Heat-related mortality at the beginning of the twenty-first century in Rio de Janeiro, Brazil.

Temperature record-breaking events, such as the observed more intense, longer-lasting, and more frequent heat waves, pose a new global challenge to health sectors worldwide. These threats are of particular interest in low-income regions with limited investments in public health and a growing urban population, such as Brazil. Here, we apply a comprehensive interdisciplinary climate-health approach, including meteorological data and a daily mortality record from the Brazilian Health System from 2000 to 2015, covering 21 cities over the Metropolitan Region of Rio de Janeiro. The percentage of absolute mortality increase due to summer extreme temperatures is estimated using a negative binomial regression modeling approach and maximum/minimum temperature-derived indexes as covariates. Moreover, this study assesses the vulnerability to thermal stress for different age groups and both genders and thoroughly analyzes four extremely intense heat waves during 2010 and 2012 regarding their impacts on the population. Results showed that the highest absolute mortality values during heat-related events were linked to circulatory illnesses. However, the highest excess of mortality was related to diabetes, particularly for women within the elderly age groups. Moreover, results indicate that accumulated heat stress conditions during consecutive days preferentially preceded by persistent periods of moderate-temperature, lead to higher excess mortality rather than sporadic single hot days. This work may provide directions in human health policies related to extreme climate events in large tropical metropolitan areas from developing countries, contributing to altering the historically based purely reactive response.

Characterizing the atmospheric conditions during the 2010 heatwave in Rio de Janeiro marked by excessive mortality rates.

Global temperatures have increased considerably over the last decades, directly impacting the number, intensity and duration of extreme events such as heat waves. Climate model projections accounting for anthropogenic factors indicate that deadly mega-heat waves are likely to become more frequent in the future. Although the atmospheric features and social-economic related impacts of heat waves have already been documented in various regions around the world, for other highly populated regions, such as the Metropolitan Region of Rio de Janeiro (MRRJ), a similar objective assessment is still needed. Heat waves directly impact the public health sector and particularly the less wealthy and elderly population groups. During February 2010, an elevated mortality peak occurred during a 8-day period (from 2 to 9 Feb 2010) characterized as a heat wave episode in MRRJ. A total excess of 737 deaths was recorded with the elderly group registering the highest mortality incidence. During this heat wave period, a quasi-stationary anticyclonic anomaly forced in altitude by a Rossby wave train was established over the south Brazilian coast. At the surface, the meteorological scenario from January 2010 to the heat wave period was marked by clear sky conditions, large precipitation deficits, and enhanced diabatic heating. During the heat wave period, warm and dry air masses were advected from interior regions towards the MRRJ, exacerbating temperature conditions by pronounced subsidence and adiabatic heating mechanisms. All these conditions contributed to pronounced positive temperature anomalies, reinforced by land-atmosphere feedbacks.

HIV Vertical transmission in Rio de Janeiro, Brazil - does the distance matter?

Mother-to-child transmission (MTCT) is the main route of transmission for HIV among under 5 children in Brazil. National data indicate that missed opportunities for HIV prevention of MTCT are still common in antenatal care (ANC). We studied variables related to target process indicators in a cohort of HIV exposed children. We used data from 1996 to 2013 related to HIV exposed uninfected and HIV-infected children attended in an HIV reference hospital in Rio de Janeiro, Brazil. Data were collected from baseline questionnaires applied to all children followed-up in the hospital. Gestational and perinatal history were extracted from the mother's ANC card. Infants were categorized according to dates of first HIV care at the unit (1996-2000, 2001-2006 and 2007-2013). Distances between recorded addresses and the nearest maternity/hospital were measured by Euclidean distance, the shortest car route calculated in Google Maps and the route of the available bus line. Of the 599 children who fulfilled the inclusion criteria, 178 (29.7%) were HIV-infected. Approximately 70% of infants exposed to the virus from 1996-2000 were infected, dropping to 15.2% from 2001-2006 and rebounding to 30.1% from 2007-2013. Birth cohort was associated with ANC, and mothers from 2007-2013 had a lower chance of attending ANC (OR = 0.16; 95%CI 0.08-0.30). In addition, when the distance home-birthplace was higher than 9.5 km, there was a lower chance that the mother had attended ANC (OR = 0.35; 95%CI 0.18-0.68). Birth cohort was associated to HIV and ANC, and our data showed that a reduction of ANC might be related to rebound in HIV cases. There seems to have an association between larger distances from home to the birthplace and absence of ANC, which suggests that ANC was being performed in the tertiary units instead of in the primary care facilities as recommended.

[Urban sporotrichosis: a neglected epidemic in Rio de Janeiro, Brazil]. / Esporotricose urbana: epidemia negligenciada no Rio de Janeiro, Brasil.

In the scientific literature, sporotrichosis has traditionally been associated with agricultural work, since the causative agent is found naturally in the soil. However, cases have been reported recently in an urban area, related to zoonotic transmission. The current study aimed to contribute to knowledge on sporotrichosis in an urban area through an exploratory analysis of its socio-spatial distribution in Rio de Janeiro, Brazil, from 1997 to 2007, identifying the areas with the heaviest transmission. The database from the Health Surveillance Service at the Evandro Chagas Institute for Clinical Research, Oswaldo Cruz Foundation, was used to estimate incidence rates and spatial distribution. During the study period, 1,848 cases of sporotrichosis were reported, predominantly in adult women not currently in the labor market. The leading source of infection was wounds caused by domestic cats, which contributed to the spread of sporotrichosis in this urban area. Georeferencing of 1,681 cases showed a transmission belt along the border between the city of Rio de Janeiro and the adjacent municipalities in the Greater Metropolitan Area.

Esporotricose urbana: epidemia negligenciada no Rio de Janeiro, Brasil / Urban sporotrichosis: a neglected epidemic in Rio de Janeiro, Brazil

Na literatura científica, a esporotricose esteve associada por anos a profissionais que lidam com a terra, local onde o fungo causador habita. Recentemente, numa área urbana tem sido registrada a ocorrência relacionada à transmissão zoonótica. Este trabalho objetivou contribuir para o conhecimento sobre a esporotricose em área urbana, por intermédio da analise exploratória de sua distribuição socioespacial no Rio de Janeiro, Brasil, entre 1997 e 2007, identificando os espaços de transmissão mais intensos. Utilizando-se base de dados do Serviço de Vigilância em Saúde, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, foram realizadas análises de frequência da doença e sua distribuição espacial. No período estudado, foram registrados 1.848 casos de esporotricose, com predomínio em mulheres adultas fora do mercado de trabalho. A fonte de contaminação predominante foi ferimento causado pelo gato doméstico, o que contribuiu para a disseminação da esporotricose em área urbana. O georreferenciamento de 1.681 casos evidenciou um cinturão de transmissão ao longo da divisa entre a capital e os municípios da região metropolitana.

In the scientific literature, sporotrichosis has traditionally been associated with agricultural work, since the causative agent is found naturally in the soil. However, cases have been reported recently in an urban area, related to zoonotic transmission. The current study aimed to contribute to knowledge on sporotrichosis in an urban area through an exploratory analysis of its socio-spatial distribution in Rio de Janeiro, Brazil, from 1997 to 2007, identifying the areas with the heaviest transmission. The database from the Health Surveillance Service at the Evandro Chagas Institute for Clinical Research, Oswaldo Cruz Foundation, was used to estimate incidence rates and spatial distribution. During the study period, 1,848 cases of sporotrichosis were reported, predominantly in adult women not currently in the labor market. The leading source of infection was wounds caused by domestic cats, which contributed to the spread of sporotrichosis in this urban area. Georeferencing of 1,681 cases showed a transmission belt along the border between the city of Rio de Janeiro and the adjacent municipalities in the Greater Metropolitan Area.

Georreferenciamento de dados de saúde na escala submunicipal: algumas experiências no Brasil / Geocoding health data in sub-municipal scale: some brazilian experiences

Neste trabalho, são relatadas experiências de georreferenciamentode dados de saúde em alguns Municípios brasileiros, analisadas segundo a disponibilidade e atualização de bases cartográficas e o tratamento de dados de endereço nos sistemas de informações em saúde (SIS). A diversidade de estratégias de georreferenciamento de dados no Brasil é resultado das condições particulares de desenvolvimento desses projetos nos Municípios, o que influi na eficiência e precisão da localização dos eventos de saúde. São sugeridas estratégias para captação e armazenamento de dados de endereço nos SIS e sua compatibilização com os cadastros de logradouros existentes, bem como o desenvolvimento de programas e aplicativos que permitam buscas e relacionamentos entre essas duas bases de dados...

This work describes experiences in geocoding health data in Brazilian municipalities, analyzed according to the availability and update of cartographic databases and the treatment given to addresses data in health information systems (SIS). The diversity of current geocoding strategies in Brazil results of local conditions on which these projects are developed, presenting variable efficiency and accuracy for health event location. The authors suggest strategies to capture and store addresses data in SIS, compatible with the existent street registries, as well as the development of programs and scripts to search and link these two databases.