Epidemiology of hepatitis B virus infection in people living in poverty in the central-west region of Brazil.

BACKGROUND: People living in poverty (PLP) are highly vulnerable to hepatitis B virus (HBV) infection. This study aimed to investigate the epidemiology of HBV infection in PLP in the metropolitan region of Goiânia, Goiás State, in the Central-West Region of Brazil. METHODS: A cross-sectional study was conducted from August to December 2016 in adults aged ≥12 years living in poverty. The following serological markers for HBV were investigated: hepatitis B surface antigen (HBsAg), antibody to HBV core antigen (total anti-HBc), IgM anti-HBc, and hepatitis B surface antibody (anti-HBs), which were detected by enzyme-linked immunosorbent assay (ELISA). Poisson regression analysis with robust variance was performed to verify the factors associated with HBV exposure. RESULTS: The study included 378 participants. The overall prevalence rate of HBV (any viral marker) was 9.8% (95% confidence interval [CI], 7.2-13.2). The prevalence rate of HBsAg in combination with total anti-HBc was 0.8% (95% CI, 0.3-2.4), total anti-HBc in combination with anti-HBs was 7.7% (95% CI, 5.4-10.9), and total anti-HBc alone was 1.3% (95% CI, 0.5-3.0) in the population. Furthermore, isolated positivity for anti-HBs was identified in only 25.4% (95% CI, 21.3-30.0) of the participants. Multiple regression analysis revealed that age (adjusted prevalence ratio [APR], 1.04; 95% CI, 1.01-1.07), female sex (APR, 2.18; 95% CI, 1.01-4.73), sexual intercourse under the influence of alcohol (APR, 2.49; 95% CI, 1.36-7.06), and exposure to Treponema pallidum (APR, 3.10; 95% CI, 1.36-7.06) were associated with HBV exposure. CONCLUSION: There was a high prevalence of HBV exposure in PLP in the Central-West Region of Brazil, indicating significant viral spread of the infection. Additionally, there was low serological evidence of immunisation against hepatitis B, indicating that a large proportion of the participants in this study are susceptible to the infection. The results support the need for public health policies that facilitate access to the existing healthcare services in hard-to-reach groups with special regard to immunisation programmes against hepatitis B.

Exposure to hepatitis C virus in homeless men in Central Brazil: a cross-sectional study.

BACKGROUND: Homeless men are highly vulnerable to acquisition of the hepatitis C virus (HCV) compared to the general population. In Brazil, a country of continental dimensions, the extent of HCV infection in this population remains unknown. The objective of this study is to investigate the epidemiological profile of exposure to HCV in homeless men in Central Brazil. METHODS: A Cross-sectional study was conducted in 481 men aged over 18 years attending therapeutic communities specialized in the recovery and reintegration of homeless people. Participants were tested for anti-HCV markers using rapid tests. Poisson regression analysis was used to verify the risk factors associated with exposure to HCV. RESULTS: The prevalence of HCV exposure was 2.5% (95.0% CI: 1.4 to 4.3%) and was associated with age, absence of family life, injection drug use, number of sexual partners, and history of sexually transmitted infections (STI). Participants reported multiple risk behaviors, such as alcohol (78.9%), cocaine (37.1%) and/or crack use (53.1%), and inconsistent condom use (82.6%). Injection drug use was reported by 8.7% of participants. CONCLUSIONS: The prevalence of HCV infection among homeless men was relatively high. Several risk behaviors were commonly reported, which shows the high vulnerability of this population. These findings emphasize the need for the development of specific strategies to reduce the risk of HCV among homeless men.

Predictors of hospital readmission after fractures: One-year follow-up study.

OBJECTIVE: Identify the incidence and predictive factors for readmissions of elderly hospitalized with fractures. METHOD: Prospective cohort study on 376 elderly people from a trauma referral large hospital in central Brazil. Data were collected from medical records of elderly people with radiological diagnosis of fractures. Readmission that occurs up to one year after the first discharge was defined the outcome variable. Pre- and post-admission characteristics were analyzed as predictive factors. Multiple analysis was performed using robust Poisson regression. RESULTS: The main cause of hospitalization was fracture of the femur (53.2%) and the most frequent trauma mechanism was fall from standing height (72.9%). The incidence of readmission was 20.7%, of which 30.5% were related to the fracture itself, with emphasis on Surgical Site Infection. The predictors of readmissions were: age range 60 to 69 years, COPD, delirium and fracture of the femur. CONCLUSIONS: The incidence of readmissions was high, with various causes and associated conditions pre-admission (age range 60-69, presenting COPD) and post-admission (delirium). The monitoring of these factors in the hospital environment is essential for prevention of readmissions.

Incidence of delirium following hospitalization of elderly people with fractures: risk factors and mortality.

OBJECTIVE: To identify the incidence, risk factors for delirium, and its association with death in the elderly hospitalized with fractures. METHOD: Prospective cohort, with a one-year follow-up of elderly people with clinical or radiological diagnosis of fracture, from an emergency and trauma hospital in the state of Goiás. The outcome delirium was defined by the medical description in the medical record. The predictor variables were demographic, health conditions, and hospitalization complications. A hierarchical multiple analysis was performed using robust Poisson regression, with Relative Risk as a measure of effect. RESULTS: A total of 376 elderly patients were included. The incidence of delirium was 12.8% (n = 48). Risk factors were male gender, age ≥80 years, dementia, heart disease, osteoporosis, chronic obstructive pulmonary disease, high-energy traumas, pneumonia, urinary tract infection, and surgery. The risk of death in the sample was 1.97 times higher (HR: 1.97 95% CI 1.19-3.25) in elderly people with delirium. CONCLUSION: Delirium had an intermediate incidence (12.8%); the risk of death in this group was about 2 times higher in one year after hospital admission. Demographic factors, past history of diseases, surgery, and complications have increased the risk and require monitoring during hospitalization of elderly people with fractures.

Survival Analysis of Hospitalized Elderly People with Fractures in Brazil Over One Year.

OBJECTIVE: This study analyzes the causes of death, survival, and other related factors in hospitalized elderly people with fractures over the course of one year. METHODS: We followed 376 fracture patients for one year in a prospective cohort study to a reference hospital in central Brazil. The Cox regression model was used to analyze factors associated with survival. RESULTS: The results indicate that the one-year mortality rate was high (22.9%). The independent factors linked to lower overall survival were as follows: patients aged >80 years with previous intensive care unit (ICU) admission and presence of comorbidities (diabetes mellitus [DM] and dementia). CONCLUSION: Our study results may contribute to a better understanding of the impact of fractures on the elderly population and reinforce the need to oversee age-groups, diabetic patients, and patients with complications during hospitalization.

Bio-behavioral survey of syphilis in homeless men in Central Brazil: a cross-sectional study.

The objective of this study was to investigate the prevalence and factors associated with syphilis in homeless men in Central Brazil. It is a cross-sectional study conducted with 481 individuals attending four therapeutic communities between October and December 2015. A structured interview was conducted to collect sociodemographic data and risk factors for syphilis. Rapid/point-of-care and VDRL tests were performed to determine exposure to syphilis and the presence of active syphilis, respectively. Poisson regression analysis was used to verify the risk factors associated with the outcomes investigated. Of the study participants, 10.2% were reactive to the rapid test, and 5.4% had active syphilis. At the multiple regression analysis, schooling (adjusted prevalence ratio - APR: 0.89; p = 0.005), history of genital ulcer (APR: 2.59; p = 0.002), STI history (APR: 1.97; p = 0.042), and sexual intercourse under drug effects (APR: 1.60; p = 0.022) were independent factors associated with lifetime syphilis. Also, history of genital ulcer (APR: 2.19; p = 0.019), STI history (APR: 1.74; p = 0.033) and number of sexual partners in the last year (APR: 1.02; p = 0.044) were associated with active syphilis. The prevalence of syphilis among homeless men was rather high, confirming the vulnerability of this group to this infection. These results emphasize the need for educational intervention, improvement of risk reduction programs, availability of diagnostic tests, especially the rapid test, and treatment.

Incidence of delirium following hospitalization of elderly people with fractures: risk factors and mortality / Incidencia de delirium tras hospitalización de ancianos con fracturas: factores de riesgo y mortalidad / Incidência de delirium após internação de idosos com fraturas: fatores de risco e mortalidade

ABSTRACT Objective: To identify the incidence, risk factors for delirium, and its association with death in the elderly hospitalized with fractures. Method: Prospective cohort, with a one-year follow-up of elderly people with clinical or radiological diagnosis of fracture, from an emergency and trauma hospital in the state of Goiás. The outcome delirium was defined by the medical description in the medical record. The predictor variables were demographic, health conditions, and hospitalization complications. A hierarchical multiple analysis was performed using robust Poisson regression, with Relative Risk as a measure of effect. Results: A total of 376 elderly patients were included. The incidence of delirium was 12.8% (n = 48). Risk factors were male gender, age ≥80 years, dementia, heart disease, osteoporosis, chronic obstructive pulmonary disease, high-energy traumas, pneumonia, urinary tract infection, and surgery. The risk of death in the sample was 1.97 times higher (HR: 1.97 95% CI 1.19-3.25) in elderly people with delirium. Conclusion: Delirium had an intermediate incidence (12.8%); the risk of death in this group was about 2 times higher in one year after hospital admission. Demographic factors, past history of diseases, surgery, and complications have increased the risk and require monitoring during hospitalization of elderly people with fractures.

RESUMEN Objetivo: Identificar la incidencia, los factores de riesgo para el delirium y su asociación con el óbito en ancianos hospitalizados con fracturas. Método: Cohorte prospectiva, con acompañamiento de un año con ancianos con diagnóstico clínico o radiológico de fractura, de un hospital de urgencias y trauma en Goiás, Brasil. El resultado delirium fue definido por la descripción médica en el registro médico. Las variables predictoras fueron demográficas, condiciones de salud y complicaciones de la hospitalización. Se realizó el análisis de regresión múltiple jerárquica utilizando la regresión de Poisson con varianza robusta, con Riesgo Relativo como medida de efecto. Resultados: Fueron incluidos 376 ancianos. La incidencia de delirium fue 12,8% (n = 48). Los factores de riesgo fueron: sexo masculino, edad ≥ 80 años, demencia, cardiopatía, osteoporosis, EPOC, traumas de alta energía, neumonía, infección urinaria y cirugía. El riesgo de óbito en la muestra fue 1,97 veces mayor (HR: 1,97 IC 95% 1,19-3,25) en ancianos con delirium. Conclusión: El delirium tuvo una incidencia intermediaria (12,8%); el riesgo de óbito en ese grupo fue aproximadamente 2 veces mayor en un año después de la admisión hospitalaria. Factores demográficos, historia anterior de enfermedades, realización de cirugía y la ocurrencia de complicaciones aumentaron el riesgo y necesitan ser monitoreados durante la hospitalización de ancianos con fracturas.

RESUMO Objetivo: Identificar a incidência, os fatores de risco para o delirium e sua associação com óbito em idosos hospitalizados com fraturas. Método: Coorte prospectiva, com seguimento de um ano de idosos com diagnóstico clínico ou radiológico de fratura, de um hospital de urgência e trauma de Goiás. O desfecho delirium foi definido pela descrição médica no prontuário. As variáveis preditoras foram demográficas, condições de saúde e complicações da internação. Realizou-se análise múltipla hierarquizada utilizando-se regressão de Poisson robusta, com Risco Relativo como medida de efeito. Resultados: Foram incluídos 376 idosos. A incidência de delirium foi 12,8% (n = 48). Os fatores de risco foram: sexo masculino, idade ≥80 anos, demência, cardiopatia, osteoporose, doença pulmonar obstrutiva crônica, acidentes de alta energia, pneumonia, infecção do trato urinário e cirurgia. O risco de óbito na amostra foi 1,97 vezes maior (HR: 1,97 IC 95% 1,19-3,25) em idosos com delírio. Conclusão: O delirium teve uma incidência intermediária (12,8%); o risco de óbito nesse grupo foi cerca de 2 vezes maior em um ano após a admissão hospitalar. Fatores demográficos, história pregressa de doenças, realização de cirurgia e ocorrência de complicações aumentaram o risco e precisam ser monitorados durante a internação de idosos com fraturas.

Bio-behavioral survey of syphilis in homeless men in Central Brazil: a cross-sectional study / Um inquérito bio-comportamental sobre sífilis em homens sem-teto no Centro-oeste do Brasil: um estudo transversal / Cuestionario bioconductual sobre la sífilis en hombres sin techo en el Centro-oeste de Brasil: un estudio transversal

The objective of this study was to investigate the prevalence and factors associated with syphilis in homeless men in Central Brazil. It is a cross-sectional study conducted with 481 individuals attending four therapeutic communities between October and December 2015. A structured interview was conducted to collect sociodemographic data and risk factors for syphilis. Rapid/point-of-care and VDRL tests were performed to determine exposure to syphilis and the presence of active syphilis, respectively. Poisson regression analysis was used to verify the risk factors associated with the outcomes investigated. Of the study participants, 10.2% were reactive to the rapid test, and 5.4% had active syphilis. At the multiple regression analysis, schooling (adjusted prevalence ratio - APR: 0.89; p = 0.005), history of genital ulcer (APR: 2.59; p = 0.002), STI history (APR: 1.97; p = 0.042), and sexual intercourse under drug effects (APR: 1.60; p = 0.022) were independent factors associated with lifetime syphilis. Also, history of genital ulcer (APR: 2.19; p = 0.019), STI history (APR: 1.74; p = 0.033) and number of sexual partners in the last year (APR: 1.02; p = 0.044) were associated with active syphilis. The prevalence of syphilis among homeless men was rather high, confirming the vulnerability of this group to this infection. These results emphasize the need for educational intervention, improvement of risk reduction programs, availability of diagnostic tests, especially the rapid test, and treatment.

O estudo teve como objetivo investigar a prevalência da sífilis e fatores associados em homens sem-teto no Centro-oeste do Brasil. A amostra nesse estudo transversal incluiu 481 indivíduos que frequentavam comunidades terapêuticas entre outubro e dezembro de 2015. Uma entrevista estruturada foi usada para coletar dados sociodemográficos e fatores de risco para sífilis. Foram realizados testes rápidos e VDRL para determinar a exposição à sífilis e a presença de sífilis ativa, respectivamente. A análise de regressão de Poisson foi usada para verificar os fatores de risco associados aos desfechos investigados. Entre os participantes, 10,2% foram reativos ao teste rápido e 5,4% tinham sífilis ativa. Na análise de regressão múltipla, a escolaridade (razão de prevalência ajustada - RPA: 0,89; p = 0,005), história de úlcera genital (RPA: 2,59; p = 0,002), história de DST (RPA: 1,97; p = 0,042) e relações sexuais sob o efeito de drogas (RPA: 1,60; p = 0,022) apareceram como fatores independentes associados à história pregressa de sífilis. Além disso, a história de úlcera genital (RPA: 2,19; p = 0,019), história de DST (RPA: 1,74; p = 0,033) e número de parceiros sexuais no último ano (RPA: 1,02; p = 0,044) estiveram associados à sífilis ativa. A prevalência de sífilis em homens sem-teto era bastante elevada, confirmando a vulnerabilidade desse grupo à infecção. Os achados enfatizam a necessidade de intervenções educacionais, melhoria dos programas de redução de risco, disponibilidade de testes diagnósticos (sobretudo o teste rápido) e tratamento adequado.

El objetivo de este estudio fue investigar la prevalencia y los factores asociados con la sífilis en hombres sin techo en el Centro-oeste de Brasil. Se trata de un estudio transversal, llevado a cabo con 481 personas que asistían a cuatro comunidades terapéuticas entre octubre y diciembre de 2015. La entrevista estructurada se realizó con el fin de recabar datos sociodemográficos y factores de riesgo para la sífilis. Se realizaron pruebas de diagnóstico rápido y serológicas para la sífilis (VDRL por sus siglas en inglés) para determinar la exposición a la sífilis y la presencia de sífilis activa, respectivamente. Se usó el análisis por regresión de Poisson para verificar los factores de riesgo asociados con los resultados investigados. Entre los participantes en el estudio, un 10,2% fueron reactivos a las pruebas de diagnóstico rápido, y un 5,4% tenían sífilis activa. En el análisis de regresión múltiple, la escolarización (la razón de prevalencia ajustada - APR: 0,89; p = 0,005), un historial de úlcera genital (APR: 2,59; p = 0,002), un historial de ETS (APR: 1,97; p = 0,042), e intercambios sexuales bajo los efectos de las drogas (APR: 1,60; p = 0,022) fueron factores independientes asociados con la sífilis a lo largo de la vida. Asimismo, un historial de úlcera genital (APR: 2,19; p = 0,019), un historial de ETS (APR: 1,74; p = 0,033) y el número de parejas de índole sexual en el último año (APR: 1,02; p = 0,044) estuvieron asociados con sífilis activa. La prevalencia de sífilis entre los hombres sin techo fue bastante alta, confirmando la vulnerabilidad de este grupo a la infección. Estos resultados enfatizan la necesidad de intervenciones educativas, así como una mejora en los programas de reducción del riesgo, disponibilidad de pruebas de diagnóstico, especialmente pruebas rápidas, y tratamiento.