Fertility rates among very young adolescent women: temporal and spatial trends in Brazil.

BACKGROUND: We assessed whether the reported decrease in fertility rates among 15 to 19 years old Brazilian adolescents has met with a parallel decrease in very young adolescent (10 to 14 years old) fertility rates. So we explored temporal trends for fertility rates among very young adolescents between 2000 and 2012 for Brazil as a whole, its regions and states; and also analyzed the spatial distribution of fertility rates among Brazilian municipalities in the years 2000 and 2012. METHODS: We used data from the Information System on Live Births to calculate the rates. To examine the temporal trends, we used linear regression for time series with Prais-Winsten estimation, including the annual percentage change, for the country, regions, and states. To analyze the spatial distribution among Brazilian municipalities, we calculated the Global Moran Index and created a local Moran significance and cluster map through Local Indicators of Spatial Association (LISA). We also elaborated a thematic map with the rates using empirical Bayesian estimation. RESULTS: Brazilian very young adolescent fertility rates remained high and stable throughout the 2000 to 2012 period, and significantly decreased in three out of 26 states, and in the federal district. On the other hand, an increase was observed in two Northern and Northeastern states. The rates were spatially dependent in Brazilian municipalities (Moran Index = 0.22 in 2012; p = 0.05). The maps indicated a heterogeneous distribution of the rates, with high-rate clusters predominant in the North and low-rate clusters predominant in the South, Southeast, and Midwest. CONCLUSIONS: Our findings indicate that Brazilian very young adolescent fertility rates have not decreased in parallel with adolescent fertility rates as they remain high and did not decrease from 2000 and 2012, even though a few states presented a decrease. Thus, these phenomena probably have distinct underlying causes that warrant further elucidation. Progress in this field is crucial for the development of specific policies and programs focused on very young adolescents.

[Prevalence and spatial distribution of neural tube defects in São Paulo State, Brazil, before and after folic acid flour fortification]. / Prevalência e distribuição espacial de defeitos do tubo neural no Estado de São Paulo, Brasil, antes e após a fortificação de farinhas com ácido fólico.

This cross-sectional study analyzed the prevalence and spatial distribution of neural tube defects before and after folic acid flour fortification. The study used the Information System on Live Births (SINASC) and presented prevalence rates according to maternal characteristics with odds ratios (OR) and 95% confidence intervals (95%CI). Polynomial regression was used in time trend analysis and empirical Bayesian smoothed maps for spatial analysis. Total prevalence of neural tube defects decreased by 35%, from 0.57/1,000 to 0.37/1,000 live births after fortification (OR = 0.65; 95%CI: 0.59-0.72). There was a reduction among newborns of mothers with the following characteristics: all age groups (except < 15 years), more than three years of schooling, and seven or more prenatal visits. There was a reduction over time and in most of São Paulo State, except in a few municipalities (counties) located in the western region of the State. Other factors may have contributed to the observed decline, but the results corroborate flour fortification as an important measure to prevent neural tube defects. Further research is needed to elucidate the lack of a decline in neural tube defects in the western part of São Paulo State.

Prevalência e distribuição espacial de defeitos do tubo neural no Estado de São Paulo, Brasil, antes e após a fortificação de farinhas com ácido fólico / Prevalence and spatial distribution of neural tube defects in São Paulo State, Brazil, before and after folic acid flour fortification / Prevalencia y distribución espacial de defectos del tubo neural en el Estado de São Paulo, Brasil, antes y después del enriquecimiento de harinas con ácido fólico

Estudo transversal que analisou prevalência e distribuição espacial de defeitos do tubo neural, antes e após a fortificação das farinhas de trigo e milho com ácido fólico no Estado de São Paulo, Brasil, com uso do Sistema de Informações sobre Nascidos Vivos (SINASC). São apresentadas prevalências segundo características maternas por meio de odds ratio (OR) e intervalos de 95% de confiança (IC95%). Para análise temporal e espacial, foram utilizados, respectivamente, regressão polinomial e mapas com suavização bayesiana empírica. A prevalência diminuiu 35%, de 0,57 para 0,37 por mil nascidos vivos após a fortificação (OR = 0,65; IC95%: 0,59-0,72). Verificou-se redução para mulheres de todas as idades (exceto < 15 anos), com mais de três anos de estudo e sete consultas ou mais de pré-natal. Confirmou-se redução temporal na maior parte do estado, exceto alguns municípios do oeste. Outros aspectos podem ter contribuído para o declínio observado, porém os resultados reiteram a fortificação de farinhas como medida importante para prevenção de defeitos do tubo neural. Outras análises devem ser realizadas para justificar resultado inverso no oeste paulista.

This cross-sectional study analyzed the prevalence and spatial distribution of neural tube defects before and after folic acid flour fortification. The study used the Information System on Live Births (SINASC) and presented prevalence rates according to maternal characteristics with odds ratios (OR) and 95% confidence intervals (95%CI). Polynomial regression was used in time trend analysis and empirical Bayesian smoothed maps for spatial analysis. Total prevalence of neural tube defects decreased by 35%, from 0.57/1,000 to 0.37/1,000 live births after fortification (OR = 0.65; 95%CI: 0.59-0.72). There was a reduction among newborns of mothers with the following characteristics: all age groups (except < 15 years), more than three years of schooling, and seven or more prenatal visits. There was a reduction over time and in most of São Paulo State, except in a few municipalities (counties) located in the western region of the State. Other factors may have contributed to the observed decline, but the results corroborate flour fortification as an important measure to prevent neural tube defects. Further research is needed to elucidate the lack of a decline in neural tube defects in the western part of São Paulo State.

Estudio transversal que analizó la prevalencia y distribución espacial de defectos del tubo neural, antes y después del enriquecimiento de las harinas de trigo y maíz con ácido fólico en el Estado de Sao Paulo, Brasil, con el uso del Sistema de Información sobre Nacidos Vivos (SINASC). Se presentaron prevalencias, según características maternas, mediante odds ratio (OR) e intervalos de un 95% de confianza (IC95%). Para un análisis temporal y espacial, fueron utilizados, respectivamente, regresión polinomial y mapas con suavizamiento bayesiano empírico. La prevalencia disminuyó un 35%, de 0,57 a 0,37 por mil nacidos vivos tras el enriquecimiento (OR = 0,65; IC95%: 0,59-0,72). Se verificó la reducción en mujeres de todas las edades (excepto < 15 años), con más de tres años de estudio y siete consultas o más de carácter prenatal. Se confirmó la reducción temporal en la mayor parte del estado, excepto algunos municipios del oeste. Otros aspectos pueden haber contribuido al declive observado, no obstante, los resultados reiteran el enriquecimiento de harinas como una medida importante para la prevención de defectos en el tubo neural. Otros análisis deben ser realizados para justificar el resultado inverso en el oeste paulista.

[Social inequality in morbidity and mortality from oral and oropharyngeal cancer in the city of São Paulo, Brazil: 1997-2008]. / Desigualdade social no adoecimento e morte por câncer de boca e orofaríngeo no município de São Paulo, Brasil: 1997 a 2008.

Occupation of geographical space is historically determined by the socioeconomic model and the dynamism of its social, political, and ideological relations. This study aimed to evaluate the spatial distribution of morbidity and mortality from cancer of the mouth and oropharynx and related socioeconomic variables in the city of São Paulo, Brazil, from 1997 to 2008. Data were collected from the Population-Based Cancer Registry and the Program for Improvement of Mortality Data (PRO-AIM) and were georeferenced using Terraview and GeoDa. The theoretical framework for evaluating the results was the work of Milton Santos. The incidence rates showed spatial autocorrelation with a Global Moran index of 0.226 and mortality rates of 0.337. Incidence of cancer of the mouth and oropharynx did not show a well-defined spatial pattern in the city of São Paulo, but mortality rates were highly unequal, concentrating the lowest rates in the central area of the city, which is wealthier and economically less unequal.

Desigualdade social no adoecimento e morte por câncer de boca e orofaríngeo no município de São Paulo, Brasil: 1997 a 2008 / Social inequality in morbidity and mortality from oral and oropharyngeal cancer in the city of São Paulo, Brazil: 1997-2008

A ocupação do espaço geográfico é determinada historicamente pelo modelo socioeconômico e pelo dinamismo de suas relações sociais, políticas e ideológicas. O objetivo deste trabalho é avaliar a distribuição espacial e o efeito de indicadores socioeconômicos no adoecimento e morte por câncer de boca e orofaríngeo no Município de São Paulo, Brasil, no período de 1997 a 2008. Os dados foram coletados no Registro de Câncer de Base Populacional e no Programa de Aprimoramento das Informações de Mortalidade - PRO-AIM e georreferenciados pelos softwares Terraview e GeoDa. O referencial teórico para avaliação dos resultados foi baseado na teoria de Milton Santos. As taxas de incidência apresentaram um índice de autocorrelação Global de Moran de 0,226 e as taxas de mortalidade de 0,337. A Incidência de câncer de boca e orofaríngeo não apresenta um padrão espacial bem definido no Município de São Paulo, mas é bastante desigual no que se refere à Mortalidade, concentrando as suas menores taxas na área central, mais rica e economicamente menos desigual.

Occupation of geographical space is historically determined by the socioeconomic model and the dynamism of its social, political, and ideological relations. This study aimed to evaluate the spatial distribution of morbidity and mortality from cancer of the mouth and oropharynx and related socioeconomic variables in the city of São Paulo, Brazil, from 1997 to 2008. Data were collected from the Population-Based Cancer Registry and the Program for Improvement of Mortality Data (PRO-AIM) and were georeferenced using Terraview and GeoDa. The theoretical framework for evaluating the results was the work of Milton Santos. The incidence rates showed spatial autocorrelation with a Global Moran index of 0.226 and mortality rates of 0.337. Incidence of cancer of the mouth and oropharynx did not show a well-defined spatial pattern in the city of São Paulo, but mortality rates were highly unequal, concentrating the lowest rates in the central area of the city, which is wealthier and economically less unequal.

Análise da mudança da cobertura e uso da terra dos municípios de Jacarei e Santa Branca-SP como subsídio ao estudo das ocorrências de raiva transmitida por morcegos / Analysis of cover and land use change in the municipalities of Santa Branca and Jacarei-SP to the study of the occurrence of rabies transmitted by bats

Neste trabalho avaliou-se a influência do uso e cobertura da terra nas ocorrências de raiva animal nos municípios de Jacareí e Santa Branca, Vale do Paraíba, Estado de São Paulo. Combinou-se o mapeamento a partir de imagens TM/Landsat-5 com os dados de ocorrência da enfermidade, entre 2002 e 2009. Animais silvestres atropelados em rodovias, morcegos urbanos e Desmodus rotundus de áreas rurais e animais de fazenda de interesse econômico foram considerados. Dez amostras foram positivas para raiva, três de morcegos insetívoros da área urbana de Jacareí e sete animais de fazenda de interesse econômico, sendo dois de Jacareí e cinco de Santa Branca. Nenhum dos animais silvestres avaliados foram raiva-positivos. A análise da dinâmica da cobertura e uso da terra não evidenciou alteração significante. Embora a enfermidade ocorresse sem uma aparente mudança na região, provavelmente devido à escala de análise utilizada, concluiu-se que a classe reflorestamento e agropecuária foram relacionadas à enfermidade, por ocorrerem com maior freqüência na área analisada.

In this paper, the influence of land cover and land use on the rabies in Jacareí and Santa Branca municipalities, Paraíba's Valley of the State of Sao Paulo was evaluated by combining the Landsat satellite images mapping with data of rabies occurrence, in 2002-2009. Wildlife roadkills, urban bats, Desmodus rotundus bats from rural areas and livestock were considered. Ten samples were rabies-positive, being three insectivorous bats from the urban Jacareí, and seven livestock, being two from Jacarei and five from Santa Branca. None of the wildlife examined was rabies-positive. The landscape and land use analysis found that no significant changes occurred. Although the disease has occurred even without apparent changes in the region, probably due to the scale used in this study, it was concluded that the reforestation and agriculture areas were associated to the disease to show major frequency in the analyzed areas.

[Epidemiological profile of reported beriberi cases in Maranhão State, Brazil, 2006-2008]. / Perfil epidemiológico do beribéri notificado de 2006 a 2008 no Estado do Maranhão, Brasil.

This study aimed to describe the epidemiological profile of beriberi cases and related deaths reported from 2006 to 2008 in Maranhão State, Brazil. Data were obtained from beriberi notification forms at the State Health Department. The global Moran index was used to evaluate spatial auto-correlation. 1207 cases and 40 deaths were reported. The western and central regions of the State showed strong spatial auto-correlation of incidence rates. Cases and deaths were concentrated from May to August, in young men (20-40 years). Regular alcohol consumption and smoking were recorded among fatal cases. Low income and heavy labor were widespread among cases. Common symptoms were asthenia, numbness, and swollen legs, difficulty walking, and calf pain. The profile of cases and their symptoms (except swollen legs) are characteristic of dry beriberi. We recommend further studies on the resurgence of beriberi in Brazil.

Perfil epidemiológico do beribéri notificado de 2006 a 2008 no Estado do Maranhão, Brasil / Epidemiological profile of reported beriberi cases in Maranhão State, Brazil, 2006-2008

This study aimed to describe the epidemiological profile of beriberi cases and related deaths reported from 2006 to 2008 in Maranhão State, Brazil. Data were obtained from beriberi notification forms at the State Health Department. The global Moran index was used to evaluate spatial auto-correlation. 1207 cases and 40 deaths were reported. The western and central regions of the State showed strong spatial auto-correlation of incidence rates. Cases and deaths were concentrated from May to August, in young men (20-40 years). Regular alcohol consumption and smoking were recorded among fatal cases. Low income and heavy labor were widespread among cases. Common symptoms were asthenia, numbness, and swollen legs, difficulty walking, and calf pain. The profile of cases and their symptoms (except swollen legs) are characteristic of dry beriberi. We recommend further studies on the resurgence of beriberi in Brazil.

O objetivo do estudo foi descrever o perfil epidemiológico dos casos e óbitos de beribéri notificados de 2006-2008 no Estado do Maranhão, Brasil. Informações foram obtidas de fichas de notificação da Secretaria de Estado da Saúde do Maranhão e utilizou-se o Índice Global de Moran para avaliar autocorrelação espacial. Foram notificados 1.207 casos e 40 óbitos. Regiões oeste e central mostraram forte presença de autocorrelação espacial da incidência. Ocorrência de casos e óbitos concentrou-se de maio a agosto, em homens jovens (20-40 anos). Hábito de consumir álcool e fumar esteve presente entre os óbitos; baixa renda e ocupação com atividade pesada, entre os casos. Os sintomas mais comuns foram diminuição da força, dormência e edema das pernas, dificuldade para caminhar e dor na panturrilha. O perfil dos acometidos e os sintomas, exceto edema de membros inferiores, são característicos de beribéri seco. É pertinente que estudos sobre seu ressurgimento no país sejam aprofundados.

Landscape risk factors for attacks of vampire bats on cattle in Sao Paulo, Brazil.

Vampire-bat (Desmodus rotundus) attacks on cattle are a major concern for cattle-raising area. Blood loss and paralytic rabies due to bat bites can impose severe losses on the livestock. We took four municipalities inside the Sao Joao da Boa Vista veterinary district (Sao Paulo, Brazil) as a study area and tested a set of landscape features for spatial correlation with distance to areas in which vampire-bat attacks on cattle were documented. Bat- and cattle-related data from the Sao Paulo State Rabies Control Program were used. Landscape data (first-order rivers and their tributaries, main roads, railways and urban areas) were obtained from official cartographic agencies; forest, sugarcane and pasture data were acquired from remote-sensing mappings. The study area was taken as a grid split into 178 cells. Each 4kmx4km cell was filled with bat, cattle and landscape data. Our analysis detected that grid cells that were closer to areas of bat attacks on cattle had higher cattle density and a greater percentage of the land committed to sugarcane cropping, and were close to forest fragments. These results shed light on the need for rethink the Rabies Control Program strategies for defining the surveillance of vampire-bat populations and rabies control in the state of Sao Paulo, Brazil.

Influência do sexo de indivíduos da mesma colônia no controle químico das populações do morcego hematófago Desmodus rotundus (Phyllostomidae) no estado de São Paulo / Influence of sex differences in the same colony for chemical control of vampire Desmodus rotundus (Phyllostomidae) populations in the state of São Paulo, Brazil

Os objetivos do presente trabalho foram estudar a fidelidade ao abrigo diurno por indivíduos de ambos os sexos da espécie Desmodus rotundus e verificar a eficácia da ação da pasta vampiricida 2 por cento na redução do tamanho de suas colônias no estado de São Paulo, por meio de estudo experimental de campo. Durante os anos de 1999 e 2000, 626 morcegos distribuídos em 12 abrigos foram capturados com redes-de-espera (armadas durante a noite) e marcados. Em seguida, 10 por cento da população previamente estimada recebeu a pasta vampiricida. No Experimento I foram tratados apenas machos, no Experimento II apenas fêmeas e no Experimento III, 5 por cento dos machos e 5 por cento das fêmeas foram tratados. Após 5 e 10 dias, foram feitas contagens dos morcegos que sobreviveram e morreram. As fêmeas mostraram-se mais fiéis aos abrigos (p<0,01) e melhores disseminadoras de pasta vampiricida (p<0,01).

Influência do sexo de indivíduos da mesma colônia no controle químico do morcego hematófago Desmodus rotundus (Chiroptera, Phyllostomidae) / Sex influence in the chemical control of vampire bat Desmodus rotundus (Chiroptera, Phyllostomidae) from the same colony

Estuda aspectos da biologia dos morcegos hematófagos, Desmodus rotundus, e analisar a eficácia da pasta vampiricida 2 por cento na reduçäo de suas colônias, quando tratados indivíduos de sexo diferente. Em 1999 e 2000, 626 indivíduos foram capturados em redes-de-espera, armadas a noite na entrada de 12 abrigos diurnos do Estado de Säo Paulo. Esses morcegos foram marcados, medidos, tratados ou näo e soltos novamente. Foram feitas estimativas visuais do tamanho e distribuiçäo das colônias dentro do abrigo. Foram tratados com a pasta, em cada abrigo, 10 por cento da populaçäo de D. rotundus inicialmente avaliada. Em um grupo foram tratados apenas machos (Experimento I), em outro apenas fêmeas (II) e no último 5 por cento de machos e 55 de fêmeas (III). Após 5 e 10 dias, foi feita a contagem dos número de carcaças e indivíduos sobreviventes. As colônias estudadas tinham em média ca.130 indivíduos, distribuídos em um a três nichos principais e em diversos grupos pequenos. Indivíduos solitários foram também observados. Morfologicamente, fêmeas foram maiores que machos no comprimento dos antebraços e na massa corpórea (p<0,0001). Fêmeas foram mais fiéis aos abrigos (0,042) e melhores disseminadoras de pasta vampiricida (p=0,002). Além disso, foi obtida uma maior reduçäo (78,2 por cento) do tamanho das colônias quando machos e fêmeas foram tratados. A pasta vampiricida de uso tópico nos morcegos elimina mais fêmeas que machos e por isso näo deve ser o único método de controle de D. rotundus aplicado pelos Programas Estaduais de Controle da Raiva dos Herbívoros.