Prevalence and socioeconomic factors associated with smoking in people living with HIV by sex, in Recife, Brazil.

INTRODUCTION: Smoking is the leading cause of preventable death in the world. The prevalence of smoking is higher in people infected with HIV than in the general population. Although it is biologically plausible that smoking increases the morbidity and mortality of people living with HIV/AIDS, few studies in developing countries have analyzed the determinants and consequences of smoking in HIV infected people. OBJECTIVE: To estimate the prevalence of smoking and identify the socioeconomic factors associated with smoking and smoking cessation in patients with HIV by sex. METHODS: A cross-sectional study was conducted with baseline data, obtained from an ongoing prospective cohort study of patients with HIV attending two referral centers in Recife, Northeast Region of Brazil, between July 2007 and October 2009. RESULTS: The prevalence of current smoking was 28.9%. For both sexes, smoking was independently associated with heavy alcohol drinking and marijuana use. Among women, smoking was associated with living alone, not being married and illiteracy; and among men, being 40 years or older, low income and using crack. Compared with ex-smokers, current smokers were younger and more likely to be unmarried, heavy drinkers and marijuana users. CONCLUSIONS: It is important to incorporate smoking cessation interventions for the treatment of heavy alcohol drinkers and marijuana users with HIV/AIDS, which may increase life expectancy and quality of life, as smoking is related to risk of death, relapse of tuberculosis, and non communicable diseases.

Prevalence and socioeconomic factors associated with smoking in people living with HIV by sex, in Recife, Brazil / Prevalencia e fatores socioeconomicos associados com o tabagismo em pessoas vivendo com o HIV por sexo em Recife, Brasil

Introduction: Smoking is the leading cause of preventable death in the world. The prevalence of smoking is higher in people infected with HIV than in the general population. Although it is biologically plausible that smoking increases the morbidity and mortality of people living with HIV/AIDS, few studies in developing countries have analyzed the determinants and consequences of smoking in HIV infected people. Objective: To estimate the prevalence of smoking and identify the socioeconomic factors associated with smoking and smoking cessation in patients with HIV by sex. Methods: A cross-sectional study was conducted with baseline data, obtained from an ongoing prospective cohort study of patients with HIV attending two referral centers in Recife, Northeast Region of Brazil, between July 2007 and October 2009. Results: The prevalence of current smoking was 28.9%. For both sexes, smoking was independently associated with heavy alcohol drinking and marijuana use. Among women, smoking was associated with living alone, not being married and illiteracy; and among men, being 40 years or older, low income and using crack. Compared with ex-smokers, current smokers were younger and more likely to be unmarried, heavy drinkers and marijuana users. Conclusions: It is important to incorporate smoking cessation interventions for the treatment of heavy alcohol drinkers and marijuana users with HIV/AIDS, which may increase life expectancy and quality of life, as smoking is related to risk of death, relapse of tuberculosis, and non communicable diseases. .

Resumo Introdução: Tabagismo é a principal causa de morte evitável no mundo e a sua prevalência é maior em pessoas infectadas pelo HIV. Embora haja plausibilidade biológica no fato de o tabagismo aumentar a morbimortalidade de pessoas que vivem com HIV, poucos estudos em países em desenvolvimento têm analisado os determinantes e as conseqüências desse hábito nessa população. Objetivos: Estimar a prevalência de tabagismo e identificar os fatores associados com o tabagismo e com a cessação do tabagismo em infectados pelo HIV, por sexo. Métodos: Estudo seccional utilizando os dados de base de uma coorte prospectiva de pacientes com HIV atendidos em dois centros de referência em Recife, nordeste do Brasil, entre julho de 2007 e outubro de 2009. Resultados: A prevalência de tabagismo foi de 28,9%. Para ambos os sexos, o tabagismo esteve associado com alcoolismo e uso de maconha. Entre as mulheres, o tabagismo esteve associado com não ser casada, morar só, e não saber ler e escrever; e entre os homens esteve associado com idade ≥ 40 anos, baixa renda mensal e uso de crack. Comparado com os ex-fumantes, os fumantes eram mais jovens, não casados, bebiam mais e fumavam maconha. Conclusão: É importante incorporar intervenções para cessação do tabagismo no tratamento de usuários de maconha e alcoolistas com HIV/AIDS, o que pode aumentar a qualidade e expectativa de vida desses pacientes, uma vez que o tabagismo está relacionado com maior risco de morte, recidiva da tuberculose e também com doenças crônicas não infecciosas. .

Factors associated with time to acquisition of bloodstream infection in a pediatric intensive care unit.

OBJECTIVE: To evaluate the risk factors that influence time to acquisition of a laboratory-confirmed bloodstream infection (LCBI). DESIGN: Prospective cohort study with an 18-month follow-up. SETTING: A 16-bed medical and/or surgical pediatric intensive care unit that cares for patients of the Brazilian Public Health System exclusively. PATIENTS: We included children from 0 to 18 years old who were represented by 875 consecutive admissions to the pediatric intensive care unit from January 1, 2005, through June 30, 2006. The children from all but 5 (0.6%) of the admissions were followed up until discharge or death. The majority (506 [58.2%]) were hospitalized for surgical pathology, and 254 (29.2%) underwent heart surgery. METHODS: We used a standardized questionnaire and data collection from daily charts. Information on risk factors was collected before the onset of first LCBI. Survival analysis was performed using the Kaplan-Meier method. The effect of the variables on the risk of LCBI each day was estimated through a Cox model fitting. RESULTS: Fifty-seven children (6.6%) developed an LCBI, 54 (94.7%) of whom made use of a central venous catheter. LCBI incidence was 11.27 episodes/1,000 patient-days and 17.92 episodes/1,000 patient-days when associated with a central venous catheter. Factors associated with time to the first LCBI in the Cox model were age less than 2 years (hazard ratio [HR], 1.99; 95% confidence interval [CI], 1.02-3.89), malnutrition (HR, 1.74; 95% CI, 1.01-3.00), use of a central venous catheter (HR, 4.36; 95% CI, 1.30-14.64), use of antibiotics before admission (HR, 0.58; 95% CI, 0.33-0.98), and use of transfused blood products (HR, 0.40; 95% CI, 0.22-0.74). CONCLUSION: Factors associated with time to acquisition of LCBI were age less than 2 years, weight-for-age z score less than -2, and the use of a central venous catheter. Therefore, intensification of LCBI prevention efforts in patients with these characteristics is fundamental.

Uma contribuição de tecnologia da informação para a ética em pesquisas com animais de laboratório / A contribution from information technology to ethics on research with laboratory animals

Este estudo tem como objetivo o desenvolvimento de um sistema informatizado para aprimorar o controle dos procedimentos éticos nas pesquisas com animais de laboratório, no âmbito da Fundação Oswaldo Cruz (Fiocruz). O desenvolvimento desse sistema está embasado pelos princípios éticos da experimentação animal e utiliza a tecnologia da informação como meio de tornar disponíveis as informações sobre os procedimentos utilizados pela comunidade cientifica na Fiocruz, de forma a facilitar a obediência aos princípios éticos estabelecidos pelo Colégio Brasileiro de Experimentação Animal (COBEA). Sua concepção foi realizada a partir de revisão bibliográfica sobre a ética em pesquisas com animais de laboratórios e aplicações da Tecnologia da Informação nesse campo. A metodologia para construção do sistema consistiu de reuniões com a CEUA, análise da sistemática atual, entrevistas com pesquisadores, testes das sucessivas versões e aplicação de questionário para avaliação da versão final. A utilização do sistema desenvolvido pode contribuir para diminuir os problemas atuais enfrentados pela Comissão de Ética no Uso de Animais de laboratório da Fiocruz (CEUA), como atraso no início das pesquisas, desistência dos solicitantes e início de pesquisas sem a devida autorização da CEUA, com conseqüências legais.