Severe influenza A(H1N1)pdm09 in pregnant women and neonatal outcomes, State of Sao Paulo, Brazil, 2009.

To investigate the factors associated with death and describe the gestational outcomes in pregnant women with influenza A(H1N1)pdm09, we conducted a case-control study (deaths and recovered) in hospitalized pregnant women with laboratory-confirmed influenza A(H1N1)pdm09 with severe acute respiratory illness (SARI) in the state of São Paulo from June 9 to December 1, 2009. All cases were evaluated, and four controls that were matched by the epidemiological week of hospitalization of the case were randomly selected for each case. Cases and controls were selected from the National Disease Notification System-SINAN Influenza-web. The hospital records from 126 hospitals were evaluated, and home interviews were conducted using standardized forms. A total of 48 cases and 185 controls were investigated. Having had a previous health visit to a healthcare provider for an influenza episode before hospital admission was a risk factor for death (adjusted OR (ORadj) of 7.93, 95% CI 2.19-28.69). Although not significant in the multiple analysis (ORadj of 2.13, 95% CI 0.91-5.00), the 3rd trimester deserves attention, with an OR = 2.22, 95% CI 1.13-4.37 in the univariate analysis. Antiviral treatment was a protective factor when administered within 48 hours of symptom onset (ORadj = 0.16, 95% CI 0.05-0.50) and from 48 to 72 hours (ORadj = 0.09, 95% CI 0.01-0.87). There was a higher proportion of fetal deaths and preterm births among cases (p = 0.001) and live births with low weight (p = 0.019), compared to control subjects who gave birth during hospitalization. After discharge, control subjects had a favorable neonatal outcome. Early antiviral treatment during the presence of a flu-like illness is an important factor in reducing mortality from influenza in pregnant women and unfavorable neonatal outcomes. It is important to monitor pregnant women, particularly in the 3rd trimester of gestation, with influenza illness for diagnosis and early treatment.

Severe influenza A(H1N1)pdm09 in pregnant women and neonatal outcomes, State of São Paulo, Brazil, 2009

To investigate the factors associated with death and describe the gestational outcomes in pregnant women with influenza A(H1N1)pdm09, we conducted a case-control study (deaths and recovered) in hospitalized pregnant women with laboratory-confirmed influenza A (H1N1)pdm09 with severe acute respiratory illness (SARI) in the state of São Paulo from June 9 to December 1, 2009. All cases were evaluated, and four controls that were matched by the epidemiological week of hospitalization of the case were randomly selected for each case. Cases and controls were selected from the National Disease Notification System- SINAN Influenza-web. The hospital records from 126 hospitals were evaluated, and home interviews were conducted using standardized forms. A total of 48 cases and 185 controls were investigated. Having had a previous health visit to a healthcare provider for an influenza episode before hospital admission was a risk factor for death (adjusted OR (ORadj) of 7.93, 95% CI 2.19±28.69). Although not significant in the multiple analysis (ORadj of 2.13, 95% CI 0.91±5.00), the 3rd trimester deserves attention, with an OR = 2.22, 95% CI 1.13± 4.37 in the univariate analysis. Antiviral treatment was a protective factor when administered within 48 hours of symptom onset (ORadj = 0.16, 95% CI 0.05±0.50) and from 48 to 72 hours (ORadj = 0.09, 95% CI 0.01±0.87). There was a higher proportion of fetal deaths and preterm births among cases (p = 0.001) and live births with low weight (p = 0.019), compared to control subjects who gave birth during hospitalization. After discharge, control subjects had a favorable neonatal outcome. Early antiviral treatment during the presence of a flu-like illness is an important factor in reducing mortality from influenza in pregnant women and unfavorable neonatal outcomes. It is important to monitor pregnant women, particularly in the 3rd trimester of gestation, with influenza illness for diagnosis and early treatment

Vigilância de violências: considerações sobre as informações relativas às violências perpetradas contra a população LGBT no município de São Paulo / Violence surveillance: considerations about data related to violence against LGBT population in São Paulo City, Brazil

A violência é um sério problema de saúde e a notificação é fundamental para a Vigilância Epidemiológica e para a definição de prioridades e de políticas públicas. O presente estudo tenta caracterizar a ocorrência de violência na população LGBT a partir da informação das notificações de violência do Sistema Nacional de Agravos de Notificação (SINAN). A Política de Saúde Integral LGBT - MS trouxe a necessidade da inclusão de campos e quesitos para identificação da violência contra essa população que passam a integrar a ficha e sistema. Município de São Paulo. SP. Período: ano de 2017.

Risk factors for death from Influenza A(H1N1)pdm09, State of São Paulo, Brazil, 2009.

This case-control study aimed to assess the risk factors for death from influenza A(H1N1)pdm09 in patients with laboratory confirmation, who had severe acute respiratory illness-SARI and were hospitalized between June 28th and August 29th 2009, in the metropolitan regions of São Paulo and Campinas, Brazil. Medical charts of all the 193 patients who died (cases) and the 386 randomly selected patients who recovered (controls) were investigated in 177 hospitals. Household interviews were conducted with those who had survived and the closest relative of those who had died. 73.6% of cases and 38.1% of controls were at risk of developing influenza-related complications. The 18-to-59-year age group (OR = 2.31, 95%CI: 1.31-4.10 (reference up to 18 years of age)), presence of risk conditions for severity of influenza (OR = 1.99, 95%CI: 1.11-3.57, if one or OR = 6.05, 95%CI: 2.76-13.28, if more than one), obesity (OR = 2.73, 95%CI: 1.28-5.83), immunosuppression (OR = 3.43, 95%CI: 1.28-9.19), and search for previous care associated with the hospitalization (OR = 3.35, 95%CI: 1.75-6.40) were risk factors for death. Antiviral treatment performed within 72 hours of the onset of symptoms (OR = 0.17, 95%CI: 0.08-0.37, if within 48hours, and OR = 0.30, 95%CI: 0.11-0.81, if between 48 and 72 hours) was protective against death. The identification of high-risk patients and early treatment are important factors for reducing morbi-mortality from influenza.

Inquérito de cobertura vacinal e evento adverso à vacina de febre amarela no munícipio de Buri, São Paulo, Brasil, 2009 / Vaccine coverage and adverse reactions to yellow fever vaccine survey in Buri city, São Paulo State, 2009

O Brasil possui extensa área endêmica para febre amarela silvestre (FAS), na qual ocorrem, anualmente, casos da doença em indivíduos não vacinados que entram em contato com o ciclo natural. No Noroeste do Estado de São Paulo a vacinação contra a febre amarela (FA) é recomendada na rotina, uma vez que há circulação esporádica do vírus naquela região. Entre fevereiro e abril de 2009, São Paulo registrou 25 casos de FAS em cinco municípios localizados fora da área de recomendação de vacinação. Esse fato levou à ampliação da área de recomendação de vacinação contra FA. Buri foi o último município incluído, sendo importante realizar inquérito de cobertura vacinal e avaliar a possível ocorrência de eventos adversos à vacina. A prevalência esperada de sintomas leves pós-vacinação é muitovariável, dependendo de fatores intrínsecos de cada população, existindo poucos estudos de referência. Foi aplicado questionário semiestruturado, em zona urbana (ZU) e zona rural (ZR) de Buri, no período de 26 a 29 de abril de 2009. Na ZU realizou-se amostragem aleatória simples de 218 indivíduos; na ZR foram amostrados 256 indivíduos residentes em sete bairros de referência. A cobertura vacinal foi de 94,9% na ZU e 98,4% na ZR, sendo, portanto, inferior ao preconizado pelo Ministério da Saúde (100%). Observou-se uma prevalência de indivíduos com pelo menos algum sintoma pós-vacinação de 38,6% na ZU e 36,9% na ZR. Os sintomas febre (ZU = 15,6% e ZR = 14,3%), cefaléia (ZU = 20,6% e ZR = 27,0%) e mialgia (ZU = 26,1% e ZR = 24,6%) apresentaram prevalência acima do esperado.Foi observada alta prevalência de diarréia (ZU = 6,9% e ZR = 12,3%) e vômito (ZU = 3,2% e ZR = 10,7%), sintomas incomuns. Assim, faz-se importante avaliar sintomasgastrointestinais como possíveis eventos adversos relacionados à vacina 17DD de FA e realizar mais estudos relacionados a eventos adversos leves à vacina de FA em populações em situações reais

Benefícios advindos da interação homem-cão / Man-dog interaction and their benefits

A integração homem-animal, principalmente com o cão, tem sido descrita como benéfica, tanto para a saúde física como para a saúde mental do ser humano. Esses benefícios podem ser observados desde o momento em que se tem um animal de estimação em casa, propiciando relaxamento e fornecendo carinho à pessoa, até a zooterapia e os serviços prestados pelos cães aos deficientes físicos. Porém, dentro dessa relação, é necessário manter a saúde do animal, para que este não transmita nenhuma zoonose e também não seja prejudicado. Para isso, é necessária a avaliação do animal pelo veterinário, o qual também tem uma importância social indispensável neste contexto