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To identify risk factors for death from pandemic (H1N1) 2009, we obtained data for 157 hospitalized patients with confirmed cases of this disease. Multivariate analysis showed that diabetes and class III obesity were associated with death. These findings helped define priority vaccination groups in Brazil. [ABSTRACT FROM AUTHOR]

Objective: Describe a tool to estimate demand for benznidazole and nifurtimox to treat Chagas disease, and report on its implementation in a group of Latin American countries., Methods: The project was carried out in the following stages: 1) development of a tool to estimate demand, and definition of the evaluation and decision variables to estimate demand 2) data collection via a questionnaire completed by representatives of control programs, complemented with data from the literature; 3) presentation of the tool, followed by validation, and adaptation by representatives of the control programs in order to plan drug procurement for 2012 and 2013; and 4) further analysis of the obtained data, especially regarding benznidazole, and comparison of country estimates., Results: Fourteen endemic countries of Latin America took part in the third stage, and a consolidated estimate was made. The number of estimated treatments, based on the number of tablets per treatment established in the regimen of reference was: 867 in the group under 1 year of age; 2 042 835 in the group from 1 to 15 years old; 2 028 in the group from 15 to 20 years old; and 10 248 in adults over 20. This means that it is possible to provide benznidazole to less than 1% of people for whom treatment is indicated., Conclusions: The development and systematic use of demand management tools can play a key role in helping to provide access to the anti-Chagas drugs. There is a significant gap between the projected demand for drugs and current estimates of prevalence rates.

Despite the dramatic reduction in Trypanosoma cruzi vectorial transmission in Brazil, acute cases of Chagas disease (CD) continue to be recorded. The identification of areas with greater vulnerability to the occurrence of vector-borne CD is essential to prevention, control, and surveillance activities. In the current study, data on the occurrence of domiciliated triatomines in Brazil (non-Amazonian regions) between 2007 and 2011 were analyzed. Municipalities' vulnerability was assessed based on socioeconomic, demographic, entomological, and environmental indicators using multi-criteria decision analysis (MCDA). Overall, 2275 municipalities were positive for at least one of the six triatomine species analyzed (Panstrongylus megistus, Triatoma infestans, Triatoma brasiliensis, Triatoma pseudomaculata, Triatoma rubrovaria, and Triatoma sordida). The municipalities that were most vulnerable to vector-borne CD were mainly in the northeast region and exhibited a higher occurrence of domiciliated triatomines, lower socioeconomic levels, and more extensive anthropized areas. Most of the 39 new vector-borne CD cases confirmed between 2001 and 2012 in non-Amazonian regions occurred within the more vulnerable municipalities. Thus, MCDA can help to identify the states and municipalities that are most vulnerable to the transmission of T. cruzi by domiciliated triatomines, which is critical for directing adequate surveillance, prevention, and control activities. The methodological approach and results presented here can be used to enhance CD surveillance in Brazil., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objectives: In order to estimate the prevalence of influenza like illness (ILI) in adults from all state capitals and geographic regions in Brazil, a periodical monitoring of ILI cases by the national telephone survey (VIGITEL) was carried out in 2010., Method: A cross-sectional study with 47,876 telephone interviews in the state capitals and Federal District, a probabilistic sample of adult population (>18 years-old) with landline telephone. Questions concerning the results of ILI cases and pandemic influenza (H1N1) 2009, from January 10 to November 30, were analyzed. The proportion of cases stratified by sociodemographic characteristics and Brazilian geographic region was weighted with data from the National Survey with Household Sampling (PNAD) 2008., Results: The prevalence of ILI cases in the last 30 days before interview was 31.2% (95%CI 30.2-32.2%) for all state capitals and the Federal District. This prevalence was higher among women, young adults (18 to 29 years-old) and individuals with 9 to 11 years of schooling. According to the geographic region analysis, Northern Brazil presented the highest prevalence of ILI cases. A tendency to increase with further decrease was observed among the geographic regions, except the Northeast. Need for health care assistance was reported by 26.8% (95%CI 25.1-28.5) from ILI cases. Among ILI cases that sought health care assistance, 2.6% (95%CI 1.8-3.4) reported pandemic influenza (H1N1) 2009 medical suspicion., Conclusion: The results of this survey supported influenza surveillance as it provided timeliness and useful surveillance information, which were not captured by the traditional surveillance system, as the occurrence of ILI and need of health care assistance.

This study examines the planning, operations and assessment of a Seniors Vaccination Program in Campinas, São Paulo State, from the standpoint of practices adopted by central, district and local authorities and intended to ensure influenza vaccination coverage. The case study method was used, with work-health process benchmarks. The primary data source was semi-structured interviews, with institutional documents and records serving as secondary sources. The field of study was the municipal coordination of this Program in two Health Districts and one Basic Healthcare Unit. The choice of these Districts was based on differing vaccination coverage, while the Unit choice was guided by its outstanding campaign organization. At the district and local levels, the program was coordinated by nurses who assigned high priority to following routines and rules instead of pursuing the purpose of the campaign. Insufficient analysis capacities were identified, with poorly networked actions, incipient communications methods and ineffective use of information for planning purposes. The results underscore the importance of adopting management practices tailored to the purposes of healthcare efforts, ushering in responsible autonomy among workers and fostering ongoing reflection on these practices.

This is a descriptive and explorative study with a quantitative approach aimed at identifying the meaning of 'being old' according to 50 health-care workers responsible for direct nursing care to elderly residents in nursing homes. Data was obtained by means of the Portuguese version of the 'Semantic Differential Scale' validated in Brazil. Subjects were predominantly nursing assistants and 'general services' workers. The majority of them conferred to the elderly the adjectives beautiful, tender, sweet, wise, interesting, with sense of opportunity, humble and resigned. The attributes destructive, insecure, critic and intrusive were also cited. Most subjects selected adjectives that, in spite of being positive, are also related with docility and passivity.