Cannabidiol for COVID-19 Patients with Mild to Moderate Symptoms (CANDIDATE Study): A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Importance: Owing to its anti-inflammatory properties and antiviral "in vitro" effect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cannabidiol (CBD) has been proposed as a potential treatment for coronavirus disease 2019 (COVID-19). Objective: To investigate the safety and efficacy of CBD for treating patients with mild to moderate COVID-19. Design: Randomized, parallel-group, double-blind, placebo-controlled clinical trial conducted between July 7 and October 16, 2020, in two sites in Brazil. Setting: Patients were recruited in an emergency room. Participants: Block randomized patients (1:1 allocation ratio-by a researcher not directly involved in data collection) with mild and moderate COVID-19 living in Ribeirão Preto, Brazil, seeking medical consultation, and those who voluntarily agreed to participate in the study. Interventions: Patients received 300 mg of CBD or placebo added to standard symptomatic care during 14 days. Main Outcome and Measure: The primary outcome was reduction or prevention of the deterioration in clinical status from mild/moderate to severe/critical measured with the COVID-19 Scale or the natural course of the resolution of typical clinical symptoms. Primary study outcome was assessed on days 14, 21, and 28 after enrollment. Results: A total of 321 patients were recruited and assessed for eligibility, and 105 were randomly allocated either in CBD (n=49) or in placebo (n=42) group. Ninety-one participants were included in the analysis of efficacy. There were no baseline between-group differences regarding disease severity (χ2=0.025, p=0.988) and median time to symptom resolution (12 days [95% confidence interval, CI, 6.5-17.5] in the CBD group, 9 days [95% CI, 4.8-13.2] in the placebo group [χ2=1.6, p=0.205 by log-rank test]). By day 28, 83.3% in the CBD group and 90.2% in the placebo group had resolved symptoms. There were no between-group differences on secondary measures. CBD was well tolerated, producing mostly mild and transient side effects (e.g., somnolence, fatigue, changes in appetite, lethargy, nausea, diarrhea, and fever), with no significant differences between CBD and placebo treatment groups. Conclusions and Relevance: Daily administration of 300 mg CBD for 14 days failed to alter the clinical evolution of COVID-19. Further trials should explore the therapeutic effect of CBD in patients with severe COVID-19, possibly trying higher doses than the used in our study. Trial Registration: ClinicalTrials.gov identifier NCT04467918 (date of registration: July 13, 2020).

Prevalence of overweight and obesity in the adult indigenous population in Brazil: A systematic review with meta-analysis.

To carry out a systematic review to identify the prevalence of overweight and obesity in the adult indigenous population in Brazil. The databases used were PubMed, Scopus, Virtual Health Library (VHL), and Science Direct, with the following search strategy: "overweight" OR "obesity" AND "indigenous" OR "tribe" AND "Brazil". For the meta-analysis, RStudio® software was used. Were 22 articles included. The combined effect of the meta-analysis studies showed a global prevalence of overweight and obesity of 45%. Approximately half (45%) of indigenous Brazilian adults have excess weight. These findings highlight the need to implement public policies for the prevention and treatment of these morbidities.

A aplicação de um guia de medidas preventivas por médicos de família em um centro de saúde de Ribeirão Preto, São Paulo, Brasil / The application of a guide for disease prevention by family physicians in a health centre of Ribeirão Preto, São Paulo, Brazil / La aplicación de un guía de medidas preventivas por los médicos de familia en un centro de salud de Ribeirão Preto, São Paulo, Brasil

Neste estudo, foi adaptado um protocolo de prevenção, contendo medidas de prevenção primária e secundária, composto por rastreamento, aconselhamento, vacinação e quimioprofilaxia com níveis A e B de recomendação. O estudo foi desenvolvido em uma Unidade de Saúde da Família na qual atuam residentes de Medicina de Família e Comunidade. Os médicos foram treinados quanto à importância e utilização do material preventivo (tabela e encarte-lembrete) e sua adesão foi avaliada por meio do preenchimento do encarte-lembrete. No ano estudado, realizaram-se 3.995 consultas a 1.596 usuários e, em apenas 397 prontuários, encontrou-se o encarte-lembrete com registro de uma medida preventiva, o que representou 25% da população atendida. As medidas encontradas seguiram esta ordem: rastreamento (99%); aconselhamento (90%); quimioprofilaxia (55%); e vacinação (45%). Este protocolo de prevenção norteia o profissional quanto às medidas a serem oferecidas, entretanto faz-se necessário implementar outras ações para que as medidas preventivas possam ser oferecidas de maneira mais efetiva.

In this study, we adapted a protocol for preventive measures containing primary and secondary prevention, comprising screening, counseling, vaccination and chemoprophylaxis with levels A and B of recommendation. This study was conducted in a Family Healthcare Unit where Family and Community Medicine residents are trained. Medical resident students were trained on the importance and use of prevention material (protocol and reminders) and their adherence was assessed by the completion of booklet reminders. During the one-year study period, 3995 consultations were held with 1596 patients. However, the record of at least one preventive measure was found in only 397 booklet reminders, which represents 25% of the population seen. The preventive measures found were screening (99%), counseling (90%), chemoprophylaxis (55%), and vaccination (45%). This protocol provides professionals with a set of preventive measures to be offered; however, other actions are needed so that preventive measures can be provided more effectively.

En este estudio, fué adaptado un un protocolo de medidas de prevención primarias y secundarias, compuesto por selección, consejo, vacunación y quimioprofilaxis con los niveles A y B de recomendación. El estudio se realizó en una Unidad de Salud Familiar, donde trabajan residentes de Medicina Familiar y Comunitaria. Se capacitó a los médicos sobre la importancia y el uso del material de prevención (tabla y folleto recordatorio) y se evaluó su adhesión mediante las respuestas al cuestionario localizado en el folleto recordatorio. En el año de estudio, los médicos realizaron 3995 consultas a 1596 pacientes y en sólo 397 historias clínicas se encontró el folleto recordatorio con registro de una medida preventiva, lo que representa el 25% de la población atendida. Las medidas encontradas siguieron este orden: selección (99%), consejo (90%), quimioprofilaxis (55%) y vacunación (45%). Este protocolo de prevención guía a los profesionales sobre las medidas que se deben ofrecer, sin embargo, es necesario implementar otras acciones para proporcionar las medidas preventivas con mayor efectividad.

Cardiovascular risk in Japanese-Brazilian subjects / Risco cardiovascular em nipobrasileiros

OBJECTIVE: To evaluate the prevalence of risk factors for cardiovascular disease in Japanese-Brazilian subjects. SUBJECTS AND METHODS: One hundred thirty-one residents of the Mombuca community were studied. Statistical analysis was based on the X² test, Fisher's Exact test, Student's t test, and ANOVA, at a 5% significance level. RESULTS: The average age was 56.7 years-old; 76.3% had dyslipidemia, 24.4% pre-diabetes (PDM), 10.7% type 2 diabetes mellitus (T2DM), 46.6% hypertension, 52.7% abdominal obesity, and 35.8% metabolic syndrome (MS). There were significant correlations between HOMA-IR and MS diagnosis and obesity, while HOMA-β levels were decreased in T2DM and PDM. The ankle-brachial index was positive for peripheral artery disease in 22.3% of the individuals. Electrocardiograms did not show increased evidence of myocardial ischemia. CONCLUSION: Subjects of this community are exposed to major cardiovascular risk factors, namely high prevalence of MS diagnoses and increased HOMA-IR. Arq Bras Endocrinol Metab. 2012;56(9):608-13.

OBJETIVO: Avaliar a presença de fatores de risco para doença cardiovascular em nipo-brasileiros. SUJEITOS E MÉTODOS: Foram estudados 131 moradores de Mombuca. Utilizaram-se os testes do Qui-quadrado, Exato de Fisher, t de Student e ANOVA, com significância de 5%. RESULTADOS: A média de idade foi de 56,7 anos; 76,3% tinham dislipidemia, 24,4% pré-diabetes (PDM), 10,7% diabetes melito tipo 2 (DM2), 46,6% hipertensão, 52,7% obesidade abdominal e 35,8% síndrome metabólica (SM). Houve correlação significativa do HOMA-IR com SM e obesidade, enquanto HOMA-β esteve reduzido na presença de DM2 e PDM. O índice tornozelo-braquial foi positivo para doença arterial periférica em 22,3% dos indivíduos. O eletrocardiograma não mostrou aumento de isquemia miocárdica. CONCLUSÃO: A comunidade está exposta aos fatores de risco maiores para doença cardiovascular, o que pode ser resumido pela alta prevalência de diagnóstico de SM e valores elevados de HOMA-IR. Arq Bras Endocrinol Metab. 2012;56(9):608-13.

Cardiovascular risk in Japanese-Brazilian subjects.

OBJECTIVE: To evaluate the prevalence of risk factors for cardiovascular disease in Japanese-Brazilian subjects. SUBJECTS AND METHODS: One hundred thirty-one residents of the Mombuca community were studied. Statistical analysis was based on the X² test, Fisher's Exact test, Student's t test, and ANOVA, at a 5% significance level. RESULTS: The average age was 56.7 years-old; 76.3% had dyslipidemia, 24.4% pre-diabetes (PDM), 10.7% type 2 diabetes mellitus (T2DM), 46.6% hypertension, 52.7% abdominal obesity, and 35.8% metabolic syndrome (MS). There were significant correlations between HOMA-IR and MS diagnosis and obesity, while HOMA-ß levels were decreased in T2DM and PDM. The ankle-brachial index was positive for peripheral artery disease in 22.3% of the individuals. Electrocardiograms did not show increased evidence of myocardial ischemia. CONCLUSION: Subjects of this community are exposed to major cardiovascular risk factors, namely high prevalence of MS diagnoses and increased HOMA-IR.

[Teenage pregnancy rates and socioeconomic characteristics of municipalities in São Paulo State, Southeast Brazil: a spatial analysis]. / Gravidez na adolescência e características socioeconômicas dos municípios do Estado de São Paulo, Brasil: análise espacial.

Teenage pregnancy is a common public health problem worldwide. The objective of this ecological study was to investigate the spatial association between teenage pregnancy rates and socioeconomic characteristics of municipalities in São Paulo State, Southeast Brazil. We used a Bayesian model with a spatial distribution following a conditional autoregressive (CAR) form based on Markov Chain Monte Carlo algorithm. We used data from the Live Birth Information System (SINASC) and the Brazilian Institute of Geography and Statistics (IBGE). Early pregnancy was more frequent in municipalities with lower per capital gross domestic product (GDP), higher poverty rate, smaller population, lower human development index (HDI), and a higher percentage of individuals with State social vulnerability index of 5 or 6 (more vulnerable). The study demonstrates a significant association between teenage pregnancy and socioeconomic indicators.

Prevalence of diabetes mellitus in the Japanese-Brazilian community of Mombuca, Guatapará, SP.

OBJECTIVE: To estimate the prevalence of type 2 diabetes mellitus (DM2) and impaired glucose tolerance (IGT) in the Japanese-Brazilian community of Mombuca in relation to risk factors (FR) for diabetes and cardiovascular disease. SUBJECTS AND METHODS: Cross-sectional study with 131 individuals of Japanese ancestry (69% first generation), aged 20 years or more, submitted to socio-cultural, anthropometric, and biochemistry evaluation. RESULTS: Of the individuals studied (n = 131, age = 55.1 ± 15.9 years), 58.8% were women. The prevalence of DM2 and IGT were 13.7% and 14.5%, respectively. Regarding RF, 76.3% presented dyslipidemia, 52.7% abdominal obesity, 48.1% arterial hypertension, and 42.3% whole body obesity. CONCLUSIONS: The prevalence of DM2, IGT, and RF in this Japanese-Brazilian community was higher than in the adult population of the city of Ribeirão Preto-SP, Brazil, suggesting an increase in risk conditions for these morbidities.

Gravidez na adolescência e características socioeconômicas dos municípios do Estado de São Paulo, Brasil: análise espacial / Teenage pregnancy rates and socioeconomic characteristics of municipalities in São Paulo State, Southeast Brazil: a spatial analysis

A gravidez na adolescência é um problema de saúde pública comum em todo o mundo. O objetivo deste estudo ecológico é estudar o padrão espacial da associação entre os percentuais de gravidez na adolescência e características socioeconômicas dos municípios do Estado de São Paulo, Brasil. Para isso, foi utilizado um modelo bayesiano com uma distribuição espacial que segue uma estrutura condicional autorregressiva (CAR), baseado em algoritmos Monte Carlo em cadeias de Markov (MCMC). Foram usados dados do Sistema de Informações sobre Nascidos Vivos (SINASC) e do Instituto Brasileiro de Geografia e Estatística (IBGE). Verificou-se que a ocorrência de gravidezes precoces apresentou-se maior nos municípios de menor produto interno bruto (PIB) per capita, com maior incidência de pobreza, de menor tamanho populacional, menor índice de desenvolvimento humano (IDH) e maior percentual de indivíduos com índice paulista de vulnerabilidade social (IPVS) igual a 5 ou 6, ou seja, mais vulneráveis. O estudo demonstra uma estreita associação entre gravidez na adolescência e indicadores econômicos e sociais.

Teenage pregnancy is a common public health problem worldwide. The objective of this ecological study was to investigate the spatial association between teenage pregnancy rates and socioeconomic characteristics of municipalities in São Paulo State, Southeast Brazil. We used a Bayesian model with a spatial distribution following a conditional autoregressive (CAR) form based on Markov Chain Monte Carlo algorithm. We used data from the Live Birth Information System (SINASC) and the Brazilian Institute of Geography and Statistics (IBGE). Early pregnancy was more frequent in municipalities with lower per capital gross domestic product (GDP), higher poverty rate, smaller population, lower human development index (HDI), and a higher percentage of individuals with State social vulnerability index of 5 or 6 (more vulnerable). The study demonstrates a significant association between teenage pregnancy and socioeconomic indicators.

Prevalence of diabetes mellitus in the Japanese-Brazilian community of Mombuca, Guatapará, SP / Prevalência do diabetes melito na comunidade nipo-brasileira de Mombuca, Guatapará, SP

OBJECTIVE: To estimate the prevalence of type 2 diabetes mellitus (DM2) and impaired glucose tolerance (IGT) in the Japanese-Brazilian community of Mombuca in relation to risk factors (FR) for diabetes and cardiovascular disease. SUBJECTS AND METHODS: Cross-sectional study with 131 individuals of Japanese ancestry (69 percent first generation), aged 20 years or more, submitted to socio-cultural, anthropometric, and biochemistry evaluation. RESULTS: Of the individuals studied (n = 131, age = 55.1 ± 15.9 years), 58.8 percent were women. The prevalence of DM2 and IGT were 13.7 percent and 14.5 percent, respectively. Regarding RF, 76.3 percent presented dyslipidemia, 52.7 percent abdominal obesity, 48.1 percent arterial hypertension, and 42.3 percent whole body obesity. CONCLUSIONS: The prevalence of DM2, IGT, and RF in this Japanese-Brazilian community was higher than in the adult population of the city of Ribeirão Preto-SP, Brazil, suggesting an increase in risk conditions for these morbidities.

OBJETIVO: Estimar prevalências de diabetes melito tipo 2 (DM2) e tolerância à glicose diminuída (TGD) na comunidade de Mombuca, Guatapará, SP, relacionando-as com fatores de risco (FR) para diabetes e doenças cardiovasculares. SUJEITOS E MÉTODOS: Estudo transversal com 131 nipo-brasileiros (69 por cento de 1ª geração), idade > 20 anos, ambos os sexos, com avaliação sociocultural, antropométrica e bioquímica. RESULTADOS: Dos 131 participantes (idade média = 55,1 ± 15,9 anos), a maioria (58,8 por cento) era do sexo feminino. As prevalências de DM2 e TGD foram 13,7 por cento e 14,5 por cento, respectivamente. Em relação aos FR, 76,3 por cento apresentaram dislipidemia, 52,7 por cento, obesidade abdominal (OA), 48,1 por cento, hipertensão arterial (HA) e 42,3 por cento, obesidade geral. CONCLUSÕES: As prevalências de DM2, TGD e FR observadas nos nipo-brasileiros foram superiores aos valores da população adulta de Ribeirão Preto, SP, sugerindo acentuação de situações predisponentes dessas morbidades.

Symptoms of temporomandibular disorders in the population: an epidemiological study.

AIMS: To estimate the prevalence of symptoms of temporomandibular disorders (TMD) as a function of age and gender, in a representative urban sample from the Brazilian population. METHODS: A total of 1,230 inhabitants (51.5% women) aged 15 to 65 years were interviewed by a validated phone survey. Sample size had been previously calculated. TMD symptoms were assessed through five questions, as recommended by the American Academy of Orofacial Pain, in an attempt to identify possible TMD. Data were derived by age and gender. Prevalence of each TMD symptom, and of combination of symptoms, was calculated. RESULTS: At least one TMD symptom was reported by 39.2% of the individuals. Pain related to TMD was noted by 25.6% of the population. Temporomandibular joint (TMJ) sound was the most common symptom of TMD, followed by TMJ pain and masticatory muscle pain. All symptoms were more prevalent in women than in men. With men used as the reference, a relative risk (RR) of at least one TMD symptom in women was 1.31 (95% confidence interval [CI] = 1.14 to 1.52). When at least two symptoms were present, the RR was 1.93 (95% CI = 1.49 to 2.51). For three or more TMD symptoms, the RR was 2.49 (95% CI = 1.67 to 3.71). Women were also more likely than men to have TMD pain (RR = 1.78; 9% CI = 1.45 to 2.18). CONCLUSION: Individual symptoms, as well as a combination of TMD symptoms, are prevalent in the Brazilian urban population and are more frequent in women than in men. Additional studies should focus on risk factors for and relevance of TMD for the sufferers.

Obesidade e sua relação com fatores de risco para doenças cardiovasculares em uma população nipo-brasileira / Obesity and its relationship with cardiovascular risk factors in a Japanese-Brazilian population

OBJETIVO: Descrever associações entre excesso de peso e obesidade abdominal com fatores de risco cardiovascular na população nipo-brasileira de Mombuca, Guatapará, SP. MÉTODOS: Participaram do estudo 131 indivíduos com descendência japonesa (69,2 por cento da primeira e 30,8 por cento da segunda geração), com idade > 20 anos, correspondendo a 66,8 por cento da população residente dessa faixa etária. Os dados foram coletados por meio de questionários padronizados e foram realizados exames clínicos e laboratoriais. RESULTADOS: A prevalência de sobrepeso foi de 29,6 por cento entre os homens e de 25,6 por cento entre as mulheres e a de obesidade foi de 46,3 por cento entre os homens e de 39,0 por cento entre as mulheres. Entre os homens a prevalência de obesidade abdominal foi de 55,6 por cento e entre as mulheres de 20,8 por cento. O índice de massa corpórea foi associado independentemente com triglicérides, circunferência abdominal e idade; a pressão arterial sistólica com a circunferência abdominal. CONCLUSÃO: O presente estudo enfatiza a necessidade de medidas de intervenção para a prevenção da obesidade na população nipo-brasileira de Mombuca.

OBJECTIVE: To describe associations of weight excess and abdominal obesity with cardiovascular risk factors in a Japanese-Brazilian population from Mombuca, Guatapará, SP. METHODS: Cross-sectional study with 131 individuals of Japanese ancestry (69.2 percent first and 30.8 percent second generation), aged 20 years or more, corresponding to 66.8 percent of the resident population from this age group. Data were collected through standardized questionnaires and laboratory and physical examinations were performed. RESULTS: Prevalence of overweight and obesity was 29.6 percent and 46.3 percent in men and 25.6 percent and 39.0 percent in women, respectively. The prevalence of abdominal obesity was 55.6 percent in men and 20.8 percent in women. Body mass index was independently associated with triglycerides, waist circumference and age; systolic blood pressure with waist circumference. CONCLUSIONS: Data from the present survey highlight the necessity of interventions to prevent obesity in the Japanese-Brazilian population from Mombuca.

[Obesity and its relationship with cardiovascular risk factors in a Japanese-Brazilian population]. / Obesidade e sua relação com fatores de risco para doenças cardiovasculares em uma população nipo-brasileira.

OBJECTIVE: To describe associations of weight excess and abdominal obesity with cardiovascular risk factors in a Japanese-Brazilian population from Mombuca, Guatapará, SP. METHODS: Cross-sectional study with 131 individuals of Japanese ancestry (69.2% first and 30.8% second generation), aged 20 years or more, corresponding to 66.8% of the resident population from this age group. Data were collected through standardized questionnaires and laboratory and physical examinations were performed. RESULTS: Prevalence of overweight and obesity was 29.6% and 46.3% in men and 25.6% and 39.0% in women, respectively. The prevalence of abdominal obesity was 55.6% in men and 20.8% in women. Body mass index was independently associated with triglycerides, waist circumference and age; systolic blood pressure with waist circumference. CONCLUSIONS: Data from the present survey highlight the necessity of interventions to prevent obesity in the Japanese-Brazilian population from Mombuca.

Prevalência da infecção por HIV em parturientes de maternidades vinculadas ao SUS / Prevalence of infection with in unified health care system maternities

OBJETIVO: avaliar a prevalência do HIV nas parturientes de maternidades vinculadas ao SUS, pela utilização do teste rápido. MÉTODOS: estudo transversal realizado em maternidades conveniadas ao SUS no Estado de Sergipe, após treinamento realizado com os profissionais de saúde dessas maternidades. As parturientes foram submetidas ao teste rápido imunocromatográfico para HIV, independente de já o terem realizado no pré-natal, após aconselhamento e assinatura do termo de consentimento livre e esclarecido. O teste utilizado foi DetermineTM - Abbott Laboratórios do Brasil. Utilizou-se o esquema de profilaxia da transmissão vertical para todos os casos, segundo o protocolo recomendado pelo Ministério da Saúde. Foi criado banco de dados no Epi-Info 2002 e calculada a prevalência em relação a todos os testes realizados no período de janeiro de 2003 a março de 2004, por meio de análise estatística descritiva. RESULTADO: após realização de 9.215 testes rápidos, foram detectadas 39 (0,42 por cento) soropositivas para HIV, das quais 23 (59 por cento) não conheciam a sua soropositividade. Duas gestantes que já eram sabidamente HIV positivas não relataram aos profissionais sua condição no momento da admissão. O número de parturientes que referiram ter freqüentado o serviço de pré-natal foi alto (89 por cento), mas somente 32,5 por cento destas foram submetidas ao teste para HIV na gestação. CONCLUSAO: a prevalência detectada (0,42 por cento) neste estudo é semelhante à nacional. É alta a prevalência de parturientes que desconhecem sua soropositividade para HIV, o que indica inadequado funcionamento de cuidados pré-natais dispensados. Na situação atual é necessária a triagem no momento do parto, para garantia de intervenções adequadas neste momento crucial da transmissão do HIV

[Characteristics of anticontraception methods used in São Paulo State, Brazil (correction)]. / Características do uso de métodos anticoncepcionais no Estado de São Paulo.

OBJECTIVE: To analyze data on contraceptive use in the State of São Paulo, Brazil, collected by the Demographic and Health Survey (DHS) conducted in 1996. METHODS: The study data were compared to 1986 DHS and 1996 data on the Brazilian population. Contraceptive use among married or cohabiting women was evaluated focusing on age, number of children, schooling, and age and timing of female sterilization. Statistical analysis was performed using Student t-test and Kendall's non-parametric test. RESULTS: Unlike data on the Brazilian population, female sterilization rates were steady in the State of São Paulo during the studied period. The same contraceptive pattern is seen in both Brazil and São Paulo: women aged up to 30 years use largely pills; female sterilization predominates in women over 30, increasing with the number of children and decreasing with years of schooling. Male methods have also increased in recent years, being greater in São Paulo than in Brazil. São Paulo also shows a greater variety of reversible contraceptive methods. CONCLUSIONS: Although there were some differences, the prevalence of only two contraceptive methods in both Brazil and São Paulo suggests a tendency regarding the contraceptive methods offered and in reproductive health in the view of new regulations on family planning.

[Epidemiology of dengue infection in Ribeirão Preto, SP, Brazil]. / Epidemiologia da infecção pela dengue em Ribeirão Preto, SP, Brasil.

OBJECTIVE: To assess dengue transmission in a correctional facility for juvenile delinquents in Ribeirão Preto, state of São Paulo, Brazil. METHODS: A serological and virology investigation was carried out among inmates and employees of a correctional facility for juvenile delinquents in Ribeirão Preto, Brazil. The study population consisted of 105 inmates and 91 employees representing 89% of the exposed. The collected blood was stored and processed using MAC-ELISA and virus isolation. A questionnaire was applied to each subject at the time of blood collection. RESULTS: Of the total of blood samples collected (n=196), 42 (21.4%) were positive for IgM antibodies and 43 (21.9%) for IgG antibodies; of which, 15 were both IgM and IgG positive and 28 (14.3%) were IgG positive only. Serotype 1 dengue virus was isolated in 5 samples. Out of 42 IgM positive samples, 14 (33.0%) subjects did not have any physical complaints. The incidence rate was 23.8% and 18.6% among inmates and employees, respectively. The first cases in the facility were reported in 1997 and the last ones in March 1997 though results are suggestive of an earlier onset of transmission. CONCLUSIONS: The high incidence rate of dengue infection can be explained by the high population density of the facility, high Aedes aegypti infestation, high numbers of asymptomatic subjects, and a higher transmission of disease in a closed setting.

Epidemiologia da infecçäo pela dengue em Ribeiräo Preto, SP, Brasil / Epidemiology of dengue infection in Ribeiräo Preto, SP, Brazil

OBJETIVO: Avaliar a transmissäo de dengue em uma instituiçäo correcional de adolescentes localizada em Ribeiräo Preto, SP, Brasil. MÉTODOS: Foi realizado um inquérito sorológico e virológico da populaçäo de internos e funcionários de uma instituiçäo correcional de adolescentes infratores localizada em Ribeiräo Preto, SP, Brasil. A populaçäo de estudo consistiu em 105 menores e 91 funcionários que representavam 89por cento do total de pessoas expostas. O sangue coletado da populaçäo estudada foi armazenado e processado para avaliaçäo pelas técnicas de MAC-Elisa e de isolamento viral. Cada participante respondeu a um questionário aplicado na ocasiäo da coleta de sangue. RESULTADOS: Do total de amostras de sangue coletadas (n=196), 42 (21,4por cento) foram positivas para anticorpos da classe IgM, e 43 (21,9por cento), para anticorpo IgG; destes, 15 com IgM e IgG positivas e 28 (14,3por cento) com apenas IgG positiva. Em cinco amostras, foram isolados vírus da dengue, sorotipo 1. Dos 42 casos com IgM positiva, 14 (33,4por cento) näo relataram sintomas característico de dengue. A incidência entre os internos foi de 23,8por cento e, entre funcionários, de 18,6por cento. Os primeiros casos foram notificados em fevereiro de 1997, e os últimos, em março do mesmo ano, embora os resultados mostrem a possibilidade de a transmissäo ter se iniciado bem antes de ser detectada. CONCLUSOES: A alta incidência observada pode ser explicada pela grande densidade populacional na instituiçäo, alta infestaçäo do vetor Aedes aegypti, alta taxa de assintomáticos e transmissäo favorecida pelo fato de a comunidade ser fechada

Sobrevivencia de pacientes com aids em uma cidade do sudeste brasileiro / Survival of AIDS patients in a city southeastern Brazil

Objetivo. Avaliar a sobrevida dos pacientes com diagnóstico de aids em Ribeirão Preto, Brasil, de 1986 a 1997. Métodos. Foram revisadas retrospectivamente as fichas epidemiológicas de 2 214 pacientes diagnosticados no período do estudo. Foram incluídos 1 231 participantes com acompanhamento de no mínimo 30 dias após a data do diagnóstico. Informações sobre óbitos foram obtidas junto a hospitais e cartórios de registro civil de Ribeirão Preto. Resultados. A sobrevida para o grupo foi de 310 dias (10,3 meses). De 1986 até 1997, a mediana de sobrevivência passou de 362 dias (1986 a 1990) para 260 dias (1991 a 1995) e 864 dias (1996 e 1997). As curvas de Kaplan-Meier e o teste log rank evidenciaram diferenças significativas para as variáveis sexo, idade, época do diagnóstico, presença de candidíase e de neurotoxoplasmose. A regressão de Cox revelou associação entre redução da sobrevivência e as seguintes variáveis: idade (razão de risco = 1,435 para idade entre 15 e 34 anos e 1,681 para idade acima de 35 anos em relação a indivíduos abaixo de 15 anos); época do diagnóstico (razão de risco = 1,682 para o período de 1986 a 1990 e 2,324 para o período de 1991 a 1995 em relação ao período de 1996 a 1997); presença de candidíase (razão de risco = 1,391). A razão de risco para presença de neurotoxoplasmose foi 1,063, com valor de probabilidade próximo do limite de significância. Conclusões. Foi marcante o aumento na sobrevida verificado em 1996 e 1997, coincidindo com a disponibilização e utilização em larga escala das drogas anti-retrovirais.

Objective. To assess survival in patients diagnosed with AIDS in the city of Ribeirão Preto, Brazil, between 1986 and 1997. Methods. The epidemiological records of 2 214 patients diagnosed during the study period were retrospectively reviewed. From those, 1 231 patients with at least 30 days of follow-up after the date of diagnosis were included in the study. Information concerning deaths was obtained from hospitals and vital-records offices. Results. Survival for the group as a whole was 310 days (10.3 months) over the period of 1986 through 1997. Median survival was 362 days for 1986 to 1990, 260 days for 1991 to 1995, and 864 days for 1996 and 1997. The Kaplan-Meier survival curves and the log-rank test showed significant differences for the following variables: sex, age, period when diagnosis was made, and presence of candidiasis and of cerebral toxoplasmosis. Cox's regression showed an association between reduction of survival and the following variables: age (in comparison to individuals younger than 15 years, hazard ratio = 1.435 for age between 15 and 34 years, and 1.681 for age above 35 years); period of diagnosis (in comparison to the period of 1996 and 1997, hazard ratio = 1.682 for the period from 1986 to 1990, and 2.324 for the period from 1991 to 1995); and presence of candidiasis (hazard ratio = 1.391). The hazard ratio for the presence of cerebral toxoplasmosis was 1.063, with a probability value close to the limit of significance. Conclusions. Our results show a striking increase in survival in 1996 and 1997, coinciding with the availability and utilization of highly active antiretroviral drugs.