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.

Spatial distribution and socioeconomic context of tuberculosis in Rio de Janeiro, Brazil

OBJECTIVE To analyze the spatial distribution of risk for tuberculosis and its socioeconomic determinants in the city of Rio de Janeiro, Brazil.METHODS An ecological study on the association between the mean incidence rate of tuberculosis from 2004 to 2006 and socioeconomic indicators of the Censo Demogr��fico (Demographic Census) of 2000. The unit of analysis was the home district registered in the Sistema de Informa����o de Agravos de Notifica����o (Notifiable Diseases Information System) of Rio de Janeiro, Southeastern Brazil. The rates were standardized by sex and age group, and smoothed by the empirical Bayes method. Spatial autocorrelation was evaluated by Moran’s I. Multiple linear regression models were studied and the appropriateness of incorporating the spatial component in modeling was evaluated.RESULTS We observed a higher risk of the disease in some neighborhoods of the port and north regions, as well as a high incidence in the slums of Rocinha and Vidigal, in the south region, and Cidade de Deus, in the west. The final model identified a positive association for the variables: percentage of permanent private households in which the head of the house earns three to five minimum wages; percentage of individual residents in the neighborhood; and percentage of people living in homes with more than two people per bedroom.CONCLUSIONS The spatial analysis identified areas of risk of tuberculosis incidence in the neighborhoods of the city of Rio de Janeiro and also found spatial dependence for the incidence of tuberculosis and some socioeconomic variables. However, the inclusion of the space component in the final model was not required during the modeling process.

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.

Longitudinal study of acute respiratory diseases in Rio de Janeiro: occurrence of respiratory viruses during four consecutive years

The occurrence of different viruses in nasopharyngeal secretions from children less than 5 years old with acute respiratory infections (ARI) was investigated over a period of 4 years (1982-1985) in Rio de Janeiro. Of the viruses known to be associated with ARI, all but influenza C and parainfluenza types 1, 2 and 4 were found. Viruses were found more frequently in children attending emergency or pediatric wards than in outpatients. This was clearly related to the high incidence of respiratory syncytial virus (RSV) in the more severe cases of ARI. RSV positive specimens appeared mainly during the fall, over four consecutive years, showing a clear seasonal ocurrence of this virus. Emergency wards provide the best source of data for RSV surveillance, showing sharp increase in the number of positive cases coinciding with increased incidence of ARI cases. Adenovirus were the second most frequent viruses isolated and among these serotypes 1,2 and 7 were predominant. Influenza virus and parainfluenza virus type 3 were next in frequency. Influenza A virus were isolated with equal frequency in outpatient departments, emergency and pediatric wards. Influenza B was more frequent among outpatients. Parainfluenza type 3 caused outbreaks in the shanty town population annually during the late winter or spring and were isolated mainly from outpatients. Herpesvirus, enterovi-rus and rhinovirus were found less frequently. Other viruses than RSV and parainfluenza type 3 did not show a clear seasonal incidence.

Avalia����o das condi����es de estocagem da vacina contra o sarampo nas unidades sanit��rias dos munic��pios de Niter��i e S��o Gon��alo, estado do Rio de Janeiro

Com o objetivo de estudar as condi����es de estocagem da vacina contra o sarampo na rede de vacina����o dos Munic��pios de Nit��roi e S��o Gon��alo - RJ, 22 Unidades Sanit��rias foram avaliadas de acordo com as normas t��cnicas espec��ficas estabelecidas pelo Programa Nacional de Imuniza����o. Observou-se que em 86,4% das Unidades visitadas os cuidados com os refrigeradores eram adequados ou regulares mas quanto �� arruma����o das vacinas no interior dos aparelhos e ao controle de temperatura, estes percentuais ca��ram para 60,0% e 54,5%, respectivamente. De todos os itens avaliados, o mais problem��tico foi o apoio t��cnico imediato frente a situa����es de emerg��ncia, apoio esse considerado insuficiente em 90,0% dos casos. Em 100% das amostras vacinais recolhidas das Unidades Sanit��rias, os t��tulos estavam abaixo da pot��ncia m��nima preconizada para tal produto no momento da aplica����o. Torna-se necess��rio ent��o, que as condi����es de conserva����o e uso das vacinas sejam melhoradas evitando assim a forma����o de grupamentos de crian��as suscet��veis �� doen��a.

Dengue epidemic in the state of Rio de Janeiro, Brazil: virological and epidemiological aspects

Laboratorial studies were carried out on 3178 patients with signs and symptoms suggestive of dengue infection from April 1986 to December 1987 in the State of Rio de Janeiro, Brazil. The epidemic had two peaks following the first virus isolation and affected the inhabitants of 17 counties. Both sex and all age groups were affected. Dengue virus type 1 was isolated from 1039 sera and the number of confirmed cases was increased to 1874 (59%) by MAC-ELISA. Isolation rate confirmed cases reached 80% in the specimens obtained until the 4th day after the onset of disease and viraemia ranged from 10 3.0 to 10(8.5) TCID50/ml.

High prevalence of hepatitis C infection among Brazilian hemodialysis patients in Rio de Janeiro: a one-year follow-up study

Nearly 400 hemodialysis patients treated at 5 different hemodialysis units in Rio de Janeiro were tested for one year for the presence of hepatitis C and B markers. During the same period, samples were also obtained from 35 continuous ambulatory peritoneal dialysis (CAPD) patients and from 242 health care workers. Depending on the hemodialysis unit studied, anti-HCV prevalence rates ranging from 47% to 82% (mean 65%) were detected. CAPD patients showed a lower prevalence of 17%. The prevalence of antibodies against hepatitis C virus (anti-HCV) among health care workers was 2.9%. We observed a hepatitis C attack rate of 11.5% per year in the anti-HCV-negative hemodialysis patient population. An average of 9.4% of the hemodialysis patients were chronic carriers of hepatitis B virus (HBV) (range 1.8% - 20.4%), while 48.9% showed markers of previous HBV infection. The HBV attack rate was 4.5% per year (range 0% - 6%). These results indicate an alarming high prevalence of anti-HCV among hemodialysis patients of this studied region.

Lysotypes and plasmidial profile of Salmonella Serovar Typhimurium isolated from children with enteric processes in the cities of Rio de Janeiro, RJ, and Salvador, BA - Brazil

The lysotypes, plasmidial profiles, and profiles of resistance to antimicrobial agents were determined in 111 Salmonella Typhimurium strains isolated from feces and blood of children treated in Rio de Janeiro and in Salvador. Six distinct lysotypes (19, 41, 97, 105, 120 and 193) were recognized, with a predominance of lysotype 193 (59.7%) in Rio de Janeiro and of phage type 105 (38.4) in Salvador. Approximately 86.7% of the lysotype 193 strains presented multiple resistance to more than six antimicrobial agents, whereas 93% of lysotype 105 strains were fully susceptible. More than 90% of the strains presented plasmids distributed into 36 different profiles in Rio de Janeiro and into 10 profiles in Salvador. A 40 MDa plasmid was the most frequent (47%) in the strains from Rio de Janeiro, whereas a 61 MDa plasmid predominated (14.5%) in Salvador. Combined analysis of plasmid profile and classification into lysotypes (especially those belonging to types 105 and 103, proved to be more discriminatory than the other methods applied).

Secondary dengue infection in schoolchildren in a dengue endemic area in the State of Rio de Janeiro, Brazil

A seroepidemiologic survey was carried out in schoolchildren from public schools of the Niter��i municipality, state of Rio de Janeiro, Brazil, after a period of sequential epidemics by dengue virus type 1 and 2 (DEN-1 and DEN-2). 450 blood samples were obtained by fingertip puncture and collected on filter paper discs. The hemagglutination inhibition (HAI) test was carried out using DEN-1 and DEN-2 antigens. HAI titres were demonstrated in 66% (297/450) of the sera and the geometric means of the titres were 1/182 and 1/71 for DEN-1 and DEN-2, respectively. Secondary infections were observed in 61% (181/297) of positive cases. Among these, 75% (135/181) were under fifteen years old. No dengue haemorrhagic fever (DHF) was reported in these children. Asymptomatic or oligosymptomatic infections were detected in 56% of the studied population. The absolute and relative frequencies of positive tests by age group and sex did not evidence statistically significant difference. The number of individuals infected probably produced a immunologic barrier responsible for the non occurrence of dengue epidemic in the latter years.