RESUMEN
O Sistema Único de Saúde (SUS) abrange todos os níveis de atenção à saúde e garante acesso integral, universal e gratuito para toda a população brasileira. As transições demográfica e epidemiológica observadas nas últimas décadas trouxeram um cenário de maior prevalência das doenças imunoalérgicas. Nesse contexto, a implementação de políticas de saúde voltadas à assistência à saúde dessa população tornou-se um desafio. Com o objetivo de discutir a atenção à saúde dos pacientes com doenças alérgicas e imunológicas no Brasil, a Associação Brasileira de Alergia e Imunologia (ASBAI) realizou em 26 de agosto de 2022, na cidade de São Paulo, o Fórum sobre a Assistência a Pacientes com Doenças Imunoalérgicas no SUS. O evento foi estruturado no formato de painéis e contou com a participação de membros da ASBAI e representantes da gestão pública federal, do Ministério Público, de sociedade de pacientes e profissionais de saúde de diversos serviços com experiência em programas e projetos bem sucedidos na assistência a pacientes com doenças imunoalérgicas. Após a discussão, concluiu-se que ainda existem muitas necessidades não atendidas em relação à atenção à saúde da população com doenças alérgicas e imunológicas no Brasil. A ASBAI tem trabalhado no sentido de contribuir para organizar, implantar e manter a assistência a estes pacientes no âmbito do SUS.
The Brazilian Unified Health System covers all levels of health care and guarantees full, universal and free access for the entire population. The demographic and epidemiological transitions observed in recent decades have led to a higher prevalence of allergic diseases. In this context, implementing health policies to benefit these patients has become a challenge. To discuss health care for patients with allergic and immunological diseases in Brazil, the Brazilian Association of Allergy and Immunology (ASBAI) held a forum in São Paulo on August 26, 2022 called "Treating Patients with Allergic Diseases in the Unified Health System". The event's panels included members of ASBAI, representatives of the federal government, the attorney general's office, patients, and health professionals from various services with experience in successful programs for patients with allergic diseases. It was concluded that there are still many unmet health care needs for Brazilians with allergic and immunological diseases. ASBAI is contributing to the organization, implementation, and maintenance of care for these patients within the scope of the Unified Health System.
Asunto(s)
Humanos , Sociedades MédicasRESUMEN
Introdução: É necessário conhecer a situação de alergistas/ imunologistas nos diferentes cenários de atuação, identificando perfis e eventuais dificuldades. O conhecimento destes dados poderá servir de subsídio para fomentar a implementação de políticas que garantam a integralidade na atenção à saúde do paciente com doenças alérgicas e erros inatos da imunidade (EII). Objetivo: Verificar o perfil dos especialistas em Alergia e Imunologia no Brasil, em relação ao local de atuação, acesso a exames, terapias e o impacto da pandemia COVID-19 sobre o seu exercício profissional. Métodos: Estudo descritivo-exploratório, com dados coletados por inquérito on-line, utilizando-se a ferramenta Google Forms. Todos os associados adimplentes da ASBAI foram convidados a participar. O questionário abordou aspectos sociodemográficos e profissionais. As informações foram analisadas no programa SPSS versão 20.0. Resultados: Quatrocentos e sessenta associados responderam ao questionário. Observou-se predomínio de mulheres (73%), com mediana de idade de 47 anos. A maioria dos participantes atua no setor privado (95%), e 47% no setor público. Aproximadamente 80% dos que atendem no setor público referiram ter acesso a algum exame diagnóstico para doenças alérgicas e EII. Apenas 35% dos especialistas do sistema público têm acesso a imunoterapia alérgeno específica, contra 96% dos que atuam no setor privado. Já aos medicamentos imunobiológicos, 53% e 72% dos especialistas que atuam no serviço público e privado, respectivamente, referiram acesso. Mais de 60% dos associados participantes da pesquisa tiveram redução no número de consultas em pelo menos 50%, e 56% tem realizado atendimento por teleconsulta durante a pandemia de COVID-19. Conclusão: Os associados da ASBAI têm incorporado na sua prática clínica os avanços na terapia das doenças imunoalérgicas, mas vários métodos diagnósticos ainda são pouco acessíveis. A presença do especialista em Alergia e Imunologia no SUS, também precisa ser ampliada. A pandemia do coronavírus trouxe a discussão da telemedicina como um método de atendimento clínico em nossa especialidade.
Introduction: It is necessary to know the situation of allergists/ immunologists in different scenarios of action, identifying profiles and possible difficulties. The knowledge of these data can serve as a subsidy to promote the implementation of policies that ensure comprehensive health care for patients with allergic diseases and inborn errors of immunity (IEI). Objective: To verify the profile of specialists in Allergy and Immunology in Brazil, concerning the place of work, access to tests, therapies, and the impact of the pandemic on their professional practice. Methods: Descriptive-exploratory study, with data collected through an online survey, using the Google Forms tool. All compliant ASBAI members were invited to participate. The questionnaire addressed sociodemographic and professional aspects. The information was analyzed using SPSS version 20.0. Results: Four hundred and sixty associates answered the questionnaire. Women were predominant (73%), and the median age was 47 years. Most participants work in the private sector (95%) and 47% in the public sector. Approximately 80% of those who work in the public sector reported having access to some diagnostic tests for allergic diseases and IEI. Only 35% of specialists in the public system have access to specific allergen immunotherapy, against 96% of those working in the private sector. As for immunobiological drugs, 53% and 72% of specialists working in the public and private service, respectively, reported access. More than 60% of the members participating in the survey had a reduction in the number of consultations by at least 50% and 56% have been assisted by teleconsultation during the Covid19 pandemic. Conclusion: ASBAI associates have incorporated advances in the therapy of immune allergic diseases into their clinical practice, but several diagnostic methods are still inaccessible. The presence of specialists in Allergy and Immunology in the Unified Health System (Sistema Único de Saúde - SUS) also needs to be expanded. The coronavirus pandemic brought the discussion of telemedicine as a method of clinical care practice in our specialty.
Asunto(s)
Humanos , Historia del Siglo XXI , Brasil , Atención Integral de Salud , Alergia e Inmunología , Alergólogos , COVID-19 , Pacientes , Derivación y Consulta , Sociedades Médicas , Terapéutica , Sistema Único de Salud , Preparaciones Farmacéuticas , Encuestas y Cuestionarios , Telemedicina , Sector Público , Sector Privado , Consulta Remota , Pruebas Diagnósticas de Rutina , Necesidades y Demandas de Servicios de Salud , Hipersensibilidad , Inmunidad , InmunoterapiaRESUMEN
INTRODUCTION: This epidemiological household survey aimed to estimate the prevalence of the current and past SARS-CoV-2 infections in Ribeirão Preto, a municipality of southeast Brazil. METHODS: The survey was conducted in two phases using a clustered sampling scheme. The first phase spanned May 1-3 and involved 709 participants. The second phase spanned June 11-14, 2020, and involved 646 participants. RESULTS: During the first phase, RT-PCR performed on nasopharyngeal swabs was positive at 0.14%. The serological tests were positive in 1.27% of the patients during the first phase and 2.79% during the second phase. People living in households with more than five members had a prevalence of 10.83% (95%CI: 1.58-74.27) higher than those living alone or with someone other. Considering the proportion of the positive serological test results with sex and age adjustments, approximately 2.37% (95%CI: 1.32-3.42) of the population had been cumulatively infected by mid-June 2020, which is equivalent to 16,670 people (95%CI: 9,267-24,074). Considering that 68 deaths from the disease in the residents of the city had been confirmed as at the date of the second phase of the survey, the infection fatality rate was estimated to be 0.41% (95%CI: 0.28-0.73). Our results suggest that approximately 88% of the cases of SARS-CoV-2 infection at the time of the survey were not reported to the local epidemiological surveillance service. CONCLUSIONS: The findings of this study provide in-depth knowledge of the COVID-19 pandemic in Brazil and are helpful for the preventive and decision-making policies of public managers.
Asunto(s)
COVID-19 , SARS-CoV-2 , Brasil/epidemiología , Humanos , Pandemias , PrevalenciaRESUMEN
Objective To describe the clinical features and to identify factors associated with significant severe asthma in samples of patients followed in a reference center in Salvador. Methods A cross-sectional study of 473 adults, regularly followed in the "Asthma Control Program" in Bahia (Programa de Controle da Asma e da Rinite Alérgica na Bahia (ProAR)), reassessed systematically between 2013 and 2015. The patients were admitted for meeting previous criteria of severe asthma and were reclassified according to the most current definition proposed by a joint document of the "European Respiratory Society/American Thoracic Society" (ERS/ATS) (ERS/ATS 2014). Results Only 88/473 (18%) were reclassified as having severe asthma by ERS/ATS criteria (SA-ERS/ATS). Among these patients, 87% were women, 48% obese, with a median Body Mass Index (BMI) of 29 kg·m2 (IQ 26-34), furthermore, 99% had symptoms of chronic rhinitis and 83% had symptoms of Gastroesophageal Reflux Disease (GERD). None of the 88 patients claimed to be current smokers. The most frequently corticosteroids were beclomethasone dipropionate (BDP) (88%) and budesonide (BUD) (69%). The majority of the evaluations reported adequate adherence (77%), however, the minority (0,6%) detected serious errors in inhalation techniques. The median Forced Expiratory Volume (FEV1) associated with post-bronchodilator test (post-BD) was 67% predicted (IQ 55-80). The median number of eosinophils in the peripheral blood was lower in patients with SA-ERS/ATS (258 cells/mm3 (IQ 116-321) than in the other patients studied [258 cells/mm3 (IQ 154-403)]. Gastroesophageal reflux symptoms were associated with a higher severity [OR = 2.2 95% CI (1.2-4.2)]. Conclusion In this group of patients, symptoms of GERD were associated with SA-ERS/ATS and eosinophil count > 260 cells/mm3 were associated 42% with less chance SA-ERS/ATS.
Asunto(s)
Asma/diagnóstico , Adulto , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Asma/epidemiología , Beclometasona/uso terapéutico , Brasil/epidemiología , Broncodilatadores/uso terapéutico , Budesonida/uso terapéutico , Estudios Transversales , Femenino , Volumen Espiratorio Forzado , Reflujo Gastroesofágico/epidemiología , Humanos , Masculino , Obesidad/epidemiología , Rinitis/epidemiologíaRESUMEN
OBJECTIVE: To estimate the frequency of secondhand smoke exposure among patients with asthma. METHODS: A cross-sectional study of asthma patients and non-asthmatic controls using questionnaires to identify secondhand smoke exposure at home, school, work, and public places. RESULTS: We studied 544 severe asthma patients, 452 mild/moderate asthma patients, and 454 non-asthmatic patients. Among severe patients, the mean age was 51.9 years, 444 (81.6%) were female, 74 (13.6%) were living with a smoker, 383 (71.9%) reported exposure in public spaces and, of the 242 (44.5%) who worked/ studied, 46 (19.1%) reported occupational exposure. Among those with mild/moderate asthma, the mean age was 36.8 years, 351 (77.7%) were female, 50 (11.1%) reported living with a smoker, 381 (84.9%) reported exposure in public settings and, of the 330 (73.0%) who worked/ studied, 58 (17.7%) reported occupational exposure. An association between secondhand smoke exposure and disease control was found among patients with mild/moderate asthma. Among those interviewed, 71% of severe asthma patients and 63% of mild/moderate asthma patients avoided certain places due to fear of secondhand smoke exposure. CONCLUSION: Secondhand smoke exposure is a situation frequently reported by a significant proportion of asthma patients. Individuals with asthma are exposed to this agent, which can hamper disease control, exacerbate symptoms and pose unacceptable limitations to their right to come and go in public settings.
Asunto(s)
Asma/epidemiología , Contaminación por Humo de Tabaco/estadística & datos numéricos , Adulto , Anciano , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Exposición por Inhalación , Masculino , Persona de Mediana Edad , Prevalencia , Calidad de Vida , Factores de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Factores de Tiempo , Adulto JovenRESUMEN
ABSTRACT Objective To estimate the frequency of secondhand smoke exposure among patients with asthma. Methods A cross-sectional study of asthma patients and non-asthmatic controls using questionnaires to identify secondhand smoke exposure at home, school, work, and public places. Results We studied 544 severe asthma patients, 452 mild/moderate asthma patients, and 454 non-asthmatic patients. Among severe patients, the mean age was 51.9 years, 444 (81.6%) were female, 74 (13.6%) were living with a smoker, 383 (71.9%) reported exposure in public spaces and, of the 242 (44.5%) who worked/ studied, 46 (19.1%) reported occupational exposure. Among those with mild/moderate asthma, the mean age was 36.8 years, 351 (77.7%) were female, 50 (11.1%) reported living with a smoker, 381 (84.9%) reported exposure in public settings and, of the 330 (73.0%) who worked/ studied, 58 (17.7%) reported occupational exposure. An association between secondhand smoke exposure and disease control was found among patients with mild/moderate asthma. Among those interviewed, 71% of severe asthma patients and 63% of mild/moderate asthma patients avoided certain places due to fear of secondhand smoke exposure. Conclusion Secondhand smoke exposure is a situation frequently reported by a significant proportion of asthma patients. Individuals with asthma are exposed to this agent, which can hamper disease control, exacerbate symptoms and pose unacceptable limitations to their right to come and go in public settings.
RESUMO Objetivo Estimar a frequência de exposição à fumaça secundária do cigarro entre pacientes com asma. Métodos Estudo transversal, que avaliou pacientes com asma e controles sem asma, por meio de questionários, para identificar a exposição secundária à fumaça do cigarro no ambiente domiciliar, escolar, no trabalho e em ambientes públicos. Resultados Estudamos 544 asmáticos graves, 452 com asma leve/moderada e 454 sem asma. Entre os asmáticos graves, a média de idade foi de 51,9 anos, 444 (81,6%) eram do sexo feminino, 74 (13,6%) tinham fumantes em sua residência, 383 (71,9%) relataram exposição em ambientes públicos e, dos 242 (44,5%) que trabalhavam e/ou estudavam, 46 (19,1%) admitiram exposição ocupacional. Entre asmáticos leves/moderados, a média de idade foi de 36,8 anos, 351 (77,7%) eram do sexo feminino, 50 (11,1%) afirmaram haver tabagistas em sua residência, 381(84,9%) relataram exposição em ambientes públicos e, dos 330 (73,0%) que trabalhavam e/ou estudavam, 58 (17,7%) referiram exposição ocupacional. Encontrou-se associação entre exposição à fumaça secundária do cigarro e controle da doença entre pacientes com asma leve/moderada. Entre os entrevistados, 71% dos pacientes asmáticos graves e 63% daqueles com asma leve/moderada relataram evitar frequentar certos ambientes pelo receio da exposição à fumaça secundária do cigarro − relato mais associado aos pacientes com asma grave. Conclusão A exposição secundária à fumaça do cigarro é uma situação frequente e relatada por uma proporção significativa de asmáticos. Indivíduos com asma encontram-se expostos a este agente, que pode dificultar o controle da doença, exacerbar sintomas e lhes impor limitação inaceitável ao direito de ir e vir em ambientes públicos.
Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Asma/epidemiología , Contaminación por Humo de Tabaco/estadística & datos numéricos , Calidad de Vida , Factores de Tiempo , Índice de Severidad de la Enfermedad , Brasil/epidemiología , Prevalencia , Estudios Transversales , Encuestas y Cuestionarios , Factores de Riesgo , Exposición por Inhalación , Persona de Mediana EdadRESUMEN
RESUMO Objetivo Descrever características clínicas e identificar fatores associados a maior gravidade da asma, em uma amostra de pacientes acompanhados em um centro de referência em Salvador. Métodos Estudo transversal de 473 adultos, acompanhados regularmente no Programa para Controle da Asma na Bahia (ProAR), reavaliados de forma sistemática entre 2013 e 2015. Os pacientes foram admitidos por preencher critérios anteriores de asma grave e reclassificados de acordo com a definição mais atual, proposta por um documento conjunto da European Respiratory Society/American Thoracic Society (ERS/ATS 2014). Resultados Foram reclassificados como portadores de asma grave pelos critérios da ATS/ERS (AG-ERS/ATS) 88/473 (18%). Destes, 87% eram mulheres, 48% obesos, com mediana do índice de massa corporal (IMC) de 29 kg/m2 (IQ 26-34), 99% tinham sintomas de rinite crônica e 83%, sintomas de doença do refluxo gastroesofágico (DRGE). Nenhum se declarou fumante atual. Os principais corticosteroides inalatórios utilizados foram beclometasona (88%) e budesonida (69%). A maioria relatou adequada adesão (77%) e a minoria das avaliações (0,6%) revelou erros graves na técnica inalatória. A mediana do volume expiratório forçado no primeiro segundo pós-broncodilatador (VEF1pós-BD) foi 67% do predito (IQ 55-80). A mediana do número de eosinófilos no sangue periférico foi menor nos pacientes com AG-ERS/ATS [209 células/mm3 (IQ 116-321)] do que nos demais pacientes estudados [258 células/mm3 (IQ 154-403)]. Sintomas de doença do refluxo gastroesofágico (DRGE) foram associados a mais gravidade [OR = 2,2; IC95% (1,2-4,2)]. Conclusões Neste grupo de pacientes, sintomas de RGE foram associados a AG-ERS/ATS e contagem de eosinófilos > 260 células/mm3 esteve associada a 42% menos chance de AG-ERS/ATS.
ABSTRACT Objective To describe the clinical features and to identify factors associated with significant severe asthma in samples of patients followed in a reference center in Salvador. Methods A cross-sectional study of 473 adults, regularly followed in the "Asthma Control Program" in Bahia (Programa de Controle da Asma e da Rinite Alérgica na Bahia (ProAR)), reassessed systematically between 2013 and 2015. The patients were admitted for meeting previous criteria of severe asthma and were reclassified according to the most current definition proposed by a joint document of the "European Respiratory Society/American Thoracic Society" (ERS/ATS) (ERS/ATS 2014). Results Only 88/473 (18%) were reclassified as having severe asthma by ERS/ATS criteria (SA-ERS/ATS). Among these patients, 87% were women, 48% obese, with a median Body Mass Index (BMI) of 29 kg·m2 (IQ 26-34), furthermore, 99% had symptoms of chronic rhinitis and 83% had symptoms of Gastroesophageal Reflux Disease (GERD). None of the 88 patients claimed to be current smokers. The most frequently corticosteroids were beclomethasone dipropionate (BDP) (88%) and budesonide (BUD) (69%). The majority of the evaluations reported adequate adherence (77%), however, the minority (0,6%) detected serious errors in inhalation techniques. The median Forced Expiratory Volume (FEV1) associated with post-bronchodilator test (post-BD) was 67% predicted (IQ 55-80). The median number of eosinophils in the peripheral blood was lower in patients with SA-ERS/ATS (258 cells/mm3 (IQ 116-321) than in the other patients studied [258 cells/mm3 (IQ 154-403)]. Gastroesophageal reflux symptoms were associated with a higher severity [OR = 2.2 95% CI (1.2-4.2)]. Conclusion In this group of patients, symptoms of GERD were associated with SA-ERS/ATS and eosinophil count > 260 cells/mm3 were associated 42% with less chance SA-ERS/ATS
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Asma/diagnóstico , Asma/tratamiento farmacológico , Asma/epidemiología , Brasil/epidemiología , Broncodilatadores/uso terapéutico , Beclometasona/uso terapéutico , Reflujo Gastroesofágico/epidemiología , Rinitis/epidemiología , Volumen Espiratorio Forzado , Estudios Transversales , Antiasmáticos/uso terapéutico , Budesonida/uso terapéutico , Obesidad/epidemiologíaRESUMEN
ABSTRACT Objective: To determine the frequency of active smoking among patients with asthma and individuals without asthma by self-report and urinary cotinine measurement. Methods: This was a cross-sectional study conducted in the city of Salvador, Brazil, and involving 1,341 individuals: 498 patients with severe asthma, 417 patients with mild-to-moderate asthma, and 426 individuals without asthma. Smoking status was determined by self-report (with the use of standardized questionnaires) and urinary cotinine measurement. The study variables were compared with the chi-square test and the Kruskal-Wallis test. Results: Of the sample as a whole, 55 (4.1%) reported being current smokers. Of those, 5 had severe asthma, 17 had mild-to-moderate asthma, and 33 had no asthma diagnosis. Of the 55 smokers, 32 (58.2%) were daily smokers and 23 (41.8%) were occasional smokers. Urinary cotinine levels were found to be high in self-reported nonsmokers and former smokers, especially among severe asthma patients, a finding that suggests patient nondisclosure of smoking status. Among smokers, a longer smoking history was found in patients with severe asthma when compared with those with mild-to-moderate asthma. In addition, the proportion of former smokers was higher among patients with severe asthma than among those with mild-to-moderate asthma. Conclusions: Former smoking is associated with severe asthma. Current smoking is observed in patients with severe asthma, and patient nondisclosure of smoking status occurs in some cases. Patients with severe asthma should be thoroughly screened for smoking, and findings should be complemented by objective testing.
RESUMO Objetivo: Descrever a frequência de tabagismo ativo entre pacientes com asma e indivíduos sem asma, usando questionários padronizados e dosagem da cotinina urinária. Métodos: Estudo transversal realizado em Salvador (BA), com 1.341 indivíduos, sendo 498 com asma grave, 417 com asma leve/moderada e 426 sem asma. O tabagismo foi identificado por meio de autorrelato utilizando questionários e por mensuração da cotinina urinária. Para a comparação das variáveis estudadas, utilizaram-se os testes do qui-quadrado e de Kruskal-Wallis. Resultados: Dos 55 participantes (4,1%) que se declararam tabagistas atuais, 5, 17 e 33 eram dos grupos asma grave, asma leve/moderada e sem asma, respectivamente. Desses 55, 32 (58,2%) eram tabagistas diários e 23 (41,8%) eram tabagistas ocasionais. Observaram-se níveis elevados de cotinina urinária entre não fumantes autodeclarados e tabagistas pregressos, especialmente no grupo asma grave, o que sugere omissão do hábito atual de fumar. A carga tabágica entre os fumantes e a proporção de ex-tabagistas foram maiores no grupo asma grave do que no grupo asma leve/moderada. Conclusões: O tabagismo pregresso esteve associado à asma grave. Tabagismo atual também foi observado em alguns pacientes com asma grave e detectou-se omissão em alguns casos. A investigação de tabagismo deve ser meticulosa em pacientes com asma grave e a entrevista desses deve ser complementada por uma avaliação objetiva.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Asma/epidemiología , Fumar/orina , Cotinina/orina , Autoinforme , Factores Socioeconómicos , Índice de Severidad de la Enfermedad , Brasil/epidemiología , Biomarcadores/orina , Fumar/epidemiología , Estudios Transversales , Encuestas y Cuestionarios , Fumadores/estadística & datos numéricosRESUMEN
OBJECTIVE: To determine the frequency of active smoking among patients with asthma and individuals without asthma by self-report and urinary cotinine measurement. METHODS: This was a cross-sectional study conducted in the city of Salvador, Brazil, and involving 1,341 individuals: 498 patients with severe asthma, 417 patients with mild-to-moderate asthma, and 426 individuals without asthma. Smoking status was determined by self-report (with the use of standardized questionnaires) and urinary cotinine measurement. The study variables were compared with the chi-square test and the Kruskal-Wallis test. RESULTS: Of the sample as a whole, 55 (4.1%) reported being current smokers. Of those, 5 had severe asthma, 17 had mild-to-moderate asthma, and 33 had no asthma diagnosis. Of the 55 smokers, 32 (58.2%) were daily smokers and 23 (41.8%) were occasional smokers. Urinary cotinine levels were found to be high in self-reported nonsmokers and former smokers, especially among severe asthma patients, a finding that suggests patient nondisclosure of smoking status. Among smokers, a longer smoking history was found in patients with severe asthma when compared with those with mild-to-moderate asthma. In addition, the proportion of former smokers was higher among patients with severe asthma than among those with mild-to-moderate asthma. CONCLUSIONS: Former smoking is associated with severe asthma. Current smoking is observed in patients with severe asthma, and patient nondisclosure of smoking status occurs in some cases. Patients with severe asthma should be thoroughly screened for smoking, and findings should be complemented by objective testing.
Asunto(s)
Asma/epidemiología , Cotinina/orina , Autoinforme , Fumar/orina , Adulto , Biomarcadores/orina , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Fumadores/estadística & datos numéricos , Fumar/epidemiología , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To evaluate the relationship between obesity and asthma. METHODS: This was a preliminary cross-sectional analysis involving 925 subjects with mild-to-moderate or severe asthma evaluated between 2013 and 2015. Obesity was defined on the basis of body mass index (BMI) and abdominal circumference. We collected clinical, laboratory, and anthropometric parameters, as well as pulmonary function test results and data regarding comorbidities. The subjects also completed asthma control and quality of life questionnaires. RESULTS: Obese individuals had a significantly higher number of neutrophils in peripheral blood than did nonobese individuals (p = 0.01). Among the obese individuals, 163 (61%) had positive skin-prick test results, as did 69% and 71% of the individuals classified as being overweight or normal weight, respectively. Obese individuals showed lower spirometric values than did nonobese individuals, and 32% of the obese individuals had uncontrolled asthma, a significantly higher proportion than that found in the other groups (p = 0.02). CONCLUSIONS: Obese individuals with asthma seem to present with poorer asthma control and lower pulmonary function values than do nonobese individuals. The proportion of subjects with nonatopic asthma was higher in the obese group. Our results suggest that obese individuals with asthma show a distinct inflammatory pattern and are more likely to present with difficult-to-control asthma than are nonobese individuals.
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Asma/fisiopatología , Obesidad/fisiopatología , Adolescente , Adulto , Asma/sangre , Índice de Masa Corporal , Estudios Transversales , Eosinofilia/sangre , Eosinofilia/fisiopatología , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Neutrófilos/fisiología , Obesidad/sangre , Calidad de Vida , Valores de Referencia , Índice de Severidad de la Enfermedad , Espirometría , Estadísticas no Paramétricas , Capacidad Vital , Adulto JovenRESUMEN
ABSTRACT Objective: To evaluate the relationship between obesity and asthma. Methods: This was a preliminary cross-sectional analysis involving 925 subjects with mild-to-moderate or severe asthma evaluated between 2013 and 2015. Obesity was defined on the basis of body mass index (BMI) and abdominal circumference. We collected clinical, laboratory, and anthropometric parameters, as well as pulmonary function test results and data regarding comorbidities. The subjects also completed asthma control and quality of life questionnaires. Results: Obese individuals had a significantly higher number of neutrophils in peripheral blood than did nonobese individuals (p = 0.01). Among the obese individuals, 163 (61%) had positive skin-prick test results, as did 69% and 71% of the individuals classified as being overweight or normal weight, respectively. Obese individuals showed lower spirometric values than did nonobese individuals, and 32% of the obese individuals had uncontrolled asthma, a significantly higher proportion than that found in the other groups (p = 0.02). Conclusions: Obese individuals with asthma seem to present with poorer asthma control and lower pulmonary function values than do nonobese individuals. The proportion of subjects with nonatopic asthma was higher in the obese group. Our results suggest that obese individuals with asthma show a distinct inflammatory pattern and are more likely to present with difficult-to-control asthma than are nonobese individuals.
RESUMO Objetivo: Avaliar a relação entre obesidade e asma. Métodos: Análise preliminar transversal de dados de um estudo de caso-controle com 925 pacientes com asma leve a moderada ou grave, avaliados entre 2013 e 2015. A classificação de obesidade levou em conta o índice de massa corpórea (IMC) e a circunferência abdominal. Foram coletados parâmetros clínicos, laboratoriais, medidas antropométricas e de função pulmonar, assim como resultados de questionários de controle da asma e de qualidade de vida e presença de comorbidades. Resultados: Os indivíduos obesos apresentaram um número significativamente maior de neutrófilos no sangue periférico que os não obesos (p = 0,01). Entre os obesos, 163 (55%) apresentaram positividade no teste alérgico, enquanto os grupos com sobrepeso e IMC normal apresentaram positividade em 62% e 67%, respectivamente. Os parâmetros espirométricos dos indivíduos obesos foram mais baixos que os dos não obesos, e 97 obesos (32%) apresentaram asma não controlada, uma proporção significativamente maior do que a observada nos demais grupos de estudo (p = 0,02). Conclusões: Indivíduos asmáticos e obesos têm pior controle da asma e valores mais baixos de parâmetros de função pulmonar que os não obesos. A proporção de pacientes sem atopia entre asmáticos obesos foi maior que entre os não obesos. Nossos resultados sugerem que indivíduos asmáticos obesos podem apresentar um padrão inflamatório diferente do habitual e doença de mais difícil controle quando comparados com indivíduos asmáticos não obesos.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Asma/fisiopatología , Obesidad/fisiopatología , Calidad de Vida , Valores de Referencia , Asma/sangre , Espirometría , Índice de Severidad de la Enfermedad , Índice de Masa Corporal , Capacidad Vital , Volumen Espiratorio Forzado , Estudios Transversales , Estadísticas no Paramétricas , Eosinofilia/fisiopatología , Eosinofilia/sangre , Neutrófilos/fisiología , Obesidad/sangreRESUMEN
Abstract Objective: To describe and analyze the occurrence of hospitalizations for community-acquired pneumonia in children before and after the pneumococcal 10-valent conjugate vaccine implementation into the National Immunization Program. Methods: This is an ecological study that includes records of children younger than one year old, vaccinated and not vaccinated with the pneumococcal 10-valent conjugate vaccine in the periods pre- and post-inclusion of the vaccine in the National Immunization Program in the area covered by the Regional Health Superintendence of Alfenas, state of Minas Gerais, Brazil. Vaccination was considered as the exposure factor and hospitalization for community-acquired pneumonia as the endpoint, using secondary annual data by municipality. The prevalence ratio and its 95% confidence interval (95%CI) were used to verify the association between variables. The Z test was used to calculate the difference between proportions. Results: Considering the 26 municipalities of the Regional Health Superintendence of Alfenas, there was a significant reduction in hospitalizations for community-acquired pneumonia in children younger than one year of age, with prevalence ratio (PR)=0.81 (95%CI: 0.74-0.89; p<0.05), indicating a 19% lower prevalence of hospitalization for community-acquired pneumonia in the post-vaccination period. Conclusions: The results suggest the effectiveness of the pneumococcal 10-valent conjugate vaccine in preventing severe cases of community-acquired pneumonia in children younger than one year of age.
Resumo Objetivo: Descrever e analisar a ocorrência de internações por pneumonia adquirida na comunidade em crianças antes e após a implantação, no Programa Nacional de Imunização, da vacina pneumocócica 10-valente (conjugada). Métodos: Trata-se de um estudo ecológico que incluiu registros de crianças menores de um ano, vacinadas e não vacinadas com a vacina antipneumocócica 10-valente conjugada, no período pré e pós-inclusão da vacina no Programa Nacional de Imunização na área de abrangência da Superintendência Regional de Saúde de Alfenas, MG, Brasil. A vacinação foi considerada como fator de exposição e a hospitalização por pneumonia adquirida na comunidade como desfecho, com o uso de dados anuais secundários por município. Para verificar a associação entre as variáveis foi empregada a razão de prevalência e seu intervalo de confiança 95% (IC95%). Para o cálculo de diferença entre proporções empregou-se o teste Z. Resultados: Considerando os 26 municípios da Superintendência Regional de Saúde de Alfenas, houve redução significativa do número de hospitalização por pneumonia adquirida na comunidade em crianças abaixo de um ano, com razão de prevalência (RP)=0,81 (IC95% 0,74-0,89; p<0,05), o que indica uma prevalência de internação por pneumonia adquirida na comunidade 19% menor no período pós-vacinal. Conclusões: Os resultados sugerem a efetividade da vacina pneumocócica 10-valente (conjugada) na prevenção de casos graves da pneumonia adquirida na comunidade em crianças menores de um ano.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Neumonía Neumocócica/prevención & control , Neumonía Neumocócica/terapia , Vacunas Conjugadas , Vacunas Neumococicas , Hospitalización/estadística & datos numéricos , Neumonía Neumocócica/epidemiología , Brasil/epidemiología , Prevalencia , Infecciones Comunitarias Adquiridas/prevención & controlRESUMEN
Abstract Objective: To determine the prevalence of overweight and obesity in schoolchildren aged 10 to 16 years and its association with dietary and behavioral factors. Methods: Cross-sectional study that evaluated 505 adolescents using a structured questionnaire and anthropometric data. The data was analyzed through the T Test for independent samples and Mann-Whitney Test to compare means and medians, respectively, and Chi2 Test for proportions. Prevalence ratio (RP) and the 95% confidence interval was used to estimate the degree of association between variables. The logistic regression was employed to adjust the estimates to confounding factors. The significance level of 5% was considered for all analysis. Results: Excess weight was observed in 30.9% of the schoolchildren: 18.2% of overweight and 12.7% of obesity. There was no association between weight alterations and dietary/behavioral habits in the bivariate and multivariate analyses. However, associations were observed in relation to gender. Daily consumption of sweets [PR=0.75 (0.64-0.88)] and soft drinks [PR=0.82 (0.70-0.97)] was less frequent among boys; having lunch daily was slightly more often reported by boys [OR=1.11 (1.02-1.22)]. Physical activity practice of (≥3 times/week) was more often mentioned by boys and the association measures disclosed two-fold more physical activity in this group [PR=2.04 (1.56-2.67)] when compared to girls. Approximately 30% of boys and 40% of girls stated they did not perform activities requiring energy expenditure during free periods, with boys being 32% less idle than girls [PR=0.68 (0.60-0.76)]. Conclusions: A high prevalence of both overweight and obesity was observed, as well as unhealthy habits in the study population, regardless of the presence of weight alterations. Health promotion strategies in schools should be encouraged, in order to promote healthy habits and behaviors among all students.
Resumo Objetivo: Determinar a prevalência de sobrepeso e obesidade em escolares entre 10 e 16 anos e sua associação com fatores alimentares e comportamentais. Métodos: Este é um estudo transversal, que avaliou 505 escolares através de questionário estruturado e dados de antropometria. Para a análise dos dados foram utilizados o Teste T para amostras independentes e o Teste de Mann-Whitney para comparação de médias e medianas, respectivamente, e o Teste do Chi2 para proporções. A Razão de Prevalência (RP) e seus respectivos intervalos de confiança a 95% foi empregado como estimador de associação e regressão logística múltipla para ajustamento por fatores de confusão. Em todas as análises, considerou-se um nível de significância de 5%. Resultados: Observou-se excesso de peso em 30,9% dos escolares: 18,2% de sobrepeso e 12,7% de obesidade. Não se observou associação entre as alterações de peso e hábitos alimentares/comportamentais nas análises bivariadas e multivariadas. Entretanto, foram encontradas associações quanto ao sexo. Consumir doces [RP=0,75 (0,64-0,88)] e refrigerantes diariamente [RP=0,82 (0,70-0,97)] foram hábitos relatados por 273 (54,1%) crianças, menos frequentemente pelos meninos. Almoçar diariamente foi hábito discretamente mais observado entre os meninos [RP 1,11 (1,02-1,22)]. Praticar atividade física (≥3 vezes/semana) foi mais referido pelos meninos e as medidas de associação revelaram duas vezes mais atividade física nesse grupo [RP=2,04 (1,56-2,67)], quando comparado com o das meninas. Cerca de 30% dos meninos e 40% das meninas disseram não realizar atividades com gasto de energia nos períodos livres, sendo os meninos 32% menos ociosos do que as meninas [RP=0,68 (0,60-0,76)]. Conclusões: Observou-se alta prevalência tanto de sobrepeso e obesidade quanto de hábitos pouco saudáveis na população estudada, independentemente da presença de alterações do peso. Estratégias de promoção da saúde nas escolas devem ser estimuladas, no sentido de se incentivar hábitos e comportamentos saudáveis entre todos os estudantes.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Sobrepeso/epidemiología , Obesidad Infantil/epidemiología , Ejercicio Físico , Conductas Relacionadas con la Salud , Prevalencia , Estudios Transversales , Conducta AlimentariaRESUMEN
OBJECTIVE: To describe and analyze the occurrence of hospitalizations for community-acquired pneumonia in children before and after the pneumococcal 10-valent conjugate vaccine implementation into the National Immunization Program. METHODS: This is an ecological study that includes records of children younger than one year old, vaccinated and not vaccinated with the pneumococcal 10-valent conjugate vaccine in the periods pre- and post-inclusion of the vaccine in the National Immunization Program in the area covered by the Regional Health Superintendence of Alfenas, state of Minas Gerais, Brazil. Vaccination was considered as the exposure factor and hospitalization for community-acquired pneumonia as the endpoint, using secondary annual data by municipality. The prevalence ratio and its 95% confidence interval (95%CI) were used to verify the association between variables. The Z test was used to calculate the difference between proportions. RESULTS: Considering the 26 municipalities of the Regional Health Superintendence of Alfenas, there was a significant reduction in hospitalizations for community-acquired pneumonia in children younger than one year of age, with prevalence ratio (PR)=0.81 (95%CI: 0.74 to 0.89; p<0.05), indicating a 19% lower prevalence of hospitalization for community-acquired pneumonia in the post-vaccination period. CONCLUSIONS: The results suggest the effectiveness of the pneumococcal 10-valent conjugate vaccine in preventing severe cases of community-acquired pneumonia in children younger than one year of age.
Asunto(s)
Hospitalización/estadística & datos numéricos , Vacunas Neumococicas , Neumonía Neumocócica/prevención & control , Neumonía Neumocócica/terapia , Vacunas Conjugadas , Brasil/epidemiología , Infecciones Comunitarias Adquiridas/prevención & control , Femenino , Humanos , Lactante , Masculino , Neumonía Neumocócica/epidemiología , PrevalenciaRESUMEN
Resumo Introdução: Ferramentas de web e teleconferência visando aumentar a resolubilidade da Atenção Básica (AB) são ferramentas de grande valor na articulação com a atenção secundária. Objetivo: Avaliar a segunda opinião formativa através de web e teleconferência em unidades de atenção primária e secundária integrantes do PET-Saúde. Método: Foi realizado um estudo transversal incluindo oito equipes de Saúde da Família, conectadas por ferramentas de telessaúde a um centro de atenção secundária em saúde, ligado a uma instituição de ensino superior, na qual um cardiologista e um alergologista atuaram como médicos consultores. Resultado: Foram geradas 103 consultorias – 44 em Cardiologia e 59 em Alergia Respiratória e Cutânea. Identificou-se que a idade dos assistidos foi maior na segunda opinião da Cardiologia; homens prevaleceram na Cardiologia e mulheres na Alergologia. Na Atenção Básica, resolubilidade ótima ou boa em 75% dos casos. Na Cardiologia, as dúvidas quanto à solicitação e interpretação de exames complementares/condução do tratamento representaram 75% dos casos. Na Alergologia, as dúvidas no diagnóstico, 90% deles. Principais diagnósticos na Cardiologia: hipertensão arterial sistêmica, insuficiência cardíaca congestiva e arritmia sinusal. Na Alergologia: asma e dermatite atópica. Conclusão: O estudo revela potencial e relevância da telemedicina na formação, assistência e pesquisa no SUS.
Abstract Introduction: web and teleconferencing tools to increase the resolution of Primary Care Health (PHC) are valuable tools in conjunction with secondary care. Objective: To evaluate the second formative opinion by web and teleconference in PHC and secondary health center among members of the PET-Health. Method: We performed a cross-sectional study including eight Family Health teams, connected by telehealth tools to a center of secondary health care, attached to a higher education institution, where a cardiologist and an allergist acted as medical consultants. Result: We generated 103 consultancies - 44 in cardiology and 59 in respiratory and skin allergy. It was found that the assisted age was higher in the second opinion of Cardiology; men prevailed in cardiology and women in allergy. In PHC, we found great or good resolving in 75% of the cases. In cardiology application and interpretation uncertainty of additional tests/driving treatment accounted for 75% of cases. In allergy, the diagnosis uncertainty accounted for 90% of them. The main diagnostics in cardiology were hypertension, congestive heart failure and sinus arrhythmia. In allergy they were asthma and atopic dermatitis. Conclusion: The study reveals potential and relevance of telemedicine training, assistance and research in the SUS.
Asunto(s)
Humanos , Masculino , Femenino , Atención Primaria de Salud , Derivación y Consulta , Telemedicina , Estrategias de Salud Nacionales , Telediagnóstico , Cardiología , Educación a Distancia , Alergia e InmunologíaRESUMEN
ResumoDesde a introdução da terapia antirretroviral altamente ativa (HAART) em 1996, tem se observado em todo o mundo mudanças nas causas de hospitalização em pacientes com HIV/Aids. O objetivo deste artigo foi descrever as características das hospitalizações de pacientes com HIV/ Aids no período de 1997-2012. Trata-se de um estudo transversal que utiliza um banco de dados hospitalar que concentra registros de internações em 31 hospitais, públicos e privados, de 26 municípios do interior de São Paulo. Para verificação de associação entre variáveis foi empregada a Razão de Prevalência (RP) e seu intervalo de confiança a 95%. Foram registradas 10.696 internações entre 9797 adultos e crianças, ou 1,09 internações por paciente, sendo 62% do sexo masculino, com faixa etária predominante dos 21 aos 50 anos (63,5%). Considerando-se todas as faixas etárias, a mortalidade foi maior entre pacientes do sexo masculino [RP= 1,42 (IC95%: 1,28-1,57); p < 0,05]. As doenças infecciosas foram as principais responsáveis pelas hospitalizações, representando 54,5% do total. Notou-se que ainda há predominância de doenças infecciosas (oportunistas ou não), como causas de internação em pacientes com HIV/Aids, mesmo na era pós-HAART. Foram constatadas diferenças entre os sexos e as idades dos pacientes considerando importantes variáveis como óbito.
AbstractSince the introduction of highly active antiretroviral therapy (HAART) in 1996, there have been worldwide shifts in the causes of hospitalization for patients with HIV/AIDS. The aim of this study was to describe the characteristics of HIV/AIDS patient hospitalizations between 1997 and 2012. This cross-sectional study used a hospital database that centralizes records of admissions in 31 hospitals, both public and private, across 26 municipalities in the interior of São Paulo. In order to verify associations between the variables, we used the prevalence ratio (PR) and a 95% confidence interval. Among 9,797 adults and children, 10,696 admissions were registered, which was equal to 1.09 admissions per patient. Most (62%) of the patients were male, and the predominant age group was 21 and 50 years (63.5%). Mortality was higher among male patients from all age groups (PR= 1.42 [95% CI: 1.28-1.57]; p < 0.05). The main cause of hospitalization (54.5% of the total) was infectious disease, whether opportunistic or not. This was true, even in the post-HAART era. Furthermore, gender and age differences were noted in patient mortality rates.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Infecciones por VIH/tratamiento farmacológico , Terapia Antirretroviral Altamente Activa , Hospitalización , Brasil/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/mortalidad , Estudios Transversales , Síndrome de Inmunodeficiencia AdquiridaRESUMEN
A obesidade infantil duplicou entre crianças nos últimos 30 anos e, consequentemente, é hoje um grande problema de saúde pública em todo o mundo. Crianças e adolescentes obesos estão sob maior risco de serem também obesos na vida adulta e por isso, mais predispostos a fatores de risco para doenças cardiovasculares, cerebrovasculares, metabólicas, osteoarticulares, além de transtornos emocionais e psicossociais. Apesar de não haver tratamento específico para a obesidade não orgânica na infância, medidas preventivas, como mudanças no estilo de vida, com a realização de atividades físicas e hábitos alimentares saudáveis, são sabidamente efetivas na redução do peso corporal e do risco de desenvolvimento das doenças relacionadas; no entanto, na prática diária observam-se dificuldades na adoção e aderência a essas medidas. Este artigo faz uma revisão sobre a obesidade infantil abordando conceitos, epidemiologia e recomendações no manejo do problema.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Niño , Factores de Riesgo , ObesidadRESUMEN
OBJETIVO: Identificar os principais fatores associados a quedas e fraturas de fêmur em idosos. MÉTODOS: Trata-se de estudo caso-controle (um grupo de casos e dois grupos controle) na proporção de 1:1:1, em que foram estudados 135 indivíduos com idade ≥60 anos, pareados por sexo, no período de 2005 a 2012. Os dados foram coletados por meio de entrevistas nos domicílios dos participantes, e realizou-se levantamento de informações em prontuários. Para análise das diferenças entre proporções e médias entre os grupos, empregaram-se o teste qui-quadrado e o teste t Student, respectivamente. Para o estudo da associação entre variáveis, foram realizadas análises univariadas e multivariadas empregando-se regressão logística. Como medida de efeito, foram empregados odds ratio (OR) e seu intervalo de confiança a 95% (IC95%). Em todas as análises, considerou-se um nível de significância de 5%. RESULTADOS: Após análise multivariada, os fatores de proteção contra fratura de fêmur foram: ouvir bem e possuir corrimão nas escadas de suas residências. Os fatores de risco para fratura de fêmur foram: hipertensão arterial sistêmica, sedentarismo e possuir superfície escorregadia na residência. Os fatores de proteção para queda foram: possuir corrimão nas escadas de suas residências, ser portador de osteoporose e depressão. O fator de risco de queda foi o sedentarismo. CONCLUSÃO: As fraturas de fêmur representam importante fator de morbidade em idosos. Conhecer os fatores de risco para fraturas pós-queda em idosos é essencial para o planejamento de ações individuais e coletivas voltadas à prevenção deste agravo e suas consequências. Atividades físicas, planos terapêuticos mais adequados e correção de inadequações nos domicílios desses indivíduos devem ser orientados e incentivados.
OBJECTIVE: To identify the main factors associated to falls and hip fractures in the elderly. METHODS: This is a case-control study (a group of cases and two control groups) in a 1: 1: 1 proportion, studying 135 individuals aged ≥60 years, matched by sex, from 2005 to 2012. Data were collected through interviews at the homes of participants, and information was gathered from medical records. To analyze the differences between proportions and means between groups, they employed the chi-square and Student's t test, respectively. To study the association between variables, were performed univariate and multivariate analyzes using logistic regression. As effect measure, were employed odds ratio (OR) and its confidence interval at 95% (95%). In all analyzes, we considered a 5% significance level. RESULTS: After multivariate analysis, hip fracture protection factors were: listen well and have handrails on the stairs of their homes. Risk factors for hip fracture were: hypertension, sedentary lifestyle and have slippery surface in the residence. Protective factors for fall were: have handrails on the stairs of their homes, have osteoporosis and depression. Risk factor for falls was physical inactivity. CONCLUSION: Hip fractures are an important cause of morbidity in the elderly. Knowing the risk factors for post-fall fractures in the elderly is essential for planning individual and collective actions aimed at prevention of this disease and its consequences. Physical activities, more effective treatment plans and inadequacies correction in households of those individuals should be counseled and encouraged.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Accidentes por Caídas , Anciano , Informes de Casos , Informes de Casos , Fracturas del Fémur , Fracturas de Cadera , BrasilRESUMEN
INTRODUCTION: In 2010, to reduce the occurrence of serious pneumococcal disease, the Ministry of Health in Brazil incorporated the 10-valent pneumococcal vaccine in the immunization schedule of children younger than two years of age. The objective of this study was to evaluate the impact of vaccination on the incidence of infectious respiratory diseases in infants before and after the introduction of the 10-valent pneumococcal vaccine. METHODS: This cross-sectional study involved primary care and hospital networks from a city in Minas Gerais State, Brazil, between 2009 and 2012. RESULTS: A 40% reduction in the prevalence of community-acquired pneumonia (CAP) was observed after introducing the pneumococcal conjugate vaccine. Male children were 28% more likely to develop the disease. The prevalence ratio ([PR] = 1.96, 95% CI: 1.52 to 2.53, p < 0.05) suggested that not being vaccinated was associated with the occurrence of pneumonia. The prevalence of CAP was 70% lower (PR 0.30, 95% CI: 0.24 to 0.37, p<0.05) in children vaccinated as recommended compared to children with delayed vaccination, suggesting that the updated vaccine schedule improves protection. CONCLUSIONS: Immunization with the 10-valent pneumococcal vaccine appeared to reduce the number of pneumonia cases in children during the study period. Prospective studies are needed to confirm the efficacy of the vaccine against the occurrence of pneumococcal pneumonia.
Asunto(s)
Vacunas Neumococicas/administración & dosificación , Neumonía Neumocócica/prevención & control , Vacunas Conjugadas/administración & dosificación , Brasil/epidemiología , Preescolar , Estudios Transversales , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Vacunas Neumococicas/inmunología , Neumonía Neumocócica/inmunología , Prevalencia , Vacunas Conjugadas/inmunologíaRESUMEN
INTRODUCTION: In 2010, to reduce the occurrence of serious pneumococcal disease, the Ministry of Health in Brazil incorporated the 10-valent pneumococcal vaccine in the immunization schedule of children younger than two years of age. The objective of this study was to evaluate the impact of vaccination on the incidence of infectious respiratory diseases in infants before and after the introduction of the 10-valent pneumococcal vaccine. METHODS: This cross-sectional study involved primary care and hospital networks from a city in Minas Gerais State, Brazil, between 2009 and 2012. RESULTS: A 40% reduction in the prevalence of community-acquired pneumonia (CAP) was observed after introducing the pneumococcal conjugate vaccine. Male children were 28% more likely to develop the disease. The prevalence ratio ([PR] = 1.96, 95% CI: 1.52 to 2.53, p < 0.05) suggested that not being vaccinated was associated with the occurrence of pneumonia. The prevalence of CAP was 70% lower (PR 0.30, 95% CI: 0.24 to 0.37, p<0.05) in children vaccinated as recommended compared to children with delayed vaccination, suggesting that the updated vaccine schedule improves protection. CONCLUSIONS: Immunization with the 10-valent pneumococcal vaccine appeared to reduce the number of pneumonia cases in children during the study period. Prospective studies are needed to confirm the efficacy of the vaccine against the occurrence of pneumococcal pneumonia. .