Cláudia Di Lorenzo Oliveira

Spatial distribution of human and canine visceral leishmaniasis in Belo Horizonte, Minas Gerais State, Brasil, 1994-1997

In this paper, we present spatial analysis of the association between all incidents cases of human Visceral Leishmaniasis and seropositive dogs, from 1994 to 1997 in Belo Horizonte, a large Brazilian city. We geocoded 158 human cases and 11,048 seropositive dogs and compared canine prevalence rates with Human Bayesian Incidence rates in the same areas. We also used Knoxs test to evaluate the hypothesis of space-time clustering of human cases in the period. Additionally, we used Kernels maps for seropositive dogs distribution and located the human cases in the resulting smooth maps. We concluded that human and dog rates are correlated. Also, the Visceral Leishmaniasis in Belo Horizonte spread quickly, but apart from the rates magnitude, it has kept the same spatial pattern through time. We believe it is possible to use this technique to choose areas to implement control measures against Visceral Leishmaniasis in a more efficient way.

Percepção dos usuários e profissionais de saúde sobre atenção básica: comparação entre unidades com e sem saúde da família na Região Centro-Oeste do Brasil

This study analyzes perceptions of performance by primary health care facilities with and without the Family Health Program in municipalities with more than 100,000 inhabitants. Questionnaires from the Primary Care Assessment Tool developed by John Hopkins University and adapted to Brazil, contemplating eight dimensions of primary health care, were applied to users and professionals from a sample of 36 family health care facilities and 28 traditional primary care facilities. Thirty health professionals with university education, 207 with secondary education, 490 adult users, and 133 family members answered the questionnaires. The overall result did not show significant differences between perceptions of family health care facilities as compared to traditional primary health care facilities, but perceptions of health professionals were consistently more favorable than those of users. Comparing the scores for each dimension, family health care facilities always scored better (with the exception of level of access), but the difference in scores between facilities with and without the Family Health Strategy was only statistically significant for all three categories of respondents in relation to the items family focus and community orientation.

The urban environment from the health perspective: the case of Belo Horizonte, Minas Gerais, Brazil

This study aims to determine spatial patterns of mortality and morbidity for five health problems in an urban environment: homicides, adolescent pregnancy, asthma hospitalization, and two vector-borne diseases, dengue and visceral leishmaniasis. All events were obtained through the city health database and geoprocessed using residential addresses and 80 planning units consisting of census tracts. We used thematic maps, proportionate mortality/morbidity ratios by planning unit, and the overlapped rank of the 20th worse planning unit rates for each event. A spatial pattern of high rates of homicides, proportion of young mothers, and hospitalization due to asthma overlapped in socially and economically disadvantaged areas. For the two vector-borne diseases, high rates with great dispersion were found in underprivileged areas, in contrast with very low rates among higher income areas. The results indicated the coexistence of heavier disease burden for residents of urban areas where poverty and lack of effective public health policies may be modulating social health problems. For the two vector-borne diseases, an environmental intervention in one mosquito-borne disease might be playing a role in the others incidence.

Visceral leishmaniasis in large Brazilian cities: challenges for control

The objectives of this article were to discuss the rapid spread of visceral leishmaniasis in urban areas of Brazil and to raise practical questions and perspectives related to control of the disease. Among the proposed methods, the elimination of seropositive dogs is the most controversial and least accepted by society. Its impact on incidence rates varies among studies (positive in some and relatively unimportant in others). Treatment of infected dogs, although widespread in veterinary practice, is based on studies with weak scientific evidence. Insecticide spraying of areas is more acceptable to the population, but is costly and operationally difficult. Intra and inter-urban factors have scarcely been studied and may affect control of the disease. Finally, the article discusses the use of deltamethrin-impregnated dog collars and vaccines, with high expectations for impact on disease transmission, although no product currently available on the market has been fully evaluated, so that further studies are required.

Saúde urbana: "a cidade é uma estranha senhora, que hoje sorri e amanhã te devora"

More than half of the worlds population is living in cities and the world is turning more and more urbanized. This literature review explores the ramifications of urban transformation, showing how cities take shape and impact human health in our times. While cities can offer positive opportunities, their negative impacts related to the lack of social organization, precarious urban living and working conditions, lack of governance and opportunities as well as the lack of strategies for promoting social equity tend to increase the adverse effects on the health of the urban communities. The article also advocates the study of urban health as a branch of knowledge related to public health, proposing a common conceptual model and taxonomy for urban health. Future directions for research and practice are discussed in the light of some examples from the Brazilian scientific literature.

HIV genotypes and primary drug resistance among HIV seropositive blood donors in Brazil: role of infected blood donors as sentinel populations for molecular surveillance of HIV

Background:There are few surveillance studies analyzing genotypes or primary (transmitted) drug resistance in HIV-infected blood donors in Brazil. The aim of this study was to characterize patterns of HIV genotypes and primary resistance among HIV-seropositive donors identified at 4 geographically dispersed blood centers in Brazil. Methods:All HIV-infected donors who returned for counseling at the 4 REDS-II Hemocenters in Brazil from January 2007 to March 2011 were invited to participate in a case–control study involving a questionnaire on risk factors. Viral sequencing was also offered to positive cases to assign genotypes and to detect and characterize primary resistance to reverse transcriptase and protease inhibitors according to World Health Organization guidelines. Results:Of the 341 HIV-seropositive donors who consented to participate in the risk factor and genetics study, pol sequences were obtained for 331 (97%). Clade B was predominant (76%) followed by F (15%) and C (5%). Primary resistance was present in 36 [12.2%, 95% confidence interval (CI) 8.2 to 15.5] of the 303 individuals not exposed to antiretroviral therapy, varying from 8.2% (95% CI: 2.7 to 13.6) in Recife to 19.4% in São Paulo (95% CI: 9.5 to 29.2); there were no significant correlations with other demographics or risk factors. Conclusions:Although subtype B remains the most prevalent genotype in all 4 areas, increasing rates of subtype C in Sao Paulo and F in Recife were documented relative to earlier reports. Transmitted drug resistance was relatively frequent, particularly in the city of Sao Paulo which showed an increase compared with previous HIV-seropositive donor data from 10 years ago.

A case-control study of microenvironmental risk factors for urban visceral leishmaniasis in a large city in Brazil, 1999-2000

OBJECTIVESnWe investigated potential microenvironmental risk factors for visceral leishmaniasis in urban and suburban areas, and developed risk scores to characterize the household and the neighborhood. These scores may be useful to identify microenvironments within cities that place residents at greater risk of visceral leishmaniasis.nnnMETHODSnIn this case-control study, cases were all persons with visceral leishmaniasis reported from July 1999 through December 2000 in the Belo Horizonte metropolitan area, Brazil. Two kinds of controls-neighborhood and hospital-were used. Cases and controls were matched by age (+/-2 years). We developed four scores to characterize the microenvironment (indoor, outdoor, animal indoor, and animal outdoor), and also considered the level of urbanization of the area.nnnRESULTSnA total of 106 neighborhood controls and 60 hospital controls were identified for 109 cases. Among the cases, 69 (63.3%) were men and 40 (36.7%) were women. Most cases were under 15 years old (64.2%), and 39 (35.8%) were 15 years old or more. The outdoor score [odds ratio (OR) = 1.49; 95% confidence interval (CI) = 1.03-2.14] and animal outdoor scores (OR = 1.79[95% CI 1.21-2.65]) were significantly associated with the odds of visceral leishmaniasis in our sample. We also found a significant interaction between sex and age. Compared to females 15 years old or more, males 15 years old or more were more likely to have visceral leishmaniasis (OR = 7.02[95% CI 2.20-22.20]).nnnCONCLUSIONSnAnimals in the neighborhood were associated with a greater odds of visceral leishmaniasis. Cases were more likely than controls to live in transitional or rural areas, although this difference was not statistically significant, possibly because of the small sample size.

Unidade de contexto e observação social sistemática em saúde: conceitos e métodos

Assumimos que onde voce mora e importante para sua saude, para alem de quem voce e. Entendemos que o impacto do local de moradia ou unidade de contexto (UC) na saude das populacoes se deve a heterogeneidade dos atributos do entorno fisico e social da UC, para alem das caracteristicas individuais ou agregadas daqueles ali aninhados. Estes atributos, embora dependentes dos individuos, sao tipicamente externos a eles e potencialmente modificaveis. As UC sao compreendidas como unidades ecologicas inseridas em conjuntos sucessivamente mais amplos e interdependentes. Quando relevante para a hipotese do estudo, unidades geograficas administrativas podem ser utilizadas como aproximacoes da UC. Outra alternativa e a que utiliza a percepcao de seus moradores, a vizinhanca percebida. O ressurgimento do interesse com relacao a determinacao dos efeitos da UC sobre a saude correlaciona com novas tendencias na area da saude coletiva: incorporacao de novos niveis hierarquicos de exposicao, as iniquidades e seus determinantes, a urbanizacao e seus efeitos e a avaliacao de intervencoes multi-setoriais. Nosso objetivo central e rever opcoes para a escolha da UC a ser investigada alem de estrategias para a afericao de seus atributos fisicos e sociais, utilizando a observacao social sistematica (OSS). A combinacao de dados originarias de dados administrativos, da vizinhanca percebida, dos inqueritos populacionais e da OSS ainda necessita de maiores elaboracoes conceitual, metodologica e analitica. Entretanto, a compreensao da distribuicao dos atributos fisicos e sociais da UC permite compor niveis hierarquicos de complexidade relevantes para o entendimento da ocorrencia dos eventos relacionados a saude nas populacoes.

Blood donor deferral in Minas Gerais State, Brazil: blood centers as sentinels of urban population health

BACKGROUND: Shortage of safe blood donors is frequent and it is important to understand the causes of deferral of potential donors, who reside mainly in urban areas, to improve recruitment campaigns aiming at the quality/availability of donors.

Fatores associados à infecção pelo vírus do dengue no Município de Belo Horizonte, Estado de Minas Gerais, Brasil: características individuais e diferenças intra-urbanas

O dengue e a arbovirose de maior incidencia nos centros urbanos da America do Sul, America Central, Sudeste Asiatico e Pacifico Ocidental. No continente americano, o virus do dengue e transmitido pelo mosquito Aedes aegypti. Introduzida em 1996, a doenca tornou-se um dos principais problemas de saude urbana no municipio de Belo Horizonte, Estado de Minas Gerais, Brasil. Em 2000, a Secretaria Municipal de Saude de Belo Horizonte e a Universidade Federal de Minas Gerais desenvolveram um estudo soroepidemiologico o Inquerito de Soroprevalencia de Dengue no Municipio de Belo Horizonte (ISDBH) com o objetivo de quantificar a soropositividade pelo virus do dengue nos Distritos Sanitarios Centro-Sul, Leste e Venda Nova. Esta dissertacao, apresentada na forma de dois artigos, reprocessa sob um enfoque analitico os dados obitdos a partir do ISDBH. O primeiro artigo Fatores Associados a Infeccao do Dengue em Belo Horizonte: Caracteristicas Individuais e Diferencas Intra-urbanas discute a analise da infeccao nos Distritos Sanitarios pesquisados em amostra probabilistica de 627 individuos. A prevalância global de infeccao foi de 23,3%, com 95% de nivel de confianca. Dos soropositivos, 17,9% foram infectados pelos sorotipos DEN-1 e DEN-2; 4,9% somente pelo DEN-1 e 0,8% somente pelo DEN-2. Individuos soropositivos, quando, comparados aos soronegativos, eram mais frequentemente moradores dos Distritos Sanitarios Leste e de Venda Nova, nao mudaram de municipio e/ou bairro ou casa e moravam em edificacoes horizontais. Baixa renda associou-se a maior soropositividade, assim como habitacoes horizontais relacionaram-se a infestacao de vetores e a falta de mobilidade espacial do individuo associou-se com a alta taxa de infeccao. O segundo artigo Investigacoes sobre Amostragem de Inquerito Soroepidemiologico de Dengue: a Participacao da Populacao analisa a participacao dos individuos, considerando as perdas na amostragem e a distribuicao espacial dos participantes. Do universo de 1.010 individuos visitados (considerando os sorteios dos imoveis e, dentro do imovel, o do individuo), 358 (35,5%) nao aderiram a pesquisa ou nao foram encontrados, configurando as perdas previamente recompostas na amostragem original. As perdas foram caracterizadas em quatro subgrupos: por casa fechada, recusa, agendamento impossivel e outros motivos. A analise descritiva do perfil dos participantes incluiu as variaveis regiao e motivo de nao-participacao. Utilizou-se o teste da Funcao K de Ripley para observacoes espaciais dos eventos. As perdas por Distrito Sanitario 53,3% no Distrito Sanitario Centro-Sul, 36,5% no Leste e 27,2% no de Venda Nova foram antecipadamente recompostas. As analises apontaram a distribuicao espacial homogenea entre participantes e nao-participantes, a relevância da recomposicao antecipada das perdas e a maior frequencia da recusa motivada. A investigacao da distribuicao espacial da amostra subsidia a discussao sobre as condicoes ambientais e de ocupacao do espaco urbano em diferentes regioes do municipio de Belo Horizonte e propicia informacoes para distintas intervencoes para o controle dos vetores.