Óbitos intra e extra-hospitalares por infarto agudo do miocárdio nas capitais brasileiras / In- and out-of-hospital deaths by acute myocardial infarction in brazilian state capitals

Resumo Fundamento: O infarto agudo do miocárdio (IAM) é a principal causa de óbito no Brasil e no mundo. Aproximadamente metade dos óbitos ocorrem fora do ambiente hospitalar. Objetivos: Analisar a distribuição, a evolução temporal e as características sociodemográficas (CSD) dos óbitos intra e extra-hospitalares por IAM nas capitais brasileiras e a sua relação com indicadores municipais de desenvolvimento (IMD). Métodos: Estudo ecológico com contagem anual dos óbitos por IAM nas 27 capitais brasileiras de 2007 a 2016, os quais foram divididos em dois grupos, intra-hospitalar (H) e extra-hospitalar (EH). Avaliou-se a evolução temporal das taxas de mortalidade em cada grupo e as diferenças das CSD. Modelos de regressão binominal negativa compararam temporalmente a contagem de óbitos em cada grupo com as seguintes variáveis: residir nas regiões Sul e Sudeste (S/SE), índice de desenvolvimento humano municipal (IDHM), índice de Gini e expectativa de anos de estudo (EAE). Considerou-se estatisticamente valores significativos de p < 0,05. Resultados: A taxa de mortalidade EH para o conjunto das capitais aumentou ao longo do tempo. Todas as CSD pesquisadas foram difententes entre os grupos (p < 0,001). No grupo EH prevaleceram os óbitos em homens, em pacientes ≥ 80 anos e em solteiros. O S/SE elevou a incidência de óbitos extra-hospitalares (IRR = 2,84; IC 95% = 1,67-4,85), enquanto o maior EAE registrou queda (IRR = 0,86; IC 95% = 0,77-0,97). Para o grupo H, o maior IDHM reduziu a incidência de óbitos (IRR = 0,44; IC 95% = 0,33-0,58), enquanto o maior EAE apresentou crescimento (IRR = 1,09; IC 95% = 1,03-1,15). Conclusão: Os óbitos intra e extra-hospitalares por IAM nas capitais apresentam diferenças sociodemográficas, incidência influenciada por IMD e progressivo aumento da ocorrência extra-hospitalar.

Abstract Background: Acute myocardial infarction (AMI) is the main cause of death in Brazil and the world. Approximately half of these deaths occur outside the hospital. Objectives: To analyze the distribution, temporal evolution, and sociodemographic characteristics (SDC) of in- and out-of-hospital deaths by AMI in Brazilian state capitals and their relationship with municipal development indicators (MDI). Methods: This is an ecological study of the number of deaths due to AMI reported annually by the 27 Brazilian state capitals from 2007 to 2016; these were divided into 2 groups: in-hospital (H) and out-of-hospital (OH). We evaluated the temporal evolution of mortality rates in each group and differences in SDC. Negative binomial regression models were used to compare the temporal evolution of the number of deaths in each group with the following variables: residing in the South/Southeast regions (S/SE), municipal human development index (MHDI), Gini coefficient, and expected years of schooling (EYS). We considered p-values<0.05 as statisticallysignificant. Results: The OH mortality rate increased with time for all state capitals. All studied SDC were different between groups (p<0.001). In the OH group, most deaths were of men and patients aged 80 years or older and not married. S/SE increased the incidence of OH deaths (incidence rate ratio [IRR]=2.84; 95% confidence interval [CI]=1.67-4.85), while higher EYS reduced it (IRR=0.86; 95% CI=0.77-0.97). In the H group, higher MHDI reduced the incidence of deaths (IRR=0.44; 95% CI=0.33-0.58), while higher EYS increased it (IRR=1.09; 95% CI=1.03-1.15). Conclusions: In- and out-of-hospital deaths due to AMI in Brazilian state capitals were influenced by MDI, presented sociodemographic differences and a progressive increase in out-of-hospital occurrences.

Epidemiología del intento suicida en el Hospital Central de Nampula, Mozambique

Intento suicida constituye la mayoría de pacientes con lesiones autoinfligidas que acuden al servicio de urgencias. Su costo económico y social es elevado en términos de utilización de servicios de salud y el impacto que tiene en el individuo y la familia. Objetivo: Identificar algunas características epidemiológicas de casos de intento suicida vistos en el Hospital Central de Nampula, Mozambique. Material y Métodos: Estudio descriptivo, transversal y porcentual de 93 pacientes con historia de intento suicida atendidos entre mayo de 2014 y diciembre de 2016. Se identificaron algunas variables sociodemográficas, metodología y motivos, intentos previos, persistencia de la idea suicida, características del intento (impulsivo o no) y diagnóstico psiquiátrico. Resultados: Más de la mitad de los pacientes tenían entre 15 y 24 años de edad, hubo una proporción de 1.3 a 1 de mujeres vs. varones, la mayoría eran estudiantes y soltero(a)s. Conflictos interpersonales motivaron tres de cada cuatro intentos. La ideación suicida persistía en 35,5 % de los pacientes al momento de la entrevista. La mayoría efectuó el intento suicida de manera impulsiva contando con fácil acceso a un raticida de elevada letalidad, y 14,6 % tenía historia de intentos previos. Los diagnósticos psiquiátricos más frecuentes fueron trastornos de la personalidad y trastornos depresivos. Conclusiones: Conflictos interpersonales como factor desencadenante, fácil disponibilidad de un agente letal, conducta impulsiva y diagnósticos de trastornos de la personalidad y depresión son hallazgos descriptivos fundamentales de este estudio en Mozambique.

Suicidal attempt constitutes the majority of patients with self-inflicted injuries seen at hospital emergency departments. The economic and social costs are high in terms of utilization of health services and the behavior’s impact on the individual and his/her family. Objective: To identify some epidemiological characteristics of suicide attempts at Nampula Central Hospital in Mozambique. Material and Method: Descriptive, cross-sectional study on 93 patients who attempted suicide between May 2014 and December 2016. Sociodemographic variables, suicidal method, reasons for the attempt, previous attempts, persistence of suicidal ideation, psychiatric diagnosis and whether the attempt was impulsive or not were identified, data, quantified through percent figures. Results: Over half of the patients were in the 15-24, not-married, and students with a female/male ratio of 1.3. Interpersonal conflicts were the reason in ¾ parts of the attempts. Suicidal ideation persisted in 35.5 % of the patients. Most of the suicide attempts were impulsive acts, facilitated by the availability and easy access to a rodenticide called ratex, and 14.6 % of the patients had had previous attempts. The most frequent psychiatric diagnoses were personality and depressive disorders. Conclusions: Interpersonal conflicts, availability of a lethal agent, impulsive behaviour and diagnoses of personality disorders and depression were the main descripotive findings of this study in Mozambique.

Epidemiology of Mycoplasma agalactiae and Mycoplasma mycoides cluster in flocks of northeastern Brazil / Epidemiologia de Mycoplasma agalactiae e Mycoplasma mycoides cluster em rebanhos do nordeste do Brasil

ABSTRACT: The present study aimed to investigate contagious agalactia (CA) in flocks from Pernambuco State. The study involved 225 goats and 63 ewes; 288 milk samples and 100 vaginal swabs were collected in total. The PCR assays were carried out using specific primers to Mycoplasma agalactiae and the Mycoplasma mycoides cluster. Among the goat's milk samples,12.0% (27/225) were positive for Mycoplasma agalactiae DNA, while 5.3% (12/225) contained the Mycoplasma mycoides cluster. Of the vaginal swabs taken from goats, 15.4% (12/78) were positive for Mycoplasma agalactiae DNA and 3.8% (3/78) contained the Mycoplasma mycoides cluster. In the case of ewes, 4.3% (1/23) of the milk samples contained Mycoplasma agalactiae DNA, and 7.5% (3/40) were positive for the Mycoplasma mycoides cluster. Vaginal swabs taken from sheep´s were negative. Analysis of risk factors for mycoplasmosis, showed that goats and sheep flocks on the extensive breeding system are more likely to have mycoplasmosis than those on the intensive breeding system (odds ratio (OR) 6.2; p=0.004); meat goat and sheep flocks are more likely to have infection compared to dairy flocks (OR 4.8; p=0.011); unclean animal housing increases the chances of infection (OR 5.0; p=0.031) and not performing quarantine increases the chances of mycoplasmosis (OR 4.6; p=0.042). Based on these findings we conclude that CA syndrome in the semiarid region of Pernambuco state can be associated with Mycoplasma agalactiae and Mycoplasma mycoides cluster.

RESUMO: O objetivo deste estudo foi investigar a Agalaxia contagiosa em rebanhos do estado de Pernambuco. Foram examinadas 225 cabras e 63 ovelhas, das quais foram colhidas 288 amostras de leite e 100 suabes vaginais. Foram realizadas reações da PCR com iniciadores específicos para Mycoplasma agalactiae e Mycoplasma mycoides cluster. A frequência total de Mycoplasma agalactiae em amostras de leite caprino foi de 12,0% (27/225) e de 5,3% (12/225) para Mycoplasma mycoides cluster. Dos suabes vaginais de cabras as frequências detectadas na PCR foram de 15,4% (12/78) para Mycoplasma agalactiaee 3,8% (3/78) para Mycoplasma mycoides cluster. Em leite de ovelhas a frequência de Ma foi de 4.3% (1/23) e de 7,5% (3/40) para Mycoplasma mycoides cluster. Na análise dos fatores de risco para micoplasmoses verificou-se que rebanhos de caprinos e ovinos mantidos no sistema extensivo são mais prováveis de adquirir micoplasmose quando comparados com o sistema intensivo (odds ratio (OR) 6,2; p=0,004); rebanhos de caprinos e ovinos de corte são mais prováveis de adquirir micoplamsose do que rebanhos de leite (OR 4,8; p=0,011); não realizar limpeza das instalações aumenta as chances de infecção (OR 5,0; p=0,031); não realizar quarentena aumenta as chances das micoplasmoses estudadas (OR 4,6; p=0,042). Conclui-se que M. agalactiae e Mycoplasma mycoides cluster estão envolvidos na síndrome de CA em rebanhos de caprinos e ovinos do semiárido pernambucano.

Prevalence of dentine hypersensitivity among adult patients attending a dental hospital clinic in Turkey / Prevalencia de la hipersensibilidad dentinaria entre los pacientes adultos que asisten a la clínica del hospital dental en Turquía

OBJECTIVES: The aim of this study is to determine the prevalence of dentine hypersensitivity (DH) and to examine some associated factors such as the initiating stimuli among adult patients attending the Restorative Clinic of the Kirikkale University Dental Faculty, Turkey. METHODS: Questionnaires for 1169 patients, 678 men and 491 women, were completed and necessary clinical examinations performed during a one-year period and patients who were diagnosed with DH were questioned further about their occupation and smoking habits. Patients with at least two different quadrants which had sensitive teeth with sound exposed cervical dentine on the facial surface, were included in the study. The amount ofcervical lesions, buccal gingival recession and initiating factors associated with the sensitive teeth were also recorded. RESULTS: Of the 1169 patients examined, 89 were diagnosed as having dentine hypersensitivity, giving a prevalence of 7.6%. The commonest teeth affected were the upper premolars and the commonest initiating factor was cold drinks. CONCLUSIONS: The prevalence of dentine hypersensitivity in a postgraduate clinic in Turkey was 7.6%. The commonest teeth affected were the upper premolar and the commonest initiating factor was cold drinks.

OBJETIVOS: El objetivo de este estudio fue determinar la prevalencia de la hipersensibilidad dentinaria (HD) y examinar algunos factores asociados con ella, tales como los estímulos iniciadores entre los pacientes adultos que asisten a la Clínica Restaurativa la Facultad Dental Universitaria de Kirikkale, Turquía. MÉTODOS: Cuestionarios entregados a 1169 pacientes, 678 hombres y 491 mujeres, fueron respondidos, y se realizaron los exámenes clínicos necesarios por espacio de un ano. Los pacientes que fueron diagnosticados con HD, fueron interrogados ulteriormente acerca de su ocupación y el hábito defumar. Los pacientes con al menos dos cuadrantes diferentes, que tenían dientes sensibles con exposición de dentina cervical sana sobre la superficie facial, fueron incluidos en este estudio. También se registró la cantidad de lesiones cervicales, la recesión gingival bucal y los factores iniciadores asociados con la sensibilidad de los dientes. RESULTADOS: De los 1169 pacientes examinados, 89 se diagnosticaron con hipersensibilidad de la dentina, para una cifra de prevalencia de 7.6%. Los dientes más comúnmente afectados fueron los premolares superiores y los factores iniciadores más comunes fueron las bebidas frías. CONCLUSIONES: La prevalencia de la hipersensibilidad dentinaria en una clínica postgraduada en Turquía fue de 7.6%. Los dientes más comúnmente afectados fueron los premolares superiores y el facgor iniciador más común fueron las bebidas frías.