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1.
Disabil Rehabil ; : 1-7, 2024 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-38166526

RESUMO

PURPOSE: To identify potential predictors of prolonged length of hospital stay in patients submitted to lung resection surgery. MATERIALS AND METHODS: This is a cohort study, carried out in 105 patients with lung cancer, submitted to posterolateral thoracotomy pulmonary resection. Data collection included preoperative assessment of demographic, clinical, pulmonary function, respiratory muscle function, physical fitness, and behavioral habits. After surgery, length of hospital stay was documented, and the sample was divided into two groups according to the length of hospital stay (LOS): the normal hospital stay group (NLOS) until 8 days, and the prolonged hospital stay group (PLOS) with more than 8 days of hospital stay. Multiple linear regressions were performed between length of hospital stay and the studied variables, for the total sample and, specifically, for the PLOS group. RESULTS: The multiple linear regression for the total sample, the most explanatory power variables were TLC, MIP, PEF, and BMI. When considering only the PLOS, the variables that mostly explained were the MIP%, MEP and TLC%. CONCLUSION: Besides the classic outcomes used to calculate surgical risk, the body mass index, respiratory muscle strength, peak expiratory flow, and total lung capacity are predictors of the variation on length of hospital stay in patients submitted to lung resection.


The addition of the respiratory muscles function in the preoperative assessment, might contribute to predict prolonged hospital stay in patients submitted to lung resection surgery.Respiratory muscle strength might be included in a prehabilitation program for patients selected to lung resection surgery.The preoperative respiratory muscle strength increment might contribute to reduce economic cost related to prolonged hospital stay after pulmonary resection surgery.

2.
Rev Bras Epidemiol ; 26: e230055, 2023.
Artigo em Inglês, Português | MEDLINE | ID: mdl-38088714

RESUMO

OBJECTIVE: To describe the space-time evolution of TB incidence rates (TI) in indigenous and non-indigenous people, according to the Federative Units (UF) of Brazil, from 2011 to 2022. METHODS: Ecological, temporal, and spatial study on new tuberculosis cases in Brazil among indigenous and non-indigenous populations. Data from the Notifiable Diseases Information System (Sinan) were collected from 2011 to 2022 and stratified by Federal Unit, explored and statistically analyzed using R software version 4.2.3. RESULTS: The mean TI among indigenous populations in Brazil was 71.7 new cases per 100,000 inhabitants, while for non-indigenous populations it was 28.6/100,000 inhabitants. The regions of the country that presented the highest (mean) incidence among indigenous populations were: Central-West (102.8/100,000 inhabitants), Southeast (99.6/100,000 inhabitants), and North (79.9/100,000 inhabitants). For non-indigenous populations the highest incidence was in the North region (36.5/100,000 inhabitants), followed by the Southeast (31.3/100,000), and the Northeast (27,4/100,000 inhabitants). The analysis showed that the highest incidence of TB cases among indigenous populations occurred in the states of: SP, RO, RJ, MS, MT e PA. CONCLUSION: High incidence of the disease compared to the non-indigenous population show the need for a specific approach to address the health needs of these populations. Regional disparities in incidence indicate the need to address socioeconomic and infrastructure issues that affect the health of indigenous populations.


Assuntos
Tuberculose , Humanos , Incidência , Brasil/epidemiologia , Tuberculose/epidemiologia , Povos Indígenas , Fatores Socioeconômicos
3.
Rev. bras. epidemiol ; 26: e230055, 2023. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1529847

RESUMO

ABSTRACT Objective: To describe the space-time evolution of TB incidence rates (TI) in indigenous and non-indigenous people, according to the Federative Units (UF) of Brazil, from 2011 to 2022. Methods: Ecological, temporal, and spatial study on new tuberculosis cases in Brazil among indigenous and non-indigenous populations. Data from the Notifiable Diseases Information System (Sinan) were collected from 2011 to 2022 and stratified by Federal Unit, explored and statistically analyzed using R software version 4.2.3. Results: The mean TI among indigenous populations in Brazil was 71.7 new cases per 100,000 inhabitants, while for non-indigenous populations it was 28.6/100,000 inhabitants. The regions of the country that presented the highest (mean) incidence among indigenous populations were: Central-West (102.8/100,000 inhabitants), Southeast (99.6/100,000 inhabitants), and North (79.9/100,000 inhabitants). For non-indigenous populations the highest incidence was in the North region (36.5/100,000 inhabitants), followed by the Southeast (31.3/100,000), and the Northeast (27,4/100,000 inhabitants). The analysis showed that the highest incidence of TB cases among indigenous populations occurred in the states of: SP, RO, RJ, MS, MT e PA. Conclusion: High incidence of the disease compared to the non-indigenous population show the need for a specific approach to address the health needs of these populations. Regional disparities in incidence indicate the need to address socioeconomic and infrastructure issues that affect the health of indigenous populations.


RESUMO Objetivo: Descrever a evolução espaço-temporal das taxas de incidência (TIs) de tuberculose (TB) em indígenas e não indígenas, segundo as unidades federativas do Brasil, no período de 2011 a 2022. Métodos: Estudo ecológico, temporal e espacial sobre os casos novos de tuberculose no Brasil em indígenas e não indígenas. Dados provenientes do Sistema de Informação de Agravos de Notificação (SINAN) foram coletados de 2011 a 2022 e estratificados por UF, analisados exploratória e estatisticamente por meio do software R 4.2.3. Resultados: A TI média entre indígenas no Brasil foi 71,7 casos novos para cada 100 mil habitantes, enquanto para não indígenas foi de 28,6/100 mil habitantes. As regiões do país que apresentaram as maiores incidências (médias) para indígenas foram: Centro-Oeste (102,8/100 mil hab.), Sudeste (99,6/100 mil hab.) e Norte (79,9/100 mil hab.), e para não indígenas foram: Norte (36,5/100 mil hab.), Sudeste (31,3/100 mil hab.) e Nordeste (27,4/100 mil hab.). A análise mostrou que a maior incidência de casos de TB nas populações indígenas ocorreu nos estados de São Paulo, Rondônia, Rio de Janeiro, Mato Grosso do Sul, Mato Grosso e Pará. Conclusão: Altas incidências da doença em comparação com a população não indígena mostraram a necessidade de abordagem específica para atender às necessidades de saúde dessas populações. As disparidades regionais nas incidências indicaram a necessidade de abordar questões socioeconômicas e de infraestrutura que afetam a saúde desses povos.

4.
Genes (Basel) ; 13(7)2022 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-35886074

RESUMO

Asthenozoospermia is one of the main causes of male infertility and it is characterized by reduced sperm motility. Several mutations in genes that code for structural or functional constituents of the sperm have already been identified as known causes of asthenozoospermia. In contrast, the role of sperm RNA in regulating sperm motility is still not fully understood. Consequently, here we aim to contribute to the knowledge regarding the expression of sperm RNA, and ultimately, to provide further insights into its relationship with sperm motility. We investigated the expression of a group of mRNAs by using real-time PCR (CATSPER3, CFAP44, CRHR1, HIP1, IQCG KRT34, LRRC6, QRICH2, RSPH6A, SPATA33 and TEKT2) and the highest score corresponding to the target miRNA for each mRNA in asthenozoospermic and normozoospermic individuals. We observed a reduced expression of all mRNAs and miRNAs in asthenozoospermic patients compared to controls, with a more accentuated reduction in patients with progressive sperm motility lower than 15%. Our work provides further insights regarding the role of RNA in regulating sperm motility. Further studies are required to determine how these genes and their corresponding miRNA act regarding sperm motility, particularly KRT34 and CRHR1, which have not previously been seen to play a significant role in regulating sperm motility.


Assuntos
Astenozoospermia , MicroRNAs , Astenozoospermia/genética , Astenozoospermia/metabolismo , Humanos , Canais Iônicos/metabolismo , Masculino , MicroRNAs/genética , MicroRNAs/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Sêmen/metabolismo , Motilidade dos Espermatozoides/genética , Espermatozoides/metabolismo
5.
Artigo em Inglês | MEDLINE | ID: mdl-34639393

RESUMO

In line with the 1000-day initiative and the Sustainable Development Goals (SDG) 2 and 3, we present a cross-sectional analysis of maternal health, infant nutrition, and methylmercury exposure within hard-to-reach indigenous communities in the state of Pará, Brazilian Amazon. We collected data from all women of childbearing age (i.e., 12-49) and their infants under two years old in three Munduruku communities (Sawré Muybu, Sawré Aboy, and Poxo Muybu) along the Tapajos River. We explored health outcomes through interviews, vaccine coverage and clinical assessment, and determined baseline hair methylmercury (H-Hg) levels. Hemoglobin, infant growth (Anthropometric Z scores) and neurodevelopment tests results were collected. We found that 62% of women of childbearing age exceeded the reference limit of 6.0 µg/g H-Hg (median = 7.115, IQR = 4.678), with the worst affected community (Sawré Aboy) registering an average H-Hg concentration of 12.67 µg/g. Half of infants aged under 24 months presented with anemia. Three of 16 (18.8%) infants presented H-Hg levels above 6.0 µg/g (median: 3.88; IQR = 3.05). Four of the 16 infants were found to be stunted and 38% of women overweight, evidencing possible nutritional transition. No infant presented with appropriate vaccination coverage for their age. These communities presented with an estimated Infant Mortality Rate (IMR) of 86.7/1000 live births. The highest H-Hg level (19.6 µg/g) was recorded in an 11-month-old girl who was found to have gross motor delay and anemia. This already vulnerable indigenous Munduruku community presents with undernutrition and a high prevalence of chronic methylmercury exposure in women of childbearing age. This dual public health crisis in the context of wider health inequalities has the potential to compromise the development, health and survival of the developing fetus and infant in the first two critical years of life. We encourage culturally sensitive intervention and further research to focus efforts.


Assuntos
Mercúrio , Compostos de Metilmercúrio , Adolescente , Adulto , Animais , Criança , Estudos Transversais , Exposição Ambiental , Feminino , Peixes , Humanos , Lactente , Mercúrio/análise , Compostos de Metilmercúrio/toxicidade , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Rios , Adulto Jovem
6.
Artigo em Inglês | MEDLINE | ID: mdl-34501591

RESUMO

This paper is an exploratory study that examines the illegal goldmining impacts on Munduruku communities' "Good-Living" (Xipan Jewewekukap) and explores the possible relationship between chronic methylmercury (MeHg) exposure and the worsening mental health conditions in three villages in the Middle-Tapajós River, Brazilian Amazon. The region has been experiencing a long-lasting threat of goldminers' invasions. A total of 109 people were interviewed and evaluated. Total mercury (THg) exposure levels were evaluated through hair samples analysis, from which MeHg exposure levels were calculated. The Geriatric Depression Scale-Short Form (GDS-SF) was used as a screening tool in order to assess mental health indicators. Brief non-structured interviews were carried out to investigate how goldmining is impacting the communities Good-Living. A Poisson regression model was used to estimate the possible association between mental health indicators (assessed through the GDS-SF) and the following independent variables: (i) mercury exposure level (<10.0 µg/g vs. ≥10.0 µg/g), (ii) self-reported nervousness, (iii) self-reported irritability, (iv) age group, and (v) monthly income. The analysis revealed high levels of mercury in hair samples (median: 7.4 µg/g, range 2.0-22.8; 70% and 28% of the participants had THg levels ≥6.0 and ≥10.0 µg/g, respectively) and pointed to a tendency in which higher levels of methylmercury exposure (Hg ≥ 10.0 µg/g) could be linked to worse mental health indicators. Although the GDS-SF has presented limitations due to the Munduruku sociocultural context, our findings suggest a tendency of worse mental health indicators in participants presenting high levels of MeHg exposure. Despite this limitation, the qualitative approach indicates an evident association between the impacts of goldmining and the Munduruku people's decreasing autonomy to maintain a Good-Living on their own terms, pointing to the importance of carrying out new investigations, especially considering longitudinal studies with qualitative methodologies and ethnographic approaches.


Assuntos
Mercúrio , Compostos de Metilmercúrio , Idoso , Animais , Brasil , Monitoramento Ambiental , Peixes , Humanos , Saúde Mental , Mercúrio/análise , Rios
7.
Artigo em Inglês | MEDLINE | ID: mdl-34501811

RESUMO

The Amazonian indigenous peoples depend on natural resources to live, but human activities' growing impacts threaten their health and livelihoods. Our objectives were to present the principal results of an integrated and multidisciplinary analysis of the health parameters and assess the mercury (Hg) exposure levels in indigenous populations in the Brazilian Amazon. We carried out a cross-sectional study based on a census of three Munduruku indigenous villages (Sawré Muybu, Poxo Muybu, and Sawré Aboy), located in the Sawré Muybu Indigenous Land, between 29 October and 9 November 2019. The investigation included: (i) sociodemographic characterization of the participants; (ii) health assessment; (iii) genetic polymorphism analysis; (iv) hair mercury determination; and (v) fish mercury determination. We used the logistic regression model with conditional Prevalence Ratio (PR), with the respective 95% confidence intervals (CI95%) to explore factors associated with mercury exposure levels ≥6.0 µg/g. A total of 200 participants were interviewed. Mercury levels (197 hair samples) ranged from 1.4 to 23.9 µg/g, with significant differences between the villages (Kruskal-Wallis test: 19.9; p-value < 0.001). On average, the general prevalence of Hg exposure ≥ 6.0 µg/g was 57.9%. For participants ≥12 years old, the Hg exposure ≥6.0 µg/g showed associated with no regular income (PR: 1.3; CI95%: 1.0-1.8), high blood pressure (PR: 1.6; CI95%: 1.3-2.1) and was more prominent in Sawré Aboy village (PR: 1.8; CI95%: 1.3-2.3). For women of childbearing age, the Hg exposure ≥6.0 µg/g was associated with high blood pressure (PR: 1.9; CI95%: 1.2-2.3), with pregnancy (PR: 1.5; CI95%: 1.0-2.1) and was more prominent among residents in Poxo Muybu (PR: 1.9; CI95%: 1.0-3.4) and Sawré Aboy (PR: 2.5; CI95%: 1.4-4.4) villages. Our findings suggest that chronic mercury exposure causes harmful effects to the studied indigenous communities, especially considering vulnerable groups of the population, such as women of childbearing age. Lastly, we propose to stop the illegal mining in these areas and develop a risk management plan that aims to ensure the health, livelihoods, and human rights of the indigenous people from Amazon Basin.


Assuntos
Mercúrio , Animais , Brasil , Criança , Estudos Transversais , Exposição Ambiental/análise , Feminino , Peixes , Ouro , Humanos , Mercúrio/análise , Mineração , Grupos Populacionais
8.
Artigo em Inglês | MEDLINE | ID: mdl-34444495

RESUMO

Genetic polymorphisms involved in mercury toxicokinetics and toxicodynamics may be associated with severe mercury toxicity. This study aimed to investigate the impact of an ALAD polymorphism on chronic mercury exposure and the health situation of indigenous children from the Brazilian Amazon. One-hundred-and-three indigenous children (under 15 years old) were included and genotyped (rs1800435) using a TaqMan validated assay. The mean age was 6.6 ± 4.5 years old, 60% were female, 49% presented with anemia, and the mean hair mercury concentration was 7.0 ± 4.5 (1.4-23.9) µg/g, with 49% exceeding the reference limit (≥6.0 µg/g). Only two children were heterozygous ALAD, while the others were all wild type. Minor allele frequency (ALAD G) and heterozygous genotype (ALAD CG) were 1% and 2%, respectively. The two children (12 and 14 years old) with the ALAD polymorphism had mercury levels above the average as well as had neurological symptoms related to chronic mercury exposure, such as visual field alterations, memory deficit, distal neuropathy, and toe amyotrophy. Both children also reported frequent consumption of fish in the diet, at least three times a week. In conclusion, our data confirm that an ALAD polymorphism can contribute to mercury half-life time, harmful effects, and neuropsychological disorders in indigenous children with chronic mercury exposure to gold mining activity.


Assuntos
Mercúrio , Sintase do Porfobilinogênio , Animais , Criança , Pré-Escolar , Feminino , Frequência do Gene , Genótipo , Humanos , Masculino , Polimorfismo Genético , Sintase do Porfobilinogênio/genética
9.
PLoS One ; 15(10): e0240090, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031403

RESUMO

OBJECTIVES: This study aimed to analyze the factors associated with likely TB deaths, likely TB-related deaths and deaths from other causes. Understanding the factors associated with mortality could help the strategy to End TB, especially the goal of reducing TB deaths by 95% between 2015 and 2035. METHODS: A retrospective, population-based cohort study of the causes of death was performed using a competing risk model in patients receiving treatment for TB. Patients had started TB treatment in Brazil 2008-2013 with any death certificates dated in the same period. We used three categories of deaths, according to ICD-10 codes: i) probable TB deaths; ii) TB-related deaths; iii) deaths from other causes. RESULTS: In this cohort, 39,997 individuals (14.1%) died, out of a total of 283,508 individuals. Of these, 8,936 were probable TB deaths (22.4%) and 3,365 TB-related deaths (8.4%), illustrating high mortality rates. 27,696 deaths (69.2%) were from other causes. From our analysis, factors strongly associated with probable TB deaths were male gender (sHR = 1.33, 95% CI: 1.26-1.40), age over 60 years (sHR = 9.29, 95% CI: 8.15-10.60), illiterate schooling (sHR = 2.33, 95% CI: 2.09-2.59), black (sHR = 1.33, 95% CI: 1.26-1.40) and brown (sHR = 13, 95% CI: 1.07-1.19) color/race, from the Southern region (sHR = 1.19, 95% CI: 1.10-1.28), clinical mixed forms (sHR = 1.91, 95% CI: 1.73-2.11) and alcoholism (sHR = 1.90, 95% CI: 1.81-2.00). Also, HIV positive serology was strongly associated with probable TB deaths (sHR = 62.78; 95% CI: 55.01-71.63). CONCLUSIONS: In conclusion, specific strategies for active surveillance and early case detection can reduce mortality among patients with tuberculosis, leading to more timely detection and treatment.


Assuntos
Risco , Tuberculose/patologia , Adolescente , Adulto , Alcoolismo/complicações , Brasil , Criança , Pré-Escolar , Etnicidade , Feminino , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Humanos , Lactente , Recém-Nascido , Alfabetização , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores Sexuais , Análise de Sobrevida , Tuberculose/complicações , Tuberculose/mortalidade , Adulto Jovem
10.
Sleep Med ; 74: 81-85, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32841849

RESUMO

BACKGROUND: Due to the 2019 novel coronavirus (COVID-19) disease outbreak, social distancing measures were imposed to control the spread of the pandemic. However, isolation may affect negatively the psychological well-being and impair sleep quality. Our aim was to evaluate the sleep quality of respiratory patients during the COVID-19 pandemic lockdown. METHODS: All patients who underwent a telemedicine appointment from March 30 to April 30 of 2020 were asked to participate in the survey. Sleep difficulties were measured using Jenkins Sleep Scale. RESULTS: The study population consisted of 365 patients (mean age 63.9 years, 55.6% male, 50.1% with sleep-disordered breathing [SDB]). During the lockdown, 78.9% of participants were confined at home without working. Most patients (69.6%) reported at least one sleep difficulty and frequent awakenings was the most prevalent problem. Reporting at least one sleep difficulty was associated with home confinement without working, female gender and diagnosed or suspected SDB, after adjustment for cohabitation status and use of anxiolytics. Home confinement without working was associated with difficulties falling asleep and waking up too early in the morning. Older age was a protective factor for difficulties falling asleep, waking up too early and non-restorative sleep. Notably, SDB patients with good compliance to positive airway pressure therapy were less likely to report sleep difficulties. CONCLUSIONS: Home confinement without working, female gender and SDB may predict a higher risk of reporting sleep difficulties. Medical support during major disasters should be strengthened and potentially delivered through telemedicine, as this comprehensive approach could reduce psychological distress and improve sleep quality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Pandemias , Pneumonia Viral/psicologia , Síndromes da Apneia do Sono/psicologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Isolamento Social/psicologia , Idoso , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Portugal/epidemiologia , SARS-CoV-2 , Sono/fisiologia , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/terapia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Inquéritos e Questionários , Telemedicina/métodos
11.
Reprod Biomed Online ; 40(6): 856-866, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32376314

RESUMO

RESEARCH QUESTION: A previous study showed that N-acetylcysteine (NAC), used after in-vitro exposure to the gonadotoxic chemotherapeutic drug etoposide, has the ability to decrease DNA damage in human spermatozoa; however, it showed no benefit when used before exposure. This study aimed to evaluate the impact of the NAC on the preservation of sperm quality during in-vitro exposure to etoposide. DESIGN: Twenty semen samples were submitted to four experimental conditions: control, NAC-only incubation, etoposide-only incubation, and concomitant etoposide and NAC incubation. After in-vitro incubation, semen parameters, sperm chromatin condensation, sperm DNA fragmentation, sperm oxidative stress and sperm metabolism were used to evaluate the role of NAC in protecting human spermatozoa from etoposide. RESULTS: Etoposide did not affect semen parameters, nor did it cause sperm oxidative damage or alterations in glycolytic profile. However, it induced chromatin decondensation and DNA fragmentation, which were fully prevented by NAC. CONCLUSIONS: NAC was able to protect sperm DNA integrity during etoposide treatment in vitro, suggesting that NAC may be useful as an adjuvant agent in preserving male fertility during chemotherapy treatments.


Assuntos
Antineoplásicos Fitogênicos/farmacologia , Antioxidantes/farmacologia , Dano ao DNA/efeitos dos fármacos , DNA , Etoposídeo/farmacologia , Estresse Oxidativo/efeitos dos fármacos , Espermatozoides/efeitos dos fármacos , Fragmentação do DNA/efeitos dos fármacos , Humanos , Masculino , Análise do Sêmen , Preservação do Sêmen
12.
J. Health Biol. Sci. (Online) ; 8(1): 1-6, 20200101. ilus
Artigo em Inglês | LILACS | ID: biblio-1130009

RESUMO

Objectives: We conducted a retrospective, observational, case-control type study to define the clinical and epidemiological characteristics and factors associated with death in the intensive care of these patients. Methodology: We reviewed the medical records and examinations of 72 patients with confirmed diagnosis of SARS-CoV-2 infection in our intensive care unit (ICU). Results: In the review, 20 patients died during hospitalization, and 52 were discharged from the ICU. Associated with mortality, we verified, after analysis, that age, male gender, smoking, tropononin levels, creatinine, lymphocytes, bilirubin, and respiratory compliance were statistically significant. SOFA, APACHE 2, and SAPS 2 scores were good predictors of ICU mortality in this population. Conclusion: Despite several limitations, our study was able to demonstrate a series of clinical and laboratory factors associated with ICU death by COVID-19, compatible with international and multicenter case series.


Objetivo: Realizamos um estudo retrospectivo, observacional, tipo caso-controle com o objetivo de definir as características clínicas, epidemiológicas e fatores associados à morte em terapia intensiva desses pacientes. Metodologia: Revisamos os prontuários e exames de 72 pacientes com diagnóstico confirmado de infecção por SARS-CoV-2 em nossa unidade de terapia intensiva (UTI), realizando uma análise de fatores associados a óbito em terapia intensiva em nossa população. Resultados: Em nosso centro, 20 pacientes morreram durante o internamento, e 52 tiveram alta da UTI. Associado à mortalidade, verificamos, após análise, que idade, sexo masculino, tabagismo, níveis de tropononina, creatinina, linfócitos, bilirrubinas e complacência respiratória tiveram significância estatística. Os escores SOFA, APACHE 3 e SAPS 2 foram bons preditores de mortalidade em UTI nessa população em nosso meio. Conclusão: Apesar das várias limitações, nosso estudo conseguiu demostrar uma série de fatores clínicos e laboratoriais associados a óbito em UTI por COVID-19, compatível com séries de casos internacionais e multicêntricas.


Assuntos
Infecções por Coronavirus , Coronavirus , Betacoronavirus , Pacientes , População , Síndrome do Desconforto Respiratório do Recém-Nascido , Mortalidade , Cuidados Críticos , Diagnóstico , Unidades de Terapia Intensiva
13.
Cad Saude Publica ; 35Suppl 3(Suppl 3): e00074218, 2019 Aug 19.
Artigo em Português | MEDLINE | ID: mdl-31433033

RESUMO

The study aimed to describe clinical and sociodemographic characteristics, estimate incidence, and analyze factors associated with dropout and death during treatment of TB cases reported in indigenous children and adolescents in Brazil from 2006 to 2016. A historical case series was performed on incidence according to age bracket and major geographic region, and multinomial logistic regression was used to explain factors associated with treatment dropout and death. Of the 2,096 reported cases, 88.2% evolved to cure, 7.2% dropped out of treatment, and 4.6% evolved to death. There was a predominance of cases in boys 15-19 years of age and a higher proportion of deaths (55.7%) in children < 4 years. Considering indigenous children and adolescents with TB in Brazil as a whole, mean incidence was 49.1/100,000, ranging from 21.5/100,000 to 97.6/100,000 in the Northeast and Central, respectively. Cases with insufficient and irregular follow-up showed higher odds of dropout (OR = 11.1; 95%CI: 5.2-24.8/OR = 4.4; 95%CI: 1.9-10.3) and death (OR = 20.3; 95%CI: 4.9-84.9/OR = 5.1; 95%CI: 1.2-22.7). Cases in retreatment (OR = 2.4; 95%CI: 2.08-8.55) and with HIV coinfection (OR = 8.2; 95%CI: 2.2-30.9) were also associated with dropout. Extrapulmonary (OR = 1.8; 95%CI: 1.1-3.3) and mixed clinical forms (OR = 5.6; 95%CI: 2.8-11.4), age < 4 years (OR = 3.1; 95%CI: 1.5-6.4), and cases from the North (OR = 2.8; 95%CI: 1.1-7.1) and Central (OR = 2.8; 95%CI: 1.1-7.0) were associated with death. TB control in indigenous children and adolescents cannot be achieved without investments in research and development and without reducing social inequalities.


O objetivo deste estudo foi descrever características clínicas e sociodemográficas, estimar a incidência da tuberculose (TB), além de analisar fatores associados ao abandono e ao óbito na vigência do tratamento dos casos de TB notificados entre crianças e adolescentes indígenas, no Brasil, entre 2006-2016. Realizou-se análise da série histórica de incidência, segundo faixa etária e macrorregião e utilizou-se regressão logística multinomial para elucidar fatores associados ao abandono e ao óbito. Do total de 2.096 casos notificados, 88,2% tiveram cura, 7,2% abandonaram o tratamento e 4,6% evoluíram para óbito. Houve predomínio de casos em meninos de 15-19 anos e maior proporção de óbitos (55,7%) em < 4 anos. Considerando o conjunto de crianças e adolescentes indígenas com TB no Brasil, a incidência média foi 49,1/100 mil, variando de 21,5/100 mil a 97,6/100 mil nas regiões Nordeste e Centro-oeste, respectivamente. Os casos com acompanhamento insuficiente e regular tiveram maiores chances de abandono (OR = 11,1; IC95%: 5,2-24,8/OR = 4,4; IC95%: 1,9-10,3) e óbito (OR = 20,3; IC95%: 4,9-84,9/OR = 5,1; IC95%: 1,2-22,7). Os casos em retratamento (OR = 2,4; IC95%: 2,08-8,55) e com anti-HIV positivo (OR = 8,2; IC95%: 2,2-30,9) também mostraram-se associados ao abandono. As formas clínicas extrapulmonar (OR = 1,8; IC95%: 1,1-3,3) e mista (OR = 5,6; IC95%: 2,8-11,4), os casos em < 4 anos (OR = 3,1; IC95%: 1,5-6,4) e os casos provenientes das regiões Norte (OR = 2,8; IC95%: 1,1-7,1) e Centro-oeste (OR = 2,8; IC95%: 1,1-7,0) mostraram-se associados ao óbito. Acreditamos que o controle da TB em crianças e adolescentes indígenas não poderá ser alcançado sem investimentos em pesquisa e desenvolvimento e sem a redução das desigualdades sociais.


El objetivo de este estudio fue describir características clínicas y sociodemográficas, estimar la incidencia de la tuberculosis (TB), además de analizar factores asociados al abandono y al óbito en la vigencia del tratamiento de los casos de TB, notificados entre niños y adolescentes indígenas, en Brasil entre 2006-2016. Se realizó un análisis de la serie histórica de incidencia, según la franja de edad y macrorregión y se utilizó la regresión logística multinomial para elucidar factores asociados al abandono y al óbito. Del total de 2.096 casos notificados, un 88,2% tuvieron cura, un 7,2% abandonaron el tratamiento y un 4,6% evolucionaron hacia óbito. Hubo un predominio de casos en chicos de 15-19 años y mayor proporción de óbitos (55,7%) en < 4 años. Considerando el conjunto de niños y adolescentes indígenas con TB en Brasil, la incidencia media fue 49,1/100.000, variando de 21,5/100.000 a 97,6/100.000 en las regiones Nordeste y Centro-oeste, respectivamente. Los casos con un seguimiento insuficiente y regular tuvieron mayores oportunidades de abandono (OR = 11,1; IC95%: 5,2-24,8/OR = 4,4; IC95%: 1,9-10,3) y óbito (OR = 20,3; IC95%: 4,9-84,9/OR = 5,1; IC95%: 1,2-22,7). Los casos de retorno al tratamiento (OR = 2,4; IC95%: 2,08-8,55) y con anti-VIH positivo (OR = 8,2; IC95%: 2,2-30,9) también se mostraron asociados al abandono. Las formas clínicas extrapulmonares (OR = 1,8; IC95%: 1,1-3,3) y mixta (OR = 5,6; IC95%: 2,8-11,4), los casos en < 4 años (OR = 3,1; IC95%: 1,5-6,4) y los casos procedentes de las regiones Norte (OR = 2,8; IC95%: 1,1-7,1) y Centro-oeste (OR = 2,8; IC95%: 1,1-7,0) se mostraron asociados al óbito. Creemos que el control de la TB en niños y adolescentes indígenas no se podrá alcanzar sin inversiones en investigación y desarrollo y sin la reducción de las desigualdades sociales.


Assuntos
Morte , Notificação de Doenças/estatística & dados numéricos , Indígenas Sul-Americanos/estatística & dados numéricos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Tuberculose/epidemiologia , Adolescente , Distribuição por Idade , Brasil/epidemiologia , Criança , Pré-Escolar , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Feminino , Humanos , Incidência , Lactente , Masculino , Pacientes Desistentes do Tratamento/etnologia , Características de Residência/estatística & dados numéricos , Distribuição por Sexo , Fatores Socioeconômicos , Tuberculose/diagnóstico , Tuberculose/etnologia , Tuberculose/mortalidade , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/etnologia , Adulto Jovem
14.
Psicol. rev. (Belo Horizonte) ; 25(2): 442-457, ago. 2019.
Artigo em Português | LILACS, Index Psicologia - Periódicos | ID: biblio-1279556

RESUMO

No âmbito da Psicologia do desenvolvimento, têm-se realizado pesquisas que buscam investigar os processos desenvolvimentais em suas dimensões cognitivas, sociais e biológicas em todo o ciclo da vida. Nesse contexto, este trabalho buscou evidenciar o papel destacado da afetividade como dimensão essencial no processo desenvolvimental do sujeito, já que esta parece se situar no cerne da vida social, conferindo significação e sentido para a existência. Com base em alguns marcadores em Bowlby e Wallon que situam a emergência do psíquico sobre a base biológica e o caráter relacional-afetivo desse processo, buscamos as implicações entre a formação de vínculos intersubjetivos e o desenvolvimento da afetividade humana, destacando as reflexões de Merleau-Ponty e Philippe Rochat sobre a Psicologia do desenvolvimento infantil.


In the field of Developmental Psychology, researches have been carried out aiming at investigating developmental processes in their cognitive, social and biological dimensions throughout the life cycle. Within this context, this study aimed to highlight the outstanding role of affection as an essential dimension in the subject’s developmental process, as this seems to lie in the core of social life, giving meaning and direction to life. Based on some markers in Bowlby and Wallon that place the emergence of the psychic on the biological basis and the relational-affective character of this process, we mean to look for the implications between the formation of intersubjective bonds and the development of the human affectivity, highlighting the reflections of Merleau-Ponty and Philippe Rochat on the child developmental Psychology.


En el ámbito de la Psicología del desarrollo se han realizado pesquisas que tratan de investigar los procesos de desarrollo en sus dimensiones cognitivas, sociales y biológicas a lo largo del ciclo vital. En este contexto, el estudio buscó poner de relieve el importante papel de la afectividad como dimensión esencial en el proceso de desarrollo del sujeto, ya que esta parece ubicarse en el centro de la vida social, confiriendo significación y sentido a la existencia. A partir de algunos marcadores en Bowlby y Wallon que sitúan la emergencia de lo psíquico sobre la base biológica y el carácter relacionalafectivo de este proceso, buscamos las implicaciones entre la formación de vínculos intersubjetivos y el desarrollo de la afectividad humana, destacando las reflexiones de Merleau-Ponty y Philippe Rochat sobre la Psicología del desarrollo infantil.


Assuntos
Psicologia do Desenvolvimento , Desenvolvimento Infantil , Afeto
16.
Cad. Saúde Pública (Online) ; 35(supl.3): e00074218, 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1019641

RESUMO

Resumo: O objetivo deste estudo foi descrever características clínicas e sociodemográficas, estimar a incidência da tuberculose (TB), além de analisar fatores associados ao abandono e ao óbito na vigência do tratamento dos casos de TB notificados entre crianças e adolescentes indígenas, no Brasil, entre 2006-2016. Realizou-se análise da série histórica de incidência, segundo faixa etária e macrorregião e utilizou-se regressão logística multinomial para elucidar fatores associados ao abandono e ao óbito. Do total de 2.096 casos notificados, 88,2% tiveram cura, 7,2% abandonaram o tratamento e 4,6% evoluíram para óbito. Houve predomínio de casos em meninos de 15-19 anos e maior proporção de óbitos (55,7%) em < 4 anos. Considerando o conjunto de crianças e adolescentes indígenas com TB no Brasil, a incidência média foi 49,1/100 mil, variando de 21,5/100 mil a 97,6/100 mil nas regiões Nordeste e Centro-oeste, respectivamente. Os casos com acompanhamento insuficiente e regular tiveram maiores chances de abandono (OR = 11,1; IC95%: 5,2-24,8/OR = 4,4; IC95%: 1,9-10,3) e óbito (OR = 20,3; IC95%: 4,9-84,9/OR = 5,1; IC95%: 1,2-22,7). Os casos em retratamento (OR = 2,4; IC95%: 2,08-8,55) e com anti-HIV positivo (OR = 8,2; IC95%: 2,2-30,9) também mostraram-se associados ao abandono. As formas clínicas extrapulmonar (OR = 1,8; IC95%: 1,1-3,3) e mista (OR = 5,6; IC95%: 2,8-11,4), os casos em < 4 anos (OR = 3,1; IC95%: 1,5-6,4) e os casos provenientes das regiões Norte (OR = 2,8; IC95%: 1,1-7,1) e Centro-oeste (OR = 2,8; IC95%: 1,1-7,0) mostraram-se associados ao óbito. Acreditamos que o controle da TB em crianças e adolescentes indígenas não poderá ser alcançado sem investimentos em pesquisa e desenvolvimento e sem a redução das desigualdades sociais.


Abstract: The study aimed to describe clinical and sociodemographic characteristics, estimate incidence, and analyze factors associated with dropout and death during treatment of TB cases reported in indigenous children and adolescents in Brazil from 2006 to 2016. A historical case series was performed on incidence according to age bracket and major geographic region, and multinomial logistic regression was used to explain factors associated with treatment dropout and death. Of the 2,096 reported cases, 88.2% evolved to cure, 7.2% dropped out of treatment, and 4.6% evolved to death. There was a predominance of cases in boys 15-19 years of age and a higher proportion of deaths (55.7%) in children < 4 years. Considering indigenous children and adolescents with TB in Brazil as a whole, mean incidence was 49.1/100,000, ranging from 21.5/100,000 to 97.6/100,000 in the Northeast and Central, respectively. Cases with insufficient and irregular follow-up showed higher odds of dropout (OR = 11.1; 95%CI: 5.2-24.8/OR = 4.4; 95%CI: 1.9-10.3) and death (OR = 20.3; 95%CI: 4.9-84.9/OR = 5.1; 95%CI: 1.2-22.7). Cases in retreatment (OR = 2.4; 95%CI: 2.08-8.55) and with HIV coinfection (OR = 8.2; 95%CI: 2.2-30.9) were also associated with dropout. Extrapulmonary (OR = 1.8; 95%CI: 1.1-3.3) and mixed clinical forms (OR = 5.6; 95%CI: 2.8-11.4), age < 4 years (OR = 3.1; 95%CI: 1.5-6.4), and cases from the North (OR = 2.8; 95%CI: 1.1-7.1) and Central (OR = 2.8; 95%CI: 1.1-7.0) were associated with death. TB control in indigenous children and adolescents cannot be achieved without investments in research and development and without reducing social inequalities.


Resumen: El objetivo de este estudio fue describir características clínicas y sociodemográficas, estimar la incidencia de la tuberculosis (TB), además de analizar factores asociados al abandono y al óbito en la vigencia del tratamiento de los casos de TB, notificados entre niños y adolescentes indígenas, en Brasil entre 2006-2016. Se realizó un análisis de la serie histórica de incidencia, según la franja de edad y macrorregión y se utilizó la regresión logística multinomial para elucidar factores asociados al abandono y al óbito. Del total de 2.096 casos notificados, un 88,2% tuvieron cura, un 7,2% abandonaron el tratamiento y un 4,6% evolucionaron hacia óbito. Hubo un predominio de casos en chicos de 15-19 años y mayor proporción de óbitos (55,7%) en < 4 años. Considerando el conjunto de niños y adolescentes indígenas con TB en Brasil, la incidencia media fue 49,1/100.000, variando de 21,5/100.000 a 97,6/100.000 en las regiones Nordeste y Centro-oeste, respectivamente. Los casos con un seguimiento insuficiente y regular tuvieron mayores oportunidades de abandono (OR = 11,1; IC95%: 5,2-24,8/OR = 4,4; IC95%: 1,9-10,3) y óbito (OR = 20,3; IC95%: 4,9-84,9/OR = 5,1; IC95%: 1,2-22,7). Los casos de retorno al tratamiento (OR = 2,4; IC95%: 2,08-8,55) y con anti-VIH positivo (OR = 8,2; IC95%: 2,2-30,9) también se mostraron asociados al abandono. Las formas clínicas extrapulmonares (OR = 1,8; IC95%: 1,1-3,3) y mixta (OR = 5,6; IC95%: 2,8-11,4), los casos en < 4 años (OR = 3,1; IC95%: 1,5-6,4) y los casos procedentes de las regiones Norte (OR = 2,8; IC95%: 1,1-7,1) y Centro-oeste (OR = 2,8; IC95%: 1,1-7,0) se mostraron asociados al óbito. Creemos que el control de la TB en niños y adolescentes indígenas no se podrá alcanzar sin inversiones en investigación y desarrollo y sin la reducción de las desigualdades sociales.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Tuberculose/epidemiologia , Indígenas Sul-Americanos/estatística & dados numéricos , Notificação de Doenças/estatística & dados numéricos , Morte , Pacientes Desistentes do Tratamento/etnologia , Fatores Socioeconômicos , Tuberculose/diagnóstico , Tuberculose/etnologia , Tuberculose/mortalidade , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/etiologia , Tuberculose Pulmonar/epidemiologia , Brasil/epidemiologia , Características de Residência/estatística & dados numéricos , Incidência , Distribuição por Sexo , Distribuição por Idade , Continuidade da Assistência ao Paciente/estatística & dados numéricos
17.
Cad Saude Publica ; 34(5): e00048217, 2018 05 10.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29768580

RESUMO

Drug-resistant tuberculosis (DR-TB) poses a serious threat to tuberculosis (TB) control in Brazil and worldwide. The current study investigated factors associated with loss to follow-up and death in the course of treatment for DR-TB in a tertiary reference center in the city of Rio de Janeiro, Brazil. This was a retrospective cohort study of cases reported to the Information System on Special Treatments for Tuberculosis (SITETB) from January 1, 2012, to December 31, 2013. A total of 257 patients were reported to the SITETB and initiated treatment for DR-TB. Of this total, 139 (54.1%) achieved treatment success as the outcome, 54 (21%) were lost to follow-up, and 21 (8.2%) died. Following a multiple multinomial logistic regression analysis, the age bracket older than 50 years was the only protective factor against loss to follow-up, whereas less than eight years of schooling and reentry after loss to follow-up were considered risk factors. Reentry after loss to follow-up, relapse, and treatment failure appeared as risk factors. Our data reinforce the concept that loss to follow-up in drug-resistant tuberculosis is a serious public health problem, and that adequate follow-up of treatment is necessary in patients with this history and low schooling. A social support network for patients is also indispensable for avoiding unfavorable outcomes.


A tuberculose drogarresistente (TBDR) representa hoje uma grave ameaça aos avanços no controle da tuberculose (TB) no Brasil e no mundo. Neste estudo, investigam-se fatores associados ao abandono e ao óbito de casos em tratamento para TBDR, em um centro de referência terciária do Município do Rio de Janeiro, Brasil. Trata-se de um estudo de coorte retrospectiva, a partir dos casos notificados no Sistema de Informação de Tratamentos Especiais de Tuberculose (SITETB), no período de 1º de janeiro de 2012 a 31 de dezembro de 2013. Um total de 257 pacientes foi notificado no SITETB e iniciou o tratamento para TBDR. Desse total, 139 (54,1%) tiveram sucesso terapêutico como desfecho, 54 (21%) abandonaram o tratamento e 21 (8,2%) evoluíram para óbito. Após análise de regressão logística multinomial múltipla, a faixa etária acima de cinquenta anos foi observada como único fator de proteção ao abandono, ao passo que ter menos de oito anos de escolaridade e reingresso após abandono foram considerados como fatores de risco. Reingresso após abandono, recidiva e falência indicaram fatores de risco. Nossos dados reforçam a concepção de que o abandono do tratamento de tuberculose resistente é um sério problema de saúde pública, sendo necessário um adequado acompanhamento no tratamento de pacientes com esse histórico e com baixa escolaridade. Além disso, uma rede de apoio social ao paciente é imprescindível para que desfechos desfavoráveis sejam evitados.


La tuberculosis farmacorresistente (TBFR) representa hoy una grave amenaza para los avances en el control de la tuberculosis (TB) en Brasil y en el mundo. En este estudio, se investigan factores asociados al abandono y al óbito de casos en tratamiento para TBDR, dentro de un centro de referencia de carácter terciario del municipio de Río de Janeiro, Brasil. Se trata de un estudio de cohorte retrospectiva, a partir de los casos notificados en el Sistema de Información de Tratamientos Especiales de Tuberculosis (SITETB), durante el período del 1 de enero de 2012 al 31 de diciembre de 2013. Un total de 257 pacientes fue notificado en el SITETB y comenzó el tratamiento para TBDR. De ese total, 139 (un 54,1%) tuvieron éxito terapéutico como desenlace, 54 (un 21%) abandonaron el tratamiento y un 21 (8,2%) evolucionaron hacia óbito. Tras el análisis de regresión logística multinomial múltiple, la franja de edad por encima de cincuenta años se observó como el único factor de protección al abandono, al mismo tiempo que tener menos de ocho años de escolaridad y reingresar en el sistema educativo tras el abandono fueron considerados como factores de riesgo. Reingreso tras abandono, recidiva e insolvencia indicaron factores de riesgo. Nuestros datos refuerzan la concepción de que el abandono del tratamiento de tuberculosis resistente es un serio problema de salud pública, siendo necesario un adecuado acompañamiento en el tratamiento de pacientes con este historial y con baja escolaridad. Además, una red de apoyo social entorno al paciente es imprescindible para que los desenlaces desfavorables sean evitados.


Assuntos
Perda de Seguimento , Encaminhamento e Consulta/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/mortalidade , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Análise de Regressão , Estudos Retrospectivos , Fatores Socioeconômicos , Falha de Tratamento , Adulto Jovem
18.
Cad. Saúde Pública (Online) ; 34(5): e00048217, 2018. tab
Artigo em Português | LILACS | ID: biblio-889984

RESUMO

Resumo: A tuberculose drogarresistente (TBDR) representa hoje uma grave ameaça aos avanços no controle da tuberculose (TB) no Brasil e no mundo. Neste estudo, investigam-se fatores associados ao abandono e ao óbito de casos em tratamento para TBDR, em um centro de referência terciária do Município do Rio de Janeiro, Brasil. Trata-se de um estudo de coorte retrospectiva, a partir dos casos notificados no Sistema de Informação de Tratamentos Especiais de Tuberculose (SITETB), no período de 1º de janeiro de 2012 a 31 de dezembro de 2013. Um total de 257 pacientes foi notificado no SITETB e iniciou o tratamento para TBDR. Desse total, 139 (54,1%) tiveram sucesso terapêutico como desfecho, 54 (21%) abandonaram o tratamento e 21 (8,2%) evoluíram para óbito. Após análise de regressão logística multinomial múltipla, a faixa etária acima de cinquenta anos foi observada como único fator de proteção ao abandono, ao passo que ter menos de oito anos de escolaridade e reingresso após abandono foram considerados como fatores de risco. Reingresso após abandono, recidiva e falência indicaram fatores de risco. Nossos dados reforçam a concepção de que o abandono do tratamento de tuberculose resistente é um sério problema de saúde pública, sendo necessário um adequado acompanhamento no tratamento de pacientes com esse histórico e com baixa escolaridade. Além disso, uma rede de apoio social ao paciente é imprescindível para que desfechos desfavoráveis sejam evitados.


Resumen: La tuberculosis farmacorresistente (TBFR) representa hoy una grave amenaza para los avances en el control de la tuberculosis (TB) en Brasil y en el mundo. En este estudio, se investigan factores asociados al abandono y al óbito de casos en tratamiento para TBDR, dentro de un centro de referencia de carácter terciario del municipio de Río de Janeiro, Brasil. Se trata de un estudio de cohorte retrospectiva, a partir de los casos notificados en el Sistema de Información de Tratamientos Especiales de Tuberculosis (SITETB), durante el período del 1 de enero de 2012 al 31 de diciembre de 2013. Un total de 257 pacientes fue notificado en el SITETB y comenzó el tratamiento para TBDR. De ese total, 139 (un 54,1%) tuvieron éxito terapéutico como desenlace, 54 (un 21%) abandonaron el tratamiento y un 21 (8,2%) evolucionaron hacia óbito. Tras el análisis de regresión logística multinomial múltiple, la franja de edad por encima de cincuenta años se observó como el único factor de protección al abandono, al mismo tiempo que tener menos de ocho años de escolaridad y reingresar en el sistema educativo tras el abandono fueron considerados como factores de riesgo. Reingreso tras abandono, recidiva e insolvencia indicaron factores de riesgo. Nuestros datos refuerzan la concepción de que el abandono del tratamiento de tuberculosis resistente es un serio problema de salud pública, siendo necesario un adecuado acompañamiento en el tratamiento de pacientes con este historial y con baja escolaridad. Además, una red de apoyo social entorno al paciente es imprescindible para que los desenlaces desfavorables sean evitados.


Abstract: Drug-resistant tuberculosis (DR-TB) poses a serious threat to tuberculosis (TB) control in Brazil and worldwide. The current study investigated factors associated with loss to follow-up and death in the course of treatment for DR-TB in a tertiary reference center in the city of Rio de Janeiro, Brazil. This was a retrospective cohort study of cases reported to the Information System on Special Treatments for Tuberculosis (SITETB) from January 1, 2012, to December 31, 2013. A total of 257 patients were reported to the SITETB and initiated treatment for DR-TB. Of this total, 139 (54.1%) achieved treatment success as the outcome, 54 (21%) were lost to follow-up, and 21 (8.2%) died. Following a multiple multinomial logistic regression analysis, the age bracket older than 50 years was the only protective factor against loss to follow-up, whereas less than eight years of schooling and reentry after loss to follow-up were considered risk factors. Reentry after loss to follow-up, relapse, and treatment failure appeared as risk factors. Our data reinforce the concept that loss to follow-up in drug-resistant tuberculosis is a serious public health problem, and that adequate follow-up of treatment is necessary in patients with this history and low schooling. A social support network for patients is also indispensable for avoiding unfavorable outcomes.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Encaminhamento e Consulta/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/mortalidade , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Perda de Seguimento , Readmissão do Paciente/estatística & dados numéricos , Fatores Socioeconômicos , Brasil/epidemiologia , Análise de Regressão , Estudos Retrospectivos , Fatores Etários , Falha de Tratamento
19.
J Environ Manage ; 197: 393-403, 2017 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-28410517

RESUMO

The present work evaluated the effect of the acid treatment conditions of natural kaolinite (NK) regarding its efficiency in removing etheramine. The treatment was conducted using sulfuric acid at the concentrations of 1 mol L-1 (KA-01), 2 mol L-1 (KA-02) and 5 mol L-1 (KA-05) at 85 °C. The obtained adsorbents were characterized by X-ray fluorescence, X-ray diffraction, N2 adsorption/desorption isotherms, zeta potential analysis and infrared spectroscopy. The Response Surface Method was used to optimize adsorption parameters (initial concentration of etheramine, adsorbent mass and pH of the solution). The results, described by means of a central composite design, were adjusted to the quadratic model. Results revealed that the adsorption was more efficient at the etheramine concentration of 400 mg L-1, pH 10 and adsorbent mass of 0.1 g for NK and 0.2 g for KA-01, KA-02 and KA-05. The sample KA-02 presented a significant increase of etheramine removal compared to the NK sample. The adsorption kinetics conducted under optimized conditions showed that the system reached the equilibrium in approximately 30 min. The kinetic data were better adjusted to the pseudo-second order model. The isotherm data revealed that the Sips model was the most adequate one. The calculation of Eads allowed to infer that the mechanism for etheramine removal in all the evaluated samples was chemisorption. The reuse tests showed that, after four uses, the efficiency of adsorbents in removing etheramine did not suffer significant modifications, which makes the use of kaolinite to treat effluents from the reverse flotation of iron ore feasible.


Assuntos
Caulim , Adsorção , Concentração de Íons de Hidrogênio , Cinética , Difração de Raios X
20.
Psicol. ciênc. prof ; 36(4): 831-846, out.-dez. 2016. tab
Artigo em Português | LILACS | ID: biblio-829366

RESUMO

Resumo A vivência estudantil na universidade é uma questão pouco investigada e discutida, especialmente nos cursos de Psicologia, assim como o sofrimento que pode acompanhá-la, decorrente sobretudo do contato com o sofrimento psíquico de outras pessoas ou os conteúdos acadêmicos mais diretamente relacionados com a subjetividade humana. Este artigo apresenta dados de uma pesquisa cujo objetivo era o levantamento das vivências acadêmicas dos estudantes de Psicologia de uma universidade pública do interior paulista. Na coleta de dados foi utilizado um instrumento, contendo uma questão de identificação sociodemográfica, um conjunto de 20 itens de múltipla escolha (formulado como numa escala do tipo likert de cinco pontos) e cinco questões abertas, que foi respondido por 119 estudantes dos cinco anos do curso. Os resultados, após serem submetidos às análises quantitativa e qualitativa, permitiram verificar que, na Escala Likert, os alunos apresentaram, no geral, percepção favorável do curso. No entanto, nas questões abertas referentes às vivências e ao sofrimento psíquico foram apresentados indicadores explícitos de mal-estar universitário. Na última questão, que indagava sobre a vivência de sofrimento psíquico, 107 dos 119 estudantes responderam afirmativamente. A partir destes dados, se discute a necessidade urgente de ações, tanto por parte dos gestores universitários quanto das entidades que fiscalizam a formação de psicólogos....(AU)


Abstract Academic experiences constitute a poorly discussed and researched subject, which is also truth for the suffering that may go along with such experiences, especially in the psychology courses, as well as the suffering that can accompany them, stemming mainly from contact with the psychic suffering of others or with an academic content more directly related to human subjectivity. This study presents data from a survey whose purpose was to map the academic experiences of psychology students, at a Brazilian public University. A questionnaire containing a question of socio-demographic identification, a set of 20 multiple-choice items (formulated as a Likert scale of five points) and five open questions was used to collect data by 119 students of the five years of the course. The results, after being subject to quantitative and qualitative analysis, allowed to verify, in Likert scale, that the students presented, in general, a favorable perception of the course. However, the open questions relating to experiences and psychological distress presented explicit indicators of university unease. In the last question, that inquired about the experience of psychological distress, 107 of 119 students responded affirmatively. From these data, we discuss the urgent need for action, both by university administrators and by the entities that oversee the training of psychologists....(AU)


Resumen La experiencia de los estudiantes en la universidad es un asunto poco investigado y discutido, sobre todo en los cursos de psicología, así como el sufrimiento que puede acompañarla, derivados principalmente del contacto con el sufrimiento psíquico de los demás, o con contenidos académicos más directamente relacionados con la subjetividad humano. Este artículo presenta datos de una encuesta cuyo objetivo fue estudiar las experiencias académicas de los estudiantes de psicología en una universidad pública de São Paulo. Para la recolección de datos se utilizó un cuestionario que contiene una pregunta de identificación sociodemográfico, un conjunto de 20 preguntas de elección múltiple (formulado como una escala Likert de cinco puntos) y cinco preguntas abiertas que fueron respondidas por 119 estudiantes de los cinco años del curso. Los resultados, después de haber sido objeto de un análisis cuantitativo y cualitativo, permiten verificar, en escala Likert, que los estudiantes presentan, en general, una percepción favorable del curso. Sin embargo, en las preguntas abiertas, relacionadas con las experiencias y los trastornos psicológicos, se presentaron indicadores explícitos de malestar universitario. En la última pregunta, que trataba acerca de la experiencia de sufrimiento psíquico, 107 de 119 estudiantes respondieron afirmativamente. A partir de estos datos, se discute la necesidad urgente de adoptar medidas, tanto por parte de los administradores de la universidad, como por parte las entidades que supervisan la formación de los psicólogos....(AU)


Assuntos
Humanos , Masculino , Feminino , Universidades , Saúde Mental , Psicologia , Estudantes , Orientação
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