RESUMEN
We conducted a survival analysis with competing risks to estimate the mortality rate and predictive factors for immunodeficiency-related death in people living with HIV/AIDS (PLWH) in northeast Brazil. A cohort with 2372 PLWH was enrolled between July 2007 and June 2010 and monitored until 31 December 2012 at two healthcare centres. The event of interest was immunodeficiency-related death, which was defined based on the Coding Causes of Death in HIV Protocol (CoDe). The predictor variables were: sociodemographic characteristics, illicit drugs, tobacco, alcohol, nutritional status, antiretroviral therapy, anaemia and CD4 cell count at baseline; and treatment or chemoprophylaxis for tuberculosis (TB) during follow-up. We used Fine & Gray's model for the survival analyses with competing risks, since we had regarded immunodeficiency-unrelated deaths as a competing event, and we estimated the adjusted sub-distribution hazard ratios (SHRs). In 10 012·6 person-years of observation there were 3·1 deaths/100 person-years (2·3 immunodeficiency-related and 0·8 immunodeficiency-unrelated). TB (SHR 4·01), anaemia (SHR 3·58), CD4 <200 cells/mm3 (SHR 3·33) and being unemployed (SHR 1·56) were risk factors for immunodeficiency-related death. This study discloses a 13% coverage by highly active antiretroviral therapy (HAART) in our state and adds that anaemia at baseline or the incidence of TB may increase the specific risk of dying from HIV-immunodeficiency, regardless of HAART and CD4.
Asunto(s)
Infecciones por VIH/mortalidad , Pobreza , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Análisis de Supervivencia , Adulto JovenRESUMEN
We investigated the association between pulse wave velocity (PWV) and HIV infection, antiretroviral treatment-related characteristics, viral load, immune status, and metabolic changes in a cross-sectional study nested in a cohort of HIV/AIDS patients who have been followed for metabolic and cardiovascular changes since 2007. The study included patients recruited from the cohort (N = 261) and a comparison group (N = 82) of uninfected individuals, all enrolled from April to November 2009. Aortic stiffness was estimated using the carotid-femoral PWV (Complior-Artech, Paris, France). The groups were similar with respect to age, metabolic syndrome, diabetes mellitus, Framingham score, and use of antihypertensive and hypolipidemic medications. Hypertension was more frequent among the controls. Individuals with HIV had higher triglyceride, glucose and HDL cholesterol levels. Among individuals with HIV/AIDS, those with a nadir CD4+ T-cell count <200 cells/mm³ had a higher PWV (P = 0.01). There was no statistically significant difference when subjects were stratified by gender. Heart rate, age, male gender, and blood pressure were independently correlated with PWV. Nadir CD4+ T-cell count did not remain in the final model. There was no significance difference in PWV between HIV-infected individuals and uninfected controls. PWV was correlated with age, gender, and blood pressure across the entire population and among those infected with HIV. We recommend cohort studies to further explore the association between inflammation related to HIV infection and/or immune reconstitution and antiretroviral use and PWV.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Infecciones por VIH/fisiopatología , Rigidez Vascular/fisiología , Terapia Antirretroviral Altamente Activa , Velocidad del Flujo Sanguíneo/fisiología , Presión Sanguínea/fisiología , Estudios de Casos y Controles , Estudios Transversales , Infecciones por VIH/sangre , Infecciones por VIH/tratamiento farmacológico , Frecuencia Cardíaca/fisiología , Factores de Riesgo , Carga ViralRESUMEN
We investigated the association between pulse wave velocity (PWV) and HIV infection, antiretroviral treatment-related characteristics, viral load, immune status, and metabolic changes in a cross-sectional study nested in a cohort of HIV/AIDS patients who have been followed for metabolic and cardiovascular changes since 2007. The study included patients recruited from the cohort (N = 261) and a comparison group (N = 82) of uninfected individuals, all enrolled from April to November 2009. Aortic stiffness was estimated using the carotid-femoral PWV (Complior-Artech, Paris, France). The groups were similar with respect to age, metabolic syndrome, diabetes mellitus, Framingham score, and use of antihypertensive and hypolipidemic medications. Hypertension was more frequent among the controls. Individuals with HIV had higher triglyceride, glucose and HDL cholesterol levels. Among individuals with HIV/AIDS, those with a nadir CD4+ T-cell count <200 cells/mm³ had a higher PWV (P = 0.01). There was no statistically significant difference when subjects were stratified by gender. Heart rate, age, male gender, and blood pressure were independently correlated with PWV. Nadir CD4+ T-cell count did not remain in the final model. There was no significance difference in PWV between HIV-infected individuals and uninfected controls. PWV was correlated with age, gender, and blood pressure across the entire population and among those infected with HIV. We recommend cohort studies to further explore the association between inflammation related to HIV infection and/or immune reconstitution and antiretroviral use and PWV.
Asunto(s)
Infecciones por VIH/fisiopatología , Rigidez Vascular/fisiología , Adulto , Anciano , Terapia Antirretroviral Altamente Activa , Velocidad del Flujo Sanguíneo/fisiología , Presión Sanguínea/fisiología , Recuento de Linfocito CD4 , Estudios de Casos y Controles , Estudios Transversales , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/tratamiento farmacológico , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Carga Viral , Adulto JovenRESUMEN
OBJECTIVES: To estimate the probability of survival and to evaluate risk factors for death in a cohort of persons living with human immunodeficiency virus (PLHIV) who had started tuberculosis (TB) treatment. METHODS: A prospective cohort study was conducted between June 2007 and December 2009 with HIV-infected patients who had started anti-tuberculosis treatment in the State of Pernambuco, Brazil. Survival data were analysed using the Kaplan-Meier estimator, the log-rank test and the Cox model. Hazard ratios and their respective 95%CIs were estimated. RESULTS: Of a cohort of 2310 HIV-positive individuals, 333 patients who had commenced treatment for TB were analysed. The mortality rate was 5.25 per 10,000 person-years (95%CI 4.15-6.63). The probability of survival at 30 months was 74%. Risk factors for death in the study population were being female, age ≥30 years, having anaemia, not using highly active antiretroviral therapy (HAART) during treatment for TB and disseminated TB. Protective factors for death were a CD4 lymphocyte count >200 cells/mm(3) and treatment for TB having started in an out-patient clinic. CONCLUSIONS: The use of HAART can prevent deaths among HIV-TB patients, corroborating the efficacy of starting HAART early in individuals with TB.
Asunto(s)
Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/mortalidad , Tuberculosis/mortalidad , Adolescente , Adulto , Anciano , Anemia/epidemiología , Anemia/etiología , Antituberculosos/uso terapéutico , Brasil/epidemiología , Recuento de Linfocito CD4 , Estudios de Cohortes , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Factores Sexuales , Análisis de Supervivencia , Tasa de Supervivencia , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Adulto JovenRESUMEN
A 7.4 percent vaginal extract of the Brazilian pepper tree (Schinus terebinthifolius Raddi) was compared with 0.75 percent vaginal metronidazole, both manufactured by the Hebron Laboratory, for the treatment of bacterial vaginosis, used at bedtime for 7 nights. The condition was diagnosed using the combined criteria of Amsel and Nugent in two groups of 140 and 137 women, aged between 18 and 40 years. Intention-to-treat analysis was performed. Women were excluded from the study if they presented delayed menstruation, were pregnant, were using or had used any topical or systemic medication, presented any other vaginal infections, presented hymen integrity, or if they reported any history suggestive of acute pelvic inflammatory disease. According to Amsel’s criteria separately, 29 patients (21.2 percent) treated with the extract and 87 (62.1 percent) treated with metronidazole were considered to be cured (P < 0.001). According to Nugent’s score separately, 19 women (13.9 percent) treated with the extract and 79 (56.4 percent) treated with metronidazole were considered to be cured (P < 0.001). Using the two criteria together, the so-called total cure was observed in 17 women (12.4 percent) treated with the extract and in 79 women (56.4 percent) treated with metronidazole (P < 0.001). In conclusion, the cure rate for bacterial vaginosis using a vaginal gel from a pepper tree extract was lower than the rate obtained with metronidazole gel, while side effects were infrequent and non-severe in both groups.
Asunto(s)
Adulto , Femenino , Humanos , Adulto Joven , Anacardiaceae/química , Antibacterianos/uso terapéutico , Metronidazol/uso terapéutico , Extractos Vegetales/uso terapéutico , Vaginosis Bacteriana/tratamiento farmacológico , Administración Intravaginal , Antibacterianos/administración & dosificación , Método Doble Ciego , Metronidazol/administración & dosificación , Fitoterapia/métodos , Extractos Vegetales/administración & dosificación , Resultado del Tratamiento , Cremas, Espumas y Geles VaginalesRESUMEN
A 7.4% vaginal extract of the Brazilian pepper tree (Schinus terebinthifolius Raddi) was compared with 0.75% vaginal metronidazole, both manufactured by the Hebron Laboratory, for the treatment of bacterial vaginosis, used at bedtime for 7 nights. The condition was diagnosed using the combined criteria of Amsel and Nugent in two groups of 140 and 137 women, aged between 18 and 40 years. Intention-to-treat analysis was performed. Women were excluded from the study if they presented delayed menstruation, were pregnant, were using or had used any topical or systemic medication, presented any other vaginal infections, presented hymen integrity, or if they reported any history suggestive of acute pelvic inflammatory disease. According to Amsel's criteria separately, 29 patients (21.2%) treated with the extract and 87 (62.1%) treated with metronidazole were considered to be cured (P < 0.001). According to Nugent's score separately, 19 women (13.9%) treated with the extract and 79 (56.4%) treated with metronidazole were considered to be cured (P < 0.001). Using the two criteria together, the so-called total cure was observed in 17 women (12.4%) treated with the extract and in 79 women (56.4%) treated with metronidazole (P < 0.001). In conclusion, the cure rate for bacterial vaginosis using a vaginal gel from a pepper tree extract was lower than the rate obtained with metronidazole gel, while side effects were infrequent and non-severe in both groups.
Asunto(s)
Anacardiaceae/química , Antibacterianos/uso terapéutico , Metronidazol/uso terapéutico , Extractos Vegetales/uso terapéutico , Vaginosis Bacteriana/tratamiento farmacológico , Administración Intravaginal , Adulto , Antibacterianos/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Metronidazol/administración & dosificación , Fitoterapia/métodos , Extractos Vegetales/administración & dosificación , Resultado del Tratamiento , Cremas, Espumas y Geles Vaginales , Adulto JovenRESUMEN
Overall HIV test coverage among pregnant women in Brazil is 62%, but only 41% in northeastern Brazil. We aimed to identify risk factors for unawareness of HIV status among pregnant women and determine test coverage up to 14th week of pregnancy. We conducted a case-control study in a reference maternity hospital for high-risk pregnancy in Recife, where 485 puerperae were interviewed about their knowledge of results of HIV testing, biological, sociodemographic and health-care data. Cases were those who were not aware of their HIV status and controls were those who were. Only 21.65% stated that they were unaware of their HIV status during pregnancy (78.35% coverage); however, test results were recorded on an antenatal card in only 48.35%. Only 22% received the result by the 14th week of pregnancy. Unawareness was associated with low schooling (odds ratio [OR] = 2.92; P = 0.006); living outside the state capital's metropolitan region (OR = 4.11; P = 0.001); test performed in the third trimester (OR = 11.6; P = 0.000); and lack of counselling (OR = 2.31; P = 0.022) in multivariate analysis. In conclusion, there has been a considerable delay in having an HIV test. Conflict of Information obtained by interview and that on the antenatal card raises questions about deficiencies in antenatal care or lack of comprehension about the HIV test.
Asunto(s)
Serodiagnóstico del SIDA/psicología , Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo , Atención Prenatal/métodos , Serodiagnóstico del SIDA/estadística & datos numéricos , Brasil , Estudios de Casos y Controles , Consejo , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/psicología , Humanos , Entrevistas como Asunto , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/psicologíaRESUMEN
The authors propose a clinical classification to monitor the evolution of tetanus patients, ranging from grade I to IV according to severity. It was applied on admission and repeated on alternate days up to the 10th day to patients aged > or = 12 years admitted to the State University Hospital, Recife, Brazil. Patients were also classified upon admission according to three prognostic indicators to determine if the proposed classification is in agreement with the traditionally used indicators. Upon admission, the distribution of the 64 patients among the different levels of the proposed classification was similar for the groups of better and worse prognosis according to the three indicators (P > 0.05), most of the patients belonging to grades I and II of the proposed classification. In the later reclassifications, severe forms of tetanus (grades III and IV) were more frequent in the categories of worse prognosis and these differences were statistically significant. There was a reduction in the proportion of mild forms (grades I and II) of tetanus with time for the categories of worse prognostic indicators (chi-square for trend: P = 0.00006, 0.03, and 0.00000) whereas no such trend was observed for the categories of better prognosis (grades I and II). This serially used classification reflected the prognosis of the traditional indicators and permitted the comparison of the dynamics of the disease in different groups. Thus, it becomes a useful tool for monitoring patients by determining clinical category changes with time, and for assessing responses to different therapeutic measures.
Asunto(s)
Índice de Severidad de la Enfermedad , Tétanos/clasificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Tétanos/tratamiento farmacológico , Factores de Tiempo , Resultado del TratamientoRESUMEN
The authors propose a clinical classification to monitor the evolution of tetanus patients, ranging from grade I to IV according to severity. It was applied on admission and repeated on alternate days up to the 10th day to patients aged > or = 12 years admitted to the State University Hospital, Recife, Brazil. Patients were also classified upon admission according to three prognostic indicators to determine if the proposed classification is in agreement with the traditionally used indicators. Upon admission, the distribution of the 64 patients among the different levels of the proposed classification was similar for the groups of better and worse prognosis according to the three indicators (P > 0.05), most of the patients belonging to grades I and II of the proposed classification. In the later reclassifications, severe forms of tetanus (grades III and IV) were more frequent in the categories of worse prognosis and these differences were statistically significant. There was a reduction in the proportion of mild forms (grades I and II) of tetanus with time for the categories of worse prognostic indicators (chi-square for trend: P = 0.00006, 0.03, and 0.00000) whereas no such trend was observed for the categories of better prognosis (grades I and II). This serially used classification reflected the prognosis of the traditional indicators and permitted the comparison of the dynamics of the disease in different groups. Thus, it becomes a useful tool for monitoring patients by determining clinical category changes with time, and for assessing responses to different therapeutic measures.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano de 80 o más Años , Índice de Severidad de la Enfermedad , Tétanos/clasificación , Estudios de Casos y Controles , Pronóstico , Factores de Tiempo , Resultado del Tratamiento , Tétanos/tratamiento farmacológicoRESUMEN
SETTING: Metropolitan region of Recife, Brazil. OBJECTIVE: To estimate the additional protection against tuberculosis (TB) provided by a second dose of bacille Calmette-Guérin (BCG) vaccine. DESIGN: Case-control study. Cases were cases of TB newly diagnosed by the TB control programme, independent of clinical form. Three matched neighbourhood controls were selected using a systematic routine, starting from the case's address. The matching was within the age groups 7-9, 10-14 and 15-19 years. RESULTS: Analysis was conducted among 169 cases and 477 controls. For the efficacy of BCG revaccination against TB overall, matched (crude) vaccine effectiveness (VE) was -3 (95% CI -50-29) and matched (adjusted) VE was 8 (95% CI -77-52). CONCLUSIONS: This study suggests that a second dose of BCG does not offer additional protection. Revaccination should not be offered. As large numbers of subjects are already vaccinated and vaccine appears to offer some protection in older subjects, further studies with larger sample sizes could investigate the potential efficacy of revaccination with BCG in the age group > or = 15 years.
Asunto(s)
Vacuna BCG/administración & dosificación , Tuberculosis/prevención & control , Adolescente , Adulto , Brasil/epidemiología , Estudios de Casos y Controles , Niño , Femenino , Humanos , Modelos Logísticos , Masculino , Factores Socioeconómicos , Tuberculosis/epidemiología , Población UrbanaRESUMEN
Patients with sickle-cell anemia submitted to frequent blood transfusions are at risk of contamination with hepatitis C virus (HCV). Determination of HCV RNA and genotype characterization are parameters that are relevant for the treatment of the viral infection. The objective of the present study was to determine the frequency of HCV infection and the positivity for HCV RNA and to identify the HCV genotype in patients with sickle-cell anemia with a history of blood transfusion who had been treated at the Hospital of the HEMOPE Foundation. Sera from 291 patients were tested for anti-HCV antibodies by ELISA 3.0 and RIBA 3.0 Chiron and for the presence of HCV RNA by RT-PCR. HCV genotyping was performed in 19 serum samples. Forty-one of 291 patients (14.1%) were anti-HCV positive by ELISA and RIBA. Both univariate and multivariate analysis showed a greater risk of anti-HCV positivity in those who had started a transfusion regime before 1992 and received more than 10 units of blood. Thirty-four of the anti-HCV-positive patients (34/41, 82.9%) were also HCV RNA positive. Univariate analysis, used to compare HCV RNA-negative and -positive patients, did not indicate a higher risk of HCV RNA positivity for any of the variables evaluated. The genotypes identified were 1b (63%), 1a (21%) and 3a (16%). A high prevalence of HCV infection was observed in our patients with sickle-cell anemia (14.1%) compared to the population in general (3%). In the literature, the frequency of HCV infection in sickle-cell anemia ranges from 2 to 30%. The serological screening for anti-HCV at blood banks after 1992 has contributed to a better control of the dissemination of HCV infection. Because of the predominance of genotype 1, these patients belong to a group requiring special treatment, with a probable indication of new therapeutic options against HCV.
Asunto(s)
Anemia de Células Falciformes/terapia , Hepacivirus/genética , Hepatitis C/transmisión , Reacción a la Transfusión , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Femenino , Genotipo , Hepatitis C/epidemiología , Hepatitis C/virología , Anticuerpos contra la Hepatitis C/sangre , Humanos , Immunoblotting , Lactante , Persona de Mediana Edad , Prevalencia , ARN Viral/análisis , ARN Viral/genética , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de RiesgoRESUMEN
Patients with sickle-cell anemia submitted to frequent blood transfusions are at risk of contamination with hepatitis C virus (HCV). Determination of HCV RNA and genotype characterization are parameters that are relevant for the treatment of the viral infection. The objective of the present study was to determine the frequency of HCV infection and the positivity for HCV RNA and to identify the HCV genotype in patients with sickle-cell anemia with a history of blood transfusion who had been treated at the Hospital of the HEMOPE Foundation. Sera from 291 patients were tested for anti-HCV antibodies by ELISA 3.0 and RIBA 3.0 Chiron and for the presence of HCV RNA by RT-PCR. HCV genotyping was performed in 19 serum samples. Forty-one of 291 patients (14.1 percent) were anti-HCV positive by ELISA and RIBA. Both univariate and multivariate analysis showed a greater risk of anti-HCV positivity in those who had started a transfusion regime before 1992 and received more than 10 units of blood. Thirty-four of the anti-HCV-positive patients (34/41, 82.9 percent) were also HCV RNA positive. Univariate analysis, used to compare HCV RNA-negative and -positive patients, did not indicate a higher risk of HCV RNA positivity for any of the variables evaluated. The genotypes identified were 1b (63 percent), 1a (21 percent) and 3a (16 percent). A high prevalence of HCV infection was observed in our patients with sickle-cell anemia (14.1 percent) compared to the population in general (3 percent). In the literature, the frequency of HCV infection in sickle-cell anemia ranges from 2 to 30 percent. The serological screening for anti-HCV at blood banks after 1992 has contributed to a better control of the dissemination of HCV infection. Because of the predominance of genotype 1, these patients belong to a group requiring special treatment, with a probable indication of new therapeutic options against HCV
Asunto(s)
Humanos , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anemia de Células Falciformes , Transfusión Sanguínea , Hepacivirus , Hepatitis C , Anciano de 80 o más Años , Brasil , Ensayo de Inmunoadsorción Enzimática , Genotipo , Hepatitis C , Anticuerpos contra la Hepatitis C , Immunoblotting , Prevalencia , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de Riesgo , ARN ViralRESUMEN
The concept of a "socially organized space" supported by new analytical techniques and mapping of health events has guided innovative methodological developments in public health interventions. This study aimed to evaluate a social/environmental indicator constructed with a scoring methodology to stratify areas in the city of Olinda by different levels of risk for Bancroftian filariasis transmission. The study mapped areas and the location of sample households and identified all residents ages 5 to 65 years as part of the parasitological survey. Among the 3,232 individuals who had blood samples taken, 42 were microfilaremic (1.3% prevalence). Global statistical analysis of filarial case distribution has suggested spatial clustering. Some 85.7% of positive individuals resided in the two strata with the highest transmission risk. The high sensitivity of the proposed indicator for predicting the places where the vast majority of filariasis cases occurred justifies its use in planning and implementing interventions.
Asunto(s)
Filariasis Linfática/epidemiología , Adolescente , Adulto , Anciano , Animales , Brasil/epidemiología , Niño , Preescolar , Análisis por Conglomerados , Estudios de Cohortes , Estudios Transversales , Filariasis Linfática/transmisión , Ambiente , Humanos , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Condiciones Sociales , Población UrbanaRESUMEN
This study aimed to compare the radiographic characteristics of patients with pulmonary tuberculosis (TB) and human immunodeficiency virus (HIV) infection with those of HIV-negative patients. In all, 275 TB patients attending the outpatients clinics at the University Hospital/UFPE, were studied from January 1997 to March 1999. Thirty nine (14.2%) of them were HIV(+), with a higher frequency of males in this group (p=0.044). Seventy-five percent of the HIV(+) patients and 19% of the HIV(-) had a negative tuberculin test (PPD) (p < 0.001). The proportion of positive sputum smears in the two groups was similar. The radiological finding most strongly associated with co-infection was absence of cavitation (p < 0.001). It may therefore be concluded that the lack of cavitation in patients with pulmonary TB may be considered a useful indicator of the need to investigate HIV infection. This approach could contribute to increasing the effectiveness of local health services, by offering appropriate treatment to co-infected patients.
Asunto(s)
Infecciones por VIH/complicaciones , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico por imagen , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
The aim of this study was to identify fatal risk factors for children admitted to the paediatric intensive care unit of the Instituto Materno Infantil de Pernambuco, a referral hospital in Recife, a city in the north-east of Brazil. A survey was performed from June 1996 to January 1997. Risk was quantified by the crude and adjusted odds ratio. The 95 per cent confidence interval, likelihood ratio statistics, and the probability (p < 0.05) value were used to test for statistical significance. An association was established between death in children admitted to the paediatric intensive care unit and: (1) age below 2 years old; (2) use of mechanical ventilation and central venous catheter; (3) presence of hospital-acquired infection; (4) length of hospital stay of 2 days or less; and (5) Class 4 clinical severity, according to the Clinical Classification System (CCS). These results allow the identification of the children with a greater risk of death and may contribute to improvements in handling groups of patients with poor prognosis.
Asunto(s)
Mortalidad Hospitalaria , Unidades de Cuidado Intensivo Pediátrico , Distribución por Edad , Brasil , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Tiempo de Internación , Masculino , Factores de Riesgo , Índice de Severidad de la Enfermedad , Distribución por SexoRESUMEN
The objective of our study was to gain greater insight into the pattern of water contact in relation to schistosomiasis among residents of São Lourenço da Mata, a town in Pernambuco, a state in the Northeast of Brazil. We had two primary objectives: 1) to identify water contact activities that were more likely to produce infection and 2) to examine the socioeconomic factors behind water contact activities. Using a sample of persons 10-25 years old, we carried out a population-based case-control study to investigate the first objective, and a cross-sectional study for the second objective. We found that leisure water contact with flowing water (stream or river) was significantly associated with schistosomiasis. Variables showing a statistically significant association with leisure water contact were economic sector, income, and level of education of the head of the household; type of housing; possessions inside the house; type of domestic water supply; and method of excreta collection. We introduced these variables into a multivariate model to select the ones that were most closely associated with leisure water contact. We used a stepdown procedure, and two variables were retained in the final model: type of domestic water supply and type of housing. We concluded that a decrease in leisure water contact was associated with better socioeconomic conditions. Our results suggest that with the subjects we studied in São Lourenço da Mata there was a socioeconomic determination for leisure water contact. Our data highlight the importance of a broad and integrated approach in studying water contact activities and in implementing behavioral interventions for schistosomiasis prevention and control.
Asunto(s)
Esquistosomiasis/epidemiología , Adolescente , Adulto , Conducta , Brasil , Estudios de Casos y Controles , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Factores Socioeconómicos , Natación , Población Urbana , Agua/parasitologíaRESUMEN
A population-based case-control design was used to investigate the association between migration, urbanisation and schistosomiasis in the Metropolitan Region of Recife, Northeast of Brazil. 1022 cases and 994 controls, aged 10 to 25, were selected. The natives and the migrants who come from endemic areas have a similar risk of infection. On the other hand, the risk of infection of migrants from nonendemic areas seems to be related with the time elapsed since their arrival in São Lourenço da Mata; those who have been living in that urban area for 5 or more years have a risk of infection similar to that of the natives. Those arriving in the metropolitan region of Recife mostly emigrate from "zona da mata" and "zona do agreste" in the state of Pernambuco. Due to the changes in the sugar agroindustry and to the increase in the area used for cattle grazing these workers were driven to villages and cities. The pattern of urbanisation created the conditions for the establishment of foci of transmission in São Lourenço da Mata.
Asunto(s)
Esquistosomiasis/epidemiología , Migrantes , Urbanización , Adolescente , Adulto , Distribución por Edad , Brasil/epidemiología , Estudios de Casos y Controles , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Prevalencia , Factores de Riesgo , Esquistosomiasis/transmisión , Salud UrbanaRESUMEN
A case-control study was conducted to identify risk factors for death from tetanus in the State of Pernambuco, Brazil. Information was obtained from medical records of 152 cases and 152 controls, admitted to the tetanus unit in the State University Hospital, in Recife, from 1990 to 1995. Variables were grouped in three different sets. Crude and adjusted odds ratios, p-values and 95% confidence intervals were estimated. Variables selected in the multivariate analysis in each set were controlled for the effect of those selected in the others. All factors related to the disease progression - incubation period, time elapsed between the occurrence of the first tetanus symptom and admission, and period of onset - showed a statistically significant association with death from tetanus. Similarly, signs and/or symptoms occurring on admission or in the following 24 hours (second set): reflex spasms, neck stiffness, respiratory signs/symptoms and respiratory failure requiring artificial ventilation (third set) were associated with death from tetanus even when adjusted for the effect of the others.
Asunto(s)
Tétanos/mortalidad , Adolescente , Adulto , Anciano , Brasil/epidemiología , Estudios de Casos y Controles , Niño , Intervalos de Confianza , Factores Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Factores de RiesgoRESUMEN
In this article we discuss the methodological issues associated with the creation of a surveillance system for endemic diseases in urban areas based on analysis of populations at risk and on spatially referenced epidemiological indicators. We comment on the system's basic requirements, selection criteria for socioeconomic variables, and methodological steps to combine these variables so as to construct a census-based deprivation index. We also present the ways we solved some operational problems related to generation of digitized census tracts maps and linkage of morbidity data from different sources. This approach, spatial organization into account in surveillance of endemic diseases, exemplified here by tuberculosis and leprosy, allows for the interaction of several official data sets from census and health services in order to geographically discriminate inner-city risk strata. Criteria for constructing these risk strata were considered a useful tool for health planning and management activities for the control of endemic diseases in cities.
Asunto(s)
Enfermedades Endémicas/prevención & control , Vigilancia de la Población , Brasil/epidemiología , Censos , Recolección de Datos , Humanos , Lepra/epidemiología , Lepra/prevención & control , Factores de Riesgo , Factores Socioeconómicos , Tuberculosis/epidemiología , Tuberculosis/prevención & control , Población UrbanaRESUMEN
The objective of this study was to identify biological and social risk factors for the occurrence of microfilaraemia in a population of 1464 children of both sexes aged 5-14 years, living in two highly endemic areas of Recife a city in the northeast of Brazil. A survey was performed from December 1990 to July 1991 and the microfilaraemia was examined by the thick-drop technique using 45 microliters of peripheral blood. Information was obtained about use of bednet, length of time living in area and number of occupants per household. Risk was quantified by the crude and adjusted Odds Ratio. The 95 per cent confidence interval, Likelihood Ratio Statistics, and P value were used to test the statistical significance. An association was established between microfilaraemia in children and adolescents, and age, number of individuals per household, the presence of microfilaraemic adults in the household, length of time living in the area, and bednet use. Maternal microfilaraemia was not found to be a risk factor for the occurrence of microfilaraemia in offspring. These results allow the identification of children with a greater risk of microfilaraemia. In addition, these findings highlight the role of the household environment in the transmission process.