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Predicting risk of early discontinuation of exclusive breastfeeding at a Brazilian referral hospital for high-risk neonates and infants: a decision-tree analysis
No full textWe are grateful for our participants’ support. The authors would like to acknowledge developer Vinicius Ramires Leite, who created the web application for cohort. We wish to thank Dr. João Aprígio Guerra de Almeida, coordinator of the Global Network of Human Milk Banks (FIOCRUZ), Brazil, and Dr. Danielle Aparecida da Silva, coordinator of the National reference center of Human Milk Banks (FIOCRUZ) for their support and highly valuable comments. We also acknowledge the colleagues of the Human Milk Bank at
IFF/FIOCRUZ for support; and Marlene Assumpção, Alana Kohn, Antonio Azeredo, Rosânea Santos, Flavia Benedicto, Rafaelle Cristine, Pernelle Pastorelli, Silvia Azevedo, Alexia Martins, Taina Gomes, Caroline Lima, Pamela Mourão, Luiza Reis and Camila Chaves for assisting in data collection.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.Background: Determinants at several levels may affect breastfeeding practices. Besides the known historical, socio-economic, cultural, and individual factors, other components also pose major challenges to breastfeeding. Predicting existing patterns and identifying modifiable components are important for achieving optimal results as early as possible, especially in the most vulnerable population. The goal of this study was building a tree-based analysis to determine the variables that can predict the pattern of breastfeeding at hospital discharge and at 3 and 6 months of age in a referral center for high-risk infants.
Methods: This prospective, longitudinal study included 1003 infants and was conducted at a high-risk public hospital in the following three phases: hospital admission, first visit after discharge, and monthly telephone interview until the sixth month of the infant’s life. Independent variables were sorted into four groups: factors related to the newborn
infant, mother, health service, and breastfeeding. The outcome was breastfeeding as per the categories established by the World Health Organization (WHO). For this study, we performed an exploratory analysis at hospital discharge and at 3 and at 6 months of age in two stages, as follows: (i) determining the frequencies of baseline characteristics stratified by breastfeeding indicators in the three mentioned periods and (ii) decision-tree analysis. Results: The prevalence of exclusive breastfeeding (EBF) was 65.2% at hospital discharge, 51% at 3 months, and 20.6% at 6 months. At hospital discharge and the sixth month, the length of hospital stay was the most important predictor of feeding practices, also relevant at the third month. Besides the mother’s and child’s characteristics (multiple births, maternal age, and parity), the social context, work, feeding practice during hospitalization, and hospital practices and policies on breastfeeding influenced the breastfeeding rates. Conclusions: The combination algorithm of decision trees (a machine learning technique) provides a better
understanding of the risk predictors of breastfeeding cessation in a setting with a large variability in expositions. Decision trees may provide a basis for recommendations aimed at this high-risk population, within the Brazilian context, in light of the hospital stay at a neonatal unit and period of continuous feeding practice
Weather-driven mathematical models of dengue transmission dynamics in twelve Brazilian sites
No full textEsta tese investiga modelos matemáticos para avaliar o papel das flutuações climáticas na dinâmica da dengue (DENV) de 2010 a 2019. Os modelos de transmissão propostos foram baseados em um modelo SEIR, que incorpora a transmissão vertical do vetor (mosquito fêmea para ovo) e o compartimento de ovo do vetor, permitindo assim que a chuva seja introduzida para modular a eclosão dos ovos. Dados de satélite de temperatura e precipitação ao longo de dez anos foram utilizados para modular parâmetros dos modelos. Análise de sensibilidade foi realizada para avaliar a importância de cada parâmetro. Os cenários simulados foram comparados à incidência observada de dengue. Os modelos foram capazes de capturar o padrão de incidência da dengue com boa precisão até 2016. De 2016 a 2019, o ajuste do modelo mostrou resultados piores quando comparado aos dados observáveis. Os resultados do primeiro modelo demonstram que as flutuações da transmissão vertical podem afetar a incidência, sugerindo a necessidade de investigar mais a fundo esta dinâmica. O segundo modelo apresentou um bom ajuste para 10 de 12 municípios em que foi avaliado. Os dois municípios onde o ajuste não foi satisfatório, são municípios onde houve invasão por um novo sorotipo de dengue dentro do período estudado, demonstrando a necessidade de evoluir os modelos para multi-sorotipos. A melhor compreensão da relação entre as diferentes variáveis ambientais e a dengue alcançada pelos modelos propostos pode contribuir para políticas públicas de saúde em relação às doenças transmitidas por mosquitosThis thesis investigates two models to assess the role of climate fluctuations in dengue dynamics (DENV) from 2010 to 2019. The proposed transmission models were based on a susceptible, infected and recovered (SIR) model, which incorporates vector vertical transmission (from female mosquito to offspring) and the egg compartment of the vector, thus allowing the effect of rain to be introduced to modulate the hatching of eggs. Satellite data of temperature and precipitation over ten years were used to modulate model parameters. Sensitivity analysis was performed to assess the importance of each parameter in the model. The simulated scenarios of the models were compared to the observed incidence of dengue. The two models were able to capture the pattern of dengue incidence with good accuracy through 2016, although higher deviations were observed from 2016 to 2019. The results of the first model demonstrate that fluctuations in vertical transmission can affect rates and patterns of attack transmission, suggesting the need to further investigate this dynamic. The second model showed a good fit for 10 of the 12 municipalities in which it was evaluated. The two municipalities where the adjustment was not satisfactory were municipalities where a new dengue serotype was being re-introduced during the period of the study, demonstrating the need to enhance the models to include multi-serotypes. The better understanding of the relationship between different environmental variables and dengue achieved by the proposed models can contribute to public health policies in relation to mosquito-borne disease
Microbial profile of intermediate process solutions identified by bioburden test in a pharmaceutical industry
No full textOs autores externos submeteram sua publicação para apresentação de trabalho no evento “International Symposium on Immunobiologicals”, que foi coordenado e organizado pelo Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos), da Fundação Oswaldo Cruz
CoronaFatos: Entrevista - Jovens e Covid
No full textFicha técnica: Apresentação: Ana Cristina Figueira | Produção e Direção: Valéria Mauro | Edição e Finalização: Marcelo Louro | Arte: Marcelo Vianna.No CoronaFatos de hoje, conversamos sobre Jovens e Covid com a pedagoga, presidente do Mapa Educação e conselheira nacional da juventude, Wesla Monteiro
O dilema intervencionista: análise das narrativas jurídicas nas ações de internação compulsória para usuários de drogas em Belo Horizonte
No full textA internação psiquiátrica compulsória de usuários de álcool e outras drogas, ocorre por meio de determinação judicial, geralmente, a pedido da família e embasada por relatório dos profissionais de saúde. Apesar desse tipo de medida buscar suporte em legislação alinhada aos direitos humanos, faltam evidências que justifiquem as vantagens das práticas compulsórias no tratamento de dependência das drogas. Esta pesquisa, de caráter qualitativo, exploratório e documental, buscou compreender as narrativas jurídicas relativas às 14 ações de internação compulsória de adultos usuários de álcool e outras drogas, em uma Regional de Saúde de Belo Horizonte, no período de dois anos (2016-2018). Para tal, foi empregada a Análise de Conteúdo de Bardin, por meio da qual foi criada uma tipologia que congregou os dados em torno de duas categorias: estigmatização do usuário e concepções acerca da medida de tratamento obrigatório determinada judicialmente. Observou-se o predomínio de critérios não-técnicos na fundamentação das judicializações e que o conceito de periculosidade, entendido como risco a terceiros, mais do que o risco à saúde do usuário de álcool e outras drogas, avalizou a demanda pela internação compulsória. Também nesse sentido, observou-se que a atuação fragmentada das políticas públicas de saúde e assistência social favoreceu a judicialização de conflitos sociais, e que não haviam sido esgotadas as possibilidades de intervenção intra e intersetorialmente. Assim, percebeu-se a necessidade de aprimoramento do diálogo entre Poder Executivo, sociedade civil e órgãos do sistema de justiça, e a importância do estabelecimento de critérios que reduzam vieses subjetivos na aplicação da internação compulsória.Involuntary commitment of drug users occurs through a judicial determination, usually at the request of the family and based on a report from health professionals. Although this type of measure seeks support in legislation aligned with human rights, there is a lack of evidence to justify the advantages of compulsory practices in the treatment of drug addiction. This qualitative, exploratory, and documentary research sought to understand the legal narratives related to 14 involuntary commitment actions of adult users of alcohol and other drugs in Belo Horizonte, Minas Gerais, Brazil, in the period of two years (2016-2018). To this end, Bardin's Content Analysis was used, through which a typology was created that gathered the data around two categories: stigmatization of drug users and conceptions about the compulsory treatment measure determined by law. It was observed the predominance of non-technical criteria in the judicializations and that the concept of dangerousness, understood as a risk to others, rather than the risk to the health of the drug user, supported the demand for involuntary commitment. It was also observed that that the fragmented action of public health and social assistance policies favored the judicialization of social conflicts, and that the possibilities for intra- and inter-sectorial intervention had not been exhausted. Thus, it was noticed the need to improve the dialogue between the Executive Branch, civil society and organs of the justice system, and the importance of establishing criteria that reduce subjective biases in the application of involuntary commitment
Genetic Basis of Antimicrobial Resistant Gram-Negative Bacteria Isolated From Bloodstream in Brazil
No full textMultidrug-resistant microorganisms are a well-known global problem, and gram-negative
bacilli are top-ranking. When these pathogens are associated with bloodstream infections
(BSI), outcomes become even worse. Here we applied whole-genome sequencing to
access information about clonal distribution, resistance mechanism diversity and other
molecular aspects of gram-negative bacilli (GNB) isolated from bloodstream infections
in Brazil. It was possible to highlight international high-risk clones circulating in the
Brazilian territory, such as CC258 for Klebsiella pneumoniae, ST79 for Acinetobacter
baumannii and ST233 for Pseudomonas aeruginosa. Important associations can be
made such as a negative correlation between CRISPR-Cas and K. pneumoniae CC258,
while the genes blaTEM, blaKPC and blaCTX−M are highly associated with this clone.
Specific relationships between A. baumannii clones and blaOXA−51 variants were also
observed. All P. aeruginosa ST233 isolates showed the genes blaVIM and blaOXA486.
In addition, some trends could be identified, where a new P. aeruginosa MDR clone
(ST3079), a novel A. baumannii clonal profile circulating in Brazil (ST848), and important
resistance associations in the form of blaVIM−2 and blaIMP−56 being found together in one
ST233 strain, stand out. Such findings may help to develop approaches to deal with BSI
and even other nosocomial infections caused by these important GNB
What is the recovery rate and risk of long-term consequences following a diagnosis of COVID-19? A harmonised, global longitudinal observational study protocol
No full textIntroduction: Very little is known about possible clinical sequelae that may persist after resolution of acute COVID-19. A recent longitudinal cohort from Italy including 143 patients followed up after hospitalisation with COVID-19 reported that 87% had at least one ongoing symptom at 60-day follow-up. Early indications suggest that patients with COVID-19 may need even more psychological support than typical intensive care unit patients. The assessment of risk factors for longer term consequences requires a longitudinal study linked to data on pre-existing conditions and care received during the acute phase of illness. The primary aim of this study is to characterise physical and psychosocial sequelae in patients post-COVID-19 hospital discharge.
Methods and analysis: This is an international open-access prospective, observational multisite study. This protocol is linked with the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) and the WHO's Clinical Characterisation Protocol, which includes patients with suspected or confirmed COVID-19 during hospitalisation. This protocol will follow-up a subset of patients with confirmed COVID-19 using standardised surveys to measure longer term physical and psychosocial sequelae. The data will be linked with the acute phase data. Statistical analyses will be undertaken to characterise groups most likely to be affected by sequelae of COVID-19. The open-access follow-up survey can be used as a data collection tool by other follow-up studies, to facilitate data harmonisation and to identify subsets of patients for further in-depth follow-up. The outcomes of this study will inform strategies to prevent long-term consequences; inform clinical management, interventional studies, rehabilitation and public health management to reduce overall morbidity; and improve long-term outcomes of COVID-19.
Ethics and dissemination: The protocol and survey are open access to enable low-resourced sites to join the study to facilitate global standardised, longitudinal data collection. Ethical approval has been given by sites in Colombia, Ghana, Italy, Norway, Russia, the UK and South Africa. New sites are welcome to join this collaborative study at any time. Sites interested in adopting the protocol as it is or in an adapted version are responsible for ensuring that local sponsorship and ethical approvals in place as appropriat
Cyclone Idai as a trigger for Pellagra outbreak in Nhamatanda, Mozambique: a case–control study
No full textIn mid-June 2019, 3 months after cyclone Idai landfall in Mozambique, health authorities of Nhamatanda district reported an outbreak of Pellagra. Applying a mixed-method protocol, we carried out an investigation to characterize cases of pellagra, identify the associated factors for the outbreak using a case–control study, and explore the perceived impact on food security (availability, access, and usage) before and after Idai. We collected data from 121 cases and 121 controls and conducted in-depth interviews with 69 heads of households. The cases were more likely to be female (P < 0.01) and less educated (P < 0.01) than controls. Insufficient consumption of chicken and peanut before cyclone Idai arrival were statistically associated with pellagra (P < 0.05). From interviewed households' heads, 51% were experiencing food shortages even before the cyclone hit. Cyclone Idai served as a trigger to reduce niacin consumption below the threshold that protected Nhamatanda population from pellagra and caused a ≈2,300 case (707.9/100,000 inhabitants) outbreak
Use of mammary tumor spheroids to study in vitro metastatic potential and therapeutic response
No full textOs autores externos submeteram sua publicação para apresentação de trabalho no evento “International Symposium on Immunobiologicals”, que foi coordenado e organizado pelo Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos), da Fundação Oswaldo Cruz