Healthcare-associated infections are a major cause of morbidity-mortality among hospitalized patients. The aim of this epidemiological study was to determine mortality and risks related to death in adult patients with healthcare-associated infections admitted to a teaching hospital in one year. Patient data were collected from infection medical reports. The mortality rate associated with infections was 38.4%, and it was classified as a contributing factor to deaths in 87.1% of death cases. The correlation between healthcare-associated infection and death was statistically significant among clinical patients (41.3%) presenting comorbidities related to the diagnosis (55.8%), cardiovascular infection (62.2%), pneumonia (48.9%), developing sepsis (69.0%), as well as patients who had been colonized (45.2%) and infected (44.7%) by multidrug resistance microorganisms.

Elma Mathias Dessunti* Alberto Olavo Advincula Reis** RESUMO O objetivo deste estudo foi identificar e comparar aspectos da vulnerabilidade individual às DST/AIDS entre estudantes universitários da primeira e última série dos cursos de enfermagem e medicina da UEL. Selecionouse uma amostra de conveniência, composta pelos 263 alunos matriculados no ano de 2000, analisando-se os dados dos 183 estudantes sexualmente ativos (70,4%). Utilizou-se a estrutura do Modelo de Redução de Risco da AIDS para a elaboração do questionário, considerando-se um nível de significância estatística de 5%. Os alunos do primeiro ano iniciaram atividade sexual mais precocemente do que os do último ano; o número de parceiros sexuais durante toda a vida variou de 1 a 15, com média de 3,07 parceiros para os alunos da primeira série e 3,42 para os da última. Muitos estudantes demonstram uma baixa percepção de risco pessoal de adquirir DST/AIDS e, embora discutam sobre o assunto com seus pares, continuam se expondo a parceiros que tem ou tiveram outros no passado e nem sempre usaram o preservativo. Conclui-se que as experiências vivenciadas durante o curso não foram suficientes para melhorar a adesão ao preservativo entre os alunos do último ano, provavelmente em decorrência de manter relacionamentos mais estáveis, estabelecendo-se vínculo de confiança entre os pares.

Introduction:The implementation of the rapid test (RT) for syphilis increases access of vulnerable populations to early diagnosis and treatment, impacting the outcomes of infection. We aimed to assess the prevalence of and factors associated with syphilis in a Center for Testing and Counseling (CTC). Methods: We conducted a cross-sectional study at a Reference Center for sexually transmitted disease (STD) and acquired immune deficiency syndrome in Londrina, Northern Paraná State, Southern Brazil. Data regarding the 5,509 individuals who underwent RT from June 2012 to December 2014 were collected from patient records and the CTC Information System and served as the basis to check associations of syphilis cases (346) and cases without syphilis (5,163). Nine patients' records were not found. OpenEpi was used to perform a prevalence analysis and determine odds ratios to assess the associations between sociodemographic and behavioral variables (independent variables) and cases of syphilis (dependent variable). An alpha value <0.05 was considered statistically significant. Results: The prevalence of syphilis was 6.3%; higher in males (7.5%) than in females (4.3%, p <0.001). Syphilis was associated with an age of 25-34 years, little education, and single marital status. The main associated behavioral factors were men who have sex with men, drug users, STD patients, and those presenting with an STD in the last year. The use of alcohol, marijuana, cocaine, and crack was significantly associated with syphilis. Conclusions: Strategies for prevention and control of syphilis should be intensified, especially in populations identified as most vulnerable.

BackgroundIn Brazil, leprosy has been listed among the health priorities since 2006, in a plan known as the “Pact for life” (Pacto pela Vida). It is the sole country on the American continent that has not reached the global goal of disease elimination. Local health systems face many challenges to achieve this global goal. The study aimed to investigate how patients perceive the local health system's performance to eliminate leprosy and whether these perceptions differ in terms of the patients' income.Methodology/Principal FindingsA cross-sectional study was conducted in Londrina, State of Paraná, Brazil. Interviews were performed with the leprosy patients. The local health system was assessed through a structured and adapted tool, considering the domains judged as good quality of health care. The authors used univariate, bivariate and multivariate analyses. One hundred and nineteen patients were recruited for the study, 50.4% (60) of them were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The results showed that patients used the Primary Health Care service near their place of residence but did not receive the leprosy diagnosis there. Important advances of this health system were verified for the elimination of leprosy, verifying protocols for good care delivery to the leprosy patients, but these services did not develop collective health actions and did not engage the patients' family members and community.Conclusions/SignificanceThe patients' difficulty was observed to have access to the diagnosis and treatment at health services near their homes. Leprosy care is provided at the specialized level, where the patients strongly bond with the teams. The care process is individual, with limited perspectives of integration among the health services for the purpose of case management and social mobilization of the community to the leprosy problem.

As infecções relacionadas à assistência hospitalar impactam negativamente a saúde de pacientes hospitalizados, e refletem em elevados índices de morbimortalidade. Este estudo epidemiológico descritivo teve como objetivo caracterizar as infecções e avaliar seu impacto na saúde de pacientes acometidos por trauma, em um hospital universitário, no período de um ano. Os resultados mostraram que a prevalência das infecções nos pacientes do estudo foi elevada (15,6%), acometendo principalmente o sexo masculino (80,0%), com idade entre 18 e 40 anos (47,5%), período de internação maior que 15 dias (78,6%), mais frequente no trauma fechado (54,0%) e nas queimaduras (32,5%). Os principais sítios de infecção foram a pneumonia (49,5%) seguida pela infecção do trato urinário (23,8%). A intubação orotraqueal e o cateterismo vesical de longa permanência estiveram significativamente relacionados à maioria das pneumonias (60,3%; p<0,001) e infecções do trato urinário (77,3%; p<0,001), aumentando os riscos para tais infecções em 20 e 6 vezes, respectivamente. A sepse acometeu 44,7% dos pacientes. Ampla gama de microrganismos apresentou resistência aos antimicrobianos, sendo Acinetobacter baumannii (92,7%, p<0,001) e Klebsiella pneumoniae (70,5%, p<0,001) os mais prevalentes. Evoluíram a óbito 28,8% dos pacientes, e 96,8% das mortes relacionavam-se às infecções. A relação das infecções com o óbito foi estatisticamente significativa em pacientes com pneumonia (37,8%, p<0,001) e sepse (54,2%, p<0,001). A relação das infecções com a maioria dos óbitos evidenciou o impacto negativo desta complicação na saúde das vítimas de traumas. ResumoHealthcare associated infections have an impact on the health of hospitalized patients and are reflected in high rates of morbidity and mortality. The aim of this descriptive study is to characterize the infections and evaluate their impact on trauma patient health at a University Hospital over a 1-year period. The results showed that the prevalence of infections in trauma patients was elevated (15.6%), affecting mainly males (80.0%), ages between 18 and 30 years (47.5%), more than 15 days hospitalization (78.6%), more frequent in blunt trauma (54.0%) and in burns (32.5%). The principal sites of infection were pneumonia (49.5%) Palavras-chave: Infecção hospitalar. Sepse. Epidemiologia. Causas externas.

Objective: To analyze the HIV care continuum from the diagnosis in an HIV/AIDS Counseling and Testing Center (CTC), and the sociodemographic, clinical, and laboratory characteristics related to gender. Method: Epidemiological study, conducted with data of individuals assisted at a Counseling and Testing Center, and followed in an outpatient clinic for HIV/AIDS. Pearson’s Chi-square test and binary logistic regression were used to obtain odds ratios, considering alpha value <0.05. Results: The prevalence of HIV among 5,229 users was 5%. The highest chance of positive results was among men, aged 14 to 33 years old, who were not in a domestic partnership. In the analysis of TCD4+ lymphocytes and viral load (VL) of 238 cases, 56.1% had a late diagnosis. We have identified gaps in the care cascade, especially linkage to the care, retention in care, and viral load suppression. Conclusion: The results suggest a late diagnosis for both genders, as well as difficulty in reaching the viral suppression goal.

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Background Tuberculosis (TB) is the infectious disease that kills the most people worldwide. The use of geoepidemiological techniques to demonstrate the dynamics of the disease in vulnerable communities is essential for its control. Thus, this study aimed to identify risk clusters for TB deaths and their variation over time. Methods This ecological study considered cases of TB deaths in residents of Londrina, Brazil between 2008 and 2015. We used standard, isotonic scan statistics for the detection of spatial risk clusters. The Poisson discrete model was adopted with the high and low rates option used for 10, 30 and 50% of the population at risk, with circular format windows and 999 replications considered the maximum cluster size. Getis-Ord Gi* (Gi*) statistics were used to diagnose hotspot areas for TB mortality. Kernel density was used to identify whether the clusters changed over time. Results For the standard version, spatial risk clusters for 10, 30 and 50% of the exposed population were 4.9 (95% CI 2.6–9.4), 3.2 (95% CI: 2.1–5.7) and 3.2 (95% CI: 2.1–5.7), respectively. For the isotonic spatial statistics, the risk clusters for 10, 30 and 50% of the exposed population were 2.8 (95% CI: 1.5–5.1), 2.7 (95% CI: 1.6–4.4), 2.2 (95% CI: 1.4–3.9), respectively. All risk clusters were located in the eastern and northern regions of the municipality. Additionally, through Gi*, hotspot areas were identified in the eastern and western regions. Conclusions There were important risk areas for tuberculosis mortality in the eastern and northern regions of the municipality. Risk clusters for tuberculosis deaths were observed in areas where TB mortality was supposedly a non-problem. The isotonic and Gi* statistics were more sensitive for the detection of clusters in areas with a low number of cases; however, their applicability in public health is still restricted.