Objective: To identify factors associated with death from TB, evaluating TB cases reported for 2001 in the city of São Paulo (specifically in the neighborhoods of Cidade Tiradentes, Guaianazes, Itaquera and São Mateus) and comparing those evolving to death with those evolving to cure. Methods: We investigated all deaths in which TB was given as the principal cause (n = 48), analyzing medical charts and conducting home visits to interview the caregiver(s). In parallel, we investigated 96 TB cases in which the patient had been discharged after a cure had been achieved. Patients with HIV were excluded from both groups. Results: There were no differences between the two groups in terms of the clinical form of tuberculosis, laboratory test confirmation of the diagnosis and type of treatment. Death from TB was found to be associated, in a statistically significant manner, with being male, being over 50 years of age, having had less than 3 years of schooling, suffering from alcoholism and being unemployed. The logistic regression showed that the variables presenting the strongest associations with death from TB were suffering from alcoholism and being over 50, whereas being a new treatment and being employed were found to be protective. The combination of suffering from alcoholism, being unemployed and being over 50 increased the chance of evolving to death by 25 times (95%CI: 6.43-97.20). Conclusion: Ongoing education of health professionals, prompt epidemiological interventions and efficient patient referral systems could improve the indices related to this disease.

Keywords: Tuberculosis/mortality; Epidemiologic studies; Death certificates.

Objective: To compare inpatient and outpatient treatment of tuberculosis, in terms of outcomes, in the city of São Paulo, Brazil, as well to determine which variables are most frequently associated with hospitalization. Methods: A prospective, longitudinal study carried out between January and December of 2007, at two large hospitals and at outpatient clinics, in two regions of the city of São Paulo. For inpatients, data were collected with a structured questionnaire. Additional data were obtained from the São Paulo State Department of Health Tuberculosis Database. Results: Of the 474 patients included in the study, 166 were inpatients, and 308 were outpatients. The multivariate analysis showed that hospitalization for tuberculosis was associated with hospital/emergency room diagnosis of tuberculosis (OR = 55.42), with HIV co-infection (OR = 18.57), with retreatment (OR = 18.51), and with having previously sought treatment at another health care facility (OR = 12.32). For the inpatient and outpatient groups, the overall cure rates were 41.6% and 78.3%, respectively, compared with 30.4% and 58.5% for those who were co-infected with HIV, whereas the overall mortality rates were 29.5% and 2.6%, respectively, compared with 45.7% and 9.8% for those who were co-infected with HIV. Conclusions: Among inpatients, tuberculosis appears to be more severe and more difficult to diagnose, resulting in lower cure rates and higher mortality rates, than among outpatients. In addition, tuberculosis patients co-infected with HIV have less favorable outcomes.

Keywords: Tuberculosis; Hospitalization; Primary health care; Treatment outcome.

The epidemiological relevance of tuberculosis is directly related to the socioeconomic profile of a given country. Vulnerability to tuberculosis is influenced by biological factors (e.g., malnutrition, HIV infection, and age) and social factors (e.g., unhealthy housing, high population density, inappropriate working conditions, and lack of access to health services). In many cases, multiple vulnerabilities occur in conjunction. We propose here a reflection on tuberculosis from the point of view of the social determinants of health, as well as the costs associated with its diagnosis and treatment in Brazil, based not only on data in the international literature but also on evidence related to the national context. Given the magnitude of tuberculosis as a socially mediated disease, there is an evident need for greater involvement of health professionals and of the scientific community to implement relevant operational and research measures to understand the social conditions influencing the health-illness continuum for tuberculosis patients. Although the recent economic crisis in Brazil has contributed to increased mortality from all causes, including tuberculosis, health and social protection expenditures have mitigated detrimental health effects. The evidence presented here underscores the importance of public social protection policies for minimizing the effects of tuberculosis indicators, with the aim of eliminating tuberculosis in Brazil.

Keywords: Tuberculosis; Social determinants of health; Cost of illness; Costs and cost analysis.

Objective: To evaluate the effect that seasonality has on the occurrence of respiratory symptoms in a Brazilian city with a tropical climate. Methods: This was a cross-sectional study, in which data related to subjects who sought outpatient treatment at a primary health care clinic in the city of Goiânia, Brazil, were correlated with daily meteorological data. Over a one-year period, all the patients who met the inclusion criteria were interviewed on 44 distinct, randomly selected days (11 days per season). We used ANOVA in order to compare the means of the dependent variables by season. Correlations were drawn between each dependent variable and each meteorological variable. The effects of the meteorological variables were analyzed with an AutoRegressive Moving Average with eXogenous input (ARMAX) model. Results: Of the 3,354 participants, 494 (14.6%) had respiratory symptoms. Although temperature variation alone had no effect on the number of individuals with respiratory symptoms, the low levels of humidity during winter resulted in a statistically significant difference among the seasons (p < 0.01). The mean minimum relative humidity on the three days prior to the interviews correlated negatively with the number of subjects with respiratory symptoms (p = 0.04). An ARMAX model including the same variable showed a statistically significant coefficient (p < 0.0001). Conclusions: In this sample, the number of subjects with respiratory symptoms increased significantly when the relative humidity dropped, and this increase could be predicted using meteorological data.

Keywords: Seasons; Tropical climate/adverse effects; Signs and symptoms, respiratory; Logistic models.

Objective: To estimate the total time elapsed between symptom onset and diagnosis of pulmonary tuberculosis (patient delay plus health care system delay), analyzing the factors associated with delayed diagnosis in the state of Rio de Janeiro, Brazil. Methods: We conducted a questionnaire-based survey involving 218 pulmonary tuberculosis patients treated for two months at 20 health care clinics and 3 hospitals in eight cities within the state of Rio de Janeiro. We collected socioeconomic and demographic data, as well as data regarding the health care system and the medical history of the patients. Results: The median time elapsed from the onset of symptoms to diagnosis was 68 days (interquartile range [IQR]: 35-119 days). The median patient delay (time from symptom onset to initial medical visit) was 30 days (IQR: 15-60 days), and the median health care system delay (time from initial medical visit to diagnosis) was 21 days (IQR: 8-47 days). A cut-off point of 21 days was adopted. The factors independently associated with patient delay were female gender, cough, and unemployment [adjusted OR (95% CI) = 2.7 (1.3-5.6); 11.6 (2.3-58.8); and 2.0 (1.0-3.8), respectively], whereas only female gender was independently associated with health care system delay (OR= 3.2; 95% CI: 1.7-6.0). Conclusions: Delayed diagnosis of pulmonary tuberculosis remains a problem in Rio de Janeiro, increasing the risk of transmission and mortality, that risk being greater for women and the socioeconomically disadvantaged. Patients might not recognize the significance of chronic cough as a health problem. Tuberculosis education programs targeting women might improve this situation.

Keywords: Lung neoplasms; Neoplasm metastasis; Antineoplastic combined chemotherapy protocols; Radiotherapy, computer-assisted.

Objective: To describe cases of tuberculosis recurrence (TBR), stratified by temporal classification (early or late TBR), and to identify possible predictors of such recurrence. Methods: This was an analytical retrospective observational epidemiological study involving a cohort of 963 new cases of pulmonary tuberculosis, reported and treated via the Tuberculosis Control Program in the city of Carapicuíba, Brazil. The study period was from 2000 to 2010. All of the pulmonary tuberculosis patients who successfully completed the treatment (with or without confirmation of cure) were selected and followed until December 31, 2012. Results: Of the 963 cases, TBR occurred in 47 (4.88%). The mean time between the first and second tuberculosis episodes was 36.12 months. Of the 47 TBR cases, 16 (34.04%) occurred within the first 18 months after the completion of the initial treatment (early TBR) and 31 (65.96%) occurred thereafter (late TBR). There were statistically significant differences between the early and late TBR groups only regarding level of education (≤ 3 vs. > 3 years of schooling; p < 0.004) and weight gain at completion of the initial treatment (1.78 kg vs. 5.31 kg; p < 0.045)-not regarding any of the other variables studied. Conclusions: A low level of education might translate to poor treatment adherence, which impedes the killing of bacilli and facilitates their survival in a latent state, making it appear as if the treatment was effective. Minimal or no weight gain at completion of the initial treatment might be a reliable biomarker to be used by health care facilities that provide tuberculosis treatment.

Keywords: Recurrence; Tuberculosis; Risk factors.

Objective: To analyze the clinical characteristics and evolution of a group of patients with positive sputum cultures for multidrug-resistant (MDR) Mycobacterium tuberculosis and treated at a referral center in the city of Rio de Janeiro, Brazil. Methods: Based on the positive results in sputum cultures for MDR M. tuberculosis, 50 patients were selected, and their clinical data were obtained from the Brazilian Ministry of Health MDR-TB Database. The frequencies of noncompliance, relapses, failures and previous treatments for TB up to diagnosis of MDR-TB were compiled. The radiological patterns were classified as unilateral or bilateral, and with or without cavitation. Two years after the end of the standard treatment for MDR-TB, the outcome (cure, failure, noncompliance or death) for each patient was evaluated and reassessed every two years. The post-treatment follow-up period was eight years. Results: The mean number of previous treatments was 2.3 ± 0.9. The mean interval between the initial diagnosis and the development of MDR-TB was 2.0 ± 1.7 years. Two years after the initial treatment for MDR-TB, 2 patients had abandoned treatment, 8 had died, 18 had been cured, and 22 had presented treatment failure. The bivariate analysis showed that bilateral pulmonary involvement and cavitary pattern markedly reduced the chances for cure, with a relative risk of 1-0.6 (40%) and 1-0.7 (30%), respectively. At the end of the follow-up period, 2 patients had abandoned treatment, 9 had presented treatment failure, 17 had been cured, and 22 had died. Conclusions: Bilateral pulmonary involvement and cavity pattern greatly reduced the chances for cure of the patients with MDR-TB. Most patients who presented treatment failure died within the 8-year follow-up period.

Keywords: Tuberculosis, multidrug-resistant; Treatment outcome; Disease-free survival; Treatment refusal; Treatment failure.

Objective: To identify transmitted or primary resistance among cases of multidrug-resistant tuberculosis and predictive factors for cure in multidrug-resistant tuberculosis after the first treatment. Method: Descriptive study of a cohort from 2006 to 2010, in a reference unit of tuberculosis in São Paulo, Brazil. The data were obtained by the revision of medical records. Clinical criteria were used to classify transmitted and acquired resistance. Extended primary resistance was also defined, in this study, as cases initially treated with a standardized scheme, but with no therapeutic success, and the pre-treatment drug susceptibility test (DST) showed presence of resistance. Results: 156 patients with multidrug-resistant tuberculosis and their respective sputum samples were eligible for the study. Only 7% of the patients were positive for the human immunodeficiency virus (HIV). Previous treatment occurred in 95% of the sample. The cure rate after the first treatment was 54%. The median bacteriological conversion time of those who healed was one month. Bacillary resistance was considered acquired resistance in 100 (64%) and transmitted resistance in 56 (36%). By logistic regression, patients who presented primary multidrug-resistant tuberculosis (odds ratio-OR = 6,29), without comorbidity (OR = 3,37) and with higher initial weight (OR = 1.04) were associated with cure after the first treatment. Conclusion: The early detection of bacillary resistance and appropriate treatment are in favor of healing. Thus, it is crucial to know exactly the primary resistance rate avoiding the use of inadequate treatments, amplification of bacillary resistance and its transmission.

Keywords: Multidrug-resistant tuberculosis; Drug resistance; Treatment outcome.

Objective: To evaluate the level of access to health care clinics of a population of patients hospitalized for tuberculosis (TB) at two hospitals in the city of São Paulo, Brazil, comparing them with a population of TB patients under outpatient treatment only. Methods: We compiled sociodemographic, clinical and epidemiological data related to patients hospitalized for TB at two hospitals in the city of São Paulo, Brazil, between January and December of 2007, using a structured questionnaire. We also identified the outpatient clinics to which the patients were referred at discharge. The same variables were evaluated for TB outpatients during the same period, using a database. Results: The study sample consisted of 474 patients (166 inpatients and 308 outpatients: mean age, 41.0 and 39.1 years, respectively). The univariate analysis showed positive associations between hospitalization due to TB and the following variables: 30-39 year age bracket (OR = 2.17); 50-59 year age bracket (OR = 2.17); combination of pulmonary and extrapulmonary forms of TB (OR = 5.31); TB re-treatment (OR = 2.66); seeking treatment at other health care facilities prior to the diagnosis of TB (OR = 2.05); symptom duration of more than 12 weeks (OR = 2.23); and TB diagnosed at hospitals or in emergency rooms (OR = 4.68). The proportion of inpatients who resided in the same regional health district area as that in which the respective hospital was located was 77.6% and 36.8%. The proportion of discharged patients who were referred to outpatient clinics in the same areas was 67.1% and 39.7%, respectively. Conclusions: Patients hospitalized for TB should be monitored from discharge until their admission to the outpatient clinic.

Keywords: Tuberculosis; Health services accessibility; Inpatients; Outpatients.

Background: Multidrug resistant tuberculosis is a threat to tuberculosis control worldwide. In many studies, it has been suggested that inadequate treatment is a risk factor for the development of multidrug resistent tuberculosis. Objective: To identify the factors associated with inadequate treatment in a group of patients with multidrug resistent tuberculosis. Method: The authors identified all drug sensitivity test for tuberculosis performed at the Central Laboratory of the state of Ceará from 1990 to 1999. Retrospective and prospective analysis was performed, comparing the characteristics of adequately treated patients with those of inadequately treated patients. Multidrug resistance was defined as resistance to 2 drugs (rifampin and isoniazid) or more, using the Cox proportional hazards model. Results: Of the 1,500 sensitivity test performed at the Central Laboratory of Public Health of the state of Ceará, 266 revealed multidrug-resistant strains. Of those 266 patients, the authors were able to identify only 153, of whom 19 were excluded. Thus, our sampling consisted of 134 patients. Univariate analysis demonstrated that the significant factors associated with inadequate treatment were: noncompliance with the treatment, extreme poverty, drug intolerance, mistakes in the management of the patients, lack of medication being supplied by the health service, two or more previous treatments, pronounced lung cavities and bilateral lesions on chest X-rays. They found a further association (p < 0.0010) between alcoholism or smoking and noncompliance with the treatment. In the multivariate analysis, the factors associated with an outcome of inadequate treatment were: two or more previous treatments (p < 0.0001, OR = 5.9; CI 95%: 2.5-13.7), pronounced cavitation (p < 0.0217, OR = 2.7; CI 95%: 1.2-6.1) and bilateral chest X-ray lesions (p < 0.0226, OR = 3.2; CI 95%: 1.4-7.4) Conclusion: In the study, the authors observed that factors related to inadequate treatment are wide-ranging. An attempt at better control of the disease is warranted, especially in those patients with pronounced cavitation or bilateral lesions in chest X-rays. And those with 2 or more previous treatments.

Keywords: Tuberculosis, multidrug-resistant. Risk factors.

Objective: To evaluate the risk factors for the development of tuberculosis and multidrug-resistant tuberculosis (MDR-TB) in patients treated at a tertiary referral hospital. Methods: This was a cross-sectional study based on data obtained from patients treated at the Júlia Kubitschek Hospital, located in the city of Belo Horizonte, Brazil, between October of 2012 and October of 2014. We evaluated sociodemographic, behavioral, clinical, and radiological variables. The outcome considered to identify associations between tuberculosis and the explanatory variables was the treatment prescribed. To evaluate the associations between MDR-TB and the same explanatory variables, the change in MDR-TB treatment was considered. Results: The factors associated with tuberculosis were alcoholism, comorbidities, pulmonary cavitations, and a radiological pattern suggestive of tuberculosis. Cavitation and previous treatment for tuberculosis were associated with MDR-TB. Conclusions: Despite the significant progress made in the fight against tuberculosis, there is a need for coordinated actions that include social protection measures and patient support.

Keywords: Tuberculosis; Risk factors; Tuberculosis, multidrug-resistant.

Objective: To analyze the temporal trend of tuberculosis cure indicators in Brazil. Methods: An ecological time-series study using administrative data of reported cases of the disease nationwide between 2001 and 2022. We estimated cure indicators for each federative unit (FU) considering individuals with pulmonary tuberculosis, tuberculosis-HIV coinfection, and those in tuberculosis retreatment. We used regression models using joinpoint regression for trend analysis, reporting the annual percentage change and the average annual percentage change. Results: For the three groups analyzed, we observed heterogeneity in the annual percentage change in the Brazilian FUs, with a predominance of significantly decreasing trends in the cure indicator in most FUs, especially at the end of the time series. When considering national indicators, an average annual percentage change of -0.97% (95% CI: -1.23 to -0.74) was identified for the cure of people with pulmonary tuberculosis, of -1.11% (95% CI: -1.42 to -0.85) for the cure of people with tuberculosis-HIV coinfection, and of -1.44% (95% CI: -1.62 to -1.31) for the cure of people in tuberculosis retreatment. Conclusions: The decreasing trends of cure indicators in Brazil are concerning and underscore a warning to public authorities, as it points to the possible occurrence of other treatment outcomes, such as treatment discontinuity and death. This finding contradicts current public health care policies and requires urgent strategies aiming to promote follow-up of patients during tuberculosis treatment in Brazil.

Keywords: Tuberculosis; Time factors; Retrospective studies; Brazil.

Background: Tuberculosis cure is dependent upon treatment adherence. Objective: To analyze the results of tuberculosis treatment in public health clinics in the city of Campinas, in the state of São Paulo, Brazil, during 2002. Method: From a cohort of 484 patients diagnosed with tuberculosis, we evaluated 436. Treatment outcomes were described for all patients, whether new patients or patients in retreatment, including those presenting the pulmonary form, with or without acquired immunodeficiency syndrome (AIDS) comorbidity. Results: The success rate was 68.6% (72.3% among non-AIDS patients and 57.6% among AIDS patients). Among new cases, the non-AIDS group presented a 2.2-times greater chance of presenting favorable results. In the AIDS group, no differences were observed between new patients and those in retreatment. Among the unfavorable outcomes, only lethality presented a difference (18.9% among AIDS patients and 8.0% among non-AIDS patients). In patients presenting the pulmonary form, the success rate was similar between those who were initially acid-fast bacilli positive and those who were not. Conclusion: The tuberculosis control program in Campinas presented low effectiveness. In comparison to the 2001 national cohort, success rates were higher for non-AIDS patients but lower for AIDS patients. The higher success rate among cases of tuberculosis without AIDS was primarily derived from the treatment of new cases. The unfavorable profile of tuberculosis patients co-infected with AIDS, characterized by the (18.9%) lethality and the (15.3%) noncompliance, were partially responsible for the lower success rate seen among such patients. It is notable that such high proportions of noncompliant patients were seen in a city providing easy access to treatment. In order to improve the program, medical teams should receive further training in supervised treatment, health education and techniques for interacting with patients, all of which will require considerable investment.

Keywords: Key words: Tuberculosis. Treatment Refusal. Retreatment. Acquired Immunodeficiency Syndrome. Comorbidity

Objective: To identify, characterize, and quantify associations of various factors with quality of life (QoL) in patients with asthma, according to the pharmacotherapy employed. Methods: This was a cross-sectional study involving 49 patients (≥ 18 years of age) with severe uncontrolled or refractory asthma treated at a specialized outpatient clinic of the Brazilian Unified Health Care System, regularly using high doses of inhaled corticosteroids (ICs) or other medications, and presenting comorbidities. At a single time point, QoL was assessed with the Asthma Quality of Life Questionnaire (AQLQ). The overall AQLQ score and those of its domains were correlated with demographic variables (gender and age); Asthma Control Questionnaire score; pharmacotherapy (initial IC dose, inhaler devices, and polytherapy); and comorbidities. Results: Better AQLQ scores were associated with asthma control-overall (OR = 0.38; 95% CI: 0.004-0.341; p < 0.001), "symptoms" domain (OR = 0.086; 95% CI: 0.016-0.476; p = 0.001), and "emotional function" domain (OR = 0.086; 95% CI: 0.016-0.476; p = 0.001)-and with IC dose ≤ 800 µg-"activity limitation" domain (OR = 0.249; 95% CI: 0.070-0.885; p = 0.029). Worse AQLQ scores were associated with polytherapy-"activity limitation" domain (OR = 3.651; 95% CI: 1.061-12.561; p = 0.036)-and number of comorbidities ≤ 5-"environmental stimuli" domain (OR = 5.042; 95% CI: 1.316-19.317; p = 0.015). Conclusions: Our results, the importance of this issue, and the lack of studies taking pharmacotherapy into consideration warrant longitudinal studies to establish a causal relationship between the identified factors and QoL in asthma patients.

Keywords: Asthma; Asthma/drug therapy; Quality of life; Medication therapy management.

Abstract Objectives: To determine the frequency of adverse effects related to the use of the tuberculosis treatment regimen designated Regimen I and the need for regimen alterations due to these effects. Methods: A retrospective analysis of 329 medical charts of patients who were treated with Regimen I and discharged after cure between March 2000 and April 2006 was carried out at the Tuberculosis Outpatient Clinic, Department of Pulmonology of the Santa Casa de Misericórdia de São Paulo Hospital in the city of São Paulo, Brazil. Adverse effects and the timing of their appearance, as well as subsequent modifications in the treatment regimen, were investigated. Results: We included 297 patients, 146 (49.1%) of whom presented one or more adverse effects related to antituberculosis medications. The frequency of minor side effects was 41.1%, and that of major side effects was 12.8%. The most common reactions were those involving the gastrointestinal tract (40.3%) and the skin (22.1%). Adverse effects were more common in the first and second months of treatment (58.4%). Modification of the treatment regimen was necessary in 11 cases (3.7% of the total sample). Drug-induced hepatitis was the adverse effect that demanded the most regimen changes. Conclusions: In this group of patients, the frequency of adverse effects related to treatment with Regimen I was 49.1%. However, in most of the cases, it was not necessary to modify the treatment regimen due to side effects.

Keywords: Tuberculosis/therapy; Antitubercular agents/adverse effects; Hepatitis, toxic.

Objective: The aim of this study was to determine the factors associated with nocturnal, productive and dry cough among young adults in Nigeria. Methods: We evaluated 498 subjects, 20-44 years of age, in Ilorin, Nigeria, using the European Community Respiratory Health Survey (ECRHS) questionnaire, administered by trained interviewers. Results: Nocturnal cough was associated with asthma (OR = 10.87; p < 0.01), nasal allergy (OR = 6.33; p < 0.01), smoking (OR = 3.10; p < 0.01), skilled manual and non-manual work (OR = 2.86 and 2.10, respectively; p < 0.01 for both) and female gender (OR = 1.33; p = 0.17). Productive cough was associated with skilled manual and non-manual work (OR = 3.82 and 3.03, respectively; p < 0.01 for both), smoking (OR = 3.10; p < 0.01), asthma (OR = 3.27; p < 0.01) and nasal allergy (OR = 5.81; p < 0.01). Dry cough was associated with asthma (OR =5.18; p < 0.01) obesity (OR =1.88; p = 0.19), smoking (OR = 1.77; p = 1.44), nasal allergy (OR = 1.45; p = 0.26) and female gender (OR =1.36; p = 0.33). Age, gender, type of residence and obesity were not significantly associated with any type of cough (p > 0.05). Conclusions: Early prevention and treatment of conditions associated with cough, as well as the modification of social factors commonly associated with cough, are needed in order to reduce respiratory morbidity.

Keywords: Cough; Smoking; Asthma; Rhinitis; Nigeria.

Objective: To identify risk factors for death among patients with severe asthma. Methods: This was a nested case-control study. Among the patients with severe asthma treated between December of 2002 and December of 2010 at the Central Referral Outpatient Clinic of the Bahia State Asthma Control Program, in the city of Salvador, Brazil, we selected all those who died, as well as selecting other patients with severe asthma to be used as controls (at a ratio of 1:4). Data were collected from the medical charts of the patients, home visit reports, and death certificates. Results: We selected 58 cases of deaths and 232 control cases. Most of the deaths were attributed to respiratory causes and occurred within a health care facility. Advanced age, unemployment, rhinitis, symptoms of gastroesophageal reflux disease, long-standing asthma, and persistent airflow obstruction were common features in both groups. Multivariate analysis showed that male gender, FEV1 pre-bronchodilator < 60% of predicted, and the lack of control of asthma symptoms were significantly and independently associated with mortality in this sample of patients with severe asthma. Conclusions: In this cohort of outpatients with severe asthma, the deaths occurred predominantly due to respiratory causes and within a health care facility. Lack of asthma control and male gender were risk factors for mortality.

Keywords: Asthma/mortality; Asthma/therapy; Risk factors.

Objective: To evaluate the anthropometric data obtained for residents of the city of São Paulo, Brazil, in a study of Latin America conducted in two phases (baseline, in 2003, and follow-up, in 2012). Methods: This was an analysis of data obtained for São Paulo residents in a two-phase population-based study evaluating the prevalence of COPD and its relationship with certain risk factors among individuals ≥ 40 years of age. The anthropometric data included values for weight, height, body mass index (BMI), and waist circumference. In the follow-up phase of that study, the same variables were evaluated in the same population sample as that of the baseline phase. Results: Of the 1,000 São Paulo residents enrolled in the baseline phase of that study, 587 participated in the follow-up phase, and 80 (13.6%) of those 587 subjects had COPD. Comparing the baseline and follow-up phases, we found increases in all anthropometric measures in both groups (COPD and non-COPD), although the differences were significant only in the non-COPD group. The subjects with mild COPD showed increases in weight and BMI (Δweight = 1.6 ± 5.7 and ΔBMI = 0.7 ± 2.2), whereas those with moderate or severe COPD showed reductions (Δweight = −1.7 ± 8.1 and ΔBMI = −0.4 ± 3.0), as did those with severe or very severe COPD (Δweight = −0.5 ± 5.4 and ΔBMI = −0.8 ± 3.3). Conclusions: Between the two phases of the study, the subjects with mild COPD showed increases in weight and BMI, whereas those with a more severe form of the disease showed reductions.

Keywords: Pulmonary disease, chronic obstructive; Body mass index; Obesity; Waist circumference.

Objective: To identify socioeconomic factors and clinical factors associated with the development of complications in preschool children hospitalized with community-acquired pneumonia (CAP). Methods: This was a prospective longitudinal study involving children (12-59 months of age) diagnosed with CAP and admitted to the pediatric wards of two hospitals in the metropolitan area of Campinas, Brazil. Children with cystic fibrosis, heart disease, pulmonary malformations, neurological disorders, or genetic diseases were excluded. The diagnosis of CAP was based on clinical and radiological findings. Data were collected from the medical records and with a semi-structured questionnaire. The subjects were divided into two groups (complicated and uncomplicated CAP). Socioeconomic and clinical variables were compared, and multivariate logistic regression analysis was performed. Results: Of the 63 children included, 29 and 34, respectively, presented with uncomplicated and complicated CAP. No statistically significant differences were found between the groups regarding age at admission, gestational age, birth weight, gender, or socioeconomic variables. Significant differences were found between the groups regarding history of pneumonia (p = 0.03), previous antibiotic therapy (p = 0.004), time elapsed since the onset of CAP (p = 0.01), duration of fever prior to admission (p < 0.001), duration of antibiotic therapy (p < 0.001), and length of hospital stay (p < 0.001). In the multivariate analysis, only duration of fever prior to admission remained in the model (OR = 1.97; 95% CI: 1.36-2.84; p < 0.001). Conclusions: Biological variables, especially duration of fever prior to admission, appear to be associated with the development of complications in children with CAP.

Keywords: Community-acquired infections; Pneumonia; Pleural Effusion.