Health Vulnerability Index and newborn hearing screening: urban inequality. / Índice de Vulnerabilidade à Saúde e triagem auditiva neonatal: diferenciais intraurbanos.

PURPOSE: To analyze the intra-urban differentials related to the outcome of the Newborn Hearing Screening (NHS) of children living in Belo Horizonte tested in a reference service using the Health Vulnerability Index (HVI). METHODS: cross-sectional study with children living in Belo Horizonte evaluated by a Newborn Hearing Screening Reference Service (NHSRS) between 2010 and 2011. The HVI of the census tract of each child was obtained by the georeferencing of their respective addresses. Multivariate analysis was conducted using the decision tree technique, considering a statistical model for each response. A thematic map of points representing the geographic distribution of the children evaluated by the NHS program was also developed. RESULTS: The NHS failure rate for children living in areas with very high HVI, or without HVI data, was 1.5 times higher than that for children living in other census tracts. For children living in areas of low, medium, and high HVI, who underwent NHS after 30 days of life, the NHS failure rate was 2.1 times higher in children that presented Risk Indicator for Hearing Loss (RIHL) (17.2%) than in those who did not (8.1%). Uneven distribution was observed between areas for children that underwent the NHS and those who failed it. CONCLUSION: Significant intra-urban differentials were found in Belo Horizonte, indicating correlation between health vulnerability and NHS outcomes.

Índice de Vulnerabilidade à Saúde e triagem auditiva neonatal: diferenciais intraurbanos / Health Vulnerability Index and newborn hearing screening: urban inequality

RESUMO Objetivo Analisar os diferenciais intraurbanos associados ao resultado da triagem auditiva neonatal (TAN) de crianças residentes em Belo Horizonte e avaliadas em um Serviço de Referência de TAN, tendo como referência o Índice de Vulnerabilidade à Saúde (IVS). Método Estudo observacional com amostra de crianças residentes em Belo Horizonte e avaliadas por um Serviço de Referência de TAN, entre 2010 e 2011. O IVS do setor censitário de cada criança foi obtido por georreferenciamento de seu respectivo endereço. Foi elaborado modelo estatístico para as variáveis respostas: “resultado da TAN”, “resultado no reteste”, “absenteísmo no reteste” e realizada análise multivariada, utilizando-se a técnica de árvore de decisão. Foi elaborado mapa temático de pontos para representar a distribuição espacial das crianças avaliadas pelo Programa, segundo seu resultado na TAN. Resultados A probabilidade de falhar na TAN para as crianças residentes em áreas de IVS muito elevado é 1,5 vez maior do que para as crianças residentes nas demais áreas. Para as crianças que residem em áreas de IVS baixo, médio e elevado e que fizeram a TAN após os 30 dias de vida, a probabilidade de falhar é 2,1 vezes maior nas crianças que apresentam indicador de risco para deficiência auditiva (17,2%), em relação às sem indicador de risco (8,1%). Observou-se também distribuição heterogênea de realização da TAN e de resultado da avaliação entre as regiões do município. Conclusão Foram evidenciados importantes diferenciais intraurbanos no Município de Belo Horizonte, indicando associação entre a vulnerabilidade à saúde e o resultado da TAN.

ABSTRACT Purpose To analyze the intra-urban differentials related to the outcome of the Newborn Hearing Screening (NHS) of children living in Belo Horizonte tested in a reference service using the Health Vulnerability Index (HVI). Methods cross-sectional study with children living in Belo Horizonte evaluated by a Newborn Hearing Screening Reference Service (NHSRS) between 2010 and 2011. The HVI of the census tract of each child was obtained by the georeferencing of their respective addresses. Multivariate analysis was conducted using the decision tree technique, considering a statistical model for each response. A thematic map of points representing the geographic distribution of the children evaluated by the NHS program was also developed. Results The NHS failure rate for children living in areas with very high HVI, or without HVI data, was 1.5 times higher than that for children living in other census tracts. For children living in areas of low, medium, and high HVI, who underwent NHS after 30 days of life, the NHS failure rate was 2.1 times higher in children that presented Risk Indicator for Hearing Loss (RIHL) (17.2%) than in those who did not (8.1%). Uneven distribution was observed between areas for children that underwent the NHS and those who failed it. Conclusion Significant intra-urban differentials were found in Belo Horizonte, indicating correlation between health vulnerability and NHS outcomes.

Temporal and Spatial Trends in Childhood Asthma-Related Hospitalizations in Belo Horizonte, Minas Gerais, Brazil and Their Association with Social Vulnerability.

INTRODUCTION: Asthma is a multifactorial disease and a serious public health problem. Environmental factors and poverty are the main determinants of this disease. OBJECTIVE: To describe the spatial and temporal distribution of asthma-related hospitalizations and identify the areas with the highest prevalence of and vulnerability to severe asthma in a major Brazilian city. METHODS: An ecological study of hospitalizations for asthma from 2002 to 2012, in children and adolescents under 15 years of age, living in Belo Horizonte, Southeast Brazil. All events were geocoded by residence address using Hospital Information System data. The socioeconomic vulnerability of residence address was ranked using the Health Vulnerability Index. Raster surfaces were generated and time-series plots were constructed to determine spatial and time trends in the frequency of asthma-related hospitalizations, respectively. RESULTS: Asthma-related hospitalization rates were highest in children aged 0-4 years and in boys. There was a decreasing trend in the number of asthma-related hospitalizations across the study period. Approximately 48% of all hospitalizations were children living in health vulnerable areas. Seasonal trends showed a hospitalization peak in March, April, and May, coinciding with the post-rainy period. CONCLUSION: Our findings suggest that social and environmental factors may be determinants of disparities in severe asthma.

Inequities in intraurban areas in the distribution of risk factors for non communicable diseases, Belo Horizonte, 2010.

OBJECTIVE: In order to identify intraurban differentials, the prevalence of major protection and risk factors for non communicable chronic diseases were analyzed in nine health districts of Belo Horizonte, Minas Gerais, Brazil. METHODS: Analysis of data from a telephone survey conducted with 2,000 adults in Belo Horizonte, in 2010, using the average linkage method for cluster analysis among the health districts, using sociodemographic variables (education, race and marital status). The study compared the prevalence of risk factors for non communicable diseases among the health districts. RESULTS: Four clusters were identified. The best socio-demographic indicators were found in cluster 4 (South Central health district), which also showed a higher prevalence of protective factors such as higher consumption of fruits and vegetables, higher frequency of physical activity practice in the free time, use of ultraviolet protection, higher proportion of ex-smokers, and lower prevalence of whole milk and high-fat meat consumption. As a risk factor, cluster 4 showed a higher proportion of alcohol abuse. Cluster 1, with the worst socio-demographic indicators, concentrated more risk factors such as consumption of whole milk, low regular consumption of fruit and vegetables, and lower practice of physical activity in the free time. The most frequent protective indicators in cluster 1 were the regular consumption of beans, having breakfast at home, and lower alcohol abuse. CONCLUSION: Intra-urban differences were found in the distribution of risk and protection factors or non transmissible diseases, these differences can support planning aimed at actions for greater equity in health.

Inequities in intraurban areas in the distribution of risk factors for non communicable diseases, Belo Horizonte, 2010 / Desigualdades intraurbanas na distribuição dos fatores de risco para doenças crônicas não transmissíveis, Belo Horizonte, 2010

Objective: In order to identify intraurban differentials, the prevalence of major protection and risk factors for non communicable chronic diseases were analyzed in nine health districts of Belo Horizonte, Minas Gerais, Brazil. Methods: Analysis of data from a telephone survey conducted with 2,000 adults in Belo Horizonte, in 2010, using the average linkage method for cluster analysis among the health districts, using sociodemographic variables (education, race and marital status). The study compared the prevalence of risk factors for non communicable diseases among the health districts. Results: Four clusters were identified. The best socio-demographic indicators were found in cluster 4 (South Central health district), which also showed a higher prevalence of protective factors such as higher consumption of fruits and vegetables, higher frequency of physical activity practice in the free time, use of ultraviolet protection, higher proportion of ex-smokers, and lower prevalence of whole milk and high-fat meat consumption. As a risk factor, cluster 4 showed a higher proportion of alcohol abuse. Cluster 1, with the worst socio-demographic indicators, concentrated more risk factors such as consumption of whole milk, low regular consumption of fruit and vegetables, and lower practice of physical activity in the free time. The most frequent protective indicators in cluster 1 were the regular consumption of beans, having breakfast at home, and lower alcohol abuse. Conclusion: Intra-urban differences were found in the distribution of risk and protection factors or non transmissible diseases, these differences can support planning aimed at actions for greater equity in health. .

Objetivo: Visando identificar diferenciais intraurbanos, foram analisadas prevalências dos principais fatores de risco e proteção para doenças crônicas não transmissíveis nos nove distritos sanitários de Belo Horizonte, Minas Gerais. Métodos: Análise dos dados de inquérito telefônico realizado com 2.000 adultos em Belo Horizonte em 2010, empregando-se average linkage para análise de clusters entre os distritos sanitários, com base em variáveis sociodemográficas (escolaridade, cor da pele e estado civil). O estudo comparou as prevalências dos fatores de risco para doenças crônicas não transmissíveis entre os distritos sanitários. Resultados: Foram identificados quatro clusters. O cluster 4 (distrito sanitário Centro Sul) apresentou as melhores condições sociodemográficas, além de maior prevalência de fatores de proteção, como maior consumo de frutas, legumes e verduras, maior frequência de atividade física no tempo livre, uso de proteção de raios ultravioleta, maior proporção de ex-fumantes e menor prevalência de consumo de leite com gordura integral e carne com gordura aparente. Como fator de risco, o cluster 4 apresentou maior proporção de consumo abusivo de álcool. O cluster 1, com piores indicadores sociodemográficos, concentrou mais fatores de risco, como maior consumo de leite com gordura, baixo consumo de frutas, legumes e verduras regular e menos atividade física no tempo livre. Os indicadores de proteção mais frequentes no cluster 1 foram: consumo regular de feijão, café da manhã em casa e menor consumo abusivo de álcool. Conclusão: Foram encontradas diferenças intraurbanas na distribuição dos fatores de risco e proteção para doenças crônicas ...

Relative risk of visceral leishmaniasis in Brazil: a spatial analysis in urban area.

BACKGROUND: Visceral leishmaniasis (VL) is a vector-borne disease whose factors involved in transmission are poorly understood, especially in more urban and densely populated counties. In Brazil, the VL urbanization is a challenge for the control program. The goals were to identify the greater risk areas for human VL and the risk factors involved in transmission. METHODOLOGY: This is an ecological study on the relative risk of human VL. Spatial units of analysis were the coverage areas of the Basic Health Units (146 small-areas) of Belo Horizonte, Minas Gerais State, Brazil. Human VL cases, from 2007 to 2009 (n = 412), were obtained in the Brazilian Reportable Disease Information System. Bayesian approach was used to model the relative risk of VL including potential risk factors involved in transmission (canine infection, socioeconomic and environmental features) and to identify the small-areas of greater risk to human VL. PRINCIPAL FINDINGS: The relative risk of VL was shown to be correlated with income, education, and the number of infected dogs per inhabitants. The estimates of relative risk of VL were higher than 1.0 in 54% of the areas (79/146). The spatial modeling highlighted 14 areas with the highest relative risk of VL and 12 of them are concentrated in the northern region of the city. CONCLUSIONS: The spatial analysis used in this study is useful for the identification of small-areas according to risk of human VL and presents operational applicability in control and surveillance program in an urban environment with an unequal spatial distribution of the disease. Thus the frequent monitoring of relative risk of human VL in small-areas is important to direct and prioritize the actions of the control program in urban environment, especially in big cities.

Perinatal mortality and socio-spatial inequalities.

OBJECTIVE: To analyze the social inequalities in the distribution of perinatal mortality in Belo Horizonte. MATERIAL AND METHODS: The perinatal deaths of residents in Belo Horizonte in the period 2003 to 2007 were studied on the basis of the Information Systems on Mortality and Newborns. The space analysis and the Health Vulnerability Index were used to identify existing inequalities in the sanitary districts regarding coverage and risk, determined by the Odds Ratio and a value p<0.05. The multivariate analysis was used to describe a model for perinatal mortality. RESULTS: There was a proved variation in the numbers of perinatal mortality per one thousand total births in the sanitary districts (12.5 to 19.4), coverage areas (5.3 to 49.4) and areas of risk (13.2 to 20.7). The mortality rate diminished as the maternal schooling increased. The death rates deriving from asphyxia/hypoxia and non-specified fetal death grew with the increase of risk in the area. CONCLUSION: It was verified that the perinatal deaths are distributed in a differentiated form in relation to the space and the social vulnerabilities. The confrontation of this complex problem requires the establishment of intersecting partnerships.

Perinatal mortality and socio-spatial inequalities / Mortalidade perinatal e desigualdades socioespaciais / Mortalidad perinatal y desigualdades socio-espaciales

OBJECTIVE: to analyze the social inequalities in the distribution of perinatal mortality in Belo Horizonte. MATERIAL AND METHODS: the perinatal deaths of residents in Belo Horizonte in the period 2003 to 2007 were studied on the basis of the Information Systems on Mortality and Newborns. The space analysis and the Health Vulnerability Index were used to identify existing inequalities in the sanitary districts regarding coverage and risk, determined by the Odds Ratio and a value p<0.05. The multivariate analysis was used to describe a model for perinatal mortality. RESULTS: there was a proved variation in the numbers of perinatal mortality per one thousand total births in the sanitary districts (12.5 to 19.4), coverage areas (5.3 to 49.4) and areas of risk (13.2 to 20.7). The mortality rate diminished as the maternal schooling increased. The death rates deriving from asphyxia/hypoxia and non-specified fetal death grew with the increase of risk in the area. CONCLUSION: it was verified that the perinatal deaths are distributed in a differentiated form in relation to the space and the social vulnerabilities. The confrontation of this complex problem requires the establishment of intersecting partnerships. .

OBJETIVO: analisar as desigualdades sociais constatadas na distribuição da mortalidade perinatal em Belo Horizonte. MATERIAIS E MÉTODOS: estudaram-se os óbitos perinatais de residentes em Belo Horizonte, no período de 2003 a 2007, com base nos sistemas de informação sobre mortalidade e nascidos vivos e utilizaram-se a análise espacial e o índice de vulnerabilidade à saúde para identificar desigualdades existentes nos distritos sanitários, nas áreas de abrangências e de risco, determinadas pelo odds ratio e valor p<0,05, tendo-se procedido à análise multivariada para descrever um modelo referente à mortalidade perinatal. RESULTADOS: evidenciou-se variação nas taxas de mortalidade perinatal por mil nascimentos totais nos distritos sanitários (12,5 a 19,4), áreas de abrangência 5,3 a 49,4) e áreas de risco (13,2 a 20,7). A taxa de mortalidade reduziu-se à medida que aumentou a escolaridade materna. As taxas de morte decorrentes da asfixia/hipóxia e a morte fetal não especificada foram crescentes com o aumento do risco da área. CONCLUSÃO: constatou-se que as mortes perinatais se distribuem de forma diferenciada em relação ao espaço e às vulnerabilidades sociais e que, portanto, o enfrentamento desse complexo problema requer o estabelecimento de parcerias intersetoriais. .

OBJETIVO: analizar las desigualdades sociales en la distribución de la mortalidad perinatal en Belo Horizonte. MATERIAL Y MÉTODOS: fueron estudiadas las muertes perinatales de residentes en Belo Horizonte, en el período de 2003 a 2007, con base en los Sistemas de Información sobre Mortalidad y Nacidos Vivos. El análisis espacial y el Índice de Vulnerabilidad de la Salud fueron utilizados para identificar desigualdades existentes en los Distritos Sanitarios, en las áreas de influencias y de riesgo, determinadas por el Odds Ratio y el valor p<0,05. Fue utilizado el análisis multivariado para describir un modelo para la mortalidad perinatal. RESULTADOS: se evidenció una variación en las tasas de mortalidad perinatal por mil nacimientos totales en los Distritos Sanitarios (12,5 a 19,4), áreas de influencia (5,3 a 49,4) y áreas de riesgo (13,2 a 20,7). La tasa de mortalidad se redujo a medida que aumentó la escolaridad materna. Las tasas de muerte provenientes de la asfixia/hipoxia y la muerte fetal no especificada fueron crecientes con el aumento del riesgo del área. CONCLUSIÓN: se constató que las muertes perinatales se distribuyen de forma diferenciada en relación al espacio y a las vulnerabilidades sociales. El enfrentamiento de ese complejo problema requiere el establecimiento de alianzas intersectoriales. .

Fatores associados ao tempo de espera e ao acesso ao transplante renal em Belo Horizonte, Minas Gerais, Brasil / Factors associated with waiting time and access to kidney transplants in Belo Horizonte, Minas Gerais State, Brazil'

O objetivo deste artigo foi analisar os fatores associados ao acesso ao transplante renal com doador vivo e cadáver em Belo Horizonte, Minas Gerais, Brasil. Foi realizado um estudo de coorte não concorrente com pacientes inscritos na lista de espera por transplante renal, entre 2000 e 2004, os quais foram acompanhados até o transplante, óbito, exclusão ou permanência na fila de espera ao fim do estudo em 31 de dezembro de 2005. Utilizou-se o modelo de Cox para riscos competitivos. Dos 835 pacientes, 22,7% foram transplantados. Apresentaram menor risco de transplante por doador cadáver e vivo os pacientes com maior tempo em diálise e tipo sanguíneo O. Observou-se menor risco de transplante intervivos para residentes em uma área de alto risco à saúde e portadores de diabetes. A maior disparidade de acesso foi para transplante renal intervivos, uma vez que não houve diferenças sociodemográficas significativas para transplante por doador cadáver. Pode-se inferir que o sistema de alocação de órgãos contribuiu para amenizar desigualdades sociodemográficas, sendo as questões clínicas mais relevantes no acesso ao transplante com doador cadáver.

The objective of this study was to analyze factors associated with access to kidney transplants from living and cadaver donors in Belo Horizonte, Minas Gerais State, Brazil. The authors conducted a non-concurrent cohort study of patients on the waiting list for kidney transplants from 2000 to 2004 and followed until transplantation, death, exclusion, or continued presence on the line at the end of the study on December 31, 2005. The Cox model was used for competing risks. Of the 835 patients, 22.7% were transplanted. Lower risk of transplantation from living donors and cadavers was observed in patients with more time on dialysis and blood type O. Lower risk of transplantation from living donors was observed in residents in a high health risk area and in recipients with diabetes. The greatest disparity in access was observed in transplants from living donors, since there were no significant socio-demographic differences in transplants from cadaver donors. One can infer that the organ allocation system contributed to mitigating socio-demographic inequalities, and that clinical issues were more relevant in access to transplants from cadaver donors.

Diffusion pattern and hotspot detection of dengue in belo horizonte, minas gerais, Brazil.

This study considers the dengue occurrence in the city of Belo Horizonte over the last fifteen years. Approximately 186,000 cases registered from 1996 to 2011 were analyzed. The home address of individuals whose dengue case was notified was used as a proxy for exposure location. For determining possible outbreaks of disease and the specific patterns of dengue cases, spatial statistics used included Kernel's estimation. The occurrence of waves of dengue outbreaks was correlated with climatic and vector presence data. Outbreaks had different durations and intensities: case clustering, thinned out both spatially and temporally. These findings may be useful for public health professionals responsible for fighting the disease providing some tools for improving evaluation of interventions such as vector control and patient care, minimizing the collective and individual burden of the disease.

[Factors associated with waiting time and access to kidney transplants in Belo Horizonte, Minas Gerais State, Brazil']. / Fatores associados ao tempo de espera e ao acesso ao transplante renal em Belo Horizonte, Minas Gerais, Brasil.

The objective of this study was to analyze factors associated with access to kidney transplants from living and cadaver donors in Belo Horizonte, Minas Gerais State, Brazil. The authors conducted a non-concurrent cohort study of patients on the waiting list for kidney transplants from 2000 to 2004 and followed until transplantation, death, exclusion, or continued presence on the line at the end of the study on December 31, 2005. The Cox model was used for competing risks. Of the 835 patients, 22.7% were transplanted. Lower risk of transplantation from living donors and cadavers was observed in patients with more time on dialysis and blood type O. Lower risk of transplantation from living donors was observed in residents in a high health risk area and in recipients with diabetes. The greatest disparity in access was observed in transplants from living donors, since there were no significant socio-demographic differences in transplants from cadaver donors. One can infer that the organ allocation system contributed to mitigating socio-demographic inequalities, and that clinical issues were more relevant in access to transplants from cadaver donors.

Estratégia intersetorial para o controle da dengue em Belo Horizonte (Minas Gerais), Brasil / An intersectoral strategy for dengue control in Belo Horizonte (Minas Gerais), Brazil

Os altos índices larvários e a complexidade dos fatores ambientais relacionados à proliferação e sobrevivência do Aedes aegypti levaram a Prefeitura de Belo Horizonte a adotar políticas integradas e agregar parceiros para a definição de ações que possibilitem resultados mais efetivos no controle da dengue, instituindo o Grupo Executivo para o Controle da Dengue - GECD. Esse artigo traz um estudo descritivo que analisa os documentos do GECD - atas, relatórios, avaliações - e descreve as intervenções, em 2007 e 2008, resultantes em: mutirões de limpeza; mobilização da sociedade civil; intensificação de ações de fiscalização; atividades em escolas; comunicação; articulação com empresas privadas, órgãos estaduais e federais; assistência. A experiência de Belo Horizonte, com o fortalecimento do espaço interno de discussão, possibilitou a tomada de decisões de forma mais ágil e o avanço na implementação das ações de prevenção e controle. Possibilitou a emergência de questões e desafios a serem enfrentados para o desenvolvimento da gestão intersetorial no controle da dengue.

Estratégia intersetorial para o controle da dengue em Belo Horizonte (Minas Gerais), Brasil / An intersectoral strategy for dengue control in Belo Horizonte (Minas Gerais), Brazil

Os altos índices larvários e a complexidade dos fatores ambientais relacionados à proliferação e sobrevivência do Aedes aegypti levaram a Prefeitura de Belo Horizonte a adotar políticas integradas e agregar parceiros para a definição de ações que possibilitem resultados mais efetivos no controle da dengue, instituindo o Grupo Executivo para o Controle da Dengue - GECD. Esse artigo traz um estudo descritivo que analisa os documentos do GECD - atas, relatórios, avaliações - e descreve as intervenções, em 2007 e 2008, resultantes em: mutirões de limpeza; mobilização da sociedade civil; intensificação de ações de fiscalização; atividades em escolas; comunicação; articulação com empresas privadas, órgãos estaduais e federais; assistência. A experiência de Belo Horizonte, com o fortalecimento do espaço interno de discussão, possibilitou a tomada de decisões de forma mais ágil e o avanço na implementação das ações de prevenção e controle. Possibilitou a emergência de questões e desafios a serem enfrentados para o desenvolvimento da gestão intersetorial no controle da dengue.(AU)

[Spatial-temporal distribution of potential blood donors at the Hemominas Foundation, Belo Horizonte, Minas Gerais State, Brazil, in 1994 and 2004]. / Distribuição espaço-temporal dos candidatos à doação de sangue da Fundação Hemominas, Belo Horizonte, Minas Gerais, Brasil, nos anos de 1994 e 2004.

The main goal of this study was to describe the spatial and temporal distribution of candidates for blood donation in Belo Horizonte, Minas Gerais State, Brazil, who appeared at the Hemominas Foundation in 1994 and 2004. The study also compared the candidates for age, gender, and clinical approval for blood donation in space and space-time. Data were obtained from a cross-sectional study for 1994 and were randomly selected from all donor candidates for 2004. The samples were georeferenced using the residential address. The spatial analysis techniques employed were: Kernel maps, thematic maps of Bayesian empirical rates and crude rates, and Moran Global. According to the findings, spatial distribution of candidates was non-random. The Kernel maps helped detect points with higher or lower concentration of candidates. Thematic maps described the concentration of candidates in relation to the population for the various categories. The results could help detect areas for actions targeting donor recruitment and areas with specific blood donation public campaign needs.

Distribuição espaço-temporal dos candidatos à doação de sangue da Fundação Hemominas, Belo Horizonte, Minas Gerais, Brasil, nos anos de 1994 e 2004 / Spatial-temporal distribution of potential blood donors at the Hemominas Foundation, Belo Horizonte, Minas Gerais State, Brazil, in 1994 and 2004

Este estudo teve como objetivo descrever a distribuição espacial e temporal dos candidatos à doação de sangue, do Município de Belo Horizonte, Minas Gerais, Brasil, que se apresentaram no hemocentro da Fundação Hemominas, nos anos de 1994 e 2004. Comparou no espaço e no espaço-tempo as características idade, sexo e aptidão clínica destes candidatos. As informações de 1994, obtidas de estudo transversal, e as de 2004, amostrados entre os candidatos à doação durante o ano. As amostras foram georreferenciadas através dos endereços de residência. As técnicas espaciais utilizadas foram: mapas Kernel, mapas temáticos de taxas Bayesianas empíricas e de taxas brutas e o índice de Moran global. Os resultados indicaram que a distribuição espacial de candidatos não foi aleatória. Os mapas Kernel auxiliaram na detecção de locais com maior ou menor concentração de candidatos. Os mapas temáticos descreveram a concentração de candidatos relativos à população para as diferentes categorias analisadas. Estes resultados ajudam na detecção de locais para ações direcionadas à captação de candidatos à doação bem como locais com necessidades de campanhas a públicos específicos.

The main goal of this study was to describe the spatial and temporal distribution of candidates for blood donation in Belo Horizonte, Minas Gerais State, Brazil, who appeared at the Hemominas Foundation in 1994 and 2004. The study also compared the candidates for age, gender, and clinical approval for blood donation in space and space-time. Data were obtained from a cross-sectional study for 1994 and were randomly selected from all donor candidates for 2004. The samples were georeferenced using the residential address. The spatial analysis techniques employed were: Kernel maps, thematic maps of Bayesian empirical rates and crude rates, and Moran Global. According to the findings, spatial distribution of candidates was non-random. The Kernel maps helped detect points with higher or lower concentration of candidates. Thematic maps described the concentration of candidates in relation to the population for the various categories. The results could help detect areas for actions targeting donor recruitment and areas with specific blood donation public campaign needs.

[Intra-urban dynamics of dengue epidemics in Belo Horizonte, Minas Gerais State, Brazil, 1996-2002]. / Dinâmica intra-urbana das epidemias de dengue em Belo Horizonte, Minas Gerais, Brasil, 1996-2002.

This study aimed to describe the temporal-spatial patterns of dengue epidemics in Belo Horizonte, Minas Gerais State, Brazil, from 1996 to 2002 and to analyze residential address as a proxy for exposure. Reported dengue cases were analyzed according to week of onset of symptoms and residential census tract. Local Moran's index was used to assess spatial autocorrelation of incidence coefficients, and recurrent census areas over different epidemic waves were also verified. Ripley's K-function was used to compare spatial distribution patterns between the two population groups, assuming that they were distributed differently around the city. A total of 99,559 dengue cases were analyzed, resulting in seven epidemic waves with different durations and intensities, with cases clustering in a small fraction of areas, thinning out both spatially and temporally. Distinct case distribution patterns were observed according to the two exposed groups, suggesting the need to improve the reporting of possible place of infection. The observed endemic pattern of the disease also requires specific strategies and poses a major challenge for health surveillance services.

Dinâmica intra-urbana das epidemias de dengue em Belo Horizonte, Minas Gerais, Brasil, 1996-2002 / Intra-urban dynamics of dengue epidemics in Belo Horizonte, Minas Gerais State, Brazil, 1996-2002

Este estudo teve como objetivo descrever os padrões espacial e temporal das epidemias de dengue em Belo Horizonte, Minas Gerais, Brasil, entre 1996 e 2002, analisando o endereço de residência como marcador do local de exposição. Casos de dengue notificados foram agrupados segundo semana epidemiológica do início dos sintomas e setor censitário de residência. O índice de Moran local foi utilizado para avaliar a autocorrelação espacial dos coeficientes de incidência. Também foi verificada a reincidência dos setores nas diferentes ondas epidêmicas. Por meio da função K de Ripley, foram comparadas as distribuições espaciais de dois grupos populacionais, supondo terem diferentes comportamentos em relação ao seu deslocamento pela cidade. Foram analisados 99.559 casos, evidenciando-se sete alças epidêmicas com diferentes durações e intensidades, com concentração de casos numa parcela reduzida de setores e tendência de dispersão espacial e temporal. A distribuição de casos dos dois grupos populacionais evidenciou padrões diferenciados, apontando a necessidade de melhorar o registro do provável local de infecção. O padrão de endemização da doença encontrado requer estratégias específicas e constitui um maior desafio para a vigilância em saúde.

This study aimed to describe the temporal-spatial patterns of dengue epidemics in Belo Horizonte, Minas Gerais State, Brazil, from 1996 to 2002 and to analyze residential address as a proxy for exposure. Reported dengue cases were analyzed according to week of onset of symptoms and residential census tract. Local Moran's index was used to assess spatial autocorrelation of incidence coefficients, and recurrent census areas over different epidemic waves were also verified. Ripley's K-function was used to compare spatial distribution patterns between the two population groups, assuming that they were distributed differently around the city. A total of 99,559 dengue cases were analyzed, resulting in seven epidemic waves with different durations and intensities, with cases clustering in a small fraction of areas, thinning out both spatially and temporally. Distinct case distribution patterns were observed according to the two exposed groups, suggesting the need to improve the reporting of possible place of infection. The observed endemic pattern of the disease also requires specific strategies and poses a major challenge for health surveillance services.

Introdução à Estatística Espacial para a Saúde Pública

O livro pretende ir além dos mapas coropléticos (temáticos), mostrando ao leitor os primeiros passos dos pressupostos estatísticos nas abordagens espaciais. As técnicas estatísticas apresentadas ampliam as análises de modo a permitir a realização de inferências e de testes de hipóteses geradas pelos profissionais de saúde pública para responder questões sobre a distribuição de eventos no seu dia-a-dia. O livro pertence a série: Textos básicos em saúde e Capacitação e atualização em geoprocessamento em saúde (v. 3).

Indicadores de saúde materno infantil em Belo Horizonte, Minas Gerais, Brasil, 2001: análise dos diferenciais intra-urbanos / Maternal and child health indicators in Belo Horizonte, Minas Gerais State, Brazil, 2001: an analysis of intra-urban differences

A análise espacial de indicadores de saúde tem sido um importante instrumento na detecção de diferenciais intra-urbanos. O estudo objetivou traçar um perfil dos nascimentos em Belo Horizonte, Minas Gerais, Brasil, em 2001, analisando a presença de conglomerados espaciais de indicadores de saúde do recém-nascido e suas mães, a partir de dados do Sistema de Informações sobre Nascidos Vivos. Para cada área de abrangência das Unidades Básicas de Saúde, foram calculadas as proporções desses indicadores, utilizando-se o método Bayesiano empírico. Para análise espacial, foram utilizados os índices de Moran global e local (LISA). Areas com índices de autocorrelação espacial significantes (p < 0,05) foram visualizadas através de mapas. Foram encontrados conglomerados de áreas com índices de autocorrelação espacial significativos para os indicadores adolescentes, menos de oito anos de estudo, filhos mortos em gestações anteriores, cesárea e menos de quatro consultas no pré-natal, guardando relação com as características sócio-demográficas das áreas. A metodologia utilizada configurou-se como um ótimo instrumento de detecção de conglomerados de áreas de risco à saúde materno infantil, podendo facilmente ser incorporada como mecanismo de monitoramento dos eventos relacionados aos nascimentos em Belo Horizonte.

[Maternal and child health indicators in Belo Horizonte, Minas Gerais State, Brazil, 2001: an analysis of intra-urban differences]. / Indicadores de saúde materno infantil em Belo Horizonte, Minas Gerais, Brasil, 2001: análise dos diferenciais intra-urbanos.

Spatial analysis of health indicators is as an important methodology for detection of intra-urban differences. This study aimed to examine the spatial distribution of all live births in Belo Horizonte, analyzing the presence of spatial clusters of health indicators for newborns and their mothers, using data from the Information System on Live Births. For each area covered by a Primary Health Care Unit, we calculated the indicators using empirical Bayesian methods. For spatial analysis, the indicators obtained from the global Moran (I) index and Local Indicators of Spatial Association (LISA) were used. Analysis using LISA showed the presence of relevant spatial clusters for adolescent mothers and those with low schooling, stillbirths in previous pregnancies, cesarean sections, and low attendance at prenatal care, especially in areas with low socio-demographic characteristics. The methodology adopted was configured as a key instrument for detecting risk areas where clustering occurs. The method can easily be incorporated into health surveillance systems as a mechanism for controlling events related to births in a given area.