Modeling of Human Rabies Cases in Brazil in Different Future Global Warming Scenarios.

Bat species have been observed to have the potential to expand their distribution in response to climate change, thereby influencing shifts in the spatial distribution and population dynamics of human rabies cases. In this study, we applied an ensemble niche modeling approach to project climatic suitability under different future global warming scenarios for human rabies cases in Brazil, and assessed the impact on the probability of emergence of new cases. We obtained notification records of human rabies cases in all Brazilian cities from January 2001 to August 2023, as reported by the State and Municipal Health Departments. The current and future climate data were sourced from a digital repository on the WorldClim website. The future bioclimatic variables provided were downscaled climate projections from CMIP6 (a global model ensemble) and extracted from the regionalized climate model HadGEM3-GC31-LL for three future socioeconomic scenarios over four periods (2021-2100). Seven statistical algorithms (MAXENT, MARS, RF, FDA, CTA, GAM, and GLM) were selected for modeling human rabies. Temperature seasonality was the bioclimatic variable with the highest relative contribution to both current and future consensus models. Future scenario modeling for human rabies indicated a trend of changes in the areas of occurrence, maintaining the current pace of global warming, population growth, socioeconomic instability, and the loss of natural areas. In Brazil, there are areas with a higher likelihood of climatic factors contributing to the emergence of cases. When assessing future scenarios, a change in the local climatic suitability is observed that may lead to a reduction or increase in cases, depending on the region.

Numerical simulation of the deadliest flood event of Portugal: Unravelling the causes of the disaster.

The flood event of November 25 and 26, 1967 corresponds to the deadliest storm affecting Portugal in recent centuries being responsible for >500 fatalities. The main trigger was the heavy rain that fell in just a few hours, provoking a rapid increase in river flows, although other concurrent circumstances had to occur to reach the dramatic water levels estimated in some affected places. However, even today, several important uncertainties related to water levels achieved and timing of floods remain. Here we aim to clarify some of the pending issues by applying suitable high performance numerical tools to elucidate the main conditioning factors that played a key role in the intensification of this dramatic flood. In particular, the analysis has been focused on Quintas village, the location most affected, where >100 fatalities were recorded, close to 2/3 of its total population at the time. The main conclusion provided by the numerical simulations was that a plugging of water flow downstream of Quintas village, favoured by a poor terrain maintenance coupled with the bottleneck created by topographic features, caused the critical over-elevation of water levels. Simulations also corroborate the rapid increase in water levels in Quintas village, with an estimated rise of >2 m in just two hours, as well as the occurrence of the flood during the night, preventing many people to be aware of the extreme danger they were facing and safeguarding themselves.

Modeling the Climatic Suitability of COVID-19 Cases in Brazil.

Studies have shown that climate may affect the distribution of coronavirus disease (COVID-19) and its incidence and fatality rates. Here, we applied an ensemble niche modeling approach to project the climatic suitability of COVID-19 cases in Brazil. We estimated the cumulative incidence, mortality rate, and fatality rate of COVID-19 between 2020 and 2021. Seven statistical algorithms (MAXENT, MARS, RF, FDA, CTA, GAM, and GLM) were selected to model the climate suitability for COVID-19 cases from diverse climate data, including temperature, precipitation, and humidity. The annual temperature range and precipitation seasonality showed a relatively high contribution to the models, partially explaining the distribution of COVID-19 cases in Brazil based on the climatic suitability of the territory. We observed a high probability of climatic suitability for high incidence in the North and South regions and a high probability of mortality and fatality rates in the Midwest and Southeast regions. Despite the social, viral, and human aspects regulating COVID-19 cases and death distribution, we suggest that climate may play an important role as a co-factor in the spread of cases. In Brazil, there are regions with a high probability that climatic suitability will contribute to the high incidence and fatality rates of COVID-19 in 2020 and 2021.

Using green to cool the grey: Modelling the cooling effect of green spaces with a high spatial resolution.

The urban heat island effect creates warmer and drier conditions in urban areas than in their surrounding rural areas. This effect is predicted to be exacerbated in the future, under a climate change scenario. One way to mitigate this effect is to use the urban green infrastructure as a way to promote the cooling island effect. In this study we aimed to model, with a high spatial resolution, how Mediterranean urban parks can be maximized to be used as cooling islands, by answering the following questions: i) which factors influence the cooling effect and when?; ii) what type of green spaces contributes the most to the cooling effect?; iii) what is the cooling distance of influence? To answer these questions we established a sampling design where temperature and relative humidity were measured in different seasons, in locations with contrasting characteristics of green and grey cover. We were able to model the effect of green and grey spaces in the cooling island effect and build high spatial resolution predicting maps for temperature and relative humidity. Our study showed that even green spaces with reduced areas can regulate microclimate, alleviating temperature by 1-3 °C and increasing moisture by 2-8%, on average. Green spaces with a higher density of trees were more efficient in delivering the cooling effect. The morphology, aspect and level of exposure of grey surfaces to the solar radiation were also important features included in the models. Green spaces influenced temperature and relative humidity up to 60 m away from the parks' limits, whereas grey areas influenced in a much lesser range, from 5 m up to 10 m. These models can now be used by citizens and stakeholders for green spaces management and human well-being impact assessment.

GO-DACT: a phase 3b randomised, double-blind, placebo-controlled trial of GOlimumab plus methotrexate (MTX) versus placebo plus MTX in improving DACTylitis in MTX-naive patients with psoriatic arthritis.

OBJECTIVES: To assess the efficacy of golimumab in combination with methotrexate (MTX) versus MTX monotherapy in psoriatic arthritis (PsA) dactylitis. METHODS: Multicentre, investigator-initiated, randomised, double-blind, placebo-controlled, parallel-design phase 3b trial in 11 Portuguese rheumatology centres. Patients with PsA along with active dactylitis and naive to MTX and biologic disease-modifying antirheumatic drugs (bDMARDs) were randomly assigned to golimumab or placebo, both in combination with MTX. The primary endpoint was Dactylitis Severity Score (DSS) change from baseline to week 24. Key secondary endpoints included DSS and Leeds Dactylitis Index (LDI) response, and changes from baseline in the LDI and MRI dactylitis score. Analysis was by intention-to-treat for the primary endpoint. RESULTS: Twenty-one patients received golimumab plus MTX and 23 MTX monotherapy for 24 weeks. One patient from each arm discontinued. Patient inclusion was halted at 50% planned recruitment due to a favourable interim analysis. Median baseline DSS was 6 in both arms. By week 24, patients treated with golimumab plus MTX exhibited significantly greater improvements in DSS relative to MTX monotherapy (median change of 5 vs 2 points, respectively; p=0.026). In the golimumab plus MTX arm, significantly higher proportions of patients achieved at least 50% or 70% improvement in DSS and 20%, 50% or 70% improvement in LDI in comparison to MTX monotherapy. CONCLUSIONS: The combination of golimumab and MTX as first-line bDMARD therapy is superior to MTX monotherapy for the treatment of PsA dactylitis. TRIAL REGISTRATION NUMBER: NCT02065713.

The GO-DACT protocol: a multicentre, randomized, double-blind, parallel-group study to compare the efficacy of golimumab in combination with methotrexate (MTX) versus MTX monotherapy.

The GO-DACT is an investigator-initiated, national, multicentric randomized placebo-controlled double-blinded trial, that assesses dactylitis as primary endpoint. Psoriatic arthritis patients naïve to methotrexate and biologic disease modifying anti-rheumatic drugs, with at least one active dactylitis, were assigned to golimumab in combination with methotrexate or placebo in combination with methotrexate, for 24 weeks. Both clinical (dactylitis severity score and the Leeds dactylitis index) and imaging (high resolution magnetic resonance imaging), among others, were assessed as outcomes. The main objective of GO-DACT is to provide evidence to improve the treatment algorithm and care of psoriatic arthritis patients with active dactylitis. In this manuscript we describe the GO-DACT protocol and general concepts of the methodology of this trial.

Temporal relationship between environmental factors and the occurrence of dengue fever.

To determine the time-lag effect of meteorological factors on the relative risk (RR) of dengue incidence in Coronel Fabriciano city, Brazil, we applied a distributed lag nonlinear model, a modeling framework that can simultaneously represent nonlinear exposure-response dependencies and delayed effects, to establish the association between dengue incidence and weather predictors. The weekly number of notified dengue cases during the period 2004-2010 was used for analysis. When considering the rainfall, the highest RR (1.2) was observed for lag 10. Observing the cumulative effect of the precipitation, the RR for 12th and 13th week was RR = 4. The highest risk, 1.25, was observed at 25 °C, denoting that the risk of dengue transmission increases with temperature. Climate-based models that take into account the time lag between rainfall, temperature, and dengue can be useful in dengue control programs to be applied in tropical countries.

Os efeitos do crescimento urbano sobre a dengue / The effects of urban growth on dengue / Los efectos del crecimiento urbano sobre la dengue

Analisar a dinâmica espacial e temporal da dengue em Coronel Fabriciano, Minas Gerais, Brasil, e associar os casos ao crescimento das áreas urbanas e à perda de áreas naturais nos últimos anos. Métodos: Trata-se de um estudo descritivo, exploratório, de abordagem quantitativa. Os casos de dengue relativos a 2009 foram obtidos na Secretaria Municipal, incluindo-se os suspeitos e os confirmados. Obtiveram-se shape files contendo informações sobre o limite municipal, limite da área urbana, setores censitários, áreas com construções e áreas naturais. Com base na distribuição dos casos, o estimador de Kernel foi utilizado para medir sua dispersão. Resultados: Casos de dengue notificados foram georreferenciados em ambiente SIG (Sistema de Informações Geográficas). A paisagem mostrou mudanças nas unidades de zona urbana e pastagem, assim como crescimento urbano sobre a matriz de pastagem. Não foram observadas alterações nas áreas de floresta remanescente e eucalipto. Há casos distribuídos espacialmente com uma tendência a formar aglomerados. Conclusão:Observaram-se casos de dengue espacialmente agrupados na região norte da cidade, onde novos bairros surgiram nos últimos anos, acompanhando o crescimento populacional sem estrutura adequada de urbanização e planejamento. Além disso, o crescimento urbano reduziu a margem de cursos d?água e forneceu um solo nu, adequado para o acúmulo de lixo e a formação de criadouros de mosquitos. Fica mais uma vez constatado que políticas públicas eficientes e planejamento urbano adequado podem reduzir o impacto da dengue em regiões endêmicas...

To analyze the spatial and temporal dynamics of dengue in Coronel Fabriciano, Minas Gerais State, Brazil, and to associate cases to the growth of urban areas and loss of natural areas in recent years. Methods: This is a descriptive, exploratory study, with a quantitative approach. Dengue cases of 2009 were obtained from the Health Municipal Secretariat, including the suspected and confirmed cases. Shape files were obtained, containing information about the municipal boundary, boundary of the urban area, census tracts, areas with buildings and natural areas. Based on the distribution of dengue cases, the Kernel estimator was used to measure data dispersion. Results: Dengue cases reported were georeferenced in GIS (Geographic Information System) environment. The landscape showed changes in the units of urban area and pasture, as an urban growth over the pasture matrix. No changes were observed in the areas of remaining forest and eucalyptus. There are cases spatially spread with a tendency to form clusters. Conclusion: Cases of dengue were observed spatially clustered in the northern region of the city, where new neighborhoods have emerged in recent years, following the population growth without proper structure of urbanization and urban planning. In addition, urban growth have reduced the margin of watercourses providing a bare soil, suitable for accumulation of trash and formation of breeding sites for mosquitoes. Efficient public policies and appropriate urban planning might reduce the impact of dengue in endemic regions...

Analizar la dinámica espacial y temporal de la dengue en Coronel Fabriciano, Minas Gerais, Brasil, y asociar los casos al crecimiento de las áreas urbanas y la pérdida de áreas naturales en los últimos años. Métodos: Se trata de un estúdio descriptivo, exploratorio, de abordaje cuantitativo. Los casos de dengue relativos a 2009 fueron obtenidos de la Secretaria Municipal incluyéndose los sospechosos y los confirmados. Se obtuvieron shape files conteniendo informaciones sobre el limite municipal, límite de área urbana, sectores censitarios, áreas com construcciones y áreas naturales. Basado en la distribución de los casos, el estimador de Kernel fue utilizado para medir su dispersión. Resultados: Los casos de dengue notificados fueron georeferenciados en ambiente SIG (Sistema de Informaciones Geográficas). El paisaje mostró cambios en las unidades de zona urbana y pasto así como el crecimiento urbano sobre la matriz de pasto. No fueron observadas alteraciones en las áreas de floresta remaneciente y de eucalipto. Hay casos distribuidos espacialmente con una tendencia a formar aglomerados. Conclusión: Se observaron casos de dengue espacialmente agrupados en la región norte de la ciudad donde nuevos barrios surgieron en los últimos años acompañando el crecimiento poblacional sin estructura adecuada de urbanización y planeamiento. Además, el crecimiento urbano redujo el margen de cursos de agua y forneció un suelo desnudo adecuado para el acumulo de basura y la formación de criaderos de mosquitos. Se queda una vez más constatado que políticas públicas eficientes y planeamiento urbano adecuado pueden reducir el impacto de la dengue en regiones endémicas...

2011 Portuguese recommendations for the use of biological therapies in patients with psoriatic arthritis.

OBJECTIVE: To develop recommendations for the treatment of psoriatic arthritis (PsA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. METHODS: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. A draft of the recommendations was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft. At a national meeting the recommendations were discussed and all attending rheumatologists voted on the level of agreement for each recommendation. A second draft was again circulated before publication. RESULTS: A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with PsA. Specific recommendations were developed for several disease domains: peripheral arthritis, axial disease, enthesitis and dactylitis. CONCLUSION: These recommendations may be used for guidance in deciding which patients with PsA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.