BackgroundFew studies of dengue have shown group-level associations between demographic, socioeconomic, or geographic characteristics and the spatial distribution of dengue within small urban areas. This study aimed to examine whether specific characteristics of an urban slum community were associated with the risk of dengue disease.Methodology/Principal FindingsFrom 01/2009 to 12/2010, we conducted enhanced, community-based surveillance in the only public emergency unit in a slum in Salvador, Brazil to identify acute febrile illness (AFI) patients with laboratory evidence of dengue infection. Patient households were geocoded within census tracts (CTs). Demographic, socioeconomic, and geographical data were obtained from the 2010 national census. Associations between CTs characteristics and the spatial risk of both dengue and non-dengue AFI were assessed by Poisson log-normal and conditional auto-regressive models (CAR). We identified 651 (22.0%) dengue cases among 2,962 AFI patients. Estimated risk of symptomatic dengue was 21.3 and 70.2 cases per 10,000 inhabitants in 2009 and 2010, respectively. All the four dengue serotypes were identified, but DENV2 predominated (DENV1: 8.1%; DENV2: 90.7%; DENV3: 0.4%; DENV4: 0.8%). Multivariable CAR regression analysis showed increased dengue risk in CTs with poorer inhabitants (RR: 1.02 for each percent increase in the frequency of families earning ≤1 times the minimum wage; 95% CI: 1.01-1.04), and decreased risk in CTs located farther from the health unit (RR: 0.87 for each 100 meter increase; 95% CI: 0.80-0.94). The same CTs characteristics were also associated with non-dengue AFI risk.Conclusions/SignificanceThis study highlights the large burden of symptomatic dengue on individuals living in urban slums in Brazil. Lower neighborhood socioeconomic status was independently associated with increased risk of dengue, indicating that within slum communities with high levels of absolute poverty, factors associated with the social gradient influence dengue transmission. In addition, poor geographic access to health services may be a barrier to identifying both dengue and non-dengue AFI cases. Therefore, further spatial studies should account for this potential source of bias.

No abstract

Objective: To estimate the time of decision (TD) to look for medical care and the time of arrival (TA) at the health service for men (M) and women (W) suffering from acute myocardial infarction and to analyze the influence of the interpretation of pain and pain resistance behaviors during these times. Methods: This is an exploratory research, performed at the university hospital in Salvador/Bahia. 43 W and 54 M were interviewed. To study the dependence among sociodemographic and gender variables, the Fisher Exact Test was used. To analyze times, a geometric mean (GM) was used. In order to verify the association between the GM of TD and TA and the judgment of pain, and between the GM of TD and TA and the behavior of resistance to pain, as well as to test the time of interaction between the gender variable and other variables of interest, the robust regression model was used. The statistical significance adopted was 5%. Results: The GM of the TD for M was 1.13 h; for W, 0.74 h. The GM of the TA was 1.74 h for M and 1.47 h for W. Those who did not recognize the symptoms of AMI and presented behavior of resistance to pain had higher TD and TA, being the associations significant. Gender did not change the associations of interest. Conclusion:The findings demonstrate the importance of health education aiming at the benefits of early treatment.

O objetivo deste estudo foi analisar, entre gêneros, a influência de variáveis cognitivas e emocionais no tempo de decisão (TD) para procura de atendimento face ao infarto do miocárdio. Cem adultos foram entrevistados em dois hospitais de Salvador-BA. Na análise empregaram-se médias percentuais, teste Q-quadrado e modelo de regressão linear robusto. Houve a predominância de homens, com idade média de 58,78 anos e baixa condição socioeconômica. A média geométrica da amostra foi 1,1h - 0,9h para homens; 1,4h para mulheres. Constatou-se menor tempo de decisão para quem considerou grave os sintomas, e maior para quem esperou melhora e tomou algo para recuperar-se, tais associações são estatisticamente significantes. Houve interação entre gênero e variáveis: esperar a melhora dos sintomas (p=0,014), ocultá-los (p=0,016) e pedir ajuda (p=0,050), quando verificou-se a associação das variáveis de interesse e TD. Os tempos de decisão foram elevados e sofreram influência de variáveis cognitivas, emocionais e de gênero. Cuidados de enfermagem podem promover o atendimento precoce.

BackgroundOur understanding of the epidemiology of influenza is limited in tropical regions, which in turn has hampered identifying optimal region-specific policy to diminish disease burden. Influenza-like illness (ILI) is a clinical diagnosis that can be used as a surrogate for influenza. This study aimed to define the incidence and seasonality of ILI and to assess its association with climatic variables and school calendar in an urban community in the tropical region of Salvador, Brazil.MethodsBetween 2009 and 2013, we conducted enhanced community-based surveillance for acute febrile illnesses (AFI) among patients ≥5 years of age in a slum community emergency unit in Salvador, Brazil. ILI was defined as a measured temperature of ≥37.8 °C or reported fever in a patient with cough or sore throat for ≤7 days, and negative test results for dengue and leptospirosis. Seasonality was analyzed with a harmonic regression model. Negative binomial regression models were used to correlate ILI incidence with rainfall, temperature, relative humidity and the number of days per month that schools were in session while controlling for seasonality.ResultsThere were 2,651 (45.6 % of 5,817 AFI patients) ILI cases with a mean annual incidence of 60 cases/1,000 population (95 % CI 58–62). Risk of ILI was highest among 5–9 year olds with an annual incidence of 105 cases/1,000 population in 2009. ILI had a clear seasonal pattern with peaks between the 35–40th week of the year. ILI peaks were higher and earlier in 5–9 year olds compared with >19 year olds. No association was seen between ILI and precipitation, relative humidity or temperature. There was a significant association between the incidence of ILI in children 5–9 years of age and number of scheduled school days per month.ConclusionsWe identified a significant burden of ILI with distinct seasonality in the Brazilian tropics and highest rates among young school-age children. Seasonal peaks of ILI in children 5–9 years of age were positively associated with the number of school days, indicating that children may play a role in the timing of seasonal influenza transmission.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1456-8) contains supplementary material, which is available to authorized users.

Objective:To describe the difficulties encountered by individuals with arterial coronary disease in monitoring the drug treatment. Methods: It is a cross-sectional study involving 100 adults interviewed in a public hospital, in Salvador-BA; the results were analyzed as percentages and averages. Results: Men predominated, with an average age of 58.7±10.9 years, black skin color/ethnicity, low education and low income. Among the participants, 34% did not comply fully with the medical prescription because of economic conditions, forgetfulness and lack of guidance from health professionals. The purchase of at least one medication was made by 89%. Of the 81 individuals who had a prescription in the interview, 57 (70.4%) used five or more drugs daily; 67 (82.7%) did not know the name of all medicines, because: control was done by a family member, forgetfulness, difficulties to understand the prescription and, lack of a consulting habit. Conclusion: There was a low monitoring and understanding of prescribed medications. The socio-economic conditions and the unsatisfactory interdisciplinary approach seem to be the factors that explain the findings. Descriptors: Coronary artery disease; Medication therapy management; Nursing care RESUMO Objetivo: Descrever as dificuldades encontradas por indivíduos com doença arterial coronária para o seguimento de tratamento medicamentoso. Métodos: Estudo descritivo de corte transversal que incluiu 100 adultos entrevistados em hospital público, em Salvador-BA e os resultados foram analisados em percentuais e médias. Resultados: Predominou homens, média de idade de 58,7±10,9 anos, cor/etnia negra, baixa escolaridade e renda. Dentre os participantes, 34% não cumpriam integralmente a receita médica em razão de condições econômicas deficitárias, esquecimento e falta de orientação dos profissionais da saúde. A compra de, pelo menos uma medicação, era feita por 89%. Dos 81 indivíduos com a receita na entrevista, 57 (70,4%) utilizavam cinco ou mais medicamentos diariamente e 67 (82,7%) não sabiam o nome de todas as medicações por causa do controle delas ser feito pelo familiar, esquecimento, limitações para leitura da receita e falta de hábito de consultá-la. Conclusão: Constatou-se baixo seguimento e entendimento das medicações prescritas. O baixo nível socioeconômico e a abordagem interdisciplinar insatisfatória parecem constituir fatores para estes achados. Descritores: Doença da artéria coronariana; Conduta do tratamento medicamentoso; Cuidados de Enfermagem RESUMEN Objetivo: Describir las dificultades encontradas por individuos con enfermedad arterial coronaria para seguir el tratamiento medicamentoso. Métodos: Es un estudio descriptivo de corte transversal que incluyó 100 adultos entrevistados en un hospital público, en Salvador-BA; los resultados fueron analizados en porcentajes y promedios. Resultados: Predominaron los hombres, con un promedio de edad de 58,7±10,9 años, color/etnia negra, baja escolaridad y renta. Entre los participantes, 34% no cumplieron totalmente con la re...