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2.
Front Immunol ; 10: 2192, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31616412

RESUMO

The Yellow Fever (YF) vaccination is recommended for people living in endemic areas and represents the most effective strategy to reduce the risk of infection. Previous studies have warned that booster regimens should be considered to guarantee the long-term persistence of 17DD-YF-specific memory components in adults living in areas with YF-virus circulation. Considering the lower seroconversion rates observed in children (9-12 months of age) as compared to adults, this study was designed in order to access the duration of immunity in single-dose vaccinated children in a 10-years cross-sectional time-span. The levels of neutralizing antibodies (PRNT) and the phenotypic/functional memory status of T and B-cells were measured at a baseline, 30-45 days, 1, 2, 4, 7, and 10 years following primary vaccination. The results revealed that a single dose induced 85% of seropositivity at 30-45 days and a progressive time-dependent decrease was observed as early as 2 years and declines toward critical values (below 60%) at time-spans of ≥4-years. Moreover, short-lived YF-specific cellular immunity, mediated by memory T and B-cells was also observed after 4-years. Predicted probability and resultant memory analysis emphasize that correlates of protection (PRNT; effector memory CD8+ T-cells; non-classical memory B-cells) wane to critical values within ≥4-years after primary vaccination. Together, these results clearly demonstrate the decline of 17DD-YF-specific memory response along time in children primarily vaccinated at 9-12 months of age and support the need of booster regimen to guarantee the long-term persistence of memory components for children living in areas with high risk of YF transmission.

3.
Front Immunol ; 10: 1211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31293563

RESUMO

The present study aims to determine whether 17DD-YF-specific humoral and cellular immunological memory is maintained 8-years after primary vaccination with subdoses (10,447IU;3,013IU;587IU;158IU;31IU). For this purpose, this follow-up study was carried out in a subset of volunteers (n = 98) originally enrolled in the dose-response study in 2009 and 46 non-vaccinated controls. Our results demonstrated that vaccinees, who had seroconverted following primary vaccination and had not been revaccinated, present similar neutralizing antibodies levels and YF-specific cellular memory, particularly CMCD4 and EMCD8 as compared to the reference full dose (27,476IU). Although, PRNT seropositivity rates were similar across subgroups (94, 82, 83, 94, 80, and 91%, correspondingly), only doses above 587IU elicited similar iterative proportion of seropositivity rates, calculated as a progressive decrease on seropositivity rates along time (89, 80, 80, and 91%, respectively) as compared to 158IU and 31IU (68 and 46%, respectively). Noteworthy were the strong positive correlations ("EMCD4,EMCD8" and "TNFCD8,IFNCD8") observed in most subdoses, except for 31IU. Major similarities underscored the preserved antibody titers and the outstanding levels of EMCD8, relevant correlates of protection for YF-specific immunity. These findings provide evidences to support the regular use of dose sparing strategy for YF vaccine in adults.

4.
J Trop Pediatr ; 65(6): 592-602, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31006031

RESUMO

OBJECTIVE: To better understand the clinical spectrum and course of congenital Zika syndrome (CZS) during the first 18 months of life of children whose mothers had rash during pregnancy. METHODS: This longitudinal observational study evaluated the clinical progress from birth until 18 months of life of children of mothers who developed rash during or up to 3 months before gestation. Maternal rash occurred from November 2015 to May 2017. The study subjects were divided into three groups: children whose mothers tested positive by RT-qPCR for Zika virus (ZIKV) (Group 1), children whose mothers tested negative by RT-qPCR for ZIKV (Group 2), and children whose mothers did not undergo any testing for ZIKV (Group 3) but tested negative for other congenital infections. RESULTS: Between April 2016 and July 2018, we studied 108 children: 43 in Group 1, 26 in Group 2 and 39 in Group 3. The majority of children were admitted into the study within 6 months of life. CZS was diagnosed in 26 children, equally distributed in Groups 1 and 3. Of 18 children with microcephaly, 6 were in Group 1 (1 postnatal) and 12 were in Group 3 (5 postnatal). Maternal rash frequency was 10 times higher during the first trimester than in the other trimesters (OR: 10.35; CI 95%: 3.52-30.41). CZS was diagnosed during the follow-up period in 14 (54%) cases. Developmental delays and motor abnormalities occurred in all children and persisted up to 18 months. Epilepsy occurred in 18 (69%) of the cases. CONCLUSIONS: Infants born of mothers exposed to ZIKV during pregnancy showed progression of developmental, motor and neurologic abnormalities even if they were born asymptomatic. Continued postnatal monitoring of such newborns is necessary to preclude disability-associated complications.

5.
Mem Inst Oswaldo Cruz ; 114: e180517, 2019 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-30843921

RESUMO

BACKGROUND: Field testing required to license the combined measles, mumps, and rubella (MMR) vaccine must take into account the current recommendation of the vaccine in Brazil: first dose at 12 months and second dose at 15 months of age in combination with a varicella vaccine. OBJECTIVES: This study aimed to evaluate the clinical consistency, immunogenicity, and reactogenicity of three batches of MMR vaccine prepared with active pharmaceutical ingredients (API) from Bio-Manguinhos, Fiocruz (MMR-Bio), and compare it to a vaccine (MMR produced by GlaxoSmithKline) with different API. METHODS: This was a phase III, randomised, double-blind, non-inferiority study of the MMR-Bio administered in infants immunised at health care units in Pará, Brazil, from February 2015 to January 2016. Antibody levels were titrated by immunoenzymatic assays. Adverse events were recorded in diaries. FINDINGS: Seropositivity levels after MMR-Bio were 97.6% for measles, 84.7% for mumps, and 98.0% for rubella. After the MMRV vaccine, seroconversion rates and GMT increased substantially for mumps. In contrast, approximately 35% of the children had no detectable antibodies to varicella. Systemic adverse events were more frequent than local events. CONCLUSION: The demonstration of batch consistency and non-inferiority of the Bio-MMR vaccine completed the technology transfer. This is a significant technological achievement with implications for immunisation programs.


Assuntos
Vacina contra Varicela/administração & dosagem , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Varicela/prevenção & controle , Vacina contra Varicela/efeitos adversos , Vacina contra Varicela/imunologia , Método Duplo-Cego , Feminino , Humanos , Esquemas de Imunização , Lactente , Masculino , Sarampo/prevenção & controle , Vacina contra Sarampo-Caxumba-Rubéola/efeitos adversos , Vacina contra Sarampo-Caxumba-Rubéola/imunologia , Caxumba/prevenção & controle , Rubéola (Sarampo Alemão)/imunologia , Rubéola (Sarampo Alemão)/prevenção & controle , Vacinas Combinadas/administração & dosagem , Vacinas Combinadas/efeitos adversos , Vacinas Combinadas/imunologia
6.
Mem. Inst. Oswaldo Cruz ; 114: e180517, 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-990193

RESUMO

BACKGROUND Field testing required to license the combined measles, mumps, and rubella (MMR) vaccine must take into account the current recommendation of the vaccine in Brazil: first dose at 12 months and second dose at 15 months of age in combination with a varicella vaccine. OBJECTIVES This study aimed to evaluate the clinical consistency, immunogenicity, and reactogenicity of three batches of MMR vaccine prepared with active pharmaceutical ingredients (API) from Bio-Manguinhos, Fiocruz (MMR-Bio), and compare it to a vaccine (MMR produced by GlaxoSmithKline) with different API. METHODS This was a phase III, randomised, double-blind, non-inferiority study of the MMR-Bio administered in infants immunised at health care units in Pará, Brazil, from February 2015 to January 2016. Antibody levels were titrated by immunoenzymatic assays. Adverse events were recorded in diaries. FINDINGS Seropositivity levels after MMR-Bio were 97.6% for measles, 84.7% for mumps, and 98.0% for rubella. After the MMRV vaccine, seroconversion rates and GMT increased substantially for mumps. In contrast, approximately 35% of the children had no detectable antibodies to varicella. Systemic adverse events were more frequent than local events. CONCLUSION The demonstration of batch consistency and non-inferiority of the Bio-MMR vaccine completed the technology transfer. This is a significant technological achievement with implications for immunisation programs.


Assuntos
Humanos , Rubéola (Sarampo Alemão) , Vacinas Bacterianas/provisão & distribução , Imunogenicidade da Vacina/imunologia , Vírus do Sarampo , Ensaio Clínico
7.
Vaccine ; 36(28): 4112-4117, 2018 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-29784469

RESUMO

In 2009, Bio-Manguinhos conducted a dose-response study with the yellow fever vaccine, administering the vaccine in the usual mean dose of 27,476 IU (full dose, reference) and in tapered doses (10,447 IU, 3013 IU, 587 IU, 158 IU, and 31 IU) by the usual subcutaneous route and usual volume (0.5 mL). Tapered doses were obtained by dilution in the manufacturer's laboratory, and the test batches presented industrial quality. Doses down to 587 IU showed similar immunogenicity to the full dose (27,476, reference), while the 158 IU and 31 IU doses displayed lower immunogenicity. Seropositivity was maintained at 10 months, except in the group that received the 31 IU dose. The current study aims to determine whether yellow fever seropositivity was maintained eight years after YF vaccination in non-revaccinated individuals. According to the current study's results, seropositivity was maintained in 85% of 318 participants and was similar across groups. The findings support the use of the yellow fever vaccine in fractional doses during outbreaks, but each fractional dose should have at least 587 IU. This study also supports the minimum dose required by WHO, 1000 IU. CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov NCT 03338231.


Assuntos
Vacina contra Febre Amarela/imunologia , Febre Amarela/prevenção & controle , Estudos de Coortes , Relação Dose-Resposta Imunológica , Humanos , Injeções Subcutâneas , Masculino , Militares , Fatores de Tempo , Voluntários , Vacina contra Febre Amarela/administração & dosagem
8.
Trials ; 19(1): 244, 2018 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-29685164

RESUMO

BACKGROUND: The annual new-case detection rate for leprosy, while generally stable over the last decade, shows that transmission rates have remained stagnant despite the successful worldwide administration of multidrug therapy since the 1980s. As such, novel control strategies are urgently needed. Focusing on managing leprosy patient contacts, the most susceptible to contracting the disease, has been seen as a potential strategy in limiting the spread of leprosy as shown by a number of recent epidemiological studies. Immunoprophylaxis with Bacillus Calmette-Guérin (BCG) has been seen as an effective preventive measure due to its ability to stimulate the development of cellular immunity which is essential in controlling the disease, especially in its multibacillary (MB) forms. The association of immunoprophylaxis with chemoprophylaxis in a single dose of rifampicin has been shown to be a promising preventive strategy, although a variety of studies have found instances of early case detection just a few months after BCG vaccination. METHODS/DESIGN: The present study is a phase IV chemoprophylactic clinical trial consisting of administration of a single dose of rifampicin in MB leprosy patient contacts under care at the Souza Araújo Outpatient Clinic/FIOCRUZ as part of a randomized (2:1), double-blind, placebo-controlled study. It is comprised of two groups: 1) rifampicin + BCG; and 2) placebo + BCG. DISCUSSION: The aim is to evaluate whether the use of chemoprophylaxis with a single dose of rifampicin in MB leprosy patient contacts prior to the BCG vaccine would be able to prevent the onset of leprosy in those cases that may occur just a few months after vaccination. Contact subclinical infections (polymerase chain reaction) and the immunological parameters (anti-PGL-1, anti-LID-1, and IFN-γ) will be evaluated and the results will be compared after 12 months of follow-up. TRIAL REGISTRATION: The Brazilian Registry of Clinical Trials (ReBEC), RBR-69QK5P . Retrospectively registered on 1 June 2017.


Assuntos
Vacina BCG/administração & dosagem , Busca de Comunicante , Hansenostáticos/administração & dosagem , Hanseníase Multibacilar/prevenção & controle , Rifampina/administração & dosagem , Adolescente , Adulto , Idoso , Vacina BCG/efeitos adversos , Brasil , Criança , Pré-Escolar , Ensaios Clínicos Fase IV como Assunto , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Lactente , Hansenostáticos/efeitos adversos , Hanseníase Multibacilar/imunologia , Hanseníase Multibacilar/microbiologia , Hanseníase Multibacilar/transmissão , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Rifampina/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Vacinação , Adulto Jovem
9.
J Trop Pediatr ; 64(5): 373-381, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29059411

RESUMO

Background: More than half of the hospitalizations because of dengue in Brazil occurred in children <15 years of age in 2007 and 2008, an unexpected change in the epidemiological pattern. We sought to determine clinical and laboratory parameters associated with severity. Methods: A case-control study was conducted in three pediatric hospitals in Rio de Janeiro, Brazil; 233 laboratory-confirmed dengue patients were included: 69 cases and 164 controls. Specific clinical and laboratory factors were assessed using univariate and multivariate logistic regression models. Results: Lethargy [adjusted odds ratio (ORa): 9.15, 95% confidence interval (CI): 3.08-27.12], dyspnea (ORa: 8.24, 95% CI: 3.27-20.72) and abdominal pain (ORa: 6.78, 95% CI: 1.44-31.84) were independently associated with severe dengue in children. Lethargy and dyspnea presented as early as 72 and 48 h, respectively, before shock. Conclusions: Abdominal pain and lethargy confirmed their role as warning signs, which along with dyspnea might be helpful in identifying cases progressing to severe dengue.


Assuntos
Vírus da Dengue/isolamento & purificação , Hospitalização/estatística & dados numéricos , Dengue Grave/diagnóstico , Dor Abdominal/etiologia , Adolescente , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Dispneia/etiologia , Feminino , Humanos , Letargia/etiologia , Masculino , Estudos Retrospectivos , Dengue Grave/epidemiologia
10.
Rev. bras. cineantropom. desempenho hum ; 19(6): 730-742, Nov.-Dec. 2017. tab, graf, ilus
Artigo em Inglês | LILACS | ID: biblio-897878

RESUMO

Abstract Studies assessed the beneficial effects of aerobic exercise on blood pressure (BP); however, few studies have evaluated the effects of long-term resistance training on variations of this response. The aim of the study was to verify through a systematic review, the long-term effect of resistance training on BP. Searches were made on Medline through Pubmed, Science Direct, Scopus, Web of Science and Lilacs databases. Overall, 751 articles were found, of which 22 were further analyzed. The analysis followed the PRISMA checklist (Statement for Reporting Systematic Reviews and Meta-Analyses of Studies) and was divided according to two resistance training models: traditional resistance training (TRT), resistance training alone; or combined resistance training (CRT), resistance training associated with aerobic exercise. Greater BP reductions occurred for CRT compared to TRT. However, further studies are needed to better explicit the resistance training variables (number of exercises, repetitions, number of sets, intervals, speed of execution and load intensity), in order to identify the best training model and improve the methodological quality of experiments in an attempt to reduce the risk of bias.


Resumo Estudos têm verificado os efeitos benéficos do exercício aeróbico na modificação da pressão arterial (PA), entretanto poucos estudos avaliaram os efeitos a longo prazo do treinamento resistido na variação desse desfecho. Assim, o objetivo do estudo foi verificar por meio de uma revisão sistemática a ação de longo prazo do treinamento resistido na PA. Realizaram-se buscas nas bases Medline via Pubmed, Science Direct, Scopus, Web Science e Lilacs. Foram encontrados 751 artigos dos quais 22 fizeram parte da análise. A análise seguiu o checklist PRISMA (Statement for Reporting Systematic Reviews and Meta-Analyses of Studies) e foi dividida em função da utilização de dois modelos para a aplicação do treinamento resistido: treinamento resistido tradicional (TRT), somente exercícios resistidos, e treinamento resistido combinado (TRC), exercícios resistidos mais exercícios aeróbicos. As maiores reduções na PA ocorreram quando da realização do treinamento resistido combinado em relação ao treinamento resistido tradicional. Entretanto, são necessários mais estudos para melhor explicitar as variáveis do treinamento resistido (número de exercícios, repetições, número de séries, intervalos, velocidade de execução e intensidade de carga), para que se possa identificar o melhor modelo de treinamento e aprimorar a qualidade metodológica dos experimentos na tentativa de diminuir os riscos de viés.


Assuntos
Exercício Físico , Treinamento de Resistência/métodos , Pressão Arterial
11.
Cad. Saúde Pública (Online) ; 33(10): e00060917, oct. 2017.
Artigo em Português | LILACS-Express | ID: biblio-952317

RESUMO

Resumo: Febre amarela é uma doença viral potencialmente grave, transmitida por mosquitos Haemagogus, Aedes e Sabethes. A vacinação é a medida mais importante para a sua prevenção e controle. Neste artigo, analisamos as recomendações de vacinação no Brasil, segundo a epidemiologia da doença nas últimas décadas. Considerando a facilidade de deslocamentos de suscetíveis para áreas de risco, e sua tendência de expansão, é provável que eventualmente todo o país tenha de adotar a vacinação rotineira. Porém, no processo decisório de ampliação da população candidata à vacinação, questões relacionadas à segurança vacinal têm sido destacadas. Apresentamos uma análise dos riscos e benefícios da vacinação e das estratégias para o controle da doença e prevenção da sua urbanização nas regiões onde a vacina ainda não é recomendada. Concluímos que a introdução da vacina contra a febre amarela no calendário de vacinação das crianças é uma estratégia proativa, de mais fácil operacionalização, como resposta ao aumento do número de casos de febre amarela silvestre no Brasil e tentativa de prevenção da reurbanização da doença.


Resumen: La fiebre amarilla es una enfermedad viral, potencialmente grave, transmitida por mosquitos Haemagogus, Aedes y Sabethes. La vacunación es la medida más importante para su prevención y control. En este artículo, analizamos las recomendaciones de vacunación en Brasil, según la epidemiología de la enfermedad en las últimas décadas. Considerando la facilidad de los desplazamientos de personas susceptibles hacia zonas de riesgo, y la tendencia de expansión de esta enfermedad, es probable que eventualmente todo el país tenga de adoptar la vacunación rutinaria. No obstante, en el proceso de decisión para la ampliación de la población candidata a la vacunación, se han destacado cuestiones relacionadas con la seguridad de la vacunación. Presentamos un análisis de los riesgos y beneficios de la vacunación y de las estrategias para el control de la enfermedad y prevención de su urbanización en las regiones donde la vacuna todavía no está recomendada. Concluimos que la introducción de la vacuna contra la fiebre amarilla en el calendario de vacunación de los niños es una estrategia proactiva, de más fácil operacionalización, como respuesta al aumento del número de casos de fiebre amarilla silvestre en Brasil, así como una tentativa de prevención frente a la reurbanización de la enfermedad.


Abstract: Yellow fever is a potentially severe viral disease transmitted by mosquitos of the genera Haemagogus, Aedes, and Sabethes. Vaccination is the most important measure for prevention and control of the disease. This article analyzes the immunization guidelines in Brazil based on epidemiology of the disease in recent decades. Considering the ease of human movement into areas at risk of transmission and the tendency for these areas to expand, in time the entire country will probably need to adopt routine vaccination. However, in the decision on expanding the target population for vaccination, vaccine safety issues have been emphasized. We present a risk-benefit analysis of vaccination and strategies for controlling the disease and preventing its urbanization in regions where the vaccine is still not recommended. We conclude that inclusion of the yellow fever vaccine on the childhood immunization schedule is a proactive, easily operationalized strategy as a response to the increase in the number of cases of sylvatic yellow fever in Brazil, and an attempt at preventing re-urbanization of the disease.

13.
J Immunol Methods ; 448: 9-20, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28514646

RESUMO

Technological innovations in vaccinology have recently contributed to bring about novel insights for the vaccine-induced immune response. While the current protocols that use peripheral blood samples may provide abundant data, a range of distinct components of whole blood samples are required and the different anticoagulant systems employed may impair some properties of the biological sample and interfere with functional assays. Although the interference of heparin in functional assays for viral neutralizing antibodies such as the functional plaque-reduction neutralization test (PRNT), considered the gold-standard method to assess and monitor the protective immunity induced by the Yellow fever virus (YFV) vaccine, has been well characterized, the development of pre-analytical treatments is still required for the establishment of optimized protocols. The present study intended to optimize and evaluate the performance of pre-analytical treatment of heparin-collected blood samples with ecteola-cellulose (ECT) to provide accurate measurement of anti-YFV neutralizing antibodies, by PRNT. The study was designed in three steps, including: I. Problem statement; II. Pre-analytical steps; III. Analytical steps. Data confirmed the interference of heparin on PRNT reactivity in a dose-responsive fashion. Distinct sets of conditions for ECT pre-treatment were tested to optimize the heparin removal. The optimized protocol was pre-validated to determine the effectiveness of heparin plasma:ECT treatment to restore the PRNT titers as compared to serum samples. The validation and comparative performance was carried out by using a large range of serum vs heparin plasma:ECT 1:2 paired samples obtained from unvaccinated and 17DD-YFV primary vaccinated subjects. Altogether, the findings support the use of heparin plasma:ECT samples for accurate measurement of anti-YFV neutralizing antibodies.


Assuntos
Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , Anticoagulantes/sangue , Coleta de Amostras Sanguíneas/métodos , Celulose/análogos & derivados , Monitoramento de Medicamentos/métodos , Heparina/sangue , Testes de Neutralização , Vacinação , Vacina contra Febre Amarela/administração & dosagem , Febre Amarela/prevenção & controle , Vírus da Febre Amarela/imunologia , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Celulose/química , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Ensaio de Placa Viral , Febre Amarela/sangue , Febre Amarela/diagnóstico , Febre Amarela/virologia , Adulto Jovem
14.
Cien Saude Colet ; 22(3): 819-830, 2017 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-28300990

RESUMO

Epidemiology plays a strategic role at this stage of the policy cycle, contributing to goal setting, resource allocation and use of information systems. In 2009, the Municipal Health Secretariat of Rio de Janeiro initiated a reform of the health care model under the main influence the Primary Health Care concept. This study evaluates the trend of selected pay-for-performance indicators that measure the health care process in the city's PHC. This a study on repeated panels, from the administrative and clinical records of electronic medical records in the period from 2012 to 2016. We selected seven indicators that analyzed longitudinal performance within the established goal, among those that represent access, longitudinality, coordination of care - APS attributes, as well as other characteristics of the services, such as care performance and economic efficiency. This study demonstrated that management decentralization to levels closer to the user is potentially successful for the recording of clinical data under an adequate monitoring of indicators, regular clinical audits and feedback to health professionals, along with data and indicators monitoring.


Assuntos
Assistência à Saúde/organização & administração , Registros Eletrônicos de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Reembolso de Incentivo , Brasil , Cidades , Assistência à Saúde/economia , Métodos Epidemiológicos , Reforma dos Serviços de Saúde , Pessoal de Saúde/organização & administração , Acesso aos Serviços de Saúde , Humanos , Atenção Primária à Saúde/economia , Alocação de Recursos
15.
Ciênc. Saúde Colet ; 22(3): 819-830, mar. 2017. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-952608

RESUMO

Resumo A epidemiologia desempenha um papel estratégico neste estágio do ciclo de política, contribuindo para o estabelecimento de metas, alocação de recursos e uso de sistemas de informação. Em 2009, a Secretaria Municipal de Saúde do Rio de Janeiro iniciou uma reforma do modelo de atenção, utilizando como principal influência o conceito de Atenção Primária em Saúde. Este estudo avalia a tendência de indicadores selecionados do "pay-for-performance" que mensuram o processo de cuidado em saúde na APS da cidade. Estudo de painéis repetidos, a partir dos registros administrativos e clínicos dos prontuários eletrônicos no período de 2012 a 2016. Foram escolhidos sete indicadores que analisaram o desempenho longitudinal dentro da meta estabelecida, entre aqueles que representam acesso, longitudinalidade, coordenação do cuidado - atributos da APS, assim como outras características dos serviços como desempenho assistencial e eficiência econômica. Este estudo demonstrou que a descentralização da gestão para níveis mais próximos do usuário é potencialmente exitoso para o registro de dados clínicos, caso seja realizado um adequado monitoramento dos indicadores, auditorias clínicas frequentes e realizado periodicamente um "feedback" aos profissionais de saúde com os dados e indicadores acompanhados.


Abstract Epidemiology plays a strategic role at this stage of the policy cycle, contributing to goal setting, resource allocation and use of information systems. In 2009, the Municipal Health Secretariat of Rio de Janeiro initiated a reform of the health care model under the main influence the Primary Health Care concept. This study evaluates the trend of selected pay-for-performance indicators that measure the health care process in the city's PHC. This a study on repeated panels, from the administrative and clinical records of electronic medical records in the period from 2012 to 2016. We selected seven indicators that analyzed longitudinal performance within the established goal, among those that represent access, longitudinality, coordination of care - APS attributes, as well as other characteristics of the services, such as care performance and economic efficiency. This study demonstrated that management decentralization to levels closer to the user is potentially successful for the recording of clinical data under an adequate monitoring of indicators, regular clinical audits and feedback to health professionals, along with data and indicators monitoring.

18.
Rev Soc Bras Med Trop ; 49(4): 456-64, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27598632

RESUMO

INTRODUCTION: Recent studies have shown a high incidence and prevalence of latent tuberculosis infection (LTBI) in indigenous populations around the World. We aimed to estimate the prevalence and annual risk of infection (ARI) as well as to identify factors associated with LTBI in an indigenous population from the Brazilian Amazon. METHODS: We conducted a cross-sectional study in 2011. We performed tuberculin skin tests (TSTs), smears and cultures of sputum samples, and chest radiographs for individuals who reported cough for two or more weeks. Associations between LTBI (TST ≥5mm) and socio-demographic, clinical, and epidemiological characteristics were investigated using Poisson regression with robust variance. Prevalence ratio (PR) was used as the measure of association. RESULTS: We examined 263 individuals. The prevalence of LTBI was 40.3%, and the ARI was 2.4%. Age ≥15 years [PR=5.5; 95% confidence interval (CI): 3.5-8.6], contact with tuberculosis (TB) patients (PR=3.8; 95% CI: 1.2-11.9), previous TB history (PR=1.4; 95% CI: 1.2-1.7), and presence of Bacillus Calmette-Guérin (BCG) scar (PR=1.9, 95% CI: 1.2-2.9) were associated with LTBI. CONCLUSIONS: Although some adults may have been infected years prior, the high prevalence of infection and its strong association with age ≥15 years, history of TB, and recent contact with TB patients suggest that the TB transmission risk is high in the study area.


Assuntos
Índios Sul-Americanos/estatística & dados numéricos , Tuberculose Latente/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Tuberculose Latente/diagnóstico , Masculino , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Teste Tuberculínico
19.
Rev. Soc. Bras. Med. Trop ; 49(4): 456-464, July-Aug. 2016. tab, graf
Artigo em Inglês | LILACS-Express | ID: lil-792802

RESUMO

Abstract: INTRODUCTION Recent studies have shown a high incidence and prevalence of latent tuberculosis infection (LTBI) in indigenous populations around the World. We aimed to estimate the prevalence and annual risk of infection (ARI) as well as to identify factors associated with LTBI in an indigenous population from the Brazilian Amazon. METHODS We conducted a cross-sectional study in 2011. We performed tuberculin skin tests (TSTs), smears and cultures of sputum samples, and chest radiographs for individuals who reported cough for two or more weeks. Associations between LTBI (TST ≥5mm) and socio-demographic, clinical, and epidemiological characteristics were investigated using Poisson regression with robust variance. Prevalence ratio (PR) was used as the measure of association. RESULTS We examined 263 individuals. The prevalence of LTBI was 40.3%, and the ARI was 2.4%. Age ≥15 years [PR=5.5; 95% confidence interval (CI): 3.5-8.6], contact with tuberculosis (TB) patients (PR=3.8; 95% CI: 1.2-11.9), previous TB history (PR=1.4; 95% CI: 1.2-1.7), and presence of Bacillus Calmette-Guérin (BCG) scar (PR=1.9, 95% CI: 1.2-2.9) were associated with LTBI. CONCLUSIONS Although some adults may have been infected years prior, the high prevalence of infection and its strong association with age ≥15 years, history of TB, and recent contact with TB patients suggest that the TB transmission risk is high in the study area.

20.
Cad Saude Publica ; 32(7)2016 Jul 21.
Artigo em Português | MEDLINE | ID: mdl-27462847

RESUMO

The objectives were to examine psychometric properties of a screening test for the elderly and to propose a protocol for use in primary care. The method consisted of four stages: (1) inter-evaluator reliability for performance tests and self-assessment questions for eight functions; (2) sensitivity and specificity of questions on depression and social support; (3) meeting of experts to select instrumental activities of daily living (IADL); and (4) elaboration of the protocol. Screening lasted 16 minutes. Inter-evaluator reliability was excellent for performance tests but poor for questions. Depression and social support showed satisfactory sensitivity and specificity (0.74/0.77 and 0.77/0.96). Four IADL were selected by more than 55% of the experts. Following the results, a screening protocol was elaborated that prioritized the use of performance tests, maintaining questions on mood, social support, and IADL. The study suggests better reproducibility of performance tests when compared to questions. For mood and social support, the questions may provide a first screening stage. The proposed protocol allows rapid screening of problems.


Assuntos
Avaliação Geriátrica/métodos , Programas de Rastreamento/normas , Atenção Primária à Saúde/normas , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Depressão/diagnóstico , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Psicometria , Reprodutibilidade dos Testes , Autoavaliação , Sensibilidade e Especificidade , Apoio Social , Inquéritos e Questionários/normas
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