Metodologia aplicada à informação em saúde : um estudo de caso da população de lésbicas, gays, bissexuais, travestis e transexuais no Brasil

Mestrado (dissertação)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, 2017.A construção do SUS consolidou-se a partir de lutas e de um complexo contexto de ações intersetoriais. Um dos seus princípios é compreender as especificidades e singularidades, e para isso produção e difusão do conhecimento, de forma aberta e acessível passa a ser uma estratégia para alcançar a atenção equânime. A Política de saúde integral de Lésbicas, Gays, Bissexuais, Travestis e Transexuais, aponta dentre seus objetivos a produção e difusão do conhecimento e por isso sua implantação é um avanço ao introduzir a dimensão de gênero e diversidade nas políticas públicas dando visibilidade às especificidades desta população. Para subsidiar este estudo, foi realizada uma revisão de literatura sobre as singularidades da população LGBT, sobre o desenvolvimento de sistemas de informação em saúde e sobre a perspectiva da democracia digital e da participação social na melhoria dos indicadores de saúde. O objetivo deste estudo foi desenvolver um sistema de informação, um projeto de intervenção para apoio à pesquisa, sistematização e divulgação das pesquisas realizadas no âmbito do observatório da Política Nacional de Saúde Integral da População LGBT. Para alcançar este resultado foi realizada uma análise em uma amostra selecionada de sistemas de informação em saúde desenvolvidos pelo Departamento de Informática do Sistema Único de Saúde. Este foi um estudo quali-quantitativo, transversal, apoiado por um estudo de caso. Os resultados foram discutidos com base nas demandas e necessidades apresentadas por estudos anteriores. A combinação destes dois resultados atende a demanda de estimular a construção de instrumentos de informação contra-hegemônica, possibilitando a construção de indicadores baseados em uma análise mais precisa dos riscos associados à expressão da diversidade sexual como fator de vulnerabilidade. Ficou evidente a necessidade de abarcar subjetividade e questões identitárias para desconstruir políticas baseadas em modelos hegemônicos. Avançar com estas metodologias participativas significa avançar na construção de modelos não excludentes e pautados pelas demandas sociais.The creation of SUS was consolidated from struggles and a complex context of Intersectorial actions. One of its principles is to comprehend the specificities and singularities, and for this, knowledge production and diffusion, in an open and accessible way becomes a strategy to achieve equanimity. The Lesbian, Gay, Bisexual, Transvestite and Transsexual Comprehensive Health Policy points out to among its objectives the production and diffusion of knowledge and therefore its implementation is an advance in introducing the gender dimension and diversity in public policies giving visibility to the specificities of this population. In order to support this study, a literature review was carried out on the singularities of the LGBT population, on the development of the health systems and on the perspective of digital democracy and social participation in the improvement of health indicators. The objective of this study was to develop an information system, an intervention project to support research, systematization and dissemination of the research carried out within the framework of the Observatory of National Policy on Comprehensive Health for LGBT Population. To achieve this result, an analysis was performed on a selected sample of health information systems developed by the Department of Informatics of the Unified Health System. This was a quali-quantitative, cross-sectional study supported by a case study. The results were discussed based on demands and needs presented by previous studies. The combination of these two results meets the demand to stimulating the construction of counter-hegemonic information tools, enabling the construction of indicators based on more precise analysis of the risks associated with the expression of sexual diversity as a vulnerability factor. It was evident the need to embrace subjectivity and identity issues to deconstruct policies based on hegemonic models. Moving forward with these participatory methodologies means advancing in the construction of nonexclusionary models based on social demands.La construcción del SUS se consolidó a partir de luchas e un complejo contexto de acciones intersectoriales. Unos de sus principios es comprender las especificidades y singularidades, e para tanto, la producción y difusión del conocimiento, de manera abierta e accesible pasa a ser una estrategia para alcanzar una atención ecuánime. La Política de Salud Integral de Lésbicas, Gays, Bisexuales, Travestis y Transexuales, apunta entre sus objetivos a producción y difusión del conocimiento y por eso su implantación es un avance al introducir la dimensión de género y diversidad en las políticas públicas dando visibilidad a las especificidades de esta populación. Para apoyar este estudio, se llevó a cabo una revisión de la literatura sobre las singularidades de la populación LGBT, sobre el desarrollo de sistemas de información sanitarias y sobre la perspectiva de democracia digital y de la participación social en la mejoría de los indicadores de salud. El objetivo de este estudio fue desarrollar un sistema de información, un proyecto de intervención para apoyar la investigación, sistematización y difusión de las investigaciones llevadas a cabo en el contexto del Observatorio de la Política Nacional de Salud Integral de la Populación LGBT. Para lograr este resultado se realizó un análisis sobre una muestra seleccionada de sistemas de información de salud desarrolladas por el Departamento de Informática del Sistema Único de Salud. Este fue un estudio cualicuantitativo, transversal, apoyado por un estudio de caso. Los resultados fueran discutidos con base en las demandas y necesidades presentadas por estudios anteriores. La combinación de estos dos resultados sirve para la demanda de estimular la construcción de instrumentos de información contra-hegemónica, posibilitando la construcción de indicadores basados en un análisis más precisa de los riesgos asociados a la expresión de la diversidad sexual como factor de vulnerabilidad. Quedó evidente la necesidad de abrazar la subjetividad y los problemas de identidad para deconstruir políticas basadas en modelos hegemónicos. Avanzar con estas metodologías participativas significa avanzar en la construcción de modelos nonexcluyentes y guiados por las demandas sociales

Imputation method to reduce undetected severe acute respiratory infection cases during the coronavirus disease outbreak in Brazil

The coronavirus disease (COVD-19) outbreak has overburdened the surveillance of severe acute respiratory infections (SARIs), including the laboratory network. This study was aimed at correcting the absence of laboratory results of reported SARI deaths. The imputation method was applied for SARI deaths without laboratory information using clinico-epidemiological characteristics. Of 84,449 SARI deaths, 51% were confirmed with COVID-19 while 3% with other viral respiratory diseases. After the imputation method, 95% of deaths were reclassified as COVID-19 while 5% as other viral respiratory diseases. The imputation method was a useful and robust solution (sensitivity and positive predictive value of 98%) for missing values through clinical & epidemiological characteristics

Imputation method to reduce undetected severe acute respiratory infection cases during the coronavirus disease outbreak in Brazil

INTRODUCTION: The coronavirus disease (COVD-19) outbreak has overburdened the surveillance of severe acute respiratory infections (SARIs), including the laboratory network. This study was aimed at correcting the absence of laboratory results of reported SARI deaths. METHODS: The imputation method was applied for SARI deaths without laboratory information using clinico-epidemiological characteristics. RESULTS: Of 84,449 SARI deaths, 51% were confirmed with COVID-19 while 3% with other viral respiratory diseases. After the imputation method, 95% of deaths were reclassified as COVID-19 while 5% as other viral respiratory diseases. CONCLUSIONS: The imputation method was a useful and robust solution (sensitivity and positive predictive value of 98%) for missing values through clinical & epidemiological characteristics

The COVID-19 Sentinel Schools Network of Catalonia (CSSNC) project: Associated factors to prevalence and incidence of SARS-CoV-2 infection in educational settings during the 2020–2021 academic year

COVID-19; Medical risk factors; Virus testingCOVID-19; Factors de risc mèdics; Test de virusCOVID-19; Factores de riesgo médicos; Test de virusThe Sentinel Schools project was designed to monitor and evaluate the epidemiology of COVID-19 in Catalonia, gathering evidence for health and education policies to inform the development of health protocols and public health interventions to control of SARS-CoV-2 infection in schools. The aim of this study was to estimate the prevalence and incidence of SARS-CoV-2 infections and to identify their determinants among students and staff during February to June in the academic year 2020–2021. We performed two complementary studies, a cross-sectional and a longitudinal component, using a questionnaire to collect nominal data and testing for SARS-CoV-2 detection. We describe the results and perform a univariate and multivariate analysis. The initial crude seroprevalence was 14.8% (95% CI: 13.1–16.5) and 22% (95% CI: 18.3–25.8) for students and staff respectively, and the active infection prevalence was 0.7% (95% CI: 0.3–1) and 1.1% (95% CI: 0.1–2). The overall incidence for persons at risk was 2.73 per 100 person-month and 2.89 and 2.34 per 100 person-month for students and staff, respectively. Socioeconomic, self-reported knowledge, risk perceptions and contact pattern variables were positively associated with the outcome while sanitary measure compliance was negatively associated, the same significance trend was observed in multivariate analysis. In the longitudinal component, epidemiological close contact with SARS-CoV-2 infection was a risk factor for SARS-CoV-2 infection while the highest socioeconomic status level was protective as was compliance with sanitary measures. The small number of active cases detected in these schools suggests a low transmission among children in school and the efficacy of public health measures implemented, at least in the epidemiological scenario of the study period. The major contribution of this study was to provide results and evidence that help analyze the transmission dynamic of SARS-CoV-2 and evaluate the associations between sanitary protocols implemented, and measures to avoid SARS-CoV-2 spread in schools

The first year of the COVID-19 pandemic in an indigenous population in Brazil: an epidemiological study

This cross-sectional observational study that describes the epidemiological data of the first year of the COVID-19 pandemic in the Mato Grosso do Sul State, aimed to demonstrate the differences between indigenous and non-indigenous populations, characterize confirmed cases of COVID-19 according to risk factors related to ethnicity, comorbidities and their evolution and to verify the challenges in facing the disease in Brazil. SIVEP-Gripe and E-SUS-VE, a nationwide surveillance database in Brazil, from March 2020 to March 2021 in Mato Grosso do Sul state, were used to compare survivors and non-survivors from indigenous and non-indigenous populations and the epidemiological incidence curves of these populations. A total of 176,478, including 5,299 indigenous people, were confirmed. Among the indigenous population, 52.5% (confidence interval [CI] 51.2-53.9) were women, 38% (CI 36.7-39.4) were 20-39 years old, 56.7% were diagnosed by rapid antibody tests, 12.3% (CI 95%:11.5-13.2) had at least one comorbidity, and 5.3% (CI 95%:4.7–5.9) were hospitalized. In the non-indigenous patients, 56.8% were confirmed using RT-PCR, 4.4% (CI 95%:4.3-4.5) had at least one comorbidity, and 8.0% (CI 95%:7.9-8.2) were hospitalized. The majority of non-survivors were ≥60 years old (65.1% indigenous vs. 74.1% non-indigenous). The mortality in indigenous people was more than three times higher (11% vs. 2.9%). Indigenous people had a lower proportion of RT-PCR diagnoses; deaths were more frequent in younger patients and were less likely to be admitted to hospital. Mass vaccination may have controlled the incidence and mortality associated with COVID-19 in this population during the period of increased viral circulation

The COVID-19 Sentinel Schools Network of Catalonia (CSSNC) project : Associated factors to prevalence and incidence of SARS-CoV-2 infection in educational settings during the 2020-2021 academic year

The Sentinel Schools project was designed to monitor and evaluate the epidemiology of COVID-19 in Catalonia, gathering evidence for health and education policies to inform the development of health protocols and public health interventions to control of SARS-CoV-2 infection in schools. The aim of this study was to estimate the prevalence and incidence of SARS-CoV-2 infections and to identify their determinants among students and staff during February to June in the academic year 2020-2021. We performed two complementary studies, a cross-sectional and a longitudinal component, using a questionnaire to collect nominal data and testing for SARS-CoV-2 detection. We describe the results and perform a univariate and multivariate analysis. The initial crude seroprevalence was 14.8% (95% CI: 13.1-16.5) and 22% (95% CI: 18.3-25.8) for students and staff respectively, and the active infection prevalence was 0.7% (95% CI: 0.3-1) and 1.1% (95% CI: 0.1-2). The overall incidence for persons at risk was 2.73 per 100 person-month and 2.89 and 2.34 per 100 person-month for students and staff, respectively. Socioeconomic, self-reported knowledge, risk perceptions and contact pattern variables were positively associated with the outcome while sanitary measure compliance was negatively associated, the same significance trend was observed in multivariate analysis. In the longitudinal component, epidemiological close contact with SARS-CoV-2 infection was a risk factor for SARS-CoV-2 infection while the highest socioeconomic status level was protective as was compliance with sanitary measures. The small number of active cases detected in these schools suggests a low transmission among children in school and the efficacy of public health measures implemented, at least in the epidemiological scenario of the study period. The major contribution of this study was to provide results and evidence that help analyze the transmission dynamic of SARS-CoV-2 and evaluate the associations between sanitary protocols implemented, and measures to avoid SARS-CoV-2 spread in schools

Drinking Water Quality Surveillance Information System (SISAGUA) : characteristics, evolution and applicability

O Sistema de Informação de Vigilância da Qualidade da Água para Consumo Humano (Sisagua) é um instrumento utilizado no Brasil para registro das formas de abastecimento de água e dos dados de monitoramento da qualidade da água preconizados na norma de potabilidade. Essas informações são utilizadas no gerenciamento de riscos à saúde associados ao abastecimento de água no país e subsidiam a atuação da vigilância da qualidade da água para consumo humano, a estruturação de políticas públicas na área de saúde ambiental e saneamento, a prevenção de doenças de veiculação hídrica, e a caracterização da qualidade da água consumida pela população brasileira. Este artigo descreve o histórico do Sisagua e apresenta as principais características da atual versão (Sisagua 4) em relação à coleta e processamento dos dados, às variáveis, aos usos e acessos, à cobertura e qualidade dos dados, bem como focaliza as aplicabilidades, as limitações e os desafios do sistema.The Drinking Water Quality Surveillance Information System (SISAGUA) is an instrument used in Brazil to record forms of water supply and water quality monitoring data recommended by the potable water standard. This information is used in the management of health risks associated with water supply in the country and supports the surveillance of drinking water quality, the structuring of public policies in the area of environmental health and sanitation, the prevention of waterborne diseases, and the characterization of the quality of water consumed by the Brazilian population. This article describes the history of SISAGUA and presents the main features of its current version (SISAGUA 4) regarding data collection and processing, variables, uses and accesses, data coverage and quality, as well as the system’s applicability, limitations and challenges.El Sistema de Información de Vigilancia de la Calidad del Agua para Consumo Humano (Sisagua) es un instrumento utilizado en Brasil para registrar las formas de abastecimiento de agua y de los datos de monitoreo de la calidad del agua preconizados en la norma de potabilidad. Esta información se utiliza en la gestión de riesgos a la salud asociados al abastecimiento de agua en el país y da base a la actuación de la vigilancia de la calidad del agua para consumo humano, a la estructuración de políticas públicas en el área de salud ambiental y el saneamiento, a la prevención de enfermedades de transmisión hídrica, y a la caracterización de la calidad del agua consumida por la población brasileña. En este artículo se describe el histórico del Sisagua y se presentan las principales características de la actual versión (Sisagua 4) en relación a la recolección y el procesamiento de los datos, a las variables, a los usos y accesos, a la cobertura y calidad de los datos, así como a las aplicabilidad, limitaciones y los desafíos del sistema

Estrategia de vigilancia participativa mediante dispositivos móviles Guardianes de la Salud: visita del Papa Francisco a Colombia, septiembre de 2017

Introducción: las tecnologías móviles por su fácil uso y gran difusión se han convertido en una herramienta importante en salud pública, permitiendo identificar brotes de manera temprana como complemento de la vigilancia tradicional. El objetivo fue analizar los datos de una aplicación móvil para detectar rápidamente enfermedades de interés en salud pública relacionadas con la visita del Papa Francisco a Colombia. Métodos: se utilizó vigilancia participativa por medio de la aplicación móvil Guardianes de la Salud, implementada para Colombia en dispositivos Android, adaptada del desarrollo de Proepi y Ministerio de Salud de Brasil para los Juegos Olímpicos de Rio de Janeiro 2014. Se interrogó sobre 20 síntomas que permitían detectar síndromes respiratorios, febriles, gastrointestinales, exantémicos e ictéricos, relacionados con eventos de interés en salud pública. Se preguntaba por antecedentes de viaje y contacto con otros enfermos. Se monitorearon los datos durante los días de visita del Papa al país y hasta siete días después. Resultados: se recibieron 935 reportes, 60,2% (283) fueron de Bogotá, 23,0% (215) del departamento del Meta y 22,0% (206) de Antioquia, se recibieron también reportes de otros países como Brasil (21), Estados Unidos, Panamá (3), Chile (2) y Costa Rica (1). El 55,1% (516) fueron mujeres, el promedio de edad fue 39 años (D.E. 12,3). El 8,5% (80) reportaron su estado de salud mal, siendo el principal síntoma dolor de cabeza en el 41,3% (33), seguido de malestar 40,0% (32) y congestión nasal 38,8% (31). El 53,7% (43) de los reportes estuvieron asociados a alguno de los síndromes priorizados, siendo el principal el febril en 22 casos y gastrointestinal en 11. Conclusión: no se detectaron conglomerados de casos de importancia en salud pública. La herramienta permitió involucrar al público en general en la notificación de su estado de salud. Es necesario promover el uso de esta aplicación ya que medida que aumenta el número de usuarios, también aumenta la sensibilidad que brinda el monitoreo ampliado de la vigilancia participativa.Introduction: mobile technologies, due to their easy use and widespread dissemination, have become an important tool in public health, allowing early identification of outbreaks as a complement to traditional surveillance. The objective was to analyze the data of a mobile application to detect diseases of interest in public health related to the visit of Pope Francis to Colombia. Methods: participatory surveillance is applied through the Guardianes de la Salud mobile application, implemented for Colombia on Android devices, adapted from the development of Proepi and the Ministry of Health of Brazil for the Rio de Janeiro 2014 Olympic Games. It was questioned about 20 symptoms That allows to detect respiratory, febrile, gastrointestinal, exanthemic and icteric syndromes, related to events of interest in public health. He asked about travel history and contact with other patients. The data is monitored during the days of the Pope's visit to the country and up to seven days later. Results: 936 reports were received, 60.2% (283) were from Bogotá, 23.0% (215) from the department of Meta and 22.0% (206) from Antioquia, there are also reports from other countries such as Brazil ( 21), the United States, Panama (3), Chile (2) and Costa Rica (1). 55.1% (516) were women, the average age was 39 years (D.E. 12.3). 8.5% (80) reported their health status, being the main symptom of headache in 41.3% (33), followed by discomfort 40.0% (32) and nasal congestion 38.8% ( 31). 53.7% (43) of the reports are associated with some of the prioritized syndromes, the main one being February in 22 cases and gastrointestinal in 11. Conclusion: no conglomerates of important public health cases were detected. The tool allowed to involve the general public in the notification of their health status. It is necessary to promote the use of this application or the measure that increases the number of users, as well as the sensitivity provided by the expanded monitoring of participatory surveillance

Estrategia de vigilancia participativa mediante dispositivos móviles Guardianes de la Salud: visita del Papa Francisco a Colombia, septiembre de 2017

Introducción: las tecnologías móviles por su fácil uso y gran difusión se han convertido en una herramienta importante en salud pública, permitiendo identificar brotes de manera temprana como complemento de la vigilancia tradicional. El objetivo fue analizar los datos de una aplicación móvil para detectar rápidamente enfermedades de interés en salud pública relacionadas con la visita del Papa Francisco a Colombia. Métodos: se utilizó vigilancia participativa por medio de la aplicación móvil Guardianes de la Salud, implementada para Colombia en dispositivos Android, adaptada del desarrollo de Proepi y Ministerio de Salud de Brasil para los Juegos Olímpicos de Rio de Janeiro 2014. Se interrogó sobre 20 síntomas que permitían detectar síndromes respiratorios, febriles, gastrointestinales, exantémicos e ictéricos, relacionados con eventos de interés en salud pública. Se preguntaba por antecedentes de viaje y contacto con otros enfermos. Se monitorearon los datos durante los días de visita del Papa al país y hasta siete días después. Resultados: se recibieron 935 reportes, 60,2% (283) fueron de Bogotá, 23,0% (215) del departamento del Meta y 22,0% (206) de Antioquia, se recibieron también reportes de otros países como Brasil (21), Estados Unidos, Panamá (3), Chile (2) y Costa Rica (1). El 55,1% (516) fueron mujeres, el promedio de edad fue 39 años (D.E. 12,3). El 8,5% (80) reportaron su estado de salud mal, siendo el principal síntoma dolor de cabeza en el 41,3% (33), seguido de malestar 40,0% (32) y congestión nasal 38,8% (31). El 53,7% (43) de los reportes estuvieron asociados a alguno de los síndromes priorizados, siendo el principal el febril en 22 casos y gastrointestinal en 11. Conclusión: no se detectaron conglomerados de casos de importancia en salud pública. La herramienta permitió involucrar al público en general en la notificación de su estado de salud. Es necesario promover el uso de esta aplicación ya que medida que aumenta el número de usuarios, también aumenta la sensibilidad que brinda el monitoreo ampliado de la vigilancia participativa.Introduction: mobile technologies, due to their easy use and widespread dissemination, have become an important tool in public health, allowing early identification of outbreaks as a complement to traditional surveillance. The objective was to analyze the data of a mobile application to detect diseases of interest in public health related to the visit of Pope Francis to Colombia. Methods: participatory surveillance is applied through the Guardianes de la Salud mobile application, implemented for Colombia on Android devices, adapted from the development of Proepi and the Ministry of Health of Brazil for the Rio de Janeiro 2014 Olympic Games. It was questioned about 20 symptoms That allows to detect respiratory, febrile, gastrointestinal, exanthemic and icteric syndromes, related to events of interest in public health. He asked about travel history and contact with other patients. The data is monitored during the days of the Pope's visit to the country and up to seven days later. Results: 936 reports were received, 60.2% (283) were from Bogotá, 23.0% (215) from the department of Meta and 22.0% (206) from Antioquia, there are also reports from other countries such as Brazil ( 21), the United States, Panama (3), Chile (2) and Costa Rica (1). 55.1% (516) were women, the average age was 39 years (D.E. 12.3). 8.5% (80) reported their health status, being the main symptom of headache in 41.3% (33), followed by discomfort 40.0% (32) and nasal congestion 38.8% ( 31). 53.7% (43) of the reports are associated with some of the prioritized syndromes, the main one being February in 22 cases and gastrointestinal in 11. Conclusion: no conglomerates of important public health cases were detected. The tool allowed to involve the general public in the notification of their health status. It is necessary to promote the use of this application or the measure that increases the number of users, as well as the sensitivity provided by the expanded monitoring of participatory surveillance