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1.
Microbes Infect ; 22(2): 72-73, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32092539

RESUMO

One of the most perplexing questions regarding the current COVID-19 coronavirus epidemic is the discrepancy between the severity of cases observed in the Hubei province of China and those occurring elsewhere in the world. One possible answer is antibody dependent enhancement (ADE) of SARS-CoV-2 due to prior exposure to other coronaviruses. ADE modulates the immune response and can elicit sustained inflammation, lymphopenia, and/or cytokine storm, one or all of which have been documented in severe cases and deaths. ADE also requires prior exposure to similar antigenic epitopes, presumably circulating in local viruses, making it a possible explanation for the observed geographic limitation of severe cases and deaths.


Assuntos
Anticorpos Facilitadores , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/patologia , Pneumonia Viral/patologia , China/epidemiologia , Infecções por Coronavirus/mortalidade , Geografia Médica , Humanos , Pandemias , Pneumonia Viral/mortalidade
2.
Autoimmun Rev ; 19(1): 102423, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31733367

RESUMO

PURPOSE: AIDs may disproportionately impact specific racial groups, but autoimmune (AID) prevalence information by minority racial group is sparse for many AIDs. The objective of this analysis was to supplement previously published AID prevalence rates by providing information on race rate ratios (minority race populations compared to Caucasian populations) in the United States. Preliminary to estimating race rate ratios, contemporary US-specific, health care utilization-based AID prevalence rates and female-to-male ratios were estimated and compared to previously published AID prevalence rates. METHODS: We used a large national electronic medical record database of 52 million individuals to estimate age-adjusted direct standardized rates for 22 AIDs for 2010 through 2016 by gender, race, and US census division. These were compared to previously published estimates. RESULTS: Female-to-male ratios were comparable with published studies. Almost all observed Multiracial AID rates were significantly higher than Caucasian rates, as well as 9 of 22 AID rates observed among Native Americans and 8 of 22 AID rates estimated among African-American patients. Regional variation was noted: highest African-American systemic lupus erythematosus rates were observed in the West North Central and South Atlantic divisions, highest African-American multiple sclerosis rates in the South Atlantic and Pacific divisions, and highest Native American rheumatoid arthritis rates in the West North Central, Mountain, and Pacific divisions. CONCLUSIONS: Substantial AID heterogeneity exists by race and by geographic area. An important research area is further exploring factors related to heterogeneity such as potential interactions between genetic susceptibility and environmental factors.


Assuntos
Doenças Autoimunes/etnologia , Doenças Autoimunes/epidemiologia , Lúpus Eritematoso Sistêmico/etnologia , Lúpus Eritematoso Sistêmico/epidemiologia , Afro-Americanos , Feminino , Geografia Médica , Humanos , Masculino , Prevalência , Razão de Masculinidade , Estados Unidos/epidemiologia , Estados Unidos/etnologia
3.
Rev Saude Publica ; 53: 97, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800910

RESUMO

OBJECTIVES: To develop a deprivation index to study health inequalities in 221 areas of Ecuador, to describe the pattern of deprivation in Ecuador, and to explore the applications of the index to study health inequalities by analysing the association between deprivation and mortality in the study areas. METHODS: We performed principal component analyses of available indicators of the 221 cantons of Ecuador. A set of 41 sociodemographic, social capital, and subjective well-being variables were obtained from the 2010 National Population Census and the National Living Conditions Survey 2013-2014. To explore the application of the index in public health, the association between the index and standardised mortality ratios was estimated through a Poisson regression model. RESULTS: The final index was constructed with 17 indicators. The first component explained 51.8% of the total variance of the data. A geographic pattern and a positive association of the index with the standardised mortality ratios of the cantons were observed in both men and women. CONCLUSIONS: We constructed a deprivation index that can identify disadvantaged areas in Ecuador. This index could be a valuable tool for the detection of vulnerabilised populations and the development of interventions and policies adapted to local needs.


Assuntos
Disparidades nos Níveis de Saúde , Indicadores Básicos de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Equador/epidemiologia , Feminino , Geografia Médica , Humanos , Masculino , Mortalidade , Áreas de Pobreza , Saúde Pública , Fatores Socioeconômicos
5.
Artigo em Russo | MEDLINE | ID: mdl-31765548

RESUMO

This article provides an overview of the change of topics in the medical-geographical studies in Russia. It highlights the conventional nature of this science, its dependence on political, ideological and scientific demands as well as institutional difficulties. It concludes that the goal of further historical research is to focus on the restoration of synchronous meanings of medical geography, its links with other disciplines and the elucidation of Russia's participation in the transnational project of medico-geographical research.


Assuntos
Geografia Médica , Federação Russa
7.
BMC Cancer ; 19(1): 940, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604464

RESUMO

BACKGROUND: In Brazil, 211 thousand (16.14%) of all death certificates in 2016 identified cancer as the underlying cause of death, and it is expected that around 320 thousand will receive a cancer diagnosis in 2019. We aimed to describe trends of cancer mortality from 1996 to 2016, in 133 intermediate regions of Brazil, and to discuss macro-regional differences of trends by human development and healthcare provision. METHODS: This ecological study assessed georeferenced official data on population and mortality, health spending, and healthcare provision from Brazilian governmental agencies. The regional office of the United Nations Development Program provided data on the Human Development Index in Brazil. Deaths by misclassified or unspecified causes (garbage codes) were redistributed proportionally to known causes. Age-standardized mortality rates used the world population as reference. Prais-Winsten autoregression allowed calculating trends for each region, sex and cancer type. RESULTS: Trends were predominantly on the increase in the North and Northeast, whereas they were mainly decreasing or stationary in the South, Southeast, and Center-West. Also, the variation of trends within intermediate regions was more pronounced in the North and Northeast. Intermediate regions with higher human development, government health spending, and hospital beds had more favorable trends for all cancers and many specific cancer types. CONCLUSIONS: Patterns of cancer trends in the country reflect differences in human development and the provision of health resources across the regions. Increasing trends of cancer mortality in low-income Brazilian regions can overburden their already fragile health infrastructure. Improving the healthcare provision and reducing socioeconomic disparities can prevent increasing trends of mortality by all cancers and specific cancer types in Brazilian more impoverished regions.


Assuntos
Assistência à Saúde , Monitoramento Epidemiológico , Mortalidade/tendências , Neoplasias/epidemiologia , Neoplasias/mortalidade , Brasil/epidemiologia , Feminino , Geografia Médica/métodos , Gastos em Saúde , Recursos em Saúde , Nível de Saúde , Disparidades em Assistência à Saúde , Número de Leitos em Hospital , Desenvolvimento Humano , Humanos , Seguro Saúde , Masculino , Fatores Socioeconômicos
8.
Medicine (Baltimore) ; 98(37): e17165, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517868

RESUMO

A thyroid cancer ultrasonography screening for all residents 18 years old or younger living in the Fukushima prefecture started in October 2011 to investigate the possible effect of the radiological contamination after the Fukushima Daiichi Nuclear Power Plant accidents as of March 12 to 15, 2011. Thyroid cancer in 184 cases was reported by February 2017. The question arises to which extent those cancer cases are a biological consequence of the radiation exposure or an artefactual result of the intense screening of a large population.Experiences with the Chernobyl accident suggest that the external dose may be considered a valid surrogate for the internal dose of the thyroid gland. We, therefore, calculated the average external effective dose-rate (µSv/h) for the 59 municipalities of the Fukushima prefecture based on published data of air and soil radiation. We further determined the municipality-specific absolute numbers of thyroid cancers found by each of the two screening rounds in the corresponding municipality-specific exposed person-time observed. A possible association between the radiation exposure and the thyroid cancer detection rate was analyzed with Poisson regression assuming Poisson distributed thyroid cancer cases in the exposed person-time observed per municipality.The target populations consisted of 367,674 and 381,286 children and adolescents for the 1st and the 2nd screening rounds, respectively. In the 1st screening, 300,476 persons participated and 270,489 in the 2nd round. From October 2011 to March 2016, a total of 184 cancer cases were found in 1,079,786 person-years counted from the onset of the exposure to the corresponding examination periods in the municipalities. A significant association between the external effective dose-rate and the thyroid cancer detection rate exists: detection rate ratio (DRR) per µSv/h 1.065 (1.013, 1.119). Restricting the analysis to the 53 municipalities that received less than 2 µSv/h, and which represent 176 of the total 184 cancer cases, the association appears to be considerably stronger: DRR per µSv/h 1.555 (1.096, 2.206).The average radiation dose-rates in the 59 municipalities of the Fukushima prefecture in June 2011 and the corresponding thyroid cancer detection rates in the period October 2011 to March 2016 show statistically significant relationships.


Assuntos
Acidente Nuclear de Fukushima , Neoplasias Induzidas por Radiação/epidemiologia , Doses de Radiação , Neoplasias da Glândula Tireoide/epidemiologia , Adolescente , Criança , Pré-Escolar , Relação Dose-Resposta à Radiação , Detecção Precoce de Câncer , Geografia Médica , Humanos , Incidência , Lactente , Recém-Nascido , Japão/epidemiologia , Modelos Estatísticos , Neoplasias Induzidas por Radiação/diagnóstico por imagem , Prevalência , Exposição à Radiação/efeitos adversos , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/efeitos da radiação , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia
10.
Hemoglobin ; 43(3): 166-173, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31272240

RESUMO

Iran, as a country located in the Thalassemia Belt, has made great progress in thalassemia prevention and treatment. The thalassemia prevention program was implemented in 1995 and the country-wide thalassemia treatment network, consisting of 64 medical universities and faculties, is active. The acknowledgment of the status of thalassemia treatment and prevention in Iran can be of significance to researchers of the countries affected with thalassemia. In the present research, the database of the Treatment Deputy Office of the Ministry of Health, Treatment and Medical Education and that of the Hemovigilance Network of the Iranian Blood Transfusion Organization, were used. The data were analyzed using the Statistical Package of the Social Sciences, version 23. The findings show 90.13% reduction in the expected cases of new ß-thalassemia (ß-thal) births in 2015. Moreover, out of 18,983 hemoglobinopathy patients, 17,342 are ß-thal major (ß-TM) and ß-thal intermedia (ß-TI) patients covered by 198 medical centers. Out of the total number of blood donations in Iran, 19.17% are allocated to thalassemia treatment. Iran has reached an acceptable level of success in thalassemia prevention and the preparation of safe and adequate blood. Iran's achievements can be adapted to other developing countries, particularly in the Middle East.


Assuntos
Talassemia beta/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Gerenciamento Clínico , Feminino , Geografia Médica , Hemoglobinopatias/diagnóstico , Hemoglobinopatias/epidemiologia , Hemoglobinopatias/prevenção & controle , Hemoglobinopatias/terapia , Humanos , Lactente , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Vigilância em Saúde Pública , Sistema de Registros , Adulto Jovem , Talassemia beta/diagnóstico , Talassemia beta/prevenção & controle , Talassemia beta/terapia
11.
J Trauma Acute Care Surg ; 87(1): 92-99, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31260425

RESUMO

BACKGROUND: Geographic distribution of trauma system resources including trauma centers and helicopter bases correlate with outcomes. However, ground emergency medical services (EMS) coverage is dynamic and more difficult to quantify. Our objective was to evaluate measures that describe ground EMS coverage in trauma systems and correlate with outcome. METHODS: Trauma system resources in Pennsylvania were mapped. Primary outcome was county age-adjusted transportation injury fatality rate. Measures of county EMS coverage included average distance to the nearest trauma center, number of basic life support and advanced life support units/100 square miles, distance differential between the nearest trauma center and nearest helicopter base, and nearest neighbor ratio (dispersed or clustered geographic pattern of agencies). Spatial-lag regression determined association between fatality rates and these measures, adjusted for prehospital time, Injury Severity Score, and socioeconomic factors. Relative importance of these measures was determined by assessing the loss in R value from the full model by removing each measure. A Geographic Emergency Medical Services Index (GEMSI) was created based on these measures for each county. RESULTS: Median fatality rate was higher in counties with fewer trauma system resources. Decreasing distance to nearest trauma center, increasing advanced life support units/100 square miles, greater distance reduction due to helicopter bases, and dispersed geographic pattern of county EMS agencies were associated with lower fatality rates. The GEMSI ranged from -6.6 to 16.4 and accounted for 49% of variation in fatality rates. Adding an EMS agency to a single county that produced a dispersed pattern of EMS coverage reduced predicted fatality rate by 6%, while moving a helicopter base into the same county reduced predicted fatality rate by 22%. CONCLUSION: The GEMSI uses several measures of ground EMS coverage and correlates with outcome. This tool may be used to describe and compare ground EMS coverage across trauma system geographies, as well as help optimize the geographic distribution of trauma system resources. LEVEL OF EVIDENCE: Ecological study, level IV.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Ambulâncias/estatística & dados numéricos , Serviços Médicos de Emergência/organização & administração , Geografia Médica , Humanos , Escala de Gravidade do Ferimento , Pennsylvania/epidemiologia , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapia
12.
Neurology ; 93(8): e747-e757, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31320472

RESUMO

OBJECTIVE: To determine whether lower socioeconomic status (SES) and longer home to hospital driving time are associated with reductions in tissue plasminogen activator (tPA) administration and timeliness of the treatment. METHODS: We conducted a retrospective observational study using data from the Get With The Guidelines-Stroke Registry (GWTG-Stroke) between January 2015 and March 2017. The study included 118,683 ischemic stroke patients age ≥18 who were transported by emergency medical services to one of 1,489 US hospitals. We defined each patient's SES based on zip code median household income. We calculated the driving time between each patient's home zip code and the hospital where he or she was treated using the Google Maps Directions Application Programing Interface. The primary outcomes were tPA administration and onset-to-arrival time (OTA). Outcomes were analyzed using hierarchical multivariable logistic regression models. RESULTS: SES was not associated with OTA (p = 0.31) or tPA administration (p = 0.47), but was associated with the secondary outcomes of onset-to-treatment time (OTT) (p = 0.0160) and in-hospital mortality (p = 0.0037), with higher SES associated with shorter OTT and lower in-hospital mortality. Driving time was associated with tPA administration (p < 0.001) and OTA (p < 0.0001), with lower odds of tPA (0.83, 0.79-0.88) and longer OTA (1.30, 1.24-1.35) in patients with the longest vs shortest driving time quartiles. Lower SES quintiles were associated with slightly longer driving time quartiles (p = 0.0029), but there was no interaction between the SES and driving time for either OTA (p = 0.1145) or tPA (p = 0.6103). CONCLUSIONS: Longer driving times were associated with lower odds of tPA administration and longer OTA; however, SES did not modify these associations.


Assuntos
Hospitais/estatística & dados numéricos , Classe Social , Acidente Vascular Cerebral/tratamento farmacológico , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Geografia Médica , Humanos , Masculino , Pessoa de Meia-Idade , Ativador de Plasminogênio Tecidual/administração & dosagem , Estados Unidos , Adulto Jovem
13.
BMC Med Inform Decis Mak ; 19(1): 139, 2019 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331394

RESUMO

BACKGROUND: Despite WHO guidelines for testing all suspected cases of malaria before initiating treatment, presumptive malaria treatment remains common practice among some clinicians and in certain low-resource settings the capacity for microscopic testing is limited. This can lead to misdiagnosis, resulting in increased morbidity due to lack of treatment for undetected conditions, increased healthcare costs, and potential for drug resistance. This is particularly an issue as multiple conditions share the similar etiologies to malaria, including brucellosis, a rare, under-detected zoonosis. Linking rapid diagnostic tests (RDTs) and digital test readers for the detection of febrile illnesses can mitigate this risk and improve case management of febrile illness. METHODS: This technical advance study examines Connected Diagnostics, an approach that combines the use of point-of-care RDTs for malaria and brucellosis, digitally interpreted by a rapid diagnostic test reader (Deki Reader) and connected to mobile payment mechanisms to facilitate the diagnosis and treatment of febrile illness in nomadic populations in Samburu County, Kenya. Consenting febrile patients were tested with RDTs and patient diagnosis and risk information were uploaded to a cloud database via the Deki Reader. Patients with positive diagnoses were provided digital vouchers for transportation to the clinic and treatment via their health wallet on their mobile phones. RESULTS: In total, 288 patients were tested during outreach visits, with 9% testing positive for brucellosis and 0.6% testing positive for malaria. All patients, regardless of diagnosis were provided with a mobile health wallet on their cellular phones to facilitate their transport to the clinic, and for patients testing positive for brucellosis or malaria, the wallet funded their treatment. The use of the Deki Reader in addition to quality diagnostics at point of care also facilitated geographic mapping of patient diagnoses in relation to key risk areas for brucellosis transmission. CONCLUSIONS: This study demonstrates that the Connected Dx approach can be effective even when addressing a remote, nomadic population and a rare disease, indicating that this approach to diagnosing, treatment, and payment for healthcare costs is feasible and can be scaled to address more prevalent diseases and conditions in more populous contexts.


Assuntos
Brucelose/diagnóstico , Malária/diagnóstico , Telemedicina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brucelose/epidemiologia , Brucelose/terapia , Telefone Celular , Criança , Pré-Escolar , Testes Diagnósticos de Rotina/métodos , Estudos de Viabilidade , Feminino , Geografia Médica , Humanos , Lactente , Quênia/epidemiologia , Malária/epidemiologia , Masculino , Pessoa de Meia-Idade , Testes Imediatos , Migrantes , Adulto Jovem
14.
Emerg Infect Dis ; 25(8): 1461-1468, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31310227

RESUMO

We investigated an outbreak of listeriosis detected by whole-genome multilocus sequence typing and associated with packaged leafy green salads. Nineteen cases were identified in the United States during July 5, 2015-January 31, 2016; isolates from case-patients were closely related (median difference 3 alleles, range 0-16 alleles). Of 16 case-patients interviewed, all reported salad consumption. Of 9 case-patients who recalled brand information, all reported brands processed at a common US facility. The Public Health Agency of Canada simultaneously investigated 14 cases of listeriosis associated with this outbreak. Isolates from the processing facility, packaged leafy green salads, and 9 case-patients from Canada were closely related to US clinical isolates (median difference 3 alleles, range 0-16 alleles). This investigation led to a recall of packaged leafy green salads made at the processing facility. Additional research is needed to identify best practices and effective policies to reduce the likelihood of Listeria monocytogenes contamination of fresh produce.


Assuntos
Surtos de Doenças , Microbiologia de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Doenças Transmitidas por Alimentos/microbiologia , Listeria , Listeriose/epidemiologia , Listeriose/microbiologia , /microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Criança , Pré-Escolar , Notificação de Doenças , Feminino , Genoma Bacteriano , Geografia Médica , Humanos , Listeria/classificação , Listeria/genética , Listeria/isolamento & purificação , Listeriose/transmissão , Masculino , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Gravidez , Vigilância em Saúde Pública , Estações do Ano , Estados Unidos/epidemiologia , Adulto Jovem
15.
Emerg Infect Dis ; 25(8): 1571-1573, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31310229

RESUMO

Eating raw or insufficiently cooked mollusks is a known risk factor for human echinostomiasis. We confirmed identification of Artyfechinostomum sufrartyfex trematodes as the causative agent of disease among 170 children in northern Bihar, India. We also identified the snail Pila globosa as a potential source of infections in the study area.


Assuntos
Platelmintos , Infecções por Trematódeos/epidemiologia , Infecções por Trematódeos/parasitologia , Adolescente , Fatores Etários , Animais , Antiprotozoários/uso terapêutico , Criança , Pré-Escolar , Feminino , Geografia Médica , Humanos , Índia/epidemiologia , Masculino , Tipagem Molecular , Platelmintos/classificação , Platelmintos/genética , Platelmintos/isolamento & purificação , Vigilância em Saúde Pública , Avaliação de Sintomas , Resultado do Tratamento , Infecções por Trematódeos/diagnóstico , Infecções por Trematódeos/tratamento farmacológico
16.
Nat Microbiol ; 4(9): 1508-1515, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31182801

RESUMO

Dengue is a mosquito-borne viral infection that has spread throughout the tropical world over the past 60 years and now affects over half the world's population. The geographical range of dengue is expected to further expand due to ongoing global phenomena including climate change and urbanization. We applied statistical mapping techniques to the most extensive database of case locations to date to predict global environmental suitability for the virus as of 2015. We then made use of climate, population and socioeconomic projections for the years 2020, 2050 and 2080 to project future changes in virus suitability and human population at risk. This study is the first to consider the spread of Aedes mosquito vectors to project dengue suitability. Our projections provide a key missing piece of evidence for the changing global threat of vector-borne disease and will help decision-makers worldwide to better prepare for and respond to future changes in dengue risk.


Assuntos
Aedes/fisiologia , Dengue/transmissão , Mosquitos Vetores , Aedes/virologia , Animais , Mudança Climática , Dengue/virologia , Vírus da Dengue/fisiologia , Geografia Médica , Saúde Global , Humanos , Modelos Estatísticos , Fatores de Risco , Urbanização/tendências
17.
Emerg Infect Dis ; 25(7): 1389-1393, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31211678

RESUMO

We analyzed antimicrobial susceptibility test results reported in healthcare-associated infections by California hospitals during 2014-2017. Approximately 3.2% of Enterobacteriaceae reported in healthcare-associated infections were resistant to carbapenems and 26.9% were resistant to cephalosporins. The proportion of cephalosporin-resistant Escherichia coli increased 7% (risk ratio 1.07, 95% CI 1.04-1.11) per year during 2014-2017.


Assuntos
Carbapenêmicos/farmacologia , Cefalosporinas/farmacologia , Infecção Hospitalar , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/efeitos dos fármacos , Resistência beta-Lactâmica , California/epidemiologia , Enterobacteriaceae/genética , Geografia Médica , Humanos , Testes de Sensibilidade Microbiana
18.
Emerg Infect Dis ; 25(7): 1425-1427, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31211936

RESUMO

We screened African wild dogs (Lycaon pictus) in Kruger National Park, South Africa, for Mycobacterium bovis infection using an interferon-gamma release assay. We detected M. bovis sensitization in 20 of 21 packs; overall apparent infection prevalence was 83%. These animals experience high infection pressure, which may affect long-term survival and conservation strategies.


Assuntos
Doenças do Cão/epidemiologia , Doenças do Cão/microbiologia , Mycobacterium bovis , Tuberculose/veterinária , Animais , Animais Selvagens , Cães , Geografia Médica , Vigilância em Saúde Pública , África do Sul/epidemiologia
19.
Environ Monit Assess ; 191(Suppl 2): 366, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31254075

RESUMO

The spatial distribution of the prevalence of asthma and chronic obstructive pulmonary disease (COPD) remains under the influence of a wide array of environmental, climatic, and socioeconomic determinants. However, a large proportion of these influences remain unexplained. In completion, this study examined the spatial associations between asthma/COPD morbidity and their determinants using ordinary least squares (OLS) and geographically weighted regressions (GWR). Inpatient records collected from the secondary and tertiary care hospitals in Kandy from 2010 to 2014 were considered as the dependent variable. Potential risk factors (explanatory variables) were identified in four distinguished classes: 1) meteorological factors, (2) direct and indirect factors of air pollution, (3) socioeconomic factors, and (4) characteristics of the physical environment. All possible combinations of candidate explanatory variables were evaluated through an exploratory regression. A comparison between the regression models was also explored. The best OLS regression models revealed about 55% of asthma variation and 62% of COPD variation while GWR models yielded 78% and 74% of the variation of asthma and COPD occurrences respectively. Relative humidity, proximity to roads (0-200 m), road density, use of firewood as a source of fuel, and elevation play a vital role in predicting morbidity from asthma and COPD. Both local and global regression models are important in assessing spatial relationships of asthma and COPD. However, the local models exhibit a better prediction capability for assessing non-stationary relationships of asthma and COPD than global models. The geostatistical aspects used in this study may also provide insights for evaluating heterogeneous environmental risk factors in other epidemiological studies across different spatial settings.


Assuntos
Asma/epidemiologia , Geografia Médica/métodos , Modelos Estatísticos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Monitoramento Ambiental/estatística & dados numéricos , Humanos , Análise dos Mínimos Quadrados , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Regressão Espacial , Sri Lanka/epidemiologia
20.
Environ Monit Assess ; 191(Suppl 2): 331, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31254126

RESUMO

Visceral leishmaniasis is a public health problem in Brazil. This disease is endemic in most of Bahia state, with increasing reports of cases in new areas. Ecological niche models (ENM) can be used as a tool for predicting potential distribution for disease, vectors, and to identify risk factors associated with their distribution. In this study, ecological niche models (ENMs) were developed for visceral leishmaniasis (VL) cases and 12 sand fly species captured in Bahia state. Sand fly data was collected monthly by CDC light traps from July 2009 to December 2012. MODIS satellite imagery was used to calculate NDVI, NDMI, and NDWI vegetation indices, MODIS day and night land surface temperature (LST), enhanced vegetation index (EVI), and 19 Bioclim variables were used to develop the ENM using the maximum entropy approach (Maxent). Mean diurnal range was the variable that most contributed to all the models for sand flies, followed by precipitation in wettest month. For Lutzomyia longipalpis (L. longipalpis), annual precipitation, precipitation in wettest quarter, precipitation in wettest month, and NDVI were the most contributing variables. For the VL model, the variables that contributed most were precipitation in wettest month, annual precipitation, LST day, and temperature seasonality. L. longipalpis was the species with the widest potential distribution in the state. The identification of risk areas and factors associated with this distribution is fundamental to prioritize resource allocation and to improve the efficacy of the state's program for surveillance and control of VL.


Assuntos
Ecossistema , Insetos Vetores/fisiologia , Leishmaniose Visceral/transmissão , Psychodidae/fisiologia , Animais , Brasil/epidemiologia , Monitoramento Ambiental/estatística & dados numéricos , Geografia Médica , Insetos Vetores/classificação , Leishmaniose Visceral/epidemiologia , Psychodidae/classificação , Chuva , Temperatura Ambiente
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