Celso Stephan

Spatial distribution of the risk of dengue fever in southeast Brazil, 2006-2007

BackgroundMany factors have been associated with circulation of the dengue fever virus and vector, although the dynamics of transmission are not yet fully understood. The aim of this work is to estimate the spatial distribution of the risk of dengue fever in an area of continuous dengue occurrence.MethodsThis is a spatial population-based case-control study that analyzed 538 cases and 727 controls in one district of the municipality of Campinas, São Paulo, Brazil, from 2006-2007, considering socio-demographic, ecological, case severity, and household infestation variables. Information was collected by in-home interviews and inspection of living conditions in and around the homes studied. Cases were classified as mild or severe according to clinical data, and they were compared with controls through a multinomial logistic model. A generalized additive model was used in order to include space in a non-parametric fashion with cubic smoothing splines.ResultsVariables associated with increased incidence of all dengue cases in the multiple binomial regression model were: higher larval density (odds ratio (OR) = 2.3 (95%CI: 2.0-2.7)), reports of mosquito bites during the day (OR = 1.8 (95%CI: 1.4-2.4)), the practice of water storage at home (OR = 2.5 (95%CI: 1.4, 4.3)), low frequency of garbage collection (OR = 2.6 (95%CI: 1.6-4.5)) and lack of basic sanitation (OR = 2.9 (95%CI: 1.8-4.9)). Staying at home during the day was protective against the disease (OR = 0.5 (95%CI: 0.3-0.6)). When cases were analyzed by categories (mild and severe) in the multinomial model, age and number of breeding sites more than 10 were significant only for the occurrence of severe cases (OR = 0.97, (95%CI: 0.96-0.99) and OR = 2.1 (95%CI: 1.2-3.5), respectively. Spatial distribution of risks of mild and severe dengue fever differed from each other in the 2006/2007 epidemic, in the study area.ConclusionsAge and presence of more than 10 breeding sites were significant only for severe cases. Other predictors of mild and severe cases were similar in the multiple models. The analyses of multinomial models and spatial distribution maps of dengue fever probabilities suggest an area-specific epidemic with varying clinical and demographic characteristics.

Home medicine chests and their relationship with self-medication in children and adolescents

OBJECTIVE To investigate the contents of home medicine chests and their relationship with self-medication in children and adolescents in the towns of Limeira and Piracicaba, SP, Brazil. METHODS This is a descriptive population study based on a home survey of a simple random sample from both towns, comprising 705 households from census sectors selected by means of cluster sampling. INCLUSION CRITERIA age <or= 18 years; an obligatory interview with at least one guardian; inventory of medicines kept at home; and having taken at least one medication during the 15 days prior to the interview. The participants were split into two groups based on medication: self-medication (lay advice) and medical prescription. Tests of linear association were performed, in addition to a descriptive analysis of the variables and multiple logistic regression. RESULTS A total of 3,619 medicines were found (mean = 5.1/household; 79.6% were pharmaceutical preparations). The rooms most commonly used to store medications were bedrooms (47.5%), kitchens (29.9%), and bathrooms (14.6%); 76.5% were in cardboard boxes and within easy reach of 142 children aged <or= 6 years. Taking the pharmaceutical preparations in isolation (n = 2,891), the most common were analgesics/antipyretics (26.8%) and systemic antibiotics (15.3%), and the self-medication group had significantly larger stocks of these medications (p < 0.01). Storing medications in the bathroom (odds ratios = 1.59) and legal guardians with <or= 4 years of primary education (odds ratios = 2.40) indicated greater risk of self-medication. CONCLUSIONS Keeping medicines at home is a common practice, and it is important to implement campaigns to encourage rational use, reduced waste and safe storage of medicines.

Expressão geográfica da epidemia de Aids em Campinas, São Paulo, de 1980 a 2005

OBJETIVO: Analizar la distribucion espacial de los casos notificados de Sida en adultos y su relacion con las condiciones de vida en el municipio de Campinas, Sureste de Brasil. METODOS: Datos sobre Sida en hombres (n=2.945) y mujeres (n=1.230) encima de 13 anos de edad, y residenciados en Campinas y notificados en el Sistema Nacional de Agravios de Notificacion fueron utilizados para mapear la distribucion espacial de la enfermedad y la relacion de masculinidad. Se construyeron mapas para los periodos de 1980 a 1995, de 1996 a 2000 y de 2001 a 2005. Las variables incluidas en el analisis fueron: direccion, sexo y edad. Fue utilizado indicador compuesto ponderado para estudiar las condiciones de vida y salud en el territorio. Las direcciones de residencia de los pacientes fueron geocodificados con base cartografica, posterior a la correccion y estandarizacion con base en el trazado de las calles. Se ajusto modelo aditivo generalizado para analizar la distribucion espacial de la tasa de casos hombre/mujer en el espacio, en los tres periodos de estudio. RESULTADOS: La tasa de casos hombre/mujer fue mayor en las regiones de mejores condiciones de vida (central) y en el entorno del presidio (noroeste), donde se establecen provisoriamente familias de detenidos y ex detenidos, mientras que esta tasa fue menor en urbanizaciones de la periferia de la ciudad (suroeste). CONCLUSIONES: Las tendencias de feminizacion y pauperizacion de la epidemia del Sida se confirman frente a la disminucion de la tasa de casos hombres/mujeres en el periodo, particularmente en las poblaciones vulnerables y empobrecidas. Sistemas de informaciones geograficas y analisis espacial de datos pueden ser utiles para las acciones de vigilancia y control de la epidemia de Sida.

Spatial Distribution of the Risk of Dengue and the Entomological Indicators in Sumare, State of Sao Paulo, Brazil

Dengue fever is a major public health problem worldwide, caused by any of four virus (DENV-1, DENV-2, DENV-3 and DENV-4; Flaviviridae: Flavivirus), transmitted by Aedes aegypti mosquito. Reducing the levels of infestation by A. aegypti is one of the few current strategies to control dengue fever. Entomological indicators are used by dengue national control program to measure the infestation of A. aegypti, but little is known about predictive power of these indicators to measure dengue risk. In this spatial case-control study, we analyzed the spatial distribution of the risk of dengue and the influence of entomological indicators of A. aegypti in its egg, larva-pupa and adult stages occurring in a mid-size city in the state of São Paulo. The dengue cases were those confirmed by the citys epidemiological surveillance system and the controls were obtained through random selection of points within the perimeter of the inhabited area. The values of the entomological indicators were extrapolated for the entire study area through the geostatistical ordinary kriging technique. For each case and control, the respective indicator values were obtained, according with its geographical coordinates and analyzed by using a generalized additive model. Dengue incidence demonstrated a seasonal behavior, as well as the entomological indicators of all mosquitos evolutionary stages. The infestation did not present a significant variation in intensity and was not a limiting or determining factor of the occurrence of cases in the municipality. The risk maps of the disease from crude and adjusted generalized additive models did not present differences, suggesting that areas with the highest values of entomological indicators were not associated with the incidence of dengue. The inclusion of other variables in the generalized additive models may reveal the modulatory effect for the risk of the disease, which is not found in this study.

Geographic expression of AIDS epidemic in Campinas, Southeastern Brazil, between 1980 and 2005

OBJETIVO: Analizar la distribucion espacial de los casos notificados de Sida en adultos y su relacion con las condiciones de vida en el municipio de Campinas, Sureste de Brasil. METODOS: Datos sobre Sida en hombres (n=2.945) y mujeres (n=1.230) encima de 13 anos de edad, y residenciados en Campinas y notificados en el Sistema Nacional de Agravios de Notificacion fueron utilizados para mapear la distribucion espacial de la enfermedad y la relacion de masculinidad. Se construyeron mapas para los periodos de 1980 a 1995, de 1996 a 2000 y de 2001 a 2005. Las variables incluidas en el analisis fueron: direccion, sexo y edad. Fue utilizado indicador compuesto ponderado para estudiar las condiciones de vida y salud en el territorio. Las direcciones de residencia de los pacientes fueron geocodificados con base cartografica, posterior a la correccion y estandarizacion con base en el trazado de las calles. Se ajusto modelo aditivo generalizado para analizar la distribucion espacial de la tasa de casos hombre/mujer en el espacio, en los tres periodos de estudio. RESULTADOS: La tasa de casos hombre/mujer fue mayor en las regiones de mejores condiciones de vida (central) y en el entorno del presidio (noroeste), donde se establecen provisoriamente familias de detenidos y ex detenidos, mientras que esta tasa fue menor en urbanizaciones de la periferia de la ciudad (suroeste). CONCLUSIONES: Las tendencias de feminizacion y pauperizacion de la epidemia del Sida se confirman frente a la disminucion de la tasa de casos hombres/mujeres en el periodo, particularmente en las poblaciones vulnerables y empobrecidas. Sistemas de informaciones geograficas y analisis espacial de datos pueden ser utiles para las acciones de vigilancia y control de la epidemia de Sida.

Estudo caso-controle com resposta multinomial: uma proposta de análise

This study reviews articles on case-control studies in which the cases were classified in two or more types. Application of multinomial models and their adequacy for case-control studies are discussed. Among the available multinomial adjustments, we argue that the polytomous logistic model is the most suitable for obtaining epidemiological measures of risk and association in case-control studies. By way of illustration, we present an application of this model in a population-based case-control study, comparing the results with those obtained in a binomial logistic model. The multinomial approach allows investigating, in a single analysis, the occurrence of associations between covariates and more or more subclasses of cases, thus providing the epidemiologically relevant possibility of identifying individualized risk and protective factors for each subclass.

Reiki for Cancer Patients Undergoing Chemotherapy in a Brazilian Hospital: A Pilot Study.

The purpose of this pilot study was to explore whether individualized Reiki given to cancer patients at a Brazilian hospital improved symptoms and well-being. Data from 36 patients who received 5 Reiki sessions were collected using the MYMOP and were compared before and after their treatment and also with 14 patients who did not receive Reiki and who acted as a comparison group. Twenty-one patients reported feeling better, 12 felt worse, and 3 reported no change. Of the comparison group, 6 patients reported feeling better and 8 felt worse. The Reiki practice delivered as part of the integrative care in oncology did produce clinically significant effects, although not statistically significant results, for more than half of the patients undergoing cancer treatment.

Conhecimento e adesão às precauções padrão: Estudantes diante dos riscos biológicos no Brasil e na Colômbia

Objective To assess scales of adherence to universal precautions and means of knowledge transmission among healthcare students in Brazil and Colombia. Methods We conducted a pilot study to validate the questionnaire that started a cohort study. Twenty-six students in Colombia and 25 in Brazil were intentionally selected. The participants were comparable in number and sociodemographic characteristics in both countries and studied the health professions (medicine, nursing and dentistry). The program SPSS version 18.0 was used to create the database and to carry out statistical analysis. Results We evaluated a total of 51 students. They had a a mean (SD) age of 21.78 (2.33), 84.3 % were women, 66.7 % had white skin, 47.1 % were medical students, and 70,6 % were in their 4th year. They answered about sexual habits reporting that 45.1 had only one partner% in the last year, 23.5 % did not use protection, and, of those who were protected, 45.1 % used a condom. The mean knowledge was 10.88 (±0.952) points to an expected 9 points; Cronbachs Alpha (α) was 0.823. The mean adherence to universal precautions (UPs) was 33.69 (±3.36) points to an expected 30.75; α was 0.741. We found a significant difference in knowledge levels (p<0.007) between the two countries and in the adherence to PUs by year of study (p<0.001). Conclusions Knowledge about means of transmission was good. Adherence to universal precautions was acceptable, but low in terms of the use of glasses, face masks, and discarding sharp objects. Dentistry students showed the best adherence.

A system for occupational injury surveillance in Piracicaba, southeastern Brazil.

This article describes the experience of developing the Occupational Injury Surveillance System in the city of Piracicaba, in upstate São Paulo, Brazil. The system has the following characteristics: the information entered into the system is obtained directly, in real time, where the injured individuals receive medical treatment; the system has universal coverage, including all accidents occurring on the job in Piracicaba regardless of the workers employment status, workplace, and place of residence; the health monitoring and promotion actions are activated in response to the identification of sentinel events; and the analysis of spatial distribution of occupational injuries is a basic tool for elaborating strategies for treating the injured as well as policies for accident prevention. The system began operating on November 1, 2003. 10,777 occupational injuries had been identified by October 31, 2005, corresponding to an annual incidence proportion of 3.8% in the city. We present a brief description of a detailed investigation of one of the injuries.

Low socioeconomic condition and the risk of dengue fever: A direct relationship

This study aimed to characterize the first dengue fever epidemic in Várzea Paulista, São Paulo, Brazil, and its spatial and spatio-temporal distribution in order to assess the association of socioeconomic factors with dengue occurrence. We used autochthonous dengue cases confirmed in a 2007 epidemic, the first reported in the city, available in the Information System on Diseases of Compulsory Declaration database. These cases where geocoded by address. We identified spatial and spatio-temporal clusters of high- and low-risk dengue areas using scan statistics. To access the risk of dengue occurrence and to evaluate its relationship with socioeconomic level we used a population-based case-control design. Firstly, we fitted a generalized additive model (GAM) to dengue cases and controls without considering the non-spatial covariates to estimate the odds ratios of the occurrence of the disease. The controls were drawn considering the spatial distribution of the household of the study area and represented the source population of the dengue cases. After that, we assessed the relationship between socioeconomic variables and dengue using the GAM and obtained the effect of these covariates in the occurrence of dengue adjusted by the spatial localization of the cases and controls. Cluster analysis and GAM indicated that northeastern area of Várzea Paulista was the most affected area during the epidemic. The study showed a positive relationship between low socioeconomic condition and increased risk of dengue. We studied the first dengue epidemic in a highly susceptible population at the beginning of the outbreak and therefore it may have allowed to identify an association between low socioeconomic conditions and increased risk of dengue. These results may be useful to predict the occurrence and to identify priority areas to develop control measures for dengue, and also for Zika and Chikungunya; diseases that recently reached Latin America, especially Brazil.