Eduardo Freese de Carvalho

Dengue and dengue hemorrhagic fever in the State of Pernambuco, 1995-2006

In Pernambuco, the first dengue cases occurred in 1987. After a seven-year interval without autochthonous cases, a new epidemic occurred in 1995. Important aspects of the dengue epidemics during the period 1995-2006 have been analyzed here, using epidemiological, clinical and laboratory data. A total of 378,374 cases were notified, with 612 confirmed cases of dengue hemorrhagic fever and 33 deaths. The mortality rate was 5.4%. The incidence rate increased from 134 to 1,438/100,000 inhabitants, corresponding to the epidemics due to serotypes 2 and 3, in 1995 and 2002, respectively. Dengue mainly affected adults (20-49 years); 40.7% were male and 59.3% were female. From 2003 onwards, the number of cases among individuals younger than 15 years old increased. Out of 225 dengue hemorrhagic fever cases, 42.7% primary and 57.3% secondary infections were identified (p = 0.0279). Neurological manifestations were also observed. From 2002 onwards, serotypes 1, 2 and 3 were circulating; serotype 3 was predominant.

Sexually transmitted infections in a female population in rural north-east Brazil: prevalence, morbidity and risk factors

Objectives To determine the prevalence of major sexually transmitted infections (STIs) and gynaecological morbidity in women of reproductive age living in rural communities in north‐east Brazil and to assess risk factors associated with the presence of STIs.

Atenção à saúde da criança: uma análise do grau de implantação e da satisfação de profissionais e usuários em dois municípios do estado de Pernambuco, Brasil

OBJECTIVES: to evaluate the implementation of child health care at two municipalities of the state of Pernambuco, Brazil. METHODS: evaluative research, implementation analysis. It was considered as units of analysis: unit of the Family Health Program (FHP) with professionals trainned in the Integrated Management of Childhood Illness Strategy (IMCI), unit without this training and conventional health care unit. The degree of implementation was achieved by case management and structure evaluation. Professional and users perceptions were appraised by interview and focus group discussion. RESULTS: degree of implementation satisfactory for FHP services, insatisfactory at the conventional unit in Municipality 1 and insatisfactory for units in Municipality 2. Professionals considered effectiveness of services and interpersonal relationship as good, but difficulties in the reference system and lack of integration with work group of conventional units. Users reported, good services effectiveness, but access and interpersonal relationship difficulties. CONCLUSIONS: deficiencies in case management and potentiality of the health care provided by nurse professional were determinant aspects for the variability on implementation degree. It was not possible to define the influence of the IMCI strategy. There is better professional and user satisfaction at FHP units, but problems of access and integrality of health care.

Avaliação da implantação da atenção à hipertensão arterial pelas equipes de Saúde da Família do município do Recife (PE, Brasil)

The implementation analysis of the arterial hypertension care by the Family Health teams in Recife city (Pernambuco, Brazil) was based on a normative evaluation of the structure and work process and analysis of some context elements. An interview was applied to a randomized sample of doctors and nurses of 72 Family Health teams and the hypertension programme coordinator, and official documents were analyzed. A score system was used to classify the performance of the implementation level in excellent (when 90-100% of activities were implemented); adequate (70-79%); inadequate (50-69%); and critical (<50%). The results show a significant weakness in the arterial hypertension care by the Family Health teams in Recife. The absence of specific programme coordination is related to the low performance observed. The implementation level was considered inadequate and some problems were identified due to the poor infrastructure, deficient inputs, low professional qualification for hypertension care and insipient use of information for planning the actions.

Description of a Prospective 17DD Yellow Fever Vaccine Cohort in Recife, Brazil

From September 2005 to March 2007, 238 individuals being vaccinated for the first time with the yellow fever (YF) -17DD vaccine were enrolled in a cohort established in Recife, Brazil. A prospective study indicated that, after immunization, anti-YF immunoglobulin M (IgM) and anti-YF IgG were present in 70.6% (IgM) and 98.3% (IgG) of the vaccinated subjects. All vaccinees developed protective immunity, which was detected by the plaque reduction neutralization test (PRNT) with a geometric mean titer of 892. Of the 238 individuals, 86.6% had IgG antibodies to dengue virus; however, the presence of anti-dengue IgG did not interfere significantly with the development of anti-YF neutralizing antibodies. In a separate retrospective study of individuals immunized with the 17DD vaccine, the PRNT values at 5 and 10 years post-vaccination remained positive but showed a significant decrease in neutralization titer (25% with PRNT titers < 100 after 5 years and 35% after 10 years).

Prevalência de osteoporose e fraturas vertebrais em mulheres na pós-menopausa atendidas em serviços de referência

Este estudo tem por objetivo verificar a prevalencia de osteoporose e a presenca de fraturas vertebrais em mulheres na pos-menopausa. Foram estudadas, em servicos de referencias, 627 mulheres com idade acima de 50 anos, com media de idade de 63,9 ± 8,3 anos, tempo de menopausa de 16,2 ± 8,6 anos, e indice de massa corporea de 26,6 ± 4.3 Kg/m2. A prevalencia de osteoporose foi de 28,8% na coluna lombar e de 18,8% no colo do femur. Esta foi maior nas pacientes que apresentaram historia de fraturas quando jovens. Na faixa entre 60 a 69 anos, 33,2% tinham osteoporose na coluna lombar e entre 70 e 79 anos, 38,2%. Das pacientes com mais de 80 anos 54,5% apresentam osteoporose na coluna lombar e 72,7% no colo do femur. Trinta e sete por cento tinham fraturas, sendo que 9% apresentam fraturas grau I, e 10,9% fraturas severas. Considerando-se os diversos grupos etarios, a prevalencia de fraturas vertebrais foi de 20% entre 50 e 59 anos, 25,6% entre 60 e 69 anos, 58,3% entre 70 e 79 anos, e 81,8% entre 80 e 89 anos. Em mulheres na pos-menopausa, a maioria sem sintomas clinicos, verificamos uma alta taxa de prevalencia de osteoporose, e fraturas vertebrais.

Tendência da mortalidade por doenças do aparelho circulatório no Brasil: 1950 a 2000

BACKGROUND The circulatory system diseases (CAD), one of the most important current health problems, have started to show a declining trend in mortality in several countries, although they are still proportionally the number one regarding the statistics of morbimortality. OBJECTIVE To analyze the mortality trend due to CAD in Brazilian capital cities, during the period of 1950 to 2000. METHODS Temporal series study, of Standardized Mortality Ratios by CAD. We used secondary data on death from the statistical annual reports from IBGE (the Brazilian Institute of Geography and Statistics) and from the Mortality Information System. We carried out a linear trend analysis of the Standardized Mortality Ratios due to CAD in the Brazilian capital cities that presented complete mortality series, considering the census years during the study period (1950 to 2000). RESULTS Although proportionally the CAD represent the main cause of death in the Brazilian population, as well as presenting a proportional increase during the period of analysis of this study, the risk of death, represented by the Standardized Mortality Ratios, have been decreasing, particularly from the eighties onward. It is noteworthy the fact that Fortaleza, Salvador, Belo Horizonte, Rio de Janeiro and São Paulo presented elevated Standardized Mortality Ratios, however with a decreasing trend (p<0.05 and p<0.10), since the start of the analyzed period. CONCLUSION The behavior of the risk of death due to CAD suggests that this group of diseases is the first to be established, following the increase in industrialization observed from the thirties onward and after the Second World War in Brazil, as it occurred in Sao Paulo and Rio de Janeiro, cities that historically experienced a process of development and urbanization earlier and at a higher extent, when compared to the other capital cities.FUNDAMENTO: As doencas do aparelho circulatorio (DAC), um dos mais importantes problemas de saude da atualidade, apesar de proporcionalmente ainda liderarem as estatisticas de morbi-mortalidade, comecam a apresentar tendencia declinante da mortalidade em diversos paises. OBJETIVO: Analisar a tendencia da mortalidade por DAC nas capitais brasileiras, no periodo de 1950 a 2000. METODOS: Estudo de serie temporal das razoes de mortalidade padronizadas por DAC. Utilizamos dados secundarios de obitos dos anuarios estatisticos do IBGE e do Sistema de Informacao de Mortalidade. Realizamos analise de tendencia linear das razoes de mortalidade padronizadas por DAC nas capitais brasileiras que apresentaram series completas de mortalidade, considerando os anos censitarios do periodo do estudo (1950 a 2000). RESULTADOS: Apesar de proporcionalmente as DAC representarem a primeira causa de obito na populacao brasileira, bem como apresentarem crescimento proporcional no periodo de analise deste estudo, o risco de obito, representado pelas razoes de mortalidade padronizadas, apresenta-se em decrescimo, particularmente a partir da decada de 80. Destacam-se as cidades de Fortaleza, Salvador, Belo Horizonte, Rio de Janeiro e Sao Paulo, que apresentam razoes de mortalidade padronizadas elevadas, porem em decrescimo (p < 0,05 e p < 0,10) desde o inicio do periodo analisado. CONCLUSAO: O comportamento do risco de obito por DAC sugere que esse grupo de enfermidades e o que primeiro se estabelece, acompanhando o aumento da industrializacao no Brasil, verificado a partir da decada de 1930 e apos a Segunda Guerra Mundial, Como ocorreu em Sao Paulo e Rio de Janeiro, que historicamente experimentaram um processo de desenvolvimento e urbanizacao anterior e diferenciado em relacao as outras capitais.

Repercussão das doenças crônicas não-transmissíveis na concessão de benefícios pela previdência social

This paper strives to identify the current impact of Non-Transmissible Chronic Diseases (NTCDs) on sickness and disability benefits paid out by Brazils National Social Security Institute (INSS) between 2000 and 2002. A total of 17,970 new cases were studied, registered at the two local agencies in Recife, Pernambuco State, Northeast Brazil. Initially the cases were divided up according by major diseases groups, following the CID-10 classification. Osteomuscular diseases (OMDs) and cardiovascular diseases (CVDs) were among the main reasons for granting sickness benefits. Among the disability benefits, CVDs, mental disorders (MDs), and OMDs, were the main reasons. In terms of specific diseases within the major DCNT groups, the main reasons for granting sickness benefits were high blood pressure, diabetes mellitus, arthrosis, breast and intestinal cancer, mood disorders and schizophrenia. For disability benefits, the main causes were cerebrovascular diseases, diabetes mellitus, cancer of the gastro-intestinal tract and schizophrenia. Most (66%) of the recipients were men between 39 and 58 years of age, and the initial value of the benefit was of up to three minimum wages per month.Este artigo busca identificar a repercussao das Doencas Cronicas Nao-Transmissiveis (DCNT) na concessao de auxilio-doenca e aposentadoria por invalidez, a partir das agencias do Instituto Nacional de Seguro Social (INSS), no periodo 2000-2002. Foi analisado o universo dos 17.970 beneficios concedidos, nas duas modalidades, do conjunto das agencias localizadas em Recife. Inicialmente, foram identificados os beneficios por todos os grandes grupos de doencas, de acordo com a CID-10. As doencas osteomusculares (DO) e as doencas do aparelho circulatorio (DAC) sao as principais causas para concessao de auxilio-doenca. Para aposentadoria por invalidez, as DAC, os transtornos mentais (TMC), e as DO sao as tres primeiras causas. As principais causas especificas de beneficios dentro dos grandes grupos das DCNT, foram identificadas, para a concessao de auxilio-doenca, a hipertensao arterial, a diabetes mellitus, as artroses, o câncer da mama e do intestino, os transtornos do humor e a esquizofrenia. Em relacao as aposentadorias por invalidez, as doencas cerebrovasculares, a diabetes mellitus, as artroses, o câncer do aparelho digestivo e a esquizofrenia. Dos beneficios concedidos, a maioria foi para homens (66%), entre 39 e 58 anos, e com valor mensal inicial de ate tres salarios minimos.

Evaluation of an interferon gamma assay in the diagnosis of latent tuberculosis infection in patients with rheumatoid arthritis.

The tuberculin skin test is not an ideal screening test for the patients with rheumatoid arthritis to identify cases of latent tuberculosis infection (LTBI) prior to the start of treatment with anti-TNFs, as it responds inadequately to late hypersensitivity, which is fundamental for producing a response to the inoculated antigen. Assays based on detection of the production of IFNγ in vitro by mononuclear peripheral cells stimulated by specific antigens are more specific than PPD in detecting LTBI. The aim of this study was to evaluate the performance of T-SPOT.TB in diagnosis of LTBI in patients with rheumatoid arthritis, comparing with the PPD. The specificity of the T-SPOT.TB varied from 87 to 90% and the negative-predictive value (NPV) from 94.4 to 100%. It can be concluded that the T-SPOT.TB showed high specificity and NPV, proving the capability of identifying false-negative cases of PPD, raising the level of safety for the use of anti-TNFs.

Avaliação do processo de implantação da estratégia da Atenção Integrada às Doenças Prevalentes da Infância no Programa Saúde da Família, no Estado de Pernambuco, Brasil

This evaluative study attempts to define the contextual determinants of the degree of implementation in the Integrated Management of Childhood Illnesses strategy in Pernambuco State, Brazil. A total of 33 Family Health Program teams were selected from 10 municipalities. In order to define the degree of implementation, the study used a specific score system and the process indicators provided by the strategy. Municipalities were classified as critical, unsatisfactory, and acceptable. All municipalities except for one presented an acceptable degree of implementation in relation to the structure. In relation to process evaluation, two municipalities received one follow-up visit and their scores were unsatisfactory. Four municipalities received two visits, and one was classified as unsatisfactory on the second follow-up visit, while another presented a critical score on the first follow-up visit. Among four municipalities that received three follow-up visits, one was classified as unsatisfactory in the three evaluations. Four municipalities achieved mean unsatisfactory scores, when considering the mean scores acquired in the three follow-up visits. There was no association between the organizational context and degrees of implementation.