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1.
Indian J Dermatol Venereol Leprol ; 87(3): 341-347, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33943064

RESUMO

BACKGROUND: Lichen planus pigmentosus can have a negative impact on the quality of life; however, this has not been studied in detail. OBJECTIVES: To study the quality of life in patients with lichen planus pigmentosus and compare it with patients with vitiligo and melasma. METHODS: This was a cross-sectional study conducted in a tertiary-care center in north India from January 2018 to May 2019. Patients ≥ 18 years of age with lichen planus pigmentosus (n = 125), vitiligo (n = 113) and melasma (n = 121) completed the Dermatology Life Quality Index (DLQI) questionnaire and answered a global question on the effect of disease on their lives. In addition, patients with vitiligo completed the Vitiligo Impact Scale (VIS)-22 questionnaire, while those with lichen planus pigmentosus and melasma filled a modified version of VIS-22. RESULTS: The mean DLQI scores in patients with lichen planus pigmentosus, vitiligo and melasma were 10.9 ± 5.95, 9.73 ± 6.51 and 8.39 ± 5.92, respectively, the difference being statistically significant only between lichen planus pigmentosus and melasma (P < 0.001). The corresponding mean modified VIS-22/VIS-22 scores were 26.82 ± 11.89, 25.82 ± 14.03 and 18.87 ± 11.84, respectively. This difference was statistically significant between lichen planus pigmentosus and melasma, and between vitiligo and melasma (P < 0.001 for both). As compared to vitiligo, patients with lichen planus pigmentosus had a significantly greater impact on "symptoms and feelings" domain (P < 0.001) on DLQI, and on "social interactions" (P = 0.02) and "depression" (P = 0.04) domains on VIS-22. As compared to melasma, patients with lichen planus pigmentosus had significantly higher scores for "symptoms and feelings," "daily activities," "leisure" and "work and school" domains of DLQI, and all domains of VIS-22. Female gender was more associated with impairment in quality of life in patients with lichen planus pigmentosus, while lower education, marriage, younger age and increasing disease duration showed a directional trend. LIMITATIONS: Use of DLQI and modified version of VIS-22 scales in the absence of a pigmentary disease-specific quality-of-life instrument. CONCLUSION: Patients with lichen planus pigmentosus have a significantly impaired quality of life. The psychosocial burden of lichen planus pigmentosus is quantitatively similar to that of vitiligo, but significantly greater than melasma.


Assuntos
Líquen Plano/psicologia , Melanose/psicologia , Transtornos da Pigmentação/psicologia , Qualidade de Vida , Vitiligo/psicologia , Adolescente , Adulto , Idoso , Estudos Transversais , Escolaridade , Feminino , Humanos , Índia , Líquen Plano/complicações , Masculino , Estado Civil , Pessoa de Meia-Idade , Transtornos da Pigmentação/etiologia , Fatores Sexuais , Centros de Atenção Terciária , Adulto Jovem
2.
Front Immunol ; 11: 1927, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33013845

RESUMO

Mannose-binding lectin (MBL) is a serum protein of innate immunity, with a central role in the activation of the complement system through the lectin pathway. This protein is encoded by MBL2 gene, and single-nucleotide polymorphisms located at exon 1, such as rs5030737 C>T (D variant), rs1800450 G>A (B variant), and rs1800451 G>A (C variant), may change the MBL structure and the serum concentration. MBL2 polymorphisms have been associated with several infectious diseases, including leprosy. Host immune response has a major impact on the clinical manifestation of leprosy since only a few individuals infected with Mycobacterium leprae will develop the disease. Therefore, the aim of this study was to evaluate the influence of MBL2 exon 1 polymorphisms (rs5030737, rs1800450, and rs1800451) on the MBL levels and leprosy immunopathogenesis. This case-control study included 350 leprosy patients from Southern Brazil, with 279 classified as multibacillary (MB) and 71 as paucibacillary (PB). The control group consisted of 350 non-consanguineous individuals, who were not diagnosed with leprosy or other infectious and autoimmune diseases. Genotyping was performed by PCR-sequence specific primers, and the MBL serum concentrations were evaluated by ELISA. MBL2 exon 1 polymorphisms were analyzed individually and grouped as genotypes, considering "A" as the wild allele and "O" as the presence of at least one polymorphism (D, B, or C variants). Differences were not observed in the distribution of genotypic and allelic frequencies between leprosy per se patients and controls. However, in a haplotypic analysis, the TGG haplotype presented a risk for development of leprosy per se in women when compared to the wild haplotype (CGG) (OR = 2.69). Comparing patients with MB and PB, in a multivariate analysis, the B variant was associated with the susceptibility of developing the MB form of leprosy (OR = 2.55). Besides that, the CAG haplotype showed an increased susceptibility to develop MB leprosy in women compared to men. It was observed that the A/O genotype in women was associated with a susceptibility to leprosy development per se (OR = 1.66) and progression to MB leprosy (OR = 3.13). In addition, the MBL serum concentrations were in accordance with the genotyping analysis. In summary, our data suggest that MBL2 exon 1 polymorphisms are associated with an increased risk to leprosy development and progression.


Assuntos
Hanseníase Multibacilar/genética , Lectina de Ligação a Manose/genética , Polimorfismo de Nucleotídeo Único , Adulto , Idoso , Brasil , Estudos de Casos e Controles , Éxons , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Hanseníase Multibacilar/diagnóstico , Hanseníase Multibacilar/microbiologia , Masculino , Pessoa de Meia-Idade , Fenótipo , Medição de Risco , Fatores de Risco , Fatores Sexuais
3.
PLoS Negl Trop Dis ; 14(9): e0008611, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32936805

RESUMO

BACKGROUND: The aim of this study is to explore whether transmission of M. leprae has ceased in Spain, based upon the patterns and trends of notified cases. METHODOLOGY: Data on new cases reported to the National Leprosy Registry between the years 2003-2018 were extracted. In absence of detailed travel history, cases were considered "autochthonous" or "imported" based on whether they were born within or outside of Spain. These data were analyzed by age, sex, clinical type, country of origin, and location of residence at time of notification. PRINCIPAL FINDINGS: Data were available on 61 autochthonous and 199 imported cases since 2003. There were clear declines in incidence in both groups, and more imported than autochthonous cases every year since 2006. Autochthonous cases were more frequently multibacillary and had older age at diagnosis compared to imported cases. All the autochthonous cases had been born before 1985 and were more than 25 years old at diagnosis. Male-to-female ratio increased with time for autochthonous cases (except for the last time period). The imported cases originated from 25 countries, half of them from Brasil and Paraguay. Autochthonous cases were mainly distributed in the traditionally endemic regions, especially Andalucía and the eastern Mediterranean coast. CONCLUSIONS: Autochthonous and imported cases have different epidemiologic patterns in Spain. There was a clear decline in incidence rates of autochthonous disease, and patterns consistent with those reported from other regions where transmission has ceased. Autochthonous transmission of M. leprae is likely to have now effectively stopped in Spain.


Assuntos
Hanseníase/epidemiologia , Hanseníase/transmissão , Adulto , Fatores Etários , Idoso , Feminino , Geografia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mycobacterium leprae/isolamento & purificação , Fatores Sexuais , Espanha/epidemiologia , Viagem
4.
PLoS One ; 15(8): e0237165, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764785

RESUMO

This study's objective was to estimate the temporal trends of leprosy according to sex and age groups, as well as to estimate and predict the progression of the disease in a hyperendemic city located in the northeast of Brazil. This ecological time-series study was conducted in Imperatriz, Maranhão, Brazil. Leprosy cases diagnosed between 2006 and 2016 were included. Detection rates stratified by sex and age groups were estimated. The study of temporal trends was accomplished using the Seasonal-Trend Decomposition method and temporal modeling of detection rates using linear seasonal autoregressive integrated moving average model according to Box and Jenkins method. Trend forecasts were performed for the 2017-2020 period. A total of 3,212 cases of leprosy were identified, the average incidence among men aged between 30 and 59 years old was 201.55/100,000 inhabitants and among women in the same age group was 135.28/100,000 inhabitants. Detection rates in total and by sex presented a downward trend, though rates stratified according to sex and age presented a growing trend among men aged less than 15 years old and among women aged 60 years old or over. The final models selected in the time-series analysis show the forecasts of total detection rates and rates for men and women presented a downward trend for the 2017-2020 period. Even though the forecasts show a downward trend in Imperatriz, the city is unlikely to meet a significant decrease of the disease burden by 2020.


Assuntos
Doenças Endêmicas/estatística & dados numéricos , Previsões/métodos , Hanseníase/epidemiologia , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Cidades/estatística & dados numéricos , Feminino , Humanos , Incidência , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
5.
Indian J Dermatol Venereol Leprol ; 86(6): 649-655, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32643632

RESUMO

Background: Many international guidelines on psoriasis management have emphasized upon the need to identify risk factors for liver fibrosis and that the risk may be increased after a certain total cumulative dose of methotrexate. Methods: Consecutive patients with moderate-to-severe psoriasis were assessed for liver fibrosis using transient elastography and noninvasive scores. Based on the presence of significant liver fibrosis, the Odds ratio associated with various factors was calculated using logistic regression analysis. Receiver operating characteristic curves were calculated to find maximal cutoff values of noninvasive tests to detect fibrosis. Results: In this cross-sectional study, 134 patients completed the study. Significant fibrosis (liver stiffness measurement ≥7, corresponding to F2 fibrosis or higher) was seen in 33 (24.6%) patients. Neither methotrexate exposure nor total cumulative dose of ≥1.5 was associated with significant fibrosis. Female sex (P = 0.024) and the presence of metabolic syndrome (P = 0.034) were the two variables associated with significant liver fibrosis. On logistic regression analysis, the odds ratio for the female gender and metabolic syndrome was estimated to be 2.51 (95% confidence interval - 1.09-5.81) and 2.33 (95% confidence interval - 1.03-5.27), respectively. Aspartate transaminase to platelet ratio index, nonalcoholic fatty liver disease score and the fibrosis-4 index had low sensitivity in comparison to transient elastography. Limitations: These included small sample size, small number of patients with a total cumulative methotrexate dose of >3-4.5 g, and lack of control group consisting of healthy persons. Another is the absence of liver biopsies considered as the gold standard in the diagnosis of liver fibrosis. Conclusions: Metabolic syndrome and female sex are associated with the development of significant liver fibrosis in patients with psoriasis. Methotrexate exposure does not seem to be significantly associated with significant liver fibrosis.


Assuntos
Fármacos Dermatológicos/uso terapêutico , Cirrose Hepática/epidemiologia , Síndrome Metabólica/complicações , Metotrexato/uso terapêutico , Psoríase/complicações , Adulto , Estudos Transversais , Técnicas de Imagem por Elasticidade , Feminino , Humanos , Cirrose Hepática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prevalência , Psoríase/tratamento farmacológico , Curva ROC , Fatores de Risco , Fatores Sexuais
6.
Int J Dermatol ; 59(7): 856-861, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32358972

RESUMO

BACKGROUND: Leprosy can cause acute reactions, which may be type 1 (reverse reaction) or type 2 (erythema nodosum leprosum - ENL). ENL has been classified as mild, moderate, or severe. In order to standardize the classification, the Erythema Nodosum Leprosum International Study (ENLIST) Group has developed an objective scale, the ENLIST ENL Severity Scale (EESS), which was the first validated severity scale of ENL in the world. The goal of the study was to describe the sociodemographic and clinical characteristics of patients with ENL attending a tertiary hospital in Piauí, Brazil, classifying them according to the EESS. METHODS: A descriptive cross-sectional observational study was conducted on 26 patients recruited sequentially from May 2017 to February 2018. Their data were statistically analyzed and compared against each other through a structured questionnaire. RESULTS: According to the score obtained in the scale, the patients were divided into two groups: mild ENL and moderate/severe ENL. The extent and number of nodules were related to the severity of the cases, and these data were statistically significant. The majority of the patients were male, between the ages of 31 and 49 years old, with low educational level, and residents in the urban area. CONCLUSIONS: This was the first study to use EESS in Brazil. This scale is easy to apply and allows for the enhancement of treatment protocols. The study also showed a correlation between the number and extension of nodules and the severity of the condition.


Assuntos
Eritema Nodoso/epidemiologia , Hanseníase Virchowiana/epidemiologia , Índice de Gravidade de Doença , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Escolaridade , Eritema Nodoso/complicações , Eritema Nodoso/patologia , Feminino , Febre/microbiologia , Humanos , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/patologia , Masculino , Pessoa de Meia-Idade , Dor/microbiologia , Prevalência , Fatores Sexuais , Inquéritos e Questionários , População Urbana , Adulto Jovem
7.
Biomedica ; 39(4): 737-747, 2019 12 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31860184

RESUMO

Introduction: Inequalities in the health field are caused by the differences in the social and economic conditions, that influence the disease risk and the measures taken to treat the disease. Objective: We aimed to estimate the social inequalities in health in Colombia, according to the type of affiliation to the health system as a proxy of socioeconomic status. Materials and methods: We conducted a retrospective descriptive analysis calculating incidence rates age and sex adjusted for all mandatory reporting events using the affiliation regime (subsidized and contributory) as a socioeconomic proxy. Estimates were made at departmental level for 2015. Social inequalities were calculated in terms of absolute and relative gaps. Results: We found social inequalities in the occurrence of mandatory reporting events in population affiliated to the Colombian subsidized regime (poor population). In this population, 82.31 cases of Plasmodium falciparum malaria per 100,000 affiliates were reported more than those reported in the contributory regime. Regarding the relative gap, belonging to the subsidized regime increased by 31.74 times the risk of dying from malnutrition in children under 5 years of age. Other events such as those related to sexual and reproductive health (maternal mortality, gestational syphilis and congenital syphilis); neglected diseases and communicable diseases related to poverty (leprosy and tuberculosis), also showed profound inequalities. Conclusion: In Colombia there are inequalities by regime of affiliation to the health system. Measured socioeconomic status was a predictor of increased morbidity and premature mortality.


Assuntos
Notificação de Doenças/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Planos de Sistemas de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Fatores Etários , Causas de Morte , Colômbia/epidemiologia , Feminino , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Notificação de Abuso , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos
8.
Lancet Infect Dis ; 19(7): 750-758, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31104909

RESUMO

BACKGROUND: Yellow fever virus infection results in death in around 30% of symptomatic individuals. The aim of this study was to identify predictors of death measured at hospital admission in a cohort of patients admitted to hospital during the 2018 outbreak of yellow fever in the outskirts of São Paulo city, Brazil. METHODS: In this observational cohort study, we enrolled patients with yellow fever virus from two hospitals in São Paolo-the Hospital das Clínicas, University of São Paulo and the Infectious Diseases Institute "Emilio Ribas". Patients older than 18 years admitted to hospital with fever or myalgia, headache, arthralgia, oedema, rash, or conjunctivitis were consecutively screened for inclusion in the present study. Consenting patients were included if they had travelled to geographical areas in which yellow fever virus cases had been previously confirmed. Yellow fever infection was confirmed by real-time PCR in blood collected at admission or tissues at autopsy. We sequenced the complete genomes of yellow fever virus from infected individuals and evaluated demographic, clinical, and laboratory findings at admission and investigated whether any of these measurements correlated with patient outcome (death). FINDINGS: Between Jan 11, 2018, and May 10, 2018, 118 patients with suspected yellow fever were admitted to Hospital das Clínicas, and 113 patients with suspected yellow fever were admitted to Infectious Diseases Institute "Emilio Ribas". 95 patients with suspected yellow fever were included in the study, and 136 patients were excluded. Three (3%) of 95 patients with suspected yellow fever who were included in the study were excluded because they received a different diagnosis, and 16 patients with undetectable yellow fever virus RNA were excluded. Therefore, 76 patients with confirmed yellow fever virus infection, based on detectable yellow fever virus RNA in blood (74 patients) or yellow fever virus confirmed only at the autopsy report (two patients), were included in our analysis. 27 (36%) of 76 patients died during the 60 day period after hospital admission. We generated 14 complete yellow fever virus genomes from the first 15 viral load-detectable samples. The genomes belonged to a single monophyletic clade of the South America I genotype, sub-genotype E. Older age, male sex, higher leukocyte and neutrophil counts, higher alanine aminotransferase, aspartate transaminase (AST), bilirubin, and creatinine, prolonged prothrombin time, and higher yellow fever virus RNA plasma viral load were associated with higher mortality. In a multivariate regression model, older age, elevated neutrophil count, increased AST, and higher viral load remained independently associated with death. All 11 (100%) patients with neutrophil counts of 4000 cells per mL or greater and viral loads of 5·1 log10 copies/mL or greater died (95% CI 72-100), compared with only three (11%) of 27 (95% CI 2-29) among patients with neutrophil counts of less than 4000 cells per mL and viral loads of less than 5·1 log10 copies/mL. INTERPRETATION: We identified clinical and laboratory predictors of mortality at hospital admission that could aid in the care of patients with yellow fever virus. Identification of these prognostic markers in patients could help clinicians prioritise admission to the intensive care unit, as patients often deteriorate rapidly. Moreover, resource allocation could be improved to prioritise key laboratory examinations that might be more useful in determining whether a patient could have a better outcome. Our findings support the important role of the virus in disease pathogenesis, suggesting that an effective antiviral could alter the clinical course for patients with the most severe forms of yellow fever. FUNDING: São Paulo Research Foundation (FAPESP).


Assuntos
Surtos de Doenças , Hospitalização , Febre Amarela/diagnóstico , Febre Amarela/mortalidade , Adulto , Fatores Etários , Brasil/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Febre Amarela/epidemiologia , Vírus da Febre Amarela/isolamento & purificação
9.
Cad Saude Publica ; 35(2): e00105318, 2019 02 18.
Artigo em Português | MEDLINE | ID: mdl-30785488

RESUMO

The study sought to analyze the magnitude of occurrence and the sociodemographic, economic and clinical profiles of leprosy associated with household social networks (HSN), with disease overlap in cities from the states of Bahia, Piauí and Rondônia, Brazil, from 2001 to 2014. This is a cross-sectional study using primary and secondary data regarding new cases of leprosy notified to the Brazilian Information System for Notifiable Diseases (SINAN, in Portuguese) residing in the cities. We applied a standardized instrument to the new cases and reviewed data from charts and from SINAN. Of a total of 1,032 (29.6%) assessed cases, 538 (52.1%) had more than one case in their HSN. There were larger frequencies of female sex (292; 54.3%), age between 41 and 60 years (240; 44.6%), primary education (272; 50.6%), income lower than the minimum wage (265; 49.3%) and living with 5 or more people (265; 49.3%). The overlap of cases in the HSN was associated in the multivariate analysis with residing in cities in the state of Rondônia (PR = 1.23; 95%CI: 1.07-1.43; p = 0.003), as well as living with 3 to 4 people in the same household (PR = 1.66; 95%CI: 1.11-2.49; p = 0.014) and having leprosy reaction (PR = 1.31; 95%CI: 0.99-1.70; p = 0.050). Case repetition within the same HSN is a frequent event in the situations we studied. Its occurrence must be considered as a sentinel indicator of greater epidemiological severity in primary health care surveillance. We highlight the vulnerability of affected families.


Assuntos
Transmissão de Doença Infecciosa/estatística & dados numéricos , Características da Família , Hanseníase/transmissão , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Doenças Endêmicas/estatística & dados numéricos , Monitoramento Epidemiológico , Feminino , Humanos , Lactente , Recém-Nascido , Sistemas de Informação , Hanseníase/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Características de Residência , Fatores Sexuais , Determinantes Sociais da Saúde , Rede Social , Fatores Socioeconômicos , Adulto Jovem
10.
Cad. Saúde Pública (Online) ; 35(2): e00105318, 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-984132

RESUMO

O estudo tem como objetivo analisar a magnitude da ocorrência e os perfis sociodemográfico, econômico e clínico de casos de hanseníase vinculados à redes de convívio domiciliar (RCD) com sobreposição da doença em municípios dos estados da Bahia, do Piauí e de Rondônia, Brasil, no período de 2001 a 2014. Trata-se de estudo transversal, com dados primários e secundários de casos novos de hanseníase, notificados no Sistema de Informação de Agravos de Notificação (SINAN) e residentes nos municípios. Foram realizadas a aplicação de instrumento padronizado aos casos novos e a revisão de dados em prontuários e na base do SINAN. De um total de 1.032 (29,6%) casos de hanseníase abordados, 538 (52,1%) tinham mais de um caso em sua RCD. Maior frequência de pessoas do sexo feminino (292; 54,3%), com idade entre 41 a 60 anos (240; 44,6%), ensino fundamental (272; 50,6%), renda menor que um salário mínimo (265; 49,3%) e residindo com cinco pessoas ou mais (265; 49,3%). A ocorrência de sobreposição de casos na RCD foi associada, na análise multivariada, a residir em municípios do Estado de Rondônia (RP = 1,23; IC95%: 1,07-1,43; p = 0,003), assim como morar com três a quatro pessoas no mesmo domicílio (RP = 1,66; IC95%: 1,11-2,49; p = 0,014) e ter reação hansênica (RP = 1,31; IC95%: 0,99-1,70; p = 0,050). A repetição de casos de hanseníase em uma mesma RCD representa um evento frequente nos cenários abordados. Sua ocorrência deve ser considerada como indicador sentinela de maior gravidade epidemiológica para a vigilância na rede de atenção básica à saúde. Ressalta-se o caráter de vulnerabilidade das famílias acometidas.


The study sought to analyze the magnitude of occurrence and the sociodemographic, economic and clinical profiles of leprosy associated with household social networks (HSN), with disease overlap in cities from the states of Bahia, Piauí and Rondônia, Brazil, from 2001 to 2014. This is a cross-sectional study using primary and secondary data regarding new cases of leprosy notified to the Brazilian Information System for Notifiable Diseases (SINAN, in Portuguese) residing in the cities. We applied a standardized instrument to the new cases and reviewed data from charts and from SINAN. Of a total of 1,032 (29.6%) assessed cases, 538 (52.1%) had more than one case in their HSN. There were larger frequencies of female sex (292; 54.3%), age between 41 and 60 years (240; 44.6%), primary education (272; 50.6%), income lower than the minimum wage (265; 49.3%) and living with 5 or more people (265; 49.3%). The overlap of cases in the HSN was associated in the multivariate analysis with residing in cities in the state of Rondônia (PR = 1.23; 95%CI: 1.07-1.43; p = 0.003), as well as living with 3 to 4 people in the same household (PR = 1.66; 95%CI: 1.11-2.49; p = 0.014) and having leprosy reaction (PR = 1.31; 95%CI: 0.99-1.70; p = 0.050). Case repetition within the same HSN is a frequent event in the situations we studied. Its occurrence must be considered as a sentinel indicator of greater epidemiological severity in primary health care surveillance. We highlight the vulnerability of affected families.


El objetivo de este estudio fue analizar la magnitud de la ocurrencia y los perfiles sociodemográficos, económicos y clínicos de casos de lepra, vinculados a las redes de convivencia domiciliaria (RCD), con sobreposición de la enfermedad, en municipios de los estados de Bahía, Piauí y Rondônia, Brasil, durante el período de 2001 a 2014. Se trata de un estudio transversal, con datos primarios y secundarios de casos nuevos de lepra, notificados en el Sistema de Información de Enfermedades de Obligada Notificación (SINAN, por su sigla en portugués) y residentes en los municipios. Se procedió a la aplicación de un instrumento estandarizado a los casos nuevos y a la revisión de datos en prontuarios y base de datos del SINAN. De un total de 1.032 (29,6%) casos de lepra abordados, 538 (52,1%) tenían más de un caso en su RCD. Existía una mayor frecuencia de personas del sexo femenino (292; 54,3%), con edades comprendidas entre 41 y 60 años (240; 44,6%), enseñanza fundamental (272; 50,6%), renta menor a un salario mínimo (265; 49,3%) y residiendo con 5 personas o más (265; 49,3%). La ocurrencia de sobreposición de casos en la RCD se asoció en el análisis multivariado a residir en municipios del estado de Rondônia (RP = 1,23; IC95%: 1,07-1,43; p = 0,003), así como vivir con de 3 a 4 personas en el mismo domicilio (RP = 1,66; IC95%: 1,11-2,49; p = 0,014) y sufrir reacción leprótica (RP = 1,31; IC95%: 0,99-1,70; p = 0,050). La repetición de casos de lepra en una misma RCD representa un evento frecuente en los escenarios abordados. Su ocurrencia debe ser considerada como un indicador centinela de mayor gravedad epidemiológica para la vigilancia en la red de atención básica en la salud. Se resalta el carácter de vulnerabilidad de las familias participantes.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Características da Família , Transmissão de Doença Infecciosa/estatística & dados numéricos , Hanseníase/transmissão , Fatores Socioeconômicos , Brasil/epidemiologia , Sistemas de Informação , Características de Residência , Fatores Sexuais , Estudos Transversais , Análise Multivariada , Doenças Endêmicas/estatística & dados numéricos , Rede Social , Monitoramento Epidemiológico , Determinantes Sociais da Saúde , Hanseníase/epidemiologia
11.
PLoS One ; 13(10): e0205234, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30289892

RESUMO

Leprosy is an infectious disease with a complex genetic and immunological background. Polymorphisms in genes that encode cytokines and receptors involved in the immune response, such as the Toll-like receptor 1 (TLR1), may be associated with disease risk. We hypothesized that polymorphisms in innate immunity genes confer susceptibility to leprosy that differs between women and men. In this study, we investigate sex differences in the association between a single nucleotide polymorphism (SNP) in TLR1 and Nucleotide-binding oligomerization domain containing 2 (NOD2) genes and leprosy susceptibility in 256 clinically classified leprosy patients and 233 control subjects in a Brazilian population. Our results showed no association between the SNP rs8057341 in NOD2 and leprosy in this population. However, the heterozygous genotype of the TLR1 SNP (rs4833095) showed a statistically significant association in women (OR = 0.54, P = 0.02). Our findings suggest that the TLR1 polymorphism was associated with an increased protection from leprosy in women.


Assuntos
Predisposição Genética para Doença , Imunidade Inata/genética , Hanseníase/genética , Proteína Adaptadora de Sinalização NOD2/genética , Receptor 1 Toll-Like/genética , Adulto , Idoso , Biópsia , Brasil , Estudos de Casos e Controles , Feminino , Genótipo , Humanos , Hanseníase/imunologia , Hanseníase/patologia , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Análise de Sequência de DNA , Fatores Sexuais , Pele/patologia , Receptor 1 Toll-Like/imunologia
12.
PLoS Negl Trop Dis ; 12(10): e0006788, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30278054

RESUMO

BACKGROUND: Leprosy is a chronic infectious disease neglected, caused by Mycobacterium leprae, considered a public health problem because may cause permanent physical disabilities and deformities, leading to severe limitations. This review presents an overview of the results of epidemiological studies on leprosy occurrence in childhood in Brazil, aiming to alert health planners and managers to the actual need to institute special control strategies. METHODOLOGY/PRINCIPAL FINDINGS: Data collection consisted of an electronic search for publications in eight databases: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), PuBMed, Biblioteca Virtual em Saúde (BVS), SciVerse Scopus (Scopus), CAPES theses database, CAPES journals database and Web of Science of papers published up to 2016. After apply selection criteria, twenty-two papers of studies conducted in four different regions of Brazil and published between 2001 and 2016 were included in the review. The leprosy detection rate ranged from 10.9 to 78.4 per 100,000 inhabitants. Despite affecting both sexes, leprosy was more common in boys and in 10-14-year-olds. Although the authors reported a high cure proportion (82-90%), between 1.7% and 5.5% of the individuals developed a disability resulting from the disease. CONCLUSIONS/SIGNIFICANCE: The findings of this review shows that leprosy situation in Brazilian children under 15 years is extremely adverse in that the leprosy detection rate remains high in the majority of studies. The proportion of cases involving disability is also high and reflects the difficulties and the poor effectiveness of actions aimed at controlling the disease. The authors suggest the development of studies in spatial clusters of leprosy, where beyond the routine actions established, are included news strategies of active search and campaigns and actions of educations inside the clusters of this disease. The new agenda needs to involve the precepts of ethical, humane and supportive care, in order to achieve a new level of leprosy control in Brazil.


Assuntos
Hanseníase/epidemiologia , Adolescente , Fatores Etários , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Hanseníase/complicações , Masculino , Prevalência , Fatores Sexuais
13.
PLoS One ; 13(9): e0191387, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30192746

RESUMO

BACKGROUND: Convergence of tuberculosis (TB) and HIV epidemics is associated with higher morbidity and mortality risks and understanding their distribution across key demographic factors is essential for prevention and control. This analysis examines the prevalence of TB, HIV and TB-HIV coinfection across age and gender in patients with presumptive TB seeking care at the National TB and Leprosy Training Center in Nigeria. METHODS: Samples from 1603 presumptive pulmonary TB cases who provided informed consent were evaluated with a sequential testing algorithm that included a smear microscopy, cultures in liquid and broth media and then genotyping by Hain line probe assays. HIV was serially tested with two HIV rapid assays and retested with a third assay in non-conclusive samples. RESULTS: Twenty-three percent (375/1603) had confirmed pulmonary TB infection, 23.6% (378/1603) were positive for HIV infection and 26.9% (101/375) of the confirmed TB cases were HIV co-infected. Males had a higher prevalence of TB: 27.6% vs. 18.0%, p < .0001; and a lower prevalence of HIV: 19.0% vs. 29.6%, p < .0001. In the age range of 25-29 years, males were twice as likely to have TB (OR = 2.2; 95% confidence interval [CI]: 1.3-3.9, p = 0.0032) while females were five times more likely to have HIV (OR = 4.8; 95% CI: 2.6-8.9, p < .0001). Persons with TB-HIV coinfection were more likely to be young, female and less likely to be married. CONCLUSION: Younger females with a high burden of HIV may be under-diagnosed and under-reported for TB in Nigeria. Community programs for intensified and early detection of TB and HIV targeting younger females are needed in this setting.


Assuntos
Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Tuberculose/epidemiologia , África ao Sul do Saara/epidemiologia , Fatores Etários , Estudos Transversais , Epidemias , Feminino , Humanos , Masculino , Prevalência , Fatores Sexuais
14.
Int J Dermatol ; 57(12): 1492-1499, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30028017

RESUMO

BACKGROUND: Many researches on gender differences in leprosy found that female patients were detected with the disease later and had more serious disabilities than male patients. We analyzed the gender differences related to epidemiological characteristics of new leprosy cases detected from 2000 to 2015 in Sichuan Province, China. METHODS: A retrospective study was undertaken to analyze the gender differences with respect to age, delay in disease detection, the main modes of detection, and disability grade. The chi-squared test and t test were applied for the comparison using Epi Info 7.2 with a significance level of a = 0.05. The data were collected from the Leprosy Management Information System in China. RESULTS: A total of 2900 new leprosy cases were detected from 2000 to 2015, of whom 2075 (71.6%) were male and 825 (28.4%) were female with a gender ratio of 2.5. The gender ratio of patients aged 15-30 was significantly lower than that of patients aged 31-45 and 46-60. Male cases were older than female cases when they were detected. The proportion of Grade 2 Disability (G2D) among men (20.6%) was significantly higher than that among women (17.3%). The average period of delay in detection among male cases was similar with that among females cases. CONCLUSIONS: Gender-related differences existed among the leprosy cases detected from 2000 to 2015. Female patients were younger than male patients. The detection of leprosy in women was not later than in the case of men. The disability situation in men was more serious than in women.


Assuntos
Hanseníase/diagnóstico , Hanseníase/epidemiologia , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , China/epidemiologia , Diagnóstico Tardio , Avaliação da Deficiência , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
15.
Int J Mycobacteriol ; 7(2): 167-172, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29900895

RESUMO

Background: Tuberculosis (TB) programs should design intervention strategies based on the sound knowledge of the existing local epidemiology and sociodemographic characteristics of drug-resistant-TB (DR-TB) cases. The aim of the study was to characterize the pulmonary multidrug-resistant (MDR) and rifampicin-resistant (RR) TB cases enrolled in a referral hospital at Addis Ababa, Ethiopia, called All Africa Leprosy, Tuberculosis, Rehabilitation and Training (ALERT) Hospital. Methods: We conducted a descriptive study based on retrospective review of medical records of 340 pulmonary MDR/RR-TB cases enrolled in ALERT Hospital from November 2011 to December 2016. To characterize the cases, we described the distribution of demographic and clinical characteristics. To compare the distribution of demographic and clinical characteristics between male and female cases, we used Pearson's Chi-squared test. Results: Males accounted for 52.9% of the 340 cases. Nine out of ten cases were in the age group of 15-44 years. Sputum acid-fast bacilli smear-positive and human immunodeficiency virus-coinfected cases constituted 63.7% and 18.1% of cases, respectively. The proportion of new cases increased through the years from nil in 2011 to 21.4% in 2016. Adult males above 24 years constituted more than three quarters (77.2%) of the total male cases, while adult females in this age group constituted 56.9%. The age distribution between male and female cases showed significant differences (P < 0.001). Conclusion: There is age disparity between male and female cases with high impact of MDR/RR-TB on productive adult male population. The transmission potential for DR-TB is also high in the community.


Assuntos
Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Adolescente , Adulto , Antituberculosos/farmacologia , Criança , Farmacorresistência Bacteriana , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores Sexuais , Escarro , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adulto Jovem
16.
Indian J Dermatol Venereol Leprol ; 84(3): 251-262, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29516900

RESUMO

Herpes zoster is a major health burden that can affect individuals of any age. It is seen more commonly among individuals aged ≥50 years, those with immunocompromised status, and those on immunosuppressant drugs. It is caused by a reactivation of varicella zoster virus infection. Cell-mediated immunity plays a role in this reactivation. Fever, pain, and itch are common symptoms before the onset of rash. Post-herpetic neuralgia is the most common complication associated with herpes zoster. Risk factors and complications associated with herpes zoster depend on the age, immune status, and the time of initializing treatment. Routine vaccination for individuals over 60 years has shown considerable effect in terms of reducing the incidence of herpes zoster and post-herpetic neuralgia. Treatment with antiviral drugs and analgesics within 72 hours of rash onset has been shown to reduce severity and complications associated with herpes zoster and post-herpetic neuralgia. This study mainly focuses on herpes zoster using articles and reviews from PubMed, Embase, Cochrane library, and a manual search from Google Scholar. We cover the incidence of herpes zoster, gender distribution, seasonal and regional distribution of herpes zoster, incidence of herpes zoster among immunocompromised individuals, incidence of post-herpetic neuralgia following a zoster infection, complications, management, and prevention of herpes zoster and post-herpetic neuralgia.


Assuntos
Antivirais/administração & dosagem , Herpes Zoster/epidemiologia , Herpes Zoster/terapia , Neuralgia Pós-Herpética/epidemiologia , Neuralgia Pós-Herpética/terapia , Corticosteroides/administração & dosagem , Terapia por Estimulação Elétrica/métodos , Herpes Zoster/prevenção & controle , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Hospedeiro Imunocomprometido/fisiologia , Incidência , Neuralgia Pós-Herpética/prevenção & controle , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento
17.
Rev Saude Publica ; 52: 20, 2018.
Artigo em Português, Inglês | MEDLINE | ID: mdl-29489990

RESUMO

OBJECTIVE To analyze, stratifield by gender, trends of the new case leprosy detection rates in the general population and in children; of grade 2 disability, and of proportion of multibacillary cases, in the state of Bahia, Brazil from 2001 to 2014. METHODS A time series study based on leprosy data from the National Information System for Notifiable Diseases. The time trend analysis included Poisson regression models by infection points (Joinpoint) stratified by gender. RESULTS There was a total of 40,054 new leprosy cases with a downward trend of the overall detection rate (Average Annual Percent Change [AAPC = -0.4, 95%CI -2.8-1.9] and a non-significant increase in children under 15 years (AAPC = 0.2, 95%CI -3.9-4.5). The proportion of grade 2 disability among new cases increased significantly (AAPC = 4.0, 95%CI 1.3-6.8), as well as the proportion of multibacillary cases (AAPC = 2.2, 95%CI 0.1-4.3). Stratification by gender showed a downward trend of detection rates in females and no significant change in males; in females, there was a more pronounced upward trend of the proportion of multibacillary and grade 2 disability cases. CONCLUSIONS Leprosy is still highly endemic in the state of Bahia, with active transmission, late diagnosis, and a probable hidden endemic. There are different gender patterns, indicating the importance of early diagnosis and prompt treatment, specifically in males without neglecting the situation among females.


Assuntos
Hanseníase/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Diagnóstico Tardio , Notificação de Doenças , Doenças Endêmicas , Feminino , Humanos , Hanseníase/diagnóstico , Hanseníase/transmissão , Masculino , Distribuição de Poisson , Características de Residência , Distribuição por Sexo , Fatores Sexuais , Fatores Socioeconômicos
18.
Artigo em Inglês | MEDLINE | ID: mdl-29491191

RESUMO

Background: Biophysical parameters of skin such as trans-epidermal water loss (TEWL), hydration, elasticity, pH, and sebum reflects it functional integrity. Advances in technology have made it possible to measure these parameters by non-invasive methods. These parameters are useful for the prediction of disease and its prognosis. It also helps in developing new skin care products according to various skin types, and to evaluate, modify, or compare the effects of existing products. Aim: The aim of the study was to measure, evaluate, and analyze variations in biophysical parameters at pre-selected skin sites in healthy Indian volunteers, across different age groups and gender. Methods: The study was conducted among 500 healthy Indian volunteers, between 5 and 70 years of age, in the outpatient department of dermatology at Sir T. Hospital, Bhavnagar. Biophysical parameters such as TEWL, hydration, elasticity, and sebum content was measured on four pre-selected body sites by a Dermalab instrument (Cortex Technology, Denmark). The skin pH was measured with a sensitive pH probe (BEPL 2100). Results: All parameters were higher in males compared to females, except for sebum content, which was equal in both genders. Transepidermal water loss and hydration was lower in middle and older age groups. The skin pH showed no statistically significant difference with age. Sebum content was higher in middle and older age groups. The nose had the highest sebum content across all age groups. The forehead showed higher median values of TEWL and hydration compared to other sites. Though elasticity has highest value on forearm, only leg region showed statistically significant value. Limitations: The present study was confined to a single geographical area, so the effect of environment changes could not be judged accurately. Seasonal variations were not studied as it was a cross-sectional study. Conclusion: Skin properties vary with age, gender, and location on the body. This knowledge will help to create a database of these parameters in the Indian population. It would assist in the diagnosis of various clinical conditions and monitor therapeutic response.


Assuntos
Absorção Cutânea/fisiologia , Fenômenos Fisiológicos da Pele , Pele/metabolismo , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Estudos Transversais , Elasticidade/fisiologia , Feminino , Voluntários Saudáveis , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Estado de Hidratação do Organismo/fisiologia , Sebo/metabolismo , Fatores Sexuais , Adulto Jovem
19.
Cad Saude Publica ; 34(1): e00196216, 2018 02 05.
Artigo em Português | MEDLINE | ID: mdl-29412328

RESUMO

The aim of this study was to analyze operational indicators and time trends in leprosy control from a gender perspective in Bahia State, Brazil, from 2001 to 2014. This was a time series study based on epidemiological data on leprosy from the Brazilian National System of Diseases of Notification, using joinpoint Poisson and polynomial regression. Of the 40,054 new cases of leprosy, 47.1% of the recorded contacts were not examined, with a significant upward trend, especially in women (average annual percentage change - AAPC = 5.6; 95%CI: 3.5; 7.7) when compared to men (AAPC = 3.0; 95%CI: 0.5; 5.6). The proportion of cure in the 2003-2014 cohort was 85%, with a downward trend, especially in men (AAPC = -0.5; 95%CI: -0.9; 0.0), compared to women (AAPC = -0.4; 95%CI: -0.7; -0.1). Treatment dropout rate was 5.5%, with a more significant downward trend in women (AAPC = -4.9; 95%CI: -8.7; -1.1) than in men (AAPC = -2.7; 95%CI: -4.4; -1.0). Relapse was recorded in 3.8% of all the entries during the same period; women showed a significant downward trend (AAPC = -2.2; 95%CI: -3.3; -1.0) and men a significant upward trend (AAPC = 4.9; 95%CI: 2.9; 6.8). Polynomial regression analysis was consistent with joinpoint regression. Leprosy in Bahia State shows operational indicators with significant magnitude and time trends, especially in the male population. Health services' insufficient performance in conducting contact surveillance and longitudinal care reveal various dimensions of vulnerability.


Assuntos
Hanseníase/prevenção & controle , Brasil/epidemiologia , Estudos de Coortes , Doenças Endêmicas/prevenção & controle , Doenças Endêmicas/estatística & dados numéricos , Feminino , Humanos , Relações Interpessoais , Hanseníase/epidemiologia , Hanseníase/transmissão , Masculino , Análise de Regressão , Fatores Sexuais , Fatores Socioeconômicos
20.
Cad. Saúde Pública (Online) ; 34(1): e00196216, 2018. tab, graf
Artigo em Português | LILACS | ID: biblio-889864

RESUMO

O objetivo deste estudo foi analisar indicadores operacionais de controle da hanseníase e sua tendência temporal, na perspectiva de gênero, no Estado da Bahia, Brasil, de 2001 a 2014. Trata-se de estudo de série temporal baseado em dados epidemiológicos da hanseníase no Sistema de Informação de Agravos de Notificação, com análise de regressão de Poisson por joinpoints e de regressão polinomial. Dos 40.054 casos novos de hanseníase analisados, 47,1% dos contatos registrados não foram examinados, mas com tendência significativa de aumento, de forma mais acentuada entre as mulheres (variação percentual anual média - AAPC = 5,6; IC95%: 3,5; 7,7) em comparação aos homens (AAPC = 3,0; IC95%: 0,5; 5,6). A proporção de cura na coorte 2003-2014 foi de 85%, com tendência de redução mais acentuada nos homens (AAPC = -0,5; IC95%: -0,9; 0,0), comparados às mulheres (AAPC = -0,4; IC95% -0,7; -0,1). A proporção de casos em abandono de tratamento no período foi de 5,5%, com tendência de redução mais significativa entre mulheres (AAPC = -4,9; IC95%: -8,7; -1,1) do que em homens (AAPC = -2,7; IC95%: -4,4; -1,0). Recidiva foi verificada em 3,8% de todas as entradas do período; as mulheres apresentaram tendência de redução significativa (AAPC = -2,2; IC95%: -3,3; -1,0) e os homens, de crescimento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). A análise por regressão polinomial foi consistente com a análise de joinpoints. A hanseníase no Estado da Bahia apresenta indicadores operacionais com magnitude e tendência temporal significativas, em especial entre a população masculina. O desempenho insuficiente dos serviços de saúde em realizar a vigilância de contatos e a longitudinalidade do cuidado revelam diferentes dimensões de vulnerabilidade.


The aim of this study was to analyze operational indicators and time trends in leprosy control from a gender perspective in Bahia State, Brazil, from 2001 to 2014. This was a time series study based on epidemiological data on leprosy from the Brazilian National System of Diseases of Notification, using joinpoint Poisson and polynomial regression. Of the 40,054 new cases of leprosy, 47.1% of the recorded contacts were not examined, with a significant upward trend, especially in women (average annual percentage change - AAPC = 5.6; 95%CI: 3.5; 7.7) when compared to men (AAPC = 3.0; 95%CI: 0.5; 5.6). The proportion of cure in the 2003-2014 cohort was 85%, with a downward trend, especially in men (AAPC = -0.5; 95%CI: -0.9; 0.0), compared to women (AAPC = -0.4; 95%CI: -0.7; -0.1). Treatment dropout rate was 5.5%, with a more significant downward trend in women (AAPC = -4.9; 95%CI: -8.7; -1.1) than in men (AAPC = -2.7; 95%CI: -4.4; -1.0). Relapse was recorded in 3.8% of all the entries during the same period; women showed a significant downward trend (AAPC = -2.2; 95%CI: -3.3; -1.0) and men a significant upward trend (AAPC = 4.9; 95%CI: 2.9; 6.8). Polynomial regression analysis was consistent with joinpoint regression. Leprosy in Bahia State shows operational indicators with significant magnitude and time trends, especially in the male population. Health services' insufficient performance in conducting contact surveillance and longitudinal care reveal various dimensions of vulnerability.


El objetivo de este estudio fue analizar indicadores operacionales de control de la lepra y su tendencia temporal, desde la perspectiva de género, en el estado de Bahía, Brasil, de 2001 a 2014. Se trata de un estudio de serie temporal, basado en datos epidemiológicos de la lepra en el Sistema Nacional de Enfermedades de Notificación Obligatoria, con análisis de regresión de Poisson por joinpoints y de regresión polinomial. De los 40.054 casos nuevos de hanseniasis analizados, un 47,1% de los contactos registrados no fueron examinados, pero con una tendencia significativa de aumento, de forma más acentuada entre las mujeres (AAPC = 5,6; IC95%: 3,5; 7,7), en comparación a los hombres (AAPC = 3,0; IC95%: 0,5; 5,6). La proporción de cura en la cohorte 2003-2014 fue de un 85%, con una tendencia de reducción más acentuada en los hombres (AAPC = -0,5; IC95%: -0,9; 0,0), comparados con las mujeres (AAPC = -0,4; IC95%: -0,7; -0,1). La proporción de casos en abandono de tratamiento durante el período fue de un 5,5%, con tendencia de reducción más significativa entre mujeres (AAPC = -4,9; IC95%: -8,7; -1,1) que en hombres (AAPC = -2,7; IC95%: -4,4; -1,0). La recidiva se verificó en un 3,8% de todas las entradas del período; las mujeres presentaron una tendencia de reducción significativa (AAPC = -2,2; IC95%: -3,3; -1,0) y los hombres, de crecimiento significativo (AAPC = 4,9; IC95%: 2,9; 6,8). El análisis por regresión polinomial fue consistente con el análisis de joinpoints. La hanseniasis en el estado de Bahía presenta indicadores operacionales con magnitud y tendencia temporal significativas, en especial entre la población masculina. El desempeño insuficiente de los servicios de salud al realizar la vigilancia de contactos y la longitudinalidad del cuidado revelan diferentes dimensiones de vulnerabilidad.


Assuntos
Humanos , Masculino , Feminino , Hanseníase/prevenção & controle , Fatores Socioeconômicos , Brasil/epidemiologia , Fatores Sexuais , Análise de Regressão , Estudos de Coortes , Doenças Endêmicas/prevenção & controle , Doenças Endêmicas/estatística & dados numéricos , Relações Interpessoais , Hanseníase/transmissão , Hanseníase/epidemiologia
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