Zika Brazilian Cohorts (ZBC) Consortium: protocol for an individual participant data meta-analysis of congenital Zika syndrome after maternal exposure during pregnancy

Despite great advances in our knowledge of the consequences of Zika virus to human health, many questions remain unanswered, and results are often inconsistent. The small sample size of individual studies has limited inference about the spectrum of congenital Zika manifestations and the prognosis of affected children. The Brazilian Zika Cohorts Consortium addresses these limitations by bringing together and harmonizing epidemiological data from a series of prospective cohort studies of pregnant women with rash and of children with microcephaly and/or other manifestations of congenital Zika. The objective is to estimate the absolute risk of congenital Zika manifestations and to characterize the full spectrum and natural history of the manifestations of congenital Zika in children with and without microcephaly. This protocol describes the assembly of the Consortium and protocol for the Individual Participant Data Meta-analyses (IPD Meta-analyses). The findings will address knowledge gaps and inform public policies related to Zika virus. The large harmonized dataset and joint analyses will facilitate more precise estimates of the absolute risk of congenital Zika manifestations among Zika virus-infected pregnancies and more complete descriptions of its full spectrum, including rare manifestations. It will enable sensitivity analyses using different definitions of exposure and outcomes, and the investigation of the sources of heterogeneity between studies and regions

Risk factors and diagnosis of diabetic foot ulceration in users of the Brazilian public health system

Background. An individual with diabetes mellitus (DM) has an approximately 25% risk of developing ulcerations and/or destruction of the feet’s soft tissues. These wounds represent approximately 20% of all causes of hospitalizations due to DM. Objective. To identify the factors for the development of diabetic foot ulceration (DFU) among individuals treated by the Brazilian public health system. Methods. This cross-sectional study was conducted on individuals with diabetes mellitus, aged above 18 years, of both sexes, and during July-October 2018 within a public healthcare unit in Brazil. All participants were assessed based on their socioeconomic, behavioral, and clinical characteristics, along with vascular and neurological evaluations. All participants were also classified according to the classification of risk of developing DFU, in accordance with the International Working Group on the Diabetic Foot (IWGDF). Statistical analyses were conducted using the chi-squared test, chi-squared test for trend, and Fisher’s exact test, with a significance level of 5% (p < 0 05). Results. The study consisted of 85 individuals. The DFU condition was prevalent in 10.6% of the participants. Adopting the classification proposed by IWGDF, observed risks for stratification categories 0, 1, 2, and 3 were 28.2%, 29.4%, 23.5%, and 8.2%, respectively. A statistically significant (p < 0 05) association was observed between the development of DFU and the following variables: time since the diagnosis of diabetes and the appearance of the nails, humidity, and deformations on the feet. Conclusion. The present study found an elevated predominance of DM patients in the Brazilian public health system (SUS) featuring cutaneous alterations that may lead to ulcers; these individuals had elevated risks of developing DFU. Furthermore, it was revealed that the feet of patients were not physically examined during treatment

Three-Year Clinical Follow-Up of Children Intrauterine Exposed to Zika Virus

Congenital Zika virus (ZIKV) infection may present with a broad spectrum of clinical manifestations. Some sequelae, particularly neurodevelopmental problems, may have a later onset. We conducted a prospective cohort study of 799 high-risk pregnant women who were followed up until delivery. Eighty-three women and/or newborns were considered ZIKV exposed and/or infected. Laboratory diagnosis was made by polymerase chain reaction in the pregnant mothers and their respective newborns, as well as Dengue virus, Chikungunya virus, and ZIKV serology. Serology for toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, and syphilis infections were also performed in microcephalic newborns. The newborns included in the study were followed up until their third birthday. Developmental delay was observed in nine patients (13.2%): mild cognitive delay in three patients, speech delay in three patients, autism spectrum disorder in two patients, and severe neurological abnormalities in one microcephalic patient; sensorineural hearing loss, three patients and dysphagia, six patients. Microcephaly due to ZIKV occurred in three patients (3.6%). Clinical manifestations can appear after the first year of life in children infected/exposed to ZIKV, emphasizing the need for long-term follow-up

Zika Brazilian Cohorts (ZBC) Consortium: Protocol for an Individual Participant Data Meta-Analysis of Congenital Zika Syndrome after Maternal Exposure during Pregnancy.

Despite great advances in our knowledge of the consequences of Zika virus to human health, many questions remain unanswered, and results are often inconsistent. The small sample size of individual studies has limited inference about the spectrum of congenital Zika manifestations and the prognosis of affected children. The Brazilian Zika Cohorts Consortium addresses these limitations by bringing together and harmonizing epidemiological data from a series of prospective cohort studies of pregnant women with rash and of children with microcephaly and/or other manifestations of congenital Zika. The objective is to estimate the absolute risk of congenital Zika manifestations and to characterize the full spectrum and natural history of the manifestations of congenital Zika in children with and without microcephaly. This protocol describes the assembly of the Consortium and protocol for the Individual Participant Data Meta-analyses (IPD Meta-analyses). The findings will address knowledge gaps and inform public policies related to Zika virus. The large harmonized dataset and joint analyses will facilitate more precise estimates of the absolute risk of congenital Zika manifestations among Zika virus-infected pregnancies and more complete descriptions of its full spectrum, including rare manifestations. It will enable sensitivity analyses using different definitions of exposure and outcomes, and the investigation of the sources of heterogeneity between studies and regions

Appraisal of positive predictive value of clinical suspicion of dengue in epidemic periods in Brazil, from 2000 to 2010

Submitted by Luciana Ferreira ([email protected]) on 2016-08-24T13:56:02Z No. of bitstreams: 2 Dissertação - Ana Laura de Sene Amâncio Zara - 2012.pdf: 2518810 bytes, checksum: 21843aab88508deb89623fca7e3dbfe3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Approved for entry into archive by Luciana Ferreira ([email protected]) on 2016-08-24T13:56:24Z (GMT) No. of bitstreams: 2 Dissertação - Ana Laura de Sene Amâncio Zara - 2012.pdf: 2518810 bytes, checksum: 21843aab88508deb89623fca7e3dbfe3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Made available in DSpace on 2016-08-24T13:56:24Z (GMT). No. of bitstreams: 2 Dissertação - Ana Laura de Sene Amâncio Zara - 2012.pdf: 2518810 bytes, checksum: 21843aab88508deb89623fca7e3dbfe3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2012-02-24Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESIntroduction: the positive predictive value (PPV) is one of the quantitative attributes of surveillance systems. The evaluation of this attribute is essential due to its usefulness in routine dengue control activities and adequate clinical management of suspected cases. Objective: to analyze the PPV of dengue reported cases with a focus on the epidemic periods. Methods: we conducted an observational descriptive cross sectional study using secondary data from the National Surveillance Information System. Cases reported from 2000 to 2010 with IgM ELISA test result from a blood sample collected between the 6th and 30th day after the onset of symptoms were selected for the study. PPV was estimated as the proportion of cases that were confirmed among the dengue suspected cases that were tested using the serological test. Results: Globally, the PPV varied from 46% to 71% during epidemic periods and from 27% to 47.5% during non-epidemic periods. No difference on the PPV according to sex or population size of municipalities was observed. PPV increased with age, with a similar pattern in all the years analyzed. Exanthema was the symptom with the highest PPV, ranging from 66% to 83%. The PPV also increased with the number of symptoms presented by the patients during all the study period, possibly reflecting a more specific diagnostic. The most common clinical presentation included fever, arthralgia, headache, retro-orbital pain, myalgia and prostration presented a low PPV. PPV was higher among patients with at least four symptoms, usually including exanthema. Conclusions: the analysis of the PPV is essential to understand the magnitude of dengue in the country. Our results highlight the need for improvement in the routine notification of dengue suspected cases. These results should also be used in the current discussion on the adoption of the new dengue case classification proposed by the World Health Organization in Brazil, particularly in the revision and adoption of new surveillance forms and other improvements in the disease surveillance system.Introdução: o Valor Preditivo Positivo (VPP) é um dos atributos quantitativos do sistema de vigilância. Na dengue, esse atributo deve ser avaliado frequentemente em função da sua utilidade no direcionamento de medidas de controle da doença e adequado manejo clínico dos pacientes. Objetivo: Analisar o VPP da suspeita clínica de dengue, com ênfase em períodos epidêmicos no Brasil, entre 2000 e 2010. Métodos: trata-se de um estudo observacional, descritivo e transversal, com análise de dados secundários registrados no Sinan. Foram incluídos na amostra todos os casos notificados entre 2000 e 2010, com data de coleta para sorologia entre 6º e 30º dia após a data dos primeiros sintomas e com resultado do exame laboratorial. O VPP foi estimado pela proporção dos casos confirmados por sorologia IgM em relação ao total de casos notificados que fizeram o teste sorológico. Resultados: globalmente, o VPP variou de 46% a 71% em períodos epidêmicos e em períodos interepidêmicos de 27% a 47,5%. Não houve diferenças de VPP entre os gêneros e entre os portes populacionais dos municípios de residência. Quanto à idade dos pacientes, faixas etárias menores apresentaram VPP menores e adultos VPP maiores, refletindo um padrão de ocorrência em todos os anos analisados. Em relação aos sinais e sintomas, o exantema foi o que apresentou VPP mais elevado em todos os anos analisados, variando de 66% a 83%. À medida que aumentava o número de sintomas, aumentava também os VPP em todos os anos analisados, provavelmente, em função de um diagnóstico mais específico para dengue. A combinação de sintomas mais frequente foi artralgia, cefaleia, dor retro-orbital, mialgia e prostração, porém com baixos VPP. Os VPP da suspeita clínica foram mais elevados em pacientes que apresentavam no mínimo quatro sintomas no momento da notificação, e o exantema esteve comumente presente na maioria delas. Conclusões: a análise do VPP é fundamental para a compreensão da magnitude que a dengue apresenta no país e os resultados desse estudo evidenciam a necessidade de aprimoramento da notificação dos casos da doença no país. Esses resultados também devem ser considerados na discussão sobre a adoção da nova definição de caso proposta pela OMS, potenciais revisões e aprimoramentos dos sistemas de vigilância e melhor aproveitamento de recursos financeiros, tecnológicos e humanos

Estimate of health services utilization and costs associated with dengue in Brazil

Submitted by Marlene Santos ([email protected]) on 2017-09-05T16:25:22Z No. of bitstreams: 2 Tese - Ana Laura de Sene Amâncio Zara - 2017.pdf: 3959463 bytes, checksum: 51394e12c85247544283c6fdfd6f2bf6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Approved for entry into archive by Luciana Ferreira ([email protected]) on 2017-09-15T15:06:02Z (GMT) No. of bitstreams: 2 Tese - Ana Laura de Sene Amâncio Zara - 2017.pdf: 3959463 bytes, checksum: 51394e12c85247544283c6fdfd6f2bf6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Made available in DSpace on 2017-09-15T15:06:03Z (GMT). No. of bitstreams: 2 Tese - Ana Laura de Sene Amâncio Zara - 2017.pdf: 3959463 bytes, checksum: 51394e12c85247544283c6fdfd6f2bf6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-08-02Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPqOutroIntroduction: dengue cost estimates are important to support complete and useful economic evaluations for decision making regarding the incorporation of new technologies, such as vaccines and alternative strategies to control Aedes. Objectives: to estimate the health services utilization (HSU) for outpatients and hospitalized in the public and private sectors, and severity of the disease, in 2012-2013; identify possible sources of data and methodologies for dengue cost estimates in Brazil, considering primary and secondary sources of data; and estimate the total costs of dengue in Brazil, in 2013-2014, considering costs of the disease and control program costs. Methods: for HSU was conducted a multicenter study in six Brazilian capitals, from questionnaires and medical records. For the cost of illness (COI) and the cost of control program were used various sources of information, from microcusteio and macrocusteio methods as data availability. Results: for the HSU study attended 2,035 patients, of whom 1,167 (57.3%) were women, 1,657 (81.4%) were outpatients, 378 (18.6%) were hospitalized, 1,361 (66 9%) patients were in the public sector, and 398 (19.6%) were children (≤ 14 years). In the public sector, patients underwent an average of 1.9 visit, and hospital patients were on average 4.5 medical visits. In the private sector, the patients were, on average, 2.2 visits, and hospital patients were on average 5.1 medical visits. The vast majority of hospitalized patients had complete blood count, platelet count and hematocrit performed, received antipyretic/analgesic, in both public and private sectors. In 2013-2014, the cost of the dengue control program was US$1.2 billion, with 23$1.2 billion, and from secondary sources (HSU), the costs were US$330.2 million. Indirect costs amounted to US$5.2 million, considering the primary sources. Conclusion: HSU patterns varied significantly according to the health sector and the severity of the disease. In general, the pattern of HUS complies with the guidelines of the MS. In 2013-2014, the total cost of dengue ranged from US$1.53 billion to US$1.69 billion. If the number of underreporting cases was adjusted, costs ranged from US$6.86 billion to US$7.78 billion. Dengue imposes substantial costs to the health and economy in Brazil. It is expected that these results can contribute to the economic and welfare planning essential for the sustainability of the dengue control program in Brazil, which generally has its costs underestimated.Introdução: estimativas de custos da dengue são importantes para subsidiar avaliações econômicas completas e úteis para tomada de decisões quanto à incorporação de novas tecnologias, como vacinas e estratégias alternativas de controle do Aedes. Objetivos: estimar a utilização de serviços de saúde (USS) pelos pacientes ambulatoriais e hospitalizados, nos setores público e privado, e por gravidade da doença, em 2012-2013; identificar possíveis fontes de dados e metodologias para estimativas de custos da dengue no Brasil, considerando fontes primárias e secundárias de dados; e estimar os custos totais da dengue no Brasil, em 2013-2014, considerando custos da doença e custos do programa de controle. Métodos: para USS foi realizado um estudo multicêntrico em seis capitais brasileiras, a partir de questionários e prontuários médicos. Para o custeio da doença e do programa de controle foram utilizadas variadas fontes de informação, a partir de métodos de microcusteio e macrocusteio conforme disponibilidade dos dados. Resultados: para o estudo de USS participaram 2.035 pacientes, dos quais, 1.167 (57,3%) eram do sexo feminino, 1.657 (81,4%) eram pacientes ambulatoriais, 378 (18,6%) foram hospitalizados, 1.361 (66,9%) pacientes eram do setor público, e 398 (19,6%) eram crianças (≤ 14 anos). No setor público, os pacientes realizaram, em média, 1,9 consulta, e os pacientes hospitalizados receberam, em média 4,5 visitas médicas. No setor privado, os pacientes realizaram, em média, 2,2 consultas, e os pacientes hospitalizados receberam, em média 5,1 visitas médicas. A grande maioria dos pacientes hospitalizados teve hemograma completo, contagem de plaquetas e hematócrito realizados e recebeu antipirético/analgésico, em ambos os setores público e privado. Em 2013-2014, o custo do programa de controle da dengue foi de US$1,2 bilhão, sendo 23$1,2 bilhão, e por fontes secundárias (USS), os custos foram de US$330,2 milhões. Os custos indiretos chegaram a US$5,2 milhões considerando as fontes primárias. Conclusão: os padrões de USS variaram significativamente de acordo com o setor de saúde e com a gravidade da doença. Em geral, o padrão de USS está em conformidade com as orientações do MS. Em 2013-2014, o custo total da dengue variou entre US$1,53 bilhão e US$ 1,69 bilhão. Se ajustado o número de casos subnotificados, os custos variam de US$6,86 bilhões a US$7,78 bilhões. A dengue impõe custos substanciais para a saúde e a economia no Brasil. Espera-se que esses resultados possam contribuir para o planejamento econômico e assistencial imprescindíveis para a sustentabilidade do programa de controle da dengue no Brasil, que, em geral, tem seus custos subestimados

Taxa de mortalidade por doença de Wilson no Brasil

Introdução: A doença de Wilson (DW) é uma doença rara, de origem genética, autossômica recessiva, caracterizada pelo acúmulo de cobre no organismo, com prevalência estimada em 1:40.000 pessoas. Diagnóstico e tratamento precoces aumentam as chances de sobrevida e reduzem as chances de sequelas irreversíveis, especialmente, as hepáticas e neurológicas, mais frequentemente associadas aos óbitos. Não há evidências sobre a mortalidade dessa doença no Brasil. Objetivos: Analisar os óbitos e a taxa de mortalidade (TM) em decorrência da DW no Brasil. Material e Método: Trata-se de um estudo transversal,com análise de série temporal das TM da DW a partir dos óbitos notificados no Sistema de Informações sobre Mortalidade (SIM) com CID 83.0, entre 2000 e 2021. Os dados foram extraídos do Departamento de Informática do Sistema Único de Saúde (SUS), com o uso do TabWin, versão 4.1.5, e analisados no programa SPSS, versão 25. A TM foi estimada dividindo- se o número de óbitos pela população residente, multiplicado por 10 milhões/ano, e padronizadas de acordo com o Censo Demográfico de 2010, utilizando-se Microsoft Excel. As tendências foram analisadas utilizando-se a regressão de Prais Winsten (p<0,05), no programa Stata, versão 14. O nível de significância de 5% foi adotado para todos os testes estatísticos. Este estudo está dispensado de apreciação pelo Comitê de Ética em Pesquisa. Resultados: Entre 2000 e 2021, 483 óbitos por DW foram notificados no Brasil, sendo 30,3% em <20 anos, 61,0% em adultos e 8,7% em idosos. A mediana de idade foi de 26 anos (IIQ 25% -75%=18-42 anos), com medianas semelhantes em todas as Regiões brasileiras (p=0,321). Os óbitos foram mais frequentes no sexo masculino (63,2%), com proporções semelhantes em todas as Regiões (p=0,378). A TM por DW variou de 0,5/10 milhões hab. (2000 e 2017) a 2,1/10 milhões hab. (2019), com uma tendência estacionária no período (Taxa incremental média anual=1,98; IC95%:-0,51%−4,54%; p=0,113). Entre 2000 e 2019, o coeficiente de variação percentual foi de 525%, aumentando de oito para 42 casos. Discussão e Conclusões: É preocupante a variação percentual do número de óbitos e uma tendência da TM por DW estacionária no Brasil, uma vez que, os procedimentos diagnósticos e os medicamentos quelantes para o tratamento são disponibilizados no SUS. A carga da DW é substancial por afetar pessoas muito jovens, o que, consequentemente, implicará em custos indiretos elevados à sociedade

Avaliação da qualidade dos dados, valor preditivo positivo, oportunidade e representatividade do sistema de vigilância epidemiológica da dengue no Brasil, 2005 a 2009

OBJETIVO: avaliar a qualidade dos dados, o valor preditivo positivo (VPP), a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue no Brasil entre 2005 e 2009. MÉTODOS: estudo de avaliação, com análise dos dados de dengue do Sistema de Informação de Agravos de Notificação (Sinan) conforme atributos selecionados da metodologia do Centers for Disease Control and Prevention (Atlanta/GA, Estados Unidos da América). RESULTADOS: houve melhora na qualidade dos dados quanto a sua consistência; o VPP dos casos de dengue variou de 34 a 65%; o sistema apresentou uma mediana de oportunidade para notificação dos casos de 3 dias e revelou-se representativo, permitindo conhecer a situação da doença no país. CONCLUSÃO: o sistema de vigilância da dengue no Brasil mostrou-se consistente, com valor preditivo positivo expressivo, oportuno para notificação de casos e representativo, capaz de detectar tendência de mudança no perfil epidemiológico da doença

Estratégias de controle do Aedes aegypti: uma revisão

Resumo OBJETIVO: descrever as principais estratégias de controle do Aedes aegypti, com ênfase nas inovações tecnológicas promissoras para utilização no Brasil. MÉTODOS: trata-se de estudo de revisão não sistemática da literatura. RESULTADOS: diversas tecnologias têm sido desenvolvidas como alternativas no controle do Ae. aegypti, utilizando-se diferentes mecanismos de ação - como monitoramento seletivo da infestação, medidas sociais, dispersão de inseticidas, novos agentes de controle biológico e técnicas moleculares para controle populacional dos mosquitos -, considerando-se também a combinação entre elas. As tecnologias em desenvolvimento demandam avaliação da eficácia, viabilidade e custos para implementação como estratégias complementares às ações já preconizadas pelo Programa Nacional de Controle da Dengue. CONCLUSÃO: a integração de diferentes estratégias de controle vetorial compatíveis e eficazes, considerando as tecnologias disponíveis e as características regionais, parece ser um método viável para tentar reduzir a infestação dos mosquitos e a incidência das arboviroses transmitidas por eles

Direct healthcare costs of lip, oral cavity and oropharyngeal cancer in Brazil.

The efficiency of public policies includes the measurement of the health resources used and their associated costs. There is a lack of studies evaluating the economic impact of oral cancer (OC). This study aims to estimate the healthcare costs of OC in Brazil from 2008 to 2016. This is a partial economic evaluation using the gross costing top-down method, considering the direct healthcare costs related to outpatients, inpatients, intensive care units, and the number of procedures, from the perspective of the public health sector. The data were extracted from the Outpatient and Inpatient Information System of the National Health System, by diagnosis according to the 10th Revision of the International Classification of Diseases, according to sites of interest: C00 to C06, C09 and C10. The values were adjusted for annual accumulated inflation and expressed in 2018 I$(1 I$ = R$2,044). Expenditure on OC healthcare in Brazil was I$495.6 million, which was composed of 50.8% (I$251.6 million) outpatient and 49.2$244.0 million) inpatient healthcare. About 177,317 admissions and 6,224,236 outpatient procedures were registered. Chemotherapy and radiotherapy comprised the largest number of procedures (88.8%) and costs (94.9%). Most of the costs were spent on people over 50 years old (72.9%) and on males (75.6%). Direct healthcare costs in Brazil for OC are substantial. Outpatient procedures were responsible for the highest total cost; however, inpatient procedures had a higher cost per procedure. Men over 50 years old consumed most of the cost and procedures for OC. The oropharynx and tongue were the sites with the highest expenditure. Further studies are needed to investigate the cost per individual, as well as direct non-medical and indirect costs of OC