Dropouts or Discontinuity of the Treatment of Tuberculosis in Rio Branco, Acre

This research investigates the factors related to the discontinuity of the treatment of tuberculosis in Rio Branco-Acre. To the fulfillment of this research, a contribution to ethnography has been adopted, for the successful apprehension of the reality to be studied. The research has been developed in two mapping steps: on the first, a search for information on the SINAN (System of National Injuries Notification - Sistema de Notificacao de Agravos Nacionais) and on the Municipal Coordination of the Tuberculosis Program databases was taken; the second aimed to record facts from the observation of the care given on a health care unit, which serves assistance to tuberculosis carriers in treatment, and the interviews of the elected subjects. On the analysis of the observations, narrative and interview collection, it was observed that the professionals of health services label some people as auspicious to discontinue the treatment and don't consider the different ways of life on the approach of their patients, complicating the formation of the bond and favoring the discontinuity. It was also identified people treating for tuberculosis that had many ways of dealing with the limitations generated by the disease, such as restrictions for the work, among others, and people that discontinued the treatment took in consideration their system of beliefs and values, as well as the perception of health/disease, due to the feeling of cure when the treatment was interrupted.

Abandono ou descontinuidade do tratamento da tuberculose em Rio Branco, Acre

Esta pesquisa investiga os fatores que estão relacionados à descontinuidade do tratamento da tuberculose em Rio Branco-Acre e foi realizada com uma contribuição da etnografia para uma apreensão da realidade a ser estudada. Foi desenvolvida em duas etapas de mapeamento: na primeira, procedeu-se à busca de informações na base de dados do SINAN (Sistema de Notificação de Agravos Nacional) e na Coordenação Municipal do Programa de Tuberculose, a segunda etapa procurou registrar fatos a partir da observação do atendimento numa unidade de saúde que presta assistência aos portadores de tuberculose em tratamento, e entrevistas com eles, assim como de profissionais que prestavam assistência. Na análise das observações, coletas de narrativas e entrevistas, observou-se que os profissionais dos serviços de saúde caracterizam algumas pessoas como propícias a descontinuarem o tratamento e não consideram os diferentes modos de vida na abordagem de seus pacientes, dificultando, assim, a formação do vínculo e favorecendo a descontinuidade ou o abandono. Identificou-se também que as pessoas que faziam o tratamento da tuberculose tinham várias formas de lidar com as limitações que foram geradas pela doença, como a restrição para o trabalho, entre outras, e as pessoas que o descontinuaram levavam em consideração seu sistema de crenças e valores, bem como a própria percepção de saúde/doença, devido a estarem se sentindo curados quando o interromperam.

Desnutrição em crianças menores de 60 meses em dois municípios no Estado do Acre: prevalência e fatores associados

OBJETIVO: Investigar a prevalência da desnutrição e fatores associados em crianças menores de 60 meses em dois municípios do Estado do Acre. MÉTODOS: Estudo transversal de base populacional realizado com 667 crianças da área urbana dos municípios de Acrelândia e Assis Brasil. A prevalência da desnutrição foi calculada pelo padrão de crescimento da Organização Mundial da Saúde de 2006, com o ponto de corte -2 escores Z. Informações sobre condições socioeconômicas, acesso aos serviços e cuidado da criança, peso ao nascer e morbidade foram obtidas por questionário estruturado. A regressão de Poisson foi utilizada para identificar os fatores associados à desnutrição de crianças. RESULTADOS: A prevalência do déficit estatura para idade e déficit peso para estatura foi de 9,9% e 4,1%, respectivamente. Os fatores associados ao déficit estatura para idade foram o baixo índice de riqueza (razão de prevalência [RP]: 1,74; intervalo de confiança em 95% [IC95%]: 0,95 - 3,18), analfabetismo do pai ou padrasto (RP: 1,82; IC95%: 1,01 - 3,27), ter 2 ou mais irmãos menores (RP: 2,88; IC95%: 1,45 - 5,72), ausência da mãe biológica no domicílio (RP: 2,63; IC95%: 1,32 - 5,24) e exposição ao esgoto a céu aberto no âmbito domiciliar (RP: 2,46; IC95%: 1,51 - 4,00). Somente o baixo peso ao nascer mostrou-se como fator associado ao déficit peso para estatura (RP: 2,91; IC95%: 1,16 - 7,24). CONCLUSÕES: Nos municípios estudados, a desnutrição em crianças menores de 60 meses apresenta-se como um importante problema de saúde pública, associado aos indicadores de iniquidades sociais, acesso aos serviços de saúde e ausência da mãe no domicílio.

Determinants of linear growth from infancy to school-aged years: a population-based follow-up study in urban Amazonian children

Background: Although linear growth during childhood may be affected by early-life exposures, few studies have examined whether the effects of these exposures linger on during school age, particularly in low-and middle-income countries. Methods: We conducted a population-based longitudinal study of 256 children living in the Brazilian Amazon, aged 0.1 y to 5.5 y in 2003. Data regarding socioeconomic and maternal characteristics, infant feeding practices, morbidities, and birth weight and length were collected at baseline of the study (2003). Child body length/height was measured at baseline and at follow-up visits (in 2007 and 2009). Restricted cubic splines were used to construct average height-for-age Z score (HAZ) growth curves, yielding estimated HAZ differences among exposure categories at ages 0.5 y, 1 y, 2 y, 5 y, 7 y, and 10 y. Results: At baseline, median age was 2.6 y (interquartile range, 1.4 y-3.8 y), and mean HAZ was -0.53 (standard deviation, 1.15); 10.2% of children were stunted. In multivariable analysis, children in households above the household wealth index median were 0.30 Z taller at age 5 y (P = 0.017), and children whose families owned land were 0.34 Z taller by age 10 y (P = 0.023), when compared with poorer children. Mothers in the highest tertile for height had children whose HAZ were significantly higher compared with those of children from mothers in the lowest height tertile at all ages. Birth weight and length were positively related to linear growth throughout childhood; by age 10 y, children weighing >3500 g at birth were 0.31 Z taller than those weighing 2501 g to 3500 g (P = 0.022) at birth, and children measuring >= 51 cm at birth were 0.51 Z taller than those measuring <= 48 cm (P = 0.005). Conclusions: Results suggest socioeconomic background is a potentially modifiable predictor of linear growth during the school-aged years. Maternal height and child's anthropometric characteristics at birth are positively associated with HAZ up until child age 10 y.

Morbidity among nursing personnel and its association with working conditions and work organization

Introduction: Work organization patterns and working conditions experienced by nursing personnel in the hospital settings may be associated to increased morbidity among these health workers. Aim: To estimate the prevalence and factors associated with self-reported diseases among nursing personnel at the emergency hospital in Rio Branco/ State of Acre, Brazil. Methods: A cross-sectional study was conducted involving 272 participants who answered a questionnaire including sociodemographic characteristics, working conditions, lifestyles, work ability, and a fatigue perception scale. The self-reported diseases in the 12 months prior to data collection were considered the dependent variable. Results: A total of 85.7% of the participants reported one or more diseases in the past 12 months. Most prevalent diseases were: musculoskeletal diseases (37.1%), digestive diseases (28.7%), mental disorders (28.3%), work injuries (27.9%), and respiratory diseases (26.8%). The following significant variables remained in the final model: high work demands (OR 2.69), reported fatigue (OR 3.59), night work (OR 6.55) and being a technician or nursing assistant (OR 4.23). Conclusions: Variables related to working conditions and work organization were associated with the occurrence of reported diseases among nursing professionals. Health promotion measures at work require a comprehensive approach including the working conditions and the work organization.

New species of Fissiphallius Martens 1988 from Brazil and notes on the morphology of Fissiphalliidae (Arachnida, Opiliones)

The seventh species of Fissiphallidae, Fissiphallius orube sp. nov., and the fourth from Brazil (type locality state of Acre, Cruzeiro do Sul, at the Moa river), is described. The new species differs from the remaining species of the family in lacking a pergula, having a knob at the base of the rutrum, and the ocularium spiniform projection with apical portion single or divided in two to three parts.

Mycobiota and mycotoxins in Brazil nut samples from different states of the Brazilian Amazon region

The objective of this study was to evaluate the presence of fungi and mycotoxins (aflatoxins and cyclopiazonic acid) in Brazil nut samples collected in different states of the Brazilian Amazon region: Acre, Amazonas, Amapa, and Para. A total of 200 husk samples and 200 almond samples were inoculated onto Aspergillus flavus-parasiticus agar for the detection of fungi. Mycotoxins were analyzed by high-performance liquid chromatography. The mycobiota comprised the following fungi, in decreasing order of frequency: almonds - Phialemonium spp. (54%), Penicillium spp. (16%), Fusarium spp. (13%), Phaeoacremonium spp. (11%), and Aspergillus spp. (4%), husks - Phialemonium spp. (62%), Phaeoacremonium spp. (11%), Penicillium spp. (10%), Fusarium spp. (9%), and Aspergillus spp. A polyphasic approach was used for identification of Aspergillus species. Aflatoxins were detected in 22 (11%) of the 200 almond samples, with 21 samples presenting aflatoxin B-1 levels above 8 mu g/kg, the limit established by the European Commission for Brazil nuts for further processing. Nineteen (9.5%) of the 200 husk samples contained aflatoxins, but at levels lower than those seen in almonds. Cyclopiazonic acid (CPA) was detected in 44 (22%) almond samples, with levels ranging from 98.65 to 1612 mu g/kg. Aspergillus nomius and A. flavus were the most frequent Aspergillus species. The presence of fungi does not necessarily imply mycotoxin contamination, but almonds of the Brazil nut seem to be a good substrate for fungal growth. (C) 2012 Elsevier B.V. All rights reserved.

Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities

Background: Studies in South-East Asia have suggested that early diagnosis and treatment with artesunate (AS) and mefloquine (MQ) combination therapy may reduce the transmission of Plasmodium falciparum malaria and the progression of MQ resistance. Methods: The effectiveness of a fixed-dose combination of AS and MQ (ASMQ) in reducing malaria transmission was tested in isolated communities of the Jurua valley in the Amazon region. Priority municipalities within the Brazilian Legal Amazon area were selected according to pre-specified criteria. Routine national malaria control programmatic procedures were followed. Existing health structures were reinforced and health care workers were trained to treat with ASMQ all confirmed falciparum malaria cases that match inclusion criteria. A local pharmacovigilance structure was implemented. Incidence of malaria and hospitalizations were recorded two years before, during, and after the fixed-dose ASMQ intervention. In total, between July 2006 and December 2008, 23,845 patients received ASMQ. Two statistical modelling approaches were applied to monthly time series of P. falciparum malaria incidence rates, P. falciparum/Plasmodium vivax infection ratio, and malaria hospital admissions rates. All the time series ranged from January 2004 to December 2008, whilst the intervention period span from July 2006 to December 2008. Results: The ASMQ intervention had a highly significant impact on the mean level of each time series, adjusted for trend and season, of 0.34 (95% CI 0.20 - 0.58) for the P. falciparum malaria incidence rates, 0.67 (95% CI 0.50 - 0.89) for the P. falciparum/P. vivax infection ratio, and 0.53 (95% CI 0.41 - 0.69) for the hospital admission rates. There was also a significant change in the seasonal (or monthly) pattern of the time series before and after intervention, with the elimination of the malaria seasonal peak in the rainy months of the years following the introduction of ASMQ. No serious adverse events relating to the use of fixed-dose ASMQ were reported. Conclusions: In the remote region of the Jurua valley, the early detection of malaria by health care workers and treatment with fixed-dose ASMQ was feasible and efficacious, and significantly reduced the incidence and morbidity of P. falciparum malaria.

Habitat Fragmentation Effects on the Orchid Bee Communities in Remnant Forests of Southeastern Brazil

The effect of habitat fragmentation on the structure of orchid bee communities was analyzed by the investigation of the existence of a spatial structure in the richness and abundance of Euglossini species and by determining the relationship between these data and environmental factors. The surveys were carried out in four different forest fragments and one university campus. Richness, abundance, and diversity of species were analyzed in relation to abiotic (size of the area, extent of the perimeter, perimeter/area ratio, and shape index) and biotic characteristics (vegetation index of the fragment and of the matrix of each of the locations studied). We observed a highly significant positive correlation between the diversity index and the vegetation index of the fragment, landscape and shape index. Our analysis demonstrated that the observed variation could be explained mainly by the vegetation index and the size of the fragment. Variations in relative abundance showed a tendency toward an aggregated spatial distribution between the fragments studied, as well as between the sampling stations within the same habitat, demonstrating the existence of a spatial structure on a small scale in the populations of Euglossini. This distribution will determine the composition of species that coexist in the area after fragmentation. These data help in understanding the differences and similarities in the structure of communities of Euglossini resulting from forest fragmentation.

Single-Nucleotide Polymorphism and Copy Number Variation of the Multidrug Resistance-1 Locus of Plasmodium vivax: Local and Global Patterns

Emerging resistance to chloroquine (CQ) poses a major challenge for Plasmodium vivax malaria control, and nucleotide substitutions and copy number variation in the P. vivax multidrug resistance 1 (pvmdr-1) locus, which encodes a digestive vacuole membrane transporter, may modulate this phenotype. We describe patterns of genetic variation in pvmdr-1 alleles from Acre and Amazonas in northwestern Brazil, and compare then with those reported in other malaria-endemic regions. The pvmdr-1 mutation Y976F, which is associated with CQ resistance in Southeast Asia and Oceania, remains rare in northwestern Brazil (1.8%) and its prevalence mirrors that of CO resistance worldwide. Gene amplification of pvmdr-1, which is associated with mefloquine resistance but increased susceptibility to CO, remains relatively rare in northwestern Brazil (0.9%) and globally (< 4%), but became common (> 10%) in Tak Province, Thailand, possibly because of drug-mediated selection. The global database we have assembled provides a baseline for further studies of genetic variation in pvmdr-1 and drug resistance in P. vivax malaria.

Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study

Abstract Background Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil. Methods The cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case–control approach. Results The overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%–1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country. Conclusions The large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at large. The known risk factors explain less than 50% of the infected cases, limiting the prevention strategies. Our findings regarding risk behaviors associated with HCV infection showed that there is still room for improving strategies for reducing transmission among drug users and nosocomial infection, as well as a need for specific prevention and control strategies targeting individuals living in poverty.