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ObjectiveTo investigate the perceptions of young people and adults, smokers and non-smokers about the current set of innovations introduced in 2018 into the Brazilian tobacco products' health warnings.MethodsTwenty focus groups were conducted in five state capitals in Brazil. The participants (n=163) were segmented by smoking status, age (15-17 years, 18-55 years) and social grade (C, D-E classes) to examine cigarette packaging and explore the participants' perceptions of health warnings.ResultsHealth warnings capture attention, eliciting apprehension, fear, disgust and concern about the negative consequences of cigarette consumption. The 2018 Brazil health warnings are spontaneously recalled by participants, even without the presence of cigarette packages. However, the analysis also reveals the challenges of overcoming communication barriers and distorted interpretations, especially among smokers. The inclusion of direct and provocative stimuli, such as the use of the word 'you', attracts attention and creates more proximity to the recipient of the message. The results also highlight the interest and fear elicited by warnings on toxic constituents and the importance of using contrasting colours in warnings, which differentiate them from the colours of cigarette packs.ConclusionIntroducing innovative components in health warnings can catch consumers' attention but considering that the interviewees encountered difficulties interpreting textual warnings about toxic constituents in cigarettes, the study reinforces the importance of adopting direct language and pictures, instead of text, which can visually transmit the warning messages and the use of specific wording that generates proximity between the emitter and receiver.

Yellow fever (YF) vaccination is recommended for persons living in YF-endemic areas as the most effective strategy to reduce the risk for infection (1). The 17D and 17DD live attenuated [...]

O trabalho teve como objetivo levantar a produção científica das aplicações dos dados do Sistema de Informação Hospitalar do SUS (SIH/SUS) em análises de questões relevantes de Saúde Coletiva. Para a busca de artigos publicados em revistas científicas no período de 1984 a 2003, foram consultadas bases de dados e sites de instituições que oferecem pós-graduação stricto sensu em saúde pública para a busca de dissertações e teses. Foram encontradas 76 publicações, que foram classificadas em cinco categorias com diferentes vertentes de análise. Embora o SIH/SUS tenha cobertura incompleta e incertezas quanto à confiabilidade de suas informações, a variedade de estudos aliada a resultados que mostraram consistência interna e coerência com os conhecimentos atuais, reforça a sua importância e a necessidade de entender os seus pontos fortes e fracos.

OBJECTIVE: To compare the immunogenicity of three yellow fever vaccines from WHO-17D and Brazilian 17DD substrains (different seed-lots). METHODS: An equivalence trial was carried out involving 1,087 adults in Rio de Janeiro. Vaccines produced by Bio-Manguinhos, Fiocruz (Rio de Janeiro, Brazil) were administered following standardized procedures adapted to allow blocked randomized allocation of participants to coded vaccine types (double-blind). Neutralizing yellow fever antibody titters were compared in pre- and post-immunization serum samples. Equivalence was defined as a difference of no more than five percentage points in seroconversion rates, and ratio between Geometric Mean Titters (GMT) higher than 0.67. RESULTS: Seroconversion rates were 98% or higher among subjects previously seronegative, and 90% or more of the total cohort of vaccinees, including those previously seropositive. Differences in seroconversion ranged from -0.05% to -3.02%. The intensity of the immune response was also very similar across vaccines: 14.5 to 18.6 IU/mL. GMT ratios ranged from 0.78 to 0.93. Taking the placebo group into account, the vaccines explained 93% of seroconversion. Viremia was detected in 2.7% of vaccinated subjects from Day 3 to Day 7. CONCLUSIONS: The equivalent immunogenicity of yellow fever vaccines from the 17D and 17DD substrains was demonstrated for the first time in placebo-controlled double-blind randomized trial. The study completed the clinical validation process of a new vaccine seed-lot, provided evidence for use of alternative attenuated virus substrains in vaccine production for a major manufacturer, and for the utilization of the 17DD vaccine in other countries.

Entre as doenças invasivas causadas pelo Haemophilus influenzae tipo b (Hib), destacam-se, pela freqüência e gravidade, as pneumonias e as meningites. No período de 1993 a 1997, foram notificados, em Minas Gerais, 720 casos de meningites por Hib, sendo a causa mais freqüente de meningite bacteriana em menores de um ano e a segunda causa no total de meningites. Entretanto, estimou-se uma ocorrência total de 1.160 casos considerando as meningites bacterianas não especificadas. O total de casos estimados de doença invasiva por Hib parece justificar a recente inclusão da vacina no esquema básico de imunizações. O alto custo da vacina reforça a necessidade de melhorar a vigilância epidemiológica da meningite, que constitui uma das fragilidades das ações de controle desta doença.

Background  Subclinical hypothyroidism (SCH) is a common clinical problem. Controversy surrounds the definition, clinical importance, and need for prompt diagnosis and treatment of the mild form of SCH. Aim  The aim of the study was to analyze the evolution of serum thyroid stimulating hormone (TSH) levels after a therapeutic homeopathic intervention in women older than 40 years with SCH. Methods  This study is a retrospective series of 19 cases of SCH, with serum TSH levels between 5 and 10 mIU/L, treated exclusively with homeopathic medicines prescribed on an individualized basis. Results  Nineteen patients were included according to the inclusion and exclusion criteria. Their mean age was 56 years, they were followed for a mean duration of 69 months, the mean number of serum TSH level measurements was 18, and the intervention was successful for 13 patients. Conclusion  The homeopathic therapeutic intervention was successful in 68% of the patients, with serum TSH levels back within the normal range (0.5–5.0 mIU/L). [ABSTRACT FROM AUTHOR]

Estudo seccional que objetivou descrever o perfil antropométrico de funcionários do Banco do Brasil e compará-lo aos resultados da Pesquisa Nacional Sobre Saúde e Nutrição ­ PNSN/1989 para a região Sudeste. Utilizou-se uma amostra de 647 bancários. Entre os funcionários, 8,8% apresentaram baixo peso, 27,8% sobrepeso e 6,4% obesidade. O excesso de peso aumentou com a idade e foi aproximadamente 3 vezes maior em homens do que em mulheres. Dentre as variáveis sócio-demográficas, o sexo, a idade e a escolaridade foram as que melhor explicaram a variação do IMC. Homens da população Sudeste tiveram proporções mais elevadas de baixo peso do que os do Banco do Brasil. Os bancários homens apresentaram freqüências maiores de sobrepeso comparados aos da PNSN. Para as mulheres, freqüências mais elevadas de sobrepeso e obesidade foram estimadas pela PNSN. As altas prevalências de excesso de peso mostram a necessidade da implementação de medidas de prevenção e controle, contribuindo para a redução destes índices, bem como para a redução de gastos sociais devidos a morbi-mortalidade por doenças crônicas.

Medical audit of hospital records has been a major component of quality of care assessment, although physician judgment is known to have low reliability. We estimated interrater agreement of quality assessment in a sample of patients with cardiac conditions admitted to an American teaching hospital. Physician-reviewers used structured review methods designed to improve quality assessment based on judgment. Chance-corrected agreement for the items considered more relevant to process and outcome of care ranged from low to moderate (0.2 to 0.6), depending on the review item and the principal diagnoses and procedures the patients underwent. Results from several studies seem to converge on this point. Comparisons among different settings should be made with caution, given the sensitivity of agreement measurements to prevalence rates. Reliability of review methods in their current stage could be improved by combining the assessment of two or more reviewers, and by emphasizing outcome-oriented events.

O artigo discute os conteúdos e a bibliografia da área temática Epidemiologia e Avaliação de Programas de Saúde, tomando por base a experiência dos cursos de pós-graduação da Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz. Para os autores, a avaliação tem como elemento essencial o julgamento de valor de uma intervenção, e o avaliador é visto como um profissional que analisa a qualidade da assistência como um fator de proteção/risco inserido entre os determinantes de saúde. Entre as disciplinas incluídas na formação do avaliador, a epidemiologia se destaca pela capacidade de integrar a avaliação de programas/serviços como seu objeto de investigação. Nos cursos, os principais tipos de estudo epidemiológico na avaliação de programas são apresentados em um módulo inicial, que é seguido de uma discussão sobre a validade/confiabilidade de medidas e classificações em que costumam se apoiar as avaliações. Um terceiro módulo discute os pressupostos teóricos e práticos na escolha dos modelos de avaliação, enquanto o quarto trabalha a idéia de "qualidade da avaliação da qualidade" das ações programáticas, ou meta-avaliação. A organização deste curso tem como eixo a expansão da aprendizagem da academia aos serviços e reconhece o benefício mútuo dessa parceria.

Background: An effective yellow fever (YF) vaccine has been available since 1937. Nevertheless, questions regarding its use remain poorly understood, such as the ideal dose to confer immunity against the disease, the need for a booster dose, the optimal immunisation schedule for immunocompetent, immunosuppressed, and pediatric populations, among other issues. This work aims to demonstrate that computational tools can be used to simulate different scenarios regarding YF vaccination and the immune response of individuals to this vaccine, thus assisting the response of some of these open questions. Results: This work presents the computational results obtained by a mathematical model of the human immune response to vaccination against YF. Five scenarios were simulated: primovaccination in adults and children, booster dose in adult individuals, vaccination of individuals with autoimmune diseases under immunomodulatory therapy, and the immune response to different vaccine doses. Where data were available, the model was able to quantitatively replicate the levels of antibodies obtained experimentally. In addition, for those scenarios where data were not available, it was possible to qualitatively reproduce the immune response behaviours described in the literature. Conclusions: Our simulations show that the minimum dose to confer immunity against YF is half of the reference dose. The results also suggest that immunological immaturity in children limits the induction and persistence of long-lived plasma cells are related to the antibody decay observed experimentally. Finally, the decay observed in the antibody level after ten years suggests that a booster dose is necessary to keep immunity against YF. [ABSTRACT FROM AUTHOR]