Letalidade e complica����es de angioplastias em hospitais p��blicos no Rio de Janeiro, RJ

OBJETIVO: Estimar a preval��ncia de letalidade e de complica����es decorrentes de angioplastia coronariana em hospitais p��blicos. M��TODOS: Foram analisados dados obtidos no Sistema de Autoriza����o Hospitalar do Sistema ��nico de Sa��de referentes aos 2.913 procedimentos de angioplastia coronariana realizados no munic��pio do Rio de Janeiro, RJ, de 1999 a 2003. Ap��s amostragem aleat��ria simples e pondera����o de dados, foram analisados 529 prontu��rios de pacientes, incluindo todos os ��bitos, submetidos �� angioplastia coronariana em quatro hospitais p��blicos: federal de ensino, estadual de ensino, federal de refer��ncia e estadual de refer��ncia. Os testes de compara����o entre as letalidades segundo caracter��sticas dos pacientes, co-morbidades, complica����es, tipos e indica����es de angioplastia coronariana foram feitas com modelos de regress��o de Poisson. RESULTADOS: A letalidade card��aca geral foi de 1,6%, variando de 0,9% a 6,8%. De acordo com grupo et��rio, a letalidade foi: 0,2% em pacientes com idade inferior a 50 anos; 1,6% entre 50 e 69; e 2,7% acima de 69 anos. A letalidade na angioplastia coronariana prim��ria e de resgate foram elevadas, 17,4% e 13,1%, respectivamente; nas angioplastias eletivas foi de 0,8%. As principais complica����es foram dissec����o (5% dos pacientes, letalidade card��aca = 11,5%) e oclus��o do vaso (2,6%; letalidade card��aca = 21,8%). Sangramento ocorreu em 5,9% dos pacientes (letalidade = 5,6%) e em 3,0% houve necessidade de transfus��o (letalidade = 12,0%). Infarto agudo aconteceu em 1,1% com letalidade de 38% e o acidente vascular encef��lico indicou uma letalidade de 17,5%. CONCLUS��ES: A letalidade foi elevada para as angioplastias prim��rias e de resgate nos quatro hospitais p��blicos estudados no per��odo de 1999-2003. As angioplastias coronarianas eletivas apresentaram letalidade e complica����es acima do esperado.

Crit��rios de admiss��o e continuidade de cuidados em centros de aten����o psicossocial, Rio de Janeiro, RJ

OBJETIVO: Analisar os crit��rios de admiss��o, encaminhamento e continuidade de cuidado a pacientes utilizados pelas equipes dos centros de aten����o psicossocial. M��TODOS: Pesquisa qualitativa com avalia����o participativa realizada em tr��s centros de aten����o psicossocial do munic��pio do Rio de Janeiro (RJ) em 2006. Foram sorteados 15 casos admitidos e 15 casos encaminhados dentre os pacientes admitidos para tratamento nos seis meses anteriores ao in��cio da pesquisa. Os crit��rios apontados pela equipe para a admiss��o do paciente para tratamento ou encaminhamento foram analisados a partir de um roteiro estruturado. A an��lise da continuidade de cuidados baseou-se em pesquisa em prontu��rio, informa����es da equipe e dos pr��prios pacientes e/ou familiares seis meses ap��s a absor����o ou encaminhamento do paciente. RESULTADOS: Os pacientes admitidos apresentavam diagn��stico de psicose (esquizofrenia), hist��ria de interna����es pr��vias, funcionamento social pobre e rede de apoio pequena e os pacientes encaminhados apresentavam transtornos ansiosos e depressivos, boa ades��o a tratamento ambulatorial, bom funcionamento social e presen��a de rede social. Quanto �� continuidade de cuidados, oito pacientes em 27 tiveram destino desconhecido. Quanto aos encaminhamentos, dos 13 pacientes encaminhados a ambulat��rios da rede, sete permaneceram em tratamento, dois retornaram aos CAPS e quatro tiveram destino desconhecido. CONCLUS��ES: Os centros admitem pacientes que se encaixam na defini����o de um transtorno mental severo e persistente. A continuidade de cuidado foi apontada como problema, provavelmente devido �� dificuldade de acompanhar os pacientes na comunidade.

DOTS in primary care units in the city of Rio de Janeiro, Southeastern Brazil

OBJECTIVE: To describe the implantation and the effects of directly-observed treatment short course (DOTS) in primary health care units. METHODS: Interviews were held with the staff of nine municipal health care units (MHU) that provided DOTS in Rio de Janeiro City, Southeastern Brazil, in 2004-2005. A dataset with records of all tuberculosis treatments beginning in 2004 in all municipal health care units was collected. Bivariate analyses and a multinomial model were applied to identify associations between treatment outcomes and demographic and treatment process variables, including being in DOTS or self-administered therapy (SAT). RESULTS: From 4,598 tuberculosis cases treated in public health units administrated by the municipality, 1,118 (24.3%) were with DOTS and 3,480 (75.7%) with SAT. The odds of DOTS were higher among patients with age under 50 years, tuberculosis relapse and prior history of default or treatment failure. The odds of death were 52.0% higher among patients on DOTS as compared to SAT. DOTS modality including community health workers (CHWs) showed the highest treatment success rate. A reduction of 21.0% was observed in the odds of default (vs. cure) among patients on DOTS as compared to patients on SAT, and a reduction of 64.0% among patients on DOTS with CHWs as compared to those without CHWs. CONCLUSIONS: Patients with a "low compliance profile" were more likely to be included in DOTS. This strategy improves the quality of care provided to tuberculosis patients, although the proposed goals were not achieved.

��bitos e interna����es por tuberculose n��o notificados no munic��pio do Rio de Janeiro

OBJETIVO: Analisar a subnotifica����o de ��bitos e interna����es por tuberculose no Sistema de Informa����o de Agravos de Notifica����o (Sinan). M��TODOS: Foram selecionados os ��bitos do Sistema de Informa����o sobre Mortalidade (SIM) com tuberculose como causa b��sica ou associada e as interna����es do Sistema de Informa����es Hospitalares do Sistema ��nico de Sa��de (SIH/SUS) com causa principal ou secund��ria tuberculose de residentes no munic��pio do Rio de Janeiro em 2004. Foi realizada associa����o probabil��stica das bases de dados do SIM e SIH-SUS com a do Sinan, referentes aos anos de 2002 a 2004. RESULTADOS: Dos 542 ��bitos por tuberculose no per��odo, 234 (43,2%) n��o foram registrados no Sinan nos dois anos anteriores. Das 1.079 interna����es, 238 (22,1%) n��o foram notificadas. Foram relacionados ��s interna����es 71 ��bitos: 47 ocorreram durante a interna����o por tuberculose, 24 ap��s a interna����o. Sete n��o foram notificados no Sinan. Os idosos tiveram 1,6 vez (IC95% 1,074;2,516) a chance de n��o notifica����o dos mais jovens, e pessoas com n��vel superior ou mais escolaridade tiveram 3,6 vezes a chance (IC95% 1,384;11,022) daqueles com nenhum ano de estudo de n��o serem notificadas. Os menores de 15 anos tiveram 4,8 vezes a chance (IC95% 2,757;8,452) de n��o notifica����o daqueles entre 15 e 59 anos. Algumas divis��es regionais de sa��de apresentaram percentual de ��bitos n��o notificados acima de 50% e esse percentual variou entre 37,8% e 12,7% para interna����es. CONCLUS��ES: Os dados sugerem problemas na detec����o de casos e apontam barreiras de acesso ao tratamento oportuno e adequado e falhas na qualidade do sistema de informa����o, com diferen��as entre as regi��es do munic��pio.

Pregnancy rates and predictors in women with HIV/AIDS in Rio de Janeiro, Southeastern Brazil

OBJECTIVE: To assess incidence and predictors of first pregnancy among women with HIV/AIDS. METHODS: Prospective cohort study was conducted in Rio de Janeiro, southeastern Brazil, between 1996 and 2003. This study comprised 225 women with HIV/AIDS followed up until their first pregnancy or first censored event (hysterectomy, tubal ligation, menopause, 50 years of age, loss to follow-up, death or the end of December 2003). Pregnancy and abortion rates were estimated, and Cox proportional hazards models were used to identify baseline characteristics associated with pregnancy risk. RESULTS: The women were followed up for 565 person/years with a median follow-up of 3 years per women. The mean age was 32 years (SD: 7), and 54.7% were white. There were 60 pregnancies in 39 women, and 18 were terminated (induced abortions), accounting for a rate of 6.9% and 2.1% women/year, respectively. Repeated pregnancies occurred in 33.3% of the women (13/39). Higher pregnancy risk was seen among younger women (HR=3.42; 95%CI: 1.69;6.95) and those living with their partners (HR=1.89; 95%CI: 1.00;3.57). Lower pregnancy risk was associated with higher education level (HR=0.43; 95%CI: 0.19;0.99) and use of antiretroviral therapy (HR=061; 95%CI: 0.31;1.17). CONCLUSIONS: Lower pregnancy rates were found in our cohort than in the general population. Sociodemographic characteristics should be taken into consideration in the management of reproductive health in HIV-positive childbearing age women. Reproductive and family planning counseling must be incorporated into HIV/AIDS programs for women to help preventing HIV transmission to their partners and offspring.

Bionomics of Culex quinquefasciatus within urban areas of Rio de Janeiro, Southeastern Brazil

OBJECTIVE: To evaluate density, parity rates, daily survival and longevity of natural populations of Culex quinquefasciatus in three neighborhoods with distinct socio-economic and infrastructure profiles. METHODS: Mosquito collections of the Culex quinquefasciatus species were performed weekly during two four month periods, from August to November 2008 (spring) and March to June 2009 (fall), in a favela (slum), a suburban area and a middle class area of Rio de Janeiro, Southeastern Brazil. Collections were performed with backpack aspirators, in 20 randomly selected houses in each area per week, during 15-20 minutes per house. Ovaries were removed from captured females and classified as initial, intermediary or final stage. Furthermore, females were dissected for determination of parity based on the condition of the tracheal system. Mosquito survival rate and longevity were estimated on a per month basis for each neighborhood. RESULTS: We collected a total of 2,062 Culex quinquefasciatus, but monthly vector density was not correlated with temperature and rainfall. We dissected the ovaries of 625 Culex quinquefasciatus, and overall, there was a higher proportion of nulliparous females during the dryer months, while gravid females were more frequent in rainy months. In the middle class neighborhood, the parity rate reached up to 93.75% with survivorship of 0.979. Lower parity and survival rates were obtained in the suburban area (as low as 36.4% parity and 0.711 daily survival). Up to 84.7% of Culex quinquefasciatus females could survive the eight day period needed to complete West Nile Virus incubation. CONCLUSIONS: The survival rate of Culex quinquefasciatus varied significantly between the neighborhoods. This suggests that vectorial capacity and disease transmission risk may vary greatly between different urban areas, which is potentially useful information for vector control programs.

Tuberculosis Control Program and patient satisfaction, Rio de Janeiro, Brazil

OBJECTIVE To evaluate factors associated with users’ satisfaction in the Tuberculosis Control Program. METHODS A cross-sectional study of 295 patients aged ≥ 18 years, with two or more outpatient visits in the Tuberculosis Control Program, in five cities in the metropolitan region of Rio de Janeiro, RJ, Southeastern Brazil, in 2010. Considering an estimated population of 4,345 patients, the sampling plan included 15 health care units participating in the program, divided into two strata: units in Rio de Janeiro City, selected with probability proportional to the monthly average number of outpatient visits, and units in the other four cities. In the units, four temporal clusters of five patients each were selected with equal probability, totaling 300 patients. A questionnaire investigating the users’ clinical and sociodemographic variables and aspects of care and service in the program relevant to user satisfaction was applied to the patients. Descriptive statistics about users and their satisfaction with the program were obtained, and the effects of factors associated with satisfaction were estimated. RESULTS Patients were predominantly males (57.7%), with a mean age of 40.9 and with low level of schooling. The mean treatment time was 4.1 months, mostly self-administered (70.4%). Additionally, 25.8% had previously been treated for tuberculosis. There was a high level of satisfaction, especially regarding medication provision, and respect to patients by the health professionals. Patients who were younger (≤ 30), those on self-administered treatment, and with graduate level, showed less satisfaction. Suggestions to improve the services include having more doctors (70.0%), and offering exams in the same place of attendance (55.1%). CONCLUSIONS Patient satisfaction with the Tuberculosis Control Program was generally high, although lower among younger patients, those with university education and those on self-administered treatment. The study indicates the need for changes to structural and organizational aspects of care, and provides practical support for its improvement.

Difficulties in access and estimates of public beds in intensive care units in the state of Rio de Janeiro

ABSTRACT OBJECTIVE To estimate the required number of public beds for adults in intensive care units in the state of Rio de Janeiro to meet the existing demand and compare results with recommendations by the Brazilian Ministry of Health. METHODS The study uses a hybrid model combining time series and queuing theory to predict the demand and estimate the number of required beds. Four patient flow scenarios were considered according to bed requests, percentage of abandonments and average length of stay in intensive care unit beds. The results were plotted against Ministry of Health parameters. Data were obtained from the State Regulation Center from 2010 to 2011. RESULTS There were 33,101 medical requests for 268 regulated intensive care unit beds in Rio de Janeiro. With an average length of stay in regulated ICUs of 11.3 days, there would be a need for 595 active beds to ensure system stability and 628 beds to ensure a maximum waiting time of six hours. Deducting current abandonment rates due to clinical improvement (25.8%), these figures fall to 441 and 417. With an average length of stay of 6.5 days, the number of required beds would be 342 and 366, respectively; deducting abandonment rates, 254 and 275. The Brazilian Ministry of Health establishes a parameter of 118 to 353 beds. Although the number of regulated beds is within the recommended range, an increase in beds of 122.0% is required to guarantee system stability and of 134.0% for a maximum waiting time of six hours. CONCLUSIONS Adequate bed estimation must consider reasons for limited timely access and patient flow management in a scenario that associates prioritization of requests with the lowest average length of stay.

Seroepidemiology of hepatitis a and b in two urban communities of Rio de Janeiro, Brazil

Hepatitis B markers were determined in 397 individuals from Niter��i and 680 from Nova Igua��u and prevalences of 9.1% (1.0% of HBsAg and 8.1% of anti HBs) and 11.1% (1.8% of HBsAg and 9.3% of antiHBs) were found, respectively. The comparative prevalence of both markers in relation to age showed a higher prevalence of HBsAg in the group 21-50 years old. Considering the antiHBs antibody, it was demostrated a gradual increase with age, reaching 14.9% in Niter��i and 29.1% in Nova Igua��u in individuals over 51 years old. For hepatitis A, in 259 samples from Niter��i, equally distributed by age groups, an overall prevalence of 74.5% of anti-HAV antibodies was found. This prevalence increases gradually reaching 90.0% at age over thirty. In 254 samples from Nova Igua��u analysed, a prevalence of 90.5% of antibodies was encountered when the same criteria of distribution of samples were used. This level of prevalence reached 90.0% already in the age over ten years old. The tests were performed by enzyme immunoassay with reagents prepared in our laboratory.

Distribui����o das fontes de infec����o do histoplasma capsulatum var: capsulatum em Rio da Prata - Munic��pio do Rio de Janeiro (RJ)

Os Autores demonstram o ��ndice de contamina����o do solo pelo Histoplasma capsulatum var. capsulatum, na localidade de Rio da Prata, ��rea periurbana com caracter��sticas rurais, do Munic��pio do Rio de Janeiro. A an��lise de 111 amostras do solo coletadas em diferentes locais determinou 8 (7,2%) amostras positivas, todas obtidas de galinheiros, em um dos quais tamb��m foi observado guano de morcegos O elevado n��vel de contamina����o do solo nesta regi��o pode ser comparado aos n��veis observados em ��reas end��micas de histoplasmose nos EUA.

Ocorr��ncia de Clostridium difficile nas fezes de crian��as do Rio de Janeiro, RJ

A ocorr��ncia de Clostridium difficile foi analisada em amostras de fezes de 175 crian��as com idade variando de 1 a 35 meses. Para o isolamento prim��rio do microrganismo foi empregado o meio de cultura seletivo diferencial "CCFA" (cicloserina-cefoxitina-frutose-agar). Num grupo de 67 crian��as sem dist��rbios gastrintestinais e que n��o estavam sob uso de agentes antimicrobianos a ocorr��ncia do C. difficile foi de 22,4%, enquanto que num outro grupo de 28 crian��as nas mesmas condi����es, por��m, sob tratamento com antimicrobianos a ocorr��ncia do microrganismo foi de 50%. Num terceiro grupo de 58 crian��as com diarr��ia e sob antibi��tico-terapia a ocorr��ncia de C. difficile atingiu 13,8%. Este mesmo percentual foi encontrado num quarto grupo de 22 crian��as com diarr��ia, por��m, sem tratamento com agentes antimicrobianos. De um modo geral, os maiores ��ndices de ocorr��ncia de C. difficile foram encontrados em crian��as com idade variando entre 1 a 12 meses (28,1%). ��ndices inferiores foram verificados entre crian��as com idade superior a 1 ano. Outrossim, os resultados evidenciam que crian��as com dist��rbios gastrintestinais apresentam menor incid��ncia deste microrganismo nas fezes. Por outro lado. n��o houve diferen��a estat��sticamente significativa entre os grupos de crian��as com e sem terapia antimicrobiana.

A serological investigation of rotavirus infections in a shanty town population in Rio de Janeiro

The presence of antibodies against rotavirus was investigated by enzyme immunosorbent assay (ELISA) in two distinct groups of children living in a shanty town in Rio de Janeiro. One hundred and thirty six plasma samples were randomly collected from children of 0 to 33 months (first group) and 255 serum samples were collected from other 85 children at ages of 2, 6 and 9 months (second group). A high percentage of antibodies were found in the newborn children and this rate decreased progressively until the age of 11 months, after which it increased again. At the age of 7 months, geometric mean antibody titers increased indicating that infection had occurred.

The prevalence of antibody to human parvovirus B19 in Rio de Janeiro, Brazil

During 1985 and 1986 serum samples were collected from the Rio de Janeiro population and examined for the presence of IgG antibody to human parvovirus B19. No difference in prevalence was found between males and females. Antibody prevalence rose from 35% in children less than five years old to almost 80% in children aged eleven to fifteen years. The antibody prevalence in individuals over 50 years old was over 90%.

Diminui����o do risco de infec����o pelo v��rus da imunodefici��ncia humana (VIH) em pacientes em hemodi��lise no estado do Rio de Janeiro, Brasil

Os estudos iniciais sobre a soropreval��ncia de anticorpos anti-VIH-1 (Ac-VIH) em unidades de hemodi��lise no Estado do Rio de Janeiro (RJ) foram feitos em 1985. Os n��meros alarmantes, pr��ximos a 14%, foram atribu��dos �� m�� qualidade do sangue obtido de "doadores profissionais" em troca de comida ou dinheiro. Recentemente uma s��rie de medidas foram adotadas na tentativa de reduzir o tr��fico de sangue. Nossa investiga����o objetivou avaliar o impacto destas na soropreval��ncia de Ac-VIH em duas unidades sat��lites no RJ. A Cl��nica Segumed foi uma das unidades estudadas em 1985. Em 1987 realizamos um segundo levantamento no mesmo grupo estudado previamente. A Casa de Sa��de Graja��, inaugurada em 1986 com a maioria dos pacientes novos em di��lise, foi estudada em 1988. O teste ELISA HIV-1 foi utilizado como rastreamento. Os resultados positivos foram confirmados com Western blot. Os resultados na Segumed mostraram uma grande diferen��a entre os dois levantamentos (14,4% vs 3,6%). Os dois casos positivos em 1987 estavam entre os identificados em 1985. Nenhum paciente se infectou entre os dois levantamentos apesar de n��o se utilizarem medidas de isolamento para os portadores de VIH e do uso de transfus��es ter aumentado no per��odo. Na CS Graja�� apenas dois casos foram encontrados (soropreval��ncia 2,4%) embora um j�� fosse conhecido desde 1985 quando vivia com um transplante. Uma revis��o de estudos semelhantes no RJ e S��o Paulo parece revelar uma tend��ncia �� diminui����o das taxas nos ��ltimos anos. N��s conclu��mos que a chance de contamina����o com VIH �� atualmente reduzida nos centros estudados e pode estar caindo globalmente no RJ. �� poss��vel que a maior vigil��ncia, e at�� fechamento de bancos de sangue, tenha resultado na melhora da qualidade do sangue no RJ.