Application of ventilator-associated events (VAE) in ventilator-associated pneumonia (VAP) notified in Brazil (IMPACTO MR-PAV): a protocol for a cohort study.

INTRODUCTION: Certain criteria for ventilator-associated events (VAE) definition might influence the type of an event, its detection rate and consequently the resource expenditure in intensive care unit. The Impact of Infections by Antimicrobial-Resistant Microorganisms - Ventilator-Associated Pneumonia (IMPACTO MR-PAV) aims to evaluate the incidence and diagnostic accuracy of ventilator-associated pneumonia (VAP) using the current criteria for VAP surveillance in Brazil versus the VAE criteria defined by the US National Healthcare Safety Network-Center for Diseases Control and Prevention (CDC) criteria. METHODS AND ANALYSIS: The study will be conducted in around 15 centres across Brazil from October 2022 to December 2023. Trained healthcare professionals will collect data and compare the incidence of VAP using both the current criteria for VAP surveillance in Brazil and the VAE criteria defined by the CDC. The accuracy of the two criteria for identifying VAP will also be analysed. It will also characterise other events associated with mechanical ventilation (ventilator-associated condition, infection-related ventilator-associated complication) and adjudicate VAP reported to the Brazilian Health Regulatory Agency (ANVISA) using current epidemiological diagnostic criteria. ETHICS AND DISSEMINATION: This study was approved by the Institutional Review Board under the number 52354721.0.1001.0070. The study's primary outcome measure will be the incidence of VAP using the two different surveillance criteria, and the secondary outcome measures will be the accuracy of the two criteria for identifying VAP and the adjudication of VAP reported to ANVISA. The results will contribute to the improvement of VAP surveillance in Brazil and may have implications for other countries that use similar criteria. TRIAL REGISTRATION NUMBER: NCT05589727; Clinicaltrials.gov.

Epidemiological Situation of Glanders in the State of Pará, Brazil.

Glanders is an anthropozoonosis caused by the bacteria Burkholderia mallei, affecting mainly equids. It has been eradicated in North America, Australia, and Western Europe, but continues to occur sporadically in countries in Asia, Africa, the Middle East, and South America. Its notification is mandatory by the World Organization for Animal Health. After 30 years, the disease reappeared in Brazil in 1999 and, thereafter, 1,413 outbreaks have been reported. However, the epidemiological situation of the disease in the country is not adequately known. Thus, 2718 animals from 654 properties in the state of Pará were randomly selected by sampling and examined using a serial protocol with Complement Fixation and Western Blot serological tests. The prevalence of properties infected with glanders in the state was estimated at 1.68% [0.84; 3.33] and of seropositive animals at 0.50% [0.27; 0.94]. The introduction of animals was individualized as a risk factor for disease introduction in the properties (OR = 5.9 [1.4; 25.5]). Despite the low prevalence of infected properties and seropositive animals, the state must review actions to fight the disease, considering that the strategies implemented have not affected the endemic balance of the disease. This process must involve all public and private agents interested in the topic.

Description of e-Health Initiatives to Reduce Chronic Non-Communicable Disease Burden on Brazilian Health System.

Chronic non-communicable diseases (NCD) account for 72% of the causes of death in Brazil. In 2013, 54 million Brazilians reported having at least one NCD. The implementation of e-Health in the Unified Health System (SUS) could fill gaps in access to health in primary health care (PHC). OBJECTIVE: to demonstrate telehealth strategies carried out within the scope of the Institutional Development Support Program of the Unified Health System (PROADI-SUS) and developed by Hospital Alemão Oswaldo Cruz, between 2018 and 2021, on evaluation, supply, and problem-solving capacity for patients with NCDs. METHODOLOGY: a prospective and descriptive study of three projects in the telehealth areas, using document analysis. The Brasil Redes project used availability, implementation, and cost-effectiveness analysis, TELEconsulta Diabetes is a randomized clinical trial, and Regula Mais Brasil is focused on the waiting list for regulation of specialties. All those strategies were developed within the scope of the SUS. RESULTS: 161 patients were attended by endocrinology teleconsultation in one project and another two research projects, one evaluating Brazil's Telehealth Network Program, and another evaluating effectiveness and safety of teleconsultation in patients with diabetes mellitus referred from primary care to specialized care in SUS. Despite the discrepancy in the provision of telehealth services in the country, there was an increase in access to specialized care on the three projects and especially on the Regula Mais Brasil Collaborative project; we observed a reduction on waiting time and favored distance education processes. CONCLUSION: the three projects offered subsidies for decision-making by the Ministry of Health in e-Health and two developed technologies that could be incorporated into SUS.

Impact of Teleconsultation on Patients With Type 2 Diabetes in the Brazilian Public Health System: Protocol for a Randomized Controlled Trial (TELEconsulta Diabetes Trial).

BACKGROUND: Although the Brazilian Unified Health System (SUS) offers universal health coverage, access to quality care is often limited by social inequality and location. Although telemedicine has been shown to be an important tool in the efforts to overcome this problem, because it can provide access to specialist care and break the geographical barriers to health care, there are no national studies demonstrating its use in public health. OBJECTIVE: This study aims to test the hypothesis that remote consultation can be as effective as standard face-to-face consultation for type 2 diabetes mellitus in the Brazilian public health system and to assess the associated costs related to teleconsultation in public health scenarios, for patients referred from Primary Health Care units of the SUS for specialist care. METHODS: This is a pragmatic, phase 2, unicentric, open-label, noninferiority, blinded allocation, data-blinded, centrally randomized clinical trial. The inclusion criteria will be adults, both sexes, ≥18 years old, glycated hemoglobin (HbA1c) ≥8%. Outcomes will be evaluated by assessing symptoms, laboratory exams, anthropometric measurements, blood pressure, adverse events, and satisfaction level for 6 months. The costs of the teleconsultation will be assessed using the time-driven activity-based costing (TDABC) method to compare the costs with the face-to-face consultations. The noninferiority margin was set at 0.5%. Assuming an SD of 1.3% for both groups, true difference between the means of zero, and a type I error level of 5% (one-sided), it was estimated that 117 individuals per group would be necessary to achieve 90% power. Statistical analysis of the efficacy will be done using intention-to-treat and per-protocol approaches. RESULTS: The results from this trial will be reported according to the CONSORT guidelines. The trial was approved by the institutional review board on October 5, 2019. Data collection started in January 2019 and is expected to finish in 2022. At the time of manuscript submission, 18 participants were recruited. CONCLUSIONS: Our expectations are that providing remote access to health care will result in improvements in the health and quality of life of patients with type 2 diabetes and reduce costs and that both patients and clinicians will benefit from and be satisfied with this technology. TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clínicos RBR-8gpgyd; https://ensaiosclinicos.gov.br/rg/RBR-8gpgyd. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/23679.

Serological prevalence of Toxoplasma gondii infection in cats (Belém, Pará, Brazil).

We evaluated the prevalence of anti-Toxoplasma gondii antibodies in the serum samples collected from domestic cats in Belém, Pará, Brazil. We also correlated the presence of T. gondii antibodies with environmental variables and cat-owner habits. Four-hundred and forty-seven serum samples from domestic cats were analyzed. The sera were tested using an indirect immunofluorescence assay. Among the animals analyzed, 21.92% (98/447) were seropositive. A statistically significant association was found in relation to age and serology among the animals over 1 year old (p<0.01): in the group up to 1 year old, 12.82% (20/156) of the animals were positive, and in the group over 1 year old, 26.80% (78/291) were positive. Our results show that the cats in Belém, Pará region have anti-T. gondii antibodies, and their owners are not aware of toxoplasmosis or how to prevent its transmission.

Serological prevalence of Toxoplasma gondii infection in cats (Belém, Pará, Brazil) / Prevalência sorológica de infecção por Toxoplasma gondii em gatos (Belém, Pará, Brasil)

Abstract We evaluated the prevalence of anti-Toxoplasma gondii antibodies in the serum samples collected from domestic cats in Belém, Pará, Brazil. We also correlated the presence of T. gondii antibodies with environmental variables and cat-owner habits. Four-hundred and forty-seven serum samples from domestic cats were analyzed. The sera were tested using an indirect immunofluorescence assay. Among the animals analyzed, 21.92% (98/447) were seropositive. A statistically significant association was found in relation to age and serology among the animals over 1 year old (p<0.01): in the group up to 1 year old, 12.82% (20/156) of the animals were positive, and in the group over 1 year old, 26.80% (78/291) were positive. Our results show that the cats in Belém, Pará region have anti-T. gondii antibodies, and their owners are not aware of toxoplasmosis or how to prevent its transmission.

Resumo Foi avaliada a prevalência de anticorpos anti-Toxoplasma gondii em amostras de soro, coletadas de gatos domésticos, em Belém, Pará, Brasil. Também correlacionou-se a presença de anticorpos contra T. gondii com variáveis ambientais e hábitos de proprietários. Quatrocentas e quarenta e sete amostras de soro de gatos domésticos foram analisadas. Os soros foram testados por ensaio de imunofluorescência indireta, e as amostras de fezes foram analisadas por meio de reação em cadeia da polimerase. Entre os animais analisados, 21,92% (98/447) foram soropositivos. Foi encontrada associação estatística significante em relação à idade e à sorologia entre os animais acima de 1 ano (p <0,01): no grupo de até 1 ano, 12,82% (20/156) dos animais positivos e, no grupo acima de 1 ano, 26,80% (78/291) positivos. Os resultados mostram que os gatos daquela região possuem anticorpos anti-T. gondii, e seus donos não estão cientes da toxoplasmose ou de como evitar sua transmissão.

Cognições gerenciais sobre inovação gerencial e gestão de pessoas / Managerial cognitions regarding managerial innovation and people management

O objetivo geral desta pesquisa foi analisar o contexto da gestão de pessoas e a inovação gerencial numa empresa de comunicação, através da percepção de seus gestores. Os objetivos específicos foram: identificar mudanças ocorridas na área de gestão de pessoas, analisar a percepção de gestores a respeito das ações gerenciais que indicam inovação e analisar a relação entre o contexto da gestão de pessoas e da inovação gerencial. A metodologia foi qualitativa com a realização de 6 entrevistas semiestruturadas com gestores de alto cargo dentro da empresa. Os resultados foram analisados através da análise de conteúdo. As cognições gerenciais revelaram que as inovações estão presentes nas ações dos gestores e no processo evolutivo da gestão de pessoas da empresa. Também, foi observado a necessidade de alinhamento dos arranjos internos da empresa a fim de possibilitar o alcance das expectativas dos seus stakeholders. Este artigo contribui ao tratar da implementação de práticas que promovem a evolução da gestão de pessoas e estimulam a criação de inovações gerenciais. Além de promover melhor entendimento sobre a dinâmica gerencial de uma empresa de comunicação que enfrenta o desafio de ser competitiva e produzir informações de valor para seus clientes.

The general objective of this research was to analyze the context of people management and managerial innovation in a communication company, through the perception of its managers. The specific objectives were: to identify changes that occurred in the area of people management, analyze the perception of managers about management actions that indicate innovation and analyze the relationship between the context of people management and managerial innovation. The methodology was qualitative with the realization of 6 semi-structured interviews with senior managers within the company. The results were analyzed through content analysis. Management cognitions revealed that innovations are present in the actions of managers and in the evolutionary process of managing the company's people. Also, the need to align the company's internal arrangements in order to enable the achievement of the expectations of its stakeholders was observed. This article contributes by addressing the implementation of practices that promote the evolution of people management and stimulate the creation of managerial innovations. In addition, it promotes better comprehension about the management dynamics of a communication company that faces the challenge of being competitive and producing value information for its customers.

Evaluation Model for developing effective indicators for health surveillance actions in Brazil / Modelagem avaliativa para a construção de indicadores de efetividade das ações de vigilância sanitária no Brasil

Abstract Objective: to present an evaluation model for developing effective indicators for the Vigilância Sanitária (VISA) (Sanitary and Health Surveillance) actions in Brazil. Methods: an exploratory, evaluative study from primary sources data - electronic form by key informants and reports on national, international and secondary benchmarking visits - documental analysis. Results: the diversity of VISA management practices made it possible to define the evaluation object: Health Surveillance Actions - as an organized action system. The components: management; regulation; sanitary and health control; sanitary and health risk monitoring and information, communication and health education were derived from the aims of the intervention and composes a central structure of the Theoretical Model and the Logical Model Actions of VISA in the Sistema Nacional de Vigilância Sanitária (SNVS) (National Sanitary and Health Surveillance System) . Conclusions: The Vigilância Sanitária (VISA) (Sanitary and Health Surveillance) accumulates experience with the process indicators for monitoring actions, being incipient are capable of evaluating its impact. The theoretical resources in the evaluation area support the information management in the VISA field and besides contributing for studies on social determinants and the incorporation of analyses in historic series.

Resumo Objetivos: apresenta-se a modelagem avaliativa para a construção de indicadores de efetividade das ações de vigilância sanitária (VISA) no Brasil. Métodos: estudo avaliativo exploratório, com dados de fontes primárias - formulário eletrônico com informantes-chave e relatórios de visitas de benchmarking nacional e internacional e secundárias - análises documentais. Resultados: a diversidade das práticas nas instâncias gestoras da VISA possibilitou a definição do objeto de avaliação: Ações de Vigilância Sanitária -, enquanto um sistema organizado de ação. Os componentes: gestão; regulação; controle sanitário; monitoramento do risco sanitário e informação, comunicação e educação para a saúde originam-se dos objetivos da intervenção e compõem a estrutura central do Modelo Teórico e do Modelo Lógico das Ações de VISA no âmbito do Sistema Nacional de Vigilância Sanitária. Conclusões: a VISA acumula experiência com indicadores de processos para monitoramento das ações, sendo incipientes aqueles capazes de avaliar o seu impacto. Os recursos teóricos da área da avaliação apoiam a gestão da informação no campo da VISA, para além da contribuição de estudos sobre os determinantes sociais e a incorporação de análises de séries históricas.

O desenvolvimento de uma escala de transição e adaptação acadêmica / The development of the scale of transition and academic adaptation

A experiência vivida por jovens calouros em universidades é composta por várias facetas. Durante o primeiro ano da universidade, o estudante passa por um processo de adaptação acadêmica marcada por mudanças. Esse período, sendo multidimensional e complexo, necessita ser investigado, principalmente no contexto brasileiro, em que muitas alterações ocorreram no ingresso ao ensino superior e poucos estudos foram desenvolvidos para avaliar as dificuldades de adaptação desses novos estudantes. O objetivo deste estudo foi desenvolver um instrumento que avalie a experiência de transição acadêmica enfrentada por jovens calouros. Participaram da pesquisa 275 estudantes de graduação de duas universidades públicas federais. O instrumento utilizado inspirou-se no Questionário de Experiências de Transição Acadêmica ­ QETA ­ introduzido por Stocker e Faria (2008), em Portugal. As análises utilizaram o SPSS ­ StatisticalPackage for the Social Sciences e princípios da análise fatorial: técnicas de extração de componentes principais e rotação Oblimin direct, com o teste de confiabilidade, Alpha de Cronbach. A escala foi definida em cinco dimensões. Os resultados confirmam a pertinência de algumas dimensões, como pares e professores e traz evidências da importância do ensino médio para o estudo sobre a transição e adaptação acadêmica no contexto universitário.

The experience lived by new students in universities consists of many facets. During the first year of University, students go through a process of academic adaptation marked by change. This multidimensional and complex period needs to be investigated, especially in the Brazilian context, in which many changes have occurred in the process of the selection procedures to higher education and only few studies have been developed to assess the difficulties of adaptation of new college students. The aim of this study was to develop an instrument to evaluate the experience of academic transition faced by new students. 275 students of two public universities participated in the research. The instrument was inspired by the Academic Transition Experiences Questionnaire ­ QETA ­ introduced by Stocker and Faria (2008), in Portugal. The analysis used the SPSS ­ Statistical Package for the Social Sciences, and principles of factor analysis: principal components extraction techniques and direct Oblimin rotation, with the reliability test, Alpha of Cronbach. The scale was set in 5 dimensions. The results confirm the relevance of some dimensions, such as peers and teachers, and bring evidence of the importance of secondary education for the studyon the transition and adaptation in the academic context.

O Desenvolvimento de uma escala de transição e adaptação acadêmica / The development of the scale of transition and academic adaptation

A experiência vivida por jovens calouros em universidades é composta por várias facetas. Durante o primeiro ano da universidade, o estudante passa por um processo de adaptação acadêmica marcada por mudanças. Esse período, sendo multidimensional e complexo,necessita ser investigado, principalmente no contexto brasileiro, em que muitas alterações ocorreram no ingresso ao ensino superior e poucos estudos foram desenvolvidos para avaliar as dificuldades de adaptação desses novos estudantes. O objetivo deste estudo foi desenvolver um instrumento que avalie a experiência de transição acadêmica enfrentada por jovens calouros. Participaram da pesquisa 275 estudantes de graduação de duas universidades públicas federais. O instrumento utilizado inspirou-se no Questionário de Experiências de Transição Acadêmica – QETA – introduzido por Stocker e Faria (2008), em Portugal. As análises utilizaram o SPSS–Statistical Package for the Social Sciences e princípios da análise fatorial: técnicas de extração de componentes principais e rotação Oblimin direct, com o teste de confiabilidade, Alpha de Cronbach. A escala foi definida em cinco dimensões. Os resultados confirmam a pertinência de algumas dimensões, como pares e professores e traz evidências da importância do ensino médio para o estudo sobre a transição e adaptação acadêmica no contexto universitário.(AU)

A Transição do ensino médio para a universidade: um estudo qualitativo sobre os fatores que influenciam este processo e suas consequências comportamentais / The transition from high school to college: a qualitative study of the factors that influence this process and their possible behavioral consequences

A entrada na Universidade para muitos jovens é marcada por uma fase de transição caracterizada por diversas mudanças que interferem em seu desenvolvimento psicossocial, além do profissional. O presente trabalho teve como objetivo a análise dos fatores que influenciaram na adaptação do aluno, egresso do ensino médio, à vida universitária, bem como a identificação das mudanças comportamentais ocorridas em função desse processo de transição acadêmica. O estudo foi realizado através de entrevistas semi-estruturadas com 8 estudantes pertencentes a diferentes cursos. Os dados foram analisados através da análise de conteúdo e categorizado em dois segmentos: Fatores que Influenciaram na Adaptação e Mudanças Comportamentais. Os resultados indicaram o destaque de sete categorias para o primeiro bloco – Infraestrutura; Informação sobre a Universidade e o curso; Fatores Externo à Universidade;Aspectos Organizacionais; Material de Estudo; Vínculos e Professores – e quatro categorias para o segundo bloco - Aspectos pessoais; Organização pessoal para o estudo; Tempo e Sintomas. O estudo contribui para pontuar as dificuldades encontradas pelos alunos ingressantes no contexto da universidade e proporcionou melhor compreensão sobre a transição acadêmica (AU)

A transição do ensino médio para a universidade: um estudo qualitativo sobre os fatores que influenciam este processo e suas possíveis consequências comportamentais / The transition from high school to college: a qualitative study of the factors that influence this process and their possible behavioral consequences

A entrada na Universidade para muitos jovens é marcada por uma fase de transição caracterizada por diversas mudanças que interferem em seu desenvolvimento psicossocial, além do profssional. O presente trabalho teve como objetivo a análise dos fatores que influenciaram na adaptação do aluno, egresso do ensino médio, à vida universitária, bem como a identifcação das mudanças comportamentais ocorridas em função desse processo de transição acadêmica. O estudo foi realizado através de entrevistas semiestrutadas com 8 estudantes pertencentes a diferentes cursos. Os dados foram analisados através da análise de conteúdo e categorizados em dois segmentos: Fatores que Influenciaram na Adaptação e Mudanças Comportamentais. Os resultados indicaram o destaque de sete categorias para o primeiro bloco ­ Infraestrutura; Informação sobre a Universidade e o curso; Fatores Externo à Universidade; Aspectos Organizacionais; Material de Estudo; Vínculos e Professores ­ e quatro categorias para o segundo bloco - Aspectos pessoais; Organização pessoal para o estudo; Tempo e Sintomas. O estudo contribui para pontuar as difculdades encontradas pelos alunos ingressantes no contexto da universidade e proporcionou melhor compreensão sobre a transição acadêmica.(AU)

For many young people, joining the university is marked by a transition process characterized by several changes that both affect and influence their psychosocial - as well as their professional - development. This work aims to analyze the factors that have ultimately been influencing the student's acclimation from high school up to his or her university life. Besides that, looked for identifcation of behavioral changes occurred because of this process of academic transition. The study was conducted through eight semi-structered interviews with students ranging from different courses. The collected data was analyzed using the approach of content analysis and categorized into two segments: a) Factors that have influenced the student's adaptation on campus; b) Behavioral changes. The results highlighted seven (7) categories concentrated on a frst block: Infrastructure; Information about the university and course; Factors external to the university; Organizational Aspects; Material of Study; Attachment and Professors ­ and four (4) categories concentrated on a second block: a) Personal aspects; b) Personal Planinng to the Studies; c) Time and d) Symptom. This work contributes to punctuate diffculties encountered by freshmen on campus and provide better understanding of the academic transition(AU)

Perfil epidemiológico e estratégias para o diagnóstico de SMSL em um país em desenvolvimento / Epidemiological profile and strategies for diagnosing SIDS in a developing country

OBJETIVO: Descrever o perfil epidemiológico, os fatores de risco e as melhores estratégias para diagnosticar a síndrome da morte súbita do lactente (SMSL) em um país em desenvolvimento. MÉTODOS: Estudo caso-controle populacional com crianças nascidas entre 01/01/2001 e 31/12/2003 em Porto Alegre (RS), divididas em três grupos: casos de SMSL (33) e controles - óbitos esclarecidos (192) e crianças vivas (192) -, que foram pareados por idade e sexo aos casos. As famílias com casos de lactentes menores de 1 ano que faleceram em casa foram identificadas, e as informações das certidões de óbito e autópsias foram comparadas para confirmar a SMSL. Os óbitos esclarecidos foram os ocorridos em hospitais, e os controles vivos foram selecionados na vizinhança dos casos de SMSL. Os pais foram entrevistados para obter informações sobre a saúde e os hábitos de sono da criança. Realizou-se uma análise multivariada para identificar fatores de risco na população estudada. RESULTADOS: A incidência da SMSL na população avaliada foi de 0,55/1.000 nascidos vivos. A análise revelou os seguintes fatores de risco: etnia (autorreferida como negra), prematuridade, baixo peso ao nascer, mãe adolescente, tabagismo na gravidez e renda familiar abaixo de um salário mínimo. Além disso, 94 por cento dos casos de SMSL foram mal-diagnosticados na certidão de óbito. CONCLUSÕES: Embora a SMSL tenha sido mal-diagnosticada, seu perfil epidemiológico é semelhante ao da literatura, assim como os fatores de risco, que poderiam ser reduzidos com campanhas preventivas. Investigar a SMSL em países em desenvolvimento requer estratégias especiais para evitar erros de diagnóstico.

OBJECTIVE: To describe the epidemiological profile, risk factors and best strategies for diagnosing sudden infant death syndrome (SIDS) in a developing country. METHODS: Population-based, case-control study with children born between January 1st, 2001, and December 31st, 2003, in Porto Alegre, southern Brazil, who were allocated into three groups: SIDS cases (33), explained death controls (192), and living controls (192). Children in the latter two groups were age- and sex-paired with SIDS cases. Families in which an infant had died at home within the first year of life were identified, and the information available on death certificates and autopsy reports was compared to confirm the diagnosis of SIDS. Explained death controls consisted of infants who had died at city hospitals, and living controls were selected in the same neighborhood as SIDS cases. All parents were interviewed to obtain information on children’s health and sleep habits. Multivariate analysis was performed to identify risk factors in the study population. RESULTS: The incidence of SIDS in the population assessed was 0.55/1,000 live births. The analysis revealed the following risk factors: ethnicity (characterized by self-reported black skin color), prematurity, low birth weight, adolescent mother, smoking during pregnancy, and family income of less than one minimum wage. Ninety-four percent of SIDS cases were misdiagnosed in the death certificate. CONCLUSIONS: Although SIDS was misdiagnosed in official death certificates, the epidemiological profile is similar to the literature, as well as risk factors, which could be reduced with preventive campaigns. Investigating SIDS in developing countries requires special strategies to avoid misdiagnosis.

Epidemiological profile and strategies for diagnosing SIDS in a developing country.

OBJECTIVE: To describe the epidemiological profile, risk factors and best strategies for diagnosing sudden infant death syndrome (SIDS) in a developing country. METHODS: Population-based, case-control study with children born between January 1st, 2001, and December 31st, 2003, in Porto Alegre, southern Brazil, who were allocated into three groups: SIDS cases (33), explained death controls (192), and living controls (192). Children in the latter two groups were age- and sex-paired with SIDS cases. Families in which an infant had died at home within the first year of life were identified, and the information available on death certificates and autopsy reports was compared to confirm the diagnosis of SIDS. Explained death controls consisted of infants who had died at city hospitals, and living controls were selected in the same neighborhood as SIDS cases. All parents were interviewed to obtain information on children's health and sleep habits. Multivariate analysis was performed to identify risk factors in the study population. RESULTS: The incidence of SIDS in the population assessed was 0.55/1,000 live births. The analysis revealed the following risk factors: ethnicity (characterized by self-reported black skin color), prematurity, low birth weight, adolescent mother, smoking during pregnancy, and family income of less than one minimum wage. Ninety-four percent of SIDS cases were misdiagnosed in the death certificate. CONCLUSIONS: Although SIDS was misdiagnosed in official death certificates, the epidemiological profile is similar to the literature, as well as risk factors, which could be reduced with preventive campaigns. Investigating SIDS in developing countries requires special strategies to avoid misdiagnosis.

Trypanosoma cruzi (Kinetoplastida, Trypanosomatidae) genotypes in neotropical bats in Brazil.

Few studies have been conducted to investigate the role played by the order Chiroptera in the sylvatic transmission cycle of Trypanosoma cruzi or their putative association with the main genotypes of the parasite. Here, the purpose was to enlarge the knowledge of this issue, in this sense, 93 specimens of bats included in 4 families, respectively Molossidae, Noctilionidae, Phyllostomidae and Vespertilionidae collected in distinct regions of Brazil were submitted to fresh blood smears and hemocultures. No patent parasitemia was observed but positive hemocultures by T. cruzi were observed in 14% (13/93) of examined samples. The majority of the parasite isolates were obtained from Phyllostomus hastatus (80%) captured in one same buriti hollow palm tree in the Cerrado region. Multilocus enzyme electrophoresis (MLEE) analyses showed that the genetic distance among these isolates was 0.35, almost the same observed when all the isolates (excluding the reference strains) were analyzed (0.40). No correlation of zymodeme with bat genera, species or geographic region of its origin could be observed, moreover, correlation of zymodeme and genotype of the parasite was not strict. Ten out of 14 T. cruzi isolates obtained from bats corresponded to the TCII genotype. Chiropterans with TCI, TCII/TCIII mixed infection as well as Trypanosoma rangeli in single or mixed infections were observed. These results show that bats may harbor and are probably important maintainers of the main genotypes (TCI, TCII, TCIII/Z3) of T. cruzi. These results support the absence of an association of TCII with any mammal order and show that bats, mainly P. hastatus, may act as amplifier hosts of TCII subpopulations of T. cruzi.

Risk factors for sudden infant death syndrome in a developing country

OBJETIVO: Analisar se fatores de risco previamente identificados para a síndrome da morte súbita do lactente têm impacto significativo em um país em desenvolvimento. MÉTODOS: Estudo retrospectivo, longitudinal, de caso-controle pareado realizado em Porto Alegre, RS. Os casos (N=39) foram lactentes nascidos entre 1996 e 2000 que morreram subitamente e inesperadamente em casa, ao dormir, com diagnóstico final da síndrome; o grupo controle (N=117) foi composto de lactentes pareados por idade e sexo que morreram em hospitais, por outra doença. Os dados foram coletados de registros médicos postmortem e respostas a questionários. Utilizou-se modelo de regressão logística para identificar os fatores associados ao desfecho. RESULTADOS: A idade média dos casos no momento da morte dos lactentes foi de 3,2 meses. As freqüências de idade gestacional, amamentação e visitas regulares a unidades básicas de saúde foram similares nos dois grupos. A posição de dormir mais comum nos casos e controles foi a lateral. A posição supina foi encontrada em alguns lactentes em ambos grupos. As variáveis maternas idade inferior a 20 anos (OR=2, IC 95 por cento:1,1;5,1) e consumo de mais de 10 cigarros/dia durante a gravidez (OR=3, IC 95 por cento: 1,3;6,4) aumentaram significativamente o risco para a síndrome. As características socioeconômicas foram similares entre os grupos e não afetaram o risco. CONCLUSÕES: Os perfis lactente-materno e os fatores de risco foram similares aos encontrados em outros países. Todavia, foram identificadas características individuais quanto aos riscos de fumar durante a gravidez e da idade materna inferior a 20 anos.

Risk factors for sudden infant death syndrome in a developing country.

OBJECTIVE: To analyze whether previously identified risk factors for sudden death syndrome have a significant impact in a developing country. METHODS: Retrospective longitudinal case-control study carried out in Porto Alegre, Southern Brazil. Cases (N=39) were infants born between 1996 and 2000 who died suddenly and unexpectedly at home during sleep and were diagnosed with sudden death syndrome. Controls (N=117) were infants matched by age and sex who died in hospitals due to other conditions. Data were collected from postmortem examination records and questionnaires answers. A conditional logistic model was used to identify factors associated with the outcome. RESULTS: Mean age at death of cases was 3.2 months. The frequencies of infants regarding gestational age, breastfeeding and regular medical visits were similar in both groups. Sleeping position for most cases and controls was the lateral one. Supine sleeping position was found for few infants in both groups. Maternal variables, age below 20 years (OR=2, 95% CI: 1.1; 5.1) and smoking of more than 10 cigarettes per day during pregnancy (OR=3, 95% CI: 1.3; 6.4), significantly increased the risk for the syndrome. Socioeconomic characteristics were similar in both groups and did not affect risk. CONCLUSIONS: Infant-maternal and socioeconomic profiles of cases in a developing country closely resembled the profile described in the literature, and risk factors were similar as well. However, individual characteristics were identified as risks in the population studied, such as smoking during pregnancy and maternal age below 20 years.

Trypanosoma cruzi (kinetoplastida Trypanosomatidae): biological heterogeneity in the isolates derived from wild hosts.

The course of experimental infection of Swiss mice with 95 sylvatic Trypanosoma cruzi isolates included in TCI or TCII genotype was characterized. The purpose was to verify biological properties and its eventual correspondence with original host species, genotype or zymodeme. The isolates of T. cruzi were 100% infective, 55% resulted in patent parasitemia with 69% (36/52) of mortality. A meaningful biological heterogeneity was observed in both, TCI and TCII isolates. TCII isolates resulted in higher patent parasitemia 64% (38/59), in contrast to the 41% TCI infected Swiss mice (14/34). Parasitemia was not always associated to mortality. Higher biological heterogeneity was observed in T. cruzi II isolates derived from L. rosalia from the Atlantic Coastal Rain forest. TCII isolates derived from marsupials resulted in very similar infection profile in Swiss mice.

Avaliação das repercussões da expansão da atenção básica em municípios em gestão plena do sistema do Estado de São Paulo / Evaluation of the consequences of primary health care expansion in municipal districts in full management of the São Paulo State Health System

Este projeto de pesquisa tem como: Objetivo geral: Avaliar as repercussões da expansão da Atenção Básica em municípios em Gestão Plena do Sistema Único de Saúde, selecionados no Estado de São Paulo e objetivos específicos: a) Identificar as diretrizes políticas no nível municipal que impulsionaram a expansão da Atenção Básica e dos outros níveis de complexidade da atenção do sistema municipal; b) Analisar a demanda por procedimentos ambulatoriais especializados e de alta complexidade, gerada pela expansão da Atenção Básica. A metodologia utilizada foi Estudo de Caso, pois possibilita conhecer o fenômeno, adequadamente, a partir da exploração intensa de um único caso. Utiliza-se de abordagens quantitativas e qualitativas. Para interpretação dos dados qualitativos, a técnica empregada foi Análise de Conteúdo. Este projeto de pesquisa apresentou os seguintes resultados: A expansão da Atenção Básica, por meio da Estratégia Saúde da Família, é motivada pelo desejo de mudança na Atenção Básica e tem como objetivo a reorganização do Sistema de Saúde Local; A expansão da Atenção Básica trouxe repercussões para o sistema, que não foram contempladas no "planejamento" inicial, tais como: O despreparo dos profissionais e a alta rotatividade, colocando em risco a sustentabilidade da Estratégia Saúde da Família e reorganização da rede de serviços de Saúde; maior demanda por serviços de média e alta complexidade.