Carlos Feitosa Luna

Seroprevalence and risk factors for dengue infection in socio-economically distinct areas of Recife, Brazil.

Brazil currently accounts for the majority of dengue cases reported in the Americas, with co-circulation of DENV 1-3. Striking variation in the epidemiological pattern of infection within cities has been observed. Therefore, investigation of dengue transmission in small areas is important to formulate control strategies. A population-based household survey was performed in three diverse socio-economic and environmental areas of Recife, a large urban center of Brazil, between 2005 and 2006. Dengue serostatus and individual- and household-level risk factors for infection were collected in residents aged between 5 and 64 years. A total of 2833 individuals were examined, and their residences were geo-referenced. Anti-dengue IgG antibodies were measured using commercial ELISA. The dengue seroprevalence and the force of infection were estimated in each area. Individual and household variables associated with seropositivity were assessed by multilevel models for each area. A spatial analysis was conducted to identify risk gradients of dengue seropositivity using Generalized Additive Models (GAM). The dengue seroprevalence was 91.1%, 87.4% 74.3%, respectively, in the deprived, intermediate and high socio-economic areas, inversely related to their socio-economic status. In the deprived area, 59% of children had already been exposed to dengue virus by the age of 5 years and the estimated force of infection was three times higher than that in the privileged area. The risk of infection increased with age in the three areas. Not commuting away from the area was a risk factor for seropositivity in the deprived area (OR=2.26; 95% CI: 1.18-4.30). Number of persons per room was a risk factor for seropositivity in the intermediate (OR=3.00; 95% CI: 3.21-7.37) and privileged areas (OR=1.81; 95% CI: 1.07-3.04). Living in a house, as opposed to an apartment, was a risk factor for seropositivity in the privileged area (OR=3.62; 95% CI: 2.43-5.41). The main difference between the privileged and other areas could be attributed to the much larger proportion of apartment dwellers. Intensive vector control, surveillance and community education should be considered in deprived urban areas where a high proportion of children are infected by an early age.

Trends in maternal-infant transmission of AIDS after antiretroviral therapy in Brazil

OBJECTIVE The increase in the number of AIDS cases among women has led to an increase in the maternal-infant transmission of human acquired immunodeficiency virus. Measures for the control of this type of transmission were implemented in Brazil in 1996. The aim of the present study was to analyze time trends in maternal-infant transmission of AIDS among Brazilian children. METHODS The present study included children born in Brazil between 1990 and 2001. We used the database of notified AIDS cases in children 13 years of age or younger between 1990 and 2004. Exponential regression models adjusted to the time series provided the annual variation rates and observed and expected values for the period. RESULTS We found a significant increasing trend for cases born prior to the year in which anti retroviral therapy was introduced, with an increase rate of about 12% (t<0.003) per year. Rates from different states ranged from 5.9% to 31%. The analysis of expected and observed cases for each of the countrys five Regions showed a reduction in the number of cases among children born from 1997 onwards, with a progressive year-to-year reduction. The number of notified cases among children born in 2001 was less than 10% the number of expected cases. CONCLUSIONS The results obtained suggest a favorable response to the implementation of policies for the prevention of maternal-infant HIV transmission in Brazil, as observed in other parts of the world.

Satisfação dos usuários do sistema de saúde brasileiro: fatores associados e diferenças regionais

Desenvolver modelos de avaliacao de satisfacao que permitam comparar sistemas de saude de diversos paises e um esforco recente no Brasil. Esse tipo de avaliacao representa importante ferramenta para desenvolver estrategias de gestao para o setor. Objetivo: identificar fatores e avaliar diferencas regionais do grau de satisfacao dos usuarios do sistema de saude brasileiro, analisando os resultados da Pesquisa Mundial de Saude (PMS) e Pesquisa Mundial de Saude com foco na Atencao Basica (PMS-AB). Foi realizado estudo avaliativo de corte transversal, onde as amostras foram selecionadas de forma aleatoria. Foram incluidas pessoas maiores de 18 anos que utilizaram o sistema de saude em periodos anteriores as coletas de dados. Enquadraram-se nos criterios de inclusao 3.932 usuarios da PMS e 591 da PMS-AB. Aplicou-se modelo logistico multivariado, tendo como variavel dependente a satisfacao e, como variaveis independentes, sexo, idade, escolaridade, forma de pagamento de servico, situacao conjugal, autopercepcao de saude, doenca de longa duracao, diagnostico de depressao, tristeza, numero de moradores por domicilio, tipo de construcao, estratos geograficos e indicador de bens. Os resultados revelaram que ser jovem, usuario exclusivo do SUS, ter baixa escolaridade e autopercepcao de saude ruim gerou mais chances de insatisfacao dos usuarios com o sistema de saude brasileiro. Os moradores da Regiao Sul do pais estao mais satisfeitos com o atendimento em saude, enquanto para pernambucanos as chances de satisfacao sao menores quando se avalia a qualidade dos servicos de saude. Os moradores desse estado apresentaram maior insatisfacao na resolucao de seus problemas de saude quando precisaram de internacao.

Análise espacial dos determinantes socioeconômicos dos homicídios no Estado de Pernambuco

OBJECTIVE To investigate the association between homicide rates and socio-economic variables taking into account the spatial site of the indicators. METHODS An ecological study was conducted. The dependent variable was the rate of homicides among the male population aged 15 to 49 years, residing in the districts of the State of Pernambuco from 1995 to 1998. The independent variables were an index of the living conditions, per capita family income, Theil inequality index, Gini index, average income of the head of the family, poverty index, rate of illiteracy, and demographic density. The following techniques were used in the analysis: a spatial autocorrelation test determined by the Moran index, multiple linear regression, a spatial regression model (CAR) and a generalized additive model for the detection of spatial trend (LOESS). RESULTS The illiteracy and the poverty index explained 24.6% of the total variability of the homicide rates and there was an inverse relationship. Morans I statistics indicated spatial autocorrelation between municipalities. The multiple linear regression model best fitted for the purposes of this study was the Conditional Auto Regressive (CAR) model. The latter confirmed the association between the poverty index, illiteracy and homicide rates. CONCLUSIONS The inverse association observed between socio-economic indicators and homicides may be expressing a process that propitiates improvement in living conditions and that is linked predominantly to conditions that generate violence, such as drug traffic.OBJETIVO: Investigar a associacao entre variaveis socioeconomicas e taxas de homicidio, considerando a localizacao espacial dos indicadores. METODOS: Utilizou-se o metodo de estudo ecologico. A variavel dependente foi taxa de homicidio da populacao masculina de 15 a 49 anos, residente nos municipios do Estado de Pernambuco, em 1995 a 1998. As variaveis independentes referem-se a: indice de condicoes de vida, renda familiar per capita, desigualdade de Theil, indice de Gini, renda media do chefe de familia, indice de pobreza, taxa de analfabetismo, densidade demografica.Utilizou-se teste de correlacao espacial determinado pelo Indice de Moran, regressao multipla, Conditional Auto Regressive (CAR) e a funcao Loess, como modelo de deteccao de tendencia especial. RESULTADOS: Os indicadores taxa de analfabetismo e indice de pobreza explicaram 24,6% da variabilidade total das taxas de homicidio, cuja associacao foi inversa. O indice de Moran revelou autocorrelacao espacial entre os municipios. O modelo de regressao espacial que melhor se adequou ao estudo foi o CAR, que confirmou a associacao entre indice de pobreza, analfabetismo e homicidio. CONCLUSOES: A relacao inversa observada entre os indicadores socioeconomicos e homicidios pode expressar determinado processo que propicia melhoria das condicoes de vida, e esta atrelado predominantemente a condicoes geradoras de violencia, como a do trafico de drogas.

Is it better to be rich in a poor area or poor in a rich area? A multilevel analysis of a case–control study of social determinants of tuberculosis

BACKGROUND Tuberculosis is known to have socio-economic determinants at individual and at area levels, but it is not known whether they are independent, whether they interact and their relative contributions to the burden of tuberculosis. METHODS A case-control study was conducted in Recife, Brazil, to investigate individual and area social determinants of tuberculosis, to explore the relationship between determinants at the two levels and to calculate their relative contribution to the burden of tuberculosis. It included 1452 cases of tuberculosis diagnosed by the tuberculosis services and 5808 controls selected at random from questionnaires completed for the demographic census. Exhaustive information on social factors was collected from cases, using the questionnaire used in the census. Socio-economic information for areas was downloaded from the census. Multilevel logistic regression investigated individual and area effects. RESULTS There was a marked and independent influence of social variables on the risk of tuberculosis, both at individual and area levels. At individual level, being aged >or=20, being male, being illiterate, not working in the previous 7 days and possessing few goods, all increased the risk of tuberculosis. At area level, living in an area with many illiterate people and where few households own a computer also increased this risk; individual and area levels did not appear to interact. Twice as many cases were attributable to social variables at individual level than at area level. CONCLUSIONS Although individual characteristics are the main contributor to the risk of tuberculosis, contextual characteristics make a substantial independent contribution.

Cellular immune response profile in patients with American tegumentary leishmaniasis prior and post chemotherapy treatment

In this study, we have the objective of evaluating the lymphoproliferative response and determining interferon (IFN)‐γ and interleukin (IL)‐10 cytokine production in the peripheral blood mononuclear cells (PBMC) of patients with American tegumentary leishmaniasis prior and post 12 months of chemotherapy treatment with meglumine antimoniate compared with the PBMC of noninfected donors. Lymphoproliferation, such as cytokine production, was evaluated through in vitro stimulus with the soluble antigenic fraction from Leishmania (Viannia) braziliensis promastigotes (1.25 µg/ml) and Concanavalin A (2.5 µg/ml). Patients showed a significant lymphoproliferative response prior and post treatment compared with the control group. Similar result, prior to chemotherapy treatment, was observed in IFN‐γ and IL‐10 production when patients were compared with the control group. After chemotherapy treatment, PBMC lymphoproliferative response of the patients revealed an increase, whereas patients have shown a decrease in IFN‐γ levels and an increase in IL‐10, although without statistical difference. These results may indicate that the patients produced a specific cellular response to the soluble antigenic fraction suggesting that besides Th1 and Th2 dichotomy, immunological regulation mechanisms with the participation of memory T cells and regulatory T cells could be present in the clinical evolution of these patients. This understanding will allow the study and identification of new L. (V.) braziliensis molecules potentially candidates to vaccines. J. Clin. Lab. Anal. 23:63–69, 2009.

Tendência da mortalidade por doenças do aparelho circulatório no Brasil: 1950 a 2000

BACKGROUND The circulatory system diseases (CAD), one of the most important current health problems, have started to show a declining trend in mortality in several countries, although they are still proportionally the number one regarding the statistics of morbimortality. OBJECTIVE To analyze the mortality trend due to CAD in Brazilian capital cities, during the period of 1950 to 2000. METHODS Temporal series study, of Standardized Mortality Ratios by CAD. We used secondary data on death from the statistical annual reports from IBGE (the Brazilian Institute of Geography and Statistics) and from the Mortality Information System. We carried out a linear trend analysis of the Standardized Mortality Ratios due to CAD in the Brazilian capital cities that presented complete mortality series, considering the census years during the study period (1950 to 2000). RESULTS Although proportionally the CAD represent the main cause of death in the Brazilian population, as well as presenting a proportional increase during the period of analysis of this study, the risk of death, represented by the Standardized Mortality Ratios, have been decreasing, particularly from the eighties onward. It is noteworthy the fact that Fortaleza, Salvador, Belo Horizonte, Rio de Janeiro and São Paulo presented elevated Standardized Mortality Ratios, however with a decreasing trend (p<0.05 and p<0.10), since the start of the analyzed period. CONCLUSION The behavior of the risk of death due to CAD suggests that this group of diseases is the first to be established, following the increase in industrialization observed from the thirties onward and after the Second World War in Brazil, as it occurred in Sao Paulo and Rio de Janeiro, cities that historically experienced a process of development and urbanization earlier and at a higher extent, when compared to the other capital cities.FUNDAMENTO: As doencas do aparelho circulatorio (DAC), um dos mais importantes problemas de saude da atualidade, apesar de proporcionalmente ainda liderarem as estatisticas de morbi-mortalidade, comecam a apresentar tendencia declinante da mortalidade em diversos paises. OBJETIVO: Analisar a tendencia da mortalidade por DAC nas capitais brasileiras, no periodo de 1950 a 2000. METODOS: Estudo de serie temporal das razoes de mortalidade padronizadas por DAC. Utilizamos dados secundarios de obitos dos anuarios estatisticos do IBGE e do Sistema de Informacao de Mortalidade. Realizamos analise de tendencia linear das razoes de mortalidade padronizadas por DAC nas capitais brasileiras que apresentaram series completas de mortalidade, considerando os anos censitarios do periodo do estudo (1950 a 2000). RESULTADOS: Apesar de proporcionalmente as DAC representarem a primeira causa de obito na populacao brasileira, bem como apresentarem crescimento proporcional no periodo de analise deste estudo, o risco de obito, representado pelas razoes de mortalidade padronizadas, apresenta-se em decrescimo, particularmente a partir da decada de 80. Destacam-se as cidades de Fortaleza, Salvador, Belo Horizonte, Rio de Janeiro e Sao Paulo, que apresentam razoes de mortalidade padronizadas elevadas, porem em decrescimo (p < 0,05 e p < 0,10) desde o inicio do periodo analisado. CONCLUSAO: O comportamento do risco de obito por DAC sugere que esse grupo de enfermidades e o que primeiro se estabelece, acompanhando o aumento da industrializacao no Brasil, verificado a partir da decada de 1930 e apos a Segunda Guerra Mundial, Como ocorreu em Sao Paulo e Rio de Janeiro, que historicamente experimentaram um processo de desenvolvimento e urbanizacao anterior e diferenciado em relacao as outras capitais.

Humoral and cellular immune responses in BALB/c and C57BL/6 mice immunized with cytoplasmic (CRA) and flagellar (FRA) recombinant repetitive antigens, in acute experimental Trypanosoma cruzi infection

In previous studies, cytoplasmic repetitive antigen (CRA) and flagellar repetitive antigen (FRA) proteins induced specific humoral and cellular immune responses in susceptible and resistant mice in the absence of Trypanosoma cruzi infection with a significant induction of the Interferon-gamma (IFN-γ) production in those animals. In this follow-up paper, the immunostimulatory and protective effects of these proteins were evaluated by immunizing with CRA or FRA antigens, BALB/c and C57BL/6 mice and challenging with a T. cruzi (Y strain). Both proteins induced humoral response with high levels of IgG isotypes as well as cellular immunity with high levels of IFN-γ when compared to controls. However, the lymphocyte proliferative response was minimal. The survival rate at 30 days post-infection was significant in CRA (60%) or FRA (50%) - immunized BALB/c mice and CRA (83.3%) - immunized C57BL/6 mice. Taken as a whole these findings indicate that CRA and FRA are immunogenic and potentially important for protective immunity.

Serum alanine aminotransferase levels, hematocrit rate and body weight correlations before and after hemodialysis session.

PURPOSE To evaluate alanine aminotransferase levels before and after a hemodialysis session and to correlate these values with the hematocrit rate and weight loss during hemodialysis. PATIENTS AND METHODS The serum alanine aminotransferase levels, hematocrit rate and body weight were measured and correlated before and after a single hemodialysis session for 146 patients with chronic renal failure. An receiver operating characteristic (ROC) curve for the serum alanine aminotransferase levels collected before and after hemodialysis was plotted to identify hepatitis C virus-infected patients. RESULTS The mean weight loss of the 146 patients during hemodialysis was 5.3% (p < 0.001). The mean alanine aminotransferase levels before and after hemodialysis were 18.8 and 23.9 IU/, respectively, denoting a significant 28.1% increase. An equally significant increase of 16.4% in the hematocrit rate also occurred after hemodialysis. The weight loss was inversely correlated with the rise in both the alanine aminotransferase level (r = 0.3; p < 0.001) and hematocrit rate (r = 0.5; p < 0.001). A direct correlation was found between the rise in alanine aminotransferase levels and the hematocrit during the hemodialysis session (r = 0.4; p < 0.001). Based on the ROC curve, the upper limit of the normal alanine aminotransferase level should be reduced by 40% relative to the upper limit of normal if the blood samples are collected before the hemodialysis session or by 60% if blood samples are collected after the session. CONCLUSION In the present study, significant elevations in the serum alanine aminotransferase levels and hematocrit rates occurred in parallel to a reduction in body weight after the hemodialysis session. These findings suggest that one of the factors for low alanine aminotransferase levels prior to hemodialysis could be hemodilution in patients with chronic renal failure.

Tendência da mortalidade por diabetes melito no Brasil: 1950 a 2000

OBJECTIVE: To analyze mortality trend by diabetes mellitus in Brazilian capitals. METHODS: It was analyzed mortality temporal trend by diabetes mellitus in Brazilian capitals, from the death data of the statistic directory of IBGE and the System of Mortality Information of the Ministry of Health, in the period from 1950 to 2000. RESULTS: It was observed the growth of proportional mortality and the Standard Mortality Ratio by diabetes in most of the capitals. Sao Paulo (SP) outstood for presenting expressive and constant proportional mortalities along the series, particularly from 1960. As to the Standard Mortality Ratio in this capital, as well as in Belo Horizonte (MG), where it was noticed the oscillation of these indicators tending to decrease in the last years, it was not observed significant trends. CONCLUSIONS: Mortality trend by diabetes is increasing in most of the capitals, with the exception of Sao Paulo and Belo Horizonte, which have shown different patterns from the other capitals.