Prophylaxis and treatment of diseases in western São Paulo state: the Sanitation Service and trachoma in the early twentieth century. / A profilaxia e o tratamento das enfermidades do oeste paulista: o Serviço Sanitário e o tracoma no princípio do século XX.

In 1906, Emílio Ribas reorganized the Sanitation Service and centralized São Paulo state public health services in the state capital. A campaign to combat trachoma, an ophthalmic disease, was implemented as part of this project. This article analyzes this campaign, which provided care for the sick living on rural properties in a process that predated the 1917 Rural Sanitary Code. The empirical data was obtained from government reports, decrees, medical journals and newspapers. We conclude that Ribas, by creating an organization that integrated the efforts of the sanitary districts and the Trachoma Commission medical teams, sought to form a complex apparatus to combat the diseases present in both urban areas and the countryside.

Em 1906, Emílio Ribas reorganizou o Serviço Sanitário e centralizou na capital os serviços de saúde pública do estado de São Paulo. Nesse projeto, a campanha de combate ao tracoma, uma enfermidade oftálmica, foi implantada. Este artigo analisa essa campanha que atendeu os enfermos das propriedades rurais em um processo que antecedeu ao Código Sanitário Rural de 1917. O material empírico foi composto por relatórios governamentais, decretos, periódicos médicos e jornais. Concluímos que Ribas, ao criar uma estrutura que unificou os esforços dos distritos sanitários com as equipes de atendimento das Comissões do Tracoma, buscou formar um complexo aparato para combater as enfermidades presentes tanto nas áreas urbanas quanto na zona rural.

A profilaxia e o tratamento das enfermidades do oeste paulista: o Serviço Sanitário e o tracoma no princípio do século XX / Prophylaxis and treatment of diseases in western São Paulo state: the Sanitation Service and trachoma in the early twentieth century

Resumo Em 1906, Emílio Ribas reorganizou o Serviço Sanitário e centralizou na capital os serviços de saúde pública do estado de São Paulo. Nesse projeto, a campanha de combate ao tracoma, uma enfermidade oftálmica, foi implantada. Este artigo analisa essa campanha que atendeu os enfermos das propriedades rurais em um processo que antecedeu ao Código Sanitário Rural de 1917. O material empírico foi composto por relatórios governamentais, decretos, periódicos médicos e jornais. Concluímos que Ribas, ao criar uma estrutura que unificou os esforços dos distritos sanitários com as equipes de atendimento das Comissões do Tracoma, buscou formar um complexo aparato para combater as enfermidades presentes tanto nas áreas urbanas quanto na zona rural.

Abstract In 1906, Emílio Ribas reorganized the Sanitation Service and centralized São Paulo state public health services in the state capital. A campaign to combat trachoma, an ophthalmic disease, was implemented as part of this project. This article analyzes this campaign, which provided care for the sick living on rural properties in a process that predated the 1917 Rural Sanitary Code. The empirical data was obtained from government reports, decrees, medical journals and newspapers. We conclude that Ribas, by creating an organization that integrated the efforts of the sanitary districts and the Trachoma Commission medical teams, sought to form a complex apparatus to combat the diseases present in both urban areas and the countryside.

Poor WASH (Water, Sanitation, and Hygiene) Conditions Are Associated with Leprosy in North Gondar, Ethiopia.

Access to safe water, sanitation, and hygiene (WASH) is critical for preventing the spread of neglected tropical diseases (NTDs) including leprosy. WASH-related transmission factors remain largely unexplored in the leprosy transmission cycle. The aim of this project is to better understand WASH exposures among leprosy cases through a case-control study in North Gondar, Ethiopia. We hypothesized that leprosy cases were more likely to have inadequate WASH access and were more likely to have concurrent schistosomiasis, as schistosomiasis immune consequences may facilitate leprosy infection. Forty leprosy cases (forty-one controls) were enrolled, tested for Schistosomamansoni, administered a demographic and WASH survey, and assigned a WASH index score. WASH factors significantly associated with leprosy on adjusted analyses included open defecation (aOR = 19.9, 95% CI 2.2, 176.3) and lack of access to soap (aOR = 7.3, 95% CI 1.1, 49.9). S. mansoni was detected in 26% of participants and in stratified analysis those with leprosy had a 3.6 (95% CI (0.8, 15.9)) greater odds of schistosomiasis in districts bordering the lake, compared to 0.33 lower odds of schistosomiasis in districts not bordering the lake (95% CI (0.09, 1.2)). Overall, results suggest that leprosy transmission may be related to WASH adequacy and access as well as to schistosomiasis co-infection.

Assessing epidemiology of leprosy and socio-economic distribution of cases.

Leprosy still represents a serious health problem in a number of countries, including Brazil. Although leprosy has been associated with poverty for a long time, it is still difficult to accurately define this relationship. Here, we evaluated in an endemic municipality the progress from 1995 to 2015 of epidemiological indicators to establish if there were any strong associations between social indicators and the occurrence of leprosy. An ecological study was conducted using the SINAN database (Brazilian leprosy-national notifiable diseases information system) in combination with georeferencing of leprosy cases. The georeferencing used the ArcGis programme and occurrence of cases was evaluated in relation to the Health Vulnerability Index (HVI), an indicator that categorises socio-economic and sanitation factors. The data identified a marked decrease in the overall prevalence of leprosy, a reduction in the new case-detection rate and a reduction in the number of cases with grade 2 disabilities (albeit with transient peaks in 2007 and 2015). Logistic regression analysis showed association of detection rates with elevated HVI. Thus, while the epidemiological indicators point to the elimination of leprosy, there is evidence of hidden cases and an association between higher rates of leprosy detection and greater social vulnerability remain.

[The sertão remediated: the clash between the elite of Goiás and sanitation thinking, 1910-1920]. / O sertão remediado: o embate entre a elite goiana e o pensamento sanitarista, 1910-1920.

In the early decades of the twentieth century, when health started becoming an issue on the political agenda, Arthur Neiva and Belisário Penna travelled to the sertão semi-arid region of Goiás state, Brazil, to diagnose the population's state of health, particularly highlighting the spread of Chagas disease and the decadence of the sertão. The political elite in the state reacted to the sanitarians' findings. This article observes the controversy played out in the pages of A Informação Goiana magazine. The publication supported the region's interests, because its leaders were sure that it was down to the people of Goiás to reveal the truth about the sertão, its people, and its potentialities.

Leprosy incidence, characterization of cases and correlation with household and cases variables of the Brazilian states in 2010.

BACKGROUND: Leprosy is millenary disease and still persists in several countries. OBJECTIVES: To estimate the incidence of leprosy in the Brazilian states and for the country in the year 2010; to describe the cases reported according to the studied variables; to verify the correlation between the overall incidence and the studied variables. METHODS: Ecological descriptive study, with population data from the 27 states, 2010. Information about reported cases were collected: gender, race, percentage of patients younger than 15 years old and living conditions. The analysis was performed using percentages, means, incidence rates and the Spearman correlation test. RESULTS: The states of Mato Grosso and Tocantins recorded the highest incidence rates; Rio Grande do Sul and Santa Catarina, the lowest; there was a higher incidence of leprosy among men; the incidence of leprosy increases proportionally with the nonwhites among the inhabitants; patients younger than 15 years; the average number of residents per household; and a decrease in coverage of water supply and presence of bathrooms. CONCLUSION: The incidence of leprosy is related to factors as gender, race and house conditions (p<0,05 for all).

Leprosy incidence, characterization of cases and correlation with household and cases variables of the Brazilian states in 2010

Abstract BACKGROUND: Leprosy is millenary disease and still persists in several countries. OBJECTIVES: To estimate the incidence of leprosy in the Brazilian states and for the country in the year 2010; to describe the cases reported according to the studied variables; to verify the correlation between the overall incidence and the studied variables. METHODS: Ecological descriptive study, with population data from the 27 states, 2010. Information about reported cases were collected: gender, race, percentage of patients younger than 15 years old and living conditions. The analysis was performed using percentages, means, incidence rates and the Spearman correlation test. RESULTS: The states of Mato Grosso and Tocantins recorded the highest incidence rates; Rio Grande do Sul and Santa Catarina, the lowest; there was a higher incidence of leprosy among men; the incidence of leprosy increases proportionally with the nonwhites among the inhabitants; patients younger than 15 years; the average number of residents per household; and a decrease in coverage of water supply and presence of bathrooms. CONCLUSION: The incidence of leprosy is related to factors as gender, race and house conditions (p<0,05 for all).

[City-laboratory: Campinas and yellow fever at the dawn of the Republican era]. / Cidade-laboratório: Campinas e a febre amarela na aurora republicana.

In the late nineteenth century, there were yellow fever epidemics in Campinas. Considered a seaside disease, the fever startled lay people and physicians. The scientific debate about the etiology of the disease left the domain of magazines and medical correspondence to orient political and sanitary actions. In order to combat the disease, the city began to resemble a laboratory and experienced its "era of sanitation and demolition," with victories over the ailment and inconvenience to the public. The State Sanitary Commission led by Emilio Ribas, aware of Finlay's Culicidae theory, rehearsed in Campinas what would happen with Oswaldo Cruz and Pereira Passos in Rio de Janeiro. The novelty of combating mosquitoes coexisted with age-old practices dear to miasmatic theory, such as disinfection.

Cidade-laboratório: Campinas e a febre amarela na aurora republicana / City-laboratory: Campinas and yellow fever at the dawn of the Republican era

No final do século XIX ocorreram epidemias de febre amarela em Campinas. Considerada doença litorânea, a febre assustou leigos e médicos. O debate científico sobre a etiologia da doença deixou revistas e correspondências médicas para orientar ações políticas e sanitárias. Visando combater a enfermidade, a cidade ganhou contornos de laboratório e vivenciou sua "era do saneamento e das demolições", com vitórias sobre o achaque e transtornos à população. A Comissão Sanitária Estadual comandada por Emílio Ribas, ciente da teoria culicidiana de Finlay, ensaiou em Campinas o que ocorreria no Rio de Janeiro de Oswaldo Cruz e Pereira Passos. A novidade do combate aos mosquitos conviveu com antigas práticas caras à teoria miasmática, como as desinfecções.

In the late nineteenth century, there were yellow fever epidemics in Campinas. Considered a seaside disease, the fever startled lay people and physicians. The scientific debate about the etiology of the disease left the domain of magazines and medical correspondence to orient political and sanitary actions. In order to combat the disease, the city began to resemble a laboratory and experienced its "era of sanitation and demolition," with victories over the ailment and inconvenience to the public. The State Sanitary Commission led by Emilio Ribas, aware of Finlay's Culicidae theory, rehearsed in Campinas what would happen with Oswaldo Cruz and Pereira Passos in Rio de Janeiro. The novelty of combating mosquitoes coexisted with age-old practices dear to miasmatic theory, such as disinfection.

Cidade-laboratório: Campinas e a febre amarela na aurora republicana / City-laboratory: Campinas and yellow fever at the dawn of the Republican era

No final do século XIX ocorreram epidemias de febre amarela em Campinas. Considerada doença litorânea, a febre assustou leigos e médicos. O debate científico sobre a etiologia da doença deixou revistas e correspondências médicas para orientar ações políticas e sanitárias. Visando combater a enfermidade, a cidade ganhou contornos de laboratório e vivenciou sua “era do saneamento e das demolições”, com vitórias sobre o achaque e transtornos à população. A Comissão Sanitária Estadual comandada por Emílio Ribas, ciente da teoria culicidiana de Finlay, ensaiou em Campinas o que ocorreria no Rio de Janeiro de Oswaldo Cruz e Pereira Passos. A novidade do combate aos mosquitos conviveu com antigas práticas caras à teoria miasmática, como as desinfecções. (AU)

Leprosy in Brazil and its association with characteristics of municipalities: ecological study, 2009-2011.

OBJECTIVE: To analyse the ecological association between the demographic and socio-economic characteristics of the Brazilian municipalities and average leprosy incidence rate in the period 2009-2011. METHODS: An ecological study taking the Brazilian municipalities as its units of analysis. The local empirical Bayes estimation method was used to obtain smoothed incidence rates (SIR) for leprosy. The mean, median, first quartile (Q1) and third quartile (Q3) of the SIR were calculated per 100 000 inhabitants. Hierarchical log-linear negative binomial regression models were used to estimate the incidence rate ratios (IRR). RESULTS: In the period 2009-2011, the average SIR of leprosy in Brazil was 20.2 per 100 000 inhabitants, and the median incidence rate among municipalities was 9.1 per 100 000 inhabitants. Significantly higher adjusted IRR were identified for large municipalities (IRR = 1.67) compared to small municipalities, as well as in municipalities with higher illiteracy rates (IRR = 2.15), more urbanised municipalities (IRR = 1.53), those with greater social inequality as per the Gini index (IRR = 1.26), high percentage of households with inadequate sanitation (IRR = 1.63), higher average number of people per room (IRR = 1.41), high proportions of Family Health Programme coverage (IRR = 1.29), high percentage of household contacts investigated (IRR = 2.30) and those with percentage of cases with grade 2 disability considered to be the medium (IRR = 1.26). CONCLUSIONS: In this study, SIR was significantly associated with municipalities with low socio-economic status. Disease control activities need to be focused on these municipalities, and investments need to be made in improving the population's living conditions.

Emílio Ribas e os desafios para sanear São Paulo / Emilio Ribas and the challenges to sanitate São Paulo

Este artigo objetiva contribuir para uma reavaliação do processo de inserção da microbiologia nas políticas públicas do final do século XIX e início do século XX e destacar a posição ocupada pela higiene e pela Saúde Pública no universo sociopolítico de São Paulo repúblicano do início do século. Há uma preocupação em rever este momento da História do Brasil, mediante um estudo sobre projetos e concepções médicas daquele período. Para isto, optou-se pelo estudo do percurso profissional trilhado por Emílio Ribas enquanto uma trajetória constitutiva da própria história de São Paulo. Ou seja, parte-se da concepção de que o resultado das pesquisas sobre Emílio Ribas ora apresentado é também um estudo sobre a história mesma de São Paulo. Lá as elites intelectuais e as autoridades públicas buscavam construir uma imagem de modernidade pautada, entre outras realizações, na constituição de uma ampla rede laboratorial com vistas a concorrer e, até mesmo, superar a antiga Capital Federal naquilo que tinha a simbolizar o novo regime político - a República - e uma nova fase da vida nacional - a pátria paulista.

Emílio Ribas e os desafios para sanear São Paulo / Emilio Ribas and the challenges to sanitate São Paulo

Este artigo objetiva contribuir para uma reavaliação do processo de inserção da microbiologia nas políticas públicas do final do século XIX e início do século XX e destacar a posição ocupada pela higiene e pela Saúde Pública no universo sociopolítico de São Paulo repúblicano do início do século. Há uma preocupação em rever este momento da História do Brasil, mediante um estudo sobre projetos e concepções médicas daquele período. Para isto, optou-se pelo estudo do percurso profissional trilhado por Emílio Ribas enquanto uma trajetória constitutiva da própria história de São Paulo. Ou seja, parte-se da concepção de que o resultado das pesquisas sobre Emílio Ribas ora apresentado é também um estudo sobre a história mesma de São Paulo. Lá as elites intelectuais e as autoridades públicas buscavam construir uma imagem de modernidade pautada, entre outras realizações, na constituição de uma ampla rede laboratorial com vistas a concorrer e, até mesmo, superar a antiga Capital Federal naquilo que tinha a simbolizar o novo regime político - a República - e uma nova fase da vida nacional - a pátria paulista. (AU)

O Plano de Saneamento da Amazônia (1940-1942) / The Amazon Sanitation Plan (1940-1942)

Aborda o Plano de Saneamento da Amazônia e o contexto político de sua formulação, entre 1940 e 1941, o papel de Getúlio Vargas, a atuação de seus principais protagonistas como Evandro Chagas, João de Barros Barreto e Valério Konder, as suas principais propostas e o seu ocaso a partir de 1942, por conta da criação do Serviço Especial de Saúde Pública (SESP), fruto dos acordos de cooperação entre Brasil e Estados Unidos, com o envolvimento de ambos na Segunda Guerra Mundial. Inclui a reprodução do Plano publicado em dezembro de 1941 nos Arquivos de Higiene.

O Plano de Saneamento da Amazônia (1940-1942) / The Amazon Sanitation Plan (1940-1942)

Aborda o Plano de Saneamento da Amazônia e o contexto político de sua formulação, entre 1940 e 1941, o papel de Getúlio Vargas, a atuação de seus principais protagonistas como Evandro Chagas, João de Barros Barreto e Valério Konder, as suas principais propostas e o seu ocaso a partir de 1942, por conta da criação do Serviço Especial de Saúde Pública (SESP), fruto dos acordos de cooperação entre Brasil e Estados Unidos, com o envolvimento de ambos na Segunda Guerra Mundial. Inclui a reprodução do Plano publicado em dezembro de 1941 nos Arquivos de Higiene.(AU)

[The Amazon Sanitation Plan (1940-1942)]. / O Plano de Saneamento da Amazônia (1940-1942).

The article addresses the Amazon Sanitation Plan and the political context in which it was formulated between 1940 and 1941. It examines the role of Getúlio Vargas, the activities of the plan's main protagonists (such as Evandro Chagas, João de Barros Barreto, and Valério Konder), its key proposals, and its demise as of 1942 upon creation of the Special Public Health Service (Sesp), which grew out of cooperation agreements between Brazil and the US following both nations' involvement in World War II. A reproduction of the Plan as published in the Arquivos de Higiene in 1941 is included.

Inequality and leprosy in Northeast Brazil: an ecological study.

BACKGROUND: Leprosy is an important public health problem in many developing countries and many features of its determinants are still obscure. METHODS: To investigate whether the incidence of leprosy is related to certain environmental and socioeconomic determinants, an ecological study was undertaken in 165 municipalities of the state of Ceará, Brazil. Social, economic, education, sanitation, demography, meteorology, and health data were collected. The dependent variable was the average incidence rate of leprosy from 1991 to 1999. Simple and multiple linear regressions were performed to assess the relationship between the dependent and the independent variables. RESULTS: The average incidence rate for all the municipalities for the 1991-1999 period, varied from 0.06 to 14.68 per 10000 persons per year. The level of inequality (beta = 1.67, P = 0.011), the mean years of study among the population >or=25 years old (beta = 1.35, P < 0.001), the population growth from 1991 to 1996 (beta = 0.02, P = 0.007), the percentage of children 7-14 years old that did not go to the school (beta = 0.02, P = 0.028), and the presence of a railroad in the municipality (beta = 0.45, P = 0.038) were found to be predictors of the incidence rate of leprosy in Ceará. CONCLUSION: Our findings fit the assumption that, in Ceará, leprosy is associated with a high level of poverty and uncontrolled urbanization. We put forward the hypothesis that urbanization increases not only social inequality eventually leading to strong polarization, but also excludes people from social and material opportunities. Apparently, such deprivations render them susceptible for leprosy.

As comissões científicas da Inspetoria de Obras contra as secas na gestäo de Miguel Arrojado Ribeiro Lisboa (1909-1912) / The scientifical commissions of the Inspetoria de Obras contra as Secas during the administration of Miguel Arrojado Ribeiro Lisboa (1909-1912)

Analisa o caráter científico das expedições governamentais montadas entre os anos de 1909 e 1912 para estudar as consequências dos efeitos da seca na regiäo nordeste do Brasil. Tem por objetivo enfocar a produçäo científica da Inspetoria de Obras Contra as Secas tendo como base alguns dos relatórios publicados na gestäo de arrojado Lisboa, além dos relatórios das expedições de Arthur Neiva e Belisário Penna e de Adolfo Lutz e Astrogildo Machado, resultado de uma parceria entre a IOCS e o Instituto Oswaldo Cruz.(AU)

As comissões científicas da Inspetoria de Obras contra as secas na gestão de Miguel Arrojado Ribeiro Lisboa (1909-1912) / The scientifical commissions of the Inspetoria de Obras contra as Secas during the administration of Miguel Arrojado Ribeiro Lisboa (1909-1912)

Analisa o caráter científico das expedições governamentais montadas entre os anos de 1909 e 1912 para estudar as consequências dos efeitos da seca na região nordeste do Brasil. Tem por objetivo enfocar a produção científica da Inspetoria de Obras Contra as Secas tendo como base alguns dos relatórios publicados na gestão de arrojado Lisboa, além dos relatórios das expedições de Arthur Neiva e Belisário Penna e de Adolfo Lutz e Astrogildo Machado, resultado de uma parceria entre a IOCS e o Instituto Oswaldo Cruz.