Mortality due to hepatocellular carcinoma associated with hepatitis B and C viruses in the state of São Paulo, Brazil.

OBJECTIVE: This study aimed to describe and analyze the temporal and spatial distribution of deaths due to hepatocellular carcinoma (HCC) associated with hepatitis B (HBV) and C viruses (HCV) in the state of São Paulo. METHODS: This is an ecological study of HCC deaths associated with HBV and HCV in the state of São Paulo, from 2009 to 2017, with data from the Mortality Information System (SIM). The temporal trend was analyzed by linear regression with Prais-Winsten estimation. Deaths were described according to sociodemographic characteristics by means of absolute and relative frequencies and were spatially distributed according to the regional health department. RESULTS: It is found that 26.3% of deaths due to HCC were associated with HBV or HCV. A higher proportion of deaths due to HCC associated with HCV was observed (22.2%) when compared to HBV (3.9%). The mortality rate due to HCC associated with HBV showed a downward trend, and the mortality rate due to HCC associated with HCV showed a steady trend. Deaths of males, white individuals, those who aged from 50 to 59 years, and those who had 8-11 years of schooling predominated. Spatial analysis revealed a heterogeneous distribution of deaths in the state of São Paulo. CONCLUSIONS: The downward trend in mortality rates due to HCC associated with HBV shows an important advance in the disease control. However, the mortality rate due to HCC associated with HCV has remained stable throughout the study period. The spatial distribution of deaths may contribute to raise hypotheses for deeper knowledge of these diseases in the regions.

Mortality due to hepatocellular carcinoma associated with hepatitis B and C viruses in the state of São Paulo, Brazil / Mortalidade por carcinoma hepatocelular associado às hepatites virais B e C no estado de São Paulo, Brasil

ABSTRACT: Objective: This study aimed to describe and analyze the temporal and spatial distribution of deaths due to hepatocellular carcinoma (HCC) associated with hepatitis B (HBV) and C viruses (HCV) in the state of São Paulo. Methods: This is an ecological study of HCC deaths associated with HBV and HCV in the state of São Paulo, from 2009 to 2017, with data from the Mortality Information System (SIM). The temporal trend was analyzed by linear regression with Prais-Winsten estimation. Deaths were described according to sociodemographic characteristics by means of absolute and relative frequencies and were spatially distributed according to the regional health department. Results: It is found that 26.3% of deaths due to HCC were associated with HBV or HCV. A higher proportion of deaths due to HCC associated with HCV was observed (22.2%) when compared to HBV (3.9%). The mortality rate due to HCC associated with HBV showed a downward trend, and the mortality rate due to HCC associated with HCV showed a steady trend. Deaths of males, white individuals, those who aged from 50 to 59 years, and those who had 8-11 years of schooling predominated. Spatial analysis revealed a heterogeneous distribution of deaths in the state of São Paulo. Conclusions: The downward trend in mortality rates due to HCC associated with HBV shows an important advance in the disease control. However, the mortality rate due to HCC associated with HCV has remained stable throughout the study period. The spatial distribution of deaths may contribute to raise hypotheses for deeper knowledge of these diseases in the regions.

RESUMO: Objetivos: Este estudo tem como objetivo descrever e analisar a distribuição temporal e espacial dos óbitos por carcinoma hepatocelular associados às hepatites virais B e C no estado de São Paulo. Métodos: Estudo ecológico dos óbitos por carcinoma hepatocelular associados a hepatites virais B e hepatites virais C no estado de São Paulo, de 2009 a 2017, com dados do Sistema de Informação sobre Mortalidade. A tendência temporal foi analisada por regressão linear, com método de Prais-Winsten. Os óbitos foram descritos segundo as características sociodemográficas, por meio de frequências absolutas e relativas, e foram espacialmente distribuídos segundo departamento regional de saúde. Resultados: Dos óbitos por carcinoma hepatocelular, 26,3% foram associados a hepatites virais B ou hepatites virais C. Observou-se maior proporção de óbitos por carcinoma hepatocelular associado a hepatites virais C (22,2%) quando comparada àquela associada a hepatites virais B (3,9%). A taxa de mortalidade por carcinoma hepatocelular associado a hepatites virais B apresentou tendência de queda, no entanto a taxa de mortalidade por carcinoma hepatocelular associado a hepatites virais C apresentou tendência estacionária. Predominaram óbitos de pacientes do sexo masculino, de cor branca, de 50-59 anos e com oito a 11 anos de estudo. A análise espacial revelou distribuição heterogênea dos óbitos no estado de São Paulo. Conclusão: A tendência de queda nas taxas de mortalidade por carcinoma hepatocelular associado a hepatites virais B revela um importante avanço no controle do agravo. Entretanto, a taxa de mortalidade por carcinoma hepatocelular associado a hepatites virais C vem-se mantendo estável ao longo do período estudado. A distribuição espacial dos óbitos pode contribuir para levantar hipóteses com vistas ao conhecimento mais aprofundado desses agravos nas regiões.

Hollow fiber liquid-phase microextraction combined with supercritical fluid chromatography coupled to mass spectrometry for multiclass emerging contaminant quantification in water samples.

The hollow fiber liquid-phase microextraction allows highly selective concentration of organic compounds that are at trace levels. The determination of those analytes through the supercritical fluid chromatography usage is associated with many analytical benefits, which are significantly increased when it is coupled to a mass spectrometry detector, thus providing an extremely sensitive analytical technique with minimal consumption of organic solvents. On account of this, a hollow fiber liquid-phase microextraction technique in two-phase mode combined with supercritical fluid chromatography coupled to mass spectrometry was developed for quantifying 19 multiclass emerging contaminants in water samples in a total chromatographic time of 5.5 min. The analytical method used 40 µL of 1-octanol placed in the porous-walled polypropylene fiber as the acceptor phase, and 1 L of water sample was the donor phase. After extraction and quantification techniques were optimized in detail, a good determination coefficient (r2 > 0.9905) in the range of 0.1 to 100 µg L-1, for most of the analytes, and an enrichment factor in the range of 7 to 28,985 were obtained. The recovery percentage (%R) and intraday precision (%RSD) were in the range of 80.80-123.40%, and from 0.48 to 16.89%, respectively. Limit of detection and quantification ranged from 1.90 to 35.66 ng L-1, and from 3.41 to 62.11 ng L-1, respectively. Finally, the developed method was successfully used for the determination of the 19 multiclass emerging contaminants in superficial and wastewater samples.

Mortality trend due to Hepatitis B and C in the city of São Paulo, 2002-2016.

OBJECTIVE: To describe mortality due to hepatitis B and C as underlying cause in the municipality of São Paulo, verifying the trend of these rates, and to assess the association of these diseases with others, from 2002 to 2016. METHODS: This is a time series study on mortality due to hepatitis B and C according to sex, with data from the Sistema de Informação de Mortalidade (SIM - Mortality Information Sistem). Prais Winsten regression was used in rate trend analysis. RESULTS: The findings of this study showed a trend of decline of mortality from hepatitis B and C in recent years, particularly among males. These infections were important associated causes of liver cell carcinoma and HIV. The proportion of deaths under 70 years of age stands out. CONCLUSIONS: The study provides a baseline for research on mortality trend and the impact of interventions, given the history of expanded detection and supply of treatments, including the most recent antivirals in Brazil, since 2015.

Occurrence of hepatitis B in pregnant women and follow-up of exposed children in the State of São Paulo, Brazil, in 2012. / Ocorrência de hepatite B em gestantes e seguimento de crianças expostas no estado de São Paulo, em 2012.

OBJECTIVE: to describe the occurrence of hepatitis B among pregnant women, immunoprophylaxis and vertical and perinatal transmission in children exposed to the virus in the São Paulo state primary care network, Brazil. METHODS: this was a cross-sectional study using prenatal records of pregnant women attending health services between January and June 2012 and a cohort of newborns; the frequencies of the results were described and the estimated occurrence of hepatitis B was calculated. RESULTS: 6,233 pregnant women were included, of whom 53.1% were between 20-29 years old, 58.7% had 8-11 years of schooling, 53.3% were white, and 73.9% lived with a partner; occurrence of hepatitis B was 0.13% (95%CI 0.04; 0.21); of the eight children of mothers with chronic hepatitis B, six had a complete vaccination schedule, and there was no vertical or perinatal transmission. CONCLUSION: there was low occurrence of hepatitis B in pregnant women and absence of vertical or perinatal transmission.

Ocorrência de hepatite B em gestantes e seguimento de crianças expostas no estado de São Paulo, em 2012 / Ocurrencia de hepatitis B en mujeres embarazadas y seguimiento de niños expuestos en el estado de São Paulo, Brasil, en 2012 / Occurrence of hepatitis B in pregnant women and follow-up of exposed children in the State of São Paulo, Brazil, in 2012

Resumo Objetivo: descrever a ocorrência da hepatite B entre gestantes, a realização de imunoprofilaxia e a transmissão vertical e perinatal nas crianças expostas ao vírus na rede de Atenção Primária à Saúde do estado de São Paulo, Brasil. Métodos: estudo transversal sobre registros de pré-natal de gestantes atendidas de janeiro a junho de 2012 e coorte dos recém-nascidos; foram descritas as frequências dos resultados e calculada a estimativa da ocorrência da hepatite B. Resultados: foram incluídas 6.233 gestantes, das quais 53,1% com 20 a 29 anos de idade, 58,7% com 8 a 11 anos de estudo, 53,3% brancas e 73,9% com companheiro; a ocorrência de hepatite B foi de 0,13% (IC95%: 0,04 a 0,21%); das oito crianças de mães com hepatite B crônica, seis tiveram esquema vacinal completo e não houve transmissão vertical ou perinatal. Conclusão: observou-se baixa ocorrência de hepatite B em gestantes e ausência de transmissão vertical ou perinatal.

Resumen Objetivo: describir el aparecimiento de hepatitis B en mujeres embarazadas, la inmunoprofilaxis y la transmisión vertical y perinatal en niños expuestos al virus en la red de atención primaria en el estado de São Paulo, Brasil. Métodos: estudio transversal con registros prenatales de mujeres embarazadas atendidas de enero a junio de 2012 y cohorte de recién nacidos; se describieron las frecuencias y se calculó el surgimiento de la hepatitis B. Resultados: se incluyeron 6.233 gestantes, de las cuales 53,1% con 20 a 29 años de edad, 58,7% con 8 a 11 años de estudios, 53,3% blancas y 73,9% viviendo en pareja; la ocurrencia de hepatitis B fue del 0,13% (IC95%: 0,04 to 0,21%); entre ocho hijos de madres con hepatitis B crónica, seis tenía un calendario de vacunación completo y no había transmisión vertical o perinatal. Conclusión: hubo baja ocurrencia de hepatitis B en mujeres embarazadas y ausencia de transmisión vertical o perinatal.

Abstract Objective: to describe the occurrence of hepatitis B among pregnant women, immunoprophylaxis and vertical and perinatal transmission in children exposed to the virus in the São Paulo state primary care network, Brazil. Methods: this was a cross-sectional study using prenatal records of pregnant women attending health services between January and June 2012 and a cohort of newborns; the frequencies of the results were described and the estimated occurrence of hepatitis B was calculated. Results: 6,233 pregnant women were included, of whom 53.1% were between 20-29 years old, 58.7% had 8-11 years of schooling, 53.3% were white, and 73.9% lived with a partner; occurrence of hepatitis B was 0.13% (95%CI 0.04; 0.21); of the eight children of mothers with chronic hepatitis B, six had a complete vaccination schedule, and there was no vertical or perinatal transmission. Conclusion: there was low occurrence of hepatitis B in pregnant women and absence of vertical or perinatal transmission.

Mortality trend due to Hepatitis B and C in the city of São Paulo, 2002-2016 / Tendência de mortalidade por hepatites B e C no município de São Paulo, 2002-2016

ABSTRACT OBJECTIVE: To describe mortality due to hepatitis B and C as underlying cause in the municipality of São Paulo, verifying the trend of these rates, and to assess the association of these diseases with others, from 2002 to 2016. METHODS: This is a time series study on mortality due to hepatitis B and C according to sex, with data from the Sistema de Informação de Mortalidade (SIM - Mortality Information Sistem). Prais Winsten regression was used in rate trend analysis. RESULTS: The findings of this study showed a trend of decline of mortality from hepatitis B and C in recent years, particularly among males. These infections were important associated causes of liver cell carcinoma and HIV. The proportion of deaths under 70 years of age stands out. CONCLUSIONS: The study provides a baseline for research on mortality trend and the impact of interventions, given the history of expanded detection and supply of treatments, including the most recent antivirals in Brazil, since 2015.

RESUMO OBJETIVO: Descrever a mortalidade por hepatites B e C como causa básica no município de São Paulo, verificando a tendência dessas taxas, e avaliar a associação dessas doenças a outras no período de 2002 a 2016. MÉTODOS: Trata-se de um estudo de série temporal sobre mortalidade por hepatites B e C segundo sexo, com dados do Sistema de Informação de Mortalidade. A regressão de Prais Winsten foi usada na análise de tendência das taxas. RESULTADOS: Os achados do presente estudo mostraram tendência de declínio da mortalidade por hepatites B e C nos últimos anos, particularmente entre pessoas do sexo masculino. Essas infecções foram causas associadas importantes ao carcinoma de células hepáticas e ao HIV. Destaca-se a proporção de óbitos com menos de 70 anos de idade. CONCLUSÕES: O estudo fornece uma linha de base para pesquisas de tendência de mortalidade e de impacto de intervenções, visto o histórico de ampliação da detecção e oferta de tratamentos, incluindo os mais recentes antivirais no Brasil, desde 2015.

The QualiRede intervention: improving the performance of care continuum in HIV, congenital syphilis, and hepatitis C in health regions.

INTRODUCTION: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). METHODS: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility's process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. RESULTS: The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices. CONCLUSION: Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.

The QualiRede intervention: improving the performance of care continuum in HIV, congenital syphilis, and hepatitis C in health regions / A intervenção QualiRede: melhoria do desempenho do contínuo do cuidado em HIV, sífilis congênita e hepatite C em regiões de saúde

ABSTRACT Introduction: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). Methods: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility's process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. Results: The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices. Conclusion: Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.

RESUMO Introdução: Modelos de cuidado contínuo baseiam recentes estratégias em HIV, infecções sexualmente transmissíveis e hepatite C (HCV). Métodos: Desenvolveram-se modelos de contínuo do cuidado em HIV, HCV e sífilis congênita incluindo todas as etapas da atenção, desde a promoção e a prevenção até o controle clínico/cura. O modelo baseou a intervenção QualiRede, desenvolvida em parceria entre universidade e Sistema Único de Saúde (SUS), direcionada a gestores e demais profissionais de 6 regiões de saúde prioritárias em São Paulo e Santa Catarina. Selecionaram-se indicadores para cada etapa do contínuo do cuidado, provenientes dos sistemas de informação do SUS e dos questionários de avaliação de processo Qualiaids e QualiAB. Os indicadores formaram a base técnica de duas oficinas com profissionais e gestores de cada região: a primeira para identificar problemas e formar um Grupo Técnico Regional; e a segunda para construir planos de ação e metas a fim de melhorar o desempenho regional. Resultados: Os indicadores estão disponíveis no website www.qualirede.org. As oficinas ocorreram em quatro regiões de São Paulo (Alto Tietê, Baixada Santista, Grande ABC e Registro) e uma região de Santa Catarina (Foz do Rio Itajaí), resultando em planos regionais em São Paulo, mas não em Santa Catarina. Observou-se domínio limitado dos novos protocolos para HIV e HCV e uso incipiente de indicadores na rotina dos serviços. Conclusão: Melhorar o desempenho do contínuo do cuidado exige apropriação dos indicadores de desempenho e coordenação integrada dos fluxos de atenção em todos os níveis de gestão.

Analytical Method for Pesticides in Avocado and Papaya by Means of Ultra-High Performance Liquid Chromatography Coupled to a Triple Quadrupole Mass Detector: Validation and Uncertainty Assessment.

In this work, the uncertainty estimation for the determination of ametryn, carbofuran, atrazine, carbaryl, and methyl parathion in papaya and avocado is presented, along with other validation parameters. The analytical method was developed using Quick, Easy, Cheap, Effective, Rugged, and Safe extraction and ultrahigh performance liquid chromatography coupled to a triple quadrupole mass detector. The method validation showed that the linear correlation coefficients were higher than 0.99 for both fruits. The limits of detection for avocado and papaya were in the range of 0.022 to 0.46 and 0.003 to 0.109 µg/g, respectively. Intermediate precision varied from 5.3% to 13.0% in papaya, and from 4.8% to 20.2% in avocado. Recoveries obtained for each pesticide in both matrices ranged between 61.3% and 119.0%. Matrix effect was calculated for all compounds in both fruits. Finally, the overall uncertainty was lower than 36% for both fruits. PRACTICAL APPLICATION: The present analytical method could be used for pesticides determination in different kind of fruits as papaya and avocado and as a practical guide for uncertainty and matrix effect determination.

Validation and assessment of matrix effect and uncertainty of a gas chromatography coupled to mass spectrometry method for pesticides in papaya and avocado samples.

In this paper a method of using the "quick, easy, cheap, effective, rugged, and safe" (QuEChERS) extraction and gas chromatography coupled to mass spectrometry detection (GC-MS) was developed for the analysis of five frequently applied pesticides in papaya and avocado. The selected pesticides, ametryn, atrazine, carbaryl, carbofuran, and methyl parathion, represent the most commonly used classes (carbamates, organophosphorous, and triazines). Optimum separation achieved the analysis of all pesticides in < 6.5 minutes. Validation using papaya and avocado samples established the proposed method as linear, accurate, and precise. In this sense, the correlation coefficients were > 0.99. The limits of detection (LOD) and quantification (LOQ) in papaya ranged from 0.03 mg/kg to 0.35 mg/kg and from 0.06 mg/kg to 0.75 mg/kg, respectively. Meanwhile for avocado, LOD values varied from 0.14 mg/kg to 0.28 mg/kg and LOQ values ranged from 0.22 mg/kg to 0.40 mg/kg. Recoveries obtained for each pesticide in both matrices ranged between 60.6% and 104.3%. The expanded uncertainty of the method was < 26% for all the pesticides in both fruits. Finally, the method was applied to other fruits.

Direct immersion single drop micro-extraction method for multi-class pesticides analysis in mango using GC-MS.

Due the negative effects of pesticides on environment and human health, more efficient and environmentally friendly methods are needed. In this sense, a simple, fast, free from memory effects and economical direct-immersion single drop micro-extraction (SDME) method and GC-MS for multi-class pesticides determination in mango samples was developed. Sample pre-treatment using ultrasound-assisted solvent extraction and factors affecting the SDME procedure (extractant solvent, drop volume, stirring rate, ionic strength, time, pH and temperature) were optimized using factorial experimental design. This method presented high sensitive (LOD: 0.14-169.20µgkg-1), acceptable precision (RSD: 0.7-19.1%), satisfactory recovery (69-119%) and high enrichment factors (20-722). Several obtained LOQs are below the MRLs established by the European Commission; therefore, the method could be applied for pesticides determination in routing analysis and custom laboratories. Moreover, this method has shown to be suitable for determination of some of the studied pesticides in lime, melon, papaya, banana, tomato, and lettuce.

Supercritical fluid chromatography with photodiode array detection for pesticide analysis in papaya and avocado samples.

To improve the analysis of pesticides in complex food matrices with economic importance, alternative chromatographic techniques, such as supercritical fluid chromatography, can be used. Supercritical fluid chromatography has barely been applied for pesticide analysis in food matrices. In this paper, an analytical method using supercritical fluid chromatography coupled to a photodiode array detection has been established for the first time for the quantification of pesticides in papaya and avocado. The extraction of methyl parathion, atrazine, ametryn, carbofuran, and carbaryl was performed through the quick, easy, cheap, effective, rugged, and safe methodology. The method was validated using papaya and avocado samples. For papaya, the correlation coefficient values were higher than 0.99; limits of detection and quantification ranged from 130-380 and 220-640 µg/kg, respectively; recovery values ranged from 72.8-94.6%; precision was lower than 3%. For avocado, limit of detection values were ˂450 µg/kg; precision was lower than 11%; recoveries ranged from 50.0-94.2%. Method feasibility was tested for lime, banana, mango, and melon samples. Our results demonstrate that the proposed method is applicable to methyl parathion, atrazine, ametryn, and carbaryl, toxics pesticides used worldwide. The methodology presented in this work could be applicable to other fruits.

Mortalidade cardiovascular e desigualdades sociais no município de São Paulo, Brasil, 1996-1998 e 2008-2010 / Cardiovascular mortality and social inequalities in São Paulo City, Brazil, 1996-1998 and 2008-2010

Objetivo: avaliar diferenças na mortalidade por doença isquêmica do coração (DIC) e doenças cerebrovasculares (DCBV) em áreas geográficas com características socioeconômicas distintas, no município de São Paulo, em 1996 a 1998 e 2008 a 2010. Métodos: foram estudados óbitos da população acima de 20 anos e indicadores sociais agregados em cinco áreas territoriais; foram calculadas razões de mortalidade padronizadas (RMP) pelo método indireto e razão de risco de mortalidade (RRM) entre áreas, estimada por regressão de Poisson e teste de tendência. Resultados: comparando-se as áreas com menor e maior exclusão, a RRM para DIC em 2008-2010 foi de 1,38 (IC95 por cento: 1,22-1,55), entre homens e 1,61 (IC95 por cento: 1,42-1,83) entre mulheres; observou-se a associação da DCBV com exclusão social em ambos os sexos e nos dois períodos (p<0,01). Conclusão: houve aumento do risco da mortalidade por DIC e DCBV, acompanhando o declínio das condições sociais nas áreas geográficas estudadas.

Objective: to evaluate differences in mortality from ischemic heart disease (IHD) and cerebrovascular disease (CVD) in geographic areas with distinct socioeconomic characteristics in São Paulo city - Brazil, during two periods: 1996-1998 and 2008-2010. Methods: we studied deaths in the population aged over 20 years and social indicators aggregated into five territorial areas. We calculated standardized mortality ratios (SMR) using the indirect method and mortality risk ratio (MRR) between areas, estimated by Poisson regression, confidence intervals of 95 per cent and trend testing. Results: among men, increased social exclusion was accompanied by increased MRR for IHD in 2008-2010, ranging from 1.19 in area 2 to 1.38 in area 5, compared to the wealthiest area the in range. Among women, this variation was 1.11 and 1.61, respectively. MRR for CVD showed association with social exclusion in both periods for both sexes (p<0,01). Conclusion: risk of mortality from IHD and CVD increased as social conditions declined in the geographic areas studied.

Coinfecção pelos vírus das hepatites B ou C e da imunodefíciência adquirida: estudo exploratório no Estado de São Paulo, Brasil, 2007 a 2010 / Co-infection of hepatitis B or C and human immunodeficiency virus: an exploratory study in the State of São Paulo, Brazil, 2007 to 2010

Objetivo: descrever as características dos casos de coinfecção pelos vírus das hepatites B (VHB) e/ou C (VHC) e o vírus da imunodeficiência humana (HIV) no estado de São Paulo, Brasil. Métodos: estudo descritivo sobre casos notificados ao Sistema de Informação de Agravos de Notificação (Sinan) entre 2007 e 2010; foram analisadas variáveis sociodemográficas, clínicas e comportamentais. Resultados: dos 46.969 casos notificados de hepatites virais, 1.318 (2,8 por cento) corresponderam a casos de coinfecção HIV/VHB, 3.032 (6,45 por cento) de coinfecção HIV/HCV e 201 (0,43 por cento) de coinfecção HIV/VHB/VHC; o contato sexual com portadores do VHB ou VHC foi mais prevalente nas coinfecções HIV/VHB; uso de drogas apresentou maior proporção nos casos de coinfecção HIV/VHC e HIV/VHB/VHC, com maior frequência nos indivíduos com 40 anos de idade ou mais (p<0,001). Conclusão: fatores de risco e mecanismos de transmissão comuns às hepatites virais e ao HIV podem explicar a frequência elevada de coinfecção.

Objective: to describe the characteristics of cases of co-infection by virus of hepatitis B (HBV) and/or C (HCV) and human immunodeficiency virus (HIV) in the state of São Paulo, Brazil. Methods: a descriptive study about cases reported to the Information System for Notifiable Diseases (Sinan) in the period 2007-2010; were analyzed socio-demographic, clinical and behavioral variables. Results: in 46,969 reported cases of viral hepatitis, 1,318 (2.8 per cent) corresponded to cases of co-infection HIV/HBV, 3,032 (6.45 per cent) of co-infection HIV/HCV and 201 (0.43 per cent) of co-infection HIV/HBV/HCV; sexual contact with carriers of HBV or HCV was more prevalent in HIV/HBV co-infection; use of drugs showed a higher proportion in cases of co-infection HIV/HCV, most often in individuals aged 40 years or more (p<0.001). Conclusion: risk factors and transmission mechanisms common to hepatitis viruses and HIV may explain the high frequency of co-infection.

Casos de hepatite B e C notificados em adolescentes ao Sistema Nacional de Informação de Agravos do Estado de São Paulo, de 2007 a 2010 / Hepatitis B and C notified in the adolescent population in the National Databank of major causes of morbidity in the State of São Paulo, form 2007 a 2010

O objetivo desse trabalho foi descrever as características da população de adolescentes residentes no Estado de São Paulo, notificadas como caso de hepatite B ou C, ao Sistema de Informação de Agravos de Notificação. Foi realizado um estudo transversalusando dados secundários do SINAN na população de 13 a 19 anos, notificada no banco de hepatites virais, no período de 2007 a 2011. A definição de caso de hepatite B ou C tem por base a confirmação laboratorial por meio de marcadores sorológicos: para a hepatite B, presença de AgHBs, e para a hepatite C, anti-HCV reagente pelo teste ELISA (enzyme-linked immunosorbent assay), confirmado pela presença de HCV RNA usando reverse transcription-polymerase chain reaction (RT-PCR). Foram analisados 616 casos de adolescentes com hepatite B (1,3% do total de casos do banco de hepatites) e 183 casosde hepatite C (0,40% do total). Para a hepatite B, a maioria foi notificada no sexo feminino (63,5%); 41% não estavavam vacinados com as 3 doses contra a hepatite B; 19% tinham 3 ou mais parceiros sexuais; 2% eram soropositivos para o HIV; 10% já tinham usado drogas ilícitas. Para a hepatite C, a maioria (54%) era do sexo masculino; 30% não tinham vacinação completa contra a hepatite B; 7,7% eram soropositivos para o HIV; 20% relataram história de 3 ou mais parceiros sexuais; 19% referiram, alguma vez, uso de drogas ilícitas. Os dados sobre hepatites virais B e C devem ser monitoradosna população adolescente, contribuindo para o conhecimento do agravo e estratégias de prevenção

Avaliação da qualidade da informação nas requisições e condições das amostras biológicas nos Laboratórios de Saúde Pública Lapa e Ipiranga do município de São Paulo / Quality assessment of requisitions and conditions of biological samples in Lapa and Ipiranga public health laboratories in the city of São Paulo

O objetivo do presente trabalho é avaliar a qualidade das informações nas requisições de exames e condições das amostras biológicas recebidas nos setores de Imunologia e Microbiologia dos Laboratórios Lapa e Ipiranga, da Prefeitura de São Paulo. Foi realizado um estudo de avaliação a partir das requisições de exames e amostras biológicas em oito unidades de saúde, o que corresponde à fase pré-analítica de exames laboratoriais. As unidades de estudo foram quatro Centros de Referência em DST/Aids e quatro unidades básicas de saúde. A coleta de dados foi realizada por meio de questionário, durante o mês de agosto de 2006. Foi realizada análise descrita e os resultados comparados às normas técnicas de boas práticas preconizadas pela Agência Nacional de Vigilância Sanitária e Prefeitura do de São Paulo. Observou-se que as condições das amostras enviadas encontravam-se majoritariamente de acordo com as recomendações. Tanto para o laboratório Lapa como Ipiranga, o preenchimento das requisições foi melhor nos Centros de Referência em DST/Aids do que nas UBS. Nos serviços de menor complexidade foram identificadas falhas na qualidade das informações, que comprometem o resultado dos exames. Esses resultados apontam para a necessidade de investimento em treinamento e divulgação de boas práticas nos processos operacionais da fase pré-analítica