Relationship between climatic factors and air quality with tuberculosis in the Federal District, Brazil, 2003-2012

Abstract Introduction: Despite the high rate of tuberculosis indicators in Brazil, the Federal District shows a low prevalence of the disease. Objective: To analyze the relationship between climatic factors and air quality with tuberculosis in the Brazilian Federal District. Methodology: This was an ecological and descriptive study comparing 3927 new cases of Tuberculosis registered at the Federal District Tuberculosis Control Program with data from the National Institute of Meteorology, Brazilian Institute of Geography and Statistics, Brazilian Agricultural Research Institute, Brasilia Environmental Institute, and the Federal District Planning Company. Results: From 2003 to 2012, there has been a higher incidence of Tuberculosis (27.0%) in male patients in the winter (27.2%). Patients under 15 years of age (28.6%) and older than 64 years (27.1%) were more affected in the fall. For youth and adults (15-64 years), the highest number of cases was reported during winter (44.3%). The disease was prevalent with ultraviolet radiation over 17 MJ/m2 (67.8%; p = <0.001); relative humidity between 31.0% and 69.0% (95.8% of cases; p = <0.00); 12 h of daily sunlight or more (40.6%; p = 0.001); and temperatures between 20 °C and 23 °C (72.4%; p = <0.001). In the city of Taguatinga and surrounding area, pollution levels dropped to 15.2% between 2003 and 2012. Smoke levels decreased to 31.9%. In the Sobradinho region, particulate matter dropped to 13.1% and smoke to 19.3%, coinciding with the reduction of Tuberculosis incidence rates during the same period. Conclusion: The results should guide surveillance actions for Tuberculosis control and elimination and indicate the need to expand observation time to new climate indicators and air quality.

Relationship between climatic factors and air quality with tuberculosis in the Federal District, Brazil, 2003-2012.

INTRODUCTION: Despite the high rate of tuberculosis indicators in Brazil, the Federal District shows a low prevalence of the disease. OBJECTIVE: To analyze the relationship between climatic factors and air quality with tuberculosis in the Brazilian Federal District. METHODOLOGY: This was an ecological and descriptive study comparing 3927 new cases of Tuberculosis registered at the Federal District Tuberculosis Control Program with data from the National Institute of Meteorology, Brazilian Institute of Geography and Statistics, Brazilian Agricultural Research Institute, Brasilia Environmental Institute, and the Federal District Planning Company. RESULTS: From 2003 to 2012, there has been a higher incidence of Tuberculosis (27.0%) in male patients in the winter (27.2%). Patients under 15 years of age (28.6%) and older than 64 years (27.1%) were more affected in the fall. For youth and adults (15-64 years), the highest number of cases was reported during winter (44.3%). The disease was prevalent with ultraviolet radiation over 17MJ/m2 (67.8%; p=<0.001); relative humidity between 31.0% and 69.0% (95.8% of cases; p=<0.00); 12h of daily sunlight or more (40.6%; p=0.001); and temperatures between 20°C and 23°C (72.4%; p=<0.001). In the city of Taguatinga and surrounding area, pollution levels dropped to 15.2% between 2003 and 2012. Smoke levels decreased to 31.9%. In the Sobradinho region, particulate matter dropped to 13.1% and smoke to 19.3%, coinciding with the reduction of Tuberculosis incidence rates during the same period. CONCLUSION: The results should guide surveillance actions for Tuberculosis control and elimination and indicate the need to expand observation time to new climate indicators and air quality.

Processo de deliberação ética: estudo de caso ético-clínico / Ethics resolution process: ethical and clinical case study / Proceso de deliberación ética: estudio de caso ético-clínico

Objetivo: descrever os processos de deliberação éticos/clínicos usando um estudo de caso fictício. Método: estudo de caso, tendo como base referencial bibliográfico atual e legislação sobre a temática.Resultados: etapas analisadas: 1) Deliberação sobre os valores: lista de problemas éticos, problema moral a ser analisado e identificação dos valores em conflito; 2) Deliberação sobre os deveres: identificação dos cursos extremos de ação, identificação dos cursos intermediários de ação (alternativas possíveis) e identificação do curso ótimo de ação; e 3) Provas de consistência: onde foram analisados os aspectos da temporalidade, da publicidade e da legalidade. Conclusão: a deliberação é um procedimento fundamental da ética, ocorrendo toda vez que os valores, individuais ou coletivos, encontrarem-se em conflito. É necessário deliberar para tomar as decisões, que são concretas levando em consideração o contexto do ato e suas consequências previsíveis.(AU)

Objective: to describe the ethical resolution process/clinicians using a fictional case study. Method: it is a case study, with a current bibliographic references and base legislation on the subject. Results: stages analyzed 1) Resolution on the values: list of ethical problems, moral problem to be analyzed, and identification of conflicting values; 2) Resolution on the duties: identification of extreme courses of action, identification of intermediate courses of action (possible alternatives) and identification of the optimal course of action; and 3) Consistency tests: where the aspects of temporality were analyzed, advertising, legality. Conclusion: the resolution is a fundamental procedure of ethics, occurring every time the values, individual or collective are in conflict. It is necessary to decide to make the decisions that are concrete considering the act of context and its predictable consequences.(AU)

Objetivo: describir los procesos de deliberación éticos/clínicos usando un estudio de caso ficticio. Método: estudio de caso, teniendo como base referencial bibliográfica actual y legislación sobre el tema.Resultados: etapas analizadas 1) Deliberación sobre los valores: lista de problemas éticos, problema moral a ser analizado, e identificación de los valores en conflicto; 2) Deliberación sobre los deberes: identificación de los cursos extremos de acción, identificación de los cursos intermediarios de acción (alternativas posibles) e identificación del curso óptimo de acción; and 3) Pruebas de consistencia: donde fueron analizados los aspectos de la temporalidad, de la publicidad, de la legalidad. Conclusión: la deliberación es un procedimiento fundamental de la ética, ocurriendo toda vez que los valores, individuales o colectivos, se encuentran en conflicto. Es necesario deliberar para tomar las decisiones, que son concretas teniendo en consideración el contexto del acto y sus consecuencias previsibles.(AU)

Síndrome de Stevens-Johnson e Necrólise Epidérmica Tóxica em um hospital do Distrito Federal / Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in a hospital in Distrito Federal / Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica en un hospital en Distrito Federal

Objetivou-se analisar as características demográficas e clínicas dos clientes diagnosticados com Síndrome de Stevens Johnson (SSJ) e Necrólise Epidérmica Tóxica (NET), bem como identificar as ações dos profissionais de saúde para o manejo das Reações Adversas a Medicamentos (RAM) em um hospital público do Distrito Federal. Pesquisa descritiva, retrospectiva, com abordagem quantitativa. Dados coletados em todos os prontuários de 22 clientes internados de janeiro de 2005 a setembro de 2012. Análise mediante estatística descritiva. Houve aumento gradativo de casos, com maior número nos anos de 2007 e 2012. Dos casos analisados, 9 foram diagnosticados com NET e 7 com SSJ; predominaram as mulheres (14) e a faixa etária de 21 aos 40 anos (10); 21 obtiveram cura. Os fármacos associados a RAM mais frequentes foram os antiepilépticos (10). Observou-se fragilidade nos registros clínicos nos prontuários e nas ações de monitoramento de RAM no serviço estudado.

This study aimed to analyze demographic and clinical aspects of patients diagnosed with Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), as well as identifying the actions of health professionals for the management of Adverse Drug Reactions (ADR) in a public hospital in Distrito Federal, Brazil. A descriptive and retrospective research was held, with quantitative approach. Data collected from all the records of 22 patients admitted with diagnosed with SJS and TEN, from January 2005 to September 2012. Data were analyzed using descriptive statistics. Of these cases, 9 were diagnosed with NET and 7, with SJS; there were more females (14); aged from 21 to 40 years (10); 21 were cured; the drugs more used were the antiepileptic ones (10). Fragility in clinical registers and in the actions to monitor the cases of ADR in this health service was observed.

Este estudio tuvo como objetivo analizar aspectos demográficos y clínicos de clientes con diagnóstico de Síndrome de Stevens Johnson (SSJ) y Necrólisis Epidérmica Tóxica (NET), así como la identificación de las acciones de los profesionales de la salud para el manejo de reacciones adversas a medicamentos (RAM) en un hospital público del Distrito Federal. Se realizó investigación descriptiva, retrospectiva con enfoque cuantitativo. Datos recogidos de prontuarios clínicos de los 22 clientes ingresados con diagnóstico de SJS y NET, de enero de 2005 a septiembre de 2012. Fueron analizados utilizando estadística descriptiva. De estos casos, 9 fueron diagnosticados con NET, 7 con SJS; había más mujeres (14); edad entre 21 y 40 años (10); 21 se curaron; predominaran los antiepilépticos (10). Fue observado que hay fragilidad en registros clínicos en los prontuarios y en las acciones de monitoreo de las RAM en este servicio de salud.

[Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in a hospital in Distrito Federal]. / Síndrome de Stevens-Johnson e Necrólise Epidérmica Tóxica em um hospital do Distrito Federal.

This study aimed to analyze demographic and clinical aspects of patients diagnosed with Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), as well as identifying the actions of health professionals for the management of Adverse Drug Reactions (ADR) in a public hospital in Distrito Federal, Brazil. A descriptive and retrospective research was held, with quantitative approach. Data collected from all the records of 22 patients admitted with diagnosed with SJS and TEN, from January 2005 to September 2012. Data were analyzed using descriptive statistics. Of these cases, 9 were diagnosed with NET and 7, with SJS; there were more females (14); aged from 21 to 40 years (10); 21 were cured; the drugs more used were the antiepileptic ones (10). Fragility in clinical registers and in the actions to monitor the cases of ADR in this health service was observed.