Leishmaniose visceral no Brasil: fundamentos e preocupações em relação ao controle de reservatórios

O controle da leishmaniose visceral zoonótica representa grande desafio, particularmente no Brasil, onde um paulatino processo de expansão geográfica da doença vem sendo verificado há mais de 30 anos. Nesse contexto, humanos não são considerados relevantes para manutenção da transmissão. Assim, as estratégias usualmente utilizadas com vistas à redução do risco de transmissão se baseiam no controle das populações de vetores e reservatórios. Dentre essas estratégias, a eliminação de cães infectados, correntemente utilizada no Brasil, tem sido das mais questionadas. Neste comentário, apresentam-se os fundamentos que justificam diferentes estratégias de controle orientadas para a população de reservatórios, assim como os limites e preocupações associadas a cada abordagem.The control of zoonotic visceral leishmaniasis is a challenge, particularly in Brazil, where the disease has been gradually spreading across the country over the past 30 years. Strategies employed for decreasing the transmission risk are based on the control of vector populations and reservoirs; since humans are considered unnecessary for the maintenance of transmission. Among the adopted strategies in Brazil, the sacrifice of infected dogs is commonly performed and has been the most controversial measure. In the present study, we provide the rationale for the implementation of different control strategies targeted at reservoir populations and highlight the limitations and concerns associated with each of these strategies

Demarcation of local neighborhoods to study relations between contextual factors and health

<p>Abstract</p> <p>Background</p> <p>Several studies have highlighted the importance of collective social factors for population health. One of the major challenges is an adequate definition of the spatial units of analysis which present properties potentially related to the target outcomes. Political and administrative divisions of urban areas are the most commonly used definition, although they suffer limitations in their ability to fully express the neighborhoods as social and spatial units.</p> <p>Objective</p> <p>This study presents a proposal for defining the boundaries of local neighborhoods in Rio de Janeiro city. Local neighborhoods are constructed by means of aggregation of contiguous census tracts which are homogeneous regarding socioeconomic indicators.</p> <p>Methodology</p> <p>Local neighborhoods were created using the SKATER method (TerraView software). Criteria used for socioeconomic homogeneity were based on four census tract indicators (income, education, persons per household, and percentage of population in the 0-4-year age bracket) considering a minimum population of 5,000 people living in each local neighborhood. The process took into account the geographic boundaries between administrative neighborhoods (a political-administrative division larger than a local neighborhood, but smaller than a borough) and natural geographic barriers.</p> <p>Results</p> <p>The original 8,145 census tracts were collapsed into 794 local neighborhoods, distributed along 158 administrative neighborhoods. Local neighborhoods contained a mean of 10 census tracts, and there were an average of five local neighborhoods per administrative neighborhood.</p> <p>The local neighborhood units demarcated in this study are less socioeconomically heterogeneous than the administrative neighborhoods and provide a means for decreasing the well-known statistical variability of indicators based on census tracts. The local neighborhoods were able to distinguish between different areas within administrative neighborhoods, particularly in relation to squatter settlements.</p> <p>Conclusion</p> <p>Although the literature on neighborhood and health is increasing, little attention has been paid to criteria for demarcating neighborhoods. The proposed method is well-structured, available in open-access software, and easily reproducible, so we expect that new experiments will be conducted to evaluate its potential use in other settings. The method is thus a potentially important contribution to research on intra-urban differentials, particularly concerning contextual factors and their implications for different health outcomes.</p

Intoxicações exógenas em crianças menores de seis anos atendidas em hospitais da região metropolitana do Rio de Janeiro

OBJETIVO: Descrever o perfil dos casos de intoxicações exógenas de crianças admitidas em hospitais de emergência da região metropolitana do Rio de Janeiro, durante três anos. MÉTODOS: Realizou-se levantamento dos dados a partir dos boletins de atendimento de emergência, tendo sido identificados os casos suspeitos ou confirmados de intoxicação nas seguintes categorias: drogas, medicamentos e substâncias biológicas; solventes orgânicos e hidrocarbonetos halogenados; produtos químicos; monóxido de carbono e outros gases, fumaças e vapores; e pesticidas. RESULTADOS: Foram registrados 1.574 casos de intoxicação entre crianças até cinco anos de idade, sendo que cerca de 40% dos casos envolveu produtos químicos de uso doméstico, 35% os medicamentos, e 15% algum tipo de pesticida. Mais da metade das intoxicações por pesticidas envolveu o chumbinho, um produto ilegalmente vendido como raticida, que frequentemente contém o agrotóxico carbamato. A distribuição dos agentes envolvidos variou significativamente segundo sexo, sendo a frequência relativa das intoxicações por medicamentos e chumbinho maior no sexo feminino em comparação ao masculino. Observou-se que a participação dos produtos químicos de uso doméstico decresceu com a idade, enquanto aumentou a dos medicamentos como agentes da intoxicação. No período analisado não observou-se redução significativa no número total de casos registrados anualmente. CONCLUSÃO: Fortalecer a rede de Centros de Controle de Intoxicações, intervir na linha de produção de embalagens para medicamentos e produtos químicos, aumentar a fiscalização sobre a comercialização ilegal do chumbinho, e enfatizar atividades de educação em saúde são ações que podem contribuir para mudar este panorama.OBJECTIVE: To describe the profile of poisoning cases among children attended during three years at emergency hospitals in the metropolitan area of Rio de Janeiro, Brazil. METHODS: All confirmed or suspected poisoning cases, due to drugs and biological substances; organic solvents and hydrocarbons; chemical products; carbon monoxide and other gases; and pesticides, were collected. RESULTS: 1,574 cases of poisoning in children up to 5 years of age were detected. Around 40% of the cases involved chemical products of domestic use, 35% were caused by drugs, and 15% by pesticides. More than half of pesticide poisonings involved the "chumbinho", an illegal product sold as a rodenticide, and usually including in its formulation a carbamate. Distribution of agents varied significantly by gender, the relative frequency of poisonings due to drugs and "chumbinho" being higher among females than males. Participation of chemical products of domestic use decreased with age, but the role of drugs increased as agents of poisoning. During the observation period there was no significant reduction in the total number of annual cases. CONCLUSION: Supporting the expansion of the network of Poison Control Centers, developing intervention for the production of safer packaging devices for drugs chemical products, suppressing the illegal commerce of "chumbinho", and fostering health education activities might contribute to modify this situation

Maternal mental health and nutritional status of six-month-old infants

OBJECTIVE To analyze if maternal mental health is associated with infant nutritional status at six month of age. METHODS A cross-sectional study with 228 six-month-old infants who used primary health care units of the city of Rio de Janeiro, Southeastern Brazil. Mean weight-for-length and mean weight-for-age were expressed in z-scores considering the 2006 World Health Organization reference curves. Maternal mental health was measured by the 12-item General Health Questionnaire. The following cutoff points were used: ≥ 3 for common mental disorders, ≥ 5 for more severe mental disorders, and ≥ 9 for depression. The statistical analysis employed adjusted linear regression models. RESULTS The prevalence of common mental disorders, more severe mental disorders and depression was 39.9%, 23.7%, and 8.3%, respectively. Children of women with more severe mental disorders had, on average, a weight-for-length 0.37 z-scores lower than children of women without this health harm (p = 0.026). We also observed that the weight-for-length indicator of children of depressed mothers was, on average, 0.67 z-scores lower than that of children of nondepressed women (p = 0.010). Maternal depression was associated with lower mean values of weight-for-age z-scores (p = 0.041). CONCLUSIONS Maternal mental health is positively related to the inadequacy of the nutritional status of infants at six months.OBJETIVO Analisar se saúde mental materna associa-se ao estado nutricional infantil no sexto mês de vida. MÉTODOS Estudo seccional com 228 crianças aos seis meses atendidas em unidades básicas de saúde do município do Rio de Janeiro. Médias de peso-para-comprimento e peso-para-idade foram expressas em escores z considerando as curvas de referência do World Health Organization 2006. A saúde mental materna foi aferida pelo General Health Questionnaire com 12 itens. Foram empregados os pontos de corte ≥ 3 para transtornos mentais comuns, ≥ 5 para transtornos mentais mais graves e ≥ 9 para depressão. Na análise estatística empregaram-se modelos de regressão linear ajustados. RESULTADOS As prevalências de transtornos mentais comuns, transtornos mentais mais graves e depressão foram de 39,9%, 23,7% e 8,3%, respectivamente. Para peso-para-comprimento, filhos de mulheres com transtornos mentais mais graves tinham, em média, 0,37 escores z mais baixos do que filhos de mulheres sem este agravo (p = 0,026). Também para o indicador peso-para-comprimento observou-se que, em relação aos filhos de mulheres não deprimidas, crianças de mães deprimidas apresentaram, em média, 0,67 escores z mais baixos (p = 0,010). Depressão materna esteve associada com valores médios mais baixos de escore z de peso-para-idade (p = 0,041). CONCLUSÕES A saúde mental materna está positivamente relacionada à inadequação do estado nutricional de crianças aos seis meses

Autoavaliação do estado de saúde e a associação com fatores sociodemográficos, hábitos de vida e morbidade na população: um inquérito nacional

Made available in DSpace on 2015-02-20T12:31:45Z (GMT). No. of bitstreams: 2 ANA_PAVAO_GUILHERME_WERNECK_MONICA_CAMPOS_ICICT_2013.pdf: 107498 bytes, checksum: 9aba08ade1ae80312fcdc2f515dc7f77 (MD5) license.txt: 1901 bytes, checksum: 5b151416ca540ee931d567773e47becf (MD5) Previous issue date: 2013Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.A autoavaliação do estado de saúde é um importante indicador da percepção de saúde. Este estudo visa investigar a associação entre autoavaliação de saúde e fatores sociodemográficos, hábitos de vida e morbidade na população brasileira. Trata-se de estudo seccional, baseado num inquérito nacional, que avaliou 12.324 indivíduos, nas cinco regiões geográficas do país. Foram aplicados modelos de regressão para avaliar a associação entre o desfecho, avaliado de forma dicotômica, e variáveis de exposição: sexo, idade, renda, escolaridade, raça, situação conjugal, tabagismo, atividade física, consumo de álcool, presença de morbidade crônica e índice de massa corporal. O aumento da idade, possuir baixos níveis de escolaridade e renda, tabagismo, sedentarismo, presença de morbidade crônica e obesidade foram os principais fatores associados à autoavaliação ruim. A identificação das características da população que estão associadas a um pior estado de saúde percebido pode contribuir para traçar um perfil dos indivíduos mais propensos a procurar os serviços de saúde.Self-rated health is an important indicator used to measure health perception. This study aimed to investigate the association between self-rated health and social and demographic factors, health behavior, and morbidity. This was a cross-sectional study based on data from a national health survey. The sample consisted of 12,324 individuals from Brazil's five major geographic regions. Regression analyses were conducted to verify the association between the outcome and the following independent variables: gender, age, income, education, race, marital status, smoking, alcohol consumption, physical activity, chronic illnesses, and body mass index. Increasing age, low education and income, smoking, sedentary habits, chronic illness, and obesity were the factors most strongly associated with worse self-rated health. The identification of population attributes associated with worse self-rated health can help trace a profile of individuals more prone to seeking health services

Restoring High Vaccine Coverage in Brazil: Successes and Challenges

Facing the decline in vaccine coverage observed since 2016, the new Brazilian government committed to reversing this scenario. To achieve this, the Federal Government launched the National Vaccination Movement and the 'Health with Science' platform to combat vaccine misinformation, promoted Microplanning, providing tools for decision-making at the territorial level, allocated 30 million dollars to states and municipalities to implement innovative vaccination strategies, standardized the rules of the information systems for the registration of vaccine doses, and directed data to the National Health Data Network (RNDS). Reversing the declining trend of vaccination coverage in Brazil is challenging, but within just one year, it is possible to observe significant results from governmental actions. Out of the eight recommended vaccines by the age of one, seven showed an increase in vaccination coverage in 2023 compared to 2022: Most states showed improvements in vaccination coverage. Many challenges persist in advancing the vaccination agenda. However, there are reasons to celebrate the reversal of the declining trend in coverage of several vaccines in this first year of government and the increase in the number of municipalities that have fully achieved the vaccination coverage target. The National Vaccination Movement, with public opinion awareness, the resumption of regionalized communication campaigns, localized micro-planning actions including extramural vaccination strategies, and the integration of information systems, has been decisive in strengthening work in the territories and thus restoring a culture of immunization, a source of pride in the country and internationally recognized, throughout the 50 years of the National Immunization Progra

Factores asociados a la incapacidad funcional global luego de transcurrido un año después del traumatismo craneoencefálico

The prevalence of factors associated with functional disability was estimated six and twelve months after traumatic brain injury (TBI) in patients initially treated in the emergency unit of reference for the Metropolitan Region of Salvador, Bahia, Brazil. A prospective cohort study was performed, including 307 individuals with TBI between the ages of 15 and 65 years whose diagnosis was confirmed via neuroimaging. Using data from the period of hospitalization, 242 patients were contacted six months after the injury and 222 patients after twelve months. Functional impairment was evaluated with the Disability Rating Scale. The overall prevalence of functional disability (60.3% in the first evaluation and 40.5% in the second) was significantly associated with age, the initial gravity of the TBI and the duration of the patient's hospitalization, as well as with: fatigue; aphasia; memory, attention and concentration disorders; balance disorders; paresis; and lack of medical consultations with specialists. The high frequency of overall functional disability in the six or twelve-month follow-up period, even for patients with mild traumas, shows the relevance of TBI as a cause of disability and impairment, as well as the need for follow-up services.Se estimó la prevalencia de los factores asociados con incapacidad funcional a los seis y doce meses en pacientes con traumatismo craneoencefálico (TCE) atendidos en una unidad de referencia en la Región Metropolitana de Salvador, Bahía, Brasil. Se realizó un estudio de cohorte prospectivo con 307 individuos con TCE de 15 a 65 años que tuvieron diagnóstico confirmado por imagen. Con los datos obtenidos durante el período de internación hospitalaria, se contactaron 242 pacientes a los seis meses del traumatismo y 222 a los 12 meses. El compromiso funcional fue evaluado con la escala de Disability Rating Scale. La prevalencia global de incapacidad funcional (60,3% en la primera evaluación y 40,5% en la segunda) estuvo asociada significativamente con la edad, la gravedad inicial del TCE y la duración de la internación en el hospital, con fatiga, afasia, trastornos de la memoria, atención y concentración, alteraciones del equilibrio, paresia y ausencia de consultas con especialistas. La alta frecuencia de incapacidad global a los seis y doce meses de seguimiento, aun en pacientes con traumatismos leves, denota la relevancia del TCE como productor de incapacidades y deficiencias, así como la necesidad de servicios de seguimiento

Estimated cost of asthma in outpatient treatment: a real-world study

OBJECTIVE: To estimate the cost of diagnosis and treatment of asthma. METHODS: We used the perspective of society. We sequentially included for 12 months, in 2011-2012, 117 individuals over five years of age who were treated for asthma in the Pneumology and Allergy-Immunology Services of the Piquet Carneiro Polyclinic, Universidade do Estado do Rio de Janeiro. All of them were interviewed twice with a six-month interval for data collection, covering 12 months. The cost units were identified and valued according to defined methods. We carried out a sensitivity analysis and applied statistical methods with a significance level of 5% for cost comparisons between subgroups. RESULTS: The study consisted of 108 patients, and 73.8% of them were women. Median age was 49.5 years. Rhinitis was present in 83.3% of the individuals, and more than half were overweight or obese. Mean family income was U$915.90/month (SD = 879.12). Most workers and students had absenteeism related to asthma. Total annual mean cost was U$1,291.20/patient (SD = 1,298.57). The cost related to isolated asthma was U$1,155.43/patient-year (SD = 1,305.58). Obese, severe, and uncontrolled asthmatic patients had higher costs than non-obese, non-severe, and controlled asthmatics, respectively. Severity and control level were independently associated with higher cost (p = 0.001 and 0.000, respectively). The direct cost accounted for 82.3$1.566,19/mês (DP = 1.503,30). A maioria dos trabalhadores e dos estudantes teve absenteísmo relacionado à asma. O custo médio anual total foi de R$2.207,99/paciente (DP = 2.220,55). O custo relacionado à asma isolada foi de R$1.984,17/paciente-ano (DP = 2.232,55). Asmáticos obesos, graves ou não controlados tiveram maiores custos em comparação aos não obesos (p = 0,001), não graves e controlados (p = 0,000). O custo direto correspondeu a 82,3% do custo total estimado. O custo com medicamentos para asma correspondeu a 62,2% dos custos diretos da asma. CONCLUSÕES: Medicamentos para asma, medidas de controle ambiental e licenças de saúde prolongadas tiveram maior impacto potencial na variação do custo total. Os resultados são uma estimativa do custo do tratamento da asma em nível secundário no Sistema Único de Saúde, assumindo-se que o tratamento utilizado represente a abordagem ideal da doença

Burden of leishmaniasis in Brazil and federated units, 1990-2016: Findings from Global Burden of Disease Study 2016.

BACKGROUND: The study presents estimates for the burden of visceral leishmaniasis (VL) and cutaneous and mucocutaneous leishmaniasis (CML) in Brazil and its 27 federated units using data from the Global Burden of Disease Study (GBD) 2016. METHODOLOGY: We report the incidence, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) for leishmaniasis in Brazil from 1990 to 2016. The metrics are presented as age-standardized rates per 100,000 inhabitants with their respective uncertainty intervals (95%UI) and relative percentages of change. PRINCIPAL FINDINGS: The age-standardized incidence rate of leishmaniasis decreased 48.5% from 1990 (71.0, 95%UI 24.3-150.7) to 2016 (36.5, 95%UI 24.7-50.9), whereas the age-standardized DALY increased 83.6% over the studied period from 12.2 (95%UI 7.9-18.8) to 22.4 (95%UI 13.3-36.2). The age-standardized incidence rate and YLL for VL increased by 52.9% and 108% from 1990 to 2016, respectively. Considering CML, the age-standardized incidence rate and YLD decreased by 51% and 31.8% respectively for the same period. For VL, similar profiles for male and female were observed, with YLL and DALY increasing over time; with males presenting slightly higher values. The highest YLL rates were among "under 1-year old" children, which increased 131.2% from 1990 to 2016. Regarding CML, the highest values of YLD and DALY were verified among males, and YLD values showed a similar profile, with rates increasing with age. The VL burden increased in some states in the Northeast and Southeast regions and decreased for CML in some Northern states. CONCLUSION: The increase of VL burden over the study period might be associated with the difficulties in controlling the disease spread. Information regarding the weight of VL and CML, including the death and disability tolls that they cause, highlights the impact of these neglected diseases on public health and the importance of effective prevention and treatment

Diferenças de gênero no apoio social e atividade física de lazer

OBJECTIVE To identify gender differences in social support dimensions’ effect on adults’ leisure-time physical activity maintenance, type, and time. METHODS Longitudinal study of 1,278 non-faculty public employees at a university in Rio de Janeiro, RJ, Southeastern Brazil. Physical activity was evaluated using a dichotomous question with a two-week reference period, and further questions concerning leisure-time physical activity type (individual or group) and time spent on the activity. Social support was measured with the Medical Outcomes Study Social Support Scale. For the analysis, logistic regression models were adjusted separately by gender. RESULTS A multinomial logistic regression showed an association between material support and individual activities among women (OR = 2.76; 95%CI 1.2;6.5). Affective support was associated with time spent on leisure-time physical activity only among men (OR = 1.80; 95%CI 1.1;3.2). CONCLUSIONS All dimensions of social support that were examined influenced either the type of, or the time spent on, leisure-time physical activity. In some social support dimensions, the associations detected varied by gender. Future studies should attempt to elucidate the mechanisms involved in these gender differences.OBJETIVO Identificar diferenças de gênero no efeito de dimensões de apoio social na manutenção, tipo e tempo da atividade física de lazer em adultos. MÉTODOS Estudo longitudinal com 1.278 funcionários públicos não docentes de uma universidade do Rio de Janeiro. A atividade física foi avaliada utilizando questão dicotômica, com um período de referência de duas semanas, e outras questões relativas ao tipo de atividade (individual ou grupo) e ao tempo gasto na atividade. O apoio social foi medido pelo Medical Outcomes Study Social Support Scale. Para a análise, os modelos de regressão logística foram ajustados separadamente por gênero. RESULTADOS A regressão logística multinomial mostrou associação entre o apoio material e as atividades individuais (OR = 2,76, IC95% 1,2;6,5) entre as mulheres. O apoio afetivo foi associado com o tempo gasto em atividades físicas de lazer (OR = 1,80, IC95% 1,1;3,2) apenas entre os homens. CONCLUSÕES Todas as dimensões de apoio social examinadas influenciaram o tipo ou o tempo gasto em atividades físicas de lazer. Em algumas dimensões de apoio social, as associações variaram segundo gênero. Estudos futuros devem elucidar os mecanismos envolvidos nessas diferenças entre os gêneros