Patrícia Emília Braga

Hepatitis C Virus Coinfection in a Cohort of HIV-Infected Individuals from Santos, Brazil: Seroprevalence and Associated Factors

Although HIV/hepatitis C virus (HCV) coinfection has been recognized worldwide in individuals exposed to blood-borne and sexually transmitted diseases (STD), limited data are available on the epidemiology of this coinfection in Brazil. A cross-sectional study was carried out to estimate the prevalence of HCV seropositivity in a cohort of people living with HIV/AIDS in Santos, Brazil, and to investigate potential risk factors for HCV infection. Anti-HCV antibodies were sought by using two immunoenzymatic assays. Overall HCV seroprevalence was 36.2% (95% confidence interval [CI] 31.9-40.4%). However, it was significantly higher (84.8%, 95% CI 78.2-91.3%) among intravenous drug users (IDU) as compared to non-IDU (20.9%, 95% CI 16.8-25.1%) (p < 0.001). Multiple logistic regression analysis revealed that HCV seropositivity among IDU was independently associated with needle sharing (adjusted odds ratio [adjOR] = 4.28, p = 0.07) and with serologic evidence of exposure to other bloodborne agents: HBV (adjOR = 4.39, p = 0.01) and HTLV-I/II (adjOR = 6.43, p = 0.02). In contrast, no association with lifetime number of sexual partners, history of STD, or of sex with commercial sex workers (CSW) could be demonstrated. Among non-IDU, HCV seropositivity was independently associated with sexual partnership with IDU (adjOR = 2.15, p = 0.08) and with HBV seropositivity (adjOR = 1.71, p = 0.05), but not with engaging in oral or anal receptive intercourse or having sex with CSW. Results indicate that exposure to blood and sexual partnership with IDU constitute the main risk factors for HCV acquisition among HIV-positive patients in Santos, Brazil. Prevention of HCV spread in this population should thus include harm reduction measures and information on safer sex practices for both IDU and their sexual partners.

Fatores associados à realização de exames preventivos para câncer nas mulheres brasileiras, PNAD 2003

Estudar fatores associados a realizacao dos exames Papanicolaou e mamografia por mulheres brasileiras. Foram analisadas informacoes sobre mulheres com 25 anos ou mais, no suplemento Saude da Pesquisa Nacional de Amostras Domiciliares (PNAD) do IBGE 2003, de realizacao de Papanicolaou nos ultimos 5 anos e mamografia nos ultimos 2 anos, sua prevalencia por variaveis demograficas, socioeconomicas e saude, acesso e utilizacao de servicos de saude. Foram realizadas analise estatistica bivariada e regressao logistica para os dois procedimentos. A prevalencia para Papanicolaou foi 75,5% e mamografia 36,1%. A regressao logistica mostrou como principais fatores preditivos para Papanicolaou: ter filhos, consulta medica no ultimo ano, renda elevada, medio a alto grau de escolaridade, ter plano de saude e morar em zona urbana. Para mamografia mostraram-se fatores preditivos importantes: distribuicao etaria (40-59 anos), consulta medica no ultimo ano, morar em zona urbana, renda elevada e ter plano de saude. No Papanicolaou ha maior incorporacao na assistencia, e o acesso a consulta medica fator essencial para a realizacao do exame. Na mamografia, a prevalencia e mais elevada nas faixas etarias recomendadas, perfil diferenciado por acesso a consulta medica e condicao socioeconomica, e muitos exames em mulheres em faixas etarias nao recomendadas.

Câncer na infância: análise comparativa da incidência, mortalidade e sobrevida em Goiânia (Brasil) e outros países

Analysis of cancer incidence, mortality, and survival rates can yield geographic and temporal trends that are useful for planning and evaluating health interventions. This article reviews cancer incidence and mortality rates and respective trends around the world in children under 15 years old, as well as their 5-year survival rates in developed and developing countries. We conclude that even though increasing or stable childhood cancer incidence rates and decreasing mortality rates have been observed in developed countries, the trends remain unknown in developing countries. Data from the city of Goiania, Brazil, show stable childhood cancer incidence and mortality rates. Five-year survival rates (48%) in Goiania are similar to those seen in underdeveloped regions and lower than those reported in developed countries (64-70%).

Diferenças de gênero ao acolhimento de pessoas vivendo com HIV em serviço universitário de referência de São Paulo, Brasil

The number of women living with HIV has increased in Brazil, demanding special attention to womens needs. To evaluate gender differences at an HIV reference center in São Paulo, 1,072 patient medical records from 1998 and 2002 were reviewed. As compared to male counterparts, women tended to be younger and have less schooling, and higher proportions of women were married and heterosexual. Thirty-six percent of women had undergone HIV testing because of an HIV+ partner. In contrast, 43% of men had undergone testing because of AIDS symptoms. At admission, 55% of men and 38% of women had an AIDS diagnosis. Women presented higher CD4+ cell counts and a higher proportion of undetectable HIV viral loads. No difference in access to antiretroviral therapy was seen after stratification for clinical status. Although the observed gender differences in socio-demographic characteristics emphasize womens social vulnerability to HIV, as compared to men, women in this cohort sought specialized care at earlier stages of infection. Knowledge about particular gender characteristics at admission to a reference center may contribute to organizing services delivery, improving care, and maximizing benefits.

Incapacidade relacionada à dor lombar crônica: prevalência e fatores associados

Disability related to chronic low back pain (CLBP) is a complex and multidimensional phenomenon. The aim of the study was to identify the prevalence of disability and factors associated with disability outcome in 177 CLBP adults. Respondents were recruited from three health care service centers and answered questions from: Demographic Identification Form, Oswestry Disability Index, Chronic Pain Self-efficacy Scale, Tampa Scale Kinesiophobia, Beck Depression Inventory, and the Revised Piper Fatigue Scale. The prevalence of disability among the respondents was 65% (95% CI: 57.5 - 72.0), and disability was moderate to severe in 80.7% of them. The multiple regression model identified three factors as independently associated with disability: work situation, low self-efficacy and depression. The factors identified to be associated with disability are modifiable. Interventions such as work relocation, depression treatment and re-conceptualization of self-efficacy may have an important impact in preventing and reducing disability in chronic low back pain patients.A incapacidade relacionada a dor lombar cronica (DLC) e um fenomeno complexo e multifatorial. O objetivo desse estudo foi identificar a prevalencia e os fatores associados a incapacidade em pacientes com dor lombar cronica. Estudo transversal com amostra composta por 177 pacientes com DLC, de tres servicos de saude; que responderam ao formulario com dados demograficos, ao Inventario de Depressao de Beck, as Escalas Oswestry Disability Index, de autoeficacia para dor cronica, Tampa de Cinesiofobia e de Fadiga de Piper. A prevalencia de incapacidade foi de 65% (IC95%: 57,5 - 72,0) e era de moderada a grave em 80,7% dos pacientes. O modelo de regressao multipla identificou tres fatores independentemente associados a incapacidade: ausencia de trabalho remunerado, autoeficacia baixa e depressao. Os fatores associados a incapacidade identificados sao modificaveis. Intervencoes como recolocacao no trabalho, tratamento para a depressao e reconceitualizacao da crenca de autoeficacia podem ter um impacto importante na prevencao e reducao de incapacidade.

[Disability related to chronic low back pain: prevalence and associated factors].

Disability related to chronic low back pain (CLBP) is a complex and multidimensional phenomenon. The aim of the study was to identify the prevalence of disability and factors associated with disability outcome in 177 CLBP adults. Respondents were recruited from three health care service centers and answered questions from: Demographic Identification Form, Oswestry Disability Index, Chronic Pain Self-efficacy Scale, Tampa Scale Kinesiophobia, Beck Depression Inventory, and the Revised Piper Fatigue Scale. The prevalence of disability among the respondents was 65% (95% CI: 57.5 - 72.0), and disability was moderate to severe in 80.7% of them. The multiple regression model identified three factors as independently associated with disability: work situation, low self-efficacy and depression. The factors identified to be associated with disability are modifiable. Interventions such as work relocation, depression treatment and re-conceptualization of self-efficacy may have an important impact in preventing and reducing disability in chronic low back pain patients.A incapacidade relacionada a dor lombar cronica (DLC) e um fenomeno complexo e multifatorial. O objetivo desse estudo foi identificar a prevalencia e os fatores associados a incapacidade em pacientes com dor lombar cronica. Estudo transversal com amostra composta por 177 pacientes com DLC, de tres servicos de saude; que responderam ao formulario com dados demograficos, ao Inventario de Depressao de Beck, as Escalas Oswestry Disability Index, de autoeficacia para dor cronica, Tampa de Cinesiofobia e de Fadiga de Piper. A prevalencia de incapacidade foi de 65% (IC95%: 57,5 - 72,0) e era de moderada a grave em 80,7% dos pacientes. O modelo de regressao multipla identificou tres fatores independentemente associados a incapacidade: ausencia de trabalho remunerado, autoeficacia baixa e depressao. Os fatores associados a incapacidade identificados sao modificaveis. Intervencoes como recolocacao no trabalho, tratamento para a depressao e reconceitualizacao da crenca de autoeficacia podem ter um impacto importante na prevencao e reducao de incapacidade.

Clinical evaluation strategies for a live attenuated tetravalent dengue vaccine

Butantan Institute is a public Brazilian biomedical research-manufacturer center affiliated to the São Paulo State Secretary of Health. Currently, Butantan is one of the main public producers of vaccines, antivenoms, and antitoxins in Latin America. The partnership between Butantan and the National Institutes of Health (NIH) of the United Sates has been one of the longest and most successful partnerships in the development and manufacturing of new vaccines. Recently, Butantan Institute has developed and manufactured a lyophilized tetravalent live attenuated dengue vaccine with the four dengue viruses attenuated and licensed from the Laboratory of Infectious Diseases at The National Institutes of Allergy and Infectious Diseases (LID/NIAID/NIH). The objective of this paper is to describe the clinical evaluation strategies of a live attenuated tetravalent dengue vaccine (Butantan-DV) developed and manufactured by Butantan Institute. These clinical strategies will be used to evaluate the Butantan-DV Phase III trial to support the Butantan-DV licensure for protection against any symptomatic dengue caused by any serotype in people aged 2 to 59 years.

Prevalence of fatigue and associated factors in chronic low back pain patients

OBJECTIVES to determine the prevalence and key factors associated with fatigue in chronic low back pain patients. METHODS cross-sectional study of 215 chronic low back pain patients from three health care centers and two industrial corporations. The crude prevalence of fatigue and its 95% confidence interval (CI) were calculated. Associations between fatigue and the independent variables were measured. RESULTS the prevalence of fatigue among the participants was 26.0% [95% CI: 20.3-32.5]. Fatigue was independently associated with depression and self-efficacy. An increase of one unit in the score of depression increased the risk of fatigue by 9%; an increase of one unit in the score of self-efficacy reduced the risk of fatigue by 2%. CONCLUSIONS fatigue was prevalent in chronic low back pain patients and associated with depression and self-efficacy. Knowing these factors can direct strategies for prevention and control of fatigue in chronic low back pain patients.Objetivos: determinar a prevalencia e os principais fatores relacionados a fadiga em pacientes com dor lombar cronica. Metodos: trata-se de estudo transversal, com a participacao de 215 pacientes com dor lombar cronica, em tres centros de saude e duas industrias. Foram calculadas a prevalencia bruta de fadiga e seu intervalo de confiabilidade de 95% (IC). Resultados: a prevalencia de fadiga entre os participantes com dor lombar cronica foi de 26% [20,3–32,5; IC 95%]. A fadiga foi associada a depressao e a autoeficacia de forma independente. O aumento de um ponto no escore de depressao aumentou o risco de fadiga em 9% e o aumento de um ponto no escore de autoeficacia reduziu o risco de fadiga em 2%. Conclusoes: fadiga foi um fator predominante em pacientes com dor lombar cronica e indicou relacao com depressao e autoeficacia. O conhecimento desses fatores pode orientar estrategias para prevencao e controle da fadiga em pacientes com dor lombar cronica.

Associação entre dor crônica e autorrelato de quedas: estudo populacional ? SABE

Estudo populacional transversal com idosos sem deficit cognitivo residentes na cidade de Sao Paulo, Brasil. O objetivo foi avaliar a associacao entre dor cronica e autorrelato de quedas. Idoso com dor cronica foi considerado aquele com dor de duracao ha mais de um ano. Os dados foram coletados por entrevista domiciliar, e as analises foram realizadas no programa Stata 11.0. A prevalencia de dor cronica foi 29,7% (IC95%: 25,4-33,9); a prevalencia de queda, no ultimo ano, entre idosos com dor foi 31,6% (IC95%: 26,4-37,5) e nao diferiu da prevalencia entre idosos sem dor (26,4%; IC95%: 23,1-30,0; p = 0,145). No entanto, quando havia dor e osteoporose ou dor e incontinencia urinaria, o risco de quedas foi 50% (p = 0,019) e 48% maior (p = 0,010), respectivamente. A associacao dor cronica e osteoporose ou incontinencia urinaria elevou a chance de quedas em idosos.The objective of this study was to assess the association between chronic pain and self-reported falls. This was a cross-sectional sample of elderly individuals without cognitive deficits, living in the city of São Paulo, Brazil, and with chronic pain. The study considered elderly that reported chronic pain for at least one year. History of falls was defined as at least one reported fall in the 12 months prior to the study. Data were obtained by home surveys of the elderly. Stata 11.0 was used for statistical analysis. Prevalence of chronic pain was 29.7% (95%CI: 25.4-33.9). Prevalence of falls in the previous year for individuals with pain was 31.6% (95%CI: 26.4-37.5) and did not differ significantly from those without pain (26.4%; 95%CI: 23.1-30.0; p = 0.145). Risk of falls was 50% higher (p = 0.019) for those with pain and osteoporosis and 48% higher for those with pain and urinary incontinence (p = 0.010). History of pain for at least one year and osteoporosis, pain, and urinary incontinency showed higher odds of falls.

Sexual abuse victimisation and perpetration in a cohort of men living with HIV/AIDS who have sex with women from Sao Paulo, Brazil

Abstract Sexual abuse leads to physical harm and devastating psychosocial consequences. It increases risk of HIV transmission and is associated with risky behaviour. Little is known about sexual abuse victimisation (SAV) and perpetration (SAP) among HIV-positive men who have sex with women (MSW). We investigated self-reported SAV and SAP among 242 Brazilian MSW selected at HIV care centres. Patients were questioned about sociodemographic data, mode of HIV acquisition, sexual practices, drug use and history of SAV or SAP. Prevalence of outcomes was estimated and risk factors for SAP investigated by logistic regression. Fifty-eight (24.1%) interviewees reported SAV. Of patients abused before 15 years of age, 64.3% reported events before the age of ten. Aggressors included relatives, friends and teachers. Among those victimised after 15 years old, 57.7% described events before 17 and 38.5% had acquainted aggressors. Fourteen (5.8%) interviewees reported SAP and most knew their victims. Sexual abuse perpetration was associated with lower schooling, marital status, illicit drug use and self-reported SAV. Sexual abuse was frequently reported by MSW from this cohort. Identifying predictors of violence and addressing SAV and SAP in comprehensive HIV care may help reduce violent behaviour, psychological distress and contribute to maximise benefits of preventive and care interventions.