Navegando por Palavras-chave "Survival Analysis"
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- ItemAcesso aberto (Open Access)AIDS by mother-to-child transmission: survival analysis of cases followed from 1983 to 2002 in different regions of Brazil(Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, 2007-01-01) Matida, Luiza Harunari [UNIFESP]; Ramos Junior, Alberto Novaes; Moncau, José Eduardo Cajado; Marcopito, Luiz Francisco [UNIFESP]; Marques, Heloisa Helena de Sousa; Succi, Regina Célia de Menezes [UNIFESP]; Della Negra, Marinella; Hearst, Norman; Secretaria Estadual da Saúde Coordenação Estadual de DST/AIDS de São Paulo; Universidade Federal do Ceará Faculdade de Medicina; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Instituto de Infectologia Emílio Ribas; University of CaliforniaAntiretroviral therapy contributes to decreasing morbidity and mortality, and ultimately to increasing survival. In Brazil, there are regional differences in HIV epidemiology regarding pregnant women and children with HIV/AIDS. This study evaluates survival time after AIDS diagnosis in 914 children infected by mother-to-child transmission, reported between 1983 and 1998 and followed until 2002, in Brazil's five regions. Time between birth and HIV diagnosis decreased over the years, mainly in the South and Southeast Regions. There was a significant improvement in survival; more than 75% of cases were still living four years after diagnosis in the 1997-1998 group. This Brazilian study demonstrates that even with regional inequalities in health care infrastructure it is possible for a developing country to establish an effective system of universal and free access to antiretroviral therapy that produces a significant increase in survival for children with AIDS.
- ItemSomente MetadadadosAIDS de transmissão materno-infantil: análise de sobrevivência dos casos notificados ao sistema oficial do estado de São Paulo de 1987 a 1994(Universidade Federal de São Paulo (UNIFESP), 1997) Matida, Luiza Harunari [UNIFESP]; Marcopito, Luiz Francisco [UNIFESP]
- ItemSomente MetadadadosEvolução clínica, antropométrica e nutricional de crianças com síndrome congênita do vírus Zika durante quatro anos após a epidemia(Universidade Federal de São Paulo (UNIFESP), 2021) Arrais, Nivia Maria Rodrigues [UNIFESP]; Pinto, Maria Isabel De Moraes [UNIFESP]; Universidade Federal de São PauloObjectives: To evaluate the growth and development of children with congenital Zika virus syndrome during their first years of life and to verify predictive variables for low weight, death and behavioral changes. To establish the frequency and severity of congenital heart disease in these children and to describe two cases of type 1 diabetes mellitus. Methods: Cohort of 71 children diagnosed with probable or confirmed congenital Zika virus syndrome according to the Brazilian Ministry of Health classification and who were followed up in Natal, Rio Grande do Norte. Maternal-infant epidemiological, clinical and laboratory data and anthropometric parameters were obtained during out patient visits. The tendency of the mean z-score of head circumference and low weight and short stature free time in children with and without microcephaly at birth were evaluated. Predictive variables for death were evaluated. The Survey of Wellbeing of Young Children questionnaire assessed development, risk for altered behavior, andf amily background. Results: Children born without microcephaly presented a decrease in the head circumference growth velocity (p=0.019) and a tendency towards a decrease in the mean z-score (p<0.001). They showed greater free time to low weight (p=0.036) and to short stature (p=0.034) compared to those born with microcephaly. The comparison of the height classification using the stadiometer and the measurements of the tibia and knee-calcaneal segments in the curves ofthe W.H.O. (2006) showed a slight agreement (ƙappa=0.316, p<0.001). Assessing the nutritional diagnoses obtained from the W.H.O. curves and Brooks curves (2011), low weight and short stature were observed only in the W.H.O. curves. For nutritional classification by body mass index, agreement was slight or moderate, regardless of height used. All 52 children whose families responded to the Survey of Wellbeing of Young Children questionnaire had microcephaly and developmental delayat the time of the interview. Normocephalic babies at birth were 36 times more likely to have behavioral changes when compared to microcephalic babies (95%CI 3.82-337.92, p=0.002). Those with hearing impairment and strabismus had less risk of behavioral changes; 35% of the families reported food insecurity in the year prior to the interview and 21% of the mothers were at risk for depression. Children with arthrogryposis were seven times more likely to die than those without this condition. Seven of 51 (13.7%) children with echocardiographic assessment had mild congenital heart disease without hemodynamic repercussions. Two children (2.8%) were diagnosed with type 1 diabetes mellitus. Conclusions: Children with SCZ born normocephalic can progress to microcephaly during the first year of life, but they have longer free time from low weight and short stature when compared to those born microcephalic. The use of height estimated by segment measurements seems to be na option for daily practice after 24 months of age. Children born normocephalic had a higher risk of behavioral changes, suggesting greater social interaction and better conditions for externalizing reactions. Food insecurity and maternal depression may reflect the psychosocial vulnerability of these families. Only children with mild congenital heart disease and without hemodynamic repercussions were observed, suggesting that the cardiologic investigation should be reserved for children with clinical or neonatal screening suggestive of impairment. Two cases of type 1 diabetes mellitus were described, suggestive of a possible role of the Zika virus as na environmental factor triggering autoimmunity.
- ItemAcesso aberto (Open Access)Improving survival in children with AIDS in Brazil: results of the second national study, 1999-2002(Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, 2011-01-01) Matida, Luiza Harunari [UNIFESP]; Ramos Junior, Alberto Novaes; Heukelbach, Jorg; Sañudo, Adriana; Succi, Regina Célia de Menezes [UNIFESP]; Marques, Heloisa Helena de Sousa; Negra, Marinella Della; Hearst, Norman; Secretaria de Estado da Saúde de São Paulo Programa Estadual de DST/AIDS; Universidade Federal do Ceará Faculdade de Medicina; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Faculdade de Ciências Médicas da Santa Casa de São Paulo; University of CaliforniaThe objective of this study is to characterize survival in children with AIDS diagnosed in Brazil between 1999-2002, compared with the first national study (1983-1998). This national retrospective cohort study examined a representative sample of Brazilian children exposed to HIV from mother-to-child transmission and followed through 2007. The survival probability after 60 months was analyzed by sex, year of birth and death, clinical classification, use of antiretroviral therapy (ART) and prophylaxis for opportunistic diseases. 920 children were included. The survival probability increased: comparing cases diagnosed before 1988 with those diagnosed from 2001-2002 it increased by 3.5-fold (from 25% to 86.3%). Use of ART, initial clinical classification, and final classification were significant (p < 0.001) predictors of survival. Issues regarding quality of records and care were identified. The results point to the success of the Brazilian policy of providing ART. The improvement of clinical status contributes to quality of life, while indicating challenges, particularly practices to improve long-term care.
- ItemSomente MetadadadosTendência secular da mortalidade e fatores associados ao óbito precoce por doença falciforme no estado de São Paulo(Universidade Federal de São Paulo (UNIFESP), 2021) Souza, Nayara Dorta De [UNIFESP]; Konstantyner, Tulio [UNIFESP]; Universidade Federal de São PauloObjective: To estimate the trend in the mortality rate and the average age of death, and to identify the sociodemographic factors associated with early death in patients with sickle cell disease in the State of São Paulo. Methods: Descriptive and analytical ecological and transversal study, based on data from the Mortality Information System. All events of death of patients residing in the State of São Paulo from 01/01/1996 to 12/31/2015 were included, which contained at least one International Disease Code for Sickle Cell Disease in any field of the medical certificate. death. The trends in mortality rates (general and stratified by age group) and average age of death over the years were estimated using simple linear regression. For the investigation of factors associated with early death, which was defined when death ocurred before the median life expectancy of patients with DF, univariate and multivariate survival analyzes were performed, using Cox regression. The Kaplan Meier graph was used to represent univariate associations. Results: The overall mortality rate per million inhabitants increased by 0.084 per year (R² = 0.783 and p <0.001). When stratified by age group, in the age subgroup it was greater than 20 years, the increase was 0.108 per year (R² = 0.789 and p <0.001) and in those under 20 years it was 0.023 per year (R² = 0.188 and p = 0.056). The analysis of the trend of the average age at death showed an increase of 0.617 years per year analyzed (R² = 0.835 and p <0.001 In the multivariate analysis of the factors associated with early death, being male (HR = 1.30), white (HR = 1.16), dying inside the hospital (HR = 1.29) and living in Greater São Paulo (HR = 1.13) presented a higher risk of early death, when compared to the reference categories. Conclusion: During the 20 years analyzed, there was an increase in the mortality rate and the average age of death with Sickle Cell Disease. The sociodemographic factors: sex, race, place of occurrence and municipality of residence were associated with the age range of death.