154 research outputs found
Estimativas em pequenas áreas geográficas: um passo necessário para a redução das desigualdades em saúde
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The Burden of Chagas Disease in the Contemporary World: The RAISE Study
Chagas disease (ChD), a Neglected Tropical Disease, has witnessed a transformative epidemiological landscape characterized by a trend of reduction in prevalence, shifting modes of transmission, urbanization, and globalization. Historically a vector-borne disease in rural areas of Latin America, effective control measures have reduced the incidence in many countries, leading to a demographic shift where most affected individuals are now adults. However, challenges persist in regions like the Gran Chaco, and emerging oral transmission in the Amazon basin adds complexity. Urbanization and migration from rural to urban areas and to non-endemic countries, especially in Europe and the US, have redefined the disease’s reach. These changing patterns contribute to uncertainties in estimating ChD prevalence, exacerbated by the lack of recent data, scarcity of surveys, and reliance on outdated models. Besides, ChD’s lifelong natural history, marked by acute and chronic phases, introduces complexities in diagnosis, particularly in non-endemic regions where healthcare provider awareness is low. The temporal dissociation of infection and clinical manifestations, coupled with underreporting, has rendered ChD invisible in health statistics. Deaths attributed to ChD cardiomyopathy often go unrecognized, camouflaged under alternative causes. Understanding these challenges, the RAISE project aims to reassess the burden of ChD and ChD cardiomyopathy. The project is a collaborative effort of the World Heart Federation, Novartis Global Health, the University of Washington’s Institute for Health Metrics and Evaluation, and a team of specialists coordinated by Brazil’s Federal University of Minas Gerais. Employing a multidimensional strategy, the project seeks to refine estimates of ChD-related deaths, conduct systematic reviews on seroprevalence and prevalence of clinical forms, enhance existing modeling frameworks, and calculate the global economic burden, considering healthcare expenditures and service access. The RAISE project aspires to bridge knowledge gaps, raise awareness, and inform evidence-based health policies and research initiatives, positioning ChD prominently on the global health agenda
Genomic African and Native American Ancestry and Chagas Disease: The Bambui (Brazil) Epigen Cohort Study of Aging.
BackgroundThe influence of genetic ancestry on Trypanosoma cruzi infection and Chagas disease outcomes is unknown.Methodology/principal findingsWe used 370,539 Single Nucleotide Polymorphisms (SNPs) to examine the association between individual proportions of African, European and Native American genomic ancestry with T. cruzi infection and related outcomes in 1,341 participants (aged ≥ 60 years) of the Bambui (Brazil) population-based cohort study of aging. Potential confounding variables included sociodemographic characteristics and an array of health measures. The prevalence of T. cruzi infection was 37.5% and 56.3% of those infected had a major ECG abnormality. Baseline T. cruzi infection was correlated with higher levels of African and Native American ancestry, which in turn were strongly associated with poor socioeconomic circumstances. Cardiomyopathy in infected persons was not significantly associated with African or Native American ancestry levels. Infected persons with a major ECG abnormality were at increased risk of 15-year mortality relative to their counterparts with no such abnormalities (adjusted hazard ratio = 1.80; 95% 1.41, 2.32). African and Native American ancestry levels had no significant effect modifying this association.Conclusions/significanceOur findings indicate that African and Native American ancestry have no influence on the presence of major ECG abnormalities and had no influence on the ability of an ECG abnormality to predict mortality in older people infected with T. cruzi. In contrast, our results revealed a strong and independent association between prevalent T. cruzi infection and higher levels of African and Native American ancestry. Whether this association is a consequence of genetic background or differential exposure to infection remains to be determined
A TRANSIÇÃO DO ENSINO MÉDIO PARA A UNIVERSIDADE: UM ESTUDO QUALITATIVO SOBRE OS FATORES QUE INFLUENCIAM ESTE PROCESSO E SUAS POSSÍVEIS CONSEQUÊNCIAS COMPORTAMENTAIS
A entrada na Universidade para muitos jovens é marcada por uma fase de transição caracterizada por diversas mudanças que interferem e influenciam em seu desenvolvimento psicossocial, além do profissional. O presente trabalho teve como objetivo a análise dos fatores que influenciaram na adaptação do aluno, egresso do ensino médio, para a vida universitária. O estudo foi realizado através de entrevistas semi-estrutadas com 8 estudantes pertencentes a diferentes cursos. Os dados foram analisados através da análise de conteúdo e categorizados em dois segmentos: Fatores que Influenciaram na Adaptação e Mudanças Comportamentais. Os resultados indicaram o destaque de quatro categorias para o primeiro bloco – Infra-estrutura, Informação sobre a Universidade e o curso, Fatores Externo à Universidade e Aspectos Organizacionais– e duas categorias para o segundo bloco - Aspectos pessoais e Organização do estudo. O estudo contribui para pontuar as dificuldades encontradas pelos alunos ingressantes no contexto da universidade e proporcionou melhor compreensão sobre a transição acadêmica
A relação entre PIB per capita e os acidentes de transporte nos municípios brasileiros, 2005, 2010 e 2015
Objective: The main objective of this paper is to analyze the relationship between GDP and three variables related to traffic accidents in Brazilian municipalities: traffic accident mortality, deaths per vehicle; and vehicles per inhabitant. Methods: 2005, 2010 and 2015 terrestrial traffic accident (ATT) mortality rates were estimated using a three years moving average and were standardized, then, we applied the empirical Bayes estimator (EBE). Fatality rates (deaths per vehicle) also were based on EBE. Vehicles per inhabitant considered the ratio between vehicle fleet and the population at municipal level. For every studied year, we estimated linear regression models between GDP and the interest variables. Results: Variables distribution indicates that, between 2005 and 2015, GDP and vehicles per inhabitant kept the same rising relationship. Fatality rates show a decreasing association with GDP. TA mortality distribution with GDP presented a pattern close to an inverted-U. Model coefficients practically did not change for the vehicle per inhabitant. Estimated association between deaths per vehicle and GDP kept the same sign, but diminished between 2005 and 2015. Model coefficient sign changed in 2015 for TA mortality. Conclusion: Similarly to what was observed in developed countries, the relationship between mortality from traffic accidents and GDP changed in the analyzed period.Objetivo: O artigo pretende analisar a relação entre o PIB per capita e três variáveis relacionadas aos acidentes de transporte nos municípios brasileiros: a mortalidade por acidentes de transporte terrestre (ATT); as mortes por veículo; e o número de veículos por pessoa. Métodos: As taxas de mortalidade por ATT foram estimadas (2005, 2010 e 2015) por meio do estimador bayesiano empírico (EBE). A taxa de mortalidade por veículo foi também estimada pelo EBE. O número de veículos por pessoa foi baseado na razão entre a frota de automóveis e a população residente. Para os três anos em análise, estimamos um modelo de regressão linear entre o PIB per capita municipal e as três variáveis de interesse. Resultados: A distribuição das variáveis mostra que a relação entre o PIB e número de veículos por pessoa se manteve crescente ao longo dos anos, e foi sempre negativa considerando as mortes por veículo. A taxa mortalidade por ATT apresentou distribuição próxima a um U-invertido. Os coeficientes do modelo de regressão praticamente não variaram para a relação entre PIB e os veículos por habitante. O sinal para o modelo com a taxa de mortalidade por veículo se manteve o mesmo (negativo), mas apresentou diminuição. A taxa mortalidade por ATT, por sua vez, apresentou inversão do sinal em 2015. Conclusões: De modo similar ao observado nos países desenvolvidos, parece ter havido uma inversão na relação entre mortalidade por ATT e PIB nos municípios brasileiros entre 2005 e 2015
Usefulness of microvolt T-wave alternans for predicting outcome in patients with Chagas disease with implantable cardioverter defibrillators
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Mortalidade prematura por doenças crônicas não transmissíveis nos municípios brasileiros, nos triênios de 2010 a 2012 e 2015 a 2017
Objective: To estimate premature mortality due to Noncommunicable Diseases in Brazilian municipalities. Methods: This ecological study estimated premature mortality rates due to cardiovascular, chronic respiratory diseases, neoplasms and diabetes in Brazilian municipalities, for the three-year periods of 2010 to 2012 and 2015 to 2017, and analyzed spatial and temporal distribution of these rates. Data treatment combined proportional redistribution of the missing data and ill-defined causes, and the application of coefficients for under-registration correction. Local empirical Bayesian estimator was used to calculate municipal mortality rates. Results: Rates for the set of chronic diseases reduced in Brazil between the three-year periods. The average rates for the total of NCDs declined in the South, Southeast and Midwest regions, stabilized in North and increased in Northeast. Mortality rates due to cardiovascular diseases were the highest in all regions, but showed the greatest declines between the periods. Neoplasms were the second leading group of causes of death. North and Northeast stood out for the increase in the average rates for this group of causes between the periods analyzed and for concentrating the highest averages of premature mortality rates due to diabetes in the 2015 to 2017 period. Conclusions: Spatial and temporal distribution of premature mortality rates due to NCDs differed among Brazilian municipalities and regions in the three-year periods evaluated. South and Southeast perceived a reduction in the rates due to cardiovascular, chronic respiratory diseases and diabetes, while North and Northeast had an increase in the rates due to neoplasms and Midwest due to diabetes.Objetivo: Estimar mortalidade prematura por Doenças Crônicas Não Transmissíveis nos municípios brasileiros. Métodos: Estudo ecológico com estimativa das taxas de mortalidade prematura por doenças cardiovasculares, respiratórias crônicas, neoplasias e diabetes nos municípios brasileiros, nos triênios de 2010 a 2012 e 2015 a 2017, e análise da distribuição espacial e temporal dessas taxas. Realizou-se redistribuição proporcional dos dados faltantes e das causas mal definidas, e aplicou-se coeficientes para correção de sub-registro. As taxas municipais de mortalidade foram calculadas pelo estimador bayesiano empírico local. Resultados: No Brasil, houve redução das médias das taxas municipais para o conjunto das doenças crônicas entre os triênios. No Sul, Sudeste e Centro-Oeste houve declínio das médias das taxas para o total das DCNTe acréscimo no Nordeste. As médias das taxas de mortalidade por doenças cardiovasculares foram as mais altas em todas as regiões, mas apresentaram os maiores declínios entre os períodos. As neoplasias representaram o segundo principal grupo de causas. Norte e Nordeste se destacaram pelo aumento das taxas médias por esse grupo de causas entre os períodos analisados e por concentrarem as taxas mais altas de mortalidade prematura por diabetes no triênio 2015 a 2017. Conclusões: Diferenças na distribuição espaço-temporal das taxas de mortalidade prematura por DCNT foram identificadas entre municípios e regiões brasileiras. Houve redução das taxas por doenças cardiovasculares, respiratórias crônicas e diabetes no Sul e no Sudeste e aumento das taxas por neoplasias no Norte e no Nordeste, e por diabetes no Norte e no Centro-Oeste
Asynchronous communication for medical journal editorial teams in a diverse global research community
Asynchronous communication for medical journal editorial teams in a diverse global research community
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