Syphilis Trigram: a domain-specific visualisation to combat syphilis epidemic and improve the quality of maternal and child health in Brazil

Background: The Brazilian health system is a large and complex system, especially considering its mixed public and private funding. The number of syphilis cases has been increasing greatly in the last four years, even though it has a cheap and simple treatment. Syphilis notification is compulsory by law, and public health surveillance pays great importance to syphilis notification during pregnancy. Syphilis infection can cause severe newborn conditions, premature births, and abortions. Methods: The Action Research methodology was applied to deal with the complex syphilis surveillance reality in Pernambuco, Brazil. Iterative learning cycles were used, totalling six cycles with a formal validation of an operational version of the Syphilis Trigram visualisation at the end of the process. The original data source was analysed and prepared for use without any new data or changes in the ordinary procedure of the current system. Results: The main result of this study is the Syphilis Trigram, a domain-specific infographic for presenting gestational and birth data. The second contribution of this study is the Average Trigram, an organised pie chart which synthesises the Syphilis Trigram relationship in an aggregated manner. Both visualisations are presented in an Infographic User Interface, a tool that gathers an infographic broad visualisation sense for data visualisation. These interfaces also gather selection and filter tools to assist and refine the presented information. The user can experience a specific case-by-case view and an aggregated perspective by any city monitored by the system. Conclusions: The proposed domain-specific visualisation amplifies the understanding of each syphilis case and the overall case characteristics of a city. This new information produced by the Trigram can clarify the reinfection/relapse cases, optimise resource allocation, and enhance syphilis healthcare policies without any new data. Therefore, health surveillance professionals can see the broad tendency, understand the key patterns through visualisation, and take action in a feasible time.

Description of e-Health Initiatives to Reduce Chronic Non-Communicable Disease Burden on Brazilian Health System

Chronic non-communicable diseases (NCD) account for 72% of the causes of death in Brazil. In 2013, 54 million Brazilians reported having at least one NCD. The implementation of e-Health in the Unified Health System (SUS) could fill gaps in access to health in primary health care (PHC). Objective: to demonstrate telehealth strategies carried out within the scope of the Institutional Development Support Program of the Unified Health System (PROADI-SUS) and developed by Hospital Alemão Oswaldo Cruz, between 2018 and 2021, on evaluation, supply, and problem-solving capacity for patients with NCDs. Methodology: a prospective and descriptive study of three projects in the telehealth areas, using document analysis. The Brasil Redes project used availability, implementation, and cost-effectiveness analysis, TELEconsulta Diabetes is a randomized clinical trial, and Regula Mais Brasil is focused on the waiting list for regulation of specialties. All those strategies were developed within the scope of the SUS. Results: 161 patients were attended by endocrinology teleconsultation in one project and another two research projects, one evaluating Brazil’s Telehealth Network Program, and another evaluating effectiveness and safety of teleconsultation in patients with diabetes mellitus referred from primary care to specialized care in SUS. Despite the discrepancy in the provision of telehealth services in the country, there was an increase in access to specialized care on the three projects and especially on the Regula Mais Brasil Collaborative project; we observed a reduction on waiting time and favored distance education processes. Conclusion: the three projects offered subsidies for decision-making by the Ministry of Health in e-Health and two developed technologies that could be incorporated into SUS.

Snakebites in Rural Areas of Brazil by Race: Indigenous the Most Exposed Group

Animal stings are environmental hazards that threaten millions annually and cause a significant socioeconomic impact. Snakebite envenoming affects 2.7 million people globally every year, mostly the poorest and rural communities, with approximately 27,000 annual cases in Brazil. This study’s objective is to identify the most exposed racial group for snakebites in rural areas of Brazil and analyze possible differences in the outcome of an accident. A retrospective epidemiological study was conducted using a database of rural snakebite cases from Brazil’s Ministry of Health (2017). Descriptive analysis and a regression model were performed to examine the association of bad outcomes after a snakebite with several covariables. While mixed-race individuals presented the highest number of cases (61.79%), indigenous and white populations were the racial groups with the highest and lowest exposure rates (194.3 and 34.1 per 100,000 population, respectively). The fatality rate was 3.5 times higher in the indigenous population compared to the white population. In the multivariable model, the number of hours between the accident and health care received and the case classification suggested an association with a bad outcome. Snakebite is prominent in Brazil, particularly among indigenous groups. Antivenom is available in the Brazilian Health System; however, efforts need to be made for decentralization.

Physicians Working Conditions Under Brazilian Labor and Employment

In Brazil, Physician employment is regulated by several federal laws. However, it is common to find physicians working in hospitals under contracts signed with individual companies. In such cases, there are no restrictions to maximum working hours. In addition, in 2017, Brazilian Labor and Employment laws passed through deep flexibility, making it easier for employers to decrease the protection of workers against the power of the capital, which worsened the health conditions of both physicians and patients. In 2018, right before the presidential elections, voters pointed out that violence and health are the worse problems in Brazil. One year after that, most Brazilians, who answered a new survey, indicated that health was the country’s worse problem. In this article, I will analyze the relationship between physicians' working conditions and the situation of the Brazilian health system.

Temporal Trend of Near Miss and its Regional Variations in Brazil from 2010 to 2018

Cases of maternal near miss are those in which women survive severe maternal complications during pregnancy or the puerperium. This ecological study aimed to identify the temporal trend of near-miss cases in different regions of Brazil between 2010 and 2018, using data from the Hospital Information System (HIS) of the Unified Brazilian Health System (SUS, in the Portuguese acronym). Hospital admission records of women between 10 and 49 years old with diagnosis included in the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and codes indicating near-miss events were selected. From 20,891,040 admissions due to obstetric causes, 766,249 (3.66%) near-miss cases were identified, and 31,475 women needed admission to the intensive care unit (ICU). The cases were found to be more predominant in black women over 35 years old from the North and Northeast regions. There was a trend of increase in near-miss rates of ∼ 13.5% a year during the period of the study. The trend presented a different behavior depending on the level of development of the region studied. The main causes of near miss were preeclampsia (47%), hemorrhage (24%), and sepsis (18%).