Objective: To analyze the temporal trends of the incidence and prevalence of tuberculosis, with and without HIV co-infection, as well as of the associated mortality, in Brazil, the Americas, and worldwide. Methods: We collected data related to tuberculosis, with and without HIV co-infection, between 1990 and 2010, in Brazil, the Americas, and worldwide. Temporal trends were estimated by linear regression. Results: We identified a trend toward a decrease in tuberculosis prevalence and mortality, and that trend was more pronounced in Brazil and the Americas than worldwide. There was also a trend toward an increase in the incidence of tuberculosis/HIV co-infection, as well as in the rates of detection of new cases of active and latent tuberculosis. The incidence of tuberculosis was found to trend downward in Brazil, whereas it trended upward worldwide. Tuberculosis incidence rates correlated positively with poverty rates and with HIV incidence rates. Conclusions: Social inequality and the advent of AIDS are the major factors that aggravate the current situation of tuberculosis. In this context, methodical approaches to the assessment of surveillance activities are welcome, because they will identify situations in which the reported tuberculosis data do not reflect the true incidence of this disease.Keywords: Tuberculosis/epidemiology; HIV; Socioeconomic factors. ResumoObjetivo: Analisar a tendência temporal das taxas de prevalência, incidência e mortalidade por tuberculose, associada ou não com HIV, no Brasil, nas Américas e no mundo. Métodos: Foram coletados os dados relacionados à tuberculose, com e sem coinfecção por HIV, entre 1990 e 2010, no Brasil, nas Américas e no mundo. As tendências foram estimadas por regressão linear. Resultados: Foi identificada uma tendência de redução nas taxas de prevalência e mortalidade de tuberculose, que foi maior no Brasil e nas Américas que no mundo. Houve uma tendência crescente na incidência da coinfecção tuberculose/HIV e nas taxas de detecção de casos de tuberculose ativa e latente. Houve uma tendência de redução da incidência de tuberculose no Brasil, mas de aumento dessa no mundo. Houve uma correlação direta das taxas de incidência de tuberculose com as taxas de pobreza e as taxas de incidência de HIV. Conclusões: Desigualdades sociais e o advento da AIDS são os principais fatores que agravam a atual situação da tuberculose. Nesse contexto, abordagens metodológicas para a avaliação das ações de vigilância da tuberculose são bem-vindas, pois essas indicarão situações de dados de notificação da tuberculose que não reflitam a verdadeira incidência dessa doença.
This is a qualitative, descriptive and exploratory research, aiming to describe the set of ideas and knowledge that guide the use of complementary and integrative health practices (CIHP) by nurses, and analyze the challenges facing the applicability of these therapies by nurses in the hospital setting. The subjects were nurses in public hospital institutions of Rio de Janeiro. Data collection was done through semi-structured interviews and a technique of creativity and sensibility called Almanac. The results showed that the hegemony of the biomedical model in the formation and performance of health professionals hinders implementation of CIHP in hospital. However, as this model does not account for the complexity of the human being emerges the possibility of sharing with CIHP in care aiming, therefore, at comprehensiveness of the human being.
Introduction International studies on this topic yield controversial results. No studies from Russia have been published. We contribute by studying associations between maternal pre-pregnant BMI and the risk of spontaneous preterm birth in Northwest Russia. Methods A historical cohort study using the data of the Murmansk County Birth Registry. All spontaneous singleton births in the county in 2006e2008 were included (n¼23 527). All women were categorised as underweight (<18.5 kg/m 2 ), normal (18.5e24.9 kg/ m 2 ), overweight (25.0e29.9 kg/m 2 ), and obese ($30.0 kg/m 2 ). Crude and adjusted associations between pre-pregnant BMI and risk of spontaneous preterm birth (<37 completed weeks) were estimated by logistic regression analyses. Results In total, 7.5% (95% CI 7.2 to 7.9) of all spontaneous births were preterm. The prevalence of preterm birth according to the mother's BMI was 7.3% (95% CI 6.9 to 7.7) for normal weight, 7.6% (95% CI 6.4 to 8.9) for underweight, 8.2% (95% CI 7.4 to 9.1) for overweight and 8.3% (95% CI 7.0 to 9.6) for obese women. The risk of spontaneous preterm birth was increased in overweight women compare to normal weight mothers (crude OR 1.15, 95% CI 1.13 to 1.31). After adjustment for marital status and education, increased risks of preterm delivery were found in both overweight (OR 1.18, 95% CI 1.04 to 1.34) and obese women (OR 1.21, 95% CI 1.00 to 1.45). Further adjustment for age, parity, infant sex, smoking and alcohol abuse, reduced the associations to non-significant level. Conclusion Overweight and obesity are associated with preterm birth in Nothwest Russia, but only before adjustment for biological factors. More detailed analyses of causal pathways are warranted. Potential mechanisms will be discussed.
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