Multimorbidity worsened anxiety and depression symptoms during the COVID-19 pandemic in Brazil.

Multimorbidity is a global health issue impacting the quality of life of all ages. Multimorbidity with a mental disorder is little studied and is likely to have been affected by the COVID-19 pandemic. We used a survey of 14,007 respondents living in Brazil to investigate whether people who already had at least one chronic medical condition had more depression and anxiety symptoms during social distancing in 2020. Generalized linear models and structural equation modelling were used to estimate the effects. A 19 % and 15 % increase in depressive symptoms were found in females and males, respectively, for each unit of increase in the observed value of reported chronic disease. Older subjects presented fewer symptoms of depression and anxiety. There was a 16 % increase in anxiety symptoms in females for each unit increase in the reported chronic disease variable and a 14 % increase in males. Younger subjects were more affected by anxiety symptoms in a dose-response fashion. High income was significantly related to fewer depressive and anxiety symptoms in both males and females. Physical activity was significantly associated with fewer anxiety and depression symptoms. Structural equation modelling confirmed these results and provided further insight into the hypothesised paths.

The global scientific research response to the public health emergency of Zika virus infection.

BACKGROUND: Science studies have been a field of research for different knowledge areas, and they have been successfully used to analyse the construction of scientific knowledge, practice and dissemination. In this study, we aimed to verify how the Zika epidemic has moulded the scientific articles published worldwide by analysing international collaborations and the knowledge landscape through time, as well as research topics and country involvement. METHODOLOGY: We searched the Web of Science (WoS), Scopus and PubMed for studies published up to 31st December 2018 on Zika using the search terms "zika", "zkv" or "zikv". We analysed the scientific production regarding which countries have published the most, on which topics, as well as country level collaboration. We performed a scientometric analysis of research on Zika focusing on knowledge mapping and the scientific research path over time and space. FINDINGS: We found two well defined research areas divided into three subtopics accounting for six clusters. With regard to country analysis, the USA and Brazil were the countries with the highest numbers of publications on Zika. China entered as a new player focusing on specific research areas. When we took into consideration the epidemics and reported cases, Brazil and France were the leading research countries on related topics. As for international collaboration, the USA followed by England and France stand out as the main hubs. The research areas most published included public health-related topics from 2015 until the very beginning of 2016, followed by an increase in topics related to the clinical aspects of the disease in 2016 and the emergence of laboratory research in 2017/2018. CONCLUSIONS: Mapping the response to Zika, a public health emergency, demonstrated a clear pattern of the participation of countries in the scientific advances. The pattern of knowledge production found in this study represented varying country perspectives, research capacity and interests based first on their level of exposure to the epidemic and second on their financial positions regarding science.

A dupla epidemia: febre amarela e desinformação / Two epidemics: the yellow fever and a lack of information / La dupla epidemia: la fiebre amarilla y la falta de información

Esta nota apresenta um breve histórico da origem da febre amarela no Brasil, das medidas de controle e das dificuldades para que orientações de saúde pública cheguem à população. Nela analisam-se alguns episódios de geração de boatos, assim como informações mentirosas e suas consequências muitas vezes danosas.Aponta-se a necessidade de oferecer e divulgar fontes confiáveis para os profissionais e a comunidade, em especial por meio do fortalecimento das instituições e de suas áreas de comunicação social. Assinala-se também a importância do trabalho de campo das equipes de atenção básica, para localizar pessoas expostas a risco, levando-lhes informações e vacinas.(AU)

This paper presents a brief history of yellow fever origin in Brazil, of the control measures and of the difficulties to the public health guidance to reach the population. It analyzes some cases of rumour propagation, as wellas fake information and its often damaging consequences. It points out the need to offer and disseminatereliable sources to professionals and the community, especially through the strengthening of institutions and their areas of social communication. It also highlights the importance of the fieldwork of the primary health care teams, so that they can find people at risk and bring information and vaccines to them.

Esta nota presenta una breve historia del origen de la fiebre amarilla en Brasil, de las medidas de control yde las dificultades de las orientaciones de salud pública para llegar a la población. Analiza algunos casos degeneración de rumores, así como informaciones falsas y sus consecuencias a menudo perjudiciales. Señalala necesidad de ofrecer y difundir fuentes confiables a los profesionales y a la comunidad, en especial a través del fortalecimiento de las instituciones y sus áreas de comunicación social. También destaca la importancia del trabajo de campo de los equipos de atención primaria de salud, para localizar personas expuestas alriesgo y así llevar a ellas informaciones y vacunas.

Association between microcephaly, Zika virus infection, and other risk factors in Brazil: final report of a case-control study.

BACKGROUND: A Zika virus epidemic emerged in northeast Brazil in 2015 and was followed by a striking increase in congenital microcephaly cases, triggering a declaration of an international public health emergency. This is the final report of the first case-control study evaluating the potential causes of microcephaly: congenital Zika virus infection, vaccines, and larvicides. The published preliminary report suggested a strong association between microcephaly and congenital Zika virus infection. METHODS: We did a case-control study in eight public maternity hospitals in Recife, Brazil. Cases were neonates born with microcephaly, defined as a head circumference of 2 SD below the mean. Two controls without microcephaly were matched to each case by expected date of delivery and area of residence. We tested the serum of cases and controls and the CSF of cases for detection of Zika virus genomes with quantitative RT-PCR and for detection of IgM antibodies with capture-IgM ELISA. We also tested maternal serum with plaque reduction neutralisation assays for Zika and dengue viruses. We estimated matched crude and adjusted odds ratios with exact conditional logistic regression to determine the association between microcephaly and Zika virus infection. FINDINGS: We screened neonates born between Jan 15 and Nov 30, 2016, and prospectively recruited 91 cases and 173 controls. In 32 (35%) cases, congenital Zika virus infection was confirmed by laboratory tests and no controls had confirmed Zika virus infections. 69 (83%) of 83 cases with known birthweight were small for gestational age, compared with eight (5%) of 173 controls. The overall matched odds ratio was 73·1 (95% CI 13·0-∞) for microcephaly and Zika virus infection after adjustments. Neither vaccination during pregnancy or use of the larvicide pyriproxyfen was associated with microcephaly. Results of laboratory tests for Zika virus and brain imaging results were available for 79 (87%) cases; within these cases, ten were positive for Zika virus and had cerebral abnormalities, 13 were positive for Zika infection but had no cerebral abnormalities, and 11 were negative for Zika virus but had cerebral abnormalities. INTERPRETATION: The association between microcephaly and congenital Zika virus infection was confirmed. We provide evidence of the absence of an effect of other potential factors, such as exposure to pyriproxyfen or vaccines (tetanus, diphtheria, and acellular pertussis, measles and rubella, or measles, mumps, and rubella) during pregnancy, confirming the findings of an ecological study of pyriproxyfen in Pernambuco and previous studies on the safety of Tdap vaccine administration during pregnancy. FUNDING: Brazilian Ministry of Health, Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations.

Características dos primeiros casos de microcefalia possivelmente relacionados ao vírus Zika notificados na Região Metropolitana de Recife, Pernambuco / Características de los primeros casos de microcefalia, posiblemente relacionadas con el virus Zika reportados en la Región Metropolitana de Recife / Characteristics of the first cases of microcephaly possibly related to Zika virus reported in the Metropolitan Region of Recife, Pernambuco State, Brazil

OBJETIVO: descrever os primeiros casos de microcefalia possivelmente relacionados ao vírus Zika em nascidos vivos notificados na Região Metropolitana do Recife, Pernambuco, Brasil. MÉTODOS: estudo descritivo de tipo série de casos (notificados de 1º de agosto a 31 de outubro de 2015), com dados obtidos dos registros médicos e de questionário aplicado às mães. RESULTADOS: foram confirmados 40 casos com microcefalia, distribuídos em oito municípios da Região Metropolitana do Recife, com maior concentração no Recife (n=12); a mediana do perímetro cefálico foi de 29 cm, do perímetro torácico, 31 cm, e do peso, 2.628 gramas; 21/25 casos apresentaram calcificação cerebral, ventriculomegalia ou lisencefalia; entre as 40 mães, 27 referiram exantema na gestação, 20 no primeiro trimestre e sete no segundo, além de prurido, cefaleia, mialgia e ausência de febre. CONCLUSÃO: a maioria dos casos apresentou características de infecção congênita; a maioria das mães apresentou quadro sugestivo de infecção pelo vírus Zika na gestação.

OBJETIVO: describir los primeros casos de microcefalia en nacidos vivos reportados al Departamento de Salud del Estado de Pernambuco, en la región metropolitana de Recife, Pernambuco, 2015. MÉTODOS: estudio epidemiológico descriptivo de serie de casos (reportados de 1 de agosto a 31 de octubre de 2015), con datos obtenidos de registros médicos y cuestionarios aplicados a las madres. RESULTADOS: 40 casos fueron confirmados con microcefalia, en ocho municipios de la región metropolitana de Recife, con mayor concentración de casos en Recife (n=12); la circunferencia media de la cabeza fue 29 cm, perímetro torácico 31 cm y peso 2.628 gramos; exámenes revelaron que 21/25 casos mostraron calcificación, dilatación ventricular o lisencefalia; de las 40 madres, 27 (68%) informan exantema durante la gestación, 20 (74%) en el primer trimestre y siete (26%) en la segunda, además de prurito, dolor de cabeza, mialgia y ausencia de fiebre. CONCLUSIÓN: la mayoría de los casos presenta características de infección congénita; la mayoría de las madres mostró características que sugieren infección por el virus Zika en el embarazo.

OBJECTIVE: to describe the first cases of microcephaly possibly related to Zika virus in live born babies reported in the Metropolitan Region of Recife, Pernambuco State, Brazil. METHODS: this was a descriptive case series study (cases reported between August 1st and October 31st 2015), using medical record data and data from a questionnaire answered by the mothers of the babies. RESULTS: 40 microcephaly cases were confirmed, distributed in eight municipalities within the Metropolitan Region, with Recife itself having the highest concentration of cases (n=12); median head circumference was 29 cm, median chest girth was 31 cm and median weight was 2,628 grams; 21/25 cases had brain calcification, ventriculomegaly or lissencephaly; 27 of the 40 mothers reported rash during pregnancy, 20 in the first trimester and 7 in the second trimester, as well as itching, headache, myalgia and absence of fever. CONCLUSION: the majority of the cases bore the characteristics of congenital infection; the clinical condition of the majority of mothers suggested Zika virus infection during pregnancy.

Characteristics of the first cases of microcephaly possibly related to Zika virus reported in the Metropolitan Region of Recife, Pernambuco State, Brazil. / Características dos primeiros casos de microcefalia possivelmente relacionados ao vírus Zika notificados na Região Metropolitana de Recife, Pernambuco.

OBJECTIVE: to describe the first cases of microcephaly possibly related to Zika virus in live born babies reported in the Metropolitan Region of Recife, Pernambuco State, Brazil. METHODS: this was a descriptive case series study (cases reported between August 1st and October 31st 2015), using medical record data and data from a questionnaire answered by the mothers of the babies. RESULTS: 40 microcephaly cases were confirmed, distributed in eight municipalities within the Metropolitan Region, with Recife itself having the highest concentration of cases (n=12); median head circumference was 29 cm, median chest girth was 31 cm and median weight was 2,628 grams; 21/25 cases had brain calcification, ventriculomegaly or lissencephaly; 27 of the 40 mothers reported rash during pregnancy, 20 in the first trimester and 7 in the second trimester, as well as itching, headache, myalgia and absence of fever. CONCLUSION: the majority of the cases bore the characteristics of congenital infection; the clinical condition of the majority of mothers suggested Zika virus infection during pregnancy.

Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: preliminary report of a case-control study.

BACKGROUND: The microcephaly epidemic, which started in Brazil in 2015, was declared a Public Health Emergency of International Concern by WHO in 2016. We report the preliminary results of a case-control study investigating the association between microcephaly and Zika virus infection during pregnancy. METHODS: We did this case-control study in eight public hospitals in Recife, Brazil. Cases were neonates with microcephaly. Two controls (neonates without microcephaly), matched by expected date of delivery and area of residence, were selected for each case. Serum samples of cases and controls and cerebrospinal fluid samples of cases were tested for Zika virus-specific IgM and by quantitative RT-PCR. Laboratory-confirmed Zika virus infection during pregnancy was defined as detection of Zika virus-specific IgM or a positive RT-PCR result in neonates. Maternal serum samples were tested by plaque reduction neutralisation assay for Zika virus and dengue virus. We estimated crude odds ratios (ORs) and 95% CIs using a median unbiased estimator for binary data in an unconditional logistic regression model. We estimated ORs separately for cases with and without radiological evidence of brain abnormalities. FINDINGS: Between Jan 15, 2016, and May 2, 2016, we prospectively recruited 32 cases and 62 controls. 24 (80%) of 30 mothers of cases had Zika virus infection compared with 39 (64%) of 61 mothers of controls (p=0·12). 13 (41%) of 32 cases and none of 62 controls had laboratory-confirmed Zika virus infection; crude overall OR 55·5 (95% CI 8·6-∞); OR 113·3 (95% CI 14·5-∞) for seven cases with brain abnormalities; and OR 24·7 (95% CI 2·9-∞) for four cases without brain abnormalities. INTERPRETATION: Our data suggest that the microcephaly epidemic is a result of congenital Zika virus infection. We await further data from this ongoing study to assess other potential risk factors and to confirm the strength of association in a larger sample size. FUNDING: Brazilian Ministry of Health, Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations.

Increase in Reported Prevalence of Microcephaly in Infants Born to Women Living in Areas with Confirmed Zika Virus Transmission During the First Trimester of Pregnancy - Brazil, 2015.

Widespread transmission of Zika virus by Aedes mosquitoes has been recognized in Brazil since late 2014, and in October 2015, an increase in the number of reported cases of microcephaly was reported to the Brazil Ministry of Health.* By January 2016, a total of 3,530 suspected microcephaly cases had been reported, many of which occurred in infants born to women who lived in or had visited areas where Zika virus transmission was occurring. Microcephaly surveillance was enhanced in late 2015 by implementing a more sensitive case definition. Based on the peak number of reported cases of microcephaly, and assuming an average estimated pregnancy duration of 38 weeks in Brazil (1), the first trimester of pregnancy coincided with reports of cases of febrile rash illness compatible with Zika virus disease in pregnant women in Bahia, Paraíba, and Pernambuco states, supporting an association between Zika virus infection during early pregnancy and the occurrence of microcephaly. Pregnant women in areas where Zika virus transmission is occurring should take steps to avoid mosquito bites. Additional studies are needed to further elucidate the relationship between Zika virus infection in pregnancy and microcephaly.

Infecções pós-operatórias por micobactérias de crescimento rápido no Brasil / Postoperative infections due to rapidly growing mycobacteria in Brazil

As micobactérias de crescimento rápido são patógenos oportunistas geralmente associadoscom infecções pós-operatórias. Diferente de M. tuberculosis, este grupo de micobactériasnão-tuberculosas (Grupo 4 de Runyon) pode crescer em meios bacteriológicos de rotina,entre eles, ágar sangue e MacConkey, assim como, no meio de Lowenstein Jensen, à temperaturade 25°C a 40°C, dentro de 7 dias de incubação. A importância da busca do isolamentoda micobactéria e medidas de intervenção cirúrgica, quando a terapia conservadorafalha, são discutidas. A suspeita clínica é necessária para evitar retardo no diagnóstico eno tratamento. As micobactérias de crescimento rápido são geralmente resistentes aos antimicrobianosusuais, mas sensíveis a uma variedade de outros antimicrobianos, tais comoamicacina e fluorquinolonas. Uma revisão da literatura sobre infecções pós-operatóriaspor micobactéria foi realizada, incluindo epidemiologia, quadro clínico, diagnóstico, tratamentoe medidas preventivas. Essa revisão ressalta o cuidado rigoroso na limpeza e naesterilização do material utilizado nos procedimentos cirúrgicos; além disso, medidas decontrole apropriadas são essenciais para evitar surtos de infecção.

Rapidly growing mycobateria are opportunistic pathogens that are frequently associatedwith infections related to surgical procedures. Unlike M. tuberculosis, this group of nontuberculousmycobacteria (Runyon group 4) can grow on routine bacteriologic media, suchas blood and MacConkey agar, as well as on Lowenstein Jensen medium at temperaturesfrom 25°C to 40°C, within 7 days of incubation. Rapidly growing mycobateria are generallyresistant to conventional antimycobacterial drugs, but are sensitive to a variety of otherantibiotics, such as amikacin and fluoroquinolones. A review of literature about mycobacterialinfection after surgical procedures, including epidemiology, clinical manifestation,diagnosis, treatment options and preventive measures are considered. The importance ofpromptly isolation the pathogen and the operative intervention necessary when conservativetherapy fails are discussed. A high degree of clinical suspicion is necessary to avoiddelays in diagnosis and treatment. This review highlights the necessity of strict monitoringof disinfection and sterilization techniques of medical devices, and appropriate controlmeasures are essential to prevent potential outbreaks.

Regulação sanitária sem fronteiras / Sanitary regulation without borders

Diversas condições e variáveis interferem na ocorrência de doenças transmissíveis, entre elas o tamanho da população, a aglomeração, a probabilidade de transmissão. A história assistiu à dinâmica das moléstias transmissíveis. O contato com outras populações e o transporte de mercadorias levou à noção de vigilância sanitária de fronteira e a certas práticas sanitárias. O direito que evoluiu com relação a estas práticas é o Direito Sanitário internacional, que lida com interesses de proteção da população e interesses do comércio e intercâmbio. As fontes deste direito são os tratados, as convenções e os atos jurídicos emanados das organizações sanitárias internacionais, é o caso da OMS. O Brasil adotou o regulamento sanitário internacional, o qual deve estar coadunado com os direitos individuais e coletivos. A aplicação deste regulamento tenta coordenar-se com o livre trânsito comercial. Afora as fontes provenientes das organizações sanitárias, temos dispositivos de regulamentação do trabalho, meio ambiente, navegação, cujas competências e responsabilidades variam conforme o enquadramento. O mundo conta hoje com organizações de blocos regionais, a dimensão e a complexidade crescentes exigem uma mudança de enfoque da segurança sanitária no panorama mundial, levando em conta que os países em desenvolvimento merecem atenção especial. Conclui-se que a grande ameaça sanitária é a diferença entre os povos.

Contra a maré à beira-mar: a experiência do SUS em Santos / The experience of the Unified Health System of Santos, SP, Brazil

Apresenta experiências e reflexöes da equipe que trabalhou na implantaçäo do SUS (Sistema Único de Saúde) em Santos, SP, no período em que a cidade foi governada por prefeitos do PT (Partido dos Trabalhadores).

A responsabilidade dos três níveis de doenças causadas pelo ambiente do trabalho no federalismo brasileiro / The responsibility of the three levels of diseases caused by the work environment in the Brazilian federalism

Análise de algumas questöes como: a indefiniçäo do papel do INAMPS em relaçäo ao sistema de saúde, tanto pela Constituiçäo como pela Lei Orgânica de Saúde; a abrangência regional (demanda por outros municípios); o financiamento dos serviços públicos e o repasse das verbas; a gestäo dos recursos humanos; a relaçäo com a iniciativa privada, as açöes de proteçäo à saúde; e as competências e atribuiçöes do Ministério do Trabalho, Ministério da Saúde e Ministério da Previdência Social. Finaliza com respostas a alguns participantes do debate (MLFF)

Curvas de sobrevivência de pacientes de AIDS em Santos, Brasil / Survival curves of AIDS patients in Santos, Brazil

Säo apresentadas as probabilidades de sobrevivência de pacientes portadores de vírus da AIDS residentes no Município de Santos, estimadas a partir do estudo de 1.056 notificaçöes feitas nos anos de 1988, 1989 e 1990. Foram analisadas fichas de investigaçäo epidemiológica, enviadas por serviços ambulatoriais ou obtidas mediante busca ativa realizada rotineiramente nos hospitais do citado Município. As informaçöes sobre óbitos originam-se dos cartórios de registro civil de Santos, Säo Vicente e Guarujá e de notificaçöes recebidas. A estimativa de perdas - óbitos registrados em cartórios de outras regiöes - é inferior a 2%, proporçäo de ocorrência na populaçäo geral segundo dados da Fundaçäo SEADE. Os pacientes foram agrupados por sexo e por estágio evolutivo da doença, sendo classificados em "casos"(IV B, IV C, IV D e IV E conforme classificaçäo do Center of Disease Control), suspeitos (classe I, II E III do C.D.C.) e soropositivos assintomáticos (classe I, II e III do C.D.C.)

Regulação e Saúde.

Arquivo de áudio contendo a palestra do Diretor da Agência Nacional de Vigilância Sanitária (ANVISA), Cláudio Maierovitch Pessanha Henriques, que abordou as atividades e funções da Agência no que diz respeito à regulação dos serviços. O palestrante traçou um paralelo entre os organismos reguladores dos sistemas biológicos e o aparato regulatório do mercado. Segundo ele, no capitalismo real a ‘saúde do mercado, principalmente no mercado da saúde, depende de regulação. Cláudio lembrou que no caso das tecnologias de consumo, cabe a saúde se preocupar com a segurança, enquanto a qualidade e a eficácia são requisitos de proteção ao consumidor, mas a situação se modifica quando lidamos com tecnologias de uso em saúde. O Diretor destacou também que a atuação das agências reguladoras deve ser baseada em evidências científicas e suas decisões devem ser apoiadas no conhecimento e na legislação. O palestrante abordou também a questão da autonomia das agências, citou alguns exemplos de atuação da ANVISA e numerou alguns outros mecanismos de participação criados pelas agências. Após a apresentação, a pesquisadora da ENSP, Maria Eliana Labra, participou de um debate que discutiu pontos relevantes cerca do assunto.