OBJECTIVE To analyze the spatial distribution of risk for tuberculosis and its socioeconomic determinants in the city of Rio de Janeiro, Brazil.METHODS An ecological study on the association between the mean incidence rate of tuberculosis from 2004 to 2006 and socioeconomic indicators of the Censo Demográfico (Demographic Census) of 2000. The unit of analysis was the home district registered in the Sistema de Informação de Agravos de Notificação (Notifiable Diseases Information System) of Rio de Janeiro, Southeastern Brazil. The rates were standardized by sex and age group, and smoothed by the empirical Bayes method. Spatial autocorrelation was evaluated by Moran’s I. Multiple linear regression models were studied and the appropriateness of incorporating the spatial component in modeling was evaluated.RESULTS We observed a higher risk of the disease in some neighborhoods of the port and north regions, as well as a high incidence in the slums of Rocinha and Vidigal, in the south region, and Cidade de Deus, in the west. The final model identified a positive association for the variables: percentage of permanent private households in which the head of the house earns three to five minimum wages; percentage of individual residents in the neighborhood; and percentage of people living in homes with more than two people per bedroom.CONCLUSIONS The spatial analysis identified areas of risk of tuberculosis incidence in the neighborhoods of the city of Rio de Janeiro and also found spatial dependence for the incidence of tuberculosis and some socioeconomic variables. However, the inclusion of the space component in the final model was not required during the modeling process.

OBJECTIVE To analyze the spatial distribution of risk for tuberculosis and its socioeconomic determinants in the city of Rio de Janeiro, Brazil.METHODS An ecological study on the association between the mean incidence rate of tuberculosis from 2004 to 2006 and socioeconomic indicators of the Censo Demográfico (Demographic Census) of 2000. The unit of analysis was the home district registered in the Sistema de Informação de Agravos de Notificação (Notifiable Diseases Information System) of Rio de Janeiro, Southeastern Brazil. The rates were standardized by sex and age group, and smoothed by the empirical Bayes method. Spatial autocorrelation was evaluated by Moran’s I. Multiple linear regression models were studied and the appropriateness of incorporating the spatial component in modeling was evaluated.RESULTS We observed a higher risk of the disease in some neighborhoods of the port and north regions, as well as a high incidence in the slums of Rocinha and Vidigal, in the south region, and Cidade de Deus, in the west. The final model identified a positive association for the variables: percentage of permanent private households in which the head of the house earns three to five minimum wages; percentage of individual residents in the neighborhood; and percentage of people living in homes with more than two people per bedroom.CONCLUSIONS The spatial analysis identified areas of risk of tuberculosis incidence in the neighborhoods of the city of Rio de Janeiro and also found spatial dependence for the incidence of tuberculosis and some socioeconomic variables. However, the inclusion of the space component in the final model was not required during the modeling process.

Background and Objectives: tuberculosis remains a relevant public health problem and the cure of diagnosed cases is a strategy to reduce high morbidity and mortality. The objective of our study is to identify factors associated with death due to tuberculosis and treatment default in patients diagnosed in the HFSE from 2007 to 2014. Method: we conducted an observational, analytical study of all 670 confirmed cases reported in this period at the local SINAN reporting base, whose outcome was registered as cure (383), tuberculosis death (159) or default (128). This system is fed from a standardized epidemiological investigation sheet containing socio-demographic and clinical variables. Statistical analysis involved variables available in SINAN and considered as unfavorable outcome that composed by death or default. Variables with high odds ratios in bivariate analysis and/or clinical relevance were considered for inclusion in a logistic regression model. As a measure of association for analysis of factors associated with unfavorable outcome versus cure, odds ratios and their 95% confidence intervals were estimated. Results: the final model identified as statistically associated with an unfavorable outcome: age ≥60 years, non-white race/color, history of previous treatment for tuberculosis, or unknown history of previous treatment, positive anti-HIV test, pulmonary form and presence of severe extrapulmonary forms. Conclusion: the results confirm the need to invest in policies that guarantee access and fair care to patients, especially those with conditions that predispose to default and severe forms.

Background and Objectives: The occurrence of neurological manifestations in the context of the circulation of Dengue virus (DENV), Zika(ZIKV) and Chikungunya (CHIKV) in Brazil is a challenge for epidemiological surveillance. This study aims to describe the clinical epidemiological profile of patients reported in a federal hospital with neurological syndromes potentially associated with these etiologies, in 2015 and 2016. Methods: Observational study, with analysis of secondary bases and data collection in medical records and epidemiological surveillance forms. We included cases reported in 2015 and 2016, meeting the criteria: a)neurological syndrome of undetermined originand registry of previous viral infection up to 60 days before neurological symptoms, laboratory confirmed or not; b) neurological syndrome without prior viral infection up to 60 days before neurological symptoms, with laboratory confirmation for DENV, CHIKV and ZIKV in CSF, serum or urine. Variables analyzed: sex, age, race/color, scholarity level, municipality of residence, signs and symptoms, syndromic andetiological diagnosis of the neurological symptoms, place/ length of hospitalization and evolution. Results: 72 cases reported: 61.1% men, median age 37 years, neurological diagnosis of Guillain-Barré syndrome (GBS) 34.7% and meningoencephalitis 31.9%. Thirty-nine cases (54.1%) were classified as associated with arboviruses, 14 of them by laboratory criteria (3 ZIKV, 6 CHIKV, 4 DENV, 1 DENV + CHIKV) and 25 by clinical-epidemiological criteria. In the laboratory confirmed the percentage of meningoencephalitis (57.1%) exceeded SGB (35.7%). Conclusion: The differential diagnosis among arboviruses in this context is a challenge for epidemiological surveillance, highlighting thepredominance of GBS and meningoencephalitis. Keywords: Arbovirus Infections. Encephalitis, Arbovirus. Guillain-Barre Syndrome. Epidemiology

OBJETIVO: Estimar a sobrevida de pacientes com Síndrome da Imunodeficiência Adquirida (SIDA) notificados e acompanhados no Hospital Federal dos Servidores do Estado (HFSE) no período de 1986 a 2006. METODOLOGIA: Utilizou-se o modelo de riscos proporcionais de Cox estendido, considerando a data de diagnóstico como variável tempo-dependente, dividindo a análise em dois períodos: <1996 e ≥1996 (após a introdução de antirretrovirais no HFSE). RESULTADOS: Dos 1.300 casos analisados, 62% eram homens. As seguintes variáveis apresentaram razões de risco (HR) significativas: critério de notificação baseado na quantificação sérica de CD4<350 (HR=0,187); grupo diagnosticado a partir de 1996 (HR=0,355); faixa etária &gt;50 anos (HR=1,386); disfunção do sistema nervoso central (HR=1,570); caquexia (HR=1,526); sarcoma de Kaposi (HR=1,376); candidíase (HR=1,295). A taxa de sobrevida geral em 5 anos foi 35,7% e, em 10 anos, 6,3%. Para os casos notificados através do critério CD4, a sobrevida em 5 e 10 anos foi 89,6%. CONCLUSÃO: Este trabalho agrega evidência ao aumento de sobrevida dos pacientes de SIDA, e aponta o critério CD4 e o grupo tratado a partir de 1996 como as variáveis com maior associação a esse aumento.

Resumo Introdução A tuberculose é uma doença endêmica em diversos países e sua ocorrência tem sido relacionada a situações de pior condição socioeconômica. Objetivo Analisar a distribuição espacial da tuberculose no município do Rio de Janeiro em 2006 e a associação entre ocorrência da doença e indicadores socioeconômicos. Método O setor censitário de residência do paciente foi georreferenciado a partir do endereço registrado no SINAN; intensidade de casos estimada a partir do estimador de Kernel. A associação entre variáveis socioeconômicas e existência de pelo menos um caso de tuberculose nos setores censitários foi avaliada por regressão logística. Resultados A base de dados final tinha 3.089 novos casos não institucionalizados. Identificou-se grande concentração de casos na Zona Norte e em pontos da Zona Sul. Na Zona Oeste, visualizou-se uma faixa de pontos desde Magalhães Bastos até Santa Cruz e Sepetiba. A intensidade de casos foi maior nas áreas mais carentes. No modelo final, permaneceram: percentual de domicílios particulares permanentes cuja pessoa responsável recebia 3 a 5 salários mínimos e o percentual de domicílios alugados. Conclusão A análise espacial identificou áreas de maior concentração de casos coincidente com áreas mais carentes. A má qualidade do registro dos endereços foi a principal limitação.

Resumo Este estudo propõe uma reflexão sobre os usos e as perspectivas da vigilância em saúde hospitalar a partir do relato de uma experiência pioneira em epidemiologia hospitalar, o Serviço de Epidemiologia/HFSE, que serviu de base para a criação dos núcleos de vigilância epidemiológica (VE) dos hospitais municipais e estaduais do Rio de Janeiro. O serviço integra ações de VE, educação continuada, capacitação, treinamento em serviço, pesquisa e avaliação de serviços desde 1986. Participa ativamente da rede nacional de VE, tendo notificado 55.747 casos de 1986 a 2016, a maioria por busca ativa. A integração dos vários níveis da vigilância e assistência agiliza as atividades clássicas de controle das doenças de notificação compulsória e fornece instrumentos de avaliação da qualidade. O importante papel na capacitação e formação de recursos humanos é evidenciado através do treinamento de 1.835 internos de medicina e 78 residentes até 2016; e pelo fato de que esta experiência tem servido de base para a implantação de diversos outros núcleos hospitalares. Entre os desafios que se impõem atualmente está a articulação com as demais comissões que compõem o Núcleo de Vigilância Hospitalar e o Núcleo de Segurança do Paciente.

Objective: To describe the clinical-epidemiological profile of suspected cases of COVID-19 admitted to a federal hospital in Rio de Janeiro, RJ, Brazil, and to identify factors associated with death. Methods: Cross-sectional study using data from local epidemiological surveillance until epidemiological week 27 of 2020 and logistic regression. Results: 376 suspected hospitalized cases of COVID-19 were included; 52.9% were women, 57.4% were 50 years old or above and 80.1% exhibited comorbidities. COVID-19 was confirmed in 51.9%. Confirmed cases had higher lethality (37.9%) than discarded cases (24.2%). In the adjusted analysis, lethality in confirmed cases was higher for the 50-69 age group (OR=11.65 – 95%CI 1.69;80.33), 70 years or older group (OR=8.43 – 95%CI 1.22;58.14), presence of neoplasia (OR=4.34 – 95%CI 1.28;14.76) and use of invasive ventilatory support (OR=70.20 - 95%CI 19.09;258.19). Conclusion: Higher mortality was associated with older individuals, neoplasia and invasive ventilatory support.

Resumo Objetivo Descrever o perfil clínico-epidemiológico dos casos suspeitos de COVID-19 internados em hospital federal do Rio de Janeiro, RJ, Brasil, e identificar fatores associados ao óbito. Métodos Estudo seccional, utilizando dados da vigilância epidemiológica local até a Semana Epidemiológica 27 de 2020. Empregou-se regressão logística. Resultados Foram incluídos 376 casos internados suspeitos de COVID-19, dos quais 52,9% eram mulheres, 57,4% tinham 50 anos ou mais de idade e 80,1% exibiam comorbidades. Foram confirmados para COVID-19 195 casos (51,9%), cuja letalidade (37,9%) foi maior, comparada à dos descartados (24,2%). Na análise ajustada, associaram-se ao óbito, nos casos confirmados, ter 50 a 69 (OR=11,65 – IC95% 1,69;80,33) e 70 ou mais anos (OR=8,43 – IC95% 1,22;58,14), apresentar neoplasia (OR=4,34 – IC95% 1,28;14,76) e usar suporte ventilatório invasivo (OR=70,20 – IC95% 19,09;258,19). Conclusão Houve elevada prevalência de comorbidades e letalidade; os principais fatores associados ao óbito foram idade, presença de neoplasia e suporte ventilatório invasivo.