Tuberculosis, AIDS and tuberculosis-AIDS co-infection in a large city.

This study aimed to analyze the incidence of tuberculosis (TB), AIDS and tuberculosis-AIDS co-infection in the municipality of Campinas, in the state of São Paulo, Brazil, in the period 2001 - 2009. A historical trend study, it uses secondary data from the Tuberculosis Surveillance Database of the University of Campinas (UNICAMP) and the São Paulo State STD-AIDS Center of Excellence and Training. It included new cases of TB, AIDS, and of tuberculosis-AIDS reported in the municipality of Campinas. A decrease in cases of TB until 2007 was observed, with an increase in 2008 and 2009. There was a general reduction in AIDS from 2007, but with an increase among men aged 60 or over, in the years 2007 to 2009. For tuberculosis-AIDS co-infection, the tendency was to reduce. The proportion of HIV tests not undertaken, among patients with tuberculosis, was high (27.5%). This scenario shows the need for integration of the databanks into the planning and control activities.

Prevalence of alcohol abuse and associated factors in a population-based study.

OBJECTIVE: To estimate the prevalence of alcohol abuse/dependence and identify associated factors among demographic, family, socioeconomic and mental health variables. METHODS: A household survey was carried out in the urban area of Campinas, southeastern Brazil, in 2003. A total of 515 subjects, aged 14 years or more were randomly selected using a stratified cluster sample. The Self-Report Questionnaire and the Alcohol Use Disorder Identification Test were used in the interview. Prevalences were calculated, and univariate and multivariate logistic analyses performed by estimating odds ratios and 95% confidence intervals. RESULTS: The estimated prevalence of alcohol abuse/dependence was 13.1% (95% CI: 8.4;19.9) in men and 4.1% (95% CI: 1.9;8.6) in women. In the final multiple logistic regression model, alcohol abuse/dependence was significantly associated with age, income, schooling, religion and illicit drug use. The adjusted odds ratios were significantly higher in following variables: income between 2,501 and 10,000 dollars (OR=10.29); income above 10,000 dollars (OR=10.20); less than 12 years of schooling (OR=13.42); no religion (OR=9.16) or religion other than Evangelical (OR=4.77); and illicit drug use during lifetime (OR=4.47). Alcohol abuse and dependence patterns were different according to age group. CONCLUSIONS: There is a significantly high prevalence of alcohol abuse/dependence in this population. The knowledge of factors associated with alcohol abuse, and differences in consumption patterns should be taken into account in the development of harm reduction strategies.

[Perception of community problems: the influence of socio-demographic and mental health factors]. / Percepção dos problemas da comunidade: influência de fatores sócio-demográficos e de saúde mental.

A cross-sectional study was designed to identify which social problems from a list of 17 were considered important and to analyze differences in perception among interviewees according to socio-demographic variables and presence of common mental disorders. A household survey was performed in Campinas, São Paulo, Brazil, with a stratified cluster sample of urban residents aged 14 years or older (N = 515) using the WHO/SUPRE-MISS interview and SRQ-20. Weighted prevalence and crude prevalence ratio with respective 95%CI were calculated. Multiple analyses were performed using Poisson regression. Drug traffic, drug abuse, unemployment, crime, and alcohol abuse were considered severe by more than 45% of the sample. Women and individuals living in medium-low income areas attributed greater severity to drug traffic, alcohol and drug abuse, child and spousal abuse, unemployment, and poverty. Females and individuals with positive SRQ-20 identified problems related to education as more severe. Differences in perception according to socioeconomic status and gender were observed, with women and low-income residents showing the greatest susceptibility.

[Factors associated with suicidal ideation in the community: a case-control study]. / Fatores associados à ideação suicida na comunidade: um estudo de caso-controle.

This paper aims to identify variables associated with suicidal ideation during the previous 12 months in the city of Campinas, São Paulo, Brazil. Using a case-control design, risk factors for suicidal ideation were investigated through analysis of independent variables related to the individual, family, and health. Some 29 cases of suicidal ideation and 166 controls were interviewed. Cases were identified through a previous cross-sectional study, and controls were randomly selected from the same population base among those with no history of suicidal ideation in the previous 12 months. Regression models were used to control for confounders and effect modifiers. According to the results, demographic variables were not associated with suicidal ideation. In the final model, the variables that remained statistically significant were depressive symptoms, emotional difficulties, lack of neighborhood support, and less frequent church attendance. Suicidal ideation was consistently associated with factors related to depressive symptoms, especially lack of energy and depressed mood.

[Tuberculosis among city jail inmates in Campinas, São Paulo, Brazil]. / Tuberculose no sistema prisional de Campinas, São Paulo, Brasil.

OBJECTIVE: To describe the incidence of tuberculosis among inmates of the municipal prison system in the city of Campinas, State of São Paulo, Brazil, from 1993 through 2000. METHODS: A retrospective study was carried out of the number of cases of tuberculosis that were notified among inmates over the study period. This involved reviewing data from a total of 4,293 inmates who were held in the four prisons that comprise Campinas' municipal prison system. Data were obtained from the tuberculosis database belonging to the Department of Social and Preventive Medicine of the School of Medical Sciences at the State University of Campinas. RESULTS: The incidence of tuberculosis peaked in 1994 (1,397.62 cases per 100,000) and was lowest in 1999 (559.04 cases per 100,000). Most cases of tuberculosis occurred in inmates in the 25 to 34 year age group (62.6%). Acquired immunodeficiency syndrome (AIDS) was the disease most commonly associated with tuberculosis (49.9%), which was most often pulmonary in type (91.9%), with positive sputum smears in 70.3% of the inmates tested. Most inmates had not received treatment before (75.4%). The treatment dropout rate reached 49%, and a cure was achieved in only 20.8% of the cases notified over the study period. CONCLUSIONS: The incidence of tuberculosis observed in this study was moderate when compared to incidence rates found in other studies of prison inmates, but this could be due to underreporting. The frequency of treatment failure noted was low, since patients who were treated under supervision showed good adherence and were cured in the majority of cases. However, the high treatment dropout rate seen in the study is alarming because it could facilitate the spread of drug resistant strains of Mycobacterium tuberculosis to the community at large. Controlling tuberculosis among prison inmates should be part of routine interventions aimed at eliminating this disease from the community and at preventing resistance to antituberculosis therapy.

Molecular epidemiology of systemic infection caused by Enterobacter cloacae in a high-risk neonatal intensive care unit.

OBJECTIVE: To investigate the molecular epidemiology of systemic nosocomial infections caused by Enterobacter cloacae. SETTING: Neonatal intensive care unit (NICU) of a tertiary-care university hospital. PATIENTS: Forty-two high-risk neonates with systemic infections caused by E. cloacae. METHODS: From 1995 to 1997, the variables associated with death in these patients were evaluated. The molecular epidemiology of the strains responsible for the systemic infections, and 14 unrelated strains, was studied using plasmid analysis and pulsed-field gel electrophoresis (PFGE). RESULTS: The overall mortality rate for infection caused by E. cloacae was 34%, whereas the crude mortality rate during the study period was 8.12% (P < .001). Gestational age (preterm neonates) and birth weight (small for gestational age) were not associated with a higher risk of death. Insertion of a venous catheter by dissection of a peripheral vein was the only invasive procedure related to death (P = .016) in this study. A molecular analysis showed that three outbreaks, each occurring in a different year, were caused by strains with distinctive DNA profiles. Only one outbreak was identified by the infection control service, in the NICU. Plasmid analysis and PFGE showed similar ability to discriminate control strains from the E. cloacae strains isolated from the neonates. CONCLUSIONS: Systemic infections caused by E. cloacae in our NICU were associated with a high mortality rate and occurred as small, unrecognized outbreaks. These results may not be generalizable because the data were from a single center.