Consulta ginecol��gica sob a ��tica de estudantes do ensino m��dio do Rio de Janeiro, RJ

OBJETIVO: Analisar diferen��as socioculturais e percep����es sobre a consulta ginecol��gica por adolescentes. M��TODOS: Estudo transversal com 418 alunas do ensino m��dio de tr��s escolas de diferentes perfis, localizadas na cidade do Rio de Janeiro, RJ, em 2010. Aplicou-se question��rio estruturado, abordando caracter��sticas sociodemogr��ficas, comportamento sexual e avalia����o da consulta ginecol��gica. Utilizou-se o teste de Qui-quadrado (Yates) e o t de Student, adotando-se p < 0,05. RESULTADOS: Alunas dos col��gios privado e p��blico apresentaram perfis semelhantes e diferiram daquelas da rede p��blica estadual que tiveram n��vel socioecon��mico mais baixo, menor escolaridade dos respons��veis, predomin��ncia da ra��a negra, maior n��mero de parceiros, gesta����es e hist��rico de viol��ncia sexual. As m��dias de idades da menarca e sexarca foram semelhantes entre as estudantes e a primeira consulta ginecol��gica foi significativamente mais tardia nas alunas da rede estadual. A maioria referiu conhecimento sobre anticoncep����o e doen��as sexualmente transmiss��veis, por��m pequena parte obteve essas orienta����es na consulta. As estudantes manifestaram desejo de que o profissional investisse mais tempo, paci��ncia e disponibilidade no atendimento. CONCLUS��ES: O atendimento ginecol��gico na adolesc��ncia �� insatisfat��rio segundo a avalia����o das adolescentes estudadas. As usu��rias dos servi��os privados submetem-se �� consulta ginecol��gica em idade mais precoce do que aquelas que t��m acesso apenas �� rede p��blica. �� necess��rio criar mecanismos que facilitem o acesso e a ades��o desse grupo et��rio �� rotina preventiva ginecol��gica.

Survey of hearing disorders in an urban population in Rondonia, Northern Brazil

OBJECTIVE: To identify the prevalence of hearing loss for the population in the urban area. METHODS: A cross-sectional household survey based on the World Health Organization Ear and Hearing Disorders Survey Protocol was conducted in 298 households in the urban area of Monte Negro, Rondonia, Northern Brazil, from 2005 to 2007. Ear examinations, behavioral audiometry and pure tone audiometry were conducted on 577 individuals. RESULTS: The results showed that 3.8% (95%CI 2.17;5.45) of population were classified in the disabling hearing impairment category. The prevalence of moderate hearing impairment was 3.4%; severe impairment was 0.4%; and profound hearing impairment was not found. CONCLUSIONS: The impairing hearing loss prevalence found in this study is within of the international prevalence for this level of hearing loss and smaller than observed in a previous study in the South region of Brazil.

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.

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.

Finding Aedes aegypti in a natural breeding site in an urban zone, Sao Paulo, Southeastern Brazil

ABSTRACT This is the description of how nine Aedes aegypti larvae were found in a natural breeding site in the Pinheiros neighborhood, city of Sao Paulo, SP, Southeastern Brazil. The record was conducted in December 2014, during an entomological surveillance program of dengue virus vectors, with an active search of potential breeding sites, either artificial or natural. Finding Ae. aegypti larvae in a tree hole shows this species&#8217; ability to use both artificial and natural environments as breeding sites and habitats, which points towards the importance of maintaining continuous surveillance on this mosquito in all kinds of water-holding containers.

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.

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.

Exposure to acellular blood products and risk of HIV infection in hemophiliacs from Belo Horizonte, Brazil

Results of a HIV prevalence study conducted in hemophiliacs from Belo Horizonte, Brazil are presented. History of exposure to acellular blood components was determined for the five year period prior to entry in the study, which occurred during 1986 and 1987. Patients with coagulations disorders (hemophilia A = 132, hemophilia B = 16 and coagulation disorders other than hemophilia = 16) were transfused with liquid cryoprecipitate, locally produced, lyophilized cryoprecipitate, imported from S��o Paulo (Brazil) and factor VIII and IX, imported from Rio de Janeiro (Brazil), Europe, and United States. Thirty six (22%) tested HIV seropositive. The univariate and multivariate analysis (logistic model) demonstrated that the risk of HIV infection during the study period was associated with the total units of acellular blood components transfused. In addition, the proportional contribution of the individual components to the total acellular units transfused, namely a increase in factor VIII/IX and lyophilized cryoprecipitate proportions, were found to be associated with HIV seropositivity. This analysis suggest that not only the total amount of units was an important determinant of HIV infection, but that the risk was also associated with the specific component of blood transfused

ENTEROVIRUSES ISOLATED FROM PATIENTS WITH ACUTE RESPIRATORY INFECTIONS DURING SEVEN YEARS IN RIO DE JANEIRO (1985-1991)

Enteroviruses were investigated in respiratory secretions collected from patients with acute respiratory infections (ARI) over a seven year period (1985-1991), as part of a longitudinal study of ARI aetiology. All the viruses that are most commonly associated with ARI were found in this study. Among the virus isolates, enteroviruses were only less frequent than respiratory syncytial viruses, adenoviruses and influenzaviruses. Forty five enterovirus samples were isolated from patients with either upper respiratory tract infections (URTI) or lower respiratory tract infections (LRTI). From these enterovirus isolates, thirty one samples were identified as poliovirus (n=18) and non polio enterovirus (n=13) by serum neutralization. Poliovirus were identified as type 1 and 2 and all of them were vaccinal strains. From thirteen non polio enterovirus, twelve were identified as echovirus serotypes 1, 2, 7, 11, 19 and 31. The remainder was identified as coxsackievirus B4.

Study of chronic hemolytic anaemia patients in Rio de Janeiro: prevalence of anti-human parvovirus B19 IgG antibodies and the developement aplastic crises

The prevalence of anti-human parvovirus B19 IgG antibodies was determined in sera from 165 chronic hemolytic anemia patients, receiving medical care at Instituto Estadual de Hematologia (IEHE), Rio de Janeiro, during the year of 1994. This sample represents around 10% of the chronic hemolytic anemia patients attending at IEHE. Most of these patients (140) have sickle cell disease. Anti-B19 IgG antibodies were detected in 32.1% of patients. No statistically significant difference (p > 0.05) was seen between IgG antibody prevalence in male (27.8%) and female (35.5%) patients. Anti-B19 IgG antibodies were more frequent in older (37.6%) than younger (28.2%) than 20 years old patients, although this difference had no statistical significance (p > 0.05). Anti-B19 IgG antibody prevalence showed that 67.9% of patients enrolled in the study were susceptible to B19 acute infection. With the aim to detect acute B19 infection, patients follow up continued until February 1996. During this period four patients presented transient aplastic crisis due to human parvovirus B19 as confirmed by the detection of specific IgM antibodies. All four patients were younger than 20 years old, and 3 were younger than 10 years old. Three of them were sickle cell disease patients. Three of the four acute B19 infection occurred during 1994 springtime.