Jair Ferreira

Adherence to antiretroviral therapy in children: a study of prevalence and associated factors

The survival of children with AIDS has increased considerably with the use of more effective antiretrovirals, but the benefits of this therapy are limited by the difficulty of adherence to the treatment. This cross-sectional study aimed to estimate the prevalence of non-adherence to antiretrovirals among children residents in Porto Alegre, Rio Grande do Sul State, Brazil, and identifying associated factors. There were 194 child caregivers interviewed. The technique utilized to evaluate adherence allowed the detection of lack of understanding of the prescribed antiretroviral regimens, as well as conscious loss of doses. Non-adherence was defined when the child had taken less than 80% of the prescribed medication during the 24 h period prior to the interview. A general prevalence of non-adherence was 49.5%, which was higher than that estimated. The non-institutional caregivers had a prevalence rate of 55.7%, while the institutional caregivers had 22.2%. In multivariate analysis, the education of the caregiver was found to have a borderline association with the outcome. Institutionalized children and those taken care of by people with a higher educational level appeared to have more protection against non-adherence to antiretroviral therapy.

Factors associated with health-related quality-of-life in HIV-infected Brazilians

Acquired immunodeficiency syndrome HIV/(AIDS) infection has become a chronic disease. This change led to a growing interest in outcomes focusing on the individual, such as health-related quality-of-life (QoL), to assess the impact of treatments. Our study evaluated the impact of the use of antiretroviral drugs, factors related to the infection and socioeconomic factors on the HQoL of HIV-infected patients. A total of 367 patients answered the questionnaire based on the World Health Organization QoL for HIV brief version. According to the modified-Poisson regression approach, the use of antiretroviral drugs was associated with worse QoL in the domain of the level of independence (P = 0.016). Being unemployed was associated with a worse QoL (P < 0.05) in five out of six domains; the only exception was the domain of spirituality (P > 0.05). Among the factors assessed, the socioeconomic aspects were most significant in determining the HQoL of the patients studied.

Teste de rastreamento de alterações de fala para crianças

BACKGROUND: validation of a screening test to detect speech disorders in children. AIM: to present validation data of a new speech disorders screening test (Terdaf), developed by Brazilian researchers. METHOD: 2,027 children, of both genders, enrolled in the first grade of elementary public schools in Canoas (Brazil) during 2001 were selected by a probabilistic cluster sampling. In order to verify Terdafs sensibility and specificity, 200 children were re-evaluated by an expert in speech disorders who had no information about the screening test results. RESULTS: prevalence of speech disorders in this sample was of 26.7%. Terdaf´s sensibility was of 81.6% (95%CI 67.5 - 90.8%), specificity was of 44.4% (95%CI 36.0 - 53.2%). When children with speech disorders due to sociocultural issues were excluded from the sample with positive Terdaf results, the screening test specificity increased to 74.1%. CONCLUSION: the new tool for speech disorders screening has a quick and easy application format and can be used by education and health professionals. It can become an important ally in the early diagnosis of speech disorders as well as in the prevention of co morbidities associated to speech disorders. A few adjustments are necessary for the application of this test. These are discussed and presented in this article.

Adequação dos encaminhamentos de gestações de alto-risco na rede básica de atenção à saúde de Porto Alegre, Rio Grande do Sul, Brasil

OBJECTIVES: to determine the most prevailing causes and referral adequacy of prenatal patients from Porto Alegre, Rio Grande do Sul, metropolitan and rural areas. METHODS: 821 referrals to the High Risk Pregnancy Clinic of the Hospital Femina of the Grupo Hospitalar Conceicao, from July 1997 to July 2000 were reviewed. Referrals were classified as: confirmed, added, modified, not conclusive or not confirmed. RESULTS: 201 (24.5%) were considered inadequate. Most common causes for referring pre-natal patients were arterial hypertension and diabetes. Inadequacy was more frequent in pregnant women residing out of the metropolitan area and among the younger ones. The most frequent inadequacy causes were referrals based on bureaucratic reasons and lack of information. Kappa rates among diagnosis performed by primary care doctors and referral services were respectively 0.28 and 0.41. CONCLUSIONS: diagnosis agreement was determined to be low. There is a need for training to improve basic healthcare services specially focused on doctors working outside the metropolitan area.

Acidentes com perfurocortantes e cobertura vacinal contra hepatite B entre trabalhadores da Saúde no Município de Santa Rosa, Estado do Rio Grande do Sul, Brasil, 2008

Objective: to investigate vaccination coverage against hepatitis B and to describe the occurrence of perforating injuries among health workers in the municipality of Santa Rosa, state of Rio Grande do Sul, Brazil, in 2008. Methods: a cross-sectional study with 322 workers; statistic significance of the associations was evaluated by chi-square test and multivariate analysis by logistic regression. Results: coverage of vaccination of 87.9%; less coverage of vaccination was observed in professionals with high school graduation (OR 2.13; IC 95% : 1.01-4.48), working in hospitals (OR 4.91; CI 95% : 1.67-14.47); the prevalence on immunized professionals with testing performed up to six months was 78.8%; and the rate of injury due perforating instruments, 40.5%. Conclusion: high occurrence of these accidents and insufficient vaccination coverage shows health professionals vulnerability to hepatitis B infection, and necessity of more investments in prevention of occupational infection.

Leprosy in Southern Brazil: a twenty-year epidemiological profile

INTRODUCTION: This study evaluated leprosy rates in Rio Grande do Sul, an area with a historically low prevalence. However, recent studies are lacking. METHODS: Data extracted from a National Database were analyzed for clinical features and compared to 1980s data. Tendency was assessed via stationarity analysis. RESULTS: Between 1990 and 2011, 4,770 cases were reported (0.21/10,000 inhabitants; 95% CI = 0.19-0.24). Detection was slightly higher among males, 1.9% cases were among children and most multibacillary (74.7%) at diagnosis. CONCLUSIONS: Leprosy is controlled in RS, but most cases are multibacillary. Early identification is important to avoid disabilities due to late diagnosis.