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Dinâmica da transmissão de chikungunya e associação com indicadores de vulnerabilidade social no Brasil

2025-11-26T13:23:17Z

Título: Dinâmica da transmissão de chikungunya e associação com indicadores de vulnerabilidade social no Brasil Autor(es): Santos, Thiago de Jesus Abstract: Introduction: In Brazil, Chikungunya epidemics have been recurrent since the virus was introduced into the country in 2014. Environmental, social, economic and political factors influence the transmission dynamics and emergence of the epidemic. The use of advanced technologies, such as geoprocessing and spatial analysis, plays a crucial role in identifying areas at risk for the incidence of the disease and in planning surveillance strategies and implementing control actions. Objective: To analyze the spatial and temporal dynamics of the incidence of Chikungunya and the association with indicators of social vulnerability in Brazil. Materials and methods: Ecological, exploratory and analytical study, which was conducted in Brazil. Records of cases reported and confirmed by clinical and clinical-epidemiological criteria of Chikungunya between the years 2017 and 2023 obtained from SINAN were used. Data relating to social vulnerability indicators were collected on the official platform of the United Nations Development Program and the Social Vulnerability Atlas. Data analysis occurred in stages: 1) characterization of the epidemiological profile of Chikungunya incidence; 2) prediction of new cases and an interrupted time series using ARIMA considering the Covid-19 pandemic; 3) temporal trends using the Prais-Winsten regression model and determination of annual percentage change; 4) spatial distribution using the local empirical Bayesian method, global and local Moran index; and 5) association between social vulnerability indicators and the incidence of Chikungunya applying global spatial regression and multiscale geographically weighted regression. Results: The analyzes showed a total of 487,775 cases of Chikungunya diagnosed in Brazil between 2017 and 2023 with an incidence of 232.1/100 thousand inhabitants, with a higher incidence in the northeast region (58.8/100 thousand inhabitants). The time series demonstrated the impact of seasonality on the incidence of the disease with an average of 2,000 cases monthly/year. With the Covid-19 pandemic in 2020, the interrupted time series demonstrated a reduction in notification. In the first ARIMA model, it was not possible to predict new cases. In the second model, it was observed that without the influence of the pandemic, there would be an increase in cases. The temporal trend showed that in 2017, the incidence increased by 1.90% and there was a decreasing trend in the period from 2020 to 2021 with a reduction of -0.93% of cases. The spatial distribution was heterogeneous and showed positive spatial autocorrelation (I: 0.71; p <0.001). The highest risk areas were concentrated in the northeast region. The factors associated with the incidence of Chikungunya in Brazil were: the social vulnerability index (R2: -1.28; p=0.003), IVS income and work (R2: 1.93; p=<0.001), percentage of people in households with inadequate water supply and sanitation (R2: 0.80; p=0.002), percentage of people aged 15 to 24 who do not study, do not work and have a per capita household income equal to or less than half the minimum wage ( R2: 0.16; p=0.003), percentage of people living in households with a per capita income of less than half the minimum wage and who spend more than one hour commuting to work (R2: 0.94; p<0.001), percentage of the population in households with density > 2 (R2: 0.58; p <0.001). The local regression pointed to the northeast region with the highest association values (t: 0.45; p <0.001), with the percentage of people in households with inadequate water supply and sewage disposal (R2: 0.80; p=0.002) and percentage of the population in households with density > 2 (R2: 0.58; p <0.001) the most impactful factors. Conclusion: The study allowed an integrated analysis of the transmission dynamics of Chikungunya in Brazil and the associated factors. The integration of technologies and multifaceted analyzes allows the mapping of risk areas and evidence for the development of public health strategies.

Fatores de risco para mortalidade hospitalar após acidente vascular cerebral

2025-11-26T00:01:34Z

Título: Fatores de risco para mortalidade hospitalar após acidente vascular cerebral Autor(es): Santana, Silvia Mayla Santos de Abstract: Introduction: Stroke is the most prevalent neurological disorder in Brazil and worldwide. It is characterized by focal involvement in cerebral blood circulation, leading to sensory, motor, and cognitive alterations. Ischemic stroke (IS) is the most prevalent type, characterized by the interruption of blood flow due to vessel obstruction, resulting in the formation of ischemic areas in the brain and, consequently, temporary or permanent clinical repercussions. Objective: To assess risk factors for in-hospital mortality in patients after IS. Method: This is a prospective cohort study that included patients with a primary diagnosis of IS, admitted within 24 hours of symptom onset, and diagnosed using cranial computed tomography. Data were collected prospectively on a daily basis, actively seeking patients in the hospital's emergency sectors from admission to discharge. Sociodemographic, clinical, previous history, severity, complications, hospitalization, and outcomes variables were analyzed using various statistical methods, including the Mann-Whitney test, Pearson's Chi-square test, Fisher's exact test, and Poisson regression models to evaluate relationships between dependent and independent variables. Results: The study included 91 patients, with 53% females and 47% males, with a mean age of 65 (SD=13.9) years. Regarding IS types and complications, IS without other alterations stood out (84.6%), followed by extensive or malignant IS (9.9%), and lastly, IS with hemorrhagic transformation (5.5%). Concerning reperfusion therapy, the study showed that 22% of patients underwent intravenous thrombolysis, with 44.8% arriving within four hours and 30 minutes of symptom onset. Regarding complications and outcomes during hospitalization, 73.6% were discharged, and 25.3% died in the hospital. Patients with a higher likelihood of in-hospital death were those with malignant or extensive IS (Consciousness Impairment [CI] = 42, p < 0.001), patients with National Institutes of Health Stroke Scale (NIHSS) (CI = 4.89, p = 0.008), absence of bilateral pupillary light reflex (CI = 5.90, p = 0.009), anticoagulant use (CI = 6.84, p = 0.005), respiratory infection (CI = 8.85, p = 0.017), elevated C-reactive protein levels (CI = 248, p < 0.001), need for Intensive Care Unit (ICU) (CI = 25.39, p < 0.001), mechanical ventilation (CI = 138, p < 0.001), and use of hospital neuromuscular blockers (CI = 12.59, p = 0.033). Additionally, patients with Alberta Stroke Program Early Computed Tomography Score between 0 and 5 and NIHSS greater than 16 had a significantly higher odds ratio for in-hospital death. Conclusion: Patients with more severe conditions, greater cerebral involvement, and at least one complication during hospitalization had a higher risk of in-hospital death. Distance did not significantly influence the mortality of IS patients, and not reaching the therapeutic window or not undergoing thrombolysis were not risk factors for death.

Práticas integrativas e complementares no âmbito da enfermagem: a formação profissional na região nordeste do Brasil

2025-11-25T23:53:30Z

Título: Práticas integrativas e complementares no âmbito da enfermagem: a formação profissional na região nordeste do Brasil Autor(es): Cabral, Ravenna da Silva Abstract: Objective: To analyze the sociodemographic profile and professional training of nurses specializing in integrative and complementary health practices in the Northeast Region of Brazil. Method: This is a mixed methods study with a quantitative and qualitative approach, carried out with nurses from the Northeast. Data collection was carried out in two stages, using two instruments, a virtual questionnaire and an interview guide. Quantitative data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 20.0 software. And the qualitative data were analyzed using Bardin's content analysis. Results: 151 nurses from the Northeast Region participated in the research, of which 68 (45.0%) had training in PICS. There was a predominance of females 55 (81.0%), single 27 (40.0%), mixed race 34 (50.0%), Catholic 32 (47.0%), working as contract service providers 42 (58 .0%), with public employment 46 (66.0%). Highlighting Primary Care with 20 (25.0%) as a place of operation. The states that had the most nurses in the area were: Sergipe with 21 (31.0%), followed by Bahia with 18 (26.0%) and Rio Grande do Norte with 10 (15.0%). The most predominant PICS were: auriculotherapy 42 (15.90%), followed by reike 24 (9.09%) and aromatherapy 23 (8.71%). Regarding the training profile, 60 (88.0%) had a postgraduate degree, with specialization/residency being the most mentioned 37 (55.0%), followed by academic and professional master's degrees with 13 (19.0%). However, only 13 (16.0%) had specialization in PICS. Knowledge about practices occurred during their professional lives according to 30 (44.0%) participants, followed by 19 (28.0%) at graduation. Updated courses in the area predominated 1 to 3 times a year, mentioned by 34 (45.0%) nurses, followed by 27 (36.0%) whenever a free opportunity appears. Conclusion: Nurses in the Northeast specializing in PICS have a predominant profile similar to the general profile of nurses. The training of these professionals is still not widespread, with no part being studied during graduation and with a minority of professionals with postgraduate degrees in the area. This study highlighted the need for strategies to advance training, stimulating curricular changes in higher education in nursing, with the aim of expanding the number of professionals in this area and therefore improving teaching and the quality of assistance provided, with comprehensive and humanized care regardless of their area of activity.

Qualidade de vida, religiosidade e espiritualidade em profissionais de saúde do Estado de Sergipe

2025-11-25T20:57:33Z

Título: Qualidade de vida, religiosidade e espiritualidade em profissionais de saúde do Estado de Sergipe Autor(es): Sousa, Paulo Henrique Santana Feitosa Abstract: Introduction: health professionals are constantly exposed to risks inherent to their work regime, dealing daily with the health-disease process, which can influence the quality of life involving domains of physical health, psychosocial status, personal beliefs and social relationships. With the advancement of science, it has been proven that faith has scientificity and is linked to human physiology and impacts on these domains, as well as religiosity and/or spirituality (R/S). Therefore, aspects of how health professionals feel about quality of life, health and other areas of life, associating them with religiosity and/or spirituality, are important for workers' health, occupational health and well-being. Objectives: to evaluate the perception of quality of life of health professionals in Sergipe and its possible relationships with spirituality and religiosity. Materials and methods: cross-sectional survey study, carried out in public and private hospitals in the State of Sergipe, which included mid- and higher-level health professionals. The data collection instruments were the sociodemographic questionnaire, the World Health Organization Quality Of Life (WHOQOL-SRPB-bref), the Spirituality-Related Attitudes Scale (ARES) and the Duke Religiosity Index (DUREL). All stages of the research were carried out in a virtual environment. Data were exported to R Core Team software (Version 4.1.0). After being coded and tabulated, they were analyzed using descriptive statistics and quantitative variables, presented using measures of central tendency and dispersion measures (mean, median and quartile); for categorical variables, relative and absolute frequencies. The hypothesis of independence between categorical variables was tested using Pearson's Chi-Square and Fisher's Exact tests. Results: 211 professionals participated in the study, with a mean age of 36.6 years (SD:8.2), 74.9% were female, 59.7% identified themselves as brown, 94.3%, 60 .7% have an income of 3 minimum wages. A mean of 71.5 (SD:14) was found in the Physical domains; psychological, 66.8 points (SD:14.8); Social Relations, 69.3 points (SD:16.8); Environment, 61.4 points (SD:14.2); Spirituality/Religion/Personal Beliefs, 74.6 points (SD:15); in the Global Quality of Life item, 69.9 points (SD:20.4); in the General Perception of Health item, 66.4 points (SD:21); and in total: 68.9 points (SD:11.6). On the ARES scale, there was an average of 22.8 points in the Beliefs and Spirituality domain (SD:3); in the domain Spiritual practices, 8.9 points (SD:1.8); in the Spiritual Experiences domain, 9.1 points (SD:1.5); Attitudes/consequences, 13.7 points (SD:2.1); and in total: 54.5 points (SD:7.4). With regard to the DUREL scale, an average of 3.4 points was observed in the Organizational Religiosity domain (SD:1.4), in the Non-Organizational Religiosity domain of 3.1 points (SD:1.6) and in the Religiosity domain Intrinsic score of 5.3 points (SD:2.4). Conclusion: The data from this investigation demonstrated a satisfactory Quality of Life (QoL) for health professionals. Gender, income, level of education and type of service (public or private) positively influenced the perception of QoL. Nursing was the professional category that most showed dissatisfaction and negative impact due to income on QoL. The Religiosity and Spirituality presented by the interviewees were satisfactory (above average) and demonstrated to be influenced by gender, income, sector of work and having children. These findings allowed reflecting on the relationship between QoL, Religiosity and Spirituality (R/S), and concluding that these give meaning to the lives of health professionals, as well as encouraging them to have better relationships. It is suggested that, given the results found, institutional measures be adopted to improve the quality of life of health professionals and that the teaching of religiosity and spirituality be included in academic curricula, once its positive impact on the perception of quality of life is proven.