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BACKGROUND: Abortion is a public health problem in Latin America and is more common among women living with HIV. OBJECTIVE: to verify the incidence and factors associated with induced abortion in a cohort of women living with HIV assisted in a reference service for care for individuals with HIV/AIDS in Rio de Janeiro/Brazil. METHODS: Prospective cohort during the period 1996-2016. We estimated the incidence of induced abortions during follow-up in the cohort by calculating person-time incidence rates [per 100 persons-years (PY)] and investigated the factors associated with the outcome "induced abortion" using a generalized linear mixed model. RESULTS: 753 women and 210 pregnancies were included in the present analysis. We estimated an induced abortion incidence rate of 0.68/100 persons-years (95% confidence interval [CI]: 0.47; 0.94) in the study period, with a significant reduction after 2006. The main factors associated with an induced abortion were currently living with a partner (adjusted OR [AdjOR] 0.32 95% CI: 0.10-0.98), number of children (2 children AdjOR 0.12, 95% CI: 0.02-0.95) and the type of antiretroviral treatment used (regimen without Efavirenz: AdjOR: 0.11, 95% CI 0.02-0.70). CONCLUSIONS: We showed a significant reduction in the incidence of induced abortions in a cohort of women living with HIV in Rio de Janeiro, Brazil, probably due to a decrease in the incidence of pregnancies observed in the same period. The factors associated with a lower occurrence of induced abortion suggest a good integration between the clinical and reproductive assistance offered to those women.
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Aborto Inducido , Infecciones por VIH , Humanos , Femenino , Brasil/epidemiología , Adulto , Incidencia , Aborto Inducido/estadística & datos numéricos , Embarazo , Infecciones por VIH/epidemiología , Infecciones por VIH/tratamiento farmacológico , Estudios Prospectivos , Adulto Joven , Factores de Riesgo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Adolescente , Fármacos Anti-VIH/uso terapéuticoRESUMEN
OBJECTIVES: The proportion of older transplant recipients has increased. Cognitive impairment is not rare after kidney transplant, but data on this issue in liver transplant recipients are scarse. MATERIALS AND METHODS: In this cross-sectional study, we evaluated all liver transplant recipients from a single center in Brazil from July 2018 to June 2020 in terms of cognitive performance to determine the prevalence of neurocognitive disorder. We compared liver transplant recipients with neurocognitive disorder with liver transplant recipients without neurocognitive disorder. We also compared those with an alcoholic cause of liver transplant with other patients. The presence of depressive symptoms was assessed. We performed correlations of clinical data with cognitive scores. RESULTS: In a sample of 100 recipients with median age of 62 years (interquartile range, 56.2-69 y), neurocognitive disorder was present in 21% of the group. Patients with cognitive impairment were older (68 y [61-72] vs 61 y [52-68]; P = .019) and had a trend to higher proportion of persistent kidney injury (33.3% vs 13.9%; P = .055) versus patients without cognitive impairment. Recipients with alcoholic cause of liver transplant exhibited worse cognitive performance in the Mini-Mental State Examination (score of 26 [23.7-28.2] vs 28 [26-29]; P = .024) and the Alzheimer Disease Assessment Scale-cognitive (score of 10.4 [8.6-14.2] vs 8 [6.3-10]; P = .008) than other patients. Weak negative correlations were shown in cognitive performance scores versus recipient age (Semantic Verbal Fluency test, r = -0.334 [P = .001]; Clock Drawing test, r = -0.209 [P = .037]; Alzheimer Disease Assessment Scale-cognitive, r = -0.323 [P = .001]). CONCLUSIONS: Neurocognitive disorder was common in liver transplant recipients, in part due to increased age. This study also suggested a role for alcoholic cause of liver transplant and persistent kidney injury in the development of cognitive impairment.
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Cognición , Disfunción Cognitiva , Trasplante de Hígado , Humanos , Estudios Transversales , Trasplante de Hígado/efectos adversos , Persona de Mediana Edad , Masculino , Femenino , Brasil/epidemiología , Factores de Riesgo , Anciano , Prevalencia , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Disfunción Cognitiva/psicología , Resultado del Tratamiento , Factores de Edad , Medición de Riesgo , Hepatopatías Alcohólicas/cirugía , Hepatopatías Alcohólicas/psicología , Hepatopatías Alcohólicas/epidemiología , Hepatopatías Alcohólicas/diagnósticoRESUMEN
The giant African land snail Achatina fulica is known to be the intermediate host of a number of nematode species that are prejudicial to human and veterinary health, being also an agricultural and urban pest. The present study investigated the presence of nematodes in A. fulica and other terrestrial mollusks in 24 municipalities of Sergipe State, northeastern of Brazil, in the dry and rainy seasons. In 2019 and 2020, the specimens were collected in standard 20 m × 10 m plots (10 min/01 collector), while in 2021, they were collected by convenience sampling. The nematode species were identified based on sequencing of the mitochondrial Cytochrome C Oxidase Subunit I (COI) gene and the ribosomal nuclear Internal Transcribed Spacer (ITS 2). Specimens of A. fulica infected with Angiostrongylus cantonensis, a nematode that causes eosinophilic meningitis (EM) in humans and animals, were collected in four municipalities. Two nematodes of veterinary importance were also identified, Aelurostrongylus abstrusus and Cruzia tentaculata in seven municipalities. This is the first record of Cruzia tentaculata in Sergipe. Free-living nematodes were also found in 18 municipalities. One of these species - Caenorhabditis briggsae - was identified in the municipality of Itabaiana. Specimens of other mollusks species were also collected. Only one of these mollusks, C. fasciata from Japaratuba, was found infected with free-living nematodes. A. fulica showed greater positivity for nematodes in the dry season, especially in the regions of Lower São Francisco River, Greater Aracaju and South Central Sergipe. The probability of infection increased when mollusks were larger and more recurrent in plots. Given that A. cantonensis is the etiological agent of EM and was found associated to A. fulica in four municipalities, it will be important to implement programs of continuous monitoring of the mollusk's fauna, combined with educational programs that provide information necessary to control A. fulica.
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Caracoles , Animales , Brasil/epidemiología , Caracoles/parasitología , Nematodos/aislamiento & purificación , Nematodos/clasificación , Especies Introducidas , Humanos , Estaciones del AñoRESUMEN
A detailed clinical-epidemiological analysis of feline sporotrichosis was conducted, and 288 cases reported between the years 2007 and 2018 were analyzed. The studied cases primarily involved mongrel cats (240/260), males (212/282), and adults (121/200). The main objectives were to identify the risk factors, calculate the monthly incidence rates, and establish a predictive model using the seasonal autoregressive integrated moving average (SARIMA) approach. The statistical analysis revealed significant associations (p < 0.05) between prolonged lesion evolution times and factors such as respiratory signs, prior treatments, and lesion contact. Empirical treatment was identified as a significant risk factor for disease progression. Moreover, the number of cases demonstrated an increasing trend over the study period, with annual peaks noted in disease incidence. The SARIMA model proved to be an effective tool for forecasting the incidence of sporotrichosis, offering robust support for epidemiological surveillance and facilitating targeted public health interventions in endemic regions. The predictive accuracy of the developed model underscored its utility in enhancing disease monitoring and supporting proactive health measures for the effective management of sporotrichosis.
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Enfermedades de los Gatos , Predicción , Esporotricosis , Animales , Esporotricosis/epidemiología , Esporotricosis/veterinaria , Gatos , Enfermedades de los Gatos/epidemiología , Brasil/epidemiología , Incidencia , Masculino , Femenino , Factores de Riesgo , Epidemias/veterinaria , Estaciones del AñoRESUMEN
BACKGROUND: The infection caused by Treponema pallidum remains a severe public health problem, with a high prevalence in individuals over 60 years. However, research into infections such as syphilis continues to be neglected in geriatrics. This study aims to evaluate data on the detection rate of syphilis in Brazil, in individuals between 60 and 120 years, by characterizing the epidemiological profile and respective factors associated with it, in addition to performing a temporal trend analysis, from 2010 to 2020. METHODOLOGY: Ecological, time-series study, which started with the collection of notifications from the database of the Information System on Compulsory Notification of Diseases. The epidemiological profile was characterized based on sociodemographic variables. The Statistical Package for the Social Sciences program, version 19.0, was used for incidence and prevalence analysis. The 2010 census by the Brazilian Institute of Geography and Statistics and projections for older people were considered. In the trend analysis, the Joinpoint regression model was used. MAIN FINDINGS: There was an upward variation in the detection of syphilis in older people from 2010 to 2018, with a peak in 2018. In 2019, there was a slight reduction in the notification of cases, which was accentuated in 2020. The prevalence of the infection was equivalent to 12.84 cases for each 100,000 Brazilians, with a mean age of 68.04 years (±7.15) for those between 60 and 120 years, being higher in white and black males. The highest proportion of older people with syphilis occurred in the South and Southeast regions. However, the trend analysis showed a significant and homogeneous increase in all regions of Brazil, for both sexes and all age groups. CONCLUSIONS: There is a tendency for an increase in cases of syphilis in older people, which reinforces the need to plan health actions to combat the disease in this population.
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Sífilis , Humanos , Sífilis/epidemiología , Brasil/epidemiología , Anciano , Masculino , Femenino , Persona de Mediana Edad , Anciano de 80 o más Años , Prevalencia , Incidencia , Treponema pallidumRESUMEN
OBJECTIVE: To describe the profile of individuals with depression who received assistance at CAPS in Brazil between 2013 and 2019, focusing on their clinical and demographic characteristics, and to calculate the estimated coverage of CAPS across the national territory and its constituent federal units. METHODS: Descriptive, ecological, time-series study with secondary data from national databases, referring to care provided at CAPS in the country for adults aged 18 years or over-diagnosed with depression (F32-32.9 and F33-F33.9). The estimated coverage of CAPS was calculated for 2013 and 2019 using registered and active services. RESULTS: There was a 107% increase in the number of patients with depression receiving treatment at CAPS between 2013 and 2019. Women accounted for 77% of the patients, with the majority falling within the age range of 41 to 61years (49%). The predominant racial demographics were white (38%) and brown (34%). The diagnosis of depressive episodes was prevalent among 65% of the patients, and individual care was administrated to 75% of them. The presumed CAPS coverage was 71% in 2013 and increased to 87% in 2019 nationwide, although significant discrepancies were observed among different states. CONCLUSION: Progress was evident in the implementation of CAPS across Brazil during the period spanning 2013 to 2019. Nonetheless, disparities persist among the federative units, and there remains an underutilization of group and family care within CAPS services.
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Depresión , Humanos , Brasil/epidemiología , Femenino , Adulto , Masculino , Persona de Mediana Edad , Depresión/epidemiología , Depresión/terapia , Adulto Joven , Adolescente , Anciano , Servicios de Salud Mental/estadística & datos numéricosRESUMEN
The measures implemented to contain the COVID-19 pandemic resulted in both behavioral and lifestyle changes. The "Changes in Lifestyle-Related Behavior" instrument was developed to assess lifestyle-related behaviors in the Indian population. However, considering current knowledge, this instrument was not adapted for the Brazilian population. In addition, the relationship between fear of COVID-19 and consumption of dietary supplements has not yet been evaluated. Thus, we aimed to investigate the relationship between the use of dietary supplements with lifestyle behavior and the fear of COVID-19, as well as assess the psychometric properties of the Brazilian version of the "Changes in Lifestyle-Related Behavior" instrument. An online questionnaire assessed sociodemographic, occupational, anthropometric, physical activity (International Physical Activity Questionnaire-short form), fear of COVID-19, and lifestyle behavior data from 416 Brazilian adults (237 females; 18-60y). Mann-Whitney, Chi-square test, exploratory, and confirmatory analyses were applied. Exploratory and confirmatory analyses showed a satisfactory adequacy level of the questionnaire (CMIN/DF = 2.689; Cronbach's α = 0.60) with 5 domains ('Bad eating behavior'; 'Healthy eating'; 'Sleep quality'; 'Interest in cooking'; 'Number of portions and meals'). Lower fear of COVID-19 scores and higher levels of physical activity were found in participants who reported previous dietary supplement intake during the pandemic; in addition, the group that did not ingest dietary supplements reported greater changes in stress and anxiety levels during the pandemic (p<0.05). The intake of dietary supplements before the pandemic was associated with greater energy expenditure and better coping with the fear of COVID-19 during the pandemic. Additionally, the Changes in Lifestyle-Related Behavior tool can be used to assess lifestyle-related variables during the pandemic.
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COVID-19 , Suplementos Dietéticos , Ejercicio Físico , Miedo , Humanos , COVID-19/psicología , COVID-19/epidemiología , Femenino , Masculino , Adulto , Miedo/psicología , Persona de Mediana Edad , Encuestas y Cuestionarios , Brasil/epidemiología , Adolescente , Adulto Joven , SARS-CoV-2 , Estilo de Vida , Conducta Alimentaria/psicología , Pandemias , Psicometría/métodosRESUMEN
INTRODUCTION: Heart transplantation is the gold standard for advanced heart failure treatment. This study examines the survival rates and risk factors for early mortality in adult heart transplant recipients at a Brazilian center. METHODS: This retrospective cohort study involved 255 adult heart transplant patients from a single center in Brazil. Data were collected from medical records and databases including three defined periods (2012-2015, 2016-2019, and 2020-2022). Statistical analysis employed Kaplan-Meier survival curves, Cox proportional hazards analysis for 30-day mortality risk factors, and Log-rank tests. RESULTS: The recipients were mostly male (74.9%), and the mean age was 46.6 years. Main causes of heart failure were idiopathic dilated cardiomyopathy (33.9%), Chagas cardiomyopathy (18%), and ischemic cardiomyopathy (14.3%). The study revealed an overall survival of 68.1% at one year, 58% at five years, and 40.8% at 10 years after heart transplantation. Survivalimproved significantly over time, combining the most recent periods (2016 to 2022) it was 73.2% in the first year and 63% in five years. The main risk factors for 30-day mortality were longer time on cardiopulmonary bypass, the initial period of transplants (2012 to 2015), older age of the donor, and nutritional status of the donor (overweight or obese). The main causes of death within 30 days post-transplant were infection and primary graft dysfunction. CONCLUSION: The survival analysis by period demonstrated that the increased surgical volume, coupled with the team's experience and modifications to the immunosuppression protocol, contributed to the improved early and mid-term outcomes.
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Insuficiencia Cardíaca , Trasplante de Corazón , Humanos , Masculino , Trasplante de Corazón/mortalidad , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Brasil/epidemiología , Adulto , Factores de Riesgo , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/cirugía , Estimación de Kaplan-Meier , Tasa de Supervivencia , Análisis de Supervivencia , Factores de Tiempo , Modelos de Riesgos ProporcionalesRESUMEN
Cervical cancer screening in Brazil is opportunistic, based on cytology and offered for women aged 25-64 years, with low coverage (30%) and 70% of cancer diagnoses done in advanced stages, without impact on mortality. The current study reports 5-year first-round results of a population-based DNA-HPV testing screening program in a Brazilian city, which intended to be a model for transition to a more efficient program. Program flowchart is simple and current, indicating repetition of a negative test after five years. The first-round (October 2017-September 2022) screened 20,551 women by DNA-HPV testing with 58.7% coverage and 99.4% compliance with the program's targeted age range. Coverage increases to 77.8% when excluding the 'pandemic period'. The DNA-HPV testing was 87.2% negative with 6.2% colposcopy referrals and 84.8% colposcopies performed. A total of 258 high-grade precursor lesions and 29 cervical cancers (mean age = 41.4 years, 83% Stage I) were detected. As a reference, 41,387 cytology tests from the previous program (2012-2016) detected 36 cervical cancers (mean age = 52.0 years, p = 0.0005), with 67% in advanced stages (p < 0.0001). Organizing cervical cancer screening using DNA-HPV testing demonstrated good coverage, high age and colposcopy compliance, and detection of more precancerous lesions and cervical cancers 10 years in advance.
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Detección Precoz del Cáncer , Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Humanos , Femenino , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/virología , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/epidemiología , Persona de Mediana Edad , Adulto , Detección Precoz del Cáncer/métodos , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/virología , Brasil/epidemiología , ADN Viral/genética , Colposcopía , Tamizaje Masivo/métodos , Papillomaviridae/genética , Papillomaviridae/aislamiento & purificación , Prevalencia , AncianoRESUMEN
During the COVID-19 pandemic, fungal infections, especially pulmonary aspergillosis, mucormycosis, and invasive candidiasis, have emerged as a significant health concern. Beyond Candida albicans, the most common cause of invasive candidiasis, other rare ascomycetous yeast species have been described in tertiary care units, potentially posing a broader health threat. We have isolated, from September 2020 to June 2021, nine Diutina catenulata strains from urine samples of six patients. This was intriguing as this fungus had not been previously identified in our institution, nor after June 2021. Therefore, we decided to outline the clinical features of the patients with this rare pathogen, to describe phenotypic characteristics, including antifungal susceptibility profiles, of this yeast species and to identify the genetic makeup through whole-genome sequencing analysis to evaluate if this was a cluster of genetically similar D. catenulata isolates in our institution. The strains were identified through MALDI-TOF MS analyses and Sanger sequencing of two rDNA regions. All patients yielding D. catenulata from urine samples needed ventilator support and used urinary catheters during hospitalization for treatment of COVID-19. None of them had received COVID-19 vaccines. Morphological and biochemical profiles of the nine strains were largely consistent, although fluconazole susceptibility varied, ranging from 4 to 32 µg/mL. Phylogenomic analysis revealed minimal genetic variation among the isolates, with low intrapopulation variation, supported by the identification of only 84 SNPs across all strains. Therefore, we propose that the yeast strains isolated were part of a cluster of D. catenulata funguria in the context of COVID-19.
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Antifúngicos , COVID-19 , SARS-CoV-2 , Centros de Atención Terciaria , Humanos , COVID-19/microbiología , COVID-19/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Brasil/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Antifúngicos/uso terapéutico , Antifúngicos/farmacología , SARS-CoV-2/genética , SARS-CoV-2/efectos de los fármacos , Anciano , Adulto , Filogenia , Pruebas de Sensibilidad Microbiana , Saccharomycetales/genética , Saccharomycetales/aislamiento & purificación , Saccharomycetales/clasificación , Secuenciación Completa del GenomaRESUMEN
OBJECTIVE: To describe the prevalence of food poverty according to dimensions of socio-economic inequality and the food groups consumed by Brazilian children. DESIGN: Dietary data from a structured qualitative questionnaire collected by the Brazilian National Survey on Child Nutrition (ENANI-2019) were used. The new UNICEF indicator classified children who consumed 3-4 and <3 out of the eight food groups as living in moderate and severe food poverty, respectively. The prevalence of consumption of each food group and ultra-processed foods (UPF) was estimated by level of food poverty according to age categories (6-23; 24-59 months). The most frequent combinations of food groups consumed by children living in severe food poverty were calculated. Prevalence of levels of food poverty were explored according to socio-economic variables. SETTING: 123 municipalities of the five Brazilian macro-regions. PARTICIPANTS: 12 582 children aged 6-59 months. RESULTS: The prevalence of moderate and severe food poverty was 32·5 % (95 % CI 30·1, 34·9) and 6·0 % (95 % CI 5·0, 6·9), respectively. Children whose mother/caregiver had lower education (<8 years) and income levels (per capita minimum wage <») had the highest severe food poverty prevalence of 8·3 % (95 % CI 6·2, 10·4) and 7·5 % (95 % CI 5·6, 9·4), respectively. The most consumed food groups among children living in food poverty in all age categories were 'dairy products', 'grains, roots, tubers, and plantains' and 'ultra-processed foods'. CONCLUSION: Food poverty prevalence was high among Brazilian children. A significant occurrence of milk consumption associated with grains and a considerable prevalence of UPF consumption were found among those living in severe food poverty.
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Encuestas Nutricionales , Pobreza , Factores Socioeconómicos , Humanos , Brasil/epidemiología , Lactante , Preescolar , Femenino , Masculino , Pobreza/estadística & datos numéricos , Prevalencia , Dieta/estadística & datos numéricos , Abastecimiento de Alimentos/estadística & datos numéricos , Comida Rápida/estadística & datos numéricosRESUMEN
INTRODUCTION: Considering the relationship between Gestational Diabetes Mellitus and maternal and perinatal adverse outcomes, it's pertinent to investigate whether this diagnosis is a predictor of fear of childbirth. As there is little data about the fear of childbirth in Brazil, it´s necessary to understand better the population, and this way the authors can identify factors that influence this fear as well as propose public health policies to treat it. OBJECTIVE: The main goal was to compare the prevalence of fear of childbirth between the groups of low-risk pregnancy and gestational diabetes mellitus. MATERIAL AND METHODS: In this cohort study, the sample consisted of 319 patients divided into low-risk pregnancy group (n = 152) and gestational diabetes mellitus group (n = 167). Patients have undergone a semi-structured interview with epidemiological, obstetric, and anthropometric data and the main cause of fear of childbirth. In addition, the patients have marked an "X" on the scale into the Fear of Birth Scale to describe their fear. After delivery, data have been collected through electronic medical records. RESULTS: The prevalence of fear of childbirth found was higher for the gestational diabetes mellitus group (46.05%) compared to the low-risk pregnancy group (34.73%) with a cutoff score ≥ 54. In the whole sample, the main cause of fear of childbirth (score ≥ 60) was the pain of labor and delivery (31.58%). CONCLUSIONS: The prevalence of fear of childbirth in the present study was greater than 30%, highlighting the relevance of implementing this assessment during prenatal care.
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Diabetes Gestacional , Miedo , Parto , Humanos , Diabetes Gestacional/psicología , Embarazo , Femenino , Miedo/psicología , Adulto , Parto/psicología , Brasil/epidemiología , Adulto Joven , Factores de Riesgo , Estudios de Cohortes , Prevalencia , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
Visceral leishmaniasis (VL) is an urgent public health concern in Brazil. We evaluated the spatiotemporal distribution of VL to better understand the effects of economic activities related to agriculture, livestock, and deforestation on its incidence in the Brazilian Legal Amazon (BLA). The data on newly confirmed cases of VL in Brazilian municipalities from 2007 to 2020 were extracted from the Brazilian Notifiable Diseases Information System (SINAN) and analyzed. The data on agricultural production (planted area in hectares) and livestock (total number of cattle) were obtained from the Brazilian Institute of Geography and Statistics (IBGE), whereas deforestation data (in hectares) were obtained from the Amazon Deforestation Estimation Project (PRODES). SatScan and the local indicators of spatial association (LISA) were used to identify the spatial and temporal patterns of VL and its relationships with economic and environmental variables. The cumulative incidence rate was found to be 4.5 cases per 100,000 inhabitants. Based on the LISA results, areas with a high incidence of VL and deforestation were identified in the states of Roraima, Pará, and Maranhão. Strengthening deforestation monitoring programs and environmental enforcement actions can help implement public policies to control illegal deforestation and mitigate the socio-environmental vulnerability in the BLA. Therefore, areas identified in this study should be prioritized for controlling VL.
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Agricultura , Conservación de los Recursos Naturales , Leishmaniasis Visceral , Ganado , Análisis Espacio-Temporal , Brasil/epidemiología , Leishmaniasis Visceral/epidemiología , Leishmaniasis Visceral/transmisión , Animales , Ganado/parasitología , Humanos , Incidencia , BovinosRESUMEN
INTRODUCTION: Southern Hemisphere countries have been underrepresented in epidemiological studies on acute kidney injury (AKI). The objectives of this study were to determine the frequency, risk factors, and outcomes of AKI in adult hospitalized patients from the emergency department of a public high-complexity teaching hospital in the city of São Paulo, Brazil. METHODS: Observational and prospective study. AKI was defined by the KDIGO guidelines (Kidney Disease: Improving Global Outcomes) using only serum creatinine. RESULTS: Among the 731 patients studied (age: median 61 years, IQR 47-72 years; 55% male), 48% had hypertension and 28% had diabetes as comorbidities. The frequency of AKI was 52.1% (25.9% community-based AKI [C-AKI] and 26.3% hospital-acquired AKI [H-AKI]). Dehydration, hypotension, and edema were found in 29%, 15%, and 15% of participants, respectively, at hospital admission. The in-hospital and 12-month mortality rates of patients with vs. without AKI were 25.2% vs. 11.1% (p<0.001) and 36.7% vs. 12.9% (p<0.001), respectively. The independent risk factors for C-AKI were chronic kidney disease (CKD), chronic liver disease, age, and hospitalization for cardiovascular disease. Those for H-AKI were CKD, heart failure as comorbidities, hypotension, and edema at hospital admission. H-AKI was an independent risk factor for death in the hospital, but not at 12 months. C-AKI was not a risk factor for death. CONCLUSIONS: AKI occurred in more than half of the admissions to the clinical emergency department of the hospital and was equally distributed between C-AKI and H-AKI. Many patients had correctable risk factors for AKI, such as dehydration and arterial hypotension (44%) at admission. The only independent risk factor for both C-AKI and H-AKI was CKD as comorbidity.
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Lesión Renal Aguda , Servicio de Urgencia en Hospital , Hospitales Universitarios , Humanos , Persona de Mediana Edad , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Brasil/epidemiología , Masculino , Femenino , Anciano , Estudios Prospectivos , Factores de Riesgo , Servicio de Urgencia en Hospital/estadística & datos numéricos , Mortalidad Hospitalaria , Adulto , Hospitalización/estadística & datos numéricos , ComorbilidadRESUMEN
BACKGROUND: Gestational weight gain (GWG) is a critical factor for maternal and fetal health. OBJECTIVE: To identify maternal predictors of inadequate GWG according to the 2009 Institute of Medicine (IOM) recommendations and Intergrowth-21st standards. METHODS: A prospective epidemiological cohort study conducted from 2017 to 2023 in southeastern Brazil assessed 1,557 women at three different stages of pregnancy (≤ 18, 20-26, and 30-36 weeks of gestation) and at delivery. Sociodemographic, obstetric, lifestyle, nutritional, and maternal morbidity characteristics were collected, along with biochemical parameters. RESULTS: Among the participants, 38.7% had GWG above IOM recommendations, while 67.5% had GWG above the Intergrowth-21st standards. Multinomial logistic regression analysis showed that women with pre-pregnancy obesity and women with the highest body fat percentage had, respectively, a 95% (OR = 1.95; 95% CI: 1.08-3.51) and 1% (OR = 1.01; 95% CI: 1.01-1.05) higher chance of GWG above IOM recommendations. Pregnant women in the lowest tertile of height, smokers, number of previous pregnancies, and women living in crowded homes had, respectively, a 57% (OR = 0.57; 95% CI: 0.41-0.80), 36% (OR = 0.64; 95% CI: 0.37-0.86), 35% (OR = 0.65; 95% CI: 0.43-0.97), and 14% (OR = 0.86; 95% CI: 0.59-0.86) lower chance of GWG above IOM recommendations. Women with diabetes were 2.53 times more likely (OR = 2.53; 95% CI: 1.32-4.83) to have GWG below IOM recommendations. Using the Intergrowth-21st standards, women with the highest body fat percentage had a 12% (OR = 1.12; 95% CI: 1.02-1.24) higher chance of GWG above the 90th percentile. Pregnant women in the lowest tertile of height were 2.82 times more likely (OR = 2.82; 95% CI: 1.08-8.13) and women with the lowest hemoglobin concentrations had a 41% lower chance (OR = 0.59; 95% CI: 0.39-0.88) of having GWG below the 10th percentile. While both guidelines identified body fat percentage and pre-pregnancy obesity as significant predictors of excessive GWG, the Intergrowth-21st standards captured a higher percentage of women exceeding GWG limits. CONCLUSION: The findings underscore the importance of comparing two instruments for assessing the adequacy of GWG. The IOM and Intergrowth-21st standards provide complementary insights, which can help implement targeted interventions for specific groups of women based on their nutritional and socioeconomic status, lifestyle, and obstetric factors to prevent pregnancy-related complications.
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Ganancia de Peso Gestacional , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Humanos , Femenino , Embarazo , Adulto , Estudios Prospectivos , Brasil/epidemiología , Adulto Joven , Estados Unidos , Estudios de Cohortes , Complicaciones del Embarazo/epidemiología , Obesidad/epidemiología , Índice de Masa CorporalRESUMEN
BACKGROUND: The coronavirus 2019 (COVID-19) pandemic impacted cancer health care in several countries, with delays in the detection and treatment of breast and cervical cancer. The objective of this study is to analyze and compare the screening, diagnosis and treatment of breast and cervical cancer in the pre-COVID period and during the COVID-19 period. METHODS: Cross-sectional study with secondary data collected from the Mortality Information System (SIM), Hospital Information System (SIH), Ambulatory Information System (SIA) and the Oncology Panel (PO) of breast cancer notifications with ICD C50.0 to C50.9 and cervix ICD C53.0 to C53.9, The analyzed period before the pandemic was from March 1 to October 1, 2019, and during the pandemic from March 1 to October 1, 2020. The period from 2013 to 2022 was also analyzed with the same information, including the number of diagnoses, treatments, and deaths from breast cancer and cervical cancer. The study population consisted of Brazilian women aged 25 to 70 years. In order to compare categorical variables between periods, the Chi-Square or Fisher's Exact tests, and Mann-Whitney U tests were applied, and the Poisson Regression model was applied to model the number of reported cases of COVID-19 and the amount of procedures. RESULTS: There was a decrease in the number of mammograms and cytopathological exams during COVID-19, as well as a decrease in cases of breast and cervical cancer. The Poisson regression showed that the increase in the number of COVID-19 cases caused a decrease in the number of breast cytopathological examinations, cervical-vaginal cytopathological examinations/microflora and screening, diagnosis, initiation of treatment for breast cancer and deaths from this disease. Meanwhile, in some regions of Brazil, as the number of Covid-19 increased, there was a significantly increase in the number of mammograms performed and cervical cancer diagnoses. CONCLUSIONS: The COVID-19 period in 2020 significantly impacted screening, diagnosis, treatment for breast and cervical cancer.
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Neoplasias de la Mama , COVID-19 , Detección Precoz del Cáncer , Neoplasias del Cuello Uterino , Humanos , Femenino , COVID-19/epidemiología , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/patología , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/patología , Persona de Mediana Edad , Estudios Transversales , Adulto , Brasil/epidemiología , Anciano , Detección Precoz del Cáncer/estadística & datos numéricos , SARS-CoV-2RESUMEN
BACKGROUND: Global dengue cases are rising, notably in Brazil. METHODS: By using monthly data, we estimated linear regressions with ARIMA errors to measure the influence of temperature and precipitation on dengue incidence in the city of Campinas, São Paulo State, Brazil. RESULTS: Findings suggest that a 1°C increase in mean temperature can lead to a cumulative increase of up to 40% in dengue incidence within 2 months. Precipitation shows no significant impact. CONCLUSIONS: Results highlight the importance of temperature on the spread of dengue and potentially other mosquito-borne diseases.
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Dengue , Temperatura , Brasil/epidemiología , Dengue/epidemiología , Incidencia , Humanos , Lluvia , Estaciones del AñoRESUMEN
BACKGROUND: Trachoma is the leading infectious cause of blindness worldwide. It is a neglected tropical disease caused by Chlamydia trachomatis. The objective of this study was to analyze the trachoma-associated morbidity and mortality in Brazil from 2000 to 2022. This ecological time-series study was based on secondary data on trachoma obtained from hospital admissions (trachoma as the primary or secondary cause) and death certificates (trachoma as the underlying or associated cause). METHODS: We calculated the sex- and age-standardized rates of hospital admissions and trachoma-specific mortality according to sociodemographic variables and analyzed the spatial distribution. RESULTS: We identified 141/263,292,807 hospital admissions (primary cause: 83.0%) and 126/27,596,830 death certificates (associated cause: 91.3%) related to trachoma. Trachoma-related sequelae were reported in 8.5% of hospital admissions and 6.3% of death certificates. Trachoma was more common in males (hospital admissions and death certificates), people aged ≥70 years (hospital admissions and death certificates), those with brown skin (hospital admissions and death certificates), and those living in the North (hospital admissions) and Northeast (death certificates) regions of Brazil. CONCLUSIONS: Despite the relatively low rates of trachoma morbidity in Brazil, the associated mortality rates are of concern. The heterogeneous patterns of occurrence in the country in terms of population and territory reinforce the need to evaluate and monitor the available data, despite the low prevalence, in order to achieve and maintain the elimination targets in Brazil in the future.
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Hospitalización , Tracoma , Humanos , Tracoma/mortalidad , Brasil/epidemiología , Masculino , Femenino , Hospitalización/estadística & datos numéricos , Persona de Mediana Edad , Anciano , Adolescente , Niño , Adulto , Preescolar , Lactante , Adulto Joven , Factores Socioeconómicos , Recién Nacido , Anciano de 80 o más Años , Distribución por Sexo , Distribución por Edad , Certificado de DefunciónRESUMEN
OBJECTIVES: to assess patient safety culture during the COVID-19 pandemic and identify the dimensions that need to be improved in hospital settings and which sector, open or closed, direct or indirect care, exhibits a higher level of safety culture. METHODS: a descriptive and cross-sectional study. The validated version for Brazil of the Hospital Survey on Patient Safety Culture instrument was applied to assess patient safety culture. Those dimensions with 75% positive responses were considered strengthened. RESULTS: all dimensions presented results lower than 75% of positive responses. Closed sectors showed a stronger safety culture compared to open ones. Indirect care sectors had a low general perception of patient safety when compared to direct care sectors. CONCLUSIONS: with the pandemic, points of weakness became even more evident, requiring attention and incisive interventions from the institution's leaders.
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COVID-19 , Pandemias , Seguridad del Paciente , SARS-CoV-2 , Humanos , Estudios Transversales , COVID-19/epidemiología , Brasil/epidemiología , Seguridad del Paciente/normas , Seguridad del Paciente/estadística & datos numéricos , Encuestas y Cuestionarios , Administración de la Seguridad/métodos , Administración de la Seguridad/normas , Hospitales , Cultura OrganizacionalRESUMEN
BACKGROUND: Routine screening for viral infections at blood donation is important to avoid transfusion-transmitted infections. It also offers an opportunity to detect an asymptomatic infection. OBJECTIVE: To study changes in serology positivity for viral infections (B and C hepatitis, HTLV-1/2, and HIV) at blood donation in a blood bank from Southern Brazil, comparing two periods of 5 years: the period from 2013 to 2017 with the period from 2018 to 2022. In addition, data on the donor fidelity rate during the studied period were sought. METHODS: Retrospective study using data from 2013 to 2022 from a single blood center electronic database from Curitiba, Southern Brazil. RESULTS: A significant drop in positive serology for all studied viruses was observed: highest in HIV (OR=0.39; 95% CI=0.27-0.57) and lowest in total anti HBc (0.56; 95 CI=0.50-0.63). Anti HBc serology became more commonly seen in women in the period of 2018-2022 when compared to men. No changes in the distribution of positive serology according to donors' ages were observed. Loyalty rates had a median of 70%, with the lowest being 60% in 2013, while the highest was 73% in 2018 and 2022. CONCLUSION: A significant reduction in discarded blood bags due to viral serology was observed when the period of 2013-2017 was compared to 2018-2022 on this blood bank; the highest reduction was observed in HIV serology and the lowest in HBc serology, which became more common in women in the second period. High rates of donor fidelity were observed during the period studied.