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Domingues R.M.S.M.,Institute Pesquisa Clinica Evandro Chagas | Hartz Z.M.A.,New University of Lisbon | Dias A.B.M.,Instituto Fernandes Figueira | Leal M.C.,Escola Nacional de Saude Publica Sergio Arouca
Cadernos de Saude Publica | Year: 2012

The persistence of negative perinatal outcomes in Rio de Janeiro suggests problems in the quality of prenatal care. The most recent study in the city showed that only 38% of prenatal care was adequate. This study aimed to evaluate the adequacy of prenatal care under the Brazilian Unified National Health System in the city of Rio de Janeiro. A cross-sectional study in 2007-2008 interviewed2,422 women receiving prenatal care for low-risk pregnancy. Evaluation of care used the PHPN index, based on guidelines from the Program for Humanization of Prenatal Care and Childbirth (Brazilian Ministry of Health) and an expanded PHPN index, which included clinical-obstetric procedures, prescription of supplementary ferrous sulfate, and educational activities. According to the PHPN index, 38.5% of prenatal care was adequate, as compared to 33.3% based on the expanded PHPN index. Strategies to expand early entry of pregnant women into prenatal care and better use of their contact with the health services in order to promote healthcare measures are essential to correct this situation.


Fraga A.C.S.A.,Institute Pesquisa Clinica Evandro Chagas | Filha M.M.T.,Escola Nacional de Saude Publica Sergio Arouca
Cadernos de Saude Publica | Year: 2014

Inadequate weight gain during pregnancy is an important predictor of complications for the mother and infant. This cross-sectional study assessed factors associated with inadequate weight gain among women in the third trimester of pregnancy who received prenatal care under the Brazilian Unified National Health System (SUS) in the city of Rio de Janeiro, Brazil, from November 2007 to July 2008. A total of 1,079 pregnant women were interviewed, and adequacy of weight gain was obtained by calculating weight gain as recommended by the U.S. Institute of Medicine. Social, demographic, and obstetric factors were analyzed as independent variables. A multinomial logistic regression model was used, and pregnant women with weight gain below or above the recommended levels were compared to those with adequate weight gain. Low schooling was associated with insufficient weight gain, while excessive gain was observed in women with hypertension and pre-gestational underweight, overweight, and obesity. Nutritional assessment during prenatal care is essential, and interventions should target cases of inadequate weight gain in order to prevent complications for the mother and infant.


Hirschfeld G.,Childrens Hospital | Hirschfeld G.,Witten/Herdecke University | Do Brasil P.E.A.A.,Institute Pesquisa Clinica Evandro Chagas
Journal of Clinical Epidemiology | Year: 2014

Objectives: Many diagnostic studies are aimed at defining "optimal" thresholds. Here, we evaluate the performance of empirically defined optimal thresholds (1) in the sample in which they were defined and (2) in the population from which the sample was drawn. Study Design and Setting: We simulated test results for 120,000 samples varying the number of people without a disease (n between 20 and 500), number of people with a disease (m between 20 and 500), the magnitude of the difference between group means [effect size (ES) between 0.5 and 4], and distributions (normal and log-normal). The thresholds associated with the maximal Youden index were defined as optimal. Performance was defined as the percentage of correct classifications in the sample and when applied to the whole population. Results: At the population level, the thresholds defined for the four ESs (0.5, 0.8, 2, and 4) yielded a median of 59%, 65%, 83%, and 97% correct classifications, respectively. At the sample level, the samples with similar characteristics yielded widely varying estimates of the performance that were systematically higher than at the population level. Conclusion: Researchers need to be careful defining cut points for mean differences that are traditionally considered "large" (ES = 0.8). The diagnostic utility of optimal thresholds needs to be assessed in prospective studies. © 2014 Elsevier Inc. All rights reserved.


Chakrabarti A.,Jawaharlal Institute of Postgraduate Medical Education & Research | Bonifaz A.,General Hospital of Mexico | Gutierrez-Galhardo M.C.,Institute Pesquisa Clinica Evandro Chagas | Mochizuki T.,Kanazawa Medical University | Li S.,Jilin University
Medical Mycology | Year: 2014

Sporotrichosis is an endemic mycosis caused by the dimorphic fungus Sporothrix schenckii sensu lato. It has gained importance in recent years due to its worldwide prevalence, recognition of multiple cryptic species within the originally described species, and its distinctive ecology, distribution, and epidemiology across the globe. In this review, we describe the current knowledge of the taxonomy, ecology, prevalence, molecular epidemiology, and outbreaks due to S. schenckii sensu lato. Despite its omnipresence in the environment, this fungus has remarkably diverse modes of infection and distribution patterns across the world. We have delved into the nuances of how sporotrichosis is intimately linked to different forms of human activities, habitats, lifestyles, and environmental and zoonotic interactions. The purpose of this review is to stimulate discussion about the peculiarities of this unique fungal pathogen and increase the awareness of clinicians and microbiologists, especially in regions of high endemicity, to its emergence and evolving presentations and to kindle further research into understanding the unorthodox mechanisms by which this fungus afflicts different human populations. © 2014 The Author.


Alves M.G.M.,Federal University of Fluminense | Hokerberg Y.H.M.,Institute Pesquisa Clinica Evandro Chagas | Faerstein E.,State University of Rio de Janeiro
Revista Brasileira de Epidemiologia | Year: 2013

Introduction: Karasek's demand-control model has been used to investigate association between job strain and health outcomes. However, different instruments and definitions have been utilized to assess the exposure 'high strain at work', which makes difficult the comparison of results across studies. Objective: To describe the measurement instruments and the definitions adopted for the exposure variable 'job strain', according to the demand-control model, by observational studies published until 2010. Methods: Systematic review of observational studies published until December 2010, addressing the exposure 'job strain', measured according to the demand-control model and used the JCQ or its derivatives, since explicit. Results: Among 877 selected abstracts, 496 (57%) met the inclusion criteria. It identified a trend towards the increasing production literature on the subject. Most studies were sectional; found no relevant differences among study populations of men and women. Sweden, USA, Japan and Canada accounted for 57% of publications, mostly including more than 1000 participants and diverse occupations. Cardiovascular outcomes and their risk factors were the most studied (45%), followed by those related to mental health (25%). In 71% of the studies used the Job Content Questionnaire (from 2 to 49 items) and 19% of the total, the Swedish version (Demand-Control Questionnaire Swedish). Quadrants of the demand-control exposure were used in 51% of the work, but with different cutoff points; scores of the two dimensions were analyzed separately in 27%, and its ratio in 14% of the total. Social support at work was assessed in 44% of the studies. Conclusion: Karasek's model should continue to raise epidemiological studies and we hope that researchers face these theoretical and methodological issues outstanding.


Nascimento C.R.,Federal University of Rio de Janeiro | Lima M.A.,Institute Pesquisa Clinica Evandro Chagas | Serpa M.J.D.A.,Institute Pesquisa Clinica Evandro Chagas | Espindola O.,Institute Pesquisa Clinica Evandro Chagas | And 2 more authors.
Blood | Year: 2011

Human T-cell lymphotropic virus type 1 (HTLV-1) is a causative agent of adult T-cell leukemia and HTLV-1-associated myelopathy/tropical spastic paraparesis. HTLV-1-associated myelopathy/tropical spastic paraparesis is a chronic inflammatory disease characterized by loss of motor movement in response to spinal marrow cell destruction by T lymphocytes. To perform their cellular function, T cells need to be activated by antigen-presenting cells, such as dendritic cells (DCs). The aim of this work was to analyze DC differentiation and activation from monocytes of HTLV-1-infected individuals. We demonstrated that monocytes from HTLV-1-infected patients who had been stimulated to differentiate had an impaired loss of CD14 expression, expressed low levels of CD1a, and maintained secretion of tumor necrosis factor-α compared with monocytes from noninfected donors.We further evaluated DC activation by tumor necrosis factor-α. We observed that in response to activation, DCs that were derived from noninfected donors had an increase in the percentage of CD83+, CD86+, and human leukocyte antigen-DR+ cells, whereas in DCs derived from HTLV-1-infected patients, the percentage of CD83+, CD86+, and human leukocyte antigen-DR+ cells remained similar to that of nonactivated cells. Moreover, these cells had an impaired capacity to stimulate allogeneic T lymphocytes.We demonstrated that DC maturation was altered in HTLV-1-infected patients, which could contribute to the development of HTLV-1-associated diseases. © 2011 by The American Society of Hematology.


Firacative C.,University of Sydney | Firacative C.,Instituto Nacional Of Salud | Trilles L.,University of Sydney | Trilles L.,Institute Pesquisa Clinica Evandro Chagas | Meyer W.,University of Sydney
PLoS ONE | Year: 2012

Background: The Cryptococcus neoformans/C. gattii species complex comprises two sibling species that are divided into eight major molecular types, C. neoformans VNI to VNIV and C. gattii VGI to VGIV. These genotypes differ in host range, epidemiology, virulence, antifungal susceptibility and geographic distribution. The currently used phenotypic and molecular identification methods for the species/molecular types are time consuming and expensive. As Matrix-Assisted Laser Desorption Ionization-Time-of-Flight Mass Spectrometry (MALDI-TOF MS) offers an effective alternative for the rapid identification of microorganisms, the objective of this study was to examine its potential for the identification of C. neoformans and C. gattii strains at the intra- and inter-species level. Methodology: Protein extracts obtained via the formic acid extraction method of 164 C. neoformans/C. gattii isolates, including four inter-species hybrids, were studied. Results: The obtained mass spectra correctly identified 100% of all studied isolates, grouped each isolate according to the currently recognized species, C. neoformans and C. gattii, and detected potential hybrids. In addition, all isolates were clearly separated according to their major molecular type, generating greater spectral differences among the C. neoformans molecular types than the C. gattii molecular types, most likely reflecting a closer phylogenetic relationship between the latter. The number of colonies used and the incubation length did not affect the results. No spectra were obtained from intact yeast cells. An extended validated spectral library containing spectra of all eight major molecular types was established. Conclusions: MALDI-TOF MS is a rapid identification tool for the correct recognition of the two currently recognized human pathogenic Cryptococcus species and offers a simple method for the separation of the eight major molecular types and the detection of hybrid strains within this species complex in the clinical laboratory. The obtained mass spectra provide further evidence that the major molecular types warrant variety or even species status. © 2012 Firacative et al.


Minayo M.C.S.,Centro Latino Americano Of Estudos Sobre Violencia E Saude Jorge Careli | de Assis S.G.,Centro Latino Americano Of Estudos Sobre Violencia E Saude Jorge Careli | de Oliveira R.V.C.,Institute Pesquisa Clinica Evandro Chagas
Ciencia e Saude Coletiva | Year: 2011

In this article, we analyze the physical and mental stress and illness of military and civil police force officers in the State of Rio de Janeiro (Brazil) due to their working conditions and professional activities. The same methodology was used for the study of two categories, namely a quantitative approach (simple random sampling by conglomerates, involving a total of 1,458 civil police officers and 1,108 military police officers, who answered questionnaires anonymously) and a qualitative approach (focal groups involving 143 professionals and 18 interviews with managers of both police forces). The data presented here are all original. Disorders identified were: overweight and obesity in both forces but mainly in the Military Police; low frequency of physical exercise and high levels of cholesterol, especially in the Civil Police. The main health complaints are neck, back or spinal cord pain, eyesight complaints and headaches/ migraines. Sixteen point two per cent of officers of both forces reported physical lesions that were more prevalent in the Military Police, among whom psychic suffering was also more frequent (SRQ-20). The need for changes in the individual and professional dimensions and in institutional aspects regarding the conditions and organization of work and of health services is emphasized.


Lima M.A.,Institute Pesquisa Clinica Evandro Chagas
Arquivos de Neuro-Psiquiatria | Year: 2013

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the CNS caused by reactivation of JC virus (JCV) in a setting of cellular immunosuppression. Originally, PML was observed in patients with advanced HIV infection, lymphoproliferative disorders and transplant recipients. However, the widespread use of HIV antiretroviral drugs and the new selective immunomodulatory and immunosuppressive medications, such as Rituximab and Natalizumab, has recently modified the epidemiology, clinical presentation and prognosis of PML. Herein, we discuss the new concepts on PML, emphasizing the recent modification in the epidemiology; the impact of new immunomodulatory treatments in the disease, PML-IRIS (Immune reconstitution inflammatory síndrome), new treatment strategies and other JCV related CNS diseases.


Almeida-Paes R.,Institute Pesquisa Clinica Evandro Chagas | de Oliveira M.M.E.,Institute Pesquisa Clinica Evandro Chagas | Freitas D.F.S.,Institute Pesquisa Clinica Evandro Chagas | do Valle A.C.F.,Institute Pesquisa Clinica Evandro Chagas | And 2 more authors.
PLoS Neglected Tropical Diseases | Year: 2014

There have been several recent changes in the taxonomy of Sporothrix schenckii as well as new observations regarding the clinical aspects of sporotrichosis. In this study, we determined the identification of the Sporothrix species associated with both classic and unusual clinical aspects of sporotrichosis observed in the endemic area of sporotrichosis in Rio de Janeiro, Brazil.To verify whether S. brasiliensis is associated with clinical manifestations of sporotrichosis, a cross-sectional study was performed in which Sporothrix isolates from 50 patients with different clinical manifestations were analyzed and their isolates were studied by phenotypic and genotypic methods. Data from these patients revealed a distinct clinical picture and therapeutic response in infections caused by Sporothrix brasiliensis (n = 45) compared to patients with S. schenckii sensu stricto (n = 5). S. brasiliensis was associated with disseminated cutaneous infection without underlying disease, hypersensitivity reactions, and mucosal infection, whereas patients with S. schenckii presented with less severe and more often localized disease, similar to the majority of previously described sporotrichosis cases. Interestingly, S. brasiliensis-infected patients overall required shorter durations of itraconazole (median 16 weeks) compared to the individuals with S. schenckii (median 24 weeks).These findings suggest that Sporothrix species are linked to different clinical manifestations of sporotrichosis and that S. brasiliensis is effectively treated with oral itraconazole. © 2014 Almeida-Paes et al.

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