Spatial and Temporal Dynamics of Chikungunya Incidence in Brazil and the Impact of Social Vulnerability: A Population-Based and Ecological Study.

To assess the temporal and spatial dynamics of chikungunya incidence and its association with social vulnerability indicators in Brazil, an ecological and population-based study was conducted herein, with confirmed cases of chikungunya and based on clinical and clinical-epidemiological criteria from 2017 to 2023. Data were obtained from the Notifiable Diseases Information System and social vulnerability indicators were extracted from the official platform of the United Nations Development Program and the Social Vulnerability Atlas. Temporal, spatial, and global spatial regression models were employed. The temporal trend showed that in 2017, the incidence increased by 1.9%, and this trend decreased from 2020 to 2021 (-0.93%). The spatial distribution showed heterogeneity and positive spatial autocorrelation (I: 0.71; p < 0.001) in chikungunya cases in Brazil. Also, the high-risk areas for the disease were concentrated in the northeast and north regions. The social vulnerability indicators associated with the outcome were those related to income, education, and housing conditions. Our analyses demonstrate that chikungunya continues to be a serious health concern in Brazil, but specially in the northeast and north regions. Lastly, mapping risk areas can provide evidence for the development of public health strategies and disease control in endemic regions.

Magnitude of visceral leishmaniasis and HIV coinfection and association with social determinants of health in the Northeast region of Brazil: a retrospective, spatiotemporal model (2010-2018).

The Northeast region of Brazil (NRB) includes the states with the highest prevalence of visceral leishmaniasis (VL), as well as those with significant increases in HIV cases. This study aims to analyze the spatiotemporal patterns of VL-HIV coinfection and its association with the social determinants of health (SDH) in the NRB. Time trend analysis and Bayesian spatial statistical inferences, Moran's autocorrelation, and retrospective space-time scanning were performed. Spatial regression modelling was used to build an explanatory model for the occurrence of VL-HIV coinfection within NRB. A total of 1550 cases of VL-HIV coinfection were confirmed. We observed a higher prevalence among males (1232; 83%), individuals aged from 20 to 59 years (850; 54.8%), non-white skin color (1,422; 91.7%), and with low education (550; 35.48%). NRB showed an increasing and significant trend in the detection rate of coinfection (APC, 5.3; 95% CI, 1.4 to 9.4). The states of Maranhão and Piauí comprised the high-risk cluster. The SDH that most correlated with the occurrence of coinfection were poor housing, low income, and low education. VL-HIV is dispersed in the NRB but chiefly affects states with greater social vulnerability. Taken together, these findings reinforce the necessity to implement surveillance strategies that will contribute to the reduction of cases in these populations.

Association between frailty phenotype, quantification of plasma HIV-1 RNA, CD4 cell count and HAART in HIV-positive subjects: a systematic review and meta-analysis of observational studies.

HIV infection causes a constant activation of the immune system and contributes to an enhanced systemic pro-inflammatory cytokine milieu, which has been associated with premature aging and frailty. We performed a systematic review and meta-analysis to analyze whether the HIV-1 RNA load, CD4+ T-lymphocyte counts and exposure to HAART in HIV-positive subjects are associated with frailty phenotype. Searches were performed in PubMed, SCOPUS, Lilacs, Web of Science, Google Scholar, and OpenThesis databases. We used the odds ratio as a measure of the association. We used either a fixed or random-effects model to pool the results of individual studies depending on the presence of heterogeneity. Eleven studies were included in the review. Data from 8035 HIV-positive subjects were analyzed; 2413 of the subjects had viral load detectable, 981 had a CD4T-cell count <350 cells/µL, and 1342 had HAART exposure information. We found an association between frailty and CD4T-cell count <350 cells/µL (OR 2.68, CI 95% 1.68-4.26, I2 = 46%), HIV-1 RNA load detectable (OR 1.71, CI 95% 1.38-2.12, I2 = 0%), and protease inhibitor-containing HAART regimen (OR 2.21, CI 95% 1.26-3.89, I2 = 0%). Further studies are necessary to evaluate the effects of other factors on the development of clinical features related to frailty.

Risk clusters of Schistosoma mansoni infection in an endemic state of Brazil: space-time modelling and association with socio-economic and environmental factors.

BACKGROUND: We analysed the spatial distribution and the socio-economic and environmental factors (SEFs) associated with Schistosoma mansoni infection in the state of Alagoas, an important tourist area in northeastern Brazil. METHODS: We conducted an ecological time-series study (2007-2016) on schistosomiasis cases and SEFs. We evaluated the temporal trends of schistosomiasis cases (annual percentage change [APC]) and their correlation with SEFs. Spatial analysis maps were built using QGIS and TerraView software. RESULTS: We observed that 4.9% of the municipalities had a high prevalence of S. mansoni infection and were located mainly in the coastal strip of Alagoas state. The positivity rate for schistosomiasis decreased during the period (8.1% in 2007 to 4.9% in 2016; APC=-5.71). There was a reduction in the number of tests performed (APC=-5.05). There was a negative correlation between S. mansoni infection and the municipal human development index (ρ=-0.34) and schooling rate (ρ=-0.24). The main species of snail was Biomphalaria glabrata (94.79%), but Biomphalaria straminea showed a higher percentage of S. mansoni detection (10.11%). Lastly, Biomphalaria tenagophila specimens were identified for the first time in Alagoas (n=28). CONCLUSIONS: Despite a reduction in the number of cases, intestinal schistosomiasis still represents a serious public health concern in Alagoas. It urgently requires planning and improvements in diagnosis, prevention programs and the state's socio-economic indicators.

Basic and associated causes of schistosomiasis-related mortality in Brazil: A population-based study and a 20-year time series of a disease still neglected.

BACKGROUND: Schistosomiasis is a persistent public health problem in Brazil. Regardless advances in diagnosis and mass treatment, schistosomiasis has a severe impact on morbimortality in the country and remains a neglected tropical disease. Herein, we assessed the basic and associated causes of schistosomiasis-related deaths and the temporal and spatial patterns of mortality from the disease in Brazil between 1999 and 2018. METHODS: We conducted an ecological and time series study. The segmented log-linear regression model was applied to assess time trends, considering all deaths recorded in the category B65/ICD-10. Additionally, we elaborated maps of mortality rates from schistosomiasis in Brazil. RESULTS: A total of 4168 schistosomiasis-related deaths were recorded in Brazil in this period, as an associated cause. Time trend analysis revealed an increase in the average age of deaths from schistosomiasis (annual percentage change (APC) = 0.84), and stable trend in Brazil (APC = 0.31). Concerning schistosomiasis-related deaths, we observed disorders related to the digestive system, liver diseases, septicemias, and chronic diseases. Surprisingly, there were deaths caused by non-endemic Schistosoma species in Brazil. Also, municipalities from non-endemic areas in Brazil presented schistosomiasis-related deaths. CONCLUSION: Altogether, our analyses demonstrated that schistosomiasis remains a significant cause of death in Brazil, and it is increasing in some areas, especially in the Northeast region. Additionally, women and the elderly showed a stable time trend of deaths. Thereby, it urgently requires improvements in the control programs strategies, in the sense of an effective reduction in cases and deaths from the disease in Brazil.

Early identification of individuals at risk for loss to follow-up of tuberculosis treatment: A generalised hierarchical analysis.

BACKGROUND: We characterise the loss to follow-up (locally termed abandoned) of tuberculosis treatment with individual and ecological health determinants and to identify the predictive capacity of these risk factors. METHODS: A cohort study with individual and ecological characterisation of patients diagnosed with tuberculosis in Sergipe/Brazil from 2015 to 2018 with either loss to follow-up or completion of treatment as a therapeutic outcome was performed. The examined variables were based on the social determinants of health with descriptive analysis, binary logistic regression, a generalised hierarchical model and graphical presentation using a nomogram. RESULTS: The loss to follow-up accounted for 18.21% of the 2,449 studied cases. The characteristics revealed that the highest abandonment percentages were people who: were male (20.0%), had black skin colour (20.3%), were aged 20-39 years (21.8%), had 4-7 years of schooling (23.6%), re-entered treatment after abandonment (36.5%), used alcohol (31.0%), used drugs (39.3%), were smokers (26.5%) and were homeless (55.4%). The ecological characteristics showed that individuals living in municipalities with a high human development index (HDI; odds ratio [OR]: 1.91) and high-income inequality (OR: 1.81) had a greater chance of not finishing the treatment. Most of these variables were identified as predictors in the generalised hierarchical model; the receiver operating characteristic curve (ROC) curve had 0.771 precision and 84.0% accuracy. CONCLUSION: The group of identified characteristics influenced the loss to follow-up of tuberculosis treatment. This data provides evidence for the early identification of individuals who are at greater risk of abandoning tuberculosis treatment.

Population-based, spatiotemporal modeling of social risk factors and mortality from schistosomiasis in Brazil between 1999 and 2018.

Schistosomiasis remains a significant public health concern in Brazil. To identify areas at, and social determinants of health (SDH) associated with, high-risk for schistosomiasis-related mortality from Brazil, we conducted a spatial and spatiotemporal modeling assessing all deaths confirmed in Brazil between 1999 and 2018. We used the segmented log-linear regression model to assess temporal trends, and the local empirical Bayesian estimator, the Global and Local Moran Index for spatial analysis. A total of 12,251 schistosomiasis-related deaths were reported in this period. Within the Mortality Information System (SIM) of the Brazilian Ministry of Health, the states of Alagoas (AL), Pernambuco (PE) and Sergipe (SE) recording the highest mortality rates: 2.21, 1.92 and 0.80 deaths/100,000 inhabitants, respectively. Analyses revealed an increase in the mean age of schistosomiasis-related deaths over the time assessed (APC = 0.9; p-value<0.05). Spatial analysis identified a concentration of municipalities presenting high risk of schistosomiasis-related mortality along the coastline of PE and AL. Similarly, we identified the formation of high space-time clusters in municipalities in the states of PE, AL, SE, Bahia, and Minas Gerais. Finally, mortality rates showed a significant correlation with 96.96% of SDH indices. The data reveal additional important changes in schistosomiasis-related deaths in Brazil between 1999 and 2018, such as a slow reduction among males (unlike females that displayed no change). Regardless, our analyses indicates that schistosomiasis continues to have the greatest detrimental impact in poor regions of Brazil and suggest the need for enhancement of current control measures to accelerate progress.

Space-time risk cluster of visceral leishmaniasis in Brazilian endemic region with high social vulnerability: An ecological time series study.

BACKGROUND: Despite visceral leishmaniasis (VL) being epidemic in most Brazilian regions, the Northeast region is responsible for the highest morbidity and mortality outcomes within the country. OBJECTIVE: To analyse the spatiotemporal dynamics of VL cases to identify the temporal trends and high-risk areas for VL transmission, as well as the association of the disease with social vulnerability in Brazilian Northeast. METHODS: We carried out an ecological time series study employing spatial analysis techniques using all VL confirmed cases of 1,794 municipalities of Brazilian Northeast between the years 2000 to 2017. The Social Vulnerability Index (SVI) was used to represent the social vulnerability. Incidence rates were standardized and smoothed by the Local Empirical Bayesian Method. Time trends were examined through segmented linear regression. Spatiotemporal analysis consisted of uni- and bivariate Global and Local Moran indexes and space-time scan statistics. RESULTS: Incidence rate remained stable and ranged from 4.84 to 3.52 cases/100,000 inhabitants. There was higher case prevalence between males (62.71%), children and adolescents (63.27%), non-white (69.75%) and urban residents (62.58%). Increasing trends of new cases were observed among adult male subjects (≥ 40 years old) and urban residents. Importantly, VL incidence showed a direct spatial dependence. Spatial and space-time clusters were identified in sertão and meio-norte sub-regions, overlapping with high social vulnerability areas. CONCLUSIONS: VL is a persistent health issue in Brazilian Northeast and associated with social vulnerability. Space-time clustering of VL cases in socially vulnerable municipalities demands intersectoral public policies of surveillance and control, with focus on reducing inequalities and improving living conditions for regional inhabitants.

Spatial and spatiotemporal dynamics of visceral leishmaniasis in an endemic North-eastern region of Brazil.

Visceral Leishmaniasis (VL) is a neglected disease with increasing incidence in Brazil, particularly in the North-eastern. The aim of this study was to analyze the spatial and spatiotemporal dynamics of VL in an endemic region of North-eastern Brazil, between 2009 and 2017. Using spatial analysis techniques, an ecological and time series study was made regarding VL cases in Sergipe filed as notifiable disease events. With data from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE), a digital population and cartographic baseline was established. Segmented linear regression was used to examine the temporal trends. The statistical analysis methods of Global and Local Moran' I, local Bayesian empirical methodology and spatial-temporal scanning were used to produce thematic maps. High instances were found among adults, males, urban residents, non-Whites and persons with low levels of education. A decrease in the recovery rate and an increase in the proportion of urban cases and lethality was found. A heterogeneous VL distribution with spatiotemporal agglomeration on the seaside of the state was seen in Sergipe. To better manage the disease, new research is encouraged together with development of public health strategies. Further, improving health care networks, especially primary care, is suggested as this approach has a key role in health promotion, prevention and monitoring of the most prevalent diseases.

Spatial patterns and temporal tendency of mortality related to Chagas disease in an endemic area of northeastern Brazil.

OBJECTIVE: To analyse spatial patterns and the temporal tendency of mortality related to Chagas disease, in order to identify priority control areas in the state of Sergipe, Northeast Brazil. METHODS: We conducted an ecological and time-series study with spatial analysis techniques on deaths from Chagas disease in the state of Sergipe (1996-2016). We used data from the Mortality Information System (SIM). The temporal analysis was performed using a statistical technique capable of describing changes in the trend pattern for the period. Thematic maps were elaborated from point and polygonal analyses. RESULTS: There were 247 deaths related to Chagas disease, with a mean of 11.7 deaths/year, most of them male (64%), and aged 50-59 years (21%) and 60-69 years (26%). Two segments with increasing, non-constant and significant trends were identified: 1996-2005 (APC = 21.6%; P = 0.01) and 2005-2016 (APC = 4.4%; P = 0.01), with APPC = 11.8% (P = 0.01). A positive and significant spatial autocorrelation with areas of higher risk of death was found in the southern region of the state. CONCLUSIONS: The trend of mortality related to Chagas disease in the state of Sergipe was increasing during the period analysed, with a heterogeneous distribution of cases. A main risk area was identified in the southern region of the state.

OBJECTIF: Analyser les profils spatiaux et la tendance temporelle de la mortalité liée à la maladie de Chagas, afin d'identifier les domaines de priorité de lutte dans l'Etat de Sergipe, dans le nord-est du Brésil. MÉTHODES: Nous avons mené une étude écologique et de séries chronologiques avec des techniques d'analyse spatiale sur les décès dus à la maladie de Chagas dans l'état de Sergipe (1996-2016). Nous avons utilisé les données du système d'information sur la mortalité (SIM). L'analyse temporelle a été réalisée à l'aide d'une technique statistique capable de décrire les changements dans le profil de tendance pour la période. Des cartes thématiques ont été élaborées à partir d'analyses ponctuelles et polygonales. RÉSULTATS: Il y a eu 247 décès liés à la maladie de Chagas, avec une moyenne de 11,7 décès/an, pour la plupart de sexe masculin (64%), et âgés de 50 à 59 ans (21%) et de 60 à 69 ans (26%). Deux segments avec des tendances à la hausse, non constantes et significatives ont été identifiés: 1996-2005 (APC = 21,6%; p = 0,01) et 2005-2016 (APC = 4,4%; p = 0,01), avec APPC = 11,8% (p = 0,01). Une autocorrélation spatiale positive et significative avec des zones à haut risque de décès a été trouvée dans la région sud de l'Etat. CONCLUSIONS: La tendance de la mortalité liée à la maladie de Chagas dans l'état de Sergipe a augmenté au cours de la période analysée , avec une répartition hétérogène des cas. Une principale zone à risque a été identifiée dans la région sud de l'Etat.

Determining the association between dengue and social inequality factors in north-eastern Brazil: A spatial modelling.

Dengue is a global public health problem. The Dengue Virus (DENV) serotypes are transmitted by an Aedes aegypti mosquito. Vector control is among the primary methods to prevent the disease, especially in tropical countries. This study aimed to analyze the spatial distribution of dengue and its relationship with social inequalities using spatial modelling. An ecological study with temporal and spatial analysis was conducted in the state of Sergipe, Northeast Brazil, over a period of 18 years. Spatial modelling was used to determine the influence of space on dengue incidence and social inequalities. The epidemic rates in 2008, 2012, and 2015 were identified. Spatial modelling explained 40% of the influence of social inequalities on dengue incidence in the state. The main social inequalities related to the occurrence of dengue were the percentage of people living in extreme poverty and inadequate sanitation. The epidemic situation even increased the risk of dengue in the population of the state of Sergipe. These results demonstrate the potential of spatial modelling in determining the factors associated with dengue epidemics and are useful in planning the intersectoral public health policies.

Spatial analysis of cerebral palsy in children and adolescents and its association with health vulnerability.

Cerebral Palsy (CP) is commonly associated with low socioeconomic status. Use of spatial statistics and a Geographic Information Systems (GIS) are scarce and may contribute to the understanding of CP in a social context. To that end a spatial analysis of CP in children and adolescents was performed to analyze the association of CP with levels of vulnerability in a city (Aracaju, Sergipe) in north-eastern Brazil. In addition, an ecological study was conducted with data obtained from a populationbased survey and secondary data. Exploratory spatial data analysis and linear regression were used. A total of 288 CP cases were identified, with a prevalence of 1.65/1,000 and differences among city neighbourhoods ranging from 0-4/1,000. The mean age of cases studied was 9 years 1 month, with a standard deviation of 5 years 2 months. Most study subjects with cerebral palsy (163) were male (56.4%). The distribution of CP in the study population was not homogeneous throughout the territory. Some areas had clusters, with more cases associated with areas of high vulnerability. Spatial data analysis using GIS was useful to gain an epidemiological understanding of CP distribution that can guide decisionmaking with respect to production, distribution, and regulation of health goods as well as services at the local level.

Determinants associated with areas with higher tuberculosis mortality rates: an ecological study.

OBJECTIVE: To characterise tuberculosis deaths in a region of northeast Brazil during the period from 2006 to 2017 and to identify determinants associated with areas with higher tuberculosis mortality rates. METHODS: Ecological descriptive study of deaths from tuberculosis with multivariate mapping and logistic regression, carried out from 2006 to 2017 in the 75 municipalities of Sergipe, Brazil. The focus of the analysis was the mean mortality rate from tuberculosis, dichotomised according to the median. The independent variables were selected based on the conceptual model of the social determinants of health. RESULTS: Mortality due to tuberculosis in Sergipe, Brazil, was most prevalent among males, mixed-race people, and people over 40 years old and with a low level of education. Multivariate logistic regression identified the mean incidence rate for tuberculosis (aOR: 1.06), the proportion of HIV testing (aOR: 7.10), people without primary education and with informal occupation (aOR: 1.26) and people living in urban households without waste collection service (aOR: 0.10) as determinants associated to municipalities with higher tuberculosis mortality rates, with area under the ROC curve of 84% (P-value 0.000). Mapping revealed evident spatial variability. CONCLUSIONS: The tuberculosis epidemic in Brazil is determined by access to health services, especially the provision of HIV testing among those diagnosed with tuberculosis, accelerated urbanisation with large pockets of poverty and unsanitary housing conditions, corroborating global trends.

OBJECTIF: Caractériser les décès dus à la tuberculose dans une région du nord-est du Brésil au cours de la période de 2006 à 2017 et identifier les déterminants associés aux zones où les taux de mortalité par tuberculose sont plus élevés. MÉTHODES: Etude descriptive écologique des décès par tuberculose avec une cartographie multivariée et une régression logistique, réalisée de 2006 à 2017 dans les 75 municipalités de Sergipe, au Brésil. L'analyse était axée sur le taux moyen de mortalité par tuberculose, dichotomisé selon la médiane. Les variables indépendantes ont été sélectionnées sur la base du modèle conceptuel des déterminants sociaux de la santé. RÉSULTATS: La mortalité due à la tuberculose à Sergipe, au Brésil, était plus fréquente chez les hommes, les personnes métissées, les personnes de plus de 40 ans et avec un faible niveau d'éducation. La régression logistique multivariée a identifié le taux moyen d'incidence de la tuberculose (aOR: 1,06), la proportion des tests de dépistage du VIH (aOR: 7,10), les personnes sans éducation primaire et occupant une fonction informelle (aOR: 1,26) et les personnes vivant dans des ménages en milieu urbain sans service de collecte des déchets (aOR: 0,10) comme étant des déterminants associés aux municipalités avec des taux de mortalité par tuberculose plus élevés, avec une aire sous la courbe ROC de 84 % (p=0,000). La cartographie a révélé une variabilité spatiale évidente. CONCLUSIONS: L'épidémie de tuberculose au Brésil est déterminée par l'accès aux services de santé, en particulier la fourniture des tests de dépistage du VIH chez les personnes diagnostiquées avec la tuberculose, l'urbanisation accélérée avec de grandes poches de pauvreté et les conditions de logement insalubres, corroborant les tendances mondiales.

Spatial and temporal analysis of tuberculosis in an area of social inequality in Northeast Brazil.

BACKGROUND: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It is a disease known worldwide for its vulnerability factors, magnitude and mortality. The objective of the study was to analyze the spatial and temporal dynamics of TB in the area of social inequality in northeast Brazil between the years 2001 and 2016. METHODS: An ecological time series study with the use of spatial analysis techniques was carried out from 2001 to 2016. The units of analysis were the 75 municipalities in the state of Sergipe. Data from the Notification of Injury Information System were used. For the construction of the maps, the cartographic base of the state of Sergipe, obtained at the Instituto Brasileiro de Geografia e Estatística, was used. Georeferenced data were analysed using TerraView 4.2.2 software (Instituto Nacional de Pesquisas Espaciais) and QGis 2.18.2 (Open Source Geospatial Foundation). Spatial analyses included the empirical Bayesian model and the global and local Moran indices. The time trend analyses were performed by the software Joinpoint Regression, Version 4.5.0.1, with the variables of sex, age, cure and abandonment. RESULTS: There was an increasing trend of tuberculosis cases in patients under 20 years old and 20-39 years old, especially in males. Cured cases showed a decreasing trend, and cases of treatment withdrawal were stationary. A spatial dependence was observed in almost all analysed territories but with different concentrations. Significant spatial correlations with the formation of clusters in the southeast and northeast of the state were observed. The probability of illness among municipalities was determined not to occur in a random way. CONCLUSION: The identification of risk areas and priority groups can help health planning by refining the focus of attention to tuberculosis control. Understanding the epidemiological, spatial and temporal dynamics of tuberculosis can allow for improved targeting of strategies for disease prevention and control.

Tendência temporal e características epidemiológicas da tuberculose em um município do nordeste do Brasil / Tendencia en el tiempo y características epidemiológicas de la tuberculosis en un municipio del noreste de Brasil / Trend temporary and epidemiological characteristics of tuberculosis in a municipality of northeast Brazil

RESUMO Introdução: A tuberculose é uma doença infecciosa considerada um grave problema de saúde pública no Brasil, com elevadas prevalências nas regiões Norte, Nordeste e Centro-oeste. Objetivo: Analisar a tendência temporal e descrever as características clínico-epidemiológicas dos casos de tuberculose no município de Lagarto/SE, Nordeste do Brasil. Métodos: Foi realizado um estudo descritivo, retrospectivo e de série temporal, por meio de dados secundários dos casos de tuberculose notificados entre o período de 2002 e 2012. As fontes de dados utilizadas foram as fichas de investigação do Sistema de Informação de Agravos de Notificação (SINAN). Analisaram-se as tendências temporais por sexo e faixa etária através de regressão linear, considerando-se p< 0,05. Resultados: Foram notificados 315 casos de tuberculose, sendo a taxa média de incidênciade 30,15 casos para cada 100 mil habitantes. Houve um decréscimo (31 porcento) da taxa de incidência, variando de 31,51(2002) para 21,74(2012). Observou-se predomínio do sexo masculino (65,4 porcento), adultos jovens (61 porcento), casos novos (84,1 porcento), forma pulmonar (84,4 porcento), bacilíferos (66,98 porcento) e ocorrência de 05 casos (1,59 porcento) de coinfecção TB/HIV. No tocante a tendência, foi observada uma redução significativa para o sexo feminino (p=0,015) e em idosos (p=0,04). Conclusões: Apesar das variações anuais nas taxas, foi perceptível uma tendência decrescente da incidência de casos de tuberculose no município de Lagarto/SE. Torna-se importante manter e intensificar as intervenções de controle, com prioridades estratégicas focadas na busca ativa de sintomáticos respiratórios, sobretudo em localidades de difícil acesso aos serviços de saúde(AU)

RESUMEN Introducción: La tuberculosis es una enfermedad infecciosa considerada un problema grave de salud pública en Brasil, con una alta prevalencia en el norte, noreste y medio oeste. Objetivo: Analizar las tendencias en el tiempo y describir las características clínicas y epidemiológicas de los casos de tuberculosis en la ciudad de Lagarto/SE, noreste de Brasil. Métodos: Se realizó un estudio descriptivo, retrospectivo y series de tiempo, el uso de datos secundarios de los casos de tuberculosis notificados entre el período 2002 y 2012. Las fuentes de datos utilizadas fueron los registros Sistema de Información de Enfermedades de Declaración Obligatoria (SINAN). Las tendencias temporales se analizaron por sexo y grupo de edad por regresión lineal, considerando p <0,05. Resultados: Se reportaron 315 casos de tuberculosis, y la tasa media de incidencia de 30,15 casos por cada 100 mil habitantes. Hubo una disminución (31 por ciento) se la tasa de incidencia que oscila entre 31,51 (2002) a 21,74 (2012). Hubo un predominio del sexo masculino (65,4 por ciento), adultos jóvenes (61 por ciento), nuevos casos (84,1 por ciento), forma pulmonar (84,4 por ciento), la tuberculosis activa (66,98 por ciento) y la ocurrencia de 05 casos (1,59 por ciento) con coinfección con el TB/HIV. En cuanto a la tendencia se observada reducción significativa para las mujeres (p = 0,015) y mayores (p = 0,04). Conclusiones: A pesar de las variaciones anuales de las tasas, fue notable una tendencia a la baja en la incidencia de casos de tuberculosis en la ciudad de Lagarto / SE. Es importante mantener e intensificar las intervenciones de control con las prioridades estratégicas centradas en la búsqueda activa de sintomáticos respiratorios, especialmente en lugares de difícil acceso a los lugares de servicios de salud(AU)

ABSTRACT Introduction: Tuberculosis is an infectious disease considered a serious public health problem in Brazil, with high prevalence in the North, Northeast and Midwest. Objective: To analyze time trends and describe the clinical and epidemiological features of tuberculosis cases in the city of Lagarto/SE, Northeast Brazil. Methods: We conducted a descriptive, retrospective and time series study, using secondary data of tuberculosis cases notified entre the period 2002 and 2012. The data sources used were the investigation chips of Information System of Notification of Diseases (SINAN). Temporal trends were analyzed by sex and age group by linear regression, considering p <0.05. Results: 315 cases of tuberculosis were reported, and the average incidence rate of 30.15 cases per 100 thousand inhabitants. There was a decrease (31 percent) the incidence rate ranging from 31.51 (2002) to 21.74 (2012). There was a predominance of males (65.4 percent), young adults (61 percent) new cases (84.1 percent), pulmonary form (84.4 percent), active tuberculosis (66.98 percent) and the occurrence of 05 cases (1.59 percent) coinfection with TB/HIV. Regarding the trend was observed a significant reduction for females (p = 0.015) and older (p = 0.04). Conclusions: Despite annual variations in rates, a downward trend in the incidence of tuberculosis cases in the city of Lagarto/SE was noticeable. It is important to maintain and intensify control interventions with strategic priorities focused on active search for respiratory symptoms, especially in difficult to access to health services locations(AU)

Trend and spatial analysis of prostate cancer mortality in the state of Sergipe, Brazil.

This is an ecological study with exploratory analysis of spatial and temporal data based on mortality data with respect to prostate cancer obtained from the Mortality Information System concerning residents of the state of Sergipe, Brazil between 2000 and 2015. The analysis of temporal trends was performed using the Joinpoint Regression Program through Poisson regression. Spatial analysis was performed using the empirical Bayesian model, Kernel analysis, Global Moran and Local indices. There were 1,986 deaths due to prostate cancer, most of which occurring after 60 years of age. An increasing, non-constant but significant trend in mortality rates was noted. The kernel density estimator showed hotspot densities of the highest rates of prostate cancer mortality in the north-eastern and central regions of the state. High-risk clusters were identified for prostate cancer mortality (I = 0.55, P<0.01). There was an increase in prostate cancer mortality rates and a heterogeneous geographic distribution of risk areas, with high-risk priority areas identified in certain regions of the state. These priority areas include the municipalities located in the Northeast (Amparo do São Francisco, Aquidabã, Canhoba, Cedro de São João and Telha), the West (Frei Paulo and Pedra Mole) and the south-western region of the state (Poço Verde and Simão Dias).

Development of an experimental model of schistosomal myeloradiculopathy.

Schistosomal myeloradiculopathy (SMR) is a severe form of presentation of schistosomiasis in which Schistosoma spp. affect the spinal cord. The aims of the present study were to develop an animal model of SMR caused by S. mansoni, to characterize both sensory and motor abnormalities in the infected animals, and to investigate the relationship of the sensory, motor and histological findings with the progression of the infection over time. Mechanical sensitivity and behavioral tests were performed followed by euthanasia in male Wistar rats divided into six groups of five animals each, on days 5, 10, 20 and 30 after infection of S. mansoni eggs. The controls were subjected to the same procedure but were administered phosphate-buffered saline (PBS). The spinal cord was removed and subjected to histological analysis. S. mansoni eggs were found in the spinal cord of 25% of the infected animals, which belonged to the groups that exhibited more significant reduction of the superficial mechanical sensitivity, thermal sensitivity and muscle strength. This model proved to be satisfactory to assess functional changes in Wistar rats and might be used in studies investigating the pathogenesis of SMR. To our knowledge, this is the first experimental model of SMR.

Análise do grau de implantação (GI) do programa de controle da esquistossomose mansônica (PCE) em um município endêmico do estado de Sergipe, Brasil / Implementation extent (IE) analysis of a schistosomiasis control program (SCP) in an endemic town in Sergipe, Brazil

Resumen:

Introducción/objetivo: la esquistosomiasis es endémica en varias regiones de Brasil, principalmente en el noreste, y tiene un fuerte impacto en la salud pública. El objetivo del estudio fue analizar el grado de implantación (GI) del Programa de Control de la Esquistosomiasis (PCE) en un municipio de la región centro-sur de Sergipe (Brasil).

Método: la investigación se dividió en dos etapas: inicialmente se realizó un estudio ecológico mediante encuestas al lado de las indicaciones PCE; y en el segundo, se hizo un estudio descriptivo, exploratorio y cuantitativo a través de cuestionarios. Se utilizó el modelo lógico validado por Quinino et al. (2010), el análisis de la dimensión de la estructura (recursos materiales, el trabajo en equipo y la cualificación profesional de los indicadores de cobertura) y proceso (definición epidemiológica, control de mariscos, saneamiento y educación para la salud, SISPCE, la vigilancia epidemiológica y los indicadores de cobertura). Resultados: la esquistosomiasis es considerada endémica en la región, con tasas de infección de 2,0 a 4,1% entre los años 2007 a 2011. La ciudad presenta un IG de 50, clasificado como no implantado, no realiza delimitación epidemiológica, ni acciones de malacología y tiene mala calificación profesional. El componente indicador de cobertura mostró un porcentaje muy bajo en comparación con el número de personas que trabajan. Conclusión: se concluye que existe una debilidad por el cumplimiento de las normas y de recomendaciones del Ministerio de Salud para el control efectivo de la esquistosomiasis en el municipio.

Abstract:

Introduction/purpose: schistosomiasis is endemic in a number of Brazilian regions, particularly in Northeastern ones, and has a major impact on public health. We aimed at analyzing implementation extent (IE) of a schistosomiasis control program (SCP) in a town in Central-Southern Sergipe, Brazil. Methods: a two-step study was conducted: Firstly, an ecological study was carried out by means of a survey on SCP indications; and secondly, a descriptive study was performed using exploratory and quantitative questionnaires. The logical model validated by Quinino et al. (2010) was used, with an analysis of structural dimension (material resources, team working and professional qualifications for coverage markers) and process (epidemiological definition, seafood control, sanitation and health education, SISPCE, epidemiological surveillance and coverage markers). Results: schistosomiasis is considered to be endemic in the region with infection rates achieving 2.0 to 4.1% in 2007-2011. The town shows a IE value 50, corresponding to a non-introduced level, does not perform epidemiological delimitation or malacology initiatives, and has poor professional qualification. The coverage metric component showed a very low rate compared to the number of dedicated workers. Conclusion: compliance with regulations and recommendations by Health Ministry regarding effective control of schistosomiasis in the town appears to be weak.

Introdução: a esquistossomose é uma doença endêmica em várias regiões do Brasil, principalmente, na região Nordeste, e possui forte impacto para a saúde pública. O estudo objetivou analisar o grau de implantação (GI) do Programa Controle da Esquistossomose (PCE) em um município da região centro-sul de Sergipe, Brasil. Método: a pesquisa envolveu dois momentos: inicialmente foi realizado um estudo ecológico através do levantamento de dados secundários do PCE; no segundo, realizou-se um estudo descritivo, exploratório e quantitativo através da aplicação de questionários. Foi utilizado o modelo lógico validado por Quinino et al. (2010), analisando a dimensão estrutura (recursos materiais, equipe de trabalho e indicadores de cobertura de habilitação profissional) e processo (delimitação epidemiológica, controle do molusco, saneamento e educação em saúde, SISPCE, vigilância epidemiológica e indicadores de cobertura). Resultados: a esquistossomose foi considerada endêmica na região, com as taxas de infecção de 2,0 a 4,1%, entre os anos de 2007 a 2011. O município apresentou um GI de 50 pontos, classificado como não implantado; não realiza delimitação epidemiológica; não realiza ações de malacologia e possui uma habilitação profissional deficiente. O componente indicador de cobertura evidenciou um percentual muito baixo em relação ao número de pessoas trabalhadas. Conclusão: conclui-se que existe uma fragilidade quanto ao cumprimento das normas e recomendações do Ministério da Saúde para um efetivo controle da esquistossomose no município.

[Spatial distribution of anti-toxoplasma antibodies in pregnant women from Aracaju, Sergipe, Brazil]. / Análise espacial da prevalência de toxoplasmose em gestantes de Aracaju, Sergipe, Brasil.

PURPOSE: To analyze the spatial distribution of the prevalence of anti-toxoplasma gondii antibodies in pregnant women from a Brazilian Northeast city, and to correlate such prevalence with average maternal age and place of residence. METHODS: A descriptive, analytical and ecological study was conducted from January 1st to December 31st 2012. Data were obtained retrospectively from the Medical Specialties Center database and processed with the Epi info statistical package (Epi 7, Centers for Disease Control and Prevention, Atlanta, USA) and with Microsoft Excel 2010. The X2 test was applied to assess the association between the prevalence of antibodies to toxoplasma gondii and the average age. Spatial analysis of infection prevalence was performed using the TerraView software, version 4.2.2, with Kernel density estimation, which estimates the quantity of events through maps in order to identify areas with the highest concentration of cases in the city. RESULTS: The seroprevalence of IgG was 68.5% (95%CI 67.2-69.8) and the prevalence of IgM was 0.36% (95%CI 0.23-0.6). A higher IgG prevalence was associated with increased age in the oldest neighborhoods of the state capital, whereas a higher IgG prevalence among younger women was detected in suburban neighborhoods. The spatial concentration of IgM antibodies was higher in suburban neighborhoods, with no significant correlation between seroprevalence and age. CONCLUSION: Geoprocessing allowed the identification of areas with the highest prevalence, as well as the most susceptible average age and it was also useful as an instrument for the evaluation and implementation of appropriate preventive measures for this municipality and for other regions of Brazil.

Spatial analysis of schistosomiasis human cases in the horticultural community of Zona da Mata of Pernambuco state, Brazil.

The objective of this study was to describe the spatial distribution of schistosomiasis in horticultural community of Natuba, district of Vitória de Santo Antão, Pernambuco state. It was conducted a parasitological survey, examined the fecal material of 310 community residents. The cases positive for Schistosoma mansoni were geocoded and included in the computerized template of the community, generating maps of spatial distribution with kernel estimators. The results showed a high prevalence of schistosomiasis, with 28.4% of the parasites. Other parasites were found in 25.8% of the population. The use of GIS tools to map and understand the possible distribution of cases of schistosomiasis in the space occupied by the community highlighting and listing locations of lower elevation (able to flooding), with a higher frequency of human cases. Studies like this provide information to the local health services, may intervene and bring about change for individuals living in areas with low housing conditions to minimize their exposure to risk of contracting schistosomiasis.