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The article presents an analysis of the spatial distribution of mortality from COVID-19 and its association with socioeconomic indicators in the north-eastern region of Brazil - an area particularly vulnerable with regard to these indicators. This populationbased ecology study was carried out at the municipal level in the years 2020 and 2021, with analyses performed by spatial autocorrelation, multiple linear regression and spatial autoregressive models. The results showed that mortality from COVID-19 in this part of Brazil was higher in the most populous cities with better socioeconomic indicators. Factors such as the onset of the COVID-19 pandemic in large cities, the agglomerations existing within them, the pressure to maintain economic activities and mistakes in the management of the pandemic by the Brazilian federal Government were part of the complex scenario related to the spread of COVID-19 in the country and this study was undertaken in an attempt to understand this situation. Analysing the different scenarios is essential to face the challenges posed by the pandemic to the world's health systems.

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O estudo analisa a associação das taxas de incidência e mortalidade por COVID-19 nos municípios do estado de Sergipe ­ Brasil com indicadores de vulnerabilidade social e desenvolvimento humano utilizados no país; e com a taxa de realização de exames RT PCR para diagnóstico da doença realizados por município. Trata-se de estudo ecológico dos casos e óbitos por COVID-19 acumulados de março de 2020 a março de 2021, ocorridos no Estado de Sergipe por município; e sua correlação com o Índice de Vulnerabilidade Social (IVS), Índice de Desenvolvimento Humano Municipal (IDHM) e quantidade de testes RT PCR realizados para diagnóstico da doença, utilizando a correlação de Spearman (ρ). Contrariando nossas hipóteses e a literatura científica, os municípios com maiores índices de vulnerabilidade social e menor desenvolvimento humano tiveram menos casos da doença e óbitos por habitante, ao mesmo tempo que testaram menos para o diagnóstico da COVID-19. O estudo aponta a iniquidade como fator a ser superado no enfrentamento da pandemia, por prejudicar um diagnóstico de cenário mais próximo da realidade, comprometendo o planejamento e implementação de medidas de saúde coletiva.

This study analyzes the association of incidence and mortality rates by COVID-19 in the municipalities of the state of Sergipe, Brazil with indicators of social vulnerability and human development used in the country, as well as with the rate of RT-PCR exams for the diagnosis of the disease performed by each municipality. This is an ecological study of COVID-19 cases and deaths accumulated from March 2020 to March 2021, which occurred in the State of Sergipe by municipality; and its correlation with the Social Vulnerability Index (SVI), Municipal Human Development Index (MHDI), and number of RT-PCR tests performed to diagnose the disease, using Spearman's correlation (ρ). Contrary to our hypotheses and the scientific literature, municipalities with higher rates of social vulnerability and lower human development had fewer cases of the disease and deaths per inhabitant, while testing less for the diagnosis of COVID-19. The study points to inequity as a factor to be overcome in the face of the pandemic, as it impairs a proper diagnosis of the scenario closer to reality, compromising the planning and implementation of collective health measures.

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OBJECTIVE: The aim of this study was to investigate the levels of physical activity (PA) and quality of life (QOL) in adults and elderly individuals with lower limb amputation (LLA). METHODS: This was a cross-sectional observational study. Participants completed three surveys as follows: a demographic survey, the International Physical Activity Questionnaire, and the World Health Organization Quality of Life. Thirty-six individuals with lower limb amputation were separated into two different groups as follows: Adults-lower limb amputation (n=12), composed of individuals with lower limb amputation who aged from 18-59 years, and Elderly-lower limb amputation (n=24), composed of individuals with lower limb amputation who aged 60 years and above. Statistical differences were determined as p<0.05. RESULTS: Age and number of individuals with a low level of functional independency were higher in the Elderly-lower limb amputation group (p<0.05). The International Physical Activity Questionnaire scores were reduced in the Elderly-lower limb amputation group (p<0.05). The Pearson's correlation test between low metabolic equivalent task (MET), time since amputation, and family income presented positive significant results in the Elderly-lower limb amputation (p<0.05). Adults-lower limb amputation just presents a positive significant correlation with the low family income (p<0.05). CONCLUSION: Elderly individuals with lower limb amputation are more susceptible to present negative health outcomes than adults with lower limb amputation.

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SUMMARY OBJECTIVE: The aim of this study was to investigate the levels of physical activity (PA) and quality of life (QOL) in adults and elderly individuals with lower limb amputation (LLA). METHODS: This was a cross-sectional observational study. Participants completed three surveys as follows: a demographic survey, the International Physical Activity Questionnaire, and the World Health Organization Quality of Life. Thirty-six individuals with lower limb amputation were separated into two different groups as follows: Adults-lower limb amputation (n=12), composed of individuals with lower limb amputation who aged from 18-59 years, and Elderly-lower limb amputation (n=24), composed of individuals with lower limb amputation who aged 60 years and above. Statistical differences were determined as p<0.05. RESULTS: Age and number of individuals with a low level of functional independency were higher in the Elderly-lower limb amputation group (p<0.05). The International Physical Activity Questionnaire scores were reduced in the Elderly-lower limb amputation group (p<0.05). The Pearson's correlation test between low metabolic equivalent task (MET), time since amputation, and family income presented positive significant results in the Elderly-lower limb amputation (p<0.05). Adults-lower limb amputation just presents a positive significant correlation with the low family income (p<0.05). CONCLUSION: Elderly individuals with lower limb amputation are more susceptible to present negative health outcomes than adults with lower limb amputation.

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BACKGROUND: We characterise the loss to follow-up (locally termed abandoned) of tuberculosis treatment with individual and ecological health determinants and to identify the predictive capacity of these risk factors. METHODS: A cohort study with individual and ecological characterisation of patients diagnosed with tuberculosis in Sergipe/Brazil from 2015 to 2018 with either loss to follow-up or completion of treatment as a therapeutic outcome was performed. The examined variables were based on the social determinants of health with descriptive analysis, binary logistic regression, a generalised hierarchical model and graphical presentation using a nomogram. RESULTS: The loss to follow-up accounted for 18.21% of the 2,449 studied cases. The characteristics revealed that the highest abandonment percentages were people who: were male (20.0%), had black skin colour (20.3%), were aged 20-39 years (21.8%), had 4-7 years of schooling (23.6%), re-entered treatment after abandonment (36.5%), used alcohol (31.0%), used drugs (39.3%), were smokers (26.5%) and were homeless (55.4%). The ecological characteristics showed that individuals living in municipalities with a high human development index (HDI; odds ratio [OR]: 1.91) and high-income inequality (OR: 1.81) had a greater chance of not finishing the treatment. Most of these variables were identified as predictors in the generalised hierarchical model; the receiver operating characteristic curve (ROC) curve had 0.771 precision and 84.0% accuracy. CONCLUSION: The group of identified characteristics influenced the loss to follow-up of tuberculosis treatment. This data provides evidence for the early identification of individuals who are at greater risk of abandoning tuberculosis treatment.

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Prostate cancer differently affects different regions of the world, displaying higher rates in more developed areas. After the implementation of prostate-specific antigen (PSA) testing, several studies described rising rates globally, but it is possible that indolent lesions are being detected given the lack of changes in mortality data. The Brazilian government recommends against PSA screening in the male population regardless of age, but the Urology Society issued a report recommending that screening should start at 50 years old for certain men and for those aged ≥75 years with a life expectancy exceeding 10 years. In this study, we examined the incidence and mortality rates of invasive prostate cancer over time in the Sergipe state of Brazil. The databases of the Aracaju Cancer Registry and Mortality Information System were used to calculate age-standardized rates for all prostate tumors (International Classification of Diseases 10th edition: C61 and D07.5) in the following age ranges: 20-44, 45-54, and ≥65 years. We identified 3595 cases of cancer, 30 glandular intraepithelial high-grade lesions, and 3269 deaths. Using the Joinpoint Regression Program, we found that the incidence of prostate cancer dramatically increased over time until the mid-2000s for all age groups, after which the rates declined. Prostate cancer mortality rates increased until 2005, followed by a non-significant annual percent change of 22.0 in 2001-2005 and a stable rate thereafter. We noticed that the increases and decreases of the incidence rates of prostate cancer were associated with the screening recommendations. Meanwhile, the increased mortality rates did not appear to be associated with decreased PSA testing; instead, they were linked to the effects of age and improvements in identification of the cause of death. Thus, we do not believe a PSA screening program would benefit the population of this study.

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BACKGROUND: Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 strain, was first identified in late 2019 in China. The outcomes of patients affected by the virus can worsen, developing acute respiratory failure and other serious complications, especially in older individuals and people with obesity and comorbidities. Thus, obese patients tend to have a more severe course of COVID-19. Thus, this review aims to synthesize the evidence in the literature that associates COVID-19 and the severity of clinical outcomes in infected obese patients. METHODS: This protocol was designed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols Statement. Scientific and gray literature will be systematically selected from PubMed/MEDLINE, Latin American Literature in Health Sciences, Online Scientific Electronic Library, Scopus, ScienceDirect, Web of Science, Embase, and Cochrane. The selection of articles will be limited to studies published in English, Portuguese, and Spanish from December 2019 onwards. The main clinical outcomes will be clinical severity in obese patients with COVID-19 as tachypnea (respiratory rate, ≥ 30 breaths per minute), hypoxemia (oxygen saturation, ≤ 93%), the ratio of the partial pressure of arterial oxygen to fraction of inspired oxygen (< 300), lung infiltrate (> 50% of the lung field involved within 24-48 h), diagnosis of the severe acute respiratory syndrome, need of invasive mechanical ventilation, and mortality. Two reviewers will independently screen all citations, full-text articles, and abstract data. Selection bias will be minimized by excluding studies published before December 2019. Conflicts will be resolved through a third reviewer and consensus-building. Moreover, findings will be reported using narrative synthesis and tabulation of the summaries. DISCUSSION: Given the need for early detection of the possible implications and treatment for patients with obesity diagnosed with COVID-19, the scoping review will be useful to capture the state of the current literature, identify the gaps, and make recommendations for future research for directing the conduct and optimization of therapies in these patients by the multiprofessional teams. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework: https://osf.io/xrkec.

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OBJECTIVES: This study was conducted to analyze the trends in colorectal cancer (CRC) incidence and mortality in the city of Aracaju, Sergipe State, Brazil, between 1996 and 2015 with Joinpoint Regression Program 4.7.0.0 and to identify the geographical distribution of CRC in the municipality. RESULTS: A total of 1322 cases of CRC and 467 CRC-related deaths during the study period were included. In total, 40% of the incident cases and 43% of the deaths occurred in men, while 60% of the incident cases and 57% of the deaths occurred in women. Males who were 20 to 44 years old had the most significant trend in growth. Among women, those in the group aged 45 to 64 years had the highest observed annual percent change (APC). In both sexes, mortality was stable. Regarding the geographic distribution, there were constant hotspots in the northeast region of the municipality. This study showed a significant increase in incidence, mainly in young men between 20 and 44 years of age, but stable mortality in Aracaju.

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RESUMO O objetivo deste estudo foi descrever a prevalência de paralisia cerebral entre crianças e adolescentes, seus subtipos, as possíveis comorbidades e as características socioeconômicas das famílias. Foi realizado um estudo epidemiológico do tipo transversal a partir de um inquérito de base populacional sobre a paralisia cerebral em crianças e adolescentes na cidade de Aracaju (SE), Brasil. O estudo obteve informações sobre 240 crianças e adolescentes com paralisia cerebral a partir das respostas a um questionário feitas por seus responsáveis. Foi encontrada a prevalência de período de 1,37 em cada mil. Alguns bairros possuem prevalência de três a quatro vezes maior, revelando que a taxa de prevalência total não é um indicador homogêneo. A maioria dos participantes foi do sexo masculino (56,25%), de raça/cor declarada como parda ou preta (67,50%), sendo que a média de idade foi de 8,56 anos. A paralisia cerebral de tipo espástica bilateral foi a mais frequente (45,42%) e a comorbidade referida na maioria dos casos foi a epilepsia (48,33%). A renda familiar mensal correspondia a $252,87 dólares. O estudo revelou que as crianças e adolescentes com paralisia cerebral são, em grande parte, pertencentes a minorias sociais, de raça/cor parda ou preta, e suas famílias vivem na linha da extrema pobreza.

RESUMEN El objetivo de este estudio fue describir la prevalencia de parálisis cerebral en niños y adolescentes, sus subtipos, las posibles comorbilidades y las características socioeconómicas de las familias. Se realizó un estudio epidemiológico transversal a partir de una encuesta poblacional sobre parálisis cerebral en niños y adolescentes de la ciudad de Aracaju, Brasil. El estudio obtuvo información de 240 niños y adolescentes con parálisis cerebral con base en las respuestas de sus padres a un cuestionario. Se encontró la prevalencia de período de 1,37 por mil. Algunos barrios tienen una prevalencia de tres a cuatro veces mayor, lo que revela que la tasa de prevalencia total no es un indicador homogéneo. La mayoría de los participantes eran varones (56,25%), de raza/color declarado parda o negra (67,50%), con un promedio de edad de 8,56 años. La parálisis cerebral espástica bilateral fue la más frecuente (45,42%), y la comorbilidad reportada en la mayoría de los casos fue la epilepsia (48,33%). El ingreso familiar mensual correspondió a 252,87 dólares. El estudio reveló que los niños y adolescentes con parálisis cerebral son mayoritariamente de minorías sociales, raza/color parda o negra, y sus familias viven en extrema pobreza.

ABSTRACT This study aimed to describe the prevalence of cerebral palsy among children and adolescents, its subtypes, associated comorbidities, and socioeconomic characteristics of families. This is a cross-sectional epidemiological study conducted from a population-based survey on cerebral palsy among children and adolescents in the city of Aracaju, Sergipe, Brazil. Results: Based on guardians' answers to the proposed questionnaire, we obtained data on 240 children and adolescents with cerebral palsy in Aracaju. The period prevalence of cerebral palsy was 1.37 per 1,000 people. Some neighborhoods showed a prevalence three to four times higher than that found to the overall city, indicating that the total prevalence is not a homogeneous indicator. Most participants were male (56.25%), self-declared as mixed-race or Black (67.50%), and aged 8.56 years on average. Bilateral spastic was the most prevalent cerebral palsy subtype (45.42%), and epilepsy was the most common comorbidity (48.33%) along with intellectual disability. Household monthly income was $ 252.87. Our results indicate that children and adolescents with cerebral palsy are mostly from minoritized groups, Black or mixed-race, and live in extreme poverty.

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Tuberculosis continues to be of the most frequent diseases in the world and one of the main causes of morbidity and mortality. Data from the World Health Organization indicate that Brazil accounts for 75% of global cases involving children. The study aims to analyze the epidemiological and spatial pattern of tuberculosis in children and adolescents in the state of Sergipe during the period from 2001 to 2017. This is an ecological, temporal series study using secondary data. The categorical variables were summarized in simple and absolute frequency. In the spatial analysis the Bayesian method for rate smoothing and the Moran index were used to evaluate spatial autocorrelation. Trend analysis was performed using the Joinpoint regression model. The mean incidence rate was 5.9, with a predominance of 15 to 19 years of age (76.4%) and a steady trend, but with a positive annual variation in both sexes. Tuberculosis in children and adolescents has significant spatial dependence in the north and northeast regions. The knowledge of the epidemiological situation of tuberculosis over the years provides subsidies for the targeting of resources in risk areas and new strategies for prevention and control of the disease among children and adolescents.

A tuberculose continua como uma das doenças mais frequentes no mundo e uma das principais causas de morbimortalidade. Dados da Organização Mundial de Saúde indicam que o Brasil responde por 75% dos casos mundiais envolvendo crianças. O estudo objetiva analisar o padrão epidemiológico e espacial da tuberculose em crianças e adolescentes no estado de Sergipe durante o período de 2001 a 2017. Trata-se de um estudo ecológico, de serie temporal, com uso de dados secundários. As variáveis categóricas foram sumarizadas em frequência simples e absoluta. Na análise espacial foi utilizado o método bayesiano para suavização de taxas e o índice de Moran para avaliar a autocorrelação espacial. A análise de tendência foi realizada por meio do modelo de regressão Joinpoint. Verificou que a taxa média de incidência foi de 5,9 com predomínio na faixa etária 15 a 19 anos (76,4%) e tendência estacionaria, porém com variação anual positiva em ambos os sexos. A tuberculose em crianças e adolescentes apresenta dependência espacial significante nas regiões norte e nordeste. O conhecimento da situação epidemiológica da tuberculose ao longo dos anos fornece subsídios para o direcionamento de recursos em áreas de risco e às novas estratégias de prevenção e controle da doença em crianças e adolescentes.

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