Zika, chikungunya and dengue: the causes and threats of new and re-emerging arboviral diseases.

The recent emergence and re-emergence of viral infections transmitted by vectors-Zika, chikungunya, dengue, Japanese encephalitis, West Nile, yellow fever and others-is a cause for international concern. Using as examples Zika, chikungunya and dengue, we summarise current knowledge on characteristics of the viruses and their transmission, clinical features, laboratory diagnosis, burden, history, possible causes of the spread and the expectation for future epidemics. Arboviruses are transmitted by mosquitoes, are of difficult diagnosis, can have surprising clinical complications and cause severe burden. The current situation is complex, because there is no vaccine for Zika and chikungunya and no specific treatment for the three arboviruses. Vector control is the only comprehensive solution available now and this remains a challenge because up to now this has not been very effective. Until we develop new technologies of control mosquito populations, the globalised and urbanised world we live in will remain vulnerable to the threat of successive arbovirus epidemics

LAS INCAPACIDADES FÍSICAS DE PACIENTES CON ACCIDENTE VASCULAR CEREBRAL: ACCIONES DE ENFERMERÍA

This paper addresses physical disabilities resulting from a cerebrovascular accident (CVA). Objectives: To identify the profile of physical disabilities resulting from CVA in the published literature and to discuss nursing interventions in advising the patients and their families in regards to the resulting disabilities. Methodology: Narrative review that used the same description in all databases, selecting papers between 1997 and 2007. Analyzed by categories of different physical disabilities. Results: 112 publications were found, 11 were selected. Three categories of disabilities have been created, according to predominance: Motor Disability (55%); Dysphasia (36%), and Aphasia (9%). Discussion: These disabilities have a high potential for interfering in daily activities generating a high degree of patient dependence on a care giver. The nurse ought to advise about the complications of immobility, dysphasia and aphasia. Conclusion: Life after effusion requires planning and nurse orientation addressed at minimizing the effects of physical disabilities for the patient.Este artículo trata de las discapacidades físicas causadas por un accidente vascular cerebral (AVC). Objetivos: identificar el perfil de las discapacidades físicas como una secuela del AVC presente en artículos y discutir las acciones de enfermería en la orientación del enfermo y su familia acerca de las discapacidades. Metodología: revisión narrativa que ha empleado los mismos descriptores en todas las bases electrónicas, seleccionando artículos entre los años de 1997 a 2007 y analizados por categorías a partir de las diferentes discapacidades físicas encontradas. Resultados: encontradas 112 publicaciones, seleccionadas 11. Se han construido tres categorías de discapacidades de acuerdo con la predominancia: discapacidad motora (55%), disfagia (36%) y afasia (9%). Discusión: todas tienen un alto potencial de interferir en las actividades cotidianas provocando alto grado de dependencia del enfermo para un cuidador. El enfermero debe orientar acerca de las complicaciones de inmovilidad, disfagia y afasia. Conclusión: La supervivencia tras el derrame exige orientaciones de enfermería dirigidas a limitar los efectos que las discapacidades tienen para el paciente.Este artigo trata das incapacidades físicas decorrentes de um acidente vascular cerebral (AVC). Objetivos: identificar o perfil das incapacidades físicas como seqüela de AVC presentes nas publicações e discutir as ações de enfermagem na orientação do paciente e família em relação às incapacidades. Metodologia: revisão narrativa que usou os mesmos descritores em todas as bases eletrônicas, selecionando artigos entre os anos de 1997 a 2007. Analisados por categorias a partir das diferentes incapacidades físicas encontradas. Resultados: encontrados 112 publicações, selecionados onze. Foram estruturadas três categorias: incapacidade motora (55%), disfagia (36%) e afasia (9%). Discussão: são incapacidades que tem um alto potencial de interferir nas atividades cotidianas gerando alto grau de dependência do paciente para com um cuidador. O enfermeiro deve orientar sobre as complicações da imobilidade, disfagia e afasia. Conclusão, a sobrevida após o AVC requer planejamento e orientações de enfermagem direcionadas a limitar o efeito das incapacidades físicas para o paciente

Evaluation of record linkage of two large administrative databases in a middle income country: stillbirths and notifications of dengue during pregnancy in Brazil.

BACKGROUND: Due to the increasing availability of individual-level information across different electronic datasets, record linkage has become an efficient and important research tool. High quality linkage is essential for producing robust results. The objective of this study was to describe the process of preparing and linking national Brazilian datasets, and to compare the accuracy of different linkage methods for assessing the risk of stillbirth due to dengue in pregnancy. METHODS: We linked mothers and stillbirths in two routinely collected datasets from Brazil for 2009-2010: for dengue in pregnancy, notifications of infectious diseases (SINAN); for stillbirths, mortality (SIM). Since there was no unique identifier, we used probabilistic linkage based on maternal name, age and municipality. We compared two probabilistic approaches, each with two thresholds: 1) a bespoke linkage algorithm; 2) a standard linkage software widely used in Brazil (ReclinkIII), and used manual review to identify further links. Sensitivity and positive predictive value (PPV) were estimated using a subset of gold-standard data created through manual review. We examined the characteristics of false-matches and missed-matches to identify any sources of bias. RESULTS: From records of 678,999 dengue cases and 62,373 stillbirths, the gold-standard linkage identified 191 cases. The bespoke linkage algorithm with a conservative threshold produced 131 links, with sensitivity = 64.4% (68 missed-matches) and PPV = 92.5% (8 false-matches). Manual review of uncertain links identified an additional 37 links, increasing sensitivity to 83.7%. The bespoke algorithm with a relaxed threshold identified 132 true matches (sensitivity = 69.1%), but introduced 61 false-matches (PPV = 68.4%). ReclinkIII produced lower sensitivity and PPV than the bespoke linkage algorithm. Linkage error was not associated with any recorded study variables. CONCLUSION: Despite a lack of unique identifiers for linking mothers and stillbirths, we demonstrate a high standard of linkage of large routine databases from a middle income country. Probabilistic linkage and manual review were essential for accurately identifying cases for a case-control study, but this approach may not be feasible for larger databases or for linkage of more common outcomes

Symptomatic dengue infection during pregnancy and the risk of stillbirth in Brazil, 2006-12: a matched case-control study.

BACKGROUND: Maternal infections during pregnancy can increase the risk of fetal death. Dengue infection is common, but little is known about its role in fetal mortality. We aimed to investigate the association between symptomatic dengue infection during pregnancy and fetal death. METHODS: We did a nested case-control study using obstetrician-collected data from the Brazilian livebirth information system (SINASC), the mortality information system (SIM), and the national reportable disease information system (SINAN). We identified all pregnancies ending in stillbirth and a random sample of livebirths between Jan 1, 2006, and Dec 31, 2012. We did linkage to determine which mothers were diagnosed with dengue infection during pregnancy. By use of stillbirths as cases and a sample of matched livebirths as a control, we calculated matched odds ratios (mORs) using conditional logistic regression adjusted for maternal age and education. FINDINGS: 275 (0·2%) of 162 188 women who had stillbirths and 1507 (0·1%) of 1 586 105 women who had livebirths were diagnosed with dengue infection during pregnancy. Symptomatic dengue infection during pregnancy almost doubled the odds of fetal death (mOR 1·9, 95% CI 1·6-2·2). The increase in risk was similar when analyses were restricted to laboratory-confirmed cases of dengue infection (1·8, 1·4-2·4). Severe dengue infection increased the risk of fetal death by about five times (4·9, 2·3-10·2). INTERPRETATION: Symptomatic dengue infection during pregnancy is associated with an increased risk of fetal death. We recommend further epidemiological and biological studies of the association between dengue and poor birth outcomes to measure the burden of subclinical infections and elucidate pathological mechanisms. FUNDING: Brazilian National Council for Scientific and Technological Development, Horizon 2020

Ability of the Chester Step Test to detect functional impairment and mortality risk in people with interstitial lung disease

People with interstitial lung disease (ILD) often experience disabling symptoms, which impairs their functional capacity, further accelerating disease progression. The 6-minute walk test (6MWT) has been the most widely used field test to assess functional capacity and to discriminate the mortality risk in people with ILD. Nevertheless, its application across settings (e.g., patients’ homes) is often limited due to the need of a 30 m corridor. Alternatives to assess functional capacity in these settings have been emerging, such as the 1-minute sit-to-stand test (1-minSTS) and the Chester step test (CST). However, the first does not allow exercise prescription. The CST is a simple and low-cost field test, which enables exercise prescription and requires minimal physical space to assess functional capacity. Its suitability to be used as a first-line screening tool to detect functional capacity impairment and mortality risk in people with ILD is however unknown. Thus, the aim of this study was to determine the discriminative ability of the CST in distinguishing people with ILD with or without functional impairment and low or higher risk of mortality. A retrospective cross-sectional study was conducted with stable (i.e., no history of acute cardiac events, acute exacerbations or other respiratory complications in the previous month) people with ILD. The following measures were collected: CST, 6MWT and 1-minSTS. A receiver operating characteristics (ROC) curve analysis was performed and area under the curve (AUC), sensitivity, specificity and accuracy were calculated. We determined a threshold for the CST to identify: i) functional impairment, based on published cut-offs of the percentage predicted of the 1-minSTS and the 6MWT (both 70% predicted); and, ii) mortality, based on different established cut-offs of the 6MWT (250, 330 and 350 m). The optimal cut-off points were identified by the highest Youden index. Eighty-three people with ILD (65 ± 14 years old; 45 [54.2%] female; FVC 77.7 ± 17.9%predicted; DLCO 50.3 ± 20.7% predicted) were included in the analysis. The cut-off points of the 1-minSTS (AUC = 0.73; 95%CI 0.63-0.84; 81% sensitivity; 65% specificity; accuracy = 0.72) and 6MWT (AUC = 0.91; 95%CI 0.82-0.99; 88% sensitivity; 83% specificity; accuracy = 0.86) identified a cut-off of 40.5 steps in CST to detect functional impairment in people with ILD. All cut-offs of the 6MWT identified a cut-off of 36 steps on the CST (6MWT < 250m: AUC = 0.89; 95% CI 0.80-0.97; 86% sensitivity; 80% specificity; accuracy = 0.80; 6MWT < 330m: AUC = 0.97; 95%CI 0.93-1; 96% sensitivity; 81% specificity; accuracy = 0.90; 6MWT < 350m: AUC = 0.93; 95%CI 0.86-1; 98% sensitivity; 70% specificity; accuracy = 0.90) to detect increased risk of mortality. Healthcare professionals may now use cut-offs of 40.5 and 36 steps in the CST to accurately detect people with ILD with functional impairment and/or at increased risk of mortality, respectively, which may contribute to the implementation of tailored and preventive interventions to improve functional capacity and reduce the risk of mortality in this population.publishe

Validating linkage of multiple population-based administrative databases in Brazil.

BACKGROUND: Linking routinely-collected data provides an opportunity to measure the effects of exposures that occur before birth on maternal, fetal and infant outcomes. High quality linkage is a prerequisite for producing reliable results, and there are specific challenges in mother-baby linkage. Using population-based administrative databases from Brazil, this study aimed to estimate the accuracy of linkage between maternal deaths and birth outcomes and dengue notifications, and to identify potential sources of bias when assessing the risk of maternal death due to dengue in pregnancy. METHODS: We identified women with dengue during pregnancy in a previously linked dataset of dengue notifications in women who had experienced a live birth or stillbirth during 2007-2012. We then linked this dataset with maternal death records probabilistically using maternal name, age and municipality. We estimated the accuracy of the linkage, and examined the characteristics of false-matches and missed-matches to identify any sources of bias. RESULTS: Of the 10,259 maternal deaths recorded in 2007-2012, 6717 were linked: 5444 to a live birth record, 1306 to a stillbirth record, and 33 to both a live and stillbirth record. After identifying 2620 missed-matches and 124 false-matches, our estimated sensitivity was 72%, specificity was 88%, and positive predictive value was 98%. Linkage errors were associated with maternal education and self-identified race; women with more than 7 years of education or who self-declared as Caucasian were more likely to link. Dengue status was not associated with linkage error. CONCLUSION: Despite not having unique identifiers to link mothers and birth outcomes, we demonstrated a high standard of linkage, with sensitivity and specificity values comparable to previous literature. Although there were no differences in the characteristics of dengue cases missed or included in our linked dataset, linkage error occurred disproportionally by some social-demographic characteristics, which should be taken into account in future analyses

Seroprevalence of Chikungunya Virus after Its Emergence in Brazil.

Chikungunya has had a substantial impact on public health because of the magnitude of its epidemics and its highly debilitating symptoms. We estimated the seroprevalence, proportion of symptomatic cases, and proportion of chronic form of disease after introduction of chikungunya virus (CHIKV) in 2 cities in Brazil. We conducted the population-based study through household interviews and serologic surveys during October-December 2015. In Feira de Santana, we conducted a serologic survey of 385 persons; 57.1% were CHIKV-positive. Among them, 32.7% reported symptoms, and 68.1% contracted chronic chikungunya disease. A similar survey in Riachão do Jacuípe included 446 persons; 45.7% were CHIKV-positive, 41.2% reported symptoms, and 75.0% contracted the chronic form. Our data confirm intense CHIKV transmission during the continuing epidemic. Chronic pain developed in a high proportion of patients. We recommend training health professionals in management of chronic pain, which will improve the quality of life of chikungunya-affected persons