Análise espacial de casos prováveis de dengue no município de São Luís, Maranhão, Brasil / Spatial analysis of probable dengue cases in the municipality of São Luís, Maranhão, Brazil / Análisis espacial de los casos probables de dengue en el municipio de São Luís, Maranhão, Brasil

INTRODUÇÃO: A dengue é considerada uma das principais arboviroses mundiais, caracterizada no Brasil pelo aumento de casos graves e óbitos. OBJETIVO: realizar análise espacial dos casos prováveis de dengue em São Luís - MA. MÉTODOS: Estudo ecológico de base populacional dos casos prováveis de dengue, notificados no Sistema de Informação de Agravos de Notificação (SINAN) em 2015 e 2016, ocorridos no município de São Luís ­ MA. Foram georreferenciados 4.681 casos prováveis de dengue por setores censitários, calculadas as taxas de incidência e ajustadas através do estimador bayesiano empírico local. Foi utilizado o estimador de densidade de Kernel e Moran Global e Local para a análise espacial. RESULTADOS: Evidenciou-se através do estimador de densidade de Kernel, áreas quentes (alta-densidade) nos setores censitários da região noroeste do município. As taxas de incidência foram ajustadas pela aplicação do método bayesiano empírico local, identificando-se maior quantidade de setores com média e alta incidência. A partir do índice de Moran global foi evidenciada autocorrelação espacial positiva estatisticamente significativa para as taxas de incidência de dengue (I=0,69; p<0,001) e para as taxas de incidência ajustadas pelo método bayesiano (I=0,80; p<0,001). De acordo com o índice de Moran local, identificou-se clusters de setores de alta incidência de dengue em áreas com alta densidade populacional na região nordeste e noroeste do município. CONCLUSÃO: A pesquisa demonstrou que os estimadores bayesianos ajudaram a minimizar os problemas de subnotificação e da influência do tamanho populacional nos setores censitários.

INTRODUCTION: Dengue is considered one of the main arboviruses in the world, characterized in Brazil by the increase in severe cases and deaths. OBJECTIVE: to perform spatial analysis of probable dengue cases in São Luís - MA. METHODS: Population-based ecological study of probable dengue cases, reported in the Notifiable Diseases Information System (SINAN) in 2015 and 2016, which took place in the city of São Luís - MA. 4,681 probable dengue cases were georeferenced by census sectors, incidence rates were calculated and adjusted using the local empirical Bayesian estimator. The Kernel and Moran Global and Local density estimator was used for spatial analysis. RESULTS: Hot areas (high-density) in the census sectors of the northwest region of the municipality were evidenced through the Kernel density estimator. Incidence rates were adjusted by applying the local empirical Bayesian method, identifying a greater number of sectors with medium and high incidence. From the global Moran index, statistically significant positive spatial autocorrelation was evidenced for the dengue incidence rates (I = 0.69; p <0.001) and for the incidence rates adjusted by the Bayesian method (I = 0.80; p <0.001). According to the local Moran index, clusters of sectors with a high incidence of dengue were identified in areas with high population density in the northeast and northwest regions of the municipality. CONCLUSION: The research demonstrated that Bayesian estimators helped to minimize the problems of underreporting and the influence of population size on census tracts.

INTRODUCCIÓN: El dengue es considerado una de las principales arbovirosis a nivel mundial, caracterizada en Brasil por el aumento de casos graves y muertes. OBJETIVO: Realizar un análisis espacial de los casos probables de dengue en São Luís - MA. MÉTODOS: Estudio ecológico de base poblacional de los casos probables de dengue, notificados en el Sistema de Informação de Agravos de Notificação (SINAN) en 2015 y 2016, ocurridos en el municipio de São Luís - MA. Se georreferenciaron 4.681 casos probables de dengue por sectores censales, se calcularon las tasas de incidencia y se ajustaron mediante el estimador empírico bayesiano local. Para el análisis espacial se utilizó el estimador de densidad Kernel y Moran global y local. RESULTADOS: Se evidenció a través del estimador de densidad Kernel, áreas calientes (de alta densidad) en los sectores censales de la región noroeste del municipio. Las tasas de incidencia se ajustaron mediante la aplicación del método bayesiano empírico local, identificándose una mayor cantidad de setores con incidencia media y alta. A partir del índice global de Moran se evidenció una autocorrelación espacial positiva estadísticamente significativa para las tasas de incidencia de dengue (I=0,69; p<0,001) y para las tasas de incidencia ajustadas por el método bayesiano (I=0,80; p<0,001). Según el índice local de Moran, se identificaron clusters de sectores de alta incidencia de dengue en áreas con alta densidad de población en las regiones noreste y noroeste del municipio. CONCLUSIÓN: La investigación demostró que los estimadores bayesianos ayudaron a minimizar los problemas de infradeclaración y la influencia del tamaño de la población en los sectores censales.

GEOGRAPHIC ACCESSIBILITY TO HEALTH SERVICES IN THE CASES OF HEMODILYTIC PATIENTS IN MARANHÃO / ACESSIBILIDADE GEOGRÁFICA AOS SERVIÇOS DE SAÚDE NOS CASOS DE PACIENTES HEMODILÍATICOS NO MARANHÃO

A discussão a partir do contexto da "região" notifica a migração pendular no contexto da saúde pública como determinante no processo saúde-doença. Como objetivo principal, buscou-se destacar a migração pendular a partir da busca pelo serviço de Hemodiálise, e como objetivos secundários, traçar os possíveis perfis de pacientes e caminhos percorridos. Trata-se de um estudo quantitativo, ecológico, com modelo analítico observacional. Assim, estabeleceu-se um estudo indutivo, a partir de uma fonte de dados secundária, com variáveis ​​quantitativas e amostragem aleatória simples. Através do mapeamento dos casos, verifica-se que 17,55% dos pacientes realizaram migração pendular e os da macrorregião de Pinheiro representaram o maior número, com média de 26,08%. Houve predomínio do sexo feminino (54,35%); pardos (76,74%); ensino fundamental incompleto (75. 86%); faixa etária de 5 a 14 anos (41,30%); 6 registraram óbitos e a maior expectativa de vida na faixa de até 250 dias. Houve migração pendular em busca de serviços de hemodiálise no estado do Maranhão e predominância de minorias sociais no perfil dos pacientes. Assim, comprovando a acessibilidade geográfica aos serviços de saúde como determinante relevante na adesão ao tratamento hemodialítico.

A discussão a partir da conjuntura de "região" notifica migração pública pendular no contexto da saúde como determinante no processo saúde-doença. Buscou-se, buscou-se, a partir de evidenciar do serviço do Hemodi, e como objetivos secundários, traçar os possíveis e objetivos de seu objetivo principal, e buscar perfis dos pacientes. Trata-se de um estudo científico, ecológico, de modelo analítico observacional. Assim, um estudo indutivo de dados variáveis ​​com variáveis ​​variáveis ​​e secundárias aleatórias, um estudo indutivo de dados com variáveis ​​variáveis. Através do mapeamento dos casos, constata-se que 17,55% dos pacientes realizaram a migração pendular e os oriundos da macrorregião de Pinheiro representado ou maior, com média de 26,08%. Evidenciou-se predominância do sexo feminino (54,35%); pardos (76,74%); ensino fundamental incompleto (75,86%); faixa etária de 5 a 14 anos (41,30%); 6 óbitos registrados e maior devem ser confirmados de vida na faixa até 250 dias (23,90%). Verificou-se migrações pendulares em busca de serviços hemodialíticos no estado do Maranhão e predominância das sociedades minoritárias nos perfis dos pacientes. Comprovando assim, a acessibilidade geográfica aos serviços de saúde como determinante na adesão ao tratamento hemodialítico.

Health-risk assessment of Portuguese man-of-war (Physalia physalis) envenomations on urban beaches in São Luís city, in the state of Maranhão, Brazil.

INTRODUCTION: The Portuguese man-of-war (Physalia physalis) is a cosmopolitan species, with a widespread distribution and responsible for a great number of injuries caused by cnidarians worldwide, including Brazil. Geoprocessing technology, however, has never been used to assess the spatial distribution of these animals on beaches. The aim of this study was to carry out a health risk assessment of Portuguese man-of-war (P. physalis) envenomations on the São Marcos and Calhau beaches in São Luís city, in the state of Maranhão, Brazil. METHODS: This is a descriptive and quantitative study concerning primary data on the occurrence of the Portuguese man-of-war (P. physalis) and human envenomations in the studied places, conducted over a two-year period in São Luís, Maranhão, northeastern Brazil. RESULTS: Envenomations mainly occurred on beaches presenting high density of P. physalis during the dry period. Vinegar has been incorporated as a first aid, according to recommendations set by the Brazilian Ministry of Health. CONCLUSIONS: In order to improve prevention and control actions of human envenomation, risk areas for this type of envenomation should be clearly indicated as alert areas. Inclusion of the geographical location of the envenomation in the Notification/Investigation SINAN Form was suggested for allowing the continuity of studies involving this public health issue.

Health-risk assessment of Portuguese man-of-war (Physalia physalis) envenomations on urban beaches in São Luís city, in the state of Maranhão, Brazil

Abstract INTRODUCTION: The Portuguese man-of-war (Physalia physalis) is a cosmopolitan species, with a widespread distribution and responsible for a great number of injuries caused by cnidarians worldwide, including Brazil. Geoprocessing technology, however, has never been used to assess the spatial distribution of these animals on beaches. The aim of this study was to carry out a health risk assessment of Portuguese man-of-war (P. physalis) envenomations on the São Marcos and Calhau beaches in São Luís city, in the state of Maranhão, Brazil. METHODS: This is a descriptive and quantitative study concerning primary data on the occurrence of the Portuguese man-of-war (P. physalis) and human envenomations in the studied places, conducted over a two-year period in São Luís, Maranhão, northeastern Brazil. RESULTS: Envenomations mainly occurred on beaches presenting high density of P. physalis during the dry period. Vinegar has been incorporated as a first aid, according to recommendations set by the Brazilian Ministry of Health. CONCLUSIONS: In order to improve prevention and control actions of human envenomation, risk areas for this type of envenomation should be clearly indicated as alert areas. Inclusion of the geographical location of the envenomation in the Notification/Investigation SINAN Form was suggested for allowing the continuity of studies involving this public health issue.

Quality of life of elderly quilombolas in the Brazilian northeast / Qualidade de vida em idosos quilombolas no nordeste brasileiro

Abstract Objective: To evaluate the quality of life (QoL) of elderly quilombolas (residents of quilombo settlements first established by escaped slaves) in mixed urban and rural residential developments (agrovilas) in Alcântara, Maranhão, Brazil. Method: An observational, cross-sectional and descriptive study was performed. The sample consisted of 129 elderly people of both genders, aged 60 years or older and living in northeastern Brazil. The sample was allocated into three groups, distributed according to geographic space. Quality of life was assessed using the WHOQoL-Bref instrument and a sociodemographic questionnaire was applied. The comparison between groups was carried out using the Anova test (one-way) and subsequently the Bonferroni Post-Hoc test. The correlation was obtained by the Pearson test, p<0.05. Results: Elderly quilombolas had a mean age of 69.7 years (±7.9) and were predominantly men with low income and schooling. Quality of life had higher scores in the social domain (values) and lower in the environmental domain (values). Quality of life as measured by the psychological domain was higher in group I than in groups II (p=0.012) and III (p=0.002). The facets of QoL correlated with facets of health for group I (r=0.357; p=0.032) and III (r=0.461; p<0.001). Conclusion: The situation of the quilombola population surveyed is considered vulnerable and psychological factors influence QoL.

Resumo Objetivo: Avaliar a qualidade de vida (QV) dos idosos quilombolas das agrovilas de Alcântara, Maranhão, Brasil. Método: Estudo observacional, transversal e descritivo. A amostra foi composta por 129 idosos, de ambos os sexos, com idade igual ou maior a 60 anos e residentes na região nordeste do Brasil. A amostra foi alocada em três grupos, distribuídos conforme o espaço geográfico. A QV foi avaliada por meio do instrumento WHOQOL-Bref e também foi aplicado um questionário sociodemográfico. A comparação entre grupos foi obtida pelo teste de Anova (one-way) e em seguida foi aplicado o teste de Post-Hoc de Bonferroni. A correlação foi obtida pelo teste de Pearson, p<0,05. Resultados: Os idosos quilombolas tiveram média de idade de 69,7 (±7,9) anos, sendo predominantemente homens com baixa renda e escolaridade. A QV teve maior pontuação para o domínio social (valores) e menor para o domínio meio ambiente (valores). A QV, quando verificado o domínio psicológico, houve destaque do Grupo I, o qual apresentou diferença com o Grupo II (p=0,012) e III (p=0,002). As facetas da QV tiveram correlação com as facetas de saúde para o Grupo I (r=0,357; p=0,032) e III (r=0,461; p<0,001). Conclusão: Considera-se que a situação da população quilombola pesquisada é vulnerável e fatores psicológicos influenciam a QV.

Spatial analysis of probable cases of dengue fever, chikungunya fever and zika virus infections in Maranhao State, Brazil.

Dengue fever, chikungunya fever, and zika virus infections are increasing public health problems in the world, the last two diseases having recently emerged in Brazil. This ecological study employed spatial analysis of probable cases of dengue fever, chikungunya fever, and zika virus infections reported to the National Mandatory Reporting System (SINAN) in Maranhao State from 2015 to 2016. The software GeoDa version 1.10 was used for calculating global and local Moran indices. The global Moran index identified a significant autocorrelation of incidence rates of dengue (I=0.10; p=0.009) and zika (I=0.07; p=0.03). The study found a positive spatial correlation between dengue and the population density (I=0.31; p<0.001) and a negative correlation with the Performance Index of Unified Health System (PIUHS) by basic care coverage (I=-0.08; p=0.01). Regarding chikungunya fever, there were positive spatial correlations with the population density (I=0.06; p=0.03) and the Municipal Human Development Index (MHDI) (I=0.10; p=0.002), and a negative correlation with the Gini index (I=-0.01; p<0.001) and the PIUHS by basic care coverage (I=-0.18; p<0.001). Lastly, we found positive spatial correlations between Zika virus infections and the population density (I=0.13; p=0.005) and the MHDI (I=0.12; p<0.001), as well as a negative correlation with the Gini index (I=-0.11; p<0.001) and the PIUHS by basic care coverage (I=-0.05; p=0.03). Our results suggest that several socio-demographic factors influenced the occurrence of dengue fever, chikungunya fever, and zika virus infections in Maranhao State.

Zika virus infection and microcephaly: Evidence regarding geospatial associations.

BACKGROUND: Although the Zika virus (ZIKV) epidemic ceased to be a public health emergency by the end of 2016, studies to improve knowledge about this emerging disease are still needed, especially those investigating a causal relationship between ZIKV in pregnant women and microcephaly in neonates. However, there are still many challenges in describing the relationship between ZIKV and microcephaly. The few studies focusing on the epidemiological profile of ZIKV and its changes over time are largely limited to systematic reviews of case reports and dispersal mapping of ZIKV spread over time without quantitative methods to analyze patterns and their covariates. Since Brazil has been at the epicenter of the ZIKV epidemic, this study examines the geospatial association between ZIKV and microcephaly in Brazil. METHODS: Our study is categorized as a retrospective, ecological study based on secondary databases. Data were obtained from January to December 2016, from the following data sources: Brazilian System for Epidemiological Surveillance, Disease Notification System, System for Specialized Management Support, and Brazilian Institute of Geography and Statistics. Data were aggregated by municipality. Incidence rates were estimated per 100,000 inhabitants. Analyses consisted of mapping the aggregated incidence rates of ZIKV and microcephaly, followed by a Getis-Ord-Gi spatial cluster analysis and a Bivariate Local Moran's I analysis. RESULTS: The incidence of ZIKV cases is changing the virus's spatial pattern, shifting from Brazil's Northeast region to the Midwest and North regions. The number of municipalities in clusters of microcephaly incidence is also shifting from the Northeast region to the Midwest and North, after a time lag is considered. Our findings suggest an increase in microcephaly incidence in the Midwest and North regions, associated with high levels of ZIKV infection months before. CONCLUSION: The greatest burden of microcephaly shifted from the Northeast to other Brazilian regions at the beginning of 2016. Brazil's Midwest region experienced an increase in microcephaly incidence associated with ZIKV incidence. This finding highlights an association between an increase in ZIKV infection with a rise in microcephaly cases after approximately three months.

Spatial-temporal analysis of dengue deaths: identifying social vulnerabilities.

INTRODUCTION: Currently, dengue fever, chikungunya fever, and zika virus represent serious public health issues in Brazil, despite efforts to control the vector, the Aedes aegypti mosquito. METHODS:: This was a descriptive and ecological study of dengue deaths occurring from 2002 to 2013 in São Luis, Maranhão, Brazil. Geoprocessing software was used to draw maps, linking the geo-referenced deaths with urban/social data at census tract level. RESULTS:: There were 74 deaths, concentrated in areas of social vulnerability. CONCLUSIONS:: The use of geo-technology tools pointed to a concentration of dengue deaths in specific intra-urban areas.

Spatial-temporal analysis of dengue deaths: identifying social vulnerabilities

Abstract: INTRODUCTION Currently, dengue fever, chikungunya fever, and zika virus represent serious public health issues in Brazil, despite efforts to control the vector, the Aedes aegypti mosquito. METHODS: This was a descriptive and ecological study of dengue deaths occurring from 2002 to 2013 in São Luis, Maranhão, Brazil. Geoprocessing software was used to draw maps, linking the geo-referenced deaths with urban/social data at census tract level. RESULTS: There were 74 deaths, concentrated in areas of social vulnerability. CONCLUSIONS: The use of geo-technology tools pointed to a concentration of dengue deaths in specific intra-urban areas.

Análise dos casos de leishmaniose visceral utilizando técnicas de geoprocessamento / Analysis of cases of visceral leishmaniasis using geoprocessing technique

OBJETIVOS: analisar os casos de leishmaniose visceral (LV) notificados no estado do Maranhão entre os anos de 2007 e 2014 por meio de técnicas de geoprocessamento. MÉTODOS: a partir das notificações realizadas no período do estudo, foram elaborados gráficos e mapas temáticos utilizando técnicas de geoprocessamento. RESULTADOS: os anos de 2012 e 2013 destacam-se por apresentarem o menor e o maior número de casos, 504 e 1.119 respectivamente, porém não ficando distantes da média anual encontrada (815), considerada elevada. A distribuição cumulativa demonstra maior concentração de casos na região leste do Maranhão e nos municípios mais urbanizados. CONCLUSÃO: a análise dos mapas e gráficos revela a presença da LV em quase todos os municípios, mostrando os principais focos e caracterizando o estado como epidêmico para a doença. As ferramentas de geoprocessamento mostram-se úteis à saúde coletiva ao permitirem o mapeamento de doenças, avaliação de riscos, planejamento e avaliação de ações em saúde.

OBJECTIVES: analysis of cases of visceral leishmaniasis (VL) reported in the state of Maranhão between the years 2007 and 2014 using GIS techniques. METHODS: from the notifications made during the study period, were elaborated graphics and thematic maps using GIS techniques. RESULTS: the years 2012 and 2013 stand out for having the lowest and the highest number of cases 504 and 1,119 respectively, but not getting far the annual average found (815), considered high. The cumulative distribution shows a greater concentration of cases in the eastern region of Maranhão and municipalities with greater urbanization. CONCLUSION: The analysis of maps and graphics reveals the presence of VL in all almost municipalities, showing the focus and characterizing Maranhão as an epidemic state. The GIS techniques prove useful to public health as a tool to allow the mapping of diseases, risk assessment, planning and evaluation health actions.