- Paulo is Phisician and doctor in Public Health. Has a position as a senior researcher at National School of Public He... morePaulo is Phisician and doctor in Public Health. Has a position as a senior researcher at National School of Public Health from Fundação Oswaldo Cruz, of Brazilian Ministry of Health. Has experience in Public Health, focusing on the following subjects: tuberculosis, epidemiology, indigenous health, infectious diseases and community health.edit
Objective This study analysed clinical and sociodemographic aspects and follow-up for notified cases of tuberculosis (TB) and explored inequalities in incidence rates and outcome by colour or race and the geographic macro-regions of... more
Objective This study analysed clinical and sociodemographic aspects and follow-up for notified cases of tuberculosis (TB) and explored inequalities in incidence rates and outcome by colour or race and the geographic macro-regions of Brazil. Methods This paper reports the results of a population-based descriptive epidemiological study of all notified cases of TB in Brazil during the period from 01/01/2008 to 31/12/2011. We analysed sociodemographic and clinical variables according to colour or race (white, black, Asian, mixed, and indigenous) and geographic macro-regions of the country (North, Northeast, Central-West, South, and Southeast). Results During the study period, the average incidence of TB in Brazil was 36.7 cases per 100,000 inhabitants, with the highest rates occurring in the North and Southeast regions. The analysis of TB notifications by colour or race revealed that the indigenous population presented the highest incidence rates in all macro-regions except the South, where higher rates were reported in black patients. 'Cured' was the most frequently reported treatment outcome for all skin colour categories. The highest cure rate occurred among the indigenous population (76.8%), while the lowest cure rate occurred among the black population (70.7%). Rates of treatment default were highest among blacks (10.5%) and lowest among the indigenous population (6.9%). However, the fatality rate was similar across race categories, varying between 2.8% and 3.8% for whites and the indigenous population, respectively. The lowest cure rates were observed when follow-up was inadequate (58.3%), and the highest was observed when the follow-up was classified as excellent (96.8%).
s u m m a r y Anti-tuberculosis (TB) drugs are responsible for the occurrence of several adverse drug reactions (ADRs), including hepatotoxicity. The aim was to estimate the incidence of hepatotoxicity and its association with genetic... more
s u m m a r y Anti-tuberculosis (TB) drugs are responsible for the occurrence of several adverse drug reactions (ADRs), including hepatotoxicity. The aim was to estimate the incidence of hepatotoxicity and its association with genetic poly-morphisms and clinical-epidemiological factors by comparing indigenous and non-indigenous TB patients. We investigated clinical-epidemiological variables, serum levels of liver enzymes and NAT2, CYP2E1 and GSTM1 polymorphisms. A non-conditional logistic regression was used to identify the factors associated with hepatotoxicity. Odds ratios were used as the association measures. The incidence of hepatotoxicity was 19.7% for all patients. The risk of hepatotoxicity was almost four times higher in indigenous patients, comparing to non-indigenous. We identified a new nonsynonymous single nucleotide polymorphism of NAT2 in indigenous patients. In total, 54.6% of the patients expressed a slow acetylation phenotype profile. The frequency of the null genotype of GSTM1 was higher in non-indigenous patients (p ¼ 0.002), whereas no significant differences in relation to polymorphisms of CYP2E1 were observed between the groups. Hepatotoxicity was associated with patients older than 60 and indigenous (OR ¼ 26.0; 95%CI:3.1e217.6; OR ¼ 3.8; 95%CI:1.3e11.1, respectively). Furthermore, hepatotoxicity was associated with a slow acetylation profile in indigenous patients (OR ¼ 10.7; 95% CI:1.2e97.2). Our findings suggest that there are distinct acetylation profiles in the Brazilian population, emphasizing the importance of pharmacogenetic analyses for achieving personalized therapeutic schemes and better outcomes.
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To describe the epidemiological situation and the incidence of tuberculosis and to investigate the factors associated with treatment default in the Amazonian municipalities located in the northern Brazilian international border. This... more
To describe the epidemiological situation and the incidence of tuberculosis and to investigate the factors associated with treatment default in the Amazonian municipalities located in the northern Brazilian international border. This retrospective study employed sociodemographic, clinical, and epidemiological tuberculosis data recorded in the Brazilian Notifiable Diseases Information System (SINAN) between 2001 and 2010. Logistic regression was used to identify factors associated with treatment default. Tuberculosis affected mostly indigenous peoples (51.9%), males (57.9%), and people aged 25-44 years (31.4%). The predominant clinical presentation was pulmonary (89.7%), yet in 24.5% of the cases the patients did not undergo sputum smear microscopy, and only half received supervised treatment. In 70.0% of the cases notified, patients were discharged as cured. Treatment default was recorded in 10.0% of the patients. Of all deaths, 4.1% were by tuberculosis and other causes, and 1.7% b...
Research Interests: Colombia, Brazil, Venezuela, Peru, Adolescent, and 20 moreComorbidity, Tuberculosis, Humans, Child, South American Indians, Female, Male, Young Adult, Infant, Patient Compliance, Risk factors, Newborn Infant, Aged, Middle Aged, Adult, Public health systems and services research, Retrospective Studies, Urban Population, Risk Factors, and Child preschool
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In 2005, Amazonas State, Brazil, showed hyperendemic leprosy detection coefficients and prevalence with medium endemicity. Although this State has the largest indigenous population in Brazil, there are no data on the leprosy profile in... more
In 2005, Amazonas State, Brazil, showed hyperendemic leprosy detection coefficients and prevalence with medium endemicity. Although this State has the largest indigenous population in Brazil, there are no data on the leprosy profile in these groups. This study aimed to describe and analyze the epidemiological characteristics of leprosy case reporting in the municipalities (counties) of Autazes, Eirunepé, and São Gabriel da Cachoeira, comparing indigenous and non-indigenous findings according to target variables. A total of 386 cases reported to SINAN from 2000 to 2005 were analyzed. Mean detection rates were 3.55, 14.94, and 2.13/10,000 (among non-indigenous) and 10.95, 1.93, and 0.78/10,000 (among indigenous peoples) in Autazes, Eirunepé, and São Gabriel da Cachoeira, respectively. Paucibacillary cases predominated among both indigenous and non-indigenous populations; however, dimorphous cases represented one-third of notifications. Despite coverage limitations and underreporting, ...
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OBJECTIVES: to analyze the pattern of hospital morbidity of Suruí Indian children at the local network of the Brazilian Universal Health System. METHODS: inpatient data were obtained for 380 children <10 years old hospitalized during... more
OBJECTIVES: to analyze the pattern of hospital morbidity of Suruí Indian children at the local network of the Brazilian Universal Health System. METHODS: inpatient data were obtained for 380 children <10 years old hospitalized during 2000 to 2004 at the two hospitals in the city of Cacoal, State of Rondônia, to which Indian patients are referred to Hospital Materno-Infantil (public) and Hospital Infantil e Maternidade Menino Jesus (private). Hospitalization causes were classified according to the International Disease Classification 10th revision. RESULTS: diseases of the respiratory system - Chapter X (58.2%) were the most frequent cause of hospitalization, followed by certain infectious and parasitic diseases - Chapter I (35.0%) and other conditions developed in the perinatal period - Chapter XVI (3.2%). All other causes contributed with less that 1.5% of the total number of admissions, totaling less than 4.0% combined. The majority of hospital admissions (65.5%) were observed ...
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Tuberculosis persists as a serious public health problem in Brazil. Prevalence rates are alarming in certain social groups, including indigenous peoples. This article presents an epidemiological analysis of records for the Suruí Indians... more
Tuberculosis persists as a serious public health problem in Brazil. Prevalence rates are alarming in certain social groups, including indigenous peoples. This article presents an epidemiological analysis of records for the Suruí Indians available at the Tuberculosis Control Program in the Municipality of Cacoal, Rondônia. The study includes a descriptive statistical analysis of cases reported from 1975 to 2002. There is evidence that the Suruí have an increased risk of acquiring and dying from tuberculosis as compared to other indigenous groups in Rondônia as well as non-Indians. The average incidence coefficient for tuberculosis in the Suruí was 2518.9 per 100,000 inhabitants in the period 1991-2002. It was observed that 45% of the cases were diagnosed in children < 15 years old. Over half of the cases (63.3%) were reported in men. Only 43.2% of the cases were confirmed by sputum microscopy. The use of PPD skin tests, histopathological exams or bacteriological culture were not r...
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To describe the epidemiological situation and the incidence of tuberculosis and to investigate the factors associated with treatment default in the Amazonian municipalities located in the northern Brazilian international border. This... more
To describe the epidemiological situation and the incidence of tuberculosis and to investigate the factors associated with treatment default in the Amazonian municipalities located in the northern Brazilian international border. This retrospective study employed sociodemographic, clinical, and epidemiological tuberculosis data recorded in the Brazilian Notifiable Diseases Information System (SINAN) between 2001 and 2010. Logistic regression was used to identify factors associated with treatment default. Tuberculosis affected mostly indigenous peoples (51.9%), males (57.9%), and people aged 25-44 years (31.4%). The predominant clinical presentation was pulmonary (89.7%), yet in 24.5% of the cases the patients did not undergo sputum smear microscopy, and only half received supervised treatment. In 70.0% of the cases notified, patients were discharged as cured. Treatment default was recorded in 10.0% of the patients. Of all deaths, 4.1% were by tuberculosis and other causes, and 1.7% b...
Research Interests: Colombia, Brazil, Venezuela, Peru, Adolescent, and 20 moreComorbidity, Tuberculosis, Humans, Child, South American Indians, Female, Male, Young Adult, Infant, Patient Compliance, Risk factors, Newborn Infant, Aged, Middle Aged, Adult, Public health systems and services research, Retrospective Studies, Urban Population, Risk Factors, and Child preschool
With the intention of improve knowledge on the epidemiological situation of tuberculosis (TB) among vulnerable populations in Brazil, our objective was to analyze sociodemographic characteristics and operational indicators related to TB... more
With the intention of improve knowledge on the epidemiological situation of tuberculosis (TB) among vulnerable populations in Brazil, our objective was to analyze sociodemographic characteristics and operational indicators related to TB control, comparing indigenous and non-indigenous people, in Rondônia. We conducted a retrospective and descriptive epidemiological study of new TB cases reported between 1997, January 1st and 2006, December 31st. We excluded duplicate records and those for whom the results of treatment was change in diagnosis and transfer. TB cases were classified into two categories: indigenous and non-indigenous people and analysis was performed according to sex, age, origin (urban /rural), State of residence, clinical form, diagnostic tests, monitoring indicators and results of treatment. Altogether 4832 cases were reported, with 322 cases (6.7%) in indigenous people. There was a male predominance (ratios: 1.7 to 1.3 in non-indigenous and indigenous people). The m...
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The radiographic patterns of 23/33 (69.7%) Suruí indians, of the Brazilian Amazon, treated in 2003-2004 were analyzed. The analysis showed that 44.8% presented unspecific infiltrates, 10.3% presented cavitations and 39.1% presented... more
The radiographic patterns of 23/33 (69.7%) Suruí indians, of the Brazilian Amazon, treated in 2003-2004 were analyzed. The analysis showed that 44.8% presented unspecific infiltrates, 10.3% presented cavitations and 39.1% presented multiple parenchymal involvements. Although 36% of the patients presented normal radiographs, they underwent anti-tuberculous treatment without having been submitted for other possible means of diagnosis.
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... Em meados de 1981, ocorreram os primeiros relatos da AIDS nos Estados Unidos, descritos em jovens do sexo masculino, homossexuais, sem história anterior de imunodeficiência, e que apresentavam pneumonia devida ao Pneumocystis carinii.... more
... Em meados de 1981, ocorreram os primeiros relatos da AIDS nos Estados Unidos, descritos em jovens do sexo masculino, homossexuais, sem história anterior de imunodeficiência, e que apresentavam pneumonia devida ao Pneumocystis carinii. ...
To describe the sociodemographic and clinical-epidemiological characteristics of tuberculosis cases and identify associated factors with abandoning treatment and death whilst undergoing treatment. Epidemiological study based on cases of... more
To describe the sociodemographic and clinical-epidemiological characteristics of tuberculosis cases and identify associated factors with abandoning treatment and death whilst undergoing treatment. Epidemiological study based on cases of tuberculosis recorded in indigenous and non-indigenous individuals according to race/color in Mato Grosso do Sul, Midwestern Brazil, between 2001 and 2009. Descriptive analysis of the cases was carried out according to the variables of sex, age group, residence, type of test used in the diagnosis, clinical form, supervised treatment and final status, according to race/color. Univariate/multivariate logistic regression analyses were used to identify predictors of abandoning treatment and death, using odds ratio as a measure of association. A time series of incidence according to race/color was constructed. In the period, 6,962 new cases of tuberculosis were registered, 15.6% being among indigenous. The illness was predominantly found in men and adults...
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Research Interests:
Tuberculosis persists as a serious public health problem in Brazil. Prevalence rates are alarming in certain social groups, including indigenous peoples. This article presents an epidemiological analysis of records for the Suruí Indians... more
Tuberculosis persists as a serious public health problem in Brazil. Prevalence rates are alarming in certain social groups, including indigenous peoples. This article presents an epidemiological analysis of records for the Suruí Indians available at the Tuberculosis Control Program in the Municipality of Cacoal, Rondônia. The study includes a descriptive statistical analysis of cases reported from 1975 to 2002. There is evidence that the Suruí have an increased risk of acquiring and dying from tuberculosis as compared to other indigenous groups in Rondônia as well as non-Indians. The average incidence coefficient for tuberculosis in the Suruí was 2518.9 per 100,000 inhabitants in the period 1991-2002. It was observed that 45% of the cases were diagnosed in children < 15 years old. Over half of the cases (63.3%) were reported in men. Only 43.2% of the cases were confirmed by sputum microscopy. The use of PPD skin tests, histopathological exams or bacteriological culture were not r...
Research Interests:
Research Interests:
To analyze mortality rates and to describe the demographic and epidemiological characteristics of suicides recorded in the state of Amazonas. A descriptive and retrospective study has been carried out with emphasis on municipalities,... more
To analyze mortality rates and to describe the demographic and epidemiological characteristics of suicides recorded in the state of Amazonas. A descriptive and retrospective study has been carried out with emphasis on municipalities, which have shown, simultaneously, a high mortality rates and a high proportion of self-reported indigenous population, based on 2005 - 2009 data as provided by the Informatics Department of the Unified National Health System. Among the general population of the state of Amazonas, the mortality rate, by suicide, of 4.2/100.000 inhabitants has been reported, similar to that of Manaus (4.6/100.000 inhabitants). In contrast, at Tabatinga (25.2/100.000 inhabitants), at São Gabriel da Cachoeira (27.6/100.000 inhabitants) and at Santa Isabel do Rio Negro (36.4/100.000 inhabitants), municipalities, where the proportion of self-reported indigenous population is high, besides the taxes being notably higher, it was observed that most of the suicides has occurred among men; among young men aged between 15 - 24 years; at home; by hanging; during &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;weekend&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and among the indigenous population. Our findings have unveiled that suicide comes forth as a serious public health issue in some municipalities in the state of Amazonas, further indicating that the event occurs within very specific contexts, and that the dimension and the magnitude of the problem can be even more serious among populations or in territories exclusively inhabited by indigenous people.
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Page 1. Cad. Saúde Pública, Rio de Janeiro, 28(2):267-280, fev, 2012 267 Distribuição espacial e temporal da tuberculose em indígenas e não indígenas de Rondônia, Amazônia Ocidental, Brasil Spatial and temporal distribution ...