Perfil epidemiológico dos óbitos infantis por doenças do aparelho respiratório no estado de São Paulo no período de 2017 a 2021

This article aims to correlate infant mortality rates with acute respiratory diseases in the years 2017 to 2021 in the state of São Paulo. This is an ecological epidemiological study of temporal analysis with data obtained in December 2023 from the Information Technology Department of the Unified Health System (DataSus) and originating from the Disease and Notification Information System (SINAN). It was evident from the analysis of the graphs that in the state of São Paulo, the rate of infant deaths due to diseases of the respiratory system has an important relationship with the size of the population, in addition to the intrinsic relationship between these diseases and atmospheric pollutants. Although at the beginning of 2020 the state had a drop in deaths related to the respiratory system in children, the Covid-19 pandemic brought a significant increase in this figure, thus reaffirming the need to look carefully at this challenge to the system. of Brazilian health.Este artículo tiene como objetivo correlacionar las tasas de mortalidad infantil con las enfermedades respiratorias agudas en los años 2017 a 2021 en el estado de São Paulo. Se trata de un estudio epidemiológico ecológico de análisis temporal con datos obtenidos en noviembre de 2023 del Departamento de Tecnología de la Información del Sistema Único de Salud (DataSus) y provenientes del Sistema de Información de Notificación y Enfermedades (SINAN). Del análisis de los gráficos se desprende que en el estado de São Paulo, la tasa de muertes infantiles por enfermedades del sistema respiratorio tiene una relación importante con el tamaño de la población, además de la relación intrínseca entre estas enfermedades y contaminantes atmosféricos. Si bien a principios de 2020 el estado tuvo una caída en las muertes relacionadas con el sistema respiratorio en niños, la pandemia de Covid-19 trajo un aumento significativo de esa cifra, reafirmando así la necesidad de mirar con atención este desafío al sistema brasileño. salud.Este artigo tem como objetivo correlacionar as taxas de mortalidade infantil com as doenças respiratórias agudas nos anos de 2017 a 2021 no estado de São Paulo. Trata-se de um estudo epidemiológico do tipo ecológico de análise temporal com dados obtidos no mês de novembro de 2023 no Departamento de Informática do Sistema Único de Saúde (DataSus) e originárias do Sistema de Informação de Agravo e Notificações (SINAN). Foi evidenciado a partir da análise dos gráficos que no estado de São Paulo, a taxa de óbitos infantis por doenças do aparelho respiratório apresenta importante relação com o tamanho da população, além da intrínseca relação dessas enfermidades com os poluentes atmosféricos. Embora no início do ano de 2020 o estado tenha apresentado uma baixa nas mortes relacionadas ao aparelho respiratório em crianças, a pandemia da Covid-19 trouxe um aumento significativo nesse dado, reafirmando assim, a necessidade de se olhar com atenção para esse desafio do sistema de saúde brasileiro

Dinâmica da Coinfecção de TB-HIV na Região Norte antes (2017-2019) e durante a Pandemia(2020-2022)

This article aims to compare cases of co-infection between tuberculosis and HIV in the northern region of Brazil, during the pre-pandemic period (2017 to 2019) and the post-pandemic period (2020 to 2022). This is an epidemiological study of the ecological type of temporal analysis with data obtained in September 2023 from the Department of Informatics of the Unified Health System (DATASUS) and originating from the Notifiable Diseases Information System (SINAN). Analysis of the graphs showed an increase in the lethality rate in 2020 in the northern region, which was not accompanied by an increase in the incidence of TB-HIV co-infection in the same period. In addition, there was a drop in the percentage of infections in the 2020-2023 triennium in the states of Amazonas and Pará, while in the states of Tocantins, Rondônia and Roraima the result was an increase in co-infection rates. Although more studies are still needed to analyze the underreporting of cases during the pandemic, it is inferred that the COVID-19 pandemic contributed to the discrepancy in the incidence of new cases or notification of existing cases in the different states in the north of the country.Este artigo tem como objetivo comparar casos de coinfecção entre Tuberculose e HIV na região Norte do Brasil, durante o período pré-pandêmico (2017 a 2019) e período pós Pandêmico (2020 a 2022). Trata-se de um estudo epidemiológico do tipo ecológico de análise temporal com dados obtidos em setembro de 2023 no Departamento de Informática do Sistema Único de Saúde (DATASUS) e originárias do Sistema de Informação de Agravo de Notificação (SINAN). Foi evidenciado a partir das análises dos gráficos um aumento na taxa de letalidade no ano de 2020 na região norte, não sendo acompanhado pelo aumento na incidência do coinfecção entre TB-HIV no mesmo período, além disso, ocorreu uma queda no percentual de infecções no triênio 2020-2023 nos estados do Amazonas e Pará, enquanto nos estados de Tocantins, Rondônia e Roraima o resultado foi um incremento nas taxas de coinfecção. Embora, ainda sejam necessários mais estudos para analisar a subnotificação dos casos durante a pandemia, infere-se que a pandemia do covid-19 contribuiu para a discrepância na incidência dos novos casos ou notificação dos existentes nos diferentes estados do norte do país

Seminário de Dissertação (2024)

Página da disciplina de Seminário de Dissertação (MPPP, UFPE, 2022) Lista de participantes == https://docs.google.com/spreadsheets/d/1mrULe1y04yPxHUBaF50jhaM1OY8QYJ3zva4N4yvm198/edit#gid=

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research