Measuring herpes zoster disease burden in São Paulo, Brazil: a clinico-epidemiological single-center study.

OBJECTIVES: Herpes zoster is characterized by acute neuritis and post-herpetic neuralgia. Currently, data concerning the zoster-associated impact on quality of life and healthcare resource utilization in Brazil are scarce. This study measured the zoster-associated burden in a Brazilian population. METHODS: This was a prospective, observational, single-cohort study conducted in a primary hospital's emergency room in São Paulo, Brazil. Patients enrolled at various timepoints during a zoster episode were followed over 180 days. The Zoster Brief Pain Inventory and the Initial Zoster Impact Questionnaire assessed zoster-associated pain. The EuroQoL assessed the impact of herpes zoster and/or zoster-associated pain on quality of life. Healthcare resource utilization was assessed by patient-reported questionnaires. RESULTS: One-hundred forty-six zoster patients were enrolled [mean (SD) age of 69.9 (10.9) years]. Mean (SD) worst pain scores decreased from 5.3 (3.5) at baseline to 1.9 (3.0) 180 days following rash onset. Mean (SD) EuroQoL scores significantly decreased from 0.9 (0.2) before rash appearance to 0.7 (0.2) after rash onset (p<0.001), followed by gradual improvements in quality of life over 180 days, with pre-herpes zoster quality of life achieved at the end of the observation period. The majority of patients purchased prescription medications (89.7%) and required doctor's office visits (65.8%) for zoster episodes. CONCLUSIONS: Herpes zoster is associated with a significant disease burden, including zoster-associated pain, impaired quality of life and increased healthcare resource utilization in Brazil. These results support the implementation of early intervention and prevention programs such as vaccinations to reduce the herpes zoster-associated disease burden in Brazil.

Measuring herpes zoster disease burden in São Paulo, Brazil: a clinico-epidemiological single-center study

OBJECTIVES: Herpes zoster is characterized by acute neuritis and post-herpetic neuralgia. Currently, data concerning the zoster-associated impact on quality of life and healthcare resource utilization in Brazil are scarce. This study measured the zoster-associated burden in a Brazilian population. METHODS: This was a prospective, observational, single-cohort study conducted in a primary hospital's emergency room in São Paulo, Brazil. Patients enrolled at various timepoints during a zoster episode were followed over 180 days. The Zoster Brief Pain Inventory and the Initial Zoster Impact Questionnaire assessed zoster-associated pain. The EuroQoL assessed the impact of herpes zoster and/or zoster-associated pain on quality of life. Healthcare resource utilization was assessed by patient-reported questionnaires. RESULTS: One-hundred forty-six zoster patients were enrolled [mean (SD) age of 69.9 (10.9) years]. Mean (SD) worst pain scores decreased from 5.3 (3.5) at baseline to 1.9 (3.0) 180 days following rash onset. Mean (SD) EuroQoL scores significantly decreased from 0.9 (0.2) before rash appearance to 0.7 (0.2) after rash onset (p<0.001), followed by gradual improvements in quality of life over 180 days, with pre-herpes zoster quality of life achieved at the end of the observation period. The majority of patients purchased prescription medications (89.7%) and required doctor's office visits (65.8%) for zoster episodes. CONCLUSIONS: Herpes zoster is associated with a significant disease burden, including zoster-associated pain, impaired quality of life and increased healthcare resource utilization in Brazil. These results support the implementation of early intervention and prevention programs such as vaccinations to reduce the herpes zoster-associated disease burden in Brazil.

Economic Burden of Herpes Zoster ("culebrilla") in Latin America.

BACKGROUND: Herpes zoster (HZ) is characterized by debilitating pain and blistering dermatomal rash. The most common complication of HZ is postherpetic neuralgia (PHN), a persistent pain that can substantially affect patients' quality of life. HZ has significant impact on patients' lives with considerable implications for healthcare systems and society. The purpose of this study was to evaluate the healthcare resource utilization (HCRU) and medical costs associated with HZ in Latin America. METHOD: We conducted a pooled-analysis of three prospective cohort studies of HZ patients ≥50 years of age in Argentina (n=96); Brazil (n=145) and Mexico (n=142). Patients were recruited at different time-points during their HZ episode and were followed for six months. The incidence of PHN was defined as a worst ZBPI pain score of ≥3, persisting or appearing more than 90 days after the onset of rash. Work effectiveness was measured on a 100-point Likert scale where 100 was described as completely effective (able to work like before HZ began) and 0 as not effective at all. Direct costs included costs due to use of antiviral medications and all medical services used to treat HZ. Indirect cost was based on foregone earnings from patients due to work loss and presenteeism, and work loss by family caretakers. One-way sensitivity analysis was performed to assess the impact on total costs. All costs are reported in 2015 USD currency. RESULTS: 383 HZ patients were included and PHN incidence was 38.6%. The most commonly used resources were visits to the doctor's office (79.1% of patients), the emergency room (48.8%) and a specialist (37.9%); hospitalization was reported for 5.7% of patients. The overall direct cost per case was $763.19 USD, indirect cost was $701.40, for a total of $1,464.59 per HZ episode in Latin America. Total cost associated with HZ in patients with PHN was markedly higher compared to patients without PHN ($2,001.13 vs. $867.72, respectively) with indirect costs accounting for the most part of this difference. The sensitivity analysis was generally robust to changes in the assumptions made. CONCLUSION: HZ and its sequelae impose a substantial economic burden in Latin America which is expected to rise as the population ages and the number of HZ cases increases. The results support the need for early intervention, preventative strategies and improved disease management to reduce the HZ-associated disease burden in Latin America.

Elderly men's quality of life and lower urinary tract symptoms: an intricate relationship

PURPOSE: To evaluate the impact of lower urinary tract symptoms (LUTS) on the quality of life (QoL) in a group of elderly men. MATERIALS AND METHODS: Observational clinical study contained 200 men recruited between March-September 2008 in the community and Urology and Geriatrics ambulatories. The data collected included health and sociodemographic conditions; the International Prostate Symptom Score (IPSS); an anxiety/depression inventory; the World Health Organization Quality of Life -Bref and -Old questionnaires (WHOQoL). Participants were classified according to IPSS: Group I (moderate/severe symptoms) and Group II (absence/mild symptoms) and 100 men were included in each group. RESULTS: The groups were statistically similar in sociodemographic, morbidity, and anxiety/depression scores. Both QoL scales showed significant lower median scores in group I in all parameters, except the global subjective self-evaluation of QoL. The domains social and environmental relations presented the most significative differences (p < 0.0005) in both questionnaires, and final mean WHOQoL-OLD score was lower in group I (p < 0.0005). CONCLUSIONS: For elderly men, moderate to severe LUTS do significantly impact almost all parameters of QoL proposed by the WHO, especially social and environmental relations.

Tratamento da dor associada à osteoartrose de joelho em idosos: um ensaio clínico aleatório e duplamente encoberto com o clonixinato de lisina / Treatment of pain associated to knee osteoarthrosis in elderly people: a randomized double-blind clinical trial with lysine clonixinate

JUSTIFICATIVA E OBJETIVOS: A osteoartrose (OA) é a artropatia mais comum e uma das principais causas de dor crônica na população idosa, podendo levar a grande incapacidade funcional nestes indivíduos. Objetivando o tratamentoda dor em idosos com OA de joelho utilizou-se o clonixinato de lisina (CL) e avaliou-se a sua efetividade.MÉTODO: Estudo clínico e duplamente encoberto,aleatório e placebo controlado com 109 idosos com dor associada à OA de joelho. Os participantes foram divididos em dois grupos: Grupo CL e P (placebo) que receberam comprimidos para uso três vezes ao dia por 30 dias.Realizadas avaliações iniciais, após 15 dias e ao final doestudo, quanto à intensidade de dor em repouso, ao movimento inicial, à deambulação e à compressão articular; necessidade de analgesia complementar, rigidez matinal; incapacidade funcional associada à dor, aderência, tolerabilidade e avaliação global do tratamento.RESULTADOS: O CL reduziu significantemente a dor ao início do movimento e à deambulação já nos primeiros 15 dias, redução de 30% da dor protocinética e de 31,6% à deambulação, mas os melhores resultados ocorreram com 30 dias, quando as reduções foram de 42,3% e 45,5%, protocinética e à deambulação, respectivamente. A analgesia complementar foi significantemente menor com o CL: 2,6% e 9,5%, grupos CL e P, respectivamente. Não ocorreram diferenças entre os grupos para rigidez matinal e incapacidade funcional. Houve grande aderência e tolerabilidade. A avaliação global foi favorável para o CL,sendo excelente ou boa em 50%.CONCLUSÃO: O clonixinato de lisina foi efetivo no tratamento da dor associada à osteoartrite de joelho em idosos.

BACKGROUND AND OBJECTIVES: Osteoarthrosis (OA) is the most common arthropathy and one of the major causes of chronic pain in elderly population, which may lead to major functional incapacity of these individuals.Aiming at treating pain of elderly patients with knee OA,we have used lysine clonixinate (LC) and have evaluated its effectiveness. METHOD: Randomized, double-blind, placebo-controlledclinical trial with 109 elderly patients with painassociated to knee OA. Participants were distributed in two groups: Group LC and Group P (placebo), who received tablets to be used three times a day for 30 days.Evaluations were performed initially, 15 days after andat study completion, as to pain intensity at rest, at initial movement, walking and joint compression, and the needfor additional analgesia, morning stiffness; pain-related functional incapacity, adherence, tolerability and global treatment valuation.RESULTS: LC has signifi cantly decreased pain at initialmovement and walking already in the first 15 days, with 30% decrease in protokinetic pain and 31.6% in walking, but best results were seen after 30 days, when reductions were 42.3% and 45.5%, respectively. Additional analgesia was significantly lower with LC: 2.6% and 9.5% for groups LC and P, respectively. There were no differences between groups in morning stiffness and functional incapacity.There has been major adherence and tolerability.Global evaluation was favorable to LC, being excellent orgood for 50% of patients.CONCLUSION: Lysine clonixinate was effective to trea tpain associated to knee osteoarthritis in elderly people.

Elderly men's quality of life and lower urinary tract symptoms: an intricate relationship.

PURPOSE: To evaluate the impact of lower urinary tract symptoms (LUTS) on the quality of life (QoL) in a group of elderly men. MATERIALS AND METHODS: Observational clinical study contained 200 men recruited between March-September 2008 in the community and Urology and Geriatrics ambulatories. The data collected included health and sociodemographic conditions; the International Prostate Symptom Score (IPSS); an anxiety/depression inventory; the World Health Organization Quality of Life -Bref and -Old questionnaires (WHOQoL). Participants were classified according to IPSS: Group I (moderate/severe symptoms) and Group II (absence/mild symptoms) and 100 men were included in each group. RESULTS: The groups were statistically similar in sociodemographic, morbidity, and anxiety/depression scores. Both QoL scales showed significant lower median scores in group I in all parameters, except the global subjective self-evaluation of QoL. The domains social and environmental relations presented the most significative differences (p < 0.0005) in both questionnaires, and final mean WHOQoL-OLD score was lower in group I (p < 0.0005). CONCLUSIONS: For elderly men, moderate to severe LUTS do significantly impact almost all parameters of QoL proposed by the WHO, especially social and environmental relations.

The cost-effectiveness of influenza vaccination for people aged 50 to 64 years: an international model.

OBJECTIVES: Routine influenza vaccination is currently recommended in several countries for people aged more than 60 or 65 years or with high risk of complications. A lower age threshold of 50 years has been recommended in the United States since 1999. To help policymakers consider whether such a policy should be adopted more widely, we conducted an economic evaluation of lowering the age limit for routine influenza vaccination to 50 years in Brazil, France, Germany, and Italy. METHODS: The probabilistic model was designed to compare in a single season the costs and clinical outcomes associated with two alternative vaccination policies for persons aged 50 to 64 years: reimbursement only for people at high risk of complications (current policy), and reimbursement for all individuals in this age group (proposed policy). Two perspectives were considered: third-party payer (TPP) and societal. Model inputs were obtained primarily from the published literature and validated through expert opinion. The historical distribution of annual influenza-like illness (ILI) incidence was used to simulate the uncertain incidence in any given season. We estimated gains in unadjusted and quality-adjusted life expectancy, and the cost per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Comparing the proposed to the current policy, the estimated mean costs per QALY gained were R$4,100, EURO 13,200, EURO 31,400 and EURO 15,700 for Brazil, France, Germany, and Italy, respectively, from a TPP perspective. From the societal perspective, the age-based policy is predicted to yield net cost savings in Germany and Italy, whereas the cost per QALY decreased to R$2800 for Brazil and EURO 8000 for France. The results were particularly sensitive to the ILI incidence rate, vaccine uptake, influenza fatality rate, and the costs of administering vaccination. Assuming a cost-effectiveness threshold ratio of EURO 50,000 per QALY gained, the probabilities of the new policy being cost-effective were 94% and 95% for France, 72% and near 100% for Germany, and 89% and 99% for Italy, from the TPP and societal perspectives, respectively. CONCLUSIONS: Extending routine influenza vaccination to people more than 50 years of age is likely to be cost-effective in all four countries studied.

[Influenza]. / Influenza.

Influenza (flu) is an acute contagious viral infection characterized by inflammation of the respiratory tract that every winter affects more than 100 million people in Europe, Japan and the United States of America, also being responsible for several thousand of excess deaths (data from the United States reveal between 20,000 to 40,000 excess deaths annually). The Mixovirus influenzae is the agent that causes influenza, commonly called flu. There are 3 types of influenza virus: A, B, C, and only types A and B are perceived to be clinically relevant in humans. Due to the segmented nature of its genetic material, the influenza virus is highly mutagenic, causing frequent insertion of new antigenic strains into the community, against which the population presents no immunity. Presently, there are few options for the control of influenza and annual immunization is the most effective means to prevent disease and its complications. In Brazil, according to data collected by the VigiGripe's Project - linked to the Federal University of Sao Paulo -, circulation of the influenza virus also has a seasonal pattern, with peak activity occurring between May and September. Yearly vaccination is, therefore, best indicated on March and April. Currently, there are four medications available for the treatment of influenza viruses: amantadine and rimantadine, and two second generation pharmaceutical products, the neuraminidase inhibitors, oseltamivir and zanamivir. The latter two drugs have set the stage for a new approach to the management and control of influenza infections.

Influenza / Influenza

A influenza (gripe) é doença infecciosa aguda de origem viral que acomete o trato respiratório e a cada inverno atinge mais de 100 milhöes de pessoas na Europa, Japäo e Estados Unidos, causando anualmente a morte de cerca de 20 a 40 mil pessoas somente neste último país. O agente etiológico é o Myxovirus influenzae, ou vírus da gripe. Este subdivide-se nos tipos A, B e C, sendo que apenas os do tipo A e B apresentam relevância clínica em humanos. O vírus influenza apresenta altas taxas de mutaçäo, o que resulta freqüentemente na inserçäo de novas variantes virais na comunidade, para as quais a populaçäo näo apresenta imunidade. Säo poucas as opçöes disponíveis para o controle da influenza. Dentre essas, a vacinaçäo constitui a forma mais eficaz para o controle da doença e de suas complicaçöes. Em funçäo das mutaçöes que ocorrem naturalmente no vírus influenza, recomenda-se que a vacinaçäo seja realizada anualmente. No Brasil, segundo dados obtidos pelo Projeto VigiGripe - ligado à Universidade Federal de Säo Paulo -, verifica-se que a influenza apresenta pico de atividade entre os meses de maio e setembro. Assim, a época mais indicada para a vacinaçäo corresponde aos meses de março e abril. Para o tratamento específico da influenza estäo disponíveis quatro medicamentos antivirais: os fármacos clássicos amantadina e rimantidina e os antivirais de segunda geraçäo oseltamivir e zanamivir. Os últimos, acrescentam alternativas para o tratamento da influenza e ampliam as opçöes disponíveis para o seu controle

Impact of influenza vaccination on civilian aircrew illness and absenteeism.

BACKGROUND: Approximately 10% of the general population worldwide acquires influenza infection every year. Airline crews run a particularly high risk of contracting influenza and influenza-like viruses because they come in contact with hundreds of potentially infected individuals every day. Respiratory diseases are the most frequent cause of absenteeism among flight crews in airline companies. Several studies have shown the efficacy of influenza vaccination in the workplace of healthy, working adults leading to increased productivity and lower absenteeism. We conducted a double blind, randomized, placebo-controlled study on flight crews of an airline company in order to determine the safety and efficacy of a trivalent inactivated influenza vaccine in reducing illness and absences from work. METHODS: The 813 healthy members of a Brazilian airline company were randomly assigned to receive injections of either an influenza vaccine or a placebo, with a follow-up period of 7 mo after vaccination. Primary outcomes included influenza-like illness episodes and absenteeism from work due to such episodes. RESULTS: Demographic characteristics were similar in the two groups. No significant side-effects occurred in either group. Compared to the placebo group, individuals receiving the vaccine showed 39.5% fewer episodes of flu-like illness (p < 0.001) and 26% fewer days of work lost (p = 0.03). The vaccinated group developed 33% fewer episodes of any severe flu-like illness (p < 0.01). CONCLUSION: The data indicates that influenza vaccination is safe in airline flight crews and may produce health-related benefits including reduced absenteeism.

Hipertensão arterial no idoso: peculiaridades na fisiopatologia, no diagnóstico e no tratamento / Arterial Hypertension in the elderly: peculiarities of physiopathology, diagnostics, and treatment

A HAS em idosos está associada a um importante aumento nos eventos cardiovasculares com consequente diminuição da sobrevida e piora na qualidade de vida. Inumeros estudos demonstraram os beneficios do tratamento da HAS na população desta faixa etaria, com redução significativa dos eventos cardiovasculares e melhora na qualidade de vida. Tanto o tratamento medicamentoso como o não-farmacologico devem ser empregados, sempre considerando o individuo com suas co-morbidades e expectativas. As modificações de estilo de vida podem ter otima aderencia desde que bem orientadas, especialmente atraves de equipe multidisciplinar. O uso da terapia farmacologica combinada (duas drogas no mesmo comprimido) é uma necessidade para os idosos, melhorando a aderencia e a eficacia anti-hipertensiva e diminuindo os efeitos colaterais. Existem varios casos não contemplados nos grandes ensaios, por exemplo os idosos frageis ou os muito idosos, em que o tratamento deve ser feito com bom senso e de forma individualizada

Applicability of the CERAD neuropsychological battery to Brazilian elderly

There is a limited choice of psychometric tests for Portuguese speaking people which have been evaluated in well defined groups. A Portuguese version of CERAD neuropsychological battery was applied to a control group of healthy elderly (CG) (mean age 75.1 years/ education 7.9 years), 31 Alzheimer disease (AD) patients classified by clinical dementia rating (CDR) as CDR1 (71.4/ 9.0) and 12 AD patients CDR 2 (74.1/ 9.3). Cut-off points were: verbal fluency-11; modified Boston naming-12; Mini-mental State Examination (MMSE) -26; word list memory-13; constructional praxis-9; word recall-3, word recognition-7; praxis recall-4. There was a significant difference between CG and AD-CDR1 (p<0.0001) for all tests. There was a less significant difference for constructional praxis and no difference for Boston naming. Comparison between AD-CDR1 and AD-CDR2 showed difference only for MMSE, verbal fluency, and Boston naming. The performance of CG was similar to that of a US control sample with comparable education level. These results indicate that this adaptation may be useful for the diagnosis of mild dementia but further studies are needed to define cut-offs for illiterates/low education people

Eficacia e tolerabilidade do extrato de kava-kava WS 1490 em estados de ansiedade: estudo multicentrico brasileiro / Tolerability of kava-kava extract WS 1490 on anxiety disorders (multicentric brazilian study)

O objetivo deste estudo foi observar a eficacia e a tolerabilidade do extrato de kava-kava WS 1490(Laitan en pacientes com diagnostico de ansiedade,segundo a Escala de Hamilton modificada.Oitocentos e cinquenta pacientes foram inicialmente avaliados destes,766(90,1 por cento)fofam avaliados quanto a eficacia.Os pacientes(192 homens e 574 mulheres) apresentavam idade media de 42,8 mais ou menos13,1 anos e receberam 100mg do extrato de kava-kava WS tres vezes ao dia,por um periodo de quatro semanas.A media das somas dos escores iniciais,segundo a Escala de Ansiedade de Hamilton(HAMA),mostrou reducao de 30 no inicio para 9 ao final do tratamento(p menor 0,0001)A tolerabilidade foi considerada otima ou boa em 95,8 por cento dos casos.Este estudo mostrou que o uso isolado do extrato de kava-kava WS 1490 apresenta resultados positivos na abordagem dos estados ansiosos,reduzindo,de forma significativa,o humor ansioso,os quadros de tensao,insonias e sintomas de origem muscular(por exemplo,dor e fadiga)