Biological, social, and healthcare factors associated with death due to influenza A(H1N1) during the 2009 epidemic in Brazil

Background: In June 2009, the World Health Organization (WHO) raised the global alert level for the A(H1N1)pdm09 influenza pandemic and at that time sustained transmission in Brazil was established. It was urgent to carry out studies that evaluated possible risk factors for death from Influenza A(H1N1) to improve case management strategies to reduce the lethality of the disease. This study aimed to identify risk factors for death from Influenza A(H1N1), including the effectiveness of the vaccine against influenza A(H1N1) concerning mortality. Methods: A case-control of incident cases of influenza A(H1N1) reported in the Epidemiological Information Systems of the states of São Paulo, Paraná, Pará, Amazonas, and Rio Grande do Sul was conducted. Results: 305 participants were included, 70 of them cases and 235 controls, distributed as follows: Amazonas – 9 cases/10 controls, Pará – 22 cases/77 controls, São Paulo – 19 cases/49 controls, Paraná – 10 cases/54 controls, Rio Grande do Sul – 10 cases/45 controls. These participants had a mean age of 30 years, with 33 years among cases and 25 years among controls. There was a predominance of females both among cases and controls. Biological (age), pre-existing diseases (congestive heart failure, respiratory disease, and diabetes mellitus), and care factors (ICU admission) associated with death from Influenza A(H1N1) were identified. Conclusion: The risk factors identified in this investigation allowed subsidizing the elaboration of clinical conducts, but also indicate important aspects for facing “new” influenza epidemics that are likely to occur in our country

Determinantes sociais da não-adesão ao tratamento de tuberculose em Buenos Aires, Argentina

El objetivo fue identificar los determinantes individuales y de área de la no adherencia al tratamiento de la tuberculosis (TB) en municipios de Buenos Aires, Argentina. Se realizó un estudio transversal con un modelo jerarquizado. El análisis se llevó a cabo mediante regresión logística múltiple en dos niveles, en base a datos primarios y secundarios. Los varones tuvieron mayor riesgo de no adherencia al tratamiento. La falta de provisión de agua en el hogar aumentó el riesgo de no adherencia. En aquellos hogares cuyo jefe de familia no tenía cobertura de salud también el riesgo de no adherencia fue mayor, al igual que en los pacientes que utilizaron más de un medio de transporte para llegar al centro de salud. En las áreas con mayor proporción de hogares con red de gas natural, mayor proporción de hogares con necesidades básicas instisfechas por la capacidad de subsistencia y mayor proporción de hogares que no tenían inodoros fue mayor el riesgo de no adherencia. Se concluye que los factores sociales y económicos tienen influencia sobre la adherencia al tratamiento, tanto a nivel individual, como de área.This study aimed to identify the individual and environmental determinants of nonadherence to tuberculosis (TB) treatment in selected districts in the Buenos Aires Metropolitan Area, in Argentina. We conducted a cross-sectional study using a hierarchical model. Using primary and secondary data, logistic regression was performed to analyze two types of determinants. The likelihood of nonadherence to treatment was greatest among male patients. The following factors led to a greater likelihood of nonadherence to treatment: patients living in a home without running water; head of household without medical insurance; need to use more than one means of transport to reach the health center; place of residence in an area with a high proportion of households connected to the natural gas network; place of residence in an area where a large proportion of families fall below the minimum threshold of subsistence capacity; place of residence in an area where a high proportion of households do not have flushing toilets and basic sanitation. Our results show that social and economic factors – related to both individual and environmental characteristics – influence adherence to TB treatment.O objetivo deste trabalho foi identificar os determinantes individuais e de área da não-adesão ao tratamento da tuberculose (TB) em municípios de Buenos Aires, Argentina. Foi realizado um estudo transversal com um modelo hierarquizado. A análise dos determinantes foi realizada em dois níveis por meio de análise de regressão logística em dois níveis, com base em dados primários e secundários. Além disso, a falta de abastecimento de água em casa aumentou o risco de não-adesão. Nesses domicílios, cujo chefe de família não tinha a cobertura de saúde, também o risco de não-adesão foi maior, como em pacientes que usaram mais de um meio de transporte para chegar ao centro de saúde. Em áreas com uma maior proporção de domicílios com uma rede de gás natural e com necessidades básicas insatisfeitas para os meios de vida e uma maior proporção de domicílios sem sanitários foi maior o risco de não-adesão. Conclui-se que os fatores sociais e econômicos influenciam a adesão ao tratamento da TB, tanto individualmente como em termos de área.Fil: Herrero, María Belén. Centro de Estudios de Estado y Sociedad; Argentina. Facultad Latinoamericana de Ciencias Sociales. Sede Académica Argentina Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Arrossi, Silvina. Centro de Estudios de Estado y Sociedad; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ramos, Silvina. Centro de Estudios de Estado y Sociedad; ArgentinaFil: Braga, Jose Ueleres. Universidade do Estado do Rio de Janeiro; Brasi

Via, hombre y vehiculo: factores de riesgo asociados con la gravedad de los accidentes de transito

OBJETIVO Analisar as características das vítimas, vias e veículos envolvidos em acidentes de trânsito e os fatores de risco de acidentes com ocorrência de óbito.  MÉTODOS Estudo de coorte não concorrente considerando os acidentes de trânsito em Fortaleza, CE, de janeiro de 2004 a dezembro de 2008. Foram utilizados dados do Sistema de Informação de Acidente de Trânsito de Fortaleza, do Sistema de Informações de Mortalidade, do Sistema de Informações Hospitalares e dos bancos de dados de Habilitação e Veículos do Departamento Estadual de Trânsito. Técnicas de relacionamento determinístico e probabilístico foram aplicadas para integrar as bases de dados. Efetuou-se a análise descritiva das variáveis relativas às pessoas, às vias, aos veículos e ao tempo. Foram utilizados os modelos lineares generalizados na investigação de fatores de risco para óbito por acidente de trânsito. O ajuste do modelo foi verificado pela razão de verossimilhança e análise ROC.  RESULTADOS Registraram-se 118.830 acidentes no período. Predominaram colisão/abalroamento (78,1%), atropelamentos (11,9%) e choque com obstáculo fixo (3,9%) e com motocicletas (18,1%). Ocorreram óbitos em 1,4% dos acidentes. Estiveram independentemente associados ao óbito por acidente de trânsito: bicicletas (OR = 21,2; IC95% 16,1;27,8), atropelamentos (OR = 5,9; IC95% 3,7;9,2), choque com obstáculo fixo (OR = 5,7; IC95% 3,1;10,5) e acidentes com motociclistas (OR = 3,5; IC95% 2,6;4,6). Os principais fatores contribuintes foram envolvimento de uma única pessoa (OR = 6,6; IC95% 4,1;10,73), presença de condutores não habilitados (OR = 4,1; IC95% 2,9;5,5) um único veículo envolvido (OR = 3,9; IC95% 2,3;6,4), sexo masculino (OR = 2,5; IC95% 1,9;3,3), tráfego em vias de jurisdição federal (OR = 2,4; IC95% 1,8;3,7), horário madrugada (OR = 2,4; IC95% 1,8;3,0) e dia de domingo (OR = 1,7; IC95% 1,3;2,2), todas ajustadas segundo modelo log-binomial.  CONCLUSÕES As ações de promoção e prevenção de acidentes no trânsito devem focar os acidentes com veículos de duas rodas, que mais frequentemente envolvem uma única pessoa, não habilitada, do sexo masculino, em horários noturnos, em finais de semana e nas vias onde se desenvolvem maiores velocidades.OBJETIVO Analizar las características de las víctimas, vías y vehículos involucrados en accidentes de tránsito y los factores de riesgo de accidentes con ocurrencia de óbito. MÉTODOS Estudio de cohorte no concurrente considerando los accidentes de tránsito en Fortaleza, CE, de enero de 2004 a diciembre de 2008. Se utilizaron datos del Sistema de Informaciones de Mortalidad, del Sistema de Informaciones Hospitalarias y de los bases de datos de Licencia para conducir y Vehículos del Departamento Estatal de Tránsito. Técnicas de relacionamiento determinístico y probabilístico se aplicaron para integrar las bases de datos. Se efectuó el análisis descriptivo de las variables relacionadas con las personas, las vías los vehículos y el tiempo. Se utilizaron los modelos lineales generalizados en la investigación de los factores de riesgo para óbito por accidente de tránsito. El ajuste del modelo fue verificado por la tasa de vero-semejanza y el análisis ROC. RESULTADOS Se registraron 118.830 accidentes en el período. Predominaron colisión/choque (78,1%), atropellamientos (11,9%), choque con obstáculo fijo (3,9%), con motocicletas (18,1%). Ocurrieron óbitos en 1,4% de los accidentes. Estuvieron independientemente asociados al óbito por accidente de tránsito: bicicletas (OR= 21,2; IC95% 16,1;27,8), atropellamientos (OR= 5,9; IC95% 3,7;9,2), choque con obstáculo fijo (OR= 5,7; IC95% 3,1;10,5) y accidentes con motociclistas (OR= 3,5; IC95% 2,6;4,6). Los principales factores contribuyentes fueron envolvimiento de una única persona (OR= 6,6; IC95% 4,1;10,73), presencia de conductores sin licencia para conducir (OR= 4,1; IC95% 2,9;5,5), un único vehículo involucrado (OR= 3,9; IC95% 2,3;6,4), sexo masculino (OR= 2,5; IC95% 1,9; 3,3), tránsito en vías de jurisdicción federal (OR= 2,4; IC95% 1,8;3,7), horario madrugada (OR= 2,4; IC95% 1,8;3,0), y día domingo (OR= 1,7; IC95% 1,3;2,2), todas ajustadas de acuerdo con el modelo log-binomial. CONCLUSIONES Las acciones de promoción y prevención de accidentes en el tránsito deben enfocarse en accidentes con vehículos de dos ruedas, que más frecuentemente involucran una única persona, sin licencia para conducir, del sexo masculino, en horarios nocturnos, en fines de semana y en las vías donde se desarrollan mayores velocidades.OBJECTIVE : To describe the main characteristics of victims, roads and vehicles involved in traffic accidents and the risk factors involved in accidents resulting in death. METHODS A non-concurrent cohort study of traffic accidents in Fortaleza, CE, Northeastern Brazil, in the period from January 2004 to December 2008. Data from the Fortaleza Traffic Accidents Information System, the Mortality Information System, the Hospital Information System and the State Traffic Department Driving Licenses and Vehicle database. Deterministic and probabilistic relationship techniques were used to integrate the databases. First, descriptive analysis of data relating to people, roads, vehicles and weather was carried out. In the investigation of risk factors for death by traffic accident, generalized linear models were used. The fit of the model was verified by likelihood ratio and ROC analysis. RESULTS There were 118,830 accidents recorded in the period. The most common types of accidents were crashes/collisions (78.1%), running over pedestrians (11.9%), colliding with a fixed obstacle (3.9%), and with motorcycles (18.1%). Deaths occurred in 1.4% of accidents. The factors that were independently associated with death by traffic accident in the final model were bicycles (OR = 21.2, 95%CI 16.1;27.8), running over pedestrians OR = 5.9 (95%CI 3.7;9.2), collision with a fixed obstacle (OR = 5.7, 95%CI 3.1;10.5) and accidents involving motorcyclists (OR = 3.5, 95%CI 2.6;4.6). The main contributing factors were a single person being involved (OR = 6.6, 95%CI 4.1;10.73), presence of unskilled drivers (OR = 4.1, 95%CI 2.9;5.5) a single vehicle (OR = 3.9, 95%CI 2,3;6,4), male (OR = 2.5, 95%CI 1.9;3.3), traffic on roads under federal jurisdiction (OR = 2.4, 95%CI 1.8;3.7), early morning hours (OR = 2.4, 95%CI 1.8;3.0), and Sundays (OR = 1.7, 95%CI 1.3;2.2), adjusted according to the log-binomial model. CONCLUSIONS Activities promoting the prevention of traffic accidents should primarily focus on accidents involving two-wheeled vehicles that most often involves a single person, unskilled, male, at nighttime, on weekends and on roads where they travel at higher speeds

Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial

Background: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. Methods: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. Results: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p<0.01) in arm 1. Compared to the MGIT group, culture conversion after 6 months was higher for Xpert in arm 1 (90.9% vs. 79.3%, p=0.39) and LPA in arm 2 (80.0% vs. 83.0%, p=0.81). Conclusions: In the Xpert arm, there was a significant reduction in days to the start of appropriate anti-TB treatment and a trend towards greater culture conversion in the sixth month

Clinical predictors of severe forms of influenza A(H1N1)pdm09 in adults and children during the 2009 epidemic in Brazil.

The World Health Organization (WHO) raised the global alert level for the A(H1N1) influenza pandemic in June 2009. However, since the beginning of the epidemic, the fight against the epidemic lacked foundations for managing cases to reduce the disease lethality. It was urgent to carry out studies that would indicate a model for predicting severe forms of influenza. This study aimed to identify risk factors for severe forms during the 2009 influenza epidemic and develop a prediction model based on clinical epidemiological data. A case-control of cases notified to the health secretariats of the states of Rio de Janeiro, São Paulo, Minas Gerais, Paraná, and Rio Grande do Sul was conducted. Cases had fever, respiratory symptoms, positive confirmatory test for the presence of the virus associated with one of the three conditions: (i) presenting respiratory complications such as pneumonia, ventilatory failure, severe acute respiratory distress syndrome, sepsis, acute cardiovascular complications or death; or respiratory failure requiring invasive or non-invasive ventilatory support, (ii) having been hospitalized or (iii) having been admitted to an Intensive Care Unit. Controls were individuals diagnosed with the disease on the same date (or same week) as the cases. A total of 1653 individuals were included in the study, (858 cases/795 controls). These participants had a mean age of 26 years, a low level of education, and were mostly female. The most important predictors identified were systolic blood pressure in mmHg, respiratory rate in bpm, dehydration, obesity, pregnancy (in women), and vomiting (in children). Three clinical prediction models of severity were developed, for adults, adult women, and for children. The performance evaluation of these models indicated good predictive capacity. The area values under the ROC curve of these models were 0.89; 0.98 and 0.91 respectively for the model of adults, adult women, and children respectively

Análisis espacial del abandono del tratamiento de tuberculosis, Buenos Aires, Argentina

Área de Salud, Economía y Socieda