The Effect of Geoclimatic Factors on the Distribution of Paracoccidioidomycosis in Mato Grosso do Sul, Brazil.

The incidence of paracoccidioidomycosis (PCM) varies in Latin America, and it is influenced by environmental factors. This study evaluated the distribution of PCM acute/subacute form (AF) cases and their correlation with geoclimatic factors in the Mato Grosso do Sul (MS) state. The study included 81 patients diagnosed with the PCM/AF at the University Hospital of the Federal University of Mato Grosso do Sul between January 1980 and February 2022. Geographic coordinates, health microregion of patient's residence, compensated average temperature, relative air humidity (RH), El Niño Southern Oscillation (ENSO), and average global temperature were analyzed. The highest incidence was observed in the Aquidauana (7/100,000 inhabitants), while Campo Grande, the state's capital, had the highest number (n = 34; 42.4%) and density (4.4 cases/km2) of cases. The number of cases increased during extended periods of the El Niño phenomenon. A positive correlation was found between higher RH and PCM/AF cases. Most PCM/AF cases were found in areas with loamy soils and RH ranging from 60.8 to 73.6%. In MS, the health microregions of PCM/AF patients are characterized by deforestation for agricultural and pasture use, coupled with loamy soils and specific climatic phenomena leading to higher soil humidity.

Treatment compliance of patients with paracoccidioidomycosis in Central-West Brazil.

OBJECTIVE: To evaluate the treatment compliance of patients with paracoccidioidomycosis. METHODS: We studied 188 patients with paracoccidioidomycosis admitted to a tertiary referral hospital in the Central-West Region of Brazil from 2000 to 2010, to assess their compliance to treatment. In order to be considered compliant, patients needed to present two established criteria: (1) receive medicines from the pharmacy, and (2) achieve a self-reported utilization of at least 80% of the dispensed antifungal compounds prescribed since their previous appointment. RESULTS: Most patients were male (95.7%), had the chronic form of the disease (94.2%), and were treated with cotrimoxazole (86.2%). Only 44.6% of patients were treatment compliant. The highest loss to follow-up was observed in the first 4 months of treatment (p < 0.02). Treatment compliance was higher for patients with than for those without pulmonary involvement (OR: 2.986; 95%CI 1.351-6.599), and higher for patients with than without tuberculosis as co-morbidity (OR: 2.763; 95%CI 1.004-7.604). CONCLUSIONS: Compliance to paracoccidioidomycosis treatment was low, and the period with the highest loss to follow-up corresponds to the first four months. Pulmonary paracoccidioidal involvement or tuberculosis comorbidity predicts a higher compliance to paracoccidioidomycosis therapy.

Primeiros socorros: investigação do treinamento de professores de uma escola da rede pública de Campo Grande / First aid: investigating the training of teachers at a public school in Campo Grande / Primeros auxilios: estudiar la capacitacion de los profesores en una escuela pública en Campo Grande

Introdução: Qualquer pessoa pode passar por situações de urgência e emergência, em qualquer lugar. Dessa forma, a primeira pessoa a se deparar com a cena deve ser o primeiro a prestar socorros. Objetivo: identificar o conhecimento em primeiros socorros de professores de uma escola municipal. Método: Estudo de caráter exploratório, quantitativo realizado com professores de uma escola municipal de Campo Grande. A amostra foi composta por 43% (n=30) dos professores. Foi realizado a aplicação de um questionário após treinamento de primeiros socorros. Resultados e discussão: Quando questionados sobre os números de emergência, 43,4% (n=13) conheciam. Em relação a abertura de vias aéreas, 46,6% (n=14) responderam corretamente. Posicionamento da vítima para compressão cardíaca foi assinalado assertivamente por 53,4% (n=16). Conclusão: Mesmo após receberem treinamentos, grande parte dos professores ainda não se demonstraram preparados a prestar assistência de urgência ou emergência. O profissional capacitado para responder esta demanda seria o enfermeiro (AU).

Introduction: Anyone can go through urgent and emergency situations, anywhere. Thus, the first person to come across the scene must be the first to provide assistance. Objective: to identify first aid knowledge of teachers at a municipal school. Method: An exploratory, quantitative study carried out with teachers from a municipal school in Campo Grande - MS. The sample was composed of 43% (n = 30) of teachers. A questionnaire was administered after first aid training. Results and discussion: When asked about the emergency numbers, 43.4% (n = 13) knew about it. Regarding the opening of the airways, 46.6% (n = 14) responded correctly. Positioning the victim for cardiac compression was assertively reported by 53.4% (n = 16). Conclusion: Even after receiving training, most teachers have not yet shown themselves prepared to provide urgent or emergency assistance. The professional trained to answer this demand would be the nurse (AU).

Introducción: Cualquiera puede pasar por situaciones urgentes y de emergencia, en cualquier lugar. Por lo tanto, la primera persona que se encuentre con la escena debe ser la primera en brindar asistencia. Objetivo: Identificar el conocimiento de primeros auxilios que tienen los maestros de una escuela municipal. Método: Estudio exploratorio cuantitativo realizado con docentes de una escuela municipal de Campo Grande, MS. La muestra estuvo compuesta por el 43% (n=30) de los docentes. Se administró un cuestionario después del entrenamiento de primeros auxilios. Resultados y discusión: Cuando se les preguntó los números de emergencia, el 43,4% (n = 13) los sabía. En cuanto a la apertura de las vías aéreas, el 46,6% (n=14) respondió correctamente. La posición de la víctima para la compresión cardíaca fue marcada asertivamente por el 53,4% (n=16). Conclusión: Incluso después de recibir la capacitación, la mayoría de los docentes aún no está preparado para brindar asistencia de urgencia o de emergencia. El profesional capacitado para responder a esta demanda sería el enfermero (AU).

A percepção da gestante sobre a qualidade do atendimento pré-natal em UBS, Campo Grande, MS / Pregnant women perception of the quality of prenatal care at UBS, Campo Grande, MS / La Percepción de la mujer embarazada acerca de la calidad de la atención prenatal en UBS, Campo Grande, MS

A assistência pré-natal tem o intuito de identificar aquelas pacientes com mais probabilidade de apresentar evolução desfavorável e acolher a mulher desde o princípio de sua gestação. O objetivo foi contribuir para a melhoria da qualidade do atendimento pré-natal nas unidades básicas de saúde (UBSs) do município de Campo Grande, MS, construindo saberes segundo a percepção da gestante. Tratou-se de um estudo descritivo exploratório de natureza qualitativa. A coleta de dados foi realizada por meio de entrevista estruturada aberta. Para analisar os resultados, o estudo foi dividido em cinco categorias temáticas, as quais demonstraram o entendimento, a opinião e os sentimentos das gestantes. Por fim, percebeu-se que para a assistência pré-natal ser de qualidade, é necessário que os profissionais e as gestantes caminhem juntos. Os profissionais precisam criar meios para que as gestantes não deixem de realizar consultas e elas podem esclarecer suas dúvidas, não existindo barreiras que atrapalhem essa comunicação.

Prenatal care assistance aims to identify those patients with a greater likelihood of unfavorable developments, and to welcome the woman from the beginning of her pregnancy. The goal was to contribute to the improvement of the quality of prenatal care in the Units of Basic Health (UBS) in the municipality of Campo Grande, MS, building knowledge from the perception of pregnant women. This is a descriptive exploratory qualitative study. Data collection was conducted through open structured interviews. The study was divided into five thematic categories, which demonstrate the understanding, opinions and feelings of pregnant women. Finally, we realized that the quality of prenatal care requires that professionals and the pregnant women to work together. Professionals need to engage the commitment of these pregnant women to their appointments, and pregnant women need the chance to have their questions answered without communication barriers.

La atención prenatal tiene la intención de identificar a aquellas pacientes con mayor probabilidad de presentar una evolución desfavorable, y de acoger a las mujeres desde el comienzo de su gestación. El objetivo fue contribuir a mejorar la calidad de la atención prenatal en las Unidades de Salud Básicas (UBS) del municipio de Campo Grande, MS, construyendo el conocimiento a partir de la percepción de la mujer embarazada. Estudio descriptivo exploratorio de naturaleza cualitativa. La recolección de datos se realizó mediante entrevistas de estructura abierta. Para analizar los resultados el estudio se dividió en cinco categorías temáticas, que mostraron la comprensión, opinión y sentimientos de las mujeres embarazadas. Por último, se señala que para que la atención prenatal sea de calidad es necesario que los profesionales y las mujeres embarazadas caminen juntos. Los profesionales necesitan crear medios para que estas mujeres embarazadas no dejen de realizar consultas y puedan clarificar sus dudas, sin barreras que obstaculicen esta comunicación.

Decreasing prevalence of the acute/subacute clinical form of paracoccidioidomycosis in Mato Grosso do Sul State, Brazil.

With the objective to evaluate the behavior of paracoccidioidomycosis in the last three decades, clinical and epidemiological data of 595 patients admitted to clinical services of the Federal University of Mato Grosso do Sul from 1980 to 2009 were investigated. Gender, age distribution, clinical form, comorbidity with tuberculosis or AIDS, and mortality were compared by decades of clinical admission. It was shown that during the three decades there was a decrease in women percentage, and the same manner occurred a reduction in participants in the age group of 20 to 39 years. Moreover, the acute/subacute forms have been diminished in the period. These fluctuations are closely related and can be simultaneously analyzed. Increased AIDS co-infection prevalence from the first to the second decade was also revealed, coinciding with the appearance of the retroviral epidemic and stabilizing during the third decade. No change in the tuberculosis co-infection rate was observed (overall = 6.9%). It reinforces the importance of this co-morbidity. The overall mortality rate remained steady at 6.7%, not varying significantly from one decade to another. The persistent mortality rate calls attention to the importance of this neglected disease.

Treatment compliance of patients with paracoccidioidomycosis in Central-West Brazil / Adesão ao tratamento de pacientes com paracoccidioidomicose na Região Centro-Oeste do Brasil

ABSTRACT Objective: To evaluate the treatment compliance of patients with paracoccidioidomycosis. Methods: We studied 188 patients with paracoccidioidomycosis admitted to a tertiary referral hospital in the Central-West Region of Brazil from 2000 to 2010, to assess their compliance to treatment. In order to be considered compliant, patients needed to present two established criteria: (1) receive medicines from the pharmacy, and (2) achieve a self-reported utilization of at least 80% of the dispensed antifungal compounds prescribed since their previous appointment. Results: Most patients were male (95.7%), had the chronic form of the disease (94.2%), and were treated with cotrimoxazole (86.2%). Only 44.6% of patients were treatment compliant. The highest loss to follow-up was observed in the first 4 months of treatment (p < 0.02). Treatment compliance was higher for patients with than for those without pulmonary involvement (OR: 2.986; 95%CI 1.351-6.599), and higher for patients with than without tuberculosis as co-morbidity (OR: 2.763; 95%CI 1.004-7.604). Conclusions: Compliance to paracoccidioidomycosis treatment was low, and the period with the highest loss to follow-up corresponds to the first four months. Pulmonary paracoccidioidal involvement or tuberculosis comorbidity predicts a higher compliance to paracoccidioidomycosis therapy.

RESUMO Objetivo: Avaliar a adesão ao tratamento de paracoccidioidomicose. Métodos: Estudo conduzido com 188 pacientes com paracoccidioidomicose atendidos em um hospital terciário na Região Centro-Oeste do Brasil, de 2000 a 2010, para avaliar adesão ao tratamento. Foram considerados aderentes pacientes que tiveram o seguinte critério: retiraram os medicamentos na farmácia e autorrelataram a utilização de, no mínimo, 80% de dispensação dos antifúngicos prescritos na última consulta. Resultados: A maioria dos pacientes era homem (95,7%), tinha a forma crônica da doença (94,2%) e foi tratada com sulfametoxazol/trimetropim (86,2%). Apenas 44,6% dos pacientes aderiram ao tratamento. A maior perda de seguimento foi observada nos primeiros 4 meses de tratamento (p < 0,02). Adesão ao tratamento foi maior em pacientes com do que sem envolvimento pulmonar (RC: 2,986; IC95% 1,351-6,6599) e maior para os pacientes com do que sem tuberculose associada (RC 2,763; IC95% 1,004-7,604). Conclusões: A adesão ao tratamento da paracoccidioidomicose foi baixa e os primeiros 4 meses constituíram o período com maior evasão. Pacientes com envolvimento paracocidióidico pulmonar ou tuberculose associada revelaram maior adesão ao tratamento da paracoccidioidomicose.

Decreasing prevllence of the acute/subacute cliical form of paracoccidioidomyccosis in mato grosso do sul state, Braiil / Reducao na prevalencia da forma aguda/subaguda da paracoccidioidomicose em Mato Grosso do Sul, Brasil

With the objective to evaluate the behavior of paracoccidioidomycosis in the last three decades, clinical and epidemiological data of 595 patients admitted to clinical services of the Federal University of Mato Grosso do Sul from 1980 to 2009 were investigated. Gender, age distribution, clinical form, comorbidity with tuberculosis or AIDS, and mortality were compared by decades of clinical admission. It was shown that during the three decades there was a decrease in women percentage, and the same manner occurred a reduction in participants in the age group of 20 to 39 years. Moreover, the acute/subacute forms have been diminished in the period. These fluctuations are closely related and can be simultaneously analyzed. Increased AIDS co-infection prevalence from the first to the second decade was also revealed, coinciding with the appearance of the retroviral epidemic and stabilizing during the third decade. No change in the tuberculosis co-infection rate was observed (overall = 6.9%). It reinforces the importance of this co-morbidity. The overall mortality rate remained steady at 6.7%, not varying significantly from one decade to another. The persistent mortality rate calls attention to the importance of this neglected disease.

Com o objetivo de avaliar o comportamento da paracoccidioidomicose nas últimas três décadas, dados clínicos e epidemiológicos de 595 pacientes atendidos dentre 1980 a 2009 no Hospital da Universidade Federal de Mato Grosso do Sul foram estudados. Sexo, faixa etária, forma clínica, associação com tuberculose ou AIDS e mortalidade foram comparados por década em que a doença foi diagnosticada. Observou-se, nas três décadas do estudo, uma redução do percentual de mulheres, de pacientes do grupo de 20 a 39 anos, assim como de casos com a forma aguda/subaguda. Estas alterações estão intimamente relacionadas e podem ser analisadas simultaneamente. Houve aumento de casos de coinfecção com AIDS da primeira para segunda década, coincidindo com o surgimento da epidemia, e manteve-se estável durante a década seguinte. Não houve alteração da taxa de coinfecção com tuberculose, que no geral foi de 6,9% o que reforça a importância desta comorbidade. A taxa geral de mortalidade foi de 6,7% e também não variou entre as décadas estudadas. A manutenção da taxa de óbitos chama a atenção para a relevância dessa doença negligenciada.