Tendência de mortalidade por linfoma não Hodgkin em uma área de exposição ao glifosato: comparativo entre Chapecó-SC e o cenário nacional. | Mortality trends by Non-Hodgkin Lymphoma in a glyphosate exposure area: comparison between Chapecó-SC.

Introdução: o câncer é atualmente a segunda causa de morte mundial, sendo um dos grandes problemas de saúde pública. O linfoma não Hodgkin (LNH) está entre os tipos de câncer que mais afetam trabalhadores rurais, tendo diversos fatores relacionados ao desenvolvimento da doença, entre eles o contato com pesticidas e herbicidas. Métodos: estudo ecológico do tipo série temporal de mortalidade, sendo a população de estudo os óbitos de pessoas maiores de 20 anos notificados pelo sistema de mortalidade para o município de Chapecó e para o Brasil, entre os anos de 1980 a 2014. As informações foram retiradas do DATASUS. Foram utilizados os códigos 200 e 202 do CID-9 no período de 1980-1995, e C82 a C85 do CID-10 para 1996-2014. As análises de dados foram feitas nos programas Microsoft Office Excel e Stata. Resultados: as taxas anuais de mortalidade por LNH para indivíduos de 20 anos ou mais no Brasil, durante 1980 e 2014, variaram de 1,69 a 3,06 por 100.000 habitantes, enquanto em Chapecó as taxas variaram de zero a 9,67 por 100.000 habitantes no mesmo período. Conclusão: a tendência de aumento na incidência de óbito em Linfoma não Hodgkin é observada tanto em Chapecó quanto no Brasil, porém as taxas de Chapecó são bem maiores que a brasileira, indicando que nesta região há um conjunto de fatores que pode favorecer o agravo.Palavras-chave: linfoma não Hodgkin; mortalidade; epidemiologia. -----------------------------------------------------------------------------------------AbstractIntroduction: cancer is currently the second leading cause of death worldwide and one of the major public health problems. Non-Hodgkin Lymphoma (NHL) is among the cancers that most affect rural workers, which could be associated with a number of factors related to the development of the disease, including contact with pesticides and herbicides. Methods: this is an ecological study of the temporal series of mortality of people over 20 years old. It has been analysed the number of deaths reported by the mortality system for the municipality of Chapecó and for Brazil, taking in account the period between 1980 and 2014. That information has been taken from DATASUS. There have been used the Codes 200 and 202 of ICD-9 in the period 1980-1995, and C82-C85 of ICD-10 for 1996-2014. Data analyses have been done by using Microsoft Office Excel and Stata. Results: annual mortality rates by NHL for individuals aged 20 years and over in Brazil during 1980 and 2014 ranged from 1.69 to 3.06 per 100,000 inhabitants, while in Chapecó rates ranged from zero to 9.67 per 100,000 inhabitants in the same period. Conclusion: the trend of increased incidence of death in non-Hodgkin's lymphoma is observed in both Chapecó and Brazil, but Chapecó rates are much higher than in Brazil, indicating that in this region there are a number of factors that may influence the development of the disease.Keywords: non-Hodgkin lymphoma; mortality; epidemiology

A post-incorporation study on the use of palivizumab in the Brazilian public health system

Respiratory syncytial virus (RSV) is the main cause of lower respiratory disease in infants and children under five years of age. As there is no specific treatment for RSV infections, prophylaxis with the specific monoclonal antibody palivizumab (PVZ) has been widely recommended for high-risk cases during the RSV season. The present study aimed to evaluate the effectiveness of a public prophylaxis program with palivizumab on the incidence of hospitalizations for lower respiratory tract infections and RSV in children at high risk for severe RSV infections. A retrospective cohort study was carried out with preterm children or children under two years of age with chronic lung disease or hemodynamically significant congenital heart disease; the children were selected on the basis of their exposure status, which was defined as the prophylactic use of palivizumab during the RSV season. Children were enrolled retrospectively in two hospitals located in Southern Brazil, from May 2009 to August 2016. In a sample of 129 children, 69 (53.5%) received palivizumab and adherence to three or more doses was observed in 78%; 60 (46.5%) children did not receive palivizumab. PVZ prophylaxis was independently associated with a 66% reduction in hospitalizations for any cause (26/69 - 37.7%) in the PVZ group and 34/60 (56.7%) in the control group). A 52% reduction in hospitalizations due to lower respiratory tract infection was observed in the PVZ group (15/69 -21.7%) and 25/60 (41.7%) in the control group. These findings suggest that, for the group of studied patients, the adoption of an RSV prophylaxis scheme reached the same effectiveness as those described in previous clinical trials

A post-incorporation study on the use of palivizumab in the Brazilian public health system

Respiratory syncytial virus (RSV) is the main cause of lower respiratory disease in infants and children under five years of age. As there is no specific treatment for RSV infections, prophylaxis with the specific monoclonal antibody palivizumab (PVZ) has been widely recommended for high-risk cases during the RSV season. The present study aimed to evaluate the effectiveness of a public prophylaxis program with palivizumab on the incidence of hospitalizations for lower respiratory tract infections and RSV in children at high risk for severe RSV infections. A retrospective cohort study was carried out with preterm children or children under two years of age with chronic lung disease or hemodynamically significant congenital heart disease; the children were selected on the basis of their exposure status, which was defined as the prophylactic use of palivizumab during the RSV season. Children were enrolled retrospectively in two hospitals located in Southern Brazil, from May 2009 to August 2016. In a sample of 129 children, 69 (53.5%) received palivizumab and adherence to three or more doses was observed in 78%; 60 (46.5%) children did not receive palivizumab. PVZ prophylaxis was independently associated with a 66% reduction in hospitalizations for any cause (26/69 - 37.7%) in the PVZ group and 34/60 (56.7%) in the control group). A 52% reduction in hospitalizations due to lower respiratory tract infection was observed in the PVZ group (15/69 -21.7%) and 25/60 (41.7%) in the control group. These findings suggest that, for the group of studied patients, the adoption of an RSV prophylaxis scheme reached the same effectiveness as those described in previous clinical trials

Incidence and risk factors for tuberculosis in people living with HIV: cohort from HIV referral health centers in Recife, Brazil.

OBJECTIVE: To identify the incidence of and risk factors for tuberculosis in people living with HIV (PLHIV). DESIGN: Observational, prospective cohort study. METHODS: A total of 2069 HIV-infected patients was observed between July 2007 and December 2010. The Kaplan-Meier method was used to estimate the probability of survival free of tuberculosis, and Cox regression analysis to identify risk factors associated with the development of tuberculosis. RESULTS: Survival free of tuberculosis (TB) was 91%. The incidence rate of tuberculosis was 2.8 per 100 persons/years. Incidence of tuberculosis was higher when subjects had CD4 cell count <200 cells/mm(3); were not on antiretroviral therapy; in those who had, a body mass index <18.5 kg/m(2), anemia (or were not tested for it), were illiterate or referred previous tuberculosis treatment at entry into the cohort. Those not treated for latent TB infection had a much higher risk (HR = 7.9) of tuberculosis than those with a negative tuberculin skin test (TST). Having a TST≥5 mm but not being treated for latent TB infection increased the risk of incident tuberculosis even in those with a history of previous tuberculosis. CONCLUSIONS: Preventive actions to reduce the risk of TB in people living with HIV should include an appropriate HAART and treatment for latent TB infection in those with TST≥5 mm. The actions towards enabling rigorous implementation of treatment of latent TB infection and targeting of PLHIV drug users both at the individual and in public health level can reduce substantially the incidence of TB in PLHIV

Associacao entre tabagismo e o uso de crack com a descontinuidade da terapia antirretroviral combinada em Recife, Pernambuco, Brasil

Apesar da eficácia da terapêutica antirretroviral combinada para o tratamento de pessoas vivendo com HIV/Aids, a não adesão aos medicamentos tem se tornado uma das maiores ameaças à efetividade dessa terapêutica. O objetivo desse estudo foi estimar a prevalência de uso irregular autorreferido da terapia antirretroviral e os fatores associados com essa irregularidade em pessoas vivendo com HIV. Foi realizado um estudo seccional de pessoas vivendo com HIV/Aids atendidas em dois centros de referência no Recife, Nordeste do Brasil, entre junho 2007 e outubro de 2009. Foram analisados os fatores socioeconômicos, de apoio social e de hábitos do indivíduo, ajustados através de análise de regressão logística multivariada. A prevalência de pessoas vivendo com HIV/Aids que relataram o uso irregular da terapia antirretroviral combinada (TARC) foi de 25,7%. No modelo multivariado final, o uso irregular da TARC esteve associado às seguintes variáveis: ter menos de 40 anos (OR = 1,66, IC95%: 1,29-2,13), fumantes (OR = 1,76, IC95%: 1,31-2,37) ou ex-fumantes (OR = 1,43, IC95%: 1,05-1,95) e ser usuário de crack (OR = 2,79, IC95%: 1,24-6,32). Medidas especiais devem ser direcionadas para cada um dos seguintes grupos: adultos com menos de 40 anos, fumantes, ex-fumantes e usuários de crack. Ações voltadas para a cessação do tabagismo e do crack devem ser incorporadas ao programa de controle dos infectados pelo HIV, visando promover a maior adesão aos antirretrovirais e, consequentemente, aumentar a expectativa e a qualidade de vida.Despite the effectiveness of combination antiretroviral therapy in the treatment of people living with HIV/AIDS (PLWHA), nonadherence to medication has become a major threat to its effectiveness. This study aimed to estimate the prevalence of self-reported irregular use of antiretroviral therapy and the factors associated with such an irregularity in PLWHA. A cross-sectional study of PLWHA who attended two referral centers in the city of Recife, in Northeastern Brazil, between June 2007 and October 2009 was carried out. The study analyzed socioeconomic factors, social service support and personal habits associated with nonadherence to antiretroviral therapy, adjusted by multivariable logistic regression analysis. The prevalence of PLWHA who reported irregular use of combination antiretroviral therapy (cART) was 25.7%. In the final multivariate model, the irregular use of cART was associated with the following variables: being aged less than 40 years (OR = 1.66, 95%-CI: 1.29-2.13), current smokers (OR = 1.76, 95%-CI: 1.31-2.37) or former smokers (OR = 1.43, 95%-CI: 1.05-1.95), and crack cocaine users (OR = 2.79, 95%-CI: 1.24-6.32). Special measures should be directed towards each of the following groups: individuals aged less than 40 years, smokers, former smokers and crack cocaine users. Measures for giving up smoking and crack cocaine should be incorporated into HIV-control programs in order to promote greater adherence to antiretroviral drugs and thus improve the quality of life and prolong life expectancy

Validating a scoring system for the diagnosis of smear-negative pulmonary tuberculosis in HIV-infected adults.

BACKGROUND: The challenge of diagnosing smear-negative pulmonary TB (tuberculosis) in people living with HIV justifies the use of instruments other than the smear test for diagnosing the disease. Considering the clinical-radiological similarities of TB amongst HIV-infected adults and children, the proposal of this study was to assess the accuracy of a scoring system used to diagnose smear-negative pulmonary TB in children and adolescents, in HIV-infected adults suspected of having smear-negative pulmonary TB. METHODS: A Phase III validation study aiming to assess the diagnostic accuracy of a scoring system for diagnosing smear-negative pulmonary TB in HIV-infected adults. The study assessed sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values of the scoring system. Three versions of the scoring system were tested. RESULTS: From a cohort of 2,382 (HIV-infected adults), 1276 were investigated and 128 were diagnosed with pulmonary TB. Variables associated with the diagnosis of TB were: coughing, weight loss, fever, malnutrition, chest X-ray, and positive tuberculin test. The best diagnostic performance occurred with the scoring system with new scores, with sensitivity = 81.2% (95%-CI 74.5% -88%), specificity = 78% (75.6% -80.4%), PPV = 29.2% (24.5% -33.9%) and NPV = 97.4% (96.4% -98.4%), LR+ = 3.7 (3.4-4.0) and LR- = 0.24 (0.2-0.4). CONCLUSION: The proposed scoring system (with new scores) presented a good capacity for discriminating patients who did not have pulmonary TB, in the studied population. Further studies are necessary in order to validate it, thus permitting the assessment of its use in diagnosing smear-negative pulmonary TB in HIV-infected adults

Incidence and risk factors for tuberculosis in people living with HIV attended in referral centers for HIV in Recife - Brazil

Submitted by Stephany Silva ([email protected]) on 2016-05-02T13:50:03Z No. of bitstreams: 1 Tese Joanna dArc 2012.pdf: 2752607 bytes, checksum: 1ccaff6981b3215ba79b2c41857a9d18 (MD5)Approved for entry into archive by Adagilson Silva ([email protected]) on 2019-09-16T12:13:53Z (GMT) No. of bitstreams: 1 Tese Joanna dArc 2012.pdf: 2752607 bytes, checksum: 1ccaff6981b3215ba79b2c41857a9d18 (MD5)Made available in DSpace on 2019-09-16T12:13:53Z (GMT). No. of bitstreams: 1 Tese Joanna dArc 2012.pdf: 2752607 bytes, checksum: 1ccaff6981b3215ba79b2c41857a9d18 (MD5) Previous issue date: 2012Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, Brasil.Os efeitos deletérios da coinfecção tuberculose/ vírus da imunodeficiência humana, tanto na morbidade quanto nas altas taxas de mortalidade encontradas nesse grupo, indicam a necessidade de prevenção da tuberculose, especialmente devido à condição de saúde já fragilizada das pessoas que vivem com HIV, que muitas vezes já faz uso de uma quantidade elevada de medicamentos. A fim de contribuir para a prevenção da tuberculose, esta tese tem por objetivo identificar a incidência e os fatores de risco para a tuberculose em pessoas que vivem com HIV atendidas em serviços de referência para HIV/Aids na cidade do Recife. Nesses serviços acompanhou-se uma coorte de pacientes infectados pelo HIV entre julho de 2007 e dezembro de 2010. A população de estudo composta de 2.069 pacientes foi acompanhada por um tempo médio de 928,7 dias (3,9 anos). A probabilidade de sobrevivência livre de TB foi calculada através do Kaplan-Meier e realizou-se análise de regressão de Cox uni e multivariada para a identificação dos fatores de risco para tuberculose. Ao final do período de estudo, a probabilidade de não desenvolver tuberculose foi de 91%. A taxa de incidência de TB na coorte foi de 2,79 por 100 pessoa/ano. Os fatores de risco para o desenvolvimento da tuberculose foram: contagem de células T CD4 < 200 cél/mm3; indicação para tratamento de tuberculose latente sem a consequente realização; índice de massa corporal < 18,5 kg/m2; tratamento para tuberculose anterior ao início do seguimento; anemia e ser fumante ou ex-fumante. Conhecer o perfil de maior risco para o desenvolvimento da tuberculose permite atuar preventivamente, antes que a infecção evolua para a doença, evitando assim o surgimento da tuberculose nas pessoas vivendo com HIV.The deleterious effects of Mycobacterium tuberculosis and human immunodeficiency virus coinfection, both in the high morbidity and mortality rates found in this group, indicate the need for prevention of tuberculosis, especially given the already fragile health status of people living with HIV, which often makes use of already a high amount of drug. To contribute to the prevention of tuberculosis, this thesis aims to identify the incidence and risk factors for tuberculosis in people living with HIV treated in referral centers for HIV/AIDS in Recife. We conducted a cohort of HIV-infected patients between July 2007 and December 2010 in these centers. The study population comprised 2069 patients; they were followed for an average of 928.7 days (3.9 years). The probability of survival free of TB was calculated using the Kaplan-Meier analysis. The Cox regression univariate and multivariate analyzes was performed to identify risk factors for tuberculosis. At the end of the study period, the probability of not develop tuberculosis was 91%. The incidence rate of TB in the cohort was 2.79 per 100 person/year. Risk factors for developing tuberculosis were: CD4 cell count < 200 cells/mm3; indication for treatment of latent tuberculosis infection without performing the same; body mass index < 18.5 kg/m2, treatment for tuberculosis prior to beginning of followup; Anemia and being a current smoker or former smoker. Knowing the profile of higher risk for the development of tuberculosis allows preventive action before the infection developing into the disease, thus avoiding the emergence of tuberculosis in people living with HIV