ABSTRACT Background: Hepatitis E virus (HEV) infection in patients with pre-existing liver disease has shown high morbidity and lethality. The consequences of HEV superinfection in patients with chronic hepatitis C virus (HCV) infection are not fully understood. This study aimed to evaluate the association between the presence of anti-HEV antibodies, liver cirrhosis, and insulin resistance. Methods: A total of 618 patients chronically infected with HCV were included from three reference centers for viral hepatitis in São Paulo, Brazil. Presence of anti-HEV IgG was assessed by enzyme-linked immunosorbent assay (WANTAI HEV-IgG ELISA). Results: The seroprevalence of anti-HEV in patients with cirrhosis was significantly higher than in patients without cirrhosis (13.2% vs 8%, OR = 1.74, p = 0.04). Seropositivity for anti-HEV, adjusted for sex, age, and HCV genotype showed an association trend with hepatic cirrhosis (aOR = 1.75, p = 0.059). Presence of HEV antibodies, adjusted for age, body mass index and cirrhosis, was shown to be independently associated with insulin resistance (aOR: 4.39; p = 0.045). Conclusion: Patients with chronic hepatitis C are under risk of hepatitis E virus superinfection in Brazil. The trend toward association between cirrhosis and previous HEV infection suggests that it may accelerate liver fibrosis in patients with chronic hepatitis C. In addition, previous infection by HEV is independently associated with insulin resistance in the studied population, which may be an extra-hepatic manifestation of hepatitis E that persists after resolution of the active infection, and may contribute to fibrosis progression.

RESUMO CONTEXTO: A infecção pelo vírus da hepatite C (HCV) é uma das principais causas de hepatite C crônica e provoca implicações graves para pacientes, familiares e sistema de saúde. OBJETIVO: Os objetivos deste estudo foram: analisar a gravidade da fibrose hepática, comorbidades e complicações da hepatite C; examinar a qualidade de vida relacionada à saúde (QVRS), a perda de produtividade e o uso de recursos e custos no sistema público por pacientes brasileiros com hepatite C crônica, genótipo tipo 1. MÉTODOS: Foi realizado um estudo transversal, multicêntrico em pacientes com hepatite C crônica genótipo-1 para avaliar a carga da doença no sistema público de saúde brasileiro entre novembro de 2014 e março de 2015. Os pacientes foram submetidos a uma elastografia hepática transitória (FibroScan) para avaliar a fibrose e a uma entrevista composta por um questionário desenvolvido para o estudo e cinco questionários padronizados: EQ-5D-3L, HCV-PRO, e WPAI:HepC. RESULTADOS: Foram recrutados 313 pacientes. A amostra foi composta predominantemente por mulheres (50,8%), caucasianos/brancos (55,9%) e indivíduos empregados (39,9%). A média de idade foi 56 (DP=10,4) anos. Em média, os pacientes com HCV esperaram 40,6 (DP=49,6) meses entre o diagnóstico e o primeiro tratamento. Ademais, 42,8% dos pacientes que realizaram o FibroScan tinham cirrose; a comorbidade mais frequente foi doença cardiovascular (62,6%) e a complicação mais comum as varizes esofágicas (54,5%). Os resultados também mostraram que “dor e desconforto” foi a dimensão de QVRS mais afetada (55,0% dos pacientes relataram alguns problemas) e que a média do escore do HCV-PRO foi 69,1 (DP=24,2). Em relação à perda de produtividade, o componente do WPAI:HepC mais afetado foi atividade diária (23,5%) e entre os pacientes empregados, presenteísmo foi mais frequente do que absenteísmo (18,5% vs 6,5%). Os custos diretos médicos totais com essa amostra foi de 12.305,72USD por paciente em um período de dois anos; o tratamento medicamentoso representou 95% desse total. CONCLUSÃO Esse estudo mostrou a maioria dos pacientes possui cirrose, apresenta alta prevalência de doenças cardiometabolicas e varizes esofágicas, QVRS reduzida principalmente em termos de dor/desconforto e dano na produtividade, especialmente presenteísmo. Adicionalmente, nós demonstramos que o HCV impõe uma carga econômica no sistema de saúde brasileiro e que os medicamentos correspondem à maioria dos custos.

ABSTRACT BACKGROUND: Infection by hepatitis C virus is one of the leading causes of chronic hepatitis C and cause severe burden for patients, families and the health care system. OBJECTIVE: The aims of this research were to assess the severity of liver fibrosis, comorbidities and complications of hepatitis C virus; to examine health-related quality of life (HRQoL), productivity loss and resource use and costs in a sample of Brazilian chronic hepatitis C, genotype 1, patients. METHODS: This was a cross-sectional multicenter study performed in genotype-1 chronic hepatitis C patients to assess disease burden in the Brazilian public health care system between November 2014 and March 2015. Patients were submitted to a liver transient elastography (FibroScan) to assess liver fibrosis and answered an interview composed by a questionnaire specifically developed for the study and three standardized questionnaires: EQ-5D-3L, HCV-PRO and WPAI:HepC. RESULTS: There were 313 subjects enrolled, with predominance of women (50.8%), caucasian/white (55.9%) and employed individuals (39.9%). Mean age was 56 (SD=10.4) years old. Moreover, 42.8% of patients who underwent FibroScan were cirrhotic; the most frequent comorbidity was cardiovascular disease (62.6%) and the most frequent complication was esophageal varices (54.5%). The results also showed that “pain and discomfort” was the most affected HRQoL dimension (55.0% of patients reported some problems) and that the mean HCV-PRO overall score was 69.1 (SD=24.2). Regarding productivity loss, the most affected WPAI:HepC component was daily activity (23.5%) and among employed patients, presenteeism was more frequent than absenteeism (18.5% vs 6.5%). The direct medical costs in this chronic hepatitis C sample was 12,305.72USD per patient in the 2 years study period; drug treatment costs represented 95.9% of this total. CONCLUSION: This study showed that most patients are cirrhotic, present high prevalence of cardiometabolic diseases and esophageal varices, reduced HRQoL mainly in terms of pain/discomfort, and work productivity impairment, especially presenteeism. Additionally, we demonstrated that hepatitis C virus imposes an economic burden on Brazilian Health Care System and that most of this cost is due to drug treatment.

ABSTRACT Background and aims: Hepatitis E virus infection in patients with underlying chronic liver disease is associated with liver decompensation and increased lethality. The seroprevalence of hepatitis E virus in patients with chronic hepatitis C in Brazil is unknown. This study aims to estimate the seroprevalence of hepatitis E virus in patients with chronic hepatitis C and to describe associated risk factors. Methods: A total of 618 patients chronically infected with hepatitis C virus from three reference centers of São Paulo, Brazil were included. Presence of anti-HEV IgG was assessed by enzyme-linked immunosorbent assay (WANTAI HEV-IgG ELISA). Results: Out of the 618 patients tested, 10.2% turned out positive for anti-HEV IgG (95% CI 8.0–12.8%). Higher seroprevalence was found independently associated with age over 60 years (OR = 2.04; p = 0.02) and previous contact with pigs (OR = 1.99; p = 0.03). Conclusions: Patients with chronic hepatitis C are under risk of hepatitis E virus superinfection in São Paulo. Contact with pigs is a risk factor for the infection, suggesting a possible zoonosis with oral transmission.

ABSTRACT The recent development of interferon-free regimens based on direct-acting antivirals for the treatment of chronic hepatitis C virus infection has benefited many but not all patients. Some patients still experience treatment failure, possibly attributed to unknown host and viral factors, such as IFNL3 gene polymorphism. The present study assessed the prevalence of rs12979860-CC, rs12979860-CT, and rs12979860-TT genotypes of the IFNL3 gene, and its relationship with ancestry informative markers in 949 adult Brazilian healthy blood donors. Race was analyzed using ancestry informative markers as a surrogate for ancestry. IFNL3 gene was genotyped using the ABI TaqMan single nucleotide polymorphisms genotyping assays. The overall frequency of rs12979860-CC genotype was 36.9%. The contribution of African ancestry was significantly higher among donors from the northeast region in relation to southeast donors, whereas the influence of European ancestry was significantly higher in southeast donors. Donors with rs12979860-CC and rs12979860-CT genotypes had similar ancestry background. The contribution of African ancestry was higher among rs12979860-TT genotype donors in comparison to both rs12979860-CC and rs12979860-CT genotypes. The prevalence of rs12979860-CC genotype is similar to that found in the US, despite the Brazilian ancestry informative markers admixture. However, in terms of ancestry, rs12979860-CT genotype was much closer to rs12979860-CC individuals than to rs12979860-TT.

OBJECTIVE: The aim of this study was to evaluate the occurrence of the well-known predisposing factors and signs and symptoms usually associated with either overreaching or overtraining syndrome in physical fitness centers in São Paulo City, Brazil. METHOD: A questionnaire consisting of 13 question groups pertaining to either predisposing factors (1-7) or signs and symptoms (8-13) was given to 413 subjects. The general training schedule of the volunteers was characterized by workout sessions of 2.18 ± 0.04 h for a total of 11.0 ± 0.3 h/week for 33 ± 2 months independent of the type of exercise performed (walking, running, spinning, bodybuilding and stretching). A mean score was calculated ranging from 1 (completely absent) to 5 (severe) for each question group. A low occurrence was considered to be a question group score lower than 4, which was observed in all 13 question groups. RESULTS: The psychological evaluation by POMS Mood State Questionnaire indicated a normal non-inverted iceberg. The hematological parameters, creatine kinase activity, cortisol, total testosterone and free testosterone concentrations were within the normal ranges for the majority of the volunteers selected for this analysis (n = 60). CONCLUSION: According to the questionnaire score analysis, no predisposing factors or signs and symptoms usually associated with either overreaching or overtraining were detected among the members of physical fitness centers in São Paulo City, Brazil. This observation was corroborated by the absence of any significant hematological or stress hormone level alterations in blood analyses of the majority of the selected volunteers (n = 60).

OBJETIVO: Traduzir para português brasileiro, adaptar culturalmente e avaliar as propriedades psicométricas (validade e confiabilidade) de um questionário de qualidade de vida (HIV/AIDS-Targeted Quality of Life Instrument, HAT-QoL) específico para pacientes infectados pelo HIV. MÉTODO: Estudo transversal realizado no ambulatório de infectologia da Escola Paulista de Medicina da Universidade Federal de São Paulo. Coletaram-se características sociodemográficas e clínicas de 106 indivíduos infectados pelo HIV, que responderam os questionários de qualidade de vida HAT-QoL e SF-36. O coeficiente de correlação de Pearson aferiu a validade de construto. Para avaliar a confiabilidade foram calculados o alfa de Cronbach e o coeficiente de correlação intraclasse. RESULTADOS: A proporção de homens na amostra foi de 70,8%. A média de idade foi 39,9 anos. Dos participantes, 40,5% eram homo ou bissexuais. Onze (10,4%) pacientes tinham contagem de células CD4 < 200 células/mm3. Entre os nove domínios do HAT-QoL, sete (função geral, satisfação com a vida, preocupações com a saúde, preocupações com a medicação, aceitação do HIV, confiança no profissional e função sexual) apresentaram efeito teto substancial. O domínio "função sexual" foi o que apresentou efeito teto mais alto (63,2%). O domínio preocupações financeiras apresentou efeito chão substancial (30,2%). Associações estatisticamente significativas foram observadas entre os domínios do HAT-QoL e características sociodemográficas e clínicas e domínios do questionário SF-36. A consistência interna foi satisfatória (alfa de Cronbach = 0,73 a 0,90). A reprodutibilidade inter e intraobservador foi muito alta (0,87 a 0,98 e 0,82 a 0,97, respectivamente). CONCLUSÃO: O HAT-QoL em português brasileiro é um instrumento válido, confiável e que pode contribuir para avaliar o impacto da infecção pelo HIV sobre a qualidade de vida de pacientes brasileiros.

OBJECTIVES: To translate the HIV/AIDS-Targeted Quality of Life Instrument (HAT-QoL) into Brazilian Portuguese, culturally adapt it, and evaluate its psychometric properties (validity and reliability) as a Brazilian version. METHODS: This cross-sectional study was carried out at the laboratory of infectious diseases at Escola Paulista de Medicina (Universidade Federal de São Paulo). Data were collected on clinical and sociodemographic characteristics of 106 HIV-infected individuals who answered the HAT-QoL and the SF-36®. Pearson's correlation coefficient was used to measure construct validity. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients. RESULTS: The sample was 70.8% male. The mean age was 39.9 years, with 40.5% of the participants being homosexual or bisexual. Eleven (10.4%) patients had a CD4 cell count < 200 cells/mm3. A substantial ceiling effect was observed in 7 of 9 HAT-QoL domains (overall function, life satisfaction, health worries, medication worries, HIV acceptance, provider trust, and sexual function). Sexual function was the domain with the highest ceiling effect (63.2%). A substantial floor effect (30.2%) was observed for financial worries. Statistically significant associations were observed between the HAT-QoL domains and clinical and sociodemographic characteristics, as well as with SF-36 domains. Internal consistency was satisfactory (Cronbach's alpha = 0.730.90). Inter- and intra-observer reproducibility was very high (0.870.98 and 0.820.97, - respectively). CONCLUSION: The Brazilian Portuguese version of the HAT-QoL is valid, reliable, and may contribute to evaluating the impact of HIV infection on the quality of life of patients in Brazil.

Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in most Brazilian Hospitals, and there are few studies which show the efficacy of control measures in such situations. This study evaluated intensive care unit (ICU) patients, in two years divided in control, intervention and post-intervention group. Intervention measures: hands-on educational programs for healthcare workers; early identification of MRSA infected or colonized patients, labeled with a bed-identification tag for contact isolation; nasal carriers, patients, and healthcare professionals treated with topical mupirocin for five days. The hospital infection rates in the control period were compared to the ones in the post-intervention period. Hospital infection rates were found by means of the NNISS methodology The incidence coefficients of MRSA hospital infection (monthly average of 1,000 pts/day) in the control, intervention and post-intervention groups were respectively: 10.2, 5.1 and 2.5/1,000 pts/day (p<0.001) and MRSA-originated bloodstream infections were 3.6, 0.9 and 1.8/1,000 central venous catheter/day (p=0.281). Nasal colonization in both intervention and post-intervention periods was of 30.9% and 22.1% among the hospitalized patients, respectively 54.4% and 46.1% of whom were already MRSA-positive when admitted to the unit. In the intervention period, most of those MRSA infected patients (76.2%) were nasal carrier. Mortality rates were, respectively 26.6%; 27.3% and 21.0% (p<0.001). Nasal carriers, both patients (93.7%) and healthcare professionals (88.2%), were successfully treated with topical mupirocin. Intervention measures for the prevention and control of MRSA infections in ICUs, have been efficient in the reduction of the bloodstream and MRSA-originated hospital infections incidence, and reduced the overall mortality rate significantly.

OBJETIVO: O objetivo deste estudo foi estimar o padrão de tratamento, a utilização de recursos e os gastos para cada estágio da HCVB, no ambiente do Sistema Único de Saúde (SUS) do Brasil, no ano 2005. MÉTODOS: Foi desenvolvido painel Delphi de especialistas para obter informação sobre o padrão de tratamento da HCVB no Brasil. Os dados foram coletados com dez médicos especialistas em hepatologia e doenças infecciosas. A valoração dos recursos foi obtida predominantemente das tabelas de pagamentos do Sistema Único de Saúde e tabelas de preços de medicamentos. As estimativas de custo tiveram a perspectiva do pagador público. Os dados foram analisados estatisticamente pelo programa SPSS 12.0 para Windows. RESULTADOS: Os gastos estimados dos pacientes foram separados em cada estágio da HCVB. O gasto estimado anual por paciente foi: R$ 980,89 para hepatite B crônica, sem cirrose e sem tratamento antiviral; R$ 1.243,17 para cirrose compensada sem tratamento antiviral; R$ 22.022,61 para cirrose descompensada; R$ 4.764,95 para o carcinoma hepatocelular; e R$ 87.372,60 para o transplante hepático. CONCLUSÃO: Os gastos estimados com procedimentos e medicamentos, excluindo antivirais, representaram os principais componentes do gasto da HCVB. Neste modelo, os gastos aumentam dramaticamente nos estágios mais avançados, sugerindo que retardar a progressão da doença poderá reduzir o gasto no longo prazo.

BACKGROUD: Chronic Hepatitis B Virus (CHBV) is a disease that places a large financial burden on healthcare systems and society. OBJECTIVE: The aim of this study was to estimate patient management patterns, and associated medical resource utilization and expenses, for each of the four stages of chronic HBV infection in the public unified healthcare system settings, in 2005. METHODS. An expert panel comprised of ten physicians, leading specialists in hepathology and infectious diseases, was convened to obtain information regarding management of CHBV patients in Brazil. Expense inputs were mainly obtained from government fee schedules and pharmaceutical price tables. Costs were estimated under the perspective of the public health system. Data were analyzed using Windows SPSS version 12.0. RESULTS: Estimated patient expenses were calculated for the four stages of CHBV infection. The estimated annual expenses per patient were: R$ 980.89 (US$ 392) for chronic hepatitis B with no cirrhosis and without antiviral therapy; R$ 1,243.17 (US$ 496) for compensated cirrhosis without antiviral therapy; R$ 22,022.61 (US$ 8809) for decompensated cirrhosis; R$ 4,764.95 (US$ 1,905) for hepatocellular carcinoma; and R$ 87,372.60 (US$ 34,948) for liver transplant. CONCLUSION: Estimated expenses associated with drugs and procedures represented the main components of the expenses of CHBV infection. In this model, expenses increase dramatically as the disease progresses to more advanced stages, suggesting that over the long term delaying progression may reduce costs.

OBJETIVO: Descrever o perfil de utilização de medicamentos por idosos residentes em áreas de diferentes níveis socioeconômicos de um centro urbano do Nordeste do Brasil. MÉTODOS: Inquérito domiciliar entre idosos (60 anos ou mais) da cidade de Fortaleza, Ceará, selecionados por amostragem sistemática em múltiplos estágios e estratificada por nível socioeconômico (melhor = área central; intermediário = área intermediária; pior = área periférica). Estatística descritiva foi apresentada pelas percentagens dos respectivos totais para variáveis categóricas e médias (± desvio-padrão) para variável contínua. Realizou-se análise multivariada para identificação de fatores associados a uso de medicamentos prescritos; não-prescritos e inadequados. RESULTADOS: A maioria dos idosos (80,3% na área central) usava pelo menos um medicamento prescrito. Mais de um terço (37,4%) na área periférica usava pelo menos um não-prescrito, e quase 20% pelo menos um inadequado. O uso de medicamentos prescritos foi associado à idade avançada (razão de chances - RR=1,7; IC 95%: 1,1-2,8); sexo masculino (RR=0,5; IC 95%: 0,3-0,7); visitas a serviços de saúde (RR=2,5; IC 95%: 1,9-3,1); doenças crônicas (RR=4,0; IC 95%: 2,5-6,2); e nível socioeconômico (RR=2,0; IC 95%: 1,5-2,6). O uso de medicamentos não prescritos foi associado a comprometimento funcional (RR=1,5; IC 95%: 1,1-2,2) e nível socioeconômico (RR=0,6; IC 95%: 0,5-0,8). O uso de medicamentos inadequados foi associado principalmente a sexo masculino (RR=0,4; IC 95%: 0,2-0,8); doenças crônicas (RR=2,0; IC 95%: 1,2-3,3), e nível socioeconômico (RR=0,7; IC 95%: 0,5-0,9). CONCLUSÕES: As proporções de idosos usando medicamentos prescritos, não-prescritos e inadequados foram significativas, havendo desigualdades particularmente entre aqueles de diferentes níveis socioeconômicos. Os resultados apontam para a necessidade de programas para otimizar o acesso e racionalizar o uso de medicamentos entre idosos no Brasil.

OBJECTIVE: To identify medication use patterns among elderly people residing in areas with different socioeconomic status in the city of Fortaleza, Brazil. METHODS: A total of 668 elderly (aged 60 years or older) residing in the city of Fortaleza, Ceará, Brazil, selected from a multistage random sampling stratified by socioeconomic status (higher, intermediate, and lower areas), were interviewed in a household survey. Descriptive statistics for dichotomous variables were presented as percent of the respective totals, and those for continuous variables as mean ± SD. Multivariate analyses were performed to identify factors associated with the use of prescription, non-prescription and inappropriate) drugs. RESULTS: Most (80.3% in the hgiher area) were on at least one non- prescription drug. More than one third (37.4%) were on at least one non- prescription drug and nearly 20% used at least one inappropriate in the lower area. PD use was associated with advanced age (OR=1.7, 95% CI=1.1-2.8); male sex (OR=0.5, 95% CI=0.3-0.7); health service visits (OR=2.5, 95% CI=1.9-3.1); chronic diseases (OR=4.0, 95% CI=2.5-6.2); and higher socioeconomic status (OR=2.0, 95% CI=1.5-2.6).Non- prescription drug use was associated with disability (OR=1.5, 95% CI=1.1-2.2), and higher socioeconomic status (OR=0.6; 95% CI=0.5-0.8). Inappropriate drugs use was mainly associated with male sex (OR=0.4, 95% CI=0.2-0.8); chronic diseases (OR=2.0, 95% CI=1.2-3.3); and higher socioeconomic status (OR=0.7, 95% CI=0.5-0.9). CONCLUSIONS: The proportions of elderly using prescription, non- prescription and inappropriate drugs were remarkable and inequalities were seen particularly among those from different socioeconomic status. These results emphasize the need for strategies to optimize the access and rationalize the use of drugs for elderly people in Brazil.

OBJETIVO: Descrever o perfil de utilização de medicamentos por idosos residentes em áreas de diferentes níveis socioeconômicos de um centro urbano do Nordeste do Brasil. MÉTODOS: Inquérito domiciliar entre idosos (60 anos ou mais) da cidade de Fortaleza, Ceará, selecionados por amostragem sistemática em múltiplos estágios e estratificada por nível socioeconômico (melhor = área central; intermediário = área intermediária; pior = área periférica). Estatística descritiva foi apresentada pelas percentagens dos respectivos totais para variáveis categóricas e médias (± desvio-padrão) para variável contínua. Realizou-se análise multivariada para identificação de fatores associados a uso de medicamentos prescritos; não-prescritos e inadequados. RESULTADOS: A maioria dos idosos (80,3% na área central) usava pelo menos um medicamento prescrito. Mais de um terço (37,4%) na área periférica usava pelo menos um não-prescrito, e quase 20% pelo menos um inadequado. O uso de medicamentos prescritos foi associado à idade avançada (razão de chances - RR=1,7; IC 95%: 1,1-2,8); sexo masculino (RR=0,5; IC 95%: 0,3-0,7); visitas a serviços de saúde (RR=2,5; IC 95%: 1,9-3,1); doenças crônicas (RR=4,0; IC 95%: 2,5-6,2); e nível socioeconômico (RR=2,0; IC 95%: 1,5-2,6). O uso de medicamentos não prescritos foi associado a comprometimento funcional (RR=1,5; IC 95%: 1,1-2,2) e nível socioeconômico (RR=0,6; IC 95%: 0,5-0,8). O uso de medicamentos inadequados foi associado principalmente a sexo masculino (RR=0,4; IC 95%: 0,2-0,8); doenças crônicas (RR=2,0; IC 95%: 1,2-3,3), e nível socioeconômico (RR=0,7; IC 95%: 0,5-0,9). CONCLUSÕES: As proporções de idosos usando medicamentos prescritos, não-prescritos e inadequados foram significativas, havendo desigualdades particularmente entre aqueles de diferentes níveis socioeconômicos. Os resultados apontam para a necessidade de programas para otimizar o acesso e racionalizar o uso de medicamentos entre idosos no Brasil.

OBJECTIVE: To identify medication use patterns among elderly people residing in areas with different socioeconomic status in the city of Fortaleza, Brazil. METHODS: A total of 668 elderly (aged 60 years or older) residing in the city of Fortaleza, Ceará, Brazil, selected from a multistage random sampling stratified by socioeconomic status (higher, intermediate, and lower areas), were interviewed in a household survey. Descriptive statistics for dichotomous variables were presented as percent of the respective totals, and those for continuous variables as mean ± SD. Multivariate analyses were performed to identify factors associated with the use of prescription, non-prescription and inappropriate) drugs. RESULTS: Most (80.3% in the hgiher area) were on at least one non- prescription drug. More than one third (37.4%) were on at least one non- prescription drug and nearly 20% used at least one inappropriate in the lower area. PD use was associated with advanced age (OR=1.7, 95% CI=1.1-2.8); male sex (OR=0.5, 95% CI=0.3-0.7); health service visits (OR=2.5, 95% CI=1.9-3.1); chronic diseases (OR=4.0, 95% CI=2.5-6.2); and higher socioeconomic status (OR=2.0, 95% CI=1.5-2.6).Non- prescription drug use was associated with disability (OR=1.5, 95% CI=1.1-2.2), and higher socioeconomic status (OR=0.6; 95% CI=0.5-0.8). Inappropriate drugs use was mainly associated with male sex (OR=0.4, 95% CI=0.2-0.8); chronic diseases (OR=2.0, 95% CI=1.2-3.3); and higher socioeconomic status (OR=0.7, 95% CI=0.5-0.9). CONCLUSIONS: The proportions of elderly using prescription, non- prescription and inappropriate drugs were remarkable and inequalities were seen particularly among those from different socioeconomic status. These results emphasize the need for strategies to optimize the access and rationalize the use of drugs for elderly people in Brazil.

OBJETIVO: Avaliar o perfil sociodemográfico e o padrão de uso da cocaína entre usuários de drogas hospitalizados. MÉTODOS: Estudo transversal com dependentes químicos maiores de 18 anos, internados em alguns hospitais psiquiátricos da região metropolitana da Grande São Paulo, Brasil, com condições clínicas de responder a questionário padronizado e que concordaram em participar do estudo. Foram selecionados seis hospitais psiquiátricos que recebiam, por procura espontânea, pacientes da rede pública e privada de toda a região da Grande São Paulo. A coleta de informações foi feita por meio de entrevistas estruturadas, aplicada individualmente por psicóloga treinada. Para análise estatística utilizou-se do teste t de Sudent e Qui-quadrado, e o nível de significância foi fixado em 5%. RESULTADOS: Encontrou-se maior taxa (38,4%) de usuários de crack e pequena prevalência (1,6%) de usuários de drogas injetáveis. Os dependentes de cocaína fumada apresentavam baixa escolaridade, encontravam-se mais freqüentemente desempregados, haviam morado nas ruas, usavam maiores quantidades de droga e tinham sido presos em maior número de vezes do que aqueles que usavam outras vias de administração da droga. CONCLUSÕES: Os resultados sugerem que o uso de drogas é um grave problema de saúde pública na Grande São Paulo, mostrado pelo número de internações hospitalares por dependência. Os usuários de crack apresentam pior condição socioeconômica e maior envolvimento com a violência e a criminalidade.

OBJECTIVE: To describe the epidemiological profile and patterns of cocaine use among hospitalized drug users. METHODS: A cross-sectional study was carried out among drug users, aged 18 years or more, hospitalized in one out six selected psychiatric hospitals in the metropolitan area of Greater São Paulo, whose clinical conditions allowed them to reliably answer to a standardized questionnaire and who agreed to participate. Six psychiatric hospitals who attended spontaneously referred public and private patients from all Greater São Paulo were selected. Data collection was conducted using structured interviews, individually applied by a trained psychologist. Statistical analysis was performed using Student t-test and Chi-square test at p<0.05. RESULTS: There was a predominance of crack use (38.4%) over intravenous drug use (1.6%). Addicts who smoked cocaine had lower education, most were unemployed and had previously lived on the streets, and used higher amounts of drugs. These addicts also had been previously incarcerated more often than addicts who used other routes for drug administration. CONCLUSIONS: Drug use is a serious public health problem in Greater São Paulo, and this is shown by the great amount of hospital admissions due to drug addiction. Crack users have lower socioeconomic status and more often engage in violence and crimes.

OBJETIVO: Avaliar o perfil sociodemográfico e o padrão de uso da cocaína entre usuários de drogas hospitalizados. MÉTODOS: Estudo transversal com dependentes químicos maiores de 18 anos, internados em alguns hospitais psiquiátricos da região metropolitana da Grande São Paulo, Brasil, com condições clínicas de responder a questionário padronizado e que concordaram em participar do estudo. Foram selecionados seis hospitais psiquiátricos que recebiam, por procura espontânea, pacientes da rede pública e privada de toda a região da Grande São Paulo. A coleta de informações foi feita por meio de entrevistas estruturadas, aplicada individualmente por psicóloga treinada. Para análise estatística utilizou-se do teste t de Sudent e Qui-quadrado, e o nível de significância foi fixado em 5%. RESULTADOS: Encontrou-se maior taxa (38,4%) de usuários de crack e pequena prevalência (1,6%) de usuários de drogas injetáveis. Os dependentes de cocaína fumada apresentavam baixa escolaridade, encontravam-se mais freqüentemente desempregados, haviam morado nas ruas, usavam maiores quantidades de droga e tinham sido presos em maior número de vezes do que aqueles que usavam outras vias de administração da droga. CONCLUSÕES: Os resultados sugerem que o uso de drogas é um grave problema de saúde pública na Grande São Paulo, mostrado pelo número de internações hospitalares por dependência. Os usuários de crack apresentam pior condição socioeconômica e maior envolvimento com a violência e a criminalidade.

OBJECTIVE: To describe the epidemiological profile and patterns of cocaine use among hospitalized drug users. METHODS: A cross-sectional study was carried out among drug users, aged 18 years or more, hospitalized in one out six selected psychiatric hospitals in the metropolitan area of Greater São Paulo, whose clinical conditions allowed them to reliably answer to a standardized questionnaire and who agreed to participate. Six psychiatric hospitals who attended spontaneously referred public and private patients from all Greater São Paulo were selected. Data collection was conducted using structured interviews, individually applied by a trained psychologist. Statistical analysis was performed using Student t-test and Chi-square test at p<0.05. RESULTS: There was a predominance of crack use (38.4%) over intravenous drug use (1.6%). Addicts who smoked cocaine had lower education, most were unemployed and had previously lived on the streets, and used higher amounts of drugs. These addicts also had been previously incarcerated more often than addicts who used other routes for drug administration. CONCLUSIONS: Drug use is a serious public health problem in Greater São Paulo, and this is shown by the great amount of hospital admissions due to drug addiction. Crack users have lower socioeconomic status and more often engage in violence and crimes.

OBJECTIVE: To evaluate the prevalence and the risk factors for tuberculosis (TB) infection and disease among hospitalized cocaine users. METHOD: A cross-sectional study performed on a sample of 440 addicts over 18 years of age, admitted to hospitals of the metropolitan area of the Greater São Paulo city, whose clinical conditions allowed them to answer a standard questionnaire, and who agreed to participate in the study. The prevalence of TB infection was assessed through positive tuberculin testing (PPD), and of TB disease by the finding of M. tuberculosis in the sputum of patients with respiratory symptoms. RESULTS: Respiratory symptoms were present in 21% of the patients, the most frequent being weight loss and cough, which disappeared when cocaine use was discontinued. The general prevalence of TB infection was 28%. The prevalence of TB disease was 0.6%. The factors which were associated with positive PPD were: age, color/race, time spent in prison, and drug use in prison. CONCLUSION: No increased prevalence of TB infection and disease was found in these patients. Older addicts had a higher probability of having TB infection, and so had those who had been in prison.

Para verificar o risco potencial para hepatite viral pós-transfusional de doadores anti-HBc positivos e investigar se outros marcadores sorológicos do HBV poderiam identificar a presença ou não do vírus, mil doadores de primeira vez foram recrutados entre junho e julho de 1997. Estes doadores foram testados para os testes de rotina utilizados em centros de transfusão brasileiros. Cento e vinte desses doadores foram anti-HBc positivos (12%). Nestes foram realizados os testes HbeAg, anti-HBc, anti-HBs e a pesquisa do HBV-DNA por PCR. Dez eram HbsAg positivos, todos com presença do HBV-DNA demonstrada por PCR. Três doadores HbsAg negativos foram HBV-DNA positivos. Dois doadores HBV-DNA positivos também o foram para o anti-HBs. Todos os doadores HBV positivos apresentavam pelo menos outro marcador sorológico do HBV, além do anti-HBc. O anti-HBc é uma importante causa de descarte de sangue. A pesquisa isolada do HbsAg não é completamente protetora e a presença do anti-HBc permanece necessária como teste de triagem. A presença do anti-HBs não é sempre indicativa da ausência do vírus. A adição de outros marcadores pode ser uma alternativa para predizer a presnça do vírus quando comparada com a PCR. Outros estudos, no entanto, devem ser conduzidos para confirmar este achado.

In order to assess the potential risk of anti-HBc-positive blood donors for post-transfusional hepatitis and to investigate whether other HBV serological markers are capable of identifying the presence of the virus, 1000 first-time blood donors were enrolled between June and July 1997. These donors were screened using routine Brazilian blood center tests (HIV 1 and 2, HTLV 1 and 2, Chagas disease, Syphilis, HCV, HBsAg, anti-HBc and ALT ). The 120 (12%) found to be anti-HBc-positive underwent further tests: HBe, anti-HBe, anti-HBs and HBV-DNA by PCR. Ten cases were HBsAg positive and all were HBV-DNA positive by PCR. Three HBsAg-negative donors were HBV-DNA-positive. Two HBV-DNA-positive donors were also anti-HBs-positive. All the HBV-positive donors had at least one HBV marker other than anti-HBc. Anti-HBc is an important cause of blood rejection. Testing for HBsAg alone is not fully protective and anti-HBc remains necessary as a screening test. The presence of anti-HBs is not always indicative of absence of the virus. The addition of other HBV serological markers could represent an alternative in predicting the presence of the virus when compared with PCR. It is recommended that other studies should be carried out to confirm this finding.

Staphylococcus aureus is an important pathogen causing bacteremia, primarily affecting hospitalized patients. We studied the epidemiology of S. aureus bacteremia, comparing two periods (early and mid 1990s) and developed a predictive model of mortality. A nested case-control was done. All 251 patients over 14 years old with positive blood cultures for S. aureus were selected. MRSA (methicillin resistant S. aureus) was isolated in 63% of the cases. When comparing the two periods MRSA community-acquired bacteremia increased from 4% to 16% (p=0.01). There was no significant difference in the mortality rate between the two periods (39% and 33%, p=0.40). Intravascular catheters provoked 24% of the cases of bacteremia and were associated with the lowest rate of mortality. In a logistic regression analysis, three variables were associated with death: septic shock, source of bacteraemia and resistance to methicillin. The probability of dying among patients with MRSA and those with methicillin sensitive S. aureus bacteraemia ranged from 10% to 90% and from 4% to 76%, respectively, depending on the source of the bacteraemia and the occurrence of septic shock. The MRSA found in Brazil may be a particularly virulent strain.