RESUMO
Tecnologia: Combinação de glicosamina e condroitina. Indicação: Tratamento de osteoartrite em adultos. Pergunta: O tratamento com a combinação de glicosamina e condroitina é mais eficaz e seguro que os demais tratamentos para osteoartrite disponíveis no SUS? Métodos: Uma revisão rápida de evidências, uma revisão de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2. Resultados: Foi selecionada uma revisão sistemática, que atendiam aos critérios de inclusão. Conclusão: A combinação de glicosamina com condroitina, comparados ao placebo, mostrou ser mais eficaz para tratamento da dor e função e alcançou o segundo lugar nas alternativas terapêuticas para tratamento da dor e função
Technology: Combination of glucosamine and chondroitin. Indication: Treatment of osteoarthritis in adults. Question: Is the treatment with the combination of glucosamine and chondroitin more effective and safer than the other treatments for osteoarthritis available in the Brazilian Public Health System? Methods: A rapid review of evidence, a overview of systematic reviews, with bibliographic search done in PUBMED database, using a structured search strategy. The methodological quality of systematic reviews was assessed using AMSTAR-2. Results: A systematic review was selected, which met the inclusion criteria. Conclusion: The combination of glucosamine and chondroitin, compared to placebo, proved to be more effective for the treatment of pain and function and reached second place in therapeutic alternatives for the treatment of pain and function
Assuntos
Humanos , Masculino , Feminino , Osteoartrite/tratamento farmacológico , Condroitina/uso terapêutico , Glucosamina/uso terapêutico , Eficácia , Combinação de Medicamentos , Pesquisa Comparativa da Efetividade , Revisão SistemáticaRESUMO
The Zika virus (ZIKV) epidemic, which was followed by an unprecedented outbreak of congenital microcephaly, emerged in Brazil unevenly, with apparent pockets of susceptibility. The present study aimed to detect high-risk areas for ZIKV infection and microcephaly in Goiania, a large city of 1.5 million inhabitants in Central-West Brazil. Using geocoded surveillance data from the Brazilian Information System for Notifiable Diseases (SINAN) and from the Public Health Event Registry (RESP-microcefalia), we analyzed the spatiotemporal distribution and socioeconomic indicators of laboratory confirmed (RT-PCR and/or anti-ZIKV IgM ELISA) symptomatic ZIKV infections among pregnant women and clinically confirmed microcephaly in neonates, from 2016 to 2020. We investigated temporal patterns by estimating the risk of symptomatic maternal ZIKV infections and microcephaly per 1000 live births per month. We examined the spatial distribution of maternal ZIKV infections and microcephaly cases across the 63 subdistricts of Goiania by manually plotting the geographical coordinates. We used spatial scan statistics estimated by discrete Poisson models to detect high clusters of maternal ZIKV infection and microcephaly and compared the distributions by socioeconomic indicators measured at the subdistrict level. In total, 382 lab-confirmed cases of maternal ZIKV infections, and 31 cases of microcephaly were registered in the city of Goiania. More than 90% of maternal cases were reported between 2016 and 2017. The highest incidence of ZIKV cases among pregnant women occurred between February and April 2016. A similar pattern was observed in the following year, although with a lower number of cases, indicating seasonality for ZIKV infection, during the local rainy season. Most congenital microcephaly cases occurred with a time-lag of 6 to 7 months after the peak of maternal ZIKV infection. The highest estimated incidence of maternal ZIKV infections and microcephaly were 39.3 and 2.5 cases per 1000 livebirths, respectively. Districts with better socioeconomic indicators and with higher proportions of self-identified white inhabitants were associated with lower risks of maternal ZIKV infection. Overall, the findings indicate heterogeneity in the spatiotemporal patterns of maternal ZIKV infections and microcephaly, which were correlated with seasonality and included a high-risk geographic cluster. Our findings identified geographically and socio-economically underprivileged groups that would benefit from targeted interventions to reduce exposure to vector-borne infections.
Assuntos
Microcefalia/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Infecção por Zika virus/epidemiologia , Zika virus , Brasil/epidemiologia , Feminino , Humanos , Incidência , Recém-Nascido , Microcefalia/etiologia , Gravidez , Complicações Infecciosas na Gravidez/economia , Fatores de Risco , Fatores Socioeconômicos , Análise Espaço-Temporal , Infecção por Zika virus/complicações , Infecção por Zika virus/economiaRESUMO
O objetivo deste estudo foi investigar a motivaçaÌo para primeira experieÌncia no uso de drogas e recaiÌdas apoÌs abstineÌncia por pessoas com dependeÌncia quiÌmica induzida pelo crack. Estudo descritivo, de abordagem mista. Foram realizadas 600 entrevistas com a utilizaçaÌo de questionaÌrio estruturado, na etapa quantitativa, e oito grupos focais, na etapa qualitativa, com total de 39 participantes. Para anaÌlise de dados utilizou-se o software SPSS e o meÌtodo de interpretaçaÌo de sentidos. A curiosidade motivou a iniciaçaÌo do uso de drogas, assim como a pressaÌo dos amigos e problemas familiares. JaÌ a dificuldade de ficar sem a droga, vontade de sentir o efeito novamente, pressaÌo de amigos, problemas familiares, decepçaÌo pela desconfiança dos familiares e o uso de drogas na proÌpria instituiçaÌo de tratamento foram relatados como motivadores de recaiÌda. Os dados em ambas as metodologias foram convergentes e ratificaram os resultados obtidos.
The aim of this study was to investigate the motivation for first-time drug use and relapses after abstinence of people with chemical dependency to crack cocaine. A descriptive study, with a mixed approach. In the quantitative phase, six hundred interviews were conducted using a structured questionnaire. In the qualitative phase, eight focus groups were created, with 39 total participants. SPSS software and the sense interpretation method were used to analyze the data. Curiosity, as well as peer pressure and family problems, motivated the initiation of drug use. Difficulty to live without the drug, desire to feel its effect again, peer pressure, family problems, disappointment in lack of trust of family members, and drug use at the rehabilitation institution were reported as relapse motivators. The data in both methodologies were convergent and confirmed the obtained results.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Síndrome de Abstinência a Substâncias , Cocaína Crack , Transtornos Relacionados ao Uso de Cocaína/etiologiaRESUMO
Brazil has the largest cocaine market in South America, and crack cocaine use is closely associated with HIV-1 infection. This study investigated the prevalence, risk factors, and HIV-1 subtypes, including recombinant forms and mutations associated with drug resistance, among crack cocaine users in Central-West Brazil. We recruited 600 crack cocaine users admitted to a referral hospital in Goiânia for psychiatric disorders. The participants were interviewed; blood samples were collected for anti-HIV-1/2 serological screening. HIV-1 pol gene sequences (entire protease [PR] and partial reverse transcriptase [RT]) were obtained from plasma RNA. HIV-1 subtypes, recombinant viruses, transmitted drug resistance (TDR), and secondary drug resistance mutations were investigated. The median participant age was 30 years (range, 18-68 years); most were male, single, unemployed, and of mixed races. Among them, 2.8% (17/600) were HIV-1 positive: 2.2% of men (11/507) and 6.5% of women (6/93). The main predictors of HIV-1 seropositivity were a sexual partner with HIV infection, irregular condom use, and previous homelessness. HIV-1 pol sequences (12/17) indicated the predominance of subtype B (n = 7), followed by recombinant forms FPR/BRT (n = 1) and BPR/FRT (n = 2) and subtypes F1 (n = 1) and C (n = 1). TDR prevalence was 58.3% (7/12). Isolates from two participants showed mutations associated with resistance to nucleoside reverse transcriptase inhibitors (NRTI) only (M41L, T125C, T125F, M184V), while an isolate from one patient who had received antiretroviral therapy (ART) since 2008 had a mutation associated with resistance to non-NRTI (G190S). Five isolates had secondary mutations to protease inhibitors (K20M, L10V, L33I, A71T, A71V). In conclusion, the findings of HIV-1 circulation, TDR to NRTI, and secondary mutations to protease inhibitors in ART-naïve crack cocaine users support the importance of monitoring this population in regions far from the epicenter of the HIV epidemic.
Assuntos
Cocaína Crack , Usuários de Drogas/estatística & dados numéricos , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , HIV-1 , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Cocaína Crack/administração & dosagem , Cocaína Crack/efeitos adversos , Feminino , Variação Genética , Genótipo , Infecções por HIV/virologia , HIV-1/classificação , HIV-1/genética , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Filogenia , Prevalência , Fatores de Risco , Adulto Jovem , Produtos do Gene pol do Vírus da Imunodeficiência HumanaRESUMO
OBJECTIVE: To estimate the prevalence of hepatitis B virus and C virus infections and their genotypes and analyze the risk factors for the markers of exposure to hepatitis B virus in female sex workers in a region of intense sex trade. METHODS: This is a cross-sectional study performed with four hundred and two female sex workers in Goiânia, Brazil. Data have been collected using the Respondent-Driven Sampling. The women have been interviewed and tested for markers of hepatitis B and C viruses. Positive samples have been genotyped. The data have been analyzed using the Respondent-Driven Sampling Analysis Tool, version 5.3, and Stata 11.0. RESULTS: The adjusted prevalence for hepatitis B virus and C virus were 17.1% (95%CI 11.6-23.4) and 0.7% (95%CI 0.1-1.5), respectively. Only 28% (95%CI 21.1-36.4) of the participants had serological evidence of vaccination against hepatitis B virus. Being older (> 40 years), being single, having a history of blood transfusion and use of cocaine, and ignoring the symptoms of sexually transmitted infections were associated with positivity for hepatitis B virus (p < 0.05). We have detected the subgenotype A1 of hepatitis B virus (n = 3) and the subtypes of hepatitis C virus 1a (n = 3) and 1b (n = 1). CONCLUSIONS: We can observe a low prevalence of infection of hepatitis B and C viruses in the studied population. However, the findings of the analysis of the risk factors show the need for more investment in prevention programs for sexual and drug-related behavior, as well as more efforts to vaccinate this population against hepatitis B. The genotypes of the hepatitis B virus and C virus identified are consistent with those circulating in Brazil.
Assuntos
Hepacivirus/genética , Vírus da Hepatite B/genética , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Profissionais do Sexo/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Genótipo , Hepatite B/sangue , Hepatite C/sangue , Humanos , Masculino , Prevalência , Fatores de Risco , Estudos Soroepidemiológicos , Infecções Sexualmente Transmissíveis , Fatores Socioeconômicos , Adulto JovemRESUMO
ABSTRACT OBJECTIVE To estimate the prevalence of hepatitis B virus and C virus infections and their genotypes and analyze the risk factors for the markers of exposure to hepatitis B virus in female sex workers in a region of intense sex trade. METHODS This is a cross-sectional study performed with four hundred and two female sex workers in Goiânia, Brazil. Data have been collected using the Respondent-Driven Sampling. The women have been interviewed and tested for markers of hepatitis B and C viruses. Positive samples have been genotyped. The data have been analyzed using the Respondent-Driven Sampling Analysis Tool, version 5.3, and Stata 11.0. RESULTS The adjusted prevalence for hepatitis B virus and C virus were 17.1% (95%CI 11.6-23.4) and 0.7% (95%CI 0.1-1.5), respectively. Only 28% (95%CI 21.1-36.4) of the participants had serological evidence of vaccination against hepatitis B virus. Being older (> 40 years), being single, having a history of blood transfusion and use of cocaine, and ignoring the symptoms of sexually transmitted infections were associated with positivity for hepatitis B virus (p < 0.05). We have detected the subgenotype A1 of hepatitis B virus (n = 3) and the subtypes of hepatitis C virus 1a (n = 3) and 1b (n = 1). CONCLUSIONS We can observe a low prevalence of infection of hepatitis B and C viruses in the studied population. However, the findings of the analysis of the risk factors show the need for more investment in prevention programs for sexual and drug-related behavior, as well as more efforts to vaccinate this population against hepatitis B. The genotypes of the hepatitis B virus and C virus identified are consistent with those circulating in Brazil.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Vírus da Hepatite B/genética , Hepatite C/epidemiologia , Hepacivirus/genética , Profissionais do Sexo/estatística & dados numéricos , Hepatite B/epidemiologia , Fatores Socioeconômicos , Brasil/epidemiologia , Infecções Sexualmente Transmissíveis , Estudos Soroepidemiológicos , Prevalência , Estudos Transversais , Fatores de Risco , Hepatite C/sangue , Genótipo , Hepatite B/sangueRESUMO
OBJECTIVES: to investigate the prevalence and risk behaviors by means of reporting of sexually transmitted diseases among crack users. METHOD: cross-sectional study carried out with 588 crack users in a referral care unit for the treatment of chemical dependency. Data were collected by means of face-to-face interview and analyzed using Stata statistical software, version 8.0. RESULTS: of the total participants, 154 (26.2%; 95% CI: 22.8-29.9) reported antecedents of sexually transmitted diseases. Ages between 25 and 30 years (RP: 2.1; 95% CI: 1.0-4.0) and over 30 years (RP: 3.8; 95% CI: 2.1-6.8), alcohol consumption (RP: 1.9; 95% CI: 1.1-3.3), antecedents of prostitution (RP: 1.9; 95% CI: 1.3-2.9) and sexual intercourse with person living with human immunodeficiency virus/AIDS (RP: 2.7; 95% CI: 1.8-4.2) were independently associated with reporting of sexually transmitted diseases. CONCLUSION: the results of this study suggest high risk and vulnerability of crack users for sexually transmitted diseases.
Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína Crack , Assunção de Riscos , Infecções Sexualmente Transmissíveis/epidemiologia , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Adulto JovemRESUMO
OBJETIVO: descrever o perfil clínico-epidemiológico e a distribuição espacial dos casos suspeitos de dengue com hospitalização em Goiânia-GO, Brasil, durante a epidemia de 2013. MÉTODOS: estudo descritivo sobre dados do Sistema de Informação de Agravos de Notificação, Sistema Gerenciador de Ambiente Laboratorial, Sistema de Regulação de Leitos, e do Sistema da Companhia de Processamento de Dados de Goiânia. RESULTADOS: foram incluídos 616 casos suspeitos de dengue com idade média de 36 anos (desvio-padrão: 14,8), 55,2% do sexo feminino, 9,3% confirmados laboratorialmente e 9,7% apresentando comorbidades; a comorbidade mais frequente foi hipertensão arterial (20%); os sinais de alarme mais frequentes foram vômitos persistentes (23,7%) e plaquetopenia (22,7%); verificou-se positividade dos resultados laboratoriais inclusive nas coletas inoportunas, após cinco dias do inicio dos sintomas, e grande dispersão na distribuição espacial dos casos. CONCLUSÃO: entre os casos suspeitos de dengue internados, predominaram adultos e com presença de sinais e sintomas de alarme.
OBJECTIVE: to describe the clinical and epidemiological features and the spatial distribution of suspected dengue cases admitted to hospital in Goiânia, state of Goiás, during the 2013 epidemic. METHODS: this was a descriptive study of suspected dengue cases admitted to hospital in Goiânia based on four databases. RESULTS: 616 suspected dengue cases were included in the study; patients' mean age was 36 years (SD: 14.8), 55.2% were female, 9.3% were laboratory confirmed and 9.7% had comorbidities; the most common comorbidity was hypertension (20%); the most common warning signs were persistent vomiting (23.7%) and thrombocytopenia (22.7%); laboratory results were positive including for late sample collections taken five days after the onset of symptoms. There was great dispersion in the spatial distribution of cases. CONCLUSION: the majority of suspected dengue cases admitted to hospital were adults who had warning signs and symptoms.
OBJETIVO: describir el perfil clínico-epidemiológico y la distribución espacial de los casos sospechosos de dengue con hospitalización en Goiania-GO, durante la epidemia de 2013. MÉTODOS: estudio descriptivo basado en datos del "Sistema de información de Enfermedades de Declaración Obligatoria", "Sistema de gestión ambiental y laboratorio", "Sistema de regulación de camas" y "Sistema de la compañía de procesamiento de datos de Goiana". RESULTADOS: se incluyeron 616 casos sospechosos de dengue; la media de edad fue de 36 años (Desviación Estándar: 14,8), el 55,2% eran mujeres, 9,3% fueron confirmados en laboratorio y 9,7% presentaron comorbilidades; la comorbilidad más frecuente fue hipertensión arterial (20%). Las señales de alarma más frecuentes fueron vómitos persistentes (23,7%) y trombocitopenia (22,7%); hubo resultados positivos de laboratorio inclusive en las colectas inadvertidas, después de cinco días del inicio de los síntomas y hubo gran variación en la distribución espacial de los casos. CONCLUSIÓN: entre los casos sospechosos de dengue internados, predominaron los adultos y la presencia de signos y síntomas de alarma.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Brasil/epidemiologia , Dengue/diagnóstico , Dengue/epidemiologia , Epidemiologia Descritiva , Hospitalização , Características de Residência , Sinais e Sintomas , Fatores Socioeconômicos , Sistema Único de SaúdeRESUMO
AbstractObjectives: to investigate the prevalence and risk behaviors by means of reporting of sexually transmitted diseases among crack users.Method: cross-sectional study carried out with 588 crack users in a referral care unit for the treatment of chemical dependency. Data were collected by means of face-to-face interview and analyzed using Stata statistical software, version 8.0.Results: of the total participants, 154 (26.2%; 95% CI: 22.8-29.9) reported antecedents of sexually transmitted diseases. Ages between 25 and 30 years (RP: 2.1; 95% CI: 1.0-4.0) and over 30 years (RP: 3.8; 95% CI: 2.1-6.8), alcohol consumption (RP: 1.9; 95% CI: 1.1-3.3), antecedents of prostitution (RP: 1.9; 95% CI: 1.3-2.9) and sexual intercourse with person living with human immunodeficiency virus/AIDS (RP: 2.7; 95% CI: 1.8-4.2) were independently associated with reporting of sexually transmitted diseases.Conclusion: the results of this study suggest high risk and vulnerability of crack users for sexually transmitted diseases.
ResumoObjetivos:investigar a prevalência e comportamentos de risco através do relato de doenças sexualmente transmissíveis em usuários de crack.Método:estudo transversal, realizado com 588 usuários de crack, de uma unidade de referência para tratamento de dependência química. Os dados foram obtidos por meio de entrevista face a face e analisados em programa estatístico Stata, versão 8.0.Resultados:do total de participantes, 154 (26,2%; IC 95%: 22,8-29,9) referiram antecedentes de doenças sexualmente transmissíveis. Idade entre 25 e 30 anos (RP: 2,1; IC 95%: 1,0-4,0) e superior a 30 anos (RP: 3,8; IC 95%: 2,1-6,8), consumo de álcool (RP: 1,9; IC 95%: 1,1-3,3), antecedentes de prostituição (RP: 1,9; IC 95%: 1,3-2,9) e relação sexual com pessoa vivendo com o vírus da imunodeficiência humana/aids (RP: 2,7; IC 95%: 1,84,2) foram independentemente associados ao relato de doenças sexualmente transmissíveis.Conclusão:os resultados deste estudo sugerem elevado risco e vulnerabilidade dos usuários de crackpara as doenças sexualmente transmissíveis.
ResumenObjetivos:investigar la prevalencia y las conductas de riesgo a través del informe de las enfermedades de transmisión sexual entre los usuarios de crack.Método:estudio transversal con 588 usuarios de crack, de una unidad de referencia para el tratamiento de la dependencia química. Los datos fueron obtenidos a través de entrevista cara a cara y se analizaron utilizando el programa estadístico Stata, versión 8.0.Resultados:del total de participantes, 154 (26,2%; IC 95%: 22,8-29,9) informaron antecedentes de enfermedades de transmisión sexual. Edad entre 25 y 30 años (RP: 2,1; IC9 5%: 1,0-4,0) y superior a 30 años (RP: 3,8; IC 95%: 2,1-6,8), consumo de alcohol (OR: 1,9; IC 95%: 1,1-3,3), antecedentes de prostitución (RP: 1,9; IC 95%: 1,3-2,9) y relaciones sexuales con persona viviendo con el virus de inmunodeficiencia humana/ SIDA (RP: 2,7; IC 95%: 1,8-4,2) se asociaron de forma independiente con la notificación de las enfermedades de transmisión sexual.Conclusión:los resultados de este estudio sugieren alto riesgo y la vulnerabilidad de los usuarios de crackpara las enfermedades de transmisión sexual.