ABSTRACT
Visceral leishmaniasis (VL) is one of the most prevalent parasitic diseases worldwide. In 2019, 97% of the total numbers of cases in Latin America were reported in Brazil. In São Paulo state, currently 17.6% of infected individuals live in the western region. To study this neglected disease on a regional scale, we describe the spread of VL in 45 municipalities of the Regional Network for Health Assistance11(RNHA11). Environmental, human VL (HVL), and canine VL (CVL) cases, Human Development Index, and Lutzomyia longipalpis databases were obtained from public agencies. Global Moran's I index and local indicators of spatial association (LISA) statistics were used to identify spatial autocorrelation and to generate maps for the identification of VL clusters. On a local scale, we determined the spread of VL in the city of Teodoro Sampaio, part of the Pontal of Paranapanema. In Teodoro Sampaio, monthly peri-domicile sand fly collection; ELISA, IFAT and Rapid Test serological CVL; and ELISA HVL serum surveys were carried out. In RNHA11 from 2000 to 2018, Lu. longipalpis was found in 77.8%, CVL in 69%, and HVL in 42.2% of the 45 municipalities, and 537 individuals were notified with HVL. Dispersion occurred from the epicenter in the north to Teodoro Sampaio, in the south, where Lu. longipalpis and CVL were found in 2010, HVL in 2018, and critical hotspots of CVL were found in the periphery. Moran's Global Index showed a weak but statistically significant spatial autocorrelation related to cases of CVL (I = 0.2572), and 11 municipalities were identified as priority areas for implementing surveillance and control actions. In RNHA11, a complex array of socioeconomic and environmental factors may be fueling the epidemic and sustaining endemic transmission of VL, adding to the study of a neglected disease in a region of São Paulo, Brazil.
Subject(s)
Leishmaniasis, Visceral/veterinary , Neglected Diseases/epidemiology , Population Surveillance , Animals , Brazil/epidemiology , Demography , Disease Reservoirs/parasitology , Disease Reservoirs/veterinary , Dog Diseases/epidemiology , Dog Diseases/parasitology , Dogs , Humans , Insect Vectors , Leishmania infantum , Leishmaniasis, Visceral/epidemiology , Psychodidae , Risk Factors , Urban Population , ZoonosesABSTRACT
ABSTRACT Introduction: Urban green spaces can offer opportunities for regular physical activity, providing benefits in the lives of members of the population, such as physical, social and affective health. The aim of this article consists of analyzing the influence of urban green spaces on physical activity, focusing on urban environmental quality and the health of those who engage in physical activities in open areas. The study has a multidisciplinary approach from the perspective of environmental health. Method: The study design was based on qualitative research, using a bibliographic and document search as well as field surveys, whose technique involved direct observation (DO). The sample selection was based on Miot (2011), consisting of a total of 36 individuals aged between 18 and 40 years, who perform physical activities regularly, at least three times a week, for at least 50 minutes. Questionnaires were also applied using the IPAQ (assessment of physical activity) and Borg Scale parameters. Results: The study showed that the research participants became more active, possibly being stimulated and motivated by their surroundings with widespread vegetation cover, the good infrastructure of the venue and the guidance provided during the research. Conclusion: The research project showed that the greater the frequency and intensity of physical activity in open areas, the better the body's physiological adaptability. Level of Evidence II; Prognostic study.
RESUMO Introdução: Os parques verdes urbanos podem oferecer oportunidades para a prática regular de atividade física, proporcionando benefícios para a vida da população, como por exemplo, saúde física, social e afetiva. O objetivo do presente artigo consiste em analisar a influência dos parques verdes urbanos na prática de atividades físicas, focando-se na qualidade ambiental urbana e na saúde dos praticantes de atividades físicas em áreas abertas. O estudo tem uma abordagem multidisciplinar segundo a perspectiva da saúde ambiental. Método: O projeto de estudo baseou-se em pesquisa qualitativa, utilizando pesquisa bibliográfica e documental e levantamentos de campo, cuja técnica contou com a observação direta (DO). A seleção da amostra foi baseada em Miot (2011), contando com36 indivíduos com idade entre 18 e 40 anos que praticam regularmente atividades físicas, pelo menos, três vezes por semana, por no mínimo 50 minutos. Também foram realizados questionários utilizando o IPAC (nível de atividade física avaliado) e os parâmetros da Escala de Borg. Resultados: O estudo mostrou que os participantes da pesquisa se tornaram mais ativos, possivelmente, sendo estimulados e motivados pelo ambiente com grande presença de vegetação, a boa infraestrutura do local e as orientações feitas durante a pesquisa. Conclusão: A pesquisa mostrou que quanto maior a frequência e a intensidade da atividade física em áreas abertas, melhor é a adaptabilidade fisiológica do organismo. Nível de evidência II; Estudo prognóstico.
RESUMEN Introducción: Los parques verdes urbanos pueden ofrecer oportunidades para la práctica regular de actividad física, proporcionando beneficios para la vida de la población, como por ejemplo, salud física, social y afectiva. El objetivo del presente artículo consiste en analizar la influencia de los parques verdes urbanos en la práctica de actividades físicas, enfocándose en la calidad ambiental urbana y la salud de los practicantes de actividades físicas en áreas abiertas. El estudio tiene un abordaje multidisciplinario según la perspectiva de la salud ambiental. Método: El proyecto de estudio se basó en la investigación cualitativa, mediante búsqueda bibliográfica y documental, y levantamientos de campo, cuya técnica contó con la observación directa (OD). La selección de la muestra se basó en Miot (2011), contando con 36 individuos con edad entre 18 y 40 años, que practican regularmente actividades físicas, al menos tres veces por semana, durante al menos 50 minutos. También fueron realizados cuestionarios utilizando el IPAC (nivel de actividad física evaluado) y los parámetros de la Escala de Borg. Resultados: El estudio mostró que los participantes de la investigación se volvieron más activos, posiblemente siendo estimulados y motivados por el ambiente con gran presencia de vegetación y la buena infraestructura del local y las orientaciones realizadas durante la investigación. Conclusión: La investigación mostró que cuanto mayor es la frecuencia e intensidad de la actividad física en áreas abiertas, mejor es la adaptabilidad fisiológica del organismo. Nivel de evidencia II; Estudio pronóstico.
ABSTRACT
BACKGROUND: Visceral leishmaniasis (VL) is an emerging zoonosis, and Brazil harbors about 90% of those infected in Latin America. Since 1998, the disease has been spreading quickly in São Paulo state, and the western region is considered an emerging focus of VL in Brazil. Our aim was to evaluate the clinical characteristics and spatial distribution of VL in children referred to a public tertiary hospital located in the western region of São Paulo state, Brazil. METHODS: Medical records of children up to 18 years of age who were diagnosed with VL between January 2006 and December 2010 were reviewed. Geospatial analysis was performed using the ArcGIS 10.2 platform. RESULTS: Sixty-three patients were enrolled in the study; the median age was 3.3 ± 3.3 years. The median time interval between the onset of clinical symptoms and diagnosis was 16.1 ± 11.1 days, and the median time in the pediatric ward was 18.0 ± 9.4 days. Liposomal amphotericin B was the first-line treatment in 90.5% of the patients and 9.6% relapsed. One patient died (1.6%), and 19% were submitted to the pediatric intensive care unit. CONCLUSION: The short interval between the onset of symptoms, diagnosis, and treatment and the reduced number of days of hospitalization certainly influenced the small number of deaths, relapses, and severity among the children infected with VL. However, the disease is spreading fast in the western region of São Paulo state. Thus, integrated actions and effective monitoring of the disease are needed to complement curative practices.
Subject(s)
Leishmaniasis, Visceral/epidemiology , Adolescent , Amphotericin B/therapeutic use , Animals , Antiprotozoal Agents/therapeutic use , Brazil/epidemiology , Child , Child, Preschool , Communicable Diseases, Emerging/diagnosis , Communicable Diseases, Emerging/drug therapy , Communicable Diseases, Emerging/epidemiology , Dog Diseases/epidemiology , Dogs , Female , Humans , Infant , Infant, Newborn , Leishmaniasis, Visceral/diagnosis , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/veterinary , Male , Prevalence , Retrospective Studies , Sensitivity and Specificity , Spatial AnalysisABSTRACT
In Brazil, the rates of mother-to-child-transmission (MTCT) of human immunodeficiency virus (HIV) decreased from 20% to 1-2% in some regions. However, the country contains 90% of individuals infected with visceral leishmaniasis (VL) in Latin America, and the west region of São Paulo state faces an alarming expansion of the disease. We describe the epidemiological aspects of the expanding infection of VL and a case report of an HIV-VL-co-infected child from the west region of São Paulo state. The patient was an AIDS-C3 with low levels of CD4, high viral load, severe diarrhea, oral and perineal candidiasis, severe thrombocytopenia, and protein-caloric malnourishment. She evolved with sepsis, renal and cardiac failure. An rK rapid diagnosis test, indirect fluorescent antibody test (IFAT), and bone marrow aspirate were performed for VL. Her symptoms improved significantly after liposomal amphotericin B administration. From the 45 municipalities that compose the Regional Health Department of Presidente Prudente, Lutzomyia longipalpis vectors were found in 58% of them. VL infected dogs were found in 33% of those municipalities, infected dogs and humans were found in 29%, 20% are starting and 33% of the municipalities are preparing VL investigation. It is likely, in this patient, that VL advanced the clinical progression of the HIV disease and the development of AIDS severity. Supported by favorable conditions, the region becomes a new frontier of VL in Brazil.