Search

Background Mass vaccination is being used in response to coronavirus disease (COVID-19) epidemics, including those driven by emerging variants of concern. We evaluated the effectiveness of the inactivated whole-virus vaccine, CoronaVac, against symptomatic COVID-19 in the elderly population of Sao Paulo State, Brazil during widespread circulation of the P.1 variant. Methods We conducted a test-negative, case-control study of adults ≥70 years of age from Sao Paulo State from January 17 to April 29, 2021, during which vaccination with a two-dose regimen of CoronaVac was implemented. We identified RT-PCR-confirmed COVID-19 cases as well as controls who had a symptomatic illness with a negative RT-PCR test from national surveillance and state vaccination databases. Controls were pair-matched to cases by age category, sex, self-report race, municipality, prior COVID-19 status, and date of RT-PCR testing. We estimated vaccine effectiveness, adjusted for age and comorbidities, using conditional logistic regression. Findings We selected 7,950 matched pairs with a mean age of 76 years from 26,433 COVID-19 cases and 17,622 test-negative controls. Adjusted vaccine effectiveness was 18.2% (95% CI, 0.0 to 33.2) and 41.6% (95% CI, 26.9 to 53.3) in the period 0-13 and ≥14 days, respectively, after the 2nd dose. Administration of a single vaccine dose was not associated with reduced odds of COVID-19. Vaccine effectiveness ≥14 days after the 2nd dose declined with increasing age and was 61.8% (95% CI 34.8 to 77.7), 48.9% (95% CI 23.3 to 66.0) and 28.0% (95% CI 0.6 to 47.9) among individuals 70-74, 75-79 and ≥80 years of age, respectively (pinteraction = 0.05). Interpretation CoronaVac was 42% effective in the real-world setting of extensive P.1 transmission, but significant protection was not observed until completion of the two-dose regimen and vaccine effectiveness declined with increasing age. These findings underscore the need to maintain non-pharmaceutical interventions when mass vaccination with CoronaVac is used as part of an epidemic response. Funding Pan American Health Organization. Research in context Evidence before this study We searched Pubmed for articles published from inception of the pandemic until May 10, 2021, with no language restrictions, using the search terms “vaccine”, “COVID-19”, “SARS-CoV-2”, “elderly”, “age”, “older”. Randomised controlled trials (RCTs) have yielded varying estimates (51-84%) for the effectiveness of the inactivated whole-virus vaccine, CoronaVac, against symptomatic COVID-19. Current evidence is lacking on whether CoronaVac or other COVID-19 vaccines are effective against disease caused by the SARS-CoV-2 variant of concern, P.1, or in a setting of extensive P.1 circulation. No studies have reported the real-world effectiveness of CoronaVac and other inactivated vaccines among elderly individuals, a population that was underrepresented in RCTs of these vaccines. Added value of this study In a population-based matched test-negative case-control study, we found that a two-dose regimen of CoronaVac had an effectiveness of 42% in preventing symptomatic COVID-19 among adults ≥70 years of age during an epidemic associated with widespread P.1 variant transmission. Significant protection was not observed until the period ≥14 days after administration of the second dose. We observed a significant decline in vaccine effectiveness with increasing age in the elderly population. Implications of all the available evidence In the setting of extensive P.1 transmission, the effectiveness of CoronaVac in adults ≥70 years of age was similar to that observed in RCTs conducted in younger populations prior to the emergence of P.1. These findings provide supportive evidence for the use of this vaccine in countries that are experiencing P.1-associated epidemics. However, significant protection was not detected until after administration of the second dose, indicating that vaccination in countries where CoronaVac supplies are constrained may need to prioritize completion of the two dose regimen among the highest risk populations. The delay in achieving vaccine-mediated protection also underscores the need to initiate and maintain non-pharmaceutical interventions when mass vaccination with CoronaVac is used in a response to an epidemic. National immunisation programs should optimise the vaccination of the very elderly (≥80 years), accounting for specific vaccines or vaccination schemes.

Vaccination is fast becoming a key intervention against the ongoing COVID-19 pandemic. We conducted cross-sectional online surveys to investigate COVID-19 vaccine acceptance across nine Low- and Middle-Income Countries (LMICs, N = 10,183), assuming vaccine effectiveness at 90% and 95%. The prevalence of vaccine acceptance increased from 76.4% (90% effectiveness) to 88.8% (95% effectiveness). Considering a 90% effective vaccine, Malaysia, Thailand, Bangladesh, and five African countries (Democratic Republic of Congo, Benin, Uganda, Malawi, and Mali) had lower acceptance odds compared to Brazil. Individuals who perceived taking the vaccine as important to protect themselves had the highest acceptance odds (aOR 2.49) at 95% effectiveness. Vaccine acceptance was also positively associated with COVID-19 knowledge, worry/fear regarding COVID-19, higher income, younger age, and testing negative for COVID-19. However, chronic disease and female gender&nbsp, reduced the odds for vaccine acceptance. The main reasons underpinning vaccine refusal were fear of side effects (41.2%) and lack of confidence in vaccine effectiveness (15.1%). Further research is needed to identify country-specific reasons for vaccine hesitancy in order to develop mitigation strategies that would ensure high and equitable vaccination coverage across LMICs.

COVID-19 affects persons living with HIV (PLWH) both directly (via morbidity/mortality) and indirectly (via disruption of HIV care). From July–November 2020, an online survey was conducted to investigate the psychosocial well-being of PLWH and changes in HIV care during the second semester of the COVID-19 outbreak. Data were collected on the socio-demographic characteristics of PLWH, their psychosocial well-being, impact of COVID-19 preventive measures on their daily routines and HIV follow-up. Of the 247 responses analyzed (mean age: 44.5 ± 13.2 years, 73.7% male), 67 (27.1%) and 69 (27.9%) respondents screened positive for anxiety (GAD-2 score ≥ 3) and depression (PHQ-2 score ≥ 3), respectively. HIV care had returned to pre-COVID-19 state for 48.6% PLWH, and 108 (43.7%) had no HIV follow-up during the past month. Over three quarters (76.1%) of respondents expressed willingness to receive the COVID-19 vaccine. Compared to previous findings in April 2020, substance use increased from 58.6% to 67.2% (p &lt, 0.001). Our findings suggest that the well-being and medical follow-up of PLWH are still affected after almost a year into the COVID-19 outbreak. Remote HIV follow-up (telemedicine) with psychosocial support should be envisaged in the medium to long-term. Given that most PLWH accept COVID-19 vaccination, they may be prioritized for this intervention.

ObjectiveTo estimate the change in odds of covid-19 over time following primary series completion of the inactivated whole virus vaccine CoronaVac (Sinovac Biotech) in São Paulo State, Brazil.DesignTest negative case-control study.SettingCommunity testing for covid-19 in São Paulo State, Brazil.ParticipantsAdults aged ≥18 years who were residents of São Paulo state, had received two doses of CoronaVac, did not have a laboratory confirmed SARS-CoV-2 infection before vaccination, and underwent reverse transcription polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 from 17 January to 14 December 2021. Cases were matched to test negative controls by age (in 5 year bands), municipality of residence, healthcare worker status, and epidemiological week of RT-PCR test.Main outcome measuresRT-PCR confirmed symptomatic covid-19 and associated hospital admissions and deaths. Conditional logistic regression was adjusted for sex, number of covid-19 associated comorbidities, race, and previous acute respiratory illness.ResultsFrom 202 741 eligible people, 52 170 cases with symptomatic covid-19 and 69 115 test negative controls with covid-19 symptoms were formed into 43 257 matched sets. Adjusted odds ratios of symptomatic covid-19 increased with time since completion of the vaccination series. The increase in odds was greater in younger people and among healthcare workers, although sensitivity analyses suggested that this was in part due to bias. In addition, the adjusted odds ratios of covid-19 related hospital admission or death significantly increased with time compared with the odds 14-41 days after series completion: from 1.25 (95% confidence interval 1.04 to 1.51) at 70-97 days up to 1.94 (1.41 to 2.67) from 182 days onwards.ConclusionsSignificant increases in the risk of moderate and severe covid-19 outcomes occurred three months after primary vaccination with CoronaVac among people aged 65 and older. These findings provide supportive evidence for the implementation of vaccine boosters in these populations who received this inactivated vaccine. Studies of waning should include analyses designed to uncover common biases.

BackgroundThe first case of COVID-19 infection was diagnosed in Brazil 26th February 2020. By March 16th, physical distancing and confinement measures were implemented by the Brazilian government. Little is known about how these measures were followed up by the Brazilian people and their impact on daily routine.MethodsIn early April 2020, using an online platform, we organized an online survey among adults living in Brazil about their COVID-19 preventive behavior and impact on their daily routine.ResultsData from 23,896 respondents were analyzed (mean age: 47.4 years). Due to COVID-19 restrictions, half (51.1%) of the professionals reported working from home. Regular handwashing was practiced by 98.7% of participants; 92.6% reported adhering to the 1.5-2 m physical distancing rule, but only 45.5% wore a face mask when going outside. While 29.3% of respondents found it relatively easy to stay at home, indoor confinement was extremely difficult for 7.9% of participants. Moreover, 11% of participants were extremely worried about their health during the COVID-19 epidemic. Younger people, male, persons living in a rural area/village or popular neighbourhoods, students and workers reported less preventive behaviour.ConclusionRestrictive measures markedly affected the daily and professional routines of Brazilians. Participants showed a satisfactory level of adherence to national COVID-19 prevention guidelines. Qualitative and follow-up studies are needed to monitor the impact of COVID-19 in the Brazilian society.

Objective To evaluate the impact of the coronavirus disease 2019 (COVID-19) measures on the lives and psychosocial well-being of persons with epilepsy (PWE) during the third trimester of the COVID-19 pandemic. Methods A structured questionnaire investigating different aspects of the lives and psychosocial well-being of PWE during the COVID-19 pandemic was developed. Persons with epilepsy were invited via social media to anonymously respond to a secure web-based online questionnaire ( www.icpcovid.com ). Responses were collected between July 26th and December 3rd, 2020. Hospital anxiety and depression scales (HADS) were used to screen respondents for depression (HADS-D) and anxiety (HADS-A). Results Responses of 407 PWE were included in the analysis; 304 (74.7%) respondents were female and 245 (60.2%) living in Europe, 157 (38.6%) in South America, and 5 (1.2%) in Canada. Seventy-six (18.7%) reported a decrease of income during the COVID-19 lockdown, and 122 (30.0%) experienced difficulties in obtaining anti-seizure medication (ASM), mostly (72/122, 59.0%) due to unavailability. Seizure frequency increased in 122 (30.0%); 295 (72.5%) screened positive for anxiety, and 159 (39.1%) for depression. Hundred eighty-eight (46.2%) reported reluctance to seek medical care; 27.3% believed that epilepsy was associated with an increased risk of COVID-19 disease. Forty-six (74.2%) of 62 PWE who were followed up by telephone or video consult were satisfied with this consult. Fifty-five respondents, most (89.1%) of whom were from Europe, had also participated in a previous survey during the early months of the pandemic. In this subgroup, although there was no difference in prevalence of a positive screening for depression or anxiety, mean scores on HADS-A and HADS-D increased from 6.65 ± 3.99 to 7.27 ± 4.01 (p = 0.418), and from 5.84 ± 4.43 to 6.60 ± 4.45 (p = 0.371), respectively. Conclusions The COVID-19 pandemic continues to impact the psychosocial and somatic well-being of PWE. To minimize this impact, ensuring uninterrupted access to ASM is essential. Teleconsultations are valid alternatives for continued follow-up, but should include attention to psychosocial well-being. Persons with epilepsy should be more actively informed that epilepsy is not a risk factor for developing (more severe) COVID-19 disease.

OBJECTIVE Verify perceptions of the health team about patient safety culture in home care in a large city in Brazilian Midwest region. METHOD A survey study involving Safety Attitudes Questionnaire and professional profile inventory. Results: From the 37 professionals, most were female (n = 32, 86.5%), lived with their spouse (n = 25, 67.6%), worked in a statutory work regime (n = 29; 78.4%) and have only one job (n = 23; 62.2%). A higher median score for job satisfaction (80.0) and a lower score for management perception (31.8) were found. There was a negative correlation between weekly workload and teamwork (p = 0.02). Safety climate was significantly higher among consolidated (Consolidação das Leis do Trabalho - CLT) professionals in the safety climate (p = 0.001) and overall (p = 0.005) domains. Physicians had a higher perception of the safety climate domain when compared to professionals in other categories (p = 0.005). Age was positively associated to the climate in the safety (p = 0.002), working conditions (p = 0.03) and overall (p = 0.04) domains. CONCLUSION Teamwork and job satisfaction were scored as positive and management actions were considered the main weakness of the safety culture. Resumen OBJETIVO Verificar las percepciones del equipo de salud sobre la cultura de seguridad del paciente en la atención domiciliar en un municipio de grande porte en la región Centro-Oeste del Brasil. MÉTODO Estudio tipo Survey, con aplicación del Cuestionario de Actitudes de Seguridad y perfil profesional. RESULTADOS De los 37 profesionales, la mayoría era del sexo femenino (n=32, 86,5%), vivía con su cónyuge (n=25, 67,6%), laboraba en régimen de trabajo supeditado al código de los funcionarios públicos (n=29; 78,4%) y tenía vínculo laboral (n=23; 62,2%). Se han verificado mayor puntaje mediano para satisfacción en el trabajo (80,0) y menor para percepción de la gerencia (31,8). Hubo una correlación negativa entre la carga horaria semanal y el trabajo en equipo (p=0,02). El clima de seguridad fue significativamente mayor entre profesionales supeditados a la Consolidación de Leyes Laborales en los dominios: clima de seguridad (p=0,001) y global (p=0,005). Los médicos presentaron mayor percepción del clima en el dominio seguridad cuando comparados a los profesionales de otras categorías (p=0,005). La edad fue positivamente asociada al clima en los dominios de seguridad (p=0,002), condiciones de trabajo (p=0,03) y global (p=0,04). CONCLUSIÓN El trabajo en equipo y la satisfacción en el trabajo fueron puntuados como positivos y las acciones gerenciales, consideradas las principales fragilidades de la cultura de seguridad. Resumo OBJETIVO Verificar as percepções da equipe de saúde sobre a cultura de segurança do paciente na atenção domiciliar em um município de grande porte na região Centro-Oeste do Brasil. MÉTODO Estudo tipo Survey, com aplicação do Questionário de Atitudes de Segurança e perfil profissional. RESULTADOS Dos 37 profissionais, a maioria era do sexo feminino (n=32, 86,5%), vivia com cônjuge (n=25, 67,6%), trabalhava em regime de trabalho estatutário (n=29; 78,4%) e tinha vínculo empregatício (n=23; 62,2%). Verificaram-se maior escore mediano para satisfação no trabalho (80,0) e menor para percepção da gerência (31,8). Houve uma correlação negativa entre a carga horária semanal e o trabalho em equipe (p=0,02). O clima de segurança foi significativamente maior entre profissionais celetistas nos domínios clima de segurança (p=0,001) e global (p=0,005). Os médicos apresentaram maior percepção do clima no domínio segurança quando comparados aos profissionais de outras categorias (p=0,005). A idade foi positivamente associada ao clima nos domínios de segurança (p=0,002), condições de trabalho (p=0,03) e global (p=0,04). CONCLUSÃO O trabalho em equipe e a satisfação no trabalho foram pontuados como positivos e as ações gerenciais, consideradas as principais fragilidades da cultura de segurança.

Background: Empirical data on the consequences of the novel coronavirus disease (COVID-19) pandemic on HIV care are lacking. We surveyed people living with HIV (PLWH) in different countries to investigate whether their medical follow-up and psychosocial well-being had been compromised due to COVID-19 and associated restrictions. Methods: In April 2020, a cross-sectional survey among PLWH was conducted using a web-based multilingual questionnaire. The research tool assessed HIV follow-up, psychosocial well-being, COVID-19 (flu-like) symptoms and prevention measures. Consenting respondents provided answers anonymously. Results: Three hundred seventeen PLWH were included (mean age 43.4 +/- 11.7; 71.6% men); 60.3% of participants resided in Belgium and Brazil. One hundred forty (44.2%) reported experiencing a cold with at least one flu-like symptom since January 2020. Of the 18 who reported COVID-19 test results, 4 (22.2%) were positive. Seventy-four (23.3%) respondents screened positive for major depressive disorders, whereas 72 (22.7%) had generalized anxiety disorders. Fifty-six (17.7%) respondents reported difficulties in obtaining antiretroviral medications because of COVID-19-related measures. Adaptations of HIV care during the COVID-19 outbreak included greater quantities of antiretroviral refill in 67 (21.1%), phone consultations in 25 (7.9%), and new refill sites in 12 (3.9%). Factors associated with a reduced risk of experiencing flu-like symptoms included flu vaccination during the past 12 months (P = 0.005) and adaptations of HIV care during the COVID-19 pandemic (P = 0.010). Conclusion: COVID-19 and associated restrictive measures seem detrimental to the well-being and follow-up of PLWH. We recommend that health systems devise innovative approaches for antiretroviral provision and psychosocial support to PLWH during such outbreaks.

Background: The first case of COVID-19 infection was diagnosed in Brazil 26th February 2020. By March 16th, physical distancing and confinement measures were implemented by the Brazilian government. Little is known about how these measures were followed up by the Brazilian people and their impact on daily routine.Methods: In early April 2020, using an online platform, we organized an online survey among adults living in Brazil about their COVID-19 preventive behavior. Results: Data from 23.896 respondents were analyzed (mean age: 47.4 years). Due to COVID-19 restrictions, half (51.1%) of the professionals reported working from home. Regular handwashing was practiced by 98.7% of participants; 92.6% reported adhering to the 1.5-2m physical distancing rule, but only 45.5% wore a face mask when going outside. While 29.3% of respondents found it relatively easy to stay at home, indoor confinement was extremely difficult for 7.9% of participants. Moreover, 11% of participants were extremely worried about their health during the COVID-19 epidemic.Younger people, male, persons living in a rural area/village or popular neighbourhoods, students and workers reported less preventive behaviour. Conclusion: Restrictive measures markedly affected the daily and professional routines of Brazilians. Participants showed a satisfactory level of adherence to national COVID-19 prevention guidelines. Qualitative and follow-up studies are needed to monitor the impact of COVID-19 in the Brazilian society.

Introducao: E pouco conhecido o processo de orientacao e formacao dos agentes comunitarios de saude (ACS) para tratar de epidemias. Neste contexto, salienta-se a importância da aproximacao entre estudantes de Medicina e ACS para o fortalecimento da educacao permanente dos ACS. Objetivo: Promover a educacao permanente dos ACS sobre dengue por meio da participacao efetiva dos estudantes de medicina para desenvolver habilidades de comunicacao dos envolvidos. Metodo: O metodo adotado foi o grupo focal com seis ACS de uma Unidade Basica de Saude (UBS) em Jatai, Goias, Brasil. O grupo focal foi conduzido por estudantes de medicina, seguido da Analise de Conteudo. Resultados: Os estudantes observaram que os ACS acreditam que as estrategias comunicacionais adotadas sao efetivas e acessiveis. Entretanto, constataram que ha falhas comunicacionais a serem sanadas, pois a comunidade continua relutante em por em pratica seus conhecimentos, encontrando assim um desafio a ser trabalhado com os ACS ao longo de sua formacao academica. Os alunos ja comecaram a elaborar suas estrategias de acao, com base em conhecimentos construidos sobre comunicacao e saude coletiva. Conclusoes: Acredita-se que este trabalho e de grande importância para desenvolver habilidades comunicacionais nos estudantes e para fortalecer seu compromisso com a responsividade social.

Introdução: É pouco conhecido o processo de orientação e formação dos agentes comunitários de saúde (ACS) para tratar de epidemias. Neste contexto, salienta-se a importância da aproximação entre estudantes de Medicina e ACS para o fortalecimento da educação permanente dos ACS. Objetivo: Promover a educação permanente dos ACS sobre dengue por meio da participação efetiva dos estudantes de medicina para desenvolver habilidades de comunicação dos envolvidos. Método: O método adotado foi o grupo focal com seis ACS de uma Unidade Básica de Saúde (UBS) em Jataí, Goiás, Brasil. O grupo focal foi conduzido por estudantes de medicina, seguido da Análise de Conteúdo. Resultados: Os estudantes observaram que os ACS acreditam que as estratégias comunicacionais adotadas são efetivas e acessíveis. Entretanto, constataram que há falhas comunicacionais a serem sanadas, pois a comunidade continua relutante em por em prática seus conhecimentos, encontrando assim um desafio a ser trabalhado com os ACS ao longo de sua formação acadêmica. Os alunos já começaram a elaborar suas estratégias de ação, com base em conhecimentos construídos sobre comunicação e saúde coletiva. Conclusões: Acredita-se que este trabalho é de grande importância para desenvolver habilidades comunicacionais nos estudantes e para fortalecer seu compromisso com a responsividade social.

Symptoms, treatment and diagnosis: dengue fever in print media during the first epidemics in Ribeirão Preto, São Paulo, Brazil

Backgrouns and Objectives: Study of vaccination coverage (VC) demonstrates the implementation of public policy actions in the health, although the determined goals are partially achieved, thus justifying the study of VC. To carry out the situational diagnosis of VC in children under one year of age at national, state (Goias) and municipal (Jatai) levels from 2011 to 2015. Methods: A sectional descriptive study was carried out, based on the collection of secondary data from the SI-PNI records on the Datasus platform about VC in children under one year of age on Datasus. Results: Vaccination coverage in the country reached, in general, indices superior to those established by the goal with some exceptions. The state of Goias, together with the municipality of Jatai, showed similar results regarding vaccination coverage by type of vaccine in children under one year, being evident the high rates of vaccination coverage in said municipality. Conclusion: VC in children under one year nationally reveals rates above the target. The Goias State presented a similar vaccination situation to that observed in the Central-West region. The high VC by type of vaccine in children under one year indicates that the municipality of Jatai expresses effectiveness in the PNI.

Highlights • Proper use of face masks by the general public can curtail COVID-19 transmission. • The World Health Organization encourages countries to adopt mass masking policies. • Targeted strategies can increase face mask use even in resource-limited settings. • Impact of mass masking on COVID-19 transmission to be assessed via community trials. • Efficacy of surgical vs cloth masks for COVID-19 warrants further investigations., In new guidelines published on June 5th 2020, the World Health Organization (WHO) recommends that in areas with ongoing COVID-19 community transmission, governments should encourage the general public to wear face masks in specific situations and settings as part of a comprehensive approach to suppress COVID-19 transmission. Recent online surveys in 206,729 persons residing in nine low- and middle-income countries showed that 32.7%-99.7% of respondents used face masks with significant differences across age groups and sexes. Targeted health promotion strategies and government support are required to increase mask use by the general population.

Objective The objective of this study was to assess access to healthcare and to estimate the prevalence of depression and anxiety among persons with epilepsy (PWE) during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Methods We conducted a multicountry online survey among PWE. Persons with epilepsy were invited to participate through various social media channels. The Hospital Anxiety and Depression Scale (HADS) and 9-item Patient Health Questionnaire (PHQ-9) scale were used to score anxiety and depression. Logistic regression modeling was used to investigate factors associated with anxiety and depression. Results Three hundred ninety-nine PWE were included (mean age: 38.22 ± 12.09 years), the majority were female (80.2%) and living in high-income countries (83.2%). Two hundred three PWE reported symptoms of a cold since January 2020. Nine (25%) of the 36 PWE tested for COVID were positive. A total of 72 PWE (19.6%) reported problems to obtain antiseizure medication (ASM), which in 25% of cases was directly COVID-related. Of the 399 PWE, 201 (50.4%) screened positive for anxiety according to the HADS; 159 (39.8%) and 187 (46.9%) PWE screened positive for depression based on the HADS and PHQ-9 scale, respectively. Female gender and financial problems were associated with both depression and anxiety. A planned follow-up consultation with the treating physician was associated with a lower risk of depression, whereas difficulties to access ASM treatment increased the odds of depression. In 65/137 (47.4%) PWE with a planned follow-up visit with the treating physician, this consultation was canceled. Conclusions Innovative approaches are needed to ensure continuity in access to ASM treatment. Healthcare workers should ensure continued follow-up, either through inperson or telehealth appointments, to timely identify symptoms of anxiety and depression and act accordingly., Highlights • We performed a multicountry online survey among 399 persons with epilepsy (PWE). • During COVID-19, 19.6% of the PWE had difficulties to obtain antiseizure drugs. • Overall, 39.8% of the PWE screened positive for depression, 50.4% for anxiety. • Follow-up consultations with the treating physician were canceled in 47.4% of the PWE.

O objetivo deste estudo foi analisar o estilo de vida e a antropometria de idosas do projeto Geração 60+, de Sacramento, Minas Gerais. Participaram vinte idosas praticantes de atividades físicas com idade média de 68±9 anos. Por intermédio de questionário, foram coletados dados sociodemográficos, históricos e antecedentes familiares de doenças, sintomas clínicos, estilo de vida e conhecimento sobre atividade física, tipo e frequência das atividades realizadas. As variáveis antropométricas coletadas foram o índice de massa corpórea (IMC) e relação cintura quadril (RCQ). Empregou-se estatística descritiva para análise dos dados. Observou-se que 55% das idosas eram casadas, 85% aposentadas e 75% tinham baixo nível de escolaridade. O histórico de doenças crônicas degenerativas referiu 50% maternas e 30% paternas. As participantes apresentaram sintomas de alguma doença, 85% visitavam periodicamente o médico e usavam medicamentos. As idosas eram não fumantes e 85% não consumiam álcool. Realizavam as principais refeições e 25% faziam dieta. Observou-se prevalência (70%) para a prática de atividade física mais de três vezes por semana, durante 1 hora. Informaram não saber a diferença entre atividade física e exercício físico, mas reconheceram a sua importância para a saúde, 85% foram influenciadas por profissionais de saúde a realizar atividades físicas. A maioria das idosas apresentou IMC acima dos valores de referência e todas estavam com RCQ acima da normalidade. Apesar de a maioria demonstrar comportamentos preventivos e saudáveis, seus indicadores antropométricos refletiram risco à saúde. Existe uma necessidade de ações mais efetivas no projeto e de estratégias de educação em saúde, especialmente para a população de baixa escolaridade.

No litoral sul do estado de São Paulo, ocorreu uma epidemia de encefalite pelo arbovírus Rocio de 1975 a 1978. As altas taxas de morbidade e mortalidade causaram impacto social. Neste trabalho, o objetivo foi apresentar um estudo sobre como a mídia impressa relatou os acontecimentos sociais relacionados ao surgimento da epidemia no primeiro semestre de 1975. Reportagens sobre a epidemia no litoral sul foram obtidas do banco de dados dos jornais A Tribuna, Folha de S.Paulo e Jornal da Tarde. Foram analisadas as notícias até o mês de julho de 1975, fase inicial e de maior impacto da epidemia. Com a identificação de casos de encefalite, de causa desconhecida, a Secretaria de Estado da Saúde desaconselhou a ida de turistas para o litoral, utilizando a mídia como veículo de divulgação. Diante das notícias, ocorreu a fuga dos turistas e, consequentemente, a crise do comércio. Observou-se a revolta dos comerciantes, que geraram embates contra a mídia, no que tange à forma de divulgação da epidemia. Alguns prefeitos alegaram inveracidade de notícias publicadas. A proibição feita pelas autoridades sanitárias foi relatada pela mídia de forma abrangente, englobando sujeitos envolvidos nesse discurso. Assim, foram reveladas ao público as tensões geradas entre os detentores do conhecimento científico e o poder econômico local. Os jornais realizaram cobertura abrangente, abordando vários temas, entretanto disseminaram incertezas e fizeram uso de imagens sensacionalistas, além de desarticular acontecimentos biológicos e sociais. Os temas chegaram aos leitores de forma fragmentada e com sentidos sociais comprometidos.

Introdução - No litoral sul do Estado de São Paulo, no período de 1975 a 1978, ocorreu uma epidemia, a Encefalite pelo arbovírus Rocio. A região foi objeto de estudo de diversos investigadores. Altas taxas de morbidade e mortalidade devido ao processo epidêmico foram observadas e causaram impacto socioeconômico. A maioria dos indivíduos infectados, no início da epidemia, era do sexo masculino e estava em idade produtiva, sendo trabalhadores rurais da região. Diante das limitações hospitalares e inespecificidade do tratamento na época, houve desde uma lenta convalescença, seqüelas até a ocorrência de óbitos, afetando a economia da região, que repercutiu principalmente na queda no turismo. Mediante este fato, justifica-se a importância deste estudo histórico-documental da encefalite por arbovírus Rocio. Objetivo - Objetivou-se relatar acontecimentos sociais e naturais, medidas clínicas, impactos midiáticos e avanços científicos relacionados à doença, verificando, a trajetória do Rocio. Método - Foi feita uma revisão de literatura de trabalhos publicados desde o início da epidemia até os dias atuais. As fontes consultadas foram teses, dissertações, livros, periódicos, bancos de dados de jornais e revistas, bases de dados cooperativas, relatórios de instituições públicas, contato com especialistas e comunicações em eventos. Resultados - Foi possível analisar como a mídia impressa relatou os acontecimentos sociais relacionados à epidemia e como foi a reação popular às notícias veiculadas, além de discutir a possibilidade de o homem voltar a ser acometido pelo Rocio, diante das atuais mudanças climáticas, acelerada urbanização e pressão sobre a cobertura vegetal no litoral sul do Estado, o que altera a ecologia das populações dessa região. Conclusões - Houve o desencontro entre informações veiculadas pela mídia e dados científicos fornecidos por pesquisadores e autoridades sanitárias, o que dificultava a aceitação da epidemia pela população e viabilizava a distorção de informações e criação de barreiras aos métodos de combate ao possível vetor. Ainda não se sabe como o vírus Rocio tornou-se emergente no litoral sul do Estado em 1975 e o porquê do seu silenciamento, entretanto é conhecido que esse arbovírus ainda mantém atividade, possibilitando o retorno da epidemia no país. Introduction - On the south coast of São Paulo State, Brazil, there was an encephalitis epidemic due to the arbovirus Rocio from 1975 to 1978. Thus, the region has been the object of study by researchers. High rates of morbidity and mortality caused an enormous social impact. The most infected individuals at the beginning of the epidemic was male and was in the productive age. Facing the limitations of the hospital and nonspecific treatment at the time, there was since a slow convalescence, sequels and even the occurrence of deaths, affecting the regional economy, which mainly reflected the drop in local tourism. In view of this fact, it is the importance of this historical and documentary study of encephalitis caused by arbovirus Rocio during the epidemic period. Aim - The aim of this study was to report social and natural events, clinical measurements, media impacts and scientific advances related to the disease, checking the trajectory of virus Rocio. Method It was made a literature review of studies published since the beginning of the epidemic until the present day. The sources which were consulted: theses, dissertations, books, periodicals, databases of newspapers and magazines, electronic databases, reports from public institutions, contact with specialists in communications and events. Results - In this study, it was possible to analize how the written press communicated the social reactions related to the epidemic and how the population reacted the news communicated, in addition was possible to discuss the possibility of the human being be affected by Rocio again due to the current climate change, accelerated urbanization and pressure on the vegetation on the coast south of the State, thus changing the ecology of the population of that region. Conclusions - There was a contradiction between the information carried by the media and scientific data provided by researchers and health authorities, which hindered the acceptance of the epidemic by the population and facilitated the distortion of information. This fact created barriers to methods of combating the possible vector. It is not known how the virus Rocio has become emerging on the south coast of the State in 1975 and why it became silent, however it is know that the arbovirus still has activity, what allows the return of the epidemic in the country.

Introducao - Ha reduzido conhecimento no campo da Saude Publica sobre a funcao social da midia em saude e, particularmente, sobre a relacao entre a midia e o contexto de uma epidemia associada a vetores biologicos, como a dengue. Diante desse quadro, optou-se por estudar a primeira epidemia de dengue em Ribeirao Preto, a qual ocorreu entre novembro de 1990 e marco de 1991. O fato dessa epidemia, assim como as demais, ter sido estudada apenas em seu aspecto biologico, desconsiderando o aspecto social, justifica a realizacao deste estudo. Objetivo - Investigar como se deu a construcao midiatica da primeira epidemia de dengue no municipio de Ribeirao Preto, de novembro de 1990 a marco de 1991, para os leitores dos jornais e revistas veiculadas na epoca. Metodo O material de pesquisa foram reportagens de jornais e revistas confeccionadas na regiao de Ribeirao Preto e na capital do Estado de Sao Paulo - as de grande circulacao na epoca da primeira epidemia de dengue em Ribeirao Preto, de novembro de 1990 a marco de 1991. O metodo adotado foi o Discurso do Sujeito Coletivo, fundamentado na Teoria das Representacoes Sociais. Resultados Foram resgatadas as representacoes sociais veiculadas pela midia e o poder de difusao dessas representacoes no processo de divulgacao cientifica para o publico em geral durante a primeira epidemia de dengue. A analise do conteudo midiatico permitiu apresentar os principais assuntos veiculados no noticiario por meio da elaboracao dos discursos. Conclusoes Foi possivel entender como se deu a construcao dos sentidos acerca da dengue: o jornal fez existir uma realidade epidemica. Comprovou-se a defasagem na informacao disponibilizada nos meios de comunicacao e observou-se vies politico nas reportagens veiculadas, desviando a atencao que deveria ser direcionada para educacao e promocao da saude. Salientou-se a importancia de formacao de profissionais que transitem na interface Saude Publica e Comunicacao para que questoes politicas nao prevalecam sobre questoes prioritarias de saude na midia impressa Introduction There is limited knowledge in the field of Public Health about the social role of media in health and particularly on the relationship between the media and the context of an epidemic associated with biological vectors such as dengue. So, it was decided to study the first epidemic of dengue at Ribeirao Preto, which occurred between November 1990 and March 1991. This epidemic, like the others, was studied only in its biological aspect, ignoring the social aspect, which justifies this study. Aim The aim of this study was to investigate how was the media construction of the first epidemic of dengue in Ribeirao Preto, from November 1990 to March 1991 for the readers of newspapers and magazines circulating at the time. Method The research material were reports of newspapers and magazines made at Ribeirao Preto and at the capital of the State of Sao Paulo - the large circulation - at the time of the first dengue epidemic at Ribeirao Preto, from November 1990 to March 1991. The method adopted was the Collective Subject Discourse, which is based on the Social Representations Theory. Results Social representations in the media were rescued in the media and also the power of diffusion of these representations in the process of scientific diffusion to the general public during the first dengue epidemic. The analysis of media content allowed to present the main issues in the newspapers and magazines through the speeches elaboration. Conclusions In this research, it could be understood how was the construction of meanings about dengue: the newspaper created a reality epidemic. The lag of information provided by mass media was proven and there was political bias in the news published, diverting the attention that should be directed towards education and health promotion. A professional transiting the interface Public Health and Communication is important so that political issues do not prevail on priority issues of health in printed media

Introdução: A tuberculose é uma doença milenar e infectocontagiosa causada pelo Mycobacterium tuberculosis. Trata-se de uma doença prevenível e com histórico de cura desde meados do século XX, mesmo assim, ainda é considerada um dos maiores problemas de saúde pública global do século XXI, sendo as regiões mais afetadas, o Sudeste Asiático e a África Subsaariana, onde Moçambique faz parte. Objetivo: O estudo buscou descrever os aspectos epidemiológicos da tuberculose e dos serviços de atendimento à pessoa com tuberculose (SAPTB) no Município de Chimoio no período 2018-2019. Método: Trata-se de um estudo transversal com abordagem quantitativa no qual foram usados dados primários e secundários. Os dados primários foram referentes aos aspectos da estrutura organizacional e funcional dos SAPTB obtidos a partir da aplicação de um questionário aos gestores dos SAPTB dos Centros de Saúde (C.S). Os dados secundários foram relativos aos aspectos sociodemográficos e clínico-epidemiológicos dos casos de tuberculose notificados no período 2018-2019 confirmados pelos métodos laboratoriais de baciloscopia e GeneXpert®MTB/RIF. Para o estudo de fatores associados, foi utilizado o modelo de regressão logística não ajustado entre as variáveis independentes (sociodemográficos e clínico-epidemiológicas) e dependente (desfecho desfavorável do tratamento da doença: óbito, perda de seguimento hospitalar e/ou abandono e falência terapêutica). As variáveis que apresentaram p≤0,20 foram consideradas candidatas para a inclusão nos modelos de regressão logística múltiplo ajustado pelo sexo e faixa etária. Na sequência, a força de associação (Odds Ratio-OR) entre as variáveis e os respectivos intervalos de 95% confiança (IC95%) foram calculados. Teste de Hosmer e Lemeshow (HL) foi aplicado para a avaliação da qualidade da bondade do ajuste do modelo de regressão logística múltiplo final. Resultados: Todos os C.S tinham SAPTB e equipe técnica estabelecida, porém, diferentes na composição e no tempo de resposta laboratorial. Foram no total, 1.078 casos identificados, sendo, 1.030 novos, 48 reingressados e 555 coinfectados TB-HIV. Destes, 642 (59,6%) eram do sexo masculino, 455 (42,2%) tinham idades na faixa etária de 30 a 44 anos, 901 (83,6%) residentes de zona suburbana e 858 (79,6%) desempregados. Muitos casos não tinham registro sobre estado civil e nível de escolaridade, destacando-se dos poucos casos com essa informação, 65 (6,0) com companheiro e 258 (23,9%) com nível de escolaridade entre 8 e 12 anos respectivamente. Foram envolvidos 1.009 casos no estudo de fatores associados, dos quais, 904 foram declarados curados, 53 óbitos, 49 perdas de seguimento e/ou abandonos do seguimento hospitalar e 3 com falência terapêutica, tendo sido identificado a TB-DR como fator associado (OR=134,3; IC 95%: 47,5-380,1) ao desfecho desfavorável do tratamento observado entre os casos estudados. Conclusão: Esses dados descrevem a estrutura organizacional dos SAPTB nos C.S dos Serviços Distritais da Saúde Mulher e Ação Social de Chimoio e ressaltam seus desafios no enfrentamento do quadro epidemiológico da tuberculose e o possível fator associado, sendo importante para instituir novas estratégias de monitoria e avaliação do Programa de Controle à Tuberculose local. Introduction: Tuberculosis is an ancient infectious disease caused by Mycobacterium tuberculosis. It is a preventable disease with history of cure since the mid-twentieth century, yet it is still considered one of the greatest global public problems of the 21st century, with the most affected regions being Southeast Asia and Sub-Saharan Africa where Mozambique is part. Objectives: The study aimed to describe the epidemiological aspects of tuberculosis and the services for the care of person with tuberculosis (SAPTB) in the Municipality of Chimoio in the period 2018-2019. Method: This is a cross-sectional study with a quantitative approach in which were used primary and secondary data. Primary data were related to aspects of the organizational and functional structure of the SAPTB obtained from the application of a questionnaire to the managers of the SAPTB of the Health Centers (H.C). Secondary data were related to socio-demographic and clinical-epidemiological aspects of tuberculosis cases notified in the period 2018-2019 confirmed by the laboratory methods of bacilloscopy and GeneXpert®MTB/RIF. For the study of associated factors, the logistic regression model was used not adjusted between the independent variables (socio-demographic and clinical-epidemiological) and dependent (unfavourable outcome of the treatment of the disease: death, loss to follow-up and/or abandonment and therapeutic failure) variables. The variables that presented p≤0.20 were considered candidates for inclusion in the multiple logistic regression models adjusted for gender and age group. Subsequently, the strength of association (Odds Ratio-OR) between the variables was determined and the respective 95% confidence intervals (95% IC). Hosmer and Lemeshow test were applied to assess the quality of goodness of fit of the final multiple logistic regression model. Results: All the H.C had SAPTB and established technical team, however, different in composition and laboratory response time. 1,078 cases were identified, of which, 1,030 were new, 48 were re-infected and 555 were co-infected TB-HIV. Of these, 642 (59.6%) were male, 455 (42.2%) were aged between 30 and 44 years, 901 (83.6%) were living in suburban areas and 858 (79.6%) were unemployed. Many cases had no record on marital status and level of schooling, standing out from the few cases with this information, 65 (6.0) with a partner and 258 (23.9%) with a level of schooling between 8 and 12 years respectively. A total of 1009 cases were involved in the study of association factors, of which, 904 were declared cured, 53 deaths, 49 losses to follow-up and/or abandonment of hospital follow-up and 3 with treatment failure, and TB-DR was identified as factors associated (OR=134.3; IC 95%: 147.5-380.1) with the unfavourable treatment outcome observed among the cases studied. Conclusions: These data describe the organizational structure of SAPTB in the H.C of the District Health, Women and Social Services of Chimoio and highlight their challenges in addressing the epidemiological picture of tuberculosis and possible associated factors, being important to institute new strategies for monitoring and evaluating the local TB Control Program.