Anderson Soares da Silva

Avaliação crítica do Sistema de Informação da Atenção Básica (SIAB) e de sua implantação na região de Ribeirão Preto, São Paulo, Brasil

As the health information system used by the Family Health Program teams, the Primary Care Information System (SIAB) is a potential tool for follow-up of registered families and local planning, thus motivating the present study. Semi-structured interviews were held with key individuals in this health information system chain, among Family Health Teams in the municipality of Ribeirao Preto and surrounding region, Sao Paulo State, Brazil, with the objective of analyzing certain characteristics in the system, including: knowledge and having received training to handle it and utilization for local planning and social control. The study concluded that the SIAB is an easy system to handle, but that it presents some limitations already found in other health information systems, such as: difficulty in identifying individuals in the program, limited number of diseases reported, and limited utilization to back planning and decision-making at the local level. Therefore, the analysis of the SIAB was highly important for improving this health information system and can contribute to future improvements and adaptations in the program.

Fatores associados à procura por serviços de saúde numa perspectiva relacional de gênero

Male culture values involve risk behaviors to health, since the way men perceive and experience their masculinity is one of the most influential shapers of falling sick and dying. The scope of this study was to identify the factors associated with the demand for health services and differences between the sexes by selecting users of health services. The dependent variables were sex of the user (cultural indicator) and failure to seek out health services. Independent variables included socio-demographic and clinical-epidemiological characteristics. The Prevalence Ratio studied by univariate and multivariate analysis was used in the analysis of the association between variables. The factors associated with non-demand for health services included: being male, hours of operation of health care facilities, working hours of the user and not having any disease. By multivariate analysis the factors facilitating demand for health services (protection) were: being female aged 26 to 49 years. Effective consolidation of a health care model that questions the contradiction that exists between the epidemiological data regarding mens health and the position of the health services using common sense regarding the apparent invulnerability of men to falling sick is of great relevance.

Impact of the antipneumococcal conjugate vaccine on the occurrence of infectious respiratory diseases and hospitalization rates in children

INTRODUCTION In 2010, to reduce the occurrence of serious pneumococcal disease, the Ministry of Health in Brazil incorporated the 10-valent pneumococcal vaccine in the immunization schedule of children younger than two years of age. The objective of this study was to evaluate the impact of vaccination on the incidence of infectious respiratory diseases in infants before and after the introduction of the 10-valent pneumococcal vaccine. METHODS This cross-sectional study involved primary care and hospital networks from a city in Minas Gerais State, Brazil, between 2009 and 2012. RESULTS A 40% reduction in the prevalence of community-acquired pneumonia (CAP) was observed after introducing the pneumococcal conjugate vaccine. Male children were 28% more likely to develop the disease. The prevalence ratio ([PR] = 1.96, 95% CI: 1.52 to 2.53, p < 0.05) suggested that not being vaccinated was associated with the occurrence of pneumonia. The prevalence of CAP was 70% lower (PR 0.30, 95% CI: 0.24 to 0.37, p<0.05) in children vaccinated as recommended compared to children with delayed vaccination, suggesting that the updated vaccine schedule improves protection. CONCLUSIONS Immunization with the 10-valent pneumococcal vaccine appeared to reduce the number of pneumonia cases in children during the study period. Prospective studies are needed to confirm the efficacy of the vaccine against the occurrence of pneumococcal pneumonia.

Análise dos fatores associados a quedas com fratura de fêmur em idosos: um estudo caso-controle

OBJECTIVE: To identify the main factors associated to falls and hip fractures in the elderly. METHODS: This is a case-control study (a group of cases and two control groups) in a 1: 1: 1 proportion, studying 135 individuals aged ≥60 years, matched by sex, from 2005 to 2012. Data were collected through interviews at the homes of participants, and information was gathered from medical records. To analyze the differences between proportions and means between groups, they employed the chi-square and Students t test, respectively. To study the association between variables, were performed univariate and multivariate analyzes using logistic regression. As effect measure, were employed odds ratio (OR) and its confidence interval at 95% (95%). In all analyzes, we considered a 5% significance level. RESULTS: After multivariate analysis, hip fracture protection factors were: listen well and have handrails on the stairs of their homes. Risk factors for hip fracture were: hypertension, sedentary lifestyle and have slippery surface in the residence. Protective factors for fall were: have handrails on the stairs of their homes, have osteoporosis and depression. Risk factor for falls was physical inactivity. CONCLUSION: Hip fractures are an important cause of morbidity in the elderly. Knowing the risk factors for post-fall fractures in the elderly is essential for planning individual and collective actions aimed at prevention of this disease and its consequences. Physical activities, more effective treatment plans and inadequacies correction in households of those individuals should be counseled and encouraged.

Chronic liver disease prevention strategies and liver transplantation

Chronic liver disease is a considerable burden on society, being one of the three main causes of death in certain regions of Africa and Asia. Liver transplant is the only treatment option for cirrhosis, which is the end stage of many chronic liver diseases. This article reviews the preventable causes of cirrhosis and the preventive strategies which could be implemented in order to avoid the catastrophic consequences of cirrhosis. With small variations around the world, 70 to 80% of the end stage liver diseases are caused by excessive alcohol consumption and by viral hepatitis, both of which are potentially preventable. Excessive alcohol consumption has important public health consequences because of its involvement not only with cirrhosis, but also with motor vehicle accidents, unemployment, domestic violence etc. Among the viral causes, Hepatitis Virus B and C have the greatest impact on public health. Effective vaccine is available for Hepatitis Virus B and must be put in use. While a vaccine for Hepatitis Virus C is awaited, effective preventive strategies should be undertaken to avoid the preventable cases of end stage liver disease.As doencas hepaticas cronicas estao entre as tres principais causas de morte na Africa e Asia.O transplante de figado e o unico tratamento curativo para esta doenca hepatica de carater terminal.O presente artigo tem como objetivo apresentar as causas passiveis de prevencao de cirrose e as estrategias que podem ser utilizadas no sentido de preveni-las. Com pequenas variacoes ao redor do mundo, 70 a 80 % das doencas hepaticas terminais sao causadas por consumo excessivo de alcool e por hepatites virais que sao doencas passiveis de prevencao.O consumo excessivo de alcool e importante problema de saude publica, pois envolve violencia domestica, acidentes de trânsito, alem da possivel evolucao para cirrose e suas consequencias. Entre as causas virais as hepatites pelo virus B e C tem o maior impacto na saude publica. Para a hepatite B ja ha vacinas disponiveis. Enquanto a vacina para a hepatite C e ainda aguardada, estrategias efetivas de prevencao devem ser efetuadas com o objetivo precipuo de se evitar, por consequencia, casos de hepatopatias cronicas desta natureza.

Impact of the pneumococcal 10-valent vaccine on reducing hospitalization for community-acquired pneumonia in children.

Abstract Objective: To describe and analyze the occurrence of hospitalizations for community-acquired pneumonia in children before and after the pneumococcal 10-valent conjugate vaccine implementation into the National Immunization Program. Methods: This is an ecological study that includes records of children younger than one year old, vaccinated and not vaccinated with the pneumococcal 10-valent conjugate vaccine in the periods pre- and post-inclusion of the vaccine in the National Immunization Program in the area covered by the Regional Health Superintendence of Alfenas, state of Minas Gerais, Brazil. Vaccination was considered as the exposure factor and hospitalization for community-acquired pneumonia as the endpoint, using secondary annual data by municipality. The prevalence ratio and its 95% confidence interval (95%CI) were used to verify the association between variables. The Z test was used to calculate the difference between proportions. Results: Considering the 26 municipalities of the Regional Health Superintendence of Alfenas, there was a significant reduction in hospitalizations for community-acquired pneumonia in children younger than one year of age, with prevalence ratio (PR)=0.81 (95%CI: 0.74-0.89; p<0.05), indicating a 19% lower prevalence of hospitalization for community-acquired pneumonia in the post-vaccination period. Conclusions: The results suggest the effectiveness of the pneumococcal 10-valent conjugate vaccine in preventing severe cases of community-acquired pneumonia in children younger than one year of age.

Rituximab, fludarabine, and cyclophosphamide versus fludarabine and cyclophosphamide for treatment of chronic lymphocytic leukemia: A systematic review with meta-analysis

BACKGROUND Chronic lymphocytic leukemia (CLL) is a disease of the lymphoid system, in which the most common therapy is fludarabine plus cyclophosphamide (FC). The addition of rituximab to FC has been used, a combination known as FCR. OBJECTIVES To perform a systematic review with meta-analysis of clinical trials between 2000 and 2012 comparing FC and FCR in patients with CLL. MATERIAL AND METHODS Electronic databases were searched using keywords related to the objectives of this review. The outcomes examined were progression-free survival and complete remission. RESULTS The progression-free survival and the overall survival showed significant difference between the two regimens, with complete remission being more frequent in FCR-treated patients (odds ratio=2.58; 95% CI: 2.13-3.13). Patients treated with FCR showed significantly higher neutropenia and serious adverse reactions. CONCLUSION Despite the favorable results of the FCR regimen on outcomes including complete remission, progression-free survival, and overall survival, there is a lack of methodological rigor and appropriate analyses in many of these studies, and thus, there is a need for further studies examining the effect of rituximab in CLL patients.

Assessment of microbiological air quality in hemato-oncology units and its relationship with the occurrence of invasive fungal infections: an integrative review

Worldwide aging of the human population has promoted an increase in the incidence of neoplasia, including hematological cancers, which render patients particularly vulnerable to invasive fungal infections. For this reason, air filtration in hematooncology units has been recommended. However, scarce literature has assessed the impact of microbiological air quality on the occurrence of fungal infections in this population. We performed an integrative review of studies in the MEDLINE database that were published between January 1980 and October 2012, using the following combinations of keywords: air × quality × HEPA, air × quality × hematology, and airborne fungal infections. The search yielded only 13 articles, suggesting that high-efficiency filtering of the ambient air in hemato-oncology units can prevent the incidence of invasive fungal infections. However, no randomized clinical trial was found to confirm this suggestion. Currently, there is no consensus about the maximum allowable count of fungi in the air, which complicates filtration monitoring, including filter maintenance and replacement, and needs to be addressed in future studies.

Performance of glycated haemoglobin (HbA1c) as a screening test for diabetes and impaired glucose tolerance (IGT) in a high risk population—The Brazilian Xavante Indians

AIMS To examine the properties of HbA1c to detect diabetes and IGT in adult Brazilian Xavante Indians, a high risk population for diabetes. METHODS The survey was carried out between October 2010 and January 2012 and based on a 75 g oral glucose tolerance test (OGTT). Basal and 2h capillary glycaemia were measured by HemoCue Glucose 201+; HbA1c using an automated high-performance liquid chromatography analyzer (Tosoh G7). RESULTS 630 individuals aged ≥ 20 years were examined and 80 had a previous diagnosis of diabetes. Sensitivity, specificity and accuracy for HbA1c ≥ 6.5% (≥ 48 mmol/mol) were 71.3%, 90.5% and 87.2%. The areas under the ROC curve (AUC) was 0.88 (95%CI: 0.83-0.93). To identify IGT, HbA1c values between 5.7% and 6.4% (39-47 mmol/mol) presented sensitivity, specificity and accuracy of 87.2%, 24.7% and 51.4%, with an AUC of 0.62 (95%CI: 0.57-0.67). CONCLUSIONS The ADA/WHO proposed cut-off of 6.5% (48 mmol/mol) for HbA1c was adequate to detect diabetes among the Xavante. However, the performance of the ADA proposed cut-off points for pre-diabetes, when used to detect IGT was inadequate and should not be recommended.

Fraturas de fêmur em idosos no Brasil: análise espaço-temporal de 2008 a 2012

Fraturas de femur em pessoas com idade igual ou superior a 60 anos (idosos) representam um grande impacto para a saude publica, e estao associadas a elevada morbimortalidade e grandes custos socioeconomicos. Buscou-se descrever temporal e espacialmente os casos de fratura de femur em idosos de todas as regioes do pais, por sexo, em um periodo de cinco anos. Foram realizadas descricoes de serie temporal e espacial bayesiana, baseadas em dados obtidos do Sistema de Informacoes Hospitalares do Sistema Unico de Saude (SIH-SUS), empregando modelo de regressao de Poisson, sobre os casos ocorridos entre os anos de 2008-2012. No periodo estudado ocorreram mais de 181 mil casos de fratura de femur, predominando o sexo feminino, sem correlacoes espaciais e diferencas temporais importantes. Apesar de nao se observar predominio de comportamento temporal e espacial, o numero de casos de fratura de femur no Brasil e alto e com grandes custos financeiros e sociais. Politicas publicas de saude visando a controlar os fatores predisponentes para esse evento devem ser urgentemente implementadas.