Follow-up of patients diagnosed with and treated for tuberculosis in Brazil: financial burden on the household.

OBJECTIVE: To evaluate the implications of the proportion of annual family income spent in the pre- and post-diagnosis periods in tuberculosis patients followed for after at least one year after completing tuberculosis treatment in Brazil. METHODS: This was a cross-sectional study of tuberculosis patients followed for at least one year after completing tuberculosis treatment in five Brazilian capitals (one in each region of the country). RESULTS: A total of 62 patients were included in the analysis. The overall average cost of tuberculosis was 283.84 Brazilian reals (R$) in the pre-diagnosis period and R$4,161.86 in the post-diagnosis period. After the costs of tuberculosis disease, 71% of the patients became unemployed, with an overall increase in unemployment; in addition, the number of patients living in nonpoverty decreased by 5%, the number of patients living in poverty increased by 6%, and the number of patients living in extreme poverty increased by 5%. The largest proportion of annual household income to cover the total costs of tuberculosis was for the extremely poor (i.e., 40.37% vs. 11.43% for the less poor). CONCLUSIONS: Policies to mitigate catastrophic costs should include interventions planned by the health care system and social protection measures for tuberculosis patients with lower incomes in order to eliminate the global tuberculosis epidemic by 2035-a WHO goal in line with the United Nations Sustainable Development Goals.

Follow-up of patients diagnosed with and treated for tuberculosis in Brazil: financial burden on the household / Acompanhamento de pacientes com diagnóstico e tratamento de tuberculose no Brasil: ônus financeiro para a família

ABSTRACT Objective: To evaluate the implications of the proportion of annual family income spent in the pre- and post-diagnosis periods in tuberculosis patients followed for after at least one year after completing tuberculosis treatment in Brazil. Methods: This was a cross-sectional study of tuberculosis patients followed for at least one year after completing tuberculosis treatment in five Brazilian capitals (one in each region of the country). Results: A total of 62 patients were included in the analysis. The overall average cost of tuberculosis was 283.84 Brazilian reals (R$) in the pre-diagnosis period and R$4,161.86 in the post-diagnosis period. After the costs of tuberculosis disease, 71% of the patients became unemployed, with an overall increase in unemployment; in addition, the number of patients living in nonpoverty decreased by 5%, the number of patients living in poverty increased by 6%, and the number of patients living in extreme poverty increased by 5%. The largest proportion of annual household income to cover the total costs of tuberculosis was for the extremely poor (i.e., 40.37% vs. 11.43% for the less poor). Conclusions: Policies to mitigate catastrophic costs should include interventions planned by the health care system and social protection measures for tuberculosis patients with lower incomes in order to eliminate the global tuberculosis epidemic by 2035-a WHO goal in line with the United Nations Sustainable Development Goals.

RESUMO Objetivo: Avaliar as implicações da proporção da renda familiar anual gasta nos períodos pré e pós-diagnóstico em pacientes com tuberculose acompanhados durante pelo menos um ano após o término do tratamento da tuberculose no Brasil. Métodos: Estudo transversal com pacientes com tuberculose acompanhados durante pelo menos um ano após o término do tratamento da tuberculose em cinco capitais brasileiras (uma em cada região do país). Resultados: Foram incluídos na análise 62 pacientes. O custo médio global da tuberculose foi de R$ 283,84 no período pré-diagnóstico e de R$ 4.161,86 no período pós-diagnóstico. Após os custos da doença tuberculosa, 71% dos pacientes ficaram desempregados, com um aumento global do desemprego; além disso, o número de pacientes não pobres diminuiu 5%, o número de pacientes pobres aumentou 6% e o número de pacientes extremamente pobres aumentou 5%. A maior proporção de renda familiar anual para cobrir os custos totais da tuberculose foi observada nos pacientes extremamente pobres (40,37% vs. 11,43% nos menos pobres). Conclusões: As políticas para mitigar os custos catastróficos devem incluir intervenções planejadas pelo sistema de saúde e medidas de proteção social para pacientes de baixa renda com tuberculose, a fim de eliminar a epidemia global de tuberculose até 2035, uma meta da OMS alinhada com os Objetivos de Desenvolvimento Sustentável propostos pela Organização das Nações Unidas.

Local action plan to promote access to the health system by indigenous Venezuelans from the Warao ethnic group in Manaus, Brazil: Analysis of the plan´s development, experiences, and impact through a mixed-methods study (2020).

BACKGROUND: The provision of care and monitoring of health are essential for indigenous Venezuelans from the Warao ethnic group, who are at risk of decimation. OBJECTIVE: Analyze a Local Action Plan (LAP) to promote access to the health system of indigenous Venezuelans from the Warao ethnic group (IVWEG) in Manaus, Brazil. METHOD: A mixed-methods study was performed. Quantitative data were collected to assess the provision of care and monitoring of health conditions in IVWEG through a survey that was self-completed by healthcare providers. Qualitative narrative data were collected to gain insight into IVWEG that seek care. We applied descriptive statistics, grouping analysis (GA) by hierarchical levels, and multiple correspondence analysis (MCA). Content analysis was applied to qualitative data. RESULTS: 106 healthcare providers participated in the study, with the following characteristics: 94 (88.7%) females, 67 (63.2%) pardo race/color, 40 (37.7%) working in primary healthcare, and 49 (46.2%) nurses. In addition, 43 (40.6%) of the healthcare providers reported providing care to IVWEG. Among the providers, 89 (84%) had received training for assisting IVWEG. Additionally, 30 IVWEG were enrolled for interviews in the qualitative phase. The barriers to seeking care were language, distance to health units, and lack of money for transportation. The LAP proved to facilitate access to the health system by indigenous Venezuelans from the Warao ethnic group in Manaus. The study contributed to knowledge on a LAP addressed to IVWEG and helped improved their access to the health system, providing appropriate training for healthcare providers and other relevant actors by implementing a coherent and consistent public health policy at the local level.

Feasibility of GeneXpert® Edge for Tuberculosis Diagnosis in Difficult-to-Reach Populations: Preliminary Results of a Proof-of-Concept Study.

GeneXpert® Edge (GX-Edge) is a new point-of-care platform not yet tested in the field. In this proof-of-concept study conducted for the diagnosis of tuberculosis in communities living alongside two large rivers of the Brazilian Amazon, we demonstrate that GX-Edge implemented in boats to offer onsite testing is a feasible strategy to investigate potentially devastating diseases such as tuberculosis in difficult-to-reach populations, such as riverside communities.

Atmospheric Pollution and Hospitalization for Cardiovascular and Respiratory Diseases in the City of Manaus from 2008 to 2012.

OBJECTIVE: To relate the levels of air pollution and hospital admissions for cardiovascular and respiratory diseases in the city of Manaus in Brazil from 2008 to 2012. METHOD: This is an ecological time-series study among children (under 5 years of age) and elderly (above 60 years of age). Data on the daily number of hospitalizations for cardiovascular and respiratory diseases, pollutants (PM2.5), temperature, and humidity were used. Poisson generalized additive models were used to estimate the association between variables. Increases in hospitalizations for cardiovascular and respiratory diseases were estimated for the interquartile range (IQR) daily mean level of each variable studied, with a confidence interval of 95%. RESULTS: Respiratory diseases and children: -0.40% (95% CI: -1.11, 0.30), 0.59% (95% CI: -0.35, 1.52), and 0.47% (95% CI: -3.28, 4.21) for PM2.5, temperature, and humidity, respectively. Respiratory diseases and elderly: 0.19% (95% CI: -0.93, 1.31), -0.10% (95% CI: -1.85, 1.65), and -6.17% (95% CI: -13.08, 0.74) for PM2.5, temperature, and humidity, respectively. Cardiovascular diseases and elderly: -0.18% (95% CI: -0.86, 0.50), -0.04% (95% CI: -1.10, 1.03), and -3.37% (95% CI: -7.59, 0.85) for PM2.5, temperature, and humidity, respectively. CONCLUSIONS: The time-series study found no significant association between PM2.5, temperature, humidity, and hospitalization, unlike the evidences provided by the present academic literature. Since there is no air quality monitoring network in Manaus and the option available in the present study was to reproduce some information obtained from remote sensing, there is a need for implementation of ground monitoring stations for health and environmental studies in the region.

Intervenções de enfermagem para pacientes neurocríticos / Nursing interventions for neurocritical patients

Objetivo: identificar as intervenções de Enfermagem para pacientes neurocríticos em uma Unidade de Terapia Intensiva. Método: trata-se de um estudo quantitativo, descritivo, transversal, com 84 pacientes neurocríticos. Coletaram-se as intervenções de Enfermagem mediante os registros de Enfermagem no instrumento de Sistematização da Assistência de Enfermagem da unidade. Realizaram-se a análise estatística dos dados. Resultados: revela-se que as principais intervenções de Enfermagem identificadas foram a realização da Escala de Coma de Glasgow (87,8%), Escala de Agitação e Sedação Richmond (84,3%), avaliação das pupilas (79,7%), cabeceira elevada a 30° (100%), monitorização dos sinais vitais (46,4%) e avaliação da Escala de Braden (36,9%). Conclusão: relacionam-se as principais intervenções de Enfermagem realizadas ao posicionamento neurológico, monitorização neurológica, monitorização dos sinais vitais e à prevenção de lesão por pressão. Acredita-se que os resultados deste estudo trazem importantes contribuições para o planejamento da assistência ao paciente neurocrítico, contribuindo para a prática baseada em evidências científicas na Enfermagem.(AU)

Objective: to identify nursing interventions for neuro-critical patients in an Intensive Care Unit. Method: this is a quantitative, descriptive, cross-sectional study with 84 neuro-critical patients. Nursing interventions were collected through the Nursing records in the unit of Nursing Care Systematization of the unit. Statistical analysis of the data was performed. Results: it is revealed that the main nursing interventions identified were the Glasgow Coma Scale (87.8%), Richmond Agitation and Sedation Scale (84.3%), pupil evaluation (79.7%), headboard elevated to 30 ° (100%), monitoring of vital signs (46.4%) and evaluation of the Braden Scale (36.9%). Conclusion: the main nursing interventions performed are related to neurological positioning, neurological monitoring, monitoring of vital signs and the prevention of pressure injury. It is believed that the results of this study bring important contributions to the planning of care for neuro-critical patients, contributing to the practice based on scientific evidence in Nursing.(AU)

Objetivo: identificar intervenciones de Enfermería para pacientes neurocríticos en una Unidad de Cuidados Intensivos. Método: es un estudio cuantitativo, descriptivo, transversal con 84 pacientes neurocríticos. Las intervenciones de Enfermería se recogieron a través de los registros de Enfermería en la unidad de Sistematización de Cuidados de Enfermería de la unidad. Se realizó un análisis estadístico de los datos. Resultados: se revela que las principales intervenciones de Enfermería identificadas fueron la Escala de coma de Glasgow (87.8%), la Escala de Agitación y Sedación de Richmond (84.3%), la evaluación de los alumnos (79.7%), cabecero elevado a 30 ° (100%), monitoreo de signos vitales (46.4%) y evaluación de la Escala de Braden (36.9%). Conclusión: las principales intervenciones de Enfermería realizadas están relacionadas con el posicionamiento neurológico, el monitoreo neurológico, el monitoreo de los signos vitales y la prevención de lesiones por presión. Se cree que los resultados de este estudio hacen contribuciones importantes a la planificación de la atención de pacientes neurocríticos, contribuyendo a la práctica basada en evidencia científica en Enfermería.(AU)

Organization of health services for tuberculosis case diagnosis and treatment in Manaus, Amazonas, Brazil, 2014. / Organização dos serviços de saúde para o diagnóstico e tratamento dos casos de tuberculose em Manaus, Amazonas, 2014.

OBJECTIVE: to describe the organization of health services for tuberculosis case diagnosis and treatment in the city of Manaus, Amazonas, Brazil. METHODS: this was a descriptive study of 156 new tuberculosis cases diagnosed and residing in Manaus in 2014, characterized according to socioeconomic, demographic, health-disease process aspects, relationship with health services and treatment outcome, by administering individual questionnaires in the 1st and 6st months of treatment. RESULTS: some 70% of cases were diagnosed at the tuberculosis reference center; most of the cases were unaware that there was a community health agent in their neighborhood; regarding treatment follow-up, 55.3% had to join an appointment waiting list; only 67.3% of cases were monitored by the same professional throughout entire treatment. CONCLUSION: the findings indicate presence of barriers to case diagnosis and treatment, both in the referral center and also in primary healthcare units.

Home visits of the nurse and its relationship with hospitalization by diseases sensitive to primary health care / Visitas domiciliares del enfermero y su relación con las hospitalizaciones por enfermedades sensibles a la atención primária / Visitas domiciliares do enfermeiro e sua relação com as internações por doenças sensíveis à atenção básica

Abstract Objective: To identify if nurses' home visits recorded by the family health strategy are proportional to the registered population and the population covered by the family health team, and its relationship with the rate of hospitalization for conditions sensitive to primary health care. Method: Secondary data were gathered from the Information Systems of Primary Care and Hospitalization regarding potential population coverage, number of visits done, hospitalizations for diseases sensitive to primary health care. An exploratory analysis was performed with data grouping for triennium (2010-2012 and 2013-2015) and assignment of scores for each variable, creating the classification strata in: low, medium and high. Results: It was identified that the number of registered home visits does not meet the estimated population coverage as well as does not impact on the admissions sensitive to primary health care. Conclusion and implications for practice: Even with high coverage of the family health strategy, home visits are not the main focus of nurses yet. Home visits should be used as a tool for disease prevention and health promotion, which may explain the non-reduction of hospitalizations sensitive to primary health care.

Resumen Objetivo: Identificar si las visitas domiciliarias registradas en la Estrategia Salud de la Familia son proporcionales a la población registrada y la población cubierta por la estrategia, y su relación con la tasa de internación por condiciones sensibles a la atención básica. Método: Se recogieron datos secundarios del Sistema de Información de la Atención Básica y Sistemas de Información Hospitalaria con respecto a: cobertura poblacional potencial, número de visitas realizadas, internaciones por enfermedades sensibles a la atención básica. Se ha llevado a cabo un análisis exploratorio con agrupación de los datos por trienio (2010-12 y 2013-15) y asignación de escores para cada variable, permitiendo establecer la clasificación en baja, media y alta. Resultados: Se identificó que la cantidad de visitas domiciliarias registradas no atiende la cobertura poblacional estimada así como no impacta en las internaciones sensibles a la atención básica. Conclusión e implicaciones para la práctica: A pesar de la elevada cobertura de la estrategia salud de la familia, las visitas domiciliarias aún no son el principal foco de los enfermeros. Las visitas domiciliarias deberían ser utilizadas como herramienta de prevención de enfermedades y promoción de la salud, lo que quizá explique la no reducción de las internaciones sensibles a la atención básica.

Resumo Objetivo: Identificar se as visitas domiciliares registradas pela estratégia saúde da família são proporcionais à população registrada e à população coberta pela estratégia, e sua relação com a taxa de internação por condições sensíveis a atenção básica. Método: Foram coletados dados secundários do Sistema de Informação da Atenção Básica e Sistema de Informações Hospitalares referentes a: cobertura populacional potencial, número de visitas realizadas, internações por doenças sensíveis a atenção básica. Foi realizada análise exploratória com agrupamento dos dados por triênio (2010-2012 e 2013-2015) e atribuição de escores para cada variável, permitindo estabelecer a classificação a baixa, média e alta. Resultados: Identificou-se que a quantidade de visitas domiciliares registradas não atende a cobertura populacional estimada, assim como não impacta nas internações sensíveis à atenção básica. Conclusão e implicações para a prática: Mesmo com elevada cobertura da estratégia saúde da família, as visitas domiciliares ainda não são o principal foco dos enfermeiros. As visitas domiciliares deveriam ser utilizadas como ferramenta de prevenção de doenças e promoção da saúde, o que talvez explique a não redução das internações sensíveis à atenção básica.

Organização dos serviços de saúde para o diagnóstico e tratamento dos casos de tuberculose em Manaus, Amazonas, 2014 / Organización de los servicios de salud hacia el diagnóstico y tratamiento de los casos de tuberculosis en Manaus, Amazonas, Brasil, 2014 / Organization of health services for tuberculosis case diagnosis and treatment in Manaus, Amazonas, Brazil, 2014

Objetivo: descrever a organização dos serviços de saúde para diagnóstico e tratamento dos casos de tuberculose na cidade de Manaus, Amazonas, Brasil. Métodos: estudo descritivo de 156 casos novos de tuberculose diagnosticados e residentes em Manaus, em 2014, caracterizados quanto aos aspectos socioeconômicos, demográficos, processo saúde-doença, relação com os serviços de saúde e resultado do tratamento, mediante aplicação de questionários individuais no 1o e no 6o mês de tratamento. Resultados: cerca de 70% dos casos foram diagnosticados no centro de referência para tuberculose; a maioria deles desconhecia existir agente comunitário de saúde em seu bairro; quanto ao acompanhamento de tratamento, 55,3% necessitam ingressar em filas para marcação de consultas; somente 67,3% dos casos foram acompanhados pelo mesmo profissional durante todo o tratamento. Conclusão: os achados indicam presença de barreiras no diagnóstico e tratamento dos casos, tanto no centro de referência como nas unidades de atenção primária à saúde.

Objetivo: describir la organización de los servicios de salud para el diagnóstico y tratamiento de la tuberculosis en Manaus, Amazonas, Brasil. Métodos: estudio descriptivo de 156 casos nuevos de tuberculosis diagnosticados y residentes en Manaus en 2014, caracterizados cuanto a aspectos socioeconómicos, demográficos, proceso salud-enfermedad, relación con los servicios de salud y resultado del tratamiento, mediante la aplicación de cuestionarios individuales en el primero y el sexto mes de tratamiento. Resultados: aproximadamente 70% de los casos fueron diagnosticados en el centro de referencia para tuberculosis; la mayoría desconocía la existencia de un agente comunitario de salud del barrio; en cuanto al seguimiento de tratamiento, 55,3% necesitan obtener fichas para marcar las consultas; sólo un 67,3% de los casos fueron acompañados por el mismo profesional durante todo el tratamiento. Conclusión: los hallazgos indican la presencia de barreras para el diagnóstico y el tratamiento de casos, sea en el centro de referencia o en unidades de atención primaria de salud.

Objective: to describe the organization of health services for tuberculosis case diagnosis and treatment in the city of Manaus, Amazonas, Brazil. Methods: this was a descriptive study of 156 new tuberculosis cases diagnosed and residing in Manaus in 2014, characterized according to socioeconomic, demographic, health-disease process aspects, relationship with health services and treatment outcome, by administering individual questionnaires in the 1st and 6st months of treatment. Results: some 70% of cases were diagnosed at the tuberculosis reference center; most of the cases were unaware that there was a community health agent in their neighborhood; regarding treatment follow-up, 55.3% had to join an appointment waiting list; only 67.3% of cases were monitored by the same professional throughout entire treatment. Conclusion: the findings indicate presence of barriers to case diagnosis and treatment, both in the referral center and also in primary healthcare units.

A saúde no contexto de uma reserva de desenvolvimento sustentável: o caso de Mamirauá, na Amazônia Brasileira / Health in the context of a sustainable development reserve: the case of Mamirauá, in the Brazilian Amazon

Resumo O objetivo deste artigo é analisar as condições de vida e saúde de ribeirinhos de oito comunidades da Reserva Mamirauá, a partir da categoria de análise da Reprodução Social de Juan Samaja. Seu método é descritivo, e foram utilizados questionário estruturado, observação direta e análise documental. A pesquisa identificou baixo envolvimento dos ribeirinhos em relação ao controle social e ao apoio comunitário, o que indica problemas na interação biocomunal e política. O atendimento às demandas sociais está organizado de forma conflituosa, uma vez que várias instituições que atuam nesse território não se articulam. A interação da dimensão política com a tecnoeconômica apresentou Razão de Prevalência <1,0 nas comunidades em que o Instituto Mamirauá promoveu maior diversificação das atividades. Contudo, os rendimentos para subsistência sofrem forte variação e não alcançam a soma de 1 salário mínimo em 60,6% das famílias. Foram observadas elevadas frequências em queixas de saúde (78,8%) e acidentes de trabalho (70,9%) e, quanto à avaliação dos serviços, 54 % dos ribeirinhos deram nota inferior a 2 pontos. Concluímos que os processos sociais que determinam as situações de saúde dos ribeirinhos de Mamirauá são oriundos da estrutura de poder configurada pelas práticas territorializadas das políticas ambiental e indígena, e pelos programas de saúde pública, cuja sobreposição tem produzido interações conflituosas no que diz respeito às competências e responsabilidades com a atenção à saúde. O apoio à cogestão da Reserva foi pontual e, dessa forma, pouco alterou os resultados danosos dessa estrutura social sobre os grupos mais vulneráveis.

Abstract This article aims to analyze the living and health conditions of riverside inhabitants from eight communities within the Mamirauá Reserve, through the category of analysis of Social Reproduction by Juan Samaja. The chosen method was descriptive, and it was used a structured questionnaire, direct observation and documental analysis. The research has identified low involvement of the riverside inhabitants in social control and community support, which indicates issues regarding bio-communal and political interaction. The response to social demands is organized in a conflicting way, since various institutions that operate in this territory are not articulated. The interaction between political and techno-economic dimensions presented a Prevalence Ratio <1.0, especially in communities where the Mamirauá Institute promoted a greater diversification of its activities. However, the people's subsistence income suffers strong variations and does not reach the sum of one minimum wage in 60.6% of the families. We observed high frequencies in health complaints (78.8%) and occupational accidents (70.9%), and 54% of judged the provided health services with scores under 2. We concluded that the social processes that determine the health situation of the communities are due to the structure of power that is configured by territorial practices of environmental and indigenous policies, and by overlapped health public programs, that create conflicting situations concerning competences and responsibilities with health attention. The support to the co-management of the Reserve was punctual and, in this way, it barely affected the negative results of this social structure on the most vulnerable groups.

Situação da tuberculose em pessoas privadas de liberdade no período de 2007 a 2012 / Situation of tuberculosis in people deprived of freedom in the period 2007 to 2012

Objetivo: identificar a situação da tuberculose e sua variação temporal em pessoas privadas de liberdade noBrasil, no período de 2007 a 2012. Método: estudo descritivo, ecológico, dos casos de tuberculose notificadosnos estados brasileiros. Utilizou-se, como fonte de dados para a população geral, o Sistema de Informação deAgravos de Notificação; e das pessoas privadas de liberdade (PPL), o sistema integrado de informaçõespenitenciárias. Os dados foram agrupados nos triênios 2007-2009 e 2010-2012. Resultados: entre as PPL, ataxa de incidência foi 25 a 30 vezes maior que na população geral. As taxas de cura, abandono e mortalidadeentre as PPL, no período 2010-2012, foi 69,3%, 9,0% e 1,3%, com variação temporal de 4,1%, 15,9% 18,7%,respectivamente, comparados com o período de 2007-2009. Conclusão: os indicadores de tuberculoseanalisados são piores entre as PPL, no entanto, em ambas as populações, encontram-se distante da meta parao controle da doença.

[Cost of illness attributable to environmental factors in the city of Manaus, state of Amazonas, Brazil]. / Custo das doenças atribuíveis a fatores ambientais na cidade de Manaus, Amazonas, Brasil.

The study estimated the cost of illness attributable to environmental factors in the city of Manaus between the years 1998 to 2009. The causes of hospitalization were grouped based on studies of the Global Burden of Disease and Comparative Risk Assessment of the World Health Organization. The value was estimated by the sum of (i) hospital spending on treatment of diseases directly attributable to environmental factors, and (ii) the costs of lost workdays resulting from the stay in hospital estimated on the basis of the average earnings of Manaus workers. The data were further calibrated taking into account the coverage of the population with private health insurance. The cost of illness, considering the values corrected by the General Market Price Index for the year 2009 was estimated at R$ 286,852,666.97, of which cardiovascular disease, respiratory infections of the lower airways and diarrheal diseases are responsible for 78.6% of these values. Of the fractions attributable to environmental factors, cardiovascular diseases account for 16% (CI: 7-23%), respiratory infections and respiratory infections of the lower airways for 41% (CI: 32-47%), and diarrhea for 94% (CI: 84-98%) of the global burden of disease.

Custo das doencas atribuiveis a fatores ambientais na cidade de Manaus, Amazonas, Brasil / Cost of illness attributable to environmental factors in the city of Manaus, state of Amazonas, Brazil

O presente estudo estimou o custo das doenças atribuíveis a fatores ambientais na cidade de Manaus, entre os anos de 1998 a 2009. As causas de internação hospitalar foram agrupadas com base nos estudos de Carga Global de Doença e da Análise Comparativa de Risco da Organização Mundial da Saúde. O valor foi estimado por meio da soma dos (i) gastos hospitalares com tratamento das doenças atribuíveis a fatores ambientais com os (ii) valores dos dias de trabalho perdidos resultante da permanência em leito hospitalar, estimados a partir da remuneração média dos trabalhadores de Manaus. Os dados ainda foram calibrados levando-se em consideração a cobertura da população com plano de saúde privado. O custo das doenças, considerando os valores corrigidos pelo Índice Geral de Preços do Mercado para o ano de 2009, foi estimado em R$ 286.852.666,97, dos quais as doenças cardiovasculares, as infecções respiratórias das vias aéreas inferiores e as doenças diarreicas são responsáveis por 78,6%. Das frações atribuíveis a fatores ambientais, as doenças cardiovasculares respondem por 16% (IC: 7-23%), as infecções respiratórias das vias aéreas inferiores por 41% (IC: 32-47%), e as diarreias por 94% (IC: 84-98%) da carga global das doenças.

The study estimated the cost of illness attributable to environmental factors in the city of Manaus between the years 1998 to 2009. The causes of hospitalization were grouped based on studies of the Global Burden of Disease and Comparative Risk Assessment of the World Health Organization. The value was estimated by the sum of (i) hospital spending on treatment of diseases directly attributable to environmental factors, and (ii) the costs of lost workdays resulting from the stay in hospital estimated on the basis of the average earnings of Manaus workers. The data were further calibrated taking into account the coverage of the population with private health insurance. The cost of illness, considering the values corrected by the General Market Price Index for the year 2009 was estimated at R$ 286,852,666.97, of which cardiovascular disease, respiratory infections of the lower airways and diarrheal diseases are responsible for 78.6% of these values. Of the fractions attributable to environmental factors, cardiovascular diseases account for 16% (CI: 7-23%), respiratory infections and respiratory infections of the lower airways for 41% (CI: 32-47%), and diarrhea for 94% (CI: 84-98%) of the global burden of disease.

Validation of the Brazilian version of the Berg balance scale for patients with Parkinson's disease.

BACKGROUND: Changes in balance occur with the progression of Parkinson's disease (PD). OBJECTIVE: To validate the Brazilian version of the Berg Balance Scale (BBS) for PD patients, determining its reliability and internal consistency and correlating it with PD-specific instruments. METHOD: We evaluated 53 patients (M/F 37/16, mean age+/-SD, 62+/-7.9 years) with PD (mean+/-SD, 7.8+/-4.4 years). Unified Parkinson's Disease Rating Scale (UPDRS), Schwab and England Scale (SandE , Hoehn and Yahr Staging Scale (HY) and BBS were used to assess patients. Statistical analyses for inter-rater reliability, internal consistency and correlations among BBS, UPDRS, SandE and HY were performed. RESULTS: The mean scores+/-SD on UPDRS and BBS were, respectively, 41.6+/-17.8 and 47.2+/-8.2. The median on SandE and HY scales were 80% and 2.5, respectively. The BBS presented a high intra-class correlation coefficient (ICC=0.84) and internal consistency (Cronbrach's alpha=0.92). There was a statistically significant correlation between BBS and disease duration (r(s)= -0.520, p<0.001), UPDRS subscales II and III (r(s)= -0.467, p=0.011; r(s)= -0.374, p=0.046, respectively), stage of disease (HY; r(s)= -0.507, p<0.001) and the activities of daily living (SandE; r(s)=0.492, p<0.001). CONCLUSION: The BBS is a promising tool for the assessment of balance in PD, correlating with the stage of disease and the level of independence.

Validation of the brazilian version of the berg balance scale for patients with parkinson's disease / Validação da versão brasileira da Escala de Equilíbrio de Berg para pacientes com a doença de Parkinson

Background: Changes in balance occur with the progression of Parkinson's disease (PD). OBJECTIVE: To validate the Brazilian version of the Berg Balance Scale (BBS) for PD patients, determining its reliability and internal consistency and correlating it with PD-specific instruments. METHOD: We evaluated 53 patients (M/F 37/16, mean age±SD, 62±7.9 years) with PD (mean±SD, 7.8±4.4 years). Unified Parkinson's Disease Rating Scale (UPDRS), Schwab and England Scale (S&E), Hoehn and Yahr Staging Scale (HY) and BBS were used to assess patients. Statistical analyses for inter-rater reliability, internal consistency and correlations among BBS, UPDRS, S&E and HY were performed. RESULTS: The mean scores±SD on UPDRS and BBS were, respectively, 41.6±17.8 and 47.2±8.2. The median on S&E and HY scales were 80 percent and 2.5, respectively. The BBS presented a high intra-class correlation coefficient (ICC=0.84) and internal consistency (Cronbrach's α=0.92). There was a statistically significant correlation between BBS and disease duration (r s= -0.520, p<0.001), UPDRS subscales II and III (r s= -0.467, p=0.011; r s= -0.374, p=0.046, respectively), stage of disease (HY; r s= -0.507, p<0.001) and the activities of daily living (S&E; r s=0.492, p<0.001). CONCLUSION: The BBS is a promising tool for the assessment of balance in PD, correlating with the stage of disease and the level of independence.

Alterações de equilíbrio ocorrem com a progressão da doença de Parkinson (DP). Objetivo: Validar a versão brasileira da Escala de Equilíbrio de Berg (EEB) para pacientes com DP, determinando a confiabilidade, a consistência interna e correlacionando com instrumentos específicos da DP. MÉTODO: Foram avaliados 53 pacientes (H/M 37/16, idade média±DP, 62±7,9 anos) com DP (media±DP, 7,8±4,4 anos). Escala de Graduação Unificada da Doença de Parkinson (UPDRS), Escala de Schwab e England (S&E), Escala de Estágios de Hoehn e Yahr (HY) e EEB foram utilizadas. Análise estatística para confiabilidade entre examinadores, consistência interna e correlações entre EEB, UPDRS, S&E e HY foram realizadas. RESULTADOS: Os escores médios±DP nas escalas UPDRS e EEB foram, respectivamente, 41,6±17,8 e 47,2±8,2. A mediana nas escalas S&E e HY foram 80 por cento e 2,5. A EEB mostrou ter alto coeficiente de correlação intraclasse (ICC=0,84) e consistência interna (α de Cronbach=0,92). Houve correlação estatisticamente significativa entre EEB e a duração da doença (r s= -0,520, p<0,001), sub-escalas II e III do UPDRS (r s= -0,467, p=0,011; r s= -0,374, p=0,046, respectivamente), estágio da doença (HY; r s= -0,507, p<0,001), com as atividades da vida diária (S&E; r s= 0,492; p<0,001). CONCLUSÃO: A EEB é um instrumento promissor para avaliar o equilíbrio na DP, correlacionando-se com o estágio da doença e o nível de independência.

Frequency and significance of vocalizations in Sydenham's chorea.

Sydenham's chorea (SC) is a complication of Streptococcus infection characterized by a combination of motor and non-motor features. We have investigated the presence of vocalizations in 89 consecutive patients with SC evaluated during a one-year period in the UFMG Movement Disorders Clinic. Seven (4/3 M/F) of the 89 patients (29/60 M/F) presented with simple vocalizations not preceded by premonitory sensations but in association with facial chorea in five patients. These findings suggest that vocalizations are not a common feature in SC and their phenomenology is quite distinct from the characteristics of vocal tics in tic disorders.

Coréia de Syndenham: uma dança entre o Streptococcus, o sistema imune e os núcleos da base / Syndenham's chorea: a dance involving the Streptococcus the immune system and the basal ganglia

A coréia de Syndenham (CS) é a manifestação da febre reumática e consiste em movimentos involuntários anormais que se assemelham a uma "dança". Em sua etiopatogênese, várias evidências apontam para mecanismos auto-imunes desencadeados por uma infecção na orofaringe pelo Streptococcus ß-hemolítico do grupo A. Esses processos imunes interferem no funcionamento dos núcleos da base, gerando desde o quadro motor de coréia até os distúrbios psiquiátricos associados à CS.