Cluster-Based Multinomial Logistic Regression Model for Health-Related Quality of Life Among People Living with HIV in Brazil.

Improvement in treatment options has increased the survival of people living with HIV (PLHIV). Thus, we evaluated the factors associated with better health-related quality of life (HRQoL) among PLHIV in Brazil. This was a cross-sectional study carried out among 349 PLHIV. Data were collected using an interview-based questionnaire, and HRQoL was assessed by the Brazilian version of the WHOQOL HIV BREF instrument. We used non-hierarchical cluster analysis (K-means) to compile the WHOQOL HIV BREF's overall and domain scores into a unique more multidimensional measure for HRQoL consisting of three clusters: poor, fair and good; associations with clusters of better HRQoL were assessed using multinomial logistic regression models. The mean and median overall HRQoL scores were 15.13 (SD = 3.39) and 16, respectively. The reliability and validity of the Brazilian version of the WHOQOL HIV BREF instrument was confirmed among PLHIV in a non-metropolitan, medium-sized municipality of Brazil, which reaffirmed the cross-cultural validity of this instrument. The factors male sex; heterosexual and asexual orientations; higher individual income; undetectable viral load; absence of any comorbidity and presence of an infectious or a chronic comorbidity, with mental illness as the reference; and never having consumed illegal substances were independently associated with good HRQoL. Thus, the compilation of the WHOQOL HIV BREF's overall and domain scores into a unique multidimensional measure for HRQoL, which this study proposed for the first time, may facilitate more robust interpretations and models of predictors. These differentials could simplify HRQoL as an indicator of health and wellbeing to be routinely used as a key outcome in the clinical management of patients and in the global monitoring of health system responses to HIV.

RESUMEN: La mejora en las opciones de tratamiento ha aumentado la supervivencia de las personas que viven con el VIH (PVVIH). Por lo tanto, evaluamos los factores asociados con una mejor calidad de vida relacionada con la salud (CVRS) entre las PVVIH en Brasil. Se trata de un estudio transversal realizado con 349 PVVIH. Los datos se recopilaron mediante un cuestionario basado en entrevistas y la CVRS se evaluó mediante la versión brasileña del instrumento WHOQOL VIH BREF. Usamos un análisis de conglomerados no jerárquico (K-medias) para compilar las puntuaciones generales y de dominios del WHOQOL HIV BREF en una medida única más multidimensional para la CVRS que consta de tres conglomerados: deficiente, regular y bueno; y las asociaciones con grupos de mejor CVRS se evaluaron mediante modelos de regresión logística multinomial. Las puntuaciones de la CVRS global media y mediana fueron 15,13 (DE = 3,39) y 16. La confiabilidad y validez del WHOQOL VIH BREF versión brasileña fue confirmada entre personas que viven con el VIH en un municipio no metropolitano de mediana población de Brasil, lo que reafirma la validez transcultural de este instrumento. Los factores sexo masculino; orientaciones heterosexuales y asexuales; mayores ingresos individuales; carga viral indetectable; ausencia de comorbilidad y presencia de comorbilidad infecciosa o crónica, teniendo como referencia la enfermedad mental; y nunca haber consumido sustancias ilegales se asociaron de forma independiente con una buena CVRS. Por lo tanto, la compilación de las puntuaciones generales y de dominio del WHOQOL HIV BREF en una medida multidimensional única para la CVRS, que este estudio propuso por primera vez, puede facilitar interpretaciones y modelos de predictores más robustos. Estos diferenciales podrían simplificar la HRQoL como un indicador de salud y bienestar para ser utilizado de forma rutinaria como un resultado clave en el manejo clínico de los pacientes y en el monitoreo global de las respuestas del sistema de salud al VIH.

The Influence of the Omicron Variant on RNA Extraction and RT-qPCR Detection of SARS-CoV-2 in a Laboratory in Brazil.

The emergence of SARS-CoV-2 variants can affect their detection via RT-qPCR. The Omicron variant has a greater affinity for the upper respiratory system and causes clinical conditions similar to bronchitis, as opposed to the pneumonitis-like conditions caused by other SARS-CoV-2 variants. This characteristic increases the viscosity of clinical samples collected for diagnosis. Coinciding with the arrival of the Omicron variant, we observed a failure in control gene expression in our laboratory. In this report, we have optimized a rapid nucleic acid extraction step to restore gene expression and detect the presence of the SARS-CoV-2 virus. We reevaluated 3000 samples, compared variant types occurring in different time periods, and confirmed that the presence of the Omicron variant was responsible for changes observed in the characteristics of these clinical samples. For samples with large amounts of mucus, such as those containing the Omicron variant, a modification to the nucleic acid extraction step was sufficient to restore the quality of RT-qPCR results.

Analysis of anti-tuberculosis drug resistance and sociodemographic and clinical aspects of patients admitted in a referral hospital / Análise da resistência a medicamentos antituberculose e aspectos sociodemográficos e clínicos de pacientes atendidos em hospital referência

ABSTRACT Objective To determine the occurrence of anti-tuberculosis drug resistance and its association with sociodemographic and clinical characteristics of patients in a referral hospital. Methods This was a cross-sectional study based on data from patients who had mycobacterial culture identified and defined antimicrobials sensitivity profile (June 2014 to February 2016). The descriptive statistical analysis and Fisher's exact test were used to compare proportions. Results The study included 104 patients who had positive results for Mycobacterium tuberculosis . Bacilloscopy had high positivity (93.3%). A total of 15 patients (14.4%) had resistant strains and six (5.6%) multidrug-resistant. The sociodemographic and clinical characteristics were not related with resistance. Conclusion This study contributed to further the understandings about the tuberculosis patients' profile, the study also served as a tool for development of specific public policies. Patients diagnosed with resistant tuberculosis must be under greater supervision.

RESUMO Objetivo Verificar a ocorrência de resistência a fármacos antituberculose e a associação com características sociodemográficas e clínicas de pacientes de um hospital referência. Métodos Estudo transversal, com dados de pacientes que tiveram a cultura de micobactérias identificada e o respectivo perfil de sensibilidade aos antimicrobianos definido (junho de 2014 a fevereiro de 2016). Foram realizados a análise estatística descritiva e o teste exato de Fisher, para comparação de proporções. Resultados O estudo envolveu 104 pacientes, e todos tiveram resultados para Mycobacterium tuberculosis . A baciloscopia atingiu alta positividade (93,3%), e 15 pacientes (14,4%) apresentaram linhagens resistentes, sendo 6 (5,6%) multirresistentes. As características sociodemográficas e clínicas não foram associadas à resistência. Conclusão A pesquisa permitiu conhecer melhor o perfil dos pacientes com tuberculose e constitui ferramenta para elaboração de políticas públicas específicas. Os pacientes diagnosticados com tuberculose resistente devem ser submetidos à maior supervisão.

Analysis of anti-tuberculosis drug resistance and sociodemographic and clinical aspects of patients admitted in a referral hospital.

OBJECTIVE: To determine the occurrence of anti-tuberculosis drug resistance and its association with sociodemographic and clinical characteristics of patients in a referral hospital. METHODS: This was a cross-sectional study based on data from patients who had mycobacterial culture identified and defined antimicrobials sensitivity profile (June 2014 to February 2016). The descriptive statistical analysis and Fisher's exact test were used to compare proportions. RESULTS: The study included 104 patients who had positive results for Mycobacterium tuberculosis . Bacilloscopy had high positivity (93.3%). A total of 15 patients (14.4%) had resistant strains and six (5.6%) multidrug-resistant. The sociodemographic and clinical characteristics were not related with resistance. CONCLUSION: This study contributed to further the understandings about the tuberculosis patients' profile, the study also served as a tool for development of specific public policies. Patients diagnosed with resistant tuberculosis must be under greater supervision.

Comparison between Ogawa-Kudoh and modified Petroff techniques for mycobacteria cultivation in the diagnosis of pulmonary tuberculosis.

OBJECTIVE: To compare the performance of the Ogawa-Kudoh method with the modified Petroff technique in diagnosis of pulmonary tuberculosis. METHODS: A total of 205 sputum samples from 166 patients with clinical suspicion or under pulmonary tuberculosis follow-up, seen at a public tertiary care hospital, from July 2014 to July 2016 were used. All samples were simultaneously processed using the Ogawa-Kudoh and modified Petroff decontamination methods, according to the recommendations of the Ministry of Health. In the statistical analysis, the McNemar test and the Kappa index were used, respectively, to compare proportions and verify agreement between data. RESULTS: The Ogawa-Kudoh and modified Petroff methods were efficient in mycobacteria detection, with no significant differences in results (p=0.549) and contamination rate of the cultures (p=0.065). The agreement between techniques was considered excellent (Kappa index of 0.877) and Ogawa-Kudoh, as compared to the modified Petroff technique, showed sensitivity of 90.4%, specificity of 96.6%, positive predictive value of 94.3% and negative predictive value of 94.2%. CONCLUSION: The Ogawa-Kudoh technique proved to be sufficiently sensitive and specific for diagnosis of pulmonary tuberculosis, and, therefore, suitable for routine laboratory application. Since it is simple, low-cost and has less technical requirements for biosafety and professional training, Ogawa-Kudoh is an alternative for managers and healthcare professionals to promote the expansion of bacteriological diagnostic coverage of pulmonary tuberculosis.

Comparison between Ogawa-Kudoh and modified Petroff techniques for mycobacteria cultivation in the diagnosis of pulmonary tuberculosis / Comparação entre os métodos de Ogawa-Kudoh e Petroff modificado para o cultivo de micobactérias no diagnóstico da tuberculose pulmonar

ABSTRACT Objective To compare the performance of the Ogawa-Kudoh method with the modified Petroff technique in diagnosis of pulmonary tuberculosis. Methods A total of 205 sputum samples from 166 patients with clinical suspicion or under pulmonary tuberculosis follow-up, seen at a public tertiary care hospital, from July 2014 to July 2016 were used. All samples were simultaneously processed using the Ogawa-Kudoh and modified Petroff decontamination methods, according to the recommendations of the Ministry of Health. In the statistical analysis, the McNemar test and the Kappa index were used, respectively, to compare proportions and verify agreement between data. Results The Ogawa-Kudoh and modified Petroff methods were efficient in mycobacteria detection, with no significant differences in results (p=0.549) and contamination rate of the cultures (p=0.065). The agreement between techniques was considered excellent (Kappa index of 0.877) and Ogawa-Kudoh, as compared to the modified Petroff technique, showed sensitivity of 90.4%, specificity of 96.6%, positive predictive value of 94.3% and negative predictive value of 94.2%. Conclusion The Ogawa-Kudoh technique proved to be sufficiently sensitive and specific for diagnosis of pulmonary tuberculosis, and, therefore, suitable for routine laboratory application. Since it is simple, low-cost and has less technical requirements for biosafety and professional training, Ogawa-Kudoh is an alternative for managers and healthcare professionals to promote the expansion of bacteriological diagnostic coverage of pulmonary tuberculosis.

RESUMO Objetivo Comparar o desempenho do método de Ogawa-Kudoh ao de Petroff modificado no diagnóstico da tuberculose pulmonar. Métodos Utilizaram-se 205 amostras de escarro de 166 pacientes com suspeita clínica ou controle de tuberculose pulmonar atendidos em um hospital público terciário, entre os meses de julho de 2014 a julho de 2016. Todas as amostras foram processadas simultaneamente pelos métodos de descontaminação Ogawa-Kudoh e Petroff modificado, seguindo as recomendações do Ministério da Saúde. Na análise estatística, foi empregado o teste de McNemar, para comparação de proporções, e o índice Kappa, para verificar o grau de concordância entre os dados. Resultados Os métodos Ogawa-Kudoh e Petroff modificado mostraram-se eficientes na detecção de micobactérias, não sendo verificadas discordâncias significativas tanto nas comparações de pares de resultados (p=0,549), como na taxa de contaminação das culturas (p=0,065). O grau de concordância das técnicas foi considerado excelente (índice Kappa de 0,877), e o Ogawa-Kudoh, em relação ao Petroff modificado, apresentou 90,4% de sensibilidade, 96,6% de especificidade, 94,3% de valor preditivo positivo e 94,2% de valor preditivo negativo. Conclusão O método de Ogawa-Kudoh revelou-se suficientemente sensível e específico para o diagnóstico da tuberculose pulmonar e, portanto, adequado para a aplicação na rotina laboratorial. Por ser mais simples, de baixo custo e com menores exigências técnicas de biossegurança e capacitação profissional, o Ogawa-Kudoh apresenta-se como alternativa para gestores e profissionais da área promoverem a ampliação da cobertura diagnóstica bacteriológica da tuberculose pulmonar.

Prevalências de doenças de grande impacto na saúde pública em idosos frágeis residentes na Zona da Mata Mineira-Brasil: um estudo de base populacional / Prevalence of major Public Health impact diseases among frail elderly residents in the Zona da Mata region in the state of Minas Gerais-Brazil: a population-based study

O objetivo deste estudo transversal, descritivo, observacional e de base populacional foi identificar as prevalências de certas doenças de elevado custo e impacto no setor de Saúde Pública e de alguns hábitos de vida de idosos frágeis residentes na zona da Mata Mineira (Brasil). A pesquisa envolveu 7.113 idosos frágeis, de ambos os sexos, com idade igual ou superior a 60 anos. As informações foram obtidas, a partir do banco de dados eletrônico mantido e organizado pelo Centro Mais Vida. Observou-se um maior número de idosos do sexo feminino (67,6%), com idade entre 60 a 69 anos (40,4%) e casados (48,5%). 9,3% da população pesquisada apresentavam comprometimento cognitivo leve, 11,8% incapacidade cognitiva, 5,0% depressão, 9,0% demências, 7,9% insuficiência cardíaca, 21,6% diabetes Mellitus, 44,5% dislipidemias. Quanto aos hábitos de vida, 69,6% eram sedentários, 11,1% fumavam tabaco e 2,7% eram etilistas. Esses dados permitem comparações em nível internacional e são essenciais para a elaboração de políticas efetivas e intervenções primárias, secundárias e terciárias a nível populacional.

This cross-sectional, descriptive, observational and population-based study aimed to identify the prevalence of costly diseases and their impact on the public health sector, as well as lifestyle habits of frail elderly residents in Zona da Mata, Minas Gerais (Brazil). The research involved 7,113 frail elderly of both genders, aged over 60 years. Data were obtained from the electronic database maintained and organized by the institution Centro Mais Vida. A greater number of frail elderly females (67.6%) aged from 60 to 69 years old (40.4%) and married (48.5%) was observed. 9.3% of the surveyed population had mild cognitive impairment, 11.8% had cognitive disability, 5.0% had depression, 9.0% had dementia, 7.9% had heart failure, 21.6% had diabetes Mellitus and 44.5% had dyslipidemia. For lifestyle, 69.6% were sedentary, 11.1% smoked tobacco and 2.7% were alcoholics. Such data allow comparisons at international level and are critical for the development of effective policies as well as primary, secondary and tertiary-level interventions among the population.

Qualidade da dieta de estudantes de uma universidade pública brasileira / Diet quality of students at a brazilian public university

O objetivo deste estudo transversal foi avaliar as dietas de acadêmicos de uma universidade pública brasileira quanto à adequação energética, ao consumo de macro e micronutrientes e de fibras alimentares. A pesquisa foi realizada de março/2010 a dezembro/2011, utilizando-se o Registro Alimentar de três dias e o software Dietpro5i para a coleta e a determinação da composição das dietas, respectivamente. O estudo envolveu 278 indivíduos distribuídos em quatro grupos: Educação Física/feminino (n=66), Educação Física/masculino (n=69), Farmácia/feminino (n=79) e Farmácia/masculino (n=64). Realizou-se estatística descritiva e ANOVA/post hoc de Tukey (SPSS vs.14.0). Em todos os grupos, observou-se uma dieta hiperenergética, hiperproteica, hiperglicídica, adequada quanto à contribuição calórica dos macronutrientes e em ferro e deficiente em cálcio e fibras alimentares. Observou-se que 39,3% de todos os indivíduos apresentaram consumo insuficiente de zinco. Comparando estatisticamente os grupos, destaca-se que o maior consumo energético médio pertence ao grupo Educação Física/masculino (3.760,3±686,6 kcal/dia; p<0,002 para todos os grupos), sendo que 53,1% deles realizavam uma dieta hipercalórica. Esse grupo também apresentou o maior consumo médio de proteínas (1,7±0,7 g/kg/dia), carboidratos (358,8±91,4 g/dia), ferro (13,9±4,5 mg/dia) (p<0,05 para esses componentes de todos os grupos) e zinco (12,1±5,3 mg/dia; p=0,004 para Farmácia/masculino). Do grupo Farmácia/feminino, observou-se o menor consumo médio de cálcio (601,1±227,0 mg/dia; p<0,022 para homens de ambos os cursos), enquanto o grupo Farmácia/masculino apresentou o maior percentual de indivíduos com dieta deficiente em fibras alimentares (85,8%; p=0,022 para Farmácia/feminino). Essas constatações sinalizam algumas inadequações alimentares, as quais podem constituir um fator de risco, a longo prazo, para a saúde dessa população.

The aim of this study was to evaluate students' diets at a Brazilian public university with regard to energetic adequacy and the consumption of macronutrients, micronutrients, and dietary fiber. This research was conducted from March/2010 to December/2011, using the Three-day Diet Record and Dietpro5i software, to collect and analyze the diet composition information. It was composed of 278 subjects, divided into four groups: Physical Education/ female (n=66), Physical Education/male (n=69), Pharmacy/female (n=79), and Pharmacy/male (n=64). Descriptive statistics and ANOVA/post hoc Tukey were performed (SPSS vs.14.0). All groups presented diets with high contents in energy, carbohydrates, and protein; adequate for macronutrient caloric contribution and iron; and low in calcium and dietary fiber. It was observed that 39.3% of all individuals presented low zinc consumption. Statistically comparing the groups, what stands out is that the highest mean energy consumption was found in the Physical Education/male group (3.760.3±686.6 kcal/ day; p<0.002 among all groups), and 53.1% of them were under a high-energy diet. This group also presented the highest mean consumption for protein (1.7±0.7 g/kg/ day), carbohydrates (358.8±91.4 g/day), iron (13.9±4.5 mg/day) (p<0.05 for this component among all groups), and zinc (12.1±5.3 mg/day; p=0.004 for Pharmacy/male). Pharmacy/female presented the lowest mean calcium consumption (601.1±227.0 mg/day; p<0.022 for both male groups), while the Pharmacy/male group presented the highest percentage of individuals with deficient dietary fiber intake (85.8%; p=0.022 for Pharmacy/ female). Some results indicate dietary inadequacy, which can become a risk factor for this population's health in the long term.

Perfil de utilização de medicamentos por idosos frágeis institucionalizados na Zona da Mata Mineira, Brasil / Drug use profile of institutionalized frail elderly people in the Zona da Mata region of Minas Gerais, Brazil

O objetivo desse estudo foi identificar o perfil de utilização de medicamentos por idosos frágeis institucionalizados, o uso de fármacos potencialmente inadequados e as possíveis interações medicamentosas. Participaram 122 idosos, os quais tiveram suas fichas pessoais e receituários consultados. Os medicamentos foram classificados segundo o Anatomical Therapeutic Chemical System e, para identificar aqueles potencialmente inadequados, foram utilizados os critérios de Beers-Fick. As possíveis interações foram estabelecidas com o auxílio do Micromedex e outras fontes. Observou-se que 68,0% dos idosos eram mulheres, 55,7% possuíam 80 anos ou mais e 67,2% encontravam-se polimedicados. As doenças do aparelho circulatório (27,0%) foram as mais prevalentes, enquanto a maior parte dos medicamentos (38,8%) atuava no sistema nervoso. Verificou-se 219 possíveis interações e 58 medicamentos potencialmente inadequados (7,8%). Essas constatações sinalizam algumas falhas na prescrição e evidenciam a necessidade da revisão dos esquemas terapêuticos, visando seu uso racional, seguro e efetivo.

The aim of this study was to identify the profile of drugs taken by frail elderly people in long-term nursing homes and the usage of potentially inappropriate medications and possible drug interactions. There were 122 elderly participants whose personal records and prescriptions were reviewed. Drugs were classified according to the Anatomical Therapeutic Chemical Classification System and the Beers-Fick criteria were used to identify those which were potentially inappropriate for older patients. Possible interactions were established with the help of Micromedex and other sources. It was observed that 68.0% of the participants were women, 55.7% were aged 80 years or more and 67.2% were polymedicated. Circulatory system diseases (27.0%) were the most prevalent, while most of the drugs (38.8%) acted on the nervous system. There were 219 possible drug interactions and 58 potentially inappropriate medications (7.8%). These findings indicate some errors in the prescriptions and highlight the need to review drug regimens, aiming at the rational, safe and effective use of medication.

Perfil sociodemográfico de idosos frágeis institucionalizados em Juiz de Fora - Minas Gerais / Socio-demographic Profile of Frail Institutionalized Elderly in Juiz de Fora - Minas Gerais

O objetivo deste estudo foi identificar o perfil sociodemográfico de idosos frágeis institucionalizados em Juiz de Fora - MG. Trata-se de um estudo transversal, descritivo e observacional, que envolveu 122 idosos frágeis, de ambos os sexos, com idade igual ou superior a 60 anos, residentes em sete instituições de longa permanência para idosos particulares do município. Foi utilizado, para coleta de dados, um questionário sobre aspectos sociodemográficos, econômicos e hábitos de vida, preenchido com o auxílio dos responsáveis técnicos pelas instituições. Realizou-se também a consulta nas fichas pessoais e de receituários dos idosos. Foi realizada a análise estatística descritiva dos dados com o auxílio do software Statistical Package for the Social Sciences (SPSS) versão 14.0. Obteve-se que 68,0% dos idosos eram do sexo feminino, 55,7% possuía 80 anos ou mais, 50,8% eram viúvos, 63,1% tinham filhos e 81,1% possuíam algum familiar residente na cidade. O principal motivo da institucionalização foi por opção da família, que costumava visitar regularmente 95,1% dos idosos. Constatou-se que 54,9% dos idosos eram aposentados e 68,9% possuíam plano de saúde. A prática de atividades físicas e recreativas era pouco frequente nas instituições. Quanto ao uso de medicamentos, 67,2% utilizavam cinco ou mais. Essas constatações sinalizam vários aspectos importantes que espelham algumas precariedades das ILPI, as quais oferecem poucas alternativas de ocupação aos idosos frágeis e demonstram a necessidade de implantação de ações com vistas a promover mudanças que contribuam para melhoria da qualidade de vida do idoso.

The aim of this study was to identify the socio-demographic profile of frail institutionalized elderly in Juiz de Fora - MG. It is a transversal, descriptive, and observational study that involved 122 frail elderly, of both genders, aged 60 or older, residents of seven privately-operated homes for the aged in the city. A questionnaire with socio-demographic, economic, and lifestyle related questions was used to collect the information, gathered with staff help. Personal histories and prescriptions were also consulted. These data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 14.0. The results showed that 68.0% were female, 55.7% were 80 or older, 50.8% were widowed, 63.1% had children, and 81.1% had a relative living in the city. The main reason for institutionalization was decision by family, who customarily visited regularly 95.1% of the elderly. It was found that 54.9% of the elderly were retired and 68.9% had health insurance. As for medication use, 67.2% used five or more medicines. These results point to a number of important aspects that show how precarious these institutions are, which offer few occupational choices to the frail elderly and clearly require changes to improve the quality of life for the aged.