Detection of risk clusters for deaths due to tuberculosis specifically in areas of southern Brazil where the disease was supposedly a non-problem.

BACKGROUND: Tuberculosis (TB) is the infectious disease that kills the most people worldwide. The use of geoepidemiological techniques to demonstrate the dynamics of the disease in vulnerable communities is essential for its control. Thus, this study aimed to identify risk clusters for TB deaths and their variation over time. METHODS: This ecological study considered cases of TB deaths in residents of Londrina, Brazil between 2008 and 2015. We used standard, isotonic scan statistics for the detection of spatial risk clusters. The Poisson discrete model was adopted with the high and low rates option used for 10, 30 and 50% of the population at risk, with circular format windows and 999 replications considered the maximum cluster size. Getis-Ord Gi* (Gi*) statistics were used to diagnose hotspot areas for TB mortality. Kernel density was used to identify whether the clusters changed over time. RESULTS: For the standard version, spatial risk clusters for 10, 30 and 50% of the exposed population were 4.9 (95% CI 2.6-9.4), 3.2 (95% CI: 2.1-5.7) and 3.2 (95% CI: 2.1-5.7), respectively. For the isotonic spatial statistics, the risk clusters for 10, 30 and 50% of the exposed population were 2.8 (95% CI: 1.5-5.1), 2.7 (95% CI: 1.6-4.4), 2.2 (95% CI: 1.4-3.9), respectively. All risk clusters were located in the eastern and northern regions of the municipality. Additionally, through Gi*, hotspot areas were identified in the eastern and western regions. CONCLUSIONS: There were important risk areas for tuberculosis mortality in the eastern and northern regions of the municipality. Risk clusters for tuberculosis deaths were observed in areas where TB mortality was supposedly a non-problem. The isotonic and Gi* statistics were more sensitive for the detection of clusters in areas with a low number of cases; however, their applicability in public health is still restricted.

Survival time among patients who were diagnosed with tuberculosis, the precocious deaths and associated factors in southern Brazil.

BACKGROUND: A diagnosis of tuberculosis (TB) does not mean that the disease will be treated successfully, since death may occur even among those who are known to the health services. Here, we aimed to analyze patient survival time from the diagnosis of TB to death, precocious deaths, and associated factors in southern Brazil. METHODS: We conducted a longitudinal study with patients who were diagnosed with TB and who died due to the disease between 2008 and 2015 in southern Brazil. The starting point for measuring survival time was the patient's diagnosis date. Techniques for survival analysis were employed, including the Kaplan-Meier test and Cox's regression. A mixed-effect model was applied for identifying the associated factors to precocious deaths. Hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (95% CI) were estimated. We defined p value <0.05 as statistically significant for all statistics applied. RESULTS: One hundred forty-six patients were included in the survival analysis, observing a median survival time of 23.5 days. We observed that alcoholism (HR=1.55, 95% CI=1.04-2.30) and being male (HR=6.49, 95% CI=1.03-2.68) were associated with death. The chance of precocious death within 60 days was 10.48 times greater than the chance of early death within 30 days. CONCLUSION: Most of the deaths occurred within 2 months after the diagnosis, during the intensive phase of the treatment. The use of alcohol and gender were associated with death, revealing inequality between men and women. This study advanced knowledge regarding the vulnerability associated with mortality. These findings must be addressed to fill a gap in the care cascades for active TB and ensure equity in health.

HIV Care Continuum from diagnosis in a Counseling and Testing Center.

OBJECTIVE: To analyze the HIV care continuum from the diagnosis in an HIV/AIDS Counseling and Testing Center (CTC), and the sociodemographic, clinical, and laboratory characteristics related to gender. METHOD: Epidemiological study, conducted with data of individuals assisted at a Counseling and Testing Center, and followed in an outpatient clinic for HIV/AIDS. Pearson's Chi-square test and binary logistic regression were used to obtain odds ratios, considering alpha value <0.05. RESULTS: The prevalence of HIV among 5,229 users was 5%. The highest chance of positive results was among men, aged 14 to 33 years old, who were not in a domestic partnership. In the analysis of TCD4+ lymphocytes and viral load (VL) of 238 cases, 56.1% had a late diagnosis. We have identified gaps in the care cascade, especially linkage to the care, retention in care, and viral load suppression. CONCLUSION: The results suggest a late diagnosis for both genders, as well as difficulty in reaching the viral suppression goal.

[Living with sexual diversity: experience report]. / Convivendo com a diversidade sexual: relato de experiência.

This study reports the experience of undergraduate students and faculty from the School of Nursing - Londrina State University, in a Civil Society Organization (CSO) that works with transvestites and men who provide sexual services for a fee. In the first school semester, students and faculty remained daily at CSO in order to care for immediate necessities and perform weekly lectures. In the second semester, workshops on sexual diversity were ministered by the transvestites to students and faculty followed by workshops, that were ministered, weekly, by students and faculty involving themes previously chosen by the transvestites. This experience is deemed to be enriching and contributes to students and faculty's personal and professional growth, as well as improves care quality and life quality of the transvestites.

Psychosocial and behavioral factors associated to STD/AIDS risk among health students.

This study aimed to identify and compare psychosocial and behavioral factors associated to STD/AIDS risk among students enrolled in the first and last years of the Nursing and Medical Undergraduate Programs at State University of Londrina. A convenience sample was selected from 263 enrolled students, and the 183 students who were sexually active (70.4%) had their data assessed. The Aids Risk Reduction Model framework was used to design the questionnaire in which a 5% statistical significance level was considered. Some risk factors were identified such as the perception of invulnerability, multiple sexual partners, consumption of alcoholic beverages before intercourse, and the discontinuous use or no use of condom. The risk factors are common both to the freshman and senior students, with no significant differences related to the passage of time or to the students' higher educational level. Senior students tend to be monogamous which makes them feel safer and decrease the use of condom with their sexual partners.

[The meaning of learning how to research during graduation]. / O significado de aprender a pesquisar durante a graduação.

This paper is based on the following inquiry: how do the students realize their research learning process? The aim was to understand the meaning of learning how to research to students. It is a qualitative study that uses the Bardin referential. The sheet used to collect the data had the two guideline questions and were applied to 42 students of the Transition Curriculum and to 49 students of the Integrated Curriculum at UEL Nursing Course. The assessment of the speeches allowed the gathering of five groups segmented into thematic subgroups that unfold the students' meaning of learning. This approach has permitted the acknowledgement that research learning is a complex, dynamic and constant process which requires time they can develop their competence in research.

Prevalence and factors associated with syphilis in a Reference Center.

INTRODUCTION:: The implementation of the rapid test (RT) for syphilis increases access of vulnerable populations to early diagnosis and treatment, impacting the outcomes of infection. We aimed to assess the prevalence of and factors associated with syphilis in a Center for Testing and Counseling (CTC). METHODS:: We conducted a cross-sectional study at a Reference Center for sexually transmitted disease (STD) and acquired immune deficiency syndrome in Londrina, Northern Paraná State, Southern Brazil. Data regarding the 5,509 individuals who underwent RT from June 2012 to December 2014 were collected from patient records and the CTC Information System and served as the basis to check associations of syphilis cases (346) and cases without syphilis (5,163). Nine patients' records were not found. OpenEpi was used to perform a prevalence analysis and determine odds ratios to assess the associations between sociodemographic and behavioral variables (independent variables) and cases of syphilis (dependent variable). An alpha value <0.05 was considered statistically significant. RESULTS:: The prevalence of syphilis was 6.3%; higher in males (7.5%) than in females (4.3%, p <0.001). Syphilis was associated with an age of 25-34 years, little education, and single marital status. The main associated behavioral factors were men who have sex with men, drug users, STD patients, and those presenting with an STD in the last year. The use of alcohol, marijuana, cocaine, and crack was significantly associated with syphilis. CONCLUSIONS:: Strategies for prevention and control of syphilis should be intensified, especially in populations identified as most vulnerable.

[Latent tuberculosis infection in persons with HIV/AIDS, associated factors, and progression to active disease in a city in southern Brazil]. / Infecção latente por tuberculose entre pessoas com HIV/AIDS, fatores associados e progressão para doença ativa em município no Sul do Brasil.

The study proposed to identify the prevalence of latent tuberculosis infection (LTBI) in persons living with HIV/AIDS (PLWHA), associated factors, and progression to active tuberculosis among the identified cases. This was an epidemiological and descriptive study. The study population consisted of PLWHA seen from 2003 and 2014 in a reference center for HIV/AIDS. Data were collected from patient files and the Brazilian Information System for Notifiable Diseases (SINAN). Bivariate statistical analysis used the chi-square test in which variables with p < 0.2 were selected to enter the multiple regression model. Type I error was set at 5% (p < 0.05) for all the tests. In the study, 690 cases were analyzed, and 66 (9.4%) had a diagnosis of LTBI, with a prevalence of 7.5 cases per 100 patients. Of the 53 cases (80.3%) of LTBI who were prescribed treatment with isoniazid, only 26 (39.4%) concluded treatment, and 10 (15.1%) dropped out. Male gender (adjusted OR = 1.8; 95%CI: 1.1-3.3), current incarceration (adjusted OR = 7.6; 95%CI: 2.35-24.9), and high lymphocyte count were associated with LTBI diagnosis (adjusted OR = 1.1; 95%CI: 1.1-1.2). Forty-seven (6.7%) of LTBI cases progressed to active TB. Diagnosis and treatment of LTBI in PLWHA were not prioritized, which contributed to the development of active disease among cases. The study contributed to knowledge on LTBI in PLWHA, demonstrating crucial aspects in the management of PLWHA and the importance of detecting LTBI and early initiation of isoniazid, aimed at improved quality of life and prognosis for PLWHA.

Positividade ao hiv e fatores associados em um centro de testagem e aconselhamento / Positividad al vih y factores asociados en un centro de consejería y pruebas / Hiv positivity and associated factors in a counseling and testing center

RESUMO Objetivo: Analisar os fatores sociodemográficos e comportamentais associados à positividade ao Vírus da Imunodeficiência Humana (HIV) em usuários de um Centro de Testagem e Aconselhamento (CTA). Método: Estudo transversal com 5.229 usuários que realizaram o teste rápido para HIV, registrados no Sistema de Informação do CTA. As análises bivariadas e multivariadas foram realizadas utilizando-se a regressão logística binária, com apresentação do OddsRatio, intervalo de confiança de 95% e p-valor <0,05. Resultados: A prevalência de infecção pelo HIV foi de 5,0% (259), com maior acometimento da população mais jovem (p=0,010). Observou-se maior positividade entre as pessoas vivendo com HIV/Aids (91,3%; p<0,001) e homens que fazem sexo com homens (HSH) (20%; p<0,001). Nas análises multivariadas verificou-se maior associação à infecção pelo HIV no modelo 2 que inclui, as variáveis sociodemográficas e comportamentais, como: o recorte populacional de HSH, o compartilhamento de seringas, a orientação sexual HSH, ter infecções sexualmente transmissíveis (IST) nos últimos 12 meses, parceiro soropositivo para HIV e uso irregular ou não uso do preservativo nos últimos 12 meses com parceiro fixo. Conclusão: A vulnerabilidade ao HIV foi mais associada aos fatores relacionados ao compartilhamento de seringas e ao comportamento sexual, especialmente os HSH e as parcerias fixas.

resumen Objetivo: analizar los factores sociodemográficos y comportamentales asociados a la positividad al Virus de la Inmunodeficiencia Humana (VIH) en usuarios de un Centro de Consejería y Pruebas. Método: estudio transversal con 5.229 usuarios que realizaron la prueba rápida para VIH, registrados en el Sistema de Información del Centro. Los análisis bivariados y multivariados fueron realizados utilizando la regresión logística binaria, con presentación del OddsRatio, intervalo de confianza de 95% y p-valor <0,05. Resultados: la prevalencia de infección por el VIH fue de 5,0% (259), con mayor acometimiento de la población más joven (p=0,010). Se observó mayor positividad entre las personas viviendo con VIH/sida (91,3%; p<0,001) y hombres que hacen sexo con hombres (HSH) (20%; p<0,001). En los análisis multivariados se verificó mayor asociacióna la infección por el VIH en el modelo 2 que incluye las variables sociodemográficas y comportamentales como: el recorte poblacional de HSH, el compartir jeringas, la orientación sexual HSH, tener enfermedades de transmisión sexual (ETS) en los últimos 12 meses, compañero seropositivo para VIHy uso irregular o la falta del uso de preservativo en los últimos 12 meses con compañero fijo. Conclusión: la vulnerabilidad al VIH fue más asociada a los factores relacionados al compartir jeringas y al comportamiento sexual, especialmente los HSH y los compañeros fijos.

ABSTRACT Objective: To analyze the sociodemographic and behavioral factors associated with Human Immunodeficiency Virus (HIV) positivity in users of a Counseling and Testing Center (CTC). Method: Across-sectional study with 5,229 users who performed the rapid HIV test, registered in the CTC's Information System. Bivariate and multivariate analyzes were performed using binary logistic regression, presenting OddsRatio, 95% confidence interval and p-value <0.05. Results: The prevalence of HIV infection was 5.0% (259), with greater involvement of the younger population (p=0.010). Greater positivity was observed among people living with HIV/AIDS(91.3%; p <0.001) and men who have sex with men (MSM) (20%; p<0.001). In multivariate analyzes, there was a greater association with HIV infection in model 2, which includes sociodemographic and behavioral variables, such as: the populational cut of MSM, needle sharing, MSM sexual orientation, having sexually transmitted infections (STIs) in the last 12 months, HIV-positive partner and irregular or no condom use in the last 12 months with a steady partner. Results: Conclusion: Vulnerability to HIV was more associated with factors related to needle sharing and sexual behavior, especially MSM and steady partnerships.

[Academic activity report as a strategy for learning research]. / Relatório de atividade acadêmica como recurso de aprendizagem da pesquisa.

This study aimed to analyze academic activity reports about the structure and mental abilities developed by graduate students of two nursing curriculum proposals at a Brazilian university. The study was based on 83 students: 39 from the Transition Curriculum (group I) and 44 from the Integrated Curriculum (group II). Data were collected through a registration card with topics from the December 2002 report by group I and the December 2003 report by group II. The results, presented as frequency percentages, showed that group II elaborated the academic activity report with a better structure than group I. This group also developed a more complex reasoning, especially in the "development" topic. Interventions with group II present a better development in this teaching strategy.

HIV Care Continuum from diagnosis in a Counseling and Testing Center / Cascada del cuidado del VIH a partir del diagnóstico en Centro de Pruebas y Consejo / Cascata do cuidado do HIV a partir do diagnóstico em Centro de Testagem e Aconselhamento

ABSTRACT Objective: To analyze the HIV care continuum from the diagnosis in an HIV/AIDS Counseling and Testing Center (CTC), and the sociodemographic, clinical, and laboratory characteristics related to gender. Method: Epidemiological study, conducted with data of individuals assisted at a Counseling and Testing Center, and followed in an outpatient clinic for HIV/AIDS. Pearson's Chi-square test and binary logistic regression were used to obtain odds ratios, considering alpha value <0.05. Results: The prevalence of HIV among 5,229 users was 5%. The highest chance of positive results was among men, aged 14 to 33 years old, who were not in a domestic partnership. In the analysis of TCD4+ lymphocytes and viral load (VL) of 238 cases, 56.1% had a late diagnosis. We have identified gaps in the care cascade, especially linkage to the care, retention in care, and viral load suppression. Conclusion: The results suggest a late diagnosis for both genders, as well as difficulty in reaching the viral suppression goal.

RESUMEN Objetivo: Analizar la cascada del cuidado del VIH a partir del diagnóstico en Centro de Pruebas y Consejo (CTA); y las características sociodemográficas, clínicas y laboratoriales relacionadas al sexo. Método: Estudio epidemiológico, realizado con datos de indivíduos atendidos en un Centro de Pruebas y Consejo y acompañados en ambulatorio de VIH/sida. Han sido utilizados el test chi cuadrado y regresión logística binaria, para obtención del odds ratio, considerando alfa < 0,05. Resultados: La prevalencia de VIH nos 5.229 usuarios ha sido de 5%, con mayor chance de resultado positivo entre hombres, franja etaria de 14 a 33 años, que no presentaban unión estable. En el análisis de linfocitos TCD4+ y carga viral (CV) de 238 casos, 56,1% realizaron diagnóstico tardío. Han sido identificadas lagunas en la cascada del cuidado, especialmente en la vinculación, retención en el cuidado y supresión de la carga viral. Conclusión: Los resultados sugieren diagnóstico tardío para ambos los sexos, además dificultad en alcanzar la meta de supresión viral.

RESUMO Objetivo: Analisar a cascata do cuidado do HIV a partir do diagnóstico em Centro de Testagem e Aconselhamento (CTA); e as características sociodemográficas, clínicas e laboratoriais relacionadas ao sexo. Método: Estudo epidemiológico, realizado com dados de indivíduos atendidos num Centro de Testagem e Aconselhamento e acompanhados em ambulatório de HIV/aids. Foram utilizados o teste Qui-quadrado e regressão logística binária, para obtenção do odds ratio, considerando alfa < 0,05. Resultados: A prevalência de HIV nos 5.229 usuários foi de 5%, com maior chance de resultado positivo entre homens, faixa etária de 14 a 33 anos, que não apresentavam união estável. Na análise de linfócitos TCD4+ e carga viral (CV) de 238 casos, 56,1% realizaram diagnóstico tardio. Foram identificadas lacunas na cascata do cuidado, especialmente na vinculação, retenção no cuidado e supressão da carga viral. Conclusão: Os resultados sugerem diagnóstico tardio para ambos os sexos, além de dificuldade em alcançar a meta de supressão viral.

Sepse: avaliação da qualidade do atendimento em setor de urgência e emergência / Sepsis: assessment of healthcare quality in an urgency and emergency unit

Introduction:Sepsis is a serious condition caused by unregulated immune response to an infection and is considered one of the leading causes of death worldwide. Objective:To assess the quality of care provided to septic patients in the emergency unit ofa university hospital, according to the guidelines provided by the Surviving Sepsis Campaign. Methods:Longitudinal study conducted with septic patients in an emergency unit. Data were collected from sepsis notifications and medical records. The statistical analysis was performed by measures of central tendency and binary logistic regression. Results:We assessed 139 patients from the Surviving Sepsis Campaign perspective. The adequacy of the behaviors related to the performance of exams reached 64.2% for lactate, and 55.3% for blood cultures. In the first hour, 49.6% of the patients had received antimicrobial therapy. There was no compliance with the treatment for hypotension and hyperlactatemia in 69.8% of cases. Mortality reached 61.2% of the cases, and the associated risk factors were: multiple organ dysfunctions; high APACHE II and SOFA scores; hyperlactatemia; and mechanical ventilation. Conclusion:Care provided to patients with sepsis in the emergency unit followed most Surviving Sepsis Campaign guidelines; however, it is possible to increase compliance with the recommendations, thus resulting in better prognoses.

Introdução: A sepse é uma condição grave causada por resposta imune desregulada a uma infecção e é considerada uma das principais causas de morte no mundo.Objetivo:Avaliar a qualidade do atendimento ao paciente séptico no setor de urgência e emergência de um hospital universitário, conforme as diretrizes preconizadas pela Surviving Sepsis Campaign. Métodos:Estudo longitudinal, realizado com pacientes sépticos em um setor de urgência e emergência. Os dados foram coletados nas notificações de sepse e prontuários. A análise estatística foi realizada por medidas de tendência central e regressão logística binária. Resultados: Foram avaliados 139 pacientes na perspectiva da Surviving Sepsis Campaign. A adequação das condutas relacionadas às coletas de exames atingiu 64,2% para o lactato e 55,3% para hemoculturas. Receberam terapia antimicrobiana na primeira hora 49,6% dos pacientes. Não houve adesão ao tratamento da hipotensão e hiperlactatemia em 69,8% dos casos. A mortalidade atingiu 61,2% dos casos e os fatores de risco associados foram: múltiplas disfunções orgânicas; pontuação elevada nos escores APACHE II e SOFA; hiperlactatemia; e ventilação mecânica. Conclusão: O atendimento ao paciente com sepse no setor de urgência e emergência seguiu a maioria das diretrizes da Surviving Sepsis Campaign;porém, é possível aumentar a adesão às recomendações, resultando em melhores prognósticos.

Prevalence and evolution of Mycobacterium tuberculosis infection in tuberculosis case contacts.

INTRODUCTION: The tuberculin test is a diagnostic method for detecting latent tuberculosis (TB) infection, especially among disease contact cases. The objective of this study was to analyze the prevalence and evolution of Mycobacterium tuberculosis infection among TB contact cases. METHODS: A retrospective cohort study was performed in a reference center for TB. The study population consisted of 2,425 patients who underwent a tuberculin test from 2003 to 2010 and whose results indicated contact with individuals with TB. The data were collected from the registry book of the tuberculin tests, patient files and the Information System Records of Notification Grievance. To verify the evolution of TB, case records through September 2014 were consulted. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). In all hypothesis tests, a significance level of 0.05 was used. RESULTS: From the studied sample, 435 (17.9%) contacts did not return for reading. Among the 1,990 contacts that completed the test, the prevalence of latent TB infection was 35.4%. Of these positive cases, 50.6% were referred to treatment; the dropout rate was 42.5%. Among all of the contacts, the TB prevalence was 1.8%, from which 13.2% abandoned treatment. CONCLUSIONS: The collected data indicate the need for more effective public policies to improve TB control, including administering tests that do not require a return visit for reading, enhancing contact tracing and encouraging actions that reinforce full treatment adherence.

Patients' perceptions on the performance of a local health system to eliminate leprosy,Paraná State, Brazil.

BACKGROUND: In Brazil, leprosy has been listed among the health priorities since 2006, in a plan known as the "Pact for life" (Pacto pela Vida). It is the sole country on the American continent that has not reached the global goal of disease elimination. Local health systems face many challenges to achieve this global goal. The study aimed to investigate how patients perceive the local health system's performance to eliminate leprosy and whether these perceptions differ in terms of the patients' income. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study was conducted in Londrina, State of Paraná, Brazil. Interviews were performed with the leprosy patients. The local health system was assessed through a structured and adapted tool, considering the domains judged as good quality of health care. The authors used univariate, bivariate and multivariate analyses. One hundred and nineteen patients were recruited for the study, 50.4% (60) of them were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The results showed that patients used the Primary Health Care service near their place of residence but did not receive the leprosy diagnosis there. Important advances of this health system were verified for the elimination of leprosy, verifying protocols for good care delivery to the leprosy patients, but these services did not develop collective health actions and did not engage the patients' family members and community. CONCLUSIONS/SIGNIFICANCE: The patients' difficulty was observed to have access to the diagnosis and treatment at health services near their homes. Leprosy care is provided at the specialized level, where the patients strongly bond with the teams. The care process is individual, with limited perspectives of integration among the health services for the purpose of case management and social mobilization of the community to the leprosy problem.

Atendimento às vítimas de acidentes de trânsito pelo serviço pré-hospitalar: estudo transversal / Assistance to victims of traffic accidents through the prehospital service: a cross-sectional study / Atención del servicio pre-hospitalario a las víctimas de accidentes de tráfico: estudio transversal

OBJETIVO: avaliar o perfil dos atendimentos de acidentes de trânsito realizados pelo Serviço de Atendimento Móvel de Urgência (SAMU) de uma cidade da região Sul do Brasil. MÉTODO: estudo transversal, retrospectivo e quantitativo, desenvolvido com dados de 342 vítimas de acidentes de trânsito atendidos pelo SAMU no ano de 2015, analisados estatisticamente. RESULTADOS: entre as vítimas, prevaleceram os homens (71,3%); com idades de 15 a 44 anos (65,7%); e que se envolveram em acidentes de automóveis com motos (29,2%). As lesões mais frequentes foram as escoriações (48,2%) e as corto-contusas (33,0%); e as que acometeram múltiplos locais do corpo (50,6%) e os membros inferiores e superiores (85,1%). O suporte avançado atendeu 75,1% das ocorrências. CONCLUSÃO: constatou-se associação estatística entre os mecanismos do acidente com os grupos etários, com as fraturas abertas e fechadas e com as lesões nos membros superiores e inferiores

AIM: to evaluate the profile of traffic accident assistance performed by the Mobile Emergency Service (Serviço de Atendimento Móvel de Urgência ­ SAMU) of a city in the South of Brazil. METHOD: a cross-sectional, retrospective and quantitative study, developed with data from 342 victims of traffic accidents attended by SAMU in 2015, statistically analyzed. RESULTS: among the victims, men prevailed (71.3%); ages ranged from 15 to 44 years (65.7%); and who were involved in automobile accidents with motorcycles (29.2%). The most frequent lesions were bruises (48.2%) and short-bruises (33.0%); and those involving multiple body sites (50.6%) and lower and upper limbs (85.1%). Advanced support accounted for 75.1% of incidents. CONCLUSION: it was found a statistical association between the mechanisms of accident with age groups, with open and closed fractures and lesions in the upper and lower limbs

OBJETIVO: evaluar el perfil de la atención a los accidentes de tráfico realizada por el Servicio de Atención Móvil de Urgencia (SAMU) de una ciudad de la región Sur de Brasil MÉTODO: estudio transversal, retrospectivo y cuantitativo, desarrollado con los datos de 342 víctimas de accidentes de tráfico atendidos por el SAMU en el 2015, analizados estadísticamente. RESULTADOS: entre las víctimas, prevalecieron los hombres (71,3%); con edades de 15 a 44 años (65,7%); involucrados en accidentes de motos (29,2%). Las lesiones más frecuentes fueron las laceraciones (48,2%) y las cortopunzantes (33,0%); y las que ocurren en varios lugares del cuerpo (50,6%) y los miembros inferiores e superiores (85,1%). El soporte avanzado atendió 75,1% de las ocurrencias. CONCLUSIÓN: se constató que hay asociación estadística entre los mecanismos del accidente con los grupos etarios, con las fracturas abiertas y cerradas y con las lesiones en los miembros superiores e inferiores

Prevalence and factors associated with syphilis in a Reference Center

Abstract INTRODUCTION: The implementation of the rapid test (RT) for syphilis increases access of vulnerable populations to early diagnosis and treatment, impacting the outcomes of infection. We aimed to assess the prevalence of and factors associated with syphilis in a Center for Testing and Counseling (CTC). METHODS: We conducted a cross-sectional study at a Reference Center for sexually transmitted disease (STD) and acquired immune deficiency syndrome in Londrina, Northern Paraná State, Southern Brazil. Data regarding the 5,509 individuals who underwent RT from June 2012 to December 2014 were collected from patient records and the CTC Information System and served as the basis to check associations of syphilis cases (346) and cases without syphilis (5,163). Nine patients’ records were not found. OpenEpi was used to perform a prevalence analysis and determine odds ratios to assess the associations between sociodemographic and behavioral variables (independent variables) and cases of syphilis (dependent variable). An alpha value <0.05 was considered statistically significant. RESULTS: The prevalence of syphilis was 6.3%; higher in males (7.5%) than in females (4.3%, p <0.001). Syphilis was associated with an age of 25-34 years, little education, and single marital status. The main associated behavioral factors were men who have sex with men, drug users, STD patients, and those presenting with an STD in the last year. The use of alcohol, marijuana, cocaine, and crack was significantly associated with syphilis. CONCLUSIONS: Strategies for prevention and control of syphilis should be intensified, especially in populations identified as most vulnerable.

Infecção latente por tuberculose entre pessoas com HIV/AIDS, fatores associados e progressão para doença ativa em município no Sul do Brasil / Latent tuberculosis infection in persons with HIV/AIDS, associated factors, and progression to active disease in a city in southern Brazil / Infección latente por tuberculosis entre personas con VIH/SIDA, factores asociados y progresión para una enfermedad activa en un municipio del sur de Brasil

Resumo: Propôs-se levantar a prevalência de infecção latente por tuberculose (ILTB) entre pessoas vivendo com HIV/AIDS (PVHA), fatores associados e se entre os casos identificados houve progressão para tuberculose ativa. Trata-se de estudo epidemiológico e descritivo. A população foi composta de PVHA, atendidas entre 2003 e 2014 em um centro de referência para HIV/AIDS. Os dados foram coletados com base em prontuários e fichas do Sistema de Informação de Agravos de Notificação (SINAN). Procedeu-se à estatística bivariada, com aplicação do teste qui-quadrado, em que as variáveis com valores de p < 0,2 foram selecionadas para entrar no modelo de regressão múltipla. Foi fixado em todos os testes o erro tipo I em 5% (p < 0,05). No estudo, 690 casos foram analisados, sendo que 66 (9,4%) apresentaram o diagnóstico de ILTB, tendo uma prevalência de 7,5 casos para cada 100 pacientes. Dos 53 (80,3%) casos de ILTB que tiveram o tratamento indicado com isoniazida, apenas 26 (39,4%) concluíram e 10 (15,1%) abandonaram. Observou-se que as variáveis sexo masculino (OR ajustado = 1,8; IC95%: 1,1-3,3), situação prisional (OR ajustado = 7,6; IC95%: 2,35-24,9) e contagem de linfócitos mais altos são fatores associados ao diagnóstico de ILTB (OR ajustado = 1,1; IC95%: 1,1-1,2). Verificou-se que 47 (6,7%) dos casos de ILTB progrediram para TB ativa. O diagnóstico e o tratamento de ILTB nas PVHA não foram priorizados, o que contribuiu para o desenvolvimento de doença ativa entre os casos. O trabalho contribuiu para o avanço do conhecimento acerca da ILTB entre PVHA, demonstrando aspectos cruciais no que tange ao manejo de PVHA e ainda a importância da detecção da ILTB e a instituição precoce da isoniazida, visando à melhor qualidade de vida e prognóstico das PVHA.

Abstract: The study proposed to identify the prevalence of latent tuberculosis infection (LTBI) in persons living with HIV/AIDS (PLWHA), associated factors, and progression to active tuberculosis among the identified cases. This was an epidemiological and descriptive study. The study population consisted of PLWHA seen from 2003 and 2014 in a reference center for HIV/AIDS. Data were collected from patient files and the Brazilian Information System for Notifiable Diseases (SINAN). Bivariate statistical analysis used the chi-square test in which variables with p < 0.2 were selected to enter the multiple regression model. Type I error was set at 5% (p < 0.05) for all the tests. In the study, 690 cases were analyzed, and 66 (9.4%) had a diagnosis of LTBI, with a prevalence of 7.5 cases per 100 patients. Of the 53 cases (80.3%) of LTBI who were prescribed treatment with isoniazid, only 26 (39.4%) concluded treatment, and 10 (15.1%) dropped out. Male gender (adjusted OR = 1.8; 95%CI: 1.1-3.3), current incarceration (adjusted OR = 7.6; 95%CI: 2.35-24.9), and high lymphocyte count were associated with LTBI diagnosis (adjusted OR = 1.1; 95%CI: 1.1-1.2). Forty-seven (6.7%) of LTBI cases progressed to active TB. Diagnosis and treatment of LTBI in PLWHA were not prioritized, which contributed to the development of active disease among cases. The study contributed to knowledge on LTBI in PLWHA, demonstrating crucial aspects in the management of PLWHA and the importance of detecting LTBI and early initiation of isoniazid, aimed at improved quality of life and prognosis for PLWHA.

Resumen: Se propone averiguar la prevalencia de infección latente por tuberculosis (ILTB) entre personas viviendo con VIH/SIDA (PVVS), sus factores asociados, y si entre los casos identificados hubo progresión hacia la tuberculosis activa. Se trata de un estudio epidemiológico y descriptivo. La población estaba compuesta de PVVS, atendidas entre 2003 y 2014 en un centro de referencia para VIH/SIDA. Los datos fueron recogidos en base a historiales clínicos y fichas del Sistema Brasileiro de Información de Enfermedades de Notificación Obligatoria (SINAN). Se procedió a una estadística bivariada, con aplicación del test chi-cuadrado, donde las variables con valores de p < 0,2 fueron seleccionadas para entrar en el modelo de regresión múltiple. Se fijó en todos los tests el error tipo I en un 5% (p < 0,05). En el estudio, se analizaron 690 casos, donde 66 (un 9,4%) presentaron el diagnóstico de ILTB, teniendo una prevalencia de 7,5 casos para cada 100 pacientes. De los 53 (80,3%) casos de ILTB que tuvieron el tratamiento indicado con isoniazida, sólo 26 (39,4%) lo concluyeron y 10 (15,1%) lo abandonaron. Se observó que las variables sexo masculino (OR ajustado = 1,8; IC95%: 1,1-3,3), situación en régimen de prisión (OR ajustado = 7,6; IC95%: 2,35-24,9) y un cómputo de linfocitos más altos son factores asociados al diagnóstico de ILTB (OR ajustado = 1,1; IC95%: 1,1-1,2). Se verificó que 47 (6,7%) de los casos de ILTB progresaron hacia una tuberculosis activa. El diagnóstico y el tratamiento de ILTB en las PVVS no fueron priorizados, lo que contribuyó al desarrollo de la enfermedad activa entre los casos. El trabajo contribuyó al avance del conocimiento acerca de la ILTB entre PVVS, demostrando aspectos cruciales en lo que atañe al manejo de PVVS, e incluso la importancia de la detección de ILTB y la administración precoz de la isoniazida, con el fin de mejorar la calidad de vida y el pronóstico de las PVVS.

Centro de testagem e aconselhamento: características dos usuários e prevalência de infecção pelo HIV / Testing and counseling center: characteristics of users and HIV infection prevalence

A política brasileira de diagnóstico precoce e prevenção da infecção pelo HIV fortaleceu-se a partir dos Centros de Testagem e Aconselhamento (CTA). O objetivo deste estudo foi analisar as características de residentes do município de Rolândia que procuraram pelo diagnóstico de HIV no próprio município e no município de referência, assim como a prevalência de soropositividade. Trata-se de uma pesquisa descritiva, cujos dados foram levantados do Sistema de Informação (SI) do CTA referentes ao período de 2006 a 2010. Os dados foram tabulados e analisados por meio de frequências simples e relativas. Em Rolândia, foram 5.502 pacientes, sendo 79,5% mulheres, 64,8% apresentavam união estável, e 40,8% procuraram o CTA alegando prevenção. Dos 37 pacientes que estiveram no CTA de Londrina, 62,1% eram solteiros ou separados, 27,0% compareceram devido à exposição a situação de risco, e 19% apresentavam sintomas da aids. Dentre todos os pacientes que realizaram o exame anti-HIV, o índice de positividade foi de 0,60%. Esta pesquisa reiterou a importância de conhecer os usuários que demandam os CTA e a soroprevalência, constituindo informações relevantes para elaboração de políticas públicas, implantação de estratégias de prevenção e ações de assistência e promoção à saúde da população.

The Brazilian policy on early diagnosis and prevention of HIV infection was consolidated through the establishment of Testing and Counseling Centers (TCCs). The aim of this study was to analyze the characteristics of residents of the municipality of Rolândia who sought HIV diagnosis in their own municipality and in the municipality of reference, as well as seropositivity prevalence. This is a descriptive research whose data was collected from the TCC's Information System (IS) referring to the period from 2006 to 2010. The data was tabulated and analyzed through simple and relative frequencies. In Rolândia, there were 5,502 patients, of whom 79.5% were women, 64.8% were in a stable relationship and 40.8% sought the TCC for prevention. Among the 37 patients of Londrina's TCC, 62.1% of them were single or divorced; 27.0% went to the TCC due to exposure to risk situation, and19% presented AIDS symptoms. Among all patients tested for HIV, the positivity index stood at 0.60%. This research reiterated the importance of knowing the users who need the TCC, in addition to seroprevalence, comprising relevant information for the implementation of public policies, prevention strategies and actions aimed at promoting the population's healthcare.

Impacto das infecções relacionadas à assistência à saúde em pacientes acometidos por trauma / Impact of health care-related infections in trauma patients

As infecções relacionadas à assistência hospitalar impactam negativamente a saúde de pacientes hospitalizados, e refletem em elevados índices de morbimortalidade. Este estudo epidemiológico descritivo teve como objetivo caracterizar as infecções e avaliar seu impacto na saúde de pacientes acometidos por trauma, em um hospital universitário, no período de um ano. Os resultados mostraram que a prevalência das infecções nos pacientes do estudo foi elevada (15,6%), acometendo principalmente o sexo masculino (80,0%), com idade entre 18 e 40 anos (47,5%), período de internação maior que 15 dias(78,6%), mais frequente no trauma fechado (54,0%) e nas queimaduras (32,5%). Os principais sítios de infecção foram a pneumonia (49,5%) seguida pela infecção do trato urinário (23,8%). A intubação orotraqueal e o cateterismo vesical de longa permanência estiveram significativamente relacionados à maioria das pneumonias (60,3%; p<0,001) e infecções do trato urinário (77,3%; p<0,001), aumentando os riscos para tais infecções em 20 e 6 vezes, respectivamente. A sepse acometeu 44,7% dos pacientes.Ampla gama de microrganismos apresentou resistência aos antimicrobianos, sendo Acinetobacter baumannii (92,7%, p<0,001) e Klebsiella pneumoniae (70,5%, p<0,001) os mais prevalentes. Evoluíram a óbito 28,8% dos pacientes, e 96,8% das mortes relacionavam-se às infecções. A relação das infecções com o óbito foi estatisticamente significativa em pacientes com pneumonia (37,8%, p<0,001) e sepse(54,2%, p<0,001). A relação das infecções com a maioria dos óbitos evidenciou o impacto negativo desta complicação na saúde das vítimas de traumas.

Healthcare associated infections have an impact on the health of hospitalized patients and are reflected inhigh rates of morbidity and mortality. The aim of this descriptive study is to characterize the infections andevaluate their impact on trauma patient health at a University Hospital over a 1-year period. The resultsshowed that the prevalence of infections in trauma patients was elevated (15.6%), affecting mainly males(80.0%), ages between 18 and 30 years (47.5%), more than 15 days hospitalization (78.6%), more frequentin blunt trauma (54.0%) and in burns (32.5%). The principal sites of infection were pneumonia (49.5%) followed by urinary tract infection (23.8%). The tracheal intubation and long-term vesical catheterization were significantly related to most pneumonias (60.3%; p<0.001) and urinary tract infection (77.3%; p<0.001), increasing the risk for such infections on 20 and 6 times, respectively. Sepsis occurred in 44.7% of patients. A wide range of microorganisms showed resistance to antimicrobials, and Acinetobacter baumannii (92.7%, p <0.001) and Klebsiella pneumoniae (70.5%, p <0.001) were the most prevalent. 28.8% of the patients evolved to death, and 96.8% of deaths were related to infections. The relation between infections and death was statistically significant in pneumonia patients (37.8%, p <0.001) and sepsis (54.2%, p <0.001). The association of infections with the death showed the negative impact of this health complication in trauma patients.

Prova tuberculínica: o controle da tuberculose em pacientes infectados pelo vírus da imunodeficiência humana (HIV) / Tuberculin test: the control of tuberculosis in human immunodeficiency virus (HIV) infected patients

Objetivo: analisar os resultados das Provas Tuberculínicas (PT) em pacientes infectados pelo vírus da imunodeficiência humana (HIV) e a conduta frente aos mesmos num Centro de Referência do município de Londrina-PR. Métodos: Estudo de coorte retrospectivo, cujos dados foram levantados do livro de registro de PT, dos prontuários e fichas de notificação. Resultados: Dos 220 pacientes que realizaram a PT, a maioria era do sexo masculino, entre 21 e 50 anos, com 4 a 11 anos de escolaridade e 188 completaram o exame. Destes, nove (4,8%) foram reatores à PT. Seis casos tiveram indicação de tratamento de infecção latente de tuberculose (ILTB), destes, apenas um completou o esquema. Constatou-se que 33 (17,6%) pacientes apresentaram PT negativa e contagem de TCD4+ abaixo de 200 cél/mm³, entretanto, a maioria não realizou o exame após a reconstituição imune.Conclusão: A realização periódica da PT deve ser rigorosa, assim como o tratamento da ILTB nos indivíduos portadores de HIV.

Objective: to analyze the results of Tuberculin Skin Test (TST) in human immunodeficiency virus (HIV) infected patients and the conduct relative to the results in the Reference Center of Londrina-PR. Methods: A retrospective cohort study, whose data were collected from the register book of TST, the hospital records and notification. Results: From the 220 patients who underwent TST, most of them were male, between 21 and 50 year-old, with4 to 11 years of schooling, and 188 completed the tests. Nine of them (4.8%) were reactive to TST. Six cases were indicated for treatment of latent tuberculosis infection (LTBI), only one completed the scheme. It was found that 33 (17.6%) patients had negative TST and CD4+ counting below 200 cells/mm³, however, most did not performed the test after immune reconstitution. Conclusion: Periodic TST must be rigorous as well as the treatment of LTBI in HIV-infected individuals.