Homeopathic Treatment of Subclinical Hypothyroidism-A Series of 19 Cases.

BACKGROUND: Subclinical hypothyroidism (SCH) is a common clinical problem. Controversy surrounds the definition, clinical importance, and need for prompt diagnosis and treatment of the mild form of SCH. AIM: The aim of the study was to analyze the evolution of serum thyroid stimulating hormone (TSH) levels after a therapeutic homeopathic intervention in women older than 40 years with SCH. METHODS: This study is a retrospective series of 19 cases of SCH, with serum TSH levels between 5 and 10 mIU/L, treated exclusively with homeopathic medicines prescribed on an individualized basis. RESULTS: Nineteen patients were included according to the inclusion and exclusion criteria. Their mean age was 56 years, they were followed for a mean duration of 69 months, the mean number of serum TSH level measurements was 18, and the intervention was successful for 13 patients. CONCLUSION: The homeopathic therapeutic intervention was successful in 68% of the patients, with serum TSH levels back within the normal range (0.5-5.0 mIU/L).

[Tuberculosis in indigenous peoples in the Brazilian Amazon: an epidemiological study in the Upper Rio Negro region]. / Tuberculose em indígenas da Amazônia brasileira: estudo epidemiológico na região do Alto Rio Negro.

OBJECTIVE: To describe the sociodemographic, clinical, and epidemiological characteristics of reported tuberculosis cases among indigenous individuals of São Gabriel de Cachoeira, State of Amazonas, Brazil, and to identify the factors associated with mortality during treatment; and to estimate the prevalence of latent tuberculosis infection (LTBI) and associated factors and obtain information on the therapeutic course and the individual perceptions regarding acquistion of tuberculosis in the district of Iauaretê. METHODS: Firstly, a retrospective epidemiological study (1997 to 2007) was conducted using data from the Brazilian Notifiable Diseases Surveillance System (SINAN). Next, a cross-sectional study (2010) was conducted with respiratory symptomatic subjects and contacts of Iauaretê. RESULTS: Seven hundred and twenty-three new cases were reported, with incidence of 273.4/100 000 and mortality of 13.2/100 000. There was a predominance of males (57%), aged > 45 years (37.6%), people with no schooling (42.7%), and cases from rural areas (76.9%). Patients aged 0 to 20 years were at lower risk of death when compared to those aged > 45 years (OR = 0.3; IC95%: 0.1 a 0.9). In Iauaretê, with 15.3% of the reported cases, 184 people were interviewed. A prevalence of LTB of 76.1% was reported. Tuberculin skin test > 5 mm was associated with the > 15-year old age group, history of active tuberculosis, and radiological alterations. A previous history of tuberculosis was cited by 54 people (29.3%). The main explanation for the disease was "puffing/poisoning" (24.1%). The therapeutic course included industrialized drugs (42.6%), medicinal plants/roots, shamanism, and prayer (42.7%). CONCLUSIONS: The risk of tuberculosis infection and disease in this population was high. Despite the reduced incidence resulting from recent efforts, tuberculosis control requires closer surveillance of contacts and improvement in communication strategies between health teams and indigenous populations.

Tuberculose em indígenas da Amazônia brasileira: estudo epidemiológico na região do Alto Rio Negro / Tuberculosis in indigenous peoples in the Brazilian Amazon: an epidemiological study in the Upper Rio Negro region

OBJETIVO: Descrever as características sociodemográficas e clínico-epidemiológicas dos casos de tuberculose notificados na população indígena do Município de São Gabriel de Cachoeira, Estado do Amazonas, Brasil, e identificar fatores associados ao óbito durante o tratamento; e estimar a prevalência de infecção latente por tuberculose (ILTB) e fatores associados e obter informações sobre o itinerário terapêutico e a percepção acerca do adoecimento dos indígenas do Distrito de Iauaretê. MÉTODOS: Primeiramente, realizou-se um estudo epidemiológico retrospectivo (1997 a 2007) com base nos dados do Sistema de Informação de Agravos de Notificação. Posteriormente, realizou-se um estudo transversal (2010) em sintomáticos respiratórios e contatos no Distrito Indígena de Iauaretê. RESULTADOS: Registraram-se 723 casos novos, com incidência de 273,4/100 000 e mortalidade de 13,2/100 000. Houve predomínio em homens (57%), idade > 45 anos (37,6%), pessoas sem escolaridade (42,7%) e na área rural (76,9%). Doentes de 0 a 20 anos apresentaram menor chance de óbito quando comparados à idade > 45 anos (OR = 0,3; IC95%: 0,1 a 0,9). Em Iauaretê, que concentrou 15,3% das notificações, foram entrevistados 184 indígenas. Revelou-se prevalência de ILTB de 76,1%. Prova tuberculínica > 5 mm associou-se com idade > 15 anos, história de tuberculose ativa e alterações radiológicas. Tuberculose anterior foi citada por 54 indígenas (29,3%). A principal explicação para o adoecimento foi sopro/envenenamento (24,1%). O itinerário terapêutico incluiu medicamentos industrializados (42,6%), plantas medicinais/raízes, pajelança/xamanismo e reza (42,7%). CONCLUSÕES: A prevalência de infecção tuberculosa e doença ativa nessa população foi elevada. As estratégias de controle tiveram resultados positivos, com redução na incidência em tempos recentes. Entretanto, para controlar a tuberculose é necessário intensificar a vigilância dos contatos e aperfeiçoar as estratégias de comunicação das equipes com a população indígena.

OBJECTIVE: To describe the sociodemographic, clinical, and epidemiological characteristics of reported tuberculosis cases among indigenous individuals of São Gabriel de Cachoeira, State of Amazonas, Brazil, and to identify the factors associated with mortality during treatment; and to estimate the prevalence of latent tuberculosis infection (LTBI) and associated factors and obtain information on the therapeutic course and the individual perceptions regarding acquistion of tuberculosis in the district of Iauaretê. METHODS: Firstly, a retrospective epidemiological study (1997 to 2007) was conducted using data from the Brazilian Notifiable Diseases Surveillance System (SINAN). Next, a cross-sectional study (2010) was conducted with respiratory symptomatic subjects and contacts of Iauaretê. RESULTS: Seven hundred and twenty-three new cases were reported, with incidence of 273.4/100 000 and mortality of 13.2/100 000. There was a predominance of males (57%), aged > 45 years (37.6%), people with no schooling (42.7%), and cases from rural areas (76.9%). Patients aged 0 to 20 years were at lower risk of death when compared to those aged > 45 years (OR = 0.3; IC95%: 0.1 a 0.9). In Iauaretê, with 15.3% of the reported cases, 184 people were interviewed. A prevalence of LTB of 76.1% was reported. Tuberculin skin test > 5 mm was associated with the > 15-year old age group, history of active tuberculosis, and radiological alterations. A previous history of tuberculosis was cited by 54 people (29.3%). The main explanation for the disease was "puffing/poisoning" (24.1%). The therapeutic course included industrialized drugs (42.6%), medicinal plants/roots, shamanism, and prayer (42.7%). CONCLUSIONS: The risk of tuberculosis infection and disease in this population was high. Despite the reduced incidence resulting from recent efforts, tuberculosis control requires closer surveillance of contacts and improvement in communication strategies between health teams and indigenous populations.

Análise de desempenho do Programa de Triagem Neonatal do Estado do Rio de Janeiro, Brasil, de 2005 a 2007 / Performance analysis of the Rio de Janeiro State Neonatal Screening Program, 2005-2007

As diretrizes enfatizam o momento adequado para a coleta do teste de triagem neonatal entre o 3º e o 7º dias de vida, em 100 por cento dos recém-natos. O tratamento do hipotireoidismo congênito e da fenilcetonúria iniciado até 2 semanas de vida é capaz de evitar as sequelas neurológicas dessas doenças. O programa de triagem neonatal do Estado do Rio de Janeiro foi credenciado para Fase II do Programa Nacional de Triagem Neonatal com dois modelos de programa - modelo A e modelo B. Foi realizada análise de desempenho do PTN de 2005 a 2007. Entre 2002 e 2007, a cobertura foi crescente e chegou a 80,4 por cento, com 33,8 por cento das coletas realizadas até 7 dias. Ambos os modelos tiveram desempenhos semelhantes e aquém das metas preconizadas, com 50 por cento dos casos confirmados obtendo diagnóstico com mais de 48 dias de vida. Os atrasos acumulados nas diversas etapas do processo podem anular os benefícios da detecção precoce, fundamento da triagem neonatal. Os efeitos deletérios de longo prazo transcendem a esfera individual acarretando impacto no sistema de saúde e grande ônus social.

Guidelines emphasize that the appropriate time frame for neonatal screening with the heel stick test is from the 3rd to 7th day of life, in 100 percent of newborns. Treatment for congenital hypothyroidism and phenylketonuria, when initiated in the first two weeks of life, is capable of preventing the neurological sequelae of these diseases. The Rio de Janeiro State Neonatal Screening Program was accredited for Phase 2 of the National Neonatal Screening Program, with two program models (A and B). A performance analysis was conducted for the Neonatal Screening Program, for the years 2005 to 2007. Coverage increased from 2002 to 2007, reaching 80.4 percent, with 33.8 percent of the blood samples drawn in the first 7 days of life. The two models showed similar performance, short of the targets, with 50 percent of the confirmed cases receiving their diagnosis at more than 48 days of life. The delays accumulated in the various stages of the process can impede the benefits of early detection, the cornerstone of neonatal screening. The deleterious long-term effects transcend the individual sphere, with an impact on the health system and a major social burden.

[Performance analysis of the Rio de Janeiro State Neonatal Screening Program, 2005-2007]. / Análise de desempenho do Programa de Triagem Neonatal do Estado do Rio de Janeiro, Brasil, de 2005 a 2007.

Guidelines emphasize that the appropriate time frame for neonatal screening with the heel stick test is from the 3rd to 7th day of life, in 100% of newborns. Treatment for congenital hypothyroidism and phenylketonuria, when initiated in the first two weeks of life, is capable of preventing the neurological sequelae of these diseases. The Rio de Janeiro State Neonatal Screening Program was accredited for Phase 2 of the National Neonatal Screening Program, with two program models (A and B). A performance analysis was conducted for the Neonatal Screening Program, for the years 2005 to 2007. Coverage increased from 2002 to 2007, reaching 80.4%, with 33.8% of the blood samples drawn in the first 7 days of life. The two models showed similar performance, short of the targets, with 50% of the confirmed cases receiving their diagnosis at more than 48 days of life. The delays accumulated in the various stages of the process can impede the benefits of early detection, the cornerstone of neonatal screening. The deleterious long-term effects transcend the individual sphere, with an impact on the health system and a major social burden.

Promoção, proteção e apoio à amamentação na atenção primária à saúde no Estado do Rio de Janeiro, Brasil: uma política de saúde pública baseada em evidência / Breastfeeding promotion, protection, and support in primary health care in the State of Rio de Janeiro, Brazil: a case of evidence - based public health policy

Este artigo avalia uma política de promoção, proteção e apoio ao aleitamento materno desenvolvida em unidades básicas de saúde do Estado do Rio de Janeiro, Brasil, analisando seus pressupostos, intervenções e resultados com base em um modelo lógico. Através de uma revisão sistemática, foram identificados procedimentos e estratégias efetivas na extensão da duração do aleitamento materno, os quais compuseram os "Dez Passos" da "Iniciativa Unidade Básica Amiga da Amamentação", lançada no Estado em 1999. Uma metodologia de avaliação correspondente foi desenvolvida e utilizada para verificar o desempenho de 24 unidades básicas de saúde de diferentes partes do Estado. Foi verificada uma associação direta da prática desses passos com a prevalência de aleitamento materno exclusivo e com a satisfação da clientela. Uma análise dos significados atribuídos pelas gestantes e mães acerca do apoio recebido da unidade básica de saúde para amamentar identificou cinco estruturas de significação: "nenhum apoio", "apoio dúbio", "incentivo", "manejo" e "parceria". O modelo de avaliação propiciou o reconhecimento imediato das oportunidades de melhora nas ações do programa para a reversão dos baixos índices de aleitamento materno exclusivo.

Surveillance system of vaccine adverse events and local data analysis--the experience in a middle-sized city in Brazil, 1999-2001.

We reviewed all vaccine adverse events (VAE) notified in a middle-sized Brazilian city (n=247) to the National Immunisation Program between January 1999 and December 2001. Vaccine doses used in that period were considered for rate estimates. Aspects of the surveillance system (SS) and their influences on collected data were considered, searching for contributions of local data analysis to investigation of VAE and to the monitoring of vaccine safety. Notification rates in our study were higher when compared to national data. Changes in the notification pattern were observed following vaccination campaign periods. An increase in aseptic meningitis cases temporally associated to yellow fever vaccine was detected. The analysis of local data provided information unperceived in national consolidated data. Through this analysis we detected: events related to application technique and handling; people's perception changes on VAE; and the local SS's ability to raise new hypothesis. We suggested changes to the notification form regarding data entry criteria and analysis.

[Breastfeeding promotion, protection, and support in primary health care in the State of Rio de Janeiro, Brazil: a case of evidence-based public health policy]. / Promoção, proteção e apoio à amamentação na atenção primária à saúde no Estado do Rio de Janeiro, Brasil: uma política de saúde pública baseada em evidência.

This article evaluates a policy for breastfeeding promotion, protection, and support in primary health care units in Rio de Janeiro State, Brazil, analyzing the assumptions, interventions, and results based on a log-frame model. A systematic review sought to identify effective procedures and strategies for extending breastfeeding duration, constituting the basis for creating "Ten Steps" in the "Breastfeeding-Friendly Primary Care Initiative" launched in Rio de Janeiro State in 1999. A corresponding evaluation method was developed and applied to verify the performance of 24 primary health care units from different parts of the State. A direct association was found between the practical implementation of these steps and prevalence of exclusive breastfeeding, as well as with mothers' satisfaction. An analysis of meanings ascribed by pregnant women and mothers to the support provided for breastfeeding identified five categories: "no support", "doubtful support", "encouragement", "guidance", and "partnership". The evaluation model allowed staff at the health care units to recognize opportunities for improving the program, in order to reverse the current low prevalence of exclusive breastfeeding.