ABSTRACT Background: Chronic hepatitis B (CHB) affects 257 million people worldwide. However, the proportion of patients eligible for treatment in the public health system has not been established. This study describes the clinical and laboratory profiles of untreated CHB patients and estimates the eligibility rate for antiviral therapy in accordance with the Brazilian Clinical Protocol and Therapeutic Guidelines. Methods: Records of 670 CHB patients were collected from May 2012 to September 2013 in Minas Gerais. Data from each patient were analyzed by hepatitis B virus (HBV) management. Results: 461 CHB patients were treatment-naive. Of these, 23 were HBeAg-positive, 352 were HBeAg-negative, and 14 were clinically diagnosed with cirrhosis. Periodic monitoring was performed in only three patients. However, 9.3% of untreated patients met the eligibility criteria for HBV treatment. Conclusions: Few CHB patients were active carriers and eligible candidates for antiviral therapy. This study revealed inadequate pre-treatment conduct in the Brazilian public health system, emphasizing the need for regular laboratory follow-up for patients initially not eligible for treatment. Such information may indirectly subsidize the planning and improvement of actions and services related to optimal HBV management in the public sphere.

Abstract This meta-analysis, which is based on a previously published systematic review, aims to contribute to the scientific discussion on hepatitis B virus (HBV) infection in workers who are exposed to domestic and healthcare wastes. Publications were sought which had been made available on the data used by December 2013 and updated to December 2016. The quality of the included studies was assessed according to the guidelines of Loney et al. for the critical appraisal of studies on the prevalence or incidence of a health problem. To verify the presence of heterogeneity between the papers, we used the Chi-squared test based on a Q statistic. A funnel plot was used to test for publication bias. All included studies had across-sectional study design. The association between exposure to waste and positive serology for the HBV surface antigen (HBsAg) showed a significant association [odds ratio (OR) 1.89, 95% confidence interval (CI) 1.27-2.86; p = 0.0019]. The prevalence rates of HBsAg and anti-HBc seropositivity was 0.04 (95% CI 0.03-0.05) and 0.21 (95% CI 0.14-0.28), respectively (p <0.0001). We found no evidence of publication bias. The results of this meta-analysis indicate a statistically significant association between exposure to solid waste, whether healthcare or domestic, and positive HBV infection markers. Therefore, the working conditions of waste collectors should be analyzed more closely. Immunization against HBV is recommended as the chief preventive measure for all solid waste workers.

Resumo O contato humano com os resíduos implica riscos biológicos, químicos e físicos à saúde dos trabalhadores envolvidos com a coleta, o transporte e o armazenamento. O potencial de risco para a saúde humana decorrente do contato com os resíduos de saúde ou domiciliares ainda gera muita polêmica. Sendo assim, a proposta deste trabalho foi de identificar o contexto das discussões científicas sobre risco/infecção pelos vírus das hepatites B e C em trabalhadores que coletam resíduos de serviço de saúde ou domiciliares. As buscas abrangeram publicações até 2013 em bancos de dados nacionais e internacionais, sendo selecionados 11 artigos através de uma revisão da literatura, dos quais seis concluem que há maior risco de infecção nos trabalhadores que coletam resíduos domiciliares se comparados com os não expostos aos resíduos, três estudos apontam haver maiores riscos entre os profissionais que coletam os resíduos de saúde se comparados com aqueles que coletam os resíduos comuns, e outros dois concluem não haver diferenças entre expostos e não expostos.

Abstract Human contact with solid waste poses biological, chemical, and physical health risks for workers involved in waste collection, transportation, and storage. The potential risk to human health resulting from contact with health services waste or household waste still sparks considerable controversy. The aim of this study was to identify the context of scientific discussions on risk/infection from the hepatitis B and C viruses in workers that collect solid waste from health services or households. The search covered publications up to 2013 in Brazilian and international databases, and 11 articles were selected through a literature review. Of these, six conclude that there is an increased risk of infection in workers that collect household waste when compared to those unexposed to waste, three point to greater risk for workers that collect health services waste as compared to those that collect ordinary waste, and the other two found no difference between exposed and unexposed individuals.

Resumen El contacto humano con los residuos implica riesgos biológicos, químicos y físicos para la salud de los trabajadores que participan en su recogida, transporte y almacenamiento. El riesgo potencial para la salud humana, como resultado del contacto con los desechos médicos o del hogar, sigue generando mucha controversia. Por lo tanto, el propósito de este estudio fue identificar el contexto de las discusiones científicas sobre el riesgo/infección por el virus de la hepatitis B y C en los trabajadores de recolección de residuos de servicios de salud o del hogar. Fueron recogidos artículos publicados hasta 2013 en bancos de datos nacionales e internacionales; se seleccionaron 11 artículos a través de una revisión de la literatura, seis de los cuales concluyen que hay un mayor riesgo de infección entre los trabajadores que recogen la basura doméstica, en comparación con los no expuestos a los residuos, tres estudios sugieren que existe un mayor riesgo entre los profesionales que recogen los residuos médicos, en comparación con los que la recogida de residuos ordinarios, y otras dos concluyen que no había diferencias entre expuestos y no expuestos.

Resumo O contato humano com os resíduos implica riscos biológicos, químicos e físicos à saúde dos trabalhadores envolvidos com a coleta, o transporte e o armazenamento. O potencial de risco para a saúde humana decorrente do contato com os resíduos de saúde ou domiciliares ainda gera muita polêmica. Sendo assim, a proposta deste trabalho foi de identificar o contexto das discussões científicas sobre risco/infecção pelos vírus das hepatites B e C em trabalhadores que coletam resíduos de serviço de saúde ou domiciliares. As buscas abrangeram publicações até 2013 em bancos de dados nacionais e internacionais, sendo selecionados 11 artigos através de uma revisão da literatura, dos quais seis concluem que há maior risco de infecção nos trabalhadores que coletam resíduos domiciliares se comparados com os não expostos aos resíduos, três estudos apontam haver maiores riscos entre os profissionais que coletam os resíduos de saúde se comparados com aqueles que coletam os resíduos comuns, e outros dois concluem não haver diferenças entre expostos e não expostos.

Abstract Human contact with solid waste poses biological, chemical, and physical health risks for workers involved in waste collection, transportation, and storage. The potential risk to human health resulting from contact with health services waste or household waste still sparks considerable controversy. The aim of this study was to identify the context of scientific discussions on risk/infection from the hepatitis B and C viruses in workers that collect solid waste from health services or households. The search covered publications up to 2013 in Brazilian and international databases, and 11 articles were selected through a literature review. Of these, six conclude that there is an increased risk of infection in workers that collect household waste when compared to those unexposed to waste, three point to greater risk for workers that collect health services waste as compared to those that collect ordinary waste, and the other two found no difference between exposed and unexposed individuals.

Resumen El contacto humano con los residuos implica riesgos biológicos, químicos y físicos para la salud de los trabajadores que participan en su recogida, transporte y almacenamiento. El riesgo potencial para la salud humana, como resultado del contacto con los desechos médicos o del hogar, sigue generando mucha controversia. Por lo tanto, el propósito de este estudio fue identificar el contexto de las discusiones científicas sobre el riesgo/infección por el virus de la hepatitis B y C en los trabajadores de recolección de residuos de servicios de salud o del hogar. Fueron recogidos artículos publicados hasta 2013 en bancos de datos nacionales e internacionales; se seleccionaron 11 artículos a través de una revisión de la literatura, seis de los cuales concluyen que hay un mayor riesgo de infección entre los trabajadores que recogen la basura doméstica, en comparación con los no expuestos a los residuos, tres estudios sugieren que existe un mayor riesgo entre los profesionales que recogen los residuos médicos, en comparación con los que la recogida de residuos ordinarios, y otras dos concluyen que no había diferencias entre expuestos y no expuestos.

The presence of transmitted human immunodeficiency virus (HIV)-1 drug-resistance (TDR) at the time of antiretroviral therapy initiation is associated with failure to achieve viral load (VL) suppression. Here, we report TDR surveillance in a specific population of men who have sex with men (MSM) in Belo Horizonte, Brazil. In this study, the rate of TDR was evaluated in 64 HIV-infected individuals from a cohort of MSM between 1996-June 2012. Fifty-four percent had a documented recent HIV infection, with a seroconversion time of less than 12 months. The median CD4+T lymphocyte count and VL were 531 cells/mm3and 17,746 copies/mL, respectively. Considering the surveillance drug resistance mutation criteria, nine (14.1%) patients presented TDR, of which three (4.7%), five (7.8%) and four (6.2%) had protease inhibitors, resistant against nucleos(t)ide transcriptase inhibitors and against non-nucleoside reverse-transcriptase inhibitors mutations, respectively. Two of the patients had multi-drug-resistant HIV-1. The most prevalent viral subtype was B (44, 68.8%), followed by subtype F (11, 17.2%). This study shows that TDR may vary according to the population studied and it may be higher in clusters of MSM.

Hepatitis B and C constitute important public health problems worldwide. In Brazil, studies on prevalence of viral hepatitis have local and regional characteristics; consequently it is difficult to define the national epidemiological situation. Our objective was to evaluate the seroprevalence of hepatitis B and C in conscripts of the Brazilian Army. A transversal study among males aged 17 to 22 years was conducted nationwide. After informed consent, each volunteer filled in a social-behavioral questionnaire and had blood drawn to test for HBsAg and anti-HCV. A total of 7,372 volunteers were evaluated in the second half of 2002. The prevalence of HBsAg was 2.6% (95% confidence interval: 2.2, 3.0) and that of anti-HCV was 1.5% (95% confidence interval: 1.2, 1.8). A wide variation among macro regions and states in the same region was observed for both markers. In conclusion, although this population theoretically had a low risk for HBV and HCV infection, these results are higher than expected for this age range. These findings may indicate a change in the pattern of HBV and HCV transmission in Brazil. Due to the different dynamics of these epidemics, further studies are warranted to confirm these apparent trends.

OBJETIVO: O processo de envelhecimento populacional brasileiro tem sido acompanhado por transformações epidemiológicas e sociais que, em outros países, aumentaram a demanda por instituições de longa permanência. Nesse sentido, desenvolveu-se estudo sobre dinâmica da institucionalização de idosos através da análise da oferta de leitos e características demográficas dos residentes em asilos. MÉTODOS: Foi realizado levantamento dos asilos de idosos do Município de Belo Horizonte, MG. Foram registradas datas de nascimento e admissão de 1.128 residentes de 33 dos 40 asilos em funcionamento no município. A lotação foi calculada através da capacidade informada e da taxa de institucionalização, segundo dados da Pesquisa Nacional por Amostra de Domicílios (PNAD). RESULTADOS: As taxas de institucionalização de idosos (65+) do município foram 0,9% (mulheres) e 0,3% (homens). A lotação mediana dos asilos era de 92%. Dentre os 1.128 residentes arrolados (92,5% do total), as mulheres (81%) apresentavam maiores médias de idade (76,4 x 70,4 anos; p=0,00) e estada (5,6 x 4,5 anos; p=0,01). DISCUSSÃO/CONCLUSÕES: Elevada lotação, listas de espera nos asilos filantrópicos (85% do total) e rígidos critérios para admissão (metade recusava idosos demenciados ou dependentes) sugerem que a baixa taxa de institucionalização se deve à escassez de vagas. A predominância de idosas reflete a prevalência de viúvas ou separadas na comunidade (66% contra 76% de homens casados). A proporção de homens adultos (31% < 65 anos) sugere dificuldade de se auto-sustentarem após a viuvez. Elevada taxa de mortalidade (24% durante 20 meses de acompanhamento de amostra aleatória de 263 residentes), incompatível com o rigor dos critérios de admissão, determina a baixa mediana de estada (3 anos). Os dados refletem o anacronismo de um sistema não direcionado à manutenção dos idosos em seus próprios domicílios.

INTRODUCTION: Epidemiological and social changes related to population aging in Brazil will probably increase the need for nursing homes (NH). The study analyses the dynamics of institutionalization in Belo Horizonte, a 3 million inhabitant city of whom 8.0% are aged 60 or more. METHODS: Age and length of stay of 1,128 NH residents (92.5% of the estimated population) was registered and occupancy and institutionalization rates were determined. RESULTS: Among women aged 65+ in Belo Horizonte, 0.88% were living in NH; among men, 0.26%. Occupancy rates were 92%. Women (81%) were older than men (76.4 x 70.4 years; two-tailed t test = 6.4; p=0.00) and lived there for a longer period (5.6 x 4.5 years; two-tailed t test = 2.6; p=0.01). Almost 1/3 of the men were aged < 65. CONCLUSIONS: High occupancy rates, long waiting lists and hard criteria for admission (half reject demented or dependent individuals) insinuates that these low institutionalization rates are related to scarcity of beds. The preponderance of women reflects the proportion of those widowed or separated in the community (66% of those aged 65-+, versus 76% of married man). The high frequency of institutionalized men aged <65 suggests lower capacity of maintaining themselves after widowhood. High death rates (24% during a 20 month follow-up of a 263 random sample) determines the small median length of stay (3 years). These data unveil the anachronism of a system which is not directed towards the maintenance of the Brazilian older people among their families and homes.

Os objetivos deste trabalho são avaliar risco ocupacional de exposição ao HIV entre estudantes de medicina, avaliar o conhecimento e o uso das medidas de biossegurança e a cobertura da vacinação contra hepatite B. Questionário específico foi aplicado a 136 estudantes de medicina da Universidade Federal de Minas Gerais. A maioria da população avaliada, 87 (64%) estudantes relataram participar de procedimentos cirúrgicos, 68 (50%) já sofreram algum tipo de exposição a sangue, 90 (66,2%) afirmaram conhecer as medidas universais de biossegurança e 33 (24,3%) relataram conhecer os procedimentos em caso de exposição a sangue contaminado. A população avaliada apresenta alto risco de exposição a material biológico e cerca de um terço desta tem baixo nível de conhecimento das medidas de biossegurança, apesar de fazer uso delas. Torna-se necessário a utilização de estratégias como ensino formal, treinamento em serviço e criação de serviços especializados em biossegurança para a modificação desta realidade.

The objectives of this study were to evaluate the occupational risk of medical students, their knowledge and practice of universal biosafety measures and hepatitis B immunization coverage. A specific questionnaire was applied to 136 medical students of the Universidade Federal de Minas Gerais: 87 (64%) students were involved in surgical procedures, 68 (50%) had been exposed to blood, 90 (66.2%) knew the universal biosafety measures and 33 (24.3%) knew the procedure in case of blood exposure. Thus, this population has a high risk of blood exposure and although there is a low formal knowledge about universal biosafety measures, most of these were generally used. New strategies, such as formal teaching of universal biosafety measures, in loco supervision, and biosafety teams, are necessary to change this situation.

OBJETIVO: O processo de envelhecimento populacional brasileiro tem sido acompanhado por transformações epidemiológicas e sociais que, em outros países, aumentaram a demanda por instituições de longa permanência. Nesse sentido, desenvolveu-se estudo sobre dinâmica da institucionalização de idosos através da análise da oferta de leitos e características demográficas dos residentes em asilos. MÉTODOS: Foi realizado levantamento dos asilos de idosos do Município de Belo Horizonte, MG. Foram registradas datas de nascimento e admissão de 1.128 residentes de 33 dos 40 asilos em funcionamento no município. A lotação foi calculada através da capacidade informada e da taxa de institucionalização, segundo dados da Pesquisa Nacional por Amostra de Domicílios (PNAD). RESULTADOS: As taxas de institucionalização de idosos (65+) do município foram 0,9% (mulheres) e 0,3% (homens). A lotação mediana dos asilos era de 92%. Dentre os 1.128 residentes arrolados (92,5% do total), as mulheres (81%) apresentavam maiores médias de idade (76,4 x 70,4 anos; p=0,00) e estada (5,6 x 4,5 anos; p=0,01). DISCUSSÃO/CONCLUSÕES: Elevada lotação, listas de espera nos asilos filantrópicos (85% do total) e rígidos critérios para admissão (metade recusava idosos demenciados ou dependentes) sugerem que a baixa taxa de institucionalização se deve à escassez de vagas. A predominância de idosas reflete a prevalência de viúvas ou separadas na comunidade (66% contra 76% de homens casados). A proporção de homens adultos (31% < 65 anos) sugere dificuldade de se auto-sustentarem após a viuvez. Elevada taxa de mortalidade (24% durante 20 meses de acompanhamento de amostra aleatória de 263 residentes), incompatível com o rigor dos critérios de admissão, determina a baixa mediana de estada (3 anos). Os dados refletem o anacronismo de um sistema não direcionado à manutenção dos idosos em seus próprios domicílios.

INTRODUCTION: Epidemiological and social changes related to population aging in Brazil will probably increase the need for nursing homes (NH). The study analyses the dynamics of institutionalization in Belo Horizonte, a 3 million inhabitant city of whom 8.0% are aged 60 or more. METHODS: Age and length of stay of 1,128 NH residents (92.5% of the estimated population) was registered and occupancy and institutionalization rates were determined. RESULTS: Among women aged 65+ in Belo Horizonte, 0.88% were living in NH; among men, 0.26%. Occupancy rates were 92%. Women (81%) were older than men (76.4 x 70.4 years; two-tailed t test = 6.4; p=0.00) and lived there for a longer period (5.6 x 4.5 years; two-tailed t test = 2.6; p=0.01). Almost 1/3 of the men were aged < 65. CONCLUSIONS: High occupancy rates, long waiting lists and hard criteria for admission (half reject demented or dependent individuals) insinuates that these low institutionalization rates are related to scarcity of beds. The preponderance of women reflects the proportion of those widowed or separated in the community (66% of those aged 65-+, versus 76% of married man). The high frequency of institutionalized men aged <65 suggests lower capacity of maintaining themselves after widowhood. High death rates (24% during a 20 month follow-up of a 263 random sample) determines the small median length of stay (3 years). These data unveil the anachronism of a system which is not directed towards the maintenance of the Brazilian older people among their families and homes.