Spatiotemporal Bayesian modeling of the risk of congenital syphilis in São Paulo, SP, Brazil.

The aim of this study is to analyze the spatiotemporal risk of congenital syphilis (CS) in high-prevalence areas in the city of São Paulo, SP, Brazil, and to evaluate its relationship with socioeconomic, demographic, and environmental variables. An ecological study was conducted based on secondary CS data with spatiotemporal components collected from 310 areas between 2010 and 2016. The data were modeled in a Bayesian context using the integrated nested Laplace approximation (INLA) method. Risk maps showed an increasing CS trend over time and highlighted the areas that presented the highest and lowest risk in each year. The model showed that the factors positively associated with a higher risk of CS were the Gini index and the proportion of women aged 18-24 years without education or with incomplete primary education, while the factors negatively associated were the proportion of women of childbearing age and the mean per capita income.

Cirrhosis regression after SVR with indirect methods of fibrosis analysis: How far is it real?

Hepatitis C virus has infected over 71 million people worldwide, and it is the main cause of cirrhosis in the western world. Currently, the treatment involves direct-acting antiviral agents (DAAs) and its main goal is to achieve sustained virologic response (SVR). The aim of this study was to evaluate the impact of SVR using DAAs in the improvement of liver fibrosis using scores evaluation by indirect method, liver function, and inflammation indirect biomarkers. Patients with cirrhosis with SVR after treatment (n = 104) were evaluated using liver function scores, indirect fibrosis methods, alpha-fetoprotein, and ferritin at t-base and t-SVR. Statistically significant positive results in all parameters were observed: 54 patients were classified as 5 in the CP score in t-base, and 77 in t-SVR; a significant decrease was observed in MELD score, alpha-fetoprotein, ferritin, APRI, FIB-4 and liver stiffness in liver elastography. We did not observe difference in the liver function scores between regressors and non-regressors of liver stiffness, as well as in indirect inflammation biomarkers. The measurements of fibrosis using the indirect methods have significantly decreased in patients with cirrhosis treated who achieved SVR associated with decreased indirect inflammation biomarkers and improved liver function scores.

Assessment of functional health literacy in Brazilian carers of older people.

Individuals with low health literacy have less knowledge of their own health condition. Carers play a key role in older people's activities of daily living. OBJECTIVE: to evaluate the performance of carers of older people using the S-TOFHLA (Short Test of Functional Health Literacy in Adults) and to identify caregiver characteristics associated with low functional health literacy. METHODS: a cross-sectional study was conducted. The S-TOFHLA, a sociodemographic instrument, the Mini-Mental State Exam and the Patient Health Questionnaire-2 were applied to 80 carers of older patients routinely followed by doctors from the Primary Health Care Sector of the City of Botucatu, São Paulo. The multivariate analysis used an ordinal logistic regression model with test (S-TOFHLA) scores as the dependent variable. The level of statistical significance adopted was 0.05. RESULTS: the individuals had a mean age of 54.6 (± 11.7); 27% of the carers evaluated had inadequate levels of health literacy (S-TOFHLA ≥54). A higher proportion of individuals with low education had inadequate or marginal health literacy (p<0.001). CONCLUSION: nearly 1/3 of the carers had marginal or inadequate levels of health literacy. These results highlight the difficulties of many carers in understanding health information.

Indivíduos com baixo alfabetismo em saúde têm menos conhecimento sobre sua própria condição de saúde. Cuidadores desempenham um papel fundamental nas atividades de vida diária dos idosos. OBJETIVO: avaliar o desempenho de cuidadores de pessoas idosas usando o "S-TOFHLA (Short Test of Functional Health Literacy in Adults)" e identificar características do cuidador associadas ao baixa alfabetismo em saúde. MÉTODOS: um estudo transversal foi conduzido. O S-TOFHLA, um instrumento sociodemográfico, o Miniexame do Estado Mental e o "Patient Health Questionnaire - 2" foram aplicados a 80 cuidadores de pacientes idosos rotineiramente acompanhados por médicos do Setor de Atenção Primária à Saúde da cidade de Botucatu, São Paulo. A análise multivariada utilizou um modelo de regressão logística ordinal com os escores do S-TOFHLA como variável dependente. O nível de significância estatística adotado foi de 0,05. RESULTADOS: os indivíduos tiveram idade média de 54,6 (± 11,7) anos; 27% dos cuidadores avaliados apresentavam níveis inadequados de alfabetização em saúde. Uma proporção maior de indivíduos com baixa escolaridade apresentou alfabetização em saúde inadequada e limítrofe (p<0,001). CONCLUSÃO: aproximadamente 1/3 dos cuidadores apresentaram níveis limítrofes e inadequados de alfabetização em saúde. Esses resultados destacam as dificuldades de muitos cuidadores em compreender informações sobre saúde.

Assessment of functional health literacy in Brazilian carers of older people / Avaliação do analfabetismo funcional em saúde em cuidadores de idosos brasileiros

ABSTRACT. Individuals with low health literacy have less knowledge of their own health condition. Carers play a key role in older people's activities of daily living. Objective: to evaluate the performance of carers of older people using the S-TOFHLA (Short Test of Functional Health Literacy in Adults) and to identify caregiver characteristics associated with low functional health literacy. Methods: a cross-sectional study was conducted. The S-TOFHLA, a sociodemographic instrument, the Mini-Mental State Exam and the Patient Health Questionnaire-2 were applied to 80 carers of older patients routinely followed by doctors from the Primary Health Care Sector of the City of Botucatu, São Paulo. The multivariate analysis used an ordinal logistic regression model with test (S-TOFHLA) scores as the dependent variable. The level of statistical significance adopted was 0.05. Results: the individuals had a mean age of 54.6 (± 11.7); 27% of the carers evaluated had inadequate levels of health literacy (S-TOFHLA ≥54). A higher proportion of individuals with low education had inadequate or marginal health literacy (p<0.001). Conclusion: nearly 1/3 of the carers had marginal or inadequate levels of health literacy. These results highlight the difficulties of many carers in understanding health information.

RESUMO. Indivíduos com baixo alfabetismo em saúde têm menos conhecimento sobre sua própria condição de saúde. Cuidadores desempenham um papel fundamental nas atividades de vida diária dos idosos. Objetivo: avaliar o desempenho de cuidadores de pessoas idosas usando o "S-TOFHLA (Short Test of Functional Health Literacy in Adults)" e identificar características do cuidador associadas ao baixa alfabetismo em saúde. Métodos: um estudo transversal foi conduzido. O S-TOFHLA, um instrumento sociodemográfico, o Miniexame do Estado Mental e o "Patient Health Questionnaire - 2" foram aplicados a 80 cuidadores de pacientes idosos rotineiramente acompanhados por médicos do Setor de Atenção Primária à Saúde da cidade de Botucatu, São Paulo. A análise multivariada utilizou um modelo de regressão logística ordinal com os escores do S-TOFHLA como variável dependente. O nível de significância estatística adotado foi de 0,05. Resultados: os indivíduos tiveram idade média de 54,6 (± 11,7) anos; 27% dos cuidadores avaliados apresentavam níveis inadequados de alfabetização em saúde. Uma proporção maior de indivíduos com baixa escolaridade apresentou alfabetização em saúde inadequada e limítrofe (p<0,001). Conclusão: aproximadamente 1/3 dos cuidadores apresentaram níveis limítrofes e inadequados de alfabetização em saúde. Esses resultados destacam as dificuldades de muitos cuidadores em compreender informações sobre saúde.

Influence of the inflammatory response on treatment of hepatitis C with triple therapy.

INTRODUCTION: Chronic hepatitis C is a leading cause of liver disease. Infection triggers an immediate immune response in the host that is mediated by humoral/cellular mechanisms. T cells respond to infection via secretion of cytokines, which inhibit or stimulate one another, leading to cytokine imbalance and ultimately affecting treatment. Studies using interferon (IFN) and ribavirin (RBV) showed that TCD8+ cells and cytokine levels are associated with sustainable virological response (SVR). However, studies that investigated the effects of triple therapy (TT) are limited. METHODS: The study included hepatitis C virus (HCV)+ RNA, naives, genotype 1, ≥18 years, and advanced fibrosis (F≥3) patients. Samples were collected at baseline and after 12 weeks (W12) of TT. Six cytokines were analyzed by flow cytometry. RESULTS: Of 31 patients, four were excluded (two deaths, one interrupted TT, and one F2 patient). Of the 27 remaining patients, 21 (78%) were cirrhotic. SVR was achieved in 63% of the patients. The patients had a mean age of 55.11 ± 10.03 years. Analyses at baseline showed that the chemokine CCL5/Regulated on Activation, Normal T Cell Expressed and Secreted (RANTES) (p=0.04) and interleukin (IL)-6 (p=0.02), which was associated with SVR. RANTES (p=0.04) and IL-8 (p=0.01) levels were associated with SVR at W12. CONCLUSIONS: Similar to patterns observed during double therapy, IL-6, IL-8, and RANTES levels were associated with SVR in TT, indicating the potential role of interferon in immune response to hepatitis C virus.

Influence of the inflammatory response on treatment of hepatitis C with triple therapy

Abstract INTRODUCTION: Chronic hepatitis C is a leading cause of liver disease. Infection triggers an immediate immune response in the host that is mediated by humoral/cellular mechanisms. T cells respond to infection via secretion of cytokines, which inhibit or stimulate one another, leading to cytokine imbalance and ultimately affecting treatment. Studies using interferon (IFN) and ribavirin (RBV) showed that TCD8+ cells and cytokine levels are associated with sustainable virological response (SVR). However, studies that investigated the effects of triple therapy (TT) are limited. METHODS: The study included hepatitis C virus (HCV)+ RNA, naives, genotype 1, ≥18 years, and advanced fibrosis (F≥3) patients. Samples were collected at baseline and after 12 weeks (W12) of TT. Six cytokines were analyzed by flow cytometry. RESULTS: Of 31 patients, four were excluded (two deaths, one interrupted TT, and one F2 patient). Of the 27 remaining patients, 21 (78%) were cirrhotic. SVR was achieved in 63% of the patients. The patients had a mean age of 55.11 ± 10.03 years. Analyses at baseline showed that the chemokine CCL5/Regulated on Activation, Normal T Cell Expressed and Secreted (RANTES) (p=0.04) and interleukin (IL)-6 (p=0.02), which was associated with SVR. RANTES (p=0.04) and IL-8 (p=0.01) levels were associated with SVR at W12. CONCLUSIONS Similar to patterns observed during double therapy, IL-6, IL-8, and RANTES levels were associated with SVR in TT, indicating the potential role of interferon in immune response to hepatitis C virus.

Spatial risk of death in patients with AIDS in Campinas, São Paulo, Brazil. / Risco espacial de óbito de pacientes com aids em Campinas, São Paulo, Brasil.

OBJECTIVE: To analyze the spatial risk of AIDS mortality in census tracts in a large Brazilian city. METHOD: We studied three retrospective cohorts of individuals with AIDS, who were residents in the city of Campinas, in the State of São Paulo, Brazil. The occurrence of death was analyzed from 1980 to 1990 (cohort 1), 1996 to 2000 (cohort 2), and from 2001 to 2005 (cohort 3). We adjusted a Bayesian semi-parametric model, using the Integrated Nested Laplace Approximation (INLA) method, which allowed for the mapping of mortality risk for the three cohorts. RESULTS: The incidence of death in cohorts 1, 2 and 3 were, respectively, 72.73, 32.21 and 13.11%. The death risk maps showed a tendency of mortality decrease, and presented the sectors with the highest and lowest risk for each period. The model showed that, in the three cohorts, factors associated with the highest risk of death were: being male, and having an age at diagnosis greater than 49 years old. The homosexual/bisexual orientation was associated with lower risk of dying. CONCLUSIONS: Even considering the reduction in the risk of death from AIDS in recent years, after access to highly active antiretroviral therapy, the highest incidence was found among the poorest individuals in the three studied cohorts. The maps and risk factors obtained suggest possible actions for monitoring the disease in the city.

Frequency of dementia among elderly admitted to a Geriatrics Inpatients Sector of a Brazilian public hospital.

Patients with dementia are commonly admitted to inpatient sectors. The aim of this study was to describe the frequency of dementia among elderly inpatients admitted to the Geriatrics Sector of a Brazilian Tertiary University Hospital, and to identify associations between dementia and clinical and sociodemographic factors. METHODS: All patients admitted to the Geriatrics Sector of a public Brazilian university-hospital from March 1st 2014 to January 31st 2015 were assessed by geriatricians. The patients were divided into groups "with or without diagnosis of dementia". Univariate analysis was performed between these two groups using the Chi-Square Test, Student's t-test or the Mann-Whitney Test. RESULTS: One hundred and three elderly inpatients, with a mean age of 82 (±7.9) years, were assessed. Overall, 74.7% had low educational level (<4 years), 66% used polypharmacy, 57.2% developed delirium during hospitalization and 59% were totally dependent for basic activities of daily living. The diagnosis of dementia was observed in 59 (57%) subjects. CONCLUSION: The frequency of dementia was high among the elderly inpatients evaluated. The association between dementia and certain clinical conditions, such as incontinence, delirium and use of psychoactive drugs, was in line with the medical literature.

Pacientes com demência são comumente admitidos em setores de internação. O objetivo deste estudo foi descrever a frequência de demência em pacientes idosos internados em uma enfermaria de geriatria de um hospital universitário terciário brasileiro e identificar associações entre demência e fatores clínicos e sociodemográficos. MÉTODOS: Todos os pacientes internados na enfermaria de geriatria de um hospital universitário público brasileiro no período de 1 de março de 2014 a 31 de janeiro de 2015 foram avaliados por geriatras. Os pacientes foram divididos em dois grupos: com ou sem diagnóstico prévio de demência. Análise univariada foi utilizada na comparação dos resultados dos dois grupos por meio do Teste do Qui-Quadrado, teste t-Student e o teste de Mann-Whitnney. RESULTADOS: Foram avaliados 103 pacientes idosos, com idade média de 82 (±7,9) anos; 74,7% apresentaram escolaridade baixa (<4 anos), 66% usavam polifarmácia, 57,2% desenvolveram delirium durante a hospitalização e 59% eram totalmente dependentes das atividades básicas da vida diária. O diagnóstico de demência foi observado em 59 indivíduos (57%). CONCLUSÃO: A frequência de demência foi alta entre pacientes idosos avaliados. A associação entre demência e certas condições clínicas, como a incontinência, o delírio e o uso de drogas psicoativas, está em consonância com a literatura médica.

Frequency of dementia among elderly admitted to a Geriatrics Inpatients Sector of a Brazilian public hospital / Frequência de demência em idosos internados em enfermaria de geriatria de um hospital público brasileiro

ABSTRACT. Patients with dementia are commonly admitted to inpatient sectors. The aim of this study was to describe the frequency of dementia among elderly inpatients admitted to the Geriatrics Sector of a Brazilian Tertiary University Hospital, and to identify associations between dementia and clinical and sociodemographic factors. Methods: All patients admitted to the Geriatrics Sector of a public Brazilian university-hospital from March 1st 2014 to January 31st 2015 were assessed by geriatricians. The patients were divided into groups "with or without diagnosis of dementia". Univariate analysis was performed between these two groups using the Chi-Square Test, Student's t-test or the Mann-Whitney Test. Results: One hundred and three elderly inpatients, with a mean age of 82 (±7.9) years, were assessed. Overall, 74.7% had low educational level (<4 years), 66% used polypharmacy, 57.2% developed delirium during hospitalization and 59% were totally dependent for basic activities of daily living. The diagnosis of dementia was observed in 59 (57%) subjects. Conclusion: The frequency of dementia was high among the elderly inpatients evaluated. The association between dementia and certain clinical conditions, such as incontinence, delirium and use of psychoactive drugs, was in line with the medical literature.

RESUMO. Pacientes com demência são comumente admitidos em setores de internação. O objetivo deste estudo foi descrever a frequência de demência em pacientes idosos internados em uma enfermaria de geriatria de um hospital universitário terciário brasileiro e identificar associações entre demência e fatores clínicos e sociodemográficos. Métodos: Todos os pacientes internados na enfermaria de geriatria de um hospital universitário público brasileiro no período de 1 de março de 2014 a 31 de janeiro de 2015 foram avaliados por geriatras. Os pacientes foram divididos em dois grupos: com ou sem diagnóstico prévio de demência. Análise univariada foi utilizada na comparação dos resultados dos dois grupos por meio do Teste do Qui-Quadrado, teste t-Student e o teste de Mann-Whitnney. Resultados: Foram avaliados 103 pacientes idosos, com idade média de 82 (±7,9) anos; 74,7% apresentaram escolaridade baixa (<4 anos), 66% usavam polifarmácia, 57,2% desenvolveram delirium durante a hospitalização e 59% eram totalmente dependentes das atividades básicas da vida diária. O diagnóstico de demência foi observado em 59 indivíduos (57%). Conclusão: A frequência de demência foi alta entre pacientes idosos avaliados. A associação entre demência e certas condições clínicas, como a incontinência, o delírio e o uso de drogas psicoativas, está em consonância com a literatura médica.

Use of medications is strongly associated with worse self-perceived health in institutionalized and community-dwelling elderly / Uso de medicamentos está fortemente associado com pior autopercepção de saúde em idosos instituicionalizados e não institucionalizados

Objective: This study aimed to investigate self-perceived health among a sample of institutionalized and a sample of communitydwelling elderly in two cities of the São Paulo State, Brazil: Bauru and Botucatu. Methods: Ninety-five elderly individuals from ten long-term care homes from Bauru, SP and Botucatu, SP and 101 community-dwelling elderly users of three centers for the elderly in Bauru, SP were assessed. After obtaining the personal and health data, the evaluation of self-perception of health was performed by asking how the elderly person perceived his health in the most recent days; the response options were very poor, poor, fair, good or excellent. Results: There was a statistically significant difference (< 0.001) between institutionalized and community-dwelling elderly considering self-perceived health.. After adjusting the model of ordinal logistic regression, it was observed that institutionalized individuals who regularly used prescription medications had a chance 7.5 times greater than nonusers of having a worse self-perceived health [OR = 7.5; 95%CI (2.1­26.6; p = 0.002)]. In the community-dwelling group it was observed that individuals who regularly used prescription medications had a chance 4.5 times greater than nonusers of having a worse self-perceived health [OR = 4.5; 95%CI (1.5­13.7; p = 0.008)]. Conclusions: Worse self-perceived health was associated with taking prescription medications among both institutionalized and community-dwelling elderly.

Objetivo: Este estudo teve como objetivo investigar autopercepção de saúde em uma amostra de idosos institucionalizados e uma de não institucionalizados em duas cidades do Estado de São Paulo: Bauru e Botucatu. Métodos: Participaram noventa e cinco idosos de nove instituições de longa permanência de Bauru e de uma de Botucatu e 101 idosos usuários de três centros para idosos em Bauru. Após a obtenção dos dados pessoais e de saúde, avaliação da autopercepção de saúde foi realizada perguntando como o idoso percebeu sua saúde nos últimos dias; as opções de resposta foram péssima, ruim, regular, boa ou excelente. Resultados: Houve diferença estatisticamente significante entre os grupos, considerando autopercepção de saúde (< 0.001). Com o ajuste do modelo de regressão logística ordinal, observaou-se que os indivíduos institucionalizados que usavam regularmente medicamentos prescritos por médicos tinham 7,5 vezes mais chances que os que não usavam de ter uma autopercepção de saúde pior [OR = 7,5; IC95% (2,1­26,6; p = 0,002)]. No grupo dos não institucionalizados, indivíduos que usavam regularmente medicamentos prescritos por médicos tinham 4,5 vezes mais chances do que os que não usavam de ter uma autopercepção de saúde pior [OR = 4,5; IC95% (1,5­13,7; p = 0,008)]. Conclusões: Uma pior auto-percepção de saúde foi associada a tomar medicamentos de uso contínuo em idosos institucionalizados e da comunidade.

Risco espacial de óbito de pacientes com aids em Campinas, São Paulo, Brasil / Spatial risk of death in patients with AIDS in Campinas, São Paulo, Brazil

RESUMO: Objetivo: O estudo teve como objetivo analisar o risco espacial de mortalidade por aids em setores censitários de município brasileiro de grande porte. Método: Foram estudadas três coortes retrospectivas de indivíduos notificados por aids e residentes no município de Campinas, São Paulo, nos períodos de 1980 a 1990 (coorte 1), 1996 a 2000 (coorte 2) e 2001 a 2005 (coorte 3), a fim de identificar a ocorrência do óbito. Foi ajustado um modelo semiparamétrico Bayesiano, empregando o método de Aproximação de Laplace Aninhada e Integrada (INLA), que permitiu obter mapas de risco de óbito nas três coortes estudadas. Resultados: A incidência de óbito nas coortes 1, 2 e 3 foram, respectivamente, 72,73; 32,21 e 13,11%. Os mapas de risco de óbito apontaram tendência de queda da mortalidade e evidenciaram os setores que apresentaram maior e menor risco em cada período. O modelo mostrou que, nas três coortes, os fatores associados ao maior risco de óbito foram: ser do sexo masculino e possuir idade de diagnóstico superior a 49 anos. A orientação homossexual/bissexual foi associada ao menor risco de morrer. Conclusões: Mesmo diante da diminuição do risco de morte por aids nos últimos anos, após o acesso à terapia antirretroviral altamente ativa, a maior incidência se concentra entre os mais pobres nas três coortes estudadas. Os mapas e o fatores de risco obtidos orientam possíveis ações e monitoramento da doença no município.

ABSTRACT: Objective: To analyze the spatial risk of AIDS mortality in census tracts in a large Brazilian city. Method: We studied three retrospective cohorts of individuals with AIDS, who were residents in the city of Campinas, in the State of São Paulo, Brazil. The occurrence of death was analyzed from 1980 to 1990 (cohort 1), 1996 to 2000 (cohort 2), and from 2001 to 2005 (cohort 3). We adjusted a Bayesian semi-parametric model, using the Integrated Nested Laplace Approximation (INLA) method, which allowed for the mapping of mortality risk for the three cohorts. Results: The incidence of death in cohorts 1, 2 and 3 were, respectively, 72.73, 32.21 and 13.11%. The death risk maps showed a tendency of mortality decrease, and presented the sectors with the highest and lowest risk for each period. The model showed that, in the three cohorts, factors associated with the highest risk of death were: being male, and having an age at diagnosis greater than 49 years old. The homosexual/bisexual orientation was associated with lower risk of dying. Conclusions: Even considering the reduction in the risk of death from AIDS in recent years, after access to highly active antiretroviral therapy, the highest incidence was found among the poorest individuals in the three studied cohorts. The maps and risk factors obtained suggest possible actions for monitoring the disease in the city.

[Spatial analysis of counting data with excess zeros applied to the study of dengue incidence in Campinas, São Paulo State, Brazil]. / Análise espacial de dados de contagem com excesso de zeros aplicado ao estudo da incidência de dengue em Campinas, São Paulo, Brasil.

Dengue incidence occurs predominantly within city limits. Identifying spatial distribution of the disease at the local level helps formulate strategies to control and prevent the disease. Spatial analysis of counting data for small areas commonly violates the assumptions of traditional Poisson models due to the excessive amount of zeros. This study compared the performance of four counting models used in mapping diseases: Poisson, negative binomial, zero-inflated Poisson, and zero-inflated negative binomial. The methods were compared in a simulation study. The models analyzed in the simulation were applied to a spatial ecological study of dengue data aggregated by census tracts in the city of Campinas, São Paulo State, Brazil, 2007. Spatial analysis was conducted with Bayesian hierarchical models. The zero-inflated Poisson model showed the best performance for estimating relative risk of dengue incidence in the census tracts.

Long-term outcome of severe acute kidney injury survivors followed by nephrologists in a developing country.

AIM: This study aimed to evaluate the long-term outcome of patients after a severe episode of acute kidney injury (AKI) on survival and progression to chronic kidney disease (CKD) and to identify risk factors associated with these outcomes. METHODS: We performed a prospective study that evaluated the long-term outcome of 509 AKI stage 3 patients who were followed by nephrologists in a Brazilian University Hospital from 2004 to 2013. RESULTS: Age was 60.2 years (47.5-71) and the follow-up time was 25 months (12-44). The late mortality was 38.1% and age (HR 2.89, 95% CI=1.88 to 4.46, P < 0.0001), diabetes (HR 1.46, 95% CI=1 0.02 to 2.16, P < 0.047), liver disease (HR 2.95, 95% CI=1.19 to 7.3, P = 0.02) and creatinine (Cr) at the time of hospital discharge (HR 1.21, 95% CI=1.04 to 1.41, P = 0.01) were associated with poor long-term survival. At the moment of hospital discharge, 52.1% of patients had complete recovery of renal function, 39.7% had partial recovery and 8.3% had not recovered renal function. After 36 months, 43.5% of patients progressed to CKD, and 5.3% needed for chronic dialysis. Factors associated with progression to CKD were age (HR 1.02, 95% CI=1.008 to 1.035, P = 0.009), CKD (HR 1.05 95% CI=1.007 to 1.09, P = 0.04), diabetes (HR 1.12, CI 1.008-1.035, P = 0.009) and number of AKI episodes (HR 1.65, 95% CI=1.19 to 2.2, P = 0.0023). CONCLUSION: This study showed that AKI patients have high mortality after hospital discharge and age, diabetes, liver disease, and Cr value at the time of discharge were factors associated with long-term mortality. The risk factors for this progression to CKD were age, the presence of diabetes and the number of AKI episodes.

Análise espacial de dados de contagem com excesso de zeros aplicado ao estudo da incidência de dengue em Campinas, São Paulo, Brasil / Spatial analysis of counting data with excess zeros applied to the study of dengue incidence in Campinas, São Paulo State, Brazil / Análisis espacial de datos de conteo con exceso de ceros, aplicado al estudio de la incidencia de dengue en Campinas, São Paulo, Brasil

Resumo: A incidência de dengue ocorre predominantemente em áreas urbanas das cidades. Identificar o padrão de distribuição espacial da doença no nível local contribui na formulação de estratégias de controle e prevenção da doença. A análise espacial de dados de contagem para pequenas áreas comumente viola as suposições dos modelos tradicionais de Poisson, devido à quantidade excessiva de zeros. Neste estudo, comparou-se o desempenho de quatro modelos de contagem utilizados no mapeamento de doenças: Poisson, Binomial negativa, Poisson inflacionado de zeros e Binomial negativa inflacionado de zeros. Os métodos foram comparados em um estudo de simulação. Os modelos analisados no estudo de simulação foram aplicados em um estudo ecológico espacial, aos dados de dengue agregados por setores censitários, do Município de Campinas, São Paulo, Brasil, em 2007. A análise espacial foi conduzida por modelos hierárquicos bayesianos. O modelo de Poisson inflacionado de zeros apresentou melhor desempenho para estimar o risco relativo de incidência de dengue nos setores censitários.

Abstract: Dengue incidence occurs predominantly within city limits. Identifying spatial distribution of the disease at the local level helps formulate strategies to control and prevent the disease. Spatial analysis of counting data for small areas commonly violates the assumptions of traditional Poisson models due to the excessive amount of zeros. This study compared the performance of four counting models used in mapping diseases: Poisson, negative binomial, zero-inflated Poisson, and zero-inflated negative binomial. The methods were compared in a simulation study. The models analyzed in the simulation were applied to a spatial ecological study of dengue data aggregated by census tracts in the city of Campinas, São Paulo State, Brazil, 2007. Spatial analysis was conducted with Bayesian hierarchical models. The zero-inflated Poisson model showed the best performance for estimating relative risk of dengue incidence in the census tracts.

Resumen: La incidencia de dengue se produce, predominantemente, en las áreas urbanas de las ciudades. Identificar el patrón de distribución espacial de la enfermedad a nivel local contribuye a la formulación de estrategias de control y prevención de la enfermedad. El análisis espacial de datos de conteo para pequeñas áreas comúnmente transgrede las suposiciones de los modelos tradicionales de Poisson, debido a la cantidad excesiva de ceros. En este estudio, se comparó el desempeño de cuatro modelos de conteo utilizados en el mapeo de enfermedades: Poisson, binomial negativo, Poisson con exceso de ceros y binomial negativo con exceso de ceros. Los métodos fueron comparados en un estudio de simulación. Los modelos analizados en el estudio de simulación fueron aplicados en un estudio ecológico espacial, a los datos de dengue agregados por sectores censales, del Municipio de Campinas, São Paulo, Brasil, 2007. El análisis espacial fue realizado con modelos jerárquicos bayesianos. El modelo de Poisson con exceso de ceros presentó un mejor desempeño para estimar el riesgo relativo de incidencia de dengue en los sectores censales.

The absence of the human platelet antigen polymorphism effect on fibrosis progression in human immunodeficiency virus-1/hepatitis C virus coinfected patients.

INTRODUCTION: Hepatic fibrosis progression in patients with chronic hepatitis C virus infections has been associated with viral and host factors, including genetic polymorphisms. Human platelet antigen polymorphisms are associated with the rapid development of fibrosis in HCV-monoinfected patients. This study aimed to determine whether such an association exists in human immunodeficiency virus-1/hepatitis C virus-coinfected patients. METHODS: Genomic deoxyribonucleic acid from 36 human immunodeficiency virus-1/hepatitis C virus-coinfected patients was genotyped to determine the presence of human platelet antigens-1, -3, or -5 polymorphisms. Fibrosis progression was evaluated using the Metavir scoring system, and the patients were assigned to two groups, namely, G1 that comprised patients with F1, portal fibrosis without septa, or F2, few septa (n = 23) and G2 that comprised patients with F3, numerous septa, or F4, cirrhosis (n = 13). Fisher's exact test was utilized to determine possible associations between the human platelet antigen polymorphisms and fibrosis progression. RESULTS: There were no deviations from the Hardy-Weinberg equilibrium in the human platelet antigen systems evaluated. Statistically significant differences were not observed between G1 and G2 with respect to the distributions of the allelic and genotypic frequencies of the human platelet antigen systems. CONCLUSION: The greater stimulation of hepatic stellate cells by the human immunodeficiency virus and, consequently, the increased expression of transforming growth factor beta can offset the effect of human platelet antigen polymorphism on the progression of fibrosis in patients coinfected with the human immunodeficiency virus-1 and the hepatitis C virus.

The absence of the human platelet antigen polymorphism effect on fibrosis progression in human immunodeficiency virus-1/hepatitis C virus coinfected patients

Hepatic fibrosis progression in patients with chronic hepatitis C virus infections has been associated with viral and host factors, including genetic polymorphisms. Human platelet antigen polymorphisms are associated with the rapid development of fibrosis in HCV-monoinfected patients. This study aimed to determine whether such an association exists in human immunodeficiency virus-1/hepatitis C virus-coinfected patients.

Human Platelet Polymorphism can be a genetic marker associated with HIV/HCV coinfection.

To evaluate the associations of HPA polymorphisms -1, -3, and -5 with HIV/HCV coinfection were included in this study 60 HIV/HCV-coinfected patients from the Sao Paulo State health service centers. Data reported by Verdichio-Moraes et al. (2009: J. Med Virol 81:757-759) were used as the non-infected and HCV monoinfected groups. Human Platelet Polymorphism genotyping was performed in 60 Patients co-infected with HIV/HCV by PCR-SSP or PCR-RFLP. HIV subtyping and HCV genotyping was performed by RT-PCR followed sequencing. The data analyses were performed using the χ2 test or Fisher's Exact Test and the logistic regression model. Patients coinfected with HIV/HCV presented HCV either genotype 1 (78.3%) or non-1 (21.7%) and HIV either subtype B (85.0%) or non-B (15%). The Human Platelet Polymorphism-1a/1b genotype was more frequent (P < 0.05) in HIV/HCV coinfection than in HCV monoinfection and the allelic frequency of Human Platelet Polymorphism-5b in the Patients coinfected with HIV/HCV was higher (P < 0.05) than in HCV monoinfected cases and non-infected individuals. These data suggest that the presence of specific HPA allele on platelets could favor the existence of coinfection. On the other hand, Human Platelet Polymorphism-5a/5b was more frequent (P < 0.05) in HIV/HCV coinfected and HCV monoinfected groups than in the non-infected individuals, suggesting that this platelet genotype is related to HCV infection, regardless of HIV presence. Results suggest that the Human Platelet Polymorphism profile in HIV/HCV coinfected individuals differs from the one of both HCV monoinfected and non-infected population. So, the Human Platelet Polymorphism can be a genetic marker associated with HIV/HCV coinfection.

Prevalence of the hepatitis C virus among University employees in São Paulo, Southeastern Brazil: predictive factors and geoprocessing spatial analysis.

BACKGROUND: There are limited studies on the prevalence and risk factors associated with hepatitis C virus (HCV) infection. Objective Identify the prevalence and risk factors for HCV infection in university employees of the state of São Paulo, Brazil. METHODS: Digital serological tests for anti-HCV have been performed in 3153 volunteers. For the application of digital testing was necessary to withdraw a drop of blood through a needlestick. The positive cases were performed for genotyping and RNA. Chi-square and Fisher's exact test were used, with P-value <0.05 indicating statistical significance. Univariate and multivariate logistic regression were also used. RESULTS: Prevalence of anti-HCV was 0.7%. The risk factors associated with HCV infection were: age >40 years, blood transfusion, injectable drugs, inhalable drugs (InDU), injectable Gluconergam®, glass syringes, tattoos, hemodialysis and sexual promiscuity. Age (P=0.01, OR 5.6, CI 1.4 to 22.8), InDU (P<0.0001, OR=96.8, CI 24.1 to 388.2), Gluconergam® (P=0.0009, OR=44.4, CI 4.7 to 412.7) and hemodialysis (P=0.0004, OR=90.1, CI 7.5 - 407.1) were independent predictors. Spatial analysis of the prevalence with socioeconomic indices, Gross Domestic Product and Human Development Index by the geoprocessing technique showed no positive correlation. CONCLUSIONS: The prevalence of HCV infection was 0.7%. The independent risk factors for HCV infection were age, InDU, Gluconergan® and hemodialysis. There was no spatial correlation of HCV prevalence with local economic factors.

PREVALENCE OF THE HEPATITIS C VIRUS AMONG UNIVERSITY EMPLOYEES IN SÃO PAULO, SOUTHEASTERN BRAZIL: predictive factors and geoprocessing spatial analysis / Prevalência do vírus da hepatite C em funcionários universitários do Estado de São Paulo, Brasil: fatores preditivos e análise espacial por geoprocessamento

Background There are limited studies on the prevalence and risk factors associated with hepatitis C virus (HCV) infection. Objective Identify the prevalence and risk factors for HCV infection in university employees of the state of São Paulo, Brazil. Methods Digital serological tests for anti-HCV have been performed in 3153 volunteers. For the application of digital testing was necessary to withdraw a drop of blood through a needlestick. The positive cases were performed for genotyping and RNA. Chi-square and Fisher’s exact test were used, with P-value <0.05 indicating statistical significance. Univariate and multivariate logistic regression were also used. Results Prevalence of anti-HCV was 0.7%. The risk factors associated with HCV infection were: age >40 years, blood transfusion, injectable drugs, inhalable drugs (InDU), injectable Gluconergam®, glass syringes, tattoos, hemodialysis and sexual promiscuity. Age (P=0.01, OR 5.6, CI 1.4 to 22.8), InDU (P<0.0001, OR=96.8, CI 24.1 to 388.2), Gluconergam® (P=0.0009, OR=44.4, CI 4.7 to 412.7) and hemodialysis (P=0.0004, OR=90.1, CI 7.5 – 407.1) were independent predictors. Spatial analysis of the prevalence with socioeconomic indices, Gross Domestic Product and Human Development Index by the geoprocessing technique showed no positive correlation. Conclusions The prevalence of HCV infection was 0.7%. The independent risk factors for HCV infection were age, InDU, Gluconergan® and hemodialysis. There was no spatial correlation of HCV prevalence with local economic factors. .

Contexto Existem escassos estudos sobre a prevalência e fatores de risco associados à infecção pelo vírus da hepatite C. Objetivos Identificar a prevalência e os fatores de risco para a infecção pelo vírus da hepatite C em funcionários de uma Universidade do Estado de São Paulo, Brasil. Métodos Testes sorológicos digitais para anti vírus da hepatite C foram realizados em 3.153 voluntários. Para a aplicação do teste digital foi necessário retirar uma gota de sangue através de uma picada de agulha. Nos casos positivos foram realizados genotipagem e RNA. Os testes Qui-quadrado e exato de Fisher foram utilizados, com valor de P<0,05 sendo considerado como estatisticamente significante. Regressão logística univariada e multivariada também foram aplicadas. Resultados A prevalência de anti vírus da hepatite C foi de 0,7%. Os fatores de risco associados com a infecção pelo vírus da hepatite C foram idade >40 anos, transfusão de sangue, uso de drogas injetáveis, uso de drogas inalatórias, Gluconergam® injetável, uso de seringas de vidro, tatuagens, hemodiálise e promiscuidade sexual. Idade (P=0,01, OR 5,6, IC 1,4-22,8), uso de drogas inalatórias (P<0,0001, OR=96,8, IC 24,1-388,2), Gluconergam® injetável (P=0,0009, OR=44,4, IC 4,7-412,7) e hemodiálise (P=0,0004, OR=90,1, IC 7,5-407,1) foram preditores independentes. A análise espacial da prevalência com índices socioeconômicos, produto interno bruto e índice de desenvolvimento humano, por meio da técnica de geoprocessamento, não mostrou correlação positiva. Conclusões A prevalência da infecção pelo vírus da hepatite C foi de 0,7%. Os fatores de risco independentes para a infecção pelo vírus da hepatite C foram idade, uso de drogas inalatórias, Gluconergan® injetável e hemodiálise. Não houve correlação espacial da prevalência de vírus da hepatite C com fatores econômicos locais. .