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1.
Acta Trop ; 207: 105496, 2020 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-32315604

RESUMO

Brazilian spotted fever (BSF) is a highly lethal disease in southeastern Brazil. BSF is caused by the bacterium Rickettsia rickettsii and is transmitted by the bites of the tick of the genus Amblyomma. The spatial distribution of BSF risk areas is not well known in the country given the complexity of the transmission cycle. This study used the ecological niche modeling (ENM) approach to anticipate the potential distribution of the etiological agent (Rickettsia rickettsii), vectors (Amblyomma sculptum and A. dubitatum), and hosts (Hydrochoerus hydrochaeris, Didelphis aurita, and D. marsupialis) of BSF in Brazil. We compiled occurrence records for all vectors, hosts, and BSF from our own field surveillance, online repositories, and literature. ENM identified BSF risk areas in southeastern and southern Brazil, and anticipated other dispersed suitable areas in the western, central, and northeastern coast regions of Brazil. Tick vectors and mammalian hosts were confined to these same areas; however, host species showed broader suitability in northern Brazil. All species ENMs performed significantly better than random expectations. We also tested the BSF prediction based on 253 additional independent cases identified in our surveillance; the model anticipated 251 out of 253 of these independent cases. Background similarity tests comparing the ENMs of R. rickettsii, tick vectors, and mammalian hosts were unable to reject null hypotheses of niche similarity. Finally, we observed close coincidence between independent BSF cases, and areas suitable for combinations of vectors and hosts, reflecting the ability of these model pairs to anticipate the distribution of BSF cases across Brazil.

3.
Cien Saude Colet ; 24(8): 2971-2982, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31389544

RESUMO

The aim of the present study was to analyze the mortality trend due to ischemic heart disease (IHD) among older adults, identify changes in the trend and determine the correlation with influenza vaccine coverage (2000 to 2012) in the state of São Paulo between 1980 and 2012. An ecological time series study was conducted involving secondary data from Brazilian information systems. Linear and polynomial regression models as well as joinpoint regression were used to estimate the trends. Pearson's correlation coefficient was used to evaluate the correlation between age-standardized mortality coefficients and vaccine coverage. A decreasing tendency in mortality due to IHD occurred in both sexes, higher mortality rates were found for males and greater reductions were found in the period after the vaccination campaigns. However, no statistically significant changes occurred in the year coinciding with or near the onset of the campaigns. In the overall sample, no evidence of a linear correlation was found between the mortality coefficients and vaccination coverage. Other factors directly associated with morbidity and mortality due to ischemic heart disease may have influenced the trend.


Assuntos
Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Isquemia Miocárdica/epidemiologia , Vacinação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Fatores Sexuais , Cobertura Vacinal/estatística & dados numéricos
4.
Ciênc. Saúde Colet ; 24(8): 2971-2982, ago. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1011871

RESUMO

Abstract The aim of the present study was to analyze the mortality trend due to ischemic heart disease (IHD) among older adults, identify changes in the trend and determine the correlation with influenza vaccine coverage (2000 to 2012) in the state of São Paulo between 1980 and 2012. An ecological time series study was conducted involving secondary data from Brazilian information systems. Linear and polynomial regression models as well as joinpoint regression were used to estimate the trends. Pearson's correlation coefficient was used to evaluate the correlation between age-standardized mortality coefficients and vaccine coverage. A decreasing tendency in mortality due to IHD occurred in both sexes, higher mortality rates were found for males and greater reductions were found in the period after the vaccination campaigns. However, no statistically significant changes occurred in the year coinciding with or near the onset of the campaigns. In the overall sample, no evidence of a linear correlation was found between the mortality coefficients and vaccination coverage. Other factors directly associated with morbidity and mortality due to ischemic heart disease may have influenced the trend.


Resumo O objetivo deste artigo é analisar a tendência dos coeficientes de mortalidade por doenças isquêmicas do coração (DIC) nos idosos no estado de São Paulo, entre 1980 e 2012, identificar mudanças na tendência e verificar a relação entre as coberturas da vacinação contra influenza e os referidos coeficientes de mortalidade. Trata-se de um estudo ecológico de série temporal, realizado com dados secundários do Sistema de Informação sobre Mortalidade (SIM), do Instituto Brasileiro de Geografia e Estatística (IBGE) e do Sistema de Informações do Programa Nacional de Imunização. Para análise dos dados, utilizaram-se técnicas de correlação, modelos de regressão linear, polinomial e joinpoint regression. Observou-se tendência de queda dos coeficientes de mortalidade por DIC em ambos os sexos, sobremortalidade masculina e redução mais expressiva dos coeficientes no período após a intervenção vacinal. As mudanças estatisticamente significativas encontradas nas tendências não ocorreram em ano coincidente ou próximo do início das campanhas. Para o total de idosos, não foi constatada correlação linear entre os coeficientes de mortalidade e as coberturas vacinais. Outros fatores associados à morbimortalidade dos idosos por DIC podem ter influenciado na tendência.

5.
Epidemiol Serv Saude ; 28(1): e2018047, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30970069

RESUMO

OBJECTIVE: to analyze the survival of people with AIDS and association with schooling and race/skin color. METHODS: this was a retrospective cohort study of people diagnosed with AIDS between 1998 and 1999, in the South and Southeast regions of Brazil. We used survival analysis (Kaplan-Meier method), stratified by schooling and race/skin color and multivariate analysis was performed using Cox regression. RESULTS: the study included 2,091 people who had survived at 60 months, with 65% survival among White participants and 62% among Black/brown participants. Irregular use of antiretroviral (HR=11.2 - 95%CI8.8;14.2), and age ≥60 years (HR=2.5 - 95%CI1.4;4.4) were related to lower survival; schooling >8 years (HR=0.4 - 95%CI0.3;0.6) and being female (HR=0.6 - 95%CI0.5;0.8) were positively related to survival; those with less schooling had lower survival. CONCLUSION: lower schooling levels overlap race/skin color differences in relation to survival; these inequalities explain the differences found, despite the policies on universal access to antiretroviral.


Assuntos
Síndrome de Imunodeficiência Adquirida/mortalidade , Fármacos Anti-HIV/administração & dosagem , Grupos de Populações Continentais/estatística & dados numéricos , Pigmentação da Pele , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/etnologia , Adolescente , Adulto , Brasil , Estudos de Coortes , Escolaridade , Feminino , Acesso aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Análise de Sobrevida , Adulto Jovem
6.
Rev Bras Epidemiol ; 22: e190016, 2019 Apr 01.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30942326

RESUMO

OBJECTIVE: to analyze the distribution of leptospirosis according to sociodemographic, epidemiologic, and clinical characteristics, assistance time, rainfall and spatial distribution in Campinas/SP in the period from 2007 to 2014. METHOD: This is an ecological study using information from the confirmed cases. A descriptive analysis was carried out according to the selected variables. The relationship between the cases and rainfall was verified through the Spearman's correlation coefficient. The cases/deaths were georeferenced per areas classified according to socioenvironmental deprivation indexes in Campinas. RESULTS: From the 264 cases, 76.1% occurred in men, 58,4% in the 20 to 49 years old age range. Approximately 55% were hospitalized, with a prevalence of clinical-laboratorial diagnoses of 89.4%, and the lethality was 10.6%. The urban area concentrated 74.2% of the cases, and 48,9% occurred in the household environment. The main risk factor was evidence of the presence of rodents at the site. There was strong correlation between the incidence of cases and rainfall (p < 0.05) in 2010 to 2012. A higher concentration of the cases was observed in the Center-Southwest region. Spatial distribution of cases/deaths showed clusters in regions classified at lower socioeconomic levels. CONCLUSIONS: The patterns of occurrence of leptospirosis in Campinas showed similarity with other Brazilian municipalities. The identification of areas with higher incidence of cases/deaths contributes to the adoption of strategies for intervention and prioritization of resources aiming at the reduction of the risk of infection and at early treatment for those affected.


Assuntos
Leptospirose/epidemiologia , Adulto , Fatores Etários , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Leptospirose/transmissão , Masculino , Pessoa de Meia-Idade , Chuva , Características de Residência , Fatores de Risco , Estações do Ano , Fatores Socioeconômicos , População Urbana , Adulto Jovem
7.
Pathog Glob Health ; 113(1): 27-31, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30714498

RESUMO

Although traditionally chikungunya virus is considered non-fatal, recent studies suggest that there may be in fact underreporting of deaths in some situations. A major chikungunya epidemic hit Jamaica in 2014 but no chikungunya-associated deaths were reported. We assessed the excess of all-cause deaths during this epidemic. Excess deaths were estimated by difference between observed and expected mortality based on the average age-specific mortality rate of 2012-2013, using the 99% confidence interval. There was an excess of 2,499 deaths during the epidemic (91.9/100,000 population), and a strong positive correlation between the monthly incidence of chikungunya and the excess of deaths (Rho = 0.939, p < 0.005). No significant concomitant epidemiological or climatic phenomenon occurred. Chikungunya is a major contributor to morbidity during epidemics and may be an unrecognized cause of death. Thus, it is urgent to review clinical protocols and improve the investigations of specific-cause deaths during chikungunya epidemics. Excess deaths could be a strategic tool for epidemiological surveillance.


Assuntos
Febre de Chikungunya/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Causas de Morte , Criança , Pré-Escolar , Epidemias , Feminino , Humanos , Lactente , Recém-Nascido , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Adulto Jovem
8.
Cad Saude Publica ; 35(2): e00145117, 2019 02 18.
Artigo em Português | MEDLINE | ID: mdl-30785490

RESUMO

This study describes the trend of the coefficients of mortality due to cerebrovascular diseases (CbVD) among the elderly in São Paulo State, Brazil, from 1980 to 2012, before and after influenza vaccination campaigns, and identifies change points. It is an ecological, time-series study carried out with death data from the Health Ministry's Mortality Information System and population data from the Brazilian Institute of Geography and Statistics. We used linear, polynomial and joinpoint regression models in the data analysis. Between 1980 and 2012, there were 480,955 deaths due to CbVD. The mean mortality coefficients decreased for both sexes in all age groups we analyzed, with the greatest reduction in the older ages and male sex. We observed a significant reduction in the mortality trend in 1998 for male sex in the age group 60-69 years (annual percent change - APC = -3%, 95%CI: -4.3; -1.6) and for all elderly (APC = -3.8%, 95%CI: -4.4; -3.1). Considering the period as a whole, we did not observe change points for the age group 70-79 (average annual percent change - AAPC = -3.3%, 95%CI: -3.5; -3.1) and, for male sex, for the group ≥ 80 years (AAPC = -2.9%, 95%CI: -3.1; -2.6). For all elderly, the mean percentage reduction was of 3.1% per year (AAPC = -3.1%, 95%CI: -3.5; -2.7). Results show a reduction in the mortality due to CbVD in the period, with different percentage variations in coefficient reduction. The study's findings add information to the debate regarding possible effects of vaccination campaigns in reducing mortality due to CbVD among the elderly.


Assuntos
Transtornos Cerebrovasculares/mortalidade , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Distribuição por Idade , Idoso , Brasil/epidemiologia , Causas de Morte/tendências , Transtornos Cerebrovasculares/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos , Vacinação
9.
Vector Borne Zoonotic Dis ; 19(4): 249-254, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30335584

RESUMO

Leishmaniasis is a vector-borne parasitic protozoan infection that affects mammals and involves a complex epidemiology. Although dogs are considered the main reservoir in zoonotic visceral leishmaniasis (VL), the possible presence of other mammalian species acting as reservoirs has been associated as a possible cause of lack of success in the control of human VL in many endemic areas. The knowledge about natural infections of some species is still scarce, such as nonhuman primates (NHP), especially from the genus Callithrix (marmosets). We investigated the infection by Leishmania (Leishmania) infantum, the agent of VL in the Americas, in 26 marmosets captured monthly, from April 2014 to March 2015, in an environmentally protected area (EPA) in Southeastern Brazil. The EPA has undergone significant environmental changes and has a transmission focus of canine VL since 2009. Serology was performed through the direct agglutination test, which detected low antibody titers in seven marmosets (7/26; 26.9%, 95% confidence interval 9.9-44.0), being five Callithrix penicillata (black-tufted-ear marmoset) and two Callithrix jacchus (white-tufted-ear marmoset). The presence of the DNA of Leishmania was investigated in blood and skin samples by PCR and genetic sequencing. This is the first report of the detection of L. (L.) infantum in the skin of a marmoset, which was verified in a sample from one C. penicillata. The results demonstrate the natural infection of marmosets by L. (L.) infantum and may suggest the participation of these animals as hosts in the parasite's transmission cycle in the EPA. However, more comprehensive studies are needed to elucidate their role on the VL epidemiology in this area and also in different endemic areas, especially because these NHP are increasingly in contact with humans and domestic animals, particularly due to environmental changes.


Assuntos
Callithrix/parasitologia , Doenças do Cão/parasitologia , Leishmania infantum/isolamento & purificação , Leishmaniose Visceral/veterinária , Doenças dos Macacos/parasitologia , Animais , Anticorpos Antiprotozoários/sangue , Brasil/epidemiologia , Callithrix/sangue , Reservatórios de Doenças/veterinária , Doenças do Cão/epidemiologia , Cães , Leishmania infantum/genética , Leishmania infantum/imunologia , Leishmaniose Visceral/epidemiologia , Doenças dos Macacos/sangue , Doenças dos Macacos/epidemiologia , Zoonoses
10.
Rev. bras. epidemiol ; 22: e190016, 2019. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-990729

RESUMO

RESUMO: Objetivo: Analisar a distribuição de casos e óbitos humanos por leptospirose, segundo características sociodemográficas, epidemiológicas, clínicas, tempo de atendimento, pluviosidade e distribuição espacial em Campinas, São Paulo, no período de 2007 a 2014. Método: Estudo ecológico utilizando informações dos casos confirmados de leptospirose. Realizou-se análise descritiva dos casos, segundo variáveis selecionadas. A relação entre casos autóctones e pluviosidade foi verificada pelo coeficiente de correlação de Spearman. Georreferenciaram-se casos/óbitos por áreas classificadas segundo indicadores socioambientais. Resultados: Dos 264 casos, 76,1% eram homens e 58,4% tinham entre 20 e 49 anos. Cerca de 55% foram hospitalizados. Prevaleceu o diagnóstico clínico-laboratorial (89,4%) e a letalidade foi de 10,6%. Na área urbana, ocorreram 74,2% dos casos e, 48,9%, no domicílio. O principal fator de risco foi o local com sinal de roedores. Houve forte correlação entre a incidência de casos e a pluviosidade (p < 0,05) nos anos de 2010 a 2012. Observou-se maior concentração de casos na região centro-sudoeste. A distribuição espacial dos casos/óbitos mostrou aglomerados em regiões classificadas como de menor nível socioeconômico. Conclusão: Os padrões de ocorrência de leptospirose em Campinas, São Paulo, mostraram similaridade com outras cidades brasileiras. A identificação de áreas com maior incidência de casos/óbitos contribui para a adoção de estratégias específicas de intervenção e priorização de recursos na redução do risco de infecção e tratamento precoce dos acometidos pela doença.


ABSTRACT: Objective: to analyze the distribution of leptospirosis according to sociodemographic, epidemiologic, and clinical characteristics, assistance time, rainfall and spatial distribution in Campinas/SP in the period from 2007 to 2014. Method: This is an ecological study using information from the confirmed cases. A descriptive analysis was carried out according to the selected variables. The relationship between the cases and rainfall was verified through the Spearman's correlation coefficient. The cases/deaths were georeferenced per areas classified according to socioenvironmental deprivation indexes in Campinas. Results: From the 264 cases, 76.1% occurred in men, 58,4% in the 20 to 49 years old age range. Approximately 55% were hospitalized, with a prevalence of clinical-laboratorial diagnoses of 89.4%, and the lethality was 10.6%. The urban area concentrated 74.2% of the cases, and 48,9% occurred in the household environment. The main risk factor was evidence of the presence of rodents at the site. There was strong correlation between the incidence of cases and rainfall (p < 0.05) in 2010 to 2012. A higher concentration of the cases was observed in the Center-Southwest region. Spatial distribution of cases/deaths showed clusters in regions classified at lower socioeconomic levels. Conclusions: The patterns of occurrence of leptospirosis in Campinas showed similarity with other Brazilian municipalities. The identification of areas with higher incidence of cases/deaths contributes to the adoption of strategies for intervention and prioritization of resources aiming at the reduction of the risk of infection and at early treatment for those affected.

11.
Epidemiol. serv. saúde ; 28(1): e2018047, 2019. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-1001961

RESUMO

Resumo Objetivo: analisar a sobrevida de pessoas com aids e sua associação com escolaridade e raça/cor da pele. Métodos: coorte de diagnosticados entre 1998 e 1999, nas regiões Sul e Sudeste do Brasil, com análise de sobrevida (método de Kaplan--Meier), estratificada por escolaridade e raça/cor da pele; a análise multivariada foi realizada mediante regressão de Cox. Resultados: foram incluídas 2.091 pessoas com sobrevida em 60 meses, a percentuais de 65% entre brancos e 62% entre pretos/pardos; o uso irregular de antirretrovirais (HR=11,2 - IC95%8,8;14,2) e a idade ≥60 anos (HR=2,5 - IC95%1,4;4,4) foram relacionados com menor sobrevida; escolaridade >8 anos (HR=0,4 - IC95%0,3;0,6) e sexo feminino (HR=0,6 - IC95%0,5;0,8) relacionaram-se positivamente com sobrevida; os menos escolarizados tiveram sobrevida menor. Conclusão: menor escolaridade sobrepôs-se às diferenças de raça/cor da pele, quando relacionada à sobrevida; tais desigualdades explicaram as diferenças observadas, mesmo com políticas de acesso universal aos antirretrovirais.


Resumen Objetivo: analizar la sobrevida de personas con sida y su asociación con escolaridad y raza/color de la piel. Métodos: cohorte de diagnosticados entre 1998 y 1999, en las regiones Sur y Sudeste de Brasil, con análisis de supervivencia (Kaplan-Meier), estratificados por educación y raza/color de la piel; el análisis multivariante se realizó con regresión de Cox. Resultados: fueron incluidas 2.091 personas con sobrevida de 60 meses, a porcentuales de 65% entre blancos y 62% entre negros/pardos; el uso irregular de antirretrovirales (HR=11,2 - IC95%8,8;14,2) y la edad ≥60 años (HR=2,5 - IC95%1,4;4,4) se relacionaron con una menor sobrevida; escolaridad >8 años (HR=0,4 - IC95%0,3;0,6) y sexo femenino (HR=0,6 - IC95%0,5;0,8) se relacionaron positivamente con sobrevida; los menos escolarizados tuvieron sobrevida menor. Conclusión: menor escolaridad se superpuso a las diferencias de raza/color de la piel referida, cuando relacionada a la supervivencia; tales desigualdades explicaron las diferencias observadas, aún con políticas de acceso universal a antirretrovirales.


Abstract Objective: to analyze the survival of people with AIDS and association with schooling and race/skin color. Methods: this was a retrospective cohort study of people diagnosed with AIDS between 1998 and 1999, in the South and Southeast regions of Brazil. We used survival analysis (Kaplan-Meier method), stratified by schooling and race/skin color and multivariate analysis was performed using Cox regression. Results: the study included 2,091 people who had survived at 60 months, with 65% survival among White participants and 62% among Black/brown participants. Irregular use of antiretroviral (HR=11.2 - 95%CI8.8;14.2), and age ≥60 years (HR=2.5 - 95%CI1.4;4.4) were related to lower survival; schooling >8 years (HR=0.4 - 95%CI0.3;0.6) and being female (HR=0.6 - 95%CI0.5;0.8) were positively related to survival; those with less schooling had lower survival. Conclusion: lower schooling levels overlap race/skin color differences in relation to survival; these inequalities explain the differences found, despite the policies on universal access to antiretroviral.

12.
Cad. Saúde Pública (Online) ; 35(2): e00145117, 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-984136

RESUMO

Este estudo descreve a tendência dos coeficientes de mortalidade por doenças cerebrovasculares (DCbV) em idosos no Estado de São Paulo, Brasil, entre 1980 e 2012, antes e depois das campanhas de vacinação contra a influenza, e identifica pontos de mudanças. Trata-se de um estudo ecológico de série temporal, realizado com dados de óbitos do Sistema de Informações sobre Mortalidade do Ministério da Saúde e dados populacionais do Instituto Brasileiro de Geografia e Estatística. Para análise dos dados, foram utilizados modelos de regressão linear, polinomial e joinpoint regression. Entre 1980 e 2012, foram registrados 480.955 óbitos por DCbV. Os coeficientes médios de mortalidade diminuíram em ambos os sexos para todas as faixas etárias analisadas, com maior redução nas idades mais longevas e no sexo masculino. Observou-se queda significativa na tendência de mortalidade em 1998 para o sexo masculino, na faixa de 60-69 anos (annual percent change - APC = -3%, IC95%: -4,3; -1,6) e para o total dos idosos (APC = -3,8%, IC95%: -4,4; -3,1). Considerando-se o período como um todo, não se observaram pontos de mudanças para a faixa de 70-79 (average annual percent change - AAPC = -3,3%, IC95%: -3,5; -3,1) e, no sexo masculino, para o grupo ≥ 80 anos (AAPC = -2,9%, IC95%: -3,1; -2,6). Para o total de idosos, a redução percentual média foi de 3,1% ao ano (AAPC = -3,1%, IC95%: -3,5; -2,7). Os resultados mostraram redução da mortalidade por DCbV no período estudado, com diferentes variações percentuais de queda dos coeficientes. Os achados deste estudo adicionam informações para o debate sobre o possível efeito das campanhas de vacinação na redução da mortalidade por DCbV na população idosa.


This study describes the trend of the coefficients of mortality due to cerebrovascular diseases (CbVD) among the elderly in São Paulo State, Brazil, from 1980 to 2012, before and after influenza vaccination campaigns, and identifies change points. It is an ecological, time-series study carried out with death data from the Health Ministry's Mortality Information System and population data from the Brazilian Institute of Geography and Statistics. We used linear, polynomial and joinpoint regression models in the data analysis. Between 1980 and 2012, there were 480,955 deaths due to CbVD. The mean mortality coefficients decreased for both sexes in all age groups we analyzed, with the greatest reduction in the older ages and male sex. We observed a significant reduction in the mortality trend in 1998 for male sex in the age group 60-69 years (annual percent change - APC = -3%, 95%CI: -4.3; -1.6) and for all elderly (APC = -3.8%, 95%CI: -4.4; -3.1). Considering the period as a whole, we did not observe change points for the age group 70-79 (average annual percent change - AAPC = -3.3%, 95%CI: -3.5; -3.1) and, for male sex, for the group ≥ 80 years (AAPC = -2.9%, 95%CI: -3.1; -2.6). For all elderly, the mean percentage reduction was of 3.1% per year (AAPC = -3.1%, 95%CI: -3.5; -2.7). Results show a reduction in the mortality due to CbVD in the period, with different percentage variations in coefficient reduction. The study's findings add information to the debate regarding possible effects of vaccination campaigns in reducing mortality due to CbVD among the elderly.


Este estudio describe la tendencia de los coeficientes de mortalidad por enfermedades cerebrovasculares (DCbV) en ancianos del Estado de São Paulo, Brasil, entre 1980 y 2012, antes y después de las campañas de vacunación contra la gripe, e identifica puntos de cambio. Se trata de un estudio ecológico de serie temporal, realizado con datos de óbitos del Sistema de Informaciones sobre Mortalidad del Ministerio de la Salud y datos poblacionales del Instituto Brasileño de Geografía y Estadística. Para el análisis de los datos se utilizaron modelos de regresión lineal, polinomial y regresión joinpoint. Entre 1980 y 2012, se registraron 480.955 óbitos por DCbV. Los coeficientes medios de mortalidad disminuyeron en ambos sexos, en todas las franjas de edad analizadas, con una mayor reducción en las edades más longevas y dentro del sexo masculino. Se observó una caída significativa en la tendencia de la mortalidad en 1998 en el sexo masculino, en la franja de 60-69 años (annual percent change - APC = -3%, IC95%: -4,3; -1,6) y para el total de los ancianos (APC = -3,8%, IC95%: -4,4; -3,1). Considerándose el período como un todo, no se observaron puntos de cambios para la franja de 70-79 (average annual percent change - AAPC = -3,3%, IC95%: -3,5; -3,1) y en el sexo masculino para el grupo ? 80 años (AAPC = -2,9%, IC95%: -3,1; -2,6). Para el total de ancianos, la reducción del porcentaje medio fue 3,1% al año (AAPC = -3,1%, IC95%: -3,5; -2,7). Los resultados mostraron la reducción de la mortalidad por DCbV en el período estudiado, con diferentes variaciones porcentuales de caída de los coeficientes. Los hallazgos de este estudio añaden información para el debate sobre el posible efecto de las campañas de vacunación en la reducción de la mortalidad por DCbV dentro de la población anciana.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Vacinas contra Influenza/administração & dosagem , Transtornos Cerebrovasculares/mortalidade , Influenza Humana/prevenção & controle , Fatores Socioeconômicos , Brasil/epidemiologia , Transtornos Cerebrovasculares/prevenção & controle , Fatores Sexuais , Causas de Morte/tendências , Vacinação , Distribuição por Idade
13.
Emerg Infect Dis ; 24(12): 2352-2355, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30277456

RESUMO

During 2014-2015, a total of 31 deaths were associated with the first chikungunya epidemic in Puerto Rico. We analyzed excess mortality from various causes for the same months during the previous 4 years and detected 1,310 deaths possibly attributable to chikungunya. Our findings raise important questions about increased mortality rates associated with chikungunya.


Assuntos
Febre de Chikungunya/mortalidade , Febre de Chikungunya/virologia , Vírus Chikungunya , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/história , História do Século XXI , Humanos , Pessoa de Meia-Idade , Vigilância da População , Porto Rico/epidemiologia , Estações do Ano , Adulto Jovem
14.
Rev Bras Epidemiol ; 21: e180017, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30234884

RESUMO

OBJECTIVE: To analyze the spatial risk of AIDS mortality in census tracts in a large Brazilian city. METHOD: We studied three retrospective cohorts of individuals with AIDS, who were residents in the city of Campinas, in the State of São Paulo, Brazil. The occurrence of death was analyzed from 1980 to 1990 (cohort 1), 1996 to 2000 (cohort 2), and from 2001 to 2005 (cohort 3). We adjusted a Bayesian semi-parametric model, using the Integrated Nested Laplace Approximation (INLA) method, which allowed for the mapping of mortality risk for the three cohorts. RESULTS: The incidence of death in cohorts 1, 2 and 3 were, respectively, 72.73, 32.21 and 13.11%. The death risk maps showed a tendency of mortality decrease, and presented the sectors with the highest and lowest risk for each period. The model showed that, in the three cohorts, factors associated with the highest risk of death were: being male, and having an age at diagnosis greater than 49 years old. The homosexual/bisexual orientation was associated with lower risk of dying. CONCLUSIONS: Even considering the reduction in the risk of death from AIDS in recent years, after access to highly active antiretroviral therapy, the highest incidence was found among the poorest individuals in the three studied cohorts. The maps and risk factors obtained suggest possible actions for monitoring the disease in the city.


Assuntos
Síndrome de Imunodeficiência Adquirida/mortalidade , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Fatores Etários , Terapia Antirretroviral de Alta Atividade , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Características de Residência , Fatores Sexuais , Fatores Socioeconômicos , Análise de Sobrevida , População Urbana
15.
Trans R Soc Trop Med Hyg ; 112(10): 443-449, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30085307

RESUMO

Background: In 2014 there was a large chikungunya epidemic in the Dominican Republic, with 539 099 reported cases and 6 deaths. Although chikungunya is considered a low-mortality disease, studies have suggested this is an underestimation. This study assessed deaths associated with the epidemic. Methods: Mortality data were obtained from the National Statistics Office, the surveillance system for acute febrile illnesses, and the National Epidemiological Surveillance System. Expected all-cause mortality by age group was estimated using the years 2010-2012 as the baseline. The excess deaths were calculated as the difference between observed and expected deaths during the epidemic. Results: The mortality rate increased during the chikungunya epidemic in 2014. There was a strong correlation between monthly excess of deaths and chikungunya cases (Pearson's r=0.89). There was an excess of deaths (>99% confidence interval) among individuals <5 y and >40 y of age. The mortality rates were higher among the elderly. The death excess was 2853. Correcting for the estimated underreporting, there were 4952 deaths during the chikungunya epidemic (49.8 deaths/100 000 population). Conclusion: This study suggests that chikungunya is an important cause of death (underlying or contributing). It is urgent to review clinical protocols and investigate the causes associated with deaths during chikungunya epidemics.


Assuntos
Febre de Chikungunya/mortalidade , Vigilância da População , Adolescente , Adulto , Idoso , Causas de Morte/tendências , Criança , Pré-Escolar , República Dominicana/epidemiologia , Estudos Epidemiológicos , Feminino , Genótipo , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
Mycoses ; 61(7): 455-463, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29575049

RESUMO

Some animals have an important relationship with fungal infections, and searching for pathogens in animal samples may be an opportunity for eco-epidemiological research. Since studies involving wildlife are generally restricted, using samples from road kills is an alternative. The aim of this study was to verify whether pathogenic fungi of public health importance occur in wildlife road kills from Santa Catarina State, Brazil. Organ samples (n = 1063) from 297 animals were analysed according to Polymerase Chain Reaction (PCR) using universal primers to detect fungi in general and, subsequently, using primers specific to Paracoccidioides brasiliensis, Histoplasma capsulatum and Cryptococcus spp. There were 102 samples positive for fungal species. Eight samples were positive for P. brasiliensis, three samples were positive for Cryptococcus spp. and one sample had coinfection by these two fungi. No sample was positive for Histoplasma spp. according to the molecular detection. Genetic sequencing allowed the identification of Fungal sp. in 89 samples, Cryptococcus neoformans in two samples and Aspergillus penicillioides in three samples. This study shows the importance of wild animals in the epidemiology of fungal infections and assists in the mapping of pathogen occurrence in a region that was not previously evaluated.


Assuntos
Animais Selvagens/microbiologia , Fungos/genética , Micoses/veterinária , Saúde Pública , Animais , Aspergillus/genética , Aspergillus/isolamento & purificação , Brasil/epidemiologia , Cryptococcus neoformans/genética , Primers do DNA , DNA Fúngico/genética , Raposas/microbiologia , Fungos/isolamento & purificação , Fungos/patogenicidade , Haplorrinos/microbiologia , Histoplasma/genética , Histoplasma/isolamento & purificação , Humanos , Doenças dos Macacos/diagnóstico , Doenças dos Macacos/epidemiologia , Doenças dos Macacos/microbiologia , Micoses/diagnóstico , Micoses/epidemiologia , Micoses/microbiologia , Paracoccidioides/genética , Paracoccidioides/isolamento & purificação , Reação em Cadeia da Polimerase , Guaxinins/microbiologia
17.
Rev. bras. epidemiol ; 21: e180017, 2018. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-958814

RESUMO

RESUMO: Objetivo: O estudo teve como objetivo analisar o risco espacial de mortalidade por aids em setores censitários de município brasileiro de grande porte. Método: Foram estudadas três coortes retrospectivas de indivíduos notificados por aids e residentes no município de Campinas, São Paulo, nos períodos de 1980 a 1990 (coorte 1), 1996 a 2000 (coorte 2) e 2001 a 2005 (coorte 3), a fim de identificar a ocorrência do óbito. Foi ajustado um modelo semiparamétrico Bayesiano, empregando o método de Aproximação de Laplace Aninhada e Integrada (INLA), que permitiu obter mapas de risco de óbito nas três coortes estudadas. Resultados: A incidência de óbito nas coortes 1, 2 e 3 foram, respectivamente, 72,73; 32,21 e 13,11%. Os mapas de risco de óbito apontaram tendência de queda da mortalidade e evidenciaram os setores que apresentaram maior e menor risco em cada período. O modelo mostrou que, nas três coortes, os fatores associados ao maior risco de óbito foram: ser do sexo masculino e possuir idade de diagnóstico superior a 49 anos. A orientação homossexual/bissexual foi associada ao menor risco de morrer. Conclusões: Mesmo diante da diminuição do risco de morte por aids nos últimos anos, após o acesso à terapia antirretroviral altamente ativa, a maior incidência se concentra entre os mais pobres nas três coortes estudadas. Os mapas e o fatores de risco obtidos orientam possíveis ações e monitoramento da doença no município.


ABSTRACT: Objective: To analyze the spatial risk of AIDS mortality in census tracts in a large Brazilian city. Method: We studied three retrospective cohorts of individuals with AIDS, who were residents in the city of Campinas, in the State of São Paulo, Brazil. The occurrence of death was analyzed from 1980 to 1990 (cohort 1), 1996 to 2000 (cohort 2), and from 2001 to 2005 (cohort 3). We adjusted a Bayesian semi-parametric model, using the Integrated Nested Laplace Approximation (INLA) method, which allowed for the mapping of mortality risk for the three cohorts. Results: The incidence of death in cohorts 1, 2 and 3 were, respectively, 72.73, 32.21 and 13.11%. The death risk maps showed a tendency of mortality decrease, and presented the sectors with the highest and lowest risk for each period. The model showed that, in the three cohorts, factors associated with the highest risk of death were: being male, and having an age at diagnosis greater than 49 years old. The homosexual/bisexual orientation was associated with lower risk of dying. Conclusions: Even considering the reduction in the risk of death from AIDS in recent years, after access to highly active antiretroviral therapy, the highest incidence was found among the poorest individuals in the three studied cohorts. The maps and risk factors obtained suggest possible actions for monitoring the disease in the city.

18.
PLoS Curr ; 92017 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-29263941

RESUMO

Introduction: Chikungunya is an emerging arbovirus that reached the Western Hemisphere at the end of 2013. Studies in the Indian Ocean and India suggest that passive surveillance systems cannot recognize many of deaths associated with chikungunya, which can be inferred by an increase in the overall mortality observed during chikungunya epidemics. Objective: We assess the mortality associated with chikungunya epidemics in the most affected states in Brazil, from 2015 and 2016. Methods: We studied the monthly mortality by age group, comparing a period without epidemics to a chikungunya epidemic period, which we defined arbitrarily as consecutive months with incidences of more than 50 cases/100,000 persons. Results: We obtained official data from the National System of Reported Diseases (SINAN) and the Mortality Information System (SIM), both maintained by the Ministry of Health. We identified a significant increase in the all-cause mortality rate during chikungunya epidemics, while there was no similar mortality in the previous years, even during dengue epidemics. We estimated an excess of 4,505 deaths in Pernambuco during the chikungunya epidemics (47.9 per 100,000 persons).The most affected age groups were the elderly and those under 1 year of age, and the same pattern occurred in all the states. Discussion: Further studies at other sites are needed to confirm the association between increased mortality and chikungunya epidemics indifferent age groups. If these findings are confirmed, it will be necessary to revise the guidelines to recognize the actual mortality associated with chikungunya and to improve therapeutic approaches and protective measures in the most vulnerable groups.

19.
Cien Saude Colet ; 22(11): 3781-3792, 2017 Nov.
Artigo em Português, Inglês | MEDLINE | ID: mdl-29211183

RESUMO

The study investigates the survival of patients with co-infection AIDS-TB through a retrospective study of a cohort of individuals aged 13 or more and the diagnosis of AIDS reported in the years 1998-99 and following 10 years. Of the 2,091 AIDS cases, 517 (24.7%) had positive diagnosis for tuberculosis, and 379 (73.3%) were male. The risk among co-infected patients was 1,65 times the not co-infected. Have been compared the exposed and non-exposed through the Kaplan-Meier and Cox method. The variables associated with longer survival were: female gender (HR = 0.63), educational level ≥ eight years (HR = 0.52), CD4 diagnostic criteria (HR = 0.64); and shorter survival: age ≥ 60 years (HR = 2.33), no use of HAART (HR = 8.62), no investigation to Hepatitis B (HR = 2.44) and opportunistic infections ≥ two (HR = 1.97). The average survival rate, related to TB infection was 69 months for the Southeast region and 73 months for the South. AIDS and tuberculosis require monitoring and treatment adherence and they are markers of the quality of care and survival of patients in Brazil.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Síndrome de Imunodeficiência Adquirida/mortalidade , Adesão à Medicação , Tuberculose/mortalidade , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adolescente , Adulto , Fatores Etários , Terapia Antirretroviral de Alta Atividade , Brasil/epidemiologia , Estudos de Coortes , Coinfecção , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Taxa de Sobrevida , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Adulto Jovem
20.
Ciênc. Saúde Colet ; 22(11): 3781-3792, Nov. 2017. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-890185

RESUMO

Resumo O presente estudo buscou analisar a sobrevida de pacientes com a coinfecção AIDS-Tuberculose por meio de um estudo de coorte retrospectivo de indivíduos com 13 anos ou mais e diagnóstico de AIDS notificados nos anos de 1998-99 e seguimento de 10 anos. Dos 2.091 casos de AIDS, 517 (24,7%) tinham diagnóstico positivo para tuberculose, sendo 379 (73,3%) masculinos. O risco entre os coinfectados foi 1,65 vezes os não coinfectados. As variáveis associadas à maior sobrevida foram: sexo feminino (HR = 0,63), escolaridade ≥ oito anos (HR = 0,52), critério diagnóstico CD4 (HR = 0,64); e à menor sobrevida: faixa etária ≥ 60 anos (HR = 2,33), não uso de ARV (HR = 8,62), não investigação para hepatite B (HR = 2,44) e doenças oportunistas (≥ duas) (HR = 1,97). A sobrevivência acumulada foi de 71% nos não coinfectados e 62% nos coinfectados na região Sul e de 74% e 58%, respectivamente, na região Sudeste, 60 meses após o diagnóstico de AIDS. A AIDS e a Tuberculose exigem acompanhamento e adesão ao tratamento e são marcadores da atenção à saúde e da sobrevivência dos pacientes no Brasil.


Abstract The study investigates the survival of patients with co-infection AIDS-TB through a retrospective study of a cohort of individuals aged 13 or more and the diagnosis of AIDS reported in the years 1998-99 and following 10 years. Of the 2,091 AIDS cases, 517 (24.7%) had positive diagnosis for tuberculosis, and 379 (73.3%) were male. The risk among co-infected patients was 1,65 times the not co-infected. Have been compared the exposed and non-exposed through the Kaplan-Meier and Cox method. The variables associated with longer survival were: female gender (HR = 0.63), educational level ≥ eight years (HR = 0.52), CD4 diagnostic criteria (HR = 0.64); and shorter survival: age ≥ 60 years (HR = 2.33), no use of HAART (HR = 8.62), no investigation to Hepatitis B (HR = 2.44) and opportunistic infections ≥ two (HR = 1.97). The average survival rate, related to TB infection was 69 months for the Southeast region and 73 months for the South. AIDS and tuberculosis require monitoring and treatment adherence and they are markers of the quality of care and survival of patients in Brazil.

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