[Evolution of the completeness and consistency of the gastroschisis registry in the Brazilian Live Birth Information System, from 2005 to 2020]. / Evolução da completude e consistência do registro de gastrosquise no Sistema de Informações sobre Nascidos Vivos no Brasil, de 2005 a 2020.

This study aimed to evaluate the evolution of the completeness and consistency of the gastroschisis registry in the Brazilian Live Birth Information System (SINASC). It is a time-series study on the completeness of the variable "occurrence of congenital anomaly" and the consistency of gastroschisis diagnosis in SINASC, in biennia from 2005 to 2020, for federative units, region, and Brazil. The consistency was estimated by the ratio between deaths from gastroschisis registered in the Brazilian Mortality Information System (SIM) and the total number of cases recorded in SINASC. Temporal trend was analyzed by joinpoint regression. In the period, 46,574,995 live births and 10,024 cases of gastroschisis were recorded. A total of 5,632 infant deaths due to gastroschisis were identified. The percentage of incompleteness decreased from 6.52% to 1.87%, with an annual percentage variation (APV) of -14.5%, and completeness reached excellence (≤ 5% of incompleteness), except in the Central-West Region. Case/death ratios above 1 were found in the North and Northeast regions and in some federative units in the Central-West, but there was a decrease, approaching the mortality found in studies in the South and Southeast regions. Its reduction was more pronounced until 2009-2010 (APV = -10.7%) and smaller later (APV = -4.4%). The quality of the gastroschisis registry reflects regional differences in the overall quality of SINASC, constituting as a marker for malformations that require complex neonatal care.

O objetivo deste estudo foi avaliar a evolução da completude e da consistência do registro de gastrosquise no Sistema de Informações sobre Nascidos Vivos (SINASC) no Brasil. Trata-se de estudo de série temporal sobre a completude da variável "ocorrência de anomalia congênita" e a consistência do diagnóstico de gastrosquise no SINASC, nos biênios entre 2005 e 2020, para Unidades da Federação, região e Brasil. A consistência foi estimada pela razão entre óbitos por gastrosquise registrados no Sistema de Informações sobre Mortalidade (SIM) e o total de casos registrados no SINASC. A tendência temporal foi analisada por regressão joinpoint. No período, havia registro de 46.574.995 nascidos vivos e 10.024 casos de gastrosquise entre eles. Identificamos 5.632 óbitos infantis por gastrosquise. O percentual de incompletude diminuiu de 6,52% para 1,87%, com variação percentual anual (VPA) de -14,5%, e a completude atingiu a excelência (≤ 5% de incompletude), exceto no Centro-oeste do país. Razão óbito/caso acima de 1 foi encontrada nas regiões Norte e Nordeste e em alguns estados do Centro-oeste, mas houve diminuição, aproximando-se da mortalidade encontrada em estudos no Sul e Sudeste. Sua redução foi mais acentuada até 2009-2010 (VPA = -10,7%) e menor posteriormente (VPA = -4,4%). A qualidade do registro de gastrosquise reflete as diferenças regionais da qualidade geral do SINASC, configurando-se uma condição marcadora para malformações que demandam atenção neonatal complexa.

El objetivo de este estudio fue evaluar la evolución de la completitud y consistencia del registro de la gastrosquisis en el Sistema de Información de los Nacidos Vivos (SINASC) en Brasil. Se trata de un estudio de serie temporal sobre la completitud de la variable "aparición de anomalía congénita" y la consistencia del diagnóstico de gastrosquisis en el SINASC, en los bienios entre 2005 y 2020, en estados, regiones y Brasil. La consistencia se estimó por la razón entre las defunciones por gastrosquisis registradas en el Sistema de Información de Mortalidad (SIM) y el total de casos inscritos en el SINASC. La tendencia temporal se analizó mediante regresión joinpoint. Durante el período, hubo 46.574.995 nacidos vivos y 10.024 casos de gastrosquisis entre ellos. Identificamos 5.632 muertes infantiles por gastrosquisis. El porcentaje de incompletitud disminuyó de 6,52% a 1,87%, con una variación porcentual anual (VPA) de -14,5%, y la completitud alcanzó la excelencia (≤ 5% de incompletitud), excepto en la región Centro-oeste del país. Se encontró una relación defunciones/caso superior a 1 en las regiones Norte y Nordeste y en algunos estados del Centro-oeste, pero hubo una disminución, acercándose a la mortalidad encontrada en estudios en el Sur y Sudeste. Su reducción fue más pronunciada hasta 2009-2010 (VPA = -10,7%) y después menor (VPA = -4,4%). La calidad del registro de gastrosquisis refleja diferencias regionales relacionadas con la calidad general del SINASC, configurando una condición manifiesta de malformaciones que demandan cuidados neonatales complejos.

Trends in prevalence of gastroschisis in Brazil from 2007 to 2020: A national population-based cross-sectional study.

BACKGROUND: Gastroschisis is a congenital abnormality of the abdominal wall which worldwide prevalence is increasing with time. Up to now, young maternal age is the main factor associated with gastroschisis. Brazil has a great proportion of adolescent mothers. OBJECTIVES: To estimate prevalence of gastroschisis in Brazil, explore the effect of very young maternal age, and analyze regional distribution and time trends. METHODS: Cross-sectional population-based study using data from official national information systems from 2007 to 2020, covering 9,831 gastroschisis cases. Low maternal age was assessed as risk factor through odds ratio. Prevalence time trends by maternal age and geographic area were analyzed using joinpoint regression. RESULTS: Overall prevalence of gastroschisis in Brazil was 2.47 per 10,000 births. From first to last biennium, there was a 23% relative increase. Last biennium prevalence was higher in the Central-west region and lower in the Northeast. Compared to mothers of 20-34 years old (YO), the odds-ratio for prevalence and 95% confidence intervals for gastroschisis were, as follows: (a) 10-14 YO-4.9 (4.3,5.5); (b) 15-19 YO-3.6 (3.5,3.8); and (c) 35-49 YO-0.3 (95% CI 0.3, 0.4). CONCLUSIONS: Prevalence of gastroschisis in Brazil relatively increased 23% from 2007 to 2020. This happened in all maternal age groups. Differences between regions may be associated to data quality. Young mothers had a higher prevalence of gastroschisis and still higher for those under 15 YO. Mother age over 34 YO was a protective factor.

Identification and characterisation of SARS-CoV-2 and Human alphaherpesvirus 1 from a productive coinfection in a fatal COVID-19 case.

BACKGROUND: During routine Coronavirus disease 2019 (COVID-19) diagnosis, an unusually high viral load was detected by reverse transcription real-time polymerase chain reaction (RT-qPCR) in a nasopharyngeal swab sample collected from a patient with respiratory and neurological symptoms who rapidly succumbed to the disease. Therefore we sought to characterise the infection. OBJECTIVES: We aimed to determine and characterise the etiological agent responsible for the poor outcome. METHODS: Classical virological methods, such as plaque assay and plaque reduction neutralisation test combined with amplicon-based sequencing, as well as a viral metagenomic approach, were performed to characterise the etiological agents of the infection. FINDINGS: Plaque assay revealed two distinct plaque phenotypes, suggesting either the presence of two severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains or a productive coinfection of two different species of virus. Amplicon-based sequencing did not support the presence of any SARS-CoV-2 genetic variants that would explain the high viral load and suggested the presence of a single SARS-CoV-2 strain. Nonetheless, the viral metagenomic analysis revealed that Coronaviridae and Herpesviridae were the predominant virus families within the sample. This finding was confirmed by a plaque reduction neutralisation test and PCR. MAIN CONCLUSIONS: We characterised a productive coinfection of SARS-CoV-2 and Herpes simplex virus 1 (HSV-1) in a patient with severe symptoms that succumbed to the disease. Although we cannot establish the causal relationship between the coinfection and the severity of the clinical case, this work serves as a warning for future studies focused on the interplay between SARS-CoV-2 and HSV-1 coinfection and COVID-19 severity.

Perfil dos casos notificados de síndrome respiratória aguda grave em um hospital do Rio de Janeiro / Profile of reported cases of severe acute respiratory syndrome in a hospital in Rio de Janeiro / Perfil de los casos notificados de síndrome respiratorio agudo severo en un hospital de Río de Janeiro

Objetivo: descrever o perfil clínico-epidemiológico e analisar a variável de desfecho óbito entre os casos notificados de Síndrome Respiratória Aguda Grave em um hospital federal do Rio de Janeiro. Método: estudo transversal descritivo, elaborado a partir de dados secundários da vigilância epidemiológica da Área de Epidemiologia do Hospital Federal dos Servidores do Estado. Resultados: os casos de síndrome respiratória aguda grave notificados pelo Hospital Federal dos Servidores do Estado apresentaram um perfil de idosos, com elevada prevalência de comorbidades. Os fatores relacionados ao óbito hospitalar foram: faixa etária 70 a 79 anos, sexo masculino, presença de dispneia, desconforto respiratório, saturação <95%, cardiopatias, doença renal, doença neurológica, pneumopatia, neoplasias, uso de suporte ventilatório invasivo. Conclusão: a vigilância epidemiológica assume um papel fundamental, não somente na notificação, investigação e encerramento dos casos, mas também na identificação das características da população acometida e dos fatores relacionados à maior gravidade da nova doença

Objective: to describe the clinical-epidemiological profile and analyze the death outcome variable among reported cases of Severe Acute Respiratory Syndrome (SARS) in a federal hospital in Rio de Janeiro. Method: a descriptive cross-sectional study, based on secondary data from the epidemiological surveillance of the Epidemiology Area of the Hospital Federal dos Servidores do Estado. Results: the Severe Acute Respiratory Syndrome notification carried out by the Hospital Federal dos Servidores do Estado presented a profile of elderly people, with a high prevalence of comorbidities. The related factors with hospital death were: age group 70 to 79 years, male gender, presence of dyspnea, respiratory distress, saturation <95%, heart disease, kidney disease, neurological disease, lung disease, neoplasms, use of invasive ventilatory support. Conclusion: epidemiological surveillance plays a fundamental role, not only in the notification, investigation and closure of cases, but also in the identification of the characteristics of the affected population and the related factors with the greater severity of the new disease

Objetivo: describir el perfil clínico-epidemiológico y analizar la variable resultado muerte entre los casos notificados de Síndrome Respiratorio Agudo Severo en un hospital federal de Río de Janeiro. Método: estudio descriptivo transversal, basado en datos secundarios de la vigilancia epidemiológica del Área de Epidemiología del Hospital Federal dos Servidores do Estado. Resultados: la notificación del Síndrome Respiratorio Agudo Severo realizada por el Hospital Federal dos Servidores do Estado presentó un perfil de ancianos, con alta prevalencia de comorbilidades. Los factores relacionados a la muerte hospitalaria fueron: grupo de edad de 70 a 79 años, sexo masculino, presencia de disnea, dificultad respiratoria, saturación <95%, enfermedad cardíaca, enfermedad renal, enfermedad neurológica, enfermedad pulmonar, neoplasias, uso de soporte ventilatorio invasivo. Conclusión: la vigilancia epidemiológica juega un papel fundamental, no solo en la notificación, investigación y cierre de casos, sino también en la identificación de las características de la población afectada y los factores relacionados a la mayor gravedad de la nueva enfermedad

Identification and characterisation of SARS-CoV-2 and Human alphaherpesvirus 1 from a productive coinfection in a fatal COVID-19 case

BACKGROUND During routine Coronavirus disease 2019 (COVID-19) diagnosis, an unusually high viral load was detected by reverse transcription real-time polymerase chain reaction (RT-qPCR) in a nasopharyngeal swab sample collected from a patient with respiratory and neurological symptoms who rapidly succumbed to the disease. Therefore we sought to characterise the infection. OBJECTIVES We aimed to determine and characterise the etiological agent responsible for the poor outcome. METHODS Classical virological methods, such as plaque assay and plaque reduction neutralisation test combined with amplicon-based sequencing, as well as a viral metagenomic approach, were performed to characterise the etiological agents of the infection. FINDINGS Plaque assay revealed two distinct plaque phenotypes, suggesting either the presence of two severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains or a productive coinfection of two different species of virus. Amplicon-based sequencing did not support the presence of any SARS-CoV-2 genetic variants that would explain the high viral load and suggested the presence of a single SARS-CoV-2 strain. Nonetheless, the viral metagenomic analysis revealed that Coronaviridae and Herpesviridae were the predominant virus families within the sample. This finding was confirmed by a plaque reduction neutralisation test and PCR. MAIN CONCLUSIONS We characterised a productive coinfection of SARS-CoV-2 and Herpes simplex virus 1 (HSV-1) in a patient with severe symptoms that succumbed to the disease. Although we cannot establish the causal relationship between the coinfection and the severity of the clinical case, this work serves as a warning for future studies focused on the interplay between SARS-CoV-2 and HSV-1 coinfection and COVID-19 severity.

COVID-19: estudo seccional de casos suspeitos internados em um hospital federal do Rio de Janeiro e fatores associados ao óbito hospitalar / COVID-19: estudio seccional de casos sospechosos ingresados a un hospital federal de Rio de Janeiro, Brasil, y factores asociados a óbito hospitalario / COVID-19: a cross-sectional study of suspected cases admitted to a federal hospital in Rio de Janeiro, Brazil, and factors associated with hospital death

Objetivo: Descrever o perfil clínico-epidemiológico dos casos suspeitos de COVID-19 internados em hospital federal do Rio de Janeiro, RJ, Brasil, e identificar fatores associados ao óbito. Métodos: Estudo seccional, utilizando dados da vigilância epidemiológica local até a Semana Epidemiológica 27 de 2020. Empregou-se regressão logística. Resultados: Foram incluídos 376 casos internados suspeitos de COVID-19, dos quais 52,9% eram mulheres, 57,4% tinham 50 anos ou mais de idade e 80,1% exibiam comorbidades. Foram confirmados para COVID-19 195 casos (51,9%), cuja letalidade (37,9%) foi maior, comparada à dos descartados (24,2%). Na análise ajustada, associaram-se ao óbito, nos casos confirmados, ter 50 a 69 (OR=11,65 - IC95% 1,69;80,33) e 70 ou mais anos (OR=8,43 - IC95% 1,22;58,14), apresentar neoplasia (OR=4,34 - IC95% 1,28;14,76) e usar suporte ventilatório invasivo (OR=70,20 - IC95% 19,09;258,19). Conclusão: Houve elevada prevalência de comorbidades e letalidade; os principais fatores associados ao óbito foram idade, presença de neoplasia e suporte ventilatório invasivo.

Objetivo: Describir el perfil clínico-epidemiológico de casos sospechosos de COVID-19 ingresados en hospital federal de Río de Janeiro, RJ, Brasil, y factores asociados al óbito. Métodos: Estudio transversal utilizando datos de la vigilancia epidemiológica local de casos sospechosos hospitalizados hasta la Semana Epidemiológica 27 de 2020 y regresión logística. Resultados: Se incluyeron 376 casos, de los cuales 52,9% era de mujeres, 57,4% tenía 50 años o más, 80,1% tenía comorbilidades. Se confirmó para COVID-19 un 51,9% . Los casos confirmados tuvieron una mayor letalidad (37,9%) que los descartados (24,2%). La mortalidad ajustada en los confirmados fue mayor en los grupos de edad de 50 a 69 años (OR=11,65 - IC95% 1,69; 80,33), 70 años o más (OR=8,43 - IC95% 1,22;58,14), con neoplasia (OR=4,34 - IC95% 1,28;14,76) y uso de soporte ventilatorio invasivo (OR=70,20 - IC95% 19,09;258,19). Conclusión: La mayor mortalidad se asoció con personas de edad avanzada, con neoplasias y uso de soporte ventilatorio invasivo.

Objective: To describe the clinical and epidemiological profile of suspected COVID-19 cases admitted to a federal hospital in Rio de Janeiro, RJ, Brazil, and to identify factors associated with death. Methods:This was a cross-sectional study using local epidemiological surveillance data as at epidemiological week 27 of 2020 and logistic regression. Results: 376 hospitalized suspected COVID-19 cases were included; 52.9% were female, 57.4% were 50 years old or over and 80.1% had comorbidities. 195 (51.9%) COVID-19 cases were confirmed and their lethality was higher (37.9%) than among discarded cases (24.2%). In the adjusted analysis, death among confirmed cases was associated with being in the 50-69 age group (OR=11.65 - 95%CI 1.69;80.33), being aged 70 or over (OR=8.43 - 95%CI 1.22;58.14), presence of neoplasms (OR=4.34 - 95%CI 1.28;14.76) and use of invasive ventilatory support (OR=70.20 - 95%CI 19.09;258.19). Conclusion: High prevalence of comorbidities and lethality was found; the main factors associated with death were being older, neoplasms and invasive ventilatory support.

COVID-19: a cross-sectional study of suspected cases admitted to a federal hospital in Rio de Janeiro, Brazil, and factors associated with hospital death. / COVID-19: estudo seccional de casos suspeitos internados em um hospital federal do Rio de Janeiro e fatores associados ao óbito hospitalar.

OBJECTIVE: To describe the clinical and epidemiological profile of suspected COVID-19 cases admitted to a federal hospital in Rio de Janeiro, RJ, Brazil, and to identify factors associated with death. METHODS: This was a cross-sectional study using local epidemiological surveillance data as at epidemiological week 27 of 2020 and logistic regression. RESULTS: 376 hospitalized suspected COVID-19 cases were included; 52.9% were female, 57.4% were 50 years old or over and 80.1% had comorbidities. 195 (51.9%) COVID-19 cases were confirmed and their lethality was higher (37.9%) than among discarded cases (24.2%). In the adjusted analysis, death among confirmed cases was associated with being in the 50-69 age group (OR=11.65 - 95%CI 1.69;80.33), being aged 70 or over (OR=8.43 - 95%CI 1.22;58.14), presence of neoplasms (OR=4.34 - 95%CI 1.28;14.76) and use of invasive ventilatory support (OR=70.20 - 95%CI 19.09;258.19). CONCLUSION: High prevalence of comorbidities and lethality was found; the main factors associated with death were being older, neoplasms and invasive ventilatory support.

[Microcephaly and central nervous system findings associated with congenital Zika virus and other infectious etiologies in the state of Rio de Janeiro: crosssectional study, 2015 a 2017Microcefalia y alteraciones del sistema nervioso central relacionadas con la infección congénita por el virus del Zika y otras etiologías infecciosas en el Estado de Río de Janeiro: estudio transversal, 2015-2017]. / Microcefalia e alterações do sistema nervoso central relacionadas à infecção congênita pelo vírus Zika e outras etiologias infecciosas no estado do Rio de Janeiro: estudo transversal, 2015 a 2017.

OBJECTIVE: To describe the clinical and epidemiological profile of cases with confirmed microcephaly or central nervous system (CNS) findings associated with congenital Zika virus infection and other infectious etiologies in the state of Rio de Janeiro, Brazil, from November 2015 to July 2017. METHOD: A cross-sectional study was performed with 298 cases (as defined by the Ministry of Health) communicated to the Rio de Janeiro State Department of Health in the study period. Demographic, epidemiological, clinical, radiological, and laboratory variables were assessed. Descriptive bivariate and multivariable logistic regression analysis was used to determine the association between specific factors and death outcome. RESULTS: The median age of mothers was 24 years; 30.9% reported fever and 64.8% reported a rash during pregnancy. The median head circumference at birth was 29 cm, and median birth weight was 2 635 g. An etiological diagnosis of congenital Zika was made in 46.0%, whereas 13.8% were diagnosed with syphilis, toxoplasmosis, rubella, cytomegalovirus, and herpes simplex infections (STORCH), with predominance of syphilis, and 40.3% had an unspecified infectious agent. CNS findings other than microcephaly were observed in 88.3%, especially intracranial calcifications, ventriculomegaly, and brain atrophy. Overall lethality was 7.0% - 19.0% in laboratory confirmed Zika cases and 22.2% in toxoplasmosis cases. Multivariable analysis revealed birth weight as the main predictor of death. CONCLUSIONS: Despite the Zika epidemic, 13.8% of the studied cases were diagnosed with STORCH. The lethality and high frequency of neurological findings beyond microcephaly reflect severe infection, with impact on families and health care system.

OBJETIVO: Describir el perfil clínico-epidemiológico de los casos confirmados de microcefalia y de alteraciones del sistema nervioso central (SNC) relacionados con la infección congénita por el virus del Zika y otras etiologías infecciosas en el Estado de Río de Janeiro en el período comprendido entre noviembre del 2015 y julio del 2017. MÉTODOS: Se realizó un estudio transversal de 298 casos (según la definición del Ministerio de Salud) notificados a la Secretaría de Estado de Salud de Río de Janeiro en el período objeto de estudio. Se analizaron variables demográficas, epidemiológicas, clínicas, radiológicas y de laboratorio, con un análisis estadístico descriptivo bivariado y de regresión logística múltiple para estudio de los factores relacionados con la defunción. RESULTADOS: La edad mediana de las madres fue de 24 años; un 30,9% informó fiebre y un 64,8%, exantema durante la gestación. La mediana del perímetro cefálico al nacer fue de 29 cm y la del peso, de 2635 g. El diagnóstico etiológico fue de infección congénita por el virus del Zika en un 46,0%; sífilis, toxoplasmosis, rubéola, infección por citomegalovirus e infección por el virus del herpes simple (STORCH) en un 13,8%, con predominio de sífilis; e infección por un agente infeccioso no definido en un 40,3%. Se describieron alteraciones del SNC diferentes de microcefalia en un 88,3%, con predominio de calcificaciones cerebrales, ventriculomegalia y atrofia cerebral. La letalidad total alcanzó 7,0%; se confirmaron en el laboratorio 19,0% de los casos de infección por el virus del Zika y 22,2% de los casos de toxoplasmosis. En el análisis de regresión logística múltiple, el peso al nacer fue el principal pronóstico de defunción. CONCLUSIONES: A pesar de la epidemia de la infección por el virus del Zika, 13,8% de los casos fueron causados por STORCH. La letalidad y la elevada presencia de malformaciones neurológicas, además de microcefalia, muestran la gravedad de la infección y sus repercusiones para las familias y para el sistema de salud.

Microcefalia e alterações do sistema nervoso central relacionadas à infecção congênita pelo vírus Zika e outras etiologias infecciosas no estado do Rio de Janeiro: estudo transversal, 2015 a 2017

[RESUMO]. Objetivo. Descrever o perfil clínico-epidemiológico dos casos confirmados de microcefalia e/ou alterações do sistema nervoso central (SNC) relacionadas a infecção congênita pelo vírus Zika e outras etiologias infecciosas no estado do Rio de Janeiro no período de novembro de 2015 a julho de 2017. Métodos. Realizou-se um estudo transversal de 298 casos (conforme definição do Ministério da Saúde) notificados à Secretaria de Estado de Saúde do Rio de Janeiro no período estudado. Analisaram-se variáveis demográficas, epidemiológicas, clínicas, radiológicas e laboratoriais, com análise estatística descritiva bivariada e múltipla por regressão logística para estudo de fatores associados ao óbito. Resultados. A idade mediana das mães foi 24 anos; 30,9% relataram febre, e 64,8%, exantema à gestação. A mediana do perímetro cefálico ao nascer foi 29 cm e a do peso foi 2 635 g. O diagnóstico etiológico foi de Zika congênita em 46,0%; de sífilis, toxoplasmose, rubéola, citomegalovírus e vírus herpes simplex (STORCH) em 13,8%, com predomínio da sífilis; e de agente infeccioso não definido em 40,3%. Alterações do SNC diferentes de microcefalia foram descritas em 88,3%, predominando calcificações cerebrais, ventriculomegalia e atrofia cerebral. A letalidade total foi 7,0%, sendo 19,0% nos casos de Zika confirmada laboratorialmente e 22,2% nos de toxoplasmose. Na análise múltipla, o peso ao nascer foi o principal preditor de óbito. Conclusões. Apesar da epidemia de Zika, 13,8% dos casos foram por STORCH. A letalidade e a elevada ocorrência de malformações neurológicas além da microcefalia mostram a gravidade da infecção, com impacto nas famílias e no sistema de saúde.

[ABSTRACT]. Objective. To describe the clinical and epidemiological profile of cases with confirmed microcephaly or central nervous system (CNS) findings associated with congenital Zika virus infection and other infectious etiologies in the state of Rio de Janeiro, Brazil, from November 2015 to July 2017. Method. A cross-sectional study was performed with 298 cases (as defined by the Ministry of Health) communicated to the Rio de Janeiro State Department of Health in the study period. Demographic, epidemiological, clinical, radiological, and laboratory variables were assessed. Descriptive bivariate and multivariable logistic regression analysis was used to determine the association between specific factors and death outcome. Results. The median age of mothers was 24 years; 30.9% reported fever and 64.8% reported a rash during pregnancy. The median head circumference at birth was 29 cm, and median birth weight was 2 635 g. An etiological diagnosis of congenital Zika was made in 46.0%, whereas 13.8% were diagnosed with syphilis, toxoplasmosis, rubella, cytomegalovirus, and herpes simplex infections (STORCH), with predominance of syphilis, and 40.3% had an unspecified infectious agent. CNS findings other than microcephaly were observed in 88.3%, especially intracranial calcifications, ventriculomegaly, and brain atrophy. Overall lethality was 7.0% — 19.0% in laboratory confirmed Zika cases and 22.2% in toxoplasmosis cases. Multivariable analysis revealed birth weight as the main predictor of death. Conclusions. Despite the Zika epidemic, 13.8% of the studied cases were diagnosed with STORCH. The lethality and high frequency of neurological findings beyond microcephaly reflect severe infection, with impact on families and health care system.

[RESUMEN]. Objetivo. Describir el perfil clínico-epidemiológico de los casos confirmados de microcefalia y de alteraciones del sistema nervioso central (SNC) relacionados con la infección congénita por el virus del Zika y otras etiologías infecciosas en el Estado de Río de Janeiro en el período comprendido entre noviembre del 2015 y julio del 2017. Métodos. Se realizó un estudio transversal de 298 casos (según la definición del Ministerio de Salud) notificados a la Secretaría de Estado de Salud de Río de Janeiro en el período objeto de estudio. Se analizaron variables demográficas, epidemiológicas, clínicas, radiológicas y de laboratorio, con un análisis estadístico descriptivo bivariado y de regresión logística múltiple para estudio de los factores relacionados con la defunción. Resultados. La edad mediana de las madres fue de 24 años; un 30,9% informó fiebre y un 64,8%, exantema durante la gestación. La mediana del perímetro cefálico al nacer fue de 29 cm y la del peso, de 2635 g. El diagnóstico etiológico fue de infección congénita por el virus del Zika en un 46,0%; sífilis, toxoplasmosis, rubéola, infección por citomegalovirus e infección por el virus del herpes simple (STORCH) en un 13,8%, con predominio de sífilis; e infección por un agente infeccioso no definido en un 40,3%. Se describieron alteraciones del SNC diferentes de microcefalia en un 88,3%, con predominio de calcificaciones cerebrales, ventriculomegalia y atrofia cerebral. La letalidad total alcanzó 7,0%; se confirmaron en el laboratorio 19,0% de los casos de infección por el virus del Zika y 22,2% de los casos de toxoplasmosis. En el análisis de regresión logística múltiple, el peso al nacer fue el principal pronóstico de defunción. Conclusiones. A pesar de la epidemia de la infección por el virus del Zika, 13,8% de los casos fueron causados por STORCH. La letalidad y la elevada presencia de malformaciones neurológicas, además de microcefalia, muestran la gravedad de la infección y sus repercusiones para las familias y para el sistema de salud.

Yellow fever: profile of cases and factors associated with death in a hospital in the State of Rio de Janeiro, 2017-2018.

OBJECTIVE: Describe the clinical and epidemiological profile of confirmed cases of yellow fever whose patients were hospitalized in a general hospital for infectious diseases in the State of Rio de Janeiro, Brazil, from March 11, 2017 to June 15, 2018, during a recent outbreak and factors associated with death. METHODS: This is a retrospective observational study with analysis of secondary databases of local epidemiological surveillance system, and complementary data collection from epidemiological investigation records and clinical records. Study variables included demographic, epidemiological, clinical, and laboratory data. A descriptive statistical analysis and a bivariate and multivariate analysis by logistic regression were performed to analyze factors associated with death. RESULTS: Fifty-two patients diagnosed with yellow fever were hospitalized, 86.5% male patients, median age 49.5 years, 40.4% rural workers. The most frequent signs and symptoms were fever (90.4%), jaundice (86.5%), nausea and/or vomiting (69.2%), changes in renal excretion (53.8%), bleeding (50%), and abdominal pain (48.1%), with comorbidity in 38.5% of all cases. The lethality rate was 40.4%. Factors significantly associated with a higher chance of death in the bivariate analysis were: bleeding, changes in renal excretion, and maximum values of direct bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine. In the multivariate analysis by logistic regression, only changes in renal excretion and ALT remained significant predictors of higher chance of death. A threshold effect was also observed for AST. The cutoff points identified as high risk for death were ALT > 4,000 U/L and AST > 6,000 U/L. CONCLUSIONS: This study contributed to the knowledge on the profile of confirmed cases of high severity yellow fever. The main factors associated with death were changes in renal excretion and elevated serum transaminases, especially ALT. High lethality emphasizes the need for early diagnosis and treatment, and the importance of increasing vaccination coverage.

Fatores associados ao óbito dos casos graves de influenza A(H1N1)pdm09 / Factors associated with death of severe cases of influenza A(H1N1)pdm09

Resumo Introdução A primeira pandemia de influenza do século XXI ocorreu em 2009, causada pelo novo subtipo de vírus da gripe, o vírus influenza A(H1N1)pdm09. Objetivo Analisar os fatores associados ao óbito por Síndrome Respiratória Aguda Grave (SRAG) por influenza A(H1N1)pdm09 em residentes do município do Rio de Janeiro. Método Análise de dados secundários, incluindo 1.191 casos confirmados para influenza A(H1N1) com critério clínico para SRAG, residentes no município do Rio de Janeiro, em 2009. Análise estatística descritiva e regressão logística para estudo dos fatores associados ao óbito. Resultados 60,3% ocorreram em mulheres, sendo 185 gestantes; 48,1% em menores de 20 anos; 35,7% tinham comorbidades; 91,4% foram hospitalizados; 7,4% foram a óbito. Observou-se maior chance de óbito associada à baixa escolaridade, à presença de comorbidade, ao padrão radiológico de infiltrado intersticial, consolidação ou misto, à confirmação laboratorial e ao estado vacinal contra gripe ignorado. Conclusão Indivíduos com baixa escolaridade, com pelo menos uma comorbidade e com comprometimento pulmonar com um padrão radiológico com infiltrado intersticial, consolidação ou misto tiveram maior chance de evolução a óbito. O melhor conhecimento desse perfil permite um planejamento mais eficiente da assistência à saúde dos pacientes.

Abstract Introduction the first influenza pandemic of the 21st century occurred in 2009, caused by the new subtype of influenza virus, influenza A (H1N1) pdm09. Objective to analyze the factors associated with death due to Severe Acute Respiratory Infection (SARI) caused by influenza A (H1N1) pdm09 in residents of the city of Rio de Janeiro. Method Analysis of secondary data, including 1,191 confirmed cases of influenza A (H1N1) pdm09 with clinical criteria for SARI, residents of the city of Rio de Janeiro, in 2009. Descriptive statistical analysis and logistic regression for the study of factors associated with death. Results 60.3% occurred in women, with 185 pregnant women; 48.1% in children under 20 years old; 35.7% had comorbidities; 91.4% were hospitalized, and 7.4% died. There was a higher chance of death associated with low educational level, presence of comorbidity, radiological pattern of interstitial infiltrate, consolidation or mixed; laboratory confirmation; vaccination status ignored. Conclusion individuals with low educational level who had at least one comorbidity and had pulmonary involvement with a radiological pattern with interstitial infiltrate, consolidation or mixed had a higher chance of dying. Knowledge of this profile allows for more efficient planning of health care.

Yellow fever: profile of cases and factors associated with death in a hospital in the State of Rio de Janeiro, 2017-2018 / Febre amarela: perfil dos casos e fatores associados ao óbito em hospital referência no estado do Rio de Janeiro, 2017-2018

ABSTRACT OBJECTIVE Describe the clinical and epidemiological profile of confirmed cases of yellow fever whose patients were hospitalized in a general hospital for infectious diseases in the State of Rio de Janeiro, Brazil, from March 11, 2017 to June 15, 2018, during a recent outbreak and factors associated with death. METHODS This is a retrospective observational study with analysis of secondary databases of local epidemiological surveillance system, and complementary data collection from epidemiological investigation records and clinical records. Study variables included demographic, epidemiological, clinical, and laboratory data. A descriptive statistical analysis and a bivariate and multivariate analysis by logistic regression were performed to analyze factors associated with death. RESULTS Fifty-two patients diagnosed with yellow fever were hospitalized, 86.5% male patients, median age 49.5 years, 40.4% rural workers. The most frequent signs and symptoms were fever (90.4%), jaundice (86.5%), nausea and/or vomiting (69.2%), changes in renal excretion (53.8%), bleeding (50%), and abdominal pain (48.1%), with comorbidity in 38.5% of all cases. The lethality rate was 40.4%. Factors significantly associated with a higher chance of death in the bivariate analysis were: bleeding, changes in renal excretion, and maximum values of direct bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine. In the multivariate analysis by logistic regression, only changes in renal excretion and ALT remained significant predictors of higher chance of death. A threshold effect was also observed for AST. The cutoff points identified as high risk for death were ALT > 4,000 U/L and AST > 6,000 U/L. CONCLUSIONS This study contributed to the knowledge on the profile of confirmed cases of high severity yellow fever. The main factors associated with death were changes in renal excretion and elevated serum transaminases, especially ALT. High lethality emphasizes the need for early diagnosis and treatment, and the importance of increasing vaccination coverage.

RESUMO OBJETIVO Descrever o perfil clínico-epidemiológico dos casos confirmados de febre amarela internados em hospital geral de referência para doenças infecciosas no estado do Rio de Janeiro, Brasil, de 11 de março de 2017 a 15 de junho de 2018, durante recente surto e fatores associados ao óbito. MÉTODOS Estudo observacional retrospectivo, com análise de bases de dados secundários da vigilância epidemiológica local e coleta complementar de dados nas fichas de investigação epidemiológica e prontuários clínicos. As variáveis analisadas incluíram dados demográficos, epidemiológicos, clínicos e laboratoriais. Foi conduzida análise estatística descritiva bivariada e múltipla por regressão logística para estudo de fatores associados ao óbito. RESULTADOS Foram internados 52 casos confirmados, 86,5% deles homens, com mediana de idade de 49,5 anos e 40,4% trabalhadores rurais. Os sinais e sintomas mais frequentes foram: febre (90,4%), icterícia (86,5%), náuseas e/ou vômitos (69,2%), alterações de excreção renal (53,8%), hemorragias (50%) e dor abdominal (48,1%), com comorbidade em 38,5% dos casos. A letalidade foi de 40,4%. Os fatores associados significativamente à maior chance de óbito na análise bivariada foram: hemorragia, alterações de excreção renal e valores máximos de bilirrubina direta, aspartato aminotransferase (AST), alanina aminotransferase (ALT), ureia e creatinina. Na análise múltipla por regressão logística, apenas alterações de excreção renal e ALT permaneceram como preditores significativos de maior chance de óbito. Observou-se ainda efeito limítrofe para AST. Os pontos de corte identificados como de alto risco para óbito foram ALT > 4.000 U/L e AST > 6.000 U/L. CONCLUSÕES O estudo contribuiu para o conhecimento do perfil de casos confirmados de febre amarela com gravidade alta. Os principais fatores associados ao óbito foram a alteração da excreção renal e a elevação sérica de transaminases, sobretudo a ALT. A letalidade elevada reforça a necessidade de diagnóstico e tratamento precoces, e a importância do incremento da cobertura vacinal.

Análise espacial de casos de tuberculose e associação com fatores socioeconômicos: uma experiência no município do Rio de Janeiro / Spatial analysis of tuberculosis cases and association with socioeconomic factors: an experience in the city of Rio de Janeiro

Resumo Introdução A tuberculose é uma doença endêmica em diversos países e sua ocorrência tem sido relacionada a situações de pior condição socioeconômica. Objetivo Analisar a distribuição espacial da tuberculose no município do Rio de Janeiro em 2006 e a associação entre ocorrência da doença e indicadores socioeconômicos. Método O setor censitário de residência do paciente foi georreferenciado a partir do endereço registrado no SINAN; intensidade de casos estimada a partir do estimador de Kernel. A associação entre variáveis socioeconômicas e existência de pelo menos um caso de tuberculose nos setores censitários foi avaliada por regressão logística. Resultados A base de dados final tinha 3.089 novos casos não institucionalizados. Identificou-se grande concentração de casos na Zona Norte e em pontos da Zona Sul. Na Zona Oeste, visualizou-se uma faixa de pontos desde Magalhães Bastos até Santa Cruz e Sepetiba. A intensidade de casos foi maior nas áreas mais carentes. No modelo final, permaneceram: percentual de domicílios particulares permanentes cuja pessoa responsável recebia 3 a 5 salários mínimos e o percentual de domicílios alugados. Conclusão A análise espacial identificou áreas de maior concentração de casos coincidente com áreas mais carentes. A má qualidade do registro dos endereços foi a principal limitação.

Abstract Background Tuberculosis is an endemic disease in several countries, and its occurrence is related to situations of worse socioeconomic status. Objective To analyze spatial distribution of tuberculosis in the city of Rio de Janeiro in 2006 and the association between occurrence of the disease and the socioeconomic indicators. Method Patient's census tract of residence was georeferenced from the address registered in SINAN. Intensity of cases was estimated using the Kernel estimator (KDE) and association between the socioeconomic variables and existence of at least one case of tuberculosis in the census tracts was evaluated through logistic regression. Results The final database presented 3089 new non-institutionalized cases of tuberculosis. High concentration of cases was identified along the north district, with some points in the south district of the city. Along the west district, a range of points was observed from Magalhães Bastos to Santa Cruz and Sepetiba. Intensity of cases was higher in the most deprived areas. The following variables remained in the final model: percentage of permanent private households whose responsible person had a monthly income of 3-5 minimum wages and percentage of rented households. Conclusion Spatial analysis identified areas of high concentration of cases of tuberculosis coinciding with the most deprived areas. The poor quality of address registration was the main limitation of this study.

Vigilância das síndromes neurológicas notificadas em um hospital federal em um contexto de epidemia de Zika, chikungunya e dengue / Surveillance of neurological syndromes reported at a federal hospital in a context of Zika, chikungunya and dengue epidemics / Vigilancia de los síndromes neurológicos notificados en um hospital federal en un contexto de epidemia de Zika, chikungunya y dengue

Justificativa e Objetivos: A ocorrência de manifestações neurológicas no contexto da circulação dos vírus da dengue (DENV), Zika (ZIKV) e chikungunya (CHIKV) no Brasil é um desafio para a vigilância epidemiológica. Este estudo descreve o perfil clínico-epidemiológico dos pacientes notificados em um hospital federal com síndromes neurológicas potencialmente associadas a esses vírus em 2015 e 2016. Métodos: Estudo observacional, com análise de bases secundárias e coleta de dados em prontuários e fichas de investigação epidemiológica. Foram incluídos casos notificados no período supracitado, que atendessem aos critérios: a) síndrome neurológica de origem indeterminada e registro de infecção viral prévia até 60 dias antes do quadro neurológico, confirmados (ou não) laboratorialmente; b) síndrome neurológica sem registro de infecção viral prévia até 60 dias antes do quadro neurológico, com confirmação laboratorial para DENV, CHIKV e ZIKV em líquido cefalorraquidiano, soro ou urina. Variáveis analisadas: sexo, idade, raça/cor, escolaridade, município de residência, sinais e sintomas, diagnóstico sindrômico e etiológico do quadro neurológico, local/tempo de internação e evolução. Resultados: 72 casos notificados: 61,1% homens, idade mediana de 37 anos, quadro neurológico com síndrome de Guillain-Barré (SGB) (34,7%) e meningoencefalite (31,9%). Foram classificados como associados a arboviroses 39 casos (54,1%), dos quais 25 por critério clínico-epidemiológico e 14 pelo critério laboratorial (3 ZIKV, 6 CHIKV, 4 DENV, 1 DENV+CHIKV). Nos laboratorialmente confirmados o percentual de meningoencefalite (57,1%) ultrapassou SGB (35,7%). Conclusão: O diagnóstico diferencial entre as arboviroses nesse contexto é um desafio para a vigilância epidemiológica, destacando-se o predomínio da SGB e das meningoencefalites.(AU)

Background and Objectives: The occurrence of neurological manifestations in the context of the circulation of dengue virus (DENV), Zika (ZIKV) and chikungunya (CHIKV) in Brazil is a challenge for epidemiological surveillance. This study aims to describe the clinical-epidemiological profile of patients reported in a federal hospital with neurological syndromes potentially associated with these etiologies, in 2015 and 2016. Methods: Observational study, with analysis of secondary bases and data collection in medical records and epidemiological surveillance forms. We included cases reported in 2015 and 2016, meeting the criteria: a) neurological syndrome of undetermined origin and registry of previous viral infection up to 60 days before neurological symptoms, laboratory confirmed or not; b) neurological syndrome without prior viral infection up to 60 days before neurological symptoms, with laboratory confirmation for DENV, CHIKV and ZIKV in CSF, serum or urine. Variables analyzed: sex, age, race/color, scholarity level, municipality of residence, signs and symptoms, syndromic and etiological diagnosis of the neurological symptoms, place/ length of hospitalization and evolution. Results: 72 cases reported: 61.1% men, median age 37 years, neurological diagnosis of Guillain-Barré syndrome (GBS) 34.7% and meningoencephalitis 31.9%. Thirty-nine cases (54.1%) were classified as associated with arboviruses, 14 of them by laboratory criteria (3 ZIKV, 6 CHIKV, 4 DENV, 1 DENV + CHIKV) and 25 by clinical-epidemiological criteria. In the laboratory confirmed the percentage of meningoencephalitis (57.1%) exceeded SGB (35.7%). Conclusion: The differential diagnosis among arboviruses in this context is a challenge for epidemiological surveillance, highlighting the predominance of GBS and meningoencephalitis.(AU)

Justificación y objetivos: : La aparición de manifestaciones neurológicas en el contexto de la circulación de los virus del dengue (DENV), Zika (ZIKV) y chikungunya (CHIKV) en Brasil es un desafío para la vigilancia epidemiológica. Objetivo es describir el perfil clínico-epidemiológico de los pacientes notificados en un hospital federal con síndromes neurológicos potencialmente asociados al arbovirus en 2015 y 2016. Métodos: Estudio observacional, con análisis de bases secundarias y recolección de datos en prontuarios y fichas de investigación epidemiológica. Incluidos casos notificados en 2015 y 2016, que cumplan los criterios: a) síndrome neurológico de origen indeterminado y registro de infección viral previa hasta 60 días antes del cuadro neurológico, confirmados de laboratorio o no; b) síndrome neurológico sin registro de infección viral previa hasta 60 días antes del cuadro neurológico, con confirmación de laboratorio en líquido, suero u orina. En el presente estudio se analizaron los resultados obtenidos en el análisis de los resultados obtenidos en el estudio. Resultados: 72 casos notificados: 61,1% hombres, edad mediana 37 años, cuadro neurológico con síndrome de Guillain-Barré (SGB) 34,7% y meningoencefalitis 31,9%. Se han clasificado como asociados a arbovirosis 39 casos (54,1%), de los cuales 14 por el criterio de laboratorio (3 ZIKV, 6 CHIKV, 4 DENV, 1 DENV + CHIKV) y 25 por criterio clínico-epidemiológico. En los laboratorios confirmados el porcentaje de meningoencefalitis (57,1%) superó a SGB (35,7%). Conclusiones: El diagnóstico diferencial entre las arbovirosis es un desafío para vigilancia epidemiológica, destacándose el predominio de la SGB y de las meningoencefalitis.(AU)

Three decades of hospital epidemiology and the challenge of integrating Health Surveillance: reflections from a case study. / Três décadas de epidemiologia hospitalar e o desafio da integração da Vigilância em Saúde: reflexões a partir de um caso.

This study proposes a reflection on the uses and future prospects of hospital-based health surveillance based on the account of a pioneering experience in hospital epidemiology, the epidemiology service at the Hospital Federal dos Servidores do Estado - HFSE, which served as the basis for the creation of epidemiologic surveillance units in municipal and state hospitals in Rio de Janeiro, Brazil. The epidemiology service has combined epidemiological surveillance, continuing education, in-service training, research, and health service evaluation since 1986. The service is part of the national epidemiological surveillance network and was responsible for the notification of 55,747 cases between 1986 and 2016, most of which were the result of active search. The integration of various levels of health surveillance and health care makes classical control activities more agile and provides instruments for measuring. The important role played by the service in human resources training is evident in the training of 1,835 medical interns and 78 residents up to 2016. In addition, this experience has served as the basis for the implantation of several other hospital epidemiological surveillance units. Current challenges include the promotion of effective communication and coordination among the other health surveillance committees.

Resumo Este estudo propõe uma reflexão sobre os usos e as perspectivas da vigilância em saúde hospitalar a partir do relato de uma experiência pioneira em epidemiologia hospitalar, o Serviço de Epidemiologia/HFSE, que serviu de base para a criação dos núcleos de vigilância epidemiológica (VE) dos hospitais municipais e estaduais do Rio de Janeiro. O serviço integra ações de VE, educação continuada, capacitação, treinamento em serviço, pesquisa e avaliação de serviços desde 1986. Participa ativamente da rede nacional de VE, tendo notificado 55.747 casos de 1986 a 2016, a maioria por busca ativa. A integração dos vários níveis da vigilância e assistência agiliza as atividades clássicas de controle das doenças de notificação compulsória e fornece instrumentos de avaliação da qualidade. O importante papel na capacitação e formação de recursos humanos é evidenciado através do treinamento de 1.835 internos de medicina e 78 residentes até 2016; e pelo fato de que esta experiência tem servido de base para a implantação de diversos outros núcleos hospitalares. Entre os desafios que se impõem atualmente está a articulação com as demais comissões que compõem o Núcleo de Vigilância Hospitalar e o Núcleo de Segurança do Paciente.

Três décadas de epidemiologia hospitalar e o desafio da integração da Vigilância em Saúde: reflexões a partir de um caso / Three decades of hospital epidemiology and the challenge of integrating Health Surveillance: reflections from a case study

Resumo Este estudo propõe uma reflexão sobre os usos e as perspectivas da vigilância em saúde hospitalar a partir do relato de uma experiência pioneira em epidemiologia hospitalar, o Serviço de Epidemiologia/HFSE, que serviu de base para a criação dos núcleos de vigilância epidemiológica (VE) dos hospitais municipais e estaduais do Rio de Janeiro. O serviço integra ações de VE, educação continuada, capacitação, treinamento em serviço, pesquisa e avaliação de serviços desde 1986. Participa ativamente da rede nacional de VE, tendo notificado 55.747 casos de 1986 a 2016, a maioria por busca ativa. A integração dos vários níveis da vigilância e assistência agiliza as atividades clássicas de controle das doenças de notificação compulsória e fornece instrumentos de avaliação da qualidade. O importante papel na capacitação e formação de recursos humanos é evidenciado através do treinamento de 1.835 internos de medicina e 78 residentes até 2016; e pelo fato de que esta experiência tem servido de base para a implantação de diversos outros núcleos hospitalares. Entre os desafios que se impõem atualmente está a articulação com as demais comissões que compõem o Núcleo de Vigilância Hospitalar e o Núcleo de Segurança do Paciente.

Abstract This study proposes a reflection on the uses and future prospects of hospital-based health surveillance based on the account of a pioneering experience in hospital epidemiology, the epidemiology service at the Hospital Federal dos Servidores do Estado - HFSE, which served as the basis for the creation of epidemiologic surveillance units in municipal and state hospitals in Rio de Janeiro, Brazil. The epidemiology service has combined epidemiological surveillance, continuing education, in-service training, research, and health service evaluation since 1986. The service is part of the national epidemiological surveillance network and was responsible for the notification of 55,747 cases between 1986 and 2016, most of which were the result of active search. The integration of various levels of health surveillance and health care makes classical control activities more agile and provides instruments for measuring. The important role played by the service in human resources training is evident in the training of 1,835 medical interns and 78 residents up to 2016. In addition, this experience has served as the basis for the implantation of several other hospital epidemiological surveillance units. Current challenges include the promotion of effective communication and coordination among the other health surveillance committees.

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 Demográfico (Demographic Census) of 2000. The unit of analysis was the home district registered in the Sistema de Informação de Agravos de Notificação (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'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.

Spatial distribution and socioeconomic context of tuberculosis in Rio de Janeiro, Brazil / Distribuição espacial e contexto socioeconômico da tuberculose, Rio de Janeiro, Brasil

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 Demográfico (Demographic Census) of 2000. The unit of analysis was the home district registered in the Sistema de Informação de Agravos de Notificação (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'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.

OBJETIVO Analisar a distribuição espacial de sobrerrisco para tuberculose e seus determinantes socioeconômicos no município do Rio de Janeiro.MÉTODOS Estudo ecológico sobre a associação entre a média da taxa de incidência da tuberculose de 2004 a 2006 e indicadores socioeconômicos do Censo Demográfico do ano 2000. A unidade de análise foi o bairro de residência registrado no Sistema de Informação de Agravos de Notificação do município do Rio de Janeiro, RJ. As taxas foram padronizadas por sexo e faixa etária e suavizadas pelo método bayesiano empírico. A autocorrelação espacial foi avaliada pelo índice de Moran. Foram estudados modelos de regressão linear múltipla e avaliada a pertinência de incorporar o componente espacial na modelagem.RESULTADOS Observou-se risco maior de adoecimento em alguns bairros da zona portuária e zona norte, além de grande incidência nas favelas da Rocinha e Vidigal, na zona sul e Cidade de Deus, na zona oeste. O modelo final identificou associação positiva para as variáveis: percentual de domicílios particulares permanentes em que o responsável recebia de três a cinco salários mínimos; percentual de moradores individuais no bairro; e percentual de pessoas que viviam em domicílio com mais de duas pessoas por dormitório.CONCLUSÕES A análise espacial identificou áreas de sobrerrisco de incidência da tuberculose nos bairros do município do Rio de Janeiro e encontrou dependência espacial para a incidência de tuberculose e algumas variáveis socioeconômicas. Entretanto, a inclusão do componente espacial, no modelo final, não se mostrou necessária durante o processo de modelagem.

Tuberculosis Control Program and patient satisfaction, Rio de Janeiro, Brazil.

OBJECTIVE To evaluate factors associated with users' satisfaction in the Tuberculosis Control Program. METHODS A cross-sectional study of 295 patients aged ≥ 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' 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 (≤ 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.

Tuberculosis Control Program and patient satisfaction, Rio de Janeiro, Brazil / Programa de Controle da Tuberculose e satisfação dos usuários, Rio de Janeiro

OBJECTIVE To evaluate factors associated with users’ satisfaction in the Tuberculosis Control Program. METHODS A cross-sectional study of 295 patients aged ≥ 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’ 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 (≤ 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 ...

OBJETIVO Avaliar fatores associados à satisfação de usuários do Programa de Controle de Tuberculose. MÉTODOS Estudo transversal realizado com 295 pacientes ≥ 18 anos que tiveram duas ou mais consultas no Programa de Controle da Tuberculose em cinco municípios da região metropolitana do Rio de Janeiro, RJ, em 2010. Contemplando população estimada de 4.345 pacientes, o desenho da amostra incluiu 15 unidades com o programa, divididas em dois estratos: unidades da cidade do Rio de Janeiro, selecionadas com probabilidade proporcional à média de consultas mensais, e unidades dos outros quatro municípios, incluídas com certeza. Nas unidades, quatro conglomerados temporais com cinco pacientes cada foram selecionados com equiprobabilidade, totalizando 300 pacientes. Utilizou-se questionário que investigou variáveis clínicas e sociodemográficas dos usuários e aspectos dos serviços e do atendimento no programa relevantes na percepção de satisfação desses. Estatísticas descritivas e a satisfação com o programa foram obtidas e os efeitos dos fatores associados à satisfação foram estimados. RESULTADOS Predominaram pacientes do sexo masculino (57,7%), com média de 40,9 anos e baixa escolaridade. O tempo médio de tratamento foi 4,1 meses, majoritariamente do tipo autoadministrado (70,4%). Ainda, 25,8% já tinham realizado tratamento prévio de tuberculose. Houve elevado nível de satisfação, sobretudo com relação à provisão de medicamentos e respeito aos pacientes pelos profissionais de saúde. Mostraram-se mais insatisfeitos: pacientes mais jovens (≤ 30 anos), submetidos a tratamento autoadministrado e com nível superior. Sugestões de melhoria dos serviços incluíram aumento da quantidade de médicos (70,0%) e r...