Spatial and spatiotemporal patterns of human visceral leishmaniasis in an endemic southeastern area in countryside Brazil.

Visceral leishmaniasis (VL) has shown endemic pattern and epidemic episodes in urban and rural areas, however, there are still gaps in knowledge with regards to disease transmission. This study aimed to analyze the spatiotemporal dispersion of VL cases in the municipality of Araçuaí, Minas Gerais. A study of confirmed VL cases was conducted considering the endemic and epidemic periods between 2012 and 2017. The incidence rate was calculated, and for spatial analysis, the kernel map, directional distribution ellipse, and space-time scanning techniques were used. The correlations between VL cases and exposure variables (precipitation, humidity, and temperature) were calculated. The mean incidence of VL in the endemic period was 18.5 (95% confidence interval (CI) 5.9-32.5) and 44.4 in the epidemic period (95%CI, 12.0-28.6) by 100,000 inhabitants. The relative risk for the epidemic period was 2.4 (95% CI 1.4-4.1) when compared to the endemic period. A higher incidence of the disease was observed in rural areas of the municipality. Kernel mapping analysis revealed hotspots in the urban area of the municipality. The directional distribution ellipse encompasses the urban perimeter and part of the rural area of the municipality, expanding eastward during the epidemic period. Spatial analysis revealed a high-risk cluster for VL in rural areas. A positive correlation was observed between VL cases and temperature during the endemic period. Spatial analysis allowed us to outline the epidemiological scenario of human VL cases. These findings may be useful in case surveillance and in the work of health professionals and managers in Brazil.

Spatial and spatiotemporal patterns of human visceral leishmaniasis in an endemic southeastern area in countryside Brazil

ABSTRACT Visceral leishmaniasis (VL) has shown endemic pattern and epidemic episodes in urban and rural areas, however, there are still gaps in knowledge with regards to disease transmission. This study aimed to analyze the spatiotemporal dispersion of VL cases in the municipality of Araçuaí, Minas Gerais. A study of confirmed VL cases was conducted considering the endemic and epidemic periods between 2012 and 2017. The incidence rate was calculated, and for spatial analysis, the kernel map, directional distribution ellipse, and space-time scanning techniques were used. The correlations between VL cases and exposure variables (precipitation, humidity, and temperature) were calculated. The mean incidence of VL in the endemic period was 18.5 (95% confidence interval (CI) 5.9-32.5) and 44.4 in the epidemic period (95%CI, 12.0-28.6) by 100,000 inhabitants. The relative risk for the epidemic period was 2.4 (95% CI 1.4-4.1) when compared to the endemic period. A higher incidence of the disease was observed in rural areas of the municipality. Kernel mapping analysis revealed hotspots in the urban area of the municipality. The directional distribution ellipse encompasses the urban perimeter and part of the rural area of the municipality, expanding eastward during the epidemic period. Spatial analysis revealed a high-risk cluster for VL in rural areas. A positive correlation was observed between VL cases and temperature during the endemic period. Spatial analysis allowed us to outline the epidemiological scenario of human VL cases. These findings may be useful in case surveillance and in the work of health professionals and managers in Brazil.

A utilização do método clínico centrado na pessoa e a relação com a melhoria da performance clínica de médicos do programa de educação permanente para médicos da estratégia de saúde da família da região ampliada de saúde Jequitinhonha - MG / The use of patient centered clinical method and its relation to the improved clinical performance of the program for continuing education for family health doctors in Jequitinhonha - MG

O Programa de Educação Permanente para Médicos da Estratégia de Saúde da Família (PEP) foi implantado na Região Ampliada de Saúde Jequitinhonha (RASJ), em 2010, com a finalidade de melhorar o nível de resolubilidade da Atenção Primária à Saúde, com a utilização da educacão permanente voltada ao Método Clínico Centrado na Pessoa (MCCP) e melhoria da performance clínica dos médicos. Este trabalho objetivou avaliar o programa na RASJ. Foi desenvolvido em 14 municípios, com 31 médicos e 383 usuários dos serviços. Pesquisa descritiva e quantitativa utilizou como instrumentos de coleta de dados questionários e gravaïções das entrevistas das consultas. Foi realizada análise descritiva dos dados e aplicado o X2 e o Teste Exato de Fisher. Os médicos relataram redução de encaminhamentos (93,5%) e pedidos de exames desnecessïários (96,8%), assim como reestruturação das consultas (93,5%); 76,1% dos usuários perceberam melhoria nos atendimentos após a participação do médico no PEP. Conclui-se, assim, que a educação permanente nos moldes do PEP pode melhorar o desempenho clínico dos médicos e aumentar o envolvimento do usuário no atendimento pela utilizaçãoo do MCCP.