Orientação temporal e funções executivas na predição de mortalidade entre idosos: estudo Epidoso

OBJETIVO: Analisar a capacidade preditiva de índice cognitivo funcional para mortalidade entre idosos. MÉTODOS: Estudo de coorte realizado com 1.667 idosos acima de 65 anos residentes no município de São Paulo, SP, no período 1991-2001. O índice cognitivo funcional foi construído a partir da orientação temporal e funções executivas (fazer compras e tomar medicação), controlado por variáveis sociodemográficas, hábitos de vida, morbidade, autopercepção de saúde, internação, edentulismo e suporte social. Os óbitos ocorridos no período foram investigados com familiares em entrevistas domiciliares, em cartórios e registros da Fundação Seade (até 2003). Foram calculados riscos relativos brutos e ajustados com respectivos intervalos com 95% de confiança por meio de análise bivariada e múltipla com regressão de Poisson, adotando-se p<0,05. RESULTADOS: No modelo multivariado final os fatores de risco independentes identificados pelo índice foram: perda parcial da orientação temporal ou funções executivas (RR=1,37; IC 95%: 1,03;1,83); perda total da orientação e parcial das funções (RR=1,71; IC 95%: 1,24;2,37); perda parcial da orientação e total das funções (RR=1,76; IC 95%: 1,35;2,28); perda total da orientação e das funções (RR=1,64; IC 95%: 1,30;2,06), Quanto às condições de saúde: internação (RR=1,45; IC 95%: 1,22;1,73); diabetes (RR=1,20; IC 95%: 1,00;1,44); edentulismo total (RR=1,34; IC 95%: 1,09;1,66). Relacionamento mensal com parentes foi identificado como fator protetor (RR=0,83; IC 95%: 0,69;1,00). CONCLUSÕES: O Índice Cognitivo Funcional pode auxiliar clínicos e planejadores em decisões sobre estratégias de seguimento e prevenção de causas tratáveis de déficit cognitivo e perda funcional para diminuir a mortalidade entre os idosos.

Tendência temporal de asma em crianças e adolescentes no Brasil no período de 1998 a 2008

OBJETIVO: Analisar as tendências de asma em crianças e adolescentes entre 1998 e 2008 no Brasil. MÉTODOS: Foram analisados os dados de prevalência de asma da Pesquisa Nacional por Amostra de Domicílios, dos anos de 1998, 2003 e 2008. A amostra foi constituída por 141.402, 144.443 e 134.032 indivíduos em 1998, 2003 e 2008, respectivamente, e a análise foi ajustada pelo desenho amostral. As tendências de asma foram descritas por sexo, regiões do Brasil e local de residência, em crianças (zero a nove anos) e adolescentes (dez a 19 anos). RESULTADOS: A prevalência de asma entre crianças foi 7,7% em 1998, 8,1% em 2003 e 8,5% em 2008, com um incremento anual de 1%. O maior aumento anual foi observado nas regiões Sudeste e Norte (1,4%). Entre o grupo de adolescentes, a prevalência de asma foi de 4,4% em 1998, 5,0% em 2003 e 5,5% em 2008, com aumento de 2,2% ao ano. Na região Nordeste, o aumento anual na prevalência de asma foi de 3,5%. Os maiores incrementos foram observados entre os meninos e entre moradores da zona rural. CONCLUSÕES: Apesar de a asma apresentar um decréscimo em países emergentes, no Brasil os resultados apontam um incremento da asma entre crianças e adolescentes no período de 1998 e 2008, especialmente na zona rural.

Magnitude, tendência temporal e fatores associados à anemia em crianças do Estado da Paraíba

OBJETIVO: Estimar a prevalência da anemia em crianças, sua tendência temporal e identificar fatores associados. MÉTODOS: Estudo de corte transversal, de base populacional, envolvendo 1.108 crianças, com idade entre seis e 59 meses, de ambos os sexos, do Estado da Paraíba, em 2007. A hemoglobina foi analisada em sangue venoso com contador automático. Foram considerados para anemia valores < 11,0 g/dL, forma leve 9-11g/dL, moderada 7-9 g/dL e grave < 7,0 g/dL. As condições socioeconômicas e demográficas das crianças foram obtidas por meio de questionário aos pais ou responsáveis. As proporções foram comparadas pelo teste do qui-quadrado de Pearson, e a associação entre as concentrações de hemoglobina e potenciais fatores de riscos foi testada pelo modelo de regressão de Poisson. A tendência temporal da anemia foi avaliada pelo incremento/redução na prevalência de anemia nos anos de 1982, 1992 e 2007. RESULTADOS: A prevalência de anemia foi de 36,5% (IC95% 33,7;39,3). Observa-se que 1,3% (IC95% 0,7;1,8) foi na forma grave, 11,1% (IC95% 9,4;13,5) na forma moderada e 87,6% (IC95% 79,1;91,2) na forma leve. Houve um incremento de 88,5% nos casos de anemia no período entre 1982 e1992 e uma estabilização na prevalência entre 1992 e 2007. A análise ajustada no modelo de Poisson mostrou maior suscetibilidade à anemia nas crianças de seis a 24 meses de idade, naquelas amamentadas por seis meses ou mais, que co-habitavam com mais de quatro pessoas no mesmo domicílio e moravam em casas com menos de cinco cômodos. CONCLUSÕES: A alta prevalência de anemia mostra que continua sendo um importante problema de saúde pública no Estado da Paraíba. Apesar da estabilização na prevalência entre 1992 e 2007, a anemia apresenta-se em elevado patamar, o que impõe medidas mais efetivas de prevenção e controle.

Mortalidade por acidentes de motocicleta no Brasil: análise de tendência temporal, 1996-2009

OBJETIVO Analisar a tendência da mortalidade por acidentes de motocicleta no Brasil. MÉTODOS Estudo descritivo de séries temporais sobre a taxa de mortalidade de acidentes de motocicleta no Brasil, segundo unidades federativas e faixas etárias entre 1996 e 2009. Os dados de óbitos foram obtidos no Sistema de Informação sobre Mortalidade do Ministério da Saúde e da população no Instituto Brasileiro de Geografia Estatística. Taxas de mortalidade padronizadas foram calculadas no período para o Brasil como um todo e Unidades Federativas. Variações anuais das taxas de mortalidade foram estimadas pelo método de Prais-Winsten de regressão linear. RESULTADOS A taxa de mortalidade por acidentes de motocicleta aumentou de 0,5 para 4,5/100.000 habitantes de 1996 a 2009 (aumento de 800% no período e 19% ao ano). Estados com maiores taxas em 2009 foram: Piauí, Tocantins, Sergipe e Mato Grosso. As maiores taxas de crescimento foram observadas nos Estados das regiões Norte, Nordeste e Centro-Oeste. CONCLUSÕES Houve grande aumento das taxas de mortalidade por acidente de motocicleta em todo o Brasil no período, principalmente nos Estados do Nordeste.

Temporal trends and spatial distribution of unsafe abortion in Brazil, 1996-2012

OBJECTIVE To analyze temporal trends and distribution patterns of unsafe abortion in Brazil. METHODS Ecological study based on records of hospital admissions of women due to abortion in Brazil between 1996 and 2012, obtained from the Hospital Information System of the Ministry of Health. We estimated the number of unsafe abortions stratified by place of residence, using indirect estimate techniques. The following indicators were calculated: ratio of unsafe abortions/100 live births and rate of unsafe abortion/1,000 women of childbearing age. We analyzed temporal trends through polynomial regression and spatial distribution using municipalities as the unit of analysis. RESULTS In the study period, a total of 4,007,327 hospital admissions due to abortions were recorded in Brazil. We estimated a total of 16,905,911 unsafe abortions in the country, with an annual mean of 994,465 abortions (mean unsafe abortion rate: 17.0 abortions/1,000 women of childbearing age; ratio of unsafe abortions: 33.2/100 live births). Unsafe abortion presented a declining trend at national level (R2: 94.0%, p < 0.001), with unequal patterns between regions. There was a significant reduction of unsafe abortion in the Northeast (R2: 93.0%, p < 0.001), Southeast (R2: 92.0%, p < 0.001) and Central-West regions (R2: 64.0%, p < 0.001), whereas the North (R2: 39.0%, p = 0.030) presented an increase, and the South (R2: 22.0%, p = 0.340) remained stable. Spatial analysis identified the presence of clusters of municipalities with high values for unsafe abortion, located mainly in states of the North, Northeast and Southeast Regions. CONCLUSIONS Unsafe abortion remains a public health problem in Brazil, with marked regional differences, mainly concentrated in the socioeconomically disadvantaged regions of the country. Qualification of attention to women’s health, especially to reproductive aspects and attention to pre- and post-abortion processes, are necessary and urgent strategies to be implemented in the country.

Temporal evolution and spatial distribution of maternal death

OBJECTIVE To analyze the temporal evolution of maternal mortality and its spatial distribution.METHODS Ecological study with a sample made up of 845 maternal deaths in women between 10 and 49 years, registered from 1999 to 2008 in the state of Rio Grande do Sul, Southern Brazil. Data were obtained from Information System on Mortality of Ministry of Health. The maternal mortality ratio and the specific maternal mortality ratio were calculated from records, and analyzed by the Poisson regression model. In the spatial distribution, three maps of the state were built with the rates in the geographical macro-regions, in 1999, 2003, and 2008.RESULTS There was an increase of 2.0% in the period of ten years (95%CI 1.00;1.04; p = 0.01), with no significant change in the magnitude of the maternal mortality ratio. The Serra macro-region presented the highest maternal mortality ratio (1.15, 95%CI 1.08;1.21; p < 0.001). Most deaths in Rio Grande do Sul were of white women over 40 years, with a lower level of education. The time of delivery/abortion and postpartum are times of increased maternal risk, with a greater negative impact of direct causes such as hypertension and bleeding.CONCLUSIONS The lack of improvement in maternal mortality ratio indicates that public policies had no impact on women’s reproductive and maternal health. It is needed to qualify the attention to women’s health, especially in the prenatal period, seeking to identify and prevent risk factors, as a strategy of reducing maternal death.

Temporal trends in the prevalence of asthma and rhinoconjunctivitis in adolescents

ABSTRACT OBJECTIVE To analyze the temporal trend of asthma and rhinoconjunctivitis prevalences as well as their symptoms in adolescents. METHODS Two cross-sectional studies were conducted using the same methodology and questionnaire as was used for adolescents aged 12 to 14 years in the Brazilian city of Florianopolis, SC, Southern Brazil. Based on the international protocol of the International Study of Asthma and Allergies in Childhood (ISAAC) study, adolescents were evaluated in 2001 and 3,150 in 2012. The schools included in this study were the same as in the 2001 study. These schools were randomly selected after stratification by network (public and private) and geographic location. The total average percentage variation was estimated for the prevalence of asthma and rhinoconjunctivitis and their symptoms. RESULTS The prevalence of reported asthma was 10.9% in 2001 and 14.8% in 2012, with an average variation of 2.8% in the period. The highest average variation in the period was observed among female adolescents (4.1%). In parallel a significant increase occurred in reported physician-diagnosed asthma, 7.3% in 2001 and 11,1% in 2012, with an annual variation of 4.5%. The largest increases in reported physician-diagnosed asthma were seen in female (5.9%) and male (4.5%) public school pupils. In addition, a significant increase in reported rhinoconjunctivitis occurred, with the average variation in the period being 5.2%. Reports of severe asthma symptoms remained unchanged during the period, while the annual variation for reported current wheezing (-1.3%) and wheezing during exercise (-1.2%) decreased. CONCLUSIONS The results showed a significant increase in the annual average variation for asthma and rhinoconjunctivitis prevalence during the 2001 to 2012 period.

Evaluation of temporal, seasonal and geographic stability of the molluscicidal property of Euphorbia splendens latex

Laboratory tests with aqueous solutions of Euphorbia splendens var. hislopii latex have demonstrated seasonal stability of the molluscicidal principle, with LD90 values of 1.14 ppm (spring), 1.02 ppm (fall), 1.09 ppm (winter), and 1.07 ppm (summer) that have been determined against Biomphalaria tenagophila in the field. Assays on latex collected in Belo Horizonte and Recife yielded LD90 values similar to those obtained with the reference substance collected in Rio de Janeiro (Ilha do Governador), demonstrating geographic stability of the molluscicidal effect. The molluscicidal action of aqueous dilutions of the latex in natura, centrifuged (precipitate) and lyophilized, was stable for up to 124 days at room temperature (in natura) and for up to 736 days in a common refrigerator at 10 to 12ºC (lyophilized product). A 5.0 ppm solution is 100% lethal for snails up to 13 days after preparation, the effect being gradually lost to almost total inactivity by the 30th day. This observation indicated that the active principle is instable. These properties together with the wide distribution of the plant, its resistance and adaptation to the tropical climate, its easy cultivation and the easy obtention of latex and preparation of the molluscicidal solution, make this a promising material for large-scale use in the control of schistosomiasis

Human lagochilascariasis treated sucessfully with ivermectin: a case report

A 15 year old male patient was diagnosed as being infected with the nematode Lagochilascaris minor, presenting as abscesses over the left mastoid region, and invading the temporal bone, mastoid sinuses and possibly the CNS. Surgical drainage and administration of cambendazole and levamisole led to improvement, followed by an early relapse and poor tolerance to the antihelminthic drugs. Repeated doses of ivermectin (an animal preparation) were used for the first time to treat this condition and resulted in complete remission of signs of infection, maintained for 15 months after the end of drug therapy, indicating cure of the disease.

Autoantibodies before, during and after administration of recombinant interferon-alpha for chronic viral hepatitis

This study was undertaken to investigate the presence of autoantibodies in patients with chronic viral hepatitis B and C, before, during and after interferon-alpha (IFN-alpha) therapy and to study their relation to dose and type of IFN-alpha and response to treatment. Fifty patients with chronic hepatitis were divided in two groups, a control-group of 21 patients (10 type B and 11 type C) who were followed for 6 months without treatment and an IFN-group consisting of 29 patients (8 type B and 21 type C) who received IFN therapy for 6 months. Serum samples were tested for a range of antibodies at the start of the study, during therapy and at the end of the 6 month period. Antibodies tested for included: antinuclear, smooth muscle, antimitochondrial, parietal cell and thyroid microsomal. Four (8%) of the total patient group had autoantibodies at the beginning of the study (two in each group). During the follow-up period no patient in the control group developed antibodies compared with 3 (11%) patients in the treatment group. Autoantibodies developed in patients treated with higher doses of IFN and were found in those patients who tended to show a poor response to IFN-therapy. Further studies are needed to establish the relationship between poor response to IFN-alpha and development of autoantibodies.

Temporal association between the isolation of Sabin-related poliovirus vaccine strains and the Guillain-Barré syndrome

Thirty eight paralysis cases classified as Guillain-Barré syndrome (GBS) in Brazil were analysed. In all these cases Sabin-related poliovirus vaccine strains were isolated. In most of the cases the last vaccine dose was given months or years before the onset of GBS, suggesting a persistent infection or the transmission of the Sabin-related strains to the patients. The isolation of Sabin-related strains from GBS cases some days or weeks after the onset of the disease, demonstrated a temporal association between the isolation of the strains and the disease. Although the isolates from the GBS cases may not be the etiological agent of the disease, this study strongly indicates that infections caused by Sabin-related vaccine strains can trigger the GBS in certain cases.

Hepatitis B vaccine in infants: a randomized controlled trial comparing gluteal versus anterolateral thigh muscle administration

A significantly diminished antibody response to hepatitis B vaccine has been demonstrated in adults when the buttock is used as the injection site. However, in Brazil, the buttock continues to be recommended as site of injection for intramuscular administration of vaccines in infants. In this age group, there are no controlled studies evaluating the immunogenicity of the hepatitis B vaccine when administered at this site. In the present study, 258 infants were randomized to receive the hepatitis B vaccine either in the buttock (n = 123) or in the anterolateral thigh muscle (n = 135). The immunization schedule consisted of three doses of hepatitis B vaccine (Engerix Bâ, 10 mug) at 2, 4 and 9 months of age. There were no significant differences in the proportion of seroconversion (99.3% x 99.2%), or in the geometric mean titer of ELISA anti-HBs (1,862.1 x 1,229.0 mIU/mL) between the two groups. This study demonstrates that a satisfactory serological response can be obtained when the hepatitis B vaccine is administered intramuscularly into the buttock.

Indications of carbapenem resistance evolution through heteroresistance as an intermediate stage in Acinetobacter baumannii after carbapenem administration

We describe an in vivo evolution of an antimicrobial profile from susceptibility to full-resistance to carbapenems, with heteroresistance as an intermediate stage, in an Acinetobacter baumannii strain. Heteroresistance was characterized by the growth of sub-populations within the susceptibility halo in both disk-diffusion and Etest. PCRs for the main A. baumannii carbapenemases were negative. The exact resistance mechanism, diagnostic methods and clinical relevance of heteroresistance in A. baumannii warrant further investigations. This is the first description of such phenomenon in vivo and the second report of heteroresistance to carbapenems in A. baumannii.

Temporal differences in blood meal detection from the midguts of Triatoma infestans

We used genus/species specific PCRs to determine the temporal persistence of host DNA in Triatoma infestans experimentally fed on blood from six common vertebrate species: humans, domestic dogs, guinea pigs, chickens, mice, and pigs. Twenty third or fourth instar nymphs per animal group were allowed to feed to engorgement, followed by fasting-maintenance in the insectary. At 7, 14, 21, or 28 days post-feeding, the midgut contents from five triatomines per group were tested with the respective PCR assay. DNA from all vertebrate species was detected in at least four of five study nymphs at seven and 14 days post-feeding. DNA of humans, domestic dogs, guinea pigs, pigs, and chickens were more successfully detected (80-100%) through day 21, and less successfully (20-100%) at day 28. Findings demonstrate that species-specific PCRs can consistently identify feeding sources of T. infestans within two weeks, a biologically relevant time interval.

TEMPORAL TRENDS IN THE DETECTION RATES OF HEPATITIS B IN THE SANTA CATARINA STATE, BRAZIL

Hepatitis B is a serious public health problem. The state of Santa Catarina presents areas of high endemicity. The aim of this study was to describe temporal trends in detection rates of hepatitis B in the period from 2002 to 2009 in Santa Catarina and in its regions. A time series study was carried out. Crude rates were calculated and standardized by age using the direct method. Annual variation percentages were estimated by Joinpoint regression. There were two distinct and significant trends in Santa Catarina. From 2002 to 2006 a significant increase of 5.9% per year was observed. From 2006, there was a significant decrease of 6.4% per year. In this same period the southern and far-western regions had significant increases of 15.9% and 4.6% and significant decreases of 7.5% and 4.8%, respectively. Greater Florianópolis and Northeast also showed significant increases until 2006, of 15.4% and 17.4%, respectively. In the following period, non-significant decreases of 5.8% and 9.8% respectively were observed. Foz do Rio Itajaí and Planalto Serrano showed non-significant increases up to half of the studied period of 21.1% and 12.0%, respectively and after, significant decreases of 21.5% and 18.0%, respectively. Vale do Itajaí showed a significant decrease of 9.7%; Planalto Norte showed a non-significant decrease of 0.6% and Midwest a non-significant increase of 2.7% per year, in the period from 2002 to 2009.