Tend��ncia temporal da amamenta����o na cidade do Rio de Janeiro: 1996-2006

OBJETIVO: Analisar a tend��ncia temporal da pr��tica de aleitamento materno (AM) e de aleitamento materno exclusivo (AME). M��TODOS: Foram analisados dados de sistema de monitoramento baseado em inqu��ritos realizados nos anos de 1996, 1998, 2000, 2003 e 2006 durante a Campanha Nacional de Imuniza����o na cidade do Rio de Janeiro, RJ. A popula����o de estudo foi constitu��da de 19.044 crian��as menores de um ano de idade que compareceram aos postos de vacina����o. Para cada ano foi estudada uma amostra probabil��stica por conglomerado (postos de vacina����o), auto-ponderada representativa da popula����o de crian��as menores de 12 meses (<12). Foi aplicado question��rio estruturado com quest��es fechadas sobre alimenta����o da crian��a no momento do estudo e caracter��sticas sociodemogr��ficas da m��e. Foram adotados os indicadores de AM e de AME propostos pela Organiza����o Mundial da Sa��de. RESULTADOS: O AM<12 aumentou de 61,3% para 73,4% entre 1996 e 2006. Tend��ncia similar foi observada em todas as faixas et��rias analisadas. O AME em crian��as <4 e <6 meses (AME<6) aumentou, respectivamente, de 18,8% para 42,4% e de 13,8% para 33,3%. Melhorias em AM>6 e em AME<6 foram observadas em todas as categorias de todas as vari��veis sociodemogr��ficas maternas. Para AME<6, a desvantagem observada em 1996 entre mulheres de menor escolaridade e em 1998 entre mulheres que trabalhavam n��o foi completamente superada at�� 2006. CONCLUS��ES: O AM e o AME aumentaram no per��odo estudado independentemente da faixa et��ria da crian��a e das caracter��sticas sociodemogr��ficas maternas. N��o foram totalmente superadas diferen��as observadas entre mulheres em diferentes situa����es sociodemogr��ficas.

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.

Observat��rio de favelas (Rio de Janeiro): a comunica����o institucional e a comunica����o para o desenvolvimento

Relat��rio de est��gio apresentado �� Escola Superior de Comunica����o Social como parte dos requisitos para obten����o de grau de mestre em Gest��o Estrat��gica das Rela����es P��blicas.

Homic��dios e disputas territoriais nas favelas do Rio de Janeiro

OBJETIVO : Avaliar o risco de homic&#237;dios em favelas do Rio de Janeiro, considerando as disputas territoriais em curso na cidade. M&#201;TODOS : O estudo baseou-se em dados de mortalidade por homic&#237;dios na cidade do Rio de Janeiro, de 2006 a 2009. Foram avaliados os riscos em favelas e seus entornos, em fun&#231;&#227;o da sua localiza&#231;&#227;o e do dom&#237;nio por grupos armados e tr&#225;fico de drogas. Foram empregados m&#233;todos e conceitos da geografia e etnografia, com as abordagens de observa&#231;&#227;o participante, entrevistas e an&#225;lise de dados secund&#225;rios de sa&#250;de. RESULTADOS : As taxas de mortalidade por homic&#237;dios no interior das favelas foram equivalentes ou mesmo menores que o restante da cidade, mas consideravelmente maiores nos arredores das favelas, sobretudo em zonas de conflito entre dom&#237;nios armados rivais. CONCLUS&#213;ES : A presen&#231;a do tr&#225;fico armado em zonas estrat&#233;gicas da cidade aumenta as taxas de mortalidade por viol&#234;ncia e promove a &#8220;ecologia do perigo&#8221; no entorno de favelas.

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

OBJECTIVE To evaluate factors associated with users&#8217; satisfaction in the Tuberculosis Control Program. METHODS A cross-sectional study of 295 patients aged &#8805; 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&#8217; 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 (&#8804; 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&#8217;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.