��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.

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.

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.

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.

Um festival �� um festival: em Yerevan e no Rio de Janeiro

Cr��tica de teatro a v��rios espectaculos apresentados em festivais em Yerevan, Arm��nia, e no Rio de Janeiro, Brasil.