Influenza-associated excess mortality in southern Brazil, 1980-2008.

In order to estimate influenza-associated excess mortality in southern Brazil, we applied Serfling regression models to monthly mortality data from 1980 to 2008 for pneumonia/influenza- and respiratory/circulatory-coded deaths for all ages and for those aged ≥60 years. According to viral data, 73∙5% of influenza viruses were detected between April and August in southern Brazil. There was no clear influenza season for northern Brazil. In southern Brazil, influenza-associated excess mortality was 1∙4/100,000 for all ages and 9∙2/100,000 person-years for persons aged ≥60 years using underlying pneumonia/influenza-coded deaths and 10∙0/100,000 for all ages and 86∙6/100,000 person-years for persons aged ≥60 years using underlying respiratory/circulatory-coded deaths. Influenza-associated excess mortality rates for southern Brazil are similar to those published for other countries. Our data support the need for continued influenza surveillance to guide vaccination campaigns to age groups most affected by this virus in Brazil.

Bloodstream infections in home infusion patients: the influence of race and needleless intravascular access devices.

OBJECTIVES: To determine the cause of increased central venous catheter-associated (CVC) bloodstream infection (BSI) rates in a cohort of pediatric hematology /oncology patients receiving home health care (HHC). METHODS: A retrospective cohort study of hematology/oncology patients with CVCs receiving HHC from January 1992 through November 1994. RESULTS: Of 182 patients with CVCs identified during the study period, 58 (32%) acquired 90 BSIs during 75,085 CVC days. BSI rates increased significantly from 1992 through 1994 (0.8 vs 1.0 vs 1.7 BSIs per 1000 CVC days; p < 0.005). Known risk factors, including catheter type, patient age less than 5 years, sex, or diagnosis, were not associated with increased BSI rates. After introduction of needleless devices for CVC access to the HHC regimen in May 1993, BSI rates increased 80% (from 0.81 to 1.46 BSIs/1000 CVC days, relative risk 1.8; p < 0.02). The only other significant risk factor was the race of the patient. White children had the lowest BSI rate before and after needleless-device introduction (0.4 vs 0.9 BSIs/1000 CVC days; p > 0.1), whereas black patients had the highest, unaffected by the introduction of these devices (2.5 BSIs/1000 CVC days). Both Hispanic (0.5 vs 1.6 BSIs/1000 CVC days) and Asian-American children's (0.4 vs 1.5 BSIs/1000 CVC days) BSI rates increased threefold and fourfold after the introduction of needleless devices. CONCLUSIONS: Our data suggest that pediatric hematology/oncology patients receiving HHC via needleless devices may have an increased risk of BSIs, and this risk may vary by race. We hypothesize that prevention of BSIs may require consideration of cultural, ethnic, and language differences when parents are trained to provide care for their children with CVCs in the home.

Prevalence of low birth weight among Hispanic infants with United States-born and foreign-born mothers: the effect of urban poverty.

Although Hispanics are a poorly educated and medically underserved minority, the incidence of low birth weight (less than 2,500 g) Hispanic infants is similar to that of non-Hispanic whites. The authors used 1982-1983 Illinois vital records and 1980 US census income data to determine the contribution of maternal nativity and place of residence to this epidemiologic paradox. The proportion of low birth weight Hispanic (n = 22,892) infants ranged from 4.3% for Mexicans to 9.1% for Puerto Ricans. Maternal age, education, trimester of prenatal care initiation, and place of residence were associated with the prevalence of low birth weight infants among Puerto Rican but not foreign-born Mexican or Central-South American mothers. In very low-income (less than $10,000/year) census tracts, Mexican and other Hispanic infants with US-born mothers had low birth weight rates of 14 and 15%, respectively. In contrast, Mexican and other Hispanic infants with foreign-born mothers who resided in these areas had low birth weight rates of 3 and 7%, respectively. In a logistic model that included only impoverished infants, the adjusted odds ratio of low birth weight for those with US-born mothers equalled 6.3 (95 percent confidence interval 2.3-16.9). The authors conclude that urban poverty is negatively associated with Hispanic birth weight only when the mother is Puerto Rican or a US-born member of another subgroup.