Association of social network and social support with health-related quality of life and fatigue in long-term survivors of Hodgkin lymphoma.

PURPOSE: As the number of survivors of Hodgkin's lymphoma (HL) increases, there has been a growing interest in long-term treatment-related side effects and their impact on the quality of life (QoL). The aim of this study was to assess the association of social network and social support with the QoL and fatigue among long-term HL survivors. METHODS: A total of 200 HL survivors were included. The generic Short Form-12 (SF-12) questionnaire, the QoL cancer survivor's questionnaire (QOL-CS), and the Multidimensional Fatigue Inventory were used to assess QoL and fatigue. Social network and social support were evaluated with the Social Support Survey. RESULTS: Social network and all social support measures were favorably associated with two or more SF-12 scales, mainly with physical functioning and the mental health scales. Social network and social support dimensions were also associated with better QOL-CS scores. Affective support, informational support, positive interaction, and emotional support were associated with less fatigue. CONCLUSIONS: Both social network and social support are associated with better QoL and lower levels of fatigue in HL survivors. This information may be useful to health professionals and community organizations in implementing effective interventions to improve these patients' quality of life.

Prevalência da infecção por lentivírus de pequenos ruminantes em caprinos em Teresina, Piauí / Prevalence of small ruminants lentiviruses infection in goats from Teresina, Piauí, Brazil

The prevalence of anti-lentiviruses antibodies of small ruminants was investigated in goat herds in the city of Teresina, PI, Brazil. A seroepidemiological survey was conducted involving 480 animals, apparently healthy, belonging to six rural properties. The diagnostic test was the agar gel immunodiffusion (AGID), using antigens produced from cellular cultures infected with caprine arthritis encephalitis virus (CAEV Cork). Prevalences by gender and age were estimated considering sampling fractions for each farm. A general prevalence of 4.2 percent, was observerved, being 4.2 percent for females and 3.6 percent for males. Prevalences were higher among older goats. Regarding the breed standard, 23.5 percent were of the Anglo Nubian, 5.9 percent of the Boer, 35.3 percent Anglo Nubian x Boer crossbred, and 35.3 percent of undefined breed. It is concluded that small ruminant lentiviruses are endemic among goat herds of Teresina.

Association between routine visits for dental checkup and self-perceived oral health in an adult population in Rio de Janeiro: the Pró-Saúde Study.

OBJECTIVE: To investigate the association between routine visits for dental checkup and self-perceived oral health. METHODS: Cross-sectional data from a study of university employees in Rio de Janeiro - The Pró-Saúde Study. Self-perceived oral health and the reported pattern and frequency of visits to the dentist were obtained through a multidimensional self-administered questionnaire. RESULTS: Data were obtained from 3252 participants. When compared with individuals who reported self-perceived oral health as good ('very good', 'good' or 'fair') individuals who reported self-perceived oral health as bad ('bad' or 'very bad') were significantly more likely to be older, male, less educated, poorer; they also reported more frequently to have lost more teeth and not visiting the dentist for routine dental 'checkup'. Among those who reported visiting for dental checks at least annually, 3% reported bad oral health, as opposed to 15% among those who reported visiting the dentist only when in trouble. Compared with those who reported visiting the dentist at least annually, odds ratio of bad oral health was 3.9 (95% CI, 2.68-5.67) for subjects who reported visiting only when in trouble, 2.6 (95% CI, 1.51-4.62) who reported visiting for dental checks less frequently than once every 2 years, and 1.4 (95% CI, 0.77-2.52) for subjects who reported visiting for dental checks once every 2 years, after controlling for sex, age, education, income and tooth loss. CONCLUSIONS: Not visiting the dentist for a routine dental check increased the chance of reporting one's own oral health as bad. In any case, the habit of visiting for dental 'checkup, once per year or once every 2 years was associated with nearly all the individuals perceiving his/her oral health positively. However, in order to gather more solid scientific data to guide public policies it is necessary to perform longitudinal studies, especially experiments in different populations focused mainly on the socioeconomic characteristics and dental clinical conditions.

Multilevel modelling of the incidence of visceral leishmaniasis in Teresina, Brazil.

Epidemics of visceral leishmaniasis (VL) in major Brazilian cities are new phenomena since 1980. As determinants of transmission in urban settings probably operate at different geographic scales, and information is not available for each scale, a multilevel approach was used to examine the effect of canine infection and environmental and socio-economic factors on the spatial variability of incidence rates of VL in the city of Teresina. Details on an outbreak of greater than 1200 cases of VL in Teresina during 1993-1996 were available at two hierarchical levels: census tracts (socio-economic characteristics, incidence rates of human VL) and districts, which encompass census tracts (prevalence of canine infection). Remotely sensed data obtained by satellite generated environmental information at both levels. Data from census tracts and districts were analysed simultaneously by multilevel modelling. Poor socio-economic conditions and increased vegetation were associated with a high incidence of human VL. Increasing prevalence of canine infection also predicted a high incidence of human VL, as did high prevalence of canine infection before and during the epidemic. Poor socio-economic conditions had an amplifying effect on the association between canine infection and the incidence of human VL. Focusing interventions on areas with characteristics identified by multilevel analysis could be a cost-effective strategy for controlling VL. Because risk factors for infectious diseases operate simultaneously at several levels and ecological data usually are available at different geographical scales, multilevel modelling is a valuable tool for epidemiological investigation of disease transmission.

A modelling analysis of pertussis transmission and vaccination in Rio de Janeiro, Brazil.

Pertussis is an infectious respiratory disease for which mass vaccination is an effective preventive strategy. In many developed countries, where high vaccination coverage has been maintained for approximately 50 years, re-emergence of the disease has been observed in all age groups. In the municipality of Rio de Janeiro (RJ), where vaccination started in the 1980s, surveillance data show no sign of disease re-emergence. We developed a mathematical model that incorporates the major demographic aspects of a large urban centre in a developing nation, in addition to the most important epidemiological aspects of disease transmission. Parameter values were estimated based on RJ demographic and vaccine coverage data. Overall, all vaccination strategies determined a major decrease (over 95% decrease when compared to the pre-vaccine era) in the incidence of primary infections (occurring in individuals who have never been immunized through infection or vaccine). On the other hand, the strategies (a) three doses at age 2-11 months, (b) three doses plus booster at age 12-23 months, (c) three doses plus booster at age 4-5 years, and (d) three doses plus both boosters, differently affected the incidence of secondary infections (occurring in previously infected/vaccinated individuals). Given that the immunity against pertussis wanes with time and that the infectious agent has not been eliminated from the population, it is expected that pertussis will continue to be a problem in RJ. Actually, since immunity acquired from vaccine wanes faster than disease-acquired immunity and the possibility of natural boosters has decreased with mass vaccination, an increase in the incidence of secondary infections among older age groups is expected (and predicted by the model). Possible explanations as to why this dynamics is not captured by the RJ surveillance system are discussed. A poorly effective surveillance system and a lack of awareness regarding loss of immunity and the possibility of pertussis infection in older age groups are among them. Finally, we bring attention to the need of (i) field studies for the measurement of pertussis incidence in adolescents and adults; (ii) better understanding of the transmission dynamics currently occurring in RJ, and (iii) re-evaluation of vaccination strategies with the possible introduction of acellular vaccines for the vaccination of older individuals.

Household structure and urban services: neglected targets in the control of visceral leishmaniasis.

Visceral leishmaniasis (VL) caused by Leishmania chagasi is a growing public-health problem in many parts of the New World. Although several studies have focused on the consequences of environmental damage, human migration and land occupation on the incidence of VL, the effects on the disease of the substandard living conditions that often result from the process of urbanization have not been investigated in detail. The present study was based in the Brazilian city of Teresina, where, since 1980, there have been two large outbreaks of VL (one in 1981-1985 and the other in 1993-1996), each involving at least 1000 newly reported cases. The role of household structure and the provision of urban services in the city, as predictors of the occurrence of VL, was studied in a case-control investigation. After controlling for age, crowding, and the background incidence of VL in the area where the subjects lived, the risk of acquiring the disease was found to be significantly higher for those who lived in houses with an inadequate sewage system and those who had no regular rubbish collection. Improving household structure and providing basic urban services might be effective strategies for controlling the spread of VL in urban areas.

Family socio-economic background modified secular trends in age at menarche: evidence from the Pró-Saúde Study (Rio de Janeiro, Brazil).

BACKGROUND: Since age at menarche has been associated with socio-economic status, its downward secular trend might vary according to the different socio-economic status levels of the family in which women lived during their childhood. AIM: This study seeks to describe secular trends in age at menarche for Brazilian women whose fathers had different levels of educational attainment. SUBJECTS AND METHODS: A self-administered questionnaire was applied to 2053 women born between 1931 and 1977. Multiple linear regression models were employed to estimate trends in age at menarche according to categories of educational level of the participants' father. RESULTS: The age at first menstruation varied from 7 to 19 years, with a mean age of 12.3 years (+/- 1.64 SD). The reduction in age at menarche was 2.4 months per decade for all women. Among daughters of fathers with less than 8 years of schooling this reduction was 3.6 months per decade, and among daughters of fathers with 8 years or more of study it was 1.2 months per decade. CONCLUSION: Improvements in living conditions in Brazil over the last decades seem to have had a stronger effect on the reduction of the age at menarche among women who lived their childhood in worse socio-economic standards.

Prognostic factors for death from visceral leishmaniasis in Teresina, Brazil.

BACKGROUND: A possible strategy to reduce fatality rates of visceral leishmaniasis is to identify prognostic factors that can be easily assessed and used as an aid to clinical decision-making. PATIENTS AND METHODS: A case-control study was developed in Teresina, Brazil, in which cases were patients who died during treatment (n = 12) and controls (n = 78) comprised a random sample of patients who were alive when treatment was finished. RESULTS: Variables significantly associated with death were severe anemia, fever for more than 60 days, diarrhea and jaundice. The prognostic system had a sensitivity of 85.7% and a specificity of 92.5%. CONCLUSION: The prognostic model developed in this study had satisfactory performance and might be useful in developing countries, since it is simple and inexpensive. However, it is still preliminary and needs to be improved and validated using larger and more recent samples.

The burden of Leishmania chagasi infection during an urban outbreak of visceral leishmaniasis in Brazil.

First noted in the city of Teresina in 1981, the last decades have witnessed a remarkable increase in urban transmission of American visceral leishmaniasis (VL) in many Brazilian cities. Teresina, the site of this study, has faced two large outbreaks of VL. The first occurred from 1981-1985 when almost 1000 new cases were reported. The second started in the 1990s, and between 1993 and 1996 more than 1200 new cases were detected. This report describes the prevalence of infection with Leishmania chagasi in Teresina at the end of the second outbreak and gives estimates of the number of people who became infected during the epidemic. Between June 1995 and May 1996, 200 households were chosen at random from a list of addresses covering about 93% of Teresina's urban households. In each household, one person over the age of 1 year was screened for Leishmania antibodies and skin-tested. Nearly 50% of persons had a positive leishmanin reaction, but only 13.9% had detectable antibodies to L. chagasi. While prevalence estimates based on the leishmanin skin-test increased with age (P<0.001), those based on serological tests showed a lesser, and non significant, variation with age (P=0.31). Using a geometric growth equation, and assuming that the annual distribution of clinical cases may serve as an approximation to what would have been the distribution of infections by year, we estimated that over 320000 persons were infected during the epidemic. Little is known about the epidemiology of VL in urban areas, where social networks, population density, and relationships of housing with the natural environment are more varied and complex than in the rural scene. In those areas, control interventions have failed to eliminate transmission of the parasite and prevent new epidemics. Further epidemiological studies of VL in urban areas might be needed to inform control actions.

The epidemiology of hepatitis A in Rio de Janeiro: environmental and domestic risk factors.

A serological study of hepatitis A was carried out in low-income areas scheduled for a major sanitation programme in Rio de Janeiro, Brazil. Blood spots were collected by finger puncture and transported on filter paper, and total antibodies to hepatitis A virus were detected by ELISA. Households were also interviewed to collect information on their environmental conditions and socio-economic status. A generalized linear model using a complementary log-log function was fitted to the data, using the logarithm of age as an explanatory variable to derive adjusted rate ratios (RR). The risk of infection was greater among households with 2-3 members per room (RR = 1.4; 95% CI = 1.04-1.8) or more than three per room (RR = 1.5; 95% CI = 1.2-2.0). People living on hilltops (RR = 1.5; 95% CI = 1.02-2.2), near to open sewers (RR = 1.2; 95% CI = 1.03-1.5) or lacking a kitchen (RR = 1.4; 95% CI = 1.08-1.9) were also at greater risk than others. The number of taps and water-using fittings in the house was associated with a protective effect (RR = 0.9 for each tap; 95% CI = 0.9-0.98). A significant protective association was found with maternal education but not with gender or household income. The results do not suggest a strong association with water quality. Ownership of a ceramic water filter was associated with a protective effect on the margin of significance, but the practice of boiling drinking-water was not, nor was the type of water source used. The results suggest that that the risk of infection with hepatitis A is determined by environmental variables in the domestic and public domains.

Classification trees and logistic regression applied to prognostic studies: a comparison using meningococcal disease as an example.

The authors used logistic regression and classification trees to develop prediction models for fatal outcomes in meningococcal disease in a cohort of 829 children hospitalized for meningococcal disease during 1989-1990 in Rio de Janeiro. The area under the receiver operator characteristic (ROC) curve was 92 per cent for logistic regression and 88 per cent for classification trees. Logistic regression may be preferred when the main objective is to obtain explicit measures for statistical inference and measures of the force of the association between each variable and the outcome. However, estimation of the probability of dying for each patient involves manipulation of the logistic regression formula, which would not easily be done in an emergency room. Classification trees provided comparable discrimination between fatal and non-fatal outcomes, and yielded a graphical display of the results that is easier to understand and is straightforward to apply in clinical settings.

Doppler echocardiographic evaluation of HIV-positive patients in different stages of the disease.

OBJECTIVE: To evaluate by Doppler echocardiography (DE) early abnormalities of ventricular function in HIV-positive patients, as well as other cardiac abnormalities that can be detected by this method, with special emphasis on mitral valve flow. METHODS: 84 HIV-positive patients, 59 with CD4 cell count > 500/mm3 (Group A) and 25 with CD4 cell count < 500/mm3 (Group B), were analyzed. CD4 cells were counted and matched with structural data and systolic and diastolic function of the left ventricle (LV), as analyzed by DE. The results were compared with those obtained in 47 healthy individuals (Group C). RESULTS: 8% of patients in Group B had mild pericardial effusion; 31.5% showed decreased systolic function of the LV, and 12% had moderate mitral regurgitation. A wave velocity from the mitral inflow was different among the 3 groups, being higher in Group B, where the deceleration time of the E wave of the mitral inflow and the E/A ratio were significantly lower with a normal value of the isovolumic relaxation time (IVRT). CONCLUSION: HIV-positive patients with a CD4 cell count > 500/mm3 had no abnormalities by DE. Patients with a more advanced infection (those with a CD4 cell count < 500/mm3), had a significantly abnormal LV systolic function and a higher incidence of pericardial effusion and mitral regurgitation. Mitral valve inflow by Doppler did not indicate diastolic dysfunction.

Paediatric burns and associated risk factors in Rio de Janeiro, Brazil.

This is a case-control study conducted at two major public units for paediatric burn injuries in Rio de Janeiro, Brazil. Cases (n = 94) were 0-11-year-old Brazilian children admitted to one of these two burn units. Controls (n = 148) were 0-11-year-old children admitted to the paediatric clinics of the two hospitals where the cases were chosen and from another hospital placed at the same geographic region. Odds ratios (OR) based on logistic regression and 95 percent confidence intervals (95%-CI) were estimated for a number of putative risk factors. The risk of burns was higher for children who lived in crowded households (OR = 2.2; 95%-CI = 1.1-4.7), were not the first-born (OR = 2.5; 95%-CI = 1.2-5.2), had a pregnant mother (OR = 5.0; 95%-CI = 1.2-21.8), had a mother recently dismissed from a job (OR = 7.0; 95%-CI = 1.5-33.9) and had recently moved residence (OR = 4.9; 95%-CI = 1.7-14.3). A history of previous accident had a significant protective effect among males who lived in good environmental conditions (OR = 0.3; 95%-CI = 0.1-0.7), whereas no significant effect was detected in any other strata of gender and living conditions. Proper regulation of design and production of industrial products such as alcohol and domestic stoves, coupled with adequate social support and health education programmes could contribute to lower the incidence of severe burn injuries.