Spatial analysis of measles vaccination coverage in the State of São Paulo.

BACKGROUND: Measles is a contagious viral disease that seriously affects children. The measles vaccine is widely recommended in Brazil and in the world; however, the disease remains relevant for the health authorities. The aim of the present study was to evaluate first and second dose of measles vaccine coverage (VC) in the cities of São Paulo and its spatial dynamics between 2015 and 2020. METHOD: In this mixed-type ecological study, we used secondary, public domain data from 2015 to 2020, extracted from the Digital Information System of the National Immunization Program, Mortality Information System and the National Live Birth Information System. After calculating the VC, the following four categories were created: very low, low, adequate, and high, and the spatial autocorrelation of VC was analyzed using the Global and Local Moran's statistics. RESULTS: A steady decline in adherence to the vaccination was observed, which dynamically worsened until 2020, with a high number of cities fitting the classification of ineffective coverage and being potentially harmful to the effectiveness of the immunization activities of their neighbors. CONCLUSION: A direct neighborhood pattern was observed between the units with low vaccination coverage, which implied that the reduction in measles VC was somehow related to and negatively influenced by the geographic location and social culture of these areas.

Spatial analysis of vaccine coverage on the first year of life in the northeast of Brazil.

BACKGROUND: Over time, vaccination has been consolidated as one of the most cost effective and successful public health interventions and a right of every human being. This study aimed to assess the spatial dynamics of the vaccine coverage (VC) rate of children aged < 1 year per municipality in the Brazilian Northeast at 2016 and 2017. METHODS: This is a mixed-type ecological study that use a Public domain data Health Information. Vaccine doses were obtained from the Information System of the Brazilian National Immunization Program, and live births from the Brazilian Information System of Live Births of the Brazilian Unified Health System. Descriptive analysis of the coverage of all the vaccines for each year of the study was conducted, and Mann-Whitney U test was used to compare VC between the study years. Chi-squared test was used to evaluate the association between the years and VC, which was stratified into four ranges, very low, low, adequate, and high. Spatial distribution was analyzed according to both each study year and vaccine and presented as thematic maps. Spatial autocorrelation was analyzed using Moran's Global and Local statistics. RESULTS: Compared with 2017, 2016 showed better VC (p < 0.05), except for Bacillus Calmette-Guérin. In the spatial analysis of the studied vaccines, the Global Moran's Index did not show any spatial autocorrelation (p > 0.05), but the Local Moran's Index showed some municipalities, particularly the Sertão Paraibano region, with high VC, high similarity, and a positive influence on neighboring municipalities (p < 0.05). In contrast, most municipalities with low VC were concentrated in the Mata Paraibano region, negatively influencing their neighbors (p < 0.05). CONCLUSION: Uneven geographic regions and clusters of low VC for children aged < 1 year in the State of Paraíba were spatially visualized. Health policy makers and planners need to urgently devise and coordinate an action plan directed at each state's regions to fulfill the vaccination calendar, thereby reversing the vulnerability of this age group, which is at a higher risk of diseases preventable by vaccination.

Distribution of rare earth elements in soils of contrasting geological and pedological settings to support human health assessment and environmental policies.

Establishing quality reference values (QRVs) for rare earth elements (REEs) in soils is essential for the screening of these emergent contaminants. Currently, Brazil has the second-largest reserve of REEs, but data regarding background concentrations and distributions in soils remain scarce. The aim of this study was to establish the QRVs and assess the spatial distribution of REEs in soils, including REE fractionations and anomalies in (Piauí) state (251,529.186 km2), northeastern Brazil. This study reports the most detailed data on REE geochemistry in Brazilian soils. A total of 243 composite soil samples was collected at 0-20 cm depth. The mean background concentrations in soils followed the abundance of the earth's upper crust: Ce > La > Nd > Pr > Sm > Dy > Gd > Er > Yb > Eu > Tb > Lu. The ∑REEs (mg kg-1) showed the following order based on the individual mesoregions of Piauí state: Southeast (262.75) > North and Central-North (89.68) > Southwest (40.33). The highest QRVs were observed in the Southeast mesoregion. The establishment of QRVs based on the mesoregion scale improves data representativeness and the monitoring of natural REE values by identifying hot spots. Geostatistical modeling indicated significant local variability, especially in the Southeast mesoregion. The levels of these elements in this spatial zone are naturally higher than the other values across Piauí state and the mesoregion itself and indicate a high potential to exceed the QRVs. Our approach provides much needed data to help strengthen policies for both human health and environmental protection.

Social determinants of health and maxillofacial injuries in children and adolescents victims of violence: A novel GIS-based modelling application.

BACKGROUND: Physical violence against children and adolescents comprises a serious public health problem and often results in oral and maxillofacial traumas. Social determinants may favour the occurrence of these events, but few studies have critically evaluated the interaction between social and geographical risk factors. AIMS: To investigate the spatiotemporal distribution of oral and maxillofacial traumas resulting from violence against children and adolescents through geostatistical techniques. METHODS: This study was an ecological analysis of cases of trauma caused by violence against Brazilian children and adolescents using aggregated data from victims attended at a Center of Forensic Medicine and Forensic Dentistry between January 2012 and December 2015. Data were analysed through modelling based on geographic information system (GIS). RESULTS: Two distinct patterns of longitudinal trajectory of oral and maxillofacial trauma related to violence against children and adolescents were identified (TP1 and TP2, P < 0.05). The spatial regression analysis revealed a statistically significant association between higher incidence of cases and areas with worse socioeconomic conditions (ß = 0.047, SE = 0.020, P < 0.05). CONCLUSION: Neighbourhoods with considerable socio-spatial vulnerability for violence against children and adolescents and maxillofacial traumas were identified.

Assessment of the Spatial Distribution of Metal(Oid)s in Soils Around an Abandoned Pb-Smelter Plant.

Todos os Santos (All Saints) Bay area, NE-Brazil, is known for one of the most important cases of urban lead (Pb) contamination in the world. The main objective of this work was to assess and interpret the spatial distribution of As, Cd, Hg, Pb, and Zn in "background" soils of this environmentally impacted bay area, using a combination of geostatistical and multivariate analytical methods to distinguish between natural and anthropogenic sources of those metal(oid)s in soils. We collected 114 topsoil samples (0.0-0.2 m depth) from 38 sites. The median values for trace metal concentrations in soils (mg kg-1) followed the order Pb (33.9) > Zn (8.8) > As (1.2) > Cd (0.2) > Hg (0.07), clearly reflecting a Pb-contamination issue. Principal component analysis linked Cd, Pb, and Zn to the same factor (F1), chiefly corroborating their anthropogenic origin; yet, both Pb and Zn are also influenced by natural lithogenic sources. Arsenic and Hg concentrations (F2) are likely related to the natural component alone; their parent material (igneous-metamorphic rocks) seemingly confirm this hypothesis. The heterogeneity of sources and the complexity of the spatial distribution of metals in large areas such as the Todos os Santos Bay warrant, the importance of multivariate and geostatistical analyses in the interpretation of environmental data.

Spatial analysis of vaccine coverage in children under the age of 1 year by mesoregions in Paraíba a northeastern Brazilian state.

Immunization is one of the most effective measures in public health, and it is responsible for the reduction of vaccine-preventable diseases. In the present study, vaccine coverage (VC) and the spatial dynamics of homogeneity of VC (HVC) were compared and analyzed in the terms of the immunobiologicals administered to children aged < 1 year in a state in Paraíba, Brazil. This is a mixed ecological study that used public-domain secondary data from the years 2016 and 2017 from the Information System of the Brazilian National Immunization Program (SI-PNI) and the Brazilian National Information System of Live Births (SINASC). VC rates were calculated by dividing the number of administered doses by the number of live births. Then, VC was classified into four categories. The Municipal HVC was considered adequate when the overall VC exceeds 75%. The study included a descriptive analysis and a spatial autocorrelation analysis for HVC using global and local Moran's statistics. The stratified VC analysis revealed a significant number of municipalities in each of the state's mesoregions with low or very low VC rates for all immunobiologicals, with the Mata Paraibana mesoregion having the worst percentages in both years studied. The spatial analysis of HVC revealed several clusters of inadequate homogeneity, with Mata Paraibana being the worst mesoregion in 2016. The analysis of spatial dynamics and spatial statistics techniques allows the precise identification of vulnerable areas, "vaccination pockets," making it possible to develop plans aimed at meeting the targets of the PNI.

Proposal for computer-aided diagnosis based on ultrasound images of the kidney: is it possible to compare shades of gray among such images?

OBJECTIVE: To compare ultrasound images of the kidney obtained, randomly or in a controlled manner (standardizing the physical aspects of the ultrasound system), by various professionals and with different devices. MATERIALS AND METHODS: We evaluated a total of 919 images of kidneys, obtained by five professionals using two types of ultrasound systems, in 24 patients. The images were categorized into four types, by how they were acquired and processed. We compared the gray-scale median and different gray-scale ranges representative of virtual histological tissues. RESULTS: There were statistically significant differences among the five professionals, regardless of the type of ultrasound system employed, in terms of the gray-scale medians for the images obtained (p < 2.2e-16). Analyzing the four categories of images-a totally random image (without any standardization); a standardized image (with fixed values for gain, time gain control, and dynamic range); a normalized version of the random image; and a normalized version of the standardized image-we determined that the random image, even after normalization, differed quite significantly among the professionals (p = 0.006098). The analysis of the normalized version of the standardized image did not differ significantly among the professionals (p = 0.7319). CONCLUSION: Our findings indicate that a gray-scale analysis of ultrasound images of the kidney performs better when the image acquisition process is standardized and the images undergo a process of normalization.

OBJETIVO: Comparar imagens renais ultrassonográficas obtidas de maneira aleatória e controlada (padronizando fatores físicos do aparelho de ultrassom) por diferentes profissionais e aparelhos. MATERIAIS E MÉTODOS: Foram obtidos quatro tipos de imagens, de acordo com sua aquisição e processamento por cinco profissionais e dois tipos de aparelhos de ultrassonografia, em 24 pacientes, totalizando 919 imagens. Comparamos a mediana de escala de cinza e diferentes intervalos de tons de cinza representantes de tecidos histológicos virtuais. RESULTADOS: As medianas de escala de cinza de imagens renais obtidas por dois tipos de aparelhos foram estatisticamente diferentes (p < 2.2e-16). Analisando os quatro tipos de imagens, partindo de uma totalmente aleatória (sem qualquer padronização), uma padronizada (fixado o ganho, time gain control e dynamic range), e essas duas passando por um processo de normatização, obteve-se que a imagem aleatória é totalmente diversa entre os profissionais (p = 0,006098), mesmo passando pelo processo de normatização. A imagem padronizada, após passar pelo processo de normatização, apresentou resultados equivalentes, não possuindo diferença estatística (p = 0,7319). CONCLUSÃO: Constatou-se que na análise de tons de cinza deve-se usar um mesmo tipo de máquina e uma imagem em que sejam padronizados aspectos físicos, passando por um processo de normatização/padronização.

Spatial modelling of the infestation indices of Aedes aegypti: an innovative strategy for vector control actions in developing countries.

BACKGROUND: Larval indices such as the house index (HI), Breteau index (BI) and container index (CI) are widely used to interpret arbovirus vector density in surveillance programmes. However, the use of such data as an alarm signal is rarely considered consciously when planning programmes. The present study aims to investigate the spatial distribution pattern of the infestation of Aedes aegypti, considering the data available in the Ae. aegypti Infestation Index Rapid Survey (LIRAa) for the city of Campina Grande, Paraíba State in Brazil. METHODS: The global and local Moran's indices were used in spatial analysis to measure the effects of spatial dependencies between neighbourhoods, using secondary data related to HI and BI gathered from surveillance service. RESULTS: Our analysis shows that there is a predominance of high rates of mosquito infestation, placing Campina Grande at a near-constant risk of arbovirus outbreaks and epidemics. A highly significant Moran's index value (P < 0.001) was observed, indicating a positive spatial dependency between the neighbourhoods in Campina Grande. Using the Moran mapping and LISA mapping, the autocorrelation patterns of Ae. aegypti infestation rates among neighbourhoods have revealed hotpots that should be considered a priority to preventive actions of the entomological surveillance services. Predominance of high infestation rates and clearer relationships of these between neighbourhoods were observed between the months of May and July, the period with the highest rainfall in the city. CONCLUSIONS: This analysis is an innovative strategy capable of providing detailed information on infestation locations to the relevant public health authorities, which will enable a more efficient allocation of resources, particularly for arbovirus prevention.

Spatial distribution of maxillofacial injuries caused by urban violence: An ecological analysis to identify high-risk areas.

OBJECTIVES: To investigate the spatial and spatial-temporal distribution of oral and maxillofacial injuries caused by urban violence, as well as to identify underlying disparities at regional level through a geostatistical approach. METHODS: This was a historical ecological cohort study of trauma cases caused by urban violence using aggregate data from victims assisted in a Brazilian medical-forensic service between January 2012 and December 2015. The longitudinal patterns of change observed in each geographic area (neighbourhoods) were evaluated using the finite mixture model (FMM). The spatial autocorrelation of events was investigated using the Getis-Ord Indicator (Gi*) to identify significant hot and cold spatial clusters. With a spatial regression model, it was also found when socioeconomic variables, residential infrastructure and neighbourhood infrastructure were associated with high incidence rates. The significance level was set at P ≤ 0.05. RESULTS: The finite mixture model revealed three different patterns of longitudinal trajectory of the incidence of oral and maxillofacial trauma caused by urban violence (TP1 to TP3, P < 0.05). TP1 was characterized by an incidence that remained stable and high over time, comprising 17.4% of the city's neighbourhoods. In TP2, it was observed that the incidence was moderate, with a slightly increasing trend in the last year evaluated, representing around 41.8% of the sample. In contrast, in TP3, it was found that the incidence was relatively low and remained stable over time, accounting for about 40.8% of the sample. The Getis-Ord (Gi*) statistic identified significant high-risk clusters in the western (P < 0.05), southern (P < 0.05), and eastern regions (P < 0.05) and low risk in the northern region (P < 0.05). The spatial regression model indicated significant association between areas with unfavourable socioeconomic conditions and higher incidence of events (ß = 0.178, SE = 0.046, P < 0.001). CONCLUSIONS: Clusters demarcating areas with high socio-spatial vulnerability for urban violence and oral and maxillofacial injuries were identified. The findings highlight the need to improve living conditions in segregated urban areas and develop intersectoral actions to improve living conditions, employment, public safety, social support, health care and prevention.

Concentrations of polycyclic aromatic hydrocarbons in liver samples of juvenile green sea turtles from Brazil: Can these compounds play a role in the development of fibropapillomatosis?

Fibropapillomatosis (FP) poses a significant threat to the conservation of green sea turtles (Chelonia mydas). Polycyclic aromatic hydrocarbons-PAHs are considered mutagenic, carcinogenic and toxic, and can act as cofactor of this disease. In order to evaluate possible differences between green sea turtles with and without FP, we monitored 15 PAHs in liver samples of 44 specimens (24 with FP) captured in Brazil. We detected eight PAHs and quantified phenanthrene in all green sea turtles with FP. Specimens without FP presented lower values than the tumored ones (1.48 ng g-1 and 17.35 ng g-1, respectively; p < 0.0001). There were no significant differences between tumored and non-tumored specimens, among studied areas, or Southwest Atlantic Fibropapillomatosis Score. Even though we found higher concentrations in the liver samples of green sea turtles with FP, further studies are necessary to confirm if these pollutants are involved in the pathogenesis of the disease.

Functional disability and socioeconomic and demographic factors in elderly.

OBJECTIVE: to verify the prevalence of functional disability and associated socioeconomic and demographic factors in elderly patients of Campina Grande/PB. METHOD: cross-sectional study with elderly patients of both genders. The variables associated with functional disability were assessed using Poisson regression. RESULTS: A total of 420 elderly patients were included (68.1% women). The highest prevalence of functional disability were found among females aged 80 or older, white, widowed, of economic classes D/E , who lived alone, with frequency of contacts of up to 224 people and diversity of contacts of up to 14 people. After multivariate analysis, statistically significant association was observed between functional disability, gender and age group. CONCLUSION: the association between functional disability gender and age group is shown to be an important guidance for health interventions since it will allow health services to plan actions aiming to improve, maintain or restore the functional capacity of the elderly population.