Resumo Objetivo Desenvolver curvas de referência para o peso fetal estimado em uma população de Curitiba, Sul do Brasil, e compará-las com curvas estabelecidas para outras populações. Métodos Foi realizado um estudo observacional, transversal e retrospectivo. Um modelo de referência para o peso fetal estimado foi desenvolvido usando uma amostra local de 2.211 gestações únicas de baixo risco de distúrbios do crescimento e idade gestacional bem definida. Este modelo foi comparado graficamente com as curvas de Hadlock e Intergrowth 21st. Resultados As curvas de referência para o peso fetal estimado foram desenvolvidas para uma população local. O coeficiente de determinação foi de R2 = 99,11%, indicando que 99,11% das variações do peso fetal foram explicadas pelo modelo. Em comparação com as curvas de Hadlock, os percentis 50, 90, e 97 neste modelo foram inferiores, enquanto o percentil 10 quase se sobrepôs, e o percentil 3 foi ligeiramente superior no modelo proposto. Os percentis foram maiores no modelo proposto em comparação com as curvas do Intergrowth 21st, particularmente para os percentis 3, 10, e 50. Conclusão Fornecemos uma curva de referência local para o peso fetal estimado. O modelo proposto foi diferente de outros modelos, e essas diferenças podem ser devido ao uso de diferentes populações para a construção do modelo.

Abstract Objective To develop reference curves of estimated fetal weight for a local population in Curitiba, South of Brazil, and compare them with the curves established for other populations. Methods An observational, cross-sectional, retrospective study was conducted. A reference model for estimated fetal weight was developed using a local sample of 2,211 singleton pregnancies with low risk of growth disorders and well-defined gestational age. This model was compared graphically with the Hadlock and Intergrowth 21st curves. Results Reference curves for estimated fetal weight were developed for a local population. The coefficient of determination was R2 = 99.11%, indicating that 99.11% of the fetal weight variations were explained by the model. Compared with Hadlock curves, the 50th, 90th, and 97th percentiles in this model were lower, whereas the 10th percentile nearly overlapped, and the 3rd percentile was slightly higher in the proposed model. The percentiles were higher in the proposed model compared with the Intergrowth 21st curves, particularly for the 3rd, 10th, and 50th percentiles. Conclusion We provide a local reference curve for estimated fetal weight. The proposed model was different from other models, and these differences might be due to the use of different populations for model construction.

RESUMO Este estudo investigou a relação entre suporte social, características sociodemográficas, clínicas e adesão ao Tratamento Antirretroviral (TARV) utilizando o questionário Social Support Inventory for People who are HIV Positive or Have AIDS. Para isso, foram avaliados 119 usuários HIV-positivos - dos quais 53,8% eram homens. Em relação à disponibilidade e satisfação, os valores médios foram de 3,37 (DP=1,00) para o suporte instrumental e 3,48 (DP=1,06) para o suporte emocional. Observaram-se diferenças significativas na disponibilidade e satisfação do suporte social com variáveis sociodemográficas e clínicas. Verificou-se que, quanto maior a disponibilidade e a satisfação com o suporte social, maior o OR para a adesão ao tratamento. O desenvolvimento de estratégias de apoio social pode contribuir positivamente para o controle da doença e melhor qualidade de vida dos usuários.

ABSTRACT This study aimed to assess the relationship between social support, sociodemographic and clinical characteristics and treatment adherence using the Social Support Inventory for People who are HIV Positive or Have AIDS. Thus, it were evaluated 119 HIV-positive patients, of which 53.8% were men. Regarding the availability and satisfaction mean values were 3.37 (DP=1.00) for the instrumental support and 3.48 (DP=1.06) for emotional support. Significant differences were found in the availability and satisfaction of social support with clinical and sociodemographic variables. It was found that the greater the availability and satisfaction with social support, the greater the OR for adherence to treatment. The development of social support strategies can positively contribute to disease control and better quality of life of HIV-positive patients.

RESUMO Introdução: A variabilidade nas manifestações clínicas da anemia falciforme (HbSS) pode ser influenciada pelos haplótipos no grupamento da globina β S, nomeados de acordo com a origem geográfica: República Centro-Africana (CAR), Benin (BEN), Senegal (SEN) Camarões (CAM) e árabe-indiano. Objetivo: Identificar haplótipos e genótipos da globina β S, suas frequências e as possíveis associações com manifestações clínicas em pacientes com anemia falciforme no estado do Paraná. Método: Estudo longitudinal e descritivo na distribuição dos haplótipos e associativo na análise da influência destes sobre as manifestações clínicas. Identificaram-se as regiões polimórficas da globina β S de 100 pacientes HbSS pela técnica da polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). A associação dos haplótipos com as manifestações clínicas foi analisada em um subgrupo de 52 pacientes pediátricos. Resultados: As frequências dos haplótipos foram CAR: 76%; BEN: 17,5%; SEN: 0,5%; CAM: 0,5% e Atípico (Atp): 5,5%. Os genótipos foram CAR/CAR: 62%; CAR/BEN: 20%; CAR/Atp: 6%; CAR/SEN: 1%; CAR/CAM: 1%; BEN/BEN: 6%; BEN/Atp: 3% e Atp/Atp: 1%. A porcentagem média de hemoglobina fetal (HbF) dos pacientes CAR/CAR e CAR/BEN foi maior que em outros estudos. Os haplótipos da globina β S não tiveram influência nas manifestações clínicas. A dactilite e o sequestro esplênico ocorreram com mais frequência nas crianças abaixo de 3 anos de idade. Conclusão: Na população estudada, não foi possível identificar associação dos haplótipos com as manifestações clínicas. Esse fato pode ser decorrente do predomínio quase absoluto dos haplótipos CAR e BEN, de diferentes polimorfismos e da miscigenação da população brasileira.

ABSTRACT Introduction: Haplotypes in the β S-globin cluster are named according to their geographical origin as Central African Republic (CAR), Benin (BEN), Senegal (SEN), Cameroon (CAM) and Arab-Indian. They are considered to have influence on the diversity of clinical manifestations in sickle cell anemia (HbSS). Objective: To identify β S haplotypes and genotypes, their frequencies and their probable association with clinical presentation in patients with sickle cell anemia in the state of Paraná. Method: Longitudinal and descriptive study for the definition of haplotypes, and associative study for analysis of their influence on clinical severity. By polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), polymorphic regions of 100 HbSS patients were identified. The association of haplotypes with clinical manifestations was analyzed in a subset of 52 pediatric patients. Results: In the state of Paraná, haplotype frequencies were: CAR: 76% BEN: 17.5% SEN: 0.5%, CAM: 0.5% and Atypical (Atp): 5.5%. Genotype frequencies were: CAR/CAR: 62%; CAR/BEN: 20%; CAR/Atp: 6%; CAR/ SEN: 1%; CAR/CAM: 1%; BEN/BEN: 6%; BEN/Atp: 3%, Atp/Atp: 1%. The average percentage of fetal hemoglobin (HbF) in CAR/CAR and CAR/BEN patients was higher than in other studies. Clinical manifestations were not influenced by β S haplotypes. Dactylitis and splenic sequestration occurred more frequently in children below 3 years of age. Conclusion: In this study, no association was found between haplotypes and clinical manifestations, probably given the almost absolute predominance of CAR and BEN haplotypes. However, this fact alerts to the possible influence of other polymorphisms and miscegenation in the Brazilian population.

ABSTRACT Introduction: Multiple factors negatively affect the quality of life of patients infected with hepatitis C virus. This study aims to evaluate the effect of pharmacological treatment on the quality of life of these individuals. Methods: This is a cross-sectional study conducted in two Southern Brazilian centers that used two instruments (a generic and a specific one) for measuring the quality of life in patients with chronic hepatitis C: the Short Form-36 (SF-36); and the Chronic Liver Disease Questionnaire (CLDQ) for liver disease. We included patients from two centers without any treatment (control group), or receiving medication (peginterferon + ribavirin ± telaprevir or boceprevir, i.e., respectively, dual, and triple therapies). Results: One hundred and forty-seven patients were included. Patients under treatment (n = 86) had a lower score in 7 of the 8 SF-36 domains, with statistical significance (p<0.05) only for the emotional function domain. Patients who were not treated (n = 58) had higher scores in 4 of the 6 (p<0.05) CLDQ domains. A comparison of patients, receiving dual or triple therapies for both questionnaires, was only significant in the Vitality domain from CLDQ. Conclusions: Treatment can affect the subjective perception of patients regarding quality of life. Due to the complexity of the disease, each patient must be evaluated in multiple dimensions. Thus, the results may be useful for understanding the patient's perceptions during treatment, and it can also serve as a reference for care instructions.

ABSTRACT Glycemic control in patients with diabetes mellitus type 1 (DM1) reduces the risk of complications but requires a rigorous health care routine. Thus, diabetes education is central to increasing treatment compliance and self-care practices. This study aimed to evaluate the quality of life (QoL) and glycemic control of DM1 patients being treated with insulin analogs and receiving medication review with follow-up. This was a transversal study that included 110 patients registered at the 3rd Health Regional of Ponta Grossa-PR, aged ≥ 18 years, and receiving pharmaceutical care for at least 1 year. The Diabetes Quality of Life Measure (DQOL)-Brazil was used to evaluate QoL. The data were statistically analyzed using SPSS version 17.0 with 95% confidence levels. Of the 110 patients, 58.2% were women. The average age was 33.7 years (±10.5), and the average glycated hemoglobin (HbA1c) value was 8% (±1.4). The mean total DQOL-Brazil score was 2.11 (95% confidence interval, 2.02 - 2.21). All DQOL-Brazil scores were lower in patients with HbA1c ≤ 8%, indicating a better QoL. Good glycemic control, thus, appears to have a positive influence on the QoL, and pharmaceutical interventions are able to contribute to the achievement of therapeutic targets.

Este estudo pretende identificar os fatores relacionados ao óbito na Influenza Pandêmica A(H1N1) 2009 em pacientes tratados com Oseltamivir. Trata-se de um estudo observacional e retrospectivo, realizado com dados de pacientes que apresentaram diagnóstico laboratorial da doença. Os dados foram coletados dos formulários de notificação da doença, pertencentes a uma base de dados do Ministério da Saúde. As análises estatísticas foram realizadas pelos testes de qui-quadrado, t de Student e por regressão logística, considerando significativos os valores de p<0,05. A maior ocorrência de óbitos foi observada nos pacientes com idade entre 20 e 59 anos, de baixa escolaridade, com a presença de comorbidades, não vacinados, tratados tardiamente e que apresentavam sintomas mais severos da infecção. A identificação de fatores de risco para o óbito reforça a necessidade de prevenção e assistência precoce, principalmente na presença de fatores que aumentam a gravidade clínica da doença.

This study aimed to identify factors related to death in Pandemic Influenza A(H1N1)2009 in patients treated with Oseltamivir. It is an observational and retrospective study, carried out with data of patients who had presented laboratorial diagnosis of the illness. Data were collected from the notification forms of the disease, belonging to a database of the Ministry of Health. Statistical analysis was performed by chi-square, Student t test and logistic regression, considering significant p values <0,05. The highest mortality was observed in patients aged between 20 and 59 years, low schooling, with the presence of comorbidities, not vaccinated, treated late and had more severe symptoms of infection. The identification of risk factors for death reinforces the need for prevention and early care, especially in the presence of factors that increase the clinical severity of disease.

Este estudio se propone identificar los factores relacionados con la muerte dela influenza pandémica A(H1N1)2009 en pacientes tratados con Oseltamivir. Es un estudio observacional y retrospectivo, realizado con datos de los pacientes que presentan diagnóstico de laboratorio. Los datos fueron recogidos de los formularios de notificación de la enfermedad, pertenecientes a una base de datos del Ministerio de Salud. Los análisis estadísticos se realizó mediante las pruebas del qui-cuadrado, t de Student y regresión logística, en vista de significativo los valores de p<0,05. La mayor mortalidad se observó en pacientes con edades entre 20 y 59 años, baja escolaridad, con la presencia de comorbilidades, no vacunados, tratados tardíamente y que habían síntomas más graves de la infección. La identificación de factores de riesgo para la muerte refuerza la necesidad de la prevención y atención temprana, especialmente en la presencia de factores que aumentan la gravedad de la enfermedad.

This study aimed to identify factors related to death in Pandemic Influenza A(H1N1)2009 in patients treated with Oseltamivir. It is an observational and retrospective study, carried out with data of patients who had presented laboratorial diagnosis of the illness. Data were collected from the notification forms of the disease, belonging to a database of the Ministry of Health. Statistical analysis was performed by chi-square, Student t test and logistic regression, considering significant p values <0,05. The highest mortality was observed in patients aged between 20 and 59 years, low schooling, with the presence of comorbidities, not vaccinated, treated late and had more severe symptoms of infection. The identification of risk factors for death reinforces the need for prevention and early care, especially in the presence of factors that increase the clinical severity of disease.

Este estudio se propone identificar los factores relacionados con la muerte dela influenza pandémica A(H1N1)2009 en pacientes tratados con Oseltamivir. Es un estudio observacional y retrospectivo, realizado con datos de los pacientes que presentan diagnóstico de laboratorio. Los datos fueron recogidos de los formularios de notificación de la enfermedad, pertenecientes a una base de datos del Ministerio de Salud. Los análisis estadísticos se realizó mediante las pruebas del qui-cuadrado, t de Student y regresión logística, en vista de significativo los valores de p<0,05. La mayor mortalidad se observó en pacientes con edades entre 20 y 59 años, baja escolaridad, con la presencia de comorbilidades, no vacunados, tratados tardíamente y que habían síntomas más graves de la infección. La identificación de factores de riesgo para la muerte refuerza la necesidad de la prevención y atención temprana, especialmente en la presencia de factores que aumentan la gravedad de la enfermedad.

Este estudo pretende identificar os fatores relacionados ao óbito na Influenza Pandêmica A(H1N1) 2009 em pacientes tratados com Oseltamivir. Trata-se de um estudo observacional e retrospectivo, realizado com dados de pacientes que apresentaram diagnóstico laboratorial da doença. Os dados foram coletados dos formulários de notificação da doença, pertencentes a uma base de dados do Ministério da Saúde. As análises estatísticas foram realizadas pelos testes de qui-quadrado, t de Student e por regressão logística, considerando significativos os valores de p<0,05. A maior ocorrência de óbitos foi observada nos pacientes com idade entre 20 e 59 anos, de baixa escolaridade, com a presença de comorbidades, não vacinados, tratados tardiamente e que apresentavam sintomas mais severos da infecção. A identificação de fatores de risco para o óbito reforça a necessidade de prevenção e assistência precoce, principalmente na presença de fatores que aumentam a gravidade clínica da doença.

The aim of this study was to conduct a cost-utility study of adefovir, entecavir, interferon alpha, pegylated interferon alpha, lamivudine and tenofovir for chronic hepatitis B in the context of Brazilian Public Health Care System. A systematic review was carried out for efficacy and safety. Another review was performed to collect utility data and transition probabilities between health states. A Markov model was developed in a time horizon of 40 years with annual cycles for three groups of: HBeAg positive, HBeAg negative, and all patients. These strategies were compared to a fourth group that received no treatment. Discount rates of 5% were applied and sensitivity analyses were performed. Tenofovir offered the best cost-utility ratio for the three evaluated models: U$397, U$385 and U$384 (per QALY, respectively, for HBeAg positive, negative, and all patients). All other strategies were completely dominated because they showed higher costs and lower effectiveness than tenofovir. The sequence of cost-utility in the three models was: tenofovir, entecavir, lamivudine, adefovir, telbivudine, pegylated interferon alpha, and interferon alpha. In the sensitivity analysis, adefovir showed lower cost-utility than telbivudine in some situations. The study has some limitations, primarily related to the creation of scenarios and modeling. In this study, tenofovir presented the best cost-utility ratio. The results obtained in this study will be valuable in decision-making and in the review of the clinical protocol, mainly involving the allocation of available resources for health care.

IntroductionThe objetctive of this study was to evaluate the 2009 Pandemic Influenza A (H1N1) in the elderly and identify the clinical characteristics, mortality and prognostic factors of the infection in these patients.MethodsThis was an observational, retrospective study. Data were collected from the National Notifiable Diseases (SINAN), from the Brazilian Ministry of Health. Only patients 60 years old or more that had laboratory confirmed infections were included. The socio-demographic and clinical variables and outcomes were evaluated to compare mortality rates in the presence or absence of these factors.ResultsWe included 93 patients in the study, 16.1% of whom died. The symptoms of cough and dyspnea, the use of the antiviral oseltamivir, influenza vaccine and comorbidities influenced the outcomes of cure or death. Chest radiography can aid in diagnosis.ConclusionsAlthough relatively few elderly people were infected, this population presented high lethality that can be justified by the sum of clinical, physical and immunological factors in this population. Treatment with oseltamivir and vaccination against seasonal influenza have significantly reduced rates of hospitalization and mortality.

OBJETIVO: Descrever as características clínicas e a letalidade, além de analisar os fatores prognósticos da infecção pela influenza pandêmica A (H1N1), em crianças do estado do Paraná. MÉTODOS: Estudo observacional e retrospectivo. Os dados foram coletados a partir do Sistema Nacional de Agravos de Notificação (Sinan), do Ministério da Saúde, entre março e dezembro de 2010. Foram incluídas as crianças com idade entre zero e 12 anos, com confirmação laboratorial da infecção. As variáveis referentes às características demográficas e clínicas e aos desfechos foram avaliadas estatisticamente a fim de comparar as taxas de letalidade na presença e na ausência desses fatores. Os fatores prognósticos foram identificados por regressão logística. Consideraram-se como significativos os valores de p<0,05. RESULTADOS: Foram incluídas 1.307 crianças, das quais 19 foram a óbito. Os fatores de risco para o óbito foram cardiopatias (OR 7,1; IC95% 1,5 - 32,7), imunodepressão (OR 14,9; IC95% 3,9 - 56,2), dispneia (OR 9,5; IC95% 2,8 - 32,9), pneumonia (OR 23,8; IC95% 2,4 - 239,8), presença de sibilos (OR 11,9; IC95% 1,4 - 103,7) e tempo para o início do tratamento a partir do início dos sintomas (OR 1,3; IC95% 1,2 - 1,5). O tratamento precoce com o antiviral oseltamivir foi um fator de proteção ao óbito (OR 0,012; IC95% 0,003 - 0,05). CONCLUSÕES: Os fatores de risco subjacentes apresentaram papel fundamental na determinação dos desfechos. O diagnóstico e o tratamento precoce foram importantes para a diminuição dos óbitos pela influenza A (H1N1) 2009 em crianças.

OBJECTIVE: To analyze the pandemic influenza A (H1N1) 2009 in children of the state of Paraná, Southern Brazil, in order to identify clinical features, lethality, and prognostic factors for the infection. METHODS: This was a retrospective observational study. Data were collected from the National Notifiable Disease System (Sinan) from the Brazilian Ministry of Health, from March to December, 2010. Children aged between zero and 12 years-old, with laboratorial confirmation of the infection, were included. Variables related to demographic and clinical characteristics and outcomes were evaluated statistically in order to compare the lethality rates in the presence and absence of these factors. The prognostic factors were identified by logistic regression, being significant p<0.05. RESULTS: 1,307 children were included and 19 of them died. Risk factors for death were heart diseases (OR 7.1; 95%CI 1.5 - 32.7), immunosuppression (OR 14.9; 95%CI 3.9 - 56.2), dyspnea (OR 9.5; 95%CI 2.8 - 32.9), pneumonia (OR 23.8; 95%CI 2.4 - 239.8), presence of wheezing (OR 11,9; 95%CI 1.4 - 103.7), and time to start treatment since the onset of symptoms (OR 1.3; 95%CI 1.2 - 1.5). Early treatment with the antiviral drug oseltamivir was a protective factor for death (OR 0.012; 95%CI 0.003 - 0.05). CONCLUSIONS: Underlying risk factors had a major role in determining outcomes. Early diagnosis and treatment were important for the reduction of deaths from influenza A (H1N1) 2009 in children.

OBJETIVO: Describir las características clínicas y la letalidad, además de analizar los factores pronósticos de la infección por la influenza pandémica A (H1N1) en niños de la provincia de Paraná (Brasil). MÉTODOS: Se trató de un estudio observacional y retrospectivo. Los datos fueron recogidos a partir del Sistema Nacional de Agravos de Notificação (Sinan), del Ministerio de Salud, entre marzo y diciembre de 2010. Se incluyeron a los niños con edad entre cero y 12 años, con confirmación laboratorial de la infección. Las variables referentes a las características demográficas y clínicas y a los desenlaces fueron evaluadas estadísticamente, a fin de comparar las tasas de letalidad en la presencia y ausencia de esos factores. Los factores pronósticos fueron identificados por regresión logística. Se consideraron como significativos los valores de p<0,05. RESULTADOS: Se incluyeron a 1.307 niños, de los que 19 fallecieron. Los factores de riesgo para óbito fueron cardiopatías (OR 7,1; IC95% 1,5-32,7), inmunodepresión (OR 14,9; IC95% 3,9-56,2), disnea (OR 9,5; IC95% 2,8-32,9), neumonía (OR 23,8; IC95% 2,4-239,8), presencia de silbidos (OR 11,9; IC95% 1,4-103,7) y tiempo para el inicio del tratamiento a partir del inicio de los síntomas (OR 1,3; IC95% 1,2-1,5). El tratamiento temprano con el antiviral oseltamavir fue un factor de protección al óbito (OR 0,012; IC95% 0,003-0,05). CONCLUSIONES: La tasa de letalidad observada en niños fue menor que la encontrada en el grupo que contrajo la enfermedad. Los factores de riesgo subyacentes presentaron un rol fundamental en la determinación de los desenlaces. El diagnóstico y el tratamiento tempranos fueron importantes para la reducción de los óbitos por influenza A (H1N1) 2009 en niños.

Treatment for chronic hepatitis B in Brazil are funded by the Ministry of Health and by the state Departments of Health. Clinical protocol and therapeutic guidelines approve the use of adefovir, entecavir, interferon-a, lamivudine, and tenofovir for the treatment of chronic hepatitis B. The aim of this study was to establish the profile of users of these drugs in the state of Paraná. A cross-sectional study was conducted with patients under treatment in Paraná in August 2011. The following data were obtained: gender, hepatitis B used drug, International Classification of Diseases, and regional health unit. The monthly cost of these drugs for the public health system was also calculated. 1,093 patients registered were found, 70% male, and 2.6% co-infected with the delta agent. Tenofovir was the drug most commonly used (355 users). The highest prevalence was found in the regional health units of Pato Branco, Cascavel, Foz do Iguaçú, Francisco Beltrão, Toledo, Londrina, and Maringá. The annual cost for the public health system in Paraná was U$1,066,867. Through this study it was possible to investigate the distribution and profile of users of drugs for the treatment of chronic hepatitis B in Paraná in August 2011.

O objetivo deste estudo foi verificar se a gestação esteve associada como fator de risco para o óbito na infecção por Influenza A (H1N1)/2009. Comparou-se a letalidade da influenza pandêmica entre mulheres em idade fértil e gestantes, realizando ainda a busca por outros fatores que diferenciem os grupos em relação aos desfechos. Os dados foram coletados no Sistema de Informação de Agravos de Notificação (SINAN), do Ministério da Saúde. Foram utilizados os casos confirmados laboratorialmente, sendo incluídas 1.861 mulheres com idades entre 10 e 49 anos, das quais 352 eram gestantes. A taxa de letalidade observada durante a pandemia de 2009 foi de 4,5% para as gestantes e 6,4% para as não gestantes (p = 0,197). O resultado da regressão logística não evidenciou associação entre a presença de gestação e o óbito (OR = 0,7; IC95%: 0,41-1,21). No entanto, houve diferenças significativas entre os dois grupos em relação à idade média, ao tratamento com oseltamivir, à escolaridade e à presença de outros fatores de risco.

The aim of this study was to verify whether pregnancy was a risk factor for death in influenza A (H1N1)/2009 infection. We compared the case-fatality rates for pandemic influenza among non-pregnant women of childbearing age and pregnant women, besides investigating other factors that differentiated the groups in relation to the outcomes. The data were collected from the National Information System on Diseases of Notification (SINAN), of the Ministry of Health. The study used cases with laboratory confirmation and included 1,861 women from 10 to 49 years of age, of whom 352 were pregnant. The case-fatality rate during the 2009 pandemic was 4.5% for pregnant women and 6.4% for non-pregnant women (p = 0.197). Logistic regression did not show an association between pregnancy and death (OR = 0.7; 95%CI: 0.41-1.21). However, there were significant differences between the two groups in relation to mean age, treatment with oseltamivir, schooling, and presence of other risk factors.

O objetivo deste estudo foi verificar se a gestação esteve associada como fator de risco para o óbito na infecção por Influenza A (H1N1)/2009. Comparou-se a letalidade da influenza pandêmica entre mulheres em idade fértil e gestantes, realizando ainda a busca por outros fatores que diferenciem os grupos em relação aos desfechos. Os dados foram coletados no Sistema de Informação de Agravos de Notificação (SINAN), do Ministério da Saúde. Foram utilizados os casos confirmados laboratorialmente, sendo incluídas 1.861 mulheres com idades entre 10 e 49 anos, das quais 352 eram gestantes. A taxa de letalidade observada durante a pandemia de 2009 foi de 4,5% para as gestantes e 6,4% para as não gestantes (p = 0,197). O resultado da regressão logística não evidenciou associação entre a presença de gestação e o óbito (OR = 0,7; IC95%: 0,41-1,21). No entanto, houve diferenças significativas entre os dois grupos em relação à idade média, ao tratamento com oseltamivir, à escolaridade e à presença de outros fatores de risco.

The aim of this study was to verify whether pregnancy was a risk factor for death in influenza A (H1N1)/2009 infection. We compared the case-fatality rates for pandemic influenza among non-pregnant women of childbearing age and pregnant women, besides investigating other factors that differentiated the groups in relation to the outcomes. The data were collected from the National Information System on Diseases of Notification (SINAN), of the Ministry of Health. The study used cases with laboratory confirmation and included 1,861 women from 10 to 49 years of age, of whom 352 were pregnant. The case-fatality rate during the 2009 pandemic was 4.5% for pregnant women and 6.4% for non-pregnant women (p = 0.197). Logistic regression did not show an association between pregnancy and death (OR = 0.7; 95%CI: 0.41-1.21). However, there were significant differences between the two groups in relation to mean age, treatment with oseltamivir, schooling, and presence of other risk factors.

OBJETIVO: Avaliar os aspectos da influenza pandêmica A (H1N1) 2009 em pacientes hospitalizados a fim de identificar os fatores de risco para o internamento e, consequentemente, para o agravamento da doença. MÉTODOS: Estudo observacional e retrospectivo realizado entre março e dezembro de 2010. Os dados foram coletados a partir do Sistema Nacional de Agravos de Notificação do Ministério da Saúde. Foram incluídos somente os pacientes hospitalizados e não hospitalizados com confirmação laboratorial da infecção durante o período de estudo. As variáveis referentes às características demográficas e clínicas foram avaliadas estatisticamente a fim de comparar as taxas de internamento na presença ou na ausência desses fatores. Os fatores de risco foram identificados por regressão logística. RESULTADOS: Foram incluídos no estudo 4.740 pacientes com confirmação laboratorial da infecção. Desses, 1.911 foram internados, e 258 (13,5%) foram a óbito. Os fatores de risco para o internamento foram idade (faixa etária de 20 a 29 anos), etnia negra ou indígena, presença de algumas comorbidades (cardiopatias, pneumopatias, nefropatias, hemoglobinopatia, imunodepressão, diabetes, obesidade, puerpério e tabagismo), número alto de comorbidades associadas, e alguns sintomas (dispneia, diarreia, vômito, dor torácica, hemoptise, pneumonia e sibilos). Níveis maiores de escolaridade e uso precoce do oseltamivir foram relacionados a fatores de proteção. A hospitalização contribuiu para o aumento da sobrevida. CONCLUSÕES: O conhecimento das características epidemiológicas que podem estar associadas a internação, gravidade da doença e mortalidade podem ser úteis na adoção de medidas preventivas e no diagnóstico e tratamento precoce da doença, colaborando para a diminuição dos óbitos e da necessidade de hospitalização.

OBJECTIVE: To evaluate pandemic influenza A (H1N1) 2009 in hospitalized patients in order to identify risk factors for hospitalization and, consequently, for the worsening of the disease. METHODS: This retrospective observational study was conducted between March and December of 2010. The data were collected from the Brazilian Ministry of Health National Case Registry Database. We included only patients (inpatients and outpatients) in whom H1N1 infection was confirmed (via laboratory testing) during the study period. The variables regarding demographic and clinical characteristics were statistically evaluated in order to compare the hospitalization rates in the presence or absence of these factors. Risk factors were identified by logistic regression analysis. RESULTS: We included 4,740 patients with laboratory confirmation of H1N1 infection. Of these, 1,911 individuals were hospitalized, and 258 (13.5%) died. The risk factors for hospitalization were age (20-29 years), African or Indigenous ethnicity, presence of specific comorbidities (heart disease, lung disease, kidney disease, hemoglobinopathy, immunosuppression, diabetes, obesity, puerperium, and smoking), a high number of comorbidities, and specific symptoms (dyspnea, diarrhea, vomiting, chest pain, hemoptysis, pneumonia, and wheezing). Higher levels of education and early use of oseltamivir were found to be protective factors. Hospitalization contributed to an increase in survival. CONCLUSIONS: Knowledge of the epidemiological characteristics that can be associated with hospitalization, disease severity, and mortality can be helpful in the adoption of preventive measures, as well as in the early diagnosis and treatment of disease, which might contribute to the reduction in the numbers of hospitalizations and deaths.

OBJECTIVE: The pandemic of new influenza A (H1N1) has spread rapidly throughout the world, characterized by high transmissibility, but low pathogenicity and virulence. The aim of this study was to understand the pandemic event and available technologies for disease surveillance, prevention, control and management. METHODS: In this retrospective study, we used data from patients in the State of Paraná who had been diagnosed with the disease during the 2009 pandemic. Data were collected from the disease notification form and the study only included patients with confirmed laboratory diagnosis by RT-PCR. RESULTS: We present the epidemiological profile of 4,740 patients that met the inclusion criteria. The variables age, level of schooling and gestational age were shown to be associated with mortality due to the infection. Gender and race/ethnicity were not associated with the outcome of the infection. CONCLUSION: These results underscore the importance of knowing the variables associated with unfavorable outcomes of pandemic influenza infection in order to minimize the health related consequences. Attention should be given to its forms of transmission and to the frailty of certain age groups that have no cross-immunity.