Wildo Navegantes de Araújo

Influence of household rat infestation on leptospira transmission in the urban slum environment.

Background The Norway rat (Rattus norvegicus) is the principal reservoir for leptospirosis in many urban settings. Few studies have identified markers for rat infestation in slum environments while none have evaluated the association between household rat infestation and Leptospira infection in humans or the use of infestation markers as a predictive model to stratify risk for leptospirosis. Methodology/Principal Findings We enrolled a cohort of 2,003 urban slum residents from Salvador, Brazil in 2004, and followed the cohort during four annual serosurveys to identify serologic evidence for Leptospira infection. In 2007, we performed rodent infestation and environmental surveys of 80 case households, in which resided at least one individual with Leptospira infection, and 109 control households. In the case-control study, signs of rodent infestation were identified in 78% and 42% of the households, respectively. Regression modeling identified the presence of R. norvegicus feces (OR, 4.95; 95% CI, 2.13–11.47), rodent burrows (2.80; 1.06–7.36), access to water (2.79; 1.28–6.09), and un-plastered walls (2.71; 1.21–6.04) as independent risk factors associated with Leptospira infection in a household. We developed a predictive model for infection, based on assigning scores to each of the rodent infestation risk factors. Receiver operating characteristic curve analysis found that the prediction score produced a good/excellent fit based on an area under the curve of 0.78 (0.71–0.84). Conclusions/Significance Our study found that a high proportion of slum households were infested with R. norvegicus and that rat infestation was significantly associated with the risk of Leptospira infection, indicating that high level transmission occurs among slum households. We developed an easily applicable prediction score based on rat infestation markers, which identified households with highest infection risk. The use of the prediction score in community-based screening may therefore be an effective risk stratification strategy for targeting control measures in slum settings of high leptospirosis transmission.

Relação entre violência física, consumo de álcool e outras drogas e bullying entre adolescentes escolares brasileiros

O objetivo deste estudo foi identificar a associacao entre o consumo de alcool e outras drogas e o bullying com o envolvimento em situacoes de violencia fisica entre adolescentes de 13 a 15 anos, em escolas publicas e privadas das capitais brasileiras e do Distrito Federal. Foram analisados os dados da Pesquisa Nacional de Saude do Escolar (PeNSE) de 2009. Para analise dos dados foi utilizada a regressao logistica. A prevalencia de envolvimento em situacoes de violencia fisica foi 12,9% maior no sexo masculino. Em ambos os sexos, foram observadas associacoes entre violencia fisica e ser vitima de bullying com o uso de drogas ilicitas e efeito potencializado do consumo de alcool e drogas. Para o sexo masculino, o uso de alcool mostrou associacao significante com violencia fisica. Morar o pai ou ambos os genitores na residencia apresentou associacao inversa para violencia fisica no sexo feminino. O conhecimento de fatores associados a violencia fisica entre adolescentes e importante para auxiliar estrategias de promocao da saude e da cultura de paz, rompendo com a ideia de que a violencia entre adolescentes e algo banal e esperado.This study aimed to identify the association between alcohol and drug consumption and bullying on the one hand and involvement in situations of physical violence among adolescents 13 to 15 years in public and private schools in State capitals and the Federal District of Brazil. The study analyzed data from the National School Health Survey (PeNSE) for the year 2009. Data analysis used logistic regression. Prevalence of involvement in physical violence was 12.9% more common in boys than girls. Both genders showed associations between physical violence or being a victim of bullying and use of illegal drugs, plus the heightened effect of the combined consumption of alcohol and other drugs. In boys, alcohol consumption showed a significant association with physical violence. Having the father or both parents living at home was inversely associated with physical violence in girls. Knowledge of factors associated with physical violence among adolescents is important for supporting health promotion strategies and a culture of peace, thereby counteracting the idea of taking teenage violence for granted.

Molecular identification and typing of Mycobacterium massiliense isolated from postsurgical infections in Brazil

OBJECTIVE One hundred thirty-one cases of postsurgical infections were reported in Southern Region of Brazil between August 2007 and January 2008. Thirty-nine (29.8%) cases were studied; this report describes epidemiological findings, species identification, antimicrobial susceptibility and clonal diversity of rapidly growing mycobacteria isolated in this outbreak. METHODS All 39 isolates were analyzed by Ziehl-Nielsen stained smear, bacterial culture and submitted to rpoB partial gene sequencing for identification. The isolates were also evaluated for their susceptibility to amikacin, cefoxitin, clarithromycin, ciprofloxacin, doxycycline, tobramycin and sulfamethoxazole. RESULTS Thirty-six isolates out of the confirmed cases were identified as Mycobacterium massiliense and the remaining three were identified as Mycobacterium abscessus, Mycobacterium chelonae and Mycobacterium fortuitum. All M. massiliense isolates were susceptible to amikacin (MIC90 = 8 µg/mL) and clarithromycin (MIC90 = 0.25 µg/mL) but resistant to cefoxitin, ciprofloxacin, doxycycline, tobramycin and sulfamethoxazole. Molecular analysis by pulsed-field gel electrophoresis clustered all 36 M. massiliense isolates and showed the same pattern (BRA 100) observed in three other outbreaks previously reported in Brazil. CONCLUSIONS These findings suggest a common source of infection for all patients and reinforce the hypotheses of spread of M. massiliense BRA100 in Brazilian hospital surgical environment in recent years.

Risk Factors for Death from Pandemic (H1N1) 2009, Southern Brazil

To identify risk factors for death from pandemic (H1N1) 2009, we obtained data for 157 hospitalized patients with confirmed cases of this disease. Multivariate analysis showed that diabetes and class III obesity were associated with death. These findings helped define priority vaccination groups in Brazil.

Knowledge, attitudes, and practices related to Leptospirosis among urban slum residents in Brazil.

Leptospirosis disproportionately affects residents of urban slums. To understand the knowledge, attitudes, and practices regarding leptospirosis, we conducted a cross-sectional study among residents of an urban slum community in Salvador, Brazil. Of the 257 residents who were interviewed, 225 (90%) were aware of leptospirosis and more than two-thirds of respondents correctly identified the modes of disease transmission and ways to reduce exposure. However, study participants who performed risk activities such as cleaning open sewers had limited access to protective clothing such as boots (33%) or gloves (35%). Almost all respondents performed at least one activity to prevent household rat infestation, which often included use of an illegal poison. Our findings support the need for interventions targeted at the individual and household levels to reduce risk of leptospirosis until large-scale structural interventions are available to residents of urban slum communities.

Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09‐related pneumonia: an individual participant data meta‐analysis

The impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection.

Years of potential life lost and hospitalization costs associated with leptospirosis in Brazil

OBJECTIVE To estimate costs of hospitalization and years of potential life lost associated with leptospirosis. METHODS Databases of the Brazilian Ministry of Healths information system were used to carry out probabilistic linkage of cases and hospitalizations leading to death by leptospirosis in 2007. Within the Information System for Notifiable Diseases, confirmed cases were subdivided into hospitalization and death. These were then linked to the Hospital Information System (records with primary diagnosis) and the Mortality Information System (underlying cause of death A27.0, A27.8, and A27.9) databases. The partial cost of hospitalization, deaths by disease, and years of potential life and work lost, were estimated. RESULTS Most hospitalizations leading to death occurred among males aged 18-49 years, of white ethnicity, living in urban areas, and with incomplete elementary education. Years of potential life lost amounted to 6,490, 75% of which were in the 20-49 years age group. When adjusted for the population, this loss represented 15 days of life/thousand persons. The ratio of years of potential life lost to number of deaths was on average 30 years per death. The estimated financial impact amounted to R

Mortality Due to Chagas Disease in Brazil According to a Specific Cause

22.9 million in non-earned wages. Hospitalization costs totaled R

Anos potenciais de vida perdidos e custos hospitalares da leptospirose no Brasil

831.5 thousand. Estimated days of wages lost per admission period (median: 6 days) amounted to R

Risk Factors for Mycobacterium abscessus subsp. bolletii infection after laparoscopic surgery during an outbreak in Brazil.

103.0 thousand. CONCLUSIONS There was a high social cost in terms of years of potential life lost and partial hospital costs associated with leptospirosis when compared to the possibility of early treatment or prevention of infection, both of which could minimize the impact of the disease on the Brazilian population.OBJETIVO: Estimar los costos asociados a la hospitalizacion y los anos potenciales de vida perdidos debido a la leptospirosis. METODOS: Se utilizaron los bancos de datos de sistemas de informacion en salud del Ministerio de la Salud para la conexion probabilistica de los casos e internaciones que evolucionaron a obito por leptospirosis en 2007. En el Sistema de Informacion de Agravios de Notificacion los casos confirmados fueron subdivididos en internacion y obito, siendo relacionados con las siguientes bases: Sistemas de Informaciones Hospitalarias (registros con diagnostico principal) y Sistemas de Informaciones sobre Mortalidad (causa basica del obito, A27.0, A27.8 y A27.9). Se estimaron los costos parciales de internacion, los obitos por la enfermedad, los anos potenciales de vida y de trabajo perdidos. RESULTADOS: Las caracteristicas de la mayoria de las internaciones que evolucionaron para obito eran: sexo masculino, entre 18 y 49 anos, raza blanca, zona urbana y educacion primaria incompleta. Fueron 6.490 anos potenciales de vida perdidos, siendo 75% del grupo de edad de 20 a 49 anos. Al realizar ajuste en la poblacion, la perdida fue de 15 dias de vida/1.000 habitantes. La proporcion de anos potenciales vida perdidos por el numero de obitos fue en promedio de 30 anos perdidos para cada obito. El impacto financiero estimado fue equivalente a R