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1.
Cad Saude Publica ; 36Suppl 1(Suppl 1): e00188718, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32130313

RESUMO

According to the World Health Organization, from 2010 to 2014, there were around 55 million abortions worldwide, 45% of which were unsafe. In Brazil, data on abortion and its complications are incomplete. Health care data are only available for the public sector and mortality data depend on investigations of deaths. This study sought to describe the situation of abortion in the country using public data available in the different Information Systems - SIM (mortality), SINASC (live births) and SIH (hospitalization). From 2008 to 2015, there were around 200,000 hospitalizations/year for procedures related to abortion, 1,600 of which for medical and legal reasons. From 2006 to 2015, we found 770 maternal deaths in SIM whose underlying cause was abortion. There was a discreet reduction in the number of deaths from abortion in the period, with regional variation. This number could be increased by around 29% per year if deaths with mentions of abortion and declared with a different underlying cause were considered. Among the deaths reported as resulting from abortion, 1% were abortions due to medical and legal reasons and 56.5% were non-specified abortions. The proportion of deaths from abortion identified in SIH, in relation to the total number of deaths from abortion identified in SIM, varied between 47.4% in 2008 and 72.2% in 2015. Although official health data do not allow us to estimate the number of abortions in Brazil, we were able to establish the profile of women at higher risk for death from abortion: black and indigenous women, with low educational levels, under 14 and over 40 years of age, living in the North Northeast and Central regions, without a partner.

2.
AIDS ; 34(1): 63-71, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31567163

RESUMO

OBJECTIVES: Tuberculosis preventive therapy for people living with HIV is effective, widely recommended, and increasingly prescribed, but completion rates are less than ideal, and adherence is not typically monitored. We sought to quantify adherence to isoniazid preventive therapy using a urine metabolite assay. DESIGN: Two cross-sectional surveys. SETTING: Rio de Janeiro, Brazil, 2008-2009; and Northwest Province, South Africa, 2018-2019. PARTICIPANTS: Two hundred and three Brazilian and 93 South African patients attending HIV clinics with active prescriptions for isoniazid preventive therapy MAIN OUTCOME MEASURES:: Self-reported isoniazid adherence, paired with semiquantitative measurement of urine isoniazid metabolites. RESULTS: By self-report, 90% of patients [95% confidence interval (CI) 86-93%] reported having taken a dose of isoniazid on the day of enrollment or the preceding day, and 91% (95% CI 87-94%) reported missing an average of one dose or fewer per week. By urine testing, only 65% (95% CI 59-70%) of all patients, and 69% (95% CI 63-74%) of those who reported having taken isoniazid on the current or preceding day, had detectable urine metabolites (expected in 95% of patients at 24 h). Longer time since starting preventive therapy was independently associated with a negative urine test for isoniazid metabolites (adjusted prevalence ratio 1.11 per month of isoniazid, 95% CI 1.05-1.18). CONCLUSION: Adherence to isoniazid preventive therapy among patients with HIV in Brazil and South Africa is inadequate, is overestimated by self-report, and declines with time on treatment. Shorter regimens for TB preventive therapy may improve adherence and completion, but adherence support for all patients may be necessary.

3.
AIDS ; 34(1): 139-147, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31634189

RESUMO

OBJECTIVES: In 2018, Brazilian guidelines changed to recommend tuberculosis (TB) preventive therapy for all people with HIV and a CD4 cell count 350 cells/µl or less, but only for those with a positive tuberculin skin test (TST) if CD4 cell count is than 350 cells/µl. We determined the potential effectiveness of CD4-based guidelines for TB testing and preventive therapy. DESIGN: Secondary analysis of the stepped-wedge, cluster-randomized THRio trial for isoniazid preventive therapy (IPT). METHODS: We analyzed data from 4114 newly registered patients with HIV in 29 clinics followed until TB diagnosis, death, or administrative censoring. We compared incidence rates of TB and TB/death between CD4, TST, IPT, and antiretroviral therapy categories. RESULTS: Initial CD4 cell count was 350 cells/µl or less in 2138 (52%) and more than 350 cells/µl in 1976 (48%) patients. TST was performed for 2922 (71%), of whom 657 (16%) were TST-positive [278 (13%) CD4 ≤ 350 vs. 379 (19%) CD4 > 350]. A total of 619 (15%) received IPT and 2806 (68%) received antiretroviral therapy. For patients with CD4 cell count 350 cells/µl or less who did not receive IPT, the incidence rate of TB was 1.79/100 person-years (pys) and TB/death was 3.89/100 pys. For patients with CD4 cell count more than 350 who did not receive IPT, the incidence rates of TB and TB/death were 0.57/100 and 1.49/100 pys for TST-negatives, and 1.05/100 and 1.64/100 pys for TST-unknowns. CONCLUSION: TB incidence was high among all patients who did not receive IPT, including those with CD4 cell count more than 350 cells/µl and negative or unknown TST results. TB preventive therapy should be provided to all people living with HIV in medium burden settings, regardless of CD4 cell count and TST status.

4.
Cad Saude Publica ; 35(12): e00074318, 2019.
Artigo em Português | MEDLINE | ID: mdl-31800783

RESUMO

Brazil's Information System on Diseases of Notification (Sinan) is the main tool used by tuberculosis (TB) control programs to assess control measures and TB incidence. This requires data from the system that are reliable and accurate, among other features. The study thus aimed to upgrade the entry variables, condition at closure, HIV testing, AIDS-related illness, and diabetes. Linkage was performed between the Sinan-TB database, the Mortality Information System (SIM), and the single AIDS database for the city of Rio de Janeiro, Brazil. Criteria for upgrading the variables were based on technical materials on TB and the Sinan database and were implemented in a script in Structured Query Language (SQL). There was a 115% increase in treatment dropout due to the decrease in transfers, records without closure, and patients closed due to cure in less than 150 days. There was a 2.4% increase in records with diseases associated with diabetes in the affirmative category after using data from the SIM. For the variables HIV testing and AIDS-associated illness, the increases were 5.3% and 8.7%, respectively, when the information in the AIDS database was considered. In conclusion, upgrading the Sinan-TB database through integration with other information systems improved the data's quality for decision-making on TB control.

5.
Rev Soc Bras Med Trop ; 52: e20190315, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800922

RESUMO

INTRODUCTION: Immunological control of Mycobacterium tuberculosis infection is dependent on the cellular immune response, mediated predominantly by Th1 type CD4+ T cells. Polarization of the immune response to Th2 can inhibit the host immune protection against pathogens. Patients with tuberculosis coinfected with helminths demonstrate more severe pulmonary symptoms, a deficiency in the immune response against tuberculosis, and an impaired response to anti-tuberculosis therapy. METHODS: We evaluated the cellular immune response and the impact of the presence of Ascaris lumbricoides on the immune and clinical response in pulmonary tuberculosis patients. Ninety-one individuals were included in the study: 38 tuberculosis patients, 11 tuberculosis patients coinfected with Ascaris lumbricoides and other helminths, 10 Ascaris lumbricoides patients, and 34 non-infected control individuals. Clinical evolution of pulmonary tuberculosis was studied on 0, 30, 60, and 90 days post-diagnosis of Mycobacterium tuberculosis and Ascaris lumbricoides. Furthermore, immune cells and plasma cytokine profiles were examined in mono/coinfection by Mycobacterium tuberculosis and Ascaris lumbricoides using flow cytometry. RESULTS: There were no statistical differences in any of the evaluated parameters and the results indicated that Ascaris lumbricoides infection does not lead to significant clinical repercussions in the presentation and evolution of pulmonary tuberculosis. CONCLUSIONS: The association with Ascaris lumbricoides did not influence the Th1, Th2, and Th17 type responses, or the proportions of T lymphocyte subpopulations. However, higher serum levels of IL-6 in tuberculosis patients may explain the pulmonary parenchymal damage.


Assuntos
Ascaríase/imunologia , Ascaris lumbricoides , Interleucina-6/sangue , Tuberculose Pulmonar/imunologia , Adulto , Animais , Anticorpos Anti-Helmínticos/sangue , Ascaríase/complicações , Estudos de Casos e Controles , Coinfecção , Citocinas/sangue , Citocinas/imunologia , Progressão da Doença , Feminino , Citometria de Fluxo , Humanos , Interleucina-6/imunologia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Tuberculose Pulmonar/complicações , Adulto Jovem
6.
Cad Saude Publica ; 35(7): e00186418, 2019 Aug 12.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31411284

RESUMO

Despite the reduction in under-five mortality, the causes are still mostly avoidable, and survival may be compromised by life-threatening conditions at birth. The study estimated the burden of life-threatening conditions at birth, neonatal near miss, and mortality, with an emphasis on avoidable causes, as well as under-five survival in live birth cohorts. This was a retrospective cohort study of live birth in the city of Rio de Janeiro, Brazil (2012-2016). The databases from the Brazilian Information System on Live Births and the Brazilian Mortality Information System were linked. Pragmatic criteria were used to define life-threatening conditions and near miss. Deaths were classified according to the Brazilian list of causes of avoidable deaths. Morbidity and mortality and survival indicators were estimated (Kaplan-Meier). Of the 425,505 live birth , 2.2% presented life-threatening conditions at birth. The under-five, infant and neonatal mortality rates were 0.01, 0.06, and 14.97 per 1,000 person-days, respectively. Avoidable, unclearly avoidable, and ill-defined causes accounted respectively for 61%, 35%, and 4% of the deaths. The risk of death from avoidable causes attributable to life-threatening conditions at birth was 97.6%. Survival was lower in newborns with life-threatening conditions compared to those without life-threatening conditions. The pragmatic criteria for life-threatening conditions determined the profile of proportional mortality by causes of death according to the three groups of causes in the Brazilian list of causes of avoidable deaths. Life-threatening conditions at birth increases the risk of morbidity and mortality in under-five children and raises the discussion on vulnerability and the need for care for these children and social support for their families.

7.
Cad Saude Publica ; 35(3): e00098918, 2019 04 08.
Artigo em Português | MEDLINE | ID: mdl-30970098

RESUMO

The prevalence of preterm births has shown a growing trend in many countries, including developed ones. Studies in Brazil have shown that the Information System on Live Births (SINASC, in Portuguese), until 2010, underestimated the prevalence of preterm births, when compared with studies based on primary data. Starting in 2011, gestational age at birth has been calculated in SINASC according to the last menstrual period (LMP), when available. This study sought to evaluate the accuracy of the gestational age assessment using LMP, compared with two other estimates, and correlate it with birth weight. This is a population study with data from SINASC available from Brazilian Health Informatics Department between 2011 and 2015. Definitions of preterm birth, low birth weight and birth asphyxia were taken from the literature. Adequacy of birth weigh to gestational age was calculated based on Fenton and Intergrowth-21 curves. We compared weight means according to the presence or lack of preterm birth. gestational age assessment was based on LMP in 58.5% and 41.5% used another method. We found that the preterm proportion was 12% in the LMP group and 8.4% in the other method group, while low birth weight was 6.5% and 8.4%, respectively. Mean weight of preterm infants was higher in the LMP group. Use of LMP as a gestational age estimator overestimated the proportion of weight equal to or higher than 2,500g among preterm infants, which does not seem compatible with the expected distribution for this group. LMP favored "correction" of prematurity for the parameters that are comparable to those of primary data studies, though the distortions we found between gestational age and birth weigh may indicate that there are still problems with this estimator.


Assuntos
Idade Gestacional , Sistemas de Informação/estatística & dados numéricos , Nascimento Vivo/epidemiologia , Nascimento Prematuro/epidemiologia , Declaração de Nascimento , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Triagem Neonatal/métodos , Gravidez , Nascimento Prematuro/diagnóstico por imagem , Prevalência , Reprodutibilidade dos Testes , Ultrassonografia Pré-Natal
8.
Cad. Saúde Pública (Online) ; 35(7): e00186418, 2019. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-1011713

RESUMO

Apesar da redução da mortalidade na infância, as causas ainda são majoritariamente evitáveis, e a sobrevida pode estar condicionada à situação de ameaça à vida ao nascer. Foram estimadas a carga de ameaça à vida ao nascer, de near miss neonatal, e a mortalidade, com ênfase na evitabilidade, e sobrevida na infância, em coortes de nascidos vivos. Estudo de coorte retrospectiva de nascidos vivos residentes no Município do Rio de Janeiro (2012-2016). Os bancos de dados dos Sistemas de Informações sobre Nascidos Vivos e sobre Mortalidade foram relacionados. Critérios pragmáticos foram utilizados para definir ameaça à vida e near miss. Óbitos foram classificados segundo a lista brasileira de causas de mortes evitáveis. Foram estimados indicadores de morbimortalidade e a sobrevida (Kaplan-Meier). Dos 425.505 nascidos vivos, 2,2% apresentaram ameaça à vida ao nascer. As taxas de mortalidade na infância, infantil e neonatal foram, respectivamente: 0,01; 0,06 e 14,97 por mil pessoas-dia. Causas evitáveis, não claramente evitáveis e mal definidas corresponderam, respectivamente, a 61%, 35% e 4% dos óbitos. O risco de morte por causas evitáveis atribuível ao nascimento com ameaça à vida foi de 97,6%. A sobrevida foi menor entre recém-nascidos com ameaça à vida, comparados àqueles sem ameaça à vida. Os critérios pragmáticos de ameaça à vida determinaram o perfil de mortalidade proporcional por causas de morte segundo os três grupos de causas da lista brasileira de causas de mortes evitáveis. Nascer com ameaça à vida define crianças com maior risco de morbimortalidade e põe, em pauta, a discussão sobre a vulnerabilidade e as necessidades de assistência às crianças e do apoio social às suas famílias.


A pesar de la reducción de la mortalidad en la infancia, las causas de fallecimiento todavía son mayoritariamente evitables y la supervivencia puede estar condicionada con la situación de amenaza para la vida al nacer. En este trabajo se estimaron la carga de amenaza para la vida al nacer, el near miss neonatal y la mortalidad, con énfasis en la evitabilidad y supervivencia en la infancia en cohortes de nacidos vivos. Es un estudio de cohorte retrospectivo de nacidos vivos, residentes en el municipio de Río de Janeiro, Brasil (2012-2016). Se relacionaron los bancos de datos de los Sistemas de Información sobre Nacidos Vivos y sobre Mortalidad. Se utilizaron criterios pragmáticos para la definición amenaza para la vida al nacer y near miss. Los óbitos se clasificaron según la lista brasileña de causas de muertes evitables. Se estimaron indicadores de morbimortalidad y supervivencia (Kaplan-Meier). De los 425.505 nacidos vivos, un 2,2% presentaron amenaza para la vida. Las tasas de mortalidad en la infancia, infantil y neonatal fueron, respectivamente: 0,01; 0,06 y 14,97 por 1.000 personas-día. Las causas evitables, no claramente evitables y mal definidas, correspondieron, respectivamente, a un 61%, 35% y 4% de los óbitos. El riesgo de muerte por causas evitables atribuible al nacimiento con amenaza para la vida fue de un 97,6%. La supervivencia fue menor entre recién nacidos con amenaza para la vida, comparados con aquellos sin amenaza para la vida. Los criterios pragmáticos de amenaza para la vida determinaron el perfil de mortalidad proporcional por causas de muerte, según los tres grupos de causas de la lista brasileña de causas de muertes evitables. Nacer con amenaza para la vida define a los niños con un mayor riesgo de morbimortalidad y pone en relevancia la discusión sobre vulnerabilidad y necesidades asistenciales para los niños, así como el apoyo social a sus familias.


Despite the reduction in under-five mortality, the causes are still mostly avoidable, and survival may be compromised by life-threatening conditions at birth. The study estimated the burden of life-threatening conditions at birth, neonatal near miss, and mortality, with an emphasis on avoidable causes, as well as under-five survival in live birth cohorts. This was a retrospective cohort study of live birth in the city of Rio de Janeiro, Brazil (2012-2016). The databases from the Brazilian Information System on Live Births and the Brazilian Mortality Information System were linked. Pragmatic criteria were used to define life-threatening conditions and near miss. Deaths were classified according to the Brazilian list of causes of avoidable deaths. Morbidity and mortality and survival indicators were estimated (Kaplan-Meier). Of the 425,505 live birth , 2.2% presented life-threatening conditions at birth. The under-five, infant and neonatal mortality rates were 0.01, 0.06, and 14.97 per 1,000 person-days, respectively. Avoidable, unclearly avoidable, and ill-defined causes accounted respectively for 61%, 35%, and 4% of the deaths. The risk of death from avoidable causes attributable to life-threatening conditions at birth was 97.6%. Survival was lower in newborns with life-threatening conditions compared to those without life-threatening conditions. The pragmatic criteria for life-threatening conditions determined the profile of proportional mortality by causes of death according to the three groups of causes in the Brazilian list of causes of avoidable deaths. Life-threatening conditions at birth increases the risk of morbidity and mortality in under-five children and raises the discussion on vulnerability and the need for care for these children and social support for their families.

9.
Cad. Saúde Pública (Online) ; 35(3): e00098918, 2019. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-1001638

RESUMO

Resumo: A prevalência de nascimento pré-termo tem apresentado uma tendência crescente em vários países, inclusive naqueles desenvolvidos. Estudos no Brasil relatam que o Sistema de Informações sobre Nascidos Vivos (SINASC), até 2010, subestimava a prevalência de nascimentos pré-termo, quando comparada aos estudos baseados em dados primários. A partir de 2011, a idade gestacional ao nascer no SINASC tem sido calculada, quando disponível, pela data da última menstruação (DUM). O objetivo foi avaliar a acurácia da determinação da idade gestacional gerada pela DUM, comparando com a de outros estimadores, e correlacioná-la com o peso ao nascer. Estudo de base populacional com dados do SINASC disponíveis no Departamento de Informática do SUS entre 2011 e 2015. As definições de prematuridade, baixo peso e asfixia ao nascer foram aquelas determinadas na literatura. A adequação do peso ao nascer com a idade gestacional foi calculada baseando-se nas curvas de Fenton e Intergrowth-21. Compararam-se as médias de peso pela presença ou não de prematuridade. A estimação da idade gestacional foi realizada pela DUM em 58,5%, e 41,5% utilizaram outro método. Encontrou-se que a proporção de prematuridade foi de 12% no grupo DUM e 8,4% no grupo outro método, já o baixo peso ao nascer foi de 6,5% e 8,4%, respectivamente. A média de peso dos prematuros no grupo DUM foi maior. O uso da DUM como estimador da idade gestacional superestimou a proporção de peso maior ou igual a 2.500g nos prematuros, o que não parece compatível com a distribuição esperada para esta faixa. A DUM favoreceu a "correção" da prematuridade para os parâmetros comparáveis aos de estudos com dados primários, embora as distorções encontradas entre idade gestacional e peso ao nascer possam indicar que ainda existem problemas com este estimador.


Abstract: The prevalence of preterm births has shown a growing trend in many countries, including developed ones. Studies in Brazil have shown that the Information System on Live Births (SINASC, in Portuguese), until 2010, underestimated the prevalence of preterm births, when compared with studies based on primary data. Starting in 2011, gestational age at birth has been calculated in SINASC according to the last menstrual period (LMP), when available. This study sought to evaluate the accuracy of the gestational age assessment using LMP, compared with two other estimates, and correlate it with birth weight. This is a population study with data from SINASC available from Brazilian Health Informatics Department between 2011 and 2015. Definitions of preterm birth, low birth weight and birth asphyxia were taken from the literature. Adequacy of birth weigh to gestational age was calculated based on Fenton and Intergrowth-21 curves. We compared weight means according to the presence or lack of preterm birth. gestational age assessment was based on LMP in 58.5% and 41.5% used another method. We found that the preterm proportion was 12% in the LMP group and 8.4% in the other method group, while low birth weight was 6.5% and 8.4%, respectively. Mean weight of preterm infants was higher in the LMP group. Use of LMP as a gestational age estimator overestimated the proportion of weight equal to or higher than 2,500g among preterm infants, which does not seem compatible with the expected distribution for this group. LMP favored "correction" of prematurity for the parameters that are comparable to those of primary data studies, though the distortions we found between gestational age and birth weigh may indicate that there are still problems with this estimator.


Resumen: La prevalencia de nacimiento pretérmino está presentando una tendencia creciente en varios países, incluso en los desarrollados. Estudios en Brasil reflejan que el Sistema de Información sobre Nacidos Vivos (SINASC), hasta 2010, subestimaba la prevalencia de nacimientos pretérmino, cuando se compara con los estudios basados en datos primarios. A partir de 2011, la edad gestacional al nacer ha sido calculada en el SINASC, cuando se encontraba disponible, mediante la fecha de la última menstruación (DUM). El objetivo fue evaluar la precisión en la determinación de la edad gestacional generada por los DUM, comparándola con la de otros estimadores, y correlacionándola con el peso al nacer. Se trata de un estudio de base poblacional con datos del SINASC, disponibles en el Departamiento de Informática del Sistema Único de Salud entre 2011 y 2015. Las definiciones de prematuridad, bajo peso y asfixia al nacer fueron aquellas determinadas en la literatura. La adecuación del peso al nacer con la edad gestacional se calculó basándose en las curvas de Fenton e Intergrowth-21. Se compararon las medias de peso por la presencia o no de prematuridad. La estimación de la edade gestacional se realizó mediante DUM en un 58,5%, y un 41,5% utilizaron otro método. Se descubrió que la proporción de prematuridad fue de un 12% en el grupo DUM y un 8,4% en el grupo otro método, ya que el bajo peso al nacer fue un 6,5% y 8,4%, respectivamente. La media de peso de los prematuros en el grupo DUM fue mayor. El uso de la DUM, como estimador de la edad gestacional, sobreestimó la proporción de peso mayor o igual a 2.500g en los prematuros, lo que no parece compatible con la distribución esperada para esta franja. La DUM favoreció la "corrección" de la prematuridad en relación con los parámetros comparables a los de estudios con datos primarios, a pesar de que las distorsiones encontradas entre edad gestacional y peso al nacer puedan indicar que todavía existen problemas con este estimador.

10.
Cad Saude Publica ; 36(1): e00057219, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31939547

RESUMO

To assess the adequacy of prenatal care offered in the Brazilian capital cities and the diagnosis of gestational syphilis through public data from health information systems. The modified Kotelchuck index for adequacy of prenatal care was built using Brazilian Information System on Live Births (SINASC) data. Data on gestational syphilis, congenital syphilis, estimated population coverage by the Family Health Strategy (FHS), the Municipal Human Development Index (MHDI) and data from National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) were accessed in public sites. The profile of pregnant women associated with inadequate care was assessed by logistic regression. In total, 685,286 births were analyzed. Only 2.3% of women did not attend prenatal appointments. The mean adequacy was 79.7%. No correlation was found between adequacy of prenatal care and FHS coverage (p = 0.172), but a positive correlation was found with the MHDI (p < 0.001). Inadequacy of prenatal care was associated with age below 20 years old, schooling less than 4 years, non-white skin color and not having a partner. Among the congenital syphilis cases, 17.2% of mothers did not attend prenatal care. Gestational syphilis more often affected vulnerable women, including a higher proportion of adolescents, women with low schooling, and women of non-white color. The PMAQ-AB showed a median availability of 27.3% for syphilis rapid tests, 67.7% for benzathine penicillin, and 86.7% for benzathine penicillin administration by health teams. The use of public data showed a low adequacy of prenatal care in Brazilian capitals, denoting insufficient quality for the diagnosis and treatment of gestational syphilis, despite the availability of supplies. Continuous monitoring can be carried out using public data, indicating to local strategies to eliminate congenital syphilis.

11.
Rev. Bras. Saúde Mater. Infant. (Online) ; 18(4): 711-721, Oct.-Dec. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1013113

RESUMO

Abstract Objectives: this study aimed to describe the epidemiological profile and prevalence of hepatitis B infection in pregnant women living in Rio Branco, Acre, Brazil. Methods: this was a cross-sectional study concerning the prevalence of Hepatitis B in a cohort of women who gave birth in Rio Branco from 2007 to 2015. Data were obtained through health information systems. Pregnant women presenting one or more serological markers or positive molecular biology examination were considered confirmed cases of infections. Infection prevalence, the odds ratio (5% significance) and sociodemographic, clinical, obstetric and neonatal variable frequency distributions were calculated. The student's t-test and Mann Whitney test were applied, as well as the chi-square test or Fisher's exact test, at a significance level of 5%. Results: a total of 62,100 pregnant women were identified for the study period. The prevalence of Hepatitis B in the group was of 0.38% (206 cases), and only 12,5% were diagnosed during the first gestation trimester. A significant difference (p=0.034) in the mean age of infected women was observed when compared to those without infection. The chance of an infected pregnant woman giving birth to a child with a 1st Apgar minute <7 was of 2.01 (CI95%= 1.09-3.71; p=0.995), higher than observed for healthy pregnant woman. Concerning infected patients, the most reported risk exposure was dental treatment (19.2%). Conclusions: the prevalence of Hepatitis B among pregnant women was lower than reported in other national studies. Low Hepatitis B detection during the first gestation trimester was identified, which reinforces the need to intensify early diagnosis during prenatal follow-up, especially due to the severity of the disease and the possibility of vertical transmission.


Resumo Objetivos: descrever o perfil epidemiológico e prevalência da infecção de hepatite B em gestantes residentes em Rio Branco, Acre. Métodos: estudo transversal da prevalência de hepatite B na coorte de mulheres que gestaram em Rio Branco de 2007 a 2015. Os dados foram obtidos através dos sistemas de informação em saúde. Foi considerado caso confirmado de para a infecção a gestante que apresentasse um ou mais marcadores sorológicos ou exame de biologia molecular. Foi calculada a prevalência da infecção, razão de chance (significância de 5%) e distribuição de frequências de variáveis sociodemográficas, clínicas, obstétricas e neonatais. Calculou-se o teste t de Student e Mann Whitney além do teste do qui-quadrado ou exato de Fisher, com significância de 5%. Resultados foram identificadas 62.100 gestantes no período de interesse. A prevalência de hepatite B no grupo foi de 0,38% (206 casos). Destas, apenas 12,5% foram diagnosticadas no 1º trimestre da gestação. Houve diferença significativa (p=0,034) na média de idade das infectadas quando comparadas às sem infecção. A chance de uma gestante infectada ter um filho com Apgar de 1º minuto <7 foi 2,01 (IC95%: 1,09-3,71; p=0,995) vezes maior que uma gestante saudável. Das pacientes infectadas a exposição de risco mais relatada foi o tratamento dentário (19,2%). Conclusões: a prevalência de hepatite B entre gestantes foi inferior à encontrada em outros estudos nacionais. Foi identificada uma baixa detecção de hepatite B no primeiro trimestre gestacional, o que reforça a necessidade de intensificar o diagnóstico precoce durante o seguimento de pré-natal, especialmente pela gravidade da doença e possibilidade da ocorrência de transmissão vertical.


Assuntos
Humanos , Feminino , Gravidez , Perfil de Saúde , Gestantes , Estudos Populacionais em Saúde Pública , Hepatite B/epidemiologia , Primeiro Trimestre da Gravidez , Diagnóstico Pré-Natal , Brasil , Biomarcadores , Distribuição de Qui-Quadrado , Estatísticas não Paramétricas , Transmissão Vertical de Doença Infecciosa , Notificação de Doenças , Detecção Precoce de Câncer
12.
Cad Saude Publica ; 34(11): e00038218, 2018 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-30427409

RESUMO

Recent data from the municipality of Rio de Janeiro, Brazil, shows a sharp drop in the number of reported occurrences of Zika during the summer of 2016/2017, compared to the previous summer. There is still a much higher incidence among women than men, almost certainly due to sexual transmission. An unexpected feature of the new data is that there are proportionally far more cases affecting children under 15 months than older age classes. By comparing incidence rates in 2016/2017 and 2015/2016, we were able to deduce the proportion of reported cases affecting men and women, and verify that gender disparity is still present. Women and children are still risk groups for Zika infection, even during non-epidemic seasons.


Assuntos
Doenças Virais Sexualmente Transmissíveis/epidemiologia , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/transmissão , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Criança , Pré-Escolar , Surtos de Doenças , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Fatores Sexuais , Doenças Virais Sexualmente Transmissíveis/transmissão , Doenças Virais Sexualmente Transmissíveis/virologia , Adulto Jovem , Zika virus/isolamento & purificação , Infecção por Zika virus/virologia
14.
PLoS One ; 13(11): e0207859, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30462733

RESUMO

OBJECTIVES: To estimate the burden of tuberculosis (TB) in reported AIDS cases, to compare the characteristics of TB/HIV subjects with those without TB and to evaluate survival with or without TB in Brazil. METHODS: The data source was the linked database between AIDS (2011-2014) and TB (2011-2014) databases from the Notifiable Diseases Information System (SINAN). The sociodemographic, clinical, laboratory results and use of antiretroviral therapy (ART) data were compared by TB occurrence or not. Survival probability was estimated using the Kaplan-Meier method and associated factors were sought using Cox regression. RESULTS: The proportion of TB diagnosed from 2011 to 2014 among AIDS cases reported between 2006 and 2014 was 6.3%. Subjects coinfected with TB were predominantly male, older, with lower schooling, with lower CD4 count, higher viral load, and higher proportion of ART initiation than those without TB. 57.5% were diagnosed with HIV before TB, 38.2% as concurrent TB/HIV and 4.3% with TB before HIV. 16,466 reported TB cases were not found in the AIDS database, although registered as HIV-infected in the SINAN TB database between 2011 and 2014. Median survival for PLHIV was 581 days, with 582 for those without TB, significantly higher than 547 for those with TB (log-rank teste, p = 0,001). In the Cox multivariate analysis, male gender [aHR = 1.27 (CI 95% 1.22-1.33)], older age [aHR = 1.020 (CI 95% 1.019-1.022)] and TB coinfection [aHR = 1.97 (CI 95% 1.88-2.07)] were positively associated with adjusted hazard of death, whereas CD4 count 200-499 cells [aHR = 0.21 (CI 95% 0.20-0.22)] and receiving ART [aHR = 0.2 2(CI 95% 0.21-0.23)] reduced the risk of death. CONCLUSIONS: HIV-infected subjects should be screened for TB at care entry, to minimize diagnosis and treatment delays when active TB is present or to increase the odds of being offered latent TB infection therapy to prevent TB. On the other hand, TB cases should be promptly tested for HIV. All those will contribute to reduce mortality among people living with AIDS.


Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Bases de Dados Factuais , Tuberculose/complicações , Tuberculose/epidemiologia , Adulto , Brasil/epidemiologia , Feminino , Humanos , Masculino , Análise de Sobrevida
15.
Artigo em Inglês | PAHO-IRIS | ID: phr-49455

RESUMO

[ABSTRACT]. Objective. To identify individual- and health services–related factors associated with deaths in subjects diagnosed with tuberculosis (TB). Methods. A nonconcurrent cohort study with passive follow-up was conducted using a probabilistic linkage method to analyze a sample of patients diagnosed and reported as having TB in 2006 and followed up until 2008. New cases, cases with previous treatment (readmission after loss to follow-up or relapse), and transfers across health services were included. Proportional hazards models were used to estimate the independent effect of covariates related to the individual and to the health services on mortality from all causes. Results. Age above 60 years, admission to a hospital with emergency services, HIV-associated TB, and readmission to an outpatient facility after disease relapse or loss to follow-up were identified as risk factors for death. Variables related to process and results indicators of Brazil’s National TB Program were not associated with mortality from all causes. Conclusions. Advanced age, previous treatment for TB, and treatment at a secondary-level outpatient facility or a hospital with emergency services on site were associated with mortality in TB patients. Better strategies to improve TB care delivered at health units are needed to prevent death from TB, especially among the elderly.


[RESUMEN]. Objetivo. Identificar los factores individuales y los factores relacionados con los servicios de salud asociados con la muerte de personas con diagnóstico de tuberculosis. Métodos. Se realizó un estudio de cohortes no concurrentes con seguimiento pasivo, con un método de nexo probabilístico, para analizar una muestra de pacientes a quienes se les diagnosticó tuberculosis y se notificaron sus casos en el 2006, y se les dio seguimiento hasta el 2008. Se incluyeron casos nuevos, casos con tratamiento anterior (reingreso después de haber abandonado el seguimiento o por recaída) y transferencias entre distintos servicios de salud. Se usaron modelos de riesgos proporcionales para calcular el efecto independiente de las covariables relacionadas con los individuos y con los servicios de salud en la mortalidad por todas las causas. Resultados. Se determinó que los factores de riesgo de muerte son: edad mayor de 60 años, ingreso a un hospital con servicios de urgencia, tuberculosis asociada con la infección por el VIH y reingreso a un establecimiento de atención ambulatoria después de la recaída de la enfermedad o de abandonar el seguimiento. Las variables relacionadas con los procesos y los indicadores de resultados del Programa Nacional contra la Tuberculosis de Brasil no se asociaron con la mortalidad por todas las causas. Conclusiones. La edad avanzada, el antecedente de tratamiento antituberculoso y el tratamiento en un establecimiento ambulatorio de nivel secundario o un hospital con servicios integrados de urgencia se asociaron con la mortalidad de los pacientes con tuberculosis. Se necesitan mejores estrategias para optimizar los servicios de atención de la tuberculosis que prestan las unidades de salud a fin de evitar la muerte por esta enfermedad, especialmente en las personas de mayor edad.


[RESUMO]. Objetivo. Identificar fatores individuais e relacionados aos serviços de saúde asociados com mortalidade em indivíduos com diagnóstico de tuberculose (TB). Métodos. Estudo longitudinal não concorrente de seguimento passivo por método de linkage probabilístico, realizado em uma amostra de pacientes diagnosticados e notificados com TB em 2006 e seguidos até 2008. Casos novos, com histórico de tratamento anterior (readmitidos após perda de seguimento ou recorrência) ou transmitidos entre diferentes serviços de saúde foram incluídos. Modelos de riscos proporcionais foram utilizados para estimar o efeito independente de covariáveis do individuo e do serviço de saúde na mortalidade por todas as causas. Resultados. Idade maior de 60 anos, admissão em hospital com serviço de emergência, coinfecção HIV/TB e reingresso a um serviço ambulatorial após recorrência da TB ou perda de seguimento foram identificados como fatores de risco para a morte. Variáveis de processo e indicadores de resultados do Programa Nacional de Controle da Tuberculose não guardaram relação com a mortalidade por todas as causas. Conclusões. Idade avançada, tratamento prévio da TB e tratamento em unidade ambulatorial de nível secundário ou em hospital com serviço de emergência no local apresentaram associação com mortalidade em pacientes com TB. São necessárias estratégias melhores para aprimorar a atenção à TB ofertada nas unidades de saúde, principalmente para idosos.


Assuntos
Registro Médico Coordenado , Mortalidade , Análise de Sobrevida , Tuberculose , Serviços de Saúde , Brasil , Registro Médico Coordenado , Mortalidade , Análise de Sobrevida , Serviços de Saúde , Registro Médico Coordenado , Mortalidade , Análise de Sobrevida , Brasil , Tuberculose , Serviços de Saúde
16.
Rev Soc Bras Med Trop ; 51(3): 347-351, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29972566

RESUMO

INTRODUCTION: Dengue has affected Rio de Janeiro City since the 1980s. The sequential Zika and chikungunya virus introductions during 2015 aggravated the health scenario, with 97,241 cases of arboviral diseases reported in 2015-2016, some with neurological disorders. METHODS: Arbovirus-related neurologic cases were descriptively analyzed, including neurological syndromes and laboratory results. RESULTS: In total, 112 cases with non-congenital neurologic manifestations (Guillain-Barré syndrome, 64.3%; meningoencephalitis, 24.1%; acute demyelinating encephalomyelitis, 8%) were arbovirus-related; 43.7% were laboratory-confirmed, of which 57.1% were chikungunya-positive. CONCLUSIONS: Emerging arbovirus infections brought opportunities to study atypical, severe manifestations. Surveillance responses optimized case identification and better clinical approaches.


Assuntos
Febre de Chikungunya/complicações , Dengue/complicações , Doenças do Sistema Nervoso/virologia , Infecção por Zika virus/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Febre de Chikungunya/epidemiologia , Criança , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/virologia , Dengue/epidemiologia , Notificação de Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Adulto Jovem , Infecção por Zika virus/epidemiologia
18.
Rev. Soc. Bras. Med. Trop ; 51(3): 347-351, Apr.-June 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1041465

RESUMO

Abstract INTRODUCTION Dengue has affected Rio de Janeiro City since the 1980s. The sequential Zika and chikungunya virus introductions during 2015 aggravated the health scenario, with 97,241 cases of arboviral diseases reported in 2015-2016, some with neurological disorders. METHODS Arbovirus-related neurologic cases were descriptively analyzed, including neurological syndromes and laboratory results. RESULTS In total, 112 cases with non-congenital neurologic manifestations (Guillain-Barré syndrome, 64.3%; meningoencephalitis, 24.1%; acute demyelinating encephalomyelitis, 8%) were arbovirus-related; 43.7% were laboratory-confirmed, of which 57.1% were chikungunya-positive. CONCLUSIONS Emerging arbovirus infections brought opportunities to study atypical, severe manifestations. Surveillance responses optimized case identification and better clinical approaches.

19.
Rev Saude Publica ; 52: 43, 2018.
Artigo em Português, Inglês | MEDLINE | ID: mdl-29668812

RESUMO

OBJECTIVE: To estimate the coverage of the reporting of cases of HIV-infected pregnant women, to estimate the increase in the coverage of the reporting with the routine search of data in other Brazilian health information systems, and to identify missed opportunities for identification of HIV-infected pregnant women in Brazilian maternity hospitals. METHODS: This is a descriptive study on the linkage of Brazilian databases with primary data from the "Nascer no Brasil" study and secondary database collection from national health information systems. The "Nascer no Brasil" is a national-based study carried out in 2011-2012 with 23,894 pregnant women, which identified HIV-infected pregnant women using prenatal and medical records. We searched for cases of HIV-infected pregnant women identified in the "Nascer no Brasil" study in the Information System of Notifiable Diseases, the Control System for Laboratory Tests of the National CD4+/CD8+ Lymphocyte Count and HIV Viral Load Network, and the Logistics Control System for Medications. We used the OpenRecLink software for the linkage of databases. We estimated the notification coverage, with the respective confidence interval, of the evaluated Brazilian health information systems. RESULTS: We estimated the coverage of the reporting of HIV-infected pregnant women in the Information System of Notifiable Diseases as 57.1% (95%CI 42.9-70.2), and we located 89.3% of the HIV-infected pregnant women (95%CI 81.2-94.2) in some of the Brazilian health information systems researched. The search in other national health information systems would result in an increase of 57.1% of the reported cases. We identified no missed opportunities for the diagnosis of HIV+ in pregnant women in the maternity hospitals evaluated by the "Nascer no Brasil" study. CONCLUSIONS: The routine search for information in other Brazilian health information systems, a procedure carried out by the Ministry of Health for cases of AIDS in adults and children, should be adopted for cases of HIV in pregnancy.


Assuntos
Notificação de Doenças/estatística & dados numéricos , Infecções por HIV/epidemiologia , Sistemas de Informação em Saúde , Complicações Infecciosas na Gravidez/epidemiologia , Gestantes , Brasil/epidemiologia , Criança , Notificação de Doenças/normas , Feminino , Humanos , Gravidez , Cuidado Pré-Natal , Adulto Jovem
20.
PLoS One ; 13(2): e0192985, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29438439

RESUMO

AIMS: to estimate the mother to child transmission (MTCT) of HIV among infected pregnant women identified in the "Birth in Brazil" study and to evaluate care practices provided in order to identify missed opportunities at preventing the MTCT of HIV infection in the country. METHODS: Descriptive study using data obtained from the consultation of different databases: the "Birth in Brazil" study database and the Brazilian National Information Systems (NIS) databases. We used cases of pregnant women infected with HIV identified in the "Birth in Brazil" study, and cases of AIDS in children under 5 years old identified in the NIS, to estimate the MTCT of HIV infection in the country, with a 95% confidence interval. We also estimated the HIV cascade (HIV diagnosis; use of antiretroviral treatment (ART) during pregnancy, labour, and for the newborn; adequate care during childbirth considering viral load at birth; and no breastfeeding) using data from the same sources. RESULTS: MTCT of HIV of 2.0% (95% CI 0.3%-13.8%). At birth, 84.0% of HIV infected woman showed a positive HIV diagnosis, 74.9% received combined ART during pregnancy, 80.7% received ART during childbirth, 77.1% received adequate care during childbirth, 86.8% of newborns received ART within the first 24 hours after birth, and 2.8% of newborns were breastfed. Considering all steps, 61.3% of the women (95% CI 48.3%-72.8%) received all available medical interventions. In the analysis restricted to women identified in the NIS, 65.3% (95% CI 48.0%-79.3%) of HIV infected women received all available medical interventions. CONCLUSION: Brazil has healthcare policies that guarantee free access to tests, ART and substitutes for maternal milk. However, missed opportunities to prevent MTCT of HIV were identified in at least one-third of women and may be making it difficult to reach HIV-elimination targets especially in the less developed country regions.


Assuntos
Infecções por HIV/transmissão , Transmissão Vertical de Doença Infecciosa , Complicações Infecciosas na Gravidez , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Brasil , Aleitamento Materno , Pré-Escolar , Feminino , Infecções por HIV/complicações , Infecções por HIV/prevenção & controle , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Masculino , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Carga Viral , Adulto Jovem , Zidovudina/uso terapêutico
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