Tag: pubmed

Rev Bras Epidemiol. 2021 Apr 9;24:e210016. doi: 10.1590/1980-549720210016. eCollection 2021.

ABSTRACT

OBJECTIVES: To propose a methodological path to investigate the coverage and information filling of maternal-infant deaths recorded in the Ministry of Health’s Mortality Information System for regional spaces.

METHODS: Four steps were proposed: 1) Assessment of the completeness of the maternal and child variables, which was measured using the deterministic linkage technique between the Mortality Information System (Sistema de Informações sobre Mortalidade – SIM) and the Live Birth Information System (Sistema de Informações sobre Nascidos Vivos – SINASC); 2) Application of the multiple imputation technique to achieve the total filling of the missing information of the variables; 3) Estimation of death coverage; 4) The Unknown Variable Information Index (Índice de Informação Desconhecida da Variável – IIDV) was measured, which represents the combined effect of data completeness and coverage of deaths. The proposal of the methodological path was exemplified for neonatal deaths in the municipalities of Paraíba that are part of the new classification proposed by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística – IBGE), as adjacent rural areas, in three triennium periods from 2009 to 2017.

RESULTS: The percentage of matching records was 45%. Most of the variables had a percentage of non-completion below 10% and around 17% for the mother’s education. Coverages ranged from 75 to 83%. The IIDV for all variables was between 21 and 36% after the linkage.

CONCLUSION: The path of the methodological proposal proved to be effective, which can be replicated to other regions, and can be extended to other categories of deaths such as post-neonatal. The combination of the proposed procedures demands low operating costs and their uses are relatively simple to be applied by the managers and technicians of the vital statistics information systems.

PMID:33852706 | DOI:10.1590/1980-549720210016

Cad Saude Publica. 2021 Apr 7;37(3):e00069820. doi: 10.1590/0102-311X00069820. eCollection 2021.

ABSTRACT

Vertical HIV transmission is still an important global public health problem. This study aimed to verify vertical HIV transmission in Rio Branco, Acre, Brazil, and to assess the possibility of its elimination. A cross-sectional study was conducted of HIV in pregnant women and a longitudinal study on the incidence of vertical HIV transmission in pregnant women living in the municipality (county) of Rio Branco in 2007-2015. The cohorts of pregnant women consisted of women who had liveborn children, stillbirths, or abortions. The data were obtained from the Brazilian Information System for Notificable Diseases (SINAN), Brazilian Information System on Live Births (SINASC), Brazilian Mortality Information System (SIM), and Brazilian Hospital Information Systems (SIH). Databases. Probabilistic database linkage was performed with the OpenRecLink software. The authors calculated the HIV prevalence rate in pregnant women, the vertical transmission rate, and the principal associated factors. HIV prevalence in pregnant women showed an upward trend, and the mean prevalence was 0.18%. Variables statistically associated with the occurrence of HIV in pregnant women were maternal age ≥ 20 years (p = 0.007), lower schooling (p = 0.054), and unmarried conjugal status/without partner (p = 0.001). Vertical HIV transmission was 6.9%. Use of antiretroviral therapy (ART) during prenatal care, even among pregnant women that already knew they were HIV-positive, was less than 90%. The elective cesarean rate was less than 60%, and the use of ART during delivery and by the newborn in the first 24 hours showed variations, depending on the period in which the maternal diagnosis was made. Although the strategies for the elimination of vertical HIV transmission are well established, this study’s results point to important flaws in the cascade of care for HIV-infected pregnant women in Rio Branco.

PMID:33852661 | DOI:10.1590/0102-311X00069820

Cad Saude Publica. 2021 Apr 7;37(3):e00112020. doi: 10.1590/0102-311X00112020. eCollection 2021.

ABSTRACT

The World Health Organization highlights the importance of health services organization and performance in tuberculosis (TB) control activities. This study aimed to assess the performance of primary healthcare services in Belo Horizonte, Minas Gerais State, Brazil, in TB control activities in the dimensions Structure and Process, before and after the use of a validated instrument called Stratification by Degree of Clinical Risk and Tuberculosis Treatment Dropout (ERTB). This was a descriptive and prospective study with two interviews (455 professionals), the second of which after the ERTB. Performance classification was: ≤ 49.9%, critical; 50-79.9%, unsatisfactory, and ≥ 80%, satisfactory. The comparative assessment used the McNemar statistical test with p < 0.05. After risk stratification, most of the variables in each dimension improved significantly. The authors conclude that it was possible to identify satisfactory performance in most of the variables assessed in the Structure and Process dimensions in primary healthcare services in Belo Horizonte in relation to TB control activities, using a standardized questionnaire.

PMID:33852663 | DOI:10.1590/0102-311X00112020

Rev Lat Am Enfermagem. 2021 Apr 9;29:e3408. doi: 10.1590/1518-8345.4166.3408. eCollection 2021.

ABSTRACT

OBJECTIVE: to evaluate the contribution of an instructional module identifying the number and characteristics of lymph nodes by undergraduate nursing students.

METHOD: an experimental, randomized, controlled and masked study using an instructional module for intervention. The 68 students who made up the control group or the experimental group performed the prototype lymph node palpation in the initial and final phases, following the free registration of the characteristics and number of these structures. Between the phases, the instructional module (palpation prototype and a registration guide instrument) was applied to the experimental group. Descriptive statistics and mixed linear regression were used for analysis.

RESULTS: the experimental group showed greater accuracy (p<0.05) in the evaluation of the size, consistency, mobility and coalescence of the lymph nodes in the final phase when compared to the control; it also showed more chances to correctly evaluate the consistency ( OR 45,26; 95% CI<7,74>‡<264.54> p<0.0001), mobility (OR 55.95; CI 95% 12.45 – 251.60; p<0.0001) and size (OR 25.64; CI 95% 3.92 – 160.2; p=0.0002) of the lymph nodes.

CONCLUSION: the results reinforce the contribution of the instructional module to increase the knowledge of nursing students about the evaluation of lymph nodes.

PMID:33852680 | DOI:10.1590/1518-8345.4166.3408

Clinics (Sao Paulo). 2021 Apr 9;76:e2189. doi: 10.6061/clinics/2021/e2189. eCollection 2021.

ABSTRACT

OBJECTIVES: This study explored the effects of the timing of laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) on liver function, bile biochemical indices, inflammatory reactions, and cholecysto-choledocholithiasis patient prognoses.

METHODS: A total of 103 cholecysto-choledocholithiasis patients were stratified into control (CG; n=51; LC at 4-7 d after ERCP) and observation groups (OG; n=52; LC at 1-3 d after ERCP) using a random number table.

RESULTS: The surgical time was shorter and intraoperative blood loss was less in OG than in CG, and the two groups were not statistically different in terms of time to the first passage of gas through anus, length of postoperative hospital stay, conversion rate to laparotomy, and stone-free rate. Four weeks after LC, alanine aminotransferase (ALT), total bilirubin (TBil), albumin (ALB), and glutamyl transpeptidase (GGT) levels declined in both groups, but the difference was not statistically significant. Three days after LC, total bile acid (TBA) levels increased, and cholesterol (CHO), unconjugated bilirubin (UCB), and TBiL levels were reduced in both groups, but were not statistically different (p>0.05). Three days after LC, interleukin (IL)-6, procalcitonin (PCT), and high-sensitivity C-reactive protein (hs-CRP) levels in the serum and bile increased in both groups and were lower in OG. The total incidence of perioperative complications was 1.92% in OG, which was lower than 15.69% in the CG.

CONCLUSION: For cholecysto-choledocholithiasis patients, LC at 1-3 d after ERCP can shorten surgical times, reduce intraoperative blood loss, improve liver function and bile biochemistry, relieve inflammatory reactions, reduce complications, and improve prognoses.

PMID:33852651 | DOI:10.6061/clinics/2021/e2189

Clinics (Sao Paulo). 2021 Apr 9;76:e2501. doi: 10.6061/clinics/2021/e2501. eCollection 2021.

ABSTRACT

OBJECTIVES: Antineutrophil cyto plasmic antibody-associated vasculitis (AAV) is a fatal disease. Currently, predictors of mortality due to AAV are based on the distribution of organ involvement. The novel fibrosis index (NFI) is an index composed of laboratory results that reflect the degree of liver fibrosis. This study aimed to evaluate whether NFI can predict poor outcomes in patients with AAV without substantial liver disease.

METHODS: A total of 210 patients with immunosuppressive drug-naïve AAV were retrospectively reviewed. NFI was calculated as follows: NFI=(serum bilirubin × (alkaline phosphatase)2)/(platelet count×(serum albumin)2). NFI cut-off was set at 1.24 (the highest quartile). Poor outcomes were defined as all-cause mortality, relapse, and end-stage renal disease (ESRD).

RESULTS: During the median 34.5 months of follow-up, 21 patients (10%) died, 72 patients (34.3%) relapsed, and 38 patients (18.1%) had ESRD due to AAV progression. The median calculated NFI was 0.61, and it was higher in AAV patients with all-cause mortality than in those without mortality, but the difference was not statistically significant (1.26 vs. 0.59). AAV patients with NFI at diagnosis ≥1.24 exhibited a significantly lower cumulative patient survival rate than those with NFI at diagnosis <1.24 (p=0.002). Multivariate Cox hazard model analysis showed that NFI at diagnosis ≥1.24 was an independent predictor of all-cause mortality in AAV (hazard ratios [HR] 2.850, 95% confidence interval [CI] 1.026, 7.910).

CONCLUSIONS: NFI ≥1.24, which may be an independent predictive marker for all-cause mortality in AAV patients without substantial liver disease.

PMID:33852653 | DOI:10.6061/clinics/2021/e2501

Clinics (Sao Paulo). 2021 Apr 9;76:e2592. doi: 10.6061/clinics/2021/e2592. eCollection 2021.

ABSTRACT

OBJECTIVES: To compare the surgical outcomes of inferomedial wall orbital decompression (IM-OD) and balanced medial plus lateral wall orbital decompression (ML-OD) in patients with inactive Graves’ orbitopathy (GO) with regard to exophthalmos reduction and ocular motility abnormalities.

METHODS: Forty-two patients with inactive GO eligible for OD were randomly assigned to either the IM-OD or ML-OD groups. Pre and postoperative evaluations included Hertel exophthalmometry, sensory, and motor extraocular motility assessment, standardized photographs in the nine gaze positions, and computed tomography (CT) of the orbits. ClinicalTrials.gov: NCT03278964.

RESULTS: Exophthalmometry reduction was statistically significant in both groups (p<0.001), but was greater in the ML-OD group (p=0.010). New-onset esotropia occurred in 11.1% and 23.5% of patients who underwent IM-OD and ML-OD, respectively, with no statistically significant difference in the frequency of pre and postoperative strabismus in either group. The mean increase in preoperative esotropia was 24±6.9 and 12±8.8 prism diopters in patients who underwent IM-OD and ML-OD, respectively. In the IM-OD group, abduction and elevation worsened at the first (p<0.05) and third (p<0.05) postoperative visits but were restored at 6 months. The versions did not change postoperatively with ML-OD. The preoperative CT-measured medial rectus muscle area predicted new-onset strabismus (p=0.023). Significant postoperative medial rectus muscle enlargement occurred in both groups (p<0.001). Restriction in elevation and abduction was significantly associated with enlarged inferior (p=0.007) and medial rectus muscle areas (p=0.002).

CONCLUSIONS: IM-OD is as safe as ML-OD with regard to new-onset strabismus, and represents a good alternative for patients who do not require significant exophthalmos reduction. ML-OD offers greater exophthalmos reduction and smoother postoperative recovery. Patients with preoperative enlarged medial rectus muscle on CT are at risk for new-onset esotropia, and preoperative esotropia is likely to increase after OD.

PMID:33852655 | DOI:10.6061/clinics/2021/e2592

PLoS One. 2021 Apr 14;16(4):e0249953. doi: 10.1371/journal.pone.0249953. eCollection 2021.

ABSTRACT

INTRODUCTION: New HIV infection during pre-conception and pregnancy is a significant contributor of mother-to-child transmission of HIV in South Africa. This study estimated HIV incidence (defined as new infection within the last one year from the time of the survey which included both new infections occurred during pregnancy or just before pregnancy) among pregnant women and described the characteristics of recently infected pregnant women at national level.

METHODS: Between 1 October and 15 November 2017, we conducted a national cross-sectional survey among pregnant women aged 15-49 years old attending antenatal care at 1,595 public facilities. Blood specimens were collected from pregnant women and tested for HIV in a centralised laboratory. Plasma viral load and Limiting Antigen Avidity Enzyme Immunosorbent Assay (LAg) tests were further performed on HIV positive specimens to differentiate between recent and long-term infections. Recent infection was defined as infection that occurred within one year from the date of collection of blood specimen for the survey. Data on age, age of partner, and marital status were collected through interviews. Women whose specimens were classified as recent by LAg assay and with viral loads >1,000 copies/mL were considered as recently infected. The calculated proportion of HIV positive women with recent infection was adjusted for assay-specific parameters to estimate annual incidence. Survey multinomial logistic regression was used to examine factors associated with being recently infected using HIV negative women as a reference group. Age-disparate relationship was defined as having a partner 5 or more years older.

RESULTS: Of 10,049 HIV positive participants with LAg and viral load data, 1.4% (136) were identified as recently infected. The annual HIV incidence was 1.5% (95% confidence interval (CI): 1.2-1.7). In multivariable analyses, being single (adjusted odds ratio, aOR: 3.4, 95% CI: 1.8-6.2) or cohabiting (aOR: 3.8, 95% CI: 1.8-7.7), compared to being married as well as being in an age-disparate relationship among young women (aOR: 3.1, 95% CI: 2.0-4.7; reference group: young women (15-24years) whose partners were not 5 years or more older) were associated with higher odds of recent infection.

CONCLUSIONS: Compared to previous studies among pregnant women, the incidence estimated in this study was substantially lower. However, the UNAIDS target to reduce incidence by 75% by 2020 (which is equivalent to reducing incidence to <1%) has not been met. The implementation of HIV prevention and treatment interventions should be intensified, targeting young women engaged in age-disparate relationship and unmarried women to fast track progress towards the UNAIDS target.

PMID:33852629 | DOI:10.1371/journal.pone.0249953

PLoS One. 2021 Apr 14;16(4):e0250158. doi: 10.1371/journal.pone.0250158. eCollection 2021.

ABSTRACT

While the world awaits a widely available COVID-19 vaccine, availability of testing is limited in many regions and can be further compounded by shortages of reagents, prolonged processing time and delayed results. One approach to rapid testing is to leverage the volatile organic compound (VOC) signature of SARS-CoV-2 infection. Detection dogs, a biological sensor of VOCs, were utilized to investigate whether SARS-CoV-2 positive urine and saliva patient samples had a unique odor signature. The virus was inactivated in all training samples with either detergent or heat treatment. Using detergent-inactivated urine samples, dogs were initially trained to find samples collected from hospitalized patients confirmed with SARS-CoV-2 infection, while ignoring samples collected from controls. Dogs were then tested on their ability to spontaneously recognize heat-treated urine samples as well as heat-treated saliva from hospitalized SARS-CoV-2 positive patients. Dogs successfully discriminated between infected and uninfected urine samples, regardless of the inactivation protocol, as well as heat-treated saliva samples. Generalization to novel samples was limited, particularly after intensive training with a restricted sample set. A unique odor associated with SARS-CoV-2 infection present in human urine as well as saliva, provides impetus for the development of odor-based screening, either by electronic, chemical, or biological sensing methods. The use of dogs for screening in an operational setting will require training with a large number of novel SARS-CoV-2 positive and confirmed negative samples.

PMID:33852639 | DOI:10.1371/journal.pone.0250158

PLoS One. 2021 Apr 14;16(4):e0250110. doi: 10.1371/journal.pone.0250110. eCollection 2021.

ABSTRACT

BACKGROUND: Prediction of the dynamics of new SARS-CoV-2 infections during the current COVID-19 pandemic is critical for public health planning of efficient health care allocation and monitoring the effects of policy interventions. We describe a new approach that forecasts the number of incident cases in the near future given past occurrences using only a small number of assumptions.

METHODS: Our approach to forecasting future COVID-19 cases involves 1) modeling the observed incidence cases using a Poisson distribution for the daily incidence number, and a gamma distribution for the series interval; 2) estimating the effective reproduction number assuming its value stays constant during a short time interval; and 3) drawing future incidence cases from their posterior distributions, assuming that the current transmission rate will stay the same, or change by a certain degree.

RESULTS: We apply our method to predicting the number of new COVID-19 cases in a single state in the U.S. and for a subset of counties within the state to demonstrate the utility of this method at varying scales of prediction. Our method produces reasonably accurate results when the effective reproduction number is distributed similarly in the future as in the past. Large deviations from the predicted results can imply that a change in policy or some other factors have occurred that have dramatically altered the disease transmission over time.

CONCLUSION: We presented a modelling approach that we believe can be easily adopted by others, and immediately useful for local or state planning.

PMID:33852642 | DOI:10.1371/journal.pone.0250110