ABSTRACT
ABSTRACT Background: People living with HIV (PLH) under combined antiretroviral therapy (cART) are at risk of developing type 2 diabetes mellitus (T2DM). Objective: We examined the incidence of T2DM, associated factors and mean time to outcome in PLH under cART. Method: Data for this multicenter cohort study were obtained from PLH aged over 18, who started cART in 13 Brazilian sites from 2003 to 2013. Factors associated with incident T2DM were evaluated by Cox multiple regression models. Results: A total of 6724 patients (30,997.93 person-years) were followed from January 2003 to December 2016. A T2DM incidence rate of 17.3/1000 person-years (95%CI 15.8-18.8) was observed. Incidence of isolated hypertriglyceridemia and impaired fasting glucose (IFG) were 84.3 (95%CI 81.1-87.6) and 14.5/1000 person-years (95%CI 13.2-15.9), respectively. Mean time to T2DM onset was 10.5 years (95%CI 10.3-10.6). Variables associated with incident T2DM were age 40-50 [Hazard Ratio (HR) 1.7, 95%CI 1.4-2.1] and ≥ 50 years (HR 2.4, 95%CI 1.9-3.1); obesity (HR 2.1, 95%CI 1.6-2.8); abnormal triglyceride/HDL-cholesterol ratio (HR 1.8, 95%CI 1.51-2.2). IFG predicted T2DM (HR 2.6, 95%CI 1.7-2.5) and occurred on average 3.3 years before diabetes onset. Exposure to stavudine for ≥ 2 years was independently associated with incident T2DM [HR 1.6, 95%CI 1.0-2.2). Conclusion: Brazilian PLH under cART are at significant risk of developing T2DM and share risk factors for diabetes onset with the general population, such as older age, obesity, and having metabolic abnormalities at baseline. Moreover, stavudine use was independently associated with incident T2DM. Identifying PLH at a higher risk of T2DM can help caretakers trigger health promotion and establish specific targets for implementation of preventive measures.
Subject(s)
Humans , Adult , Aged , Acquired Immunodeficiency Syndrome , Diabetes Mellitus, Type 2/epidemiology , Incidence , Risk Factors , Cohort Studies , Middle AgedABSTRACT
Stray dogs are associated with environment and public health impacts. São Paulo is a city with approximately 2.5 million owned dogs and until the time of writing no studies describing the distribution of the stray dog population have been conducted in this city. Therefore, no scientific support for intervention plans is available. The objective of this study was to evaluate the association of local sociodemographic and environmental factors with the population perception of presence of stray dogs in urban fragments of São Paulo city. A convenience sample of six urban fragments was selected. In-depth interviews were performe, using a systematic random sample of households in each study area, between October/2010 and January/2011 to identify socio-demographic factors of interest and determine the population's perception of stray dogs. Additionally, the presence of stray dogs was estimated by photographic mark-recapture method. The degree of human-dog proximity and environmental factors such as waste handling were associated to the sighting of stray dogs. Stray dogs were observed in two of the six study areas, agreeing with the greater population perception of this issue on those areas. Intervention in these factors and encouragement of responsible ownership are two potential solutions for management and reduction of problems associated with the presence of stray dogs.(AU)
A presença de cães errantes está associada a impactos no meio ambiente e na saúde pública. São Paulo é uma cidade com aproximadamente 2.5 milhões de cães domiciliados e até o presente momento, não foram desenvolvidos estudos que descrevam a distribuição da população errante na cidade. Desta forma, não há suporte científico para planejar intervenções. O objetivo deste estudo foi avaliar a associação entre os fatores sociodemográficos e ambientais da população local com a frequência com que relataram a visualização de cães errantes em fragmentos urbanos da cidade de São Paulo. Foi definida uma amostra de conveniência composta por seis fragmentos urbanos, onde um questionário foi aplicado em uma amostra sistemática dos domicílios de cada área de estudo. Este questionário, aplicado entre outubro de 2010 e janeiro de 2011, determinou os fatores socio-econômicos de interesse e a percepção da presença de cães errantes pela população. Também foi estimada a presença de cães pelo método de marcação e recaptura fotográfica. Foi possível estabelecer uma relação entre a visualização de cães errantes pela população local e o grau de proximidade com cães e o manejo de resíduos do domicílio. Cães errantes foram observados em duas das seis áreas trabalhadas, em concordância com a maior percepção da sua presença pela população local. Intervenções nestes fatores e incentivo a guarda responsável são duas ações com potencial de contribuir para redução dos problemas causados pela presença de cães errantes.(AU)