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To analyze the characteristics associated with vaccination against Covid-19 in pregnant and postpartum women with Severe Acute Respiratory Syndrome in Brazil and to investigate a possible association between vaccination and the clinical course and outcome of the disease. Retrospective cohort study of hospitalized pregnant and postpartum women diagnosed with Severe Acute Respiratory Syndrome (SARS) by SARS-CoV-2, presenting onset of signs and symptoms between May and October 2021. Secondary data were used, available in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe). Data were analyzed using the SPSS statistical program, medians were applied to present continuous variables and frequencies, and proportions were calculated for categorical variables, using logistic and multivariate regression analysis. The final study population included 3,585 pregnant and postpartum women, of whom 596 (16.6) were vaccinated: 443 (74.3%) received one dose and 153 (25.7%) received two doses. They were factors associated with non-vaccination against Covid-19 age ≤ 19 anos (OR: 2.57; IC95% 1.40;4.71), non-white women (OR: 1.34; IC95% 1.07;1.67) and those who required ventilatory support (OR: 1.51; IC95% 1.19;1.90) and invasive ventilation (OR: 2.05; IC95% 1.37;3.08). On the other hand, vaccination was associated with advanced maternal age (OR: 0.60; IC95% 0.48;0.76), presence of comorbidities (OR: 0.57; IC95% 0.45;0.72) and loss of taste (OR: 0.63; IC95% 0.48;0.82). Demographic, ethnic-racial and clinical characteristics were associated with the vaccination status of pregnant and postpartum women with SARS by SARS-CoV-2 in Brazil. Vaccination against Covid-19 in the obstetric population has already shown positive results in the evolution of severe cases, which reiterates its importance. It is essential that health services advance vaccination against Covid-19 in the obstetric population, especially adolescentes and non-white women.

To analyze the incidence of Severe Acute Respiratory Syndrome (SARS), lethality and mortality of Brazilian pregnant and postpartum women infected with SARS-CoV-2, before and after vaccination against Covid-19. This is an ecological study of time series, carried out with secondary data from the Brazilian Ministry of Health, from March 2020 to April 2024. Slopes and trend changes in the time series were identified by Mann-Kendall and generalized fluctuation tests, respectively. The series was modeled using Generalized Additive Models with interaction between time and start of vaccination. A Pearson correlation was used between the number of accumulated doses and the incidence, lethality and mortality rates, in addition to comparing the average rates before and after the vaccination peak of the first dose using ANOVA. Significant temporal variations were observed in the incidence rates of SARS, lethality and mortality in pregnant and postpartum women with SARS-CoV-2, before and after vaccination against Covid-19 in Brazil, with a significant decreasing trend after the start of vaccination. It was observed that time alone did not show a significant effect on the reduction of lethality and mortality rates, which occurred only when there was an interaction effect between time and the start of vaccination. The accumulated doses of the vaccine correlated with the decrease in the analyzed rates, which explained 39.18% of variation in the incidence rate, 43.34% in the lethality rate, and 34.81% in the mortality rate. The monthly averages of the incidence, lethality, and mortality rates before and after vaccination reduced significantly. The findings of this study indicate that vaccination against Covid-19 in Brazilian pregnant and postpartum women had a positive effect on reducing the incidence of SARS by SARS-CoV-2, lethality and mortality rates in the obstetric population.

The increase in violence against health professionals in the COVID-19 pandemic makes it necessary to identify the predictors of violence, in order to prevent these events from happening. Evaluating the prevalence and analyzing the variables involved in the occurrence of violence against health professionals during the COVID-19 pandemic in Brazil. This is a cross-sectional study conducted online involving Brazilian health professionals during the COVID-19 pandemic. The data were collected through a structured questionnaire (Google Online Form) sent to health professionals on social networks and analyzed through logistic regression by using sociodemographic variables. The set of grouped variables was assigned to the final model when p <0.05. A network was built using the Mixed Graph Models (MGM) approach. A centrality measurement chart was constructed to determine which nodes have the greatest influence, strength and connectivity between the nodes around them. The predictors of violence in the adjusted regression model were the following: being a nursing technician / assistant; having been working for less than 20 years; working for over 37 hours a week; having suffered violence before the pandemic; having been contaminated with COVID-19; working in direct contact with patients infected by the virus; and having family members who have suffered violence. The network created with professionals who suffered violence demonstrated that the aggressions occurred mainly in the workplace, with an indication of psycho-verbal violence. In cases in which the aggressors were close people, aggressions were non-verbal and happened both in public and private places. The assaults practiced by strangers occurred in public places. Violence against health professionals occurs implicitly and explicitly, with consequences that can affect both their psychosocial well-being and the assistance given to their patients and families.

Breast cancer remains an important public health problem that is responsible for high morbidity and mortality rates, especially in developing countries. To analyze the socioeconomic and access disparities related to breast cancer mortality in 399 cities in the state of Parana, Brazil. Ecological, descriptive and analytical cross-sectional study based on secondary data from the Mortality Information System from 2009 to 2012 in the state of Parana. Breast cancer mortality rate was calculated considering the mortality cases and women population of each municipality, both based on women older than 20 years old. Moran global and local analyses were used to verify the presence of spatial autocorrelation and spatial regression modeling (Spatial Lag-SAR) with the purpose of analyzing the association between socioeconomic indicators, access and mortality rates for breast cancer. Significant positive spatial autocorrelation was found for breast cancer mortality rates (I = 0.5432, p = 0.001). In the spatial regression analysis, the model explained 61% of the variance of the mortality rates for breast cancer. The mortality rate for breast cancer was negatively associated with the illiteracy rate (Coefficient = -0.0279) and positively associated with the access index (Coefficient = 12.9525). The lower illiteracy rate has not been sufficient to reduce the specific mortality rate by breast cancer, and the higher the score of accessibility to cancer services, the higher the specific mortality due to breast cancer. The results show that in the state of Parana, the problem is not related to a lack of education of the patients or the distance walked, but rather with the organization of services. These conclusions have important political implications on the organization and quality of the services provided for the diagnosis and treatment of breast cancer in the state of Parana.

Brazil is in a critical situation due to the COVID-19 pandemic. Healthcare workers that are in the front line face challenges with a shortage of personal protective equipment, high risk of contamination, low adherence to the social distancing measures by the population, low coronavirus testing with underestimation of cases, and also financial concerns due to the economic crisis in a developing country. This study compared the impact of COVID-19 pandemic among three categories of healthcare workers in Brazil: physicians, nurses, and dentists, about workload, income, protection, training, feelings, behavior, and level of concern and anxiety. The sample was randomly selected and a Google Forms questionnaire was sent by WhatsApp messenger. The survey comprised questions about jobs, income, workload, PPE, training for COVID-19 patient care, behavior and feelings during the pandemic. The number of jobs reduced for all healthcare workers in Brazil during the pandemic, but significantly more for dentists. The workload and income reduced to all healthcare workers. Most healthcare workers did not receive proper training for treating COVID-19 infected patients. Physicians and nurses were feeling more tired than usual. Most of the healthcare workers in all groups reported difficulties in sleeping during the pandemic. The healthcare workers reported a significant impact of COVID-19 pandemic in their income, workload and anxiety, with differences among physicians, nurses and dentists.

ABSTRACT Objective: To analyze the prevalence of syphilis in during pregnancy and its association with socioeconomic characteristics, reproductive history, prenatal and labor care, and newborn characteristics. Method: A retrospective, cross-sectional study based on gestational and congenital syphilis reports. A (records) linkage was performed in the Brazilian databases: “Information System for Notifiable Diseases” (Sistema de Informação de Agravos de Notificação - SINAN); “Live Births Information System” (Sistema de Informação sobre Nascidos Vivos - SINASC); and “Mortality Information System” (Sistema de Informação sobre Mortalidade - SIM). Results: The prevalence of gestational syphilis was 0.57%. The following associations of syphilis in pregnancy were found: non-white skin color/ethnicity (PR=4.6, CI=3.62-5.76); low educational level (PR=15.4; CI=12.60-18.86); and absence of prenatal care (PR=7.4, CI=3.68-14.9). The perinatal outcomes associated with gestational syphilis were prematurity (PR=1.6 CI=1.17-2.21) and low birth weight (PR=1.6; CI=1.14-2.28). Two deaths from congenital syphilis, one death from another cause and five stillbirths were reported. Conclusion: The results signify a long way until reaching the World Health Organization’s goal of eradicating congenital syphilis. RESUMEN Objetivo: analizar la prevalencia de sífilis en la gestación y su asociación con características socioeconómicas, histórico reproductivas, asistencia en el prenatal y parto y, características del recién nacido. Método: estudio retrospectivo, transversal, realizado a partir de las notificaciones de sífilis gestacional y sífilis congénita. Se realizó linkage con los bancos de datos del Sistema de Información de Daños de Notificación, Sistema de Información sobre Nacidos Vivos y Sistema de Información sobre Mortalidad. Resultados: la prevalencia de la sífilis gestacional fue 0,57%. Las siguientes asociaciones a la sífilis en la gestación fueron encontradas: raza/color no blanca (RP=4,6; IC=3,62-5,76); baja escolaridad (RP=15,4; IC=12,60-18,86); y ausencia de acompañamiento prenatal (RP=7,4; IC=3,68-14,9). Los resultados perinatales asociados a la sífilis gestacional fueron prematuridad (RP=1,6 IC=1,17-2,21) y bajo peso al nacer (RP=1,6; IC=1,14-2,28). Se notificaron dos muertes por sífilis congénita, un óbito por otra causa y cinco nacidos muertos. Conclusión: Los resultados señalizan un largo camino para el alcance de la meta de la Organización Mundial de la Salud de erradicación de la sífilis congénita. RESUMO Objetivo: Analisar a prevalência de sífilis na gestação e sua associação com características socioeconômicas, histórico reprodutivo, assistência no pré-natal e no parto e características do recém-nascido. Método: Estudo retrospectivo, transversal, realizado a partir das notificações de sífilis gestacional e sífilis congênita. Realizou-se linkage dos bancos de dados do Sistema de Informação de Agravos de Notificação, Sistema de Informação sobre Nascidos Vivos e Sistema de Informação sobre Mortalidade. Resultados: A prevalência da sífilis gestacional foi de 0,57%. Foram encontradas as seguintes associações à sífilis na gestação: raça/cor não branca (RP=4,6; IC=3,62-5,76); baixa escolaridade (RP=15,4; IC=12,60-18,86); e ausência do pré-natal (RP=7,4; IC=3,68-14,9). Os desfechos perinatais associados à sífilis gestacional foram prematuridade (RP=1,6 IC=1,17-2,21) e baixo peso ao nascer (RP=1,6; IC=1,14-2,28). Notificaram-se dois óbitos por sífilis congênita, um óbito por outra causa e cinco natimortos. Conclusão: Os resultados apontam que há um longo caminho para o alcance da meta da Organização Mundial da Saúde de erradicação da sífilis congênita.

Background The coronavirus 2019 (COVID-19) pandemic impacted cancer health care in several countries, with delays in the detection and treatment of breast and cervical cancer. The objective of this study is to analyze and compare the screening, diagnosis and treatment of breast and cervical cancer in the pre-COVID period and during the COVID-19 period. Methods Cross-sectional study with secondary data collected from the Mortality Information System (SIM), Hospital Information System (SIH), Ambulatory Information System (SIA) and the Oncology Panel (PO) of breast cancer notifications with ICD C50.0 to C50.9 and cervix ICD C53.0 to C53.9, The analyzed period before the pandemic was from March 1 to October 1, 2019, and during the pandemic from March 1 to October 1, 2020. The period from 2013 to 2022 was also analyzed with the same information, including the number of diagnoses, treatments, and deaths from breast cancer and cervical cancer. The study population consisted of Brazilian women aged 25 to 70 years. In order to compare categorical variables between periods, the Chi-Square or Fisher’s Exact tests, and Mann-Whitney U tests were applied, and the Poisson Regression model was applied to model the number of reported cases of COVID-19 and the amount of procedures. Results There was a decrease in the number of mammograms and cytopathological exams during COVID-19, as well as a decrease in cases of breast and cervical cancer. The Poisson regression showed that the increase in the number of COVID-19 cases caused a decrease in the number of breast cytopathological examinations, cervical-vaginal cytopathological examinations/microflora and screening, diagnosis, initiation of treatment for breast cancer and deaths from this disease. Meanwhile, in some regions of Brazil, as the number of Covid-19 increased, there was a significantly increase in the number of mammograms performed and cervical cancer diagnoses. Conclusions The COVID-19 period in 2020 significantly impacted screening, diagnosis, treatment for breast and cervical cancer.

Lung cancer (LC) is one of the main causes of mortality in Brazil; geographic, cultural, socioeconomic and health access factors can affect the development of the disease. We explored the geospatial distribution of LC mortality, and associated factors, between 2015 and 2019, in Parana state, Brazil. We obtained mortality (from the Brazilian Health Informatics Department) and population rates (from the Brazilian Institute of Geography and Statistics [IBGE]) in people over 40 years old, accessibility of oncology centers by municipality, disease diagnosis rate (from Brazilian Ministry of Health), the tobacco production rate (IBGE) and Parana Municipal Performance Index (IPDM) (from Parana Institute for Economic and Social Development). Global Moran's Index and Local Indicators of Spatial Association were performed to evaluate the spatial distribution of LC mortality in Parana state. Ordinary Least Squares Regression and Geographically Weighted Regression were used to verify spatial association between LC mortality and socioeconomic indicators and health service coverage. A strong spatial autocorrelation of LC mortality was observed, with the detection of a large cluster of high LC mortality in the South of Parana state. Spatial regression analysis showed that all independent variables analyzed were directly related to LC mortality by municipality in Paraná. There is a disparity in the LC mortality in Parana state, and inequality of socioeconomic and accessibility to health care services could be associated with it. Our findings may help health managers to intensify actions in regions with vulnerability in the detection and treatment of LC.

Breast cancer is the most common cause of cancer death among women. The objective of this study was to analyze time trends in overall mortality from breast cancer in Brazil, Brazilian regions and States. This is an exploratory study, of the time series of deaths from breast cancer contained in the Mortality Information System (SIM), of women living in Brazil, Brazilian regions and States, from 1996 to 2013. For the trend analysis, the polynomial regression model was used, and a significant trend was considered when the estimated model obtained a p value <0.05. There was a tendency of increased mortality from breast cancer in Brazilian women (average increase of 0.18 per year; p <0.001), with regional differences, particularly in the age group 20-49 years (0.07 per year; p <0.001). The age group 50-69 years remained constant but had high average rates (37.14). More effective planning is needed to focus on the different scenarios of the Brazilian regions. Screening strategies for the incidence and mortality from breast cancer must also be rethought according to age group in the country.

Patients in serious condition due to COVID-19 often require special care in intensive care units (ICUs). This disease has affected over 758 million people and resulted in 6.8 million deaths worldwide. Additionally, the progression of the disease may vary from individual to individual, that is, it is essential to identify the clinical parameters that indicate a good prognosis for the patient. Machine learning (ML) algorithms have been used for analyzing complex medical data and identifying prognostic indicators. However, there is still an urgent need for a model to elucidate the predictors related to patient outcomes. Therefore, this research aimed to verify, through ML, the variables involved in the discharge of patients admitted to the ICU due to COVID-19. In this study, 126 variables were collected with information on demography, hospital length stay and outcome, chronic diseases and tumors, comorbidities and risk factors, complications and adverse events, health care, and vital indicators of patients admitted to an ICU in southern Brazil. These variables were filtered and then selected by a ML algorithm known as decision trees to identify the optimal set of variables for predicting patient discharge using logistic regression. Finally, a confusion matrix was performed to evaluate the model's performance for the selected variables. Of the 532 patients evaluated, 180 were discharged: female (16.92%), with a central venous catheter (23.68%), with a bladder catheter (26.13%), and with an average of 8.46- and 23.65-days using bladder catheter and submitted to mechanical ventilation, respectively. In addition, the chances of discharge increase by 14% for each additional day in the hospital, by 136% for female patients, 716% when there is no bladder catheter, and 737% when no central venous catheter is used. However, the chances of discharge decrease by 3% for each additional year of age and by 9% for each other day of mechanical ventilation. The performance of the training data presented a balanced accuracy of 0.81, sensitivity of 0.74, specificity of 0.88, and the kappa value was 0.64. The test performance had a balanced accuracy of 0.85, sensitivity 0.75, specificity 0.95, and kappa value of 0.73. The McNemar test found that there were no significant differences in the error rates in the training and test data, suggesting good classification. This work showed that female, the absence of a central venous catheter and bladder catheter, shorter mechanical ventilation, and bladder catheter duration were associated with a greater chance of hospital discharge. These results may help develop measures that lead to a good prognosis for the patient.