Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | | | - Glyn Lewis
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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32
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Rasella D, Alves FJO, Rebouças P, de Jesus GS, Barreto ML, Campello T, Paixao ES. Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal data. BMC Med 2021; 19:127. [PMID: 34059069 PMCID: PMC8166529 DOI: 10.1186/s12916-021-01994-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reducing poverty and improving access to health care are two of the most effective actions to decrease maternal mortality, and conditional cash transfer (CCT) programmes act on both. The aim of this study was to evaluate the effects of one of the world's largest CCT (the Brazilian Bolsa Familia Programme (BFP)) on maternal mortality during a period of 11 years. METHODS The study had an ecological longitudinal design and used all 2548 Brazilian municipalities with vital statistics of adequate quality during 2004-2014. BFP municipal coverage was classified into four levels, from low to consolidated, and its duration effects were measured using the average municipal coverage of previous years. We used negative binomial multivariable regression models with fixed-effects specifications, adjusted for all relevant demographic, socioeconomic, and healthcare variables. RESULTS BFP was significantly associated with reductions of maternal mortality proportionally to its levels of coverage and years of implementation, with a rate ratio (RR) reaching 0.88 (95%CI 0.81-0.95), 0.84 (0.75-0.96) and 0.83 (0.71-0.99) for intermediate, high and consolidated BFP coverage over the previous 11 years. The BFP duration effect was stronger among young mothers (RR 0.77; 95%CI 0.67-0.96). BFP was also associated with reductions in the proportion of pregnant women with no prenatal visits (RR 0.73; 95%CI 0.69-0.77), reductions in hospital case-fatality rate for delivery (RR 0.78; 95%CI 0.66-0.94) and increases in the proportion of deliveries in hospital (RR 1.05; 95%CI 1.04-1.07). CONCLUSION Our findings show that a consolidated and durable CCT coverage could decrease maternal mortality, and these long-term effects are stronger among poor mothers exposed to CCT during their childhood and adolescence, suggesting a CCT inter-generational effect. Sustained CCT coverage could reduce health inequalities and contribute to the achievement of the Sustainable Development Goal 3.1, and should be preserved during the current global economic crisis due to the COVID-19 pandemic.
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Affiliation(s)
- Davide Rasella
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
| | - Flávia Jôse Oliveira Alves
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Poliana Rebouças
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | | | - Maurício L Barreto
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Tereza Campello
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
- Future Food Beacon of Excellence, Centre for Research in Race and Rights, School of Biosciences, University of Nottingham, Nottingham, United Kingdom
| | - Enny S Paixao
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Santos MID, Santos GFD, Freitas A, Sousa Filho JFD, Castro C, Paiva ASS, Friche AADL, Barber S, Caiaffa WT, Barreto ML. Urban income segregation and homicides: An analysis using Brazilian cities selected by the Salurbal project. SSM Popul Health 2021; 14:100819. [PMID: 34041354 PMCID: PMC8142279 DOI: 10.1016/j.ssmph.2021.100819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/16/2021] [Accepted: 05/11/2021] [Indexed: 11/19/2022] Open
Abstract
This paper investigates the associations of income segregation with homicide mortality across 152 cities in Brazil. Despite GDP increases, an important proportion of the Brazilian population experiences poverty and extreme poverty. Segregation refers to the way that different groups are located in space based on their socioeconomic status, with groups defined based on education, unemployment, race, age, or income levels. As a measure of segregation, the dissimilarity index showed that overall, it would be necessary to relocate 29.7% of urban low-income families to make the spatial distribution of income homogeneous. For the ten most segregated cities, relocation of more than 37% of families would be necessary. Using negative binomial models, we found a positive association between segregation and homicides for Brazilian cities: one standard deviation higher segregation index was associated with a 50% higher homicide rate when we analyze all the socioeconomic context. Income segregation is potentially an important determinant of homicides, and should be considered in setting public policies.
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Affiliation(s)
| | - Gervásio Ferreira dos Santos
- Center of Data and Knowledge Integration for Health (CIDACS), Brazil
- Faculty of Economics (PPGE) – Federal University of Bahia, Brazil
| | - Anderson Freitas
- Center of Data and Knowledge Integration for Health (CIDACS), Brazil
| | - J. Firmino de Sousa Filho
- Center of Data and Knowledge Integration for Health (CIDACS), Brazil
- Faculty of Economics (PPGE) – Federal University of Bahia, Brazil
| | - Caio Castro
- Center of Data and Knowledge Integration for Health (CIDACS), Brazil
| | | | - Amélia A. de Lima Friche
- Observatory for Urban Health in Belo Horizonte (OSUBH) – Federal University of Minas Gerais, Brazil
| | - Sharrelle Barber
- Department of Epidemiology and Biostatistics – Drexel University Dornsife School of Public Health, Brazil
| | - Waleska Teixeira Caiaffa
- Observatory for Urban Health in Belo Horizonte (OSUBH) – Federal University of Minas Gerais, Brazil
| | - Maurício L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Brazil
- Institute of Public Health (ISC) – Federal University of Bahia, Brazil
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Veiga RV, Schuler-Faccini L, França GVA, Andrade RFS, Teixeira MG, Costa LC, Paixão ES, Costa MDCN, Barreto ML, Oliveira JF, Oliveira WK, Cardim LL, Rodrigues MS. Classification algorithm for congenital Zika Syndrome: characterizations, diagnosis and validation. Sci Rep 2021; 11:6770. [PMID: 33762667 PMCID: PMC7990918 DOI: 10.1038/s41598-021-86361-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/09/2021] [Indexed: 11/09/2022] Open
Abstract
Zika virus was responsible for the microcephaly epidemic in Brazil which began in October 2015 and brought great challenges to the scientific community and health professionals in terms of diagnosis and classification. Due to the difficulties in correctly identifying Zika cases, it is necessary to develop an automatic procedure to classify the probability of a CZS case from the clinical data. This work presents a machine learning algorithm capable of achieving this from structured and unstructured available data. The proposed algorithm reached 83% accuracy with textual information in medical records and image reports and 76% accuracy in classifying data without textual information. Therefore, the proposed algorithm has the potential to classify CZS cases in order to clarify the real effects of this epidemic, as well as to contribute to health surveillance in monitoring possible future epidemics.
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Affiliation(s)
- Rafael V Veiga
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil. .,Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | | | | | - Roberto F S Andrade
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Instituto de Física, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Maria Glória Teixeira
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Larissa C Costa
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Enny S Paixão
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,London School of Hygiene and Tropical Medicine, London, England, United Kingdom
| | - Maria da Conceição N Costa
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Maurício L Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Juliane F Oliveira
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Department of Mathematics, Centre of Mathematics of the University of Porto (CMUP), Porto, Portugal
| | - Wanderson K Oliveira
- Hospital das Forças Armadas, Ministério da Defesa, Distrito Federal, Brasília, Brazil
| | - Luciana L Cardim
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
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35
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Gomes-Filho IS, Santos PNP, Cruz SS, Figueiredo ACMG, Trindade SC, Ladeia AM, Cerqueira EMM, Passos-Soares JS, Coelho JMF, Hintz AM, Barreto ML, Fischer RG, Loomer PM, Scannapieco FA. Periodontitis and its higher levels of severity are associated with the triglyceride/high density lipoprotein cholesterol (TG/HDL-C) ratio. J Periodontol 2021; 92:1509-1521. [PMID: 33689171 DOI: 10.1002/jper.21-0004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Periodontitis and the Triglyceride/High Density Lipoprotein Cholesterol (TG/HDL-C) ratio have both been associated with cardiovascular disease, metabolic syndrome, and obesity. Additionally, the ratio is a possible substitute for predicting insulin resistance. This study investigated the association between periodontitis, its severity levels (exposures), and the TG/HDL-C ratio (outcome). METHODS A cross-sectional study of public health service users in Brazil considered socioeconomic-demographic characteristics, lifestyle behavior, and general and oral health conditions. Anthropometric measurements and blood pressure were also measured. Systemic biomarker data were obtained, as well as assessment of periodontal diagnosis and its severity. The TG/HDL-C ratio was calculated using the serum triglyceride level over HDL cholesterol and the cut-off point, TG/HDL-C ≥2.3 serving as the cutoff indicting dyslipidemia. Logistic and linear regressions were used to statistically analyze the data. RESULTS A total of 1011 participants were included, with 84.17% having periodontitis and 49.85% having a TG/HDL-C ratio ≥2.3. For individuals with periodontitis, the odds of TG/HDL-C ratio ≥2.3 were 1.47 times greater than in those without periodontitis (ORAdjusted = 1.47, 95% CI: 1.02-2.14). Similar results were found for those with moderate and severe periodontitis, with a slight increase in the measurement magnitude with disease severity. CONCLUSION A positive relationship between periodontitis and the TG/HDL-C ratio ≥2.3 was found, suggesting a possible association with periodontal disease severity.
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Affiliation(s)
- Isaac S Gomes-Filho
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Pedro N P Santos
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Simone S Cruz
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil.,Health Sciences Center, Federal University of Recôncavo of Bahia, Bahia, Brazil
| | - Ana C M G Figueiredo
- Epidemiology Surveillance, Federal District Health State Department, Distrito Federal, Brasília, Brazil
| | - Soraya C Trindade
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Ana M Ladeia
- Bahiana School of Medicine and Public Health, Bahia Foundation for the Development of Sciences, Salvador, Bahia, Brazil
| | - Eneida M M Cerqueira
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | | | - Julita M F Coelho
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Alexandre M Hintz
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Maurício L Barreto
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Ricardo G Fischer
- Department of Periodontology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Peter M Loomer
- School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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36
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Gomes-Filho IS, Balinha IDSCE, da Cruz SS, Trindade SC, Cerqueira EDMM, Passos-Soares JDS, Coelho JMF, Ladeia AMT, Vianna MIP, Hintz AM, de Santana TC, Dos Santos PP, Figueiredo ACMG, da Silva ICO, Scannapieco FA, Barreto ML, Loomer PM. Moderate and severe periodontitis are positively associated with metabolic syndrome. Clin Oral Investig 2020; 25:3719-3727. [PMID: 33226499 DOI: 10.1007/s00784-020-03699-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study investigated the association between periodontitis severity (exposure) and metabolic syndrome (MetS - outcome), using two criteria for diagnosis of the outcome, since this relationship remains unexplored. MATERIALS AND METHODS A case-control study was conducted with 870 individuals: 408 with first MetS diagnosis (cases) and 462 without MetS (controls). Participants' general information was obtained using a questionnaire and laboratory data was collected from medical records. Periodontitis severity criteria followed the Center for Disease Control and Prevention: none, mild, moderate, and severe. Odds ratios (OR) and 95% confidence intervals (95% CI) were determined by logistic regression analysis. RESULTS Findings showed a positive association between moderate and severe periodontitis and MetS: ORadjusted = 1.64 (95% CI: 1.01 to 2.68) and ORadjusted = 1.94 (95% CI: 1.19 to 3.16), respectively, after adjustment for age, sex, schooling level, smoking habit, and cardiovascular disease. The adjusted measurements showed that among individuals with moderate or severe periodontitis, the probability of having MetS was around two times greater than among those without periodontitis, and that the chance was greater among participants with severe periodontitis than those with moderate periodontitis. CONCLUSION An association between the severity of periodontal status and MetS was found, suggesting a possible relationship between the two diseases. CLINICAL RELEVANCE MetS influences the etiology of cardiovascular diseases, one of the leading causes of mortality worldwide. The findings suggest that the greater the severity of periodontitis, the greater is the association magnitude with MetS. The health professional needs to recognize that the importance of periodontal disease may play in MetS.
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Affiliation(s)
- Isaac Suzart Gomes-Filho
- Department of Health, Feira de Santana State University, Avenida Getúlio Vargas, 379, Centro, Feira de Santana, Bahia, 44025-010, Brazil.
| | - Izadora da S C E Balinha
- Department of Health, Feira de Santana State University, Avenida Getúlio Vargas, 379, Centro, Feira de Santana, Bahia, 44025-010, Brazil
| | - Simone S da Cruz
- Department of Health, Feira de Santana State University, Avenida Getúlio Vargas, 379, Centro, Feira de Santana, Bahia, 44025-010, Brazil.,Health Sciences Center, Federal University of Recôncavo of Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | - Soraya C Trindade
- Department of Health, Feira de Santana State University, Avenida Getúlio Vargas, 379, Centro, Feira de Santana, Bahia, 44025-010, Brazil
| | - Eneida de M M Cerqueira
- Department of Health, Feira de Santana State University, Avenida Getúlio Vargas, 379, Centro, Feira de Santana, Bahia, 44025-010, Brazil
| | - Johelle de S Passos-Soares
- Department of Health, Feira de Santana State University, Avenida Getúlio Vargas, 379, Centro, Feira de Santana, Bahia, 44025-010, Brazil.,Department of Preventive Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Julita Maria F Coelho
- Department of Health, Feira de Santana State University, Avenida Getúlio Vargas, 379, Centro, Feira de Santana, Bahia, 44025-010, Brazil
| | - Ana Marice T Ladeia
- Bahiana School of Medicine and Public Health, Bahia Foundation for the Development of Sciences, Salvador, Bahia, Brazil
| | - Maria Isabel P Vianna
- Department of Preventive Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Alexandre M Hintz
- Department of Health, Feira de Santana State University, Avenida Getúlio Vargas, 379, Centro, Feira de Santana, Bahia, 44025-010, Brazil
| | - Teresinha C de Santana
- Department of Health, Feira de Santana State University, Avenida Getúlio Vargas, 379, Centro, Feira de Santana, Bahia, 44025-010, Brazil
| | - Pedro P Dos Santos
- Department of Health, Feira de Santana State University, Avenida Getúlio Vargas, 379, Centro, Feira de Santana, Bahia, 44025-010, Brazil
| | | | - Ivana C O da Silva
- Department of Health, Feira de Santana State University, Avenida Getúlio Vargas, 379, Centro, Feira de Santana, Bahia, 44025-010, Brazil
| | | | - Maurício L Barreto
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Peter M Loomer
- School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Castro-de-Araujo LF, Machado DB, Barreto ML, Kanaan RA. Subtyping schizophrenia based on symptomatology and cognition using a data driven approach. Psychiatry Res Neuroimaging 2020; 304:111136. [PMID: 32707455 PMCID: PMC7613209 DOI: 10.1016/j.pscychresns.2020.111136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 07/07/2020] [Accepted: 07/14/2020] [Indexed: 12/01/2022]
Abstract
Schizophrenia is a highly heterogeneous disorder, not only in its phenomenology but in its clinical course. This limits the usefulness of the diagnosis as a basis for both research and clinical management. Methods of reducing this heterogeneity may inform the diagnostic classification. With this in mind, we performed k-means clustering with symptom and cognitive measures to generate groups in a machine-driven way. We found that our data was best organised in three clusters: high cognitive performance, high positive symptomatology, low positive symptomatology. We hypothesized that these clusters represented biological categories, which we tested by comparing these groups in terms of brain volumetric information. We included all the groups in an ANCOVA analysis with post hoc tests, where brain volume areas were modelled as dependent variables, controlling for age and estimated intracranial volume. We found six brain volumes significantly differed between the clusters: left caudate, left cuneus, left lateral occipital, left inferior temporal, right lateral, and right pars opercularis. The k-means clustering provides a way of subtyping schizophrenia which appears to have a biological basis, though one that requires both replication and confirmation of its clinical significance.
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Affiliation(s)
- Luis Fs Castro-de-Araujo
- Center of Data and Knowledge Integration for Health (CIDACS). R. Mundo, 121, Salvador BA, Brazil; University of Melbourne, Department of Psychiatry, Austin Health. Studley Road, Heidelberg, Victoria, Australia.
| | - Daiane B Machado
- Center of Data and Knowledge Integration for Health (CIDACS). R. Mundo, 121, Salvador BA, Brazil; Centre for Global Mental health (CGMH), London School of Hygiene and Tropical Medicine. King's College London. David Goldberg Centre, De Crespigny Park, London United Kingdom
| | - Maurício L Barreto
- Center of Data and Knowledge Integration for Health (CIDACS). R. Mundo, 121, Salvador BA, Brazil; Institute of Collective Health, UFBA. Rua Basílio da Gama, Salvador BA Brazil.
| | - Richard Aa Kanaan
- University of Melbourne, Department of Psychiatry, Austin Health. Studley Road, Heidelberg, Victoria, Australia.
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Pescarini JM, Craig P, Allik M, Amorim L, Ali MS, Smeeth L, Barreto ML, Leyland A, Aquino EML, Katikireddi SV. The Brazilian conditional cash transfer program and cardiovascular mortality: a data linkage study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Conditional cash transfer programmes (CCTs) make monetary transfers to poor families conditional on health check-ups and/or education attendance. CCTs have been key in reducing poverty and improving child and maternal health in low- and middle-income countries (LMICs) but their impact on cardiovascular mortality have not been studied. We aimed to evaluate the effect of the CCT Bolsa Familia Program (BFP) on premature all-cause and cardiovascular mortality in Brazil.
Methods
The 100 Million Brazilian Cohort combined information about individuals applying for social programmes, the BFP and mortality data. We analysed ∼8 million individuals aged 30-69 who applied from 2011 to 2015. We calculated inverse probability weights (IPW) for the probability to receive BFP based on baseline observed characteristics (age, education, race, geographical location, household characteristics and year of application). Individuals were followed until they reached 70 years of age, died by any cause, or until 31st Dec 2015. We used Poisson regression (with person-years as the offset) and IPWs to compare BFP recipients to a comparable control population. Females and males were analysed separately.
Results
By following individuals for up to 4 years, 43,562 deaths by all-causes occurred among 4,197,658 females and 69,209 deaths among 3,672,393 males. Female BFP beneficiaries had approximately 60% lower all-cause mortality (IRR=0.40;95%CI=0.37-0.42) and CVD mortality (IRR=0.42;95%CI=0.37-0.47) than non-beneficiaries. Males who are BFP beneficiaries had ∼50% lower all-cause (IRR=0.53;95%CI=0.52-0.55) and 60% lower cardiovascular mortality (IRR=0.40;95%CI=0.38-0.42) than non-beneficiaries.
Conclusions
BFP, the world's largest CCT, may substantially decrease premature mortality. CCTs might have important implications for the growing burden of non-communicable diseases, with impacts potentially due to improved nutrition, socioeconomic conditions and improved primary care access.
Key messages
The Brazilian CCT, a widely recognized programme for poverty alleviation, have showed to be associated with lower overall and cardiovascular premature mortality in both women and men. Other countries, particularly LMICs, may learn from the health benefits of CCTs and should consider its potential large effect on mortality when planning austerity policies.
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Affiliation(s)
- J M Pescarini
- The Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - P Craig
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - M Allik
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - L Amorim
- Institute of Mathematics and Statistics, Federal University of Bahia, Salvador, Brazil
| | - M S Ali
- The Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Non-Communicable Disease Epidemiology, LSHTM, London, UK
| | - L Smeeth
- Department of Non-Communicable Disease Epidemiology, LSHTM, London, UK
- Health Data Research, London, UK
| | - M L Barreto
- The Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - A Leyland
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - E M L Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - S V Katikireddi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Pereira M, Paixão E, Trajman A, de Souza RA, da Natividade MS, Pescarini JM, Pereira SM, Barreto FR, Ximenes R, Dalcomo M, Ichihara MY, Nunes C, Barral-Netto M, Barreto ML. The need for fast-track, high-quality and low-cost studies about the role of the BCG vaccine in the fight against COVID-19. Respir Res 2020; 21:178. [PMID: 32653040 PMCID: PMC7351640 DOI: 10.1186/s12931-020-01439-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/30/2020] [Indexed: 11/24/2022] Open
Abstract
Bacillus Calmette-Guérin (BCG) vaccination is routine and near-universal in many low- and middle-income countries (LMIC). It has been suggested that BCG can have a protective effect on COVID-19 morbidity and mortality. This commentary discusses the limitations of the evidence around BCG and COVID-19. We argue that higher-quality evidence is necessary to understand the protective effect of the BCG vaccine from existing, secondary data, while we await results from clinical trials currently conducted in different settings.
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Affiliation(s)
- Marcos Pereira
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil.
| | - Enny Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil.,Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anete Trajman
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Julia M Pescarini
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil
| | | | | | - Ricardo Ximenes
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, Brazil
| | - Margareth Dalcomo
- Centro de Referência Hélio Fraga, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil
| | - Ceuci Nunes
- Hospital Couto Maia, Secretaria Estadual de Saúde da Bahia, Salvador, Brazil
| | - Manoel Barral-Netto
- Instituto Gonçalo Moniz - Fundação Oswaldo Cruz (Fiocruz), Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Maurício L Barreto
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil.,Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil
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40
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Castro-de-Araujo LF, Machado DB, Barreto ML. Care-seeking as a proxy indicator of the mental health of elderly Brazilians. Braz J Psychiatry 2020; 42:591-598. [PMID: 32491042 PMCID: PMC7678904 DOI: 10.1590/1516-4446-2019-0721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 12/27/2019] [Indexed: 11/21/2022]
Abstract
Objective: To assess a large set of metadata made public by the Brazilian Ministry of Health on older subjects who visited outpatient mental health services in Brazil from 2008 to 2012. Methods: We extracted data from the Brazilian Unified Health System Information Technology Department (Departamento de Informática do Sistema Único de Saúde, DATASUS), then calculated rates of visits per population in each of the five regions of Brazil, using census data for each year. Finally, logistic regressions were performed with depressive disorders or dementias as dependent variables, controlled by age and year of visit, stratified by region. Results: Mood disorders were the leading reason for visits to outpatient mental health services by older adults, followed by delusional disorders. The calculated rates were lower than the known prevalence of depressive disorders and dementias, but the regressions revealed typical patterns. Males were less likely to present with a depressive disorder, while older subjects were more likely to present with depression and dementia. Conclusions: Publicly available data from DATASUS may not enable inferences about the prevalence of mental disorders in elders, but inferential analyses match what is known about these conditions. This approach is supplemental to other more common ones and is of special importance for policymakers and health system managers.
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Affiliation(s)
- Luis F Castro-de-Araujo
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Centro de Integração de Dados e Conhecimentos para Saúde (CIDACS), Salvador, BA, Brazil
| | - Daiane B Machado
- Centro de Integração de Dados e Conhecimentos para Saúde (CIDACS), Salvador, BA, Brazil.,Centre for Global Mental health (CGMH), London School of Hygiene and Tropical Medicine, London, England
| | - Maurício L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde (CIDACS), Salvador, BA, Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
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41
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Gomes-Filho IS, Coelho JMF, Miranda SS, Cruz SS, Trindade SC, Cerqueira EMM, Passos-Soares JS, Costa MDCN, Vianna MIP, Figueiredo ACMG, Hintz AM, Coelho AF, Passos LCS, Barreto ML, Scannapieco F. Severe and moderate periodontitis are associated with acute myocardial infarction. J Periodontol 2020; 91:1444-1452. [PMID: 32219849 DOI: 10.1002/jper.19-0703] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND An association between periodontitis and cardiovascular disease is now well documented; however, the effect of periodontitis severity levels on this outcome, specifically on acute myocardial infarction (AMI), remains unexplored. This study investigated the association between levels of periodontitis severity (exposure) and AMI (outcome). METHODS This case-control study, matched by sex and age, was conducted with 621 participants, with 207 individuals treated in the emergency department of Santa Izabel and Ana Nery Hospitals in Salvador, Bahia, Brazil, diagnosed with a first AMI event, and compared to 414 individuals without a diagnosis of AMI. Levels of periodontitis severity followed two criteria: (1) Center for Disease Prevention and Control and American Academy of Periodontology; (2) Gomes-Filho et al. (2018) using criteria that also evaluated bleeding upon probing. Conditional logistic regression analysis was performed and odds ratios (ORs) and their 95% confidence intervals (CIs) were obtained. RESULTS The adjusted association measurements showed a positive association between both severe (ORadjusted ranged from 2.21 to 3.92; 95% CI ranged from 1.03 to 10.05) and moderate periodontitis (ORadjusted ranged from 1.96 to 2.51; 95% CI ranged from 1.02 to 6.19), and AMI, for both periodontitis diagnostic criteria. It demonstrated that among those with moderate and severe periodontitis, the chance of having AMI was approximately two to four times greater than among those without periodontitis. CONCLUSION The findings demonstrate that there is an association between the severity of the periodontal condition and AMI, suggesting a possible relationship among the levels of periodontitis severity and the cardiovascular condition.
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Affiliation(s)
- Isaac S Gomes-Filho
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Julita Maria F Coelho
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Samilly S Miranda
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Simone S Cruz
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil.,Department of Epidemiology, Federal University of Recôncavo of Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | - Soraya C Trindade
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Eneida M M Cerqueira
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Johelle S Passos-Soares
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil.,Department of Preventive Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Maria da Conceição N Costa
- Department of Epidemiology, Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Maria Isabel P Vianna
- Department of Preventive Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Ana Cláudia M G Figueiredo
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil.,Department of Epidemiology, Federal University of Recôncavo of Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | | | - Amanda F Coelho
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | | | - Maurício L Barreto
- Department of Epidemiology, Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
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42
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Coelho JMF, Miranda SS, Cruz SS, Santos DN, Trindade SC, Cerqueira EDMM, Passos‐Soares JDS, Costa MDCN, Figueiredo ACMG, Hintz AM, Almeida ARB, Pereira MN, Souza NM, Barreto ML, Gomes‐Filho IS. Common mental disorder is associated with periodontitis. J Periodontal Res 2020; 55:221-228. [DOI: 10.1111/jre.12705] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/13/2019] [Accepted: 09/18/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Julita Maria F. Coelho
- Department of Biological Sciences Feira de Santana State University Bahia Brazil
- Department of Health Feira de Santana State University Bahia Brazil
| | | | - Simone S. Cruz
- Department of Health Feira de Santana State University Bahia Brazil
- Department of Epidemiology Federal University of Recôncavo of Bahia Bahia Brazil
| | - Darci N. Santos
- Department of Epidemiology Collective Health Institute Federal University of Bahia Salvador Brazil
| | | | | | - Johelle de S. Passos‐Soares
- Department of Health Feira de Santana State University Bahia Brazil
- Department of Preventive Dentistry Federal University of Bahia Salvador Brazil
| | | | | | | | - Alba R. B. Almeida
- Department of Education/Psychology State University of Bahia Bahia Brazil
| | | | - Nayra M. Souza
- Department of Health Feira de Santana State University Bahia Brazil
| | - Maurício L. Barreto
- Department of Epidemiology Collective Health Institute Federal University of Bahia Salvador Brazil
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43
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Oliveira JF, Rodrigues MS, Skalinski LM, Santos AES, Costa LC, Cardim LL, Paixão ES, Costa MDCN, Oliveira WK, Barreto ML, Teixeira MG, Andrade RFS. Interdependence between confirmed and discarded cases of dengue, chikungunya and Zika viruses in Brazil: A multivariate time-series analysis. PLoS One 2020; 15:e0228347. [PMID: 32012191 PMCID: PMC6996800 DOI: 10.1371/journal.pone.0228347] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/13/2020] [Indexed: 01/14/2023] Open
Abstract
The co-circulation of different arboviruses in the same time and space poses a significant threat to public health given their rapid geographic dispersion and serious health, social, and economic impact. Therefore, it is crucial to have high quality of case registration to estimate the real impact of each arboviruses in the population. In this work, a Vector Autoregressive (VAR) model was developed to investigate the interrelationships between discarded and confirmed cases of dengue, chikungunya, and Zika in Brazil. We used data from the Brazilian National Notifiable Diseases Information System (SINAN) from 2010 to 2017. There were three peaks in the series of dengue notification in this period occurring in 2013, 2015 and in 2016. The series of reported cases of both Zika and chikungunya reached their peak in late 2015 and early 2016. The VAR model shows that the Zika series have a significant impact on the dengue series and vice versa, suggesting that several discarded and confirmed cases of dengue could actually have been cases of Zika. The model also suggests that the series of confirmed and discarded chikungunya cases are almost independent of the cases of Zika, however, affecting the series of dengue. In conclusion, co-circulation of arboviruses with similar symptoms could have lead to misdiagnosed diseases in the surveillance system. We argue that the routinely use of mathematical and statistical models in association with traditional symptom-surveillance could help to decrease such errors and to provide early indication of possible future outbreaks. These findings address the challenges regarding notification biases and shed new light on how to handle reported cases based only in clinical-epidemiological criteria when multiples arboviruses co-circulate in the same population.
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Affiliation(s)
- Juliane F. Oliveira
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Centre of Mathematics of the University of Porto (CMUP), Department of Mathematics, Porto, Portugal
- * E-mail:
| | - Moreno S. Rodrigues
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Fundação Oswaldo Cruz, Porto Velho, Rondônia, Brazil
| | - Lacita M. Skalinski
- Universidade Estadual de Santa Cruz, Ilhéus, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Aline E. S. Santos
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Larissa C. Costa
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Luciana L. Cardim
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Enny S. Paixão
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- London School of Hygiene and Tropical Medicine, London, England, United Kingdom
| | | | - Wanderson K. Oliveira
- Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Distrito Federal, Brazil
| | - Maurício L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | | | - Roberto F. S. Andrade
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Instituto de Física, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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44
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Magalhães BSN, Pereira VLA, Machado LS, Dias TS, Balthazar DA, Barreto ML, Troccoli F, Cunha NC, Nascimento ER, Almeida FM, Almosny NR. Occurrence of Avian Mycoplasmas in Free-Living Muscovy-Ducks (Cairina Moschata). Braz J Poult Sci 2020. [DOI: 10.1590/1806-9061-2020-1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | | | | | - TS Dias
- Universidade Federal Fluminense, Brazil
| | - DA Balthazar
- Universidade Federal Rural do Rio de Janeiro, Brazil
| | | | - F Troccoli
- Fundação Zoológico do Rio de Janeiro, Brazil
| | - NC Cunha
- Universidade Federal Fluminense, Brazil; Universidade Federal Fluminense, Brazil
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45
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Barreto ML, Ichihara MY, Almeida BA, Barreto ME, Cabral L, Fiaccone RL, Carreiro RP, Teles CAS, Pitta R, Penna GO, Barral-Netto M, Ali MS, Barbosa G, Denaxas S, Rodrigues LC, Smeeth L. The Centre for Data and Knowledge Integration for Health (CIDACS): Linking Health and Social Data in Brazil. Int J Popul Data Sci 2019; 4:1140. [PMID: 34095542 PMCID: PMC8142622 DOI: 10.23889/ijpds.v4i2.1140] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The Centre for Data and Knowledge Integration for Health (CIDACS) was created in 2016 in Salvador, Bahia-Brazil with the objective of integrating data and knowledge aiming to answer scientific questions related to the health of the Brazilian population. This article details our experiences in the establishment and operations of CIDACS, as well as efforts made to obtain high-quality linked data while adhering to security, ethical use and privacy issues. Every effort has been made to conduct operations while implementing appropriate structures, procedures, processes and controls over the original and integrated databases in order to provide adequate datasets to answer relevant research questions. Looking forward, CIDACS is expected to be an important resource for researchers and policymakers interested in enhancing the evidence base pertaining to different aspects of health, in particular when investigating, from a nation-wide perspective, the role of social determinants of health and the effects of social and environmental policies on different health outcomes.
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Affiliation(s)
- ML Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - MY Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - BA Almeida
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - ME Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Computer Science Department, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - L Cabral
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - RL Fiaccone
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Statistics Department, Federal University of Bahia (UFBA), Brazil.
| | - RP Carreiro
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - CAS Teles
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - R Pitta
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - GO Penna
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Tropical Medicine Centre, University of Brasília (UnB), Brazil.
- Escola Fiocruz de Governo, FIOCRUZ Brasília, Brazil.
| | - M Barral-Netto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - MS Ali
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
| | - G Barbosa
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - S Denaxas
- Institute of Health Informatics, University College London, United Kingdom.
| | - LC Rodrigues
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
| | - L Smeeth
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
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46
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Paixão ES, Rodrigues MS, Cardim LL, Oliveira JF, L C C, Costa MDCN, Barreto ML, Rodrigues LC, Smeeth L, Andrade RFS, Oliveira WK, Teixeira MG. Impact evaluation of Zika epidemic on congenital anomalies registration in Brazil: An interrupted time series analysis. PLoS Negl Trop Dis 2019; 13:e0007721. [PMID: 31545803 PMCID: PMC6776346 DOI: 10.1371/journal.pntd.0007721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/03/2019] [Accepted: 08/19/2019] [Indexed: 01/24/2023] Open
Abstract
This study aimed to assess the impact of the Zika epidemic on the registration of birth defects in Brazil. We used an interrupted time series analysis design to identify changes in the trends in the registration of congenital anomalies. We obtained monthly data from Brazilian Live Birth Information System and used two outcome definitions: 1) rate of congenital malformation of the brain and eye (likely to be affected by Zika and its complications) 2) rate of congenital malformation not related to the brain or eye unlikely to be causally affected by Zika. The period between maternal infection with Zika and diagnosis of congenital abnormality attributable to the infection is around six months. We therefore used September 2015 as the interruption point in the time series, six months following March 2015 when cases of Zika started to increase. For the purposes of this analysis, we considered the period from January 2010 to September 2015 to be "pre-Zika event," and the period from just after September 2015 to December 2017 to be "post-Zika event." We found that immediately after the interruption point, there was a great increase in the notification rate of congenital anomalies of 14.9/10,000 live births in the brain and eye group and of 5.2/10,000 live births in the group not related with brain or eye malformations. This increase in reporting was in all regions of the country (except in the South) and especially in the Northeast. In the period "post-Zika event", unlike the brain and eye group which showed a monthly decrease, the group without brain or eye malformations showed a slow but significant increase (relative to the pre-Zika trend) of 0.2/10,000 live births. These findings suggest an overall improvement in the registration of birth malformations, including malformations that were not attributed to Zika, during and after the Zika epidemic.
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Affiliation(s)
- Enny S Paixão
- Centro de Integração de Dados e Conhecimentos para Saúde, Centro de Pesquisas Gonçalo Muniz, Fiocruz, Salvador,Brazil.,Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Moreno S Rodrigues
- Centro de Integração de Dados e Conhecimentos para Saúde, Centro de Pesquisas Gonçalo Muniz, Fiocruz, Salvador,Brazil
| | - Luciana L Cardim
- Centro de Integração de Dados e Conhecimentos para Saúde, Centro de Pesquisas Gonçalo Muniz, Fiocruz, Salvador,Brazil
| | - Juliane F Oliveira
- Centro de Integração de Dados e Conhecimentos para Saúde, Centro de Pesquisas Gonçalo Muniz, Fiocruz, Salvador,Brazil
| | - Catharina L C
- Centro de Integração de Dados e Conhecimentos para Saúde, Centro de Pesquisas Gonçalo Muniz, Fiocruz, Salvador,Brazil
| | | | - Maurício L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Centro de Pesquisas Gonçalo Muniz, Fiocruz, Salvador,Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Laura C Rodrigues
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Liam Smeeth
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roberto F S Andrade
- Centro de Integração de Dados e Conhecimentos para Saúde, Centro de Pesquisas Gonçalo Muniz, Fiocruz, Salvador,Brazil.,Instituto de Física, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Wanderson K Oliveira
- Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Distrito Federal, Brazil
| | - Maria Glória Teixeira
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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47
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de Souza RA, Nery JS, Rasella D, Guimarães Pereira RA, Barreto ML, Rodrigues L, Pereira SM. Family health and conditional cash transfer in Brazil and its effect on tuberculosis mortality. Int J Tuberc Lung Dis 2019; 22:1300-1306. [PMID: 30355409 DOI: 10.5588/ijtld.17.0907] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Social protection can reduce poverty and act on the determinants of tuberculosis (TB). OBJECTIVE To evaluate the impact of the Family Health Strategy (FHS) and the Bolsa Família Programme on TB-related mortality in Brazil. METHODS This was an ecological study in which the units of analysis were Brazilian municipalities between 2001 and 2012. The principal independent variables were the levels of coverage of the primary health care system and the conditional cash transfer programme. The dependent variable was TB mortality rate (obtained from national databases). Descriptive analysis and negative binomial regression based on panel data using fixed-effects models were performed. Crude and adjusted estimates were calculated for continuous and categorical variables. RESULTS A high FHS coverage was significantly associated with a reduction in the TB mortality rate (RR 0.80, 95%CI 0.72-0.89). An increase in the coverage of the Brazilian cash transfer programme was significantly associated with a reduction in the TB mortality rate (RR 0.87, 95%CI 0.81-0.96). CONCLUSION FHS and the Bolsa Família conditional cash transfer programme had a positive impact on the TB mortality rate in Brazil. Public policies should include economic support combined with health promotion.
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Affiliation(s)
- R A de Souza
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia
| | - J S Nery
- Federal University of the Vale do São Francisco, Salvador, Bahia
| | - D Rasella
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia
| | | | - M L Barreto
- Institute Gonçalo Muniz, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - L Rodrigues
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - S M Pereira
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia
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48
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Uzêda JCO, Ribeiro-Silva RDC, Silva NDJ, Fiaccone RL, Malta DC, Ortelan N, Barreto ML. Correction: Factors associated with the double burden of malnutrition among adolescents, National Adolescent School-Based Health Survey (PENSE 2009 and 2015). PLoS One 2019; 14:e0219315. [PMID: 31247043 PMCID: PMC6597194 DOI: 10.1371/journal.pone.0219315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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49
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Dos S Jesus T, Dos S Costa R, Alcântara-Neves NM, Barreto ML, Figueiredo CA. Variants in the CYSLTR2 are associated with asthma, atopy markers and helminths infections in the Brazilian population. Prostaglandins Leukot Essent Fatty Acids 2019; 145:15-22. [PMID: 31126515 DOI: 10.1016/j.plefa.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Asthma is a chronic disease of the airways and its most common phenotype is characterized by a T2 type response with IgE production and inflammatory mediators in response to common allergens. Cysteinyl leukotrienes (CysLTs), LTC4, LTD4 and LTE4, are mediators known to possess important proinflammatory action. CysLTs can bind to the Cysteinyl leukotriene receptor type 2 (CysLTR2) and activate an inflammatory. Polymorphisms in CysLTR2 have been associated with asthma and atopy, although the mechanism is not clear. OBJECTIVE To evaluate the association between genetic polymorphisms in CYSLTR2 with asthma phenotypes, atopy markers and helminth infection. METHODS Genotyping was performed using a panel Illumina and carried out in 1245 participants of SCAALA program (Social Change, Asthma, Allergy in Latin American). Logistic regressions for asthma, helminth infections (Trichuris trichiura and Ascaris lumbricoides) and allergy markers (skin tests and IgE production) were performed using PLINK 1.9 software adjusted for sex, age, helminth infection and ancestry markers. RESULTS The G allele of rs1323556 was negatively associated with asthma in the additive model (OR 0.74, 95% CI 0.59-0.93) and in the dominant model (OR 0.71, 95% CI 0.53-0.74). The G allele of rs1575464 was also negatively associated with asthma in two genetic models, additive (OR 0.77, 95% CI 0.62-0.96) and dominant (OR 0.73, 95% CI 0.55-0.97). The G allele of rs61735175 was positively associated with asthma severity in the additive model (OR 1.72, 95% CI 1.07-2.77) and in the dominant model (OR 1.77, 95% CI 1.09-2.85). Five SNVs were associated with atopy markers and four SNVs were associated with helminth infections. CONCLUSION Polymorphisms in the CYSLTR2 gene are associated with asthma, atopy markers and helminth infection in Brazilian individuals, which may lead to protection or risk for such conditions, however, more studies are needed to evaluate the functional of this variants here in described.
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Affiliation(s)
- Talita Dos S Jesus
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Universidade Federal da Bahia, Instituto de Ciências da Saúde, Av. Reitor Miguel Calmon, s/n - Canela, Salvador, Bahia, Brazil
| | - Ryan Dos S Costa
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Universidade Federal da Bahia, Instituto de Ciências da Saúde, Av. Reitor Miguel Calmon, s/n - Canela, Salvador, Bahia, Brazil
| | - Neuza Maria Alcântara-Neves
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Universidade Federal da Bahia, Instituto de Ciências da Saúde, Av. Reitor Miguel Calmon, s/n - Canela, Salvador, Bahia, Brazil
| | | | - Camila Alexandrina Figueiredo
- Departamento de Biorregulação, Laboratório de Imunofarmacologia e Biologia Molecular, Universidade Federal da Bahia, Instituto de Ciências da Saúde, Av. Reitor Miguel Calmon, s/n - Canela, Salvador, Bahia, Brazil.
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Alves FJO, Machado DB, Barreto ML. Effect of the Brazilian cash transfer programme on suicide rates: a longitudinal analysis of the Brazilian municipalities. Soc Psychiatry Psychiatr Epidemiol 2019; 54:599-606. [PMID: 30456426 DOI: 10.1007/s00127-018-1627-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE There is a growing awareness of the economic and contextual factors that may play a role in the aetiology of suicide. The Programa Bolsa Família (PBF) the Brazilian conditional cash transfer programme, established in 2004, aims to attenuate the effects of poverty of Brazilians. Our study aims to evaluate the effect of Bolsa Família Programme (BFP) coverage on suicide rates in Brazilian municipalities. METHODS We conducted an ecological study using 2004-2012 panel data for 5507 Brazilian municipalities. We calculated age-standardized suicide rates for each municipality and year. BFP coverage was categorized according to three levels (< 30%, ≥ 30% and < 70% and ≥ 70%) and duration (coverage ≤ 70% for all years, ≥ 70% for 1 year, ≥ 70% for 2 years, ≥ 70% for 3 or more years). We used negative binomial regression models with fixed effects, adjusting for socio-economic, demographic and social welfare co-variables. RESULTS An increase in BFP coverage was associated with a reduction in suicide rates. The strongest effect was observed when in addition to greater municipal coverage (RR 0.942, 95% CI 0.936-0.947), the duration of the high coverage was maintained for 3 years or more (RR 0.952 95% CI 0.950-0.954). CONCLUSIONS The results provide evidence that the conditional cash transfer programme may reduce suicide in Brazilian municipalities, mitigating the effect of poverty on suicide incidence.
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Affiliation(s)
- Flávia Jôse Oliveira Alves
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz (FIOCRUZ), Parque Tecnológico, Edf. Tecnocentro, Sala 315, Rua Mundo, nº 121, Salvador, Bahia, Brazil. .,Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - Daiane Borges Machado
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz (FIOCRUZ), Parque Tecnológico, Edf. Tecnocentro, Sala 315, Rua Mundo, nº 121, Salvador, Bahia, Brazil.,Centre for Global Mental health (CGMH), London School of Hygiene and Tropical Medicine, London, UK
| | - Maurício L Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz (FIOCRUZ), Parque Tecnológico, Edf. Tecnocentro, Sala 315, Rua Mundo, nº 121, Salvador, Bahia, Brazil.,Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
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