Validação de variáveis de declarações de óbito por causas externas, Recife, PE, Brasil

OBJECTIVE: To validate variables other than the basic cause of death on death certificates from external causes of residents younger than 20 years old living in Recife, Brazil, in 1995. METHODS: A survey of death records of the Institute of Forensic in Recife was carried out in order to validate death certificate variables included in official mortality registries. Agreement analysis was performed using Kappa indexes and sensitivity. As a result of the methodology used, the study data was considered to be more consistent and therefore regarded as standard. RESULTS: Those variables forensic specialists indicated as their direct responsibility showed an excellent (gender, age, and category of violence) and good (type of accident) agreement. However, there were significant discrepancies in those variables seen as either of indirect or no forensic responsibility, such as locality and area where death took place, medical care provided and accident location. CONCLUSIONS: Data reveal a dissociation between the reasons for including some variables in death certificates and the obtaining strategy and their social purpose.OBJETIVOS: Validar, nas declarações de óbitos por causas externas de menores de 20 anos residentes no Recife em 1995, outras variáveis que não a causa básica dos óbitos. MÉTODOS: Pesquisaram-se os documentos existentes no Instituto de Medicina Legal de Recife para validar variáveis das declarações de óbitos constantes nos dados oficiais de mortalidade. Analisou-se a concordância pelos índices de Kappa e da sensibilidade. Tendo em vista a metodologia utilizada, os dados da pesquisa foram considerados mais exatos e, como tais, tomados como padrão. RESULTADOS: Para as variáveis que os peritos do Instituto de Medicina Legal entenderam como de sua responsabilidade direta, os resultados mostraram concordância ótima -- sexo, idade e tipo de violência -- ou boa -- tipo de acidente. Porém, para as entendidas como de sua responsabilidade indireta ou como não sendo de sua responsabilidade, importantes discordâncias foram observadas -- local e município de ocorrência do óbito, assistência médica e local do acidente. CONCLUSÃO: Os dados revelam a dissociação entre o objetivo da inclusão das variáveis nas declarações de óbito e seu uso social e a estratégia para obtê-las

Análise espacial dos determinantes socioeconômicos dos homicídios no Estado de Pernambuco

OBJECTIVE: To investigate the association between homicide rates and socio-economic variables taking into account the spatial site of the indicators. METHODS: An ecological study was conducted. The dependent variable was the rate of homicides among the male population aged 15 to 49 years, residing in the districts of the State of Pernambuco from 1995 to 1998. The independent variables were an index of the living conditions, per capita family income, Theil inequality index, Gini index, average income of the head of the family, poverty index, rate of illiteracy, and demographic density. The following techniques were used in the analysis: a spatial autocorrelation test determined by the Moran index, multiple linear regression, a spatial regression model (CAR) and a generalized additive model for the detection of spatial trend (LOESS). RESULTS: The illiteracy and the poverty index explained 24.6% of the total variability of the homicide rates and there was an inverse relationship. Moran´s I statistics indicated spatial autocorrelation between municipalities. The multiple linear regression model best fitted for the purposes of this study was the Conditional Auto Regressive (CAR) model. The latter confirmed the association between the poverty index, illiteracy and homicide rates. CONCLUSIONS: The inverse association observed between socio-economic indicators and homicides may be expressing a process that propitiates improvement in living conditions and that is linked predominantly to conditions that generate violence, such as drug traffic.OBJETIVO: Investigar a associação entre variáveis socioeconômicas e taxas de homicídio, considerando a localização espacial dos indicadores. MÉTODOS: Utilizou-se o método de estudo ecológico. A variável dependente foi taxa de homicídio da população masculina de 15 a 49 anos, residente nos municípios do Estado de Pernambuco, em 1995 a 1998. As variáveis independentes referem-se a: índice de condições de vida, renda familiar per capita, desigualdade de Theil, índice de Gini, renda média do chefe de família, índice de pobreza, taxa de analfabetismo, densidade demográfica.Utilizou-se teste de correlação espacial determinado pelo Índice de Moran, regressão múltipla, Conditional Auto Regressive (CAR) e a função Loess, como modelo de detecção de tendência especial. RESULTADOS: Os indicadores taxa de analfabetismo e índice de pobreza explicaram 24,6% da variabilidade total das taxas de homicídio, cuja associação foi inversa. O índice de Moran revelou autocorrelação espacial entre os municípios. O modelo de regressão espacial que melhor se adequou ao estudo foi o CAR, que confirmou a associação entre índice de pobreza, analfabetismo e homicídio. CONCLUSÕES: A relação inversa observada entre os indicadores socioeconômicos e homicídios pode expressar determinado processo que propicia melhoria das condições de vida, e está atrelado predominantemente a condições geradoras de violência, como a do tráfico de drogas

QUANTITATIVE REAL-TIME PCR (Q-PCR) FOR SPUTUM SMEAR DIAGNOSIS OF PULMONARY TUBERCULOSIS AMONG PEOPLE WITH HIV/AIDS

Objective: To assess quantitative real-time polymerase chain reaction (q-PCR) for the sputum smear diagnosis of pulmonary tuberculosis (PTB) in patients living with HIV/AIDS with a clinical suspicion of PTB. Method: This is a prospective study to assess the accuracy of a diagnostic test, conducted on 140 sputum specimens from 140 patients living with HIV/AIDS with a clinical suspicion of PTB, attended at two referral hospitals for people living with HIV/AIDS in the city of Recife, Pernambuco, Brazil. A Löwenstein-Jensen medium culture and 7H9 broth were used as gold standard. Results: Of the 140 sputum samples, 47 (33.6%) were positive with the gold standard. q-PCR was positive in 42 (30%) of the 140 patients. Only one (0.71%) did not correspond to the culture. The sensitivity, specificity and accuracy of the q-PCR were 87.2%, 98.9% and 95% respectively. In 39 (93%) of the 42 q-PCR positive cases, the CT (threshold cycle) was equal to or less than 37. Conclusion: q-PCR performed on sputum smears from patients living with HIV/AIDS demonstrated satisfactory sensitivity, specificity and accuracy, and may therefore be recommended as a method for diagnosing PTB

A review of the classification of rabies virus lineages maintained by insectivorous bats in Brazil

Trabalho apresentado à 23ª Revista de Educação Continuada em Medicina Veterinária e Zootecnia, 2012, São Paul

Erica: Prevalences Of Hypertension And Obesity In Brazilian Adolescents

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents. METHODS: Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95% CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population. RESULTS: We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95% CI 9.0-10.3); with the lowest being in the North, 8.4% (95% CI 7.7-9.2) and Northeast regions, 8.4% (95% CI 7.6-9.2), and the highest being in the South, 12.5% (95% CI 11.0-14.2). The prevalence of obesity was 8.4% (95% CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95% CI 25.5-31.2), than overweight adolescents, 15.4% (95% CI 17.0-13.8), or eutrophic adolescents, 6.3% (95% CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%. CONCLUSIONS: ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5.501Brazilian Department of Science and Technology at the Secretariat of Science and TechnologyStrategic Inputs of the Ministry of Health (Departamento de Ciencia e Tecnologia da Secretaria de Ciencia e Tecnologia e Insumos Estrategicos do Ministerio da Saude - Decit/SCTIE/MS)Health Fund Sector (Fundo Setorial de Saude - CT-health) at the Ministry of science, Technology and Innovation (Ministerio da Ciencia, Tecnologia e Inovacao - MCTI)FINEP [01090421]CNPq [2010/565037-2]hospital research incentive fund for Clinics in Porto Alegre (fundo de incentivo a Pesquisa do Hospital de Clinicas de Porto Alegre - HCPA) [405,009/FIPE-2012-7]Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Erratum to: The study of cardiovascular risk in adolescents – ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents

1585

Erica: Prevalence Of Metabolic Syndrome In Brazilian Adolescents

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)To determine the prevalence of metabolic syndrome and its components in Brazilian adolescents. METHODS: We evaluated 37,504 adolescents who were participants in the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, school-based, national study. The adolescents, aged from 12 to 17 years, lived in cities with populations greater than 100,000 inhabitants. The sample was stratified and clustered into schools and classes. The criteria set out by the International Diabetes Federation were used to define metabolic syndrome. Prevalences of metabolic syndrome were estimated according to sex, age group, school type and nutritional status. RESULTS: Of the 37,504 adolescents who were evaluated: 50.2% were female; 54.3% were aged from 15 to 17 years, and 73.3% were from public schools. The prevalence of metabolic syndrome was 2.6% (95% CI 2.3-2.9), slightly higher in males and in those aged from 15 to 17 years in most macro-regions. The prevalence was the highest in residents from the South macro-region, in the younger female adolescents and in the older male adolescents. The prevalence was higher in public schools (2.8% [95% CI 2.4-3.2]), when compared with private schools (1.9% [95% CI 1.4-2.4]) and higher in obese adolescents when compared with nonobese ones. The most common combinations of components, referring to 3/4 of combinations, were: enlarged waist circumference (WC), low HDL-cholesterol (HDL-c) and high blood pressure; followed by enlarged WC, low HDL-c and high triglycerides; and enlarged WC, low HDL-c, high triglycerides and blood pressure. Low HDL was the second most frequent component, but the highest prevalence of metabolic syndrome (26.8%) was observed in the presence of high triglycerides. CONCLUSIONS: ERICA is the first Brazilian nation-wide study to present the prevalence of metabolic syndrome and describe the role of its components. Despite the prevalence of Metabolic Syndrome being low, the high prevalences of some components and participation of others in the syndrome composition shows the importance of early diagnosis of this changes, even if not grouped within the metabolic syndrome.501Department of Science and Technology of the Secretariat of Science, Technology and Strategic Inputs of the Ministry of Health (Decit/SCTIE/MS)Health Sectorial Fund (Fundo Setorial de Saude - CT-Saude) of the Ministry of Science, Technology and Innovation (MCTI)FINEP [01090421]CNPq [2010/565037-2]Research Incentive Fund of the Hospital de Clinicas de Porto Alegre - (Fundo de Incentivo a Pesquisa do Hospital de Clinicas de Porto Alegre - FIPE-HCPA) [405.009/2012-7]Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq