Treatment of Human Sporotrichosis Caused by Sporothrix brasiliensis.

We describe the successful treatment of a series of 30 zoonotic sporotrichosis cases from southern Brazil. Sporothrix brasiliensis was the species genotypically identified in all 25 confirmed cases. Five other cases were classified as probable, without laboratory confirmation, but with clinical and epidemiological data of cat-transmitted sporotrichosis. Two isolates were sequenced by translation elongation factor-1 alpha (EF1α) loci in order to compare their sequences, and both of them showed distinct genotypes from S. brasiliensis strains from other Brazilian states. Itraconazole (ITZ) or potassium iodide (KI) were the first choice treatment in 28 and 2 cases, respectively. Microdilution assay showed a wild-type profile of S. brasiliensis isolates to ITZ. However, a lack of clinical response occurred in 42% of cases, especially those treated with ITZ 100 mg/day, and treatment needed modifications, by either increased doses or antifungal combinations. Clinical cure required a mean of 187 days of treatment, which was dependent on the clinical form of the disease and age of patients. Therapy, including dosages and durations, for cutaneous forms of sporotrichosis requires re-evaluation, since cases caused by S. brasiliensis may influence treatment efficacy.

CATastrophe: Response to the challenges of zoonotic sporotrichosis in southern Brazil.

BACKGROUND: In Brazil, zoonotic sporotrichosis became a national public health problem, with thousands of cases in the last decade in several regions of the country. In this context, health education activities are critical, especially in promoting early diagnosis and access to proper health care in sporotrichosis hyperendemic areas. Therefore, we report the implementation of a public specialised reference service (SRS) for diagnosis and treatment of sporotrichosis in southern Brazil. We evaluated the impact of the SRS on diagnostic confirmation and speed of diagnosis. METHODS: The SRS was implemented in Rio Grande City. We implemented a public service to promote the correct diagnosis, treatment and follow-up of human sporotrichosis cases. To study the impact of implementing SRS, the annual number of cases and the period between the appearance of lesions until diagnosis were compared, using prior data and that post-implementation. RESULTS: The implementation of the SRS directly benefited almost 50 patients in only four years, with the collaboration of almost 50% of the local health groups, together with an increase of more than 200% in diagnosis confirmation and speed of diagnosis, showing the reach, impact and importance of the SRS. CONCLUSION: The impact on the individual and collective health of the local population highlights the value of this public health approach in facing the epidemiological threat of zoonotic sporotrichosis.

Gestante adolescente e seu sentimento acerca do apoio familiar / Pregnant adolescent and her feelings about family support

Objetivo: identificar o sentimento em relação às principais fontes de apoiopara mulheres que vivenciaram a gestação na adolescência. Método: estudo qualitativo,exploratório e descritivo, desenvolvido em município do sul do Brasil. Participarammulheres com idade entre 10 e 19 anos que tiveram filho no ano de 2010, excluindoaquelas com óbito fetal, não residentes no município ou não eram responsáveis pelacriação do filho. Realizada entrevista individual e utilizada a análise de conteúdo,constituindo as categorias: relação entre situação conjugal e apoio paterno e relação entrea reação familiar à gestação e o apoio recebido. Resultados: a participação e apoio dospais dos bebês e da figura materna no contexto da gravidez na adolescência, pareceuprimordial no enfrentamento da situação de tornar-se mãe. Conclusão: entender como asadolescentes se sentem apoiadas diante de uma gestação pode contribuir para as políticaspúblicas e processos de trabalho direcionados às suas necessidades.

Aim: to identify the feeling about the main sources of support for young womenwho have already experienced adolescent pregnancy. Method: qualitative, exploratory anddescriptive study, developed in a city in Southern Brazil. The participants were women agedfrom 10 to 19 years old, who had a child in 2010, excluding those with fetal death, notresiding in the municipality or not responsible for the child’s raising. Individual interviewwas carried and the content analysis was used, constituting the categories: relationshipbetween marital status and paternal support and relationship between the family reaction togestation and the support received. Results: the participation and support of the babies’ parents and the maternal figure in the context of teenage pregnancy seem essential to face thesituation of becoming a mother. Conclusion: understanding the way that adolescents feel thesupport when facing a pregnancy, at such stage of their lives, may contribute to the publicpolicies and work processes directed to their needs.

Objetivo: identificar el sentimiento en relación a las principales fuentes deapoyo para las jóvenes mujeres que se quedaron embarazadas en la adolescencia. Método:estudio cualitativo, exploratorio y descriptivo realizado en una ciudad en el sur de Brasil.Participaron mujeres de 10 a 19 años, que tuvieron hijo en 2010, excluyendo aquellas conmuerte fetal, las que no vivían en la ciudad o no eran responsables por criar el niño. Paratanto se realizó una entrevista individual y se utilizó el análisis de contenido, constituyendolas categorías: relación entre estado civil y apoyo paterno y relación entre la reacciónfamiliar, la gestación y el apoyo recibido. Resultados: la participación y apoyo de los padresy de la figura materna en el contexto del embarazo en la adolescencia parece ser primordialpara enfrentar esta situación de ser madre joven. Conclusión: entender como lasadolescentes se sienten apoyadas en esa fase de su vida puede contribuir para las políticaspúblicas y procesos de trabajo dirigidos a sus necesidades.

Pregnancy recurrence in adolescents in Southern Brazil.

OBJECTIVE: To determine the pregnancy recurrence among adolescents and young people in a city located in the extreme south of Brazil and to identify associated factors. METHOD: One hundred and twelve (112) women participated, having delivered their children in 2010, while adolescents. The sample was stratified in two stages, being the first a census of the whole population of the city and the second a convenience sample. For statistical analysis, Pearson Chi-square test was used, with a significance level of 5%. RESULTS: The recurrence rate was 53.6%, with an average of 28.6 months. At the time of delivery, in 2010, recurrence was significantly associated with level of education (p=0.044) as well as not being in school (p=0.036). In 2014, the factors associated were level of education (p<0.001), transcript of grades (p=0.030) and income (p=0.030). CONCLUSION: Recurrence of teenage pregnancy represents a lack of importance given to formal education, a fact that mitigates the opportunities and hinders insertion in the labor market, creating a cycle of social inequality. Multidisciplinary efforts involving schools, health services and the youth in educational activities are thus vital, aiming at critical thinking to transform reality.

Pregnancy recurrence in adolescents in Southern Brazil / Recorrência de gestação em adolescentes do extremo sul do Brasil

Summary Objective: To determine the pregnancy recurrence among adolescents and young people in a city located in the extreme south of Brazil and to identify associated factors. Method: One hundred and twelve (112) women participated, having delivered their children in 2010, while adolescents. The sample was stratified in two stages, being the first a census of the whole population of the city and the second a convenience sample. For statistical analysis, Pearson Chi-square test was used, with a significance level of 5%. Results: The recurrence rate was 53.6%, with an average of 28.6 months. At the time of delivery, in 2010, recurrence was significantly associated with level of education (p=0.044) as well as not being in school (p=0.036). In 2014, the factors associated were level of education (p<0.001), transcript of grades (p=0.030) and income (p=0.030). Conclusion: Recurrence of teenage pregnancy represents a lack of importance given to formal education, a fact that mitigates the opportunities and hinders insertion in the labor market, creating a cycle of social inequality. Multidisciplinary efforts involving schools, health services and the youth in educational activities are thus vital, aiming at critical thinking to transform reality.

Resumo Objetivo: Determinar a recorrência de gravidez em adolescentes de um município no extremo sul do Brasil e identificar os fatores associados. Método: Participaram 112 mulheres que tiveram filho em 2010, quando eram adolescentes. A amostra foi estudada em dois estágios, sendo no primeiro por meio de um censo do município e no segundo por uma seleção de conveniência. Para análise estatística, foi utilizado o teste Qui-quadrado de Pearson com nível de significância de 5%. Resultados: A taxa de recorrência de gravidez encontrada foi de 53,6% com tempo médio de 28,6 meses. No momento do parto, em 2010, estiveram significativamente associados à recorrência a escolaridade (p=0,044) e o fato de não estar estudando (p=0,036). Em 2014, foram a escolaridade (p<0,001), o histórico escolar (p=0,030) e a renda (p=0,030). Conclusão: A recorrência de gravidez na adolescência representa a pouca valorização da educação formal, o que mitiga a vivência de oportunidades e dificulta a inserção no mercado de trabalho, criando um ciclo de desigualdade social. É imprescindível unir esforços multidisciplinares nas escolas e nos serviços de saúde, em conjunto com os jovens, em ações educativas que visem a uma relação crítica reflexiva transformadora da realidade.

Maternidade na adolescência: ressignificando a vida? / Teenage maternity: life's new meaning?

OBJECTIVE: To identify transformations arising from teen pregnancy from the perspective of young women. METHODS: Study of qualitative and descriptive approach with 34 young women of low socio-economic strata that gave birth in the year 2010 as teenagers. The data have been collected through semi-structured interviews with questions about life before and after maternity, explored through content analysis. RESULTS: The life of the teenagers before pregnancy is heterogeneous in social, work and schooling aspects. After maternity, the freedom of being is re-configured, bringing losses related to the abandonment of studies, to the reduction in social life and to the stigma of teenage maternity; the gains from resignification of lifestyle, the abandonment of illegal and criminal conduct, increased self-confidence the reduction of exposure to violence inside the family, accompanied by new responsibilities, from the reconciliation of study and work or the abandonment of one of these activities. CONCLUSION: Maternity generates a feeling of satisfaction brought about by the experience of being a mother, with a new social identity.

OBJETIVO: Identificar as transformações oriundas da maternidade na adolescência na perspectiva de jovens mulheres. MÉTODO: Estudo de abordagem qualitativa descritiva com 34 jovens de estrato socioeconômico baixo que tiveram parto no ano de 2010 enquanto adolescentes. Os dados foram coletados quatro anos após o parto por meio de entrevista semiestruturada com questões sobre a vida antes e após a maternidade e explorados por meio da Análise de Conteúdo. RESULTADOS: A vida das adolescentes antes da gravidez é heterogênea nos aspectos sociais, laborais e estudantis. Após a maternidade, reconfigura-se a liberdade de ser, trazendo perdas relacionadas ao abandono dos estudos, a privação da vida social e ao estigma da maternidade compreendida como precoce; e ganhos oriundos da ressignificação do modo de vida, abandono de condutas ilegais e criminosas, aquisição de autoconfiança e da redução da exposição à violência intrafamiliar, acompanhado de novas responsabilidades, da conciliação do estudo e trabalho ou do abandono de uma destas atividades. CONCLUSÃO: A maternidade acarreta um sentimento de plenitude trazido pela experiência de ser mãe, com uma nova identidade social.

[Agreement between data from prenatal care cards and maternal recall in a medium-sized Brazilian city]. / Concordância entre informações do Cartão da Gestante e do recordatório materno entre puérperas de uma cidade brasileira de médio porte.

Prenatal care is a key indicator of the quality of health services. The current study aimed to evaluate the correlation between data from prenatal care cards and maternal recall in the city of Rio Grande, Rio Grande do Sul State, Brazil. The cross-sectional study included all mothers from 2010 who had received prenatal care. Interviews were conducted with a pre-coded questionnaire in the maternity hospital. Of the 2,288 mothers interviewed, 1,228 (53.7%) had the prenatal care card with them and thus comprised the group for comparison. The analysis used kappa correlation and confidence interval. The variables six or more prenatal visits, clinical breast and gynecological examination, two blood tests, VDRL, HIV serology, urine test, and tetanus vaccination showed statistically significant differences between annotated and maternal recall data (p ≤ 0.001). Adequacy of prenatal care based on the guidelines of the Program for Humanization of Prenatal Care (PHPN) was 23.9% according to information provided by the patients and 4.4% according to information recorded on the prenatal cards (p ≤ 0.001). The prenatal care card showed underreporting, which limited the quality assessment of prenatal care.

Concordância entre informações do Cartão da Gestante e do recordatório materno entre puérperas de uma cidade brasileira de médio porte / Agreement between data from prenatal care cards and maternal recall in a medium-sized Brazilian city / Correspondencia entre la información de la cartilla de gestante y el diario materno entre puérperas de una ciudad media brasileña

Prenatal care is a key indicator of the quality of health services. The current study aimed to evaluate the correlation between data from prenatal care cards and maternal recall in the city of Rio Grande, Rio Grande do Sul State, Brazil. The cross-sectional study included all mothers from 2010 who had received prenatal care. Interviews were conducted with a pre-coded questionnaire in the maternity hospital. Of the 2,288 mothers interviewed, 1,228 (53.7%) had the prenatal care card with them and thus comprised the group for comparison. The analysis used kappa correlation and confidence interval. The variables six or more prenatal visits, clinical breast and gynecological examination, two blood tests, VDRL, HIV serology, urine test, and tetanus vaccination showed statistically significant differences between annotated and maternal recall data (p≤ 0.001). Adequacy of prenatal care based on the guidelines of the Program for Humanization of Prenatal Care (PHPN) was 23.9% according to information provided by the patients and 4.4% according to information recorded on the prenatal cards (p ≤ 0.001). The prenatal care card showed underreporting, which limited the quality assessment of prenatal care.

A assistência pré-natal é um indicativo da qualidade dos serviços de saúde. Esse estudo objetivou avaliar a concordância entre os dados do pré-natal da memória materna e do cartão da gestante no Município do Rio Grande, Rio Grande do Sul, Brasil. Estudo transversal incluindo todas puérperas do ano de 2010 que realizaram pré-natal. As entrevistas e a coleta dos dados do cartão ocorreram nas maternidades. Das 2.288 puérperas entrevistadas, 1.228 (53,7%) portavam o cartão da gestante, sendo a comparação realizada nesse grupo. A análise foi feita utilizando-se o teste de concordância kappa e o intervalo de confiança. A realização de seis ou mais consultas de pré-natal, exame das mamas e ginecológico, dois exames de sangue, VDRL, anti-HIV, urina e a vacinação antitetânica demonstraram diferença estatística entre os dados referidos e anotados (p ≤ 0,001). A adequação do pré-natal pelo índice do Programa de Humanização do Pré-Natal (PHPN) nos dados referidos foi de 23,9% e de 4,4% nos dados anotados (p ≤ 0,001). Observamos um sub-registro no cartão da gestante, o qual influenciou negativamente na avaliação da qualidade do pré-natal.

La asistencia prenatal es un indicativo de la calidad de los servicios de salud. Este estudio tuvo por objetivo evaluar la correspondencia entre los datos prenatales del diario materno y de la cartilla de gestante en el municipio de Río Grande, Rio Grande do Sul, Brasil. Es un estudio transversal incluyendo a todas las puérperas del año 2010 que recibieron asistencia prenatal. Las entrevistas y la recogida de los datos de la cartilla se produjeron en las maternidades. De las 2.288 puérperas entrevistadas, 1.228 (53,7%) llevaban la cartilla de gestante, realizándose la comparación en ese grupo. El análisis se ejecutó utilizándose el test de concordancia kappa y el intervalo de confianza. La realización de seis o más consultas de prenatal, examen de mamas y ginecológico, de los exámenes de sangre, VDRL, anti-VIH, orina y la vacunación antitetánica demostraron una diferencia estadística entre los datos proporcionados y los anotados (p ≤ 0,001). La adecuación del servicio prenatal por el índice del Programa de Humanización de Prenatal (PHPN) en los datos recogidos fue de un 23,9% y de un 4,4% en los datos anotados (p ≤ 0,001). Observamos un subregistro en la cartilla de la gestante, el cual influenció negativamente en la evaluación de la calidad de prenatal.