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1.
Ciênc. Saúde Colet ; 24(8): 2895-2908, ago. 2019. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-1011882

RESUMO

Resumo Realizou-se revisão integrativa que objetivou identificar e analisar publicações nacionais sobre motivos para a não notificação de incidentes de segurança do paciente por profissionais no contexto dos serviços de saúde brasileiros. Em janeiro de 2017 realizou-se busca no Portal da Biblioteca Virtual em Saúde, PubMed e Web of Science, por publicações dos últimos 10 anos. Identificou-se 1.007 publicações e, após aplicação dos critérios de inclusão e exclusão, analisou-se 8 artigos, sendo 5 de abordagem qualitativa e 3 quantitativa. Todas as pesquisas foram desenvolvidas em hospitais, exclusivamente com profissionais da enfermagem, sendo que 75% em serviços do Sudeste do país. A maioria dos estudos evidenciou subnotificação de incidentes, principalmente devido a: medo ou receio em notificar; notificação focada em eventos mais graves, falta de conhecimento sobre o tema ou como notificar e centralização da notificação no profissional enfermeiro. Embora o estudo desta temática seja incipiente no Brasil, a presente revisão encontrou importantes fragilidades e motivos apontados pelos profissionais para a não notificação de incidentes, revelando a necessidade de incentivar sua participação, eliminando ou reduzindo barreiras, com o objetivo de fortalecer a segurança dos pacientes.


Abstract An integrative review was performed to identify and analyze national studies on barriers to patient safety incident reporting by health professionals within Brazilian health services. A search in the Virtual Health Library (BVS) Portal, PubMed and Web of Science was performed in January 2017 for papers published in the last ten years. One thousand and seven publications were identified and, following application of inclusion and exclusion criteria, eight papers were analyzed, five of which were qualitative and three quantitative. All research was conducted in hospitals, exclusively with nursing professionals, and 75% was conducted in Southeast Brazil. Most studies showed an under-reporting of incidents, and the main reasons were fear about reporting, reporting focused on more severe incidents, lack of knowledge about the subject or how to report and, registered nurse-centered reporting. While study of this theme is still incipient in Brazil, this review found important weaknesses in the process and barriers to incident reporting by professionals, revealing a need for encouraging their participation, eliminating or reducing such barriers with a view to strengthening patient safety.

2.
Cien Saude Colet ; 24(8): 2895-2908, 2019 Aug 05.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31389537

RESUMO

An integrative review was performed to identify and analyze national studies on barriers to patient safety incident reporting by health professionals within Brazilian health services. A search in the Virtual Health Library (BVS) Portal, PubMed and Web of Science was performed in January 2017 for papers published in the last ten years. One thousand and seven publications were identified and, following application of inclusion and exclusion criteria, eight papers were analyzed, five of which were qualitative and three quantitative. All research was conducted in hospitals, exclusively with nursing professionals, and 75% was conducted in Southeast Brazil. Most studies showed an under-reporting of incidents, and the main reasons were fear about reporting, reporting focused on more severe incidents, lack of knowledge about the subject or how to report and, registered nurse-centered reporting. While study of this theme is still incipient in Brazil, this review found important weaknesses in the process and barriers to incident reporting by professionals, revealing a need for encouraging their participation, eliminating or reducing such barriers with a view to strengthening patient safety.

3.
Rev. bras. med. trab ; 14(2): 78-83, maio.-ago. 2016.
Artigo em Português | LILACS | ID: biblio-1794

RESUMO

Contexto: O número de usuários de drogas ilícitas é estimado globalmente em 210 milhões de pessoas ao ano, das quais pelo menos 200.000 morrem em decorrência do uso. O consumo de drogas afeta não apenas o usuário, mas também a família, os amigos, os colegas de trabalho e a comunidade. Objetivo: O presente estudo traçou um perfil sociodemográfico de trabalhadores em tratamento para recuperação da dependência química na região de Campinas (SP). Método: Estudo transversal exploratório com dados colhidos por meio de questionário autoaplicado e anônimo em centros de recuperação para tratamento de dependência química no município de Campinas. A pesquisa foi conduzida entre julho de 2011 e julho de 2012 e analisou as condições de saúde e trabalho. A população estudada constituía-se de trabalhadores que estiveram em acompanhamento por mais de 30 dias, totalizando 200 pessoas. Resultados: A faixa etária de 18 a 54 anos representou 87,8% da amostra, com predominância de participantes com ensino médio completo e que desenvolviam alguma atividade remunerada, sendo que 54,5% estavam empregados formalmente, 48,4% com contratos inferiores a um ano, e 42,1% com faixa salarial abaixo de R$ 1.020,00. Conclusão: Este estudo apresenta informações pouco exploradas em outras pesquisas e com potencial para aprimorar as intervenções relacionadas à prevenção, ao tratamento e à reabilitação de trabalhadores em situação semelhante.


Context: The number of illicit drug users is estimated at 210 million people a year worldwide, of which at least 200,000 die as a consequence of the use. Drug use affects not only the user but also the family, friends, coworkers, and the community. Objective: This study outlines a sociodemographic profile of workers undergoing treatment for chemical dependency recovery in Campinas (SP). Method: Cross-sectional, exploratory study with data collected in rehabilitation centers for chemical dependency treatment in Campinas by means of a self-administered and anonymous questionnaire. The research was conducted between July 2011 and July 2012 and focused on the analysis of health and work conditions. The study included workers who were followed up for more than 30 days (n=200). Results: 87.8% of the population were aged 18­54 years, most of them had completed high school, had a remunerated activity, and of which 54.5% were formally employed, 48.4% with less than one year contracts and 42.1% with salary range below R$1,020.00 (Brazilian real). Conclusion: This study provides information not explored in other researches and has a potential value related to the prevention, treatment, and rehabilitation of workers in similar conditions.


Assuntos
Saúde do Trabalhador , Cocaína/efeitos adversos , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Brasil , Estudos Transversais , Inquéritos e Questionários
4.
Arq Gastroenterol ; 53(2): 68-75, 2016 Apr-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27305411

RESUMO

BACKGROUND: - The fourth most frequent tumor in the world, colorectal cancer is commonly diagnosed at an advanced stage. OBJECTIVE: - To analyze factors that interfere in the diagnosis of colorectal cancer in users of the Public Health System treated at an universitary hospital in Curitiba, Paraná State, Brazil. METHODS: - Cross-sectional, quantitative and descriptive study with 120 patients treated at the institution between 2012 and 2013. Data collection, carried out by means of medical record appointments and patients' interviews, addressed sociodemographic variables; clinical profile; timespan between symptoms, examination, diagnosis, treatment onset and difficulties encountered. Statistical analyses were performed by means of Stata 8.0. RESULTS: - Abdominal pain was the most frequent complaint and rectal bleeding presented the highest chance of advanced colorectal cancer diagnosis. From 52.5% of patients with late diagnosis of colorectal cancer, 81% reported difficulties in the health system. CONCLUSION: - Results suggest that late diagnosis is due to symptom absence in the early stage of the disease, patients' lack of perception about the severity of the symptoms, need of better of health teams to search early diagnosis. Educational interventions are deemed necessary to the population and health teams, besides actions prioritizing the access to diagnostic testing for serious illnesses.


Assuntos
Neoplasias Colorretais/diagnóstico , Diagnóstico Tardio , Adulto , Idoso , Brasil , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Setor Público , Fatores de Risco
5.
Artigo em Inglês | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: lil-791912

RESUMO

The purpose of this study was to evaluate the nutritional status of patients at the start of treatment and at the third month of treatment at the Psychosocial Care Centers for Alcohol and Drugs in Curitiba, in the state of Paraná, and verify its relationship with socioeconomic and demographic aspects, as well as drug use patterns in the two groups. A total of 254 adults were evaluated, 175 from the group at the start of treatment, and 79 from the group in the third month. The two groups presented changes in nutritional status, both low weight and excess weight. Low weight was associated with women and the recent use of crack, and excess weight with alcohol use time and frequent use of marijuana. The study showed the great vulnerability of this population in relation to the nutritional aspect.


O objetivo deste estudo foi avaliar o estado nutricional de pacientes em início e no terceiro mês de tratamento nos Centros de Atenção Psicossocial Álcool e Drogas de Curitiba-PR e verificar a sua relação com os aspectos socioeconômicos, demográficos e padrões de uso de drogas nesses dois grupos. Foram avaliados 254 adultos, 175 do grupo de início de tratamento e 79 de terceiro mês. Ambos apresentaram alterações no estado nutricional, tanto baixo peso como excesso de peso. O baixo peso associou-se ao sexo feminino e uso recente de crack, e o excesso de peso ao tempo de uso de álcool e ao uso frequente de maconha. O estudo demonstrou a grande vulnerabilidade dessa população em relação ao aspecto nutricional.


El objetivo de este estudio fue evaluar el estado nutricional de pacientes en inicio y en el tercer mes de tratamiento en los Centros de Atención Psicossocial Alcohol y Drogas de Curitiba-PR y verificar su relación con los aspectos socioeconómicos, demográficos y estándares de uso de drogas en ésos dos grupos. Fueron evaluados 254 adultos, 175 del grupo de inicio de tratamiento y 79 de tercer mes. Ambos presentaron alteraciones en el estado nutricional, tanto bajo peso como exceso de peso. El bajo peso se asoció al sexo femenino y uso reciente de crack, y el exceso de peso al tiempo de uso de alcohol y al uso frecuente de marihuana. El estudio demostró la grande vulnerabilidad de esa población con relación al aspecto nutricional.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Usuários de Drogas , Serviços de Saúde Mental , Avaliação Nutricional , Estado Nutricional , Transtornos Relacionados ao Uso de Substâncias
6.
Arq. gastroenterol ; 53(2): 68-75, April.-June 2016. tab
Artigo em Inglês | LILACS-Express | ID: lil-783816

RESUMO

ABSTRACT Background - The fourth most frequent tumor in the world, colorectal cancer is commonly diagnosed at an advanced stage. Objective - To analyze factors that interfere in the diagnosis of colorectal cancer in users of the Public Health System treated at an universitary hospital in Curitiba, Paraná State, Brazil. Methods - Cross-sectional, quantitative and descriptive study with 120 patients treated at the institution between 2012 and 2013. Data collection, carried out by means of medical record appointments and patients' interviews, addressed sociodemographic variables; clinical profile; timespan between symptoms, examination, diagnosis, treatment onset and difficulties encountered. Statistical analyses were performed by means of Stata 8.0. Results - Abdominal pain was the most frequent complaint and rectal bleeding presented the highest chance of advanced colorectal cancer diagnosis. From 52.5% of patients with late diagnosis of colorectal cancer, 81% reported difficulties in the health system. Conclusion - Results suggest that late diagnosis is due to symptom absence in the early stage of the disease, patients' lack of perception about the severity of the symptoms, need of better of health teams to search early diagnosis. Educational interventions are deemed necessary to the population and health teams, besides actions prioritizing the access to diagnostic testing for serious illnesses.


RESUMO Contexto - Quarto tumor mais frequente no mundo, o câncer colorretal comumente é diagnosticado em estádio avançado. Objetivo - Analisar fatores que interferem no diagnóstico do câncer colorretal de usuários do Sistema Único de Saúde, atendidos em hospital universitário de Curitiba. Métodos - Estudo transversal, quantitativo e descritivo com 120 pacientes atendidos na instituição em 2012 e 2013. A coleta de dados, realizada por meio de consulta ao prontuário e entrevista aos pacientes, abordou variáveis sociodemográficas; perfil clínico; tempo decorrido entre sintomas, atendimento, diagnóstico e início do tratamento e dificuldades encontradas. As análises estatísticas foram feita com pelo Stata 8.0. Resultados - Dor abdominal foi a queixa mais frequente e sangramento retal representou maior chance de diagnóstico avançado de câncer colorretal. Dos 52,5% dos pacientes que diagnosticaram a doença tardiamente, 81% relataram dificuldades com o serviço de saúde. Conclusão - Os resultados sugerem que o diagnóstico tardio é devido à ausência de sintomas na fase inicial da doença, falta de percepção dos pacientes sobre a gravidade dos sintomas, necessidade de maior preparo das equipes de saúde para o diagnóstico precoce. São necessárias intervenções educativas junto à população e equipes de saúde, além de ações que priorizem o acesso a exames diagnósticos de doenças graves.

7.
Rev. bras. hematol. hemoter ; 37(5): 341-347, Sept.-Oct. 2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-764216

RESUMO

BACKGROUND: Published criteria defining the accelerated phase in chronic myeloid leukemia are heterogeneous and little is known about predictors of poor outcome.METHODS: This is a retrospective study of 139 subjects in the accelerated phase of chronic myeloid leukemia treated with imatinib at a single center in Brazil. The objective was to identify risk factors for survival, major cytogenetic response and progression to blast phase in this population. The factors analyzed were: blasts 10-29%, basophils ≥ 20%, platelets > 1 × 106/µL or <1 × 105/µL and white blood cells > 1 × 105/µL in the peripheral blood, as well as clonal evolution, splenomegaly, hemoglobin < 10 g/dL, time between diagnosis of chronic myeloid leukemia and imatinib treatment, and hematologic toxicity.RESULTS: Risk factors for poor survival in multivariate analysis were Grades 3-4 hematologic toxicity (p-value = 0.001), blasts 10-29% (p-value = 0.023), and hemoglobin < 10 g/dL (p-value = 0.04). Risk factors for not achieving major cytogenetic response were blasts 10-29% (p-value = 0.007), hemoglobin < 10 g/dL (p-value = 0.001), and previous use of interferon (p-value = 0.032). Risk factors for progression to the blast phase were hemoglobin < 10 g/dL (p-value = 0.005), basophils ≥ 20% (p-value = 0.023), and time from diagnosis of chronic myeloid leukemia to imatinib treatment > 12 months (p-value = 0.030).CONCLUSION: These data indicate that patients with the above risk factors have a worse prognosis. This information can guide the therapy to be used.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Prognóstico , Leucemia Mieloide de Fase Acelerada , Leucemia Mielogênica Crônica BCR-ABL Positiva , Mortalidade , Mesilato de Imatinib
8.
J. bras. psiquiatr ; 64(3): 221-229, July-Sept. 2015. tab
Artigo em Português | LILACS-Express | ID: lil-766159

RESUMO

Objetivo Analisar as características sociodemográficas e o padrão de uso de drogas em pacientes dos CAPS-AD de Curitiba, Paraná. Métodos Trata-se de um estudo observacional, transversal e descritivo em uma amostra de 268 indivíduos, 184 em início e 84 no terceiro mês de tratamento. Os questionários foram aplicados no período entre abril e setembro de 2012 e, além das variáveis sociodemográficas pesquisadas, obtiveram-se informações sobre quais substâncias eram utilizadas, tempo e frequência de uso. Para análise dos dados, utilizaram-se os programas Excel e Epi-Info. Médias e testes de qui-quadrado foram utilizados para a comparação dos grupos. Resultados Em ambos os grupos, predominaram sexo masculino, baixa escolaridade, baixa renda, ser da cor branca, residir com familiar ou amigo e possuir moradia própria. As drogas lícitas foram as mais utilizadas, e a maconha foi a droga ilícita mais utilizada na vida. O crack foi a droga mais utilizada no último ano e no último mês. Inalantes e alucinógenos foram os menos utilizados. Pacientes em terceiro mês de tratamento eram significativamente mais velhos, casados, tiveram menor uso na vida e no último mês de maconha, cocaína e crack, faziam uso mais frequente de álcool, e mais de um terço nunca tinha usado droga ilícita na vida. Conclusão Os achados deste estudo podem subsidiar o desenvolvimento de estratégias que possibilitem que grupos vulneráveis possam acessar e se manter em tratamento nos CAPS-AD.


Objective The purpose of the study was to analyze the socio-demographic characteristics and the pattern of drug use in patients of CAPS-AD in Curitiba, Paraná. Methods A descriptive cross-sectional study was carried out in a sample of 268 individuals, of which 184 in early phase and 84 in the third month of treatment. Between April and September of 2012, the data was collected with the application of a questionnaire that contained sociodemographic questions and information about characteristics of drug use as substances, time and frequency of use. For data analysis, the programs of Excel and Epi-Info were used. Averages and chi-square tests were calculated in order to compare the two groups. Results The predominant characteristics in both groups were: male, white color, low education, low income, reside with family or friend and own their house. Legal drugs were the most used. Marijuana was the illicit drug most used in life. Considering the last year and last month, crack was the most used. Inhalants and hallucinogens were the least used. Patients in the third month of treatment were significantly older, married and lifetime use of drugs was lower compared to the other group. Also, use of marijuana, cocaine and crack were lower in the last month. Nonetheless, they made more frequent use of alcohol and, over a third had never used illicit drugs in life. Conclusion The findings may help to guide new strategies to increase access to treatment of vulnerable groups and also to remain in treatment in the CAPS-AD.

9.
Rev. ABENO ; 11(1): 9-15, 2011.
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-875760

RESUMO

O PET-Saúde veio consolidar as parcerias entre a UFPR e as Secretarias Municipais de Saúde de Colombo e de Curitiba. Essa integração conta ainda com a participação dos Programas de Residências da UFPR: Multiprofissional em Saúde da Família e Medicina de Família e Comunidade no município de Colombo. As atividades têm por objetivo a formação de um profissional com visão integral do processo saúde-doença e com prática humanizada da assistência à saúde individual e coletiva. Os acadêmicos e bolsistas/voluntários do PET-Saúde, sob orientação e acompanhamento de preceptores, tutores, e residentes, participam de diversas atividades nas USF, incluindo: participação nas reuniões de equipe, nos programas e oficinas, territorialização, visitas domiciliares, atenção integral às famílias por meio de ações educativas, preventivas e clínico-restauradoras, realização de atividades educativas e preventivas em equipamentos sociais, como escolas, creches, abrigos e centros de convivência. Além disso, está sendo conduzida uma pesquisa em duas fases para avaliar as condições de saúde bucal de escolares e seus familiares que residem nas áreas de abrangências das USF que participam do PET-Saúde. Com relação aos resultados parciais da pesquisa, verificou-se que, dos 593 escolares avaliados em Curitiba, 44,0% apresentaram alta severidade à cárie dentária. E no município de Colombo, dos 798 escolares avaliados, 36,6% apresentaram alta severidade à doença. Por meio do PET-Saúde, as atividades desenvolvidas possibilitam uma integração entre o ensino e o serviço, buscando sempre a disseminação do conhecimento e a formação de profissionais generalistas com capacidade de atender as demandas sociais (AU).


The PET-Health program consolidates the partnership between UFPR and the Department of Health in the cities of Colombo and Curitiba. This integration also includes the participation of UFPR Residency Programs: Multidisciplinary in Family Health and Family and Community Medicine programs in the city of Columbo. The activities are aimed at training a professional with a comprehensive approach to the health-disease process and with the ability to practice humane healthcare at the individual and collective levels. Students and monitors, under the guidance and supervision of tutors, mentors, and residents participate in various activities in the USF, including: participation in group meetings, programs and workshops, assignment of regions and home visits, and comprehensive family care through educational, preventive and clinical-restorative actions, besides educational and preventive activities in social facilities such as schools, daycare centers, shelters and community centers. In addition, a study is being conducted in two phases to evaluate the oral health status of the schoolchildren and their families who reside in areas covered by the USF taking part in the PET-Health program. With respect to the partial results of the survey, it was found that 44.0% of 593 schoolchildren in Curitiba had highly severe dental caries, and in the city of Columbus, 36.6% of 798 schoolchildren showed a highly severe degree of the disease. PET-Health activities enable integration between teaching and service, always striving to disseminate knowledge and to train general practitioners able to meet social demands (AU).


Assuntos
Humanos , Masculino , Feminino , Brasil , Saúde da Família , Estratégia Saúde da Família , Saúde Bucal , Sistema Único de Saúde , Odontologia , Guias como Assunto
10.
Braz J Infect Dis ; 14(4): 360-71, 2010 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20963321

RESUMO

Antiretroviral therapy (ART) has reduced morbidity and mortality related to human immunodeficiency virus (HIV) infection, but in spite of this advance, HIV mutations decrease antiretroviral susceptibility, thus contributing to treatment failure in patients. Genotyping HIV-1 allows the selection of new drugs after initial drug failure. This study evaluated the genotypic profile of HIV-1 isolates from treated (drug-experienced) patients in Paraná, Brazil. The prevalence of mutations in reverse transcriptase (RT) and protease (PR) genes were assessed. We analyzed 467 genotypes of patients with HIV-1 viral loads above 1,000 copies/mL. Mutations at HIV-1 RT and PR genes and previously used ART regimens were recorded. The most prevalent RT mutations were: 184V (68.31%), 215YF (51.6%), 103NS (46%), 41L (39.4%), 67N (38.54%), 210W (23.5%), 190ASE (23.2%), and 181C (17.4%). PR mutations were 90M (33.33%), 82ATFS (29%), 46I (26.8%) and 54V (22.2%). The prevalence of mutations was in line with previous national and international reports, except to nonnucleoside analogue reverse transcriptase inhibitors related mutations, which were more prevalent in this study. Previous exposure to antiretroviral drugs was associated with genotypic resistance to specific drugs, leading to treatment failure in HIV patients.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Protease de HIV/genética , Transcriptase Reversa do HIV/genética , HIV-1/genética , Mutação/genética , Adulto , Terapia Antirretroviral de Alta Atividade , Brasil , Farmacorresistência Viral/genética , Feminino , Genótipo , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , HIV-1/enzimologia , Humanos , Masculino , Falha de Tratamento , Carga Viral
11.
Braz J Infect Dis ; 14(3): 230-6, 2010 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20835505

RESUMO

OBJECTIVE: Because epidemiological data on circulating HIV subtypes among HIV-positive patients in the state of Paraná were not known until now, the aims of this study were to describe the genetic diversity profile of HIV-1 in treated patients in Paraná, Brazil, and report the differences in protease (PR) and reverse transcriptase (RT) mutations in HIV-1 subtypes. PATIENTS AND METHODS: A cross-sectional study was conducted from 2003 to 2006. Plasma viral RNA of 389 patients was extracted and PR and RT genes were polymerase chain reaction-amplified and sequenced. Sequences were subtyped and examined for antiretroviral resistance mutations. Data on gender of patient harboring the viruses and past history of antiretroviral treatment were also collected. RESULTS: Most viruses were either subtype B (61.44%) or subtype C (20.57%). Subtype C and F were more frequent in women (p < 0.00). The prevalence of subtypes was similar over the years studied. The most frequent RT mutations in all subtypes were M184V and mutations at codons 215, 41, 103, 67, 219, and 190. Mutations 41L, 210W, 215YF, and 74V were significantly more prevalent on subtype B, and the mutation 106M was significantly more prevalent on subtype C. The most frequent major PI mutations in all subtypes occurred at codons 46, 82, and 90. PR mutations 32I, 46I, and 84V were significantly more prevalent on subtype B. The minor PI mutations on codons 36, 93, and 63 were more prevalent on subtypes F, C, and B, respectively. CONCLUSION: We concluded that the predominant strain of HIV-1 in Paraná is subtype B, followed by subtype C. Some mutations at PR and TR had subtype predominance in accordance with other authors' report.


Assuntos
Farmacorresistência Viral/genética , Variação Genética/genética , Infecções por HIV/virologia , Protease de HIV/genética , Transcriptase Reversa do HIV/genética , HIV-1/genética , Mutação/genética , Adulto , Terapia Antirretroviral de Alta Atividade , Estudos Transversais , Feminino , Genótipo , Infecções por HIV/tratamento farmacológico , HIV-1/classificação , HIV-1/efeitos dos fármacos , Humanos , Masculino , Reação em Cadeia da Polimerase , RNA Viral/genética
12.
Braz. j. infect. dis ; 14(4): 360-371, July-Aug. 2010. ilus, tab
Artigo em Inglês | LILACS | ID: lil-561208

RESUMO

Antiretroviral therapy (ART) has reduced morbidity and mortality related to human immunodeficiency virus (HIV) infection, but in spite of this advance, HIV mutations decrease antiretroviral susceptibility, thus contributing to treatment failure in patients. Genotyping HIV-1 allows the selection of new drugs after initial drug failure. This study evaluated the genotypic profile of HIV-1 isolates from treated (drug-experienced) patients in Paraná, Brazil. The prevalence of mutations in reverse transcriptase (RT) and protease (PR) genes were assessed. We analyzed 467 genotypes of patients with HIV-1 viral loads above 1,000 copies/mL. Mutations at HIV-1 RT and PR genes and previously used ART regimens were recorded. The most prevalent RT mutations were: 184V (68.31 percent), 215YF (51.6 percent), 103NS (46 percent), 41L (39.4 percent), 67N (38.54 percent), 210W (23.5 percent), 190ASE (23.2 percent), and 181C (17.4 percent). PR mutations were 90M (33.33 percent), 82ATFS (29 percent), 46I (26.8 percent) and 54V (22.2 percent). The prevalence of mutations was in line with previous national and international reports, except to nonnucleoside analogue reverse transcriptase inhibitors related mutations, which were more prevalent in this study. Previous exposure to antiretroviral drugs was associated with genotypic resistance to specific drugs, leading to treatment failure in HIV patients.


Assuntos
Adulto , Feminino , Humanos , Masculino , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Protease de HIV/genética , Transcriptase Reversa do HIV/genética , HIV-1 , Mutação/genética , Terapia Antirretroviral de Alta Atividade , Brasil , Farmacorresistência Viral/genética , Genótipo , Infecções por HIV/virologia , HIV-1 , Falha de Tratamento , Carga Viral
13.
Braz. j. infect. dis ; 14(3): 230-236, May-June 2010. ilus, tab
Artigo em Inglês | LILACS | ID: lil-556834

RESUMO

OBJECTIVE: Because epidemiological data on circulating HIV subtypes among HIV-positive patients in the state of Paraná were not known until now, the aims of this study were to describe the genetic diversity profile of HIV-1 in treated patients in Paraná, Brazil, and report the differences in protease (PR) and reverse transcriptase (RT) mutations in HIV-1 subtypes. PATIENTS AND METHODS: A cross-sectional study was conducted from 2003 to 2006. Plasma viral RNA of 389 patients was extracted and PR and RT genes were polymerase chain reaction-amplified and sequenced. Sequences were subtyped and examined for antiretroviral resistance mutations. Data on gender of patient harboring the viruses and past history of antiretroviral treatment were also collected. RESULTS: Most viruses were either subtype B (61.44 percent) or subtype C (20.57 percent). Subtype C and F were more frequent in women (p < 0.00). The prevalence of subtypes was similar over the years studied. The most frequent RT mutations in all subtypes were M184V and mutations at codons 215, 41, 103, 67, 219, and 190. Mutations 41L, 210W, 215YF, and 74V were significantly more prevalent on subtype B, and the mutation 106M was significantly more prevalent on subtype C. The most frequent major PI mutations in all subtypes occurred at codons 46, 82, and 90. PR mutations 32I, 46I, and 84V were significantly more prevalent on subtype B. The minor PI mutations on codons 36, 93, and 63 were more prevalent on subtypes F, C, and B, respectively. CONCLUSION: We concluded that the predominant strain of HIV-1 in Paraná is subtype B, followed by subtype C. Some mutations at PR and TR had subtype predominance in accordance with other authors' report.


Assuntos
Adulto , Feminino , Humanos , Masculino , Farmacorresistência Viral/genética , Variação Genética/genética , Infecções por HIV/virologia , Protease de HIV/genética , Transcriptase Reversa do HIV/genética , HIV-1 , Mutação/genética , Terapia Antirretroviral de Alta Atividade , Estudos Transversais , Genótipo , Infecções por HIV/tratamento farmacológico , HIV-1 , Reação em Cadeia da Polimerase , RNA Viral/genética
14.
Cad Saude Publica ; 20 Suppl 2: S220-30, 2004.
Artigo em Português | MEDLINE | ID: mdl-15608936

RESUMO

A prenatal care program was evaluated to measure its effectiveness and impact. In 1999 a new prenatal care program was introduced in Curitiba, Paraná State, Brazil, in health services under the Unified National Health System, introducing organizational changes in order to enhance accessibility, increase the number and distribution of prenatal visits, and ensure minimum necessary procedures. To evaluate how these changes were assimilated in routine practice, a cohort study was proposed in a sample of 660 primigravidae randomly selected among women enrolled in the program before the 20th week of gestation, from March to August, 2000. Two home visits and consultation of maternity cards or patient records during prenatal and hospital care were performed. The results indicate good accessibility and professional adherence to the protocol, but problems still remain with initiating care before the end of the first trimester and adequate distribution of consultations. According to the study criteria, adequate care was found for only 38.6% of the women, pointing to the complexity of factors that influence adequate prenatal care.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Cuidado Pré-Natal/normas , Programas Médicos Regionais/normas , Brasil , Estudos de Coortes , Feminino , Número de Gestações , Humanos , Entrevistas como Assunto , Gravidez , Cuidado Pré-Natal/métodos , Avaliação de Programas e Projetos de Saúde
15.
Cad. saúde pública ; 20(supl.2): 220-230, 2004. ilus, tab
Artigo em Português | LILACS | ID: lil-390952

RESUMO

A assistência pré-natal tem sido alvo de avaliações acerca dos seus componentes essenciais e impactos em contextos diversos. Em 1999, um novo programa de atenção pré-natal para as mulheres usuárias do SUS passou a vigorar no Município de Curitiba, Paraná, Brasil, com modificações no fluxo de atendimento, número e distribuição de consultas, e procedimentos necessários a cada consulta, criando a oportunidade de realizar uma pesquisa com o objetivo de avaliar a sua implantação efetiva, tomando por referência as diretrizes técnicas estabelecidas pelo programa. O estudo abrangeu uma coorte de 660 primigestas, inscritas antes da vigésima semana de gravidez, entre março e agosto de 2000, com informações obtidas por meio de duas entrevistas domiciliares, consulta no cartão da gestante ou prontuário ambulatorial, e no prontuário hospitalar. A disponibilidade, acessibilidade e seguimento do protocolo pelos profissionais demonstram-se satisfatórias, mas mantém-se um início tardio e distribuição inadequada das consultas. Na classificação de adequação geral adotada, apenas 38,6 por cento das mulheres preencheram todos os requisitos. Os resultados contribuem para a compreensão das complexas determinações presentes no desempenho adequado de um programa de pré-natal.


Assuntos
Pesquisa sobre Serviços de Saúde , Planos e Programas de Saúde , Cuidado Pré-Natal
16.
Curitiba; Curitiba [cidade]. Secretaria da Saúde; 1996. 70 p. ilus, tab, graf.
Monografia em Português | LILACS | ID: lil-185442

RESUMO

Abordagem integral e integrada da atençäo à saúde capaz de assegurar, pela soma de esforços dos diversos setores (inter e intra setoriais numa maternidade sem riscos e sofrimentos que sejam evitáveis à mäe e seu bebê


Assuntos
Planos e Programas de Saúde , Serviços de Saúde Materna , Qualidade da Assistência à Saúde , Mortalidade Materna , Parto , Período Pós-Parto , Cuidado Pré-Natal
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