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      Clinical-epidemiological characteristics and temporal trend of new cases of grade 2 disability leprosy in the state of Maranhão, Brazil, 2011- 2020 Translated title: Características clínico-epidemiológicas y tendencia temporal de los nuevos casos de lepra grado 2 de discapacidad en el estado de Maranhão, Brasil, 2011-2020 Translated title: Características clínico-epidemiológicas e tendência temporal de casos novos de hanseníase com grau 2 de incapacidade física, no estado do Maranhão, 2011-2020

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          Study contributions

          Main results

          Out of 2,147 grade 2 disability leprosy cases, the majority were male, of mixed race/skin color, multibacillary and borderline. The São Luís regional health unit showed a falling trend.

          Implications for services

          The results can guide strategies for the leprosy control program in the state, aiming at new approaches towards early diagnosis, treatment and prevention of disabilities.

          Perspectives

          Further studies are needed, such as spatial distribution of cases and detection rates of leprosy in children under 15 years of age, in order to gain a better understanding of the epidemiological profile of leprosy in Maranhão.

          Abstract

          Objective:

          to describe the clinical and epidemiological characteristics of new cases of grade 2 disability leprosy and to analyze its trend in the state of Maranhão, from 2011 to 2020.

          Methods:

          this was a descriptive cross-sectional and ecological time-series study, using data from the Notifiable Health Conditions Information System. A descriptive analysis of the event was carried out according to the sociodemographic and clinical-laboratory characteristics of the cases. The temporal trend of event incidence was analyzed using Prais-Winsten regression.

          Results:

          of the 2,147 cases, 71.5% were male, 48.9% had up to 8 years of schooling, 66.5% were of mixed race/color, 95.5% had the multibacillary form, 58.8% were borderline, 32.3% had negative bacilloscopy at diagnosis. There was a stationary trend in the state and a falling trend in the São Luís Health Region (annual percentage change = -64.4%; 95% confidence interval: -73.7;-51.9).

          Conclusion:

          incidence trend was stable in the state of Maranhão and falling in São Luís.

          Resumen

          Objetivo:

          describir las características clínicas y epidemiológicas de los nuevos casos de lepra con discapacidad física grado 2 y analizar su tendencia en el estado de Maranhão, de 2011 a 2020.

          Métodos:

          estudio transversal descriptivo y ecológico de serie temporal con datos del Sistema de Información de Agravamiento de Notificaciones. Se realizó un análisis descriptivo de características sociodemográficas y clínico-laboratoriales. La tendencia temporal de la incidencia de eventos se analizó mediante la regresión de Prais-Winsten.

          Resultados:

          de los 2.147 casos, 71,5% era masculino, 48,9% tenía hasta 8 años de escolaridad, 66,5% era de raza/piel parda, 95,5% de forma multibacilar, 58,8% dimorfa, 32,3% con baciloscopia negativa al diagnóstico. Hubo tendencia estacionaria en el estado y tendencia decreciente en la Región de Salud São Luís (variación anual = -64,4%; intervalo de confianza 95%: -73,7;-51,9).

          Conclusión:

          la tendencia de la incidencia se mantuvo estable en el estado de Maranhão y decreciente en São Luís.

          Resumo

          Objetivo:

          descrever as características clínico-epidemiológicas dos casos novos de hanseníase com grau 2 de incapacidade física e analisar sua tendência no estado do Maranhão, Brasil, 2011-2020.

          Métodos:

          estudo transversal descritivo e ecológico de série temporal, com dados do Sistema de Informação de Agravos de Notificação; realizou-se análise descritiva do evento segundo características sociodemográficas e clínico-laboratoriais dos casos; a tendência temporal da incidência do evento foi analisada pela regressão de Prais-Winsten.

          Resultados:

          dos 2.147 casos notificados, 71,5% foram do sexo masculino, 48,9% possuíam até 8 anos de estudo, 66,5% eram de raça/cor da pele parda, 95,5% da forma multibacilar, 58,8% da forma dimorfa e 32,3% com baciloscopia negativa no diagnóstico; observou-se estacionaridade na tendência no estado, e tendência decrescente na regional de saúde de São Luís (variação anual = -64,4%; intervalo de confiança de 95% -73,7;-51,9).

          Conclusão:

          a tendência da incidência foi estável no estado do Maranhão e decrescente em São Luís.

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          Most cited references28

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          Uso da análise de séries temporais em estudos epidemiológicos

          Esse artigo visa introduzir e cativar o interesse sobre a análise de séries temporais em estudos epidemiológicos. São descritos aspectos conceituais desse tipo de análise e sistematizadas indicações metodológicas. Foram definidos os principais conceitos da análise de séries temporais (tendência, variação cíclica e sazonal, associação e variação aleatória), e operacionalizada sua aplicação epidemiológica. Foram apresentados os métodos para avaliação da tendência (porcentagem de modificação anual), baseados em modelos de regressão de Prais-Winsten, e para quantificação da variação sazonal, segundo o modelo de Serfling. Foi, ainda, introduzida a modalidade de análise de regressão segmentada para séries temporais interrompidas, como estratégia de avaliação do efeito de intervenções em saúde.
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            Leprosy: Clinical aspects and diagnostic techniques

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              Multibacillary leprosy by population groups in Brazil: Lessons from an observational study

              Background Leprosy remains an important public health problem in Brazil where 28,761 new cases were diagnosed in 2015, the second highest number of new cases detected globally. The disease is caused by Mycobacterium leprae, a pathogen spread by patients with multibacillary (MB) leprosy. This study was designed to identify population groups most at risk for MB disease in Brazil, contributing to new ideas for early diagnosis and leprosy control. Methods A national databank of cases reported in Brazil (2001–2013) was used to evaluate epidemiological characteristics of MB leprosy. Additionally, the databank of a leprosy reference center was used to determine factors associated with higher bacillary loads. Results A total of 541,090 cases were analyzed. New case detection rates (NCDRs) increased with age, especially for men with MB leprosy, reaching 44.8 new cases/100,000 population in 65–69 year olds. Males and subjects older than 59 years had twice the odds of MB leprosy than females and younger cases (OR = 2.36, CI95% = 2.33–2.38; OR = 1.99, CI95% = 1.96–2.02, respectively). Bacillary load was higher in male and in patients aged 20–39 and 40–59 years compared to females and other age groups. From 2003 to 2013, there was a progressive reduction in annual NCDRs and an increase in the percentage of MB cases and of elderly patients in Brazil. These data suggest reduction of leprosy transmission in the country. Conclusion Public health policies for leprosy control in endemic areas in Brazil should include activities especially addressed to men and to the elderly in order to further reduce M. leprae transmission.
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                Author and article information

                Contributors
                Role: designed the research Role: collected Role: analyzed Role: interpreted Role: drafted and reviewed Role: veracity
                Role: designed the research Role: collected Role: analyzed Role: interpreted Role: drafted and reviewed Role: veracity
                Role: designed the research Role: collected Role: analyzed Role: interpreted Role: drafted and reviewed Role: veracity
                Role: designed the research Role: collected Role: analyzed Role: interpreted Role: drafted and reviewed Role: veracity
                Role: designed the research Role: collected Role: analyzed Role: interpreted Role: drafted and reviewed Role: veracity
                Role: designed the research Role: collected Role: analyzed Role: interpreted Role: drafted and reviewed Role: veracity
                Journal
                Epidemiol Serv Saude
                Epidemiol Serv Saude
                ress
                Epidemiologia e Serviços de Saúde : Revista do Sistema Unico de Saúde do Brasil
                Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil
                1679-4974
                2237-9622
                18 September 2023
                2023
                : 32
                : 2
                : e2022435
                Affiliations
                [1 ]Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde e Tecnologia, Imperatriz, MA, Brazil
                Author notes
                [Correspondence: ] Rodolfo José de Oliveira Moreira. [E-mail: ] rodolfo.moreira@ 123456discente.ufma.br

                AUTHOR CONTRIBUTIONS: Moreira RJO, Bezerra JM, Santos FS, Pascoal LM, Dos Santos LH and Neto MS designed the research, collected, analyzed and interpreted the data, and also drafted and reviewed the manuscript. All the authors have approved the final version of the study and are responsible for its veracity.

                CONFLICTS OF INTEREST: The authors declare they have no conflicts of interest.

                Associate editor: Thaynã Ramos Flores - https://orcid.org/0000-0003-0098-1681

                Author information
                http://orcid.org/0000-0003-3812-444X
                http://orcid.org/0000-0002-4799-9638
                http://orcid.org/0000-0001-7840-7642
                http://orcid.org/0000-0003-0876-3996
                http://orcid.org/0000-0003-2280-4643
                http://orcid.org/0000-0002-6105-1886
                Article
                00705
                10.1590/S2237-96222023000200026
                10510615
                37729263
                2d91cc63-0f74-41d2-93ac-eedf957fa0e1

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 13 June 2022
                : 21 June 2023
                Page count
                Figures: 0, Tables: 4, Equations: 0, References: 22
                Categories
                Research Note

                leprosy,epidemiology,incidence,degree of physical disability,time series study,lepra,epidemiología,incidencia,grado de discapacidad física,estudio de series temporales,hanseníase,epidemiologia,incidência,grau de incapacidade física,estudo de séries temporais

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