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1.
Rev Bras Enferm ; 73 Suppl 4: e20180985, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32756754

RESUMO

OBJECTIVES: to identify the female homicide profile in the city of Goiânia. METHODS: a cross-sectional, descriptive study that characterized female deaths by homicide from 2008 to 2015. They occurred in Goiânia, and registered in the Mortality Information System. Cases of homicide of women aged ≥ 10 years were eligible. Other causes of death were excluded. Descriptive statistical analysis with frequencies. RESULTS: three hundred seventy-six women died from assault, with an increase in the percentage of deaths annually. Most of the victims were young (57.5%), single (78.8%), mixed-ethnicity (61.1%) and with low education (58.4%). The most frequent means of assault was firearm (64.0%). The health districts with the highest record of female deaths due to assault were southwest, center and northwest. CONCLUSIONS: the predominant profile of women victims of femicide was young, mixed-ethnicity, single, with low level of education and living in less favored regions.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32429589

RESUMO

This study analyzed factors associated with the quality of life (QoL) of prison officers (POs) in the Midwest Region of Brazil. POs in five penitentiary units participated in this cross-sectional study. Sociodemographic data were obtained through face to face interview and a World Health Organization Quality of Life abbreviated version (WHOQOL-BREF) questionnaire was applied to assess QoL. Student's t-test or ANOVA were used for bivariate analysis and multiple linear regression was applied for adjusted analysis. The domains used for outcomes were: physical, psychological, social relations, and the environment. The lowest score among WHOQOL-BREF domains was environment (59.9; 95%CI 58.0-61.5). After adjustment, the factors associated with the physical domain were 'female sex' and 'no history of workplace PO-PO violence'; factors associated with the psychological domain were 'female sex', 'without spouse', and 'no history of inmate-PO violence'; factors associated with the social relationships domain were 'female sex', 'work experience in years', 'no higher education', 'no private health insurance', and 'no history of inmate-PO violence'; and factors associated with environment domain were 'female sex', 'work experience in years', 'no private health insurance', and 'no history of PO-PO violence'. This study showed that female workers and those with a history of violence at work had worse QoL scores. This investigation highlights the importance of prison management in promoting QoL of POs, as well as support and development of strategies to prevent workplace violence.

3.
PLoS One ; 14(8): e0221525, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31437226

RESUMO

We aimed to investigate the nasopharyngeal colonization (NPC) by Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus in the elderly population and to assess the demographic factors associated with NPC. This was an observational cohort study in which outpatients aged ≥60 years were enrolled from April to August 2017, with a follow-up visit from September through December 2017. Nasopharyngeal (NP) swabs were collected, bacteria were detected and isolated, and isolates were subjected to phenotypic and molecular characterization using standard microbiological techniques. At enrolment, the rates of S. aureus, methicillin-resistant S. aureus (MRSA), H. influenzae, and S. pneumoniae among 776 elderly outpatients were 15.9%, 2.3%, 2.5%, and 2.2%, respectively. Toxin production was detected in 21.1% of methicillin-susceptible S. aureus, and three SCCmec types were identified: II/IIb, IVa, and VI. At the follow-up visit, all carriage rates were similar (p > 0.05) to the rates at enrolment. Most of S. pneumoniae serotypes were not included in pneumococcal conjugate vaccines (PCVs), except for 7F, 3, and 19A. All strains of H. influenzae were non-typeable. Previous use of antibiotics and 23-valent pneumococcal polysaccharide vaccination (p < 0.05) were risk factors for S. aureus and MRSA carriage; S. aureus colonization was also associated with chronic kidney disease (p = 0.021). S. pneumoniae carriage was associated with male gender (p = 0.032) and an absence of diabetes (p = 0.034), while not receiving an influenza vaccine (p = 0.049) and chronic obstructive pulmonary disease (p = 0.031) were risk factors for H. influenzae colonization. The frailty of study participants was not associated with colonization status. We found a higher S. aureus carriage rate compared with the S. pneumoniae- and H. influenzae-carriage rates in a well-attended population in a geriatric outpatient clinic. This is one of the few studies conducted in Brazil that can support future colonization studies among elderly individuals.


Assuntos
Portador Sadio/microbiologia , Haemophilus influenzae/fisiologia , Nasofaringe/microbiologia , Staphylococcus aureus/fisiologia , Streptococcus pneumoniae/fisiologia , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
4.
Artigo em Inglês | MEDLINE | ID: mdl-31398793

RESUMO

(1) Background: The aim of this research was to analyze factors associated with quality of life (QoL) and marital satisfaction in married family caregivers of patients with mental disorders. (2) Methods: A cross-sectional study was conducted in all community mental health services in Goiania municipality, Brazil, in 2016-2017. Married family caregivers of patients with severe and persistent mental disorders were recruited and their QoL and marital satisfaction was assessed by using the World Health Organization Quality of Life Instrument Abbreviated version (WHOQOL-BREF) and Marital Satisfaction Scale. Multiple linear regressions were performed to identify factors associated with QoL and marital satisfaction. (3) Results: For 163 family caregivers, the psychological and environmental QoL domains presented the best and the worst scores, respectively. Factors independently associated with better QoL for caregivers were male caregiver, the younger age of a caregiver, >8 years of schooling, ≥5 years as a caregiver who performed physical activities, caregiver without chronic disease, and no patient's crisis in the last 30 days. Factors independently associated with marital satisfaction of the caregiver were male caregiver, caregiver with >8 years of schooling, caregiver who received support by relatives to care for the patient, caregiver who performed physical activities, no patient's crisis in the last 30 days, and patient hospitalization in the last six months; (4) Conclusions: The main predictor for marital satisfaction was support by relatives, and for QoL it was no patient's crisis in the last 30 days.


Assuntos
Cuidadores/psicologia , Doença Crônica/enfermagem , Doença Crônica/psicologia , Casamento/psicologia , Transtornos Mentais/enfermagem , Transtornos Mentais/psicologia , Satisfação Pessoal , Qualidade de Vida/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
5.
Vaccine ; 37(36): 5357-5363, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31351796

RESUMO

Brazil introduced the 10-valent pneumococcal vaccine (PCV10) to the routine national immunization program (NIP) in March 2010. In 2017, we investigated the effects of PCV10 on nasopharyngeal carriage of vaccine-types (VT) and non-vaccine-types (NVT) of Streptococcus pneumoniae (Spn) among children living in São Paulo city. We also compared the prevalence of VT and NVT with previous carriage surveys performed in 2010 (baseline) and 2013. METHOD: The carriage survey was conducted among 531 children, aged 12 months to <24 months, recruited from public Primary Health Units during the immunization campaign, using previous surveys methodology, except for qPCR, which was performed in the 2017 survey only. RESULTS: No statistical difference was found in the prevalence of Spn either by culture (59.7%) or by qPCR (61.2%). Spn carriage increased from 40.3% (baseline) to 59.7% (2017 survey) (p < 0.001). Colonization by VT isolates significantly decreased by 90.9% (19.8-1.8%) and 95.5% (19.8-0.9%) in the 2013 and 2017 surveys, respectively, compared to that at baseline. NVT isolates increased significantly by 128% (19.6-44.8%) and 185% (19.6-55.9%) in the respective post-PCV10 surveys, most led to high prevalence of serotypes 6C (27%), 15B (9.8%), 19A (9.2%), 15A (6.0%), and 16F (5.7%). In 2017, reduction in serotype 6A (4.2-0.6%, p < 0.001) and increase in serotype 19A (1.8-6.0%, p = 0.001) were found; serotype 3 isolate was not detected in the present survey. We identified the emergence of 19A isolates CC320, associated with high penicillin (MIC ≥ 2.0 mg/L) and cefotaxime (MIC ≥ 1.0 mg/L) values. CONCLUSION: After 7 years of PCV10 introduction in the NIP, colonization by VT among toddlers decreased substantially to a residual level, along with substantial serotype replacement by novel serotypes not present in any current conjugated pneumococcal vaccine and serotype 19A. The present findings can assist policy decisions in Brazil.

6.
BMC Public Health ; 19(1): 443, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035990

RESUMO

BACKGROUND: People living in poverty (PLP) are highly vulnerable to hepatitis B virus (HBV) infection. This study aimed to investigate the epidemiology of HBV infection in PLP in the metropolitan region of Goiânia, Goiás State, in the Central-West Region of Brazil. METHODS: A cross-sectional study was conducted from August to December 2016 in adults aged ≥12 years living in poverty. The following serological markers for HBV were investigated: hepatitis B surface antigen (HBsAg), antibody to HBV core antigen (total anti-HBc), IgM anti-HBc, and hepatitis B surface antibody (anti-HBs), which were detected by enzyme-linked immunosorbent assay (ELISA). Poisson regression analysis with robust variance was performed to verify the factors associated with HBV exposure. RESULTS: The study included 378 participants. The overall prevalence rate of HBV (any viral marker) was 9.8% (95% confidence interval [CI], 7.2-13.2). The prevalence rate of HBsAg in combination with total anti-HBc was 0.8% (95% CI, 0.3-2.4), total anti-HBc in combination with anti-HBs was 7.7% (95% CI, 5.4-10.9), and total anti-HBc alone was 1.3% (95% CI, 0.5-3.0) in the population. Furthermore, isolated positivity for anti-HBs was identified in only 25.4% (95% CI, 21.3-30.0) of the participants. Multiple regression analysis revealed that age (adjusted prevalence ratio [APR], 1.04; 95% CI, 1.01-1.07), female sex (APR, 2.18; 95% CI, 1.01-4.73), sexual intercourse under the influence of alcohol (APR, 2.49; 95% CI, 1.36-7.06), and exposure to Treponema pallidum (APR, 3.10; 95% CI, 1.36-7.06) were associated with HBV exposure. CONCLUSION: There was a high prevalence of HBV exposure in PLP in the Central-West Region of Brazil, indicating significant viral spread of the infection. Additionally, there was low serological evidence of immunisation against hepatitis B, indicating that a large proportion of the participants in this study are susceptible to the infection. The results support the need for public health policies that facilitate access to the existing healthcare services in hard-to-reach groups with special regard to immunisation programmes against hepatitis B.


Assuntos
Hepatite B/epidemiologia , Pobreza/estatística & dados numéricos , Adulto , Fatores Etários , Biomarcadores , Brasil/epidemiologia , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Anticorpos Anti-Hepatite B , Antígenos de Superfície da Hepatite B , Vírus da Hepatite B/imunologia , Humanos , Masculino , Prevalência , Análise de Regressão , Testes Sorológicos , Fatores Sexuais , Comportamento Sexual , Infecções por Treponema/epidemiologia , Adulto Jovem
7.
Rev Bras Enferm ; 71(6): 2876-2882, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30517388

RESUMO

OBJECTIVE: to evaluate the incidence of exclusive breastfeeding and the risk factors associated to its interruption in premature infants after hospital discharge. METHOD: this is a prospective cohort with 113 premature infants in a neonatal unit, whom were followed-up from 7 to 15 days after hospital discharge. The outcome was the interruption of exclusive breastfeeding. Maternal and neonatal exposure variables were evaluated by a regression model and described by the confidence interval (95%) and risk ratio. RESULTS: exclusive breastfeeding rate was 81.4% at discharge and 66.4% at 7 to 15 days after discharge. Double gestation, time of mechanical ventilation and birth weight were associated with higher risks of interruption of exclusive breastfeeding after discharge. CONCLUSION: there is a need for the implementation of actions that promote the early onset and maintenance of exclusive breastfeeding of premature infants.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Recém-Nascido Prematuro/crescimento & desenvolvimento , Adulto , Peso ao Nascer , Brasil , Aleitamento Materno/métodos , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/organização & administração , Masculino , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários
8.
Rev. bras. enferm ; 71(6): 2876-2882, Nov.-Dec. 2018. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-977618

RESUMO

ABSTRACT Objective: to evaluate the incidence of exclusive breastfeeding and the risk factors associated to its interruption in premature infants after hospital discharge. Method: this is a prospective cohort with 113 premature infants in a neonatal unit, whom were followed-up from 7 to 15 days after hospital discharge. The outcome was the interruption of exclusive breastfeeding. Maternal and neonatal exposure variables were evaluated by a regression model and described by the confidence interval (95%) and risk ratio. Results: exclusive breastfeeding rate was 81.4% at discharge and 66.4% at 7 to 15 days after discharge. Double gestation, time of mechanical ventilation and birth weight were associated with higher risks of interruption of exclusive breastfeeding after discharge. Conclusion: there is a need for the implementation of actions that promote the early onset and maintenance of exclusive breastfeeding of premature infants.


RESUMEN Objetivo: evaluar la incidencia de la lactancia materna exclusiva y los factores de riesgo asociados a su interrupción en prematuros después del alta hospitalaria. Método: cohorte prospectiva con 113 prematuros en unidad neonatal, acompañados de 7 a 15 días después del alta hospitalaria. El resultado fue la interrupción de la lactancia materna exclusiva. Las variables de exposición materna y neonatal fueron evaluadas por medio del modelo de regresión y descritas por la razón de riesgo e intervalo de confianza (95%). Resultados: la incidencia de lactancia materna exclusiva fue del 81,4% en la alta y del 66,4% entre 7 y 15 días después del alta. Las variables gestación doble, tiempo de ventilación y peso al nacer se asociaron a un mayor riesgo de interrupción de la lactancia materna exclusiva después del alta. Conclusión: es necesaria la implementación de acciones que promuevan el inicio precoz y el mantenimiento de la lactancia materna exclusiva del prematuro.


RESUMO Objetivo: Avaliar a incidência do aleitamento materno exclusivo e os fatores de risco associados à interrupção de aleitamento materno exclusivo em prematuros após a alta hospitalar. Método: Coorte prospectiva com 113 prematuros em unidade neonatal, e acompanhados entre 7 e 15 dias após a alta hospitalar. Teve-se como desfecho a interrupção do aleitamento materno exclusivo. As variáveis de exposição maternas e neonatais foram avaliadas por meio do modelo de regressão e descritas pela razão de risco e intervalo de confiança (95%). Resultados: A incidência de aleitamento materno exclusivo foi de 81,4% na alta e 66,4% entre 7 e 15 dias após a alta. As variáveis gestação dupla, tempo de ventilação e peso ao nascer foram associadas a um maior risco de interrupção do aleitamento materno exclusivo após a alta. Conclusão: É necessária a implementação de ações que promovam o início precoce e manutenção do aleitamento materno exclusivo no prematuro.

9.
PLoS One ; 13(11): e0208211, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30496296

RESUMO

BACKGROUND: In 2010, a ten-valent pneumococcal conjugate vaccine (PCV10) was introduced in the routine infant national immunization program in Brazil. Invasive pneumococcal disease (IPD) caused by serotype 19A (Spn19A) increased after the introduction of PCVs in several countries. We compared the frequency, antimicrobial resistance and molecular patterns of invasive Spn19A strains before and after PCV10 introduction in Brazil using data from the national laboratory-based surveillance. METHODS: We analyzed invasive Spn19A strains isolated from 2005-2009 (pre-PCV10 period), 2011-2015 and 2016-2017 (post-PCV10 periods). Antimicrobial susceptibility was performed for all Spn19A strains, and multilocus sequence typing (MLST) was performed for strains isolated in the age groups <5 years and ≥50 years. RESULTS: Among the study period, a total of 9,852 invasive Spn strains were analyzed, and 673 (6.8%) belonged to serotype 19A. Overall, the proportion of Spn19A among the total number of IPD strains increased from 2.8% in 2005-2009 to 7.0% and 16.4% in 2011-2015 and 2016-2017, respectively. The relative increase in Spn19A was observed especially in children <5 years old (2005-2009: 3.2%; 2011-2015: 15.5%; 2016-2017: 31.2%). The percentage of penicillin resistance (MIC 2.0-4.0 µg/mL), erythromycin resistance and multidrug resistance (MDR) increased after PCV10 introduction due to the expansion of the MDR clonal complex CC320 (2005-2009: 8.6%; 2011-2015: 56.1%; 2016-2017: 66.5%). CONCLUSION: We observed an expansion of MDR-CC320 among invasive Spn19A strains after PCV10 introduction in Brazil, probably related to a combination of factors, such as vaccination and antimicrobial pressure. Continued surveillance of Spn19A strains is necessary to monitor the sustainability of this clonal complex in the Brazilian population.


Assuntos
Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Adulto , Antibacterianos/farmacologia , Técnicas de Tipagem Bacteriana , Brasil/epidemiologia , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Resistência a Múltiplos Medicamentos , Humanos , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Infecções Pneumocócicas/tratamento farmacológico , Sorogrupo , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/genética , Adulto Jovem
10.
BMC Pulm Med ; 18(1): 109, 2018 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-29970066

RESUMO

BACKGROUND: Multiple factors are involved in asthma exacerbations, including environmental exposure and viral infections. We aimed to assess the association between severe asthma exacerbations, acute respiratory viral infections and other potential risk factors. METHODS: Asthmatic children aged 4-14 years were enrolled for a period of 12 months and divided into two groups: those with exacerbated asthma (group 1) and non-exacerbated asthma (group 2). Clinical data were obtained and nasopharyngeal samples were collected through nasopharyngeal aspirate or swab and analysed via indirect fluorescent immunoassays to detect influenza A and B viruses, parainfluenza 1-3, adenovirus and respiratory syncytial virus. Rhinovirus was detected via molecular assays. Potential risk factors for asthma exacerbation were identified in univariate and multivariate analyses. RESULTS: In 153 children (group 1: 92; group 2: 61), median age 7 and 8 years, respectively, the rate of virus detection was 87.7%. There was no difference between groups regarding the frequency of virus detection (p = 0.68); however, group 1 showed a lower frequency (19.2%) of inhaled corticosteroid use (91.4%, p < 0.01) and evidence of inadequate disease control. In the multivariate analysis, the occurrence of three or more visits to the emergency room in the past 12 months (IRR = 1.40; p = 0.04) and nonadherence to inhaled corticosteroid (IRR = 4.87; p < 0.01) were the only factors associated with exacerbation. CONCLUSION: Our results suggest an association between asthma exacerbations, poor disease control and nonadherence to asthma medication, suggesting that viruses may not be the only culprits for asthma exacerbations in this population.


Assuntos
Asma/fisiopatologia , Asma/virologia , Infecções Respiratórias/complicações , Infecções Respiratórias/virologia , Viroses/complicações , Adolescente , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Asma/tratamento farmacológico , Brasil , Criança , Pré-Escolar , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Masculino , Adesão à Medicação , Análise Multivariada , Análise de Regressão , Sistema Respiratório/virologia
11.
Vaccine ; 36(19): 2559-2566, 2018 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-29650385

RESUMO

BACKGROUND: In March 2010, the 10-valent pneumococcal conjugate vaccine (PCV10) was introduced into the routine immunization program in Brazil. We describe the pneumococcal serotypes that caused invasive pneumococcal diseases (IPD) before and after the introduction of PCV10 using data from a national laboratory-based surveillance system. METHOD: We compared the prevalence of vaccine types (VT) and non-vaccine types (NVT) of Streptococcus pneumoniae in three periods, pre-PCV10 (January/2005-December/2009), early post-PCV10 (January/2010-December/2013), and late post-PCV10 (January/2014-December/2015), by episode in meningitis and non-meningitis cases and by age group. Changes in serotype prevalence in the early and late post-PCV10 periods were determined using pre-PCV10 period as a reference. RESULTS: A total of 8971 IPD isolates from patients aged 2 months to 99 years were analyzed. In the late post-PCV10 period, the VT-IPD reduction in the 2-month to 4-year age group was 83.4% for meningitis and 87.4% for non-meningitis cases; in the age groups 5-17 years, 18-64 years, and ≥65 years, VT declined by 56.1%, 54.1%, and 47.4%, respectively, in meningitis cases, and by 60.9%, 47.7%, and 53.4%, respectively, in non-meningitis cases. NVT-IPD increased throughout the study period, driven mainly by serotypes 3, 6C, and 19A, which remained the predominant types causing IPD in the late post-PCV10 period. CONCLUSION: We observed direct and indirect PCV10 protection against IPD caused by VT and a shift in the distribution of serotypes 5 years after the introduction of PCV10. Continued IPD surveillance is needed to evaluate the sustainability of the high prevalence of serotypes 3, 6C, and 19A, which were not included in PCV10.


Assuntos
Infecções Pneumocócicas/microbiologia , Vacinas Pneumocócicas/uso terapêutico , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/patogenicidade , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Programas de Imunização , Lactente , Masculino , Meningite Pneumocócica/epidemiologia , Meningite Pneumocócica/microbiologia , Meningite Pneumocócica/prevenção & controle , Pessoa de Meia-Idade , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Prevalência , Sorogrupo
12.
Hum Vaccin Immunother ; 14(5): 1138-1145, 2018 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-29068749

RESUMO

The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in the Brazilian National Immunization Program in March 2010, scheduled at 2, 4, and 6 months, with a booster at 12-15 months of age. The meningococcal C conjugate vaccine (MCC) was introduced in November 2010, scheduled at 3 and 5 months, with a booster dose at 12-15 months of age and no catch-up for older age groups. In this interrupted time-series analysis study, we used Brazilian mortality data from 2005 to 2015 for children under five years of age (excluding data from the state of Bahia) to assess the combined impact of these vaccines on the overall burden of meningitis mortality among children aged 0-23 months and 2-4 years, as defined using meningitis and meningococcemia specific International Classification of Diseases - tenth revision codes. Secular trends and seasonality were taken into account. We found significant reductions for both age groups relative to those observed for the comparison group of diseases, with immediate effects after the transition period (2010-2011) of 29.2% and 27.5% for children aged 0-23 months and 2-4 years, respectively. These immediate effects were sustained throughout the post-vaccination period (2012-2015). In total, 337 deaths were averted by the combined effect of both vaccines, 238 (95%CI 169-319) for children aged 0-23 months and 99 (95%CI 56-144) for those aged 2-4 years. These results add strong evidence in support of investments in these vaccines by low and middle-income countries.


Assuntos
Meningite Meningocócica/mortalidade , Meningite Pneumocócica/mortalidade , Vacinas Meningocócicas/uso terapêutico , Vacinas Pneumocócicas/uso terapêutico , Vacinação/métodos , Brasil/epidemiologia , Pré-Escolar , Feminino , Humanos , Programas de Imunização/economia , Programas de Imunização/métodos , Imunização Secundária/economia , Imunização Secundária/métodos , Lactente , Recém-Nascido , Masculino , Meningite Meningocócica/prevenção & controle , Meningite Pneumocócica/prevenção & controle , Vacinas Meningocócicas/economia , Vacinas Pneumocócicas/economia , Avaliação de Programas e Projetos de Saúde , Resultado do Tratamento , Vacinação/economia , Vacinas Conjugadas/uso terapêutico
13.
Vaccine ; 36(4): 479-483, 2018 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-29249544

RESUMO

BACKGROUND: Varicella vaccine was introduced into the Brazilian Immunization Program in October 2013, as a single-dose schedule administered at 15 months of age. Its effectiveness had not yet been assessed in the country. METHODS: A matched case-control study was carried out in São Paulo and Goiânia (Southeast and Midwest regions, respectively), Brazil. Suspected cases, were identified through a prospective surveillance established in the study sites. All cases had specimens from skin lesion collected for molecular laboratory testing. Cases were confirmed by either clinical or PCR of skin lesions and classified as mild, moderate, and severe disease. Two neighborhood controls were selected for each case. Cases and controls were aged 15-32 months and interviewed at home. Evidence of prior vaccination was obtained from vaccination cards. Univariate and multivariate logistic regression models were used, and odds ratio and its respective 95% confidence intervals were estimated. Vaccine effectiveness was estimated by comparing de odds of having received varicella vaccine among cases and controls. RESULTS: A total of 168 cases and 301 controls were enrolled. Moderate and severe illness, was found in 33.3% and 9.9% of the cases. Effectiveness of a single dose varicella vaccine was 86% (95%CI 72-92%) against disease of any severity and 93% (95%CI 82-97%) against moderate and severe disease. Out of 168 cases, 81.8% had positive PCR results for wild-type strains, and 22.0% were breakthrough varicella cases. Breakthrough cases were milder compared to non-breakthrough cases (p < .001). CONCLUSIONS: Effectiveness of single dose varicella vaccine in Brazil is comparable to that in other countries where breakthrough varicella cases have also been found to occur. The goal of the varicella vaccination program, along with disease burden and affordability should be taken into consideration when considering the adoption of a second dose of varicella vaccine into national immunization programs.


Assuntos
Vacina contra Varicela/imunologia , Varicela/epidemiologia , Varicela/prevenção & controle , Adolescente , Adulto , Brasil/epidemiologia , Varicela/diagnóstico , Vacina contra Varicela/administração & dosagem , Criança , Pré-Escolar , Feminino , Humanos , Programas de Imunização , Lactente , Masculino , Razão de Chances , Avaliação de Resultados em Cuidados de Saúde , Vigilância em Saúde Pública , Índice de Gravidade de Doença , Vacinação , Adulto Jovem
14.
PLoS One ; 12(9): e0184204, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28880953

RESUMO

Background: Ten-valent pneumococcal conjugate vaccine (PCV10) was introduced in the National Immunization Program of Brazil in March/2010. Although there are recent reports of PCV10 impact on pneumonia hospitalizations, there is still uncertainty regarding the indirect impact in individuals non-targeted by vaccination. We assessed both direct and indirect effect of PCV10 on pneumonia hospitalizations and the impact on the economic burden of pneumonia hospitalizations. Methods: An interrupted time-series analysis was conducted considering monthly rates of pneumonia hospitalizations and comparison groups, in all age-groups, from January/2005-December/2015. We used records of the National Hospitalizations Information System. Observed pneumonia rates in the post-vaccination period (2011­2015) were compared to predicted rates, should PCV10 had not been introduced. Relative percent difference in rates and its 95% confidence interval were estimated. The number of pneumonia hospitalizations averted by vaccination was calculated as the difference between the predicted and observed cumulative number of pneumonia hospitalizations in the post-vaccination period. The impact of PCV10 on economic burden was presented as averted costs of pneumonia hospitalization. Results: Significant decrease in rates of pneumonia hospitalization was observed in both children targeted by vaccination (17.4%­26.5%; p<0.01), and in age-groups not targeted by vaccination (11.1%­27.1%, in individuals 10­49 years; p<0.01). In contrast, PCV10 introduction did not alter the increasing trends in pneumonia hospitalization among elderly ≥65 years. A total of 457,564 pneumonia hospitalizations was averted in Brazil for individuals aged <50 years, with a total averted costs of BRL 383.2 million (Int$ 225.2 million, and USD 147 million) for the 5 year period after PCV introduction. Conclusion: Vaccination with PCV10 5 years after its introduction in Brazil was associated with a relevant reduction in pneumonia hospitalization in the target age-groups, with an indirect effect in individuals aged 10­49 years, and significant reduction in associated economic burden. The increasing trends in pneumonia hospitalization rates in the elderly is a matter of concern for public health and should be further investigated.


Assuntos
Vacinas Pneumocócicas/economia , Vacinas Pneumocócicas/uso terapêutico , Pneumonia Pneumocócica/economia , Pneumonia Pneumocócica/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Hospitalização , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Modelos Teóricos , Pneumonia Pneumocócica/microbiologia , Streptococcus pneumoniae/fisiologia , Fatores de Tempo , Adulto Jovem
15.
Einstein (Sao Paulo) ; 15(2): 212-219, 2017.
Artigo em Inglês, Português | MEDLINE | ID: mdl-28767921

RESUMO

Objective: To determine and compare hospitalization costs of bacterial community-acquired pneumonia cases via different costing methods under the Brazilian Public Unified Health System perspective. Methods: Cost-of-illness study based on primary data collected from a sample of 59 children aged between 28 days and 35 months and hospitalized due to bacterial pneumonia. Direct medical and non-medical costs were considered and three costing methods employed: micro-costing based on medical record review, micro-costing based on therapeutic guidelines and gross-costing based on the Brazilian Public Unified Health System reimbursement rates. Costs estimates obtained via different methods were compared using the Friedman test. Results: Cost estimates of inpatient cases of severe pneumonia amounted to R$ 780,70/$Int. 858.7 (medical record review), R$ 641,90/$Int. 706.90 (therapeutic guidelines) and R$ 594,80/$Int. 654.28 (Brazilian Public Unified Health System reimbursement rates). Costs estimated via micro-costing (medical record review or therapeutic guidelines) did not differ significantly (p=0.405), while estimates based on reimbursement rates were significantly lower compared to estimates based on therapeutic guidelines (p<0.001) or record review (p=0.006). Conclusion: Brazilian Public Unified Health System costs estimated via different costing methods differ significantly, with gross-costing yielding lower cost estimates. Given costs estimated by different micro-costing methods are similar and costing methods based on therapeutic guidelines are easier to apply and less expensive, this method may be a valuable alternative for estimation of hospitalization costs of bacterial community-acquired pneumonia in children. Objetivo: Determinar e comparar custos hospitalares no tratamento da pneumonia bacteriana adquirida na comunidade por diferentes metodologias de custeio, na perspectiva do Sistema Único de Saúde. Métodos: Estudo de custo, com coleta de dados primários de uma amostra de 59 crianças com 28 dias a 35 meses de idade hospitalizadas por pneumonia bacteriana. Foram considerados custos diretos médicos e não médicos. Três metodologias de custeio foram utilizadas: microcusteio por revisão de prontuários, microcusteio considerando diretriz terapêutica e macrocusteio por ressarcimento do Sistema Único de Saúde. Os custos estimados pelas diferentes metodologias foram comparados utilizando o teste de Friedman. Resultados: Os custos hospitalares de crianças com pneumonia grave foram R$ 780,70 ($Int. 858.7) por revisão de prontuários, R$ 641,90 ($Int. 706.90) por diretriz terapêutica e R$ 594,80 ($Int. 654.28) por ressarcimento do Sistema Único de Saúde, respectivamente. A utilização de metodologias de microcusteio (revisão de prontuários e diretriz) resultou em estimativas de custos equivalentes (p=0,405), enquanto o custo estimado por ressarcimento foi significativamente menor do que aqueles estimados por diretriz (p<0,001) e por revisão de prontuário (p=0,006), sendo, assim, significativamente diferentes. Conclusão: Na perspectiva do Sistema Único de Saúde, existe diferença significativa nos custos estimados quando se utilizam diferentes metodologias, sendo a estimativa por ressarcimento a que resulta em valores menores. Considerando que não há diferença nos valores de custos estimados por diferentes metodologias de microcusteio, a metodologia de custeio por diretriz, de mais fácil e rápida execução, é uma alternativa válida para estimativa de custos de hospitalização por pneumonias bacterianas em crianças.


Assuntos
Custos de Cuidados de Saúde/normas , Hospitalização/economia , Programas Nacionais de Saúde/economia , Pneumonia Bacteriana/terapia , Brasil , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação/economia , Masculino , Registros Médicos/economia , Mecanismo de Reembolso/economia
16.
PLoS One ; 12(6): e0179222, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28594913

RESUMO

Few studies have reported the effect of 10-valent pneumococcal conjugate vaccine (PCV10) on otitis media (OM) in infants. In particular, no population-based study in upper-middle income countries is available. In 2010, Brazil introduced PCV10 into its routine National Immunization Program using a 3+1 schedule. We measured the impact of PCV10 on all-cause OM in children. An interrupted time-series analysis was conducted in Goiânia/Brazil considering monthly rates (per 100,000) of all-cause OM outpatient visits in children aged 2-23 months. We used case-based data from the Outpatient Visits Information System of the Unified Health System coded for ICD-10 diagnosis for the period of August/2008 to July/2015. As a comparator, we used rates of outpatient visits due to all-other causes. The relative reduction of all-cause OM and all-other causes of outpatient visits were calculated as the difference between the predicted and observed cumulative rates of the PCV10 post-vaccination period. We then subtracted the relative reduction of all-other causes of outpatient visits from all-cause OM to obtain the impact of PCV10 on OM. In total, 6,401 OM outpatient visits were recorded in 4,793 children aged 2-23 months. Of these, 922 (19.2%) children had more than one OM episode. A significant reduction in all-cause OM visits was observed (50.7%; 95%CI: 42.2-59.2%; p = 0.013), while the reduction in visits due to all-other causes was 7.7% (95% CI 0.8-14.7%; p<0.001). The impact of PCV10 on all-cause OM was thus estimated at 43.0% (95%CI 41.4-44.5). This is the first study to show significant PCV10 impact on OM outpatient visits in infants in a developing country. Our findings corroborate the available evidence from developed countries.


Assuntos
Otite Média/epidemiologia , Otite Média/etiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Vacinas Pneumocócicas/imunologia , Brasil/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Vacinação
17.
Einstein (Säo Paulo) ; 15(2): 212-219, Apr.-June 2017. tab
Artigo em Inglês | LILACS | ID: biblio-891386

RESUMO

ABSTRACT Objective To determine and compare hospitalization costs of bacterial community-acquired pneumonia cases via different costing methods under the Brazilian Public Unified Health System perspective. Methods Cost-of-illness study based on primary data collected from a sample of 59 children aged between 28 days and 35 months and hospitalized due to bacterial pneumonia. Direct medical and non-medical costs were considered and three costing methods employed: micro-costing based on medical record review, micro-costing based on therapeutic guidelines and gross-costing based on the Brazilian Public Unified Health System reimbursement rates. Costs estimates obtained via different methods were compared using the Friedman test. Results Cost estimates of inpatient cases of severe pneumonia amounted to R$ 780,70/$Int. 858.7 (medical record review), R$ 641,90/$Int. 706.90 (therapeutic guidelines) and R$ 594,80/$Int. 654.28 (Brazilian Public Unified Health System reimbursement rates). Costs estimated via micro-costing (medical record review or therapeutic guidelines) did not differ significantly (p=0.405), while estimates based on reimbursement rates were significantly lower compared to estimates based on therapeutic guidelines (p<0.001) or record review (p=0.006). Conclusion Brazilian Public Unified Health System costs estimated via different costing methods differ significantly, with gross-costing yielding lower cost estimates. Given costs estimated by different micro-costing methods are similar and costing methods based on therapeutic guidelines are easier to apply and less expensive, this method may be a valuable alternative for estimation of hospitalization costs of bacterial community-acquired pneumonia in children.


RESUMO Objetivo Determinar e comparar custos hospitalares no tratamento da pneumonia bacteriana adquirida na comunidade por diferentes metodologias de custeio, na perspectiva do Sistema Único de Saúde. Métodos Estudo de custo, com coleta de dados primários de uma amostra de 59 crianças com 28 dias a 35 meses de idade hospitalizadas por pneumonia bacteriana. Foram considerados custos diretos médicos e não médicos. Três metodologias de custeio foram utilizadas: microcusteio por revisão de prontuários, microcusteio considerando diretriz terapêutica e macrocusteio por ressarcimento do Sistema Único de Saúde. Os custos estimados pelas diferentes metodologias foram comparados utilizando o teste de Friedman. Resultados Os custos hospitalares de crianças com pneumonia grave foram R$ 780,70 ($Int. 858.7) por revisão de prontuários, R$ 641,90 ($Int. 706.90) por diretriz terapêutica e R$ 594,80 ($Int. 654.28) por ressarcimento do Sistema Único de Saúde, respectivamente. A utilização de metodologias de microcusteio (revisão de prontuários e diretriz) resultou em estimativas de custos equivalentes (p=0,405), enquanto o custo estimado por ressarcimento foi significativamente menor do que aqueles estimados por diretriz (p<0,001) e por revisão de prontuário (p=0,006), sendo, assim, significativamente diferentes. Conclusão Na perspectiva do Sistema Único de Saúde, existe diferença significativa nos custos estimados quando se utilizam diferentes metodologias, sendo a estimativa por ressarcimento a que resulta em valores menores. Considerando que não há diferença nos valores de custos estimados por diferentes metodologias de microcusteio, a metodologia de custeio por diretriz, de mais fácil e rápida execução, é uma alternativa válida para estimativa de custos de hospitalização por pneumonias bacterianas em crianças.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Custos de Cuidados de Saúde/normas , Pneumonia Bacteriana/terapia , Hospitalização/economia , Programas Nacionais de Saúde/economia , Mecanismo de Reembolso/economia , Brasil , Registros Médicos/economia , Tempo de Internação/economia
18.
Rev. bras. promoç. saúde (Impr.) ; 30(2): 179-186, 06/06/2017.
Artigo em Inglês, Espanhol, Português | LILACS | ID: biblio-847190

RESUMO

Objetivo: Avaliar a sobrecarga de trabalho dos cuidadores de usuários vinculados a um serviço público de atenção domiciliar e conhecer os fatores associados a essa condição. Métodos: Trata-se de um estudo transversal analítico, realizado com cuidadores nos domicílios dos usuários cadastrados pelo serviço de atenção domiciliar do município de Goiânia - Goiás, no ano de 2013. Selecionaram-se cuidadores com idade igual ou superior a 18 anos, alfabetizados e em exercício da função como cuidador principal há pelo menos dois meses. Os dados foram coletados por meio de entrevista com aplicação dos instrumentos de caracterização do cuidador e de avaliação de sobrecarga pela Zarit Burden Interview (ZBI) e analisados pelo SPSS, com cálculo da média, desvio padrão, intervalo de 95% de confiança, análise bivariada e regressão linear múltipla com valor de p<0,05. Resultados: Dentre os 95 cuidadores entrevistados, a idade média foi de 49,7 anos (±13,0), sendo que 93 (97,9%) eram do sexo feminino e 53 (57,9%) casados. Na avaliação da sobrecarga, a média obtida foi de 33,8 pontos. Maiores níveis de sobrecarga foram associadas ao fato de o cuidador não possuir folgas semanais (p=0,002), apresentar problemas de coluna (p=0,0039) e depressão (p=0,016). Conclusão: Conclui-se que os cuidadores apresentam sobrecarga de trabalho decorrente da tarefa de cuidar e os principais fatores associados são a falta de folga semanal, problemas de coluna e depressão.


Objective: To evaluate the work overload of caregivers of users of a public home care service and to know the factors associated with this condition. Methods: This is an analytical cross-sectional study conducted in 2013 with caregivers working in the households of users of the home care service of the municipality of Goiânia, Goiás. Eligible participants were literate caregivers aged 18 years or older working as a primary caregiver for at least two months. Data were collected through interviews with application of instruments for the characterization of the caregiver and burden was evaluated using the Zarit Burden Interview (ZBI). The data were analyzed using SPSS version 15.0, with calculation of mean and standard deviation and a 95% confidence interval. Bivariate analysis and multiple linear regression were used with p-value set at<0.05. Results: The mean age of the 95 interviewees was 49.7 years (±13,0); 93 of them (97.9%) were women and 53 (57.9%) were married. The mean score in the burden evaluation was 33.8. Higher ZBI scores were associated with not having a weekly day off (p=0.002), problems in the back (p=0.039) and depression (p=0.016). Conclusion: The caregivers' work overload results from the caring task and the main factors associated with it are the lack of a weekly day off, problems in the back and depression.


Objetivo: Evaluar la sobrecarga de trabajo de cuidadores de usuarios vinculados de un servicio público de atención domiciliaria y conocer los factores asociados con esa condición. Métodos: Se trata de un estudio transversal y analítico realizado con cuidadores en los domicilios de usuarios con registro realizado por el servicio de atención domiciliaria del municipio de Goiânia - Goiás, en el año de 2013. Fueron seleccionados los cuidadores con 18 años o más, alfabetizados y actuando en la función de cuidador principal desde hace dos meses. Se recogieron los datos a través de entrevista con la aplicación de los instrumentos de caracterización del cuidador y de evaluación de la sobrecarga por la Zarit Burden Interview (ZBI). Los datos fueron analizados por el SPSS versión 15.0 con el cálculo de la media, la desviación típica, el intervalo de confianza del 95%, el análisis bivariado y la regresión linear múltiple con el valor de p<0,05. Resultados: La media de edad entre los 95 cuidadores entrevistados fue de 49,7 años (±13,0), siendo 93 (97,9%) del sexo femenino y 53 (57,9%) casados. La media de la puntuación de la evaluación de la sobrecarga fue de 33,8. Niveles más elevados de sobrecarga se asociaron al hecho del cuidador no tener descansos semanales (p=0,002) y tener problemas en la columna (p=0,0039) y depresión (p=0,016). Conclusión: Se concluye que los cuidadores tienen sobrecarga de trabajo decurrente de la tarea de cuidar y que los principales factores asociados son la ausencia de descanso semanal, los problemas de columna y la depresión.


Assuntos
Cuidadores , Assistência Domiciliar , Atenção Primária à Saúde
19.
Vaccine ; 35(16): 2025-2033, 2017 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-28318769

RESUMO

BACKGROUND: Routine infant immunization with meningococcal C conjugate (MCC) vaccination started in Brazil in November 2010, scheduled at three and five months plus a booster at 12-15months of age. No catch-up was implemented. We assessed the impact of vaccination on meningococcal C disease (MenC) four years after vaccination start in the National Immunization Program. METHODS: We performed an ecological quasi-experimental design from 2008 to 2014 using a deterministic linkage between the National Notification and the National Reference Laboratory databases for meningitis. We conducted an interrupted time-series analysis considering Brazil except for Salvador municipality, because an epidemic of serogroup C disease occurred in this city, which prompted a mass vaccination campaign with catch-up for adolescents in 2010. Observed MenC rates in the post-vaccination period were compared to expected rates calculated from the pre-vaccination years. Results for Salvador were presented as descriptive data. An additional time-series analysis was performed for the state of São Paulo. RESULTS: A total of 18,136 MenC cases were analyzed. The highest incidence rates were observed for infants aged <12months and no second incident peak was observed for adolescents. For Brazil, MenC rates were reduced by 67.2% (95%CI 43.0-91.4%) for infants <12months of age, 92.0% (77.3-106.8%) for the age-group 12-23months, and 64.6% (24.6-104.5%) for children aged 2-4years. For children 5-9years old, MenC rates reduced 19.2% (9.5-28.9%). Overall, 955 MenC cases were averted in Brazil in individuals aged <40years after MCC vaccination. Results from São Paulo State, mirror the patterns seen in Brazil. CONCLUSION: After four years of infants and toddlers vaccination start, MenC invasive disease reduced in the target population. This investigation provide a robust baseline to ascertain how much the upcoming catch-up dose in 12-13years of age will accelerate the decrease in MenC incidence rates among youths in Brazil.


Assuntos
Meningite Meningocócica/epidemiologia , Meningite Meningocócica/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Vacinas Meningocócicas/imunologia , Neisseria meningitidis Sorogrupo C/imunologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Ensaios Clínicos Controlados não Aleatórios como Assunto , Adulto Jovem
20.
Vaccine ; 35(7): 1030-1036, 2017 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-28108230

RESUMO

BACKGROUND: Vaccination coverage is the usual metrics to evaluate the immunization programs performance. For the 10-valent pneumococcal conjugate (PCV10) vaccine, measuring the delay of vaccination is also important, particularly as younger children are at increased risk of disease. Routinely collected administrative data was used to assess the timeliness of PCV10 vaccination, and the factors associated with delay to receive the first and second doses, and the completion of the PCV10 3+1 schedule. METHODS: A population-based retrospective cohort study was conducted with children born in 2012 in Central Brazil. Children who received the PCV10 first dose in public health services were followed-up until 23months of age. Timeliness of receiving each PCV10 dose at any given age was defined as receiving the dose within 28days grace period from the recommended age by the National Immunization Program. Log-binomial regression models were used to examine risk factors for delays of the first dose and the completion PCV10 3+1 schedule. RESULTS: In total, 14,282 children were included in the cohort of study. Delayed vaccination occurred in 9.4%, 23.8%, 36.8% and 39.9% children for the first, second, third and the booster doses, respectively. A total of 1912 children (12.8% of the cohort) were not adequately vaccinated at the 6months of life; 1,071 (7%) received the second dose after 6months of age, 784 (5.4%) did not receive the second dose, and 57 (0.4%) received the first dose after six months of life. CONCLUSION: A considerable delay was found in PCV10 third and booster doses. Almost 2 thousand children had not received the recommended PCV10 doses at 6months of age. Timeliness of vaccination is an issue in Brazil although high vaccination coverages.


Assuntos
Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Sistema de Registros , Streptococcus pneumoniae/imunologia , Vacinação/estatística & dados numéricos , Brasil , Feminino , Humanos , Programas de Imunização , Lactente , Recém-Nascido , Masculino , Infecções Pneumocócicas/imunologia , Infecções Pneumocócicas/virologia , Estudos Retrospectivos , Fatores de Risco , Streptococcus pneumoniae/efeitos dos fármacos , Fatores de Tempo , Cobertura Vacinal , Vacinas de Subunidades
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