Spatial distribution of tuberculosis in Manaus and its social determinants, 2008-2013.

SETTING: Brazil ranks eighteenth worldwide in annual numbers of new tuberculosis (TB) cases. The municipality of Manaus, Amazonas State, has the highest incidence of TB in Brazil. OBJECTIVE: To evaluate the quality of TB epidemiological surveillance, and to describe the spatial distribution pattern of TB incidence in Manaus and its social determinants. DESIGN: An ecological study was performed based on secondary data from TB epidemiological surveillance reports. RESULTS: An index was developed to classify neighborhoods in terms of the quality of surveillance and suspected underreporting. Based on data from neighborhoods with better surveillance performance, we observed that the average number of residents per room, the unemployment rate and the proportion of households connected to a sewage system were significant predictors of TB incidence. Seven neighborhoods in the south and west of the city had clusters of high TB transmission. CONCLUSION: Our results suggest that the association between TB and social vulnerability is obscured by the poor quality of TB surveillance data. We identified priority areas that require immediate TB control interventions and those where local surveillance efforts should be improved, and generated information useful for formulating more effective actions.

A behavioral assessment scale for attention deficit disorder in Brazilian children based on DSM-IIIR criteria.

A teacher scale based on DSM-III-R diagnostic criteria for attention deficit hyperactivity disorder (ADHD) was developed for the behavioral assessment of children in Brazil. A total of 2,082 children (782 males and 1,300 females) with a mean age of 11.2 years who were attending a public school in the greater Rio de Janeiro area were the subjects of this study. Two factors (Hyperactivity-Impulsivity and Inattention) were extracted from a principal-factor analysis conducted on the data, and the factor structure of the scale was found to be stable. Ratings of boys were higher than ratings of girls, and younger children had higher ratings than older children for both factors. Test-retest reliability for each item of the scale ranged from .56 to .70. The data are discussed in view of current controversies in the factor structure of teacher ratings of DSM-III-R ADHD symptoms.