Pre-travel consultations quality criteria: a Delphi consensus

publishersversionpublishe

spatial cluster detection

Funding Information: This study was partially supported by the Coordena\u00E7\u00E3o de Aperfei\u00E7oamento de Pessoal de N\u00EDvel Superior\u2014CAPES\u2014Finance Code 001 and Vice-dire\u00E7\u00E3o de Pesquisa e Inova\u00E7\u00E3o\u2014ENSP/Fiocruz. Publisher Copyright: © 2024 by the authors.Brazil reported 18,282 suspected congenital Zika syndrome (CZS) cases up to 2018 and accounts for 61.4% of the total reported Zika cases in the Americas in the period. To detect high-risk areas for children with CZS in the city of Rio de Janeiro, we used cluster detection and thematic maps. We analyzed data using a Poisson model in Satscan 10.1.3 software. We also analyzed the records of children with CZS from 2015 to 2016 to describe the clinical and epidemiological maternal and child profile, as well as live births in 2016 and the social development index (SDI) by neighborhood. In 2015 and 2016, the incidence rates of CZS were 8.84 and 46.96 per 100,000 live births in the city, respectively. Severe congenital findings such as microcephaly and brain damage, osteoarticular impairment, ocular abnormalities, and hearing loss were observed in 47 children. The spatial distribution of CZS was concentrated in the north and west zones in heterogeneous neighborhoods. The neighborhoods with the highest occurrence of CZS cases were found to have the worst SDIs. Stascan detected three spatial clusters in the north zone, where the SDI is lower. The clusters presented high relative risks for CZS (7.86, 1.46, and 2.08), although they were not statistically significant. Our findings highlight a higher occurrence of CZS in areas with less favorable socioeconomic conditions.publishersversionpublishe

Knowledge, attitudes and practice about zika

No Brasil um surto causado pelo vírus zika foi relatado em 2015 e estima-se a ocorrência de 1,5 milhões de casos entre 2015 e 2016. Este trabalho pretende descrever conhecimentos, atitudes e práticas sobre zika em gestantes e puérperas de uma maternidade de alto risco no estado do Rio de Janeiro. Objetiva traçar o perfil das mulheres, analisar as características socio-demográficas, clínico-epidemiológicas, investigar conhecimentos, atitudes e práticas sobre zika destas mulheres e construir um escore de avaliação do conhecimento sobre a doença. Trata-se de um estudo seccional realizado por meio de questionário estruturado elaborado com base no modelo da OMS. A criação do escore (EFWC) permitiu a qualificação do grau de conhecimento sobre zika. A maior parte das gestantes e puérperas julgou insuficiente a informação que possui sobre zika (71%) em relação a sinais e sintomas (68,3%), causa (67,5%), prevenção (61,8%) e consequências (57%). A partir do cálculo do escore, observou-se que 1,6% das mulheres não tinham conhecimento algum sobre zika; 58,5% das mulheres tem conhecimento ruim ou inferior sobre zika. Não foi observada correlação entre renda, escolaridade ou idade da população deste estudo ao conhecimento sobre zika medido pelo escore. In Brazil an outbreak caused by the zika virus was reported in 2015 and an estimated 1.5 million cases were reported in 2015 and 2016. This paper aims to describe knowledge, attitudes and practices about zika in pregnant and postpartum women of a high risk maternity hospital in the state of Rio de Janeiro. It aims to trace the profile of women, analyze the demographic, clinical and epidemiological characteristics, investigate knowledge, attitudes and practices about zika of these women and build a knowledge assessment score on the disease. This is a sectional study carried out using a structured questionnaire based on the WHO model. The score (EFWC) was elaborated to assess the degree of knowledge about zika. Most of pregnant and postpartum women considered the information they had about zika insufficient (71%) regarding signs and symptoms (68.3%), cause (67.5%), prevention (61.8%), consequences (57%). The score revealed that 1.6% of the women had no knowledge about zika; 58.5% of women had poor or inferior knowledge about zika. No correlation was found between income, schooling or age of the study population and knowledge about zika measured by the score.publishersversionpublishe

FORMAÇÃO DE PROFISSIONAIS DA SAÚDE NA VIGILÂNCIA DO ÓBITO MATERNO, INFANTIL E FETAL COMO ESTRATÉGIA DE ENFRENTAMENTO DA PANDEMIA DE COVID-19

O impacto da pandemia desencadeou uma escalada de morte de gestantes e puérperas com grandes desafios para a vigilância e atenção à saúde. O estudo tem como objetivo discutir a formação de profissionais da saúde em vigilância do óbito materno, infantil e fetal no contexto da pandemia de covid-19. Aborda os desafios do trabalho de equipe multidisciplinar na identificação, atualização e produção. São apresentadas as etapas de desenvolvimento do curso desde a sua concepção e implementação, atualização do material didático, o processo de acompanhamento pedagógico por meio de uma rede formativa docente e as contribuições para a formação dos profissionais de saúde. O cenário epidemiológico demandou o uso intensificado de tecnologias digitais de informação e comunicação, formação e apoio aos tutores-docentes e maior acolhimento a docentes e estudantes para a criação de uma ambiência que favorecesse as atividades de ensino-aprendizagem. A qualificação das ações da vigilância e do trabalho dos comitês de mortalidade tornou-se ainda mais relevante e necessária para o enfrentamento da pandemia. O comprometimento com o desenvolvimento contínuo do curso constitui uma forma de ligação dos saberes teóricos e práticos com as necessidades sociais e institucionais e, sobretudo, dos trabalhadores envolvidos no processo. PALABRAS-CHAVE: Mortalidade Materna. Mortalidade Infantil. Mortalidade Fetal. Vigilância Epidemiológica. Capacitação de Recursos Humanos em Saúde

Factors associated with severe dengue in children - case-control study in three pediatric hospitals in the city of Rio de Janeiro

Made available in DSpace on 2016-06-15T17:41:58Z (GMT). No. of bitstreams: 2 246.pdf: 2136338 bytes, checksum: b9442031a16ab0c4db2024b9f05eac73 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2011Made available in DSpace on 2016-07-05T22:26:19Z (GMT). No. of bitstreams: 3 246.pdf.txt: 255961 bytes, checksum: 3211134772743ab708a93be62021a5f2 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 246.pdf: 2136338 bytes, checksum: b9442031a16ab0c4db2024b9f05eac73 (MD5) Previous issue date: 2011Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.O presente trabalho teve por objetivo analisar os fatores demográficos e clínicolaboratoriais associados ao dengue grave em crianças internadas em três hospitais pediátricos no município do Rio de Janeiro. Inicialmente foi avaliada a literatura disponível sobre o tema por meio de revisão sistemática. Os parâmetros que demonstraram forte associação aos casos graves na revisão foram: letargia, hepatomegalia, hematócrito >50%, hemoconcentração > 22%, sangramento, que constituem sinais de alerta definidos pela Organização Mundial de Saúde (OMS). Também estavam associados à síndrome do choque do dengue (SCD): tipo de vírus, infecção secundária pelo vírus dengue e obesidade. Houve importante variação nos resultados, o que apontou para a necessidade de realização de outros estudos, com desenho e métodos de análise adequados à investigação de fatores preditivos de gravidade em crianças, permitindo a comparação do padrão clínico-epidemiológico entre diferentes populações. Para avaliação dos fatores demográficos, clínicos e laboratoriais associados ao dengue grave em crianças no município do Rio de Janeiro, foi realizado estudo casocontrole em três hospitais de referência para internação. Foram avaliadas 308 crianças na faixa etária de 0 a 18 anos internadas por dengue: 89 casos, definidos como graves pela presença de choque e 219 controles. A média de idade entre os casos foi de 7,9 anos e 9,1 anos nos controles. Não houve associação significativa entre sexo e raça ao dengue grave. Todos os sinais de alarme descritos na literatura foram significativos na análise univariada: agitação (OR:9,1;IC95%3,8–21,6 p=0,000), sonolência (OR:17,4; 8,3–36,8 p=0,000), vômitos persistentes (OR:2,3; 1,2– 4,4 p=0,01), lipotímia (OR:3,4 IC95%1,6 –7,0 p=0,001), oligúria (OR:12,0; IC95%5,9 – 24,2 p=0,000), hipotermia (OR:26,58 IC95%5,9–118,8 p=0,000), desconforto respiratório (OR:10,3 IC95%5,5–19,2 p=0,000), dor abdominal intensa (OR:3,86; IC95%2,2–6,8 p=0,000), hepatomegalia dolorosa (OR:2,69; IC95% 1,5–4,7 p=0,001), hemorragias importantes (OR:3,9; IC95% 2,1–7,2 p=0,000), aumento súbito de hematócrito (OR:2,2; IC95%1, –4,0 p=0,006), queda brusca de plaquetas (OR:5,0; IC95%1,2– 22,0 p=0,001). Permaneceram como fatores associados ao dengue com evolução para o choque em crianças no modelo final de regressão logística multivariado: sonolência (OR:11,1; IC95%4,4-28,3), oligúria (OR:1,2; IC95%4,5-27,6) e dispnéia (OR:9,2; IC95%.4,2-20,3). O estudo demonstrou a importância do monitoramento dos sinais clínicos, confirmou a relevância dos sinais de iv alarme e definiu indicadores de evolução para o quadro de choque em crianças hospitalizadas com dengue.The study aimed to evaluate demographic, clinical and laboratorial factors associated to severe dengue in hospitalized children from three pediatric hospitals in Rio de Janeiro. Initially, a systematic review about clinical and laboratorial aspects associated to severe dengue was developed. The parameters which revealed strong association to severe cases were: lethargy, hepatomegaly, hematocrit level >50%, hemoconcentration >22% and bleeding. Those are warning signs according to World Health Organization (WHO). The following signs were also associated to dengue shock syndrome (DSS): virus type, secondary dengue infection and obesity. The results presented important heterogeneity. Further studies with adequate designs and methods for the investigation of predictive factors of severity in children, allowing comparison of the clinical and epidemiological pattern in different populations, are needed. To evaluate demographic, clinical and laboratorial factors associated to severe dengue in children in Rio de Janeiro, a case-control study was conducted in three reference hospitals. A total of 308 children from 0 to 18 years old admitted with dengue diagnosis was evaluated: 89 cases of shock, according to the definition of the study, and 219 controls. The mean age was 7,9 years old for cases and 9,1 years old among controls. There was no significant association of sex and race with severe dengue. All the warning signs presented significant association with severe dengue in univariate analysis: restlessness (OR:9,1;CI95%3,8–21,6 p=0,000), lethargy (OR:17,4; CI95%8,3– 36,8 p=0,000), persistent vomiting (OR:2,3; CI95%1,2– 4,4 p=0,01), lipothymia (OR:3,4 CI95%1,6 –7,0 p=0,001), oliguria (OR:12,0; CI95%5,9 – 24,2 p=0,000), hypotermia (OR:26,58 CI95%5,9–118,8 p=0,000), respiratory distress (OR:10,3 IC95%5,5–19,2 p=0,000), intense abdominal pain (OR:3,86; IC95%2,2–6,8 p=0,000), tender hepatomegaly (OR:2,69; CI95% 1,5–4,7 p=0,001), severe hemorrhage (OR:3,9; CI95% 2,1–7,2 p=0,000), sudden hematocrit raise (OR:2,2; CI95%1, –4,0 p=0,006), rapid platelet count decrease (OR:5,0; CI95%1,2– 22,0 p=0,001). The factors which remained in the final logistic regression model associated to shock were: lethargy (OR:11,1; CI95%4,4-28,3), oliguria (OR:1,2; CI95%4,5-27,6) and dyspnea (OR:9,2; IC95%.4,2-20,3). The study stressed the importance of monitoring clinical signs, confirmed the relevance of the warning signs and defined indicators of clinical evolution to shock in hospitalized children with dengue

Evaluate the epidemiologic surveillance system in Rio de Janeiro city, period 1994-1996

Made available in DSpace on 2012-09-06T01:11:04Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 853.pdf: 1160754 bytes, checksum: 404239ad2aba2beb277c6aeeab90f1fb (MD5) Previous issue date: 1997Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.O estudo teve como objetivo avaliar o Sistema de Vigilância Epidemiológica no Município do Rio de Janeiro. Foi utilizada a metodologia do CDC, que aponta sete características para avaliação de Sistemas de Vigilância: Simplicidade, Flexibilidade, Sensibilidade, Oportunidade, Representatividade, Aceiilidade e Valor Preditivo Positivo. Para análise das características do Sistema foram selecionadas duas doenças traçadoras: a Doença Meningocócica e as Hepatites Virais. Embora cada um destes agravos constitua um subsistema dentro do Sistema de V.E., foi possível a avaliação dos pontos críticos no fluxo de cada um deles e do sistema como um todo. O sistema foi analisado nos níveis local e central (estadual e municipal) por meio de entrevistas com os profissionais de saúde dos diferentes níveis e análise de documentos e bancos de dados do período (1994 a 1996)The study aimed to evaluate the epidemiologic surveillance system in Rio de Janeiro city. The methodology used was developed by CDC, pointing out seven characteristics as tools for the evaluation: Simplicity, Flexibility, Sensitivity, Representativeness, Timeliness, Acceptability and Predictive Value Positive. Two diseases were selected as tracers of the system: meningococcal disease and viral hepatitis. Although representing subsystems, they were helpful in showing critical points in the flow of surveillance system of each and as a whole. The analysis comprised local and central levels (of the city and state of Rio de Janeiro), through interviews with health professionals, data and documental analysis of the period (1994 – 1996). Flow charts were drawn for each of the tracers according to the rules and comparatively, according to the results of the interviews with health professionals and authorities in different levels of the system. To perform the analysis different sources of information and criteria were used, such as: flow and elements of the system, recent inclusion of activities in the system, data and interview analysis of the characteristics and evaluation of the quality of data recorded in the epidemiological surveillance record. Concerning hepatitis surveillance, it´s recommended an improve in the timeliness and acceptability, so that the speed between steps can work better and all its elements be integrated. Meningococcal disease surveillance, was flexible, sensitive and showed a rapid response and good acceptability. Results point to the need to improve the integration between the elements of the system, including local and central levels, health facilities, diagnosis laboratories, health professionals and community

Acesso aos serviços de saúde por pacientes com suspeita de dengue na cidade do Rio de Janeiro, Brasil

Resumo O Rio de Janeiro mantém histórico recorrente de epidemias de dengue. Não há suficientes evidências acerca do percurso da população em busca de atendimento. O estudo visou investigar o padrão de deslocamento dos residentes do Rio de Janeiro com suspeita de dengue para atendimento nos serviços de saúde. Foram analisadas as notificações de dengue e utilizados os bairros da cidade como unidade de análise com enfoque no acesso às unidades de saúde da área de planejamento (AP) 3.3 e elaborados mapas de fluxo entre bairro de residência e unidade de atendimento. Foram notificados 48.576 residentes com suspeita de dengue no período de 2011 a 2013, 72% atendidos na AP 3.3: 37% na atenção primária e 73% em unidades de atenção secundária ou terciária; 12.545 foram atendidos em unidades fora da AP 3.3. Os resultados evidenciam uma grande variação geográfica na busca pelo atendimento na Atenção Primária dentro da própria AP 3.3 e um relevante deslocamento para unidades localizadas em bairros mais distantes, principalmente para o centro e zona sul, com 2.647 diferentes fluxos. Os achados apontam para um grande deslocamento dentro do município

Treatment of chikungunya musculoskeletal disorders: a systematic review

<p><b>Introduction</b>: Chikungunya virus is amongst the fastest expanding vector transmissible diseases in recent years and has been causing massive epidemics in Africa, Asia, Latin America and the Caribbean. Despite human infection by this virus being first described in the 1950s, there is a lack of adequate therapeutic evaluations to guide evidence-based recommendations. The current guidelines rely heavily in specialists’ opinion and experience instead of using higher rated evidence.</p> <p><b>Areas covered</b>: A systematic review of the literature was performed- not restricted to clinical trials – reporting the therapeutic response against this infection with the intent to gather the best evidence of the treatment options against musculoskeletal disorders following chikungunya fever. The 15 studies included in the analysis were categorized considering the initiation of treatment during the acute, subacute and chronic phase.</p> <p><b>Expert commentary</b>: This review demonstrates the complexity of chikungunya fever and difficulty of therapeutic management. This review found no current evidence-based treatment recommendations for the musculoskeletal disorders following chikungunya fever. To provide an optimal treatment that prevents perpetuation or progression of chikungunya infection to a potentially destructive and permanent condition without causing more harm is an aim that must be pursued by researchers and health professionals working with this disease.</p

Estudio de una cohorte de nacimientos de base poblacional en un área urbana desfavorecida de Río de Janeiro, Brasil: implementación y descripción de las características del estudio

Submitted by Janaína Nascimento ([email protected]) on 2019-07-04T01:45:01Z No. of bitstreams: 1 ve_Pedro_Renata_etal_INI_2019.pdf: 2377704 bytes, checksum: 66d55c9384941a43c97a5daee219bcc0 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-07-04T01:59:06Z (GMT) No. of bitstreams: 1 ve_Pedro_Renata_etal_INI_2019.pdf: 2377704 bytes, checksum: 66d55c9384941a43c97a5daee219bcc0 (MD5)Made available in DSpace on 2019-07-04T01:59:06Z (GMT). No. of bitstreams: 1 ve_Pedro_Renata_etal_INI_2019.pdf: 2377704 bytes, checksum: 66d55c9384941a43c97a5daee219bcc0 (MD5) Previous issue date: 2019Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Presidência. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Núcleo Operacional Sentinela de Mosquitos Vetores. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.London School of Hygiene and Tropical Medicine. Department of Disease Control. London, U.K.Fundação Oswaldo Cruz. Núcleo Operacional Sentinela de Mosquitos Vetores. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.A comprehensive cohort study including an entomological surveillance component can contribute to our knowledge of clinical aspects and transmission patterns of arbovirosis. This article describes the implementation of a populational-based birth cohort study that included an entomological surveillance component, and its associated challenges in a low-income community of Rio de Janeiro, Brazil. The participants were recruited in two periods: from 2012 to 2014, and from 2015 to 2017. The children had scheduled pediatric consultations and in case of fever. Epidemiological, clinical data and biological samples were collected at pediatric visits. Active febrile surveillance was performed by telephone calls, social networking, message apps, and household visits. A total of 387 newborns and 332 new children were included during the first and second recruitment periods, respectively. By July 2017, there were 451 children on follow-up. During the study, 2,759 pediatric visits were performed: 1,783 asymptomatic and 976 febrile/rash consultations. The number of febrile or rash consultations increased 3.5-fold after the use of media tools for surveillance. No temporal pattern, seasonality or peak of febrile cases was observed during the study period. A total of 10,105 adult mosquitoes (including 3,523 Aedes spp. and 6,582 Culex quinquefasciatus) and 46,047 Aedes eggs were collected from households, schools, and key sites. Although challenging, this structured sentinel populational-based birth cohort is relevant to the knowledge of risks and awareness of emerging pathogens

Ambulatory and hospitalized patients with suspected and confirmed mpox: an observational cohort study from BrazilResearch in context

Summary: Background: By October 30, 2022, 76,871 cases of mpox were reported worldwide, with 20,614 cases in Latin America. This study reports characteristics of a case series of suspected and confirmed mpox cases at a referral infectious diseases center in Rio de Janeiro, Brazil. Methods: This was a single-center, prospective, observational cohort study that enrolled all patients with suspected mpox between June 12 and August 19, 2022. Mpox was confirmed by a PCR test. We compared characteristics of confirmed and non-confirmed cases, and among confirmed cases according to HIV status using distribution tests. Kernel estimation was used for exploratory spatial analysis. Findings: Of 342 individuals with suspected mpox, 208 (60.8%) were confirmed cases. Compared to non-confirmed cases, confirmed cases were more frequent among individuals aged 30–39 years, cisgender men (96.2% vs. 66.4%; p < 0.0001), reporting recent sexual intercourse (95.0% vs. 69.4%; p < 0.0001) and using PrEP (31.6% vs. 10.1%; p < 0.0001). HIV (53.2% vs. 20.2%; p < 0.0001), HCV (9.8% vs. 1.1%; p = 0.0046), syphilis (21.2% vs. 16.3%; p = 0.43) and other STIs (33.0% vs. 21.6%; p = 0.042) were more frequent among confirmed mpox cases. Confirmed cases presented more genital (77.3% vs. 39.8%; p < 0.0001) and anal lesions (33.1% vs. 11.5%; p < 0.0001), proctitis (37.1% vs. 13.3%; p < 0.0001) and systemic signs and symptoms (83.2% vs. 64.5%; p = 0.0003) than non-confirmed cases. Compared to confirmed mpox HIV-negative, HIV-positive individuals were older, had more HCV coinfection (15.2% vs. 3.7%; p = 0.011), anal lesions (45.7% vs. 20.5%; p < 0.001) and clinical features of proctitis (45.2% vs. 29.3%; p = 0.058). Interpretation: Mpox transmission in Rio de Janeiro, Brazil, rapidly evolved into a local epidemic, with sexual contact playing a crucial role in its dynamics and high rates of coinfections with other STI. Preventive measures must address stigma and social vulnerabilities. Funding: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz)