Accuracy of saliva for SARS-CoV-2 detection in outpatients and their household contacts during the circulation of the Omicron variant of concern.

BACKGROUND: While nasopharyngeal (NP) swabs are considered the gold standard for severe acute respiratory coronavirus 2 (SARS-CoV-2) real-time reverse transcriptase-polymerase chain reaction (RT-PCR) detection, several studies have shown that saliva is an alternative specimen for COVID-19 diagnosis and screening. METHODS: To analyze the utility of saliva for the diagnosis of COVID-19 during the circulation of the Omicron variant, participants were enrolled in an ongoing cohort designed to assess the natural history of SARS-CoV-2 infection in adults and children. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen's kappa coefficient were calculated to assess diagnostic performance. RESULTS: Overall, 818 samples were collected from 365 outpatients from January 3 to February 2, 2022. The median age was 32.8 years (range: 3-94 years). RT-PCR for SARS-CoV-2 was confirmed in 97/121 symptomatic patients (80.2%) and 62/244 (25.4%) asymptomatic patients. Substantial agreement between saliva and combined nasopharyngeal/oropharyngeal samples was observed with a Cohen's kappa value of 0.74 [95% confidence interval (CI): 0.67-0.81]. Sensitivity was 77% (95% CI: 70.9-82.2), specificity 95% (95% CI: 91.9-97), PPV 89.8% (95% CI: 83.1-94.4), NPV 87.9% (95% CI: 83.6-91.5), and accuracy 88.5% (95% CI: 85.0-91.4). Sensitivity was higher among samples collected from symptomatic children aged three years and older and adolescents [84% (95% CI: 70.5-92)] with a Cohen's kappa value of 0.63 (95% CI: 0.35-0.91). CONCLUSIONS: Saliva is a reliable fluid for detecting SARS-CoV-2, especially in symptomatic children and adolescents during the circulation of the Omicron variant.

The impact of the Brazilian Family Health Strategy and the conditional cash transfer on tuberculosis treatment outcomes in Rio de Janeiro: an individual-level analysis of secondary data.

Background: Unsuccessful tuberculosis outcomes are frequent; bold policies are needed to end the tuberculosis (TB) epidemic to attain the third Sustainable Development Goal (SDG) by 2030. We examined the effect of the Family Health Strategy (FHS) and its interactions with the conditional cash transfer programme (CTP) on TB outcomes in Rio de Janeiro, Brazil. Methods: We performed individual-based analyses of a database resulting from deterministic and probabilistic linkages of the TB information system, FHS registries and CTP payrolls. Patients ≥15 years old treated with the standard RHZE regimen were included. The rates of successful outcomes were analysed according to coverage by FHS. Effects from the CTP and its interactions with the FHS were examined among the poorest. Results: FHS coverage increased the likelihood for successful outcomes by 14% (12-17%) among 13 482 new cases, and by 35% (25-47%) among 1880 retreatment cases. The CTP had an independent effect but no interaction with the FHS among the poorest. Conclusions: This is the first individual-based study to show a relevant protection of poor urban communities regarding patient-important health outcomes by the Brazilian FHS and CTP. These findings support strategies of universal health coverage, primary care strengthening and social protection to achieve a major SDG.

Mapping Soil Organic Carbon and Organic Matter Fractions by Geographically Weighted Regression.

The soil organic matter (SOM) content and dynamic are related to vegetation cover, climate, relief, and geology; these factors have strong variation in space in the southeastern of Brazil. The objective of the study was to compare and evaluate performance of classical multiple linear regressions (MLR) and geographically weighted regression (GWR) models to predict soil organic carbon (SOC) and chemical fractions of organic matter in the Brazilian southeastern mountainous region. The regression models were fitted based on SOC and chemical fractions of SOM. The points ( = 89) were selected by pedologist's experience along transects and toposequences. The covariates were also selected using the empirical knowledge of pedologists when choosing variables that drive soil carbon content and its dynamics. Geology map, legacy soils map, terrain attributes derived from digital elevation model, and remote sensing indices derived from RapidEye sensor bands were used as covariates. In all MLR models (except for fulvic acid fraction [FAF]), the legacy soil map was selected as a covariate by the stepwise approach. The geology map was not selected as important covariate to predict FAF and humin (HUM). At least one variable derived from remote sensing was selected by the adjusted models. For the prediction of the SOC, HUM, and FAF, the GWR models had the highest performance. The MLR models extrapolated the results, especially for SOC. The relationships among SOC, SOM fractions, and environmental covariates were affected by local landscape variability, and the GWR model was better at modeling.

Social inequalities in the temporal trend of mortality from sickle cell disease in Brazil, 1996-2019.

Contrary to international trends, the mortality rate of sickle cell disease increased in Brazil after the implementation of the neonatal screening program, probably due to improving access to diagnosis. This study aimed to assess differences in the temporal trend of the mortality rate and median age at death from sickle cell disease in Brazil, considering implemented measures to expand diagnosis, and improve health care access in-country and in the international scenario. Time series were extracted from the Brazilian Mortality Information System from 1996 to 2019. Changes in the mortality rate and median age at death were verified via segmented regression models, which were stratified by sex, region of residence, and age. Most deaths occurred in non-white people, young adults, and the Southeast and Northeast population. Sickle cell disease mortality rate increased until 2010 (13.31%; 95%CI: 6.37; 20.70), particularly in individuals aged 30 years or more (12.78%; 95%CI: 2.98; 23.53) and in the Northeast (12.27%; 95%CI: 8.92; 15.72). Most deaths occurred in the second decade of life (3.01 deaths/million), with a 59% increase in the median age of death in Brazil, from 27.6 to 30.3 years, more pronounced in females and the North Region. The observed gain in the survival of sickle cell disease in Brazil is still much lower than in developed countries and presents regional disparities, probably due to the lack of access to health care and recent treatments, such as hydroxyurea, still restricted to hematological referral centers in Brazilian capitals.

Records and altitudinal assessment of Amblyomma aureolatum and Amblyomma ovale (Acari: Ixodidae) in the State of Rio de Janeiro, southeast Brazil.

Information on the altitudinal distribution of the hard ticks Amblyomma aureolatum and Amblyomma ovale in Brazil is scarce and mainly limited to occasional records. In this study we report our evaluation of records on the altitudinal distribution of A. aureolatum and A. ovale collected from dogs and humans and directly from the environment (host-questing ticks), based on active or passive procedures. The collections were conducted in rural areas of municipalities in the state of Rio de Janeiro, Brazil between 2013 and 2017. Active procedures consisted of dragging or flagging, visual examination of vegetation and removal of ticks present on the authors' clothing or on infested dogs. Overall, 222 ticks were collected. The altitudes at the collection sites ranged from 98 to 1220 m a.s.l. We noted a significant difference in the altitudinal distribution of A. aureolatum and A. ovale (Mann-Whitney U-test, U = 518.5, P < 0.001). The overlap of these two species occurred at altitudes of between 650 and 900 m a.s.l. The results indicated that the higher the altitude, the greater the probability for the occurrence of A. aureolatum and, conversely, the lower the likelihood for the occurrence of A. ovale. The findings of this study improve currrent knowledge on the bioecology of these tick species and have implications for studies on the epidemiology of spotted fever in Brazil.

Spatial Distribution of Canine Sporotrichosis in Rio de Janeiro, Brazil (1998-2018) and Its Correlation with Socioeconomic Conditions.

Canine sporotrichosis is a poorly described global disease and a spatial approach has not yet been used to assess the disease in dogs. Therefore, this study aimed to describe the occurrence of canine sporotrichosis in the state of Rio de Janeiro, Brazil, from 1998 to 2018 and its correlation with socioeconomic characteristics using exploratory spatial data analysis. A total of 295 cases of canine sporotrichosis were identified and 249 were georeferenced. There was a higher concentration of cases in the municipality of Rio de Janeiro, as well as along the border of the city and the adjacent municipalities in the great metropolitan area. The cases occurred in areas where most of the dwellings are houses. Moreover, no focus of disease density was found in the southern part of Rio de Janeiro city over the period studied, possibly due to better socioeconomic conditions. Areas with a high concentration of canine sporotrichosis cases coincided with regions that possessed a low proportion of households without paving, suggesting that the disease is not necessarily linked to extreme poverty. The mapping of areas with a greater density of cases is fundamental to formulate targeted and strategic plans in order to implement effective public health prevention and control measures.

Salmonella spp. in Aquaculture: An Exploratory Analysis (Integrative Review) of Microbiological Diagnoses between 2000 and 2020.

The present study aimed to characterize, through descriptive statistics, data from scientific articles selected in a systematic integrative review that performed a microbiological diagnosis of Salmonella spp. in aquaculture. Data were obtained from research articles published in the BVS, Scielo, Science Direct, Scopus and Web of Science databases. The selected studies were published between 2000 and 2020 on samples of aquaculture animal production (fish, shrimp, bivalve mollusks, and other crustaceans) and environmental samples of aquaculture activity (farming water, soil, and sediments). After applying the exclusion criteria, 80 articles were selected. Data such as country of origin, categories of fish investigated, methods of microbiological diagnosis of Salmonella spp., sample units analyzed and most reported serovars were mined. A textual analysis of the word cloud and by similarity and descending hierarchical classification with the application of Reinert's algorithm was performed using R® and Iramuteq® software. The results showed that a higher percentage of the selected articles came from Asian countries (38.75%). Fish was the most sampled category, and the units of analysis of the culture water, muscle and intestine were more positive. The culture isolation method is the most widespread, supported by more accurate techniques such as PCR. The most prevalent Salmonella serovars reported were S. Typhimurium, S. Weltevreden and S. Newport. The textual analysis showed a strong association of the terms "Salmonella", "fish" and "water", and the highest hierarchical class grouped 25.4% of the associated text segments, such as "aquaculture", "food" and "public health". The information produced characterizes the occurrence of Salmonella spp. in the aquaculture sector, providing an overview of recent years. Future research focusing on strategies for the control and prevention of Salmonella spp. in fish production are necessary and should be encouraged.

Detection of Chikungunya virus in bodily fluids: The INOVACHIK cohort study.

BACKGROUND: Chikungunya is a widely distributed, re-emerging tropical disease caused by the chikungunya virus (CHIKV). Little is known about the duration for which CHIK RNA are detectable in bodily fluids, especially genital secretions, and current evidence is based on small series or case reports. An understanding of viral dynamics across different body compartments can inform diagnostic testing algorithms and public health prevention interventions. METHODOLOGY: A prospective cohort study was conducted to assess the presence and duration of detectable levels of CHIKV RNA in blood, urine, saliva, semen, and vaginal secretions. Men and women (≥ 18 years) with a positive reverse transcriptase-polymerase chain reaction (RT-PCR) test for CHIKV in the acute phase (1-14 days) of the disease were included. After enrollment, clinical data and samples were collected every 15 days over the first 2 months, and a final collection was performed 3 months after recruitment. The Kaplan-Meier interval-censoring method and the parametric Weibull model were fitted to estimate the median time of viral persistence until the lack of CHIKV RNA detection among all body fluids. Punctual estimates of the median time of CHIKV RNA persistence for each fluid were estimated using a 95% confidence interval (CI). RESULTS: From April to December 2019, 170 participants were screened. Of these, 152 (100 women) were enrolled in the study. The median and interquartile range (IQR) ages for men and women were 39.3 (IQR: 26.9, 50.7) and 43.5 (IQR: 33.8, 53.6) years, respectively. CHIKV RNA was detected in 80.3% (122/152) of serum samples, 23.0% (35/152) of urine samples, 30.3% (46/152) of saliva samples, 14.3% (6/42) of semen samples, and 20.2% (20/99) of vaginal secretion samples. The median time until the loss of CHIKV RNA detection was 19.6 days (95% CI, 17.5-21.7) in serum, 25.3 days (95% CI, 17.8-32.8) in urine, 23.1 days (95% CI, 17.9-28.4) in saliva, and 25.8 days (95% CI, 20.6-31.1) in vaginal secretion. The number of semen samples available was too small to make statistical estimates, but a last positive sample was obtained from a participant 56 days after the onset of symptoms. CONCLUSIONS: CHIKV RNA could be detected in all bodily fluids studied, including genital secretions during the acute and convalescent phases and additional studies on viral infectivity in semen and vaginal secretions are warranted.

A cross-sectional study of Leishmania spp. in draft horses from the Distrito Federal, Brazil: Seroprevalence, spatial distribution, and associated factors.

Equine leishmaniasis is a neglected tropical disease caused by the protozoan of the Leishmania genus, and it has been reported in several countries around the world, especially Brazil. Therefore, the present investigation aims to conduct a cross-sectional study to determine the prevalence, spatial distribution, and associated factors with seropositivity for Leishmania spp. in draft horses from the Distrito Federal, Brazil. The serological survey was conducted on 411 animals, employing the Indirect Immunofluorescence Test (IFA) and Enzyme-Linked Immunosorbent Assay (ELISA). The Kappa (κ) and gross agreement indexes evaluated the Leishmania spp. seropositivity by IFA and ELISA test. The statistical analysis was performed using the Chi-square test and logistic regression. The spatial analysis showed the areas with the highest number of seropositive and the Moran autocorrelation analyses between the spatial distribution and the epidemiological model's explanatory variables. A 27.01 % co-positivity was observed with a κ index of 52.64 %. The final model considered the variables: access to water bodies (p-value = 0.008, Odds Ratio (OR) = 2.26, Confidence Interval (CI) = 1.24-4.13), the absence of the use of ectoparasiticide (p-value = 0.008, OR = 1.93 CI = 1.18-3.15) and traveling animal (p-value = 0.059, OR = 1.54, CI = 0.98-2.41). The Kernel map showed hot areas with a high concentration of nine positive animals per area and some lighter areas ranging from five to seven positive animals per area where control measures should be performed. The Moran autocorrelation analysis was significant for the variables: traveling animal (Moran's I = 0.540 and pseudo-p-value = 0.001) and the absence of use ectoparasiticide (Moran's I = 0.259 and pseudo-p-value = 0.005). The current study exposes a high seroprevalence of Leishmania spp. in horses in the Distrito Federal, Brazil. Moreover, it proposes that traveling animal, the access to water bodies and the absence of the use of ectoparasiticide are significantly associated with seropositivity for Leishmania spp. in draft horses, which may contribute to the implementation of prophylactic and controls measures where leishmaniasis is already stalled.

Geographical information system and spatial-temporal statistics for monitoring infectious agents in hospital: a model using Klebsiella pneumoniae complex.

BACKGROUND: The emergence and spread of antimicrobial resistance and infectious agents have challenged hospitals in recent decades. Our aim was to investigate the circulation of target infectious agents using Geographic Information System (GIS) and spatial-temporal statistics to improve surveillance and control of healthcare-associated infection and of antimicrobial resistance (AMR), using Klebsiella pneumoniae complex as a model. METHODS: A retrospective study carried out in a 450-bed federal, tertiary hospital, located in Rio de Janeiro. All isolates of K. pneumoniae complex from clinical and surveillance cultures of hospitalized patients between 2014 and 2016, identified by the use of Vitek-2 system (BioMérieux), were extracted from the hospital's microbiology laboratory database. A basic scaled map of the hospital's physical structure was created in AutoCAD and converted to QGis software (version 2.18). Thereafter, bacteria according to resistance profiles and patients with carbapenem-resistant K. pneumoniae (CRKp) complex were georeferenced by intensive and nonintensive care wards. Space-time permutation probability scan tests were used for cluster signals detection. RESULTS: Of the total 759 studied isolates, a significant increase in the resistance profile of K. pneumoniae complex was detected during the studied years. We also identified two space-time clusters affecting adult and paediatric patients harbouring CRKp complex on different floors, unnoticed by regular antimicrobial resistance surveillance. CONCLUSIONS: In-hospital GIS with space-time statistical analysis can be applied in hospitals. This spatial methodology has the potential to expand and facilitate early detection of hospital outbreaks and may become a new tool in combating AMR or hospital-acquired infection.

Investigation of SARS-CoV-2 infection in dogs and cats of humans diagnosed with COVID-19 in Rio de Janeiro, Brazil.

BACKGROUND: Infection by SARS-CoV-2 in domestic animals has been related to close contact with humans diagnosed with COVID-19. Objectives: To assess the exposure, infection, and persistence by SARS-CoV-2 of dogs and cats living in the same households of humans that tested positive for SARS-CoV-2, and to investigate clinical and laboratory alterations associated with animal infection. METHODS: Animals living with COVID-19 patients were longitudinally followed and had nasopharyngeal/oropharyngeal and rectal swabs collected and tested for SARS-CoV-2. Additionally, blood samples were collected for laboratory analysis, and plaque reduction neutralization test (PRNT90) to investigate specific SARS-CoV-2 antibodies. RESULTS: Between May and October 2020, 39 pets (29 dogs and 10 cats) of 21 patients were investigated. Nine dogs (31%) and four cats (40%) from 10 (47.6%) households were infected with or seropositive for SARS-CoV-2. Animals tested positive from 11 to 51 days after the human index COVID-19 case onset of symptoms. Three dogs tested positive twice within 14, 30, and 31 days apart. SARS-CoV-2 neutralizing antibodies were detected in one dog (3.4%) and two cats (20%). In this study, six out of thirteen animals either infected with or seropositive for SARS-CoV-2 have developed mild but reversible signs of the disease. Using logistic regression analysis, neutering, and sharing bed with the ill owner were associated with pet infection. CONCLUSIONS: The presence and persistence of SARS-CoV-2 infection have been identified in dogs and cats from households with human COVID-19 cases in Rio de Janeiro, Brazil. People with COVID-19 should avoid close contact with their pets during the time of their illness.

Geoprocessing and spatial analysis for identifying leptospirosis risk areas: a systematic review.

Leptospirosis is a reemerging zoonosis caused by bacteria of the genus Leptospira sp. with global importance in the medical and veterinary fields, being responsible for about 59 thousand deaths each year in the world. The use of Geographic Information Systems (GIS) in the health sector is propitious and has been adopted by human and animal health professionals as an important tool in spatial analyses of health. The objective of this study was to conduct a systematic review on the geoprocessing and spatial analysis techniques adopted for mapping risk areas of human and animal leptospirosis. The articles were collected on scientific platforms by entering the following terms: SIG/GIS, leptospirose/leptospirosis, area de risco/risk area and distribuicao espacial/spatial distribution, and included in the study if they met the following criteria: a) publication in the period from 1998 to 2017; b) identification of risk areas and/or spatial distribution of leptospirosis as one of the research topics; and c) application of GIS in the methodology. As a result, we found 40 articles, published by 15 different countries, which adopted GIS for the spatial analysis and identification of risk areas of leptospirosis. Among these, only 45% (18) conducted an spatial statistical analysis. Brazil and USA had the highest numbers of publications, 16 and 7 articles, respectively. From 2007, the use of GIS and spatial analysis techniques, applied to the theme of this study, have been intensified and diversified, and 93% of the articles elected for this review were published from 2007 to 2017. The results point to a progressive interest of health professionals in applying these techniques for monitoring and conducting epidemiological analyses of leptospirosis, besides indicating a greater need for intersectoral integration between health professionals and others, in the use of spatial analysis and GIS techniques.

Triatomine dispersion rates and their association with socioeconomic and environmental conditions in Northeastern Brazil, from 2009 to 2013.

Triatomines are vectors of Trypanosoma cruzi , the etiological agent of Chagas disease, which affects between 6 and 12 million people in Latin America, with an incidence rate of 12 thousand cases per year. In the Ceara State, the predominance of the caatinga biome, coupled with a large rural area with precarious human habitations, provides several s shelters for these insects. In this study, we determined the spatiotemporal distribution of triatomine dispersion rates in the Cariri region, Southern Ceara and ascertained the possible association between these rates with socioeconomic and environmental factors. Dispersion rates (number of positive localities/number of searched localities × 100) were analyzed regarding 13 municipalities from the Ceara State, from 2009 to 2013. Socioeconomic and environmental variables collected from national research institutes were associated with the dispersion rates and their local empirical Bayesian estimates. All the municipalities recorded dispersion rates over 10% in all years, and 11 municipalities had average rates over 40% for the period of study. Significant differences were observed among the municipality means. The highest rates were observed in Antonina do Norte and Potengi. According to the correlation analysis, the proportion between the occupied population and the total population showed a significant negative correlation, as well as the percentage of the population who lives under adequate sanitary conditions. Both, the percentage of revenues from external sources and the percentage of urban households in reforested blocks had a significant positive correlation. Our results show that socioeconomic and environmental variables can be factors that contribute to both, the maintenance and the reduction of the elevated dispersion rates observed in the study area. Similar researches that encompass more municipalities from that region may reinforce Chagas disease surveillance and control in the Northeast of Brazil.

Detection and modelling of case clusters for urban leptospirosis.

OBJECTIVE: To analyse the epidemiological profile of 488 cases of leptospirosis in Rio de Janeiro, Brazil between 1997 and 2002, using a variety of methods of spatial epidemiology, to establish alert guidelines in general hospitals, which might be a tool to improve diagnosis and treatment of leptospirosis to reduce lethality rates. METHODS: Scan statistics identified six space-time clusters, which comprised a range of 2 to 28 cases per cluster. Generalized linear mixed models were used to evaluate risk factors for a cluster case which incorporated individual characteristics and spatial information on environmental and climactic factors in a single model frame. RESULTS: Cluster case events were associated with heavy rainfall (OR 3.71; 95% CI 1.83-7.51). The model did not identify socioeconomic or environmental covariates that significantly influence the risk of developing a cluster rather than non-cluster case. CONCLUSION: Clustering of leptospirosis in this urban setting appears to be due to transmission during heavy rainfall.

[Decentralization of the HIV/AIDS epidemic and inter-municipal flow of hospital admissions in the Zona da Mata, Minas Gerais State, Brazil: a spatial analysis]. / A interiorização da epidemia de HIV/AIDS e o fluxo intermunicipal de internação hospitalar na Zona da Mata, Minas Gerais, Brasil: uma análise espacial.

The aim of this article was to analyze the decentralization of the HIV/AIDS epidemic (a shift towards rural areas or away from the coast) and to investigate access to HIV/AIDS services from 1988 to 2002 in the Zona da Mata, Minas Gerais State, Brazil. An ecological study was performed using temporal and spatial approaches. A hospital admissions flow between municipalities developed, and the reference group was AIDS patients over 15 years of age admitted in 1996 and 2004, residing in municipalities in the Zona da Mata. There were 2,469 reported AIDS cases in individuals over 15 during the period. Mean incidence and mortality rates were calculated and recalculated by a local empirical Bayesian method in order to more clearly represent the municipalities with the highest concentration of cases and deaths. Decentralization of the epidemic was observed. Juiz de Fora was the municipality with the most cases and may have acted as a hub for spread of HIV in the region. Hospital care for AIDS cases in the Zona da Mata was concentrated in that municipality. There is a strong need to further investigate why referral hospitals in other municipalities in the region have not participated in providing management and care for HIV/AIDS patients.

Social inequalities in the temporal trend of mortality from sickle cell disease in Brazil, 1996-2019 / Desigualdades sociais na tendência temporal de mortalidade por doença falciforme no Brasil, 1996-2019 / Desigualdades sociales en la tendencia temporal de la mortalidad por enfermedad de células falciformes en Brasil, 1996-2019

Contrary to international trends, the mortality rate of sickle cell disease increased in Brazil after the implementation of the neonatal screening program, probably due to improving access to diagnosis. This study aimed to assess differences in the temporal trend of the mortality rate and median age at death from sickle cell disease in Brazil, considering implemented measures to expand diagnosis, and improve health care access in-country and in the international scenario. Time series were extracted from the Brazilian Mortality Information System from 1996 to 2019. Changes in the mortality rate and median age at death were verified via segmented regression models, which were stratified by sex, region of residence, and age. Most deaths occurred in non-white people, young adults, and the Southeast and Northeast population. Sickle cell disease mortality rate increased until 2010 (13.31%; 95%CI: 6.37; 20.70), particularly in individuals aged 30 years or more (12.78%; 95%CI: 2.98; 23.53) and in the Northeast (12.27%; 95%CI: 8.92; 15.72). Most deaths occurred in the second decade of life (3.01 deaths/million), with a 59% increase in the median age of death in Brazil, from 27.6 to 30.3 years, more pronounced in females and the North Region. The observed gain in the survival of sickle cell disease in Brazil is still much lower than in developed countries and presents regional disparities, probably due to the lack of access to health care and recent treatments, such as hydroxyurea, still restricted to hematological referral centers in Brazilian capitals.

Ao contrário dos estudos internacionais, houve um aumento da taxa de mortalidade por doença falciforme no Brasil após a implantação do programa de triagem neonatal, provavelmente devido à melhoria do acesso ao diagnóstico. O objetivo deste estudo foi avaliar as diferenças na tendência temporal da taxa de mortalidade por doença falciforme e idade mediana ao morrer no Brasil, considerando as medidas implementadas para ampliar o diagnóstico e melhorar o acesso à saúde no país e no cenário internacional. As séries temporais foram extraídas do Sistema de Informação sobre Mortalidade de 1996 a 2019. Mudanças na magnitude da taxa de mortalidade e na idade mediana ao morrer foram verificadas via modelos de regressão segmentada, estratificados por sexo, região de residência e idade. A maioria dos óbitos ocorreu entre jovens, pretos ou pardos, e habitantes das regiões Sudeste e Nordeste. Houve um aumento da taxa de mortalidade por doença falciforme até 2010 (13,31%; IC95%: 6,37; 20,70), especialmente em indivíduos com 30 anos ou mais (12,78%; IC95%: 2,98; 23,53) e habitantes do Nordeste (12,27%; IC95%: 8,92; 15,72). A maioria dos óbitos ocorreu durante a segunda década de vida (3,01 óbitos/milhão), com um aumento de 59% na idade mediana ao morrer no Brasil (de 27,6 para 30,3 anos), mais acentuada entre mulheres e na Região Norte. O aumento observado na sobrevivência da doença falciforme no Brasil ainda é muito menor do que em países desenvolvidos e com disparidades regionais, provavelmente pela falta de acesso aos serviços de saúde e aos tratamentos recentes, como a hidroxiureia, que ainda é restrita aos centros de referência hematológicos das capitais brasileiras.

A diferencia de los estudios internacionales, en Brasil se produjo un aumento de la tasa de mortalidad por enfermedad de células falciformes tras la implantación del programa de tamizaje neonatal, probablemente debido a la mejora del acceso al diagnóstico. El objetivo del estudio es determinar las diferencias en la tendencia temporal de la tasa de mortalidad y la edad media de muerte por enfermedad de células falciformes en Brasil, teniendo en cuenta las medidas implementadas para ampliar el diagnóstico y mejorar el acceso a la atención sanitaria en el país y en el escenario internacional. Las series temporales fueron extraídas del Sistema de Información sobre de Mortalidad de 1996 a 2019. Los cambios en la magnitud de la tasa de mortalidad y la edad media de la muerte se identificaron con modelos de regresión segmentados, estratificados por sexo, región de residencia y edad. La mayoría de las muertes ocurrieron en personas de color, adultos jóvenes y los habitantes del sureste y noreste. Hubo un aumento de la tasa de mortalidad por enfermedad de células falciformes hasta 2010 (13,31%; IC95%: 6,37; 20,70), sobre todo en individuos de 30 años o más (12,78%; IC95%: 2,98; 23,53) y en el Noreste (12,27%; IC95%: 8,92; 15,72). La mayoría de las muertes ocurrió en la segunda década de la vida (3,01 muertes/millón), con un aumento del 59% en la edad media de muerte en Brasil, de 27,6 a 30,3 años, más pronunciado en las mujeres y en el Norte. La ganancia observada en la supervivencia de la enfermedad de células falciformes en Brasil es todavía muy inferior a la de los países desarrollados y con disparidades regionales, probablemente debido a la falta de acceso a la asistencia sanitaria y a los tratamientos recientes, como la hidroxiurea, todavía restringidos a los centros de referencia hematológica de las capitales brasileñas.

[Socioeconomic context and perceived oral health in an adult population in Rio de Janeiro, Brazil: A multilevel analysis]. / Contexto sócio-econômico e percepção da saúde bucal em uma população de adultos no Rio de Janeiro, Brasil: uma análise multinível.

One of the main limitations of the ecological design is aggregation bias. The problem can be addressed by designs that use small contextual hierarchical units with internal homogeneity. This study aimed to compare different geographic data structures in order to explore contextual effects of socioeconomic variables on the odds of perceived poor oral health. The analyses were based on a mixed design that included data from civil servants participating in the "Pró-Saúde" censuses I and II and residing in the city of Rio de Janeiro, Brazil, in 1999 (n = 2,426); contextual data were obtained from the National Demographic Census conducted in 1991. We used the variance partition coefficient to compare different geographic hierarchical structures. In this study, the smallest geographic partition (census tract) was the best unit for contextual analysis for studying variability in perceived poor oral health. Individual socioeconomic attributes explained more of the variance in perceived oral health than did the socioeconomic contexts of residential areas.

Leishmaniose visceral: uma proposta para a mensuração da percepção dos profissionais de saúde em Uruguaiana (Rio Grande do Sul) / Visceral leishmaniosis: a proposal for measuring the perception of health professionals in Uruguaiana (Rio Grande do Sul)

Introdução: A leishmaniose visceral (LV) é  considerada uma das zoonoses mais relevantes das Américas devido à acentuada magnitude, à ampla distribuição geográfica e à alta taxa de letalidade. Objetivo: Avaliar a percepção dos profissionais de saúde quanto à ocorrência da LV em Uruguaiana (Rio Grande do Sul). Método: Estudo observacional transversal empregando um questionário autoaplicável durante o período de dezembro de 2016 a janeiro de 2017. Resultados: Participaram 183 profissionais de saúde, sendo 136 integrantes da Estratégia Saúde da Família, 20 agentes de controle de endemias e 27 veterinários. Identificaram-se deficiências de percepção dos profissionais de saúde a respeito da epidemiologia e da sintomatologia da doença. Conclusões: Fragilidades na percepção dos profissionais de saúde quanto à epidemiologia e à sintomatologia da LV ficaram evidenciadas, o que poderá impactar na detecção precoce de casos da doença e, consequentemente, na execução das ações preconizadas para o controle e prevenção da doença. É necessário investir em estratégias de capacitação sobre a LV, visando corrigir lacunas no conhecimento e fomentar discussões que englobem a complexidade do tema.

Introduction: Visceral leishmaniasis (VL) is  considered one of the most relevant zoonoses in the Americas due to its high magnitude, wide geographic distribution, and high fatality rate. Objective: Evaluate the perception of health professionals regarding the occurrence of VL in Uruguaiana (RS). Method: A cross-sectional observational study was carried out using a self-administered questionnaire from December 2016 to January 2017. Results: One hundred eighty-three health professionals participated in the study (one hundred thirty-six members of the Family Health Strategy, twenty endemic control agents and twenty-seven veterinarians). Health professionals' perception deficiencies were identified regarding the epidemiology and symptomatology of the disease. Conclusions: This study showed weaknesses in the knowledge of health professionals about the epidemiology and symptoms of VL, which may impact the early detection of cases and,  consequently, their favorable resolution. It is necessary to invest in training strategies on VL, aiming to correct gaps in knowledge and foster discussion on the subject.

Parasite abundance and its determinants in fishes from Brazil: an eco-epidemiological approach.

The variability in parasite abundance has an ecological basis; however, from an epidemiological point of view, the contribution of factors inherent to the host to the variability in parasite abundance remains an open question. A database consisting of 3,746 specimens of 73 fish species was used to verify the relation between the distribution of parasite abundance in fishes and a set of biotic factors inherent to the hosts. Classical and mixed Poisson regression models were constructed. Prevalence ratios (PR) and their respective 95% confidence intervals were estimated. The parasite abundance was significantly higher in female hosts, nonschooling species, species from benthopelagic and pelagic habitats, and fishes with greater body length. Overall, these results suggest that the variability in the abundance of infection is an attribute of the parasite species. Although the results are biologically plausible, important gaps may still exist and should be explored to better understand the variations in parasite abundance, which has great relevance in epidemiological studies. We reinforce the importance of choosing the statistical model most appropriate for the nature of the data to avoid spurious results, especially when the autocorrelation in the data is not taken into account.

Factors associated with parasite dominance in fishes from Brazil.

The present study used regression models to evaluate the existence of factors that may influence the numerical parasite dominance with an epidemiological approximation. A database including 3,746 fish specimens and their respective parasites were used to evaluate the relationship between parasite dominance and biotic characteristics inherent to the studied hosts and the parasite taxa. Multivariate, classical, and mixed effects linear regression models were fitted. The calculations were performed using R software (95% CI). In the fitting of the classical multiple linear regression model, freshwater and planktivorous fish species and body length, as well as the species of the taxa Trematoda, Monogenea, and Hirudinea, were associated with parasite dominance. However, the fitting of the mixed effects model showed that the body length of the host and the species of the taxa Nematoda, Trematoda, Monogenea, Hirudinea, and Crustacea were significantly associated with parasite dominance. Studies that consider specific biological aspects of the hosts and parasites should expand the knowledge regarding factors that influence the numerical dominance of fish in Brazil. The use of a mixed model shows, once again, the importance of the appropriate use of a model correlated with the characteristics of the data to obtain consistent results.