Nevin Manimala

Hepatol Commun. 2025 Jan 16;9(2):e0620. doi: 10.1097/HC9.0000000000000620. eCollection 2025 Feb 1.

ABSTRACT

BACKGROUND: Refractory ascites (RA) remains a serious complication in patients with cirrhosis. Currently, the insertion of a TIPS is considered the standard of care in these patients. To achieve symptom control in those with TIPS contraindications, tunneled peritoneal catheters (PeCa) or ascites pumps were introduced. However, data comparing the available treatment options are scarce. This study aims to compare outcomes among patients with RA treated either with TIPS, PeCa, or ascites pump.

METHODS: All patients with RA and cirrhosis treated at Hannover Medical School between 2009 and 2023 were evaluated. Endpoints included mortality, acute kidney injury (AKI), hyponatremia, peritonitis, and rehospitalization rate. Propensity score matching was conducted to adjust for group differences.

RESULTS: First, 31 patients with ascites pump were compared to 62 patients with a PeCa after propensity score matching. There were no differences regarding mortality nor incidences of AKI, hyponatremia, or rehospitalization. However, incidences of peritonitis and explantation were lower in those with ascites pump (HR 0.32, 95% CI: 0.15-0.70, and HR 0.32, 95% CI: 0.14-0.71, respectively). Second, 35 ascites pump patients were matched with 70 individuals with TIPS. No differences regarding mortality or peritonitis incidence were observed. Ascites pump patients showed higher incidences of AKI (HR 4.55, 95% CI: 2.53-8.18) and hyponatremia (HR 4.13, 95% CI: 2.08-8.22). Last, 129 patients with TIPS were compared to 129 with PeCa. Mortality was comparable, while incidences of AKI (HR 5.01, 95% CI: 3.36-7.47), hyponatremia (HR 4.64, 95% CI: 3.03-7.12), and peritonitis (HR 2.19, 95% CI: 1.41-3.41) were higher in those with PeCa.

CONCLUSIONS: While ascites pump was associated with lower incidences of device infections and explantations, TIPS was associated with the lowest incidence of clinical complications in patients with RA.

PMID:39813591 | DOI:10.1097/HC9.0000000000000620

Epidemiol Serv Saude. 2025 Jan 13;33(spe1):e2024515. doi: 10.1590/S2237-96222024v33e2024515.especial.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To describe the sociodemographic profile and access to social assistance and health services among trans people and travestis experiencing homelessness in Salvador, the capital city of Bahia state.

METHODS: This was a cross-sectional study involving 24 (4.5%) participants who identified as trans people or travestis out of a total of 529 people, aged 18 or older, living in public spaces or institutional shelters included in the survey. Data were collected between 2021 and 2022, using structured questionnaires.

RESULTS: The sample was predominantly comprised of trans women and travestis (n=18), young individuals (n=13), of Black race/skin color (n=22), single individuals (n=18) and those engaged in informal occupations (n=23), many of whom reported experiencing violence (n=17). Frequent barriers to accessing healthcare and social assistance services were found (n=15), including lack of documentation, delay in service provision and social/racial discrimination.

CONCLUSION: The findings highlight the heightened vulnerability of transgender people and travestis experiencing homelessness, who are subjected to multiple forms of discrimination and social exclusion.

PMID:39813583 | DOI:10.1590/S2237-96222024v33e2024515.especial.en

Epidemiol Serv Saude. 2025 Jan 13;33(spe1):e2024341. doi: 10.1590/S2237-96222024v33e2024341.especial.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To assess adherence to and completeness of vaccination schedules against human papillomavirus (HPV) and hepatitis A and B among transgender women and travestis in São Paulo, capital city of São Paulo state.

METHODS: This was a secondary data analysis of the multicenter TransOdara study. Data were collected from 403 transgender women and travestis aged 18 years or older, recruited through respondent-driven sampling between December 2019 and October 2020.

RESULTS: High adherence to vaccines was observed (88.8%), but completeness of the analyzed vaccination schedules was low: 12% (95%CI 8.0; 17.3) for hepatitis A, 7.2% (95%CI 3.5; 12.8) for hepatitis B and 8.1% (95%CI 3.0; 16.6) for HPV, with no statistically significant differences between them.

CONCLUSION: Despite high adherence, the low completion of vaccination schedules highlighted the need for diversified strategies to improve vaccination coverage and reduce the prevalence of vaccine-preventable sexually transmitted infections in this population.

PMID:39813582 | DOI:10.1590/S2237-96222024v33e2024341.especial.en

Cad Saude Publica. 2025 Jan 13;40(12):e00035624. doi: 10.1590/0102-311XEN035624. eCollection 2025.

ABSTRACT

This study aimed to identify latent (unobservable) dimensions representing specific physical activity-related behaviors and explore their potential effects on obesity burden and spatial distribution in Colombia. A cross-sectional study (n = 9,658) was conducted based on the Colombian National Survey of Nutritional Status. A generalized structural equations model was proposed, combining exposure and measurement models to define a disease model. Modeling identified latent dimensions of physical activity focused on screen time and means of transportation and estimated their direct and indirect effects on obesity occurrence. Mapping techniques were used to illustrate adherence to these dimensions. The latent dimensions identified were named “Screens use” and “Active transportation”; the latter was inversely associated with obesity occurrence (p = 0.004), with the use of bicycles being the dominant variable, contrasting with the use of motor vehicles. The mapping showed that departments with the highest adherence to the “Active transportation” construct have a lower prevalence of obesity. Bicycle use, as opposed to non-active transportation, represented a dimension of physical activity-related behaviors with a protective effect against obesity. This suggests that active transportation may be a crucial factor in the designing preventive interventions. Moreover, social inequalities may be contributing to the obesity epidemic and physical activity behaviors in Colombia, requiring equitable and multisectoral responses.

PMID:39813567 | DOI:10.1590/0102-311XEN035624

Cad Saude Publica. 2025 Jan 13;40(11):e00217323. doi: 10.1590/0102-311XPT217323. eCollection 2025.

ABSTRACT

This study aimed to evaluate the overall excess mortality and COVID-19 mortality in the regions of Brazil, in 2020, by sex and age group. An ecological study was carried out to calculate the overall excess mortality, by sex and age group, using the expected number of deaths in a non-pandemic context and the deaths observed in 2020. Data on deaths were extracted from the Brazilian Mortality Information System, in addition to population data from the Brazilian Institute of Geography and Statistics. Excess mortality was calculated considering: the difference between the mortality rates observed in 2020 and the average of the rates from 2015 to 2019, standardized by age; and the difference between observed deaths obtained via a quasi-Poisson model and the deaths expected for 2020. In Brazil, the standardized overall mortality rate in 2020 was 590 deaths per 100,000 inhabitants, with excess mortality of 44 deaths per 100,000 inhabitants, while the mortality rate from COVID-19 was 79 deaths per 100,000 inhabitants. The highest overall mortality rates were observed in the North and Northeast regions. The excess deaths estimated by the ratio between observed and expected deaths nationwide in 2020 was 16%; of which 17% were males, 16% were females, 7% were individuals from 0 to 59 years old, and 20% were individuals aged 60 years or older. These outcomes enabled a better understanding on the impact of the COVID-19 pandemic on the mortality in Brazil in 2020, indicating a more pronounced excess mortality in the North, Northeast and Central-West regions and among men older than 60 years.

PMID:39813565 | DOI:10.1590/0102-311XPT217323

Cad Saude Publica. 2025 Jan 13;40(11):e00052624. doi: 10.1590/0102-311XPT052624. eCollection 2025.

ABSTRACT

This study aimed to identify the existence of therapeutic itineraries shared by users of specialized mental health services in a medium-sized municipality. This is a cross-sectional study, carried out from August to November 2019 including 341 users of specialized mental health services in the municipality of Itatiba, São Paulo State, Brazil. To identify the itineraries, based on a set of variables, the users were grouped with clustering. The best measure of silhouette of cohesion and separation (> 0.3) for the clusters was achieved based on four variables: situation in which the mental health problem was identified, place of first care, origin of referral to the current service, and bond maintenance with primary health care (PHC). The clusters identified in the study demonstrated: (1) low participation of PHC in welcoming new cases, with most of the care taking place in specialized services; (2) high proportion of cases identified in crisis situations; (3) low participation of PHC in the referral of cases, with high access to specialized services by spontaneous demand; (4) lack of continuity in PHC services after entering the specialized service. The study highlighted significant weaknesses in the studied healthcare network, evincing the need to develop strategies that foster the services integration, especially regarding PHC, both to favor access to specialized care in a timely manner and to enable the continuity of care between different healthcare facilities.

PMID:39813561 | DOI:10.1590/0102-311XPT052624

Epidemiol Serv Saude. 2025 Jan 10;33(spe2):e2024432. doi: 10.1590/S2237-96222024v33e2024432.especial2.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To evaluate opportunity for vaccination in children born alive in Londrina, up to 6 months old and the relationship between socioeconomic stratum and vaccination regularity.

METHOD: Population survey study based on a retrospective cohort of children born in 2017 and 2018 that identified vaccines not administered in a given session. Vaccination regularity was compared between socioeconomic strata using Pearson’s chi-square test.

RESULTS: Out of 456 vaccination cards, the proportion of vaccination opportunities not recovered for doses to be administered at birth and at two, four and six months was 5.0% (95%CI 3.1;7.5), 4. 5% (95%CI 2.8;6.9), 7.2% (95%CI 5.0;10.2) and 2.1% (95%CI 1.0;4.0), respectively. There was no statistical difference in vaccination regularity between the strata.

CONCLUSION: Missed opportunities for vaccination were found at all ages. Socioeconomic stratum did not influence vaccination regularity.

PMID:39813547 | DOI:10.1590/S2237-96222024v33e2024432.especial2.en

Epidemiol Serv Saude. 2025 Jan 10;33(spe2):e2023539. doi: 10.1590/S2237-96222024v33e2023539.especial2.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To estimate and compare vaccination coverage among children born in 2017-2018 in São Paulo and Campinas, according to the Vaccination Coverage Survey (ICV 2020) and the National Immunization Program Information System (SI-PNI).

METHODS: ICV 2020 analyzed vaccination card records. Coverage was calculated and compared to doses recorded on the SI-PNI, divided by the target population.

RESULTS: In São Paulo, according to ICV, in 2017 only BCG (91.7%; 95%CI 87.0;94.7) and rotavirus first dose (90.6%; 95%CI 86.5;93.5) achieved the goals; in 2018, BCG (93.4%; 95%CI 89.5;95.8), rotavirus first dose (90.5%; 95%CI 85.3;94.0), pneumococcal first dose (95.3%; 95%CI 91.7;97.4), meningococcal C first dose (95.1%; 95%CI 91.5;97.2) and pneumococcal second dose (95.0%; 95%CI 91.4;95.0). In Campinas, only BCG achieved the target in 2017 (93.0%; 95%CI 88.8;95.7) and none in 2018. According to the SI-PNI, no vaccine achieved the target in either city.

CONCLUSION: Vaccination coverage was lower than expected and more precise estimates are necessary for adequate monitoring of childhood vaccination status.

PMID:39813546 | DOI:10.1590/S2237-96222024v33e2023539.especial2.en

Epidemiol Serv Saude. 2025 Jan 10;33(spe2):e20231307. doi: 10.1590/S2237-96222024v33e20231307.especial2.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To estimate vaccination coverage and analyze factors associated with full vaccination among children up to 15 months old in the city of Natal-RN, Brazil.

METHODS: Population-based survey with data recorded on children’s vaccination cards and interviews conducted in 2020 and 2021. Analysis of factors associated with complete vaccination was performed by calculating prevalence ratios (PR) and 95% confidence intervals (95%CI) using Poisson regression.

RESULTS: Among 688 children studied, vaccination coverage was 45.4% (95%CI 37.2;53.9) and 15.5% (95%CI 10.6;22.2) for valid and on-time doses, respectively. Higher vaccination coverage was associated with females (PR=1.08; 95%CI 0.78;1.48) and socioeconomic strata C and D (PR=1.44; 95%CI 1.03;2.02).

CONCLUSIONS: The results demonstrate that the city of Natal has low vaccination coverage for all immunobiologicals.

PMID:39813545 | DOI:10.1590/S2237-96222024v33e20231307.especial2.en

Epidemiol Serv Saude. 2025 Jan 10;33(spe2):e20231303. doi: 10.1590/S2237-96222024v33e20231303.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To describe the polio vaccination status in 26 state capitals, the Federal District, and 12 municipalities in Brazil, among children born between 2017 and 2018.

METHODS: This was a population-based household survey conducted from 2020 to 2022, which assessed polio vaccination coverage in children, considering valid, administered, and timely doses by municipality.

RESULTS: Data were collected from 37,801 children. Vaccination coverage for the complete valid dose schedule was 87.5% (95%CI 86.2;88.7), dropping to 79.6% (95%CI 78.1;81.0), when the booster dose was considered. The dropout rate was 4.5% for the complete schedule, and 11.7% for the first booster. There was no correlation between campaign implementation and high coverage.

CONCLUSION: Vaccination coverage for the complete valid dose schedule and the first booster did not meet the 95.0% target. Regional disparities and the association between vaccination coverage and social indicators should be taken into consideration in strategies to increase coverage.

PMID:39813544 | DOI:10.1590/S2237-96222024v33e20231303.en