Avaliação do acesso ao tratamento de tuberculose sob perspectiva dos usuários na atenção primária / Assessment of access to tuberculosis treatment from the perspective of users in primary care / Evaluación del acceso al tratamiento de tuberculosis desde la perspectiva de los usuarios en la atención primaria

Objetivo: avaliar o acesso ao tratamento em pessoas com Tuberculose na Atenção Primária à Saúde. Métodos: trata-se de uma pesquisa transversal, descritivo e observacional, com abordagem quantitativa, realizada na cidade de Caxias-Maranhão. Obteve-se uma amostra de 133 participantes, porém foram entrevistados 100 pacientes. Resultados: as maiores prevalências ocorreram em homens 55 (55%), com ensino fundamental incompleto 57 (57%). Percebeu-se também, que o acesso ao tratamento é centralizado e os indicadores geográficos foram considerados satisfatórios, como, realização do tratamento na unidade mais próxima 100 (100%), consulta médica em 24 horas 91 (91%), medicamentos 99 (99%), tempo menor de 60 minutos para se consultar 87 (87%). Conclusão: desta forma, este estudo demonstrou associação significativa em relação ao tratamento de tuberculose diante das variáveis de estudo. Portanto, garantir o acesso não é suficiente para o êxito do tratamento, refletindo a necessidade de novas estratégias que visem a promoção da saúde da população

Objective: to evaluate access to treatment in people with Tuberculosis in Primary Health Care. Methods: this is a cross-sectional, descriptive and observational study, with a quantitative approach, carried out in the city of Caxias-Maranhão. A sample of 133 participants was obtained, but 100 patients were interviewed. Results: the highest prevalence occurred in men 55 (55%), with incomplete primary education 57 (57%). It was also noticed that access to treatment is centralized and geographic indicators were considered satisfactory, such as treatment at the nearest unit 100 (100%), medical consultation in 24 hours 91 (91%), medicines 99 (99 %), less than 60 minutes to consult 87 (87%). Conclusion: thus, this study demonstrated a significant association in relation to the treatment of tuberculosis in view of the study variables. Therefore, ensuring access is not sufficient for the success of treatment, reflecting the need for new strategies aimed at promoting the population's health

Objetivo: evaluar el acceso al tratamiento en personas con tuberculosis en Atención Primaria de Salud. Método: estudio transversal, descriptivo y observacional, con enfoque cuantitativo, realizado en la ciudad de Caxias-Maranhão. Se obtuvo una muestra de 133 participantes, pero se entrevistó a 100 pacientes. Resultados: la prevalencia más alta ocurrió en hombres 55 (55%), con educación primaria incompleta 57 (57%). También se observó que el acceso al tratamiento está centralizado y los indicadores geográficos se consideraron satisfactorios, como el tratamiento en la unidad más cercana 100 (100%), consulta médica en 24 horas 91 (91%), medicamentos 99 (99%), menor 60 minutos para consultar 87 (87%). Conclusión: por lo tanto, este estudio demostró una asociación significativa en relación con el tratamiento de la tuberculosis debido a las variables del estudio. Por lo tanto, garantizar el acceso no es suficiente para el éxito del tratamiento, lo que refleja la necesidad de nuevas estrategias destinadas a promover la salud de la población

Medidas de contenção de tipo lockdown para prevenção e controle da COVID-19: estudo ecológico descritivo, com dados da África do Sul, Alemanha, Brasil, Espanha, Estados Unidos, Itália e Nova Zelândia, fevereiro a agosto de 2020 / Medidas de contención tipo lockdown para prevención y control del COVID-19: estudio ecológico descriptivo con datos de febrero a agosto de 2020 en Sudáfrica, Alemania, Brasil, España, Estados Unidos, Italia y Nueva Zelanda / Lockdown-type containment measures for COVID-19 prevention and control: a descriptive ecological study with data from South Africa, Germany, Brazil, Spain, United States, Italy and New Zealand, February - August 2020

Objetivo: Descrever as medidas de contenção de tipo lockdown e a incidência da COVID-19 em sete países: África do Sul, Alemanha, Brasil, Espanha, Estados Unidos, Itália e Nova Zelândia. Métodos: Estudo ecológico descritivo, com dados da incidência diária dos casos confirmados de COVID-19 entre 22 de fevereiro e 31 de agosto de 2020, e informações sobre medidas de lockdown implementadas pelo governo de cada país. Resultados: Os países que implementaram lockdown tiveram diminuição da incidência diária de COVID-19 (casos por milhão de habitantes) no período de três semanas, a contar do início da medida: África do Sul (3,7 a 1,7), Alemanha (37,5 a 33,7), Espanha (176,3 a 82,0), Itália (92,0 a 52,1) e Nova Zelândia (7,5 a 1,7). O Brasil e os Estados Unidos, que não implementaram lockdown, não apresentaram uma diminuição considerável. Conclusão: Após a implementação de lockdown, houve uma diminuição considerável do número de casos confirmados.

Objetivo: Describir las medidas de contención tipo lockdown y la incidencia de COVID-19 en los países de Sudáfrica, Alemania, Brasil, España, Estados Unidos, Italia y Nueva Zelanda. Métodos: Estudio ecológico descriptivo con datos de la incidencia diaria de los casos confirmados de COVID-19, del 22 de febrero al 31 de agosto de 2020 e informaciones sobre medidas de contención lockdown implementadas por los gobiernos de cada uno de los países. Resultados: Los países que implementaron lockdown, desde el inicio de su implementación hasta tres semanas después, tuvieron una disminución en la incidencia diaria (casos por millón de habitantes): Sudáfrica (3,7 a 1,7), Alemania (37,5 a 33,7), España (176,3 a 82,0), Italia (92,0 a 52,1) y Nueva Zelanda (7,5 a 1,7). Brasil y Estados Unidos, que no implementaron lockdown, no tuvieron una disminución considerable Conclusión: Luego de la implementación del lockdown, hubo una disminución considerable en el número de casos confirmados.

Objective: To describe lockdown-type containment measures and COVID-19 incidence in South Africa, Germany, Brazil, Spain, United States, Italy and New Zealand. Methods: This is a descriptive ecological study with data on daily incidence of confirmed COVID-19 cases from February 22 to August 31 2020, as well as information on lockdown measures implemented by the governments of each country. Results: Daily COVID-19 incidence (cases per 1 million inhabitants) decreased within three weeks after lockdown started in the countries that implemented it: South Africa (3.7 to 1.7), Germany (37.5 to 33.7) Spain (176.3 to 82.0), Italy (92.0 to 52.1) and New Zealand (7.5 to 1.7). As for Brazil and the United States, which did not implement lockdown, there was no considerable decrease. Conclusion: After lockdown implementation, there was a considerable decrease in the number of confirmed cases.

Social distancing patterns in nine municipalities of Rio Grande do Sul, Brazil: the Epicovid19/RS study / Padrões de distanciamento social em nove cidades gaúchas: estudo Epicovid19/RS

ABSTRACT OBJECTIVE To describe social distancing practices in nine municipalities of the state of Rio Grande do Sul, Brazil, stratified by gender, age, and educational attainment. METHODS Two sequential cross-sectional studies were conducted in the municipalities of Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria, and Uruguaiana to estimate the population prevalence of COVID-19. The study was designed to be representative of the urban population of these municipalities. A questionnaire including three questions about social distancing was also administered to the participants. Here, we present descriptive analyses of social distancing practices by subgroups and use chi-square tests for comparisons. RESULTS In terms of degree of social distancing, 25.8% of the interviewees reported being essentially isolated and 41.1% reported being quite isolated. 20.1% of respondents reported staying at home all the time, while 44.5% left only for essential activities. More than half of households reported receiving no visits from non-residents. Adults aged 20 to 59 reported the least social distancing, while more than 80% of participants aged 60 years or older reported being essentially isolated or quite isolated. Women reported more stringent distancing than men. Groups with higher educational attainment reported going out for daily activities more frequently. CONCLUSIONS The extremes of age are more protected by social distancing, but some groups remain highly exposed. This can be an important limiting factor in controlling progression of the COVID-19 pandemic.

RESUMO OBJETIVO Descrever práticas de distanciamento social em nove municípios do Rio Grande do Sul por sexo, idade, escolaridade e cidade. MÉTODOS Foram realizados dois estudos transversais sequenciais representativos da população urbana nos municípios de Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria e Uruguaiana com o intuito de estimar a prevalência populacional de Covid-19. Foi aplicado questionário contendo três perguntas sobre distanciamento social, cujas práticas foram submetidas a análises descritivas por subgrupos. Os dados foram comparados por testes qui-quadrado. RESULTADOS Em termos de grau de distanciamento social, 25,8% dos entrevistados relataram estar praticamente isolados e 41,1% indicam praticar bastante distanciamento. Relataram ficar em casa o tempo todo 20,1% dos entrevistados, e 44,5% informam que saem apenas para atividades essenciais. Mais da metade dos domicílios não recebe visitas de não moradores. O grupo que relatou menos distanciamento social foi o de adultos entre 20 e 59 anos, enquanto mais de 80% dos entrevistados com 60 anos ou mais relataram estar praticamente isolados ou fazendo bastante distanciamento. As mulheres relataram fazer mais distanciamento que os homens, e os grupos de maior escolaridade foram os que relataram sair diariamente para atividades regulares com mais frequência. CONCLUSÕES Os grupos mais jovens e mais idosos estão mais protegidos pelo distanciamento social, mas há grupos bastante expostos, o que pode ser um limitador importante no controle da progressão da epidemia de Covid-19.

Assessment on the Effects of Hepatitis B Prevention and Control Measures in Western China: A Comparison of Three Population-based Serosurveys / 生物医学与环境科学（英文）

Objective@#Despite the remarkable progress in efforts to control disease spread, the nationwide elimination of hepatitis B in China is still hindered by the persistently high rate of hepatitis B virus (HBV) infection in Western China. This study aimed to evaluate the strategy of hepatitis B prevention and control in Western China and identify potential areas and strategies for improvement.@*Methods@#Susceptible population vaccination, health education, professional training of doctors, and other prevention and control measures have been implemented in Wuwei city since 2010. Data were obtained from three representative cross-sectional serosurveys conducted in 2010, 2013, and 2015. The serum samples were subjected to enzyme-linked immunosorbent assays to detect the following seromarkers: HBV surface antigen (HBsAg), antibody against hepatitis B surface antigen (anti-HBs), and antibody against hepatitis B core antigen (anti-HBc). Estimates of variance were determined using Taylor series linearization methods.@*Results@#The three serosurveys revealed decreases in the prevalence of HBsAg (7.19% in 2010 @*Conclusion@#Although vaccine-based prevention and control measures reduced the rate of HBV infection in Wuwei City over time, the hepatitis B infection rate in children younger than 10 years was still higher than the national average level. Therefore, the prevention and control of mother-to-child transmission and the management of the infected should be the focus of future prevention and control work.

Notificación de tuberculosis en el Hospital Santojanni: Periodo 2017-1 er. semestre 2018 / Notification of tuberculosis at Santojanni Hospital: 2017-First semester 2018

El hospital general de agudos donación Francisco Santojanni se encuentra enclavado en el oeste de la Ciudad Autónoma de Buenos Aires. Fue fundado en el año 1940 como hospital para tuberculosos en terrenos cedidos por el filántropo que le dio nombre a la institución. En 1981 se constituyó en hospital polivalente de agudos. Por año se asisten aproximadamente 480.000 personas provenientes, en especial, de su área de influencia: los barrios de Liniers, Mataderos y Lugano, además de los partidos colindantes de la provincia de Buenos Aires. Se caracterizan los casos notificados de TBC en el hospital Santojanni entre enero de 2017 y junio de 2018.

Ocorrência de brucelose e tuberculose bovinas no Rio Grande do Sul com base em dados secundários / Occurrence of bovine brucellosis and tuberculosis in Rio Grande do Sul, Brazil, based on secondary data

Avaliaram-se os resultados de testes para diagnóstico da brucelose e tuberculose bovinas objetivando analisar a distribuição de positividade e características de performance do programa de controle. A análise utilizou como dados secundários todos os resultados de testes para diagnóstico realizados em bovinos no ano de 2008 no estado do Rio Grande do Sul (RS) por médicos veterinários habilitados para atuação no âmbito do Programa Nacional de Controle e Erradicação de Brucelose e Tuberculose Animal. Os dados foram estatisticamente ajustados para minimizar os efeitos de valores extremos e de dados faltantes. Os testes alcançaram 66,80% dos 497 municípios do RS e incluíram a participação de 165 médicos veterinários habilitados. 40,21% dos testes foram realizados nos meses de abril, setembro e outubro, sendo que em 73,90% dos estabelecimentos foram realizados testes para ambas as enfermidades. No caso da brucelose verificou-se que foram testados 35.289 animais, com uma frequência de positivos de 0,25%, enquanto a frequência de estabelecimentos positivos entre os 3.406 testados foi 0,94%. Fêmeas apresentaram frequência de positividade mais elevada (0,29%, de 26.724 testadas) do que machos (0,13%, de 5.235 testados). Animais entre 48-60 meses de idade apresentaram chance de positividade superior às demais faixas etárias (Razão de Chances (RC) =2,63; IC 95%=1,63-4,26). Animais de aptidão leiteira representaram 62,66% dos animais testados, e apresentaram maior chance de positividade do que animais de corte (RC=2,32; IC 95%=1,38-3,90). Adicionalmente, 73,74% dos estabelecimentos testados eram dedicados à produção de leite. Já no caso da tuberculose foram testados 62.149 animais distribuídos em 5.151 propriedades, com frequência de positivos de 0,87% e 3,13%, respectivamente. A chance de positividade aumentou com a idade, sendo que animais com idade acima de 48 meses de idades apresentaram valores superiores aqueles verificados em animais mais jovens (RC=2,07; IC 95%=1,73-2,48). 59,74% dos animais testados eram de aptidão leiteira, os quais apresentaram mais chance de serem positivos do que aqueles de corte (RC=5,03; IC 95%=4,09-6,94). Propriedades leiteiras representaram 78,50% da totalidade dos testes para tuberculose. A análise comparativa do presente trabalho com estudos precedentes de prevalência da brucelose sugere que as ações de controle em curso têm sido efetivas na redução da prevalência da enfermidade no RS. Por outro lado, as informações obtidas no âmbito da tuberculose podem ser indicadoras da condição desta enfermidade, especialmente pela inexistência de estudos de prevalência realizados há menos de 30 anos. Adicionalmente, conclui-se que a utilização de dados secundários, desde que devidamente ajustados, pode ser uma ferramenta eficaz na gestão de programas de saúde animal e em sistemas de monitoramento e vigilância.(AU)

Results of tests for the diagnosis of bovine brucellosis and tuberculosis were evaluated aiming to analyze the distribution of positivity and characteristics of performance of the control program. The analysis used as secondary data the results of all diagnostic tests of bovines executed in 2008 in the state of Rio Grande do Sul (RS) by veterinarians authorized to operate under the National Program for Control and Eradication of Animal Brucellosis and Tuberculosis. The data were statistically adjusted to minimize the effect of outliers and missing data. The tests achieved 66.80% of the 497 municipalities in the RS and included the participation of 165 authorized veterinarians. 40.21% of tests were carried out in the months of April, September and October, and in 73.90% of establishments had tests performed for both diseases. In the case of brucellosis it appeared that 35,289 animals were tested, with positivity of 0.25%, while the frequency of positive holdings among the 3,406 tested was 0.94%. Females had higher positivity rate (0.29% of 26,724 tested) than males (0.13% of 5,235 tested). Animals between 48-60 months of age presented higher chance of positivity compared to other age groups (Odds Ratio (OR) = 2.63; CI 95% = 1.63 - 4.26). Dairy cattle represented 62.66% of tested animals, which were more likely to appear as positive than beef animals (OR = 2.32; CI 95% = 1.38 - 3.90). In addition, 73.74% of the tested holdings were dairy ones. In the case of tuberculosis, 62,149 animals were tested, distributed in 5,151 holdings, with positivity of 0.87% and 3.13%, respectively. The chance of positivity increased with age, being that animals older than 48 months presented higher values compared to ​​those found in younger animals (OR = 2.07; CI 95% = 1.73 - 2.48). Dairy cattle represented 59.74% of tested animals, which were more likely to be positive than beef ones (OR = 5.03; CI 95% = 4.09 - 6.94). Dairy holdings were 78.50% of all the tests for tuberculosis. The comparative analysis of this study with previous studies on brucellosis prevalence suggested that current control measures have been effective in reducing the prevalence of this disease in RS. On the other hand, information obtained on tuberculosis can be indicators of the condition of this disease, especially in the lack of prevalence studies carried out in the last 30 years. Finally, it is concluded that the use of secondary data, if properly adjusted, can be an effective tool in the management of animal health programs and monitoring and surveillance systems.(AU)

Geospatial and modeling tools for leishmaniasis studies: a review of publication between 2008-2018 / Ferramentas geoespaciais e de modelagem para estudos de leishmaniose: uma revisão de publicação entre 2008-2018

Aspects of how geospatial technologies can be used on visceral leishmaniasis (VL) control programs are discussed. We reviewed a number of papers discussing the usage of those technologies, through a PubMed literature review. Additionally, we provided conceptual elements for a development of a hierarchical scale framework on VL for decision making in São Paulo State, using Geographical Information Systems. Supported by Geospatial Techniques, we developed a view of some instruments for helping communities to better manage their risk areas. We used a classification called Strengths of GIS and Spatial Analysis in Epidemiology (SGISSAE). This review identified 50 papers published in the PubMed. With respect to developing the theoretical perspective, this paper can help to identify points of deficiency in shortage in discussions and leishmaniasis control programs, which led us to recommend future to delimitation studies to at community-based level and to define local actions to identify and manage the disease. In the conceptual framework data at community-based level will allow us to understand more broadly the changing spatial distribution of the disease.

Aspectos sobre como as tecnologias geoespaciais podem ser usadas nos programas de controle da leishmaniose visceral (LV) são discutidos. Nós confrontamos uma série de artigos discutindo o uso dessas tecnologias, através de uma revisão da literatura no PudMed. Adicionalmente, fornecemos elementos conceituais para o desenvolvimento de uma estrutura hierárquica sobre a escala na tomada de decisão sobre a leishmaniose no Estado de São Paulo, utilizando Sistemas de Informação Geográfica. Com o apoio das técnicas geoespaciais, desenvolvemos alguns instrumentos para ajudar as comunidades a gerenciar melhor suas áreas de risco. Usamos uma classificação chamada Forças do SIG e da análise espacial em Epidemiologia (SGISSAE). A revisão nos permitiu selecionar 50 artigos publicados no PubMed. Com relação ao desenvolvimento da perspectiva teórica, este artigo pode ajudar a identificar pontos de deficiência em discussões e programas de controle da leishmaniose, o que nos levou a recomendar futuros estudos de delimitação a nível comunitário e a definir ações locais para identificar e gerenciar a doença. No quadro conceptual, os dados ao nível da comunidade permitirão compreender mais amplamente a evolução da distribuição espacial da doença.

Caracterización clínico epidemiológica del parasitismo intestinal en pacientes jóvenes / Clinical epidemiological characterization of intestinal parasitism in young patients

Introducción: entre las enfermedades infecciosas, las producidas por parásitos intestinales constituyen un importante problema de salud para el hombre. Objetivo: caracterizar clínica y epidemiológicamente el parasitismo intestinal en pacientes jóvenes. Métodos: se realizó un estudio observacional, descriptivo y transversal en la consulta externa del Hospital Militar Docente Dr Mario Muñoz Monroy; el universo de estudio estuvo representado por todos los pacientes jóvenesa tendidos durante el período de noviembre de 2013 a octubre de 2014 con el diagnóstico clínico y microbiológico de parasitosis intestinal. Resultados: existió un predominio del sexo masculino con un 91 por ciento, siendo el grupo etario más afectado el de 17 a 22 años para un 60,7 por ciento. El 19,6 por ciento de los enfermos procedían del municipio Calimete. El dolor abdominal, seguido de las diarreas fueron los síntomas más referidos por los pacientes para un 96,4 por ciento y 94,6 por ciento, respectivamente. La Giardia lamblia fue el parásito más identificado en las muestras con un 51,7 por ciento, seguido del Enterobius vermicularis en un 28,6 por ciento. La mayoría de los enfermos no acostumbra a lavar los alimentos antes de su ingestión en un 83,9 por ciento de los casos estudiados, ni practican el lavado de manos previo representando el 69,6 por ciento. Conclusiones: el mayor porcentaje de pacientes enfermos procede del área rural. Los malos hábitos higiénicos-dietéticos constituyen los principales factores de riesgo(AU)

Introduction: Among the infectious diseases, those produced by intestinal parasites are a major health problem. Objective: To characterize the clinical and epidemiological aspects of intestinal parasitism in young patients. Methods: An observational, descriptive and cross-sectional study was carried out in the external consultation of the Military Teaching Hospital Dr Mario Muñoz Monroy; the universe was represented by all the young patients treated from November 2013 to October 2014 with the clinical and microbiological diagnosis of intestinal parasitosis. Results: There was a predominance of males with 91 percent, the most affected age group being 17 to 22 years old for 60.7 percent. 19.6 percent of the patients came from Calimete municipality. Abdominal pain and diarrhea were the most commonly reported symptoms for 96.4 percent and 94.6 percent, respectively. Giardia lamblia was the most identified parasite in the samples with 51.7 percent, followed by Enterobius vermicularis in 28.6 percent. The majority of patients do not usually wash their food prior to their ingestion in 83.9 percent of the cases, nor do they practice previous hand washing, representing 69.6 percent. Conclusions: The highest percentage of sick patients comes from the rural area. Bad hygienic-dietary habits are the main risk factors(AU)

Incidência de transmissão vertical do HIV entre gestantes soropositivas cadastradas em um serviço de referência regional / Incidencia de transmisión vertical del VIH entre las gestantes seropositivas registradas en un servicio de referencia regional / Incidence of HIV vertical transmission among HIV-positive pregnant women treated at a regional reference service

surveying and to characterizing the incidence of HIV vertical transmission, from 2004 to 2013, among pregnant women accompanied by a referral service in STD, HIV/AIDS and Viral Hepatitis in the countryside of Minas Gerais. Method: it is a quantitative descriptive study. Data were obtained from the medical records of women infected by HIV registered in the unit. For analysis, there was used the simple descriptive statistics. It was approved by the Research Ethics Committee of the Higher Education Foundation of Passos (FESP), with CAAE: 28399314.8.0000.5112. Results: of the 33 pregnancies treated at the service, 60,6% (20) knew the diagnosis before pregnancy and 39,4% (13) of them obtained it during the prenatal period. In the first group there was no vertical transmission, while in the second group, there was one case, 8%. Conclusion: it is recommended that pregnant women do the test still in the first three months of pregnancy, because late diagnosis makes difficult doing prophylaxis...

levantar e caracterizar a incidência de transmissão vertical do HIV, no período de 2004 a 2013, entre gestantes acompanhadas por serviço de referência em DST, HIV/AIDS e Hepatites Virais no interior de Minas Gerais. Método: estudo quantitativo descritivo. Os dados foram obtidos em prontuários de mulheres soropositivas para o HIV. Para análise utilizou-se a estatística descritiva simples. Aprovado pela Comissão de Ética em Pesquisa da Fundação de Ensino Superior de Passos (FESP), com CAAE: 28399314.8.0000.5112. Resultados: das 33 gestações acompanhadas no serviço, 60,6% (20) conheciam o diagnóstico antes da gravidez e 39,4% (13) o obtiveram durante o pré-natal. No primeiro grupo não houve transmissão vertical, enquanto que no segundo houve um caso, 8%. Conclusão: recomenda-se realização de teste ainda no primeiro trimestre gestacional, pois o diagnóstico tardio dificulta a profilaxia...

conocer y caracterizar la incidencia de la transmisión vertical del VIH, en el período 2004-2013, entre mujeres embarazadas acompañadas en un servicio de referencia de enfermedades de transmisión sexual, VIH/SIDA y la hepatitis viral en Minas Gerais. Método: este es un estudio cuantitativo descriptivo. Los datos se obtuvieron de los registros médicos de mujeres infectadas por el VIH registradas en la unidad. Para el análisis, se utilizó la estadística descriptiva simple. Aprobado por el Comité de Ética en Investigación de la Fundación de la Educación Superior de Passos (FESP), CAEE: 28399314.8.0000.5112. Resultados: de las 33 gestaciones atendidas en el servicio, el 60,6% (20) fueron de mujeres que conocían el diagnóstico antes del embarazo y el 39,4% (13) de mujeres que sólo lo obtuvieron durante el período prenatal. En el primer grupo no hubo ninguna transmisión vertical, mientras que en el segundo hubo un caso, 8%. Conclusión: se recomienda la prueba en el primer trimestre del embarazo, ya que el diagnóstico tardío dificulta el profilaxis...

Attitudes towards and use of homoeoprophylaxis: findings of two international surveys

The use of homoeopathic remedies to prevent infectious diseases, homoeoprophylaxis (HP), was first described over 100 years ago. To date, no systematic studies have been performed to identify the attitudes that current practitioners hold about HP or current trends in the use of HP. Aims: This study aimed to discover attitudes to HP amongst accredited homeopathic practitioners particularly with respect to overall acceptance, context of use, and preferred remedies. Methodology: Two international surveys were conducted in 2014. Responses were received from 1,124 homeopaths in 35 countries; 104 of whom responded to both surveys. Results: A large proportion of respondents have positive attitudes to HP and currently use HP in their practice. However, responses also indicate that knowledge about HP is chequered. Confidence in the evidence base of HP also is variable. Conclusion: Results indicate that HP is widely practised, however, further research is needed to improve confidence in the evidence base of HP, and better programs are needed to ensure that education about HP is enhanced...

Imunização em criança exposta ou infectada pelo HIV em um serviço de imunobiológicos especiais / Immunization in children exposed or infected by HIV in a service of special immunobiologicals / Inmunización en niño expuesto o infectado por el VIH en un servicio de inmunobiológicos especiales

Objetivou-se analisar a situação vacinal de crianças expostas ou infectadas pelo HIV atendidas no programa de imunobiológicos especiais (CRIES). Estudo documental, retrospectivo, desenvolvido no CRIES de um hospital público pediátrico, em Fortaleza-CE. A amostra consistiu em 125 prontuários de crianças atendidas no período de janeiro de 2006 a setembro de 2009. Conforme o Ministério da Saúde, percebeu-se que a maioria das crianças iniciou a imunização aos 2 meses de idade, destas 65 (52,0%) com o esquema vacinal injetável contra pólio e 68 (64,8%) contra pneumococo, mas apresentaram redução da demanda no seguimento do calendário ao avançar a idade. Assim, a baixa adesão ao calendário de vacina especial foi perceptível, o que implica rompimento do processo imunológico das crianças expostas, tornando-se imprescindível um trabalho educativo pelos profissionais de saúde e a conscientização da população, visando à prevenção de doenças evitáveis no grupo de risco estudado.

It was aimed to analyze the vaccination status of children exposed or infected by HIV assisted in the program of special immunobiological (CRIES). Documentary retrospective study developed in the CRIES of a public pediatric hospital in Fortaleza-CE. The sample consisted of 125 registers of children treated from January 2006 to September 2009. It was verified that as the Ministry of Health indicates, most children started immunization at 2 months of age, 65 (52.0%) of those with the injectable polio vaccine schedule and 68 (64.8%) against pneumococcus, but presented reduction on the demand in following the schedule along the years. Thus, the poor adherence to the schedule of the special vaccine was noticeable, which implicates in the breaking of the process of immune children exposed, becoming a vital educational work by health professionals and the public awareness aiming the prevention of preventable diseases in the risk group studied.

El objetivo fue analizar la situación relativa a las vacunas de niños expuestos o infectados por el VIH atendidos en el programa de inmunobiológicos especiales (CRIES). Estudio documental, retrospectivo, desarrollado en un hospital público pediátrico, en Fortaleza-CE. La muestra fue de 125 registros médicos de niños atendidos de enero de 2006 a septiembre de 2009. Se percibió que según el Ministerio de la Salud indica, la mayoría de los niños comenzó la inmunización a los 2 meses de edad, de estos 65 (52,0%) con el calendario de vacunas inyectable contra la poliomielitis y 68 (64,8%) contra el neumococo, pero presentaron reducción de la demanda en el seguimiento del calendario al avanzar la edad. Por lo tanto, la baja adherencia al calendario de vacunación especial fue notable, lo que implica la ruptura del proceso inmunológico de los niños expuestos, convirtiéndose en una acción educativa por los profesionales de salud y la conciencia de la población, para la prevención de las enfermedades prevenibles en el grupo de riesgo estudiado.

Clinical response of newly diagnosed HIV seropositive & seronegative pulmonary tuberculosis patients with the RNTCP Short Course regimen in Pune, India.

Background & objectives In the Revised National Tuberculosis Control Programme (RNTCP) in India prior to 2005, TB patients were offered standard DOTS regimens without knowledge of HIV status. Consequently such patients did not receive anti-retroviral therapy (ART) and the influence of concomitant HIV infection on the outcome of anti-tuberculosis treatment remained undetermined. This study was conducted to determine the results of treatment of HIV seropositive pulmonary tuberculosis patients with the RNTCP (DOTS) regimens under the programme in comparison with HIV negative patients prior to the availability of free ART in India. Methods Between September 2000 and July 2006, 283 newly diagnosed pulmonary TB patients were enrolled in the study at the TB Outpatient Department at the Talera Hospital in the Pimpri Chinchwad Municipal Corporation area at Pune (Maharashtra): they included 121 HIV seropositive and 162 HIV seronegative patients. They were treated for tuberculosis as per the RNTCP in India. This study was predominantly conducted in the period before the free ART become available in Pune. Results At the end of 6 months of anti-TB treatment, 62 per cent of the HIV seropositive and 92 per cent of the HIV negative smear negative patients completed treatment and were asymptomatic; among smear positive patients, 70 per cent of the HIV-seropositive and 81 per cent of HIV seronegative pulmonary TB patients were cured. Considering the results in the smear positive and smear negative cases together, treatment success rates were substantially lower in HIV positive patients than in HIV negative patients, (66% vs 85%). Further, 29 per cent of HIV seropositive and 1 per cent of the HIV seronegative patients expired during treatment. During the entire period of 30 months, including 6 months of treatment and 24 months of follow up, 61 (51%) of 121 HIV positive patients died; correspondingly there were 6 (4%) deaths among HIV negative patients. Interpretation & conclusions The HIV seropositive TB patients responded poorly to the RNTCP regimens as evidenced by lower success rates with chemotherapy and high mortality rates during treatment and follow up. There is a need to streamline the identification and management of HIV associated TB patients in the programme with provision of ART to achieve high cure rates for TB, reducing mortality rates and ensuring a better quality of life.

Diferencias clínicas y quirúrgicas entre pacientes con tuberculosis abdominal con y sin infección por el virus de inmunodeficiencia humana / Clinical and surgical differences in patients with abdominal tuberculosis infected and non infected by human immunodeficiency virus patient

La tuberculosis abdominal (TBa) ocurre en el 1 al 2,5 % del total de la tuberculosis diagnosticadas. Objetivos: Analizar las diferencias entre las características clínicas y quirúrgicas de la TBa en pacientes VIH positivos y VIH negativos. Materiales y métodos: Estudio descriptivo-analítico retrospectivo entre dos poblaciones asistidas entre los años 1989-2009 con diagnóstico de TBa. Once pacientes eran VIH positivos y 60 VIH negativos. Se analizaron variables clínicas, humorales, hallazgos quirúrgicos, procedimientos diagnósticos utilizados y los diferentes órganos abdominales afectados. En el análisis estadístico se utilizó la prueba del Chi cuadrado o el test de Fischer. También se calcularon el ODDS Ratio (OR) e intervalo de confianza al 95 %. Resultados: se diagosticaron 71 casos de TBa de los cuales 11 (15,5 %) fueron VIH positivos. de los 71 casos la edad media fue de 38 años, los síntomas más frecuentes observados fueron pérdida de peso 90,1 %, dolor abdominal 81,4 %, hipertermia 91,6 %, entre otros. el 8,5 % de los pacientes fallecieron. Al comparar ambas poblaciones, se observaron diferencias estadísticamente significativas en la población VIH positiva quienes fueron más jóvenes, más frecuentemente de género masculino, con menor tiempo de duración de los síntomas, presentando en menor frecuencia hipertermia y disminución de peso y más frecuentemente masa abdominal palpable y adenopatías en la cavidad abdominal. La mortalidad fue también mayor en este grupo. Conclusiones: La población presentó variables estadísticamente significativas para la edad, el género, tiempo de evolución de los síntomas, entre otras variaables que pueden ser de utilidad en su diagnóstico diferencial.

Abdominal tuberculosis (TBA) occurs in 1 to 2,5 % of total tuberculosis diagnosed. Objective: To analyze the differences between clinical and surgical characteristics of the TBA in HIV patients and HIV non-reactive reagents. Materials and Methods: A retrospective descriptive-analyticstudy of two groups assisted in the years 1989-2009 with a diagnosis of TBA. Eleven patients were HIV positive and 60 HIV-negative. We analyzed the clinical, laboratory findings and surgical findings, the diagnostic procedures used and the abdominal organs affected. Statistical analysis used Chi square test or Fischer test. Also calculated the Odds Ratio (OR) and confidence interval 95 %. Results: We diagnosed 71 cases of TBA of which 11 (15,5%) were HIV positive. Of the 71 cases the average age was 38 years, the most common symptoms observed were weight loss (90,1 %), abdominal pain (81,4 %), hyperthermia (91,6 %). 8,5 % of the patients died. HIV positive and negative were compared finding statistically significant differences in the HIV who were younger, more often male, with shorter duration of symptoms. In this population weight reduction and hyperthermia was less frequently in contrast with frequently palpable abdominal mass and lymphadenopathy in the abdominal cavity. Mortality was higher in among HIV positive patients. Conclusions: the present population statistically significnt variables for age, gender and time in the presence of sympotoms, among other variable that may be useful in the differential diagnosis.

Análisis epidemiológico y gestión sanitaria de la epidemia de gripe A H1N1: experiencia en la ciudad de Buenos Aires (invierno de 2009) / Epidemiological analysis and sanitary management of the influenza a H1N1: experience in the city of Buenos Aires (outbreak in winter 2009)

Las pandemias de influenza son eventos impredecibles pero recurrentes, que suponen consecuencias gravosas para las sociedades en todo el mundo. Desde el siglo XV y XVI, con el famoso sudor anglicus, se han descrito pandemias de influenza con intervalos más o menos regulares, entre 10 y 50 años, cuya gravedad y repercusiones han sido variables destacándose en el siglo XX la "gripe española" de 1918/1919, probablemente una de las mayores y más mortíferas pandemias de la historia humana, la influenza asiática entre 1957/1958 y la de Hong Kong entre 1968/1969. En 2003 surgió preocupación mundial ante una posible pandemia de influenza aviar (H5N1) que era sindicada como la gran favorita para un próximo evento de este tipo; no obstante nunca llegó a sortear la imposibilidd de propagarse de humano a humano. En abril de 2009, la OMS (WHO) comenzó a recibir reportes de personas con un nuevo tipo de virus de influenza A (H1N1) en México y EE.UU. La rápida diseminación internacional ulterior llevó a la propia OMS a declarar el 11 de junio de 2009 la primera pandemia de influenza en 41 años. En Argentina y luego del llamado inicial de alerta de Ministerio de Salud de la Nación, el Gobierno de la Ciudad de Buenos Aires inició procesos destinados al reporte, detección y vigilancia epidemiológica de los casos locales. A principios del mes de mayo se difundieron las noticias de los primeros casos de Gripe A confirmados en el país y el 30 de junio se decretó la emergencia sanitaria en la ciudad profundizándose un proceso de análisis sobre las medidas a tomar. Las acciones específicas tomadas por el GCBA y su MSAL pueden agruparse en acciones sobre el sistema de salud y sus efectores y acciones de estrategia comunicacional. Se concluye de este episodio pandémico que la Gripe A desplazó a la gripe estacional siendo la circulación viral en adultos mayormente virus A H1N1...

Influenza pandemics are unpredictable but recurrent events, involving serious consequences for societies worldwide. From the fifteenth and sixteenth century, with the famous anglicus sweat, there have been described pandemics of influenza within more or less regular intervals, between 10 and 50 years, whose severity and impact has been variale, emphasizing in the twentieth century the "Spanish flu" of 1918/1919, probably one of the largest and most dedly pandemics in human history, between 1957/1958 the Asian flu and the Hong Kong flu from 1968 to 1969. In 2003, concern arose about a possible global pandemic of avian influenza (H5N1), which was syndicated as the most probable cause for an upcoming event of this king, yet it never get around the inability to spread from human to human. In April 2009, WHO began to receive reports of Mexico and the U.S. The rapid internatinal spread further les WHO to declare on June 11 th 2009 the first influenza pandemic in 41 years. In Argentina and after the initial warning call of the Ministry of Health of the Nation, the Government of the City of Buenos Aires initiated processes for the reporting, detection and epidemilogical surveillance of local cases. In early May, the news spread of the first confirmed cases of influenza A in the country and on June 30 was declared a health emergency in the city getting stronger a process of discussion of measures to take. The specific actions taken by the GCBA and The Ministry of Health can be grouped into action on the health system and its effectors, and communications strategies and activities. We conclude from this episode of pandemic Influenza that the A virus H1N1 has replace the seasonal flu virus, because influenza virus circulation among adults was mostly H1N1 virus, that in spite of the fact of being getting trough a pandemic episode, the overall death rate was lower of that of the seasonal flu...

Trends in leprosy over fifty years in Gudiyatham Taluk, Vellore, Tamil Nadu.

This paper presents epidemiological trends over a fifty-year period observed in a defined population served by the Schieffelin Leprosy Research and Training Centre (SLR & TC), Karigiri, Vellore District in Tamil Nadu. It covers three distinct periods, namely, the pre-MDT era with dapsone monotherapy, the MDT era under a vertical leprosy control programme and the MDT era after leprosy control services were integrated into the general health services. Prevalence rates have declined steadily from 125 per 10,000 population at the time of introduction of MDT in 1982 to 5 per 10,000 at the time of integration in 1997 to less than 1 per 10,000 in 2005. The new case-detection rate was 5.4 per 10,000 when the field programme started in 1962, and held steady at 15-20 per 10,000 between 1970 and 1980. It then showed a gradual fall from 10.8 per 10,000 in 1985 to 3.9 at the time of integration, and continued to fall in the post-integration period and was 0.8 per 10,000 in 2005. The mean age at detection showed a gradual increase from 23.4 years in the dapsone era to 31.2 years in the post-integration period. The male: female ratio showed a preponderance of males almost throughout the reference period. While polar types of leprosy (TT & LL) were common in the dapsone era, more of borderline leprosy (BT & BL) cases was seen more recently. MB rates that were high initially, declined steadily during monotherapy and stabilized between 10% and 12% during the vertical MDT programme and is showing an increase in the post-integration-period. The proportion of cases with Grade 2 disability at registration showed a gradual decline during the monotherapy period, remained relatively unchanged at 8%-10% during the the MDT period, and showed a sharp rise in the immediate post-integration period before falling. Analysis of trends of leprosy in a well-defined geographical population over a fifty-year period gives useful information on how the disease has evolved over the years. It provides opportunities to explore the reasons for the changes observed, though one has to be cautious while interpreting such data due to changes in definition, the play of operational factors, and changes in policies and strategies.