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1.
Trans R Soc Trop Med Hyg ; 114(1): 23-30, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31667507

RESUMO

BACKGROUND: Deteriorated conditions in the non-prison population can lead to an approximation of its tuberculosis (TB) risk to that in the prison population. We evaluated the association between incarceration and TB incidence rate and its interaction with population income distribution inequality in Brazilian municipalities (2013-2015). METHODS: We included 954 municipalities with at least one prison. Interaction between the Gini coefficient and prison exposure was analysed in a multiple regression model. We estimated the fraction of TB in the population attributable fraction (PAF) to exposure to prisons according the Gini coefficient. RESULTS: Compared with the non-prison population, the prisoners had 22.07 times (95% confidence interval [CI] 20.38 to 23.89) the risk of TB in municipalities where the Gini coefficient was <0.60 and 14.96 times (95% CI 11.00 to 18.92) the risk where the Gini coefficient was ≥0.60. A negative interaction in the multiplicative scale was explained by a higher TB incidence in the non-prison population in municipalities with a Gini coefficient ≥0.60. The PAF ranged from 50.06% to 5.19% in municipalities with Gini coefficients <0.40 and ≥0.60, respectively. CONCLUSIONS: Interventions to reduce prison exposure would have an ostensible impact in population TB incidence rates mainly in settings with lower Gini coefficients. In those with extreme inequality in income distribution, strategies focused on mitigating the effects of socio-economic factors should also be prioritized.

2.
Epidemiol Serv Saude ; 28(2): e2018158, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31271632

RESUMO

The Special Tuberculosis Treatment Information System (SITE-TB) arose mainly from the need to routinely monitor all persons with drug-resistant tuberculosis (DR-TB) in Brazil, as well as to qualify tuberculosis' drug control. Developed by the Professor Hélio Fraga Reference Center and the Management Sciences for Health/Brazil Project, this online system was implemented in 2013 in all Brazilian states. In addition to DR-TB, the system registers people with drug-sensitive tuberculosis with special regimen indications, and those with nontuberculous mycobacterial infections identified by differential diagnosis of tuberculosis. All confirmed tuberculosis cases should be notified on the Notifiable Diseases Information System (SINAN). In situations where treatment with special regimens is necessary, the case is closed on SINAN and notified on SITE-TB. Professionals from tuberculosis reference centers report and monitor these cases on the system, as well as manage tuberculosis' drugs.

3.
São Paulo; s.n; 2019. 221 p.
Tese em Português | LILACS | ID: biblio-1005494

RESUMO

Objetivo: A presente tese é apresentada no formato de três artigos que se articulam através do objetivo geral que foi estudar a associação entre o encarceramento e o risco de tuberculose ativa (TB) no Brasil. Os objetivos específicos dos artigos foram: (artigo-1) identificar um conjunto de macrodeterminantes socioeconômicos associados à incidência da TB, dentre eles, a proporção da população privada de liberdade (PPL) na população do município; (artigo-2) quantificar a importância relativa da exposição às prisões na incidência de TB e avaliar sua interação com a desigualdade da distribuição de renda; (artigo-3) estimar o efeito dos fatores ambientais dos presídios no tempo até o diagnóstico de TB. Métodos: Foram realizados dois estudos ecológicos (artigos-1 e 2) e um estudo de coorte retrospectiva (artigo-3). No artigo-1, relacionamos as taxas de incidência de TB (2010) dos 5565 municípios aos indicadores socioeconômicos e de saúde e à proporção de PPL. No artigo-2, as taxas de incidência de TB das populações prisional e não prisional dos 954 municípios com pelo menos uma unidade prisional (2014), foram relacionadas às variáveis contextuais dos municípios. Avaliamos também a interação da desigualdade da distribuição de renda nesta associação; e estimamos a fração atribuível à população (FAP). No artigo-3, analisamos os casos de TB na PPL do estado de São Paulo (2014 e 2015) segundo o tempo entre o encarceramento e o diagnóstico de TB. O efeito total das condições ambientais foi analisado por modelos de riscos de Cox. Todas as análises foram orientadas por diagramas causais para a seleção de variáveis de ajuste. Resultados: No artigo-1, após o ajuste por fatores individuais e região geográfica, esteve associada positivamente à incidência da TB, a proporção de PPL (razão de taxas de incidência [RTI]: 1,11; intervalo com 95% de confiança [IC95%]: 1,09-1,14), e fatores socioeconômicos e de saúde. No artigo-2, comparada com a população não prisional, a PPL apresentou (RTI) 22,07 vezes (IC95%: 20,38-23,89) o risco de TB em municípios com coeficiente de Gini =0,60. A FAP foi gradativamente menor em municípios com maior desigualdade da distribuição de renda. No artigo-3, estimou-se que a cada aumento de 50% na taxa de ocupação carcerária, houve um aumento na velocidade de ocorrência da TB de 16% (IC95%: 8%-25%) nos modelos até dois anos. Um aumento de uma unidade do logaritmo da área da cela por pessoa resultou em uma redução na velocidade até o diagnóstico de TB de 13% (IC95%: 2%-23%) nos modelos até dois anos. Conclusão: Evidenciou-se a importância da PPL na ocorrência da TB nos municípios brasileiros; o potencial impacto que teriam intervenções para reduzir a exposição aos presídios, o qual varia segundo as condições socioeconômicas; e o efeito das condições ambientais dos presídios na velocidade do tempo até o diagnóstico de TB. Intervenções nas prisões como a redução drástica das condições de superlotação e o aumento do espaço físico, teriam elevado impacto na incidência de TB na população gerla, principalmente em municípios com menor coeficiente de Gini


Objective: This thesis is presented in the form of three articles that are articulated through the general objective of studying the association between incarceration and the risk of active tuberculosis (TB) in Brazil. The specific objectives of the articles were: (article-1) to identify a set of socioeconomic macrodeterminants associated with the TB incidence, among them, the proportion of the prison population in the population of the municipality; (article-2) to quantify the relative importance of exposure to prisons in TB incidence and to assess their interaction with population income distribution inequality; (article-3) to estimate the effect of the environmental factors of prisons in time until the diagnosis of TB. Methods: Two ecological studies (articles-1 and 2) and one retrospective cohort study (article-3) were performed. In article-1, we related the TB incidence rates (2010) of the 5565 municipalities to socioeconomic and health indicators and to the proportion of prison population. In article-2, the TB incidence rates of the prison and non-prison populations of the 954 municipalities with at least one prison (2014) were related to the contextual variables of the municipalities. We also evaluated the interaction of the income distribution inequality in this association; and we estimated the fraction of tuberculosis in the population attributable to the exposure to prisons (PAF). In article-3, we analyzed the TB cases in the prison population of the São Paulo state (2014 and 2015) according to the time between incarceration and the diagnosis of TB. The total effect of the environmental conditions was analyzed by Cox risk models. All the analyzes were oriented by causal diagrams for the selection of adjustment variables. Results: In article-1, after adjustment for individual factors and geographic region, it was positively associated with the TB incidence, the proportion of prison population (incidence rate ratio [IRR]: 1.11, 95% confidence interval [ 95%CI: 1.09-1.14), and socioeconomic and health factors. In article-2, compared to the non-prison population, the prison population presented 22.07 times (95%CI: 20,38-23,89) the risk of TB in municipalities with a Gini coefficient =0.60. The PAF was gradually lower in municipalities with greater income distribution inequality. In article-3, it was estimated that with each increase of 50% in the prison occupation rate, there was an increase in the speed of TB occurrence of 16% (95%CI: 8% -25%) in the models up to two years. An increase of one unit in the logarithm of the cell area per person resulted in a reduction in the speed to TB diagnosis of 13% (95%CI: 2% -23%) in the models up to two years. Conclusion: It was evidenced the importance of prison population in the occurrence of TB in Brazilian municipalities; the potential impact of interventions to reduce exposure to prisons, which varies according to socioeconomic conditions; and the effect of prisons\' environmental conditions on the speed of time to TB diagnosis. Interventions in prisons such as the drastic reduction of overcrowding conditions and the increase in physical space, would have a high impact on the TB incidence in general population, especially in municipalities with lower Gini coefficients


Assuntos
Prisões , Tuberculose/epidemiologia , Meio Ambiente , Fatores Socioeconômicos , Estudos Retrospectivos , Estudos Ecológicos , Análise Multinível
4.
Cad Saude Publica ; 34(12): e00173917, 2018 12 20.
Artigo em Português | MEDLINE | ID: mdl-30570040

RESUMO

This study aimed to validate a method for classification of healthcare services in Brazil (basic care vs. other levels) and describe the decentralization of tuberculosis (TB) care to basic services (2002 to 2016). The healthcare services that reported and followed TB cases were classified as either "basic care" or "other levels" based on the type of establishment registered in the Brazilian National Registry of Healthcare Establishments (CNES, in Portuguese). The study estimated the agreement between this classification with a previous classification performed in 2013 by Brazil's state and local tuberculosis programs. Using the CNES registry, the authors then calculated the percentage of TB patients treated in basic care from 2002 to 2016. Agreement was 94.4%, and overall kappa index was 0.86. There was a relative increment of 31.2% in TB care provided by basic services (from 50.9% in 2002 to 66.8% in 2016). All regions of Brazil showed an increase in this percentage, except the South. The classification based on the CNES registry allowed analyzing the trend in decentralization of TB treatment to basic healthcare services in Brazil.


Assuntos
Assistência Integral à Saúde , Sistemas de Informação em Saúde/instrumentação , Política , Atenção Primária à Saúde/organização & administração , Tuberculose/terapia , Brasil/epidemiologia , Assistência Integral à Saúde/organização & administração , Administração de Serviços de Saúde , Humanos , Programas Nacionais de Saúde , Características de Residência , Tuberculose/diagnóstico , Tuberculose/epidemiologia
5.
Arch Public Health ; 76: 45, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30009021

RESUMO

Background: Alcohol and illicit drugs are associated with the discontinuation of tuberculosis (TB) treatment and can compromise the immune system. We estimated the impact of alcohol disorder and the use of illicit drug on TB treatment outcomes, considering the interaction of both substances in patients from São Paulo state, Brazil. Methods: This is a retrospective cohort of patients diagnosed with TB from 2011 to 2015. We estimated the relative risk (RR) of an unsuccessful outcome associated with alcohol disorder, use of illicit drugs and their interaction using a multiple regression model. We used the adjusted RR to estimate the population attributable fraction. Results: Out of a total 77,212 TB patients, 22.2% used at least one of the substances of interest during treatment, while 17% presented an unsuccessful outcome of TB treatment. Compared with no exposure to any substance, alcohol disorder alone (adjusted RR: 1.48; 95% CI: 1.4-1.56), drug use alone (adjusted RR: 2.1; 95% CI: 1.98-2.21) and exposure to both substances (adjusted RR: 2.09; 95% CI: 1.97-2.21) were all associated with a higher risk of an unsuccessful outcome. The adjusted RR of an unsuccessful outcome for people exposed to both substances was 32.7% (95% CI: 26.8-38.2%) and 15.8% (95% CI: 11.5-20.1%) lower than expected on the multiplicative and additive scales respectively. Among all TB patients, 15.8% (95% CI: 15-16.5%) of unsuccessful outcomes was attributable to those exposures. Conclusions: We identified a negative interaction between alcohol disorder and the use of illicit drugs on TB treatment outcomes. Despite this, interventions to reduce substance use in TB patients could have a meaningful contribution to preventing unsuccessful treatment outcomes.

6.
BMJ Open ; 8(6): e018545, 2018 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-29880560

RESUMO

OBJECTIVES: To identify scenarios based on socioeconomic, epidemiological and operational healthcare factors associated with tuberculosis incidence in Brazil. DESIGN: Ecological study. SETTINGS: The study was based on new patients with tuberculosis and epidemiological/operational variables of the disease from the Brazilian National Information System for Notifiable Diseases and the Mortality Information System. We also analysed socioeconomic and demographic variables. PARTICIPANTS: The units of analysis were the Brazilian municipalities, which in 2015 numbered 5570 but 5 were excluded due to the absence of socioeconomic information. PRIMARY OUTCOME: Tuberculosis incidence rate in 2015. DATA ANALYSIS: We evaluated as independent variables the socioeconomic (2010), epidemiological and operational healthcare indicators of tuberculosis (2014 or 2015) using negative binomial regression. Municipalities were clustered by the k-means method considering the variables identified in multiple regression models. RESULTS: We identified two clusters according to socioeconomic variables associated with the tuberculosis incidence rate (unemployment rate and household crowding): a higher socioeconomic scenario (n=3482 municipalities) with a mean tuberculosis incidence rate of 16.3/100 000 population and a lower socioeconomic scenario (2083 municipalities) with a mean tuberculosis incidence rate of 22.1/100 000 population. In a second stage of clusterisation, we defined four subgroups in each of the socioeconomic scenarios using epidemiological and operational variables such as tuberculosis mortality rate, AIDS case detection rate and proportion of vulnerable population among patients with tuberculosis. Some of the subscenarios identified were characterised by fragility in their information systems, while others were characterised by the concentration of tuberculosis cases in key populations. CONCLUSION: Clustering municipalities in scenarios allowed us to classify them according to the socioeconomic, epidemiological and operational variables associated with tuberculosis risk. This classification can support targeted evidence-based decisions such as monitoring data quality for improving the information system or establishing integrative social protective policies for key populations.


Assuntos
Tuberculose/epidemiologia , Brasil/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Incidência , Vigilância da População , Pobreza/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , Análise de Regressão , Tuberculose/prevenção & controle , Saúde da População Urbana/estatística & dados numéricos
7.
Rev Saude Publica ; 52: 53, 2018.
Artigo em Português, Inglês | MEDLINE | ID: mdl-29791528

RESUMO

OBJECTIVE To evaluate the association between the health services offered by primary care teams and the detection of new tuberculosis cases in Brazil. METHODS This was an ecological study covering all Brazilian municipalities that registered at least one new tuberculosis case (diagnosed between 2012 to 2014 and notified in the Information System of Notifiable Diseases) and with at least one primary care team evaluated by the second cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB). The variables of the PMAQ-AB were classified as proximal or distal, according to their relation with the tuberculosis diagnosis. Then, they were tested hierarchically in multiple models (adjusted by States) using negative binomial regression. RESULTS An increase of 10% in the primary health care coverage was associated with a decrease of 2.24% in the tuberculosis detection rate (95%CI -3.35- -1.11). Regarding the proximal variables in relation to diagnosis, in the multiple model, the detection of tuberculosis was associated with the proportion of teams that conduct contact investigation (increase in Incidence Rate Ratio [IRR] = 2.97%, 95%CI 2.41-3.53), carry out tuberculosis active case finding (increase in IRR = 2.17%, 95%CI 1.48-2.87), and request culture for mycobacteria (increase in IRR = 1.87%, 95%CI 0.98-2.76). CONCLUSIONS The variables related to the search actions were positively associated with the detection of new tuberculosis cases, which suggests a significant contribution to the strengthening of the sensitivity of the surveillance system. On the other hand, primary care coverage was inversely associated with the tuberculosis detection rate, which could represent the overall effect of the primary care on transmission control, probably from the identification and early treatment of cases.


Assuntos
Atenção Primária à Saúde , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Brasil/epidemiologia , Notificação de Doenças , Serviços de Saúde , Humanos , Incidência , Sistemas de Informação
8.
Am J Public Health ; 108(4): 514-516, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29470110

RESUMO

OBJECTIVES: To estimate birth reduction potentially in response to Zika virus-associated microcephaly among the 36 largest Brazilian cities. METHODS: We analyzed the number of live births per month on the basis of information on approximately 8.2 million births from all of Brazil's state capitals and cities that had more than 10 000 annual births. RESULTS: In the second half of 2016, the live birth rate was reduced by 7.78% (95% confidence interval [CI] = 6.64%, 8.89%; P < .001). This reduction was correlated with the Zika virus-associated microcephaly rate. In the cities with the highest microcephaly rate in 2015 (> 1 case per 1000 live births), the reduction in the live birth rate was 10.84% (95% CI = 8.58%, 13.04%). CONCLUSIONS: The birth rate in the largest Brazilian cities during the second half of 2016 was significantly reduced, which is potentially the effect of a birth control recommendation prompted by an epidemiological alert. Public Health Implications. The effects of population-based interventions should be weighed by considering the actual risk of disease and the sociodemographic impact of strategies such as birth control.


Assuntos
Coeficiente de Natalidade , Epidemias/estatística & dados numéricos , Microcefalia/epidemiologia , Infecção por Zika virus/epidemiologia , Brasil/epidemiologia , Cidades/epidemiologia , Cidades/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Feminino , Humanos , Microcefalia/etiologia , Microcefalia/virologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , População Urbana/estatística & dados numéricos , Zika virus , Infecção por Zika virus/complicações
9.
Rev. saúde pública (Online) ; 52: 53, 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-903455

RESUMO

ABSTRACT OBJECTIVE To evaluate the association between the health services offered by primary care teams and the detection of new tuberculosis cases in Brazil. METHODS This was an ecological study covering all Brazilian municipalities that registered at least one new tuberculosis case (diagnosed between 2012 to 2014 and notified in the Information System of Notifiable Diseases) and with at least one primary care team evaluated by the second cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB). The variables of the PMAQ-AB were classified as proximal or distal, according to their relation with the tuberculosis diagnosis. Then, they were tested hierarchically in multiple models (adjusted by States) using negative binomial regression. RESULTS An increase of 10% in the primary health care coverage was associated with a decrease of 2.24% in the tuberculosis detection rate (95%CI -3.35- -1.11). Regarding the proximal variables in relation to diagnosis, in the multiple model, the detection of tuberculosis was associated with the proportion of teams that conduct contact investigation (increase in Incidence Rate Ratio [IRR] = 2.97%, 95%CI 2.41-3.53), carry out tuberculosis active case finding (increase in IRR = 2.17%, 95%CI 1.48-2.87), and request culture for mycobacteria (increase in IRR = 1.87%, 95%CI 0.98-2.76). CONCLUSIONS The variables related to the search actions were positively associated with the detection of new tuberculosis cases, which suggests a significant contribution to the strengthening of the sensitivity of the surveillance system. On the other hand, primary care coverage was inversely associated with the tuberculosis detection rate, which could represent the overall effect of the primary care on transmission control, probably from the identification and early treatment of cases.


RESUMO OBJETIVO Avaliar a associação entre os serviços de saúde ofertados por equipes de atenção básica e a detecção de casos novos de tuberculose no Brasil. MÉTODOS Estudo ecológico, abrangendo todos os municípios brasileiros que registraram pelo menos um caso novo de tuberculose (diagnosticado entre 2012 a 2014 e notificado no Sistema de Informação de Agravos de Notificação) e com pelo menos uma equipe de atenção básica avaliada pelo segundo ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). As variáveis do PMAQ-AB foram classificadas como próximais ou distais, segundo a sua relação com o diagnóstico de tuberculose. Em seguida, foram testadas hierarquicamente em modelos múltiplos (ajustados por Unidade Federada), usando regressão binomial negativa. RESULTADOS Um incremento de 10% na cobertura da atenção básica esteve associado à redução de 2,24% na taxa de detecção de tuberculose (IC95% -3,35- -1,11). No que se refere às variáveis proximais ao diagnóstico, no modelo múltiplo, a detecção da tuberculose esteve associada à proporção de equipes que: realizam vigilância de contatos (incremento na Razão de Taxas de Incidência [RTI] = 2,97%; IC95% 2,41-3,53); fazem busca ativa de casos de tuberculose (incremento na RTI = 2,17%; IC95% 1,48-2,87); e, ofertam cultura para micobactérias (incremento na RTI = 1,87%; IC95% 0,98-2,76). CONCLUSÕES As variáveis relacionadas às ações de detecção estiveram positivamente associadas à detecção de casos novos de tuberculose, sugerindo uma contribuição significativa ao fortalecimento da sensibilidade do sistema de vigilância. Por outro lado, a cobertura da atenção básica esteve inversamente associada à taxa de detecção de tuberculose, o que poderia representar o efeito global da atenção básica sobre o controle da transmissão, provavelmente, através da identificação e tratamento precoce de casos.

10.
Rev. saúde pública (Online) ; 52: 53, 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-903516

RESUMO

ABSTRACT OBJECTIVE To evaluate the association between the health services offered by primary care teams and the detection of new tuberculosis cases in Brazil. METHODS This was an ecological study covering all Brazilian municipalities that registered at least one new tuberculosis case (diagnosed between 2012 to 2014 and notified in the Information System of Notifiable Diseases) and with at least one primary care team evaluated by the second cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB). The variables of the PMAQ-AB were classified as proximal or distal, according to their relation with the tuberculosis diagnosis. Then, they were tested hierarchically in multiple models (adjusted by States) using negative binomial regression. RESULTS An increase of 10% in the primary health care coverage was associated with a decrease of 2.24% in the tuberculosis detection rate (95%CI -3.35- -1.11). Regarding the proximal variables in relation to diagnosis, in the multiple model, the detection of tuberculosis was associated with the proportion of teams that conduct contact investigation (increase in Incidence Rate Ratio [IRR] = 2.97%, 95%CI 2.41-3.53), carry out tuberculosis active case finding (increase in IRR = 2.17%, 95%CI 1.48-2.87), and request culture for mycobacteria (increase in IRR = 1.87%, 95%CI 0.98-2.76). CONCLUSIONS The variables related to the search actions were positively associated with the detection of new tuberculosis cases, which suggests a significant contribution to the strengthening of the sensitivity of the surveillance system. On the other hand, primary care coverage was inversely associated with the tuberculosis detection rate, which could represent the overall effect of the primary care on transmission control, probably from the identification and early treatment of cases.


RESUMO OBJETIVO Avaliar a associação entre os serviços de saúde ofertados por equipes de atenção básica e a detecção de casos novos de tuberculose no Brasil. MÉTODOS Estudo ecológico, abrangendo todos os municípios brasileiros que registraram pelo menos um caso novo de tuberculose (diagnosticado entre 2012 a 2014 e notificado no Sistema de Informação de Agravos de Notificação) e com pelo menos uma equipe de atenção básica avaliada pelo segundo ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). As variáveis do PMAQ-AB foram classificadas como próximais ou distais, segundo a sua relação com o diagnóstico de tuberculose. Em seguida, foram testadas hierarquicamente em modelos múltiplos (ajustados por Unidade Federada), usando regressão binomial negativa. RESULTADOS Um incremento de 10% na cobertura da atenção básica esteve associado à redução de 2,24% na taxa de detecção de tuberculose (IC95% -3,35- -1,11). No que se refere às variáveis proximais ao diagnóstico, no modelo múltiplo, a detecção da tuberculose esteve associada à proporção de equipes que: realizam vigilância de contatos (incremento na Razão de Taxas de Incidência [RTI] = 2,97%; IC95% 2,41-3,53); fazem busca ativa de casos de tuberculose (incremento na RTI = 2,17%; IC95% 1,48-2,87); e, ofertam cultura para micobactérias (incremento na RTI = 1,87%; IC95% 0,98-2,76). CONCLUSÕES As variáveis relacionadas às ações de detecção estiveram positivamente associadas à detecção de casos novos de tuberculose, sugerindo uma contribuição significativa ao fortalecimento da sensibilidade do sistema de vigilância. Por outro lado, a cobertura da atenção básica esteve inversamente associada à taxa de detecção de tuberculose, o que poderia representar o efeito global da atenção básica sobre o controle da transmissão, provavelmente, através da identificação e tratamento precoce de casos.

11.
Cad. Saúde Pública (Online) ; 34(12): e00173917, 2018. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-974615

RESUMO

Resumo: Os objetivos deste artigo foram validar um método de classificação dos serviços de saúde (atenção básica vs. outros níveis) e descrever a descentralização do atendimento da tuberculose (TB) para a atenção básica no Brasil no período de 2002 a 2016. Os serviços de saúde que notificaram e acompanharam pessoas com TB foram classificados como "atenção básica" ou "outros níveis", considerando-se o tipo de estabelecimento registrado no Cadastro Nacional de Estabelecimentos de Saúde (CNES). Foi estimada a concordância entre essa classificação e uma realizada em 2013 pelos programas estaduais e municipais de TB. Posteriormente, utilizando-se o CNES, calculou-se o percentual de pessoas com TB atendidas na atenção básica no período de 2002 a 2016. A concordância foi de 94,4% e o índice kappa global foi 0,86. Houve um incremento relativo de 31,2% do atendimento de TB na atenção básica (50,9% em 2002 para 66,8% em 2016). Todas as regiões apresentaram aumento desse percentual, exceto a Região Sul. A classificação baseada no CNES permitiu analisar a evolução da descentralização do atendimento da TB para a atenção básica no Brasil.


Abstract: This study aimed to validate a method for classification of healthcare services in Brazil (basic care vs. other levels) and describe the decentralization of tuberculosis (TB) care to basic services (2002 to 2016). The healthcare services that reported and followed TB cases were classified as either "basic care" or "other levels" based on the type of establishment registered in the Brazilian National Registry of Healthcare Establishments (CNES, in Portuguese). The study estimated the agreement between this classification with a previous classification performed in 2013 by Brazil's state and local tuberculosis programs. Using the CNES registry, the authors then calculated the percentage of TB patients treated in basic care from 2002 to 2016. Agreement was 94.4%, and overall kappa index was 0.86. There was a relative increment of 31.2% in TB care provided by basic services (from 50.9% in 2002 to 66.8% in 2016). All regions of Brazil showed an increase in this percentage, except the South. The classification based on the CNES registry allowed analyzing the trend in decentralization of TB treatment to basic healthcare services in Brazil.


Resumen: Los objetivos de este artículo fueron validar un método de clasificación de los servicios de salud (atención básica vs. otros niveles) y describir la descentralización del cuidado de la tuberculosis (TB) hacia los servicios de atención básica en Brasil, durante el período de 2002 a 2016. Los servicios de salud que notificaron y efectuaron el seguimiento a personas con TB fueron clasificados como "atención básica" u "otros niveles", considerándose el tipo de establecimiento registrado en el Registro Nacional de Establecimientos de Salud (CNES). Se estimó la concordancia entre esta clasificación y una realizada en 2013 por los programas estatales y municipales de TB. Posteriormente, utilizando el CNES, se calculó el porcentaje de personas con TB atendidas en la atención básica durante el período de 2002 a 2016. La concordancia fue de 94,4% y el índice kappa global fue 0,86. Hubo un incremento relativo de un 31,2% del manejo de la TB en la atención básica (de un 50,9% en 2002 hasta un 66,8% en 2016). Todas las regiones presentaron un aumento de ese porcentaje, excepto la región Sur. La clasificación, basada en el CNES, permitió analizar la evolución de la descentralización del manejo de la TB hacia la atención básica en Brasil.

12.
PLoS One ; 12(4): e0176116, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28419146

RESUMO

Although many studies have identified social conditions associated with tuberculosis, contextual and individual factors have rarely been analysed simultaneously. Consequently, we aimed to identify contextual and individual factors associated with tuberculosis incidence in general population in Brazil in 2010. We also assessed whether household crowding mediates the association between socioeconomic determinants and tuberculosis incidence. Individual data of tuberculosis cases were obtained from 5,565 municipalities in Brazil in 2010 (last year of national census), and merged with contextual variables. The associations were evaluated in a multilevel analysis using negative binomial regression. After adjusting for individual factors (age, sex and race) and geographic region, the following contextual factors were associated with tuberculosis incidence rate: AIDS incidence rate [incidence rate ratio (IRR), 1.21; 95% confidence interval (CI), 1.18-1.24], unemployment rate (IRR, 1.16; 95% CI, 1.13-1.19), Gini coefficient (IRR, 1.05; 95% CI, 1.02-1.08), proportion of inmates (IRR, 1.11; 95% CI, 1.09-1.14), mean per capita household income (IRR, 0.94; 95% CI, 0.91-0.97) and primary care coverage (IRR, 0.94; 95% CI, 0.92-0.96). Inclusion of household crowding in the multivariate model led to a loss of the associations of both Gini coefficient and mean per capita household income. In conclusion, our findings suggest that income inequality and poverty, as determinants of tuberculosis incidence, can be mediated by household crowding. Moreover, prison population can represent a potential social reservoir of tuberculosis in Brazil and should be addressed as a priority for disease control. Finally, the negative association between primary health coverage and tuberculosis incidence highlights the importance of this level of care as a strategy to control this disease.


Assuntos
Tuberculose/epidemiologia , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Criança , Pré-Escolar , Aglomeração , Características da Família , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
13.
J. health sci. (Londrina) ; 19(2)30/04/2017.
Artigo em Português | LILACS-Express | ID: biblio-847536

RESUMO

A compressão do nervo isquiático pode gerar a denominada ciatalgia, caracterizada por dor em membros inferiores, distúrbios sensoriais, disfunção da marcha, paresias, parestesias e deficiência de reflexo. Uma das formas de tratamento é a mobilização neural, contudo, esta técnica apresenta algumas lacunas com relação ao seu uso. Assim, este estudo teve como objetivo analisar os efeitos da mobilização neural - MN sobre a função e trofismo muscular de ratos submetidos à compressão do nervo isquiático. Foram utilizados 30 ratos, separados em: Controle (C); Lesão (L); MN membro pélvico direito (MNPD); MN membro pélvico esquerdo (MNPE); MN no membro escapular direito (MNED). Todos os animais foram submetidos à lesão do nervo isquiático direito, utilizando pinça hemostática, o nervo foi comprimido durante 30 s. O tratamento por MN foi realizado de acordo com o grupo, no 3º, 5º, 7º, 10º, 12º e no 14º pós-operatórios (POs). Foi avaliado o Índice Funcional do Isquiático (IFC), área (µm2 ) e menor diâmetro (µm) dos tibiais anteriores. Para o IFC não foram observadas diferenças significativas entre os grupos, contudo, dentro dos grupos ocorreram diferenças indicando ligeiros e melhores resultados para MNPD. Em relação à área e menor diâmetro C apresentou valores mais elevados e MNPD foi maior do L, MNPE e MNED. Conclui-se que a MN, quando realizada no membro da compressão nervosa, promoveu efeitos benéficos, contudo, sem produzir restauração completa. (AU)


The sciatic nerve compression can lead to the so-called sciatica, characterized by pain in the lower limbs, sensory disturbance, gait dysfunction, paresis, paresthesia and reflection deficiency. One form of treatment is the neural mobilization; however, this technique has some gaps regarding its use. This study aimed to analyze the neural mobilization (NM) effects on the rats' functional and muscular tropism with sciatic nerve compression. 30 rats were used, divided into: control (C); Lesion (L); right hind limb NM (RHNM); left hind limb NM (LHNM); scapular right limb NM (SRNM). All animals were subjected to the right sciatic nerve injury using hemostatic forceps, the nerve was compressed for 30 sec. Treatment with NM was performed according to the group, on the 3rd, 5th, 7th, 10th, 12th and 14th post-surgery (PS). Sciatic Functional Index (SFI), area (µm2 ) and smaller diameter (µm) of the tibialis anterior were evaluated. For SFI significant differences were observed among the groups, however, within the groups there were no differences indicating faster and better results for RHNM. Concerning the area and smaller diameter, C showed higher values and RHNM was higher than L, LHNM and SRNM. It was concluded that the NM when performed on the nerve compression limb, promoted beneficial effects, however, without producing complete restoration. (AU)

14.
Emerg Infect Dis ; 23(3): 496-499, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28221118

RESUMO

During 2009-2014, incarceration rates in Brazil rose 34%, and tuberculosis (TB) cases among prisoners rose 28.8%. The proportion of national TB cases that occurred among prisoners increased from 6.2% to 8.4% overall and from 19.3% to 25.6% among men 20-29 years of age.


Assuntos
Prisioneiros , Tuberculose/epidemiologia , Adolescente , Antituberculosos/uso terapêutico , Brasil/epidemiologia , Feminino , Humanos , Masculino , Prisões , Estudos Retrospectivos , Tuberculose/tratamento farmacológico , Adulto Jovem
15.
Rev Panam Salud Publica ; 39(1): 3-11, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27754532

RESUMO

Objective To assess 1) the burden and socio-demographic and clinical characteristics of tuberculosis (TB) cases, and 2) the quality of TB care provided to patients who entered and remained within each health care service level (primary, secondary, or tertiary) and those who moved from one level to another, using process and results indicators. Methods This cross-sectional operational research study assessed new smear-positive pulmonary TB cases diagnosed in Brazilian state capitals in 2013 using TB program records and the TB surveillance system. Quality of care was assessed based on process and results indicators including HIV screening, TB contact screening, Directly Observed Treatment (DOT), sputum smear microscopy monitoring, and treatment outcomes. Results There were 12 977 new smear-positive TB cases reported. Of these, 7 964 (61.4%) cases were diagnosed and treated at the primary care level, 1 195 (9.2%) at the secondary level, 1 521 (11.7%) at the tertiary level, and 2 296 (17.7%) at more than one level, with 65% of the latter group moved from the tertiary level to the primary level. The proportion of cases tested for HIV was significantly higher in patients receiving care at the primary level compared to those receiving care at the secondary level (prevalence ratio (PR): 1.17; 95% confidence interval (CI): 1.07-1.28) and those attending more than one service level. Patients attending the tertiary health care level had a 122% higher PR for not doing DOT ("DOT not done") compared to patients at the primary level (PR: 2.22; CI: 2.12-2.32). When the two levels were compared, the prevalence for an unfavorable outcome (lost to follow-up, death from TB, death with TB, transferred out, or not evaluated) was higher at the tertiary health care level. Conclusions Primary health services are successfully incorporating the management of new smear-positive TB cases. Primary health care obtained better operational indicators than secondary or tertiary levels.


Assuntos
Tuberculose , Brasil , Estudos Transversais , Humanos , Prevalência , Tuberculose/diagnóstico
16.
Conscientiae saúde (Impr.) ; 15(2): 258-265, 30 jun. 2016.
Artigo em Português | LILACS-Express | ID: biblio-846483

RESUMO

Introdução: a mobilização neural é uma técnica que visa restituir a função do sistema nervoso, contudo há ainda desconhecimento sobre o local mais apropriado. Objetivos: avaliar os efeitos da mobilização neural no tratamento da compressão do nervo isquiático de ratos Wistar, e comparar os diferentes locais de aplicação. Métodos: 24 ratos Wistar foram submetidos à compressão do nervo isquiático direito, e separados em quatro grupos: lesão (GL), mobilização neural no lesionado (GPD), mobilização neural no membro contralateral (GPE) e mobilização neural no membro ipsilateral a lesão (GEP). Foram realizadas avaliações funcionais pelo tempo de elevação da pata (TEP) e dolorímetro digital de Von Frey, após a última avaliação, o nervo isquiático foi seccionado para análise histológica. Resultados: houve diferença entre o GL (23,54) e GPE (23,98) na avaliação do TEP (p=0,028), na avaliação nociceptiva e histológica não houve diferenças significativas (p>0,05). Conclusão: a mobilização neural no membro contralateral foi prejudicial, enquanto o tratamento no membro acometido e no membro ipsilateral não apresentou diferença significativa.


Introduction: neural mobilization is a technique that aims to restore the function of the nervous system, yet there still lack of knowledge about the most appropriate place. Objectives: to evaluate the effects of neural mobilization in the treatment of sciatic nerve compression Wistar rats, and compare the different application sites. Methods: 24 Wistar rats were right sciatic nerve compression, and separated into four groups: injury (GL), neural mobilization in the injured (GPD), neural mobilization in the contralateral limb (GPE) and neural mobilization in the ipsilateral limb injury (GEP). Functional assessments were performed at paw elevation time (TEP) and digital Von Frey dolorimeter after the last evaluation, the sciatic nerve was sectioned for histological analysis. Results: there was a difference between the GL (23.54) and GPE (23.98) in the evaluation of the TEP (p=0.028), in nociceptive and histological evaluation no significant differences (p>0.05). Conclusion: the neural mobilization held in the contralateral limb was harmful, while treating the affected and ipsilateral limb showed no significant difference.

17.
Rev Panam Salud Publica ; 39(1),jan. 2016
Artigo em Inglês | PAHO-IRIS | ID: phr-28195

RESUMO

Objective. To assess 1) the burden and socio-demographic and clinical characteristics of tuberculosis (TB) cases, and 2) the quality of TB care provided to patients who entered and remained within each health care service level (primary, secondary, or tertiary) and those who moved from one level to another, using process and results indicators. Methods. This cross-sectional operational research study assessed new smear-positive pulmonary TB cases diagnosed in Brazilian state capitals in 2013 using TB program records and the TB surveillance system. Quality of care was assessed based on process and results indicators including HIV screening, TB contact screening, Directly Observed Treatment (DOT), sputum smear microscopy monitoring, and treatment outcomes. Results. There were 12 977 new smear-positive TB cases reported. Of these, 7 964 (61.4%) cases were diagnosed and treated at the primary care level, 1 195 (9.2%) at the secondary level, 1 521 (11.7%) at the tertiary level, and 2 296 (17.7%) at more than one level, with 65% of the latter group moved from the tertiary level to the primary level. The proportion of cases tested for HIV was significantly higher in patients receiving care at the primary level compared to those receiving care at the secondary level (prevalence ratio (PR): 1.17; 95% confidence interval (CI): 1.07–1.28) and those attending more than one service level. Patients attending the tertiary health care level had a 122% higher PR for not doing DOT (“DOT not done”) compared to patients at the primary level (PR: 2.22; CI: 2.12–2.32). When the two levels were compared, the prevalence for an unfavorable outcome (lost to follow-up, death from TB, death with TB, transferred out, or not evaluated) was higher at the tertiary health care level. Conclusions. Primary health services are successfully incorporating the management of new smear-positive TB cases. Primary health care obtained better operational indicators than secondary or tertiary levels.


Objetivo. Evaluar 1) la carga de morbilidad por tuberculosis y las características sociodemográficas y clínicas de los pacientes y 2) la calidad de la atención de la tuberculosis que se presta a los pacientes que acuden y permanecen en cada nivel de los servicios de salud (primario, secundario o terciario) y a los pacientes que se transfirieron a otro nivel, mediante el análisis de los indicadores de funcionamiento de los procesos y los indicadores de resultados. Métodos. En el presente estudio transversal de investigación operativa se analizaron los casos nuevos de tuberculosis pulmonar con baciloscopia positiva que se diagnosticaron en las capitales estatales del Brasil en el 2013, a partir de los registros del programa contra la tuberculosis y los datos del sistema de vigilancia de la enfermedad. Se evaluó la calidad de la atención en función de los indicadores de funcionamiento y los indicadores de resultados como la detección sistemática de la infección por el virus de la inmunodeficiencia humana (VIH), el tamizaje de los contactos de casos de tuberculosis, el tratamiento estrictamente supervisado (conocido como DOT, por su sigla en inglés), la supervisión de la baciloscopia del esputo y los desenlaces terapéuticos. Resultados. Se notificaron 12 977 casos nuevos de tuberculosis con baciloscopia positiva. De los casos notificados, 7 964 (61,4%) se diagnosticaron y recibieron tratamiento en el nivel de atención primaria, 1 195 (9,2%) en el nivel secundario, 1 521 (11,7%) en el nivel terciario y 2 296 pacientes (17,7%) recibieron asistencia en servicios de varios niveles de atención; de este último grupo, el 65% pasó del nivel terciario al nivel primario de atención. La proporción de casos en los cuales se practicó la detección de la infección por el VIH fue significativamente mayor en los pacientes que acudieron al nivel primario de atención, al compararlos con los que recibieron atención en el nivel secundario (razón de prevalencia, [RP]: 1,17; intervalo de confianza [IC] de 95%: de 1,07 a 1,28) y los pacientes tratados en servicios de varios niveles de atención. En los pacientes que acudieron al nivel terciario de atención de salud, la razón de prevalencia de no seguir el DOT fue 122% más alta que en los pacientes atendidos en el nivel primario (RP: 2,22; IC de 95%: de 2,12 a 2,32). Cuando se compararon ambos niveles, la prevalencia de un resultado desfavorable (pérdida durante el seguimiento, defunción por tuberculosis, defunción con tuberculosis, transferido a otro centro o no evaluado) fue más alta en el nivel terciario de atención sanitaria. Conclusiones. Los servicios de atención primaria de salud han incorporado de manera eficaz el tratamiento de los casos nuevos de tuberculosis con baciloscopia positiva. Los indicadores operativos de la atención primaria de salud fueron mejores que los indicadores de la atención de nivel secundario o terciario.


Assuntos
Tuberculose , Atenção Primária à Saúde , Serviços de Saúde , Política , Pesquisa Operacional , Brasil , Atenção Primária à Saúde , Serviços de Saúde , Pesquisa Operacional , Brasil
18.
Rev. panam. salud pública ; 39(1): 3-11, Jan. 2016. tab, graf
Artigo em Inglês | LILACS | ID: lil-783025

RESUMO

ABSTRACT Objective To assess 1) the burden and socio-demographic and clinical characteristics of tuberculosis (TB) cases, and 2) the quality of TB care provided to patients who entered and remained within each health care service level (primary, secondary, or tertiary) and those who moved from one level to another, using process and results indicators. Methods This cross-sectional operational research study assessed new smear-positive pulmonary TB cases diagnosed in Brazilian state capitals in 2013 using TB program records and the TB surveillance system. Quality of care was assessed based on process and results indicators including HIV screening, TB contact screening, Directly Observed Treatment (DOT), sputum smear microscopy monitoring, and treatment outcomes. Results There were 12 977 new smear-positive TB cases reported. Of these, 7 964 (61.4%) cases were diagnosed and treated at the primary care level, 1 195 (9.2%) at the secondary level, 1 521 (11.7%) at the tertiary level, and 2 296 (17.7%) at more than one level, with 65% of the latter group moved from the tertiary level to the primary level. The proportion of cases tested for HIV was significantly higher in patients receiving care at the primary level compared to those receiving care at the secondary level (prevalence ratio (PR): 1.17; 95% confidence interval (CI): 1.07–1.28) and those attending more than one service level. Patients attending the tertiary health care level had a 122% higher PR for not doing DOT (“DOT not done”) compared to patients at the primary level (PR: 2.22; CI: 2.12–2.32). When the two levels were compared, the prevalence for an unfavorable outcome (lost to follow-up, death from TB, death with TB, transferred out, or not evaluated) was higher at the tertiary health care level. Conclusions Primary health services are successfully incorporating the management of new smear-positive TB cases. Primary health care obtained better operational indicators than secondary or tertiary levels.


RESUMEN Objetivo Evaluar 1) la carga de morbilidad por tuberculosis y las características sociodemográficas y clínicas de los pacientes y 2) la calidad de la atención de la tuberculosis que se presta a los pacientes que acuden y permanecen en cada nivel de los servicios de salud (primario, secundario o terciario) y a los pacientes que se transfirieron a otro nivel, mediante el análisis de los indicadores de funcionamiento de los procesos y los indicadores de resultados. Métodos En el presente estudio transversal de investigación operativa se analizaron los casos nuevos de tuberculosis pulmonar con baciloscopia positiva que se diagnosticaron en las capitales estatales del Brasil en el 2013, a partir de los registros del programa contra la tuberculosis y los datos del sistema de vigilancia de la enfermedad. Se evaluó la calidad de la atención en función de los indicadores de funcionamiento y los indicadores de resultados como la detección sistemática de la infección por el virus de la inmunodeficiencia humana (VIH), el tamizaje de los contactos de casos de tuberculosis, el tratamiento estrictamente supervisado (conocido como DOT, por su sigla en inglés), la supervisión de la baciloscopia del esputo y los desenlaces terapéuticos. Resultados Se notificaron 12 977 casos nuevos de tuberculosis con baciloscopia positiva. De los casos notificados, 7 964 (61,4%) se diagnosticaron y recibieron tratamiento en el nivel de atención primaria, 1 195 (9,2%) en el nivel secundario, 1 521 (11,7%) en el nivel terciario y 2 296 pacientes (17,7%) recibieron asistencia en servicios de varios niveles de atención; de este último grupo, el 65% pasó del nivel terciario al nivel primario de atención. La proporción de casos en los cuales se practicó la detección de la infección por el VIH fue significativamente mayor en los pacientes que acudieron al nivel primario de atención, al compararlos con los que recibieron atención en el nivel secundario (razón de prevalencia, [RP]: 1,17; intervalo de confianza [IC] de 95%: de 1,07 a 1,28) y los pacientes tratados en servicios de varios niveles de atención. En los pacientes que acudieron al nivel terciario de atención de salud, la razón de prevalencia de no seguir el DOT fue 122% más alta que en los pacientes atendidos en el nivel primario (RP: 2,22; IC de 95%: de 2,12 a 2,32). Cuando se compararon ambos niveles, la prevalencia de un resultado desfavorable (pérdida durante el seguimiento, defunción por tuberculosis, defunción con tuberculosis, transferido a otro centro o no evaluado) fue más alta en el nivel terciario de atención sanitaria. Conclusiones Los servicios de atención primaria de salud han incorporado de manera eficaz el tratamiento de los casos nuevos de tuberculosis con baciloscopia positiva. Los indicadores operativos de la atención primaria de salud fueron mejores que los indicadores de la atención de nivel secundario o terciario.


Assuntos
Atenção Primária à Saúde , Tuberculose/diagnóstico , Tuberculose/prevenção & controle , Brasil
19.
Medicina (Ribeiräo Preto) ; 48(6): 533-538, nov.-dez.2015.
Artigo em Português | LILACS | ID: lil-793111

RESUMO

Modelo do estudo: estudo experimental, de caráter transversal. Objetivo: avaliar os efeitos do laser de baixa potência (LBP), com comprimento de onda de 670nm e 820nm, na nocicepção de ratos Wistar submetidos à hipernocicepção articular no joelho direito. Metodologia: foram utilizados 18 ratos Wistar, separados em 3 grupos: G1 – não tratados; G2 – tratados com LBP 670 nm; G3 – tratados com LBP 830nm. Para a indução da hipernocicepção foi injetado no espaço articular tíbio-femoral 100 µL de formalina 5%. Para avaliar a nocicepção foi utilizado o filamento de von Frey digital, tanto com pressão sobre o joelho, quanto na região plantar; esta avaliação aconteceu: pré-lesão (AV1), após 15 (AV2), 30 (AV3) e 60(AV4) minutos da indução da hipernocicepção. Para o tratamento com LBP foi usada fluência de 8 J/cm, logo após AV2. Resultados: o limiar de retirada, quando a pressão foi realizada no joelho, mostrou que 670 nm produziu elevação do limiar em AV3 e AV4, retornando para valores semelhantes aos de AV1.Para a região plantar, apenas 830 nm mostrou restauração dos valores em AV4, e foi maior em AV3 ao comparar com o grupo controle. Conclusão: ambos os comprimentos de onda produziram elevação do limiar de retirada da pata, em ratos com hipernocicepção em joelho.


Study design: experimental study of cross-cutting nature. Objective: To evaluate the low level laser therapy (LLLT) effects, with a wavelength of 670 and 820nm, in nociception of Wistar rats submitted to hypernociception in his right knee. Methods: 18 Wistar rats, separated into 3 groups: G1 – untreated; G2– treated with LBP 670 nm; G3 – treated with LBP 830 nm. For the hypernociception induction was injected into the tibiofemoral articular space 100 µL of 5% formalin. To evaluate nociception was used digital von Frey filament, both with pressure on the knee, as in the plantar region. The evaluations occurred: pre-injury (EV1), 15 (EV2), 30 (EV3) and 60 (EV4) minutes after hypernociception induction. For the treatment with LBP was used to 8 J/cm2, after EV2. Results: the with drawal threshold, when the pressure was held at the knee, showed that 670 nm produced threshold elevation in EV3 and EV4, returning to values similar to those of EV1. For the plantar region, only 830 nm showed restoration of values inEV4, and was higher in EV3 when comparing with G1. Conclusion: Both wavelengths produced raising the paw with drawal threshold in rats with knee hypernociception.


Assuntos
Animais , Ratos , Terapia com Luz de Baixa Intensidade , Medição da Dor , Modalidades de Fisioterapia , Sinovite
20.
Cancer Epidemiol ; 35(6): 534-9, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21840286

RESUMO

BACKGROUND: Epidemiological studies have identified increased risks of leukemia in children living near power lines and exposed to relatively high levels of magnetic fields. Results have been remarkably consistent, but there is still no explanation for this increase. In this study we evaluated the effect of 60 Hz magnetic fields on acute lymphocytic leukemia (ALL) in the State of São Paulo, Brazil. METHODS: This case-control study included ALL cases (n=162) recruited from eight hospitals between January 2003 and February 2009. Controls (n=565) matched on gender, age, and city of birth were selected from the São Paulo Birth Registry. Exposure to extremely low frequency magnetic fields (ELF MF) was based on measurements inside home and distance to power lines. RESULTS: For 24h measurements in children rooms, levels of ELF MF equal to or greater than 0.3microtesla (µT), compared to children exposed to levels below 0.1 µT showed no increased risk of ALL (odds ratio [OR] 1.09; 95% confidence interval [95% CI] 0.33-3.61). When only nighttime measurements were considered, a risk (OR 1.52; 95% CI 0.46-5.01) was observed. Children living within 200 m of power lines presented an increased risk of ALL (OR 1.67; 95% CI 0.49-5.75), compared to children living at 600 m or more of power lines. For those living within 50 m of power lines the OR was 3.57 (95% CI 0.41-31.44). CONCLUSIONS: Even though our results are consistent with the small risks reported in other studies on ELF MF and leukemia in children, overall our results do not provide support for an association between magnetic fields and childhood leukemia, but small numbers and likely biases weaken the strength of this conclusion.


Assuntos
Campos Eletromagnéticos/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/etiologia , Brasil , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Habitação , Humanos , Lactente , Masculino , Razão de Chances
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