Determination of prognostic markers for COVID-19 disease severity using routine blood tests and machine learning.

The need for the identification of risk factors associated to COVID-19 disease severity remains urgent. Patients' care and resource allocation can be potentially different and are defined based on the current classification of disease severity. This classification is based on the analysis of clinical parameters and routine blood tests, which are not standardized across the globe. Some laboratory test alterations have been associated to COVID-19 severity, although these data are conflicting partly due to the different methodologies used across different studies. This study aimed to construct and validate a disease severity prediction model using machine learning (ML). Seventy-two patients admitted to a Brazilian hospital and diagnosed with COVID-19 through RT-PCR and/or ELISA, and with varying degrees of disease severity, were included in the study. Their electronic medical records and the results from daily blood tests were used to develop a ML model to predict disease severity. Using the above data set, a combination of five laboratorial biomarkers was identified as accurate predictors of COVID-19 severe disease with a ROC-AUC of 0.80 ​±â€‹ 0.13. Those biomarkers included prothrombin activity, ferritin, serum iron, ATTP and monocytes. The application of the devised ML model may help rationalize clinical decision and care.

Postintervention Immunological and Entomological Survey of Lymphatic Filariasis in the City of Olinda, Brazil, 2015-2016.

Lymphatic filariasis (LF) is a leading cause of disability due to infectious disease worldwide. The Recife Metropolitan Region (RMR) is the only remaining focus of LF in Brazil, where the parasite Wuchereria bancrofti is transmitted solely by the mosquito Culex quinquefasciatus. This study reports the results of transmission assessment surveys and molecular xenomonitoring in the city of Olinda, RMR, after nearly 15 years (2015-2016) of interventions for LF elimination. Participants were screened for W. bancrofti antigen via immunochromatographic card tests (ICT) in: 1) door-to-door surveys conducted for all children aged 5-7 years from 4 out of 17 intervention areas treated with at least five annual doses of mass drug administration (MDA), and 2) a two-stage cluster sampling survey of residents aged 5 years and older in non-MDA areas. Mosquitoes were collected via handheld aspirators in four MDA areas, differentiated by species, sex, and physiological status, pooled into groups of up to 10 blood-fed, semigravid, and gravid mosquitoes, and screened for W. bancrofti infection by real-time quantitative polymerase chain reaction (RT-qPCR). All 1,170 children from MDA areas and the entire population sample of 990 residents in non-MDA areas were ICT negative. In MDA areas, a total of 3,152 female Cx. quinquefasciatus mosquitoes in 277 households (range, 0-296 mosquitoes per house) were collected via aspiration. RT-qPCR of 233 pools of mosquitos were negative for W. bancrofti RNA; an independent reference laboratory confirmed these results. These results provide evidence that LF transmission has been halted in this setting.

Occurrence of hepatitis B and C virus infection in socioeconomic population strata from Recife, Pernambuco, Northeast Brazil.

OBJECTIVE: To estimate the probability of infection with hepatitis B (HBV) and C (HCV) viruses in different socioeconomic strata of the population of Recife, Northeast Brazil. METHODS: Study carried out from samples obtained in a survey of residents of a large urban center that had a population base and stratified sampling with random selection of households using the "Brazil Sample" package in the R software. HBV (HBsAg) and anti-HCV was performed using immunochromatographic tests. In cases positive for HBsAg, anti-HBc and HBeAg were tested using chemiluminescence, as well as HBV-DNA using real-time PCR. For cases positive for anti-HCV, the search for this antibody was repeated by chemiluminescence and for HCV-RNA by real-time PCR. The occurrence of HBsAg and anti-HCV cases in the general population was estimated based on a theoretical negative binomial distribution. RESULTS: Among 2,070 samples examined, 5 (0.24%) were HBsAg and 2 (0.1%) anti-HCV positive. The majority of cases had self-reported skin color as black/brown (6/7), education level up to high school (6/7), a steady partner (5/7) and lived in an area of low socioeconomic status (5/7). CONCLUSION: The occurrence of HBsAg and anti-HCV was lower than those previously found in population-based studies and slightly lower than the most recent estimates. Individuals with lower socioeconomic status should be a priority target of public health policies.

Clinical-laboratory characteristics predictive of COVID-19 severity: a prospective hospital cohort, in Pernambuco, Northeast Brazil.

OBJECTIVE: To describe the clinical-laboratory profile and analyze the factors associated with the severity of COVID-19. METHODS: A prospective cohort study involving patients with COVID-19 admitted to a tertiary hospital in Recife, Brazil. All cases were confirmed by RT-PCR and classified according to severity criteria. A descriptive statistical analysis of the population's characteristics was conducted. Risk factors associated with the outcome of the case according to severity were analyzed by calculating the odds ratio (OR) using the general equation estimation (GEE) model. RESULTS: Among the 75 cases included, 64% were female, and 62.7% were aged 65 years or older. The median length of stay was 9 days (6 - 14). Hypertension (65.3%) and Diabetes Mellitus (36%) were the most frequent comorbidities. Severe forms of COVID-19 constituted 41.3% of the sample. The factors associated with severity were a history of asthma (OR=4.58, 95%CI:1.13 - 18.7), report of anorexia (OR=1, 12, 95%CI:1.01-1.24), and laboratory changes that included elevated platelets (OR=1.00, 95% CI:1.00-1.01), elevated D'Dimer (OR=1, 26, 95% CI:1.04-1.52), elevated aspartate aminotransferase (OR=1.00, 95% CI:1.00-1.01), and gamma-glutamyl transferase (OR=1.22, IC95 %:0.98-1.51), hypernatremia (OR=1.31, 95%CI:1.12-1.52), and hyperkalemia (OR=1.21, 95% CI:1.04-1.41). CONCLUSION: Multisystemic involvement with a tendency for thrombophilia, electrolyte disturbances, and hepatic aggression, reflected by laboratory changes, were factors associated with the severity of COVID-19.

Occurrence of hepatitis B and C virus infection in socioeconomic population strata from Recife, Pernambuco, Northeast Brazil / Ocorrência da infecção pelo vírus das hepatites B e C em estratos socioeconômicos populacionais do município de Recife, Pernambuco, Nordeste do Brasil

ABSTRACT Objective: To estimate the probability of infection with hepatitis B (HBV) and C (HCV) viruses in different socioeconomic strata of the population of Recife, Northeast Brazil. Methods: Study carried out from samples obtained in a survey of residents of a large urban center that had a population base and stratified sampling with random selection of households using the "Brazil Sample" package in the R software. HBV (HBsAg) and anti-HCV was performed using immunochromatographic tests. In cases positive for HBsAg, anti-HBc and HBeAg were tested using chemiluminescence, as well as HBV-DNA using real-time PCR. For cases positive for anti-HCV, the search for this antibody was repeated by chemiluminescence and for HCV-RNA by real-time PCR. The occurrence of HBsAg and anti-HCV cases in the general population was estimated based on a theoretical negative binomial distribution. Results: Among 2,070 samples examined, 5 (0.24%) were HBsAg and 2 (0.1%) anti-HCV positive. The majority of cases had self-reported skin color as black/brown (6/7), education level up to high school (6/7), a steady partner (5/7) and lived in an area of low socioeconomic status (5/7). Conclusion : The occurrence of HBsAg and anti-HCV was lower than those previously found in population-based studies and slightly lower than the most recent estimates. Individuals with lower socioeconomic status should be a priority target of public health policies.

RESUMO Objetivo: Estimar a probabilidade da ocorrência de infecção pelos vírus das hepatites B (HBV) e C (HCV) em diferentes estratos socioeconômicos da população de Recife, Nordeste do Brasil. Métodos: Estudo realizado com base em amostras obtidas em um inquérito de residentes de um grande centro urbano que teve base populacional e amostragem estratificada com seleção aleatória dos domicílios por meio do pacote "Amostra Brasil" no software R. A pesquisa do antígeno de superfície do HBV (HBsAg) e do anti-HCV foi realizada por testes imunocromatográficos. Nos casos positivos para HBsAg, foram realizadas pesquisas do anti-HBc e do HBeAg por quimioluminescência, bem como do HBV-DNA, por meio de PCR em tempo real. Para os casos positivos para anti-HCV, foi repetida a pesquisa desse anticorpo por quimioluminescência e do HCV-RNA por PCR em tempo real. A ocorrência de casos HBsAg e anti-HCV na população geral foi estimada com base em uma distribuição teórica binomial negativa. Resultados: Dentre 2.070 amostras examinadas, cinco (0,24%) foram HBsAg e duas (0,1%) anti-HCV positivas. A maioria dos casos tinha cor de pele autorreferida como preta/parda (6/7), nível de escolaridade até o ensino médio (6/7), companheiro fixo (5/7) e morava em área de baixo estrato socioeconômico (5/7). Conclusão: A ocorrência de HBsAg e anti-HCV foi inferior às anteriormente encontradas em estudos de base populacional e pouco menor do que as estimativas mais recentes. Indivíduos que apresentam menor condição socioeconômica devem ser alvo prioritário das políticas públicas de saúde.

Effectiveness of screening for tuberculosis in HIV: a pragmatic clinical trial

ABSTRACT OBJECTIVE: To verify the effectiveness of screening for tuberculosis (TB) on all-cause mortality and tuberculosis cases in newly diagnosed HIV-infected patients through a clinical algorithm based on recommendations of the World Health Organization. METHODS: From March 2014 to April 2016, a pragmatic randomized clinical trial was conducted with newly diagnosed and TB-free HIV-infected adults undergoing antiretroviral therapy for up to one month at a major tertiary hospital for HIV in the state of Pernambuco, Brazil. Participants were randomized into intervention and control groups using an automatically-generated random list, and followed-up for at least 6 months. The intervention group was screened for TB at hospital admission and at every follow-up visit through a series of questions addressing TB-related symptoms (cough, fever, night sweating, and weight loss). Patients presenting with any of these symptoms were referred to a pulmonologist and underwent sputum smear microscopy, sputum culture, and rapid molecular testing (GeneXpert). When at least one test result came back positive, TB treatment was initiated. In turn, if patients tested negative but presented with severe clinal symptoms, TB preventive treatment was initiated. Screening for TB was not performed systematically in the control group. The primary outcome assessed in this study was death from all causes, and secondary outcomes included sensitivity and specificity of this screening test, as well as its detection time. RESULTS: This study evaluated 581 patients, 377 in the intervention group (64.9%) and 204 in the control group (35.1%). In total, 36 patients died during the follow-up period. Of these, 26 (6.9%) were from the intervention group, reaching a cumulative mortality coefficient of 69 per 1,000 inhabitants, and 10 (4.9%) from the control group (p = 0.341), with a cumulative mortality coefficient of 49 per 1,000 inhabitants (p = 0.341).

Conhecimento, atitudes e práticas de agentes comunitários de saúde sobre tuberculose pulmonar em uma capital do Nordeste do Brasil / Knowledge, attitudes and practices of community health agents regarding pulmonary tuberculosis in a capital city in northeastern Brazil

Resumo Esse artigo analisa o conhecimento, atitudes e práticas sobre tuberculose de agentes comunitários de saúde (ACS) no Recife, município com altas taxas de incidência e de abandono do tratamento no Brasil. O estudo transversal foi conduzido em uma amostra representativa dos ACS utilizando questionário padronizado. Descreveram-se as frequências das variáveis referentes ao conhecimento, atitudes e práticas e analisou-se a associação do conhecimento satisfatório e práticas adequadas com características dos ACS. Dos 401 ACS elegíveis, 385 (96,0%) foram entrevistados. A maioria era composta por mulheres (87,5%), com idade ≥ 40 anos (66,0%) e desempenhando a função há mais de nove anos (74,5%). Um percentual de 61,7% tinha conhecimento satisfatório e esse conhecimento (75,8%) esteve associado às práticas adequadas (p = 0,008). Quanto às atitudes, 97,1% dos ACS acreditavam estar sob risco de contrair tuberculose e 53,2% atribuíram o risco à função. Parcela significativa dos ACS apresentou conhecimento satisfatório sobre tuberculose e esse conhecimento esteve associado às práticas adequadas. Esse resultado sugere a necessidade de investimentos em ações de capacitação que podem contribuir para a melhoria dos indicadores de tuberculose no município.

Abstract This article analyses the knowledge, attitudes and practices of community health agents (CHAs) regarding tuberculosis in Recife, a municipality with a high incidence of tuberculosis and high treatment dropout rates in Brazil. The cross-sectional study was conducted with a representative sample of CHAs and a standardized questionnaire. The frequencies of the variables related to knowledge, attitudes and practices were described, and the association between satisfactory knowledge and appropriate practices of CHAs was analysed. Of the 401 eligible CHAs, 385 (96.0%) were interviewed. The majority were women (87.5%) aged ≥ 40 years (66.0%) and had been on the job for more than nine years (74.5%). A large percentage (61.7%) had satisfactory knowledge about tuberculosis, and this knowledge (75.8%) was associated with appropriate practices (p = 0.008). Regarding attitudes, 97.1% of CHAs were believed to be at risk of contracting tuberculosis, and 53.2% attributed this risk to their job. The results suggest the need for investment in training actions that may help improve tuberculosis indicators in the municipality.

Prospective birth cohort in a hyperendemic dengue area in Northeast Brazil: methods and preliminary results / Coorte de nascimento prospectiva em uma área hiperendêmica em dengue no Nordeste do Brasil: métodos e resultados preliminares / Cohorte de nacimientos en un área hiperendémica en dengue en el nordeste de Brasil: métodos y resultados preliminares

Abstract Dengue cases have increased in younger age groups in Brazil. Maternal anti-dengue antibodies can have a protective effect in the first months of life, but their decline can increase the risk of severe dengue. A prospective birth cohort was established in 2011-2012 in the city of Recife, Pernambuco State, Brazil, to determine the incidence of serotype-specific dengue infection and the kinetics of transferred maternal anti-dengue antibodies in the first years of life. This article describes the design, methods and preliminary results of this cohort study. 354 children underwent clinical and laboratory monitoring for two years, with 15% losses to follow-up. The overall rate of new infections was approximately 10% in the first year of follow-up. Information on the force of serotype-specific dengue infection and the evaluation of transferred maternal antibodies can contribute to understanding dengue etiopathogenesis.

Resumo Casos de dengue têm aumentado em grupos etários mais jovens no Brasil. Anticorpos antidengue maternos podem exercer efeito protetor nos primeiros meses de vida, mas seu declínio pode aumentar o risco de dengue grave. Uma coorte de nascimento prospectiva foi estabelecida na cidade do Recife, Pernambuco, Brasil, entre 2011-2012, para determinar a incidência de infecção sorotipo-específica do dengue e cinética dos anticorpos antidengue materno-transferidos nos primeiros anos de vida. Este artigo descreve o desenho, os métodos e resultados preliminares deste estudo de coorte. Trezentas e cinquenta e quatro crianças foram acompanhadas clínico e laboratorialmente por dois anos, com 15% de perdas de seguimento. A taxa global de novas infecções foi de aproximadamente 10% na coorte de crianças no primeiro ano de seguimento. Informações sobre a força de infecção sorotipo-específica do dengue nos primeiros anos de vida, bem como a avaliação da cinética de anticorpos materno-transferidos poderão contribuir para a compreensão da etiopatogenia da doença.

Resumen Los casos de dengue han aumentado en los grupos de edad más jóvenes en Brasil. Los anticuerpos antidengue maternos pueden ejercer un efecto protector en los primeros meses de vida, pero su decremento puede aumentar el riesgo de dengue grave. Una cohorte de nacimientos prospectiva se estableció en la ciudad de Recife, Pernambuco, Brasil, entre 2011-2012, para determinar la incidencia de infección serotipo-específica de dengue y la cinética de los anticuerpos antidengue materno-transferidos durante los primeros años de vida. Este artículo describe el diseño, los métodos y resultados preliminares de este estudio de cohorte. 354 niños fueron acompañados clínicamente y en laboratorio durante dos años, con un 15% de pérdidas en el seguimiento. La tasa global de nuevas infecciones fue de aproximadamente un 10% en la cohorte de niños durante el primer año de seguimiento. La información sobre la fuerza de infección serotipo-específica del dengue en los primeros años de vida, así como la evaluación de la cinética de los anticuerpos materno-transferidos, podrá contribuir a la comprensión de la etiopatogenia de la enfermedad.

Romarias no município de Juazeiro do Norte, Ceará: perfil da demanda por atendimento de saúde e sazonalidade de internações* / Pilgrimages in Juazeiro do Norte, Ceará, Brazil: profile of demand for healthcare assistance and seasonality of hospitalizations

Descrever o perfil de morbidade de romeiros e investigar a variação sazonal das internações durante período de romaria em Juazeiro do Norte, Ceará, Brasil. Métodos: estudo transversal com dados dos atendimentos na romaria de Finados, 2 de novembro de 2012, e desenho ecológico de séries temporais sobre internações de 2007 a 2012; foram calculados índices de sazonalidade (IS). Resultados: entre 377 romeiros atendidos, a maioria tinha idade superior a 55 anos (53,5 por cento) e procurou atendimento para aferir a pressão arterial (71,1 por cento); observou-se aumento das internações por doenças respiratórias em abril (IS=1,40; IC95 por cento 1,13-1,67), maio (IS=1,21; IC95 por cento 1,03-1,40) e junho (IS=1,30; IC95 por cento 1,04-1,55), e por doenças circulatórias em junho (IS=1,23; IC95 por cento 1,15-1,24), julho (IS=1,15; IC95 por cento 1,06-1,24) e agosto (IS=1,09; IC95 por cento 1,06-1,11). Conclusão: o perfil de morbidade com predomínio de doenças do aparelho circulatório foi compatível com a faixa etária dos romeiros; não houve incremento das internações no período da romaria...

To describe the morbidity pattern among pilgrims and investigate seasonal hospitalization variation in periods of pilgrimage in Juazeiro do Norte, Ceará, Brazil. Methods: a cross-sectional study with medical assistance data during the November 2nd 2012, All Soul’s Day pilgrimage; and an ecological time series study to investigate hospitalization seasonality between 2007 and 2012; seasonal indexes (SI) were calculated. Results: among the 377 assisted pilgrims, most of them were more than 55 years old (53.5 per cent) and looked for medical assistance to measure blood pressure (71.1 per cent); seasonal hospitalization increase was observed for respiratory diseases in April (SI=1.40, 95 per cent CI 1.13-1.67), May (SI=1.21; 95 per cent CI 1.03-1.40) and June (IS=1.30; 95 per cent CI 1.04-1.55), and for circulatory diseases in June (SI=1.23; 95%CI 1.16-1.31), July (SI=1.15; 95 per cent CI 1.06-1,24) and August (SI=1.09; 95 per cent CI 1.06-1.11). Conclusion: the morbidity pattern with prevalence of circulatory diseases was compatible with the age of pilgrims; there was no increase in hospitalizations in the period of pilgrimage...

Evaluation of diagnostic tests for Wuchereria bancrofti infection in Brazilian schoolchildren

Introduction Since the launch of the Global Programme to Eliminate Lymphatic Filariasis, more than 70% of the endemic countries have implemented mass drug administration (MDA) to interrupt disease transmission. The monitoring of filarial infection in sentinel populations, particularly schoolchildren, is recommended to assess the impact of MDA. A key issue is choosing the appropriate tools for these initial assessments (to define the best intervention) and for monitoring transmission. Methods This study compared the pre-MDA performance of five diagnostic methods, namely, thick film test, Knott's technique, filtration, Og4C3-ELISA, and the AD12-ICT card test, in schoolchildren from Brazil. Venous and capillary blood samples were collected between 11 pm and 1 am. The microfilarial loads were analyzed with a negative binomial regression, and the prevalence and associated 95% confidence intervals were estimated for all methods. The accuracies of the AD12-ICT card and Og4C3-ELISA tests were assessed against the combination of parasitological test results. Results A total of 805 schoolchildren were examined. The overall and stratified prevalence by age group and gender detected by Og4C3-ELISA and AD12-ICT were markedly higher than the prevalence estimated by the parasitological methods. The sensitivity of the AD12-ICT card and Og4C3-ELISA tests was approximately 100%, and the positive likelihood ratios were above 6. The specificity of the Og4C3-ELISA was higher than that of the AD12-ICT at different prevalence levels. Conclusions The ICT card test should be the recommended tool for monitoring school-age populations living in areas with ongoing or completed MDA. .

Diferenciais na adequação das informações de eventos vitais nos municípios de Pernambuco, 2006-2008 / Differentials in vital information in the state of Pernambuco, Brazil, 2006-2008

OBJETIVO: Avaliar os diferenciais da adequação das informações de nascimentos e óbitos do Ministério da Saúde para o cálculo da mortalidade infantil nos municípios do Estado de Pernambuco, 2006-2008. MÉTODOS: Estudo ecológico, cujas fontes de dados foram os sistemas de informação sobre nascidos vivos e mortalidade. Foram utilizados os indicadores: coeficiente de mortalidade geral padronizado por idade, desvio médio relativo do coeficiente de mortalidade geral, razão entre nascidos vivos informados e estimados, desvio médio relativo da taxa de natalidade e proporção de óbitos sem definição de causa básica. Estes indicadores foram agregados em três dimensões: mortalidade, natalidade e mal definidos. Utilizando critérios pré-estabelecidos, os municípios foram classificados como: informações vitais consolidadas, em fase de consolidação e não consolidadas. Os dados foram analisados através do programa Epiinfo e do Terraview para elaboração dos mapas. RESULTADOS: Dos 185 municípios do Estado, 141 (76,2%) foram classificados como informações vitais consolidadas, agregando aproximadamente 85% da população residente e 17 (9,2%) como não consolidadas, categoria na qual reside apenas 4,9% da população. Os municípios com 50.000 habitantes ou mais têm informações de melhor qualidade. CONCLUSÃO: O método utilizado mostrou-se potencial para classificar a qualidade das informações vitais em Pernambuco, identificando as desigualdades, que se constituem em desafios para o Estado, no sentido de possibilitar a análise destas informações a partir de dados diretos dos sistemas no âmbito municipal. Apenas dessa forma torna-se possível avaliar os investimentos realizados para a redução da mortalidade infantil em Pernambuco de forma realística.

OBJECTIVE: To assess differentials in official birth and death data for estimating infant mortality. METHODS: An ecological study was conducted based on data obtained from birth and death information systems in the state of Pernambuco, northeastern Brazil, between 2006 and 2008. The following indicators were used: age-standardized mortality rate, relative mean deviation of mortality rate, ratio of reported to estimated live births, relative mean deviation of birth rate and proportion of deaths of unknown cause. These indicators were grouped into three dimensions: mortality, fertility and ill-defined causes. Based on predetermined criteria, municipalities were classified as follows: consolidated vital data; vital data in the consolidation phase; and non-consolidated data. The data were analyzed using EpiInfo and Terraview for map preparation. RESULTS: Of the 185 municipalities in the state of Pernambuco, 141 (76.2%) were classified as having consolidated vital data, accounting for about 85% of the state population, and 17 (9.2%) were classified as having non-consolidated data, accounting for only 4.9% of the population. Larger municipalities (50,000 inhabitants or more) showed better data quality. CONCLUSION: The approach studied proved itself valuable to assess the quality of vital information and identify inequalities in Pernambuco. Reduction of inequalities is a challenge in this state in the sense of enabling vital information to be analyzed directly from data systems at the local level. It will also allow assessing the effectiveness of initiatives to reduce infant mortality in Pernambuco.

Adverse reactions following mass drug administration with diethylcarbamazine in lymphatic filariasis endemic areas in the Northeast of Brazil / Reações adversas após tratamento em massa com dietilcarbamazina em áreas endêmicas de filariose linfática no nordeste do Brasil

INTRODUCTION: The Global Programme to Eliminate Lymphatic Filariasis was launched with the goal of eliminating this disease via the annual mass drug administration (MDA) of a single dose of antifilarial drugs. Adverse drug reactions following MDA are a major factor of poor treatment adherence in several countries. This study assessed the occurrence of adverse drug reactions (ADRs) following the first round of mass treatment in two communities treated with different dosages of diethylcarbamazine (DEC) in the City of Recife, Brazil. METHODS: Population-based cross-sectional surveys were conducted in a random sample of the population living in both communities (Areas I and II). The dose of DEC recommended by the WHO (6mg/kg) was calculated based on the individual's weight-for-age. In Area II, weight differences between the genders were also considered when determining dosage. Data were obtained through interviews conducted in the first 12 to 48h and on the 5th day after MDA during household visits. RESULTS: A total of 487 and 365 individuals were interviewed in Areas I and II, respectively. The prevalence of ADRs in Area I (23.6; 95%CI: 19.1-29.5) was higher than in Area II (16.2; 95%CI:11.9-21.5)(p=0.0078). The prevalence of ADRs among females was higher than in males in Area I (p=0.0021). In Area II, no significant difference between the genders was observed (p=0.1840). Age was not associated with ADRs in either area. CONCLUSIONS: Adjusting MDA dosage schedules according to weight-for-age and sex may be may contribute to reduce the occurrence of adverse drug reactions in the population.

INTRODUÇÃO: O Programa Global de Eliminação da Filariose Linfática foi lançado visando à eliminação da doença pela administração de medicamentos em massa (MDA). As reações adversas seguidas ao MDA são um importante fator de baixa adesão ao tratamento em vários países. Este estudo avaliou a ocorrência de reações adversas medicamentosas (ADRs) após a primeira dose de tratamento em massa em duas comunidades tratadas com diferentes doses de dietilcarbamazina (DEC), na Cidade de Recife, Brasil. MÉTODOS: Estudos transversais foram realizados em uma amostra aleatória da população de duas áreas (Áreas I e II). A dose de DEC recomendada pela OMS (6mg/kg) foi calculada com base em parâmetros populacionais de peso para a idade. Na Área II, diferenças de peso entre os sexos também foram consideradas no cálculo. Dados foram obtidos através de entrevistas nas primeiras 12 às 48h e 5º dia após o tratamento durante visitas domiciliares. RESULTADOS: Um total de 487 e 365 pessoas foi entrevistado nas Áreas I e II, respectivamente. A prevalência de ADRs na Área I (23,6; IC95%: 19,1-29,5) foi maior do que na Área II (16,2; IC 95%:11,9-21,5)(p=0,0078). Na Área I, a prevalência de ADRs foi maior nas mulheres do que nos homens (p=0,0021), não se observando diferença na Área II (p=0,1840). Idade não esteve associada à ADRs. CONCLUSÕES: Doses de tratamento em massa (MDA) ajustadas por peso para a idade e sexo parecem contribuir para redução da ocorrência de ADRs na população.

Fatores associados à cárie dentária em pré-escolares do Recife, Pernambuco, Brasil / Factors associated with dental caries in preschoolers in Recife, Pernambuco State, Brazil

To investigate factors associated with dental caries in deciduous dentition, a nested case-control study was conducted in a prevalence survey of preschool children (n = 1,690) aged 18 to 36 months and 5 years of age, treated under the Family Health Program in Recife, Pernambuco State, Brazil, in 2006. Cases were children with dmft > 1 and controls with dmft = 0. The independent variables were analyzed in blocks: demographic, environmental, family structure, health care, and dental services use. OR and 95 percentCI were estimated. Variables associated with the outcome at p < 0.20 in the univariate analysis were included in a multivariate logistic regression model. The cutoff for remaining in the final model was p < 0.10. Larger households (more members), lack of running supply, time of residence, maternal (or caregiver's) schooling, attendance in public preschool, demand for dental services, and sugar intake patterns were associated factors. Variables related to social context were the main predictors of caries, thus highlighting the need for comprehensive measures to address other common childhood health problems.

Para investigar fatores associados à cárie dentária na dentição decídua, realizou-se estudo de caso-controle aninhado a inquérito de prevalência em 1.690 pré-escolares de 18-36 meses e cinco anos de idade, assistidos pela Estratégia Saúde da Família no Recife, Pernambuco, Brasil, em 2006. Os casos foram crianças com ceo-d > 1 e os controles, com ceo-d = 0. As variáveis independentes foram analisadas em blocos sociodemográfico e ambiental, estrutura familiar, cuidados com a saúde bucal e uso de serviços. Estimou-se OR brutas e IC95 por cento. Variáveis associadas ao desfecho com p < 0,20 em análises univariadas foram incluídas no modelo de regressão logística multivariado, com critério de permanência no modelo final p < 0,10. Maior número de moradores no domicílio, falta de abastecimento de água, tempo de moradia, escolaridade do cuidador, uso de pré-escola pública, procura por serviço de saúde bucal e padrão de consumo de açúcar foram fatores associados. As variáveis relacionadas ao contexto social foram os principais preditores de cárie, apontando para a necessidade de ações integradas de saúde comuns a outros agravos infantis.

Óbito por dengue como evento sentinela para avaliação da qualidade da assistência: estudo de caso em dois municípios da Região Nordeste, Brasil, 2008 / Death from dengue fever as a sentinel event for evaluation of quality of healthcare: a case study in two municipalities in Northeast Brazil, 2008

Apesar dos meios para assistência adequada aos pacientes de dengue na rede de saúde, os índices de letalidade pela doença mantêm-se altos no Brasil. Visando a identificar implicações para ocorrência do óbito, este estudo avaliou a qualidade da assistência conforme grau de implantação das ações, qualidade técnico-científica da atenção e acesso aos serviços de saúde, em dois municípios do Nordeste do Brasil. Realizou-se pesquisa avaliativa, do tipo análise de implantação, tendo o óbito por dengue como evento sentinela da qualidade da assistência. Para avaliação do grau de implantação e qualidade da atenção, pontuaram-se os critérios das entrevistas e análise dos prontuários; para o acesso, procedeu-se à análise temática. Quanto à estrutura e ao processo, os serviços de saúde encontram-se parcialmente adequados (70 por cento). Não foram encontradas barreiras geográficas e econômicas que justificassem a ocorrência dos óbitos. A qualidade técnico-científica não alcançou a adequação nos municípios (46 por cento e 30 por cento) e nos serviços avaliados, observando-se insuficiência no manejo clínico da dengue nos serviços de saúde.

Despite the existing resources for adequate dengue patient care in the Brazilian healthcare system, the case-fatality rate for the disease is still high in the country. In order to identify factors associated with dengue-related death, this study evaluated quality of care according to the degree of implementation of specific measures, the technical and scientific quality of care, and access to health services in two municipalities (counties) in Northeast Brazil. An evaluative study of the implementation analysis type was performed, with death from dengue as the sentinel event for quality of care. To assess the degree of implementation and quality of care, the study scored the interview criteria and patient chart analysis; access was evaluated by thematic analysis. As for structure and process, the health services were found to be partially adequate (70 percent). No geographic or economic barriers were found to explain the occurrence of deaths. Technical and scientific quality failed to achieve adequate levels in the municipalities (46 percent and 30 percent) or in the specific services, and clinical management of dengue by the health services proved insufficient.